UK Scheme - Aon · 2019-09-03 · of Scotland (RBS) healthcare scheme This guide has been designed...

Healthcare Scheme – scheme number 980033 Member Guide Effective from 1 October 2019

Bronze, Silver and Gold options

UK Scheme

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About AvivaAviva is the largest insurer in the UK and provides 33 million customers with insurance, savings and investment products worldwide as well as expertise in administering private medical insurance and trust schemes.

Your private medical benefit with Aviva provides you with the peace of mind that you’ll receive prompt access to diagnostic tests and eligible medical treatment, should you need it. Along with comprehensive healthcare, we also provide you with additional benefits to help you look after your health and wellbeing.

Welcome to your Royal Bank of Scotland (RBS) healthcare schemeThis guide has been designed to provide you with the key information about your scheme, and it’s important that you read this and keep for your records. The guide doesn’t, however, contain the full terms, conditions, benefits and exclusions that apply to your scheme. These are contained in the scheme rules, a copy of which is available on request from your company or by contacting Aviva.

Your healthcare scheme is designed to provide you with benefit for treatment of acute symptoms and conditions. An acute condition is a disease, illness or injury that’s likely to respond quickly to treatment which aims to return you to the state of health you were in immediately before suffering the disease, illness or injury, or which leads to your full recovery.

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If you have any questions or want to make a claim, call the customer service helpline:

0800 158 33388:00am - 8:00pm Monday to Friday8:00am - 1:00pm Saturday

Quoting scheme number:

980033Calls to and from Aviva may be monitored and/or recorded.

How to make a claimYour scheme includes the Fast Track Physio service and mental health pathway plus

This means that if you need to claim for pain in the back, neck, muscles or joints (musculoskeletal conditions) or, if you need support with your mental health, you don’t need to see your GP, just call the customer service helpline. If your claim is eligible, we’ll put you through to our independent clinical case management providers who will assess your symptoms and arrange the most appropriate treatment.

Making a claim for any other symptoms or conditions

For other symptoms or conditions, either visit your GP in the usual way, or access Aviva Digital GP. If the GP refers you to a specialist for diagnostic tests or treatment, you can start a claim by calling the customer service helpline.

For Digital GP terms and conditions apply.

How to make a claim

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Fast Track Physio

Telephone clinical assessmentThis is an in depth assessment of your symptoms and medical history by a registered physiotherapist with Nuffield Health from the Fast Track Physio service provided by Nuffield Health, to determine the most appropriate treatment pathway for you. The assessment will include questions about the nature and duration of your symptoms, the impact they are having on your daily activities, and the presence of any serious symptoms which require urgent treatment.

Providing advice and supportIf you need face-to-face physiotherapy or to be seen by a specialist, you’ll be referred to an appropriate facility or clinic close to your work or your home. Even if you don’t need a course of treatment after your assessment, a registered physiotherapist will ensure that you have all the tools to manage your recovery yourself, including a detailed exercise and advice programme. You’ll receive follow up calls from a registered physiotherapist to ensure that your recovery remains on track and that you have the support you need.

Remember: There’s no need to see

a GP first

The benefits of Fast Track Physio

• Fast Track Physio offers quick access to a telephone clinical assessment with a registered physiotherapist from Nuffield Health, who can help you deal with the pain of a musculoskeletal injury

• Getting you the right treatment at the right time, which can lead to a faster recovery

• There’s no need to see a GP, and that means less time to wait before accessing treatment and/or advice

• Your excess (for Bronze and Silver options) won’t apply to physiotherapy provided through the Fast Track Physio service. The excess will apply at the point you need to see a specialist.

Fast Track PhysioWe know that back, neck, muscle and joint pain (otherwise known as musculoskeletal pain) can stop you in your tracks and prevent you from enjoying life to the full. Fast Track Physio is provided by Nuffield Health and gives you access to a clinical case manager who will help guide you down the right treatment pathway. There’s no need to see a GP, just call the customer service helpline to access Fast Track Physio. Members aged 11 and under will need to get a GP referral before contacting the customer service helpline.

