Please refer to the Virtual GP page for further information on how to access this benefit.

This service will no longer be available via Healix but will be provided by MetLife. The Virtual GP can still be accessed via the My Healix App or Member Zone. For any further information please refer to your HR department.

Please refer to your cancer support explained.

Removed

Please refer to Member Zone for further information

Please refer to your cancer support explained

Please refer to Member Zone for further information

Please refer to Musculoskeletal pathway and Mental health pathway. 

Remote advice service with our in-network specialist gynaecologists

We will pay for up to 4 remote advice appointments per scheme year with our in-network specialist gynaecologists on self-referral.  This service can be used to discuss any women’s health concern including conditions that are normally excluded for cover such as the menopause or for contraception/fertility advice. 

Diagnostic tests and investigations following referral from our in-network gynaecologists

We will pay up to £500 per scheme year for diagnostic tests or investigations that are recommended following a remote advice appointment with our in-network specialist gynaecologists.

Remote consultations and diagnostic tests and investigations will be covered up to the limits described above only. Once the benefit limits have been reached the scheme rules will apply as detailed in your exclusions and limitations.

Please note: additional cover may be available outside of the above limits for eligible claims, please contact the claims helpline for further information.

Please refer to the women's health services  page for further information on how to access these benefits.

Women's and Men's Health Benefit

Remote advice service with our in-network specialist gynaecologists or men's health specialists

We will pay for up to 4 remote advice appointments per scheme year with our in-network specialist gynaecologists or men’s health specialists on self-referral.  This service can be used to discuss any health concern including conditions that are normally excluded for cover such as the menopause, andropause, sexual health concerns, fertility or contraception advice.

Diagnostic tests and investigations following referral from our in-network gynaecologists or men's health specialists

We will pay up to £500 per scheme year for diagnostic tests or investigations that are recommended following a remote advice appointment with our in-network specialist gynaecologists or men’s health specialists.

Remote consultations and diagnostic tests and investigations will be covered up to the limits described above only. Once the benefit limits have been reached the scheme rules will apply as detailed in your exclusions and limitations.

Please note: additional cover may be available outside of the above limits for eligible claims, please contact the claims helpline for further information.

Please refer to the women's or men's health services page for further information on how to access these benefits

Outpatient consultations with a specialist on self-referral for breast, bowel and prostate cancer symptoms

We will pay within your overall outpatient limit for self-referred* consultations and investigations for breast, bowel or prostate cancer symptoms.

If a diagnosis of cancer is made, cover for eligible treatment will be subject to any limits as detailed in your cancer treatment benefit.

*Please note, cover for self-referral is subject to the medical underwriting on your scheme

Outpatient consultations with a specialist on self-referral for breast, bowel, prostate and testicular cancer symptoms

We will pay within your overall outpatient limit for self-referred* consultations and investigations for breast, bowel, prostate or testicular cancer symptoms.

If a diagnosis of cancer is made, cover for eligible treatment will be subject to any limits as detailed in your cancer treatment benefit.

*Please note, cover for self-referral is subject to the medical underwriting on your scheme

£500 per lifetime

We will pay up to £500 per scheme lifetime towards medically necessary orthotics, when these are recommended by a practitioner or specialist.

Combined limit of £5,000 per scheme year (up to £15,000 per lifetime)

The below benefits will be paid for when treatment is required as a result of COVID-19 (commonly referred to as 'long COVID'). The benefits have a combined limit of £5,000 per scheme year up to a maximum of £15,000 per lifetime.

Outpatient consultations and diagnostics

We will pay up in full for:

• Outpatient consultations with a specialist following GP referral
• Outpatient diagnostics and investigations following GP or specialist referral
• Outpatient treatment following specialist referral

Cover is subject to our reasonable and customary fees.

Outpatient, daycase and inpatient treatment

We will pay for hospital and specialist fees, for outpatient, daycase and inpatient treatment. Please note cover is not available for acute treatment of COVID-19, including treatment in an intensive care unit, high dependency unit, acute ward setting or NHS hospital.

Outpatient mental health treatment

We will pay up to £1,500 per scheme year, for outpatient consultations for eligible mental health conditions, following GP or self-referral, when treatment is required as a result of long COVID.

If your referral is to a psychological therapist we will arrange a telephone based clinical assessment with a senior psychological therapist from our mental health network provider, who will help organise the most effective treatment for you. This could include face to face therapy, guided self-management or specialist referral. Where treatment with a psychological therapist occurs outside our network provider, it must be delivered under the direct supervision of a consultant psychiatrist.

Outpatient physiotherapy

We will pay up to £500 per scheme year for outpatient physiotherapy following GP or self-referral, when treatment is required as a result of long COVID.

If this is a self-referral, we will arrange a telephone based clinical assessment with a senior physiotherapist, who will help organise the most effective treatment for you. This could include face to face physiotherapy, guided self-management or specialist referral. The telephone based clinical assessment will not be subject to any excess, if one applies, however it will be applied to subsequent treatment should this be required. We will continue to monitor your progress by liaising with your treatment provider and authorise additional treatment where necessary and eligible.

If treatment takes place outside our physiotherapy network, the physiotherapist must still be recognised by us for benefit purposes. 

Outpatient complementary therapies

We will pay up to £250 per scheme year for chiropractic treatment, osteopathy and acupuncture, following GP or specialist referral, when treatment is required as a result of long COVID. You must be referred to a complementary practitioner we have recognised for benefit purpose.

Outpatient consultations with a specialist on self-referral for breast cancer symptoms

We will pay within your overall outpatient limit for self-referred* consultations and investigations for breast cancer symptoms.

If a diagnosis of breast cancer is made, cover for eligible treatment will be subject to any limits as detailed in your cancer treatment benefit.

*Please note, cover for self-referral is subject to the medical underwriting on your scheme

Outpatient consultations with a specialist on self-referral for breast, bowel or postate cancer symptoms

We will pay within your overall outpatient limit for self-referred* consultations and investigations for breast, bowel or prostate cancer symptoms.

If a diagnosis of cancer is made, cover for eligible treatment will be subject to any limits as detailed in your cancer treatment benefit.

*Please note, cover for self-referral is subject to the medical underwriting on your scheme

We will pay up to a maximum of 28 days per scheme year for eligible inpatient and daycase mental health treatment.  All treatment must be under the direct control and supervision of a consultant psychiatrist, and must be authorised by us in advance and in writing.

We will pay up to a maximum of 28 days per scheme year for eligible inpatient and daycase mental health treatment.  All treatment must be under the direct control and supervision of a consultant psychiatrist, and must be authorised by us in advance and in writing.

