Dental insurance policy document

Page 1 of 4NDP176 11/2016

020 7488 9880 www.unum.co.uk/dental

Your insurance explained

What we will cover

1. We will cover the member (and dependants if applicable)

set out in this policy document, the policy schedule and the

benefits schedule - as amended from time to time.

By member, we mean each of those individual employees

who have applied for cover and been accepted by Unum

Dental on behalf of the underwriters.

By dependant, we mean a member’s spouse, civil partner

or a member’s unmarried child under the age of ,

unless otherwise agreed with the employer.

2. We will pay for any dental expenses following treatment that

members and dependants are entitled to under this policy.

By treatment, we mean any dental procedure carried out

while the member or dependant is covered by this policy

(including a preventative or diagnostic procedure) which

is necessary for continued dental good health, including

treatment as a result of an accident. Reconstructive facial

plastic surgery following treatment of mouth cancer is also

considered as treatment for the purposes of this policy.

By accident, we mean a sudden and unexpected event which

causes injury to a member or dependant, including accidents

involving a vehicle in which the member or a dependant is

travelling, and accidental sports injuries.

By mouth cancer, we mean a malignant tumour, tissue or

cells, primarily in the oral cavity, lips, tongue or pharynx,

characterised by the uncontrolled growth and spread of

malignant cells and the invasion of tissue.

3. Following treatment, we will reimburse a member’s or

dependant’s dental expenses up to the sum set out in the

benefit schedule for the relevant treatment.

4. The total sum payable to a member or dependant during any

one insurance period cannot exceed the annual maximum

amount shown in the benefit schedule.

5. Where a member or dependant receives treatment abroad

and dental expenses are incurred in a foreign currency, we

will pay the claim in sterling at the exchange rate prevailing

on the day we agree to pay the claim.

What we won’t cover

6. We will not pay any claim made for:

a) Dental expenses directly or indirectly resulting from mouth

cancer conditions which existed before the start of the

member’s or dependant’s current continuous period of

cover under this policy

b) Any dental procedure which is purely cosmetic and not

necessary for continued dental good health

c) Benefits for overnight hospital stays in the Republic of

Ireland (ROI)

By period of cover, we mean the 12-month period

immediately following the start date, or in the case of a

renewed policy, the 12-month period immediately following

the renewal date - or other periods as agreed with the

employer.

Starting cover

7. We will cover each member (and dependants if applicable)

from the date stated in the dental healthcare agreement

or the date agreed with the employer (for company-paid

schemes administered by the employer).

We will provide cover on the terms set out in the current

membership rules until the renewal date, when we may offer

cover under a new set of membership rules which we will

issue to the employer.

By membership rules, we mean this dental insurance policy

document, certificate of cover (or a summary of the available

cover in the case of company-paid, employer-administered

schemes) and the healthcare agreement between the

employer and Unum Dental.

Ending cover

8. Cover will end for a member (and their dependants) when:

(i) The policy expires and is not continued

(ii) The member no longer works for the employer (or at the

end of that month if agreed with the employer)

(iii) They no longer meet the criteria for being a member (or

dependant) - unless otherwise agreed in writing by us

(iv) We give the member notice that we are cancelling cover

following an unpaid premium instalment

References to ‘we’ and ‘us’ below are to the underwriter, Unum Limited.

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(v) We give the member notice that we are cancelling cover

for them and/or their dependants according to clause 11

(vi) A false or fraudulent claim is made by a member or

dependant

(vii) We cancel cover according to our rights to do so as set

out in this policy

Cancellation

9. A member or dependant cannot cancel their membership

until the end of the insurance period, unless they leave their

employer or experience a qualifying event.

By qualifying event, we mean those life events defined

by the employer - or for company-paid schemes, birth or

adoption of a child, death of a member or dependant,

marriage or divorce of the member, a member entering a civil

partnership or a dissolution of a member's civil partnership.

Claims

10. To make a claim under this policy, a completed claim form

must be sent to us within 90 days of the treatment or, where

there has been a course of two or more treatments, within 90

days of the last treatment (unless not reasonably possible).

The claim form must be signed by, or on behalf of, the dentist

who carried out the treatment or course of treatments - and

the scheme administrator if the employer advises.

By dentist, we mean a dentist, dental surgeon or dental

practitioner registered with the General Dental Council or

equivalent outside the UK.

