THE MEDICAL SAVER PLAN PRIVATE MEDICAL COVER FOR OVERNIGHT & LONGER STAYS IN HOSPITAL
INCREASED BENEFITS . E INSU NC RA FOR 2021 A N R C U E S . N I I N .
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promotional and contractual information N promotional WHAT THE ASSOCIATIONS SAY ABOUT US
You were introduced to the Medical Saver Plan through your membership of your sponsoring association or publication. The Hospital and Medical Care Association has worked with over 1,000 well known associations to offer its plans.
GEM Motoring Assist has been arranging a wide range of top quality services for its members since 1932. For the past nine years we have been delighted to add HMCA to our list of chosen service providers and have always found working with them to be a pleasant and efficient process. Many GEM members have benefited from this long standing partnership which I hope to continue for many years to come.
Neil Worth, Chief Executive, GEM Motoring Assist
Our members have been able to take advantage of HMCA medical insurance facilities for over ten years, the longest running benefit that we have offered, which is much appreciated by them! Gordon
Gordon Rainsford, Chief Executive, English Bridge Union
HMCA has provided us with an excellent service, and have tailored several products to suit the needs of our organisation. We have found all products to be of a high quality and represent excellent value as a membership benefit. We find the entire HMCA team extremely professional, knowledgeable and helpful in their approach to business enquiries. I would not hesitate in recommending HMCA products and services to other professional bodies and organisations.
Sharon Bruty, Head of Communications, CILEx Journal
HMCA have provided a wide ranging service including medical cover to our members since 2014 at competitive prices. They are consistently both professional and friendly, we have received much positive feedback. Penny Cotton, Head of Membership, Royal Academy of Dance
2 WHY IS HMCA SO COMPETITIVE? HMCA Members was established over 40 years ago and has grown to be one of the most successful membership benefit providers in the UK. HMCA membership is also one of the most exclusive as our plans are only available to the members of trade, professional and membership groups and subscribers of select publications. Our many years of experience ensures we have a plan to suit your needs at the best possible price. Healthcare cannot be marketed like other products; it requires thoughtful planning and expert skills. Our goal is to provide the best service possible. When you call HMCA you can be assured that your call is answered in person by a member of our staff who will always be happy to help you. Whether you are making an enquiry, joining HMCA or submitting a claim, we are there for you. These are the simple reasons why the Medical Saver Plan is competitive and leads the way.
OVER
YEARS J M Blackmore PROVIDING SERVICES TO MEMBERSHIP GROUPS Association Secretary CONTENTS What the Associations Say About Us 2 Why is HMCA so Competitive? 3 Private Health Care is Peace of Mind 4 Why Choose The Medical Saver Plan? 5 Summary of Benefits 6 The Medical Saver Plan Checklist 7 Questions and Answers 8 & 9 Hospital Accommodation List 10 - 16 Description of Benefits 18 & 19 The Medical Saver Plan 20 & 21 Contractual Information The Personal Accident Cash Plan 22 Contractual Information Important Information 23 What Our Members Say 24
04/201893©2021 HMCA. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic or mechanical or photocopied, recorded or otherwise, without prior permission of HMCA. All HMCA paper products are from a sustainable source and are recyclable. 3 promotional PRIVATE HEALTH CARE IS PEACE OF MIND No matter how fit and healthy we are, it is inevitable that at some point in our lives we will fall ill and need medical care. And when illness does strike it is to the NHS that most people will turn in seeking a diagnosis, treatment and recovery.
The NHS has for some years been showing signs A private medical plan delivers prompt access to that it, too, is now not in the best of health. A hospital consultants, thus avoiding lengthy waiting growing and ageing population is putting an lists. Patients can choose from an extensive list ever-increasing strain on staff and services. A of hospitals throughout the UK. If they need to be problem exacerbated by the admitted, they will have their coronavirus pandemic. “Almost 5 million people own private room equipped with TV and telephone, and Reports of underfunding, a waiting for an appointment visiting is arranged to suit shortage of medical staff, with a hospital consultant*” patient and family. A quick, noisy and overcrowded private and convenient wards, cancelled operations service that removes many of and long waiting times will be familiar to the anxieties associated with NHS hospital stays. everyone. Furthermore, some providers have no upper age limit attached to their policies and cover can even In England, hospital waiting lists are longer than be extended to include family members. ever before, with a total waiting list of almost 5 million people.* This is the highest number since Taking control of your healthcare records began and illustrates the devastating However, those interested in taking out health impact that COVID-19 has had on the NHS. insurance should not leave it too late. As we get older our healthcare needs increase. Therefore, Quick, private and convenient as only some of the health insurance companies Understandably, these lengthy delays provide cover for pre-existing conditions, the are causing best time to invest in getting additional stress All this can be avoided private treatment for illnesses for patients, you may suffer tomorrow – is undermining by taking out today. their health and private health insurance quality of life even By acting now you can ensure further. How many people do you know your future healthcare will not be dictated by NHS whose physical health and mental bureaucracy and, just as importantly, you will be well-being has deteriorated able to benefit from the widest possible cover. from the anxiety of having to wait months for a hospital Private health insurance cannot guarantee good appointment? health, but it can ensure that when you are feeling unwell you will quickly receive the best All this can be avoided possible care, when and where you want it. The by taking out private peace of mind that comes with that knowledge health insurance. Seeing cannot be underestimated and is often the most a doctor in private important factor for people deciding to take practice used to be control of their healthcare provision and “go only for the wealthy, but private”. not anymore as the cost * The Guardian 13 May 2021 - https://www.theguardian. of private medical cover is com/society/2021/may/13/hospital-waiting-list- becoming more affordable. numbers-in-england-hit-record-high
promotional WHY CHOOSE THE MEDICAL SAVER PLAN?
• All the benefits of private medical treatment for you and your family. • VIP treatment with the specialist of your choice, at the time of your choice, at the hospital of your choice. • Any hospital on our list may be used and others with prior agreement, see pages 10-16. • Excellent benefits with substantial savings over other major plans.
These are just some of the reasons why you should consider the Medical Saver Plan as your first choice for your private health cover. When you are ill you do not want any uncertainty or inconvenience, your worries can be substantial enough without added pressures. Whilst the National Health Service has a very good system for dealing with emergencies and chronic situations, the waiting list nationwide for less urgent operations continues to grow.
Having to wait months, or even years, suffering discomfort and pain could have disastrous effects on your work and family life. By joining the Medical Saver Plan, these problems will be overcome.
5 promotional SUMMARY OF BENEFITS The maximum benefit payable for each person covered on the plan is £250,000 per year. For full details, please refer to the Description of Benefits in the contractual information at the back of this brochure.
IN-HOSPITAL TREATMENT FOR OVERNIGHT OR LONGER STAYS • Accommodation charges, ward nursing charges and ward drugs all PAID IN FULL. • A £200 a night tax-free cash benefit is available, for up to 30 nights, when NHS treatment is carried out solely as an NHS patient. This includes accident or emergency admissions. • Surgical charges for surgeons and anaesthetists combined fees, including aftercare, are dependent on the complexity of the surgery. Please refer to the Description of Benefits on pages 18 and 19. • Theatre fees, consumables, drugs and surgical dressings are dependent on the complexity of the surgery. Please refer to the Description of Benefits on pages 18 and 19. • Benefit is also payable for in-hospital treatment such as:- - Medical charges for consultant physician fees, pathology and investigations whilst in hospital. - Intensive care. - Dental care for specialist in-hospital treatment.
• OVERSEAS COVER Continuation of cover when travelling abroad on holiday or business.
