the self-pay approach to health insurance

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FREEDOM YOUR CHOICE BROCHURE | 01/02/2015

CONTENTS

A 21st Century Concept 03

The Power of Freedom 04

Table of Benefits 05

Are there any exclusions? 07

How do I make a claim? 08

Underwriting 10

Chronic Conditions 12

Your Questions Answered 14

Contact Details 15

Freedom Health Insurance introduces a fresh and innovative approach to private medical insurance.We give you the opportunity to provide medical cover for yourself and your family with flexibility at a competitive cost.

We don’t call it Freedom without good reason.

This brochure gives a brief outline of the Your Choice plan from Freedom Health Insurance and should be read in conjunction with the policy document, which provides full details. A copy of the policy is available on request.

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A 21ST CENTURY CONCEPT

Freedom to choose what you want from private medical insurance is the keynote of the Freedom Your Choice product.

Freedom to spend Freedom Health Insurance can pay you directly for the cost of in-patient treatment. You can decide to have treatment

privately in the UK, abroad or using the NHS. Either way, the choice is yours.

Freedom to choose the hospital You can choose to have your in-patient treatment anywhere in the world, as you are not restricted to a limited number of

hospitals in the UK.

Freedom to choose the time Freedom Health Insurance eliminates the potential extended delays of the National Health Service. You can plan the timing

of your treatment to fit in with other personal or business commitments.

Freedom to choose the level of cover We offer four levels of cover to suit your needs.

Freedom to choose As part of the Freedom Health Insurance plan, should you require additional support in arranging your treatment, we can

assist you.

Freedom to choose your plan at an affordable price Freedom Health Insurance offers flexible private medical insurance at a competitive price.

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THE POWER OF FREEDOM

We will provide cover for eligible acute medical conditions up to the limits specified within the schedule of benefits in a

policy year. The procedure price payable to you is set out in our schedule of procedures. The following represents the

various components of the benefit.

The annual limit that you have chosen will be specified in your certificate of insurance. Please ensure you are familiar with

the limits of your coverage and the excess options you have chosen. There is a £100 compulsory excess per claim.

In-patient hospital cost & daycare Gold Platinum Diamond Diamond Plus

Annual in-patient limit, per person, per policy year

£30,000 £50,000 £100,000No annual

limit

Hospital accommodationIncluded in the procedure price

(within the Annual in-patient limit specified)*Hospital accommodation if no surgical procedure

undergoneUp to £420 per night within the Annual in-patient limit

Hospital nursing fees, medical expenses, ancillary

charges and prescribed medicines and drugs

Included in the procedure price

(within the Annual in-patient limit specified)*Surgeon’s, anaesthetist’s, physician’s fees (whilst in

hospital)


(within the Annual in-patient limit specified)*

MRI, CT/PET scans, tests, X-rays Covered within the Annual in-patient limit

Oncology tests, drugs, consultant’s fees including

cover for chemotherapy and radiotherapy, when the

treatment is aimed to cure the medical condition.

Covered within the Annual in-patient limit

Physiotherapy during an in-patient stay Covered within the Annual in-patient limit

Oral surgical procedures as specified in our definitionIncluded in the procedure price (within the Annual in-patient limit

specified)*. Procedures must be carried out by a Specialist.

Obstetric procedures for a pregnancy complication as

specified in our definition


(within the Annual in-patient limit specified)*

after cover has been in force for 11 consecutive months.

Procedures must be carried out by a Specialist.

Private road ambulance

Not covered

No annual limit

Accommodation for parent if a child 14 or under

Up to £420 per

night within

the Annual in-

patient limit

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TABLE OF BENEFITS

Out-patient cover - This is an optional benefit for Gold, Platinum and Diamond policies. Diamond Plus cover includes out-patient cover as

standard and if you have chosen this option, it will be stated on your certificate of insurance)

Annual out-patient limit, per person, per policy year

£1,000 £1,000 £1,250

No annual limit, unless otherwise specified

Specialist consultation and treatment fees Covered in full within the

Annual out-patient limit

Covered in fullX-rays, pathology, diagnostic tests and procedures

MRI and CT scans Covered in full within the

Annual in-patient limitRadiotherapy and chemotherapy, when the treatment is

aimed to cure the medical condition.

