Corporate Health Cash Plan

Your Weekly Payments

Summary of benefits that can be claimed

www.healthshield.co.uk

Healthy & Happy

Dental ✔ 100% £40 £75 £135 £185 £240 £315

Optical ✔ 100% £40 £75 £135 £185 £240 £315

Chiropody ✔ 100% £40 £75 £135 £185 £240 £315

Prescriptions Per item 1 2 3 4 5 6

Health & wellbeing ✔ 100% £40 £75 £135 £185 £240 £315

Health screening ✔ 100% £40 £75 £135 £185 £240 £315

Combined physiotherapy ✔ 100% £75 £140 £315 £420 £585 £740

Feel BetterHospital benefits Hospital inpatient (per night) Hospital day surgery (per day)

✔Up to a maximum of 25 nights/days

per year£10 £20 £45 £65 £85 £110

Parental hospital stayUp to a maximum

of 25 nights per year

£5 £10 £25 £35 £45 £55

Specialist consultation, ECG, X-ray, pathology fees and MRI scans ✔ 100% £75 £150 £250 £390 £525 £675

Peace of Mind

Dental accident ✔ 100% £100 £200 £400 £600 £800 £1000

Maternity - antenatal appointment and adoption A single payment £75 £150 £300 £560 £695 £900

Personal accident protection ✔ A single payment £2500 £5000 £10000 £15000 £20000 £25000

My Wellnessmywellness provides you with online tools and information to help you to proactively manage your health and wellbeing. Included are services such as a virtual GP surgery, private prescriptions, 24/7 counselling and support helpline, online health assessments, cancer screening and physio triage. You can also access healthy

discounts on shopping, days out and much more. If you are a Prestige Level member, we will contribute up to £100 towards the cost of your yearly gym membership, swimming sessions, exercise classes or personal trainer.

For all mywellness services, simply log on at www.healthshield.co.uk/members to find out more.* Services and information available on mywellness can change without notice.

Level of Cover Access Level Level 1 Level 2 Level 3 Level 4 Prestige Level

Weekly Payments for You(Includes benefits for dependent children) Child

coverCashback

level

£1.20 £2.30 £5.20 £7.80 £10.80 £16.35

Weekly Payments for You and Your Partner(Includes benefits for dependent children) £2.40 £4.60 £10.40 £15.60 £21.60 £32.70

Benefits for Prestige Level Members

Family planning

Extra Benefits Exclusive to Prestige Level Members

£500

Critical illness ✔ £2000

Sickness and accident protectionContribution protection for

sickness & accident

The above benefits are the maximum levels which apply. The type of benefit, benefit levels and contribution rates may change in future. All contributions and benefits are subject to an annual review. There is worldwide cover for many benefits. *Services may vary. Please log on at www.healthshield.co.uk/members to find out which services are applicable to your plan.

About your plan• Claim100%refundonhealthcarebills,subjecttoannualreview

• DependentchildrencoveredforFREEuptotheageof21in full-timeeducation

• NoGPreferralrequiredbeforehavingtreatment

Members’ AreaLog-ontoourMembers’Areawww.healthshield.co.uk/memberswhereyoucan:

• Updateyourpersonaldetailsandcheckyourbenefitbalance

• Claimonlineandreceivefastpaymentdirecttoyouraccount

• Visitmywellnesstoaccessarangeofadditionalservices thathelpyoumanageyourhealthandwellbeingneeds

Telephone 01270 588555 Find us on

Table of contributions and benefits

Terms and conditions for the Health Shield Corporate Scheme membership plan

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GENERAL TERMS AND CONDITIONSThese are standard terms and conditions and should be read with the Key Facts document. Please make sure that you have read and understood both documents before going for treatment or sending us a claim.Who can join?If you want to join the Health Shield Corporate Schememembershipplan(‘theplan’)or increaseyourlevelofcover,youmustbebetween16and64(thatis,notyet65)whenyouapply and be employed by a company that offers the HealthShieldCorporateScheme.Ifyouapplytojointheplan,orifyouareanexistingmemberapplyingtoincreaseyourlevelofcover,youwillnotbeentitledtoreceivebenefitforanypre-existingcondition.Wemayaskyoutofillinahealthdeclarationformandwilltellyouaboutanyconditionsthatarenotcovered.Exclusions for pre-existing conditions may apply to thefollowingbenefitsonly:• Hospitalinpatient• Hospitaldaysurgery• Parentalhospitalstay• Combinedphysiotherapy• Specialistconsultation,ECG,X-ray,pathologyfeesand

MRIscans• Criticalillnesscover• SicknessandaccidentprotectioncoverTomakeclaimsforapartner,youmustbecontributingtotheplan at the rate that covers you and your partner. You musthavefilledintheappropriateformssowecanofficiallyregisteryour partner and dependent children. You, and your partneranddependentchildren(ifthisapplies),mayonlybecoveredorincludedinonemembershipplan.Your membershipWewillrefundtheappropriatepercentageofeachvalidclaim(asshowninthebenefittable)uptoyouryearlybenefitlimit.However, during the lifetime of this contract, it is importantyouunderstandthatifouroverallclaimsexperience,positionin the marketplace or surplus are worse than expected, wemay increase your contribution rates, or reduce, change orremoveanybenefit.However, if our overall claims experience, position in themarketplace or surplus are better than expected, we maybe able to improve your terms. As a result, we will reviewall benefits and contributions each year and will tell youbeforehandifareviewwillleadtoachangeinthebenefitsorcontributionspaidinthefuture.As a member, you agree to us processing personal andsensitive information about you. You, the member, mustalso sign all claim forms to declare that the details youhave provided on the forms are true, and to allow us to getindependent verification of the details from the healthcareprovidertheclaimrelatesto.Ifwebelievethatanydocumentsyousendusarenotgenuine,wemaykeepthem.We can refuse claims if we reasonably believe that thetreatment has not taken place or that you have not paidfor an item. This includes rejecting receipts from certainpractitioners and claims that we cannot check with thepractitionerconcerned.ContributionsYou will be entitled to receive the maximum benefit if yourcontributionsareuptodateandyoudonothaveapre-existingconditionthatwecannotcover.Ifyoumakeaclaimandyourcontributionsarenotpaiduptodateforanyreason,wewillnotbeabletoprocessyourclaim.Wewillputaholdonyourclaimsuntilyourcontributionscoverthedatesthatyouareclaimingfor.If you decide to end your membership, all benefits will stopafterthedateyouhavepaidupto.Qualifying periodIfyouapplytojointheplan,orifyouareanexistingmemberapplying to increase your level of cover, you will becomeeligibletomakeclaims:• 40weeksafteryourfirstorincreasedcontributionfor

