pmi pre-sale brochure_web.pdf

7/26/2019 PMI Pre-sale brochure_web.pdf

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Guide to Private Medical Insurance


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www.the-exeter.com

About the Exeter 4

Why private medical insurance? 5

Product highlights 6

Cover and benefits 10

Getting the right premium 15

How to apply 16

Claims overview 21

Further information 22

Contents


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3Private Medical Insurance

Welcome to Private MedicalInsurance by The Exeter

Theres nothing more important in life than your health.

By choosing private medical insurance, youre choosing

not to compromise on the speed, quality or comfortof your healthcare.

By choosing The Exeter, youre in the safe hands of

a mutual insurer that combines market-leading cover

with an efficient, personal service.


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4 www.the-exeter.com

About The Exeter

At The Exeter, were passionate about private medical

insurance and the important role it can play in securing

your long term health.

Over half of our members have been with us for more

than 10 years, a statistic which is the envy of many of

our competitors. There are some good reasons why

people stay loyal to The Exeter.

Our plans are designed to deliver, our customers are

not penalised for using their policies.

When you call The Exeter,you talk to a real person

at our UK office, first time, every time.

We provide membership benefitsthat provide you with

valuable reassurance in addition to our core cover.

Were consistently recognised in the industry for our product

and service excellence, winning numerous awards.

We paid 99% of private medical insurance claims

in 2014- the true test of any insurance.


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Why private medical insurance?

Private medical insurance is designed to

give you quick and convenient access toquality private medical facilities with the

highest levels of cleanliness.

By choosing private medical insurance,

you are getting reassurance that you andyour family are in the best possible hands

if your health takes a turn for the worse.

Beat the queues

For consultation and

diagnosis, for admission

and a bed.

Hundreds of hospitals

Youre rarely more than a

short journey away from

quality care, at a location

you choose.

Respect and dignity

Private hospitals scored 99%

for respect and dignity in the

2013/2014 State of Health

Care report by the CareQuality Commission.

Home comforts

All private hospitals have

private rooms and en-suite

facilities, offering privacy

and comfort.

Theres nothing more important in life than the health of

you and your family. Choose private medical insurance

today and:

Get access to quality, comfortable and cutting edge

private facilities

Be in control of your own appointments, arrange

consultations and treatment at times that suit you

Be confident in the knowledge that you wont have

to wait for the treatment you need

Get access to types of treatments and drugs thatmay not be available on the NHS.


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Product highlights

We offer a range of products and options to suit every

budget and need.

In patient and day patient treatment

Our range of comprehensive plans all include unlimited cover for in patient

and day patient treatment - unlike some insurers who impose time or financial

limits that might leave you out of pocket after a claim. After an in patient stay,

any drugs or medical aids taken home from hospital to help your recovery are

always covered with The Exeter.

Cancer cover

Cancer cover is one of the most reassuring aspects of having private medical

insurance. So, with The Exeter you will either have unlimited cover for cancer

included as standard or have the option to include unlimited cancer cover as

part of your policy.

No penalty for claiming

We dont employ no claims discounts on any of our private medical insurance

plans. The result is cover that you can use safe in the knowledge that we will

never increase your premiums as a result of any claim you make - regardless

of its length or cost.


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Hospital lists

Each of our plans has just one hospital list, detailing over 300 NHS and

private hospitals throughout the UK that you have access to with your cover.

The result - you can visit a hospital that offers the very best treatment and

procedures for any particular claim.

Unique underwriting option

We have a full range of underwriting options. So whether youre new to

private medical insurance or switching from another insurer, you can choose

the right options for your circumstances.

Our fixed moratorium underwriting option gives you a unique way to apply. For

the lowest monthly premiums apply through our Full Medical Underwriting option.

Please see How to apply on pages 16 - 20 for more details.

Health discounts

Your premiums will be 20% cheaper if you are a non-smoker and have a

healthy body mass index (BMI). If only one of these discounts applies,

your premiums will still be discounted by 10%.

