HEALTHCASHPLAN HEALTHSCHEME

CLAIM CASHON YOUR EVERYDAY HEALTHCARE BILLS SUCH AS

DENTALOPTICALTHERAPY

AND

TREATMENTS

APPLICATION FORM

+CARE4LIFE INSURANCE FROM AS LITTLE AS £2.60 PER MONTH

We all know that contacting your GP for medical advice, reassurance or guidance, especially outside of surgery hours or during the working day, can sometimes be difficult. Even after you’ve called the surgery, you may face a long delay to get an appointment or have to take one at an inconvenient time.

The GP consultation service provides 24/7 telephone access to professional advice by a fully-qualified GP. Also included is access to an online webcam consultation with a doctor.

I’ve used this service four times in the last year. The last call was for my wife; we called at 7am and a doctor called back within 25 minutes. This saved the inconvenience of trying to get a doctor’s appointment and the problem was addressed over an hour before our local surgery even opened.

Unless I need to see my GP in person, I would use this facility every time from now on.

BHSF policyholder

GREAT VALUE EXTRA BENEFITSGP HELPLINE

This confidential telephone helpline is available 365 days a year, offering a counselling service on stress, family relationships, substance abuse and debt, along with legal advice and information on financial and health matters too.

24/7 TELEPHONE HELPLINE

Network Benefits is our benefits discount site, providing discounts and savings for everyone. You can save money on day-to-day costs such as the weekly shop, high street fashion, eating out and DIY or why not browse through our offers on travel and leisure to make the most of your spare time.

SAVE MONEY AT OVER 100 HIGH STREET STORES

I CAN SPEAK TO A GP WHEN I NEED TO

With a health cash plan you can claim cash towards dental check-ups and treatment, eyesight tests, new glasses, contact lenses and therapy treatments such as physiotherapy and chiropody.

You can claim cash reimbursements for routine and emergency healthcare.

You do not need to be ill to benefit from a health cash plan, but if you do have an unexpected illness you can claim towards the cost of a diagnostic consultation, or towards the expenses associated with a stay in hospital or day-case surgery. It doesn’t matter whether you have your healthcare through the NHS or privately, a health cash plan can help you.

I go to the osteopath every two months to help with the damage done to my back, by years of leaning over a computer. The benefits are enormous. My back pain has gone and I can now see to the side without having to turn around.

With each session costing £42, my health cash plan is helping me maintain a major improvement in my physical wellbeing.

Five levels of cover to choose from

Anyone aged 17 or over, who normally resides in the United Kingdom, can apply. Personal and family cover – children can be covered on a family plan until their 18th birthday

No medical required

We authorise payment of 90% of eligible claims within two working days of receipt

Cover starts from as little as £5.00 per month

Premiums payable through convenient payroll deduction

Start claiming 13 weeks from the start date of your policy. For maternity payment, you will need to wait 10 months from the policy start date and if you have an existing medical condition, you will have to wait two years before you are covered for hospital-related claims. Telephone helplines can be accessed from the start date of your policy.

BHSF policyholder

Let us help with the cost of your everyday healthcare

HOW MY HEALTHCASH PLAN HELPS ME

No advice has been given by BHSF in relation to the sale of this product. *Unless shown otherwise the maximum amount is payable per Benefit Year. All benefits payable are subject to BHSF policy terms; copies available on request. 13 week qualifying period with the exception of maternity payment (10 month qualifying period) and for pre-existing medical conditions (2 years). Insurance Premium Tax included at the applicable rate. Issued by BHSF Limited, 2 Darnley Road, Birmingham B16 8TE. BHSF Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and Prudential Regulation Authority.

E&OE OS838 06/14

Make the most of a health cash planLOOK AT THE TABLE OPPOSITE AND SEE WHICH LEVEL OF COVER BEST SUITS YOU AND YOUR FAMILY.

THE HIGHER THE LEVEL OF COVER, THE MORE YOU CAN CLAIM.

