Your Simply Cash Plan Cover
& Terms and Conditions
Policy Document
Feel free to bother us with any enquiries
0800 056 0366
or visit www.simplyhealth.co.uk
LHF and Simplyhealth are trading names of Simplyhealth Access, registered and incorporated in England and Wales, no.183035.
Registered office: Hambleden House, Waterloo Court, Andover, Hampshire SP10 1LQ. Authorised and regulated by the Financial Services Authority.
Your calls may be recorded and monitored for training and quality assurance purposes.
CVTC.09/09
Welcome to Simplyhealth
Simplyhealth helps you get money back towards the cost of your everyday healthcare. The good news is you can start claiming
right away, with the exception of Maternity and Funeral benefit which both have a 50 week qualifying period. You’ll find full details
of your plan in this policy document. Please read it carefully and keep it in a safe place for future reference. If you have any
questions please contact our customer services team on 0800 056 0366.
One Adult Plans. What you can claim for
If you’re looking for a plan for yourself and you’d like to cover your children under 17 and living at home, you’ve come to
the right place. The amounts shown are available to you annually within your claiming year, apart from maternity, paternity,
adoption, personal accident and funeral benefit.
Weekly payment for you and your children
Payback
level
Basic
Plan
Standard
Plan
Extra
Plan
£1.50
£3.20
£5.20
Maximum payback levels per person
Dental
100%
£55
£110 £165
100%
£45
£80
50%
£350 £600 £800
50%
£30
£50
£80
50%
n/a
n/a
£100
50%
n/a
£110
£170
Includes check-ups, fillings, hygienist fees & braces
Optical
£140
Includes sight test & fitting fees, prescription glasses, goggles & sunglasses,
frames & repairs plus contact lenses
Physiotherapy, Osteopathy, Chiropractic, Acupuncture
Helps to keep you fit & healthy if you choose to go private to gain access to faster treatment
Chiropody/Podiatry
Covers treatment by a chiropodist or podiatrist
Homeopathy, Reflexology
Covers treatment by a recognised, registered practitioner
Health Screening (per adult only)
Enables you to be proactive about your health
Consultation Fees
Covers diagnostic consultations with a specialist
X-ray / Scans
50%
n/a
50%
n/a
£260 £355
50%
£400 £650
£80
£100
Covers x-rays and scans as a result of a referral from a registered consultant
Medical Apparel
n/a
Includes items such as hearing aids and surgical shoes
Hospital In-Patient, Day Case & Parental Stay (per night /day)
Cash amount available to help towards everyday expenses if you need to stay in hospital
Maternity, Paternity, Adoption – 50 week qualifying period (per adult only)
Adult n/a
Up to 20
days / nights
in total
Child n/a
n/a
n/a
Adult £33
Child £15
Adult £44
Child £20
£160 £250
Single payment at the birth / adoption of each child
Personal Accident Protection (per adult only)
Provided by FirstAssist Insurance Services Ltd and underwritten by
Great Lakes Reinsurance (UK) plc
Helpline (per adult only)
up to
£15,000
0800 975 3349
24 hours a day, 7 days a week,
365 days a year
Telephone counselling, Travel, Medical, Well-being advice, Parental / Lifestyle advice
Funeral Expenses – 50 week qualifying period
n/a
n/a
£750 £750
Covers most costs directly associated with a funeral
Worldwide Benefit Cover
Enjoy the same benefits abroad – for business or pleasure for stays of up to
and including 28 days
Adult – All benefits
Child – Applicable benefits
Family Plans. What you can claim for
If you’re looking for a plan for you and your partner and you’d like to cover up to six children under 17 and living at
home, you’ve come to the right place. The amounts shown are available to you annually within your claiming year,
apart from maternity, paternity, adoption and personal accident benefit.
Weekly payment for you, your partner and up to 6 children
Payback
level
Family
Standard Plan
Family
Extra Plan
£6.40
£10.40
Maximum payback levels per person
Dental 100%
£120
£175
100%
£90
£150
50%
£600
£800
50%
£50
£80
50%
n/a
£100
50%
£110
£170
50%
£260
£355
50%
£80
£100
50%
£400
£650
Up to
20
days / nights
in total
£33
£44
£350
£550
Includes check-ups, fillings, hygienist fees & braces
Optical
Includes sight tests & fitting fees, prescription glasses, goggles & sunglasses,
frames & repairs plus contact lenses
Physiotherapy, Osteopathy, Chiropractic, Acupuncture
Helps to keep you fit & healthy if you choose to go private to gain access to faster treatment
Chiropody/Podiatry
Covers treatment by a chiropodist or podiatrist
Homeopathy, Reflexology
Covers treatment by a recognised, registered practitioner
Health Screening (per adult only)
Enables you to be proactive about your health
Consultation Fees
Covers diagnostic consultations with a specialist
X-ray / Scans
Covers x-rays and scans as a result of a referral from a registered consultant
Medical Apparel
Includes items such as hearing aids and surgical shoes
Hospital In-Patient, Day Case & Parental Stay (per night / day) Cash amount available to help towards everyday expenses if you need to stay in hospital
Maternity, Paternity, Adoption – 50 week qualifying period (adult only)
Single payment at the birth / adoption of each child
Personal Accident Protection (per adult only)
Provided by FirstAssist Insurance Services Ltd and underwritten by
Great Lakes Reinsurance (UK) plc
Helpline (per adult only)
Telephone counselling, Travel, Medical, Well-being advice, Parental / Lifestyle advice
Worldwide Benefit Cover
Enjoy the same benefits abroad – for business or pleasure for stays of up to
and including 28 days
n/a
up to
£15,000
0800 975 3349
24 hours a day, 7 days a week,
365 days a year
Adult – All benefits
Child – Applicable benefits
Children are covered free
With the Family Plan option you can cover up to six children free of charge for appropriate benefits. This varies from the
One Adult Plan which allows you to cover any number of children. All children must be under the age of 17 and living at
home with you.
Claiming is easy
Now that you’re covered, you can start claiming immediately (funeral and maternity cover have a 50 week
qualifying period). Just follow the steps below:
1 Get your treatment and pay your bill as normal but remember to keep the receipt
2 Fill in your claim form
3 Return your claim form and receipt in the envelope provided. Alternatively the return address can be
found on the top right hand corner of your claim form
4 Sit back and relax and we’ll pay the amount you have claimed (within plan limits) usually within four
working days
Policy Summary
This cash plan is provided by Simplyhealth, a division of Simplyhealth Access. The Personal
Accident Cover is administered by FirstAssist Insurance Services Limited and underwritten by
Great Lakes Reinsurance (UK) PLC. The Helplines are provided by FirstAssist Services Ltd.
What is a cash plan?