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Mental health pathway plus

Mental health pathway plusAs we're all unique, with individual needs, we believe that mental health treatment should be tailored to your personal requirements. That's why we’ve introduced a clinical, results-driven approach to mental health

treatment.

Our innovative mental health pathway enables us to tailor the support you receive - ensuring that your treatment is guided by clinical need. Members aged 11 and under will need to get a GP referral before contacting the customer service helpline.

Telephone clinical assessment If you want some support with your mental health, call the customer service helpline in the first instance – you don’t need to see your GP. If your claim is eligible, our claims team will facilitate contact with our independent case

management provider for a clinical assessment.

The pathway provides a detailed clinical assessment with a mental health practitioner, before making recommendations on the most appropriate treatment for you.

Your bespoke treatment planFollowing your clinical assessment, the dedicated case manager will arrange the most appropriate treatment. This could be online Cognitive Behavioural Therapy, remote (telephone or video link) or face-to-face talking therapies, or psychiatrist

assessment. Where clinically appropriate, they can offer a relapse prevention programme, giving you access to up to 12 months’ online self-help support.

Remember: There’s no need to see

a GP first

The benefits of the mental health pathway plus

• Offers quick access to a telephone clinical assessment with our carefully selected clinical provider

• Getting you the right treatment at the right time, which can lead to a faster recovery

• There is cover for the treatment of chronic conditions if our independent mental health provider thinks it’s clinically appropriate

• There is cover available for one addictive conditions treatment programme if our independent mental health provider thinks it’s clinically appropriate

• There’s no need to see a GP, and that means less time to wait before accessing treatment and/or advice

• It’s an end-to-end service based on clinical need; guided by clinical expertise and insight

• Your excess (if applicable) won’t apply to any treatment provided through the mental health pathway.

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Making a claimFast Track Physio for musculoskeletal claims

The following outlines how a claim for a musculoskeletal condition works in three simple steps:

Mental health pathway plusThe following outlines how a claim for a mental health condition works in three simple steps:

Step 1 – If you need some support for your mental health

If you’re worried about your mental wellbeing, our clinical case management approach can help. There’s no need to contact your GP, just call the customer service helpline.

If you've seen your GP, you must still follow the mental health pathway to access assessment and treatment under the scheme.

1Step 1 – If you’re unwell with any back, neck, muscle or joint pain

The Fast Track Physio service is your first port of call with no need to contact your GP. Just call the customer service helpline.

If you've seen your GP, you must still follow the Fast Track physio service to access assessment and treatment under the scheme.

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Step 2 – Calling the customer service helpline – 0800 158 3338

Calls to and from Aviva may be monitored and/or recorded.

Please have the following information to hand when you call:

• your scheme number 980033 to help confirm your identity

• details of your symptoms and when they started.

One of the registered physiotherapists from the Fast Track Physio service will contact you at a convenient time to assess your symptoms.

In some instances we may require more information before confirming benefit but we’ll talk this through with you when you call.

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Step 3 – Telephone clinical assessment

Using evidence-based medical guidelines, a registered physiotherapist will conduct a thorough assessment of your problem and recommend the most effective course of treatment.

A registered physiotherapist will provide advice to help you manage symptoms and pain, how best to remain active with a tailored home exercise programme and will continue to monitor your progress throughout your claim.

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One of our advisers will transfer you to our independent clinical provider, where a therapist will conduct a thorough assessment with you. Or, if you prefer, we can arrange a suitable time to call you back.

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From a range of treatment options, the therapist will agree what’s the most appropriate help for you, these options include:

• online CBT (Cognitive Behavioural Therapy)

• remote CBT (via telephone or video link)

• face-to-face therapy (for example CBT, counselling)

• psychiatrist/psychiatric specialist assessment and treatment.

All treatment is led by experienced mental health therapists working in conjunction with our independent clinical provider. At the end of treatment you’ll be provided with a plan to help manage your symptoms in the longer term.

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Making a claim

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Step 1 – If you need some support for your mental health

If you’re worried about your mental wellbeing, our clinical case management approach can help. There’s no need to contact your GP, just call the customer service helpline.

If you've seen your GP, you must still follow the mental health pathway to access assessment and treatment under the scheme.