PhysiotherapyUp to £500 (within the

Annual out-patient limit)Up to £500

Choice 1 – Alternative Therapies – This is an optional benefit for Diamond Plus policies only

Annual alternative therapies limit, per person, per policy year £1,000

Consultations by a registered physiotherapist, osteopath,

chiropractor, acupuncturist, homeopath, podiatrist and

chiropodist after referral from a GP or Specialist.

GP referral - up to 6 visits

Specialist referral - up to £1,000 apart from physiotherapy, which

is limited to £500. This is in addition to the £500 included in the

out-patient coverage above.

Choice 3 – Rehabilitation benefits – This is an optional benefit for Diamond Plus policies only

Home nursing Covered up to 28 days

Recuperative/rehabilitation care Up to £1,000 per claim

Specialist second opinions 1 second opinion per claim

* As stated in the current schedule of procedures used by Freedom Health Insurance and/or as determined by our Chief Medical Officer.

A list of the most common procedures taken from our full schedule of procedures and a procedure payment guide is available on our

website at www.freedomhealthinsurance.co.uk or you can call us to request a copy. The procedure payment guide is the payment tariff for

eligible in-patient and day-patient procedures only. In some cases your specialist may require you to undergo more than one procedure at

a time. In these instances they are classed as a multiple procedure.

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TABLE OF BENEFITS (CONTINUED)

Choice 2 – Psychiatric Care – This is an optional benefit for Diamond Plus policies only

Inpatient treatment for a covered psychiatric illness. The

hospital you go to must be pre-authorised by usCovered up to £10,000

Out-patient treatment£1,500 per policy year. Note there is a £100 excess

per claim

Do I have an excess?

There is a compulsory excess of £100 per person per claim on your Freedom policy.

You can reduce your premium by increasing your excess. The schedule is as follows:

Our main exclusions are as follows:

• Accident and Emergency

• Treatment for chronic conditions

• Pre-existing medical conditions

• HIV/AIDS

• Cosmetic surgery

• Drug, solvent and alcohol abuse

• GP consultations

• Pregnancy and infertility

• Dental treatment

For full details please refer to your policy document.

Voluntary Excess Compulsory Excess Total Excess Premium Reduction £0 £100 £100 0%

£100 £100 £200 7.5%

£250 £100 £350 12.5%

£500 £100 £600 17.5%

£1,000 £100 £1,100 25%

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ARE THERE ANY EXCLUSIONS?

Stage 1

a) Firstly, visit your GP. If your GP considers it is medically appropriate to refer you for specialist treatment, then advise your

GP that you wish to have private treatment.

b) Call our dedicated claims helpline on +44 (0)1202 756350 where one of the claims team will be able to assist you.

Please have your policy number ready.

c) We will check your policy details and ask you some questions about your medical condition and what the GP has advised

you.

d) We will then send you a Medical Consent form for completion and ask you to obtain a copy of the referral letter that

your GP sends to the specialist.

e) In some cases we may need to obtain further information from your GP in order we can advise you on coverage. We will

advise you if this is the case and keep you informed of the progress of obtaining the necessary information. We will be

unable to confirm any coverage whilst we are awaiting the additional information requested. We may also request your

help to obtain this.

f) When we have all the required information in order to make a decision on your claim, we will inform you in writing of

what we are able to cover and any limitations that may apply.

Stage 2

a) Go and see your specialist if we have agreed your consultation and investigations (if applicable).

b) You may pay for your treatment upfront and send the itemised invoices and receipt to the Claims Department, at the

contact details shown in order we can reimburse you under the terms of your policy. However, where practical, we can

also settle your pre-authorised out-patient medical expenses direct to the hospital or treatment provider. You will be

responsible to pay any excess applicable.

c) If your specialist recommends treatment or a surgical procedure, you will need your specialist to fully complete a Part B

form which will provide us the necessary information in order we can further assess your claim. If the Part B form is not

fully completed, this could delay your claim and the form will need to be returned to your specialist for full completion.

d) In some cases we may need to obtain further information from your specialist in order we can advise you on coverage.

We will advise you if this is the case and keep you informed of the progress of obtaining the necessary information.

