your dencover dental insurance policy document

dencover customer services Customer services: Quay Point 0800 180 4505 Lakeside Boulevard Doncaster Email: South Yorkshire [email protected] DN4 5PL

Your dencover dental insurance policy document…

Dencover.com | Policy document | V3.0 | DEN/03.17 of 24

Your dencover dental insurance policy document

After we receive the correct premium, we will cover you and any other insured person(s) during the period of cover for expenses charged for certain dental work as described below. The cover will be subject to the terms and conditions set out in this policy document.

The policy sets out all the terms and conditions and explains what the cover is. The schedule gives information about the insured person(s) and the start date of the policy. The policy document, the schedule, the summary of cover document and any endorsements form the complete insurance contract and you should treat them as one document.

Please read the policy document carefully. If you do not comply with its terms and conditions, this may mean that the contract is not valid and we may not be able to pay some or all of any claim you make.

If you have any questions about this policy document or you would like to make any changes or additions to the cover, please contact our Customer Services Team on 0800 180 4505. Calls may be monitored or recorded for training, compliance and claims purposes.

Eligibility for cover You are eligible for cover under this policy if you are:

permanently living in the UK and aged over 18 on the start date; and

Iiving in the same property as the primary member, if you are an additional adult on the policy; or

a natural or legally adopted child of the primary member or their partner who is permanently living with the primary member in the UK and is over 6 months old and under 18 years of age.


More reasons to smile

Guide to your policy

About your dencover dental insurance policy .................................. 4

Accessing information ..................................................................... 4

Providing information ..................................................................... 4

Definitions of words used in this document ..................................... 5

Section 1 Cover provided under this policy....................................... 9

Section 2 General exclusions ......................................................... 12

Section 3 How to join .................................................................... 15

Section 4 Premiums ....................................................................... 16

Section 5 How to claim .................................................................. 16

Section 6 Preventing fraud ............................................................ 19

Section 7 When does my cover end? .............................................. 20

Section 8 Enquiries or complaints .................................................. 21

Section 9 Your right to change your mind ....................................... 21

Section 10 Changes to your details................................................. 22

Section 11 The Financial Services Compensation Scheme (FSCS) ..... 22

Section 12 Changes to your policy .................................................. 22

Section 13 How we use the information we hold about you ........... 22

Section 14 Other important information ........................................ 23


About your dencover dental insurance policy These terms and conditions set out how we provide you with cover under your dencover dental insurance policy. They bind you, as a member, once your application has been accepted, however you have applied.

Please read them carefully and keep them safe for future reference. If you do not comply with the terms and conditions, this may mean that the contract is not valid and we may not be able to pay some or all of any claim you make.

If you have any questions about these terms and conditions or you would like to change or add to the cover, please contact our Customer Services Team on 0800 180 4505.

Accessing information We try to make it easy for everyone to access information about us and our products. On request, we can provide this information by text phone, on audio tape, in large print and Braille. If you need this information in a different format, please contact dencover on 0800 180 4505. All our communications with you will be in English.

Providing information Please take reasonable care to answer all the questions honestly and to the best of your knowledge. If you don’t answer the questions correctly, your policy may be cancelled, or your claim may be rejected or not fully paid.


Definitions of words used in this document The following words and terms have the meanings set out below wherever they appear in this document. Accident: a sudden and unexpected identifiable external blow to the mouth that happens by chance, which causes significant dental injury to the teeth or gums (or both), resulting in medical or dental attention within 48 hours of the incident.

Additional adult: up to 3 adult relatives of the primary member, including a partner, siblings, children older than 18 and parents, as listed on the schedule, that are: permanently living in the UK in the same property as the primary member, and aged over 18 on the start date.

Benefit limit: the most we will pay as set out in the Table of Benefits.

Benefit year: the 12-month period immediately following the start date and each period of 12 months after that.

Call-out fee: the cost of attending a dental practice outside practice hours when you are seen by a dentist or specialist. The call-out fee excludes treatment costs.

Child(ren): up to 4 of the primary member’s or their partner’s natural or legally adopted children, as listed on the schedule, who are:

permanently living with the primary member in the UK; and

over 6 months and under 18 years of age.

For a claim for a child to be considered, the child must continue to satisfy this definition on the date any treatment takes place or is identified as being clinically necessary.