Where treatment is for an addiction treatment programme, cover is limited to once per scheme lifetime.

In the event that you are admitted to an NHS hospital, or you elect to receive free treatment through the NHS we will pay an NHS cash benefit of £150 per night or day, for inpatient or daycase treatment. This benefit will only apply to claims for daycase or inpatient treatment that would otherwise have been eligible for benefit under your scheme.

In the event that you are admitted to an NHS hospital, or you elect to receive free treatment through the NHS we will pay an NHS cash benefit of £200 per night or day, for inpatient or daycase treatment. This benefit will only apply to claims for daycase or inpatient treatment that would otherwise have been eligible for benefit under your scheme.

We do not pay for any GP consultations or visits other than those specified in your table of benefits. We do not pay for any charges for the completion of claim forms or referral letters, unless we have requested these specifically to assess your claim.

We do not pay for treatment for or arising from sleep disorders. This includes but is not limited to: sleep apnoea, snoring, insomnia, sleep walking, narcolepsy, and night terrors.

Removed

We will pay for outpatient acupuncture, homeopathy, chiropractic and osteopathy up to £250 per scheme year, following GP or specialist referral. You must be referred to a complementary practitioner we have recognised for benefit purposes.

We will pay for outpatient acupuncture, chiropractic and osteopathy up to £250 per scheme year, following GP or specialist referral. You must be referred to a complementary practitioner we have recognised for benefit purposes.

We will pay for outpatient consultations for eligible mental health conditions following GP or self-referral*. Cover is subject to an annual benefit limit of £1,500 in each year of cover and also subject to our reasonable and customary guidelines. If your referral is to a psychological therapist we will arrange a telephone-based clinical assessment with a senior psychological therapist from our mental health network provider who will help organise the most effective treatment for you. This could include face to face therapy, guided self-management or specialist referral. Where treatment with a psychological therapist occurs outside our network provider it must be delivered under the direct supervision of a consultant psychiatrist.

Please note: Your cover is designed to provide help for short or medium-term medical treatment that restores you back to health. Mental health conditions are often long term in nature and may become chronic conditions, for which ongoing cover will not be available on your scheme. Should your specialist/psychological therapist recommend that treatment will be required in excess of 10 sessions the nursing team will provide guidance on making other arrangements for continued treatment after this period. Any extension in cover will be subject to a full clinical review and assessed on a case by case basis – full clinical details will be required from your treating specialist.

*Please note, cover for self-referral is subject to the medical underwriting on your policy.

For further information on how to access this benefit please click here.

We will pay in full for outpatient consultations for eligible mental health conditions following GP or self-referral*. Cover is subject to our reasonable and customary guidelines. If your referral is to a psychological therapist we will arrange a telephone-based clinical assessment with a senior psychological therapist from our mental health network provider who will help organise the most effective treatment for you. This could include face to face therapy, guided self-management or specialist referral. Where treatment with a psychological therapist occurs outside our network provider it must be delivered under the direct supervision of a consultant psychiatrist.

Please note: Your cover is designed to provide help for short or medium-term medical treatment that restores you back to health. Mental health conditions are often long term in nature and may become chronic conditions, for which ongoing cover will not be available on your scheme. Should your specialist/psychological therapist recommend that treatment will be required in excess of 10 sessions the nursing team will provide guidance on making other arrangements for continued treatment after this period. Any extension in cover will be subject to a full clinical review and assessed on a case by case basis – full clinical details will be required from your treating specialist.

*Please note, cover for self-referral is subject to the medical underwriting on your policy.

For further information on how to access this benefit please click here.

We will pay a combined limit of £1,000 per scheme year for cancer outpatient therapies and cancer alternative therapies.

Cancer outpatient therapies
We will pay up to the benefit limit for physiotherapy, osteopathy, chiropractic treatment, manual lymphatic drainage and dietician services.

Cancer alternative therapies
We will reimburse up to £250 on a pay and claim basis within the above combined limit of £1,000 per scheme year for acupuncture, reflexology, aromatherapy and homeopathy.

Benefits will be paid to you on receipt of the necessary documents, which must be submitted within six months of your treatment date.

These benefits are available when recommended by your specialist and required as a direct result of eligible cancer treatment. Treatment must be taken with a practitioner we recognise for benefit purposes. For more details on how to access these benefits, please call on 0208 150 9702.

We will pay up to a total limit of £1,000 per scheme year for the following therapies, when required as a direct result of eligible cancer treatment.

Cancer outpatient therapies on GP, specialist or self-referral
We will pay up to the benefit limit for physiotherapy, osteopathy, chiropractic treatment, manual lymphatic drainage and dietician services.

Treatment must be taken with a physiotherapist, practitioner or complementary practitioner that we recognise for benefit purposes

Cancer alternative therapies on GP, specialist or self-referral
We will reimburse up to £250 on a pay and claim basis within the above combined limit of £1,000 per scheme year for acupuncture, reflexology and aromatherapy.

We will pay up to £1,000 per scheme year for outpatient mental health treatment.

Mental health treatment must be with a psychological therapist or psychiatrist for this to be eligible for cover.

This benefit is available when recommended by your specialist and required as a direct result of eligible cancer treatment. Treatment must be taken with a psychological therapist we recognise for benefit purposes. For more details on how to access this benefit, please call on 0208 150 9702.

We will pay up to £1,000 per scheme year on specialist or self-referral for outpatient mental health treatment required as a direct result of eligible cancer treatment.

Mental health treatment is only covered if it is provided by a psychological therapist or psychiatrist.

Full cover

Outpatient consultations with a specialist on self-referral for breast cancer symptoms

We will pay within your overall outpatient limit for self-referred* consultations and investigations for breast cancer symptoms.

If a diagnosis of breast cancer is made, cover for eligible treatment will be subject to any limits as detailed in your cancer treatment benefit.

*Please note, cover for self-referral is subject to the medical underwriting on your scheme

Full cover

Outpatient consultations with a practitioner

We will pay within your overall outpatient limit for consultations with a dietician, nurse, orthoptist or speech therapist following specialist referral. The practitioner must be registered with the correct governing body for their field, and meet our definition for a practitioner

Full cover

We will pay in full for out of network outpatient physiotherapy when this is referred by a specialist.