Cash plans provide insurance cover towards the costs of dental and optical healthcare, complementary
therapies, consultation costs and health screening costs. Additionally, payments are made following
hospital stays and for the birth of children (maternity cover).
Features, benefits, exclusions and limitations
Cover is provided to permanent UK residents and customers can join between the ages of 16 years
and 65 years. Dependent children under 17 years old (residing at the same address as the member)
are covered FREE for appropriate benefits as detailed in the Table of Cover. Members are covered
from the date they sign the application form and can claim from that date with the exception of
maternity and funeral cover which have a 50 week qualifying period. You will not be entitled to cover
for the duration of this policy for any pre-existing condition that you had prior to joining Simplyhealth
for Hospital in-patient. Refer to section 3 of our terms and conditions for more details. The Personal
Accident element of this policy gives you a lump sum payment if you are involved in an accident
which results in your death or permanent total disability. This cover reduces from the age of 66 to
cover death as a result of an accident only.
Duration
Simplyhealth cover is monthly and continues from month to month until it is cancelled or otherwise
comes to an end. In order that your cover remains appropriate for your needs, you should review it
regularly and inform us of any significant changes to your healthcare requirements. Refer to section 4
& 6 of our terms and conditions
Changing your mind
You have 14 days from receipt of your welcome letter, which confirms commencement of your policy,
in which to change your mind and receive a full refund of any premiums you have paid, provided
no claims have been made. If you do change your mind, please call 0800 056 0366 or write to the
Customer Services Team Leader and we will cancel your policy for you. After this period
our standard cancellation rights apply. Refer to section 5.2 of our terms and conditions.
Putting things right
At Simplyhealth we aim to provide you with the very highest levels of customer service and care at
all times. In order to maintain this service standard, we encourage feedback from our Members and
have put in place a procedure that you can use to raise any concern or complaint you may have. In
the first instance you should write to the Customer Service Team Leader at Simplyhealth, Riverside
House, 7 Canal Wharf, Leeds LS11 5WA or contact Customer Services direct on 0800 056 0366. If
you are unhappy with the response you receive we will then refer your complaint to the Simplyhealth
Group Quality Assurance Team for a final decision. Should you remain unhappy with our initial
response or our final response you have the right to refer your complaint to the Financial Ombudsman
Service, South Quay Plaza, 183 Marsh Wall, London E14 9SR. Tel: 0845 080 1800. Full details of our
complaints procedures are available on request. Refer to section 5.1 of our terms and conditions.
Financial Services Compensation Scheme (FSCS)
You are protected by the Financial Services Compensation Scheme (FSCS) – in the unlikely event
that we go out of business or into liquidation the FSCS protects you. Should this happen, any valid
outstanding claims you have at that point would be paid by the scheme. For more details on the
scheme please visit www.fscs.org.uk or contact the FSCS direct on 0207 892 7300.
Prices and Payments
Details of premium levels are shown within this document overleaf. Where applicable, premiums
include Insurance Premium Tax. We review premiums periodically, if we do make any changes, we
will notify you in writing.
How to Claim
Simplyhealth provides claim forms for all members in the welcome pack. Following any claim, a new
form is automatically sent to you. Alternatively, claim forms can be requested by calling 0800 056
0366, by visiting www.simplyhealth.co.uk, or by writing to Simplyhealth, Riverside House, 7 Canal
Wharf, Leeds LS11 5WA. Refer to section 3 of our terms and conditions.
About us and our insurance services
Part of the Simplyhealth Group. LHF and Simplyhealth are trading names of Simplyhealth Access
which is authorised and regulated by the Financial Services Authority (FSA). Our FSA register number
is 202183. You can check this on the FSA’s Register by visiting the FSA website at www.fsa.gov.
uk/register or by telephoning the FSA directly on 0845 606 1234. We can only provide you with
information on our own products and you will not receive any advice or a personal recommendation
from us for our health plans. We may ask you some questions to narrow down the product option on
which we provide you with information, but you will then need to make your own choice about how
to proceed.
Terms and conditions of your Simply Cash Plan
Definitions
Policy
To avoid repetition, the following words or expressions, wherever used in this Policy, have the
specific meanings given below. To assist You in identifying the defined words or expressions these
are shown in bold print throughout this Policy.
Our contract of insurance with You.
Physiotherapy, Acupuncture, Osteopathy, Chiropractic,
Homeopathy, Reflexology, Chiropody/Podiatry
Treatment given by a practitioner who is qualified and registered with an appropriate, approved
professional organisation recognised by Us. A list of appropriate, approved professional
organisations recognised by Us (as amended from time to time) is available upon request.
Child/Children
Natural, legally adopted or legally fostered dependent Children of You or Your partner under the
age of 17 who permanently live with You.
Claiming year
If You joined Simplyhealth before the 28th October 2002 or You joined Simplyhealth as an ASDA
employee, Your claiming year will operate from 1st January to 31st December. If You joined
Simplyhealth after the 28th October 2002 Your claiming year will operate annually from Your
Registration Date.
Cover
The range of Cover under Your Plan as detailed in the Table of Cover applicable to You.
Day Case
Treatment which, for medical reasons, means You have to go into a hospital or day-patient unit
because You need a period of clinically supervised recovery but do not have an overnight stay.
This does not include out-patient or in-patient treatment or other attendance.
Dentist
A dental Surgeon who is registered with the General Dental Council and engaged in general dental
practices. For claims made outside of the United Kingdom, the Dentist must hold comparable
qualifications to those held by a Dentist who practices in the United Kingdom.
Member
A Policyholder, who may or may not be a constitutional Member of Simplyhealth.
Partner
A spouse or civil partner under the Civil Partnership Act 2004 or a person who resides with You on
a permanent basis as if Your legal spouse or civil partner.
Plan
Policy document
The full Terms and Conditions that relate to Your Policy.
Pre-existing condition
Any illness, injury or medical condition for which You (or anyone covered under Your Policy) have
received or are awaiting treatment as a hospital in-patient prior to Your application to join the Plan.
Premium
The amount You have selected to pay which determines the level of Cover available to You.
Qualifying period
A period of time during which Premiums must be continuously paid by You but You cannot make
claims. This only applies to Maternity & Funeral Cover.
Registration Date
The date the Policy begins, as shown in Your Summary of Cover.
Review Date
The annual anniversary of the Registration Date.
Specialist/Consultant/Surgeon
A medically qualified person who specialises in a specific field of medicine who may or may not
hold a consultant position in an NHS hospital but is a member, fellow or licentiate of one of the
Royal Colleges.
Table of Cover
A table (current at the date of treatment or cost incurred) issued by Us giving the levels of Cover
applicable to each of the Premium levels of Your Plan. The Table of Cover forms part of the
contract and must be read together with this document.
