MEDICAL CARE PLAN - HMCA · through existing channels of communication. • HMCA have a low overall...
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MEDICAL CARE PLAN Private medical cover for you and your family MEMBERS INSURANCE I N S U R A N C E . I N S U R A N C E . I N S U R A N C E . I N S U R AN C E . I N S U R A N C E . This brochure includes promotional and contractual information
Transcript of MEDICAL CARE PLAN - HMCA · through existing channels of communication. • HMCA have a low overall...
MEDICAL CARE PLANPrivate medical cover for you and your family
MEMBERS
INSURANCE
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This brochure includes promotional and contractual information
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Why you need private medical coverThe NHS is good at what it does, however, no state funded scheme can offer the benefits of Private Medical Cover. All of us want the peace of mind offered by one or all of the following:
• Bypass lengthy NHS waiting lists and quickly receive medical attention
• Your own hospital room with en-suite facilities and your own TV
• You choose the specialist at a location that is convenient for you
• You see the Consultant, not their registrar or trainee
• Private medical care can speed up the recovery process
• Your family and loved ones can visit any time
• Private Hospitals strive to ensure that the risk of infection for their patients is kept as low as possible and focus on hygiene and infection control as a top priority
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WHY ARE HMCA SO COMPETITIVE? With 40 years of intimate experience of the insurance and underwriting profession HMCA are able to produce value for money products within the health care market.
• HMCA have minimal advertising costs. Dealing with membership groups and associations they do not use the normal media outlets for advertising, for example national newspapers and television.
• HMCA deal directly with group and association members through existing channels of communication.
• HMCA have a low overall cost base which is reflected in the subscriptions they charge.
WHY CHOOSE THEMEDICAL CARE PLAN?
WHO ARE HMCA?
• All the benefits of private medical treatment for you and your family.
• VIP treatment with the specialist of your choice, at the time of your choice, at the hospital of your choice.
• Any hospital on our list may be used and others with prior agreement.
• Excellent benefits with substantial savings over other major plans.
These are just some of the reasons why you should consider the Medical Care Plan as your first choice for your private health cover. When you are ill you do not want any uncertainty or inconvenience, your worries can be substantial enough without added pressures.
Whilst the National Health Service has a very good system for dealing with emergencies and chronic situations, the waiting list nationwide for less urgent operations continues to grow.
Having to wait months, or even years, suffering discomfort and pain could have disastrous effects on your work and family life. By joining the Medical Care Plan, these problems will be overcome.
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HMCA has specialised in providing benefits for membership groups in the U.K. and Ireland since the 1970s. To keep costs low we only deal with membership groups, therefore, HMCA is not on any comparison website.
HMCA Members have a dedicated team of experienced employees who service plans for tens of thousands of discerning individuals who have taken out membership over the years. They provide a high level response to policy claims, evidenced by regular feedback from our customers and the associations.
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YEARS
PROVIDING SERVICES TO MEMBERSHIP GROUPS
MEMBERS
WE ARE HERE TO HELPIf you wish to discuss your health care requirements or the Medical Care Plan, please contact usTelephone helpline: (01423) 799949Write to: HMCA, Beech Hall Knaresborough, Yorkshire HG5 0EA. Email: [email protected]: www.hmca.co.uk Beech hall, Knaresborough
Beech Hall Circa 1737
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IN-HOSPITAL TREATMENT• Accommodation Charges FULL REFUND • Ward Nursing Charges FULL REFUND• Ward Drugs FULL REFUND
• A £200 a night tax-free cash benefit is available, for up to 30 nights, when all treatment is carried out as a National Health patient in a public ward of an NHS Hospital.
• Surgical Charges for surgeons’ and anaesthetists’ combined fees, including aftercare, are refunded dependent on the complexity of the surgery.
• Theatre fees, consumables, drugs and surgical dressings are refunded dependent on the complexity of the surgery.
• Benefit is also payable for in-hospital treatment such as: • Medical charges for consultant physician fees, pathology and
investigations whilst in hospital. • Intensive care. • Dental care for specialist in-hospital treatment.
OUT-PATIENT AND ADDITIONAL BENEFITS• Consultations, investigations, pathology, physiotherapy, x-rays
and scans.
• Alternative treatments of chiropractic, osteopathy, homeopathy and acupuncture.
• Radiotherapy and chemotherapy.
• A £800 maternity grant when both parents are members.
• Parent accompanying child.
• Home-nursing following private treatments.
• Private ambulance.
• Personal accidental death benefit of £5,000.
• Personal accident disability cover of £1,000.
OVERSEAS COVER• Continuation of cover when travelling abroad on holiday or
business.
SuMMARy Of bENEfItSThe maximum benefit payable for each person covered on the plan is £250,000 per year. For full details, please refer to the Description of Benefits in the contractual information at the back of this brochure
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MEMBERS
SPECIAL GUARANTEED TRANSFER FACILITYCover can be transferred from an existing medical plan and future claims made for acute conditions originating at the time the member was participating in a previous plan will be honoured.
LONG-TERM ILLNESSAll private health plans cover short-term medical conditions which are curable. Long-term conditions which are not covered are those which are recurrent, persistent or incurable. When a condition is first diagnosed (and did not exist prior to enrolment) benefit will be provided for such diagnosis and any necessary treatment, for one initial episode.
As private health cover was never intended to replace the NHS, but meant to complement the service, all subsequent treatment will be given by the NHS. The plan does provide a £1,000 LONG-TERM ILLNESS GRANT that can be used at the discretion of HMCA to help in the transition to NHS care.
MONEY-BACK GUARANTEEYou must be satisfied or you may cancel the Medical Care Plan within fourteen days for a full refund.
FREE MEDICAL INFORMATION AND COUNSELLING HELPLINE
This service is provided free of charge to Medical Care Plan members. It is operated by qualified medical staff and provides a wealth of support and information irrespective of whether the member is making a claim for medical treatment.
This also includes a counselling service which is available 24 hours a day, 365 days a year, allowing our members to discuss their problems confidentially with a qualified counsellor at a time convenient to them.
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thanks, too, for looking after my invoices during my Heart operation period last Summer and for settling the Accounts without any fuss or bother. Luckily, I’ve been no trouble to you or myself since then so, fingers crossed, there will be no more serious problems in the foreseeable future.
Equity Reader
Q. Does the Medical Care Plan have an excess or deductible, such as the first £500 of a claim being paid by the member?
A. No. Our underwriters believe that our members should have cover from the commencement of any treatment covered under the Medical Care Plan. However, excesses are available if you want to reduce your subscription, please ring 01423 799949 for more details.
Q. Is the offer to join the Medical Care Plan dependent upon my remaining a member of my sponsoring association?
A. You must be a member of your sponsoring association when first joining the Medical Care Plan. After enrolment you become a member of the Medical Care Plan.
Q. May I transfer from my plan to your Medical Care Plan?
A. Yes. If you are in a medical plan you can transfer to the Medical Care Plan with no break in protection.
Q. I have no existing private medical cover, can I join?
A. Yes, you can join and after one full year’s membership providing you have been treatment and symptom free for 12 consecutive months, any pre-existing medical condition that occurred prior to joining us will be covered.
Q. Can you explain the benefit levels in the Description of Benefits
A. Charges for in-patient accommodation, ward drugs and nursing charges are covered in full. Other benefits are based on the type of treatment received and the complexity of any operations carried out. The complexity of all operations is advised by the specialist carrying out your treatment. Our benefits are based on our experience of the likely costs involved and we apply limits to protect against overcharging which would have the effect of increasing claims costs and our members’ subscriptions.