maternity-antenatalappointmentandadoptionbenefitandallbenefitsconnectedwithmaternity;and

• 13weeksafteryourfirstorincreasedcontributionforallotherclaims.

From the date you make your first contribution you will becoveredforthefollowingbenefitsonly:• Overnightadmissionstohospitalasaresultofanaccident• Personalaccidentprotection• ServicesavailableonmywellnessiftheseapplyExclusionsWe cannot pay benefit for any claims directly related to thefollowing:• GPfeesforprivatetreatment• Drugs,medicinesandvaccinations(includingmedicines

relatingtohomoeopathictreatmentandtravel-relatedvaccines,forexampleanti-malarialtablets)

• Vasectomies,sterilisation,IVF,fertilitytreatmentandexaminations(notincludingthefamilyplanningbenefitforPrestige-levelmembers)

• Pregnancyterminations,contraceptives,genderre-assignmentorcosmeticreasons

• Anyhealth-screeningchecks,medicalexaminations,consultationsorreportsforemployment,emigration,legalorinsurancereasons

• Treatmentprovidedtoyoubyamemberofyourfamilyoraworkcolleague

• Postageandpackingcosts• Internet,telephoneandgroupconsultations• Treatmentchargescoveredbyprivatemedicalinsurance

otherthananyexcess(ExcessfeesarecoveredundertheSpecialistConsultationallowance.)

Wecannotpaybenefitforclaimsyoumakeasaresultofthefollowing:• Apandemicdisease• Radioactivecontamination• Suicideordeliberateself-inflictedinjury• War,hostilities,invasionorcivilwarandfull-timeactive

militaryservice

• Nuclear,chemicalorbiologicalterrorism• Drug,alcoholorsolventabuse,ortakingdrugs(unlessyou

havebeentoldtobyaregisteredmedicalpractitioner)• Takingpartinprofessionalsportsorflyingasapilotor

crewmember(thatis,aircraft,gliders,hang-gliders,microlights,parachuting,paraglidingandballooning)

Pleasealsoseewhatisnotcoveredundereachsectionofcover.Benefit periodThemaximumbenefitsareshowninthetableonpage1.Asamember, youwillnot receivemore than themaximumbenefitamountunderanyofthebenefitrulesforyourself,yourpartner(iftheyarecovered)ordependentchildrenineachcaseforanyonecalendaryear.Wetreatclaimsinacalendaryearaccordingtothedatesyou(oryourpartnerordependentchild)were admitted to hospital or received treatment, whicheverapplies.If you have been covered before as a member or as adependentchildorregisteredpartnerundersomeoneelse’sHealthShieldmembership,wewilltakeaccountofanyclaimsyouhavemadeduringyournewplan’scalendaryear.When you change your level of cover, we will take accountof previous claims you have made when we work out yourmaximumentitlementforthecalendaryear.How to claimWe will deal with claims on the day we receive them andmake payment within a reasonable time. We cannot acceptphotocopied,faxedorscannedreceiptsandclaimforms(unlessyouaresendingusaclaimviatheHealthShieldwebsite).Wealsocannotacceptcredit-ordebit-cardreceipts.Youshouldincludethefollowingdetailsontheoriginalreceipts:• Thedateyoureceivedtreatment(wecannotpayfor

anythingyouhavepaidforinadvanceandnotyetreceived)• Thefullnameandtitle(Mr,Mrs,MsorMiss)oftheperson

whohasreceivedthetreatment• Theofficialstampandqualificationsofthedentist,

optician,chiropodist,physiotherapist,consultantandsoon• Thetypeoftreatmentreceived• Thereceiptclearlyshowsthepaymentamountandthatit

hasbeenpaidinfullWe cannot accept receipts which have been altered. Thereceipts must only apply to the amount paid for the personwhoreceivedtreatment.Weneedseparatereceipts foreachpersoncovered.Wewillonlypayclaimstoyoudirect,nottothehealthcarepractitionerwhoprovidesthereceipts.Wewillnotacceptapplicationsforbenefitthataremorethan12monthsoldatthetimewereceivethem.There is a list of accepted accreditations and qualificationson our website at www.healthshield.co.uk. You can also askus to send you a list by ringing 01270 588555 or emailingclaims@healthshield.co.uk.Wereviewthislisteveryyear.Thepractitioner’squalifications,registrationormembershipmustberelevanttothetreatmentthattheyareproviding.Beforereceivingtreatmentforoneofthebenefitslistedbelowpleasemakesurethatyouhavecheckedourlistofacceptedaccreditations and qualifications to see whether the personor organisation treating you has the accreditations andqualificationsweaccept:• Chiropody• Specialistconsultation,ECG,X-ray,pathologyfeesand

