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Child Health Essentials - Terms and conditions

You can choose to have the policy documents and terms and conditions emailed to you when you apply.

Introduction

This policy provides you with access to expert medical advice for a child covered by the policy.

It will also provide your child with a one off payment, per child, of £5,000 (subject to benefit limits) should your child be diagnosed with cancer during the policy year.

It will also provide £25 for each day or night that any child covered under the policy spends in hospital, up to a maximum of £250 per child per policy year.

Your policy certificate provides details of the level of benefits that are available for each child covered under the policy in each policy year.

This document explains:

  • what to do if you wish to claim,
  • what is covered under the policy; and
  • what is not covered,

Throughout this document certain words are displayed in bold type. These are defined terms and have specific meanings when used in this guide. The meanings are set out in the Definitions.

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Cover and benefits

Benefit Amount Notes
Cancer cash benefit – payment on diagnosis of cancer £5,000 or £0 per child (see your policy certificate for child benefit levels) See cancer benefit term
Babylon health services Unlimited video or phone consultations with a Babylon GP Babylon health services also include:

  • text a question or photo message to a doctor
  • private prescription service
  • secure online storage for your child’s medical records
See Babylon health services benefit term
GP helpline Unlimited number of calls per policy year See GP helpline benefit term
Paediatric helpline Unlimited number of calls per policy year Support should your child:

  • be admitted to hospital,
  • be diagnosed with a serious condition, or
  • require help to gain a second opinion.
See paediatric helpline benefit term
Hospital allowance Cash allowance of £25 per night or per day up to a combined total of £250 per child per policy year See hospital allowance benefit term

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Benefit terms

Cancer cash benefit

We will pay the cash benefit as set out in your policy certificate if a child is diagnosed with cancer whilst covered by the policy, provided that the child had not been diagnosed with cancer before joining the policy. This benefit will be paid once per child, after which it will not be available to that child again regardless of whether the policy is renewed or not.

We will not pay any benefits for a child who has been diagnosed with, been treated for or suffered with cancer before joining the policy.

We may also cancel the policy in circumstances where any pre-existing cancer has not been disclosed as part of the application for the policy. Please see the section “When we may cancel the policy” for details.

Babylon health services

To access Babylon’s services you will need to download the Babylon app and create a family account. Each child must be registered alongside a parent account.

Set up details will be provided in your welcome email and are also available on the Child Health Essentials portal.

Once registered you will be able to access the full range of Babylon services on behalf of each registered child.

A parent or guardian must be present during consultations for children under 16 years of age.

The services available are:

GP consultations

Each video consultation is designed to last 10 minutes. If you require more time you will need to book further sessions.

The Babylon health service GP can refer your child to a private specialist for treatment. If you decide to follow this advice and your child undergoes treatment privately you will have to pay the cost of that treatment yourself.

Medical records storage

This enables you to store your child’s medical records securely for you to access. This data is not stored on your phone - all personal health data, medical information and diagnostic information is encrypted and stored on military grade secure servers in the UK . You pick your own personal password that will give you access to your child’s records. The system has an automatic log out function, no records are stored on the phone itself, so your data is protected. No medical or personal information will be shared with us.

Prescription service

Babylon enables you to receive e-prescriptions which can be sent to you or directly to your chosen pharmacy following a consultation with a Babylon GP. This will be a private prescription, and you will have to pay for the cost of the prescribed medicine, drugs or dressings yourself. The prescribed medicine, drugs or dressings may have been available from the NHS free of charge.

Babylon are solely responsible for any advice provided. We are not responsible for that advice or for the consequences of following that advice in respect of a child or any other person.

Call charges are always the responsibility of the caller.

Babylon’s services are available between 8 am and 8 pm Monday to Saturday, (excluding Bank Holidays) and 4 pm to 8 pm on Sundays.

We will not be responsible for any failure in the provision of the Babylon service if this is due to circumstances beyond the reasonable control of us or any of our service providers.

If you experience difficulty downloading or using the babylon health app please contact support@babylonhealth.com or call 0330 223 1008.

