making a healthy difference

WESTFIELD EMPLOYEEPURCHASED HEALTH PLAN:

COVER FOR YOURESSENTIAL HEALTH COSTS

WESTFIELD EMPLOYEEPURCHASED HEALTH PLAN:You know how important your health is, yet keeping in tip top condition can beincreasingly expensive – like paying for visits to the dentist or for a new pair ofglasses. Which is why more people are turning to health cash plans – an easy wayto help pay for your essential healthcare.

This leaflet tells you everything you’ll need to know about how the plan works,so you can choose which level of cover is right for you.

2 WESTFIELD EMPLOYEE PURCHASED HEALTH PLAN: HEALTHY EVERYDAY

MONEY BACK TOWARDS YOURESSENTIAL HEALTH COSTSThis plan gives you money back, up to setlimits, towards the cost of your opticalbills, dental costs, therapy treatments andmore!

So you can pay for your essentialhealthcare with the reassurance that yourplan can help towards the bill.

Cover for your partnerYour partner can enjoy cover too. Simplycomplete the online application form ontheir behalf.

Quick payment of claimsWe like to keep things simple and willprocess your claim usually within fiveworking days of us receiving it. We willthen arrange payment directly into yourbank account!

WESTFIELD EMPLOYEE PURCHASED HEALTH PLAN: HEALTHY EVERYDAY 3

Diagnostic ConsultationsNot just for maintaining your routinehealthcare, the plan also helps if you’refeeling concerned about a medicalproblem. By providing you with a cashbenefit towards the cost of diagnosticconsultations, you’ll have the means toseek help sooner rather than later.

Scanning FacilitiesEarly diagnosis and intervention can helpprevent minor health problems becomingmajor ones. With this in mind, Westfieldwas the UK’s first health cash planprovider to introduce access to diagnosticscanning facilities as a standard benefit.

This benefit provides fast access to MRI,CT and PET Scanning Facilities. Thesestate of the art machines can providecrucial diagnosis of conditions such asheart disease, brain disorders and cancer.

You will not be charged for your scan. Ifyou have any out of pocket expenses, suchas for travel or meals, these will not becovered.

Arranging a scan is easy, followingreferral from your Consultant simply callour Scanning Helpline – 0845 345 4556.

Additional Surgery Choices coverFor an additional premium, you canpurchase Surgery Choices cover toenhance and complement your WestfieldEmployee Purchased Health Plan. SurgeryChoices provides you with cover for 60surgical procedures for conditions, usuallyclassed as non-urgent, such as gallstones,slipped discs, gynaecological problems, ahip replacement and more!

Further information on Surgery Choices,including full Terms and Conditions aredetailed within the separate SurgeryChoices plan leaflet, available online.

4 WESTFIELD EMPLOYEE PURCHASED HEALTH PLAN: HEALTHY EVERYDAY

PEACE OF MIND

WESTFIELD EMPLOYEE PURCHASED HEALTH PLAN: TABLE OF BENEFITS 5

YOUR BENEFITS ANDSERVICES AT A GLANCEThere’s no limit to the number of claims you can make, up to your maximumbenefit allowances.

Health cover for life…Unlike some health insurance products, your premium will not increase justbecause you get older.

…and for overseas!You can still make a claim if you need any treatments covered by your plan whilstabroad on holiday or business (exchange rates apply).

* In the case of therapy treatments, the amount shown represents a combined total for all the treatments.This amount can be used for any one, or combination of treatments.

More information on each healthcare benefit, including details of limitations and exclusions, can be found in the Benefit Rules.The qualifying periods for each healthcare benefit are stated in Section 4, General Terms and Conditions.

BENEFITS MONTHLY PREMIUM £10.00

Optical up to £115(100% reimbursement, 2 year benefit period)

Dental up to £100(100% reimbursement, 1 year benefit period)

Consultation up to £300(100% reimbursement, 1 year benefit period)

Therapy Treatments up to £125(100% reimbursement, 1 year benefit period)Physiotherapy, Acupuncture, Chiropractic,Homeopathy & Osteopathy*

MRI, CT & PET Scanning Facilities Following referral from a Consultant,please call our Scanning Helpline on0845 345 4556. For further informationplease see the Benefit Rules section,page 11.