MRIscans• Healthandwellbeing • Combinedphysiotherapy• Familyplanning(Prestige-levelonly)Worldwide coverSome benefits apply during business visits and holidaysabroad that last up to 28 days. The terms and conditions(including what is and what is not covered) will apply to theclaimsyousendin,andyoumustsendthedetailstranslatedintoEnglish,ifnecessary.Wewillconverttheamountofyourclaim into pounds sterling using the currency exchange sellrateonthedateweprocessyourclaim.Beforewecanpayyourclaim,wemayaskforacopyofyourtravel documents which confirms that you have not beenoutsideoftheUnitedKingdomformorethan28days.Whatbenefitsarecovered:• Dental• Optical• Emergencyadmissionsonlyfor: •hospitalinpatient •hospitaldaysurgery •parentalhospitalstay• Combinedphysiotherapy(thequalificationoraccreditation

ofthepractitionermaybeaninternationalequivalent)• PersonalaccidentprotectionWhatbenefitsarenotcovered:• Dentalaccident• Maternity-antenatalappointmentandadoption• Specialistconsultation,ECG,X-ray,pathologyfeesand

MRIscans• Chiropody• Healthandwellbeing• Healthscreening• Prescriptions• Familyplanning(Prestige-levelonly)• Criticalillness(Prestige-levelonly)Alsoseethe‘Exclusions’sectiononthispage.Thiscoverdoesnotreplacetravelinsurance.DEFINITIONS‘List of accepted accreditations and qualifications’ – alist of approved professional organisations and acceptedqualificationsthatwerecognise.Wereviewthislisteveryyear.The practitioner’s qualifications, registration or membershipmustberelevanttothetreatmentthattheyareproviding.‘Accident’ – a sudden, unexpected and identifiable eventcausinginjuryorillness.‘Claims experience’ – the number and cost of claimswe paid for any one calendar year (that is, January toDecember).

‘Dependent children’ – your or your partner’s children orlegallyadoptedchildrenwhoareundertheageof21,infull-timeeducationandlivingathome.‘Excess’ – the first part of any eligible treatment costs, thatwouldotherwisebepaidbyaprivatemedical insurer,whichyouhavechosentopayyourself.‘Full health screen’–afullmedicalcheck-upthatmayinvolvegiving details of your and your family’s medical history andhavingaphysicalexamination,tests,laboratorytests,scansorX-rays,andmaybefollowedbycounselling,education,referraltohospitalorfurthertreatments,orfurthertests.‘Hospice’–an institutionthatprovidespalliativecarefortheterminallyill.‘Hospital’ – an institution which has permanent facilitiesfor caring for patients, has facilities for diagnosing andtreatinginjuredorsickpeopleandprovidesnursingservicessupervisedbyregisteredgeneralnurses.Ifyouareadmittedtoahospital,itshouldbefollowingareferralbyaGP,consultantorthroughtheaccidentandemergency(A&E)department.‘Membership plan’(‘theplan’)–theHealthShieldCorporateSchememembershipplan,andthelong-terminsurancecashbenefit plan described in these terms and conditions. Theplanisregisteredinasinglenameonly(that is,yourname),although cover may also be provided for your partner anddependentchildren,ifthisapplies.‘Palliative care’–anapproachthatimprovesthequalityoflifeofpatientsandtheirfamiliesfacingtheproblemsassociatedwithlife-threateningillness.‘Pandemic’ – an infectious disease that is widespreadthroughoutanentirecountry,continent,orthewholeworld.‘Partner’–yourhusband,wifeoranyotherpersonwholiveswithyouatthesameaddressasifyouaremarried,nomatterwhethertheyaremaleorfemale.‘Practice-plan premiums’ – payments made to a schemeprovidedbyyourdentist.‘Pre-existing condition’ – any disease, illness or injury thatyou have received medication, advice or treatment for, andexperienced symptoms of, no matter whether the conditionhasbeendiagnosedbeforethestartofyourcover.‘Registered treatment centre’ – a centre that is registeredwith the Department of Health and appears on the NationalAdministrativeCodeServiceRegister.‘Surplus’ – any money left over after meeting claims andexpensesduringthefinancialyear.‘We’, ‘our’, ‘us’ – Health Shield Friendly Society Limited,ElectraWay,CreweBusinessPark,Crewe,Cheshire,CW16HS.‘You’–you,aswellasanypartneranddependentchildrenwhoarecovered,ifthisapplies,inthismembershipplan.BENEFIT TERMSHEALTHY & HAPPYDentalWewillpaybenefitfordentaltreatment,attheappropriaterateanduptotheappropriatemaximuminanyonecalendaryear.Pleaseseethe‘Howtoclaim’sectiononthispagebeforegoingfortreatmentorsendingusaclaim.Whatiscovered:• Anaestheticfees• Check-upcharges• Adentalbraceorgumshieldprovidedbythedentist• Joiningfeesandpractice-planpremiums• Dentalcrowns,bridgesandwhitefillings• Dentalveneers• Dentures,orrepairstodenturesatdentallaboratories• Hygienistfees• Orthodonticandperiodontictreatment• Tooth-whiteningtreatmentprovidedbythedentist• X-raysWhatisnotcovered:• Cancellationchargesmadebythedentist(forexample,for

missedappointments)• Dentalconsumables(forexample,toothbrushes,

mouthwash,dentalflossandsoon)• Dentalinsurancepremiums• Dentalprescriptioncharges(wecoverthesecharges

undertheprescriptionsbenefit)• Dentaltreatmentchargesresultingfromadentalaccident

(wecoverthesechargesunderthedentalaccidentbenefit)Alsoseethe‘Exclusions’sectiononthispage.Optical We will pay benefit for optical treatment, at the appropriaterateanduptotheappropriatemaximuminanyonecalendaryear.Pleaseseethe‘Howtoclaim’sectiononthispagebeforegoingfortreatmentorsendingusaclaim.Ifyouhaveboughtyourcontactlensesorglassesonline,youmustsendusthereceipttogetherwithacopyoftheoptician’sprescriptionshowingyourname.Whatiscovered:• Contactlenses(permanentordisposable)• Contactlenscheck-ups• Contactlenscleaningsolutions(includingifyoubuythese

separately)• Eyelasersurgerytocorrectlong-andshort-sightedness

paidaccordingtothedateoftreatmentandnotwhenpaymentsaremade

• Eyesighttests• Lensesyoubuyseparatelytofittoexistingframes• Lensessuppliedunderanopticalinsuranceplan• Prescribedglasses• Prescribedmagnifyingglasses• Repairstoprescribedglasses• Sunglasses,safetyglassesandswimminggoggles(aslong

astheyhaveprescribedlenses)Whatisnotcovered:• Insurancepremiums• Non-prescribedglassesandcontactlenses(forexample,

ready-madeglassesandcolouredlenses)