Q. Are your terms similar to those in my present plan?
A. The benefits are summarised on pages 4 and 5 entitled ‘Summary of benefits’, and the Description of Benefits are in the contractual information on pages 18 and 19. These may differ from your current plan.
Q. Is the scope of the Medical Care Plan wider than many others?
A. As well as providing comprehensive benefits for treatment of acute medical conditions the Plan has a number of very important extra features which extend the scope:
• We include treatment for injuries sustained whilst playing sport.
• Cover continues whilst you are abroad on holiday or business for up to six months, at no extra cost.
• A free helpline is provided to give information on treatment, costs or any other general medical-related questions. This includes a confidential counselling service.
Here is a list of the questions most frequently asked by members of trade and professional groups on the subject of private medical cover provided by the Medical Care Plan. If you have any additional questions please telephone our Helpline on 01423 799949.
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QuEStIONS AND ANSWERS
MEMBERS
Q. Who do I speak to when I want to make a claim?
A. Our UK based claims team who offer a personal service and provide prompt
settlement.
Q. What happens if I am admitted to an NHS hospital?
A. If you choose to have all your treatment solely through the NHS you will receive £200 a night spent in hospital, for up to 30 nights. Of course, this is tax-free cash which you keep to spend as you wish.
Q. May I choose the hospital which treats me?
A. Yes. There are no restrictions, you can use any of the hospitals detailed on our comprehensive list. If your preferred hospital is not listed please contact our Helpline.
Q. Do you pay my specialist directly if I claim?
A. Yes. We are happy to pay your specialist on your behalf or we can reimburse you.
Q. Can you pay the hospital direct?A. Yes. We have arrangements with leading
hospital groups and they will bill us direct for any admissions to hospital. Please contact our Helpline for more information.
Q. Is day-case surgery covered?A. Yes. The plan provides benefits towards day-
case surgery.
Q. Am I covered for alternative medical treatment?
A. Yes. Under our out-patient section you are covered for chiropractic, osteopathy, homeopathy and acupuncture given by qualified practitioners.
Q. Do you have restrictive clauses relating to the NHS waiting lists?
A. No. We do not have restrictive clauses relating to the NHS waiting lists.
Q. Am I covered when travelling overseas?A. Yes. Cover continues when you travel
abroad on holiday or business fo up to six months at no extra cost.
Q. Am I covered for sporting injuries?A. Yes. There is no restriction on any sport.
Q. What is the maximum age at which I may join the Medical Care Plan or transfer from another plan?
A. There is no age limit when joining the Medical Care Plan.
Q. What is Insurance Premium Tax (IPT)?A. IPT is a tax on general insurance, for example
motor, household and medical cover, levied by the government.
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I would like to take this opportunity to thank the HMCA staff who were so understanding and efficient in dealing with my telephone call at a time which was extremely distressing as the specialist was at the time convinced that it was a recurrence. I felt I received a very personal service and if this comment can be used in any way to encourage more people to join HMCA I would be quite happy for it to be used.
National Trust Reader, Kent
Royal Overseas League member
tHE MEDICAL CAREPLAN CHECKLISt
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You should compare the Medical Care Plan with other plans by using this checklist.
NO MORATORIUM OR WAITING PERIOD FOR TRANSFERS
SPECIALISTFreedom of Choice.
PROMPT CLAIMS SERVICEOur UK based claims team offer a personal service and provide prompt settlement.
NO MEDICAL EXAMINATIONNo medical examination is required when you join.
CHOICE OF COUNTRYWIDE HOSPITALSYou have the choice of over 550 hospitals on our list and others with prior arrangement.
SPORTS ACTIVITIESThere are no exclusions.
OVERSEAS COVERCover continues when you travel abroad on holiday or business for up to six months and is included at no extra cost, whereas most other plans may reduce benefits or ask for increased subscriptions, or indeed offer no cover at all.
NO REDUCTION IN BENEFITSHMCA Insurance has consistently improved the benefits of its Medical Plans.
DENTAL TREATMENTIn-hospital or day-case surgical treatment is included.
PREGNANCY AND CHILDBIRTHComplications and miscarriages are covered.
HOME-NURSINGThe Medical Care Plan allows up to £3,600 each year.
LONG-TERM ILLNESS GRANTAfter enrolment, a member receiving treatment that ceases to be short-term qualifies for a grant of up to £1,000. This benefit can be given at the discretion of HMCA.
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SPECIAL GUARANTEED TRANSFER FACILITYCover can be transferred from an existing plan and future claims made for acute conditions originating at the time you were participating in a previous plan will be honoured.
NHS HOSPITAL CASH BENEFITA £200 a night tax-free cash benefit is available, for up to 30 nights, if treatment is wholly in an NHS Hospital.
FREE MEDICAL INFORMATION AND COUNSELLING HELPLINEThis service is provided free of charge to all Medical Care Plan members. It is operated by qualified medical staff and offers a wealth of information and help regardless of whether the member is making a claim. Information can be given on medical conditions, changing your doctor, social services, self-help groups and much more. This also includes a counselling service which is available 24 hours a day, 365 days a year, allowing our members to discuss their problems confidentially with a qualified counsellor at a time convenient to them.
WI READER WHO JOINED HMCA WITH NO PREVIOUS MEDICAL COVER
Dear SirsI write to thank you for the prompt and efficient way in which you dealt with my recent claim for my 7 day stay in hospital.I feel sure that some less reputable companies would have been much less sympathetic to a claim made so soon after the commencement of the insurance cover.I have sung your praises to many other members of my Women’s Institute, and hopefully you may receive some enquiries.Once again, well done, and thank you.