6 WESTFIELD EMPLOYEE PURCHASED HEALTH PLAN: HEALTHY EVERYDAY

PUT YOURSELFIN THE PICTURE...

Julia wears glasses and having spent£29.50 at the opticians earlier in the year,her prescription has now changed. Withthe security of knowing that WestfieldHealth would help towards the bill,Julia opted for the trendy pair ofdesigner glasses and claimed backa further £85.50.

Julia also visited the dentist for a checkup and a filling – costing her £45.60.With her Westfield plan, Julia couldclaim her money back and had thepeace of mind that should she needfurther treatment she would be able toclaim a further £54.40.

Steve injured his shoulder at work andrequired an MRI scan to determine theextent of the damage. He was told hewould have to wait up to three monthsfor a scanning appointment on the NHS.But with the cover provided by hisWestfield plan, following referral froma Consultant, Steve simply contactedthe Scanning Helpline and was able toaccess his scan within two weeks…giving him the peace of mind that heis now on the road to recovery.

Here is a taste of how the Westfield Employee Purchased Health Plan could work for you.

WESTFIELD EMPLOYEE PURCHASED HEALTH PLAN: A PERSONAL SERVICE 7

Listening to you and looking after yourneeds has always been at the heart ofeverything we do. Whether you have anenquiry about your account or need advicewith your claim, our friendly customerservice team is here to help.

Confidentiality assuredDue to the Data Protection Act 1998, wewill not discuss policy details with anyoneother than the policyholder, unless youhave given us consent for a relative orfriend to obtain account information onyour behalf.

www.westfieldhealth.comThe easiest and most convenient wayto keep in touch. You can order moreclaim forms or update your addressdetails. You can email us too atenquiries@westfieldhealth.comWe’re only a click away!

Text Messaging ServiceOur innovative Text Messaging Serviceallows you to order more claim formsand receive up to date balances on somebenefits direct to your mobile phone!Details on how to register for thisservice are available online.

Customer Helpline – 0114 250 2000*Our lines are open from 8am to 6pm,Monday to Friday (except for ChristmasEve and Public Holidays).

Customers with hearing or speechdifficulties may contact us by text phone –0114 250 2020 (operating hours as above).

* In the interest of continuously improvingour service to customers and for trainingpurposes your call will be recorded andmonitored. This will include therecording and monitoring of SensitivePersonal Data such as data relating tohealth and medical conditions.

A PERSONAL SERVICE

POLICY SUMMARY

Key features of your Health Cash Plan• A total of 5 healthcare benefits

and services• 100% reimbursement for a range of

essential healthcare expenses, up to setlimits

• Partner cover is available• Access to MRI, CT and PET Scanning

Facilities• No medical is required to join the plan• Worldwide cover is available on

most benefits• Opportunity to purchase additional

Surgery Choices cover

Key limitations and exclusions• To be eligible for cover you must live in

the UK for a minimum of 6 months eachyear (section 1, General Terms andConditions)

• To be eligible to apply for cover you mustbe at least 16 years old (section 1, GeneralTerms and Conditions)

• Professional and semi-professional sportspeople are not eligible for cover (section 1,General Terms and Conditions)

• Pre-existing medical conditions are notcovered for any benefit other than forOptical and Dental (section 1, GeneralTerms and Conditions)

• Qualifying periods apply to most benefits(section 4, General Terms and Conditions)

• Surgery Choices is not available topurchase independently of your WestfieldEmployee Purchased Health Plan(section 4, General Terms and Conditions)

• Westfield Health must receive claimswithin 13 weeks of the date of eachpayment made for treatment, goodsor services (section 7, General Termsand Conditions)

8 WESTFIELD EMPLOYEE PURCHASED HEALTH PLAN: POLICY SUMMARY

The Westfield Employee Purchased Health Plan provides cover towards the costsassociated with routine healthcare such as new prescription glasses, dental treatmentand therapy treatments. This plan also includes access to diagnostic scanning facilitiesand consultations for quick access to diagnosis.

It is designed to ease your daily life and support your overall wellbeing.

This Health Cash Plan is underwritten by Westfield Contributory Health Scheme Limited.

