In these terms and conditions “Aviva”, “we”, “us” and “our” shall mean Aviva Health UK Limited. References in these terms and conditions to “you” and “your” shall mean the party to these terms other than Aviva.
Please fully read the terms outlined below and complete all applicable parts of the registration form. Your registration will be reviewed by the Specialist Registration team and if you are successful you will be notified via email. It is therefore essential that a valid email address is supplied by you.
Please note that you will also need to refer to our:
- Provider guide
- Published fee schedule
- Any appendices relevant to your speciality
All of which shall form part of these terms and conditions.
AVIVA REGISTERED PROVIDER STATUS
By completing the Aviva application form you will be deemed to have accepted these terms and conditions.
Neither the accessing of this registration document by you, the submission of any response by you, nor the evaluation of that response by us shall, in any way, commit Aviva to award to you any recognition for the provision of services by you or to enter into discussions with you regarding the possibility of such recognition.
In particular, but without limitation, it should be noted by you that Aviva may, in its absolute discretion without giving reasons:
- Reject any incomplete or completed registration that does not conform to instructions and specifications herein.
- Discuss, modify or clarify the terms of this registration form with you at a later date.
Please note that an incomplete application, or an application without supporting documentation will not be accepted and the request for recognition as an approved provider will be declined. Once you have completed the application form and have received email confirmation from Aviva, you will become an Aviva registered provider allowing you to provide healthcare services to Aviva Health customers.
These terms and conditions and application form are issued on the understanding that Aviva will not be liable for any costs incurred by you in their preparation. You warrant that the content of your response is and will remain true and accurate in all material respects and that you will notify Aviva in writing of any material change to the information provided.
We are under no obligation to pay you unless you are an Aviva recognised provider.
PRE-AUTHORISATION, FEES AND BILLING
The private health cover available to patients varies according to their policy type with us. In all cases you are strongly advised to ensure that patients have received prior authorisation from us before proceeding with any treatment or investigation. You must make all efforts to ensure the patient you are treating is eligible for treatment prior to treatment taking place.
Out, day and in-patient treatment must be conducted at an Aviva recognised facility and must be pre-authorised.
Our claims team are happy to discuss eligibility of planned treatment, they can be contacted on 0800 158 3333.
You agree to charge in accordance with our published fee schedule. A copy of our fee schedule can be found on our website www.aviva.co.uk/pmifees. We strongly advise that you regularly check this link for any amendments.
You agree to charge appropriate consultation fees proportionate to the level of care and investigation for each patient, and only up to the maximum stated in the fee schedule. You agree to provide sufficient follow-up consultations in line with each patient’s needs and the treatment performed and as expected for each procedure.
Developments in medical practice mean that on occasion you may wish to perform procedures that are not listed in our published fee schedule. In these situations we ask you to contact our Hospital and Consultant Management Team on either 023 80 354609 or email@example.com for advice, prior to the treatment being performed and a minimum of 7 working days prior to treatment.
You agree to promptly provide such information as reasonable required by us from time to time e.g. full anaesthetic and theatre records when requested. Payment may be delayed or withheld if not received.
You are required to bill Aviva electronically via Healthcode. For more information about electronic billing please contact Healthcode on 01784 263150 or visit www.ebilling.healthcode.co.uk.
You agree to invoice us only for eligible treatment, carried out by you.
It is important that you submit invoices promptly as invoices submitted after a period of 6 (six) months from the date of treatment will be rejected. If this happens, you agree not to contact the patient for payment.
In those instances where our patient has a policy excess, we will advise you in the remittance advice that a policy excess has been applied. In these circumstances, patients will be responsible for payment of the excess and you will need to obtain this amount from them directly. However you must not charge more than the applicable excess charges.
CHARGING YOUR PATIENTS
Reimbursement for treatment for Aviva patients will be up to the maxima stated in our Fee Schedule. By agreeing to adhere to our fees you agree not to charge additional payments for that treatment or procedure from the patient. Should you wish to charge above the Aviva Fee Schedule for any procedure or treatment, please advise us as it is important that our customers are advised in advance of any likely shortfall. Please also note, that if a customer is unwilling to accept an additional short-fall, we will advise them of alternative Consultants who do adhere to Aviva fees.
If you are charging patients for treatments that are not covered by their policy, you agree that you will:
- inform the Patient in advance of treatment they are responsible for any treatment not covered by us; and
- inform the Patient in advance of the likely cost of the treatment; and
- obtain the Patient’s consent to pay personally for the costs we do not cover.
In the event that a more complex case warrants an uplift in our normal fee due to additional clinical complexity, you agree to proceed with the planned procedure and provide appropriate post-operative documentation to allow us to calculate an appropriate uplift.
