Solutions for a healthy company. A guide to your benefits

Transcription

1 Solutions for a healthy company A guide to your benefits

2 Welcome to Solutions Solutions at a glance Private medical insurance created for you. Solutions is our private medical insurance that s flexible enough to suit your company s needs and help take care of you. In a nutshell, Solutions has some obvious advantages for you and your employer. Simple one product satisfies a wide range of healthcare needs Extensive a wide range of core cover, which includes our BacktoBetter service for back, neck, muscle or joint pain (musculoskeletal conditions), as standard Flexible your employer can select from a wide range of healthcare options to suit your needs Specifically designed to meet the needs of companies with employees A flexible product that can be shaped to meet your company s needs and budget No limit to the amount of eligible claims that you can make each year Extensive benefits within core cover Includes BacktoBetter, our independent clinical case management service for musculoskeletal (MSK) conditions We use our clinical expertise to develop and shape our products, giving you a first class service Simple claims process Cover from the UK s largest insurance group 2

3 Contents 6 How Solutions works - Core cover - Options to enhance or reduce cover - BacktoBetter - Cancer cover - Added value benefits 19 Summary of cover - What s covered - Summary of cancer cover - What s not covered 26 Your questions answered 27 Further information 3

4 Why would your employer choose Aviva? At Aviva Health UK, we combine financial strength and corporate efficiency with in-depth clinical expertise. The result is a flexible approach to healthcare that our customers can trust. You have added peace of mind with Solutions, because Aviva Health UK is part of the wider Aviva group so you benefit from our extensive network and financial security. Aviva is the largest insurer in the UK and has strong businesses in selected markets across the globe. We have 320 years of financial services experience meaning we re here to stay and are committed to providing the best possible service to you. Our experience of working in financial services shouldn t be the only reason your company would choose us; we re committed to providing you with the best claims service possible. Manage your Aviva polices at the touch of a button MyAviva brings together the products that help you protect your life, health, loved ones, future and possessions in one secure and simple-to-use online place. Here are a few key advantages of our claims service BacktoBetter our independent clinical case management service for back, neck, muscle or joint pain (musculoskeletal conditions) is included as standard with Solutions. This approach allows quick and easy access to a clinical case manager to help you get better as soon as possible you don t even need to take time off work to see your GP. Specialist claims management teams we understand that certain conditions, such as cancer, heart conditions or mental health problems have complex clinical needs. So for these conditions we take a case-managed approach for every claim. You will speak to one of our case managers at Aviva who will help you through your claim. This gives extra reassurance through a difficult time and can support in getting you well as soon as possible. MyAviva you can now start a claim or update an existing claim online, using MyAviva. You ll find all the important information here, including your claim and authorisation number, as well as the status of your claim. You can even ask us to give you a callback if there s anything you re unsure of. Our cancer pledge extensive cancer cover is included as standard. 4

5 Awards and ratings You shouldn t just take our word for it though; over the years we ve won multiple awards for our products and services. These awards have been won as a result of support from industry experts and intermediaries alike. We are grateful to our customers and the industry for recognising our commitment and the hard work that goes into developing and improving our products and services. We are always looking for ways to improve our products and the way we work, so you can be sure that you will always receive the service that you re satisfied with. Health Insurance Awards Health Insurance Company of the Year 2010, 2011, 2012, 2013, 2014, 2015, 2016 & 2017 Best Group PMI Provider 2010, 2011, 2012, 2013, 2014, 2015, 2016 & 2017 Best Use of Marketing to Intermediaries 2017 Best Customer Service Provider 2012, 2013, 2016 & 2017 Clinical excellence is in our DNA We have a team of clinicians working for Aviva whose clinical expertise helps to inform every aspect of our work. We use our clinical knowledge to develop and shape our products and services. From innovating and creating our propositions, to pricing a product or analysing its benefits, our clinicians have an input every step of the way. Not only that, but they monitor our claims process and manage our relationships with hospitals and specialists. Money Marketing Awards Company of the Year 2017 Defaqto 5 Star Rating Private Medical Insurance Rated 5 Star for quality of cover by independent financial researcher Defaqto. Defaqto have given Solutions their highest rating, 5 Star, meaning that it s one of the most comprehensive products in its class within the private health insurance market. 5

6 How solutions works How do we structure Solutions? Solutions is a flexible product that offers you extensive benefits through its core cover, your company have the option to upgrade or downgrade your cover so that it meets the needs of the business. The following pages take you through what s covered within core cover and shows the options that your company can choose to add, or take away from your cover. Option 1 Mental health treatment Options that enhance cover Option 2 Routine & GP referred services Out-patient treatment of acute conditions Radiotherapy/ chemotherapy Physiotherapy, osteopathy and chiropractic Consultations or treatment with a fee approved specialist Option 3 Hospital lists Diagnostic tests Psychiatric treatment Treatment for musculoskeletal (MSK) conditions Radiotherapy/ chemotherapy Option 4 Dental and optical cover BacktoBetter Option 5 Six week option Hospital charges Specialists fees Option 8 Reduced out-patient cover Diagnostic tests In-patient/day-patient treatment of acute conditions Option 6 Member excess Option 7 Selected benefit reduction Options that reduce cover 6