Full cover for specified treatments

We will pay for the following specified obstetric procedures / treatment:           

• pelvic girdle pain in pregnancy

• miscarriage or when the foetus has died and remains with the placenta in the womb

• still birth

• hydatidiform mole (abnormal cell growth in the womb)

• ectopic pregnancy (foetus growing outside the womb)

• post-partum haemorrhage (heavy bleeding in the hours and days immediately after childbirth)

• retained placental membrane (afterbirth left in the womb after the delivery of the baby)

• eligible mental health treatment for post-natal depression subject to the conditions and limitations set out in the mental health benefit.

• medically essential caesarean section where this is an inevitable consequence of a complication to the current pregnancy.

• complications following any of the above conditions.

• flare up of a non-pregnancy related medical condition that has been made worse by pregnancy

We will require full clinical details from your specialist before we can give our decision on cover.

In the event that the newborn requires immediate treatment as a result of an eligible caesarean section, this should be administered by the NHS free of charge. If the newborn is not entitled to NHS care and is not accepted as a dependant on the scheme we will pay for treatment for up to 7 days following the birth, to allow you time to make alternative arrangements.  In cases where they are accepted as a member of the scheme they will only be entitled to benefits outlined in the benefits table and will be subject to the exclusions listed within the scheme.

Full cover for specified treatment

We will pay for the following specified oral surgical operations carried out by a specialist:

• surgically remove a complicated, buried, infected or impacted tooth root

• apicectomy or removal of the tip of a tooth’s root

• enucleation of a cyst of the jaw (removing a cyst from the jaw bone)

• surgical drainage of a fascial space (tracking) abscess

• putting a natural tooth back into a jaw bone after it is knocked out or dislodged in an accident

• treatment of facial and mandibular fractures

Full cover for specified treatment

We will pay for eligible acute treatment of the following conditions:

• cataracts

• detached retina

• surgical correction of a squint

• drooping Eyelids (ptosis) – We will only provide benefit for ptosis (drooping eyelids), if your optometrist identifies visual impairment and you are referred by your general practitioner or optician to a consultant ophthalmologist

• wet aged related macular degeneration, where we will pay for a short course of treatment following initial diagnosis

We do not pay for the ongoing treatment of chronic conditions or any treatment required as a result of a relapse in a chronic condition.

At the time of your treatment it may not always be clear that your condition is chronic, however when it becomes clear that your condition is chronic, we are not obliged to continue paying the ongoing costs of treatment, even where we have previously paid for treatment.

We do not pay for treatment of chronic conditions. By this we mean any medical condition which has at least one 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 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.

Please note: this will apply to all medical conditions, whether or not a diagnosis has been made.

Exception:  We will pay for eligible treatment arising out of a chronic condition, or for treatment of acute symptoms of a chronic condition that flare up. However, we only pay if the treatment is likely to lead quickly to a complete recovery or to you being fully restored to your previous state of health, without you having to receive prolonged treatment. For example, we pay for treatment following a heart attack arising out of chronic heart disease. This exception does not apply to treatment of a mental health condition.

Please note: in some cases it might not be clear, at the time of treatment, that the disease, illness or injury being treated is a chronic condition. We are not obliged to pay the ongoing costs of continuing, or similar, treatment. This is the case even where we have previously paid for this type of or similar treatment.

Please note this exclusion does not apply to the treatment of cancer.

We do not pay for treatment for conditions which were diagnosed or evident at birth

Removed from exclusion wording

We do not pay for :

• Consultations with a dentist or routine dental check ups

• fillings, simple extractions and treatment of gum disease

• root canal treatment

• consultations with dental specialists such as periodontists, orthodontists,endodontists, and hygienists

• the provision of dental implants, or veneers, repair or replacement of damaged teeth (including crowns, bridges, dentures or any dental prostheses), or orthodontic braces (whether fixed or removable)

• restoration of minor enamel, dentine and incisal edge fractures

• the management of or treatment (including surgical operations) of jaw shrinkage or loss as a result of dental extractions or gum disease

• treatment required for cosmetic reasons (for example orthognathic surgery and teeth whitening).

• procedures to prepare for orthodontics or prosthetic surgery

• mouth guards, gum shields, or dental appliances of any kind

Exception: we will pay for surgical operations carried out by a specialist when treating an acute condition such as:

• surgically remove a complicated, buried, infected or impacted tooth root

• apicectomy or removal of the tip of a tooth’s root

• enucleation of a cyst of the jaw (removing a cyst from the jaw bone)

• Surgical drainage of a fascial space (tracking) abscess

• putting a natural tooth back into a jaw bone after it is knocked out or dislodged in an accident

• treatment of facial and mandibular fractures

We do not pay for any dental or oral treatment other than listed in your table of benefits.

We do not pay for treatment for or associated with dialysis haemodialysis, (meaning the removal of waste matter from your blood by passing it through a kidney machine or dialyser). We do not pay for treatment for or associated with peritoneal dialysis (meaning the removal of waste matter from your blood by introducing fluid into your abdomen which acts as a filter).

Exception: We will pay for eligible treatment for short-term dialysis when needed temporarily for sudden kidney failure resulting from an eligible condition or treatment.

We do not pay for treatment for or associated with dialysis.

Exception: we will pay for temporary dialysis required as a result of complications following an eligible procedure.

We do not pay for treatment to correct your sight, this includes routine eye examinations, contact lenses (including lenses following cataract surgery), spectacles or laser eye procedures.

We do not pay for ongoing or long-term treatment of eye conditions. This includes but is not limited to:

• Glaucoma
• Diabetic retinopathy
• Occlusion therapy for squint
• Astigmatism
• Myopia
• Amblyopia

Exception: We will pay for eligible acute treatment of the following conditions:

• Cataracts
• detached retina
• Surgical correction of a squint
• Drooping Eyelids (ptosis) – We will only provide benefit for ptosis (drooping eyelids), if your optometrist identifies visual impairment and you are in turn referred by your General Practitioner or optician to a consultant ophthalmologist. We will only fund surgery if visual field tests and medical photographs confirm the ptosis is at risk of threatening the visual field testing for safe driving
• Wet aged related macular degeneration, where we will pay for a short course of treatment following initial diagnosis

We do not pay for treatment to correct your sight other than as specified in your table of benefits.

We do not pay for acute, immediate treatment required to treat pandemic and/or epidemic disease. Exception: we will pay for secondary complications arising as a result of previous pandemic and/or epidemic disease subject to all other terms and conditions of the scheme, including the restrictions placed on chronic conditions.