If you cancel your Child Health Essentials policy your access to the Babylon service will also cease. If you remove a child from your Child Health Essentials policy, the child will not be eligible for cover under the Babylon services.

GP helpline

The GP helpline offers consultations over the phone to discuss your child’s symptoms. It is intended to deal with one call per child, about one set of symptoms, and consultations typically last up to 15 minutes. The consultation may involve a longer call or more than one call but that decision will be at the discretion of the GP.

The GP helpline service is open 24 hours a day, but it may be busier at some times more than others. It is not an emergency service.

You can use the GP helpline on behalf of your child, subject to the patient confidentiality requirements of the GP or service provider. By using the GP helpline, you agree that the GP or service provider may share details of the consultation with us for the purposes of us monitoring the general quality of their service standards.

Any advice provided by the GP helpline is the responsibility of the GP helpline provider. We are not responsible for any consequences associated with relying on advice provided by the GP helpline.

We will also not be responsible for any failure to provide the GP helpline if it is due to circumstances beyond the reasonable control of us or any of our service providers.

Call charges are always the responsibility of the caller.

Paediatric helpline

If your child needs to be admitted to hospital, our helpline service provided by Red Arc is available to provide you with access to a personal nurse adviser who can offer tailored support and advice to meet your particular circumstances. These services may include practical advice, provision of additional information or a series of phone calls from a specialist nurse.

You can also call this helpline if your child is diagnosed with a serious illness. You will again be provided with access to your own personal nurse adviser, who will be able to provide support, information and guidance.

The paediatric helpline service also offers you access to a second medical opinion from a medical professional within the NHS or the UK private sector to help you with questions around your child’s diagnosis. Your personal nurse adviser will be able to help you understand what the results mean for you.

If you choose to use a private specialist to provide a second opinion you will have to pay the cost yourself. A second opinion provided by an NHS specialist or GP will normally be free of charge. You will also have to pay any additional costs, such as travel expenses and private treatment costs.

The paediatric helpline is open from 9 am to 5 pm Monday to Friday. Call charges are the responsibility of the caller. Any advice provided by the paediatric helpline is the responsibility of the paediatric helpline provider. We are not responsible for any consequences associated with relying on advice provided by the paediatric helpline

Hospital allowance

If your child is admitted to hospital we will pay £25 for each night that they are admitted as an in-patient, or for each day that they are admitted as a day-patient, up to a maximum of £250 per child per policy year.

We will not pay the hospital allowance benefit for any admission that started or was planned before your child was covered by the policy, or, if your child’s admission is:

  • for respite care, rehabilitation or domestic reasons
  • for psychiatric or mental illness
  • related to addictions or substance abuse
  • to an accident and emergency department, or
  • for cosmetic or reconstructive surgery (unless that cosmetic or reconstructive surgery immediately follows an accident or treatment for cancer, and the accident or cancer treatment took place when the child was covered by the policy.)

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How to claim

All claims must be made via the Child Health Essentials portal.

We pay all claims in sterling to the bank account from which your premiums are paid.

To make a claim for the cancer cash benefit

You will need to provide us with:

  • the child’s diagnosis
  • the date of diagnosis
  • the GP’s referral letter for specialist investigation into your child’s symptoms
  • a letter from the specialist confirming your child has been diagnosed with cancer

To make a claim for the hospital allowance

If you are making a claim under the hospital allowance benefit, you will need to tell us:

  • the date of admittance
  • the number of days/nights admittance
  • the date of discharge

You will also need to attach an electronic copy of the hospital’s discharge summary.

When we receive this information we will review the claim, and if eligible for payment, we will let you know and pay the benefit into the bank account from which premiums are paid.

For calls to the GP or paediatric helplines, simply call the number listed on your Child Health Essentials portal, and provide your policy number.

To use Babylon simply download the app as instructed in your welcome email, or follow the instructions on the Child Health Essentials portal and register each child.

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Conditions

Who can be a policyholder?

The policyholder must be a parent, grandparent or person who has parental responsibility for the child/children named on the policy certificate.

All policyholders and children must be resident in the UK for tax purposes.