Each insured adult has their own maximum benefit. Children can be included on a family policy until their 18th birthday and where benefit is provided it is limited to once times the maximum amount shared amongst all insured children.

Monthly Premium(including Insurance Premium Tax)

Bronze Silver Gold Platinum Diamond

Personal(policyholder only) £5.00 £9.65 £14.50 £20.40 £26.50

Family(policyholder, partner and dependent children) £9.65 £17.15 £26.90 £38.40 £49.50

Maximum per Insured Person per Benefit Year/s.*

Benefits Reimbursementrate Bronze Silver Gold Platinum Diamond

Dental 100% £50 £100 £150 £200 £250

Dental trauma 100% £200 £400 £600 £800 £1,000

Opticalevery two Benefit Years 100% £50 £100 £150 £200 £250

Diagnostic consultation 75% £100 £175 £250 £400 £650

Therapiescombined maximum benefit including physiotherapy, osteopathy, chiropractic and acupuncture treatment

75% £150 £350 £500 £800 £1,200

Chiropody, homeopathy and reflexology combined maximum benefit

75% £50 £75 £125 £175 £225

Hospital in-patientup to 35 nights per Benefit Year per night - £10 £20 £30 £40

Hospital day-case surgeryup to 10 events per Benefit Year per event - £10 £20 £30 £40

Recuperationpayable automatically after a valid hospital in-patient claim of at least 10 consecutive nights

lump sum - £75 £150 £225 £300

Maternity(adult benefit only) per child - £75 £150 £225 £300

Hearing aidsevery two Benefit Years 75% £100 £150 £300 £500 £750

Health screeningevery two Benefit Years 75% £50 £75 £125 £175 £250

Health care navigator(adult benefit only) - -

Personal accident(adult benefit only) up to £25,000 £50,000 £100,000 £150,000 £200,000

Telephone helpline -24 hour, 365 days a year telephone helpline offering a counselling service on stress, family

relationships, substance abuse and debt, along with information on a range of issues including legal, financial and medical matters.

GP consultation service -Providing access to a GP helpline 24 hours a day, 7 days a week. Also includes access

to an online webcam consultation available Monday - Friday, 8.30am to 6.30pm (excluding bank holidays).

Private prescription service - The private prescription service enables its doctors to issue private prescriptions and send them directly to a registered pharmacy for despatch to a patient.

Gym membership - Corporate membership rates at over 2,500 participating UK and Ireland gyms and fitness clubs.

(policyholder only)

PERSONAL COVER

£2.60PER MONTH

(policyholder and partner)

FAMILY COVER

£4.50PER MONTH

Care4 has provided me with the reassurance that when the inevitable happens, my family will have the financial support they need.

It will be an emotional time, and it doesn’t need to be made any more difficult by worries of where the money will come from to pay for the funeral.

BHSF policyholder

Do you think about the future and how your family will manage when you pass away?

Did you know the cost of a funeral has risen by 80% since 2004 - the average cost is now £3,456*.

With Care4, £5,000 is payable to your estate after your death. The money can be spent any way you want, either to cover funeral expenses or maybe as an investment for your loved ones. The payment is made tax-free under current legislation.

Care4 provides you with the reassurance of knowing you have helped to reduce some of the emotional and financial stress on your family and friends at an upsetting time.

You can choose between either personal or family Care4 cover. You can only select personal Care4 in conjunction with a personal cash plan and family Care4 in conjunction with a family cash plan. The premiums will be collected from your salary and paid to BHSF along with your health cash plan premium.

*Source: Sun Life Direct’s Cost of Dying Report 2013

CARING FOR THOSE YOU LEAVE BEHIND

PEACE OF MIND WITH CARE4

CARE4 -

The premium payable is £2.60 per month for personal cover, or £4.50 per month for family cover for a sum assured of £5,000.

CARE4YOUR QUESTIONS ANSWEREDWHAT DO I PAY?

Anyone aged 18 to 69 inclusive, who normally resides in the United Kingdom, is eligible to apply for cover.