One of our advisers will transfer you to our independent clinical provider, where a therapist will conduct a thorough assessment with you. Or, if you prefer, we can arrange a suitable time to call you back.


From a range of treatment options, the therapist will agree what’s the most appropriate help for you, these options include:

• online CBT (Cognitive Behavioural Therapy)

• remote CBT (via telephone or video link)

• face-to-face therapy (for example CBT, counselling)

• psychiatrist/psychiatric specialist assessment and treatment.

All treatment is led by experienced mental health therapists working in conjunction with our independent clinical provider. At the end of treatment you’ll be provided with a plan to help manage your symptoms in the longer term.

For all other claims For any other symptoms, you’ll need to follow the standard claims process:

Payment of billsAll eligible bills will be settled by us directly with the treatment provider. If you do receive a bill for your treatment, please send us a copy together with your scheme number, so that we can arrange payment.

Please send this to:

Bill Payment Team Aviva Health UK Limited Chilworth House Hampshire Corporate Park Templars Way Eastleigh Hampshire SO53 3RY

We’ll contact you to advise if you need to pay any part of the bills for example, the £175 excess if you have the bronze or silver level of benefit.

If you don’t contact the customer service helpline and you continue with any recommended diagnostics or treatment, you may have to pay the costs for these services yourself if they’re not eligible under your healthcare scheme.

To make the process as quick and easy as possible, most claims will be telephone assessed by our experienced claims advisers.

This means we can take all the necessary medical information from you over the telephone to assess your claim and no claim form will be required (some situations will require more information from your specialist or GP).

Private Healthcare Information NetworkYou can find independent information about the quality and cost of private treatment available from doctors and hospitals from the Private Healthcare Information Network: phin.org.uk

Step 1 – Consult your GP

If you feel unwell, go and see your GP in the usual way.

If your GP recommends you need to see a specialist for further assessment or treatment, they’ll give you a referral. This may either be:

• a named referral - where the GP recommends a particular specialist and/or hospital

• an open referral - where the GP just states which type of specialist you need to see or the type of treatment you need, without stating a specialist’s name or hospital.

All claims have to be authorised in advance by Aviva.

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• medical specialism of the specialist you need to see

• details of your condition, including symptoms, dates and diagnosis if known.

• if you’ve been given a named referral, we’ll check to make sure the specialist is recognised by us (and for Bronze and Silver options, that they work within Aviva’s fee guidelines)

• if it’s an open referral, we’ll use our specialist finder database to select an appropriate specialist and/or hospital.

To view our fee guidelines for specialists visit aviva.co.uk/pmifeesWhere possible we'll let you know whether your claim is authorised, there and then over the phone. The more information you're able to give us at this point, the easier it'll be for us to make the decision.

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Step 3 – Diagnosis, treatment or surgeryIf your specialist recommends hospital treatment please ask for a description of the treatment and a procedure code, if there is one. Once you’ve called us again with these details, we can confirm whether or not your treatment is eligible.

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Please call us so that we can confirm:

• the details of your membership

• the treatment you require is eligible under your scheme

• if there are any limits that apply to your benefit which you should be aware of

• for symptoms requiring GP referral, that your recommended specialist and hospital are recognised by us.

Making a claim

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What’s eligible for benefit – summaryBenefit limits shown below apply to each member every scheme year and all treatment must be on referral by, and under the care of, a specialist unless otherwise stated.

We will only pay for treatment which you receive whilst you are a member of the scheme.

As a member of the scheme you have your medical history disregarded which means that any pre-existing conditions you have will be eligible providing they fall within the terms and conditions of the scheme.

An excess of £175 each member every scheme year (01 October - 30 September) applies to all members on the bronze and silver options who claim for treatment.

Six week rule (Bronze option only)Please note that in-patient and day-patient benefit, including accident or emergency admissions, is not available if the NHS waiting list for your treatment is less than six weeks.

Benefits Bronze option Silver option Gold option Notes

Treatment as an in-patient or day-patient at a network facility, a hospital on the Key or Extended hospital list, or in an NHS pay bed - (only Key hospital list is available on the Bronze and Silver Options). If you have the Extended hospital list, you don't have to use our networks.