We will be unable to confirm any coverage whilst we are awaiting the additional information requested. We may also

request your help to obtain this.

e) Once we have all the necessary information we will advise you if your treatment is covered. If you are undergoing a

recognised surgical procedure privately, we will outline the monetary amount we will pay you. The monetary amount is

for you to cover your costs relating to:

• consultants’ and anaesthetists’ fees in relation to the operation,

• operating theatre costs,

• accommodation costs,

• nursing care,

• in-patient drugs and dressings,

• inpatient x-rays, physiotherapy, pathology and other diagnostic tests

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HOW DO I MAKE A CLAIM?

f) You will need to organise with the private hospital to self-pay for your treatment. Private hospitals provide fees on a fixed

price package or a fee per service.

Fixed Price Package

Most private hospitals will offer fixed price packages where the cost of the procedure and all associated costs are fixed. The

cost of surgical treatment may vary depending on your individual circumstances but the cost will be guaranteed prior to the

service. Should you wish to take advantage of a fixed price package, you can negotiate a package directly with the hospital.

Fee per service

Some hospitals may decline to give you a fixed price package if you have an unusual procedure or if your medical

circumstances make it difficult to know how much medical care will cost. In these circumstances, you will be billed on a per

item basis.

You will be responsible for settling any invoices associated with the procedure directly with the hospital and any shortfalls if

the hospital charge exceeds your procedure benefit. However, if the cost of the surgical treatment is lower than the benefit

amount we have provided you, then you will be able to keep the surplus.

g) If you decide to have the surgery on the NHS, the treatment must be agreed by us in writing before the surgery goes

ahead. Surgical procedures on the NHS will be reimbursed after treatment has taken place and will be up to 50% of the

total benefit amount we would have paid had you undertaken the treatment at a private hospital. You will need to send

us a copy of the discharge note.

h) With the monetary amount we provide you, you can also choose to have your surgical treatment anywhere in the world.

If the cost of the surgical treatment is lower than the benefit level then you will be able to keep the surplus. Costs for

any flights, transport and accommodation or complications that may arise from seeking your treatment outside of the

UK will be your responsibility.

i) If you do not have the authorised in-patient surgical treatment within 6 months, any additional treatment required

directly or indirectly as a result of not receiving the authorised treatment will not be covered under your Policy.

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Your policy is subject to different types of underwriting and we have explained what these mean to you.

a) Full medical underwriting

This is a type of underwriting where we ask you to complete a number of questions about your health.

We will review this information and decide what cover we can offer you. If necessary we may ask your General

Practitioner to provide more information to help us do this.

If you have any pre-existing medical conditions that may need treatment in the future, we will usually exclude it from

the cover along with any condition related to it.

If you agree to the policy terms we are offering you, any exclusion we apply will be shown on your certificate of

insurance and will start from your commencement date. In some cases we will advise you that an exclusion can be

reviewed at your request after a specific time period, after the policy has started. Please note that if we offer to review

an exclusion, this does not automatically mean that the exclusion will be removed.

With full medical underwriting new acute medical conditions arising after the start of your policy will be covered

immediately subject to the policy terms and conditions.

A fully medically underwritten policy does not cover medical conditions that you and your dependants already had

prior to the policy commencement date, including any related conditions that have not been disclosed and accepted by

us.

It is essential that you give us all the information we ask for, even if you have symptoms that have not been diagnosed.

If you don’t, we will not pay any claim that you make in the future, or may even cancel your policy. If you are not sure

whether or not to mention something, you should do so.

Maximum age of entry is 70.

b) Moratorium underwriting

If you choose this underwriting option, you do not need to complete any questions concerning your health at the

point of application, however, you will not be covered for any claims made in respect of pre-existing conditions during

the first two years of the policy, for which you have received treatment and/or medication, or asked advice on, or had

symptoms of whether or not diagnosed, during the five years immediately before your policy started with us.

Conditions that arise after the policy commencement date, but are related to the pre-existing condition will also be

excluded.

If you have:

• experienced symptoms,

• sought treatment,

• taken medication,

• asked for or gained advice, or

• needed treatment,

in the two years after the policy commencement date, then you will have to wait until you have completed a

continuous two-year period where you have not;

• experienced symptoms,

• sought treatment,

• taken medication,

• asked for or gained advice, or

• needed treatment,

in order for the medical condition or related medical condition to be considered for coverage.