WHO CAN APPLY?

Choose either personal or family cover; complete the application form at the back of this booklet and return it to BHSF. Subject to the terms of the insurance, it will be automatically renewed each month for as long as premiums are paid. Your cover will cease if you leave the employer through which your cover was arranged; or if you stop paying your premium. There is no surrender value to the insurance.

HOW DO I APPLY?

You will be sent a welcome pack containing your certificate of insurance and details on how to claim.

HOW DO I KNOW IF I HAVE BEEN ACCEPTED?

A claim form can be obtained from our helpdesk on 0121 629 1297. We will provide the address to which the completed claim form must be sent at the time of claim. It should be submitted to our underwriters by the representative of your estate and should be accompanied by the original death certificate. The underwriters will also require evidence of your age and may require other information which will be advised as appropriate. Payment will be made to your estate subject to the terms and conditions of the insurance.

HOW TO CLAIM?

From the effective date shown on your certificate of insurance.

WHEN DOES MY COVER START?

We will not pay the sum insured if death occurs:

1. As a result of a pre-existing condition or related condition, for which you received medication, advice or treatment, or experienced symptoms in the two years prior to the effective date, until you have not:- had any symptoms or tests, or- received any medication or other treatment, or- sought medical advice for an uninterrupted period of two years following the effective date.

EXCLUSIONS?

Care4 is provided by BHSF Services Limited and underwritten by Lloyds’s Syndicate 779, which is managed by ANV Syndicates Limited. BHSF Services Limited is authorised and regulated by the Financial Conduct Authority. ANV Syndicates Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. The information contained within ‘Your Questions Answered’ does not contain the full terms and conditions of the insurance contract and does not form part of the certificate of insurance. The full terms and conditions are provided in the certificate of insurance which will be sent to you on acceptance of your application. If you wish to receive a copy of the certificate of insurance beforehand, please call our helpdesk on 0121 629 1297.

WHO PROVIDES THE INSURANCE?

2. Directly or indirectly as a result of alcohol or solvent abuse, or the taking of drugs except under the direction of a registered medical practitioner.

3. As a result of suicide (in the opinion of the underwriter).

4. Arising from war or civil war.

5. As a result of exposure to radiation or other nuclear risks.

CARE4CARING FOR THOSE YOU LEAVE BEHIND

TO APPLY FOR A CARE4 POLICY PLEASE COMPLETE THE APPLICATION FORM AT THE BACK OF THIS BOOKLET

IMPORTANT INFORMATION WHAT TO DO ?NEXTDecide which level of health cash plan cover is best for you. For just the health cash plan, complete section A of the application form.

Return your completed application form toBHSF, FREEPOST BM2163, BIRMINGHAMB16 8BR.

1) CHOOSE YOUR COVER

Do you want to add Care4 to your cover? If so, complete section B as well.

2) ADD CARE4

In all cases please ensure you complete section C of the application form.

3) PAYROLL DEDUCTION

4) POST YOUR FORM

The Financial Conduct Authority (FCA) is an independent body that regulates the general insurance industry. It requires us to give you certain information so that you can decide if our services are right for you.

This cash plan meets the demands and needs of those who wish to have assistance towards covering their everyday healthcare costs such as dental check-ups and treatment, eye tests and glasses and complementary therapy fees. In deciding to purchase this product you will not receive advice or personal recommendation from BHSF.

This cash plan is sold by BHSF Services Limited and underwritten by BHSF Limited. Both companies are part of BHSF Group Limited, 2 Darnley Road, Birmingham B16 8TE. BHSF Services offers this product on a non-advised sale basis only.

BHSF Limited of 2 Darnley Road, Birmingham B16 8TE is an insurance company authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and Prudential Regulation Authority. Our registration number is 202038. Our permitted business includes advising on and effecting non-investment insurance contracts. Details of our registration can be checked at www.fca.org.uk/register or by telephoning 0800 111 6768. As an insurer, BHSF Limited offers only its own cash plan products in isolation; where appropriate it may offer the most suitable of its products, but only in comparison with other products underwritten by BHSF.