7 How Solutions works Core cover Radiotherapy/ chemotherapy Consultations or treatment with a fee approved specialist Out-patient treatment is subject to Aviva s fee guidelines for specialists Out-patient treatment of acute conditions Diagnostic tests Such as pathology, X-rays, CT scans and physiological tests such as ECGs Psychiatric treatment As an out-patient, up to 2,000 each member every policy year, on GP referral to a psychiatric therapist or to a psychiatric specialist Physiotherapy, osteopathy and chiropractic On specialist referral for non-musculoskeletal (MSK) conditions Musculoskeletal Out-patient, day-patient or in-patient treatment and diagnostics for back, neck, muscle or joint pain Radiotherapy/ chemotherapy BacktoBetter Hospital charges Including accommodation, meals, nursing care and drugs and dressings Specialists fees Subject to Aviva s fee guidelines for specialists Diagnostic tests Such as pathology, X-rays, CT scans and MRI scans In-patient/day-patient treatment of acute conditions 7

8 How Solutions works Core cover explained Networks These are specified groups of facilities, specialists or other practitioners that we recognise to provide treatment for particular conditions or suspected conditions. If we have an appropriate network for your condition or suspected condition, we ll tell you where you can have your treatment - which may not be at a hospital on your chosen list. We will only pay for that treatment if it is carried out within our network. A list of the conditions or suspected conditions for which we have networks in place can be found at aviva.co.uk/health-network Out-patient treatment of acute conditions Consultations or treatment with a specialist Core cover provides cover for out-patient consultations with a fee approved specialist. This means that you don t have to worry when going to see your specialist we don t put a limit on the amount of eligible consultations that you can claim for so you can focus on getting better. If you have a consultation with a specialist who is not fee approved, we will only pay up to the limits we pay our fee approved providers, which could leave you with a shortfall. Treatment by a specialist as an out-patient is subject to our fee guidelines. If we have a network of facilities, specialists or other practitioners for the treatment you need, we ll only pay for that treatment if it is carried out within our network. This is why we strongly recommend that you get in contact with us before attending consultations or undertaking any treatment so that we can tell you whether we have a network, and check that your chosen specialist or practitioner is fee approved and has agreed to work within our guidelines. If we don t have a network and you don t know which specialist you want to see then we can find a specialist and hospital for you, this will make sure that there won t be any shortfalls on the amount we ll pay your chosen specialist - shortfalls that you d be expected to make up. Diagnostic tests Costs for diagnostic tests, such as pathology, X-rays, scans and physiological tests such as ECGs are all covered in full, at a diagnostic centre, as part of Solutions core cover. Psychiatric treatment Core cover offers psychiatric treatment as an out-patient with a psychiatric therapist or psychiatric specialist, up to 2,000 each member, every policy year. This is on referral from either your GP or a specialist. Cancer treatment Core cover provides full out-patient cover for treatment of cancer on referral from a specialist. We still cover cancer in full even if your company selects the reduced out-patient cover (option 8, see page 15), because we believe that cancer cover isn t something that should be limited. 8

9 How Solutions works Physiotherapy, osteopathy, chiropractic treatment Solutions covers these therapies, in full, if you are referred by a specialist for conditions other than back, neck, muscle or joint pain (musculoskeletal conditions). Please read the next section that covers the clinical case management service for musculoskeletal conditions BacktoBetter. BacktoBetter Treatment and diagnostics for back, neck, muscle or joint pain (musculoskeletal conditions) Solutions includes BacktoBetter, our independent musculoskeletal case management service as standard for everyone covered on the policy helping you get better and back to work quicker. BacktoBetter offers access to a clinical case manager with one of our clinical case management providers, who can help you deal with the pain and disruption of a musculoskeletal injury. There is no need for you to see your GP before accessing BacktoBetter The clinical case manager will make sure you get the very best advice and organise any necessary treatment. For more information on our BacktoBetter service, please turn to page 16. In-patient/day-patient treatment of acute conditions Hospital charges The Key hospital list is provided as standard with core cover giving you access to around 300 hospitals across the UK, and also access to use any NHS hospital recognised by us. If we don t have a network for the treatment you need, you can have treatment at any of the hospitals on this list, all hospital charges will be covered in full, including costs for accommodation, meals, nursing care, drugs and dressings. Diagnostic tests Solutions gives you cover for in-patient and day-patient diagnostic tests on referral from a specialist. This includes tests such as pathology, X-rays, CT scans and MRI scans. Specialists fees We ll pay specialist fees for in-patient or day-patient treatment, up to the amount specified within Aviva s fee guidelines for specialists. Treatment for cancer Solutions provides cover in full for in-patient or day-patient treatment of cancer, on referral from a specialist. With every Solutions policy we offer extensive benefits for cancer and its treatment through our cancer pledge for more information on this please turn to page 18. 9