Hospital charges In full in Key hospitals Bronze option - six week rule applies In full in Extended hospitals

Including accommodation and meals, nursing care, drugs and surgical dressings, theatre fees

Specialists’ feesSubject to Aviva’s fee guidelines for specialists.

Bronze option - six week rule applies

In full

Diagnostic tests In full. Bronze option - six week rule applies

Including blood tests, X-rays,scans, ECGs

Radiotherapy/chemotherapy In full

Treatment for pain in the back, neck, muscles or joints – musculoskeletal conditions

In full Benefit available when using the Fast Track Physio Service

Treatment as an out-patient

Consultations with a specialist

Benefit is limited; If directly leading to, or following within six months of, related eligible treatment as an in-patient or day-patient. Up to the limits in Aviva’s specialist fee schedule.

Up to the limits in Aviva's specialist fee schedule.

In full

Treatment by a specialist as an out-patient No benefit In full

Diagnostic tests

Benefit is limited; If directly leading to, or following with six months of, related eligible radiotherapy/chemotherapy as an out-patient.

In full

Including blood tests, X-rays,scans and ECGs. We will only pay for CT, MRI or PET scans as an out-patient if they are at a diagnostic centre

Radiotherapy/chemotherapy In full

Benefit summary What’s eligible for benefit

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Treatment by a physiotherapist, osteopath, chiropractor or acupuncturist (for conditions other than pain in the back, neck, muscles or joints – musculoskeletal conditions)

No benefitIn full on specialist referral, up to 10 sessions on referral by a GP in combined total each condition, each member every scheme year

Treatment for pain in the back, neck, muscles or joints – musculoskeletal conditions

In full Benefit available when using the Fast Track Physio Service

Additional benefits

GP referred services and chronic conditions benefit:

Specialists’ fees for consultations and diagnostic tests (for chronic conditions other than cancer)

Radiology and pathology on referral by a GP (for conditions other than pain in the back, neck, muscles or joints – musculoskeletal conditions)

No benefit

Up to £1,000 in combined total per member per

scheme year

Up to £2,500 in

combinedtotal each member every

scheme year

Home nursing In full Immediately following eligible in-patient or day-patient treatment

Private ambulance In full

Parent accommodation when staying with a child In full Child of 15 and under receiving eligible

treatment; one parent only

NHS cash benefit £150 per night

Where eligible treatment as an NHS in-patient takes place without charge. Maximum of 35 nights. NHS cash benefit isn't available for the first three nights following an accident or emergency admission, cancer treatment (see 'benefits for cancer treatment' section), or if you claim for the cost of an NHS amenity bed for the same treatment


Minor surgery by a GP Up to£100 per procedure

To see what procedures are eligible visit: aviva.co.uk/gp-minor-surgery

Hospice donation £70 per day, up to 10 days

Mental health benefit:

Benefit available when using the mental health pathway. To include:

- cover for chronic psychiatric conditions, if clinically appropriate

- one addictive conditions programme during the lifetime of the scheme, if clinically appropriate

Psychiatric treatment is not available under any other benefit on this scheme.

Psychiatric treatment as an in-patient or day-patient consisting of accommodation, nursing and specialists' fees

Up to 28 days each member every scheme year

Fees for psychiatric out-patient treatment such as counselling by a psychiatric therapist or psychiatric specialist

In full


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Limited emergency overseas treatment In full

Emergency treatment as an in-patient or day-patient during overseas trips of up to 90 days in total each scheme year

Surgical procedures on the teeth performed in a hospital In full

Bronze and Silver options are subject to Aviva’s fee guidelines for specialists.


Excess £175 Nil The excess applies to each member every scheme year

Stress counselling helpline Unlimited number of calls The stress counselling helpline is available to members aged 16 and over.

This is a summary of the scheme benefits.

Full details of benefits and exclusions are given in the scheme rules, a copy of which is available upon request.


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Points of ReferenceEligible dependantsAn employee’s spouse, partner, civil partner. Unmarried children and step children under 21 years of age or under 25 years of age, whilst in full time education in the UK and who are included on the scheme.