You have 14 days from the date you receive your policy to review it. If you are not completely satisfied with the policy, simply notify BHSF in writing within 14 days and we will cancel it. Provided a claim has not been paid, we will refund any premium collected.

BHSF Services Limited (who administer the Care4 cover), of 2 Darnley Road, Birmingham B16 8TE is an Intermediary authorised and regulated by the Financial Conduct Authority. Our registration number is 308611.

Our permitted business includes advising on and effecting non-investment insurance contracts. Details of our registration can be checked at www.fca.org.uk/register or by telephoning 0800 111 6768.

Care4 is underwritten by Lloyd’s Syndicate 779 which is managed by ANV Syndicates Limited. ANV Syndicates Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority.

This insurance meets the demands and needs of those wishing to secure a lump sum payment in the event of the death of an insured person. BHSF Services Limited is a wholly owned subsidiary of BHSF Group Limited.

BHSF Services Limited only offers products from selected insurers for travel insurance, personal accident insurance and life insurance. Products are offered in isolation and without comparison to the wider market. A list of insurers offered can be provided on request.

You have 30 days from the date we issue your Care4 certificate of insurance to review it. If you are not completely satisfied with the insurance, simply notify BHSF in writing within 30 days. We will cancel your policy. Provided a claim has not been made, we will refund any premium collected.

BHSF Limited, BHSF Services Limited and Lloyd’s Syndicate 779 are covered by the Financial Services Compensation Scheme (FSCS). You may be entitled to compensation from the scheme if they are unable to meet their obligations. Entitlement will depend on the type of business and the circumstances of the claim. Further information about the compensation scheme is available on the FSCS website www.fscs.org.uk.

If you wish to register a complaint, please do so in writing to BHSF, 2 Darnley Road, Birmingham B16 8TE or by telephoning 0121 454 3601, quoting your policy number. If you are not satisfied with the outcome of the complaint, you may refer it to the Financial Ombudsman Service.

Title

I wish my application to cover my children, whose full names, date of birth and gender are:

Name

Name

Name

Surname

Forename(s)

I wish my application to cover my partner, whose full name, date of birth and gender is:

If more than three children are to be covered please supply details on a separate piece of paper.

Date of birth

Date of birth

Date of birth

Date of birth

Sex M/F

Sex M/F

Sex M/F

Sex M/F

Applicants are requested to complete all applicable sections and return the entire form to BHSF, FREEPOST BM2163, BIRMINGHAM B16 8BR. All insured persons must be normally resident in the United Kingdom and reside at the same address. Any dependent children to be covered must be under 18 years of age.

OS838 06/14

GROUP NUMBER

REP NUMBER

HEALTHSCHEME APPLICATION FORMA

Title Surname Forename(s)

Date of birth

Address

County Postcode

Town

Telephone

Email

National Insurance number

Payroll number

Employer’s name

Employer’s address

Postcode

Please tick the policy of your choice (tick one box only):

PERSONAL DETAILS1

EMPLOYER DETAILS2

CHOICE OF COVER3

COVER FOR YOUR PARTNER AND FAMILY4

PERSONAL POLICY FAMILY POLICY

£9.65 PER MONTH

PER MONTH

PER MONTH

PER MONTH

PER MONTH

BRONZE £5.00 PER MONTH

SILVER £9.65 PER MONTH

GOLD £14.50 PER MONTH

PLATINUM £20.40 PER MONTH

DIAMOND PER MONTH£26.50

£17.15

£26.90

£38.40

£49.50 Please ensure that you have signed and dated this box:

Signature

We may advise you, from time to time, about other products and services which may be of interest to you. If you do not wish to receive this information please tick the box.