We do not pay for treatment for pregnancy or childbirth, including:

• Hyperemesis (excessive and prolonged nausea and vomiting)

• Pelvic girdle pain (pelvic pain in pregnancy)

• Diastasis recti (abdominal separation)

• Pregnancy induced hypertension (high blood pressure in pregnancy)

• Pre-eclampsia

• Treatment of a foetus or embryo

• Antenatal care

• Termination of pregnancy

• Any treatment arising from assisted conception

• Any complications arising from the above condition

Exceptions: We will pay for eligible treatment of the following conditions:

• Miscarriage or when the foetus has died and remains with the placenta in the womb

• Still birth

• Hydatidiform mole (abnormal cell growth in the womb)

• Ectopic pregnancy (foetus growing outside the womb)

• Post-partum haemorrhage (heavy bleeding in the hours and days immediately after childbirth)

• Retained placental membrane (afterbirth left in the womb after the delivery of the baby)

• Eligible mental health treatment for post-natal depression subject to the conditions and limitations set out in the mental health benefit.

• Medically essential caesarean section where this is an inevitable consequence of a complication to the current pregnancy.

• Complications following any of the above conditions.

We will require full clinical details from your specialist before we can give our decision. We do not pay for any of the above if the pregnancy is a result of assisted conception.

We do not pay for any treatment related to pregnancy or childbirth, other than as specified in your table of benefits.

We will pay up to 180 days per scheme year for home nursing charges for registered nurses if recommended by a specialist and where treatment is:

• as a result of eligible private inpatient hospital treatment

• medically necessary and without it you would be required to remain as an inpatient.

• needed for medical reasons. (i.e. not social or domestic)

• under the direct supervision of a specialist

We will need full clinical details before we give our authorisation and you must have our written agreement before treatment starts.

Home nursing provided by a community mental health team is not covered by the scheme.

We will pay in full for home nursing charges for registered nurses if recommended by a specialist and where treatment is:

• as a result of eligible private inpatient hospital treatment

• medically necessary and without it you would be required to remain as an inpatient.

• needed for medical reasons. (i.e. not social or domestic)

• under the direct supervision of a specialist

We will need full clinical details before we give our authorisation and you must have our written agreement before treatment starts.

Home nursing provided by a community mental health team is not covered by the scheme

We do not pay for any transplants and/or complications related to, or resulting from transplants. We also do not pay for

• donor costs

• harvesting

• storage

• administration

• and/or any complications/treatment arising from any of the above

Exception: we will pay for recipient costs for skin or corneal grafts when eligible for benefit.

We do not pay for any transplants, adoptive cell transfer, gene therapies and/or any complications related to, or resulting from these treatments. This includes, but is not limited to CAR T cell therapy, Tumour Infiltrating Lymphocyte therapy and stem cell/bone marrow treatments.

We also do not pay for

• donor costs

• harvesting

• storage

• administration

• and/or any complications/treatment arising from any of the above

Exception: we will pay for recipient costs for skin or corneal grafts when eligible for benefit.

We do not pay for any form of plastic or reconstructive surgery, or scar revision, even when required for psychological reasons.

We will not pay for breast enlargement or reduction or any treatment or procedure to change the shape or appearance of your breast(s) whether or not it is required for medical or psychological reasons, for example backache or enlarged breasts in males.

We do not pay for any treatment, including surgery,

◦ which is for or involves the removal of healthy tissue (i.e. tissue which is not diseased), surplus or fat tissue.

◦ Where the intention of treatment, whether directly or indirectly, is the reduction or removal of surplus or fat tissue

◦ For scar revision or keloid scarring

Exception: We will pay for post-traumatic or post-surgical reconstruction to restore function or appearance if it is medically necessary as a direct result of you having an accident or because of other surgery or cancer, which itself would have been covered under the scheme.

We will pay for breast reduction/augmentation in a healthy breast if the primary purpose is to improve symmetry following surgery for cancer in the contralateral breast.

We do not pay for any treatment to change your appearance even when required for psychological reasons.

We do not pay for any treatment, including surgery:

• Where the intention of treatment, whether directly or indirectly, is the reduction or removal of healthy, surplus or fat tissue (for example, weight reduction surgery / treatment)

• Where the aim is to aesthetically enhance the appearance of the face or body where no functional condition is present (for example, botox, fillers or asymptomatic rhinoplasty)

Exception:

We will pay for medically necessary treatment to restore your appearance in the following circumstances:

• Where it results from an underlying disease process following eligible treatment (including cancer treatment)

• Where the condition is causing a functional problem (for example enlarged breasts causing severe back pain)

Please note: we use NHS guidance as a benchmark for deciding whether requests for treatment are eligible for cover.

All requests for cover must be submitted in writing with supporting medical information

Treatment for abnormalities which you have had from birth except for emergency operations carried out within 14 days of birth. We do not pay for treatment related to tongue-tie or cleft lip palates.

We do not pay for treatment for conditions which were diagnosed or evident at birth

removed from exclusion wording

removed from exclusion wording

£600 per month

In the event that you elect to receive oral chemotherapy or targeted therapies via the NHS as an outpatient, we will pay an NHS Cancer Cash benefit of £600 per month whilst you receive such treatment.

Please note this Cash Benefit is payable instead of any other benefit. This benefit would be paid to you on completion of your treatment and receipt of the necessary documents, which must be submitted within six months of your treatment date. If you require further information on how to access this benefit, please call on 0208 150 9702.

Combined limit of £1,000 per scheme year

We will pay a combined limit of £1,000 per scheme year for cancer outpatient therapies and cancer alternative therapies.

Cancer outpatient therapies
We will pay up to the benefit limit for physiotherapy, osteopathy, chiropractic treatment, manual lymphatic drainage and dietician services.

Cancer alternative therapies
We will reimburse up to £250 on a pay and claim basis within the above combined limit of £1,000 per scheme year for acupuncture, reflexology, aromatherapy and homeopathy.

Benefits will be paid to you on receipt of the necessary documents, which must be submitted within six months of your treatment date.

These benefits are available when recommended by your specialist and required as a direct result of eligible cancer treatment. Treatment must be taken with a practitioner we recognise for benefit purposes. For more details on how to access these benefits, please call on 0208 150 9702.

£1,000 per scheme year

We will pay up to £1,000 per scheme year for outpatient mental health treatment.

Mental Health treatment must be with a Psychological Therapist or Psychiatrist for this to be eligible for cover.

This benefit is available when recommended by your specialist and required as a direct result of eligible cancer treatment. Treatment must be taken with a practitioner we recognise for benefit purposes. For more details on how to access this benefit, please call on 0208 150 9702.