WESTFIELD EMPLOYEE PURCHASED HEALTH PLAN: POLICY SUMMARY 9

Duration of cover andcancellation rightsYour policy will be renewed automaticallyon a monthly basis unless your cover iscancelled or you allow it to lapse. Yourpolicy contains a 14 day cooling off periodfrom the date we accept your application. Ifyou decide to change your mind during thiscooling off period you should contact us.Providing that you have not made, or intendto make a claim, we will refund your fullpremium. After expiry of the cooling offperiod you can still cancel your cover at anytime. However, you will not be entitled to arefund, except for any premiums paidbeyond the date your cover ceased. Pleaserefer to sections 1 and 2, General Termsand Conditions.

Making a claimDetailed information on qualifying periodsand how to claim are found in sections 4and 7, General Terms and Conditions.

Claim forms can be downloaded atwww.westfieldhealth.com or orderedby calling our Customer Helpline on0114 250 2000.

Once completed, please send your claimform with the required supportinginformation to Westfield Health, WestfieldHouse, 87 Division Street, Sheffield S1 1HT.

We will pay your claims directly into yourbank account.

If you wish to complainWe are committed to providing the highestpossible level of service to our customers.However, if the services provided do notmeet your expectations then you maycontact us at: Customer ServicesDepartment, Westfield Health, WestfieldHouse, 87 Division Street, Sheffield S1 1HT.

In the event that you are not satisfied withour response, please ask for your complaintto be reviewed by an Executive Director.If you remain dissatisfied with our finalresponse you can write to the FinancialOmbudsman Service. The Ombudsman willonly consider your complaint after you havewritten confirmation from us that ourinternal complaints procedure has beenapplied in full.

CompensationWestfield Health is a member of theFinancial Services Compensation Scheme.In the unlikely event that we are unable tomeet our obligations you may be able toclaim compensation. Further informationis available from the Financial ServicesCompensation Scheme, 7th Floor,Lloyds Chambers, Portsoken Street,London E1 8BN.

This Policy Summary provides only anoutline of the plan and should be read inconjunction with the full Terms andConditions and Benefit Rules.

10 WESTFIELD EMPLOYEE PURCHASED HEALTH PLAN: BENEFIT RULES

YOUR COVER: BENEFIT RULESFull details of each benefit are listed onthe following pages. Cover is subject tothe General Terms and Conditionsspecified on pages 13 to 16.

Where words or phrases appear in boldtype, they have the special meaning forthe purposes of the plan as detailed inthe Definitions section. Information onhow to claim benefits is given in section 7and benefit periods in section 6 of theGeneral Terms and Conditions.

If there is anything about these benefitrules that you don’t understand pleasecontact our Customer Helpline on0114 250 2000 and we will be happyto help.

OPTICALYour maximum benefit is available over a twoyear benefit period.

When …• you pay an Optician and• you submit your claim in accordance withsection 7, General Terms and Conditions

We will cover…• 100% of the cost, up to the maximumallowance, see Table of Benefits – page 5

• eyesight tests• prescription spectacles, sunglasses and/orcontact lenses

• prescription lenses to an existing frame• payments that you make for prescriptioncontact lenses supplied under a monthlyscheme, when you obtain an itemised receipt

We will not cover…• repairs to frames• frames purchased without prescription lenses• non-prescription spectacles or sunglasses orcontact lenses

• solutions for contact lenses• any insurance or peace of mind guarantee• sundry items•missed appointment fees• exclusions (see section 5, General Terms andConditions)

DENTALYour maximum benefit is available over a oneyear benefit period.

When …• you pay a Dentist and• you submit your claim in accordance withsection 7, General Terms and Conditions

We will cover…• 100% of the cost, up to the maximumallowance, see Table of Benefits – page 5

• dental treatment, full or partial dentures anddental check-ups

We will not cover…• insurance or dental care schemepremiums/payments, registration oradministration fees

• teeth whitening• prescription charges• sundry items•missed appointment fees• exclusions (see section 5, General Terms andConditions)

CONSULTATIONYour maximum benefit is available over a oneyear benefit period.

