Explanations

Individual moratorium

Individual - rolling 5:2:2 specified moratorium

    • man with dog

      A moratorium is the period of time when we can’t cover any condition you had before you joined us.

      This means that in the first two years of your membership we won’t cover:

      • pre-existing conditions (including symptoms of conditions that haven’t yet been diagnosed and the recurrence of past conditions or symptoms); or
      • specified conditions – if you have pre-existing diabetes, pre-existing raised blood pressure, or you were having treatment or being monitored as a result of having a PSA test that showed abnormal levels when your plan started. We explain these specified conditions in more detail in the 'How your membership works' section of your handbook.

      What happens after two years

      If you’ve been trouble free for at least two continuous years, starting from the date you joined us, we’ll then be able to consider any claims for pre-existing conditions, in line with the benefits of your plan.

      How it works

      James’ cataracts

      James joined us a year ago and has been experiencing some sight problems over the last six months. He went to see his optician and at the appointment they noticed a cataract forming in his eye, which will need to be treated.

      James joined before he began to suffer with any signs or symptoms and he doesn’t suffer with diabetes, so we won’t exclude cataracts as a specified condition. This means we can cover James’ claim.

      James explaination

      Specified conditions

      If you have pre-existing... We will not pay benefit for...
      Hypertension
      (high blood pressure)
      Hypertension
      Ischaemic heart disease
      Stroke
      Hypertensive renal failure
       
      Diabetes Diabetes
      Ischaemic heart disease
      Cataracts
      Diabetic retinopathy
      Diabetic renal failure
      Arterial disease
      Stroke
       
      Abnormal PSA levels Any disorder of the prostate
    • Definitions

      Pre-existing conditions

      A pre-existing condition is any disease, illness or injury that:

      • you have received medication, advice or treatment for in the five years before the start of your cover, or
      • you have experienced symptoms of in the five years before the start of your cover: whether or not the condition was diagnosed

      Trouble free

      Trouble-free means that you have not done any of the following for the medical condition you need treatment for:

      • had a medical opinion from a medical practitioner, including a GP or specialist
      • taken medication (including over-the-counter drugs)
      • followed a special diet
      • had medical treatment
      • visited a practitioner, physiotherapist, osteopath, chiropractor, homeopath, acupuncturist, optician or dentist