You agree to bill electronically.
Where the procedure(s) performed is exceptionally complex, out of the ordinary, or not listed in our published Fee Schedule, please contact the Hospital and Consultant Management Team on 023 8035 4609 or firstname.lastname@example.org prior to surgery being carried out (if possible), or immediately following.
You agree to promptly provide such information as reasonable required by us from time to time e.g. full anaesthetic and theatre records when requested.
Payment will be made monthly in accordance with these terms and conditions by BACS only to the bank account that you have nominated to us in your Application on the Private Practice Register Form or to a Bank Account advised to us via the automated banking system following a change in bank details. Each payment will be accompanied with an e-remittance advice available through Healthcode, detailing the following:
- Patient name
- Provider invoice number
- Patient policy number
- Invoice amount submitted
- Patient liability (as a result of patient policy excess)
- Total amount paid
In the event a policy excess applies your patient will be made aware of the amount to pay you.
In exceptional circumstances you may need to contact us in relation to unpaid invoiced payments. We ask that you do not follow up on invoices until 45 days from invoice date.
QUALITY AND SERVICE STANDARDS
These terms and conditions are made on the understanding that you will seek to provide each patient with a high quality of service and always in accordance with good clinical practice. You warrant that at all times you are:
- appropriately experienced, qualified, competent, trained and have all appropriate qualifications to perform the treatment and services; and
- in compliance with applicable law and regulatory requirements, any rules, regulation, guidance, codes of practice of your regulatory body.
- Agree to advise Aviva of any change to practising privileges at any hospital/facility , clinical qualification and regulation through the Private Practice Register
- Aviva will advise you within 5 working days of any change to your registration status
Where clinically appropriate, you agree to provide treatment to Patients at hospitals or other appropriate facilities recognised under the Patient’s policy and to ensure that any referrals to other consultants are made to Aviva recognised consultants who are recognised to provide treatment and who charge within Aviva’s schedule of procedures.
Further to customer feedback and in order to minimise inconvenience for Patients, you agree to use reasonable endeavours to: (1) ensure that any anaesthetist providing services to Patients in conjunction with treatment you are providing have agreed to charge within the amounts of any limits of cover out Patients have; and (2) inform the Patient prior to treatment by you where an anaesthetist has been engaged who has not agreed to this.
Where clinically appropriate, you will ensure that patients are given the full details or, and can make an informed choice about, their option to receive care in a home setting. You agree to promote referrals to Aviva recognised providers wherever clinically appropriate.
Aviva policy terms and conditions may alter from time to time and recognition and use of hospital and clinic facilities alters depending on the customer’s terms and conditions. Before making any on-ward referral to either another Specialist, or facility, please ensure that the member’s claim is fully agreed and the proposed providers fully recognised by Aviva.
You agree to comply with the clinical standards relevant to your profession including requirements set by the Care Quality Commission if applicable. Aviva may refuse to fund treatment that has been provided outside of any current guidelines.
You agree to hold professional indemnity insurance from an established organisation. You agree to provide evidence of this promptly on request by Aviva.
You must ensure that you have evidence of current and unrestricted professional registration (i.e. GMC, GDC, HCPC) and UK medical malpractice indemnity (MDU/MDDUS equivalent) commensurate with your field of practice. It is your responsibility to provide evidence of such annual renewals to Aviva promptly on request.
You must notify us immediately if there is:
- any change to the information you have provided or confirmed in this application form
- any change to your GMC (or other recognised governing body) Registration (this includes conditional registration or any investigations);
- any legal or threatened action against you in connection with your profession;
- any criminal convictions;
- any suspension or dismissal from the NHS; or
- any change of practising privileges at an independent hospital/facility.
FRAUD AND MISREPRESENTATION
We act in good faith on the basis of information that patients and providers give to us. We take a very serious view of fraud or misrepresentation in any claim. As a matter of policy we will investigate fully any incidence of suspected fraud or misrepresentation whether by patients or providers of healthcare. Inaccurate billing is a matter of serious concern across the insurance industry and Aviva work closely with other insurers to address such issues and it would be prudent of you to ensure appropriate billing is reflected across your practice.
In addition, we reserve the right to withdraw our recognition from you if you submit fraudulent claims or misrepresent the circumstances of a claim so as to obtain or facilitate benefit that would not otherwise be eligible under the terms of our patients’ policy.
REQUEST FOR INFORMATION
In cases that require updates or where we have requested further information we ask that responses are prompt (within 72 hours) and in writing. This is to ensure cover is in place for on-going treatment.