We/our/us
Simplyhealth Access trading as Simplyhealth, a company incorporated in England and Wales.
Worldwide Cover
Cover is extended to business trips or holidays abroad of up to and including 28 days duration.
Claims submitted are subject to the rules as detailed in Your Table of Cover and must be
supported where necessary with a translation of the details to English.
You/Your
The Member and where applicable, any partner or dependents covered under Your Policy.
The Simplyhealth product to which this Policy document applies.
Please check your Table of Cover to see what Cover you are entitled to.
• Pre-existing medical conditions are covered by these benefits, apart from Hospital in-patient.
Dental
Optical
We will pay You up to the maximum amount of Your chosen
level, shown in the Table of Cover. You pay the cost directly
to the Dentist for dental treatment covered by this Policy, and
We will reimburse You with the cost of this treatment up to the
appropriate maximum entitlement available in Your Claiming
year under Your chosen Premium level.
We will pay You up to the maximum amount of Your chosen
level, shown in the Table of Cover. You pay the cost directly
to an optician for prescribed glasses or contact lenses and We
will reimburse You with the cost of this treatment up to the
appropriate maximum entitlement available in Your Claiming
year under Your chosen Premium level.
What is Covered
What is Covered
• Dental check-ups.
• Treatment by a qualified optician.
•Treatment provided by a dental Surgeon, periodontist
or orthodontist who is registered with the General Dental
Council (GDC).
• Sight test fees.
• Endodontic treatment.
• Addition of new prescribed lenses to existing frames.
• Hygienist fees.
• Contact lenses.
• Local anaesthetic fees and intravenous sedation.
• Consumables supplied as part of an optical prescription,
including but not limited to solutions, tints etc.
• Dental brace or gum-shield provided by a dental Surgeon or
orthodontist.
• Fitting fees.
• Prescribed glasses, including frames and prescribed lenses.
Physiotherapy,
Osteopathy,
Chiropractic,
Acupuncture
We will pay You up to the maximum amount of Your chosen
level, shown in the Table of Cover. You pay the cost directly
to a Physiotherapist, Osteopath, Chiropractor or Acupuncturist
for treatment and We will reimburse You up to the appropriate
maximum entitlement available in Your Claiming year under
Your chosen Premium level.
What is Covered
• Physiotherapy, Osteopathy, Chiropractic or
Acupuncture treatment.
• Repairs to glasses.
• Dental crowns, dentures, bridges and white fillings (including
repairs to).
What is not Covered
• Sunglasses, safety spectacles and swimming goggles with
prescription lenses.
• Laboratory fees and dental technician fees referred by a
dental Surgeon or orthodontist.
•Contact lenses paid by instalment (Please submit Your claim
when the total fees are equal to the maximum benefit offered
on Your plan).
•Any treatment supplied by a professional recognised by
Simplyhealth which is not Physiotherapy, Osteopathy,
Chiropractic or Acupuncture.
• X-rays.
What is not Covered
• Eye laser surgery.
• Dental prescription charges.
What is not Covered
• Dental consumables, including but not limited to
toothbrushes, mouthwash and dental floss.
•Optical consumables, including but not limited to contact lens
cases, spectacle cases and spectacle chains/cords, cleaning
materials or solutions purchased in isolation.
• Dental practice plan premiums and dental insurance
premiums.
• Magnifying glasses.
• Dental implants.
• Non-prescription glasses.
•Cosmetic procedures, including but not limited to;
dental veneers, tooth whitening and the replacement of
amalgam fillings with white fillings.
• Lenses supplied under an optical insurance plan.
• Joining fees.
• Laboratory fees and dental technician fees in isolation.
• Missed appointment fees and administration fees.
• Contact lens replacement insurance premiums.
• Opticians’ insurance premiums.
•All other treatments, including but not limited to reflexology,
aromatherapy, herbalism, sports massage, indian head
massage, reiki, alexander technique and cranial-sacro therapy.
• X-rays, including but not limited to MRI scans, CT scans.
• Appliances, including but not limited to lumbar roll, back
support, TENS machine.
Chiropody/Podiatry
We will pay You up to the maximum amount of Your chosen
level, shown in the Table of Cover. You pay the cost directly
to a Chiropodist or Podiatrist for Chiropody/Podiatry
treatment and We will reimburse You up to the appropriate
maximum entitlement available in Your Claiming year under
Your chosen Premium level.
What is Covered
• Treatment supplied by a chiropodist or podiatrist.
• Assessments e.g. gait analysis performed by a chiropodist
or podiatrist.
What is not Covered
• Cosmetic pedicures.
• X-rays.
•Consumables (these can be claimed under Medical Apparel).
• Consultations with a podiatric Surgeon (which may be
covered under consultation Cover).
• Surgical footwear, including but not limited to
corrective footwear.
Health Screening
We will pay You up to the maximum amount of Your chosen
level, shown in the Table of Cover. You pay the cost directly
to the health screening provider for health screening services
and We will reimburse You up to the appropriate maximum
entitlement available in Your Claiming year under Your
chosen Premium level.
What is Covered
•Full body health screening undertaken for prevention
purposes by medically qualified staff at a hospital or
registered health screening clinic.
What is not Covered
limited to X-rays, scans, ultrasounds, cholesterol and blood
tests, diagnostic procedures and tests.
• Home testing kits.
• Medical screening for employment purposes.
Hospital Day Case
We will pay You at the appropriate rate under Your chosen
Premium level for the period You are admitted as a Day
Case patient for treatment in a recognised hospital up to a
maximum of 20 days, in a Claiming year. Hospital Day Case,
parental stay and hospital in-patient cover share the same
maximum entitlement of up to 20 days/nights in total. Please
refer to 3.15 for full details.
What is Covered
Hospital In-Patient
We will pay You at the appropriate nightly rate under Your
chosen Premium level for the period You are admitted for
in-patient treatment in a recognised hospital up to a maximum
of 20 nights, in a Claiming year. Hospital Day Case, parental
stay and hospital in-patient Cover share the same maximum
entitlement of up to 20 days/nights in total. Please refer to 3.15
for full details.
What is Covered
•Any period of overnight stay in an NHS or private hospital
from 1 to 20 nights for treatment or investigation of an acute
or chronic medical condition which developed while You
were a Member of Simplyhealth.
• Separate ante or post natal hospital in-patient admissions.
• An admission to a Day Case ward or unit for treatment
or investigation as classified on the claim form by the
hospital authorities.
What is not Covered
• Out-patient treatment for chemotherapy.
• Out-patient treatment for radiotherapy.
• Any period of overnight stay in an NHS or private hospital for
treatment of a pre-existing condition.
• Out-patient treatment for oncology.
• Respite care.