Date

Policy number Last premium date

Where was it paid? State either employer’s name or direct to BHSF

IF YOU ARE, OR HAVE PREVIOUSLY BEEN INSURED BY BHSF

DECLARATION

5

6

SIGNATURE

I understand that: No hospital-related claim will be paid during the first two years of my policy in respect of any medical condition which existed or was being investigated before cover commenced and BHSF may wish to verify medical information to support a hospital-related claim. I agree to abide by the policy terms, and I acknowledge that they may be varied, as may the range or rates of benefits and/or premiums, if deemed necessary.

I declare that all the information I have given in this application is true, and that, if found to the contrary, claims may be rejected or the policy may be cancelled at any time.

I understand that my personal information will be used in accordance with the Data Protection Act 1998 by BHSF (and relevant BHSF Group companies) and by other companies who may provide a service under this insurance. This information may also be used for the efficient administration of the insurance, to monitor and continue to improve these services, and for the detection and prevention of fraud.

PRODUCT CODE

BH

BRONZE

SILVER

GOLD

PLATINUM

DIAMOND

I am applying to BHSF Services Limited for life insurance cover in the sum of £5,000.

I understand that no cover is available for any pre-existing medical condition or related medical condition until a period of two years has passed during which there have been no symptoms, tests, medication, other treatment or medical advice concerning such condition.

I wish to take out Care4 insurance as indicated.

I understand that variation can be made to the sum insured and/or monthly premiums if I am given at least 30 days notice of the change at my last known address.

In signing this application form I understand that my personal information will be used in accordance with the Data Protection Act 1998 by BHSF Services Limited (and relevant BHSF Group companies), Lloyd’s Syndicate 779 and by other companies who may provide a service under this insurance. This information may also be used for the efficient administration of the insurance, to monitor and continue to improve these services, and for the detection and prevention of fraud.

Please ensure that you have signed and dated this box:

Signature

We may advise you, from time to time, about other products and services which may be of interest to you. If you do not wish to receive this information please tick the box.

Date

Title

I wish my application to cover my partner, whose details and gender are:

Date of birth

Surname

Forename(s)

Title

My full name and date of birth is:

Date of birth

Surname

Forename(s)

(Family cover is only available if you have selected a family health cash plan policy)

Please tick the policy of your choice (tick one box only)

CARE4 APPLICATION FORMB

PERSONS TO BE INSURED

CHOICE OF COVER

7

8

DECLARATION9

SIGNATURE

PERSONAL COVER FAMILY COVER£2.60 PER MONTH £4.50 PER

MONTH

OS838 06/14

Payroll number

Employer’s name

Employer’s address

Postcode

Please deduct the appropriate amount of premium from my pay and apply it to my BHSF policy as follows (tick one box only)

Please also deduct the appropriate amount from my pay in respect of my Care4 policy as follows (tick one box only)

Title Surname Forename(s)

Date of birth

Address

County Postcode

Town

Payroll number

I hereby authorise the deduction from my salary/wages of the amount indicated (or such future amounts as may be required to secure the benefits of the selected policies) each month. Please remit same to BHSF on my behalf at the agreed intervals until further notice from me. This cancels any previous BHSF deductions authorised by me.Please ensure that you have signed and dated this box:

Signature Date

PAYROLL DEDUCTION AUTHORITY FORMCEMPLOYER DETAILS

HEALTH CASH PLAN PREMIUM

CARE4 LIFE INSURANCE PREMIUM

APPLICANT’S DETAILS

SIGNATURE

PERSONAL COVER FAMILY COVER£2.60 PER MONTH £4.50 PER

MONTH

PERSONAL POLICY FAMILY POLICY

10

11

12

13

TOTAL PREMIUM TO BE DEDUCTED FROM MY SALARY £

Please return entire form to BHSF, Freepost BM2163, Birmingham B16 8BR

PER MONTH

GROUP NUMBER

REP NUMBER

PRODUCT CODE

K4C

Sex M/F £9.65PER MONTH

PER MONTH

PER MONTH

PER MONTH

PER MONTH

BRONZE £5.00PER MONTH

SILVER £9.65PER MONTH

GOLD £14.50PER MONTH

PLATINUM £20.40PER MONTH

DIAMOND PER MONTH£26.50

£17.15£26.90£38.40£49.50

BRONZESILVERGOLDPLATINUMDIAMOND

To request further information on any of the products below - tick the box(es) of your choice...