ROOMS AND FACILITIES
As above, independent clinics and, or treatment facilities, rented rooms or otherwise allocated consultancy rooms will only be registered if they have attained full and current registration compliance with CQC and on completion and assessment of Aviva’s Clinic Recognition procedures, demonstrating we are satisfied all relevant policies, procedures and processes evidence Aviva’s clinical governance requirements in full. These may include (but not exclusive to): lone worker and chaperone policies, emergency procedures, equipment purchase and calibration as per manufacture guidelines, decontamination and infection prevention and control, consumables and drugs purchase invoicing and cold store chain, and evidence of appropriate skills and training of staff, e.g. CPR, anaphylaxis and professional revalidation.
SUPPLY OF EQUIPMENT, CONSUMABLES & DRUGS ETC.
You must not supply equipment, consumables and, or drugs directly or indirectly to our customers. Aviva specifies the purchase of these goods and services are permitted only for hospitals and registered facilities subject to full and current registration compliance with the appropriate governing body, currently the Care Quality Commission (CQC) and all such goods are for direct use within these facilities only. On request, governance assurances from these registered facilities will be provided to Aviva audit full compliances with health and safety risk management processes including (but not exclusive to):
- Purchasing, handling and storing of drugs
- Purchasing, maintenance, calibration and decontamination of equipment
- Purchasing, handling and storage of consumables.
You shall grant to Aviva and any of its group companies, its employees, any governmental or regulatory body, auditors (whether internal or external), contractors and agents, the right, on reasonable notice to:
- access any of your premises from where any of the services are managed or administered;
- interview your personnel; and/or
- copy the relevant records, as appropriate.
In order to:
- investigate or identify suspected fraud or material accounting mistakes, Aviva shall be under no obligation to inform you of the objective of the investigation;
- fulfil any request by any governmental or regulatory body in the course of carrying out its regulatory functions;
- verify the accuracy of the fees and any other amounts payable or receivable by Aviva.
- investigate any concerns raised with Aviva regarding the Provider’s service;
- audit your compliance with its obligations under these terms and conditions.
All submitted invoices will be subject to periodic audit. Where necessary a refund shall be paid to Aviva immediately.
You hereby give us your consent to audit and obtain information from Healthcode (or our replacement provider) about you.
If there is any disagreement between us, in the first instance, you agree to discuss the dispute with the Aviva Supply Chain Operations team on 02380 354609 or to raise your concerns by sending an email to email@example.com. If you are unable to resolve your dispute within 10 business days of it being referred to the Aviva Provider Management team, you may refer it to the Head of Supply Chain Management so that (s)he may address the dispute directly or through another authorised Aviva colleague such as the Clinical Director.
AVIVA’S RIGHT TO TERMINATE
Aviva reserves the right, at any time, without reason, to withdraw your recognition as an Aviva recognised provider.
Aviva reserves the right to change the registration procedure or terminate discussions without prior notice and at any time prior to the formation of any agreement relating to the process.
Where we feel that there are issues including regarding the safety and treatment of patients, indications of fraud, or failure to adhere to any contract terms, we may end your Aviva Health recognition immediately on the provision of notice, or suspend it, or apply additional conditions if we feel that it is appropriate. In any other case we shall provide 30 days notice of any change to, or the end of, recognition (which may be given at our discretion). Please note that when your status as an Aviva recognised provider ends, or is suspended, you will cease to be eligible for funding from us for any treatment of Patients. From the date that your Aviva recognition ends, this agreement will also terminate.
YOUR RIGHT TO TERMINATE
You may request to end your registered provider status with us at any time by notifying us in writing on 30 days’ notice that you no longer wish to be recognised by Aviva.
TREATMENT OF PATIENTS POST TERMINATION
If a Patient is receiving treatment on the date this agreement ends or is suspended, you agree you will, at our election, either:
- notify us and stop treating the Patient immediately and arrange for the safe transfer of the Patient to another suitable Aviva recognised provider of their choice. If the former, you shall be entitled to invoice us for that treatment on the basis of these terms. Or
- continue to provide such treatment as in the best interests of the patient, until the earlier of completion of the Patient’s treatment (which shall be up to 3 months of treatment or longer if required by the Patient) or the Patient’s safe transfer to another Aviva recognised provider of their choice;
ENDING YOUR REGISTERED PROVIDER STATUS
QUESTIONS PRIOR TO REGISTRATION SUBMISSION
You are able to ask questions to Aviva prior to submitting the registration document and are advised that all communication with Aviva in respect of this registration must only be directed to the contact(s) below and to no one else, unless agreed in writing by the contact below first:
Contact: Specialist Registration Team
All requests for registration must be submitted through the PPR on the following link.