Hospice donation

We make a donation of 250 to your hospice if you are admitted for care.

We know the vital role that hospices play for people later in life and we

think its only right that we support them.


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Health Coverfor Me

Health Choicesfor Me

Health Essentialsfor Me

Private ambulance

Medically essential

travel to, between

or from hospital in a

private road ambulance

in connection with in-

patient or day-patient

treatment.

Home nursing

Home nursing following

authorised in-patient &

day-patient treatment.

Parental

accommodation

(children up to 18)

You can stay in hospital

with your child (up to

the age of 18) if they

are having treatmentunder the policy.

NHS Cash benefit

250 per night

Paid if you have free

in-patient treatment

under the NHS that

would be covered

under your policy.

Additional benefits

All of our plans offer a range of additional benefits

as standard which provide you with increased care,

support and flexibility.


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Focus on cancer cover

We know how important offering quality cancer cover

is, which is why we have focused our energy getting

our cancer cover right.

We were one of the first private medical

insurers to offer truly unlimited cover for

cancer. Were proud of a benefit which

delivers when our members need it most.

Weve gone into full detail of what

is included in the table below but it

is important to also highlight a few

crucial features:

Our unlimited cancer cover includes:

Cover for all clinically approved

chemotherapy, even if the NHS has

rejected a drug on the grounds of cost.

No limits to cover, including NICE

approved treatments such as biological

and hormonal therapy

Stem cell and bone marrow transplants.

Treatment What does this include?

Place of treatment Treatment in hospitals and at home if you need to have

chemotherapy.

Surgery Surgery including the removal of a tumour and consequent

reconstructive surgery that you need.

Drug therapy All types of drug therapy for your cancer, including

chemotherapy & drugs to maintain any remission, providing

they have received NICE approval for clinical effectiveness.

Radiotherapy Radiotherapy including when it is given for pain relief.

Palliative Palliative treatment of cancer.

End of life care Treatment of terminal cancer.

Monitoring Follow up reviews related to the continuing care of your cancer.

Limits We do not place a time or financial limit on your cancer cover.

If you select Health Choices for Me or

Health Essentials for Me, the cover you

have will be impacted by the choicesyou make in setting up your policy.

Take a look at the individual products

Policy Document for more information.

Unlimited cancer cover comes as standard on Health Cover for Me and is a choice

on Health Choices and Health Essentials for Me.


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Cover and benefits

We know that one size of cover doesnt suit everyone,

so at The Exeter we offer a range of plans and options

to suit different budgets and needs.

Health Cover for Me

Has one simple theme, if its covered in our fee schedule there are no

financial or time limits to the amount we will pay at claim. The result

is total confidence and reassurance in having the flagship plan from

one of the UKs leading healthcare insurers.

Health Essentials for Me

Covers the cost of treatment, including the big medical bills that are hard

to budget for but without the big premiums to match. Health Essentials for

Me is a unique, innovative approach to cover - an approach that is designed

to limit your premiums, without giving you a policy with too many financial

or time limits on cover.

Health Choices for Me

Is modular private medical insurance that lets you build the right cover

at a premium that works for you. Where some modular plans give you a

vast array of confusing choices, Health Choices for Me keeps it simple,

giving you confidence in your cover.

Comprehensive cover

Give you peace of mind that you have private medical treatment covered,

whatever life throws your way. We have two comprehensive plans:

Treatment insurance

A new approach to private medical insurance, we have one plan which is

focused on cover for treatment.


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Comprehensive cover

Our comprehensive plans enable you

to have full cover from diagnosis to

scans, test to treatment, with coverage

for all stages of cancer and manipulative

treatment. If you want full cover it is

always unlimited on our Health Cover

for Me plan.

However, if you want to add and remove

options, or put in place financial limits,

then look at Health Choices for Me. This

enables you to tailor your cover to get the

right price and coverage for your needs.