WI Reader, Buckinghamshire
MEMBERS
ENGLAND BEDFORDSHIRE Bedford Bedford General HospitalBedford BMI Manor HospitalLuton Luton & Dunstable Hospital NHS Trust BERKSHIRE Ascot Heatherwood HospitalReading Circle Reading HospitalReading Spire Dunedin HospitalReading Royal Berkshire HospitalReading Berkshire Independent HospitalSlough Wexham Park HospitalSlough Spire Thames Valley HospitalThatcham West Berkshire Community HospitalWindsor King Edward VII HospitalWindsor BMI Princess Margaret HospitalWindsor Circle Windsor Clinic BRISTOL Bristol Spire Bristol ‘Glen’ HospitalBristol Nuffield Hospital BristolBristol Bristol Eye HospitalBristol Frenchay HospitalBristol Bristol Royal Infirmary
Bristol St Michaels HospitalBristol Southmead Hospital BUCKINGHAMSHIRE Amersham Amersham HospitalAylesbury Stoke Mandeville HospitalGerrards Cross Chalfont & Gerrards Cross HospitalGreat Missenden BMI The Chiltern HospitalHigh Wycombe BMI Shelburne HospitalHigh Wycombe Wycombe HospitalMilton Keynes BMI Saxon ClinicMilton Keynes Milton Keynes General HospitalPrinces Risborough The Paddocks Clinic CAMBRIDGESHIRE Cambridge Addenbrookes HospitalCambridge Spire Cambridge Lea HospitalCambridge Nuffield Hospital CambridgeCambridge Papworth HospitalHuntingdon Hinchingbrooke HospitalPeterborough Peterborough City HospitalPeterborough Fitzwilliam HospitalWisbech North Cambridgeshire Hospital CHESHIRE Altrincham Altrincham General Hospital
Cheadle BMI Alexandra HospitalChester Countess of Chester HospitalChester Nuffield Hospital GrosvenorCrewe Leighton HospitalCrewe BMI South Cheshire HospitalMacclesfield Macclesfield District General HospitalMacclesfield Spire Regency HospitalRuncorn Halton General HospitalWarrington Warrington HospitalWarrington Spire Cheshire Hospital CLEVELAND Hartlepool University Hospital of HartlepoolMiddlesbrough James Cook University HospitalStockton-on-Tees Nuffield Hospital TeesStockton-on-Tees University Hospital of North Tees CORNWALL Falmouth Falmouth HospitalHayle St Michaels HospitalPenzance West Cornwall HospitalRedruth Camborne Redruth Community HospitalTruro Duchy HospitalTruro Royal Cornwall Hospital
CUMBRIA Barrow-in-Furness Furness HospitalCarlisle Cumberland InfirmaryKendal Westmorland General HospitalWhitehaven West Cumberland HospitalWorkington Workington Community Hospital DERBYSHIRE Buxton Buxton HospitalChesterfield Chatsworth ClinicDerby Nuffield Hospital DerbyDerby Royal Derby Hospital DEVON Barnstaple North Devon District HospitalBideford Bideford & District HospitalExeter Nuffield Hospital ExeterExeter Royal Devon & Exeter HospitalExmouth Exmouth HospitalIlfracombe Ilfracombe & District Tyrrell HospitalNewton Abbott Newton Abbott HospitalPlymouth Derriford HospitalPlymouth Mount Gould HospitalPlymouth Nuffield Hospital PlymouthPlymouth Royal Eye Infirmary
HOSPItAL ACCOMMODAtION LISt
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You can use any hospital on this list, over 550 are available.
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MEMBERS
When we issue a claim form we will send an upto date list
I would like to thank you for the smooth and efficient way HMCA have dealt with the claim to date and justifies our confidence in switching from Aviva to HMCA to date. Clearly we hope not to require making more claims for a long time.
WI Life reader
Sidmouth Victoria HospitalTavistock Tavistock HospitalTeignmouth Teignmouth HospitalTiverton Tiverton & District HospitalTorquay Mount Stuart HospitalTorquay Torbay Hospital DORSET Bournemouth Christchurch HospitalBournemouth Nuffield Hospital BournemouthBournemouth Royal Bournemouth HospitalDorchester BMI Winterbourne HospitalDorchester Dorset County HospitalPoole BMI Harbour HospitalSherborne Yeatman HospitalWeymouth Weymouth Community Hospital DURHAM Bishop Auckland Bishop Auckland HospitalChester-le-Street Chester-le-Street HospitalDarlington Darlington Memorial HospitalDarlington BMI WoodlandsDurham University Hospital of North DurhamShotley Bridge Shotley Bridge Hospital ESSEX Basildon Basildon University Hospital
Brentwood Nuffield Hospital BrentwoodBrentwood Spire Hartswood HospitalBuckhurst Hill Holly House HospitalChelmsford Broomfield HospitalChelmsford Springfield HospitalClacton-on-Sea Clacton & District HospitalColchester Oaks HospitalColchester Essex County HospitalColchester Colchester General HospitalEpping St Margarets HospitalGrays Orsett HospitalHarlow Princess Alexandra HospitalHavering Queens HospitalIlford King George HospitalMaldon St Peters HospitalRedbridge Spire Roding HospitalSouthend-on-Sea Southend HospitalSouthend-on-Sea Spire Wellesley HospitalSouthend BMI Southend Private Hospital GLOUCESTERSHIRE Cheltenham Cheltenham General HospitalCheltenham Nuffield Hospital CheltenhamGloucester Gloucester Royal HospitalGloucester Winfield HospitalStroud Stroud General Hospital
HAMPSHIRE Basingstoke North Hampshire Hospital
Basingstoke BMI Hampshire ClinicEastleigh Nuffield Health Wessex Hospital Havant Spire Portsmouth HospitalLymington New Forest HospitalPortsmouth Queen Alexandra HospitalPortsmouth St Marys HospitalSouthampton Spire Southampton HospitalSouthampton Southampton General HospitalSouthampton Princess Anne HospitalSouthampton Royal South Hants HospitalWinchester Royal Hampshire County HospitalWinchester BMI Sarum Road Hospital
HEREFORDSHIREHereford Hereford County HospitalHereford Nuffield Hospital Hereford
HERTFORDSHIRE Bishops Stortford Herts & Essex General HospitalHarpenden Spire Harpenden HospitalHemel Hempstead Hemel Hempstead HospitalHertford Hertford County HospitalHitchin Pinehill HospitalSawbridgeworth Rivers HospitalSt Albans St Albans City HospitalStevenage Lister HospitalWatford Spire Bushey Hospital
Watford Watford General HospitalWelwyn Garden City Queen Elizabeth II Hospital ISLE OF WIGHT Newport St Marys Hospital KENT Ashford William Harvey HospitalBeckenham BMI Sloane HospitalBeneden Beneden Hospital Canterbury BMI Chaucer Hospital
Canterbury Kent & Canterbury HospitalChatham Spire Alexandra HospitalDartford Darent Valley HospitalDeal Victoria HospitalDover Buckland HospitalFolkestone Royal Victoria HospitalGillingham Medway Maritime HospitalHerne Bay Queen Victoria Memorial HospitalLongfield BMI Fawkham Manor HospitalMaidstone Maidstone HospitalMaidstone BMI Somerfield HospitalMaidstone Maidstone KIMSMargate Queen Elizabeth the Queen Mother HospitalOrpington BMI Chelsfield Park Hospital