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Terms and conditions for the Health Shield Corporate Scheme membership plan

• Opticalconsumables(forexample,glassescases)• FramesyoubuyseparatelyAlsoseethe‘Exclusions’sectiononpage2.ChiropodyWe will pay benefit, at the appropriate rate and up to theappropriatemaximuminanyonecalendaryear,forchiropodytreatmentfromapractitionerwhoisamemberofanapprovedprofessionalorganisation.Pleaseseethe‘Howtoclaim’sectiononpage2beforegoingfortreatmentorsendingusaclaim.Whatiscovered:• Assessments(forexample,gaitanalysis,whichisan

analysisofhowyouwalk)• Chiropodytreatment• PodiatrytreatmentWhatisnotcovered:• Consumables(forexample,archsupports,orthotics

orinsoles)evenwhenprescribedandsuppliedbythechiropodistorpodiatristatthetimeofthetreatment

• Surgicalfootwear(forexample,correctiveshoesprescribedandsuppliedasapartofthetreatment)

• X-rays• Chiropodyprescriptioncharges(wecoverthesecharges

undertheprescriptionsbenefit)Alsoseethe‘Exclusions’sectiononpage2.Prescriptions (for each item)We will pay benefit to you and your partner (if they arecovered), at the appropriate rate and up to the appropriatemaximumnumberofindividualprescriptionitemsinanyonecalendaryear,forNHSprescriptioncharges(ortheNHScashequivalent).PleaseseetheHowtoclaimsectiononpage2beforegoingfortreatmentorsendingusaclaim.Wewillaccept the labeloff themedicationpackagingor theNHSformasproofofyouroryourpartner’sname, togetherwithyourreceipt.Wedonotpayprescriptionbenefitfordependentchildren.Whatiscovered:• NHSprescriptionchargesortheNHScashequivalentfor

privateprescriptioncharges• AnNHSprepaymentcertificateuptotheappropriate

maximumofindividualprescriptionitems• Dental,combinedphysiotherapyandchiropody

prescriptionchargesWhatisnotcovered:• ChargesabovethecurrentratesetoutintheNHS

prescriptionpricingstructureAlsoseethe‘Exclusions’sectiononpage2.Health and wellbeingWe will pay benefit, at the appropriate rate and up to theappropriate maximum in any one calendar year, when apersonentitled tobenefitreceives treatmentrelatedto theirhealthandwellbeingtorelievepainorpreventanillness,fromapractitionerwho isamemberofanapprovedprofessionalorganisation.Pleaseseethe‘Howtoclaim’sectiononpage2beforegoingfortreatmentorsendingusaclaim.Wewillonlypayclaims for the treatments listedbelow.Thepractitioner must have the appropriate qualifications asshown on the separate list of accepted accreditations andqualificationsreferredtoabove.Theclaim formmust include thereasons for the treatment,andthetypeoftreatmentprovided.Whatiscovered:• Acupressure• Allergytesting,includingfoodintoleranceandnutrition

testscarriedoutbyaqualifiedpractitioner• Aromatherapymassages• BowenandAlexandertechniques• Chairmassage• Cognitivebehaviouraltherapy• Colonichydrotherapy• Counsellingfees(forexamplepsychiatric,psychological

andbereavement)• Hopiearcandles• Hot-stonemassage• Hypnotherapy• Indianheadmassage• Kinesiology• Manuallymphaticdrainage• Naturopathy• Nutritionaltherapy• Reflexology• Reiki• Shiatsu• Sportsandremedialmassagesincludingtherapies• SwedishmassageWhatisnotcovered:• Beautytreatments(includingfacials)• Herbs,herbalremedies,supplementsorvitamins,evenif

theyhavebeensuppliedaspartofyourtreatment• Vegatesting• Laboratorytestingnotreferredforbyadoctor• Hairanalysis• Hometestingkits• Anytreatment,providedbyapractitionerrecognisedbyus,

whichisnotlistedabove• Appliances(forexample,lumbarrollsandbacksupports),

eveniftheyhavebeensuppliedaspartofyourtreatment• Smokingcessationpatches,gum,electroniccigarettesand

otherremedies• Weight-managementprogrammes• RelationshipcounsellingAlsoseethe‘Exclusions’sectiononpage2.

Health screeningWe will pay benefit, at the appropriate rate and up to theappropriatemaximuminanyonecalendaryear, forahealthscreencarriedoutbymedicallyqualifiedstaffatahospitalorhealth-screeningclinictopreventanillness.Pleaseseethe‘Howtoclaim’sectiononpage2beforegoingfortreatmentorsendingusaclaim.Whatiscovered:• AfullhealthscreenWhatisnotcovered:• Hometestingkits• Testsnotincludedwithinthefullhealthscreen(for