Clinically necessary: (concerning treatment or replacement of defective or worn work) recommended by a dentist or specialist to ensure the maintenance of good oral health.

Consultant: a dentist who is a member of a college and is recognised by that college to be a consultant.


Cosmetic or aesthetic procedures: treatment to improve your appearance but not clinically necessary, including:

orthodontic treatment;

treatment you choose;

veneers, replacement of amalgam (silver) fillings with white fillings; and

tooth bleaching and whitening, including laser treatment to whiten your teeth.

dencover consultant: an independent dentist or consultant we appoint.

Dentist: a qualified dental surgeon who is currently registered with the General Dental Council and is engaged in general dental practice in the UK. This cannot be you, your partner or a relative.

In the case of dental treatment for emergency or accidental injury outside the UK, dentist means a dental practitioner who is appropriately qualified, registered and practicing in the country where you are treated.

Doctor: a qualified UK-registered medical practitioner registered with the General Medical Council who practises in the UK but not you, your partner or a relative.

Emergency: a single initial dental appointment that you urgently need to get immediate treatment for any of the following:

severe pain;

trauma to your teeth or mouth, including trauma that prevents you eating;

acute infection(s); or

stopping bleeding after a tooth has been taken out.

We do not cover treatment you need or receive after this initial appointment, unless cover is specifically provided for under any other section of this policy. The treatments we cover and the amounts we pay are shown in the Table of Benefits in this policy document.

Evidential proof: a written statement from an independent third party (excluding family or friends).

In-patient: a member who is admitted to an NHS hospital in the UK and occupies a bed for an over night stay for dental treatment.

Member: the insured person(s) who we have approved to join, and who is listed on the schedule.


Oral cancer: a diagnosis of a malignant tumour:

that is supported by a specialist’s letter and histology (microscopic study); and

whose main site is in the oral cavity (the mouth, including the hard and soft palate, accessory, salivary, lymph and other gland tissue in its mucosal lining but excluding the tonsils); and

that is characterised by the uncontrolled growth and spread of malignant cells and the invasion of tissue, excluding non-invasive cancer in its original position.

Partner: your legally married husband or wife, or your registered civil partner under the Civil Partnership Act 2004 or a person who is permanently living with you in the same household as if they were your husband or wife or registered civil partner.

Practice hours: Monday to Friday between the hours of 8am to 6pm excluding public holidays.

Pre-existing condition: a medical or dental condition, injury, illness, disease, sickness or related medical condition and associated symptoms, whether diagnosed or not, that:

you knew about or should reasonably have known about at the start date; or

you have seen or arranged to see a dentist about during the 12 months immediately before the start date; and

returns within 24 months after the start date.

Premium: the amount stated on the schedule that you agree to pay each month in return for the cover we provide.

Primary member: the insured person who purchases the policy. This person must be 18 years or older and be permanently living in the UK.

Qualifying period: the period after the start date during which we will not cover you for dental treatment that is identified as being clinically necessary, whether or not the treatment actually happened during this period. Please see the Table of Benefits to see what qualifying periods apply to your cover. The qualifying period applies to each member.

Relative: a partner, child or any other immediate family member related to you by blood or law.


Schedule: the document containing information about you and this policy document.

Specialist: a dentist who is registered with the General Dental Council as a specialist. For any treatment for oral cancer, specialist means a medical or dental practitioner.

Sport(s): an activity where:

there is a higher than average likelihood of dental injury; or

it is a requirement to wear head, face or mouth protection; or

it is reasonable to expect such head, face or mouth protection to be worn.

Start date: the date when cover under this policy starts, as noted on the schedule.

Terrorism: an act – including the use of force or violence or the threat of force or violence – by any person or group of people (whether acting alone or on behalf of or in connection with any organization or government) that is committed for political, religious, ideological or similar purposes. This includes the intention to influence any government or to put the public or any section of the public in fear resulting directly or indirectly from or in connection with the release of nuclear, biological, chemical or radiological agents.

Treatment: work done on the member’s teeth and / or gums that is covered by this policy.

UK: England, Scotland, Wales, the Channel Islands, the Isle of Man and Northern Ireland.