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Sevenoaks Sevenoaks HospitalSidcup Queen Marys HospitalTunbridge Wells Tunbridge Wells HospitalTunbridge Wells Nuffield Hospital Tunbridge WellsTunbridge Wells Spire Hospital, Tunbridge WellsWillesborough One Ashford Hospital LANCASHIRE Blackburn BMI Beardwood HospitalBlackburn Royal Blackburn HospitalBlackpool Spire Fylde Coast HospitalBlackpool Victoria HospitalBolton BMI Beaumont HospitalBolton Royal Bolton HospitalBurnley Burnley General HospitalChorley Euxton Hall HospitalClitheroe Abbey Gisburne Park HospitalLancaster BMI Lancaster HospitalOrmskirk Ormskirk & District General HospitalOrmskirk Renacres HospitalPreston Fulwood Hall HospitalPreston Royal Preston Hospital LEICESTERSHIRE Hinckley Hinckley & District HospitalLeicester Glenfield HospitalLeicester Leicester General HospitalLeicester Nuffield Hospital LeicesterLeicester Leicester Royal InfirmaryOadby Spire Leicester Hospital
LINCOLNSHIRE Boston Pilgrim Hospital
Grantham Grantham & District HospitalGrimsby St Hughs Hospital Grimsby Diana, Princess of Wales HospitalLincoln BMI Lincoln HospitalLincoln Lincoln County HospitalLouth County HospitalStamford Stamford & Rutland Hospital GREATER LONDON Ashford Ashford HospitalBarnet Barnet HospitalCarshalton St Helier HospitalEnfield Chase Farm HospitalEnfield BMI Kings Oaks HospitalHarefield Harefield HospitalHarrow Northwick Park HospitalHarrow BMI Clementine Churchill HospitalHarrow St Marks HospitalIsleworth West Middlesex University HospitalKingston upon Thames Kingston HospitalKingston upon Thames New Victoria HospitalNorthwood BMI Bishops Wood HospitalNorthwood Mount Vernon HospitalSouthall Ealing HospitalStanmore Royal National Orthopaedic HospitalUxbridge Hillingdon HospitalMiddlesex BMI The Cavell Clinic LONDON (Postal Area) E2 London Chest HospitalSE3 BMI Blackheath HospitalSW3 Royal Brompton Hospital
SW10 Chelsea & Westminster HospitalW6 Charing Cross HospitalNW4 Hendon HospitalWC1N Royal London Hospital for Integrated MedicineWC1 Great Ormond Street HospitalSE1 Guys HospitalW12 Hammersmith HospitalW12 Queen Charlottes & Chelsea HospitalN6 Highgate HospitalWC1E Hospital for Tropical DiseasesNW8 Hospital of St John & St ElizabethNW8 British Hernia CentreW1G King Edward VII HospitalW1G Weymouth Street HospitalSE5 Kings College HospitalSE13 University Hospital Lewisham E1 Royal London Hospital WhitechapelE1 BMI London Independent HospitalEC1 Moorfields Eye HospitalWC1 National Hospital for Neurology & NeurosurgeryN18 North Middlesex University HospitalSW19 Parkside Hospital WimbledonW1 The Portland Hospital for Women & Children SW15 Queen Marys Hospital RoehamptonNW3 Royal Free HospitalSW3 Royal Marsden Hospital
W1 Royal National Ear, Nose & Throat HospitalEC1 St Bartholemews HospitalSW17 St Georges HospitalW2 St Marys HospitalSE1 St Thomas’ HospitalNW1 University College HospitalNW1 Western Eye HospitalE11 Whipps Cross HospitalN19 Whittington HospitalSW5 Bupa Cromwell Hospital GREATER MANCHESTER Ashton-under-Lyne Tameside General HospitalBury Fairfield General HospitalLeigh Leigh InfirmaryManchester Spire Manchester HospitalManchester Christie HospitalManchester North Manchester General HospitalManchester Royal Manchester Childrens HospitalManchester Royal Eye HospitalManchester Royal InfirmaryManchester St Marys HospitalOldham Royal Oldham HospitalRochdale Birch Hill HospitalRochdale BMI Highfield HospitalRochdale Rochdale InfirmarySalford Oaklands HospitalSalford Salford Royal HospitalStockport Stepping Hill HospitalWigan Royal Albert Edward InfirmaryWigan Wrightington HospitalWythenshawe Wythenshawe Hospital
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When we issue a claim form we will send an upto date list
MERSEYSIDE Liverpool Broadgreen HospitalLiverpool Spire Liverpool HospitalLiverpool Royal Liverpool University HospitalLiverpool Liverpool Womens HospitalLiverpool University Hospital AintreeLiverpool Liverpool Heart & Chest HospitalOrmskirk Ormskirk & District General HospitalPrescot Whiston HospitalSt Helens Fairfield General HospitalSt Helens St Helens HospitalSouthport Southport & Formby District General HospitalWirral Clatterbridge HospitalWirral Spire Murrayfield HospitalWirral Arrowe Park Hospital NORFOLK Cromer Cromer HospitalGreat Yarmouth James Paget University HospitalKings Lynn BMI Sandringham HospitalNorwich Spire Norwich HospitalNorwich Norfolk & Norwich Uni Hosp NORTHAMPTONSHIRE Kettering Kettering General HospitalKettering Woodland HospitalNorthampton Northampton General HospitalNorthampton BMI Three Shires Hospital NORTHUMBERLAND Alnwick Alnwick InfirmaryHexham Hexham General Hospital
NOTTINGHAMSHIRE Nottingham Nottingham City HospitalNottingham BMI The Park HospitalNottingham Queens Medical CentreNottingham Circle Nottingham ClinicNottingham Nottingham Woodthorpe HospitalNottingham Spire HospitalSutton in Ashfield Kings Mill HospitalWorksop Bassetlaw District General Hospital OXFORDSHIRE Banbury Foscote HospitalBanbury Horton General HospitalOxford Churchill HospitalOxford Nuffield Orthopaedic CentreOxford Nuffield Hospital Oxford (The Manor)Oxford Oxford Eye HospitalOxford John Radcliffe Hospital SHROPSHIRE Oswestry Robert Jones & Agnes Hunt Orthopaedic HospitalShrewsbury Nuffield Hospital ShrewsburyShrewsbury Royal Shrewsbury HospitalTelford Princess Royal Hospital
SOMERSET Bath BMI Bath ClinicBath Circle Bath HospitalBath Royal National Hospital for Rheumatic DiseasesBath Royal United HospitalBridgwater Bridgwater Community Hospital
Minehead Minehead & West Somerset HospitalTaunton Musgrove Park HospitalTaunton Nuffield Hospital TauntonWeston Super Mare Weston General HospitalYeovil Yeovil District Hospital
STAFFORDSHIRE Burton-on-Trent Queens HospitalNewcastle-under-Lyme Nuffield Hospital North StaffordshireStafford Staffordshire General HospitalStafford Rowley Hall HospitalStoke-on-Trent Royal Stoke University Hospital SUFFOLK Bury-St-Edmunds BMI St Edmunds HospitalBury-St-Edmunds West Suffolk HospitalIpswich Ipswich HospitalIpswich Nuffield Hospital Ipswich SURREY Ashtead Ashtead HospitalCamberley Frimley Park HospitalCaterham North Downs HospitalCheam Spire St Anthony’sChertsey BMI Runnymede HospitalChertsey St Peters HospitalCroydon BMI Shirley Oaks HospitalEpsom Epsom General HospitaL
Farnham Spire Clare Park HospitalGuildford Nuffield Hospital GuildfordGuildford BMI Mount Alvernia HospitalGuildford Royal Surrey County HospitalHorley Spire Gatwick Park HospitalKingston-upon-Thames BMI Coombe WingLeatherhead Leatherhead HospitalRedhill East Surrey HospitalSutton Royal Marsden HospitalWeybridge Weybridge HospitalWoking Nuffield Hospital Woking
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THE ROYAL OVER-SEAS
LEAGUE
I must thank you wholeheartedly for the way
HMCA is looking after me and I will certainly spread the good news of your excellent service.