What is not Covered
•The period immediately prior to or following an overnight
in-patient stay for which payment has been made under
Hospital in-Patient.
• The first 5 nights of any stay in hospital during which Child
birth takes place.
• Out-patient treatment.
• Attendance at an accident and emergency department.
• Hospital Day Case.
• Hotel ward admission.
• Out-patient appointments.
• Out-patient treatment for kidney dialysis.
• Day care, including but not limited to psychiatric, respite care,
care for the elderly and maternity.
• Cancelled operations prior to admission.
• Minor operations carried out in a GP’s surgery or clinic.
• Attendance at an accident and emergency department.
• Pre-admission appointments.
• Treatment at home.
• Medical examinations.
• Medical and radiological tests in isolation including but not
Parental Stay
Consultation
X-ray/Scan
We will pay for one parent only at the appropriate nightly
rate under Your chosen Premium level, when You have
accompanied Your Child (who is covered under Your Policy)
who has been admitted as an in-patient overnight and for
which payment has been made at the appropriate Child rate
under hospital in-patient Cover. Up to a maximum of 20 nights,
in a Claiming year, can be paid provided that the claim is
supported by written confirmation from the hospital that one
parent accompanied their Child overnight. Hospital Day Case,
parental stay and hospital in-patient Cover share the same
maximum entitlement of up to 20 days/nights in total. Please
refer to 3.15 for full details.
We will pay You up to the maximum amount of Your chosen
level, shown in the Table of Cover. You pay the cost directly
to a medically qualified Specialist, Consultant or Surgeon
for a diagnostic consultation and We will reimburse You up
to the appropriate maximum entitlement available in Your
Claiming year under Your chosen Premium level.
We will pay You up to the maximum amount of Your chosen
level, shown in the Table of Cover. You pay the cost directly
to a medically qualified Specialist or Consultant for a X-ray/
Scan and We will reimburse You up to the appropriate
maximum entitlement available in Your Claiming year under
Your chosen Premium level.
What is Covered
What is Covered
• A diagnostic consultation.
• X-ray examinations.
•Diagnostic consultations (for which You have been charged
and paid for) whilst an in-patient in hospital.
• For scans including but not limited to MRI, PET or CT,
the scan must be the result of a referral from a
Registered Consultant.
What is Covered
• Any period of overnight stay in a NHS or private hospital from
1 to 20 nights where one parent has accompanied
their Child.
• Legally adoptive/foster parent accompanying their Child
(when the Child is registered under the Policy).
What is not Covered
• Any related tests or treatment charges included but not
limited to (see below).
What is not Covered
• Operation fees.
• Chest X-rays for emigration/immigration purposes.
• Medical examinations and reports.
• Private hospital charges, including but not limited to
room fees.
What is not Covered
• Health screening services.
• More than one parent accompanying their Child.
• Visits to clinics and GPs.
• A grandparent or other relative accompanying the Child.
• X-rays, including but not limited to mammograms, CT scans,
ultrasounds and MRI scans.
• The post natal period following the birth of a Child.
Your claim form must be completed by the hospital with details
of your child’s admission and authorised by a hospital officer.
• Dental X-rays.
• Investigative procedures, including but not limited to
colonoscopy, laparoscopy, colposcopy and sigmoidoscopy.
• Pathology and biopsy.
• Medical tests, including but not limited to ECG, EEG, and
lung function test.
• Anaesthetic fees.
• Counselling services, including but not limited to psychiatric,
psychological and bereavement.
• Dietician/nutritional services.
• Speech therapy and dyslexia services.
• Assisted conception, fertility treatment and pregnancy care.
• Pregnancy termination.
Maternity, Paternity,
Adoption
We will pay a single payment at the appropriate rate under Your
chosen Premium level in respect of each Child born to You,
provided the 50 week Qualifying period has been completed.
You must have applied to include Your Child under Your
Policy and We must have accepted that request and recorded
the Child’s details under that Policy before benefit can be paid.
What is Covered
•The birth of a Child to You (or your Partner where covered)
upon production of a copy of a Birth Certificate.
• The birth of a Child stillborn after 24 weeks gestation (upon
submission of a Stillbirth Certificate).
• Legal Adoption of a Child (upon submission of relevant
supporting documentation).
What is not Covered
• A miscarriage of up to 24 weeks gestation.
• Foster Children.
• Adoption of a Child if the Child is related to you or your
Partner prior to adoption.
• A baby born to a Child who is under 17 years of age covered
under the Policy.
• Pregnancy termination.
c) On receipt of all documentation, and with payment
approved, a cheque will normally be sent within 2 weeks.
d)All claims will be paid by cheque to the Executor of the
estate or next of kin, if applicable. The Funeral Expenses
benefit will terminate on the earlier of the following dates:
(a) The date a Policy holder ceases to be fully paid-up
b) The date the Board of Directors decide to end the
provision of this benefit.
Funeral Expenses
We will pay up to the appropriate maximum entitlement
available in Your Claiming year under Your chosen
Premium level. Qualifying period - 50 weeks.
Medical Apparel
•Medical certificates.
We will pay You up to the maximum amount of Your chosen
level, shown in the Table of Cover. You pay the cost directly
to the provider for medical apparel and We will reimburse You
up to the appropriate maximum entitlement available in Your
Claiming year under Your chosen Premium level.
• Fees of officiating Ministers for the service, cremation
or burial.
What is Covered
• Hearse or funeral car(s).
• Surgical shoes.
• Coffin with fittings.
• Mastectomy items.
• Preparation of the deceased for Cremation or Burial.
• Prosthetic, back support, truss items.
• Services of the Funeral Directors’ staff.
• Repairs to medical apparel.
What is Covered
•Cremation fees.
Homeopathy,
Reflexology Treatment
We will pay You up to the maximum amount of Your chosen
level, shown in the Table of Cover. You pay the cost
directly to the Homeopath or Reflexologist for Homeopathy/
Reflexology treatment and We will reimburse You up to the
appropriate maximum entitlement available in Your Claiming
year under Your chosen Premium level.
What is Covered
• Homeopathy or Reflexology treatment.
What is not Covered
• Any treatment supplied by a professional from an
organisation not recognised by Simplyhealth for
Homeopathy or Reflexology treatment.
• Homeopathic medicines purchased in isolation for
example from a chemist, health food shop, by mail order
or over the internet.
• Arch supports and orthotic insoles.
What is not Covered
• Funeral charges that have been fully covered by a pre-paid
funeral Plan, bond or specific saving Plan.
• Headstones.
• Notice of death placed in the press.
• Surgical hosiery, when supplied through a medical
prescription.
• Wigs, when supplied through a medical prescription.
• Hearing aids.
• Catering costs.
What is not Covered
• Floral tributes.