• LONG-TERM ILLNESS GRANT All private health plans cover short term medical conditions which are curable. Long-term conditions which are not covered are those which are persistent or incurable. When a condition is first diagnosed as being long-term (and did not exist prior to enrolment), benefit will be provided for such diagnosis and any necessary treatment, under the terms of the contract, for one initial episode. As private health cover was never intended to replace the NHS but meant to complement the service, all subsequent treatment will be given by the NHS. HMCA does provide, however, a £1,100 long-term illness grant that can be used at the discretion of HMCA to help in the transition to NHS care.
• MATERNITY GRANT When both parents are members, HMCA will authorise payment of £900 for each birth.
• SPECIAL GUARANTEED Transfer Facility Cover can be transferred from an existing medical plan and future claims made for acute conditions originating at the time the member was participating in a previous plan, will be honoured. However, at the time of joining if you or your dependants are undergoing treatment or investigations, these are excluded unless fully disclosed and accepted by us. If you think this may apply, please contact our confidential helpline on 01423 799949 and the team will be happy to help.
• Money-Back Guarantee If not satisfied you may return the Medical Saver Plan within fourteen days for a full refund.
6 promotional THE MEDICAL SAVER PLAN CHECKLIST
You could compare the Medical Saver Plan with other plans by using this checklist.
no medical examination Overseas AND SPORTS Cover INCLUDED No medical examination is required when Cover continues when you travel abroad on you join. holiday or business and is included at no extra cost, whereas most other plans may reduce no AGE RESTRICTIONS benefits or ask for increased subscriptions, You can join at any age. or indeed offer no cover at all.
Special GUARANTEED transfer specialist fACility Freedom of Choice. Cover can be transferred from an existing plan and future claims made for acute a prompt and personal claim servicE conditions originating at the time you were is provided participating in a previous plan, will be Our UK based claims team offer a personal honoured. However, at the time of joining service and provide prompt settlement. if you or your dependants are undergoing treatment or investigations, these are NHS Hospital Cash Benefit excluded unless fully disclosed and A £ 2 0 0 a n i g h t t a x - f r e e c a s h b e n e f i t i s accepted by us. If you think this may apply, available, for up to 30 nights, if NHS please contact our confidential helpline on treatment is carried out solely as an NHS 01423 799949 and the team will be happy patient. This includes accident or emergency to help. admissions.
CONTACTING HMCA BY TELEPHONE Dental Treatment We have no automated telephone lines,. In-hospital surgical treatment is included. Calls are answered by our professional UK staff. An answerphone is in operation out of EXCESS OR DEDUCTIBLE hours. If a message is left with a telephone This is available. For more details ring number, we will get back to you. 01423 799949.
choice of countrywide hospitals LONG-TERM ILLNESS GRANT You have the choice of over 500 hospitals on After enrolment, a member receiving our list and others with prior arrangement. treatment that ceases to be short-term qualifies for a grant of up to £1,100. This INITIAL CONSULTATION benefit can be given at the discretion of You will be covered for an initial specialist’s HMCA. consultation.
7 QUESTIONS & ANSWER
Here is a list of the questions most frequently asked by members of trade and professional groups on the subject of private medical cover provided by the Medical Saver Plan. If you have any additional questions please telephone our Helpline on 01423 799949.
Q. Do you pay my surgeon or hospital directly if I Q. I’m fit and healthy, why do I need Private claim? Medical Cover? A. Yes. We are happy to pay your surgeon or hospital A. You may think you can put off taking out Private on your behalf or we can reimburse you. Medical Cover until you need to use it, but you should remember not to leave it too late. If you Q. May I choose the hospital which treats me? were to be diagnosed now, with no cover in A. Yes. There are no restrictions, you can use any place, you may well find you cannot get cover of the hospitals detailed on our comprehensive for this condition in future. list, see pages 10-16. If your preferred hospital is not listed please contact our Helpline. Q. Is the offer to join the Medical Saver Plan dependent upon my remaining a member of Q. Can you explain the benefit levels in the my sponsoring association? Description of Benefits? A. You must be a member of your sponsoring A. Charges for in-patient accommodation, ward association when joining the Medical Saver drugs and nursing charges are covered in Plan. After enrolment you become a Member full. Other benefits are based on the type of of HMCA and your discount will continue. treatment received and the complexity of any operations carried out. The complexity of all Q. Is the scope of the Medical Saver Plan wider operations is advised by the specialist carrying than many others? out your treatment. Our benefits are based on A. As well as providing comprehensive our experience of the likely costs involved and in-hospital benefits for treatment of acute we apply limits to protect against over-charging medical conditions, the Plan has a number of which would have the effect of increasing claims very important extra features which extend the costs and our members’ subscriptions. scope: l We include treatment for injuries sustained Q. Am I covered for sporting injuries? whilst playing sport. A. Yes. Benefits are payable however some l Cover continues whilst you are abroad on hazardous pursuits are excluded from the holiday or business for up to six months, at Personal Accident Benefit as described on no extra cost. page 22. Q. Are your terms similar to those in my present Q. Do you have restrictive clauses relating to the plan? NHS waiting lists? A. The benefits are summarised on page 6 entitled A. No. We do not have restrictive clauses relating “Summary of Benefits”, and the “Description to the NHS waiting lists. of Benefits” is in the contractual information on pages 18 to 19. These may differ from your Q. May I transfer from my plan to your Medical current plan. Saver Plan? A. Yes. If you are in a medical plan you can transfer to the Medical Saver Plan. Q. What is Insurance Premium Tax (IPT)? A. IPT is a tax on general insurance, for example Q. Is the HMCA discount of up to 40% off just an motor, household and medical cover, levied by introductory offer? the Government. All subscriptions quoted by A. No. This discount is applied throughout your HMCA include IPT, where applicable. membership with HMCA. 8 promotional We Are here to help
If you wish to discuss your healthcare requirements or the Medical Saver Plan, please call our helpline on 01423 799949