Royal Over-seas League member
CONTINUED
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SUSSEX - EAST Brighton Royal Alexandra Childrens HospitalBrighton Royal Sussex County HospitalBrighton Sussex Eye HospitalBrighton Nuffield Hospital BrightonCrowborough Horder Centre Eastbourne Eastbourne District General HospitalEastbourne BMI Esperance HospitalHove Spire Montifiore HospitalLewes Victoria HospitalSt Leonards-on-Sea Conquest HospitalSt Leonards-on-Sea Spire Sussex HospitalUckfield Uckfield Community Hospital SUSSEX - WEST Chichester Nuffield Hospital ChichesterChichester St Richards HospitalCrawley Crawley HospitalEast Grinstead Queen Victoria HospitalHaywards Heath Nuffield Hospital Haywards HeathHaywards Heath Princess Royal HospitalHorsham Horsham HospitalWorthing Worthing HospitalWorthing BMI Goring Hall Hospital TYNE & WEAR Gateshead Queen Elizabeth HospitalNewcastle Freeman HospitalNewcastle Newcastle General HospitalNewcastle Nuffield Hospital Newcastle-upon-TyneNewcastle Royal Victoria InfirmaryNewcastle Walkergate HospitalNorth Shields North Tyneside General Hospital
South Shields South Tyneside District HospitalSunderland Eye InfirmarySunderland Sunderland Royal HospitalWashington Spire Washington Hospital WARWICKSHIRE Leamington Spa Nuffield Warwickshire HospitalNuneaton George Eliot HospitalRugby Hospital of St CrossStratford Circle Stratford ClinicWarwick Warwick Hospital WEST MIDLANDS Birmingham City HospitalBirmingham Childrens HospitalBirmingham Heartlands HospitalBirmingham BMI The Edgbaston HospitalBirmingham BMI Priory HospitalBirmingham Queen Elizabeth HospitalBirmingham Royal Orthopaedic HospitalBirmingham Womens HospitalCoventry University Hospital CoventryDudley Corbett HospitalDudley Russells Hall HospitalHalesowen West Midlands HospitalSolihull Birmingham Midland Eye CentreSolihull Spire Parkway HospitalSolihull Solihull HospitalSutton Coldfield Good Hope HospitalSutton Coldfield Spire Little Aston HospitalWalsall Manor HospitalWest Bromwich Sandwell General HospitalWolverhampton New Cross HospitalWolverhampton Nuffield Hospital Wolverhampton
WILTSHIRE Marlborough Savernake HospitalSalisbury New Hall HospitalSalisbury Salisbury District HospitalSwindon Great Western HospitalSwindon BMI Ridgeway Hospital WORCESTERSHIRE Droitwich BMI Droitwich Spa HospitalKidderminster Kidderminster HospitalRedditch Alexandra HospitalWorcester Worcester Royal HospitalWorcester Spire South Bank Hospital YORKSHIRE - NORTH Bridlington Bridlington & District HospitalHarrogate BMI The Duchy HospitalHarrogate Harrogate District HospitalMalton Malton Norton & District HospitalNorthallerton Friarage HospitalScarborough Scarborough General HospitalYork York District HospitalYork Nuffield Hospital York YORKSHIRE - SOUTH Barnsley Barnsley HospitalDoncaster Park Hill HospitalDoncaster Royal InfirmaryRotherham Rotherham HospitalSheffield BMI Thornbury HospitalSheffield Sheffield Childrens HospitalSheffield Claremont HospitalSheffield Northern General HospitalSheffield Royal Hallamshire HospitalSheffield Weston Park Hospital
YORKSHIRE - WEST Bingley Yorkshire ClinicBradford Royal InfirmaryDewsbury Dewsbury & District HospitalElland Spire Elland HospitalHuddersfield BMI Huddersfield HospitalHuddersfield Royal InfirmaryKeighley Airedale General HospitalLeeds Leeds General InfirmaryLeeds Spire Leeds HospitalLeeds Spire Methley ParkLeeds Nuffield Hospital LeedsLeeds St James University HospitalPontefract Pontefract General InfirmarySalterhebble Calderdale Royal HospitalWakefield Pinderfields General Hospital
HULL & EAST YORKSHIRE Cottingham Castle Hill HospitalGoole Goole & District HospitalHull Spire Hull & East Riding HospitalHull Royal InfirmaryScunthorpe Scunthorpe General Hospital WALES CLWYD Abergele Abergele HospitalRhyl Glan Clwyd HospitalWrexham Maelor HospitalWrexham Spire Yale Hospital DYFED Aberystwyth Bronglais General HospitalCamarthen BMI Werndale HospitalCamarthen West Wales General HospitalHaverfordwest Withybush General Hospital
When we issue a claim form we will send an upto date list
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GLAMORGAN - MID Bridgend Diana, Princess of Wales HospitalLlantrisant Royal Glamorgan HospitalMerthyr Tydfil Prince Charles Hospital GLAMORGAN - SOUTH Cardiff Cardiff Bay HospitalCardiff Spire Cardiff HospitalCardiff The Vale Hospital, HensolCardiff University Hospital of Wales GLAMORGAN - WEST Neath Neath Port Talbot HospitalSwansea Morriston HospitalSwansea Sancta Maria HospitalSwansea Singleton Hospital GWENT Abergavenny Nevill Hall HospitalNewport St Josephs Hospital GWYNEDD Bangor Gwynedd HospitalLlandudno Llandudno General Hospital SCOTLAND CENTRALFalkirk Falkirk Royal InfirmaryStirling BMI Kings Park HospitalStirling Stirling Royal Infirmary GRAMPIAN Aberdeen BMI Albyn HospitalAberdeen Royal Aberdeen Children’s HospitalAberdeen Aberdeen Royal InfirmaryAberdeen Woodend Hospital
HIGHLAND Fort William Belford HospitalInverness Raigmore HospitalWick Caithness General Hospital LOTHIAN Edinburgh Royal Hospital for Sick ChildrenEdinburgh Royal Infirmary of EdinburghEdinburgh Western General HospitalLivingston St Johns HospitalLivingston Spire Livingston Physio Clinic
STRATHCLYDE Alexandria Vale of Leven HospitalAyr BMI Carrick Glen HospitalAyr Ayr HospitalGlasgow Nuffield Hospital GlasgowGlasgow BMI Ross Hall HospitalGlasgow Southern General HospitalGlasgow Victoria InfirmaryGreenock Inverclyde Royal HospitalKilmarnock Crosshouse Hospital TAYSIDE Arbroath Arbroath InfirmaryBrechin Stracathro HospitalDundee BMI Fernbrae ClinicPerth Perth Royal Infirmary NORTHERN IRELAND COUNTY ANTRIM Belfast Belfast City HospitalBelfast Kingsbridge Private HospitalBelfast Mater HospitalBelfast Musgrave Park HospitalBelfast Royal Victoria HospitalBelfast Ulster Independent Clinic
Belfast Ulster HospitalLisburn Lagan Valley HospitalNewtownabbey Whiteabbey Hospital COUNTY ARMAGHCraigavon Craigavon Area Hospital COUNTY DOWN Bangor Bangor Community HospitalDownpatrick Downe HospitalNewry Daisy Hill HospitalNewtownards Ards Community Hospital COUNTY FERMANAGH Enniskillen South Western Acute Hospital
LONDONDERRY Ballykelly North West Ind HospitalColeraine Causeway HospitalLondonderry Altnagelvin Area HospitalMagherafelt Mid Ulster Hospital TYRONE Dungannon South Tyrone HospitalOmagh Tyrone County Hospital CHANNEL ISLANDS Alderney Mignot Memorial HospitalGuernsey Princess Elizabeth HospitalJersey Jersey General Hospital ISLE OF MAN Douglas Nobles HospitalRamsey Ramsey & District Cottage Hospital
ARTICLE REPRODUCED FROM THE ROADWORTHYJOURNAL OF THE NORTH-EAST LONDON AND ESSEX
GROUP OF ADVANCED MOTORISTS
PRIVATE HEALTH INSURANCE
In your copy of Advanced Driving motoring magazine you may, or may not have noticed an address carrier (insert) for Hospital and Medical Care Association (HMCA): it specialises in providing benefits exclusively for memberships such as ours.
For years I have laid it aside as I had a private health insurance. As we are all looking to save money during this credit crunch time I decided to phone for information.
Could my present premium be cut up to 50%?
Would HMCA take on any existing medical problem?