The receipt or receipts for the dental expenses incurred by

the member or dependant must also be sent to us. Where

the claim form and receipt(s) are received by us later than

90 days, we may choose not to accept the claim. In such

cases, we will act in a fair and reasonable way at all times.

We are required by law, in certain circumstances, to disclose

information to law enforcement agencies about suspicions of

fraudulent claims and other crime.

We will disclose information to third parties including other

insurers, the policyholder and/or any employer or trustee

connected with the scheme/policy, for the purposes of crime

prevention or investigation including reasonable suspicion

about fraud or otherwise improper claims.

Conditions

11. We are entitled, on giving reasonable notice of at least

14 days, to request that a member or dependant has a dental

examination - at our expense. If the member or dependant

refuses, we may cancel cover for that member and/or

dependants with immediate effect by giving the member

notice in writing.

12. We reserve the right to change the membership rules from

time to time, but no alteration will take effect until the

renewal date. We may amend the terms of this agreement

from time to time (subject to giving 60 days’ notice in writing

to the employer) to reflect any changes in Insurance Premium

Tax or any levy or imposition made under relevant legislation

or regulation.

13. For the purposes of the Data Protection Act 1998, Unum

Dental and the underwriters act as data controllers as defined

by the Data Protection Act, which means that the employer

will need to notify and obtain the necessary consents

from members before providing us with any personal data

or sensitive personal data which we need to set up and

administer the policy.

We have the right to request such data as is required to

quote for and administer the policy. We will record such

information accurately and keep it confidential and secure

and will use it solely for the purpose of quoting for, providing

and administering the policy and for marketing other Unum

products to the employer and its employees.

The employer must ensure that the data is correct at the time

it is provided to us and that alterations are notified to us in

reasonable time.

We will only process, transfer or permit access to any personal

data outside of the European Economic Area in compliance

with applicable data protection legislation.

Cancellation and avoidance of the policy

14. By giving notice in writing to the employer, we are entitled

to retrospectively cancel, nullify, or end the policy if we find

the employer has misrepresented, or failed to disclose, any

information in an attempt to mislead us.

15. By giving notice in writing to the employer, we may cancel

the policy with immediate effect if the employer is unable or

deemed unable to pay their debts within the meaning of the

Insolvency Act or otherwise ceases trading.

Any cancellation of this agreement will be without prejudice

to any accrued rights and obligations of both parties for the

period when the premium has been paid.

16. The policy’s premium must be paid when due, including

when paid in instalments. If any instalment is not paid

on the due date, we are entitled to cancel this policy with

immediate effect by giving notice in writing to the employer.

We are not liable to pay any claim for a member’s or

dependant’s treatment that takes place after the policy’s

cancellation. We may also offset any benefit payable for

a claim against any outstanding unpaid premium for that

member or dependant(s)

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Complaints

17. In the first instance, please direct any complaints to us at:

Unum Dental, Milton Court,

Dorking, Surrey RH4 3LZ

Tel: 020 7480 7201

We will do our best to resolve any complaint, but if the

employer is still dissatisfied, the employer has the right to

contact the Financial Ombudsman Service at the address

below without prejudice to the member’s or dependant’s

legal rights.

The Financial Ombudsman Service,

Exchange Tower,

London, E14 9SR

Helpline: 0800 023 4567 Mobiles: 0300 123 9 123

Email: complaint.info@financial-ombudsman.org.uk

Website: www.financial-ombudsman.org.uk

Financial Services Compensation Scheme

18. If Unum is unable to meet its liabilities, the employer may

be entitled to compensation from the Financial Services

Compensation Scheme (FSCS). Please note the FSCS does not

cover the Channel Islands or the Isle of Man.

19. This contract is subject to English law and by taking out the

policy, the employer accepts that any dispute will be subject

to the exclusive jurisdiction of the English courts.

20. Only the policyholder and we have legal rights under this

policy. No clause or term of this policy will be enforceable, by

virtue of the Contract (Rights of Third Parties) Act 1999, by

any other person, including any dependant.

This dental insurance is underwritten by Unum Limited under

the trading name, Unum Dental. Unum Limited is authorised

by the Prudential Regulation Authority and regulated by the

Financial Conduct Authority and the Prudential Regulation

Authority. Registered Office: Milton Court, Dorking, Surrey RH4 3LZ.

Registered in England 983768.

unum.co.uk/dental

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