When…• your GP recommends referral to a Consultant

Physician or Consultant Surgeon and• you pay a registered Consultant Physician or

Consultant Surgeon, who holds an appropriatequalification (see Definitions section) and

• you submit your claim in accordance withsection 7, General Terms and Conditions

We will cover…• 100% of the cost, up to the maximumallowance, see Table of Benefits – page 5

• diagnostic consultations

We will not cover…• treatment•MRI, CT or PET scans or the associatedRadiologist’s/Nuclear Medicine Consultant’sreport† (see Scanning Facilities)

• consultations relating to vasectomy orsterilisation (including reversal)

• consultations relating to cosmetic surgery

WESTFIELD EMPLOYEE PURCHASED HEALTH PLAN: BENEFIT RULES 11

•medical examinations, consultations or reportsfor the purpose of your employment, legal, orinsurance reasons

• room fees, prescription items/charges or sundryitems

•missed appointment fees• exclusions (see section 5, General Terms andConditions)

† Except see section 8 – Worldwide Cover,General Terms and Conditions.

THERAPY TREATMENTSPhysiotherapy, Acupuncture, Chiropractic,Homeopathy and OsteopathyYour maximum benefit is available over a oneyear benefit period and represents the total forany one or combination of treatment types.

When …• your GP or Consultant Physician/Consultant

Surgeon recommends that you receivetreatment. If requested at any time, you mustprovide us with written evidence of thisrecommendation at your own expense and

• you receive and pay for treatment from aregistered Physiotherapist, Chiropractor orOsteopath, or an Acupuncturist or Homeopathwho is a member of an approved professionalorganisation. Registration/membership mustbe relevant to the treatment that they areproviding (see Definitions section) and

• you submit your claim in accordance withsection 7, General Terms and Conditions

We will cover…• 100% of the cost, up to the maximum allowance,see Table of Benefits – page 5

• physiotherapy, acupuncture, chiropractic,homeopathy, osteopathy, treatment

• homeopathic prescriptions supplied by aHomeopath as part of a consultation

We will not cover…• any treatment that is not physiotherapy,acupuncture, chiropractic, homeopathy orosteopathy

• scans e.g. MRI, ultrasound (see ScanningFacilities and/or Consultation benefit)

• sundry items•missed appointment fees• herbs, herbal remedies, supplements orvitamins even if these have been recommendedor supplied by your Physiotherapist,Acupuncturist, Chiropractor, Homeopath orOsteopath

• exclusions (see section 5, General Terms andConditions)

MRI, CT AND PET SCANNING FACILITIESScanning Facilities are provided on behalf ofWestfield by Alliance Medical Limited, IceniCentre, Warwick Technology Park, WarwickCV34 6DA a UK based provider of managedimaging services for MRI, CT and PET Scanning.

In order to access this facility you will first needto see your consultant in order to gain a referralfor a scan. Once you have this referral pleasecontact the Scanning Helpline on 0845 345 4556,available Monday to Friday 8.00am-8.00pm.

For the scan to be covered by your plan you, thepolicyholder, must contact the Scanning Helplineand allow them to arrange the scan on yourbehalf. Costs towards scans arranged in anyother way cannot be claimed (except seeWorldwide cover, General Terms and Conditions).

Helpline staff will explain the process for bookingyour scan and will require written confirmationfrom your consultant confirming your validity inorder that all necessary arrangements can bemade. Under the plan appointments can bequickly arranged and often take place within2 weeks of initial contact. You will be requiredto complete a full safety questionnaire prior toscanning. Following your scan a report will besent to your consultant, usually within 10 days.

Patients will need to travel, at their own expense,to access the nearest available Alliance MedicalScanning Facility. CT and PET scans are availableat selected locations only.

MRI and CT Scanning If an eligiblepolicyholder* is referred by a registeredConsultant Physician/Consultant Surgeon foran MRI or CT scan this, and the associatedRadiologist’s report, will be provided under theplan at no charge to the policyholder.

For all MRI scans a Consultant Radiologist willcheck the appropriateness of your scan beforeit is arranged. For MRI scans, policyholderswho have certain conditions will not be able tobe scanned e.g. cardiac pacemaker; heartvalves; metallic objects in eyes and metallicimplants. Policyholders who are pregnant orwho are over 21 stone in weight will not be ableto be scanned.