• Invalid equipment, medical equipment and batteries.
How to claim the funeral expenses grant:
a) Contact Simplyhealth by telephoning 0800 056 0366 to
request a claim form.
b)Return the completed claim form with a Legally Certified
copy of the Death Certificate and an original copy of the
Funeral Director’s account to: Simplyhealth, Riverside House,
7 Canal Wharf, Leeds LS11 5WA.
Personal Accident Protection Policy
This policy which forms part of your Simply Cash Plan is
underwritten by Great Lakes Reinsurance (UK) PLC and
administered by FirstAssist Insurance Services Limited. If you
need to make a claim or if you have any queries, please call
the Customer Contact Team on 0800 056 0366 (Monday to
Friday 9am - 8pm). For your protection, calls may be recorded
and may be monitored.
Introduction
Please read this policy section of your plan carefully and
make sure you understand it.
If you have any questions about this insurance please write to
us or telephone the Customer Contact Team.
Any word or phrase with a specific meaning has the same
meaning wherever it appears.
The insurer will provide the insurance cover under the terms
set out in this section of the plan as long as you pay (or agree
to pay) the premium and the insurer accepts (or agrees to
accept) it.
This policy is issued for an initial period of one month from the
policy start date and will automatically continue on payment of
each month’s premium as it falls due until cover under your
policy terminates or is cancelled.
Any information supplied by the insured will form the basis of
and be incorporated into the contract. The conditions which
appear in this policy within the plan or in any endorsement
are part of the contract and must be complied with. Failure to
comply may mean that you will not be able to claim under this
section of the plan.
The laws of England and Wales, Scotland and Northern
Ireland allow us both to choose the law which will apply to this
contract. We have chosen Scottish law to apply if you live in
Scotland and the law of England and Wales to apply if you live
elsewhere in the United Kingdom.
The language used in this section of the plan and any
communications relating to it will be in English.
Definitions
Air travel
Boarding, travelling in or getting out of any fully licensed
passenger carrying aircraft (owned by a registered commercial
airline) as a fare-paying passenger.
Bodily injury
A bodily injury which is the direct result of an accidental,
external, violent and visible cause, including accidental injury as
a direct result of being exposed to the elements. This does not
include an injury caused by sickness, disease or any naturally
occurring condition or process.
Eligible children
All your children, stepchildren and legally adopted children
who, at the time of sustaining a bodily injury, are over 30 days
and under 19 years of age, single and permanently living with
you or your partner (including children in full-time education
who normally live with you outside term time).
Insured person
The insured person or persons are you, unless stated to the
contrary on the summary of cover, your partner and your
eligible children if named on the summary of cover.
Insurer
Great Lakes Reinsurance (UK) PLC.
Medical Practitioner
A person who is qualified and registered as such by the
competent authority in that country, other than you, your
partner, a member of your family or an insured person under
this policy.
Partner
Your spouse or partner who permanently resides with you in
a domestic relationship (as named on the summary of cover).
Permanent total disablement
Any permanent disability which prevents an insured person
doing any work of any kind.
Policy start date
The date shown on the summary of cover or endorsement
from which cover (or an amendment to the cover) under this
policy section of the plan commences.
We, Us, Our
FirstAssist Insurance Services Limited who administer this
section of the plan on behalf of the insurer.
You, Your
The policyholder, the person in whose name the plan
is recorded.
Benefits
We will pay you the appropriate benefit if, during any period
of insurance, an insured person sustains a bodily injury
which, within 52 weeks, is the only cause of accidental death
or permanent total disablement. The benefit we pay will be
the amount that applied at the date the insured person was
injured. The amount of your benefit is determined by the plan
you have selected which is stated on your plan.
Table of benefits
Please refer to your Table of Cover shown in your welcome
leaflet to confirm your benefit entitlement under your chosen
premium level
Permanent Total Disablement
100%
Accidental Death
50%
Reduced benefits
If an insured person is aged 66 years or over on the date of
sustaining a bodily injury then no benefit will be payable for
permanent total disablement.
Eligible children’s benefits
The benefits provided for eligible children, if insured, are set
out in the table of cover in the welcome leaflet.
Age qualification
To be eligible for this insurance an insured person must be
aged between 16 and 65 years of age on the policy start
date. Cover for an insured person, other than an eligible child,
continues until cover ends, see Conditions below.
Claims provisions
1. Before we pay benefit for permanent total disablement
which prevents an insured person from doing any work
of any kind, the disability must have lasted for at least
52 weeks. We must also be sure that the disability is
permanent and there is no possibility of a recovery.
However, if medical evidence proves, to our satisfaction,
that your condition is permanent, we may pay the benefit
within 52 weeks.
2. For any one accident resulting in a claim for death or
permanent total disablement we will only pay one benefit to
that insured person.
3. The full effects of an accident are not always immediately
known and, although permanent total disablement may
happen at the time of the accident, we have to wait a
reasonable length of time to make sure that we know the
full effects.
Because of this, we will not pay more than the death benefit
for any permanent total disablement until 13 weeks after the
date of the accident. At the end of the 13 weeks, we will only
pay the rest of the benefit due if the insured person has not
died in the meantime as a result of the accident.
What is not covered
We will not pay the benefit if the insured person sustains a
bodily injury in the following circumstances:
• driving with more alcohol in the blood than is allowed by
law.
• motorcycling (including riding mopeds and motor tricycles)
as a driver or passenger.
(except air travel - see definitions) or training or practising
for any of these activities.
• carrying out their duties in one of the armed forces.
Travelling between the insured person’s home and normal
place of work is not military duty as long as the home and
place of work are not on the same military site.
• committing or attempting to commit a criminal offence.
• being under the influence of excess alcohol.
• as the result of intentional self-inflicted injury, suicide or
attempted suicide.
• as a result of taking a drug, unless it is taken on proper
medical advice and is not for the treatment of drug
addiction.
If necessary, the insured person must also agree to a
medical examination, at our expense, whenever we ask
for one.
3. We will pay any benefit due under this section of the plan to
you (if you are living) or to your estate (if you have died).
4. We will not add interest to any amount we pay.
Fraud
We believe our policyholders are honest - the contract
between us is based on mutual trust. However, fraudulent
insurance claims are occasionally made. Where fraud (which
can include exaggeration) is detected, claims will not be
paid and we may refer the matter to the Police for criminal
prosecution. This policy section of the plan may
be rendered invalid and we may take other action consistent
with our legal rights.
Complaints procedure
Simplyhealth is responsible for complaints arising out of
the sale of this plan to you and the subsequent issue and
administration of the policy. FirstAssist is responsible
for complaints arising out of this policy section and the
administration of claims.