I was pleasantly surprised with the outcome and joined up. Just a little later in the year (much to my embarrassment) I had to contact them. Got through very quickly and had hassle free treatment and no money changed hands!
I am pleased that your Committee has given me the opportunity and permission to let you know of my excellent experience via the IAM.
So my advice is if you want to change, or begin, a Private Health Scheme get more information: - www.hmca.co.uk/roadsmart or for immediate personal attention phone 01423 866985.
I do not take any responsibility for your decision and I would like to think that we could share good practice in Roadworthy and help one another in this way.
Angela Meyler
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tHE HMCA INSuRANCE MEDICAL CARE PLANDescription of Benefits
The maximum benefit payable for each person named on the Membership Certificate for acute surgical or acute medical conditions, in each subscription year, is £250,000.
ACCOMMODATION CHARGES IN A HOSPITAL ON OUR HOSPITAL LIST
WARD NURSING CHARGES FOR EACH STAY IN HOSPITAL
NHS TREATMENTFor the duration of medical treatment carried out solely as a National Health patient in a public ward of an NHS hospital.
SURGICAL CHARGES FOR EACH STAY IN HOSPITALSurgeons’ and Anaesthetists’ Combined Fees including aftercare.Major Plus OperationMajor OperationIntermediate OperationMinor OperationAdditional Benefit for an operation requiring specialised operative techniques
THEATRE FEES, CONSUMABLES, DRUGS AND SURGICAL DRESSINGS FOR EACH STAY IN HOSPITALMajor Plus OperationMajor OperationIntermediate OperationMinor OperationAdditional Benefit for an operation requiring specialised operative techniques
PATHOLOGY, INVESTIGATIONS & PHYSIOTHERAPYWhen charged individually by the hospitalWhen charged as part of a package price
PROSTHESES FOR EACH STAY IN HOSPITALProstheses payable in accordance with the operation.Major Plus OperationMajor OperationIntermediate OperationMinor OperationAdditional Benefit for an operation requiring specialised operative techniques.
WARD DRUGS & CONSUMABLES FOR EACH STAY IN HOSPITALWhen charged separately for in-hospital treatment.
PHYSICIAN FEES FOR NON SURGICAL STAYS IN HOSPITALFirst 3 days
After 3 days
INTENSIVE CARE / HIGH DEPENDENCYBenefit is payable for medical treatment in an intensive care or high dependency unit.
£
Full refund
Full refund
200 a night for up to 30 nights a year
up to 1625up to 1145up to 765up to 435up to 2100
up to 2500up to 1595up to 1030up to 745up to 2725
£
up to 1100up to 500
up to 3000up to 1260up to 745up to 455up to 1350
Full refund
up to 120 foreach dayup to 60 foreach day
each yearup to 2175
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IN-HOSPITAL TREATMENT
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OTHER ADDITIONAL BENEFITSPERSONAL ACCIDENT BENEFITS
OUTPATIENT BENEFITS
OVERSEAS BENEFITS
DENTAL BENEFITS
PERSONAL ACCIDENTAL DEATH BENEFIT
PERSONAL ACCIDENT DISABILITY COVER
OUTPATIENT BENEFITS
Consultations/Physiotherapy or Complementary Medicine
Investigations, Pathology, X-Rays, Scans
DENTAL TREATMENTBenefit is payable only where specialist in-hospital treatment is necessary.
OVERSEAS COVERCover continues when you travel abroad on holiday or business for a period not exceeding 6 months. Excluded are general practitioners’ services and hotel expenses. Before travelling obtain form EHIC from the Post Office or telephone 0845 606 2030 for reciprocal arrangements in EEA countries.
RADIOTHERAPY/CHEMOTHERAPYA grant is given towards treatment
PARENT/GUARDIAN ACCOMPANYING A CHILDFor a child under 16 years of age, HMCA will pay the accommodation charge for one parent for a period not exceeding 20 days a year.
HOME-NURSINGFollowing treatment at a private hospital, or treatment arranged on a private basis at an NHS hospital for a qualified nurse for medical reasons.
PRIVATE AMBULANCEFor transport by a private ambulance to or from a hospital for medical reasons.
MATERNITY GRANTWhen both parents have been members for a year.
LONG-TERM ILLNESS GRANTLong-Term conditions which are not covered are those that are recurrent, persistent or incurable. After enrolment, a member receiving treatment that ceases to be short-term qualifies for a grant. This benefit can be given at the discretion of HMCA.
£
5000
1000
Benefits as for the U.K.
£
each yearup to 800
each dayup to 300
each yearup to 3600
each yearup to 350
for eachbirth 800
up to 1000
£
each yearup to 475
each yearup to 1275
FREE MEDICAL INFORMATION HELPLINE SERVICE
This service is provided free of charge to all Medical Care Plan members. It is operated by qualified medical staff, counsellors and health advisers and provides non-diagnostic advice on medical matters irrespective of whether you are making a claim for medical treatment. Advice can be sought by members on behalf of themselves and their immediate family even if the latter are not members.
tHE MEDICAL CARE PLANDescription of Benefits
1 DEFINITIONSThe following expressions have the following meanings1.1 Association HMCA Members1.2 Scheme A Scheme, managed by HMCA Members for providing benefits in respect of treatment for acute
surgical or acute medical conditions for any disease, injury or illness on a short term basis by Specialists at any hospital on the list.
1.3 Insurer HMCA Insurance Limited1.4 Year Any twelve calendar months commencing at the date of enrolment or annual renewal of a subscription.1.5 Member A person who is either an individual or group who applies for enrolment under Condition 3.1 and
is accepted.1.6 Dependants1.6.1 The Member’s Spouse or partner if living at the same address.1.6.2 A child, or grandchild, of the member, or the member’s partner, up to the age of 26, single and living at
home.1.6.3 A child, or grandchild, of the member, or the member’s partner, in full time education.1.7 Patient “The Patient” means the Member or one of his Dependants receiving benefits under the scheme.1.8.1 NHS Hospital A hospital operated under the National Health Service with facilities for medical and surgical
treatment.1.8.2 Private Hospital A hospital or nursing home with facilities for medical and surgical treatment which
charges fees for its services and in the United Kingdom is registered under the Nursing Homes Act 1975 (or is excluded from the definition of a nursing home in the Act by Section 1 (2)(a) thereof but is not an NHS Hospital) or overseas is operated or recognised by the appropriate authority where it is situated.
1.9 Acute Medical Condition Any disease, illness or injury of rapid onset, severe symptoms and brief duration.1.10 Long-Term Illness A medical condition that has become either recurrent, persistent or incurable.1.11 Treatment Surgical or medical procedures undertaken by Specialists needed to diagnose and/or cure an
acute medical condition.1.12 In-Hospital Treatment An overnight stay by a Member or his dependant for private treatment in a Private
Hospital in connection with the treatment of an acute medical condition.1.13 Specialist A medical or dental practitioner who is registered under the Medical Acts and holds or has held
a consultant appointment in an NHS Hospital or otherwise holds a certificate of specialist accreditation recognised by a competent authority.
1.14 General Practitioner A registered medical practitioner in general practice.1.15 Home Nursing The full time services of qualified resident or daily nurses whilst a bed patient when prescribed
by a specialist for medical as distinct from domestic reasons.1.16 Interpretation Where appropriate, reference to the masculine gender shall be deemed to include the
feminine.