Q. If I transfer from another provider will I be Q. Does the Medical Saver Plan have an excess covered for pre-existing medical conditions? or deductible, such as the first £500 of a claim A. Yes, when you transfer any future claims being paid by the Member? made for acute conditions originating at the A. No. We believe that our members should time you were participating in your previous have cover from the commencement of any plan will be honoured. However, when you treatment covered under the Medical Saver join if you are undergoing treatment or Plan. However, excesses are available if you investigations these are excluded unless fully want to reduce your subscription. Please ring disclosed and accepted by us. For more details 01423 799949 for more details. telephone our helpline on 01423 799949. Q. What is the maximum age at which I may join the Medical Saver Plan or transfer from another Q. I have no existing private medical cover, can I plan? join? A. There is no age limit when joining HMCA. A. Yes, you can join and after one full year’s membership providing you have Q. What happens if I am admitted to an NHS been treatment and symptom free for hospital? 12 consecutive months, any pre-existing A. If you choose to have all your treatment solely medical condition that occurred prior to joining through the NHS,or it’s an emergency admission, us will be covered. you will receive £200 a night spent in hospital, for up to 30 nights. Of course, this is tax-free Q. Who do I speak to when I want to make a claim? cash which you keep to spend as you wish. A. Our UK based claims team who offer a personal service and provide prompt settlement. Q. Am I covered when travelling overseas? A. Yes. Cover continues when you travel abroad on holiday or business at no extra cost. 9 promotional HOSPITAL ACCOMMODATION LIST You can use any hospital on this list, over 500 are available. If the hospital you would like to use is not on our list call 01423 799942
ENGLAND BEDFORDSHIRE Chester Nuffield Hospital Grosvenor Bedford BMI Manor Hospital Crewe Leighton Hospital Bedford Bedford General Hospital Macclesfield Macclesfield District General Hospital Luton Luton & Dunstable University Hospital Macclesfield Spire Regency Hospital Runcorn Halton General Hospital Warrington Warrington Hospital
BERKSHIRE Warrington Spire Cheshire Hospital Ascot Heatherwood Hospital
Reading Circle Reading Hospital Reading Spire Dunedin Hospital CORNWALL Reading Royal Berkshire Hospital Falmouth Falmouth Hospital Reading Berkshire Independent Hospital Hayle St Michael’s Hospital Slough Wexham Park Hospital Penzance West Cornwall Hospital Slough Spire Thames Valley Hospital Truro Duchy Hospital Windsor King Edward VII Hospital Truro Royal Cornwall Hospital Windsor BMI Princess Margaret Hospital CUMBRIA BRISTOL Barrow-in-Furness Furness Hospital Bristol Spire Bristol ‘Glen’ Hospital Carlisle Cumberland Infirmary Bristol Nuffield Hospital Bristol Kendal Westmorland General Hospital Bristol Bristol Eye Hospital Whitehaven West Cumberland Hospital Bristol Frenchay Hospital Bristol Bristol Royal Infirmary DERBYSHIRE Bristol St Michael’s Hospital Buxton Buxton Hospital Bristol Southmead Hospital Derby Nuffield Hospital Derby Derby Royal Derby Hospital BUCKINGHAMSHIRE Amersham Amersham Hospital DEVON Aylesbury Stoke Mandeville Hospital Barnstaple North Devon District Hospital Gerrards Cross Chalfont & Gerrards Cross Hospital Exeter Nuffield Hospital Exeter Great Missenden BMI The Chiltern Hospital Exeter Royal Devon & Exeter Hospital High Wycombe BMI Shelburne Hospital Exmouth Exmouth Hospital High Wycombe Wycombe Hospital Ilfracombe Ilfracombe Tyrrell Hospital Milton Keynes BMI Saxon Clinic Newton Abbott Newton Abbott Hospital Milton Keynes Milton Keynes General Hospital Plymouth Derriford Hospital Princes Risborough BMI The Paddocks Clinic Plymouth Mount Gould Hospital Plymouth Nuffield Hospital Plymouth CAMBRIDGESHIRE Plymouth Royal Eye Infirmary Cambridge Addenbrookes Hospital Sidmouth Victoria Hospital Cambridge Spire Cambridge Lea Hospital Tavistock Tavistock Hospital Cambridge Nuffield Hospital Cambridge Teignmouth Teighnmouth Hospital Cambridge Royal Papworth Hospital Tiverton Tiverton & District Hospital Cambridge Cambridge Heart Clinic Torquay Mount Stuart Hospital Huntingdon Hinchingbrooke Hospital Torquay Torbay Hospital Huntingdon Cromwell Clinic Peterborough Peterborough City Hospital DORSET Peterborough Fitzwilliam Hospital Bournemouth Christchurch Hospital Wisbech North Cambridgeshire Hospital Bournemouth Nuffield Hospital Bournemouth Bournemouth Royal Bournemouth Hospital CHESHIRE Dorchester BMI Winterbourne Hospital Altrincham Althrincham General Hospital Dorchester Dorset County Hospital Cheadle BMI Alexandra Hospital Poole BMI Harbour Hospital Chester Countess of Chester Hospital Sherborne Yeatman Hospital
10 When we issue a claim form, we will send you an up to date list. If the hospital you would like to use is not on our list call 01423 799949 DURHAM Bishop Auckland Bishop Auckland Hospital Chester Le Street Chester Le Street Hospital Darlington Darlington Memorial Hospital Darlington BMI Woodlands Durham University Hospital of North Durham Hartlepool University Hospital of Hartlepool Shotley Bridge Shotley Bridge Hospital Stockton-on-Tees Nuffield Hospital Tees Stockton-on-Tees University Hospital of North Tees
ESSEX Basildon Basildon University Hospital Basildon Orwell Private Cardiothoracic Unit Brentwood Nuffield Hospital Brentwood Brentwood Spire Hartswood Hospital Buckhurst Hill Holly House Hospital Chelmsford Baddow Hospital Chelmsford Broomfield Hospital Chelmsford Springfield Hospital Clacton-on-Sea Clacton & District Hospital Colchester Oaks Hospital Colchester Essex County Hospital Colchester Colchester General Hospital Epping St Margaret’s Hospital Grays Orsett Hospital Harlow Princess Alexandra Hospital Havering Queens’ Hospital Illford King George Hospital Maldon St Peter’s Hospital Redbridge Spire London East Hospital Southend-on-Sea Southend Hospital Southend-on-Sea Spire Wellesley Hospital Southend-on-Sea BMI Southend Private Hospital
GLOUCESTERSHIRE Cheltenham Cheltenham General Hospital Cheltenham Nuffield Hospital Cheltenham Gloucester Gloucester Royal Hospital Gloucester Winfield Hospital Stroud Stroud General Hospital
HAMPSHIRE Basingstoke Basingstoke & North Hampshire Hospital Basingstoke BMI Hampshire Clinic Eastleigh Nuffield Health Wessex Hospital Havant Spire Portsmouth Hospital Lymington New Forest Hospital Portsmouth Queen Alexandra Hospital Portsmouth St Mary’s NHS Treatment Centre Southampton Spire Southampton Hospital Southampton Southampton General Hospital Southampton Princess Anne Hospital Southampton Royal South Hants Hospital Winchester Royal Hampshire County Hospital Winchester BMI Sarum Road Hospital
HEREFORDSHIRE Hereford Hereford County Hospital Hereford Nuffield Hospital Hereford
When we issue a claim form, we will send you an up to date list. If the hospital you would like to use is not on our list call 01423 799949 11
11
Spectator Magazine Reader
I wanted to advise you that the exemplary service offered by everyone I have dealt with at “ HMCA has been pivotal in my decision to renew. The knowledge, politeness and a willingness to help with each interaction is a credit to your organisation. I want to thank you all for your help and kindness since I took out my insurance with you.