The coverage you get, at any hospital on

our hospital list, and the options you can

take are set out in 4 key areas:

Essential CoverIn Patient & Day Patient Treatment, including consultant & specialist fees,

diagnostic tests as an in-patient or day-patient, pre-admission tests and hospital

charges, including any necessary medical aids and take-home drugs.

CT, MRI and PET Scansincluding professional fees where appropriate.

Health Cover for Me

Unlimited


Unlimited

Out-Patient

Including consultant & specialist fees, diagnostic tests such as X-rays,

ECGs and pathological tests.

Health Cover for Me

Unlimited


Unlimited

1,000 per year

500 per year

No cover

Cancer cover

Extends the scope of benefits under Essential Cover (such as surgery and scans)

to include treatment for diagnosed cancer and adds unlimited benefit for oncology

and specialist consultations for cancer.

Health Cover for Me

Unlimited


Unlimited

No cover

Manipulative Treatment

Includes costs for physiotherapy, osteopathy, podiatry and chiropractic treatment

received as an out-patient.

Health Cover for Me

Unlimited


Unlimited

300 per year

No cover


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Treatment insurance

Health Essentials for Me is a new type

of Health Insurance. It enables you to

protect yourself against the big costs

of treatment, without having to pay

the premiums that come with more

comprehensive private medical insurance.

If you want the reassurance that

potential large costs of treatment

are covered, but are happy managing

the smaller costs yourself or utilising

the NHS, Health Essentials for Me

could be the policy for you.

You visit your GP, who may refer you to a specialist to establish a diagnosis.

This can take place within the NHS, or by paying yourself for a private

consultation and tests.

Once you have your diagnosis, if you need treatment, you contact The Exeter.

We cover all eligible treatment at any hospital on our hospital list.

How does it work?

It is very simple:

What is covered?

The key elements of your treatment coverage are listed below:

Cancer cover

With Health Essentials for Me you have

the option to add unlimited cancer coverto your policy.

This extends the scope of benefits under

core cover (such as surgery and scans) toinclude treatment for diagnosed cancer

and adds unlimited benefit for oncology

and specialist consultations for cancer.

In-patient and

day-patient

Treatment

Consultant & specialist fees, diagnostic tests as an in-patient

or day-patient, pre-admission tests and hospital charges

(including any necessary medical aids or take-home drugs).

Post-diagnosis CT,

MRI & PET Scans

CT, MRI or PET scans, ordered by a specialist to further determine

or assess your condition after an initial diagnosis has been made.

Includes professional fees where appropriate.

Out-patient surgery Surgical procedures performed by a specialist, including any

necessary medical aids or take-home drugs.

Post-operative

Physiotherapy

Up to 3 sessions of post-operative physiotherapy as an

out-patient following in-patient or day-patient surgery.


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GP Helpline

Gives you free, unlimited access to a

large team of practising GPs, providing

information and advice about your

health concerns or those of your family.

You have the option of a telephone

or webcam consultation.

Private prescription service

During your GP Helpline consultation,

your doctor may offer you a private

prescription.

This service provides a simple way of

getting private prescription medication

delivered to your home or office without

the hassle of waiting for an appointment

or taking time off work.

Membership benefits

Whichever plan you choose, as a

customer of The Exeter, you will also

have access to a number of important

membership benefits to make your

life easier when it comes to accessing

primary care.

For some people getting an appointment

to see their GP, or simply accessing

expert health advice can be a frustrating

and lengthy process:

Our current membership benefits,

provided by Medical Solutions - an

expert in their field, are designed to

bring you into more convenient contact

with healthcare professionals and

give you more convenient access

to prescription drugs.

These benefits are there for your

convenience but its important to note

that they are advisory only and cannot

be used as evidence for your claim.

5.8 millionpatients visit

A&E because they cannot geta GP appointment.

Over 30,000 callswere

made to the NHS 111 servicein Englandeach dayinJune 2015.