We, us or Unum Limited whose registered office is at Milton Court, Dorking, Surrey, RH4 3LZ, United Kingdom. Unum Limited is registered in England under company registration number 00983768.

You / your: the member(s).


You must pay the cost of any treatment and then claim it back from us, subject to the maximum benefit limit in each benefit year.

Section 1 Cover provided under this policy We will pay you up to the maximum benefit limit of your chosen plan type, as shown in the table of benefits, provided:

we have received the correct premium;

you comply with the terms and conditions in this policy document;

the insured event happens during the benefit year; and

you comply with our requests to provide evidence of your claim.

This is a monthly renewable policy. This means your policy will renew automatically every month for which we receive and accept the premium, until your policy ends. The benefit limits shown in the benefits table apply for 12 consecutive months, which is the benefit year.


dencover table of benefits

NHS

Silver

Gold

Platinum

Diamond

Start claiming

Discover your smile

Routine check ups and x-rays

£20.60 £30 £55 £80 £105 Today

Uncover your smile

Scale & polish/hygienists

£20.60

£35

80%

£65

80%

£95

80%

£125

80% Today

Recover your smile

Fillings, extractions, dentures, crowns, root canal and bridges

*Maximum benefit for crowns, root canal & bridges (see below).

£112.60

(£112.60*)

£210

(£210*)

55%

£410

(£210*)

55%

£610

(£310*)

55%

£810

(£410*)

55%

2 months

Accident

Worldwide cover £2,500 £5,000 £7,500 £10,000 £12,000 15 days

Emergency

Worldwide cover £425 £850 £850 £1,100 £1,100 15 days

Hospital care

Maximum of 20 nights N/A £50

per night £50

per night £50

per night £50

per night 3 months

Oral cancer

One-off single payment for the lifetime of the membership / policy

£2,500 £5,000 £7,500 £10,000 £12,000 2 months

£ - Maximum benefit for each member each policy year % - Amount reimbursed per claim


Recover your smile Fillings, extractions and dentures are subject to the overall annual maximum amounts in bold.

Crowns, root canal and bridges are subject to the secondary annual maximum amounts shown in brackets (£*).

The secondary annual maximum is subtracted from the overall annual maximum

Accident cover Subject to the provision of evidential proof that an accident occurred, any treatment needed as a result of an accident to restore your teeth or general oral health (or both) to their original pre-accident condition.

Hospital dental cover Each night you spend at an NHS hospital in the UK as an in-patient where the over night stay is primarily related to dental treatment. You must have been referred to the NHS hospital by a dentist or a doctor.


Section 2 General exclusions You are not covered for and will not receive any benefit for: 2.1 treatment that is identified as being clinically necessary during the relevant

qualifying period, whether or not the treatment happens during this period;

2.2 costs that relate to a claim that was submitted to dencover 60 days or more after the treatment was completed (unless this was not reasonably possible);

2.3 an over night stay, damage or treatment arising from, traceable to or caused by a pre-existing condition;

2.4 treatment (except the following; a routine examination, an x-ray, a scale & polish, and hygiene treatment) that is identified as being clinically necessary at your first examination after the start date by a dentist, if you have not had a routine examination in the 12 months immediately before the start date;

2.5 an over night stay or treatment or maintenance that has taken place during the relevant qualifying period;

2.6 costs associated with any type of treatment performed by a specialist, unless the treatment is a direct result of an accidental injury or oral cancer;

2.7 any amount above the relevant benefit limits;

2.8 costs that relate to a replacement denture when the original denture was fitted in the last 3 years;

2.9 treatment for which you cannot provide evidential proof that it is clinically necessary;

2.10 treatment by a periodontist for the gums and bone structure that surround and support your teeth;

2.11 costs where the dencover consultant tells us there is no evidence that the work conforms to generally accepted Standards of Dentistry;

2.12 claims resulting from you participating in a criminal act;

2.13 costs that are higher than the standard fee usually charged for the treatment you are receiving in the geographical part of the UK where you are being treated, or are more than the dentist would usually charge for that treatment (including call-out fees);

2.14 charges made by the dentist or any other professional for providing the medical and claims information we need;


2.15 loss of, or damage to, dentures except while being worn;

2.16 fees recoverable from or otherwise covered by other dental schemes or insurance policies;