HMCA Member, London, March 2021 ”
HERTFORDSHIRE LANCASHIRE Bishops Stortford Herts & Essex General Hospital Blackburn BMI Beardwood Hospital Harpenden Spire Harpenden Hospital Blackburn Royal Blackburn Hospital Hatfield One Hatfield Hospital Blackpool Spire Fylde Coast Hospital Hemel Hempstead Hemel Hempstead Hospital Blackpool Victoria Hospital Hertford Hertford County Hospital Bolton BMI Beaumont Hospital Hitchin Pinehill Hospital Bolton Royal Bolton Hospital Sawbridgeworth Rivers Hospital Burnley Burnley General Hospital St Albans St Albans City Hospital Chorley Euxton Hall Hospital Stevenage Lister Hospital Lancaster BMI Lancaster Hospital Watford Spire Bushey Hospital Ormskirk Ormskirk & District General Hospital Watford Watford General Hospital Ormskirk Renacres Hospital Welwyn Garden City Queen Elizabeth II Hospital Preston Fulwood Hall Hospital Preston Royal Preston Hospital ISLE OF WIGHT Newport St Mary’s Hospital LEICESTERSHIRE Hinckley Hinckley & District Hospital KENT Leicester Glenfield Hospital Ashford One Ashford Hospital Leicester Leicester General Hospital Ashford William Harvey Hospital Leicester Nuffield Hospital Leicester Beckenham BMI Sloane Hospital Leicester Leicester Royal Infirmary Benenden Benenden Hospital Oadby Spire Leicester Hospital Canterbury BMI Chaucer Hospital Canterbury Kent & Canterbury Hospital LINCOLNSHIRE Chatham Spire Alexandra Hospital Boston Boston West Hospital Dartford Darent Valley Hospital Boston Pilgrim Hospital Deal Victoria Hospital Grantham Grantham & District Hospital Dover Buckland Hospital Grimsby St Hugh’s Hospital Folkestone Royal Victoria Hospital Grimsby Diana Princess of Wales Hospital Gillingham Medway Maritime Hospital Lincoln BMI Lincoln Hospital Herne Bay Queen Victoria Memorial Hospital Lincoln Lincoln County Hospital Longfield BMI Fawkham Manor Hospital Louth County Hospital Maidstone Maidstone Hospital Stamford Stamford & Rutland Hospital Maidstone Maidstone KIMS Margate Queen Elizabeth the Queen Mother GREATER LONDON Hospital Ashford Ashford Hospital Margate Spencer Private Hospital Barnet Barnet Hospital Orpington BMI Chelsfield Park Hospital Carshalton St Helier Hospital Sevenoaks Sevenoaks Hospital Enfield Chase Farm Hospital Sidcup Queen Mary’s Hospital Enfield BMI Kings Oak Hospital Tunbridge Wells Tunbridge Wells Hospital Enfield BMI The Cavell Hospital Tunbridge Wells Nuffield Hospital Tunbridge Wells Harefield Harefield Hospital Tunbridge Wells Spire Tunbridge Wells Hospital Harrow Northwick Park Hospital Harrow BMI Clementine Churchill Hospital
12 When we issue a claim form, we will send you an up to date list. If the hospital you would like to use is not on our list call 01423 799949 Harrow St Mark’s Hospital Manchester Royal Infirmary Isleworth West Middlesex University Hospital Manchester St Mary’s Hospital Kingston upon Thames Kingston Hospital Oldham Royal Oldham Hospital Kingston upon Thames New Victoria Hospital Rochdale Birch Hill Hospital Northwood BMI Bishops Wood Hospital Rochdale BMI Highfield Hospital Northwood Mount Vernon Hospital Rochdale Rochdale Infirmary Southall Ealing Hospital Salford Oaklands Hospital Stanmore Royal National Orthopaedic Hospital Salford Salford Royal Hospital Uxbridge Hillingdon Hospital Stockport Stepping Hill Hospital Wigan Royal Albert Edward Infirmary LONDON (Postal Area) Wigan Wrightington Hospital SE3 BMI Blackheath Hospital Wythenshawe Wythenshawe Hospital NW8 British Hernia Centre W6 Charing Cross Hospital MERSEYSIDE SW10 Chelsea & Westminster Hospital Liverpool Broadgreen Hospital SW5 Cromwell Hospital Liverpool Spire Liverpool Hospital WC1 Great Ormond Street Hospital Liverpool Royal Liverpool University Hospital SE1 Guy’s Hospital Liverpool Liverpool Women’s Hospital W12 Hammersmith Hospital Liverpool University Hospital Aintree NW4 BMI Hendon Hospital Liverpool Liverpool Heart & Chest Hospital N6 Highgate Hospital Ormskirk Ormskirk & District General Hospital WC1E Hospital for Tropical Diseases Prescot Whiston Hospital NW8 Hospital of St John & St Elizabeth St Helens Fairfield Independent Hospital W1G King Edward VII Hospital St Helens St Helens Hospital SE5 King’s College Hospital Southport Southport & Formby District General E1 BMI London Independent Hospital Hospital EC1 Moorfields Eye Hospital Wirral Clatterbridge Hospital WC1 National Hospital for Neurology & Wirral Spire Murrayfield Hospital Neurosurgery Wirral Arrowe Park Hospital N18 North Middlesex University Hospital SW19 Parkside Hospital Wimbledon NORFOLK W1 The Portland Hospital for Women & Cromer Cromer Hospital Children Great Yarmouth James Paget University Hospital W12 Queen Charlotte’s & Chelsea Hospital Norwich Spire Norwich Hospital SW15 Queen Mary’s Hospital Roehampton Norwich Nolfolk & Norwich University Hospital SW3 Royal Brompton Hospital NW3 Royal Free Hospital NORTHAMPTONSHIRE WC1N Royal London Hospital for Integrated Kettering Kettering General Hospital Medicine Kettering Woodland Hospital E1 Royal London Hospital Whitechapel Northampton Northampton General Hospital SW3 Royal Marsden Hospital Northampton BMI Three Shires Hospital W1 Royal National Throat, Nose & Ear Hospital NORTHUMBERLAND EC1 St Bartholemews Hospital Alnwick Alnwick Infirmary SW17 St Georges Hospital Hexham Hexham General Hospital W2 St Marys Hospital
SE1 St Thomas’ Hospital NW1 University College Hospital NOTTINGHAMSHIRE SE13 University Hospital Lewisham Nottingham Nottingham City Hospital NW1 Western Eye Hospital Nottingham BMI The Park Hospital W1G Weymouth Street Hospital Nottingham Queens Medical Centre E11 Whipps Cross Hospital Nottingham Circle Nottingham Clinic N19 Whittington Hospitall Nottingham Nottingham Woodthorpe Hospital Nottingham Spire Hospital Sutton in Ashfield Kings Mill Hospital GREATER MANCHESTER Worksop Bassetlaw District General Hospital Ashton-under-Lyne Tameside General Hospital
Bolton BMI The Beaumont Hospital Bury Fairfield General Hospital OXFORDSHIRE Leigh Leigh Infirmary Banbury Foscote Hospital Manchester Spire Manchester Hospital Banbury Horton General Hospital Manchester Christie Hospital Oxford Churchill Hospital Manchester North Manchester General Hospital Oxford Nuffield Orthopaedic Centre Manchester Royal Manchester Children’s Hospital Oxford Nuffield Hospital Oxford (The Manor) Manchester Royal Eye Hospital Oxford John Radcliffe Hospital
When we issue a claim form, we will send you an up to date list. If the hospital you would like to use is not on our list call 01423 799949 13
Construction Manager Reader
It was a pleasure to deal with your company who offer a professional standard of service “ which is sadly missing elsewhere today. A nice change to the “do it yourself” web based service of other companies. ” HMCA Member, Cumbria, July 2020