1.17 Complementary Medicine Treatment under the referral of your General Practitioner, where the medical practitioner holds a certificate of specialist accreditation recognised by a competent authority (eg. Chiropractic, osteopathy, podiatry, homeopathy, acupuncture, etc.)
1.18 Accident or Emergency Admissions1.18.1 by ambulance to either an NHS or Private Hospital as a direct result of or immediately following an accident1.18.2 to either an NHS or Private Hospital directly from the Accident & Emergency or Casualty department for
urgent or unplanned treatment1.18.3 to either an NHS or Private Hospital on the same day as a referral for treatment is made by either a General
Practitioner or Specialist, when immediate Treatment or Diagnostic Tests are a medical necessity1.19 Chemotherapy - The treatment of cancer using specific chemical agents or drugs that are selectively
destructive to malignant cells and tissues.1.20 Ward Drugs - Medication which is administered whilst the patient is an in-patient on the ward. This does
not include Chemotherapy drugs.1.21 EEA Includes all member states of the EEA, as well as the Isle of Man and Channel Islands.
2 EXCLUSIONSBenefits shall not be payable for:-2.1 Treatment of a Long-Term Illness (refer to condition 3.3.2 to see how this exclusion is applied); monitoring
of any condition; routine follow-up consultations; treatment which does not address the underlying medical condition and only offers temporary relief of symptoms (i.e. palliative care).
2.2.1 Pre-existing injury or disease contracted prior to your enrolment date (or the member’s previous plan under the terms of the transfer facility). After one full year’s membership such pre-existing injury or disease and conditions arising or resulting therefrom of which no symptoms (indication of a disease or disorder) have manifested themselves or treatment, or medication, or advice, including check-ups, has been rendered in the preceding 12 consecutive calendar months, will be covered.
2.2.2 At the time of joining, if the member is undergoing treatment or investigations these are excluded unless fully disclosed and accepted by the Insurer in writing.
2.3 Pregnancy or childbirth, except in cases of complications of childbirth when the NHS benefit will be payable subject to both parents having been enrolled for at least twelve months.
2.4 The investigation or treatment of Infertility.2.5 Treatment for alcohol and drug abuse.2.6 Treatment for sexually transmissible diseases including Acquired Immune Deficiency Syndrome (AIDS) or
AIDS Related Complex (ARC) howsoever this Syndrome has been acquired or may be named.2.7 Treatment for injury or illness directly or indirectly occasioned by, happening through or in consequence of
war, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, riot, terrorism, rebellion, revolution, insurrection, military or usurped power.
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tHE MEDICAL CARE PLANDescription of Benefits
2.8 Treatment or advice given by a General Practitioner or Dentist.2.9 Self inflicted injuries or disabilities.2.10 Sight testing, routine medical examinations and any dental condition not involving an oro-surgical operation.2.11 Spectacles or other optical aids, hearing aids, surgical medical appliances or equipment, denture or dental
appliances.2.12 Rehabilitation, convalescence, or time spent in a community or cottage hospital, a nursing home or similar
establishment.2.13 Cosmetic surgery, whether or not for psychological reasons.2.14 Dialysis in Chronic Renal Failure.2.15 Treatment received outside the country of residence when the purpose of being abroad is wholly or in part
to obtain such treatment, unless agreed in advance with HMCA.2.16 Home Nursing not falling within the definition 1.15.2.17 Treatment not being undertaken by a Specialist.2.18 Treatment when received as a public ward patient in an NHS hospital.2.19 (i) the completion of claim forms (ii) medical reports which may be required at any time in respect of
Members or Dependants.2.20 Drugs and dressings prescribed on an out-patient basis.2.21 Treatment for mental illness or psychiatric disorders or anxiety/stress related conditions.2.22 Drugs not licensed in the U.K. for specific usage.2.24 Treatment of joint and back problems will not be covered for the first twelve months of membership.
This does not apply to members who enrol under the transfer condition or in respect of treatment required where accident is the sole cause.
2.25 Correction of abnormalities or deformities which are congenital or which originate before the date of enrolment, and any treatment related to any such abnormality or deformity.
2.26 Treatment which is experimental or has not been accepted as being effective.2.27 Breast reductions for whatever reason.2.28 Accident or Emergency Admissions, except when the treatment is received free as an NHS patient, when
the NHS grant is payable.2.29 Where previous treatment has been received by the member for any joint, either before they became a
member of the scheme or since joining it, no benefit will be payable under this policy in the case of any revision or repeat treatment to that joint.
3 CONDITIONS3.1 Anyone resident in the EEA shall be eligible to apply for enrolment of himself and his Dependants in the
Scheme.3.2 The Insurer reserves the right to refuse any application or to restrict the range of benefits and the Applicant
shall not be entitled to know the reason for such decision.3.3 Cover may be transferred from an existing plan and future claims made for acute conditions originating at
the time the member was participating in the previous plan will be honoured subject to the Description of Benefits applicable at that time.
3.3.1 The member must provide evidence of the existing plan and the commencement date of it to HMCA for the transfer terms to apply.
3.3.2 When a condition is first diagnosed (and did not exist prior to enrolment) benefit will be provided for such diagnosis and any necessary treatment for one initial episode only. Subsequent treatment is not covered. When these circumstances occur the Insurer will issue an appropriate endorsement to the certificate. The Insurer provides a discretionary Long-Term Illness Grant which can be made available to those with a Long-Term Illness to assist transition to NHS care.
3.6 On the death of a Member, a spouse who is registered as a Dependant may without formality become a Member in his or her own right at the appropriate rate, according to whether the spouse was the only dependant or whether there were one or more child dependants.
3.7 The contract is an annual one renewable from year to year at the option of the Member, subject to the
Description of Benefits and the Subscriptions in force at the date of renewal.3.9 Members who take up residence outside the EEA shall cease from the next renewal date to be members
of the Scheme.3.10 The Insurer shall be entitled at any time in relation to a Member or Dependant to terminate the contract,
or to subject the contract to different terms, if (a) The Member, or an enrolled Dependant, has at any time (i) misled the Insurer by mis-statement or concealment. (ii) otherwise failed to act with the utmost good faith. (b) the Member is a member of a group which is wound up, or whose special arrangements are amended. (c) The Insurer decides to discontinue the Scheme or any part thereof.3.11 The subscription is payable in advance and eligibility to benefit ends when the period covered by the
subscription has expired or any instalment of subscription has not been paid on the due date.3.12 Where the annual subscription is paid by instalments, such instalments are payable for the full year. The
Insurer reserve the right to deduct any outstanding instalments on settlement of a claim.3.14 The Insurer will consider claims for treatment at hospitals on the list provided. Other hospitals may be
accepted subject to prior notification and the Insurer’s written agreement.3.15 Where discounts off the basic rates are allowed, only one discount will be given.3.16 Benefits may be claimed for treatment by a specialist after referral from the patients GP. Where more than
one surgical procedure is carried out whilst an in-patient then the benefit payable towards Surgical Charges and Theatre Fees shall be 100% of the highest rated procedure plus up to 50% of the appropriate benefit for each subsequent procedure. For the purposes of benefits, operations are classified as Complex, Major Plus, Major, Intermediate or Minor. When a course of treatment is received solely as an NHS patient, the cash benefit detailed in the Description of Benefits shall be payable for each eligible night spent in hospital.
3.17 A claim form will be sent to the Member on request. Such a request should be made immediately the Member is advised to have Specialist treatment for which a claim for Benefit will be submitted.