10 How Solutions works 10

11 How Solutions works Options that enhance cover Options that enhance cover Option 2 Routine & GP referred services Consultations or treatment with a fee approved specialist Option 3 Hospital lists Out-patient treatment of acute conditions Diagnostic tests Psychiatric treatment Option 4 Dental and optical cover Option 1 Mental health treatment Radiotherapy/ chemotherapy Physiotherapy, osteopathy and chiropractic treatment for nonmusculoskeletal conditions Treatment for musculoskeletal (MSK) conditions Radiotherapy/ chemotherapy BacktoBetter Hospital charges Specialists fees Diagnostic tests In-patient/day-patient treatment of acute conditions 11

12 How Solutions works Your company can add any of the following options to core cover and enhance the benefits available from your Solutions policy. Option 1: Mental health treatment To complement the out-patient psychiatric benefit available under core cover, your company can choose to add in-patient and day-patient psychiatric treatment to your scheme. Your plan can provide a maximum of either 28 or 45 days combined in-patient and day-patient psychiatric treatment to each member every policy year. This also includes benefit for specialists fees for in-patient treatment of up to 210 each week. Option 2: Routine & GP referred services This option has an overall benefit limit of 1,000 to each member every policy year. As with most health insurance policies, our core cover excludes long-term treatment for chronic conditions. However, with Solutions, your company can choose to cover routine specialist consultations and tests for a chronic condition or follow up consultations with a specialist to monitor you when you ve finished treatment for an acute condition by adding option 2. This means that for extra peace of mind, you can undertake routine monitoring of these conditions, as long as they are not excluded under the policy, when you would usually have to use the NHS. In addition, we recognise that more and more people want to use complementary and alternative treatments and be able to access diagnostic services following a visit to their GP. This option includes the following benefits up to the combined total of 1,000 each member every policy year: consultations with a fee approved specialist and tests for chronic conditions and follow up consultations with a fee approved specialist to monitor you when you ve finished treatment for an acute condition GP referred radiology/pathology for non-musculoskeletal conditions GP referred physiotherapy, chiropractic, osteopathy and acupuncture treatment for non-musculoskeletal conditions up to 10 sessions in combined total for each condition each member every policy year GP referred chiropody, podiatry and homeopathy for non-musculoskeletal conditions GP minor surgery up to 100 each procedure (payable to the GP). What are chronic conditions? Chronic conditions are those illnesses, diseases or injuries that either continue indefinitely, have no known cure, come back (or are likely to come back), need long term monitoring or need ongoing control or relief of symptoms. Examples of chronic conditions are Diabetes or Crohn s Disease. Like most insurers we do not cover chronic conditions. However, if your company chooses Option 2: Routine and GP referred services, we ll cover consultations with a fee approved specialist and tests for a chronic condition and follow up consultations with a fee approved specialist to monitor you when you have finished treatment for an acute condition, up to the overall benefit limit. For a full explanation of chronic conditions turn to page

13 How Solutions works Option 3: Hospital lists As part of your core cover you have access to the Key hospital list, this list gives you access to around 300 private hospitals across the UK. There are additional options that your company can select to either add more, or to remove hospitals from your cover. Your company can add more hospitals by selecting: the Extended hospital list an upgrade which gives access to more hospitals, predominantly in the Greater London area. However, your company may decide you don t need access to all the hospitals in the Key hospital list and can choose one of the reduced hospital lists below: the Signature hospital list an option for companies whose employees are solely based in Scotland or Northern Ireland this list excludes all hospitals in England and Wales from your cover. the Trust hospital list a cost saving option that uses the excellent private patient units of NHS Trust and partnership hospitals. Option 4: Dental & optical Our core cover provides benefit for surgical procedures on the teeth performed in a hospital and ophthalmic procedures, however as with most health insurance policies, cover for routine dental treatment and optical expenses is excluded. With Solutions this needn t be the case our dental & optical option can provide the following benefits: 500 routine dental benefit (excess applies) 600 accidental dental benefit 300 optical benefit (excess applies) A 50 excess applies separately to both the routine dental benefit and optical benefit. This means that there will be a 50 excess applied to any dental claims and another 50 excess applied to any optical claims meaning that you will need to pay the first 50 of any claim and we ll reimburse a further 450 for dental expenses or a further 250 for optical expenses. Please note that the Trust hospital list is only available on Solutions policies covering 2 99 employees. Remember if we have a network for your condition or suspected condition, you will need to use our network facility for your treatment. Our networks may include hospitals or other facilities that aren t on your chosen list. 13