HospitalsFor members with the bronze and silver levels of benefit, if we don’t have a network for the treatment you need, you can access any hospital on Aviva’s Key hospital list. You can see which hospitals are in your area by downloading the hospital list from: aviva.co.uk/hospital-list

For members with the gold option, you can access any hospital on Aviva’s Extended hospital list, and you don’t have to use our networks.

NetworksTo help manage costs and drive consistent quality of care, we’re developing a number of networks of facilities, specialists and other practitioners for specific conditions. If we have a network for your condition or suspected condition, we’ll tell you where you can have your treatment which may not be at a hospital on your hospital list. We'll only pay for that treatment if it's carried out within our networks. If you have the Extended hospital list, you don’t have to use our networks.

A list of the conditions or suspected conditions that we have networks in place can be found at aviva.co.uk/health-network

ExcessA £175 excess applies each member every scheme year for those members on the bronze and silver levels of benefit. Benefits will only be paid once the excess amount has been exceeded and this should be settled directly with the relevant provider, for example a hospital or specialist.

The excess doesn't apply to treatment received through the mental health pathway or to physiotherapy for pain in the back, neck, muscles or joints (musculoskeletal conditions) managed by the Fast Track Physio service.

24 hour stress counselling helplineIf you’re stressed and just want someone to talk to, whatever the reason, just call the stress counselling helpline on 0800 158 3349. It doesn’t matter what’s on your mind – work issues, relationships, social strains, bereavement, money worries, anything at all. Experienced counsellors are there for you 24 hours a day, 7 days a week. The stress counselling helpline is available for members aged 16 and over.

Private Healthcare Information Network

You can find independent information about the quality and cost of private treatment available from doctors and hospitals from the Private Healthcare Information Network: phin.org.uk


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Benefit for cancer treatmentWe understand the importance of providing extensive benefit and support at every stage of your cancer treatment. Our cancer pledge means we’ll provide benefit for the cancer treatment and palliative care you need, as recommended by your specialist.

We also want to make things as comfortable as possible for you following your cancer treatment, so we’ll provide extensive benefit for your aftercare, including consultations with a dietician, as well as money towards prostheses and a wig.

Extensive benefit

and support

Our cancer pledge

What’s eligible for benefit● Hospital charges for surgery and medical admissions at a

hospital recognised by Aviva. For Bronze and Silver options, if your treatment (whether as an in-patient, day-patient or out-patient) is for a condition or suspected condition where we have a network, we’ll only pay for that treatment if it's carried out at a facility and/or under the care of a specialist (or other practitioner) recognised by us as part of that network

● Specialists’ fees (Bronze and Silver options are subject to Aviva’s fee guidelines for specialists’)

● NHS cancer cash benefit. This is payable where eligible treatment as an NHS patient takes place for cancer without charge

We’ll pay £100 for each day you receive treatment as:

- an in-patient

- a day-patient.

We’ll pay £100 for each day you:

- receive out-patient radiotherapy, chemotherapy or blood transfusions

- undergo out-patient surgical procedures.

We’ll also pay £100 for:

- each day you receive intravenous (IV) chemotherapy at home

- each week whilst you're taking oral chemotherapy drugs at home.

You won’t be able to claim more than £100 in any one day, but there’s no limit on the amount of days you can claim.

NHS cancer cash benefit isn’t available if you claim for the cost of an NHS amenity bed for the same treatment.

We may need to contact your GP or specialist for details of your treatment before we can pay your claim.