3.19 A member shall not be entitled to ask for payment in any foreign currency and claims in any such currency shall be paid in Pounds Sterling at the rate of exchange prevailing on the day of the cheque in settlement of the claim is drawn.
3.20 Any claim for benefit must not exceed the actual expenses incurred and is payable up to the limit for the time being prescribed within the Member’s chosen level. Such a claim must be in the Insurer’s prescribed form supported by accounts from whoever has provided the service. Any claim shall be made within three months of commencement of treatment or giving of advice. It shall be supported by such further evidence as the Insurer may reasonably require. In the event of treatment or the giving of advice continuing further accounts shall be submitted within one month of them being rendered and the requirement as to further evidence shall apply.
3.21 If expenses are covered by an insurance on the Member or by any Provident Insurer, the Insurer reserves the right not to pay more than its rateable proportion thereof.
3.22 For the purposes of calculating daily payments, the days of admission and discharge together count as one day.
3.23 Accommodation charges are payable only when directly related to the In-Hospital treatment received in Private Hospitals or the private wing of NHS Hospitals.
3.25 Where the treatment required results from the fault of another, the member must; (i) Take all reasonable steps that the Insurer requires to recover from the party at fault the cost of the benefits
paid by the Insurer and interest thereon. (ii) If recoverable, repay to the Insurer the cost of the benefits paid to the member with interest.3.26 The benefits payable towards a claim are those applicable to your certificate at the time the claim form is
issued. Therefore benefits from 2 separate membership years cannot be applied to the same claim.3.28 Each In-Hospital stay must be pre-authorised at least the day before, with HMCA Members being in receipt
of the completed claim form, a consultant’s report and details of the hospital’s charges, before any agreement can be given as to the eligibility and benefits payable.
3.29 The Maternity Grant is payable once both parents have been members for at least twelve months.
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tHE PERSONAL ACCIDENtCASH PLANDescription of Benefits
Included with your Medical Care Plan are Personal Accident benefits, please read these terms and conditions and make sure that they meet your needs and that you are clear about the cover and the exclusions. These documents form the contract of insurance between you and the Insurer.
Certain words in this Plan have a specific meaning. The definitions of such words are detailed under Definitions where a word has been defined, the definition will apply wherever that word appears in this Plan.
DEFINITIONS
Insurer: HMCA Insurance LimitedInsured: The person stated on the CertificateAnniversary Date: 12 months after your enrolment date, stated on your membership certificateAccidental Death: death caused by an accident which is due to a sudden, unexpected, unusual specific event which occurs at an identifiable time and place. You/your: the InsuredHazardous Pursuits: shall mean ballooning, caving, diving, hang-gliding, hydro-planing, riding on a motorcycle over 250cc (as a driver or passenger), mountaineering, parachuting, pot-holing, racing of any kind (other than on foot), rock or cliff climbing, white water rafting or canoeing, any sport carried out as a professionalPermanent Disablement/Disability: refers solely to loss of limb or loss of sight as separately defined.Loss of limb: means loss by physical separation of a hand at or above the wrist or of a foot at or above the ankle and includes total and irrecoverable loss of use of hand, arm, foot or leg.Loss of Sight: means total and permanent loss of sight in both eyes if the Insured Person has been added to the register of blind persons on the authority of a fully qualified ophthalmic specialist, or in one eye if the degree of sight remaining after correction is 3/60 or less on the Snellen Scale.
EXCLUSIONS
This Plan does not cover death or disablement/disability resulting directly or indirectly from;a) the Insured’s criminal activity, intentional actions, or self-injuryb) war, whether war be declared or not, hostilities or any act of war or civil war c) nuclear reaction, nuclear radiation or radioactive contaminationd) any act of terrorism For the purpose of this exclusion, an act of terrorism means an act or series of acts, including
the use of force or violence, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organisation(s),committed for political, religious or ideological purposes including the intention to influence any government and/or to put the public in fear for such purposes
e) the Insured being intoxicated by alcohol or drugs, except as prescribed by a registered qualified medical practitioner
f) acquired immune deficiency syndrome (AIDS) or HIV.g) hazardous pursuits
FRAUD
Insurance fraud is a crime, and costs innocent customers money every year because insurance companies have to charge higher premiums.
If you, or anyone acting on your behalf, supply the Insurer with facts or information and/or make a claim which you know to be false or inaccurate and with the intent of seeking financial gain you may be committing a fraudulent act, which is a crime. If the Insurer obtains evidence which suggests that this is the case, the Insurer may cancel the Plan and refuse to settle your claim. The Insurer will also report the matter to the police.
THE DIRECT DEBIT GUARANTEE
• This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits.
• If there are any changes to the amount, date or frequency of your Direct Debit HMCA/S PLC will notify you 3 working days in advance of your account being debited or as otherwise agreed. If you request HMCA/S PLC to collect a payment, confirmation of the amount and date will be given to you at the time of the request.
• If an error is made in the payment of your Direct Debit by HMCA/S PLC or your bank or building society you are entitled to a full and immediate refund of the amount paid from your bank or building society.
• If you receive a refund you are not entitled to, you must pay it back when HMCA/S PLC asks you to. You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.
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HMCA Insurance Limited is the insurer who underwrites the Medical Care Plan and promotes their various plans through HMCA Members both in the UK and Republic of Ireland. It does not own, nor is it owned by, any part of HMCA Members.
HMCA Members are an insurance intermediary who work on behalf of the underwriters, HMCA Insurance Limited. HMCA Members undertake all aspects relating to administration, marketing and management of claims. In return for this HMCA Members are remunerated by HMCA Insurance Limited from the subscription the members pay.
HMCA Members only promote Medical Plans underwritten by HMCA Insurance Limited and our experienced Telephone Helpline provide a non advised sales service. The Telephone Helpline are here for you to ask them any questions regarding any aspect of the Plan, you can contact them on 01423 799949.
We do not offer advice and the information sent will allow you to make a choice of how to proceed.
DEMANDS AND NEEDS
This Plan meets the demands and needs of individuals who wish to have benefits towards the cost of their private medical treatment, now and in the future.
COmPENSATION
HMCA Insurance Limited is covered by the Financial Services Compensation Scheme (FSCS). You may be entitled to compensation from the scheme in the unlikely event that HMCA Insurance Limited cannot meet its obligations. This depends on the type of business and circumstances of the claim and would provide cover for 100% of the first £2,000 and 90% of the remainder of the claim without any upper limit. Further information about compensation scheme arrangements is available from the FSCS. (www.fscs.org.uk - telephone 020 7741 4100.)
HMCA/S PLC, trading as HMCA Members of Beech Hall, Knaresborough, Yorkshire, HG5 0EA is an intermediary and is authorised and regulated by Financial Conduct Authority, reference no. 307587. This can be verified by visiting the FCA’s website https://register.fca.org.uk or by contacting the FCA on 0800 111 6768.
COmPLAINTS PROCEDURE
If you have a complaint please write to The Directors of HMCA Members, Beech Hall, Knaresborough, Yorkshire, HG5 0EA. If you are dissatisfied with the response you should write to HMCA Insurance Limited, 33/2 Cannon Lane, Gibraltar, GX11 1AA. If after their review you are still dissatisfied, your complaint can be referred to the Financial Ombudsman Service at Exchange Tower, Harbour Exchange Square, London E14 9SR.
IMPORtANt INfORMAtION yOu NEED tO KNOW fOR yOuR PROtECtION
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Protect the ones you love
