Provider: AXA PPP healthcare Product: Premier Plus - Premier Plus offers cover for private medica...
Provider: AXA PPP healthcare
Product: Premier Plus - Premier Plus offers cover for private medical treatment including inpatient and day-care treatment, associated specialists' charges and outpatient surgical procedures. In addition, it provides benefit for a range of outpatient treatments, which need not be related to a stay in hospital and have no monetary limit.
Contact number: 01892 512 345
Minimum acceptable age at commencement: None
Maximum acceptable age at commencement: None
Age cover ceases for existing clients: None
Maximum age for a dependant child to be covered: No maximum child age, but adult pricing from age 21.
Premiums can be paid monthly: Premiums payable monthly, quarterly or annually. Annual payments attract a 5% discount
Plan is fully underwritten: Private healthcare is designed primarily to provide cover for new medical problems arising after joining, although certain conditions, which are unlikely to recur, may be covered. If the member has completed a medical history declaration, their membership statement will clearly show the specific medical conditions for which they are not covered.
If they have any such exclusions on their membership, AXA PPP healthcare underwriters may be able to review them provided that the medical condition in question is completely cured and at least two years have elapsed free of any problems without treatment or medications being required.
AXA PPP healthcare will not pay benefits for any treatment of any medical condition which the member already had or which was foreseeable and which should have been disclosed to AXA PPP healthcare but was not disclosed, or was not fully or accurately disclosed, when the member joined, this includes any previous medical condition which recurs. Please refer to exclusions for more details.
Premium loading applied to pre-existing conditions: If the member has completed a medical history declaration, their membership statement will clearly show the specific medical conditions for which they are not covered.
If they have any such exclusions on their membership, AXA PPP healthcare underwriters may be able to review them provided that the medical condition in question is completely cured and at least two years have elapsed free of any problems without treatment or medications being required.
AXA PPP healthcare will consider including pre-existing conditions at extra cost.
Switch schemes on no worse terms basis: Available if switching from a AXA PPP healthcare corporate plan.
Compulsory excess applied: None
Optional excess available: The member has the option to choose an excess of £100, £200 or £500, which will reduce the premiums. The excess is payable on the first eligible claim for each member each year. It is applied each year, so if treatment spans a renewal date it would be applied twice. The excess does not apply to the NHS cash benefit or International Emergency Medical Assistance. There is no set discount for different excesses as each excess has its own rate structure.
Discount given based on premium frequency: Payment of premiums annually results in a 5% discount.
Claims pre-authorisation service: As soon as the assured's GP refers them to a specialist for their initial consultation, they must call for entitlement confirmation. The policyholder should follow these steps:
• Call their personal advisory team.
• They will check that the specialist is recognised and confirm what cover the policyholder has.
• A claim form will be sent to the policyholder which should be completed and given to the specialist or GP.
• The specialist or GP completes their section and returns the form to AXA PPP healthcare.
• The personal advisory team will contact the policyholder to confirm their benefit entitlement.
• If eligible treatment is recommended, treatment can commence.
Claims settled direct with hospital: Many hospitals have an arrangement to invoice AXA PPP healthcare direct.
Number of hospital bands available: There are two hospital bands. Hospital band one gives the highest cover and band two the lowest. A Directory of hospitals is published which lists the Private Hospitals whose charges are eligible for benefits.
inpatient costs: Full refund
• Nursing and accommodation costs.
• Consultations costs.
• Surgeons fees.
• Anaesthetist fees.
• Physicians fees.
• Drugs and dressings.
• X-rays (radiology).
• Pathology.
• Radiotherapy.
• Chemotherapy inpatient computer tomography .
• Physiotherapy.
• Intensive care costs.
Costs of parent accompanying a child: Full refund for accommodation charges for one parent staying with a member who is under 11-years-old. This is paid from the child's benefit.
Inpatient psychiatric treatment: Full refund
Operation fees: Full refund
• Complex major.
• Major plus operation.
• Major operation.
• Intermediate operation.
• Minor operation.
Outpatient costs: Full refund
• Consultation.
• X-rays (radiology).
• Pathology.
• Radiotherapy. • Chemotherapy.
• Computer tomography.
• Physiotherapy.
• Psychiatric treatment.
Day-care treatment: Full refund of day-care treatment in any private hospital or day-care unit listed in the Directory of Hospitals.
Alternative medicine: Osteopath, chiropractor, acupuncture, homeopath, chiropody. Full refund under specialist referral. The insured is covered for up to 10 sessions with a complementary practitioner subject to GP referral.
Out of band benefit: If the member has treatment in a private hospital bed which is in a hospital band higher than the one chosen, AXA PPP healthcare will only pay for the amount shown per night, except that if the treatment involves a surgical procedure AXA PPP healthcare define as complex then they will pay them in full even if they use a Band 1 bed.
Cover for home nursing costs: Full refund. Skilled nursing services given by a registered nurse at home immediately after or instead of inpatient or daycare treatment. The nursing services must be under the personal control of a specialist as part of the treatment provided and must be agreed by AXA PPP healthcare before the nursing at home begins.
Worldwide and repatriation cover: If the policyholder is taken ill or injured while they are abroad, AXA PPP healthcare give two options; evacuation or repatriation.
• Evacuation - If the hospital the policyholder has been admitted to does not have the suitable or adequate facilities to treat them, AXA PPP healthcare will either move them to the nearest hospital which does (even in another country); or if preferred, evacuate them to the UK, provided that it is medically safe to do so.
• Repatriation - AXA PPP healthcare will bring the policyholder home if they wish, provided that it is medically safe to do so. This applies even if the hospital they are in is capable of treating them effectively.
• Overseas Medical Cover - Wherever the assured are in the world, they will have their medical treatment expenses - including accident and emergency treatment - refunded. The overall maximum amount of benefit available for each member for treatment received outside the UK in a year is £100,000 for hospital cover 1 and £40,000 for hospital cover 2. This is provided that the policyholder has not travelled against medical advice or gone abroad specifically for treatment.
• International Emergency Medical Cover - In addition to the private medical insurance, the assured also benefits from AXA PPP healthcare International Emergency medical cover - SOS. This is a worldwide, 24 hour a day, 365 days a year emergency advice and 'get you home safely' facility.
Cover for costs of optical treatment: Optical Cover - Up to £15 a year for an eye test and up to £250 for prescribed glasses or prescribed contact lenses every two years.
Cover for costs of dental treatment: AXA PPP healthcare will not pay for any dental procedure including orthodontics. However they will pay for some surgical procedures which need to be carried out by an oral and maxillofacial surgeon. The only surgical procedures covered that specifically relate to teeth are:
• Replantation of the assured's own teeth following a trauma;
• Surgical removal of impacted teeth, buried teeth and complicated buried roots.
• Enucleation (removal) of cysts of the jaw.
Health at Hand: AXA PPP Health at Hand gives the assured access to a team of healthcare professionals, on call 24 hours a day, 365 days a year, free of charge. Registered nurses, paediatric nurses and pharmacists will be on hand to answer questions and help the assured understand any medical problems their doctor has already diagnosed. Calls are free of charge.
Critical illness cover: £10,000 paid if diagnosed as suffering one of the following before the age of 65:
• Cancer.
• Dementia.
• Heart attack.
• Kidney failure.
• Major organ transplant.
• Motor neurone disease.
• Multiple sclerosis.
• Paralysis.
• Parkinson's disease.
• Stroke.
Maximum annual benefit amount: None
Web link: www.axappphealthcare.co.uk