Is there an age limit for children covered on the policy?

Children can be covered up to the age of 18. Renewal terms will not be offered for any child who reaches their 18th birthday during the policy year. If the child is the only child covered on the policy, the policy will be cancelled at the next renewal date.

Adding children

You can add a newborn child to the policy if you apply to us through the Child Health Essentials portal within three months of the child’s birth.

Any other children can only be added at the renewal of your policy, via the Child Health Essentials portal.

Adding a child will increase your premiums. We will let you know what the increase will be before starting their cover.

Policy duration and premiums

The policy lasts for one year. We will charge a premium for each child covered on the policy. If you add a newborn child to the policy at any time other than renewal, we will charge a pro-rata premium for that child for their first year of cover.

The financial statement in your policy certificate shows how much must be paid and when. We will let you know if any changes you make to the policy will result in the premium changing. We will collect premiums in advance of the date they are due. We will collect any premiums due unless you tell us to cancel the policy in time for us to stop collecting the payment. We do not pay any claims if premiums are not paid to date.

If you pay monthly, each monthly premium payment is for one month’s cover. If you pay annually, each annual premium payment is for one year’s cover. If you wish to change the way you pay the premium (for example from monthly to annually), you can do this at the renewal date. If there are no changes to the policy during the policy year, any change to your premium will only take effect from the renewal date.

A child can be removed from the policy at any time and we will adjust the premium to reflect the change, or, if the child was the only child covered on the policy, the policy will be cancelled.

Renewing the policy

The policy lasts for one year. If we still offer Child Health Essentials at the end of your policy year we will automatically renew the policy unless you tell us that you do not wish to do so.

We will give you reasonable advance notice of when the policy is due to renew to give you time to decide whether you wish the automatic renewal of your policy to go ahead.

The terms and conditions of the policy that is offered at the renewal date may be different to the terms and conditions of this policy. If the terms of the policy available at renewal are different to the terms of this policy then we will let you know before we renew it for you. If you do not want to renew the policy on the proposed terms then you must tell us via the Child Health Essentials portal.

The cancer cash benefit of £5,000 provided to children under the proposed policy offered at renewal, will be reduced to £0 for future policy years if the cancer cash benefit is claimed for that child. Details of the level of cover available under the proposed new policy at renewal will be shown on the policy certificate included with your renewal documentation.

We reserve the right not to offer the Child Health Essentials product at the renewal date. If this happens, we will contact you.

Cancelling the policy

When you may cancel the policy

The cooling off period

You may cancel the policy for any reason within 14 days of the policy start date (this is called the ‘cooling off period’). Provided no claims have been made during the cooling off period, we will refund any premium already paid during that time.

After the cooling off period

You may cancel the policy at any time after the cooling off period. We will not refund any monthly premiums that have been paid for cover, but if you paid an annual premium then we will refund the proportion of the premium that represents what has been paid for the time from the cancellation date to the end of the policy year.

When we may cancel the policy

We may cancel the policy and/or terminate a child’s cover if you have:

  • misled us, for example telling us incorrect information or not telling us something that we have asked for,
  • defrauded or attempted to defraud us,
  • agreed to any attempt by someone else to defraud us, or
  • not acted openly and honestly in your dealings with us

If we cancel the policy for any of these reasons then:

  • we may backdate the cancellation, which means that we may not pay claims;
  • we will notify the policyholder by email;
  • we may not refund any premiums paid; and
  • this will end the cover of the policyholder and any children listed on the policy certificate.

If any premium is not paid the policy will be cancelled immediately. If any overdue premiums are paid within 45 days of the due date, and there are no claims pending, we will reinstate the policy.

We will not cancel the policy because of eligible claims made on behalf of any child.

If the policyholder dies

We will not automatically cancel the policy if the policyholder dies. The policy may transfer to another close relative of the child, subject to their agreement to continue the policy and accept its terms and conditions.

Law

This policy is governed by English law and will be subject to the exclusive jurisdiction of the courts of England and Wales. If we decide to waive any term or condition of this policy, we may still rely on that term or condition at a later time.