14 How Solutions works Options that reduce cover Consultations or treatment with a fee approved specialist Out-patient treatment of acute conditions Diagnostic tests Psychiatric treatment Radiotherapy/ chemotherapy Physiotherapy, osteopathy and chiropractic treatment for nonmusculoskeletal conditions Treatment for musculoskeletal (MSK) conditions Radiotherapy/ chemotherapy BacktoBetter Option 5 Six week option Hospital charges Specialists fees Option 8 Reduced out-patient cover Diagnostic tests In-patient/day-patient treatment of acute conditions Option 6 Member excess Option 7 Selected benefit reduction Options that reduce cover 14

15 How Solutions works Your company may feel that they don t require all the benefits offered through core cover, so they may choose one of the following benefit reduction options. Option 5: Six week option If your company chooses the six week option, you will still have the benefit of prompt cover should a GP refer you to a specialist for a consultation. And, if subsequent eligible treatment as an out-patient is required, that is covered too, including out-patient treatment from BacktoBetter and certain out-patient treatments covered under the NHS cancer cash benefit. The difference is that you ll only be covered for in-patient or day-patient treatment if the wait for that treatment is longer than six weeks on the NHS. If the NHS waiting time for any in-patient or day-patient treatment is less than six weeks you ll need to use NHS facilities as a non-paying patient or self-fund any private treatment; you won t be able to claim for NHS cash benefit, NHS cancer cash benefit or the cost of an NHS amenity bed if your treatment is available on the NHS within six weeks from the date your specialist recommends it. If your company takes this option you ll avoid long NHS waiting lists as it means that the maximum amount of time you ll have to wait for a procedure is six weeks. Option 6: Member excess Another option that your company can choose to add to your policy is to include a member excess of 50, 100, 150, 200, 250 or 500. We apply our excess once each member every policy year, irrespective of the number of claims made during that policy year. The excess does not apply to NHS cash benefit, the baby bonus, donations we make to a hospice, any benefit claimed under the dental and optical option (the separate optical/dental excess still applies), NHS cancer cash benefit or to the wigs benefit for cancer treatment. Option 7: Selected benefit reduction Your company may feel that you require cover for only in-patient, day-patient and out-patient costs and not the less essential extras. That s why Solutions includes the selected benefit reduction option, which lets your company remove cover and costs associated with infertility, complications of pregnancy, surgical procedures on the teeth and limited emergency overseas cover. Option 8: Reduced out-patient cover Another option your company may choose is a reduction in out-patient cover. This option limits out-patient cover to 0, 1,000 or 1,500 each member every policy year. As some out-patient diagnostics and treatment can be more expensive, it does however provide cover in full for CT, MRI and PET scans at a diagnostic centre that we recognise, radiotherapy and chemotherapy and physiotherapy for pain in the back, neck, muscles or joints (musculoskeletal conditions), claimed through BacktoBetter. The monetary limit does not apply to out-patient cancer treatment received after you ve been diagnosed with cancer. In addition we ll also cover any costs for pre-admission tests required within 14 days of an admission to check that you are fit to undergo surgery and anaesthesia. This is a summary of benefits, if your company does take out a policy the final terms will be included in your member pack. 15

16 How Solutions works BacktoBetter Musculoskeletal (MSK) injuries are a leading causes of absence. Health and safety statistics 2015/16 from HSE, estimate that 8.8 million working days are lost to workrelated musculoskeletal disorders. We believe they re one of the biggest health challenges out there today. It s not always easy to work out exactly what s wrong or what to do about it. The challenge is to make high quality clinical services easily available as quickly as possible, when they re needed. Tackling the problem head on BacktoBetter is a musculoskeletal case management service delivered by carefully selected clinical providers. It introduces high quality clinical decision-making throughout your claims. One great advantage of BacktoBetter is that you don t need to see your GP; you just need to call us and we will arrange an assessment with a clinical case manager. This makes sure that only appropriate and effective interventions are approved, which means a better outcome for you. What are musculoskeletal (MSK) conditions? MSK conditions are any conditions relating to back, neck, muscle or joint pain, commonly referred to as orthopaedic conditions. BacktoBetter can help BacktoBetter can help you recover faster. BacktoBetter provides access to a clinical case manager who can help you deal with musculoskeletal pain. (Please note, only valid claims can be referred to our BacktoBetter service certain underwriting types may require you to supply more information before you can begin your claim). There s no need to see a GP. You get the right treatment at the right time, whether this is advice and self management exercises, referral to a physiotherapist, or referral to a specialist. This can lead to a faster recovery. It s an end-to-end service that delivers clinical best practice no matter how complicated the problem is or what route your treatment requires. We ll support you to access an experienced physiotherapist, if appropriate, that is local and convenient to you through our independent clinical provider s quality assured physiotherapy networks. Plus, any physiotherapy treatment you receive through BacktoBetter won t come out of any chosen out-patient limits either. Where you ve already seen your GP about musculoskeletal (MSK) pain, you can move to the standard claim process if: l your GP has recommended osteopathy or chiropractic treatment, or l your condition does not relate to your back or neck, and l your GP has recommended radiology, pathology, or referral to a specialist. Otherwise you can continue to follow the BacktoBetter claims process. 16