12 WESTFIELD EMPLOYEE PURCHASED HEALTH PLAN: BENEFIT RULES

Certain types of complex MRI scans or scanswhich involve contrast or specific x-rays areexcluded e.g. those requiring generalanaesthetic; for an in-patient; cardiac scansinterventional MRI; including MRI athrography;contrast enhanced angiography; Oncologypatients; Liver imaging with ferrous contrastagents (e.g. Endorem).

For all CT scans, the regulations relating tox-rays means that a Consultant Radiologistwill have to authorise the scan for additionalpatient safety. For CT scans, policyholders whohave certain conditions will not be able to bescanned e.g. diabetics taking metformin.Certain types of complex CT scans are excludede.g. those requiring general anaesthetic; for anin-patient; virtual colonoscopy or angiographywhich requires the on site assistance of aRadiologist. Policyholders who are pregnant orwho are over 21 stone in weight will not be ableto be scanned.

PET Scanning If an MRI or CT scan indicatesthat a PET scan is necessary then a maximumof one PET scan and report, during a 12 monthsperiod, will be provided under the plan at nocharge to the eligible policyholder*. For allPET scans a referral will be required from aConsultant Oncologist or Surgeon. All PETscans will also require authorisation from aConsultant Nuclear Medicine Consultant tocomply with ARSAC and IRMER medicalregulations, since the scan involves radiation.For PET scans, policyholders who have certainconditions e.g. diabetics taking metformin willnot be able to be scanned. Policyholders whoare pregnant or who are over 21 stone inweight will not be able to be scanned.

If you need a scan when you are temporarilytravelling outside the UK please refer to section 8– Worldwide cover, General Terms and Conditionsand Consultation benefit in the Benefit Rulessection.

* Please refer to section 5. Exclusions, in theGeneral Terms and Conditions.

WESTFIELD EMPLOYEE PURCHASED HEALTH PLAN: TERMS AND CONDITIONS 13

GENERAL TERMSAND CONDITIONSWhere words or phrases appear in bold type, they havethe special meaning for the purposes of the plan asdetailed in the Definitions section.

If there is anything about these General Terms andConditions that you don’t understand please contact ourCustomer Helpline on 0114 250 2000 and we will behappy to help.

1. Who can have coverYou must reside in the United Kingdom for a minimumof 6 months each year to be a Westfield EmployeePurchased Health Plan policyholder.

You must be at least 16 years old to be eligible to applyfor the plan.

We do not accept professional and semi-professionalsports people for cover on the plan.

You must satisfy yourself that this plan is right for you.Neither Westfield Health nor Great Lakes Reinsurance(UK) PLC will provide any advice in this regard but youare of course free to seek information or advice from aprofessional advisor.

Like any responsible insurer we reserve the right todecline an application for cover when we believe thatthis would be detrimental to the Scheme and/or asignificant number of our policyholders.

You can only hold one Westfield Employee PurchasedHealth Plan policy at any one time.

You do not need a medical before you apply for cover.Claims for Optical and Dental benefit do not excludepre-existing medical conditions.

Pre-existing medical conditions are not covered for:MRI, CT and PET Scanning FacilitiesConsultationTherapy Treatments

You will not be entitled to claim these benefits, for anyillness, injury or condition that existed before you appliedfor the plan (including following a lapse in your cover).

You must tell us if you:are receiving or expecting to receive a consultation ortreatment;have attended a hospital or received any medicalcare from a qualified therapist or practitioner in the12 months’ period prior to you applying for the plan.

The application form includes a declaration that mustbe accepted by you, or on your behalf, before we willaccept your application for cover. If you are unable tosatisfy the health requirements you must include detailswith your application.

This application form, together with any information thatyou give, forms part of the contract of insurance.Applications can be accepted subject to a proviso thatthese pre-existing medical condition(s) will not becovered on your policy.

Surgery ChoicesFor an additional premium you can add Surgery Choicesto your health cash plan. You can only choose to includeSurgery Choices as part of the Westfield EmployeePurchased Health Plan; cover cannot be purchasedindependently. Full details of Surgery Choices cover,including limitations and exclusions, are detailed in aseparate leaflet that we recommend that you readcarefully.