2.17 administration fees, travelling expenses or phone calls in connection with any treatment;

2.18 costs that are not reasonably and necessarily incurred;

2.19 treatment needed as a direct or indirect result of terrorism;

2.20 treatment which is repeated on a tooth within 365 days of receiving the original treatment;

2.21 damage caused by alcohol, solvent abuse or drugs (except drugs taken under the direction of a doctor, dentist or consultant unless to treat drug addiction);

2.22 damage caused by medication or drugs which are not prescribed by a dentist, doctor or consultant;

2.23 damage caused while participating in any professional, semi-professional, or contact sport, including training, unless the appropriate head, face or mouth protection was worn;

2.24 accidental injuries as a result of normal dental wear and tear or the body's normal aging process;

2.25 damage caused while taking part in any flying activity except as a fare-paying passenger in a commercially licensed aircraft;

2.26 extracting wisdom teeth, elective (i.e. done by choice) surgical procedures, implants, veneers, cosmetic or aesthetic procedures, any type of tooth whitening or orthodontics;

2.27 treatment, care or repair to or in connection with tooth jewellery;

2.28 any claim that is not supported by medical evidence from a dentist, doctor or consultant;

2.29 loss or damage directly or indirectly caused by self-inflicted injuries or deliberate exposure to danger, except in an attempt to save human life;

2.30 prescription charges, laboratory fees, missed appointment fees or any other costs unless directly related to an accidental injury;

2.31 costs for dental products, such as toothbrushes, paste and floss;

2.32 costs for sedation or anaesthetic treatment;


2.33 costs related to periodontal treatment, surgery or diseases (‘periodontal’ means to do with gums);

2.34 costs related to temporary treatment that at some time will need to be replaced by a permanent fix – for example, a temporary bridge is used instead of a permanent bridge;

2.35 treatment relating to an accident or emergency if the accident or emergency was caused by you being involved in any form of fight including taking part in a violent struggle involving the exchange of physical blows or the use of weapons, unless the treatment relates to injuries sustained in self-defence;

2.36 costs that relate to permanent work that is carried out during an emergency appointment, such costs may be covered within the other benefits of this policy;

2.37 treatment you receive while outside the UK, unless the claim is in respect of an Accident or Emergency;

2.38 emergency treatment that is already covered under another section of the policy;

2.39 follow-up treatment needed after an emergency, unless this is covered under another section of the policy;

2.40 emergency or accident treatment you receive from a dentist or consultant outside the UK for treatment that is not normally provided by a dentist or consultant in the UK;

2.41 an accident caused by food or any other object while eating, chewing or drinking;

2.42 accident treatment if you fail to seek medical or dental attention within 48 hours of the incident, unless this was not reasonably possible;

2.43 ongoing treatment relating to an accident needed more than 30 days from the date of the accident;

2.44 treatment relating to an accident or emergency if the accident or emergency was caused by you failing to wear head, face or mouth protection during sport activity;

2.45 treatment needed in relation to oral cancer that is not a result of primary cancer of the lips, tongue, the major salivary glands, gums, mouth and pharynx;

2.46 treatment for secondary oral cancer;

2.47 costs for diagnostic or investigative tests in relation to oral cancer:


resulting from chewing or using tobacco products or betel nut or from prolonged alcohol, solvent or drug abuse (but not from the use of drugs taken under the direction of a doctor, dentist or consultant);

for non-invasive tumours;

that are not supported by medical evidence from a consultant;

and

2.48 hospital dental cover:

if you are not admitted to the hospital as an in-patient

if the primary reason for being admitted to the hospital is not dental related

when the over night stay is primarily related to oral cancer

if the hospital dental cover claim is also in conjunction with a treatment cover claim.

Section 3 How to join 3.1 You can apply to join as a member if you are a UK resident and are aged 18 or

above at the time you apply. We reserve the right to refuse your application and we do not have to give reasons for our refusal.

You must have a permanent home in the UK and we will use this address for all correspondence with you. We cannot accept a PO Box or 'care of' as an address.

3.2 Our policy is not suitable for professional sports individuals and their families.

3.3 The primary member can add up to three additional adults to the policy, at the same level of cover the primary member has chosen, provided they meet the criteria in Section 3.1 and are living permanently with the primary member. The primary member will have to pay an extra premium for each additional adult, payable before their cover starts.