HELP US TO HELP YOU

Or for more information on any of the products above call 0800 622 552 visit www.bhsf.co.uk or email sales@bhsf.co.uk

£10GIFT VOUCHERFOR YOU AND A FRIEND

Tell your friends about the range of benefits that BHSF offers, and if they buy a health cash plan or Plan4Life policy, as a small thank you WE WILL GIVE YOU BOTH A £10 GIFT VOUCHER. TO RECOMMEND A FRIEND TODAY CALL BHSF ON 0800 622 552 OR EMAIL SALES@BHSF.CO.UK

£10VOUCHER

Excellent value travel insurance with both European and worldwide cover for holidays and business. Extended or special cover is also available and can be arranged to suit your particular circumstances. Visit www.bhsf.co.uk for a quote today.

Financial help when you need it most. With Plan4Life, if you are diagnosed with cancer you can claim a cash sum payment of up to £20,000 to spend inwhichever way helps you most.

If your much loved family pet is poorly, the last thing you want to worry about is how much it will cost to treat them. BHSF has teamed up with one of the country’s leading pet insurers for high-quality, low-cost cover that you can trust. Visit www.bhsf.co.uk/pets for a quote today.

PLAN4LIFE CANCER COVER

TRAVEL INSURANCE

Nobody likes to think about it, but accidents do happen. With the personalaccident plan, you can claim up to £500,000 for injuries resulting from an accident.

PERSONAL ACCIDENT INSURANCE

PET INSURANCE

CASH BACK

Dental and optical benefits are payable at 100% of the receipt value and therapies are payable at 75% reimbursement, up to the appropriate maximum benefit under your chosen level of cover. All claims are subject to BHSF policy details; copies available on request.

HOW YOUR HEALTH CASH PLAN WORKSThe following examples are based on a silver personal policy at £9.65 per month.

VISIT WWW.BHSF.CO.UK TO REQUEST A CLAIM FORM

If you visit a physiotherapist or chiropractor...Claim back 75% of the cost of therapy treatments up to the combined maximum benefit of £350. £350CLAIM

UP TO

Do you wear glasses or contact lenses? Every two Benefit Years you can claim up to £100 towards the cost of eyesight tests, new glasses or contact lenses.£100CLAIM

UP TO

Claim 100% of the cost of regular dental check-ups, treatment or a trip to the hygienist, up to £100 per Benefit Year.

Do you have dental check-ups twice a year?

£100CLAIM UP TO

When paying for your treatment, ensure that you ask for a receipt

Fill out your claim form and post it to BHSF along with your receipt

POST CLAIMRECEIPT

We authorise payment of 90% of eligible claims within two working days of receipt

The therapies benefit covers physiotherapy, osteopathy, chiropractic and acupuncture treatment.

BHSF Limited and BHSF Services LimitedBoth organisations are registered at Darnley Road, Birmingham B16 8TE.

Tel: 0121 454 3601 Fax: 0121 454 7725 Email: sales@bhsf.co.uk Web: www.bhsf.co.ukCalls to our office are recorded and may be monitored for training and security purposes.

BHSF Limited authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and Prudential Regulation Authority. Registered in England number 35500.BHSF Services Limited authorised and regulated by the Financial Conduct Authority. Registered in England number 3897857. BHSF is covered by the Financial Ombudsman Service.

HEALTHSCHEME HEALTH CASH PLAN

For more information please call 0800 622 552 visit www.bhsf.co.uk or email sales@bhsf.co.uk

OS838 06/14Printed on environmentally friendly material from a sustainable source.

FOR OFFICE USE ONLY

CAMPAIGN CODE

GROUPNUMBER

REPNUMBER

PRODUCT CODE

BH