SHROPSHIRE Sutton Royal Marsden Hospital Oswestry Robert Jones & Agnes Hunt Orthopaedic Woking Nuffield Hospital Woking Hospital Shrewsbury Nuffield Hospital Shrewsbury SUSSEX - EAST Shrewsbury Royal Shrewsbury Hospital Brighton Royal Alexandra Children’s Hospital Telford Princess Royal Hospital Brighton Royal Sussex County Hospital Brighton Sussex Eye Hospital SOMERSET Brighton Nuffield Hospital Brighton Bath BMI Bath Clinic Crowborough Horder Centre Bath Circle Bath Hospital Eastbourne Eastbourne District General Hospital Bath Royal National Hospital for Rheumatic Hove Spire Montefiore Hospital Diseases Lewes Victoria Hospital Bath Royal United Hospital St Leonards-on-Sea Conquest Hospital Taunton Musgrove Park Hospital St Leonards-on-Sea Spire Sussex Hospital Taunton Nuffield Hospital Taunton Weston Super Mare Weston General Hospital SUSSEX - WEST Yeovil Yeovil District Hospital Chichester Nuffield Hospital Chichester Chichester St Richards Hospital STAFFORDSHIRE Crawley Crawley Hospital Burton-on-Trent Queen’s Hospital East Grinstead Queen Victoria Hospital Newcastle-under-Lyne Nuffield Hospital North Staffordshire East Grinstead McIndoe Surgical Centre Stafford Staffordshire General Hospital Haywards Heath Nuffield Hospital Haywards Heath Stafford Rowley Hall Hospital Haywards Heath Princess Royal Hospital Stoke-on-Trent Royal Stoke University Hospital Horsham Horsham Hospital Worthing Worthing Hospital SUFFOLK Worthing BMI Goring Hall Hospital Bury-St-Edmunds BMI St Edmunds Hospital Bury-St-Edmunds West Suffolk Hospital TYNE & WEAR Ipswich Ipswich Hospital Gateshead Queen Elizabeth Hospital Ipswich Nuffield Hospital Ipswich Newcastle Freeman Hospital Newcastle Nuffield Hospital Newcastle-upon-Tyne SURREY Ashtead Ashtead Hospital Newcastle Royal Victoria Infirmary Camberley Frimley Park Hospital Newcastle Walkergate Hospital Caterham North Downs Hospital North Shields North Tyneside General Hospital Cheam Spire St Anthony’s South Shields South Tyneside District Hospital Chertsey BMI Runnymede Hospital Sunderland Sunderland Eye Infirmary Chertsey St Peter’s Hospital Sunderland Sunderland Royal Hospital Croydon BMI Shirley Oaks Hospital Washington Spire Washington Hospital Epsom Epsom General Hospital Farnham Spire Clare Park Hospital WARWICKSHIRE Guildford Nuffield Hospital Guildford Leamington Spa Nuffield Warwickshire Hospital Guildford BMI Mount Alvernia Hospital Nuneaton George Eliot Hospital Guildford Royal Surrey County Hospital Rugby Hospital of St Cross Horley Spire Gatwick Park Hospital Stratford Circle Stratford Clinic Kingston-upon-Thames BMI Coombe Wing Warwick Warwick Hospital Leatherhead Leatherhead Hospital Redhill East Surrey Hospital
14 When we issue a claim form, we will send you an up to date list. If the hospital you would like to use is not on our list call 01423 799949 WEST MIDLANDS YORKSHIRE - SOUTH Birmingham City Hospital Barnsley Barnsley Hospital Birmingham Children’s Hospital Doncaster Park Hill Hospital Birmingham Heartlands Hospital Doncaster Royal Infirmary Birmingham BMI The Edgbaston Hospital Rotherham Rotherham Hospital Birmingham BMI Priory Hospital Sheffield BMI Thornbury Hospital Birmingham Queen Elizabeth Hospital Sheffield Sheffield Children’s Hospital Birmingham Royal Orthopaedic Hospital Sheffield Claremont Hospital Birmingham Women’s Hospital Sheffield Northern General Hospital Coventry BMI Meriden Hospital Sheffield Royal Hallamshire Hospital Coventry University Hospital Coventry Sheffield Weston Park Hospital Dudley Corbett Hospital Dudley Russells Hall Hospital YORKSHIRE - WEST Halesowen West Midlands Hospital Bingley Yorkshire Clinic Solihull Birmingham Midland Eye Centre Bradford Royal Infirmary Solihull Spire Parkway Hospital Dewsbury Dewsbury & District Hospital Solihull Solihull Hospital Elland Spire Elland Hospital Sutton Coldfield Good Hope Hospital Huddersfield BMI Huddersfield Hospital Sutton Coldfield Spire Little Aston Hospital Huddersfield Royal Infirmary Walsall Manor Hospital Keighley Airedale General Hospital West Bromwich Sandwell General Hospital Leeds Leeds General Infirmary Wolverhampton New Cross Hospital Leeds Spire Leeds Hospital Wolverhampton Nuffield Hospital Wolverhampton Leeds Spire Methley Park Leeds Nuffield Hospital Leeds WILTSHIRE Leeds St James’s University Hospital Malborough Savernake Hospital Pontefract Pontefract Hospital Salisbury New Hall Hospital Salterhebble Calderdale Royal Hospital Salisbury Salisbury District Hospital Wakefield Pinderfields General Hospital Swindon Great Western Hospital Swindon BMI Ridgeway Hospital HULL & EAST YORKSHIRE Cottingham Castle Hill Hospital WORCESTER Goole Goole & District Hospital Droitwich BMI Droitwich Spa Hospital Hull Spire Hull & East Riding Hospital Kidderminster Kidderminster Hospital Hull Royal Infirmary Redditch Alexandra Hospital Scunthorpe Scunthorpe General Hospital Worcester Worcester Royal Hospital Worcester Spire South Bank Hospital WALES
CLWYD YORKSHIRE - NORTH Abergele Abergele Hospital Bridlington Bridlington & District Hospital Rhyl Glan Clwyd Hospital Harrogate BMI The Duchy Hospital Wrexham Maelor Hospital Harrogate Harrogate District Hospital Wrexham Spire Yale Hospital Malton Malton Norton & District Hospital Middlesborough James Cook University Hospital Northallerton Friarage Hospital DYFED Scarborough Scarborough General Hospital Aberystwyth Bronglais General Hospital York Clifton Park Hospital Camarthen BMI Werndale Hospital York York District Hospital Camarthen Glangwili General Hospital York Nuffield Hospital York Haverfordwest Withybush General Hospital
Historic House Magazine Reader
I am writing just to thank you for settlement of my claim arising from my recent stay in “ an NHS hospital. Your fuss-free and prompt attention is very much appreciated, and I have already recommended HMCA to a number of my friends. ” HMCA Member, London, January 2020
When we issue a claim form, we will send you an up to date list. If the hospital you would like to use is not on our list call 01423 799949 15 GLAMORGAN - MID Brechin Stracathro Hospital Bridgend Princess of Wales Hospital Dundee BMI Fernbrae Hospital Llantrisant Royal Glamorgan Hospital Perth Perth Royal Infirmary Merthyr Tydfil Prince Charles Hospital
NORTHERN IRELAND GLAMORGAN - SOUTH
Cardiff Cardiff Bay Hospital COUNTY ANTRIM Belfast Belfast City Hospital Cardiff Spire Cardiff Hospital Belfast Kingsbridge Private Hospital Cardiff The Vale Hospital, Hensol Belfast Mater Hospital Cardiff University Hospital of Wales Belfast Musgrave Park Hospital
Belfast Royal Victoria Hospital GLAMORGAN - WEST Belfast Ulster Independent Clinic Neath Neath Port Talbot Hospital Belfast Ulster Hospital Swansea Morriston Hospital Lisburn Lagan Valley Hospital Swansea Sancta Maria Hospital Newtownabbey Whiteabbey Hospital Swansea Singleton Hospital
COUNTY ARMAGH GWENT Craigavon Craigavon Area Hospital Abergavenny Nevill Hall Hospital Newport St Joseph’s Hospital
COUNTY DOWN Downpatrick Downe Hospital GWYNEDD Newry Daisy Hill Hospital Bangor Gwynedd Hospital Llandudno Llandudno General Hospital COUNTY FERMANAGH Enniskillen South Western Acute Hospital SCOTLAND CENTRAL LONDONDERRY Stirling BMI Kings Park Hospital Ballykelly North West Independent Hospital Larbert Forth Valley Royal Hospital Coleraine Causeway Hospital Londonderry Altnagelvin Area Hospital GRAMPIAN Magherafelt Mid Ulster Hospital Aberdeen BMI Albyn Hospital Aberdeen Royal Aberdeen Children’s Hospital TYRONE Aberdeen Aberdeen Royal Infirmary Dungannon South Tyrone Hospital Aberdeen Woodend Hospital Omagh Tyrone County Hospital
HIGHLAND CHANNEL ISLANDS Fort William Belford Hospital Alderney Mignot Memorial Hospital Inverness Raigmore Hospital Guernsey Princess Elizabeth Hospital Wick Caithness General Hospital Jersey Jersey General Hospital
LOTHIAN Edinburgh Spire Murrayfield Hospital Edinburgh Spire Shawfair Park Hospital The Garden Edinburgh Royal Hospital for Sick Children Edinburgh Royal Infirmary of Edinburgh Edinburgh Western General Hospital Magazine Edinburgh The Edinburgh Clinic Livingston St John’s Hospital Reader
STRATHCLYDE I found the service I received from Alexandria Vale of Leven Hospital “ Ayr BMI Carrick Glen Hospital HMCA to be very efficient and friendly. Ayr Ayr Hospital All of my queries were answered, and Glasgow Nuffield Hospital Glasgow Glasgow BMI Ross Hall Hospital I found that the information sent to me Glasgow Queen Elizabeth University Hospital was clear and user-friendly. Greenock Inverclyde Royal Hospital Kilmarnock Crosshouse Hospital ” HMCA Member, London, TAYSIDE February 2021 Arbroth Arbroth Infirmary
16 When we issue a claim form, we will send you an up to date list. If the hospital you would like to use is not on our list call 01423 799949 . E INSU NC RA A N R C U E S . N I I N .