3.4 The primary member’s or their partner’s children (up to four children in total) can also be added to the policy, provided they permanently live with the primary member and are under the age of 18. Cover for children ends on their 18th birthday. We may ask to see an original birth certificate for each child. If a child is removed as a member, they cannot rejoin dencover (take out a dencover policy) for three years after this.

3.5 You must inform dencover of all the information that is relevant to you, your circumstances and your policy, and immediately notify dencover of any changes to that information.

Section 4 Premiums 4.1 Premiums must be paid by direct debit. In some cases, we will ask for the first

payment to be made by debit or credit card. If the primary member does not pay the premiums, we will not pay any claims you make and your policy will be cancelled.

4.2 We apply insurance premium tax (IPT) to your premium if the tax is payable. If the IPT level changes, we will amend your premium accordingly. We will write to you to notify you of this change.

Section 5 How to claim 5.1 When you become aware of an incident or condition that could lead to a claim,

you must inform dencover within 30 days.

Once the treatment has been completed, you must complete and return the claim form within 60 days (unless this is not reasonably possible), or we may not be able to pay your claim.

5.2 You can download a claim form from our website: www.dencover.com. Alternatively, you can call 0800 180 4505 (all calls are recorded for training, compliance and claims purposes) and dencover will send you a claim form.

The claim form will need to be completed by you and the dentist. It should be posted together with all the information dencover need to: Specialist Claims, PO BOX 1192, Doncaster, DN1 9PU

http://www.dencover.com/


5.3 We do not accept claim forms submitted by your dentist directly to us. We must have the original receipt for the treatment, on official headed paper and showing:

the name of the patient;

the name, address and qualifications of the person providing treatment;

a description of the treatment; and

the amount paid for it.

If there is a charge for this receipt, you must pay it. We will keep these records. Your dentist will need to sign the claim form personally. A ‘dental practice signatory’ will not be acceptable.

5.4 We will only pay you for dental treatment you have already received and paid for in full. For all claims you may be asked to provide us with your full clinical records, as provided by your dentist, including but not limited to x-rays, photographs, dental casts/models, price lists/guidelines for the dental practice or evidence of dental history. If you are claiming for a dental accident, we will need more information about the accident, such as police reports and hospital reports.

5.5 We are not responsible for costs the dentist and specialist may charge to complete or provide the information needed to submit or complete a claim. You must pay these charges.

5.6 We allocate claims to the benefit year in which the treatment is identified as being clinically necessary.

5.7 We reserve the right to discuss your claim, including the medical information we hold about you, with an independent consultant or our dencover consultant or both. You consent to this when you sign your claim form.

5.8 We will only pay for treatment if the treatment is clinically necessary and the amount payable is what is normal for similar treatment.

5.9 We may ask you to attend an appointment with an independent consultant, which we will pay for. If you do not comply with our request, we may refuse your claim or pay you a lesser amount.

5.10 We will not pay any claim if the primary member has failed to pay the premiums or is in arrears.


5.11 Once we have approved your claim, we will make the payment to your nominated bank account or we will send you a cheque. You are responsible for notifying us of any changes to your bank account to ensure we are making payments to the correct account.

5.12 Accident and emergency cover applies worldwide, provided you are on a holiday or business trip lasting no more than 28 days. If you do claim for an incident outside the UK, the same limits set out in the Table of Benefits on pages 11 apply. We will also need you to provide translations of any documents submitted to us that are not in English, which you will have to pay for. Any treatment under accident or emergency cover while outside the UK must be carried out by a dentist or specialist holding similar qualifications to those of a dentist or specialist registered in the UK.

5.13 A qualifying period applies to certain benefit types in your policy. Once the qualifying period for the benefit type has ended, you may claim under your policy for that benefit.

5.14 You must take all reasonable steps to avoid or minimize any loss or damage.

5.15 If we make any overpayment to you, we reserve the right to recover it.

5.16 If you are pursuing a third party for compensation, you must inform us about your claim against the third party as we may be entitled to recover from them our claim costs for your claim.

5.17 Benefits payable under this policy will not be taxed unless this is required by a change in tax law. If so, we will deduct any amounts the law states we must.