We may also ask for the discharge summary from the hospital

● Post surgery services - includes specialist services immediately following surgery such as consultations with a dietician or stoma nurse, and insertion and replacement of a tube for artificial feeding

● Radiotherapy and chemotherapy, including targeted drug therapies for cancer. Hormone therapy is only eligible if you need it to shrink a tumour before surgery or radiotherapy

● Bone strengthening drugs (such as bisphosphonates) that are being used to treat metastatic bone disease

● Treatment prescribed by your specialist for side effects while you're receiving chemotherapy or radiotherapy

● Stem cell and bone marrow transplants. This includes collection, storage and implantation

● Monitoring for up to ten years after your treatment for cancer has finished. We don’t pay for monitoring after treatment for non-melanoma skin cancer

● Up to £100 towards a wig if you suffer hair loss caused by cancer treatment. We’ll pay £100 in total whilst you're a member of the scheme, not per scheme year

● Up to £5,000 towards the cost of the first external prosthesis following an amputation for cancer

● Ongoing needs, such as regular replacement of tubes or drains, for up to five years after your treatment for cancer has finished

● Preventative surgery, only if you’ve already had treatment for cancer that we’ve paid for. For example, we’ll pay for a mastectomy to a healthy breast in the event that you've been diagnosed with cancer in the other breast. (We won’t pay for surgery where you have no symptoms of cancer, for example where you have a strong family history of cancer)

● End of life care:

- we’ll pay for end of life care in a hospital if this is medically necessary

- hospice donation of £100 per night, up to £10,000 if you’re admitted to a hospice

- donation of £50 per day to a registered charity if you’re visited at home by one of their nurses, up to £10,000.

Benefit for cancer treatment

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Guide to limited emergency overseas benefitYour Royal Bank of Scotland healthcare scheme includes an overseas benefit which is available for the first 90 days spent overseas on a temporary basis in any one scheme year. The 90 days are accrued on a cumulative basis. If you are outside the UK for more than 90 days during any scheme year there is no benefit under the limited emergency overseas benefit.

In the event that the country of incident doesn’t have adequate facilities to treat the condition, Aviva will evacuate the patient only, to the nearest available facility, which may not be the UK. After release from hospital following evacuation, Aviva will meet the cost of the journey either to the country evacuated from, or the UK, if this is of comparable cost.

Benefit doesn’t extend to costs incurred on behalf of any person who accompanies the patient.

This is a summary of the overseas benefit available under your corporate healthcare scheme. Full details are given in the scheme rules.

Assistance company services

We have an emergency assistance provider who deals with all aspects of overseas claims.

Before you travel you should give your scheme number and the emergency assistance provider’s telephone number to a family member or a travelling companion who can contact them on your behalf should you become involved in an emergency and be unable to contact them directly.

The telephone number is: +44 (0)2381 247290

Calls may be monitored and/or recorded.

The overseas emergency assistance provider is available 24 hours a day. When you call, please give them your name, scheme number and brief description of the problem.

Please note this is not travel insurance and benefit is restricted to the treatment of emergency conditions that are serious enough to need an immediate admission to hospital as an in-patient or day-patient. The medical emergency must arise incidental to the intended purpose of the visit. If you feel this level of benefit is not appropriate for you or that you may need further benefit, you should consider taking out a travel insurance policy.

Benefit is restricted to the treatment of emergency conditions serious enough to require immediate admission to hospital as an in-patient or day-patient. The medical emergency must arise incidental to the intended purpose of the visit.

You may also want to consider the European Health Insurance Card (EHIC) scheme which allows you to benefit from the reciprocal health arrangements when travelling to countries covered by the EHIC scheme. Application forms can be obtained from the post office or online and should be completed and validated before you travel. You should take steps to use these arrangements where possible.

In an emergency – members should go immediately to the nearest physician or hospital without delay, then contact the emergency assistance provider.

Benefit summary Benefit for treatment overseas

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● Long term or chronic conditions, except as provided under the mental health benefit and treatment for cancer

● Treatment undertaken by a specialist without GP referral (except through Fast Track Physio or the mental health pathway)

● Seeing a GP privately

● Prescription charges

● Charges by a GP, medical practitioner or specialist for completion of a claim form unless the claim is confirmed by us

● Take home drugs and dressings

● HIV/AIDS and related conditions

● Treatment received in a health hydro or similar establishment

● Cosmetic treatment (except following an accident or surgery for cancer)

● Routine medical examinations including eye tests and health screens etc. (If we’ve paid for you to have treatment for cancer, this exclusion won’t apply with regard to cancer)

● Sports injuries where you're paid or personally sponsored

● Convalescence

● Experimental treatment (limited benefit may be available - please contact us)