17 How Solutions works Cancer cover Based on figures from Macmillan Cancer Support, we estimate that in 2015, almost 900,000 people under 65 were living with a cancer diagnosis in the UK. So, we have a specialist cancer claims management team that can give you the personal support you really need if you re faced with this challenge. A case manager is on hand from the point of diagnosis so you ll have a contact all the way through your claim to make the process as easy as possible throughout a very stressful time. We re committed to making sure you get not only the right treatment but also a high level of aftercare. Our clinicians are also there as a point of reference for extra support and guidance. In-patient and day-patient treatment is covered at any hospital on your hospital list, unless we have a network in place for the treatment required, in which case we will tell you where you can have your treatment. If your company chooses to take out the six week option (option 5), it means that we won t pay for treatment as an in-patient if it s available on the NHS within six weeks from the date your specialist recommends it. If you re diagnosed with cancer, this may mean that your treatment will be available on the NHS and we won t pay for most of the treatment you need. If your company chooses to reduce your out-patient cover (within option 8 0, 1,000 or 1,500), the monetary limit does not apply to out-patient cancer treatment received after you ve been diagnosed with cancer. Our cancer pledge We understand the importance of providing extensive cover and support at every stage of cancer treatment. Our cancer pledge means we ll cover the treatment and palliative care you need as recommended by your specialist. We also want to make things as comfortable as possible following treatment, so we ll provide cover for aftercare, including dietary consultations and money towards prostheses and wigs. 17

18 How Solutions works Added value benefits with Solutions We include a range of helpful extra features at no extra charge with every Solutions policy. Access to a 24-hour GP helpline For over-the-phone consultations with a fully qualified GP when you need reassurance about medical issues, day or night. A 24-hour stress counselling helpline When you want to talk about a personal or professional issue that s causing you distress. This benefit is available to members aged 16 and over. Aviva News & Guides An online portal of tips and tools that can help you improve your health and fitness. Up to 25% off gym membership Solutions PMI also offers up to 25% off membership fees at some of the UK s leading health and fitness clubs. Manage your policy online with MyAviva MyAviva brings together the products that help you protect your life, health, loved ones, future and possessions, in one secure and simple-to-use online place. With a whole host of benefits at your fingertips, you can: view details of your policies online, including cover and benefit information track any policy excess and out-patient benefit - helping you stay in control start a claim online, update an existing claim, or arrange a callback to speak to us check information relating to a claim including the status or claim and authorisation number access useful online tools, frequently asked questions, helpful guidance and contact information, when you need them most enjoy a 20% existing customer discount on selected new Aviva products. Terms and conditions apply. download our smartphone app to manage your policies on the go. Log in to MyAviva today at aviva.co.uk/myaviva - safe, secure and tailored to use on all devices 18

19 Summary of cover Summary of cover What does Solutions offer? Solutions offers you an extensive range of cover as standard. If you need to claim for eligible back, neck, muscle or joint pain (musculoskeletal conditions) then you ll be covered through the BacktoBetter service. Should a GP recommend a visit to a specialist for non-musculoskeletal conditions, Solutions provides access to consultations, diagnostic tests, and eligible treatment as an out-patient. With Solutions, there are no limits on accommodation costs at any facilities on our networks or hospitals from your chosen hospital list and no overall restriction on how often a person can claim for eligible treatment. We pay all specialists fees in accordance with Aviva s specialist fee guidelines. To view the fee guidelines visit aviva.co.uk/pmifees Furthermore, should a specialist advise it, Solutions will also provide cover for prompt access as a day-patient or in-patient for eligible treatment at one of the facilities on our networks, or, if we don t have a network facility available for your symptom or condition, at one of the hospitals on your chosen hospital list. There is also cover for eligible treatment as an in-patient or day-patient using pay-beds at NHS hospitals recognised by us, although we cannot guarantee immediate access to NHS hospitals. 19