example,X-raysandbloodtests)• Anyotherscreeningcheckortestnotcarriedoutaspartof

oneofthoselistedabove• Healthscreenscarriedoutintheworkplaceorarranged

throughyouremployer• HealthscreenscarriedoutinmobilefacilitiesAlsoseethe‘Exclusions’sectiononpage2.Combined physiotherapyWe will pay benefit, at the appropriate rate and up to theappropriatemaximuminanyonecalendaryear,whenapersonentitledtobenefitreceivestreatmenttorelievepainorpreventanillness,fromapractitionerwhoisamemberofanapprovedprofessionalorganisation.ThisbenefitalsocoverschargesforX-raysandscanscarriedoutatclinicsontherecommendationofthepractitioneraspartofthetreatment.Pleaseseethe‘Howtoclaim’sectiononpage2beforegoingfortreatmentorsendingusaclaim.Wewillonlypayclaims for the treatments listedbelow.Thepractitioner must have the appropriate qualifications asshown on the separate list of accepted accreditations andqualificationsreferredtoabove.Theclaim formmust include thereasons for the treatment,andthetypeoftreatmentprovided.Whatiscovered:• Acupuncture• Chiropractic• Homoeopathy• Osteopathy(includingcraniosacraltherapy)• Physiotherapy• X-raysandscans,whennecessaryaspartofthetreatmentWhatisnotcovered:• Anytreatment,providedbyapractitionerwhois

recognisedbyus,whichisnotlistedabove• Appliances(forexample,lumbarrollsandbacksupports)

evenifprescribedandsuppliedbyyourpractitioneraspartofthetreatment

• Pre-existingconditions• Herbs,herbalremedies,supplementsorvitamins,evenif

theyhavebeensuppliedaspartofyourtreatment• Prescriptioncharges(wecoverthesechargesunderthe

prescriptionsbenefit)Alsoseethe‘Exclusions’sectiononpage2.FEEL BETTERHospital benefitsWecombinehospitalinpatientandhospitalday-surgerybenefitpayments.Themaximumperiodforreceivingcombineddailyornightly ratesofbenefit is25 inanyonecalendaryear foreachpersonwhoisentitledtobenefit.You must fill in your claim form yourself confirming themedical reason for the hospital treatment. The claim formmust be checked and stamped with the hospital or hospicestamp,andsignedbyamemberoftheirstaff.Oryoucansendusyourdischargeletterordischargesummarywhichwouldhavebeengiventoyouwhenyouweredischarged.Beforewecanpayyourclaim,wemayaskformoreinformationabout the treatment provided by the hospital. If there is adispute, our Board of Management will decide whether youneededtobeadmittedandwhetheramedicalfacilitykeepstothepolicydefinitionofahospital.Hospital inpatientWewillpaybenefitattheappropriatenightlyratefortheperiodapersonentitled tobenefit isadmitted (afterbeingreferredby a GP or consultant or being admitted from the accidentand emergency department) for inpatient treatment in arecognisedhospitalorhospice.Whatiscovered:• Anyperiodofovernightstayinahospice,anNHShospital,

aprivatehospitaloraregisteredtreatmentcentre,fromoneto25nights,foramedicalconditiontobetreatedorinvestigated

• Beingadmittedtotheward,fromtheaccidentandemergencydepartment,beforemidnight

• Feesforfillinginclaimformsorcertificates,aslongasyouprovideanofficialhospitalreceiptwithyourclaimandweaccepttheclaimitselfforpayment

Whatisnotcovered:• Attendingaccidentandemergency• Clinics,medicalcentresornursinghomes• Hospitalaccommodationforanelderlypersonwhoisnot

abletoliveindependently• Maternity-relatedadmissionsfordependentchildren• Thefirst10consecutiveovernightstaysasamaternity

inpatient,duringwhichtimethewomangivesbirth• Achild’sfirst10consecutiveovernightstaysasan

inpatientafterbeingborn• Outpatienttreatment• Permanentstaysinhospital• Pre-existingconditions• Anyvoluntaryadmissionstomedicalspasandspa

hospitalsfornon-essentialtreatments• Overnightstaysinhospitalhotelsbeforeandafterbeing

admittedtohospitalAlsoseethe‘Exclusions’sectiononpage2.Hospital day surgeryWewillpaybenefitattheappropriatedayratefortheperiodapersonentitledtobenefitisadmitted(afterbeingreferredby

aGPorconsultantorbeingadmitted fromtheaccidentandemergencydepartment)forhospitalday-surgerytreatmentinarecognisedhospitalwithoutanovernightstay.Whatiscovered:• Anyday-surgeryadmissioninanNHShospital,private

hospitalorregisteredtreatmentcentre,fromoneto25days,tohaveamedicalconditioninvestigatedunderanaestheticorsedationusingtheatrefacilities,ortohaveamedicalconditiontreatedunderanaestheticorsedationusingtheatrefacilities

• Operationswhicharecancelledafteryouhavebeenadmittedtohospital

• Colonoscopy,laparoscopy,colposcopyandsigmoidoscopyprocedures,aslongasananaestheticorsedationwasneededandtheprocedurewascarriedoutintheatre

• Feesforfillinginclaimformsorcertificates,aslongasyouprovideanofficialhospitalreceiptwithyourclaimandweaccepttheclaimitselfforpayment

• Outpatienttreatmentforchemotherapy,kidneydialysis,oncologyandradiotherapy

Whatisnotcovered:• Attendingaccidentandemergency• Attendingclinics,medicalcentresornursinghomes• Admissionsimmediatelybeforeorfollowinganovernight

stay(onedayeitherside)forwhichwewillpayaclaimunderthehospitalinpatientbenefit

• Elderlycare• Hospicedaycare• Maternityadmissions• Outpatientappointmentsortreatmentsthatarenot

coveredabove• Pre-admissionappointments(appointmentsbeforeyouare

admittedtohospital)• Psychiatrictreatment• Pre-existingconditions• Anyvoluntaryadmissionstomedicalspasandspa

hospitalsfornon-essentialtreatments• Overnightstaysinhospitalhotelsbeforeandafterbeing

admittedtohospitalAlsoseethe‘Exclusions’sectiononpage2.Parental hospital stayWe will pay benefit at the appropriate nightly rate for oneparenttostayovernightwitharegisteredchildwhohasbeenadmitted for inpatient treatment in a recognised hospital orhospice.You must fill in your claim form yourself confirming themedicalreasonforyourregisteredchildbeingadmitted.Theclaim form must be checked and stamped with the hospitalorhospicestamp,andsignedbyamemberof theirstaff.Oryou can send us your registered child’s discharge letter ordischargesummarywhichwouldhavebeengiventoyouwhentheyweredischarged.Whatiscovered:• Anyperiodofovernightstayinahospice,anNHShospital,

aprivatehospitaloraregisteredtreatmentcentre,fromoneto25nights,whereoneparentstayswiththeirregisteredchildandisentitledtohospitalbenefits