Full Cover

We will pay in full for the cost of external prosthesis, wigs and nipple tattooing for reconstructive purposes only.

For wigs and nipple tattooing, this benefit is available on a pay and claim basis only. Benefits will be paid to you on receipt of the necessary documents, which must be submitted within six months of your treatment date.

This benefit is available when recommended by your specialist and required as a direct result of eligible cancer treatment. Treatment must be taken with a practitioner we recognise for benefit purposes. For more details on how to access this benefit, please call on 0208 150 9702.

We will pay fees for outpatient consultations for mental health conditions when referred by a GP. Treatment with a Psychological Therapist must be under the direct supervision of a Consultant Psychiatrist unless this is delivered by a Healix Mental Health network provider. Cover is subject to an annual benefit limit of £1,000 in each year of cover and also subject to our reasonable and customary guidelines. For assistance in finding a network provider please contact the Helpline and a member of the team will arrange a referral on your behalf.

Please note: Your cover is designed to provide help for short or medium-term medical treatment that restores you back to health. Mental health conditions are often long term in nature and may become chronic conditions, for which ongoing cover will not be available on your scheme. Should your specialist/therapist recommend that treatment will be required in excess of 10 sessions the nursing team will provide guidance on making other arrangements for continued treatment after this period. Any extension in cover will be subject to a full clinical review and assessed on a case by case basis – full clinical details will be required from your treating specialist.

We will pay for outpatient consultations for eligible mental health conditions following GP or self-referral. Cover is subject to an annual benefit limit of £1,500 in each year of cover and also subject to our reasonable and customary guidelines. If your referral is to a Psychological Therapist we will arrange a telephone-based clinical assessment with a Senior Therapist from our mental health network provider who will help organise the most effective treatment for you. This could include face to face therapy, guided self-management or specialist referral. Where treatment with a Psychological Therapist occurs outside our network provider it must be delivered under the direct supervision of a Consultant Psychiatrist.

Please note: Your cover is designed to provide help for short or medium-term medical treatment that restores you back to health. Mental health conditions are often long term in nature and may become chronic conditions, for which ongoing cover will not be available on your scheme. Should your specialist/therapist recommend that treatment will be required in excess of 10 sessions the nursing team will provide guidance on making other arrangements for continued treatment after this period. Any extension in cover will be subject to a full clinical review and assessed on a case by case basis – full clinical details will be required from your treating specialist.

We will pay for up to 10 sessions of outpatient physiotherapy per scheme year, following GP or specialist referral for:

• conditions not relating to muscle, bone or joint pain
• treatment which is not provided by our physiotherapy network provider

We will pay the costs of an initial assessment followed by three further sessions if required and pre-authorisation has been obtained from us. If further sessions are required, you must contact us on 0208 150 9702 with details of your proposed treatment plan from the physiotherapist to receive pre-authorisation.

We will pay up to £250 per scheme year for outpatient physiotherapy following specialist or GP referral, if treatment takes place outside our physiotherapy network. The physiotherapist must still be recognised by us for benefit purposes.

We will pay the costs of an initial assessment followed by three further sessions if required and pre-authorisation has been obtained from us. If further sessions are required, you must contact us on 0208 150 9702 with details of your proposed treatment plan from the physiotherapist to receive pre-authorisation.

We will make a donation of £70 a day for up to a maximum of 10 days care in a recognised hospice.

In the event that you are admitted to a hospice, we will make a donation of £70 per night to the hospice, for the duration of the admission.

Updates will be made to the general exclusions to ensure they remain up to date and appropriate.

1st January 2019

N/A

As part of your BSI Medical Scheme you have access to a virtual GP service, called TrustDoc24 which is provided by Medical Solutions.

This service can be accessed 24/7, 365 days a year by phone on: 0345 319 4129, or via the app (eConsultation service is available Mon-Fri 08:00-22:00, Sat 08:00-20:00, Sun 10:00-18:00, excluding bank holidays). For further information on the service click here, and for details on how to download the app click here.

Please note, during the phone call or eConsultation you will need to provide Medical Solutions with your employer’s name, BSI, in order to access the service.

Should Medical Solutions refer you onto a specialist, please contact us on your help line number 0208 150 9702 to check if this is eligible under your scheme. Any onward referrals are subject to your scheme underwriting, personal exclusions (if applicable) and general scheme exclusions. Should further information on your past medical history be required we will need your consent to contact your NHS GP.

For back and neck conditions, you may contact the Claims Helpline without the need for referral from your GP and a nurse will assess your symptoms and help organise the most effective treatment. If appropriate, we will arrange a physiotherapy referral within 24 hours and continue to monitor your progress by liaising with your treatment provider and assess whether you require further treatment or are ready to be discharged.

For conditions relating to muscle, bone or joint pain we will pay in full for outpatient physiotherapy without the need for a GP referral when treatment is provided by our physiotherapy network provider.

We will also pay in full for GP or specialist referred physiotherapy for conditions relating to muscle, bone or joint pain, when treatment is provided by our physiotherapy network provider.

We will arrange a telephone-based clinical assessment with a Senior Physiotherapist who will help organise the most effective treatment for you. This could include face to face physiotherapy, guided self-management or specialist referral. The telephone-based clinical assessment will not be subject to any excess (if one applies) however it will be applied to subsequent treatment should this be required. We will continue to monitor your progress by liaising with your treatment provider and authorise additional treatment where necessary and eligible.

We will pay for outpatient physiotherapy, osteopathy, chiropractic treatment and acupuncture following GP or specialist referral to a physiotherapist or complementary practitioner we have recognised for benefit purposes. We will pay the costs of an initial assessment followed by three further sessions if required and pre-authorisation has been obtained from us.  If further sessions are required, you must contact us on 0208 150 9702 with details of your proposed treatment plan from the therapist to receive pre-authorisation.

If directly referred by a GP, we will pay up to a maximum of 10 sessions, in combined total per condition, for outpatient physiotherapy, osteopathy, acupuncture and chiropractic treatment.

We will pay for up to 10 sessions of outpatient physiotherapy per scheme year, following GP or specialist referral for:

• conditions not relating to muscle, bone or joint pain
• treatment which is not provided by our physiotherapy network provider

We will pay the costs of an initial assessment followed by three further sessions if required and pre-authorisation has been obtained from us. If further sessions are required, you must contact us on 0208 150 9702 with details of your proposed treatment plan from the physiotherapist to receive pre-authorisation.