5.18 You must inform us if you hold any other policy that covers any of the benefits that our policy offers. If you hold such a policy, we will pay only our proportionate share of a claim, because you will be able to claim against both policies.

5.19 We monitor all claims and may make an appointment to discuss with you any claim you make under this policy. If you do not comply with our request, we may cancel your cover and may not pay your claim(s).


Section 6 Preventing fraud 6.1 We use anti-fraud measures to prevent fraudulent claims. This helps keep our

premiums low and protects our members who make genuine claims.

6.2 We may pass information about incidents and claims to various anti-fraud and theft registers to help insurers check the information clients provide and prevent fraudulent claims. Prior to and during the lifetime of your policy, we or dencover may check these registers. When you tell us or dencover about an incident or claim, we may pass information about that incident or claim to the registers.

6.3 You must not act in a fraudulent way. If you or anyone acting for you:

makes a claim under the policy knowing the claim is false or exaggerated; or

makes a statement in support of a claim knowing the statement to be false; or

sends dencover any documents in support of a claim knowing the documents are forged or false; or

makes a claim for any loss caused by your deliberate act or with your agreement;

then dencover:

will not pay the claim;

will not pay any other claim that has been or may be made under the policy;

may declare the policy void;

will be entitled to recover from you the amount of any claim we have already paid under the policy;

will not return any of your premiums; and

will always seek to prosecute offenders and recover the costs, including our own legal costs.


6.4 We or dencover (or both) may investigate your claim:

using private investigators;

by working closely with the NHS Counter-Fraud team; and

by working closely with health professionals' trade associations.

Section 7 When does my cover end? 7.1 Your cover under the policy will end automatically, if any of the following

happens:

The policy is cancelled by the end of the 14-day cooling-off period referred to in section 9.

The primary member does not make the required premium payment. If the primary member, or any third party who is paying the premiums, fails to pay 2 consecutive monthly premiums, we will cancel all cover under this policy. We may, at our discretion, restart your cover once we have received all premiums due.

The death of the primary member.

You cancel your cover by giving us 30 days’ notice in writing of your intention to cancel. We will not refund any premiums you have already paid. We will also apply an exclusion period of 3 years during which you will not be able to start any similar dental insurance policy with us from the date the cancellation takes effect.

7.2 All cover under this policy for an additional adult, partner or child included on the policy will end when he or she dies or when they no longer satisfy the criteria for an additional adult or child or when clause 7.1 applies.

7.3 We may exercise our right to cancel your policy at any time if:

we suspect that you have made a fraudulent claim or acted fraudulently or you fail to act with utmost good faith; or

you have broken any terms and conditions of this policy that we reasonably consider to be fundamental.

7.4 We may choose not to renew the policy by giving the primary member 30 days’ written notice at the primary member’s last known address.


Section 8 Enquiries or complaints 8.1 We are dedicated to providing you with a high quality service and we want to

ensure that we maintain this at all times. If you feel that we have not offered you a first class service please tell us and we will do our best to resolve the problem immediately. If you have a complaint please contact us

By letter: dencover Customer Relations Team - PO Box 1193, Doncaster, DN1 9PW By phone: 0800 180 4505 By email: [email protected]

If it is not possible to fully resolve your complaint straight away, we will acknowledge your complaint within five working days of receipt. One of our authorised complaints handlers will investigate your complaint and keep you informed of our progress.

We hope to resolve your complaint to your satisfaction. However, if you remain dissatisfied or if our investigations have not been completed within eight weeks you can refer your complaint to the Financial Ombudsman Service:

The Financial Ombudsman Service Exchange Tower London E14 9SR

Helpline: 0800 023 4567 Mobiles: 0300 123 9 123 E-mail: [email protected] Website: http://financial-ombudsman.org.uk/

Alternatively you can contact the Online Dispute Resolution - ODR Platform. This platform has been set up by the European Commission to allow consumers who have a complaint about a product or service bought online to submit the complaint using the platform. It is intended to facilitate resolution of complaints rather than resolve them.