20 Summary of cover What s covered summary of core cover It s important to note that this benefit table is intended to provide you with only a summary of the core cover benefits offered by Solutions. Benefits Amount payable Notes A. Hospital treatment as an in-patient or day-patient At a facility recognised by us as part of a network, a hospital on the Key hospital list, or an NHS hospital recognised by us If you have the six week option, you cannot claim for these benefits if your treatment is available on the NHS within six weeks from the date your specialist recommends it. Including accommodation and meals, nursing care, drugs and surgical Hospital charges dressings, theatre fees Specialists fees Up to the limits in our specialist fee schedule Diagnostic tests Including blood tests, X-rays, scans, and ECGs CT, MRI and PET scans Radiotherapy/chemotherapy NHS cash benefit 100 each night, up to 25 nights 20 Treatment for pain in the back, neck, muscles or joints musculoskeletal conditions B. Treatment as an out-patient Consultations with a fee approved specialist Managed through our BacktoBetter service At a network facility if we have a network for your symptoms or condition If you have a consultation with a specialist who is not fee approved we will only pay up to the limits we pay our fee approved providers. Treatment by a specialist as an out-patient Specialists fees are covered up to the limits in our fee schedule Diagnostic tests Pre-admission tests (tests carried out at hospital before a member s admission to check that you are fit to undergo surgery and anesthesia. These can include ECG s and blood tests) Radiotherapy/chemotherapy CT, MRI and PET scans as an out-patient are only covered at a diagnostic centre. Specialists fees for surgical procedures are covered up to the limits in our fee schedule

21 Summary of cover Benefits Amount payable Notes B. Treatment as an out-patient (cont.) Specialist referred treatment by: a physiotherapist a chiropractor an osteopath for any condition other than pain in the back, neck, muscles or joints musculoskeletal conditions Psychiatric treatment Up to 2,000 each member every policy year On GP referral to a psychiatric therapist or psychiatric specialist Treatment for pain in the back, neck, muscles or joints musculoskeletal conditions Managed through our BacktoBetter service Benefits Amount payable Notes Additional benefits Home nursing Private ambulance Parent accommodation when staying with a child covered by the policy Immediately following in-patient or day-patient treatment that is covered by the policy and recommended by a specialist Child of 11 or under receiving treatment covered by the policy; one parent only Hospice donation 70 each day, up to 10 days Baby bonus 100 for each baby Payable to the group member Limited emergency overseas cover Treatment for complications of pregnancy and childbirth Investigations into the causes of infertility Surgical procedures on the teeth performed in a hospital Emergency treatment as an in-patient or day-patient during overseas trips of up to 90 days in total each policy year For the conditions specified in the policy wording Specialists fees are covered up to the limits in our fee schedule GP helpline Unlimited number of calls Stress counselling helpline Unlimited number of calls Available to members aged 16 and over 21

22 Summary of cover A summary of cancer cover with Solutions The table below provides a summary of the cancer cover available on Solutions. Full terms and conditions are available on request. If your company chooses the reduced out-patient cover, the monetary limit for out-patient treatment will not apply to cancer treatment received after you ve been diagnosed with cancer. If your company chooses to include the six week option, we don t pay for treatment as an in-patient or day-patient if it s available on the NHS within six weeks from the date your specialist recommends it. If you re diagnosed with cancer, this may mean that treatment will be available on the NHS and we won t pay for most of the treatment that s needed. In-patient and day-patient treatment is covered at a hospital on your hospital list unless we have a network in place for the treatment required, in which case we will tell you where you can have your treatment. Benefits Notes Hospital charges for surgery and medical admissions 4 At a facility recognised by us as part of a network, a hospital on the Key hospital list, or an NHS hospital recognised by us Specialists fees 4 Up to the limits in our specialist fee schedule NHS cancer cash benefit 100 each day We pay 100 a day for treatment received as an in-patient or day-patient, 100 for each day you receive out-patient radiotherapy, chemotherapy or blood transfusions or outpatient surgical procedures. 100 for each day you receive intravenous (IV) chemotherapy at home and 100 for each week you are taking oral chemotherapy at home. You won t be able to claim more than 100 in any one day Post surgery services 4 Includes specialist services immediately following surgery, such as consultations with a dietician or stoma nurse Radiotherapy and chemotherapy 4 Bone strengthening drugs (such as bisphosphonates) 4 We pay for bone strengthening drugs when they are being used to treat metastatic bone disease Treatment prescribed by a specialist for side effects while you re receiving chemotherapy or 4 radiotherapy Wig Up to 100 We ll pay towards the cost of a wig if one is needed due to hair loss caused by cancer treatment. This is payable once each member, not every policy year External prostheses Up to 5,000 We ll pay towards the cost of the first external prosthesis following surgery for cancer Stem cell and bone marrow transplants 4 Includes collection, storage and implantation Monitoring Up to ten years On-going medical needs Up to five years such as regular replacement of tubes or drains Preventative treatment for cancer Only if you ve already had treatment for cancer that we ve paid for. For example, we ll pay for a mastectomy to a healthy breast in the event that you have been diagnosed with cancer in the other breast End of life care: in a hospital if it s medically necessary 4 donation to a hospice donation to a registered charity 100 each night, up to 10, each day, up to 10,000 Each night you are admitted Each day that you are visited at home by one of the charities nurses 22