Our complaints process
If your complaint is not resolved or if you are unhappy with
our response, then you can progress your complaint with our
Customer Relations Department by calling 0845 758 5775
(Monday to Friday 9am-5pm), via email at
[email protected]
Transferring the policy
You cannot transfer the cover or benefits of this section of the
policy to anyone else.
Notice of trust or assignment
We will not accept or be affected by notice of any trust
or assignment or the like which relates to this section of
your plan.
When cover ends
Cover under this policy section of the plan will end when:
• you do not pay your premium on the date it is due.
• if the insured person has reached the age of 66 years on or
before the policy start date of this section of the plan.
• when the plan is terminated or cancelled.
General exclusions
Cover under this policy section of the plan will end for an
insured person:
War risks
We will not pay any benefit if an insured person sustains a
• when we pay benefit to that person for permanent total
disablement.
bodily injury as a result of war, invasion, act of foreign enemy,
hostilities (whether war be declared or not), civil war, rebellion,
revolution, terrorism, insurrection or military or usurped power.
• on the death of that insured person.
Radioactive contamination
We will not pay any benefit under this policy if an insured
person sustains a bodily injury caused directly or indirectly or
contributed to by:
• ionising radiation or contamination by radioactivity from any
nuclear fuel or from any nuclear waste from the combustion
of nuclear fuel or
• the radioactive, toxic, explosive or other dangerous
properties of any nuclear assembly or nuclear component
machinery thereof.
How to make a claim
If you think you may have cause to make a claim under this
section of the plan, please contact Simplyhealth Customer
Contact Team as soon as possible. You can do this by writing
to Simplyhealth, Riverside House, 7 Canal Wharf LS11 5WA
or by calling 0800 056 0366. If you are too ill to contact
Simplyhealth yourself, a relative, a friend or your solicitor can
do this for you.
Any delay in reporting a claim will affect how quickly we can
deal with your claim.
Claims settlement conditions
1. All claims must be made through you or your legal
representatives.
2. You must do the following:
• diving, scuba diving, mountaineering, rock or cliff climbing,
pot-holing, parachuting, sport as a professional, boxing,
racing (other than on foot), time trials or sprints, or flying
Residence
This section of the policy only applies while an insured person
is permanently resident in the United Kingdom.
• whilst a detainee in a prison establishment.
• driving a vehicle without a current valid licence.
• provide FirstAssist at your own expense, with any medical
certificates and other evidence we may ask for to support
your claim.
Conditions
• tell Simplyhealth in writing or by telephone as soon as is
reasonably possible after any incident which may give rise
to a claim under this section of the plan.
or in writing to:
FirstAssist
Customer Relations Department
1 Drake Circus
Plymouth PL1 1QH
We will carry out a separate investigation and full review that
will be concluded by us issuing a final response letter. We
will issue our final response letter within eight weeks of your
original complaint. If it is not possible to issue our response
within this timescale we will write to you explaining why.
What to do if You are still not satisfied
Complaints that cannot be resolved by FirstAssist may be
referred to the Financial Ombudsman Service. You must
approach the Financial Ombudsman Service within six months
of receipt of the final response to your complaint. We will
remind you of the time limit in our final response. Their contact
details are:
Financial Ombudsman Service
(Insurance Division)
South Quay Plaza
183 Marsh Wall
London E14 9SR
Telephone
Email
Website
0845 080 1800
[email protected]
www.financial-ombudsman.org.uk
Your rights
We must accept the Ombudsman’s final decision, but you are
not bound by it and may take further action if you wish.
Your rights as a customer to take legal action remain
unaffected by the existence or use of our complaint procedure.
However, the Financial Ombudsman Service will not adjudicate
on any cases where litigation has commenced.
Financial Services Compensation Scheme
Great Lakes Reinsurance (UK) PLC is a member of the Financial
Services Compensation Scheme (FSCS). You are protected by
the Financial Services Compensation Scheme (FSCS) - in the
unlikely event that we go out of business or into liquidation the
FSCS protects you. Should this happen, the scheme will pay
any valid outstanding claims you have at the time of the claim.
For more details on the scheme please visit www.fscs.org.uk or
contact the FSCS direct on 0207 892 7300.
This policy section of the plan is administered by FirstAssist
Insurance Services Limited and underwritten by Great Lakes
Reinsurance (UK) PLC.
FirstAssist Insurance Services Limited is registered in England
and Wales, No. 04617110.
Registered Office Marshall’s Court, Marshall’s Road, Sutton,
Surrey SM1 4DU.
FirstAssist Insurance Services Limited is authorised and
regulated by the Financial Services Authority (FSA). FSA
Register No. 310671.
Great Lakes Reinsurance (UK) PLC is registered in England
and Wales, No. 2189462.
Registered Office Plantation Place, 30 Fenchurch Street,
London EC3M 3AJ.
Great Lakes Reinsurance (UK) PLC is authorised and regulated
by the Financial Services Authority (FSA). FSA Register No.
202715.
You can check this information on the FSA’s Register by
visiting the FSA’s website www.fsa.gov.uk/register or by
contacting the FSA on 0845 606 1234.
Helpline
Parental/Lifestage Advice
Specially for Our Members, We provide a Helpline, which
offers an immediate source of counselling and straightforward
advice, entirely free. The Helpline is available 24 hours a day, 7
days a week, 365 days a year – just phone 0800 975 3349.
Call the Helpline if You could do with guidance on eldercare,
childcare, and baby and child development. We can also help
with general paediatric issues, details of paediatric experts in
Your local area and with the sorts of communication issues
that arise from time to time, especially with teenagers.
Telephone Counselling
Just pick up the phone and speak directly to a fully trained
counsellor. Typical problems We can help with include stress,
relationships, bereavement, and family issues. We can also
provide onward referral to self-help groups in Your area.
Travel Advice
You can get advice on inoculations, current medications, local
health issues, visa requirements and even equipping a first
aid kit.
Advice You Can Count On
The Helplines are provided by FirstAssist Services Ltd. There
are stringent service level agreements in place and a number
of the Helplines are recorded to ensure quality standards
are met and so that complaints can be rectified accordingly.
FirstAssist Services Limited is IS09001:2000 compliant, which
helps to ensure a quality response to your needs. This service
is provided as an initial source of advice. Any costs incurred
following advice must be borne by the Member.
Well-being Advice
Just call for help with nutritional assessments, complementary
health, dieting, reducing alcohol intake, exercise, giving up
smoking and sports injuries.
Medical Advice Line
The Medical team can provide advice and information on
a wide range of issues including all medical and surgical
conditions, pre and post treatment advice, hospital procedures
and details of local and national help and support groups.