Section 9 Your right to change your mind 9.1 In the 14 days after you receive this policy document (the cooling-off period),

the primary member may cancel this policy by contacting dencover. If the primary member does this, we will refund any premium the primary member has paid, provided no claim has been made.

mailto:[email protected]

mailto:[email protected]

http://financial-ombudsman.org.uk/


Section 10 Changes to your details 11.1 You must inform dencover as soon as reasonably possible of any changes to

the information you have given us, including any change of address, marital status or any change that affects your policy. If you do not do so, we may change your policy without notifying you, for example increasing your premium in line with what it would have been had we been made aware of the information.

Section 11 The Financial Services Compensation Scheme (FSCS) 11.1 If Unum Limited 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 over the Channel Islands or the Isle of Man.

Section 12 Changes to your policy 12.2 We reserve the right to change the terms and conditions of your policy. We

may change the cover provided, the premium or both. We will give the primary member 30 days' notice of these changes by writing to the primary members last known address. Any such changes to the policy would take place at the next monthly renewal of the policy following the 30 days’ notice period. If the primary member is unhappy with any such changes, the primary member may refuse them and cancel the policy in accordance with section 7.1.

12.2 If we make any changes to your cover, the terms and conditions in force at the time of treatment will apply, regardless of when the claim benefit is paid.

Section 13 How we use the information we hold about you 13.1 Please ensure that you show the following information to others covered

under your policy, or make them aware of its contents.

All personal information supplied to us will be dealt with in the strictest


confidence as required by the Data Protection Act 1998. Personal and sensitive personal information may be sent in confidence for processing by other companies and intermediaries, including those located outside the European Economic Area. The same duty of confidentiality is extended to any third parties to whom the administration of your policy may be subcontracted, including those based outside the European Economic Area.

Information about you and any family members covered by your policy, supplied by you, those family members, medical providers or your employer (if applicable) will be held and used to provide the services set out under the terms of this policy, administer your policy and develop customer relationships and services. In certain circumstances medical service providers (or others) may be asked to supply us with further information.

When you provide information about family members we will take this as confirmation that you have their consent to do so. As the Primary Member is acting on behalf of any family member covered by this policy, all correspondence about the policy, including any claims correspondence, will be sent to the Primary Member unless we are advised to do otherwise.

There is a legal requirement, in certain circumstances, to disclose information to law enforcement agencies about suspicions of fraudulent claims and other crime. Information will be disclosed to third parties including other insurers for the purposes of prevention or investigation of crime including reasonable suspicion about fraud or otherwise improper claims. This may involve adding non-medical information to a database that will be accessible by other insurers and law enforcement agencies. Additionally, there is an obligation to notify the General Medical Council or other relevant regulatory body about any issue where we have reason to believe a medical practitioner’s fitness to practice may be impaired.

13.2 Phone calls: your calls to dencover may be monitored and recorded for training, compliance and claims purposes.

Section 14 Other important information 14.1 Waiver: the failure or delay by you or us to insist that any term or condition of

the policy is strictly carried out or to use any related right or remedy does not permit any breach or subsequent breach of that term or condition.

14.2 The Contracts (Rights of Third Parties) Act 1999 does not give additional rights to this insurance in favour of any third party.


14.3 Law governing this policy: this policy, unless we have agreed otherwise, is governed by the law of England and both parties agree to the exclusive jurisdiction of the courts of England.

14.4 Under English law, it is an offence to make a false statement or withhold any material information to get a cover note or a schedule of insurance.

14.5 We reserve the right to refuse any insurance risk or change the premium and the terms quoted from any monthly renewal date. We will give you reasonable notice of any changes to your policy terms.

14.6 We give no assurances about the effectiveness and safety of dental treatments. You are fully responsible for all your dental decisions.

14.7 About the insurer: The insurer is Unum Limited which is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority (FCA) and the Prudential Regulation Authority. Our FCA registration number is 110408.

You can confirm this online: https://register.fca.org.uk or by calling the FCA on 0800 111 6768 (Freephone).

14.8 About the administrator: dencover is the trading name of Unum Limited - authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Unum Limited will provide the cover, and administer the policies and any subsequent claims.

14.9 To protect our staff and the staff of dencover, we expect you to treat us with respect. We and dencover will end any communication with you if there is any evidence of abuse. If the abuse continues, we will cancel all policies you hold with us.

https://register.fca.org.uk/

your dencover dental insurance policy document

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