23 Summary of cover Cancer benefits and FAQs Where will I be covered to have treatment? Are diagnostic tests covered? Will I be covered for surgery? Will I be covered for preventative treatment? What drug treatment is covered? Is radiotherapy covered? Will I be covered for palliative care? Will I be covered for end of life care? Will I be covered for routine monitoring when treatment has finished? Will I be covered for any types of experimental treatments? What other benefits and services are available? At a hospital or other facility from our networks, or if we don t have a network for your condition or suspected condition: at a hospital on your list that we recognise for your treatment and condition at home if their specialist agrees that this is possible it will depend on the treatment that you need out-patient CT, MRI and PET scans will only be covered at a diagnostic centre Yes. The policy will not pay for genetic tests to see whether you are likely to get cancer or not. However we ll pay for genomic tests that are needed to see if a particular treatment is suitable Yes. Specialist fees will be covered up to the limits in our fee schedule We ll pay for surgery to prevent further cancer if you ve already had treatment for cancer that we ve paid for for example, we ll pay for a mastectomy to a healthy breast in the event that you ve been diagnosed with cancer in the other breast, if it s recommended by your specialist We won t pay for treatment where you ve no symptoms of cancer, for example where you have a strong family history of cancer We cover in full: chemotherapy drugs used to destroy cancer cells targeted therapy and biological therapy bone strengthening drugs (such as bisphosphonates) that are being used to treat metastatic bone disease we ll also pay for treatment that you need to deal with side effects while having chemotherapy or radiotherapy, such as anti-sickness drugs and antibiotics. We ll pay for hormone therapy only if you need it to shrink a tumour before surgery or radiotherapy Hormone treatment is not covered by the policy at any other time. Your GP will be able to prescribe this or administer it Yes Yes, we ll provide cover at every stage of the disease Yes We ll pay for end of life care in hospital if it s medically necessary If you re admitted to a hospice we ll make a donation to the hospice We ll also make a donation to a registered charity if you stay at home and are visited by a nurse from that charity Yes, for up to ten years after your treatment has finished We don t pay for monitoring after treatment for non-melanoma skin cancer If you have any ongoing medical needs, such as regular replacement of tubes or drains, we ll pay for up to five years after your treatment for cancer has finished If you have experimental treatment, we ll pay the equivalent cost of the established treatment that would usually be given for your condition. If there is no equivalent treatment, we won t cover any of the costs of the experimental treatment If a drug is licensed, but not for the type of cancer that you have, we ll assess your case and if there s clinical evidence to show it s appropriate for your condition, we ll pay in full Following surgery, we ll cover a number of different specialist services that you may need, such as consultations with a dietician or a stoma nurse We ll contribute up to 5,000 towards the cost of an external prosthesis following surgery for cancer We ll pay up to 100 towards the cost of a wig if you need one due to hair loss caused by cancer treatment We ll pay for stem cell and bone marrow transplants, including the collection, storage and implantation NHS cancer cash benefit for treatment that would have been covered by the policy we ll pay 100 for in-patient or day-patient treatment for cancer; out-patient radiotherapy, chemotherapy, blood transfusions or surgical procedures; 100 each day for intravenous chemotherapy at home and 100 each week if you re taking oral chemotherapy drugs at home. You cannot claim more than 100 each day 23

24 Summary of cover What s not covered a summary Solutions doesn t cover you for: alcoholism, alcohol abuse, solvent abuse, drug abuse and other addictive conditions any musculoskeletal treatment that has not been pre-authorised by us cosmetic treatment (except following an accident or surgery for cancer) experimental treatment (limited benefit may be available please contact us) health hydros or similar establishments HIV/AIDS and related conditions infertility treatment (except as provided for under the benefit for investigations into the causes of infertility) kidney dialysis long term or chronic conditions (except as provided for under Option 2 Specialists fees for other consultations and tests ). This exclusion does not apply to treatment for cancer professional sports injuries psychiatric or mental health illnesses (except as provided for under benefit outpatient psychiatric treatment and in Option 1 in-patient or day-patient mental health treatment ) routine medical examinations (except as provided for in Option 4 dental and optical ), we do not apply this exclusion to routine monitoring for cancer where we have paid for the member s treatment for cancer self-inflicted injury sleep disorders and sleep problems such as snoring and sleep apnoea surgical or medical appliances such as neurostimulators (for example, cochlear implants) and crutches take home drugs and dressings treatment by a GP (except as provided for in Option 2 Routine & GP referred services ) treatment for pregnancy or childbirth although certain complications may be covered (as detailed in the policy wording) treatment for warts, verrucas and skin tags treatment outside of networks (for any condition or suspected condition for which we have a network) treatment required as a result of a war, terrorism, contamination by radioactivity, biological or chemical agents treatment undertaken without GP referral to a specialist (unless through BacktoBetter) varicose veins of the leg, unless they meet the criteria detailed in the policy wording weight loss surgery. There are also certain occupations which we are not able to cover under Solutions. To view the full terms and conditions you can also visit aviva.co.uk/business sexual dysfunction 24