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UNDERWRITING

c) Continued Personal Medical Exclusions (CPME) underwriting

If you have had previous medical insurance with another insurer and you were medically underwritten, you may be able

to apply for a transfer to Freedom Health Insurance.

We will ask you to complete a number of questions about your health and provide a copy of your certificate of insurance

from the other insurer. If we agree to accept your application, any personal exclusions outlined on the insurer’s previous

certificate of insurance will also be applied to your policy with Freedom Health Insurance.

Please note that the terms and conditions of your Freedom Health Insurance policy may be different to your previous

insurance policy.


d) Continued Moratorium (CM or Switch Moratorium) underwriting

If you have had previous medical insurance with another insurer and you were underwritten on a moratorium, you may

be able to apply for a transfer to Freedom Health Insurance.

We will ask you to complete a number of questions about your health and provide a copy of your certificate

of insurance from the other insurer. If we agree to accept your application, we will transfer your moratorium

commencement date from your previous insurer to Freedom Health Insurance.

Please note that the terms and conditions of your Freedom Health Insurance policy may be different to your previous

insurance policy. For information on the moratorium underwriting, please refer to the moratorium explanation in point

b) above.


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It is important to understand that your policy is designed to cover treatment for acute medical conditions where the

purpose of the treatment is to cure the medical condition. Acute medical conditions respond quickly to treatment and

the aim of the treatment is to return you to the state of health you were in immediately before suffering the medical

condition, or which leads to your full recovery.

The policy is not designed to cover chronic medical conditions where the purpose of treatment is to keep the symptoms

under control and a cure is not possible.

What do we mean by a chronic condition?

We define a chronic medical condition as:

A disease, illness, or injury that has one or more of the following characteristics:

• it needs ongoing or long-term monitoring through consultations, examinations, check-ups, and / or tests

• it needs ongoing or long-term control or relief of symptoms

• it requires your rehabilitation or for you to be specially trained to cope with it

• it continues indefinitely

• it has no known cure

• it comes back or is likely to come back

What does this mean in practice?

When you become ill with a medical condition for the first time, we will provide coverage for the treatment (if eligible

under the policy) to stabilise your medical condition. Once your condition has stabilised and the treatment you are

receiving appears only to be monitoring you, or controlling your medical condition, rather than curing it, then we will

no longer be able to offer you coverage. If this happens, we will discuss this with you. We may also need to obtain

further medical information from your GP or Specialist when making a decision on coverage.

What if your chronic condition gets worse or becomes unstable?

Although we may not be covering you for the routine monitoring and control of your chronic medical condition, if

your chronic medical condition becomes unstable and gets worse, we may be able to provide cover in order that your

chronic medical condition can be stabilised.

We have provided you some examples in order to help explain further. All examples assume that the medical condition

is eligible under the policy and benefit is available.

Example 1

Alan has been with Freedom for many years. He develops chest pain and is referred by his GP to a specialist. He has

a number of investigations and is diagnosed as suffering from angina. Alan is placed on medication to control his

symptoms.

Will Alan be covered?

We will cover Alan’s initial consultations and tests to obtain the diagnosis. We will also cover further consultations with

his specialist until his symptoms are under control and being maintained.

Two years later, Alan’s chest pain recurs more severely and his specialist recommends that he has a heart bypass

operation.

We will provide a monetary benefit amount for the recognised procedure. We will also cover the post-operative

check-ups for one year to ensure that the medical condition has been stabilised.

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CHRONIC CONDITIONS

Example 2

Eve has been with Freedom for five years when she develops breathing difficulties. Her GP refers her to a specialist

who arranges for a number of tests. These reveal that Eve has asthma. Her specialist puts her on medication and

recommends a follow-up consultation in three months to see if her condition has improved. At that consultation Eve

states that her breathing has been much better, so the specialist suggests she has a check-up every four months.

We will cover the consultations and tests and will also agree to pay for the three-month check-up. We would be unable

to cover the check-ups every four months as the condition has stabilised and is being controlled.

Eighteen months later, Eve has a bad asthma attack.

If Eve was admitted to an Accident and Emergency department, then we would be unable to provide any cover for this

treatment, as the policy is not designed to cover accident and emergency treatment.

If after her discharge from accident and emergency a specialist follow-up appointment is needed, we may agree to

cover the cost of one follow-up consultation to make sure that the symptoms are being controlled again.