Cooling Off Period – If you change your mindYour policy contains a 14 day cooling off period from thedate we accept your application. If you decide to changeyour mind during this cooling off period you shouldcontact us. Providing that you have not made, or intendto make a claim, we will refund your full premium.

2. The contract between Westfield Healthand youYour health cash plan policy operates on the basis thateach calendar month a new contract is formed betweenWestfield Health and you. We do not issue monthlyreminder notices. Your policy will be automaticallyrenewed each month providing you pay your premiumand abide by the terms and conditions of the plan,unless we receive notice from you that you do not wishto continue your cover, or we give you notice that weare not willing to accept your monthly renewal.

Your Cancellation RightsYou have the right to cancel your policy.

If we receive notice that you wish to cancel before the15th day in any month we will cancel your monthlycontract for that month and refund your premium forthat month. If we receive notice of cancellation on orafter the 15th day of the month, then we will not refundyour premium for that month but any further premiumswill not be payable. Any premium paid, in advance orthat is not due following cancellation, will be refunded toyou. We will not pay a claim for any benefit beyond thedate that you have paid up to.

To cancel your policy please contact our CustomerHelpline, email us or write to our Membership Team atWestfield Health, Westfield House, 87 Division Street,Sheffield S1 1HT.

Re-applying for cover after you have cancelledIf you cancel your policy and then decide to re-apply forcover with us you will be subject to new qualifyingperiods and will also need to declare any pre-existingmedical conditions. Previous claims may be taken intoaccount when we assess your entitlement to benefit onyour new policy. Please refer to sections 1 and 4.

Terminating your coverWe reserve the right to cancel your cover at any time,(with retrospective effect where appropriate), if: -• Under the terms and conditions of the plan you arenot eligible for cover

14 WESTFIELD EMPLOYEE PURCHASED HEALTH PLAN: TERMS AND CONDITIONS

• You provided false information and/or failed to discloseall the relevant required information when you appliedfor cover

• You submit a claim that is fraudulent or that wereasonably believe to be intentionally false, and/ormisleading, and/or exaggerated

• You (or anyone covered on your policy) act in athreatening or abusive manner, e.g. violent behaviour;verbal abuse; sexual or racial harassment, towards amember of our organisation, or one of our suppliers

• You fail to abide by any of the terms and conditions ofthis plan

Should we cancel your cover you will not have any rightto make any further claim on the plan. In addition, wemay also seek to recover any monies from you that havebeen paid to you that you were not due to under theTerms and Conditions of this plan.

If premiums for your cover have been paid in advance wemay refund premiums paid beyond the date for whichyou have had the benefit of cover. However, we retain theright to withhold such premiums if you owe us money.

We will notify you in writing our reason for cancellingyour cover and you have the right to appeal to usthrough our published Complaints Procedure, which isavailable on request.

The above does not affect your statutory rights.

3. PremiumsPremiums are payable on a monthly basis, by Direct Debit.

Your policy will lapse if you do not keep your premiumsup to date; you will cease to be a policyholder if yourpremiums are more than 3 months in arrears.

If when we receive your claim your premiums are notpaid up to date for any reason, we will not process yourclaim at that time. If you remain in the plan, claims willbe held until a payment is made to cover the date(s) forwhich you are claiming. If you do not continue to payyour premiums all benefit including Surgery Choicescover (where applicable) will cease on the date that youare paid up to.

We will not accept payment for more than 13 months’cover in advance.

Premiums include Insurance Premium Tax at the currentrate and are subject to review in respect of any changesin taxation.

Where a benefit included in the plan is underwritten byanother insurer, our agency agreements with insurersallow us to hold the premiums you pay in respect ofthese elements of the product as agent of the insurerand therefore payment to us means the same as if youhave paid that insurer direct. This does not affectelements that we underwrite.

4. Qualifying PeriodYou will have to wait a qualifying period before you areeligible for most benefits. The qualifying period startsfrom your date of registration; a separate registrationdate will apply to Surgery Choices cover if this is addedafter your policy commenced.

Following your date of registration you must renew yourmonthly contract with us for the required minimum

number of consecutive months, detailed below, to qualifyfor each benefit.

