Explanations

Simplified declaration

Simplified declaration

    • Simplified Declaration

      Group Leavers

      When you left your group healthcare scheme, we gave you two options:

      • You could start again, as a new member
      • Or, you could continue with the same underwriting terms that you had on the group scheme.

      If you chose the second option - we asked you two questions (known as a 'simplified declaration'), so we could give you a fair and accurate price:

      • Have you seen a specialist or had hospital treatment in the 12 months before changing healthcare plans?
      • Do you have any treatment planned or pending?

      If you were able to answer ‘no’ to both these questions, you would have been allowed to continue with the same underwriting terms that you had on the group scheme. If you answered ‘yes’ to one or both of the questions, you would have been given more options:

      • You could continue the underwriting terms you had on the group scheme and accept new exclusions for the problems you declared – to reduce the subscription cost
      • Or, you could pay a higher price to continue with the underwriting terms you had on the group scheme.

      Whichever option you chose, treatment will be authorised in line with the terms and conditions of your plan.

      A reference to this declaration will appear on your ‘Membership certificate’. When you make a claim, we may ask your GP or specialist for some information to confirm the answers you gave. Once they’ve confirmed this, we’ll be able to authorise treatment in line with your plan’s terms and conditions.

    • 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