Example 3

Deirdre has been with Freedom for two years when she develops symptoms that indicate she may have diabetes. Her

GP refers her to an endocrinology specialist who organises a series of investigations to confirm the diagnosis, and

she then starts on oral medication to control the diabetes. After several months of regular consultations and some

adjustments to the medication regime, the specialist confirms that the condition is now well controlled and explains

that he would like to see her every four months to review the condition.

We will pay for the treatment of the diabetes up to the point where the specialist confirms that the condition is well

controlled and only needs to see Deirdre every four months. We will be unable to consider the regular four-month

follow-ups as this would be considered routine monitoring.

One year later, Deirdre’s diabetes becomes unstable and her GP arranges for her to go into hospital for treatment.

If Deirdre was admitted to an Accident and Emergency department, then we would be unable to provide any cover for

this treatment, as the policy is not designed to cover accident and emergency treatment.

If after her discharge from accident and emergency a specialist follow-up appointment is needed, we may agree to

cover the cost of one follow-up consultation to make sure that the symptoms are being controlled again.

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The following questions are frequently asked.

• What hospitals am I covered for?

Any. The Freedom Your Choice plan enables you to choose

any hospital in the UK and abroad for in-patient treatment.

The plans are designed to give cash benefits for surgical

treatment either privately in the UK, abroad or using the

NHS.

If the cost of the treatment is lower than the benefit level

then you will be able to keep the surplus. Please note you

are responsible for settling any invoices associated with the

procedure directly with the hospital and any shortfalls if the

hospital charge exceeds your procedure benefit.

NHS benefits will be paid after surgery has taken place and

will be up to 50% of the total benefit amount payable.

• How do I join?

You have two choices:

1 Download an application form from our website

www.freedomhealthinsurance.co.uk/documents-library

then return the completed form to us.

2 Complete and submit your application online at

www.freedomhealthinsurance.co.uk

Once we accept your application, a confirmation letter

will be sent within three working days and your policy

documents will be issued within five working days. You have

fourteen days in which to change your mind and cancel the

plan by returning the documents.

If for any reason we cannot accept your application you will

be advised in writing.

• What is the method of underwriting?

Freedom Your Choice is underwritten on a Moratorium basis.

This means that any medical condition that occurred during

the five years prior to the inception of your Freedom plan

will be excluded for the first two years your policy is in force.

Cover excluded by the Moratorium may be reinstated later

if the medical condition has not recurred for a continuous

period of two years since the date it was last treated. Please

refer to page 11 for full explanation.

Full medical underwriting (FMU) policies are available upon

request.

• Is there a maximum I can claim in any year?

Yes, depending on which level of cover you select, there may

be an overall limit on claims each year and there is a specific

limit for each medical procedure.

• Do I have to use the benefit for treatment?

These plans are designed to give benefits for medical

treatment either privately in the UK, abroad or using the

NHS. Any savings arising from private treatment or free

treatment on the NHS can be kept by you. However, if you

do not have the authorised in-patient treatment within

six months, any additional treatment required directly

or indirectly as a result of not receiving the authorised

treatment will not be covered under your policy.

• Is there an age limit?

To join Freedom, you must be 18 or over and not older than

70. Children included in your policy must be under age 21

(or age 25 if in full time education), otherwise they must

apply for cover under their own separate plan.

• Can you pay the hospital at time of claim?

Yes, on your instructions we can pay your procedure benefit

sum directly to a hospital of your choice. Any savings will be

refunded to you. If the hospital costs exceed your procedure

benefit, you will be responsible for the surplus.

For full details on how the plan works please refer to the policy document.

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YOUR QUESTIONS ANSWERED

Contact us Freedom Health Insurance

Bourne Gate

25 Bourne Valley Road

Poole BH12 1DY

Tel: +44 (0)1202 756 350

Fax: +44 (0)1202 756 351 Email: [email protected]

Web: www.freedomhealthinsurance.co.uk

Calls may be recorded for quality and training purposes.

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CONTACT DETAILS

Freedom Health and Freedom Health Insurance are trading names of Freedom Healthnet Limited.

Freedom Healthnet Limited is authorised and regulated by the Financial Conduct Authority with the registration number 312282.

Registered address: Bourne Gate, 25 Bourne Valley Road, Poole, BH12 1DY. Company registration number: 4815524.

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