25 Summary of cover Chronic conditions explained A chronic condition is a disease, illness or injury that has one or more of the following characteristics: it needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests it needs ongoing or long-term control or relief of symptoms it requires your rehabilitation or for you to be specially trained to cope with it it continues indefinitely it has no known cure it comes back or is likely to come back Chronic psychiatric conditions explained If your policy includes cover for psychiatric treatment, we cover treatment that aims to lead to your full recovery. We do not cover: treatment that is given solely to alleviate symptoms, or chronic psychiatric conditions. We consider a psychiatric condition to be chronic if: it meets the definition of a chronic condition, or we have paid for treatment for that condition or a related psychiatric condition during three separate policy years. This will apply even if the treatment was not in consecutive policy years. We do not cover treatment, including diagnostic tests to treat or assess learning difficulties or developmental or behavioural problems such as Attention Deficit Hyperactivity Disorder (ADHD) and Autistic Spectrum disorders. 25

26 Your questions answered Your questions answered Can I cancel the policy? The policy can only be terminated by your company. What is the duration of the policy? Your company s private medical insurance policy is a one year contract. What s a group administrator? Your group administrator is located within your company and is the main point of contact for your company s private medical insurance policy. As a group administrator they are knowledgeable about the company policy and are responsible for the company s administration of the policy. The only time that your group administrator may not be able to fully assist you is when you make a claim. However, they will be able to advise you on the claims process. If you ever have any queries about your cover, please speak to your group administrator who will try to help you, or will refer you to our customer service helpline. What happens if I leave the scheme? If you leave your company, your membership of the policy will cease immediately. However, having been a member of a company scheme, you re entitled to benefit from continued private healthcare on an individual policy without further medical underwriting. Benefits, terms and exclusions on an individual policy may be different to those on this healthcare scheme. If you would like to discuss this further, please contact your group administrator or our sales advice line on: Calls may be monitored and/or recorded. Please note that to qualify for continued cover, you need to apply within 45 days from the date your cover ceases. If more than 45 days elapse, then you will need to be re-underwritten. What if I change my personal details? Please advise your group administrator in writing immediately should any of your personal details change e.g. address, name. If you have family cover and wish to add new dependants, for example a newborn baby, please notify your group administrator. 26

27 Further information Further information Income tax liability Under current UK tax rules, the contribution that s paid to us for your inclusion on the policy arises from your employment and is therefore a taxable benefit. Please contact your group administrator if you require further information. Language This document and all future documents and letters will be written in English. The Financial Services Compensation Scheme (FSCS) We are covered by the FSCS. You may be entitled to compensation from the FSCS if we become insolvent and cannot meet our obligations. This depends on the type of business and the circumstances of the claim. Where you are entitled to claim, insurance advising and arranging is covered for 90% of the claim, with no upper limit. Further information about compensation scheme arrangements is available from: Financial Services Compensation Scheme 10th Floor, Beaufort House 15 St Botolph Street London EC3A 7QU Website: fscs.org.uk Telephone: or If you have any cause for complaint Our aim is to provide a first class standard of service to our customers, and to do everything we can to ensure you are satisfied. However, if you ever feel we have fallen short of this standard and you have cause to make a complaint, please let us know. Our contact details are: Aviva Health UK Ltd Complaints Department PO Box 540 Eastleigh SO50 0ET We have every reason to believe that you will be totally satisfied with your Aviva policy, and with our service. It is very rare that matters cannot be resolved amicably. However, if you are still unhappy with the outcome after we have investigated it for you and you feel that there is additional information that should be considered, you should let us have that information as soon as possible so that we can review it. If you disagree with our response or if we have not replied within eight weeks, you may be able to take your case to the Financial Ombudsman Service to investigate. Their contact details are: The Financial Ombudsman Service Exchange Tower London E14 9SR Telephone: or complaint.info@financial-ombudsman.org.uk Website: financial-ombudsman.org.uk Please note that the Financial Ombudsman Service will only consider your complaint if you have given us the opportunity to resolve the matter first. Making a complaint to the Ombudsman will not affect your legal rights. Our regulators The law of England will apply in legal disputes and your contract will be written in English. We ll always write and speak to you in English. We re authorised and regulated by the Financial Conduct Authority: The Financial Conduct Authority 25 The North Colonnade Canary Wharf London E14 5HS Website: fca.org.uk Telephone: Telephone: hcqs@aviva.com 27

28 Aviva Health UK Limited. Registered in England Number Registered Office 8 Surrey Street Norwich NR1 3NG. Authorised and regulated by the Financial Conduct Authority. Firm Reference Number A wholly owned subsidiary of Aviva Insurance Limited. This insurance is underwritten by Aviva Insurance Limited. Registered in Scotland, No Registered Office: Pitheavlis, Perth, PH2 0NH. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Firm reference number Aviva Health UK Limited Head Office: Chilworth House, Hampshire Corporate Park, Templars Way, Eastleigh, Hampshire, SO53 3RY. aviva.co.uk/health GEN5187 REG001 01/2018