• Yourregisteredchildbeingadmittedtotheward,fromtheaccidentandemergencydepartment,beforemidnight

• Aparentwhostayswiththeirregisteredchild• Anadoptiveparentstayingwiththeirregisteredchild• Feesforfillinginclaimformsorcertificates,aslongas

youprovideanofficialhospitalreceiptwithyourclaimandweaccepttheclaimitselfforpayment

Whatisnotcovered:• Attendingaccidentandemergency• Clinics,medicalcentresornursinghomes• Morethanoneparentstayingwiththeirchild• Achild’sfirst10consecutiveovernightstaysasan

inpatientafterbeingborn• Outpatienttreatment• Permanentstaysinhospital• Pre-existingconditions• Anyvoluntaryadmissionstomedicalspasandspa

hospitalsfornon-essentialtreatments• Overnightstaysinhospitalhotelsbeforeandafterbeing

admittedtohospitalAlsoseethe‘Exclusions’sectiononpage2.Specialist consultation, ECG, X-ray, pathology fees and MRI scansWe will pay benefit, at the appropriate rate and up to theappropriate maximum in any one calendar year, when aperson entitled to benefit has a specialist consultation ortreatmentfromamedicallyqualifiedpersonwhospecialisesinafieldofmedicine.Thespecialistdoesnothavetobeaconsultant inahospitalbutmustbelistedontheGeneralMedicalCouncil’sSpecialistRegister or be a member, fellow or licentiate of one of theRoyalColleges.Thisbenefitalsorefundscostsyouwouldhavetopay foranECG, X-ray, pathology fees and MRI scans charged to youat the appropriate department of a hospital or as part of aconsultation.Pleaseseethe‘Howtoclaim’sectiononpage2beforegoingfortreatmentorsendingusaclaim.On the claim form, you must fill in the reason for theconsultation,treatmentortests.Whatiscovered:• Hearingaidsandaudiologytestsprovidedbyaregistered

hearingaidsupplier• Hearingaidrepairs• Investigativeprocedures(forexample,colonoscopy,

laparoscopy,colposcopyandsigmoidoscopy)• Medicaltests,includingECG,EEGandlung-functiontests• Pathologyandbiopsyfees• Physicians’orsurgeons’operationfees• Speechtherapy,dyslexiaanddyspraxiatreatmentprovided

byaregisteredmedicalpractitioner

Terms and conditions for the Health Shield Corporate Scheme membership plan

• X-ray,includingmammograms,CTscans,ultrasounds,MRIscansandscreenings

• Ifaclaimhasbeensettledbyaproviderofprivatemedicalinsurance,wecanonlypaybenefit(uptotheappropriatemaximum)foranyremainingexcessifyousendusyourstatementfromtheproviderofprivatemedicalinsurance.Pleasemakesurethatthestatementclearlyshowshowmuchexcessislefttopay

Whatisnotcovered• Anaesthetists’fees• Counsellingfees(wecoverthesefeesunderthehealth

andwellbeingbenefit)• Privateantenatalscans• Privatehospitalcharges(forexample,theatreandroom

fees)• Pre-existingconditions• ECG,X-ray,pathologyfeesandMRIscanschargedtoyou

otherthanwhentheyformpartofahospitalstayoraconsultation

Alsoseethe‘Exclusions’sectiononpage2.PEACE OF MINDDental accidentWe will pay benefit, at the appropriate rate and up to theappropriate maximum in any one calendar year, for dentaltreatmentyouneedasaresultofanaccidentalinjurytoyourteeth.Theinjurymusthavebeencausedbyadirectblowtothehead.Pleaseseethe‘Howtoclaim’sectiononpage2beforegoingfortreatmentorsendingusaclaim.Your dentist must also confirm on the receipts that thetreatmenthasbeencausedbyadirectblowtotheheadwhichhasresultedinaccidentalinjurytoyourteeth.Youmustalsoprovide full details of the accident. We treat dental accidentclaims inacalendaryearaccording to thedate theaccidenthappened.Wewillonlypayonemaximumforalltreatmentthatlastsfromonecalendaryeartoanother.Whatiscovered:• Dentaltreatmentdirectlyrelatedtoanaccident(for

example,asportsinjuryorafall),includingthefollowing. •Anaestheticfees •Dentalcrowns,bridgesandwhitefillings •Dentalveneers •ReplacementdenturesorrepairsWhatisnotcovered• Cancellationchargesmadebythedentist(forexample,for

missedappointments)• Damagetodentureswhennotbeingworn• Dentalconsumables(forexample,toothbrushes,

mouthwash,dentalflossandsoon)• Dentalprescriptioncharges(wecoverthesecharges

undertheprescriptionsbenefit)• Dentalinsurancepremiums• Joiningfeesandpractice-planpremiums• Anytreatmentyoureceive12monthsafterthedateofthe

accident• Dentaltreatmentyoureceiveforanaccidentwhich

happenedbeforeyoujoinedtheplan• InjuriescausedbyeatinganddrinkingAlsoseethe‘Exclusions’sectiononpage2.Maternity – antenatal appointments and adoptionWewillmakeasinglepaymentforeachpregnancy,uptotheappropriatemaximuminanyonecalendaryear,foranNHSorprivateantenatalscancarriedoutbyasonographer.For any scan which has taken place within 26 weeks of youbecomingpregnant,wewillonlypaybenefitifyouhavebeencoveredbytheschemeforatleast40weeks.Youmustfillintheclaimformyourself.Thehospitalorsurgerymustthencheckitandstampitwithitsofficialstamp.Whatiscovered:• AnNHSorprivateantenatalscancarriedoutbya

sonographerwhichtakesplacewithin26weeksofyoubecomingpregnant

• Feesforfillinginclaimformsorcertificates,aslongasyouprovideanofficialreceiptwithyourclaim