Third party rights

This policy does not give any rights to any person other than the policyholder and us. No other person will have any rights to rely on any terms under the policy.

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Definitions

Cancer

A malignant tumour, tissues or cells, characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue.

Child/children

A

  • child
  • grandchild, or
  • child for whom the policyholder has parental responsibility

who is named as an insured child in the policy certificate.

Close relative

A child’s

  • parent or step-parent
  • grandparent or step-grandparent
  • brother, sister, brother-in-law or sister-in-law (aged 18 or over)
  • step-brother or step-sister (aged 18 or over)

or, another person with parental responsibility for the child.

Day-patient

A child who is admitted to a hospital or day-patient unit because they need a period of medically supervised recovery but does not occupy a bed overnight.

Financial statement

The statement showing the premium payable and benefits available for each child included on the policy.

GP

A general medical practitioner included in the GP Register kept by the General Medical Council.

Hospital

A private or NHS hospital in the UK which is registered in accordance with United Kingdom legislation.

In-patient

A child who is admitted to hospital and who occupies a bed overnight or longer, for medical reasons.

Policy

Our contract of insurance with the policyholder providing the cover as detailed in this terms and conditions document. The application and policy certificate certificate form part of the contract and must be read together with this terms and conditions document.

Policy certificate

The certificate giving details of:

  • the policyholder, and
  • the insured child/children, and
  • the level of cancer cash benefit available under the policy.

Policyholder

The person named as policyholder in the policy certificate.

Policy year

The period of time from the date the policy began until the day before the first renewal date or, if the policy has been renewed, the period from the most recent renewal date until the day before the next renewal date.

UK

The United Kingdom of Great Britain and Northern Ireland.

We/our/us

Aviva Health UK Limited who administers your policy on behalf of Aviva Insurance Limited, who underwrites and provides your contract of insurance.

You/Your

The person named as policyholder in the policy certificate.

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Further information

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 are satisfied. However, if you ever feel we have fallen short of this standard and you have 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 015 1024

E-mail: hccomp@aviva.com.

We have every reason to believe that you will be totally satisfied with your Aviva policy and with our service. It is very rare that matters cannot be resolved amicably. However, if you are still unhappy with the outcome after we have investigated it for you and you feel that there is additional information that should be considered, you should let us have that information as soon as possible so that we can review it. If you disagree with our response, or if we have not replied within eight weeks, you may be able to take your case to the Financial Ombudsman Service for them to investigate. Their contact details are:

The Financial Ombudsman Service
Exchange Tower
London
E14 9SR

Telephone: 0300 123 9123

E-mail: complaint.info@financialombudsman.org.uk.

Website www.financial-ombudsman.org.uk

Please note that the Financial Ombudsman Service will only consider your complaint if you have given us the opportunity to resolve the matter first. Making a complaint to the Ombudsman will not affect your legal rights.

The Financial Services Compensation Scheme (FSCS)

We are covered by the FSCS. You may be entitled to compensation from the scheme if we cannot meet our obligations. This depends on the type of business and the circumstances of the claim. Where you are entitled to claim, insurance advising and arranging is covered for 90% of the claim, with no upper limit.

Further information about compensation scheme arrangements is available from:

Financial Services Compensation Scheme
10th Floor
Beaufort House
15 St Botolph Street
London
EC3A 7QU

Website www.fscs.org.uk

Telephone: 0800 678 1100 or 020 7741 4100

Language

All documents or letters relating to this policy will be written in English.

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Aviva UK Digital Limited introduces to Aviva Health UK Limited for health essentials insurance. Aviva UK Digital Limited is registered in England No. 09766150. Registered office: St Helen’s, 1 Undershaft, London EC3P 3DQ. Firm Reference Number 728985. Aviva Health UK Limited is registered in England Number 2464270. Registered Office 8 Surrey Street Norwich NR1 3NG. Firm Reference Number 308139. Both companies are authorised and regulated by the Financial Conduct Authority.

This insurance is underwritten by Aviva Insurance Limited. Registered in Scotland, No. 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.

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