Terms and Conditions
Section one – how to join
1.1 You can apply to join if You are 16 years of age and over
but under 65 years of age on the date that We receive Your
fully completed application form. You must be permanently
resident in the United Kingdom. We do not have to accept
Your application.
will count towards the maximum available under the new
Premium level.
d)Your Claiming year will not change if You increase or
decrease Your Premium rate.
e)You may decrease Your Premium level at any time,
providing that You have been on Your current Premium
level for a minimum of twelve months.
1.2 You can apply to include Your Children or Your
partner’s Children (at no extra cost) if the Children
permanently reside with You and are under the age of 17 at
the date We receive a notice to include them. When Your
Children become 17 they will cease to be covered by Your
Policy but can apply to become a Member in their own right.
We may refuse to allow a person to be added to Your Policy
until You have provided information satisfactory to Us about
the person, including in the case of a Child a copy of their
birth certificate.
f)If You increase Your Premium level to a Plan which
has additional Cover to Your current Plan, the normal
Qualifying periods will apply as specified within the Plan.
1.3 All the information You give to Us on or in relation to
Your application form, Your state of health, any notice to
add another person to Your Policy and any claims must be
accurate, true and complete to the best of Your knowledge
and belief. If You fail to provide information to Us in
accordance with this obligation, We reserve the right to cancel
Your Policy.
i)
Section two - Premiums
2.1 Premium Level
a)The Premium level You have chosen to pay determines
the Cover available to You. The Cover applicable to Your
Premium level is shown in the Table of Cover.
b)Premiums are due on a continuous basis, in advance,
according to Your authorised payment frequency and are
not refundable. You are not covered unless payments are
paid up to date.
c)If You increase Your Premium level any claims paid in
the Claiming year under the previous Premium level
g)You will only be allowed one Premium level increase after
Your 65th birthday.
h)Each monthly Premium relates to one month’s Cover.
If You pay Premiums more than one month in advance,
such payments will be applied on a monthly basis as
Premiums fall due.
Simplyhealth reserves the right to limit back dating the refund of any over payment made by a Member to a maximum of three years.
2.2 Insurance Premium Tax (IPT) is included as part of
Your Premium, a tax levied by the government. Should the
government announce an increase in IPT it may be necessary
for Us to amend Your Premium to reflect this. We will notify
You of this change separately.
2.3 Simplyhealth Cover is monthly and continues from month
to month until it is cancelled or otherwise come to an end.
The product is constantly reviewed to ensure it helps meet
future needs.
Section three – how to claim
We continually review Our claims procedures to make them
as simple as possible and may introduce improvements in the
future. Should this happen We will notify You in advance.
3.1 You have to have received and paid for treatment before
We will pay Your claims. Claims will be offset against the
Claiming year in which treatment was received or in which
the dates of admission and discharge from hospital fell. You
must use the claim form We provide for making claims. If You
do not have a claim form please visit www.simplyhealth.co.uk
or call Customer Services on 0800 056 0366.
3.2 When making a claim You need to send a fully completed
claim form and original receipt for any bill that You are seeking
reimbursement for. The original receipt and/or bill must be on
official headed paper and must show the name of the patient,
the name, address and qualifications of the person providing
treatment, a description of the treatment and the amount
paid for that treatment. For hospital claims the appropriate
section of the claim form needs to be completed, stamped and
endorsed by the relevant hospital authorities. Maternity claims
should be supported by a copy of the birth certificate. You
should submit claims as soon as You can but no later than
13 weeks from the date of discharge from hospital or the date
treatment was supplied and paid for.
3.3 You must provide Us with any information or proof
to support Your claim if We make a reasonable request
for You to do so. We may seek written consent for
medical information relating to a claim to be disclosed
to a Simplyhealth medical practitioner.
3.4 We reserve the right to request a second opinion from an
Optician, Dentist, Specialist or any other Specialist in their
field of expertise appointed by Us.
3.5 We do not accept original receipts that have been altered,
nor do We accept invoices, credit card receipts or photocopies
of any accounts. We do not return any receipts.
3.6 We will not pay any claim while You are in breach of
these Terms and Conditions.
3.7 We do not pay any amounts You may be charged
by a hospital or doctor or other person for completing
Your claim form and/or for medical information requested
by Us in support of Your claim. These charges will be
Your responsibility.
3.8 When You join or increase Your Premium level You can
claim straight away except for maternity Cover and funeral
Cover for which a 50 week Qualifying period applies.
3.9 For the duration of the Policy, You will not be entitled to
make a claim under hospital in-patient Cover that relates to a
pre-existing condition You had prior to joining.
3.10 You can only claim for treatment You have received
under one area of Cover.
3.11 You can only claim maternity Cover for a legally adopted
Child if the Child is unrelated to You and Your partner prior
to adoption.
3.12 Cover will not be provided in respect of any treatment
provided by a Member of Your family to You.
3.13 All outstanding claims must be submitted within one month
if You elect to increase or decrease Your Premium level.
3.14 We reserve the right to recover any overpayment of
claims from any sums payable to You and/or to recover any
such overpayments directly from You.
3.15 The maximum period for which any combination of daily
or nightly rates are payable under Cover for hospital in-patient,
hospital Day Case and parental stay is up to 20 days/nights in
total for each entitled person in any one Claiming year.
3.16 You must give Us written notification of any claim
or right of action against any party arising out of any
circumstances which gave rise to the claim under this Policy,
and must continue to keep Us informed in writing and take
all steps We reasonably require in making a claim upon that
party. We shall be entitled to prosecute in Your name for Our
benefit any claim for indemnity or damages or otherwise which
relates to any benefits and costs payable under this Policy.
3.17 If You or anyone included on Your Policy holds, or
is covered under another insurance Policy with Us, You
can claim on either or both policies up to Your maximum
entitlement as long as You have individual receipts to support
Your claim. The total reimbursement cannot exceed the value
of costs You have incurred.
5.4 Financial Services Compensation Scheme (FSCS) – You
are protected by the Financial Services Compensation Scheme
(FSCS) - in the unlikely that We go out of business or into
liquidation the FSCS protects You. Should this happen, the
scheme will pay any valid outstanding claims You have at the
appropriate level applicable to the scheme at the time of the
claim. For more details on the scheme please visit www.fscs.
org.uk or contact the FSCS direct on 0207 892 7300.
Section six – what happens if We change the Terms
and Conditions of Your Plan
6.1 We have the absolute right to change any of the Terms
and Conditions relating to the Plan.
We will give the following periods of notice:
a)In respect of any changes to cover, at least one month’s
prior notice in writing.
b) In respect of any changes to the Terms and Conditions, at
least one month’s prior notice in writing.
c) In respect of any changes to Premiums, at least one
month’s prior notice in writing.
