Healthier Solutions explained
Healthier Solutions is built around a core set of benefits that your clients can then choose to add to using our upgrade options or reduce using our cost containment options, depending on where they feel they need the cover. If upgrade options are chosen, the premium will be increased. If a cost containment option is included the premium will be reduced.
The cover and the options are explained below. The information is not exhaustive and is not intended as a policy summary. Please refer to the Healthier Solutions Policy Wording for the full details of what is and what is not covered.
- Core cover
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Our core cover includes in-patient or day-patient treatment of acute conditions at a hospital on the selected hospital list (see hospital list options below). This will include hospital charges, specialists’ fees and diagnostic tests.
Out-patient treatment is also covered for acute conditions and will also include specialists’ fees and diagnostic tests.
Core cover also includes cover for nursing at home following eligible in-patient or day-patient treatment, private ambulance, emergency overseas cover and an NHS cash benefit.
- Other treatment and therapies
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Upgrade option adding GP referred physiotherapy, osteopathy, chiropractic and acupuncture (up to ten sessions in combined total) and GP minor surgery (up to £70 per procedure payable to the GP).
- Dental and optical
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Upgrade option adding additional benefit towards routine dental expenses, accidental dental injuries and optical expenses. A £50 excess applies separately to routine dental treatment and optical benefit. The excess applies once per person per policy year.
- Psychiatric cover
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Upgrade option adding cover for both in-patient and day-patient treatment for up to 28 days if your client is diagnosed with a psychiatric condition such as clinical depression.
- Protected no claim discount NCD
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We have a 15 point NCD scale. For each year in which your client remains claim free, their discount will increase by one level, up to a maximum of 75%. For any year in which they make a new claim, their policy discount will be reduced by three levels at their next renewal.
If your client chooses to protect their NCD, then making a new claim will not result in their discount being reduced at renewal. Instead they will stay at their current level. Once this protection has been used it is lost but can be reinstated if they are claim free for two years.
No claim discount scale
Level 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 % discount off level 0 premium 0 8 16 24 31 38 44 50 56 60 63 66 69 72 75 - Reduced out-patient cover
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Cost containment option, reducing out-patient cover. This option provides cover in full for CT, MRI, PET scans and radiotherapy/chemotherapy. Your clients can choose either a £500 or £1,000 limit per person per policy year for specialist consultations, diagnostic tests, specialist referred treatment by a physiotherapist, chiropractor, osteopath and psychiatric treatment as an out-patient. It excludes some treatments from the core cover these are complications of pregnancy and childbirth, surgical procedures on the teeth and emergency overseas cover. This cost-saving option is ideal if your client is happy to use the NHS or pay the relatively low cost for any consultations and out-patient treatment that they need over their benefit limit.
- Six week option
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Cost containment option where eligible in-patient or day-patient treatment and NHS cash benefit will only be available if treatment is not available as an NHS patient within six weeks.
- Add an excess
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Cost containment option where a claims excess is applied to the policy. Policyholders can choose £100, £200, £500, £1,000, £3,000 or £5,000. This means each person covered by the policy has to pay that fixed amount towards the cost of their annual claims bill. This excess applies once per person per policy year.
- Hospital lists
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Your client must choose which hospital list they wish to have on their policy. This will be a list of hospitals that they are eligible to receive treatment in.
Healthier Solutions core cover includes the Key hospital list which provides access to a wide range of UK private hospitals.
To reduce your client’s premiums they can restrict the list of hospitals by utilising the Trust hospital list, which uses mostly private patient units of NHS Trust and Partnership hospitals. To have this option your client must live within 30 miles of a hospital that appears on the list. Choosing this option will reduce the premiums by 25%, this is applied before any other premium increases or reductions.
If your clients live in Scotland or Northern Ireland they can choose the Signature hospital list, which has been designed specifically for residents in Scotland and Northern Ireland. Choosing this option will reduce the premiums by 25%, this is applied before any other premium increases or reductions.
Alternatively your clients may wish to extend the list of hospitals they can use by choosing the Extended hospital list. Choosing this option increases the premium by 45%, this is applied before any other premium increases or reductions.
- Premiums
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Healthier Solutions premiums are calculated from our base rates which depend on the individual’s age, gender and the area of the country in which they live (from these base rates the selected option increase/reduction is applied).
WC00368 04/2011