● Incidental hospital expenses such as newspapers and telephone calls

● Kidney dialysis

● Routine dental treatment

● Investigations into the causes of, or treatment for infertility

● Treatment related to pregnancy or childbirth in any circumstances

● Overseas treatment other than as provided for in the limited emergency overseas benefit

● Surgical or medical appliances such as neurostimulators (e.g cochlear implants) and crutches

● Alcoholism, alcohol abuse, solvent abuse, drug abuse and other addictive conditions, except as provided under the mental health benefit

● Treatment of psychiatric conditions requiring a long-term, coordinated, multidisciplinary approach, for example anorexia nervosa and personality disorders

● Treatment required as a result of war, terrorism, contamination by radioactivity, biological or chemical agents

● Varicose veins of the leg, unless they meet the criteria detailed in the scheme rules

● Sleep disorders and sleep problems, such as snoring and sleep apnoea

● Treatment for warts, verrucas and skin tags

● Treatment by a practitioner, specialist or other healthcare professional who isn't recognised by us

● Treatment at a hospital, facility or any other treatment centre that isn't recognised by us

● Weight loss surgery

● Treatment for lipoedema

● For Bronze or Silver members only, treatment outside of a network (for any condition or suspected condition where we have a network).

This is a summary of the scheme benefits. Full details are given in the scheme rules, a copy of which is available upon request.

What’s not eligible – summaryThere are some things which aren’t eligible for benefit so it’s important you speak to the customer service helpline before receiving any treatment. Some examples of what isn’t eligible include:

Chronic conditions explainedA chronic condition is a disease, illness or injury which has one or more of the following characteristics:

● it needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests

● it needs ongoing or long-term control or relief of symptoms

● it requires your rehabilitation or for you to be specially trained to cope with it

● it continues indefinitely

● it has no known cure

● it comes back or is likely to come back.

What’s not eligible

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Points to remember

Can I leave the RBS schemeYou’ll only be entitled to leave the scheme during the annual benefits window or following an appropriate lifestyle event. For more information please contact your company HR team.

If you leave RBSIf you leave your company, your membership of the scheme will cease on the last day of the month you leave RBS, even if treatment was pre-authorised by Aviva. However, having been a member of the RBS healthcare scheme, you’re entitled to benefit from continued medical benefit on an individual policy. Benefits, exclusions, terms and conditions on an individual policy may be different to those on this scheme. If you’d like to discuss this further, please contact our sales advice line on: 0800 142 142 (calls to and from Aviva may be monitored and/or recorded).

To qualify for continued benefit without affecting your underwriting you need to apply within 60 days from the date your membership under the scheme ceases.

Claims for childrenChildren aged 12 and older can use our Fast Track Physio service and our mental health pathway without seeing their GP. For any other symptoms or conditions, consult their GP in the usual way and contact the customer service helpline to let us know what they have recommended.

Income tax liabilityUnder current UK tax rules, the contribution that’s paid to us for your inclusion on the scheme arises from your employment and is therefore a taxable benefit. Please contact your company HR team if you require further information.

Change of personal detailsPlease advise your company immediately should any of your personal details change, e.g. address, name, etc. If you wish to add new dependants, for example, a newborn baby, please notify your HR team as soon as possible.

If you have any cause for complaint Our aim is to provide a first class standard of service to our customers, and to do everything we can to ensure you’re satisfied. However, if you ever feel we’ve fallen short of this standard and you’ve cause to make a complaint, please let us know.

Our contact details are:

Aviva Health UK Ltd Complaints Department PO Box 540 Eastleigh SO50 0ET Telephone: 0800 051 7501 Email: [email protected]

We’ve every reason to believe that you’ll be totally satisfied with your Aviva scheme, and with our service. It’s very rare that matters can't be resolved amicably. However, if you’re still unhappy with the outcome after we’ve investigated it for you and you feel that there’s additional information that should be considered, you should let us have that information as soon as possible so that we can review it.

Please note, as the scheme is a healthcare trust and not an insurance contract, the Financial Ombudsman Service will not consider referrals from members of this scheme. If you disagree with our complaints decision and wish to pursue the matter further, as a final recourse you can write to the trustees of the scheme via the Aviva complaints department, their contact details can be found on this page.