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IMPORTANT INFORMATION SECTION
17 CONTRACTUAL THE MEDICAL SAVER PLAN DESCRIPTION OF BENEFITS The maximum benefit payable for each person named on the Membership Certificate for acute surgical or acute medical conditions, in each subscription year, is £250,000.
IN-HOSPITAL OVERNIGHT AND LONGER STAYS
ACCOMMODATION CHARGES IN A HOSPITAL ON OUR HOSPITAL LIST ...... Paid in full
WARD NURSING CHARGES FOR EACH STAY IN HOSPITAL ...... Paid in full
NHS TREATMENT ...... £200 a night for up to Treatment carried out solely as an NHS patient. This includes ...... 30 nights’ a year accident or emergency admissions. SURGICAL CHARGES FOR EACH STAY IN HOSPITAL Surgeons’ and Anaesthetists’ Combined Fees including aftercare. Major Plus Operation ...... up to £1875 Major Operation ...... up to £1260 Intermediate Operation ...... up to £850 Minor Operation ...... up to £485 Additional Benefit for an operation requiring specialised operative techniques...... up to £2200 THEATRE FEES, CONSUMABLES, DRUGS AND SURGICAL DRESSINGS FOR EACH STAY IN HOSPITAL Major Plus Operation ...... up to £2875 Major Operation ...... up to £1750 Intermediate Operation ...... up to £1150 Minor Operation ...... up to £825 Additional Benefit for an operation requiring specialised operative techniques...... up to £3000 pathology, investigations & Physiotherapy When charged individually by the hospital ...... up to £1200 When charged as part of a package price ...... up to £550 WARD DRUGS & CONSUMABLES FOR EACH STAY IN HOSPITAL When charged separately for in-hospital treatment...... Paid in full PROSTHESES FOR EACH STAY IN HOSPITAL Prostheses payable in accordance with the operation. Major Plus Operation ...... up to £3450 Major Operation ...... up to £1400 Intermediate Operation ...... up to £825 Minor Operation ...... up to £500 Additional Benefit for an operation requiring specialised operative techniques...... up to £1500 PHYSICIAN FEES FOR NON SURGICAL STAYS IN HOSPITAL First three days ...... up to £150 for each day After three days ...... up to £75 for each day
INTENSIVE CARE / HIGH DEPENDENCY ...... up to £2400 each year Benefit is payable for medical treatment in an intensive care or high dependency unit. 18 PERSONAL ACCIDENT BENEFITS
PERSONAL ACCIDENT DEATH BENEFIT ...... £1000
PERSONAL ACCIDENT DISABILITY COVER ...... £500
OUTPATIENT BENEFIT
INITIAL CONSULTATION ...... up to £275 each year You will be covered for an initial specialist’s consultation.
OTHER ADDITIONAL BENEFITS
RADIOTHERAPY/CHEMOTHERAPY ...... up to £900 each year A grant is given towards treatment.
PARENT/GUARDIAN ACCOMPANYING A CHILD ...... up to £350 each day For a child under 16 years of age, HMCA will pay the accommodation charge for one parent for a period not exceeding 20 days’ a year.
PRIVATE AMBULANCE ...... up to £400 each year For transport by a private ambulance to or from a hospital for medical reasons.
MATERNITY GRANT ...... £900 for each birth When both parents have been members for a year.
LONG-TERM ILLNESS GRANT ...... up to £1100 Long-term conditions which are not covered are those that are recurrent, persistent or incurable. After enrolment, a member receiving treatment that ceases to be short-term qualifies for a grant. This benefit can be given at the discretion of HMCA.
DENTAL & OVERSEAS BENEFITS
DENTAL TREATMENT Benefit is payable only where specialist in-hospital treatment is necessary.
OVERSEAS COVER ...... benefits as for the UK Cover continues when you travel abroad on holiday or business for a period not exceeding six months. Excluded are general practitioners’ services and hotel expenses.
19 CONTRACTUAL THE MEDICAL SAVER PLAN
1 DEFINITIONS 1.20 Ward Drugs Medication which is administered whilst the The following expressions have the following meanings patient is an in-patient on the ward. This does not include 1.1 Association HMCA Members. Chemotherapy drugs. 1.2 Scheme A Scheme, managed by HMCA Members, for 1.21 Day Case An admission to a hospital that does not involve an providing benefits in respect of treatment for acute surgical overnight stay. or acute medical conditions for any disease, injury or illness on a short term basis by Specialists at any hospital on the list. 2 EXCLUSIONS 1.3 Insurer HMCA Insurance Limited. Benefits shall not be payable for:- 1.4 Year Any twelve calendar months commencing at the date of 2.1 Treatment of a Long-term Illness (refer to condition 3.3.2 enrolment or annual renewal of a subscription. to see how this exclusion is applied); monitoring of any 1.5 Member A person who is either an individual or group and condition; routine follow-up consultations; treatment which applies for enrolment under Condition 3.1 and is accepted. does not address the underlying medical condition and only 1.6 Dependants offers temporary relief of symptoms (i.e. palliative care). 1.6.1 The Member’s Spouse or partner if living at the same 2.2.1 Pre-existing injury or disease contracted prior to your address. enrolment date (or the Member’s previous plan under the 1.6.2 A child, or grandchild, of the Member, or the Member’s terms of the transfer facility). After one full year’s Membership partner, up to the age of 26, single and living at home. such pre-existing injury or disease and conditions arising 1.6.3 A child, or grandchild, of the Member, or the Member’s or resulting therefrom of which no symptoms (indication partner, in full time education. of a disease or disorder) have manifested themselves or 1.7 Patient “The Patient” means the Member or one of his treatment, or medication, or advice, including check-ups, Dependants receiving benefits under the scheme. has been rendered in the preceding 12 consecutive calendar 1.8.1 NHS Hospital A hospital operated under the National Health months, will be covered. Service with facilities for medical and surgical treatment. 2.2.2 At the time of joining, if the member is undergoing treatment 1.8.2 Private Hospital A hospital or nursing home with facilities or investigations (including with your General Practitioner) for medical and surgical treatment which charges fees for its these are excluded unless fully disclosed and accepted by the services and in the United Kingdom is registered under the Insurer in writing. Nursing Homes Act 1975 (or is excluded from the definition 2.3 Pregnancy or childbirth, except in cases of complications of of a nursing home in the Act by Section 1 (2)(a) thereof but is childbirth when the NHS benefit will be payable subject to not an NHS Hospital) or overseas is operated or recognised both parents having been enrolled for at least twelve months. by the appropriate authority where it is situated. 2.4 The investigation or treatment of Infertility. 1.9 Acute Medical Condition Any disease, illness or injury of 2.5 Treatment for alcohol and drug abuse. rapid onset, severe symptoms and brief duration. 2.6 Treatment for sexually transmissible diseases including 1.10 Long-term Illness A medical condition that has become Acquired Immune Deficiency Syndrome (AIDS) or AIDS either recurrent, persistent or incurable. Related Complex (ARC) howsoever this Syndrome has been 1.11 Treatment Surgical or medical procedures undertaken by acquired or may be named. Specialists needed to diagnose and/or cure an acute medical 2.7 Treatment for injury or illness directly or indirectly condition. occasioned by, happening through or in consequence of 1.12 In-Hospital Treatment An overnight stay by a Member or war, invasion, acts of foreign enemies, hostilities (whether his Dependant for private treatment in a Private Hospital in war be declared or not), civil war, riot, terrorism, rebellion, connection with the treatment of an acute medical condition. revolution, insurrection, military or usurped power. 1.13 Specialist A medical or dental practitioner who is registered 2.8 Treatment or advice given by a General Practitioner or under the Medical Acts and holds or has held a consultant Dentist. appointment in an NHS Hospital or otherwise holds a 2.9 Self inflicted injuries or disabilities. certificate of specialist accreditation recognised bya 2.10 Sight testing, routine medical examinations and any dental competent authority. condition not involving an oro-surgical operation. 1.14 General Practitioner A registered medical practitioner in 2.11 Spectacles or other optical aids, hearing aids, surgical general practice. medical appliances or equipment, denture or dental 1.16 Interpretation Where appropriate, reference to the masculine appliances. gender shall be deemed to include the feminine. 2.12 Rehabilitation, convalescence, or time spent in a community 1.18 Accident or Emergency Admissions or cottage hospital, a nursing home or similar establishment. 