AMENDMENTS TO EMPLOYMENT OR PERSONAL DETAILS
All amendments to your details must be submitted through the PPR through the following link www.theppr.org.uk
You must inform us if any restrictions or warnings are made against your practice. Failure to do so may result in the removal of your registration with Aviva.
AMENDMENTS TO TERMS AND CONDITIONS
Aviva reserves the right to amend, add to or remove from these terms and conditions at anytime. We will endeavour to give you notice of any changes that are materially adverse to you, but we strongly advise that you regularly check these terms and conditions for any changes. If you feel you are unhappy with these changes, then you may ask us to withdraw your Aviva registered provider status as set out in section 6 above.
None of the Intellectual Property Rights in Aviva’s trademarks and brands shall be used by you for any purpose without Aviva’s prior written consent. Both of us acknowledges that all intellectual property rights owned by the other and its group shall remain with and vest in the other or its affiliates.
Nothing in these terms and conditions shall be deemed to constitute a legal partnership or joint venture between us nor constitute of us as the agent of the other for any purpose. These terms and conditions do not create nor shall it in any circumstances be taken as having created an exclusive relationship between us.
CORPORATE SOCIAL RESPONSIBILITY
You shall ensure that in connection with the conduct of activities pursuant to these terms and conditions:
- it fully complies with or is in the process of complying with the international workplace health and safety standard SA8000, published by Social Accountability International and national health and safety standards;
- it has in place a diversity strategy which it applies to all its employees within all its organisations and that it complies with all current equality and anti-discrimination laws and will not discriminate or permit discrimination against any individual or group within its organisation on the grounds of protected characteristics including but not limited to disability, age, sex, sexual orientation, race, colour, national origin or religion in any manner;
- it complies with the provisions of the International Labour Organisations core standards and the provisions of the United Nations Universal Declaration of Human Rights in respect to both its employees and its Service Providers;
- both you and other clinical staff demonstrate a set of environmental standards with a commitment to environmentally sustainable working practices and materials, and in addition to complying with all relevant environmental standards maintained by the International Standards Organisation and other specific national standards;
- any third parties, agents and contractors employed by you in respect of these terms and conditions will where possible comply with the ethical standards set out within the same.
ANTI-BRIBERY AND ANTI-CORRUPTION COMPLIANCE
- comply with all Applicable Laws and Regulatory Requirements, statutes, regulations, and codes relating to anti-bribery and anti-corruption including but not limited to the Bribery Act 2010 (“Relevant Requirements”);
- not engage in any activity, practice or conduct which would constitute an offence under sections 1, 2 or 6 of the Bribery Act 2010 if such activity, practice or conduct had been carried out in the UK;
- have and shall maintain in place throughout the term of these terms and conditions your own policies and procedures, including but not limited to adequate procedures under the Bribery Act 2010, to ensure compliance with the relevant requirements and this clause, and will enforce them where appropriate;
- promptly report to the us any request or demand made to you for any undue financial or other advantage of any kind received in connection with the performance of these terms and conditions and in this Clause a reference to a you shall be deemed to include a reference to that your officers, employees and associates
- immediately notify us (in writing) if a foreign public official becomes your officer or employee or acquires a direct or indirect interest in you. Both of us warrant that we have no foreign public officials as officers, employees or direct or indirect owners at the date of these terms and conditions.
These terms and conditions, together with the documents referred to in it, constitute the entire agreement and understanding between us in respect of the matters dealt with in them and supersedes any previous agreement between us relating to such matters.
Both of us acknowledges and agrees that in entering into there terms and conditions, and the documents referred to in it, it does not rely on, and shall have no remedy in respect of, any statement, representation, warranty or understanding (whether negligently or innocently made) of any person (whether party to these terms and conditions or not) other than as expressly set out in these terms and conditions as a warranty. Nothing in this section limits or excludes any liability for fraud or fraudulent misrepresentations.
THIRD PARTY RIGHTS
A person who is not a party to these terms and conditions shall have no rights pursuant to the Contracts (Rights of Third Parties Act) 1999 (“Act”) to enforce any terms under these terms and conditions. Any right or remedy of a third party which exists, or is available apart from the Act, shall not be affected. Both of us may amend or rescind these terms and conditions without reference to, or the consent of, any third party person who is not a party to these terms and conditions.
These terms and conditions, any non contractual obligations arising out of or in connection with these terms and conditions and the relationship between the Parties, shall be governed by and interpreted in accordance with the laws of England and Wales.
Each Party irrevocably submits to the exclusive jurisdiction of the courts of England and Wales over any claim or matter arising under or in connection with these terms and conditions.