59 millionpatientswait 1 week or more for

an appointment.

40%of patients areunhappy waiting 10 minutes

on the phone to book an

appointment.


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Exclusions

Weve tried to keep our exclusions to a minimum

but there are things that were unable to cover.

Weve listed significant exclusions on our products

below for a full list take a look at the individual

products Policy Summary or Policy Document.

Health Essentials for Me only

Outpatient treatment, consultations, tests or scans, prior to aninitial diagnosis.

We do not cover any treatment, consultations, tests or scans received

as an out-patient with the purpose of establishing an initial diagnosis.

Pre-existing conditions

Pre-existing conditions will either be excluded from cover altogether or excluded

for the moratorium period of your policy.

Emergency treatment

Emergency treatment is dealt with by the NHS. You are not covered until you are

transferred to private facilities and you have authorisation from us.

Ongoing or long term conditions (chronic)

Well pay for the treatment needed to stabilise the condition however we wont

pay for the treatment once it has been stabilised. Please note, we do not consider

cancer as a chronic condition.

Specialist fees in excess of those on our Fee Schedule

We publish a schedule which sets out the maximum fees we pay specialists

for the treatment they provide to you. Our most up-to-date schedule can be

found on our website.


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Getting the right premium

Voluntary excesses

Each of our plans includes a compulsory excess of

100 per person, per policy year which will be deducted

from eligible benefits on your policy.

You can choose to add a voluntary excess

to this compulsory excess to save you

money each month the higher theexcess, the lower your premiums will be.

The total excess (voluntary excess

plus compulsory excess) then applies

individually to each person to be covered

by your policy in each policy year.

If there are multiple claims or conditions

for one person within one policy year, then

the total excess is only deducted once.

Please note that Health Choices for Me

does not offer a 500 or 1,000

voluntary excess.

Calculating your premium

There are a number of factors that

influence your premium:

The ages of everyone included

on the policy

Your address

The product and cover options

you choose

Whether you add a voluntary excess

The underwriting option you choose

Your height and weight

Whether you smoke.

Voluntary excess Your costs per policy yearNil You have to pay the first 100 of eligible treatment costs

for each person covered by your policy each year

100 You have to pay the first 200 of eligible treatment costs






1,000 You have to pay the first 1,100 of eligible treatment costsfor each person covered by your policy each year

Your options are:


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How to apply

To apply for our products:

You must be a resident in the UK

You must be aged between 18 and 79

inclusive. Some of our underwriting

options have lower maximum ages,

see pages 18 - 20 for details.

Children from 3 months old to 21 may

be included on their parents policy.

Note for Health Cover for Me and


Children under 25 if still in full time

education may be included on their

parents policy. Children aged 5 years

and under are covered for free.

Underwriting options

You have a choice of how to apply

for cover, depending on the product

you select.

These are described in more detail on

pages 17 - 20.

Health Coverfor Me

Health Choicesfor Me

Health Essentialsfor Me

Full Medical Underwriting

Standard moratorium

Fixed moratorium

Continued PersonalMedical Exclusions

Continued moratorium

Once youve chosen your plan and, where applicable,

personalised your cover, you then need to decide on

the underwriting option best suited to your needs.


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If you are new to private medical insurance

Choosing Full Medical Underwriting

gives you our best price and certainty

of your cover.

If you choose this option, you will need

to complete a full medical declaration,

including details of the medical history

of all family applicants. Any pre-

existing conditions will be excluded

unless we agree to accept them.

Full Medical Underwriting

Our Standard Moratorium is common

to most medical insurers. If you

choose this, you will not have to

provide full medical details with your

application, but if you make a claim

we may request information from

your GP to determine whether the

condition was pre-existing or not.

Benefits will not be available for

treatment of any condition sufferedby an applicant if:

the applicant had symptoms,

medication, treatment or advice

in connection with that condition

in the five years before the start

of their policy; and

there has not been a clear two year

period after the start of their policy

during which the applicant has

been free of symptoms, medication,

treatment and advice in connection

with that condition.