We will pay for outpatient physiotherapy, osteopathy, chiropractic treatment and acupuncture following GP or specialist referral to a physiotherapist or complementary practitioner we have recognised for benefit purposes. We will pay the costs of an initial assessment followed by three further sessions if required and pre-authorisation has been obtained from us.  If further sessions are required, you must contact us on 0208 150 9702 with details of your proposed treatment plan from the therapist to receive pre-authorisation.

If directly referred by a GP, we will pay up to a maximum of 10 sessions, in combined total per condition, for outpatient physiotherapy, osteopathy, acupuncture and chiropractic treatment.

We will pay for outpatient complementary therapy up to £250 per scheme year, following GP or specialist referral. You must be referred to a complementary practitioner we have recognised for benefit purposes.

You are not covered for any preventative treatment.

If you are being treated for cancer we may pay for medically necessary genetically-based tests to evaluate future risk of developing further cancers, as well as the resulting prophylactic surgery if it is recommended by your specialist.

For example, we will pay for a mastectomy to a healthy breast in the event that you have been diagnosed with cancer in the other breast and your specialist indicates that prophylactic surgery is medically necessary and will be carried at the same time as surgery to the diseased breast.

You must have our written agreement before you have tests, procedures or treatment and we will need full clinical details from your consultant before we can give our decision.

In the event that you elect to receive free treatment through the NHS, we will pay an NHS Cash Benefit of £150 per night for inpatient treatment, instead of any other benefit.

This benefit will only apply to claims for daycase or inpatient treatment that would otherwise have been eligible for benefit under your scheme and is not payable for the first three nights following an Accident & Emergency admission.

Or

If you choose to occupy an amenity bed whilst receiving NHS inpatient treatment, we will pay for the costs of the amenity bed up to the maximum benefit limit. By amenity bed we mean a bed for which the NHS makes a charge but where treatment is being provided free of charge.

In the event that you are admitted to an NHS hospital, or you elect to receive free treatment through the NHS we will pay an NHS Cash Benefit of £150 per day or night, for inpatient or daycase treatment. This benefit will only apply to claims for daycase or inpatient treatment that would otherwise have been eligible for benefit under your scheme.

Please note this Cash Benefit is payable instead of any other benefit. The benefit would be paid to you on completion of your treatment and receipt of the necessary documents, which must be submitted within six months of your treatment date. If you require further information on how to access this benefit, please call on 0208 150 9702.

In the event that you elect to receive free treatment through the NHS we may pay an NHS Cash Alternative amount up to the equivalent of approximately 25% of the costs that would have been incurred privately. Please contact us to check if your procedure will be eligible for claim under this benefit.

In the event that you require an eligible elective surgical procedure, and you choose to receive this treatment free of charge on the NHS, we may pay you a cash lump sum. Please contact us to check if your procedure will qualify for this benefit.

Please note this Cash Benefit is payable instead of any other benefit. The benefit would be paid to you on completion of your treatment and receipt of the necessary documents, which must be submitted within six months of your treatment date. If you require further information on how to access this benefit, please call on 0208 150 9702.

In the event that you elect to receive free cancer treatment through the NHS, we will pay an NHS Cancer Cash Benefit of £300 per night or day following eligible inpatient or daycase treatment or outpatient radiotherapy treatment, instead of any other benefit.

In the event that you elect to receive free cancer treatment through the NHS, we will pay an NHS Cancer Cash Benefit of £300 per day or night following eligible inpatient or daycase treatment, or outpatient radiotherapy treatment.

Please note this Cash Benefit is payable instead of any other benefit. The benefit would be paid to you on completion of your treatment and receipt of the necessary documents, which must be submitted within six months of your treatment date. If you require further information on how to access this benefit, please call on 0208 150 9702.

We will pay a cash benefit of £100 per baby/child following birth or adoption, where the mother or father is a member of the BSI Medical Scheme. If both the mother and father are members of the scheme, benefit will only be payable once per child.

This benefit is subject to a 10 month waiting period from the date you join the scheme.

This benefit would be paid following the birth or adoption and submission of the necessary documents. Please note this must be claimed within six months of the birth or adoption.

We will pay a cash benefit of £100 per baby/child following birth or adoption, where the mother or father is a member of the scheme. If both the mother and father are members of the scheme, benefit will only be payable once per child. This benefit is subject to a 10 month waiting period from the date you join the scheme.

Please note this Cash Benefit is payable instead of any other benefit. The benefit would be paid to you following the birth or adoption and receipt of the necessary documents, which must be submitted within six months of the birth or adoption . If you require further information on how to access this benefit, please call on 0208 150 9702.

We do not pay for dental or oral treatment.

We do not pay for the provision of dental implants or dentures, repair or replacement of damaged teeth (including crowns, bridges, dentures or any dental prostheses).

We do not pay for the management of or treatment (including surgical operations) of jaw shrinkage or loss as a result of dental extractions or gum disease.

We also do not pay for surgical operations for the treatment of bone disease when related to gum disease or tooth disease or damage.

Exception: We will pay for surgical operations carried out by your specialist to:

• put a natural tooth back into a jaw bone after it is knocked out or dislodged in an accident

• treat irreversible bone disease involving the jaws which cannot be treated in any other way, but not if it is related to gum disease, tooth disease or damage

• surgically remove a complicated, buried or impacted tooth root, for example an impacted wisdom tooth.

We do not pay for :

• fillings, simple extractions and treatment of gum disease

• root canal treatment

• consultations with dental specialists such as periodontists, orthodontists,endodontists, and hygienists

• the provision of dental implants, or veneers, repair or replacement of damaged teeth (including crowns, bridges, dentures or any dental prostheses), or orthodontic braces (whether fixed or removable)

• restoration of minor enamel, dentine and incisal edge fractures

• the management of or treatment (including surgical operations) of jaw shrinkage or loss as a result of dental extractions or gum disease

• treatment required for cosmetic reasons (for example orthognathic surgery and teeth whitening).

• procedures to prepare for orthodontics or prosthetic surgery

• mouth guards, gum shields, or dental appliances of any kind

Exception: we will pay for surgical operations carried out by a specialist when treating an acute condition such as:

• surgically remove a complicated, buried, infected or impacted tooth root

• apicectomy or removal of the tip of a tooth’s root

• enucleation of a cyst of the jaw (removing a cyst from the jaw bone)

• Surgical drainage of a fascial space (tracking) abscess

• putting a natural tooth back into a jaw bone after it is knocked out or dislodged in an accident

• treatment of facial and mandibular fractures

We do not pay for treatment to correct your sight, for example long or short sight or failing eyesight due to ageing, or to change the refraction of one or both eyes.