1.18.1 by ambulance to either an NHS or Private Hospital as a direct 2.13 Cosmetic surgery, whether or not for psychological reasons. result of or immediately following an accident 2.14 Dialysis in Chronic Renal Failure. 1.18.2 to either an NHS or Private Hospital directly from the 2.15 Treatment received outside the country of residence when Accident & Emergency or Casualty department for urgent or the purpose of being abroad is wholly or in part to obtain such unplanned treatment treatment, unless agreed in advance with HMCA. 1.18.3 to either an NHS or Private Hospital on the same day as a 2.17 Treatment not being undertaken by a Specialist. referral for treatment is made by either a General Practitioner 2.18 Treatment when received as a public ward patient in an NHS or Specialist, when immediate Treatment or Diagnostic Tests hospital. are a medical necessity 2.19 (i) the completion of claim forms (ii) medical reports which 1.19 Chemotherapy The treatment of cancer using specific may be required at any time in respect of Members or chemical agents or drugs that are selectively destructive to Dependants. malignant cells and tissues. 2.20 Drugs and dressings prescribed on an out-patient basis. 20 2.21 Treatment for mental illness or psychiatric disorders or expired or any instalment of subscription has not been paid anxiety/stress related conditions. on the due date. 2.22 Drugs not licensed in the U.K. for specific usage. 3.12 Where the annual subscription is paid by instalments, 2.24 Treatment of joint and back problems will not be covered for such instalments are payable for the full year. The Insurer the first twelve months’ of Membership. This does not apply reserves the right to deduct any outstanding instalments on to Members who enrol under the transfer condition or in settlement of a claim. respect of treatment required where accident is the sole cau 3.14 The Insurer will consider claims for treatment at hospitals on se. the list provided. Other hospitals may be accepted subject to 2.25 Correction of abnormalities or deformities which are prior notification and the Insurer’s written agreement. congenital or which originate before the date of enrolment, 3.15 Where discounts off the basic rates are allowed, only one and any treatment related to any such abnormality or discount will be given. deformity. 3.16 Benefits may be claimed for treatment by a specialist after 2.26 Treatment which is experimental or has not been accepted as referral from the patient’s GP. Where more than one surgical being effective. procedure is carried out whilst an in-patient then the benefit 2.27 Breast reductions for whatever reason. payable towards Surgical Charges and Theatre Fees shall 2.28 Accident or Emergency Admissions, except when the be 100% of the highest rated procedure plus up to 50% of treatment is received free as an NHS patient, when the NHS the appropriate benefit for each subsequent procedure. grant is payable. For the purposes of benefits, operations are classified as 2.29 Where previous treatment has been received by the Member Complex, Major Plus, Major, Intermediate or Minor. When a for any joint, either before they became a Member of the course of treatment is received solely as an NHS patient, the scheme or since joining it, no benefit will be payable under cash benefit detailed in the Description of Benefits shall be this policy in the case of any revision or repeat treatment to payable for each eligible night spent in hospital. that joint. 3.17 A claim form will be sent to the Member on request. Such a request should be made immediately the Member is advised 3 CONDITIONS to have Specialist treatment for which a claim for benefit will 3.1 Anyone resident in the UK shall be eligible to apply for be submitted. enrolment of himself and his Dependants in the Scheme. 3.19 A Member shall not be entitled to ask for payment in any 3.2 The Insurer reserves the right to refuse any application or to foreign currency and claims in any such currency shall be restrict the range of benefits and the Applicant shall not be paid in Pounds Sterling at the rate of exchange prevailing on entitled to know the reason for such decision. the day of the cheque in settlement of the claim is drawn. 3.3 Cover may be transferred from an existing plan and future 3.20 Any claim for benefit must not exceed the actual expenses claims made for acute conditions originating at the time incurred and is payable up to the limit for the time being the Member was participating in the previous plan, will be prescribed within the Member’s chosen level. Such a claim honoured subject to the Description of Benefits applicable at must be in the Insurer’s prescribed form supported by that time. accounts from whoever has provided the service. Any claim 3.3.1 The Member must provide evidence of the existing plan and shall be made within three months’ of commencement of the commencement date of it to HMCA for the transfer terms treatment or giving of advice. It shall be supported by such to apply. further evidence as the Insurer may reasonably require. In the event of treatment or the giving of advice continuing 3.3.2 When a condition is first diagnosed (and did not exist prior to further, accounts shall be submitted within one month enrolment) benefit will be provided for such diagnosis and any of them being rendered and the requirement as to further necessary treatment for one initial episode only. Subsequent evidence shall apply. treatment is not covered. When these circumstances occur the Insurer will issue an appropriate endorsement to the 3.21 If expenses are covered by an insurance on the Member or by certificate. The Insurer provides a discretionary Long-term any Provident Association, the Insurer reserves the right not Illness Grant which can be made available to those with a to pay more than its rateable proportion thereof. Long-term Illness to assist transition to NHS care. 3.22 For the purposes of calculating daily payments, the days of 3.6 On the death of a Member, a spouse who is registered as a admission and discharge together count as one day. Dependant may without formality become a Member in his or 3.23 Accommodation charges are payable only when directly her own right at the appropriate rate, according to whether related to the In-Hospital treatment received in Private the spouse was the only Dependant or whether there were Hospitals or the private wing of NHS Hospitals. one or more child Dependants. 3.25 Where the treatment required results from the fault of 3.7 The contract is an annual one renewable from year to year another, the Member must; at the option of the Member, subject to the Description of (i) Take all reasonable steps that the Insurer requires to Benefits and Subscriptions in force at the date of renewal. recover from the party at fault the cost of the benefits paid by 3.9 Members who take up residence outside the UK shall cease the Insurer and interest thereon. from the next renewal date to be Members of the Scheme. (ii) If recoverable, repay to the Insurer the cost of the benefits 3.10 The Insurer shall be entitled at any time in relation to a paid to the Member with interest. Member or Dependant to terminate the contract, or to subject 3.26 The benefits payable towards a claim are those applicable the contract to different terms, if to your certificate at the time the claim form is issued. (a) The Member, or an enrolled Dependant, has at any time Therefore benefits from two separate Membership years (i) misled the Insurer by mis-statement or cannot be applied to the same claim. concealment. 3.28 The Maternity Grant is payable once both parents have been (ii) otherwise failed to act with the utmost good faith. members for at least twelve months. (b) the Member is a Member of a group which is wound up, or 3.29 Each In-Hospital stay must be pre-authorised at least the whose special arrangements are amended. day before, with HMCA Members being in receipt of the completed claim form, a consultant’s report and details of (c) The Insurer decides to discontinue the Scheme or any the hospital’s charges, before any agreement can be given as part thereof. to the eligibility and benefits payable. 3.11 The subscription is payable in advance and eligibility to benefit ends when the period covered by the subscription has
21 CONTRACTUAL THE PERSONAL ACCIDENT CASH PLAN
Included with your Medical Saver Plan are Personal Accident benefits, please read these rules and make sure that they meet your needs and that you are clear about the cover and the exclusions. These documents form the contract of insurance between you and the Insurer.