Standard Moratorium

5 Years

Any condition in the

5 years before joining

is excluded

Free of previousconditions

Benefits will start after

a clear 2 year period

+2 Years

Join us

If you dont currently have a private

medical insurance plan, weve outlined

the ways you can apply on this page.

The option thats best for you will depend

on your circumstances and needs.

If you choose full medical underwriting,

your premiums will be cheaper.


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There are a few rules about who can

choose this option:

All applicants must be 65 years

or younger.

All applicants must never have

suffered from a heart condition,

stroke, cancer or had a joint

replacement or joint resurfacing.

All adult applicants must never

have been diagnosed with diabetes.

Unlike most insurers, we offer a fixed

length moratorium. Under this option,

benefits will not be available for

treatment of any condition suffered

if you had symptoms, medication,

treatment or advice in connection

with that condition in the five years

before the start of your policy.

However, we will cover a pre-existing

condition two years after the start

of your policy, even if it has recurred

during that two year period. If you

apply using Fixed Moratorium, your

premiums will be higher.

See the diagram below.

Fixed Moratorium

5 Years

Any condition in the

5 years before joining

is excluded

Pre-exisiting conditions

will be covered following

the moratorium

2 Years

Join us


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If you are thinking of switching your private

medical insurance to The Exeter

We have two underwriting options

designed solely for you. If you are

switching your cover from another insurer

and want to maintain your underwriting

- weve outlined both below.

The option thats right for you will

depend on your circumstances

and needs. Remember, you can apply

with any of our five underwriting

options; if you apply using Full Medical

Underwriting, detailed on page 17,

your premiums will be cheaper.

There are a few rules about who can

choose this option:

All applicants must be covered

by a current policy which has been

underwritten based on a full

medical declaration

All applicants must be 70 years

or younger

All applicants must never have

suffered from a heart condition,

stroke, cancer, or had a joint

replacement or joint resurfacing

All adult applicants must never

have been diagnosed with diabetes

Your cover with The Exeter must

commence the same day your cover

with your previous Insurer finishes

to ensure continuous cover.

This option is designed to allow you

the opportunity to carry across the

personal medical exclusions from

your existing policy. You will need

to provide a certificate from your

previous insurer with your application.

You will also need to answer a few

questions about recent or planned

medical conditions or treatment.

Continued Personal Medical Exclusions


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To register a claim, call us on 0300 123 3200.

Were open Monday to Friday, 8am to 6pm.


Claims overview

We know that the most important thing for you is

how we perform when you need us most - at claim.

At The Exeter, we make this process as easy as possible

to ensure you can concentrate on what is most

important, your health.

We pride ourselves on the service we

provide at claim. Our experienced team

are here to make sure that claims are

authorised quickly and without fuss.

The process is detailed fully in the

each Policy Document, but if you need

to make a claim you should always

contact us before you go ahead - claims

must be pre-authorised with us.


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Further information

Making a claim

To register a claim, please contact us.Claims must be authorised by us before

you go ahead with any consultations,

tests or treatment.

Telephone: 0300 123 3200

Email: [email protected]

Contacting us

Opening times

Monday to Friday 8am 6pm

Visit our website

www.the-exeter.com

Financial Advisers

All enquiries: 0300 123 3203

[email protected]

Members

General enquiries: 0300 123 3201

Claims: 0300 123 3200

[email protected]


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Members

General enquiries: 0300 123 3201

Claims: 0300 123 3200

[email protected] [email protected]

All enquiries: 0300 123 3203

Financial Advisers

The Exeter, Lakeside House, Emperor Way, Exeter, EX1 3FD

Contact us

www.the-exeter.com

Calls may be recorded and monitored.

The Exeter is a trading name of Exeter Friendly Society Limited, which is authorised by the Prudential Regulation Authority and regulated by

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