• IfitisaregisteredpartnerhavingthescanWewillonlymakeasinglepaymentforapregnancythatlastsfromonecalendaryeartoanother.Whatisnotcovered:• Attendingaccidentandemergency• Antenatalappointmentsfordependentchildren• Apartnerwhoisnotregisteredwithus,unlessyouhave

confirmedthattheylivewithyouWe will also make a single payment, up to the appropriatemaximuminanyonecalendaryear,ifyouadoptachildaged16oryounger(aslongasyouhavebeencoveredbytheschemeforatleast40weeks).Youmustsendusacopyoftheadoptionorderwithyourclaimform.Personal accident protectionPlease call 01270 588555 or email claims@healthshield.co.uk for a separate personal accident claim form. Underthefollowingconditions,wewillonlyconsidertheamountofbenefitwewillpayunderthissectionifabodilyinjuryresultsin death or permanent total disability (permanent disabilitythatpreventsyoufromdoinganyjob–whichisnotlimitedtoyouroccupationatthetimeoftheaccident)withinoneyearoftheaccident.Wewillpaythesuminsuredinlinewiththelevelofcontributionyouhavepaid.Protectionwillendonyour70th

birthday.Youmustwritetouswithinsixmonthsofanaccidenttoletusknowaboutit.To support your claim, you will need to provide medicalevidencefromaregisteredmedicalpractitioner.Youmustpayanycostsinvolvedinprovidingthisevidence.Wewillnotpaymorethanyourbenefitmaximumperpersonasaresultofanyoneaccident.‘Bodilyinjury’meansaninjurycausedonlybyanaccidentandnotbyanysickness,diseaseorgradualcause.‘Bodilyinjury’doesnotcoverpost-traumaticstressdisorder.Wewilldecide,basedonmedicaladvice,ifwewillpaybenefit.Personal accident protection does not cover death orpermanenttotaldisabilitycausedbythefollowing:• Motorcycling(riderorpassenger)• Diving(includingscuba)• Mountaineering• Rockclimbing• Potholing• Parachuting• Boxing• Racing(otherthanonfoot)• Timetrialsorsprints• Flying(exceptairtravel)• Carryingoutdutiesinoneofthearmedforcesincluding

theArmyReserveAlsoseethe‘Exclusions’sectiononpage2.mywellnessHealth Shield membership allows you exclusive access toa list of extra services. These services include face-to-facecounselling,gymdiscounts,onlinehealth-riskassessments,exclusivememberdiscountsandmuchmore.mywellnessbrings theseservices together inoneplaceandtheycanbeeasilyaccessedonline,onanydevice,throughthemywellnesstabonourMembers’Area.Totakeadvantageoftheservices,youwillfirstneedtoregisteron to Health Shield’s Members’ Area at www/healthshield.co.uk/members where you will be asked to confirm yourHealthShieldmembernumber.Onceregistered,pleaseloginandselectthe‘mywellness’tabwhereyou’llbeabletoaccessalltheextraserviceswhichareavailabletoyou.The services available on mywellness may differ accordingto the type of plan. Services and information available onmywellnesscanchangewithoutnotice.EXTRA BENEFITS EXCLUSIVE TO PRESTIGE-LEVEL MEMBERSFamily planning (Prestige-level only)Wewillpayfamilyplanningbenefittoyouandyourpartner(iftheyarecovered),attheappropriaterateanduptotheagreedmaximum.Wewillonlypayfamilyplanningbenefittoyouandyourpartner(iftheyarecovered)onceduringyourlifetime.Thespecialistdoesnothavetobeaconsultant inahospitalbutmustbelistedontheGeneralMedicalCouncil’sSpecialistRegister or be a member, fellow or licentiate of one of theRoyalColleges.Pleaseseethe‘Howtoclaim’sectiononpage2beforegoingfortreatmentorsendingusaclaim.On the claim form, you must fill in the reason for theconsultation,treatmentortests.Whatiscovered:• Privatefamilyplanningclinics• Privatefertilitytreatmentandexaminations• PrivateIVFtreatment• Privatesterilisationfees• PrivatevasectomyfeesWhatisnotcovered:• Familyplanningbenefitfordependentchildren• ContraceptivesAlsoseethe‘Exclusions’sectiononpage2.Critical illness (Prestige-level only)We will pay critical illness benefit at the appropriate rate,if critical illness is diagnosed after the end of the 13-weekqualifyingperiod.Wewillnotpaymorethan£2,000asaresultofacriticalillness.Wewillonlypaycriticalillnessbenefittoanypersononceduringtheir lifetime.Critical illnessbenefitdoesnotapplytoanyoneaged65orover.You must make the claim within 12 months of the criticalillnessbeingdiagnosed.Please call 01270 588555 or email claims@healthshield.co.uk for a separate critical illness claim form. To supportyour claim, you will need to provide medical evidence froma registered medical practitioner. You must pay any costsinvolvedinprovidingthisevidence.Whatiscovered:• Cancer–amalignanttumourcausedbymalignantcells

growingandspreadinguncontrollablytoothertissue.Theterm‘cancer’includesleukaemiaandHodgkin’sdisease,butthefollowingarenotincludedinthecover.

•Alltumourswhicharehistologicallydescribedasbeing ‘pre-malignant’,‘non-invasive’,or‘cancerinsitu’ •AllformsoflymphomapresentinHIV •Kaposi’ssarcomapresentinHIV •Anyskincancer,otherthanmalignantmelanoma• Heartattack–whenapartoftheheartmusclediesasa

resultofnotreceivingenoughblood.Itwillcausechestpain,newelectrocardiographchangesandanincreaseincardiacenzymes.