Certain words in this Plan have a specific meaning. The Exclusions definitions of such words are detailed under Definitions where a word has been defined, the definition will apply wherever This Plan does not cover death or disablement/disability that word appears in this Plan. resulting directly or indirectly from; a) the Insured’s criminal activity, intentional actions, or Definitions self-injury Insurer HMCA Insurance Limited. b) war, whether war be declared or not, hostilities or any act of war or civil war Insured The person stated on the Certificate. c) nuclear reaction, nuclear radiation or radioactive Anniversary Date 12 months after your enrolment date, contamination stated on your Certificate. d) any act of terrorism Accidental Death Death caused by an accident which is due For the purpose of this exclusion, an act of terrorism to a sudden, unexpected, unusual specific event which occurs means an act or series of acts, including the use of at an identifiable time and place. force or violence, of any person or group(s) of persons, You/your The Insured. whether acting alone or on behalf of or in connection with any organisation(s), committed for political, religious or Hazardous Pursuits Shall mean ballooning, caving, ideological purposes including the intention to influence diving, hang-gliding, hydro-planing, riding on a motorcycle any government and/or to put the public in fear for such over 250cc (as a driver or passenger), mountaineering, purposes parachuting, pot-holing, racing of any kind (other than on foot), rock or cliff climbing, white water rafting or canoeing, e) the Insured being intoxicated by alcohol or drugs, except as any sport carried out as a professional prescribed by a registered qualified medical practitioner f) acquired immune deficiency syndrome (AIDS) or HIV Permanent Disablement/Disability Refers solely to loss of limb or loss of sight as separately defined. g) hazardous pursuits. Loss of Limb Means loss by physical separation of a hand at or above the wrist or of a foot at or above the ankle and Fraud includes total and irrecoverable loss of use of hand, arm, Insurance fraud is a crime, and costs innocent customers foot or leg. money every year because insurance companies have to charge higher premiums. Loss of Sight Means total and permanent loss of sight in both eyes if the Insured has been added to the register of If you, or anyone acting on your behalf, supply the Insurer blind persons on the authority of a fully qualified ophthalmic with facts or information and/or make a claim which you specialist, or in one eye if the degree of sight remaining after know to be false or inaccurate and with the intent of seeking correction is 3/60 or less on the Snellen Scale. financial gain, you may be committing a fraudulent act, which is a crime. If the Insurer obtains evidence which suggests that this is the case, the Insurer may cancel the Plan and refuse to settle your claim. The Insurer will also report the matter to the police.
22 IMPORTANT INFORMATION YOU NEED TO KNOW FOR YOUR PROTECTION HMCA Insurance Limited is the insurer that underwrites complaints procedure the Medical Saver Plan and promotes its various plans through HMCA Members in the UK. It does not own, nor is it If you have a complaint please write to The Directors of HMCA owned by, any part of HMCA Members. Members, Beech Hall, Knaresborough, Yorkshire, HG5 0EA. If you are dissatisfied with the response you should write HMCA Members is an insurance intermediary that works to HMCA Insurance Limited, 33/2 Cannon Lane, Gibraltar, on behalf of the underwriters, HMCA Insurance Limited. GX11 1AA. If after their review you are still dissatisfied, your HMCA Members undertakes all aspects relating to complaint can be referred to the Financial Ombudsman administration, marketing and management of claims. In Service at Exchange Tower, Harbour Exchange Square, return for this HMCA Members is remunerated by HMCA London E14 9SR. Insurance Limited from the subscription the members pay.
HMCA Members only promotes Medical Plans underwritten by HMCA Insurance Limited and its experienced Telephone Helpline provides a non-advised sales service. The Telephone Helpline is available for you to ask questions regarding any aspect of the Plan and you can contact them on 01423 799949. THE DIRECT DEBIT We do not offer advice and the information sent will allow GUARANTEE you to make a choice of how to proceed. • This Guarantee is offered by all banks and DEMANDS AND NEEDS building societies that accept instructions to pay Direct Debits. This Plan meets the demands and needs of individuals who wish to have benefits towards the cost of their private • If there are any changes to the amount, date medical treatment, now and in the future. or frequency of your Direct Debit HMCA/S PLC will notify you 3 working days in Compensation advance of your account being debited or as otherwise agreed. If you request HMCA/S HMCA Insurance Limited is covered by the Financial PLC to collect a payment, confirmation of Services Compensation Scheme (FSCS). You may be entitled the amount and date will be given to you at to compensation from the scheme in the unlikely event that the time of the request. HMCA Insurance Limited cannot meet its obligations. This • If an error is made in the payment of your depends on the type of business and circumstances of the Direct Debit by HMCA/S PLC or your bank or claim and would provide cover for 100% of the first £2,000 building society you are entitled to a full and and 90% of the remainder of the claim without any upper immediate refund of the amount paid from limit. Further information about compensation scheme your bank or building society. arrangements is available from the FSCS. (www.fscs.org.uk - telephone 020 7741 4100.) • If you receive a refund you are not entitled to, you must pay it back when HMCA/S PLC HMCA/S PLC, trading as Hospital & Medical Care Association, asks you to. You can cancel a Direct Debit at HMCA and HMCA Members is an intermediary and is any time by simply contacting your bank or authorised and regulated by the Financial Conduct Authority, building society. Written confirmation may reference no. 307587. This can be verified by visiting the be required. Please also notify us. FCA’s website https://register.fca.org.uk or by contacting the FCA on 0800 111 6768. 23 WHAT OUR MEMBERS SAY
I did like the fact I could get straight through on the phone to speak to a real person. Those that I spoke to were very very helpful indeed and called me back as promised. Great service, thanks. Shooting & Conservation Reader, Buckinghamshire, January 2021
As always excellent service, just sent my first claim form in, it was settled within a week...amazing. PGA Professional Magazine Reader, April 2021
I am so very grateful for your kind support and help in this matter which is very much appreciated. As always, the efficiency, dependability and insurance cover provided by HMCA are second to none. Roadsmart Reader, London, April 2021
I wish to thank you for the professional way my claim has been handled and the courtesy your staff have shown on each occasion I have phoned with a query. I have no hesitation in recommending your company to colleagues and friends. Well done! Third Age Matters Reader, London, January 2020
I would like to commend your staff for their empathy, kindness and consideration in my distress. Money Week Reader, London, March 2021
I would like to acknowledge not only the speed with which you have settled my claim but also your most helpful advice for me in making my claim. I will certainly be very happy in continuing with my membership of HMCA. My Countryside Reader, Canterbury, March 2020
HMCA’s response and guidance to all my questions was very good, reassuring and efficient. Thank you. Freemasonry Today Reader, West Sussex, February 2021
WE ARE HERE TO HELP If you wish to discuss your health care requirements or the Medical Saver Plan, please call our helpline on 01423 799949 or write to: HMCA, Beech Hall, Knaresborough, North Yorkshire HG5 0EA. Telephone helpline (01423) 799949 Email: [email protected] Website: www.hmca.co.uk
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