We do not pay for routine eye examinations, contact lenses, spectacles or laser eye procedures such as refractive keratotomy (RK) and photorefractive keratectomy (PRK).

We do not pay for treatment to correct your sight. This includes routine eye examinations, contact lenses (including lenses following cataract surgery), spectacles or laser eye procedures. We do not pay for ongoing or long-term treatment of eye conditions. This includes but is not limited to:

• Glaucoma

• Diabetic retinopathy

• Occlusion therapy for squint

• Astigmatism

• Myopia

• Amblyopia

Exception: We will pay for eligible acute treatment of the following conditions:

• Cataracts

• Detached retina

• Surgical correction of a squint

• Drooping Eyelids (ptosis) – We will only provide benefit for ptosis (drooping eyelids), if your optometrist identifies visual impairment and you are in turn referred by your General Practitioner or optician to a consultant ophthalmologist. We will only fund surgery if visual field tests and medical photographs confirm the ptosis is at risk of threatening the visual field testing for safe driving

• Wet aged related macular degeneration, where we will pay for a short course of treatment following initial diagnosis

We do not pay for treatment for, or any condition arising from pregnancy, childbirth or termination of pregnancy except where childbirth complications arise. This includes conditions such as:

• pre-eclampsia

• eclampsia

• pregnancy induced hypertension

• treatment of an embryo or foetus

• treatment of any pregnancy which occurs within a calendar month of any fertility treatment

Exception: We will pay for treatment of the following conditions:

• miscarriage or when the foetus has died and remains within the placenta in the womb

• hydatidiform mole (abnormal cell growth in the womb)

• ectopic pregnancy (foetus growing outside the womb)

• post-partum haemorrage (heavy bleeding in the hours and days immediately after childbirth) 

• retained placental membrane (afterbirth left in the womb after delivery of the baby)

• complications following any of the above conditions

• The above conditions will be excluded if they are directly or indirectly related to a pregnancy arising from any kind of fertility or infertility treatment

• medically essential caesarean section delivery. However we need full clinical details from your specialist before we can give our decision.

We do not pay for treatment for pregnancy or childbirth, including:

• Hyperemesis (excessive and prolonged nausea and vomiting)

• Pelvic girdle pain (pelvic pain in pregnancy)

• Diastasis recti (abdominal separation)

• Pregnancy induced hypertension (high blood pressure in pregnancy)

• Pre-eclampsia

• Treatment of a foetus or embryo

• Antenatal care

• Termination of pregnancy

• Any treatment arising from assisted conception

• Any complications arising from the above condition

Exceptions: We will pay for eligible treatment of the following conditions:

• Miscarriage or when the foetus has died and remains with the placenta in the womb

• Still birth

• Hydatidiform mole (abnormal cell growth in the womb)

• Ectopic pregnancy (foetus growing outside the womb)

• Post-partum haemorrhage (heavy bleeding in the hours and days immediately after childbirth)

• Retained placental membrane (afterbirth left in the womb after the delivery of the baby)

• Eligible mental health treatment for post-natal depression subject to the conditions and limitations set out in the mental health benefit.

• Medically essential caesarean section where this is an inevitable consequence of a complication to the current pregnancy.

• Complications following any of the above conditions.

We will require full clinical details from your specialist before we can give our decision. We do not pay for any of the above if the pregnancy is a result of assisted conception.

£300 per day or night

In the event that you elect to receive free cancer treatment through the NHS, we will pay an NHS Cancer Cash Benefit of £300 per night or day following eligible inpatient, daycase or outpatient radiotherapy treatment, instead of any other benefit.

Up to 25%

Up to 25% paid when you elect to have eligible inpatient or daycase treatment as an NHS patient incurring no charge

We will pay up to a maximum of £1,000 per member in each year of cover in fees for outpatient psychiatric consultations and treatment with a specialist following GP referral.

We will pay in full, fees for outpatient consultations for mental health conditions when referred by a GP. Treatment with a Psychological Therapist must be under the direct supervision of a Consultant Psychiatrist unless this is delivered by a Healix Mental Health network provider. Cover is subject to an annual benefit limit of £1,000 in each year of cover and also subject to our reasonable and customary guidelines. For assistance in finding a network provider please contact the Helpline and a member of the team will arrange a referral on your behalf.

Please note: Your cover is designed to provide help for short or medium-term medical treatment that restores you back to health. Mental health conditions are often long term in nature and may become chronic conditions, for which ongoing cover will not be available on your scheme. Should your specialist/therapist recommend that treatment will be required in excess of 10 sessions the nursing team will provide guidance on making other arrangements for continued treatment after this period. Any extension in cover will be subject to a full clinical review and assessed on a case by case basis – full clinical details will be required from your treating specialist.

We will pay in full for medically necessary treatment you receive on an inpatient or daycase basis in an NHS or private psychiatric unit for psychiatric conditions which we agree are eligible in writing and in advance. We will pay up to a maximum of 28 days for daycase or inpatient treatment and up to £210 per week in respect of specialist fees.

We will pay in full up to a maximum of £1,000 in costs for outpatient treatment on GP referral to a psychiatric therapist or specialist.

All treatment must be under the direct control of a Consultant Psychiatrist. Without written authorisation we may not pay any benefit.

Should you need to stay in hospital longer than was initially agreed, we will ask your specialist to provide further details confirming the medical necessity of further treatment.

Any cover for treatment of psychiatric illness will be subject to our rules on chronic conditions and all other benefit limitations and exclusions on the scheme.

We will pay up to a maximum of 28 days in any one year of cover for medically necessary treatment as an inpatient or daycase in an NHS or private psychiatric unit for mental health  conditions which, we agree are eligible in writing and in advance. All treatment must be under the direct control and supervision of a Consultant Psychiatrist. Without written authorisation we may not pay any benefit.

Please note. Mental health conditions are often long term in nature and may become chronic conditions, for which ongoing cover will not be available on your scheme. If after a full review of all the medical information available, the condition is considered to have become chronic the scheme will no longer pay benefits for the continuing or recurrent treatment of that condition (please refer to section 6 for full details on chronic conditions). Where possible, the nursing team will also provide guidance on making other arrangements for continued treatment. Inpatient benefit will be paid once per condition.

We will pay the costs of an initial assessment followed by a maximum of three further sessions, if required and pre-authorisation has been obtained from us. If further sessions are required, you must contact the Helpline with details of your proposed treatment plan from the physiotherapist to receive pre-authorisation. If directly referred by a GP, we will pay up to a maximum of 10 sessions, in combined total per condition, for outpatient physiotherapy, osteopathy, acupuncture and chiropractic treatment.