• Coronaryarterybypasssurgery–openheartsurgery,recommendedbyaconsultantcardiologist,thatusesbypassgraftstocorrectoneormorecoronaryarteriesthathavenarrowedorbecomeblocked.Non-surgicalprocedures,suchasballoonorstentangioplastyorlasertreatments,arenotincluded.

• Kidneyfailure–wherebothkidneysfailtoworkand,asaresult,youbeginregularkidneydialysisorhaveakidneytransplant.WewillpaycriticalillnessbenefitifyouneedakidneytransplantandyouhavebeenincludedonanofficialUKwaitinglist.

• Majororgantransplant–thetransplantofaheart,liver,lung,pancreasorbonemarrow,orbeingincludedonanofficialUKwaitinglisttoreceiveanorgan.

• Motorneuronedisease–confirmationbyaconsultantthatyouhavebeendiagnosedwithmotorneuronedisease.

• Multiplesclerosis–adefinitediagnosisbyaconsultantneurologistofmultiplesclerosisthatmeetsallthefollowingconditions.

•Themovementofyourmuscles,oryourphysical senses,mustcurrentlybeweakened,andhavebeen weakenedforacontinuousperiodofatleastsixmonths. •Thediagnosismustbeconfirmedbydiagnostic techniquesthatarewidelyusedatthetimeyoumake yourclaim.• Stroke–permanentneurological(nerve)damageto

thebraincausedbyaninterruptiontoitsbloodsupply.Transientischaemicattacks(temporaryinterruptionstothebrain’sbloodsupply)orepisodesresultingintemporaryneurologicalsymptomsarenotincluded.

Whatisnotcovered:• Ifyousufferedfromthatcriticalillness(orarelated

condition)orhadsurgeryatorbeforetheendofthe13-weekqualifyingperiod.

• Ifyoudiewithin28daysofbeingdiagnosedwithacriticalillnessorhavingsurgery.

• Wewillnotpaycriticalillnessbenefitforclaimscauseddirectlyorindirectlybyyoubeinginfectedby,ortreatedfor,HIVoranyHIV-relatedillness,includingAIDS.

Alsoseethe‘Exclusions’sectiononpage2.Sickness and accident protection cover (Prestige-level only)Pleasecall01270588555oremailclaims@healthshield.co.ukbeforeyoumakeaclaim.YourPrestige-levelcontributionsarecoveredforupto12monthswhenyouoryourpartner(iftheyare covered) are continuously off work and have provided anotefromyourdoctortocoverthatperiodforatleast30days,duetooneofthefollowing:• Sickness• AccidentalinjurySicknessandaccidentprotectioncoveronlyapplies ifyouoryourpartner(iftheyarecovered):• havecompletedaqualifyingperiodof13weeks;• areinfull-timeemploymentandbetweentheagesof16

and64;• arenotawareofanymedicaltreatmentoradviceyouare

duetoreceive;and• areingoodhealth.If you suffer a disability, we will pay 1/30th of your monthlycontribution,afterthefirst30daysofyourdisability,foreachconsecutive day you are disabled. We will pay the benefitevery30daysduringyourdisability,up toamaximumof12paymentsforanyoneclaim.By‘disability’,wemeanbeingtotallypreventedfromcarryingoutyournormaljoborworkasaresultofanaccidentalbodilyinjury or sickness, as confirmed by a registered medicalpractitioner,thattakesplaceafterthestartdate.‘Normaljoborwork’meanspaidworkofatleast16hoursaweekthatyoucarryout immediatelybefore thestartofyourdisability,andanysimilarjobthatyoumayreasonablybeexpectedtocarryout.Wewillnotpaydisabilitybenefitforanyperiodyouaredisabledafteryouhavereachedtheageof65(oryourretirementdate,ifearlier).When we assess the maximum benefit period, we will treatperiodsofdisabilityresulting fromthesamecauseasbeingthesameperiodofdisability,aslongastheyare notseparatedbyatleastthreebenefitmonthsbeforeyoureturntowork.ExclusionstosicknessandaccidentprotectioncoverAn exclusion period of 30 days applies to all claims. Thismeansthatwewillnotpayanybenefitforthefirst30daysofyoursicknessoraccidentalinjury.Wewillnotpayanyamountwherethedisabilityhappenswithinthe13-weekqualifyingperiod.We will not pay for any period of disability caused by anyphysical or mental disorder, any chronic (severe) illness, orany recurring or continuing disease which you had receivedtreatmentoradviceforbeforeyourcoverbegan.We will not pay for any period of disability that a registeredmedical practitioner has not provided medical evidence for.Youmustpayallthecostsinvolvedingettingmedicalevidence.We will not pay for any period of disability caused by thefollowing:• Pregnancy,childbirthoranycomplicationconnectedto

these• Amentaldisorder,unlessitisinvestigatedanddiagnosed

byaGP• HIV(humanimmunodeficiencyvirus)oranyHIV-related

illness,includingacquiredimmunedeficiencysyndrome(AIDS)

Alsoseethe‘Exclusions’sectiononpage2.

The Crystal Mark only applies to the terms and conditions section, and does not apply

to the design and layout of this leaflet. CORPORATEMP/JANUARY2017

Health Shield Friendly Society Ltd., Electra Way, Crewe Business Park, Crewe, Cheshire, CW1 6HS. Telephone: 01270 588555 Fax: 01270 251366 Opening hours: 8.00am to 6.00pm, Monday to Friday

Email: info@healthshield.co.uk Website: www.healthshield.co.ukEstablished in 1877. Authorised by the Prudential Regulation Authority and regulated by the

Financial Conduct Authority and the Prudential Regulation Authority. As part of our on-going quality control programme, calls may be monitored or recorded.

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