Simplyhealth will not be responsible if such notification, for any
reason, fails to come to Your attention. Whilst Simplyhealth
reserves the right to make material changes to the Simply Cash
Plan, any decision to withdraw maternity/adoption or funeral
Cover will be subject to 12 months’ notice. You may cancel
Your Policy if You do not like the changes We make.
6.2 We will notify You of any such changes at Your
home address.
6.3 Where You have been notified of a change to the
Terms and Conditions, claims will be paid in accordance with
the Terms and Conditions in operation at the time treatment
was supplied.
Section seven – the legal bits
7.1 Waiver – waiver by Us of any Term or Condition of the
Policy will not prevent Us from relying on such Term or
Condition thereafter.
3.18 If You are making a claim and You have insurance with
another insurance company that covers You for any of the
same benefits under Your plan You must tell us. We may
need to contact this other company as We will not be liable to
pay more than our proportionate share when split between the
insurance companies.
- otherwise failed to observe the Terms and Conditions of this
Policy or failed to act with utmost good faith.
Section four – how does cover end?
Section five - Customer Care
4.1 All Cover under this Policy will end automatically and
You will not be covered for any claims not yet submitted in
respect of You and all other persons included on Your
Policy when:
5.1 Putting things right
a) You decide to cancel Your Policy, by giving Us one
month’s notice in writing (which will take effect immediately
on receipt by Us). We will not refund any of Your monthly
Premiums that have already been paid. We reserve the
right to restrict You re-joining any plan for a period of 3 years
from the date that cancellation of Your Policy takes effect.
Where Your Premiums are paid by Your employer via payroll
deduction, You must notify Your payroll department to avoid
further Premiums being deducted.
b) You, any employer or third party who is paying Your
Premiums on Your behalf, miss paying three consecutive
monthly Premiums.
We may at Our discretion cancel Your Cover earlier in
accordance with 2.1 if You fail to pay Premiums. We may
reinstate that Cover if each outstanding Premium is paid
within one month of its due date.
c) In the event of Your Death.
d) We exercise Our right to cancel Your Policy at any time
(with retrospective effect where appropriate) if You:
- misled Us by mis-statement or concealment;
- knowingly claimed benefits for any purpose other than as are
provided for under this Policy;
- agreed to any attempt by a third party to obtain an
unreasonable pecuniary advantage to Our detriment;
4.2 All Cover under this Policy in respect of a Partner or
Child included on Your Policy will end when he/she dies or
he/she ceases to satisfy the criteria in 1.2.
At Simplyhealth We aim to provide You with the very highest
levels of customer service and care at all times. In order to
maintain this service standard, We encourage feedback from
Our Members and have put in place a procedure that You
can use to raise any concern or complaint You may have. In
the first instance You should write to the Customer Service
Team Leader at Simplyhealth Healthplan, Riverside House, 7
Canal Wharf, Leeds LS11 5WA or contact Customer Services
direct on 0800 056 0366 or email [email protected]
If You are unhappy with the response You receive then We
will refer Your complaint to the Simplyhealth Group Quality
Assurance Team for a final decision. Should You remain
unhappy with Our initial response or Our final response,
You have the right to refer Your complaint to the Financial
Ombudsman Service, South Quay Plaza, 183 Marsh Wall,
London E14 9SR. Tel: 0845 080 1800. Full details of Our
complaints procedure are available on request.
5.2 Changing Your mind – You have 14 days from receipt
of Your welcome letter in which to change Your mind
and receive a full refund of any Premiums You have paid,
providing no claims have been made. If You change Your
mind, please call 0800 056 0366 or write to: Simplyhealth,
Riverside House, 7 Canal Wharf, Leeds LS11 5WA and We
will cancel Your Policy for You.
5.3 Changes to Your details – You must inform Us as soon
as reasonably possible of any changes to the information
that You have given to Us, including any change of address,
marital status or any other material change. Failure to do so
may result in Cover being refused or cancelled or Your Policy
being cancelled.
7.2 Enforcement – no term of this Policy or any part of it, is
enforceable under the Contracts (Rights of Third Parties) Act
1999 by a person who is not party to it. Where applicable
Your Partner and/or Children are not party to the Policy.
insurance contract or administer claims We may collect data,
which the Data Protection Act 1998 defines as sensitive. By
agreeing to these Terms and Conditions You consent to this
data being processed by Us.
7.3 Choice of law – the parties to insurance contracts in the
United Kingdom may choose which law will apply. Unless We
agree otherwise, English law will be applied to Your Policy.
7.7 You have the right to see personal information which is
held by Us. There may be a charge if You want to do this.
For more details write to: The Data Controller, Simplyhealth,
Hambleden House, Waterloo Court, Andover, Hampshire
SP10 1LQ.
7.4 Language – We will communicate with You in English.
7.5 How We use information about You – as the Data
Controller, We will store and process Your personal data in
accordance with the Data Protection Act 1998.
We and other Simplyhealth companies will use Your
information to provide Our services, for assessment and
analysis, for underwriting and claims handling, to improve Our
services, and to protect Our interests. We may use Your
information to keep You informed by post, telephone, e-mail
or other means about products and services, which may be
of interest to You. If You do not wish Your information to be
used for these purposes please write to: The Data Controller,
Simplyhealth, Hambleden House, Waterloo Court, Andover,
Hampshire SP10 1LQ. We will keep information about You
confidential. However, We may give information about You
and how You use Our products to the following:
(1) Fraud prevention agencies and other organisations who
may record, use and give out information to other insurers;
(2) People who provide a service to Us or acting as agents
on the understanding that they will keep the information
confidential;
(3) Anyone to whom We may transfer our rights and duties
under this agreement;
(4) We may also give out information about You if We have
a duty to do so (such as to regulatory bodies), or if the law
allows Us to do so or if the person requesting the information
has in Our opinion, a legitimate interest in the disclosure.
7.6 Sensitive Data – in order to assess the terms of the
7.8 Claims You may have against third parties – if You are
bringing or are entitled to bring a legal compensation claim
against a third party, which would Cover claims met under
Your Policy, You must tell Us about this as We may have the
right to recover these sums from that third party. To enable Us
to do this, You must notify Us of the claim, keep Us informed
of its progress, and act in accordance with Our instructions.
Alternatively, We may take over or bring a claim in Your name
in relation to the Simplyhealth element.
Your Simply Cash Plan Cover
& Terms and Conditions
Policy Document
Feel free to bother us with any enquiries
0800 056 0366
or visit www.simplyhealth.co.uk
LHF and Simplyhealth are trading names of Simplyhealth Access, registered and incorporated in England and Wales, no.183035.
Registered office: Hambleden House, Waterloo Court, Andover, Hampshire SP10 1LQ. Authorised and regulated by the Financial Services Authority.
Your calls may be recorded and monitored for training and quality assurance purposes.
CVTC.09/09