For back and neck conditions, you may contact the Claims Helpline without the need for referral from your GP and a nurse will assess your symptoms and help organise the most effective treatment. If appropriate, we will arrange a physiotherapy referral within 24 hours and continue to monitor your progress by liaising with your treatment provider and assess whether you require further treatment or are ready to be discharged.

We will pay for outpatient physiotherapy, osteopathy, chiropractic treatment and acupuncture following GP or specialist referral to a physiotherapist or complementary practitioner we have recognised for benefit purposes. We will pay the costs of an initial assessment followed by three further sessions if required and pre-authorisation has been obtained from us.  If further sessions are required, you must contact us on 0844 858 6372 with details of your proposed treatment plan from the therapist to receive pre-authorisation.

If directly referred by a GP, we will pay up to a maximum of 10 sessions, in combined total per condition, for outpatient physiotherapy, osteopathy, acupuncture and chiropractic treatment.

For back and neck conditions, you may contact the claims helpline without the need for referral from your GP and a nurse will assess your symptoms and help organise the most effective treatment. If appropriate, we will arrange a physiotherapy referral within 24 hours and continue to monitor your progress by liaising with your treatment provider and assess whether you require further treatment or are ready to be discharged.

We will pay a Maternity Cash Benefit of £100 per child where the mother is a member of the BSI Medical Scheme. This benefit is subject to a 10 month waiting period from the joining date.

These benefits would be paid to you on completion of your treatment and submission of the necessary documents. If you require further information on how to access this benefit, please call on 0208 150 9702. We will not pay for any treatment which exceeds the amount in the list of benefits.

We will pay a cash benefit of £100 per baby/child following birth or adoption, where the mother or father is a member of the BSI Medical Scheme. If both the mother and father are members of the scheme, benefit will only be payable once per child.

This benefit is subject to a 10 month waiting period from the date you join the scheme.

This benefit would be paid following the birth or adoption and submission of the necessary documents. Please note this must be claimed within six months of the birth or adoption.

We will pay in full for inpatient, daycase or outpatient treatment for a diagnosed malignancy until treatment is deemed, by us, to be palliative. If you require ongoing or continuing treatment that is palliative, you will receive written notification of when benefit will no longer be payable. Where possible, the nursing team will also provide guidance on making other arrangements for continued treatment.

For some drugs or treatment for cancer which may be given over prolonged periods of time such as biological therapies or monoclonal antibodies, when being used within the terms of their license, cover will be available once per course of cancer treatment for as long as the treatment is being effective.

Except for the cover described above, there is no cover for drug treatments given to prevent a recurrence of cancer or for the maintenance of remission or where their use is continuing without a clear end date. However, where the treatments are given by injection, we may pay for up to three months to allow the treatment to be established and alternative arrangements made.

For more information please contact the nursing team on 0208 150 9702.

We will pay in full for active inpatient, daycase or outpatient treatment for a diagnosed malignancy. This includes diagnostic tests, surgery, chemotherapy and radiotherapy. Please note you must contact us before your treatment starts.

For some drugs or treatment for cancer which may be given over prolonged periods of time such as biological therapies or monoclonal antibodies, when being used within the terms of their license, cover will be available once per course of cancer treatment for as long as the treatment is being effective

Please note there is no cover for drug treatments given to prevent a recurrence of cancer or for the maintenance of remission or where their use is continuing without a clear end date. However, where the treatments are given by injection, we may pay for up to three months to allow the treatment to be

established and alternative arrangements made. For more information please contact the nursing team on 0208 150 9702.

Where a specialist referral is made for additional eligible treatment required in conjunction with cancer treatment, for example complementary, alternative or mental health therapy, benefit will be payable from the outpatient therapy or mental health therapy benefits.

We may ask you to provide information to help us assess your claim. For example, we may ask you for one or more of the following:

• Medical reports and other information about the treatment for which you are claiming. If we request a medical report from your specialist and they charge for providing this we will pay the cost
• Results of an independent medical examination we may ask you to undergo. We will pay for the cost of any independent medical examination we require you to have
• Original accounts and invoices in connection with your claim including any related treatment cost covered by your excess.

Please read this carefully before you commit yourself to any costs and follow the How to claim summary when claiming. If you are unsure about whether or not you are covered please contact us on 0208 150 9702, we will be happy to advise you.

We may ask you to provide information to help us assess your claim. For example we may ask you for one or more of the following:

• Medical reports and other information about the treatment for which you are claiming. If we request a medical report from your specialist and they charge for providing this we will pay the cost.
• Results of an independent medical examination or second opinion we may ask you to undergo with a consultant. We will pay for the cost of any independent medical examination or second opinion we require you to have and we will authorise this in writing, in advance.
• Results of any second opinion you have independently sought to obtain eligible treatment under the care of another consultant. On such occasions we may additionally request our own, independent, second opinion from an expert in that field to assess eligibility of cover. We will pay the costs of any second opinion we organise on your behalf, this includes the cost of the consultation and any tests undertaken as a result of that consultation.
• Original accounts and invoices in connection with your claim.

The purpose of this scheme is to help you with the costs of the treatment for an acute illness or injury, not to control or treat a long term (chronic) condition after its investigation and diagnosis.

We define a chronic condition as a disease, illness or injury which has at least one 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 continues indefinitely
• it comes back or is likely to come back
• you need to be rehabilitated or specially trained to cope with it
• it has no known cure.

If after a full review of all the medical information available, a condition is considered to have become a chronic condition, you will be given written notification that the scheme will no longer pay benefits for the continuing or recurrent treatment of the chronic condition. You will also be given time to make other arrangements for continued treatment, and the scheme will assist you and your GP to transfer management of your chronic condition to the NHS.

The purpose of this scheme is to help you with the costs of the treatment for an acute illness or injury, not to control or treat a long term (chronic) condition after its investigation and diagnosis.

We define a chronic condition as a disease, illness or injury which has at least one 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 continues indefinitely
• it comes back or is likely to come back
• you need to be rehabilitated or specially trained to cope with it
• it has no known cure

Please note: this will apply to all medical conditions, whether or not a diagnosis has been made. In some cases it might not be clear at the time of treatment that the disease, illness or injury being treated is a chronic condition. We may not pay the ongoing costs of continuing, or similar treatment even where we have previously paid for this type of or similar treatment

We do not pay for treatment for cancer once it becomes palliative in nature.

Exclusion has been removed.