Clinical complaintsFor clinical complaints relating to the conduct or competency of your specialist or the facilities at which they practise, these need to be directed to the specialist and hospital or clinic directly.For your information, the responsibility for investigating and responding to clinical complaints is as follows:

● If your complaint is about a hospital/clinic or specialist, it will be investigated in accordance with the complaints process in force

at the relevant hospital/clinic, please contact the hospital directly.

● If your complaint relates to a third party clinical case manager, this will be investigated by the clinical provider who employs that case manager.

● If your complaint is about a Fast Track physiotherapist, this will be investigated by Nuffield Health who are responsible for the therapist network.

Once you have contacted the provider who is responsible for investigating and responding to your clinical complaint, they should advise you of the full complaints process which will also include anyescalation details should you require these.

While Aviva do not have a role in investigating and responding to clinical complaints, Aviva do record clinical complaint volumes and investigation outcomes. If you would like to inform us of a clinical complaint outcome please contact us using the details provided before.

Benefit outside the UKYour healthcare scheme provides benefit for treatment in the United Kingdom with only limited benefit for emergency treatment overseas (more detail is available in the scheme rules). If you need to travel outside of the United Kingdom, you should consider taking out a travel insurance policy.

Points to remember

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Aviva Digital GPGet free around the clock access to GP video consultations, ask a question feature, pharmacy services and repeat NHS prescriptions with free delivery, all at the touch of a button.

Powered by Now Healthcare Group - a digital health company who provides video GP consultations for millions of NHS and corporate patients, effectively giving you a GP in your pocket.

You can look forward to the following benefits:

Unlimited access to GP consultations – prompt access to a GP 24/7, 365 days a year with no limit to the number of GP video consultations you can have

Choose your GP – you can choose your GP by gender, from a range of languages and keep the same GP for multiple appointments

Repeat NHS prescriptions/medication with free delivery – request in-app (all NHS England exemptions accepted) and get free delivery

Medication reminder service – use reminders for your NHS medication and notify a friend or family member when you have not taken your medication

Ask a question – ask an NHS registered GP or a member of the Now Pharmacy team a question in-app

Paediatric GP consultations – add your children under 16 to your account for GP video consultations.

Aviva Digital GP is powered by Now Healthcare Group. Sign up is subject to the terms & conditions of the Aviva Digital GP service which can be found at drnow.co.uk/avivatandc.htm

Downloading Aviva Digital GP is simple and it’s free*Aviva Digital GP is available to residents of Great Britain and Northern Ireland at home or abroad. Residents of the Channel Islands or the Isle of Man are not eligible for this service.

* Mobile data charges may apply

Aviva Digital GP

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● Claims authorisation number:

● Diagnosis/condition:

● Type of speciality and sub-speciality required:

● Date of appointment:

● Treatment (CCSD) code if known:

Notes

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Notes

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GEN3782 08.2019 REG001 © Aviva plc

Aviva Health UK Limited. Registered in England, Number 2464270. Registered Office: 8 Surrey Street, Norwich, NR1 3NG. Authorised and regulated by the Financial Conduct Authority. Firm Reference Number 308139. A wholly owned subsidiary of Aviva Insurance Limited. This insurance is underwritten by Aviva Insurance Limited. Registered in Scotland, Number 2116. Registered Office: Pitheavlis, Perth, PH2 0NH. Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Firm Reference Number 202153. Aviva Health UK Limited Head Office: Chilworth House, Hampshire Corporate Park, Templars Way, Eastleigh, Hampshire, SO53 3RY.

aviva.co.uk/health

Useful contacts

Customer service helpline

0800 158 33388:00am - 8:00pm Monday to Friday 8:00am - 1:00pm Saturday


Scheme number: 980033

24 hour stress counselling helpline

To talk to an experienced counsellor, phone

0800 158 3349This benefit is available for members aged 16 and over.

This brochure is also available in braille, large print and audio format.

If required, please contact the customer service helpline to request a version in a format more suitable for you.

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