Available from the date of registration: -MRI, CT and PET Scanning FacilitiesSurgery Choices (subject to the terms and conditionsthat are detailed in the Surgery Choices leaflet)

3 months qualifying period: -Optical; Dental; Consultation; Therapy treatments

Former PolicyholdersIn addition to the above, if you were previously coveredon this plan and your policy lapsed or was cancelled wemay take into account claims paid under your previouscover when assessing entitlement to benefit on your newpolicy: this will depend upon the benefit periods relatingto those claims.

For Surgery Choices please refer to the Surgery Choicesleaflet: Section 1, Operations Covered.

Our Helpline staff can explain the qualifying periods andbenefit entitlement that will apply to you, following alapse in your cover.

5. ExclusionsThe list of exclusions, below, should be read inconjunction with the Benefit Rules section beforereceiving treatment or paying for goods and services forwhich you intend to claim.

We will not cover:• any claim that is not submitted in accordance withsection 7, General Terms and Conditions;

• any claim that arises as a result of a pre-existingmedical condition (with the exception of Optical andDental benefit);

• any charges that a practitioner or any other organisationmakes for filling in a claim form or providing anyinformation we ask for relating to a claim;

• benefit for treatment, goods or services within yourqualifying period;

• any claim or expense of any kind arising as a directconsequence of any criminal proceedings broughtagainst you;

• any claim or expense of any kind caused directly orindirectly by ionising radiation or contamination by anynuclear fuel, or the radioactive, toxic explosive or otherdangerous properties of any explosive nuclearmachinery or part of it;

• any claim or expense of any kind directly or indirectlyarising as a result of war, invasion, rebellion orrevolution.

6. Benefit PeriodA separate benefit period applies to each cash benefitand these are detailed in the Benefit Rules section.

You must have benefit available for the date(s) on whichyou paid for treatment, goods or services.

When you have FULL BENEFIT available the benefitperiod will start on the date that you paid for thetreatment, goods or service.

During each benefit period you can submit more thanone claim under each benefit, however we will not paymore than the maximum allowance. The benefit periodthat each claim falls into is determined by the date ofyour payment.

WESTFIELD EMPLOYEE PURCHASED HEALTH PLAN: TERMS AND CONDITIONS 15

When a benefit period ends full benefit will againbecome available to claim. Any unused benefit will not becarried forward from one benefit period to the next. Thenew period for that benefit will not begin until yousubmit the next claim and will start according to thecriteria set out above.

Surgery ChoicesPlease refer to the Surgery Choices leaflet for details.

7. How to claimClaims can only be submitted on one of our claim forms.The claim form must be signed and dated by thepolicyholder.

We will not pay your claim unless it is received within13 weeks of the date that you tender each payment(i.e. cash; credit/debit card; cheque) to the practitioner/supplier for treatment, goods or services.

It is your responsibility to ensure that you allow sufficienttime for the claim to reach us within the 13 weeksdeadline. We will not accept any responsibility for claims(or supporting evidence) lost, delayed or damaged inthe post.

You must send us a full receipt detailing the paymentyou have made. This must include the supplier’s orpractitioner’s name and address; for Consultation orTherapy benefits your receipt must also specify thepractitioner’s qualification (see Definitions section).The receipt must also confirm that you were therecipient of the treatment, goods or service.

We do not accept the following: -• photocopies of receipts, invoices without a supportingreceipt or credit/debit card receipts without anaccompanying itemised receipt

• receipts where only a part payment or deposit* hasbeen paid, including receipts showing a balanceoutstanding for payment

• claims for payment(s) made in advance for a course oftreatment, a service or goods: except when the receiptalso confirms that prior to claiming you have receivedthe treatment, goods or service. The receipt mustdetail the date(s) you received the treatment, goods orservice and we must receive your claim within 13weeks of the payment date – see above

* The only exception to this is when you provide us with writtenevidence that you have entered into a payment arrangement/credit agreement for treatment, goods or services that you havereceived. The date that you pay the first instalment determinesthe benefit period that your claim falls into and we will pay youup to the benefit balance available on that date ONLY towardsthe full cost of the treatment, goods or service purchased bythe credit agreement. We do not cover administration/interestcharges. Dental insurance or care scheme premiums/paymentsare not covered on the plan.

If you can claim part or all of your costs under anotherWestfield plan, or from any other source, you are notentitled to receive more than the total amount that youhave paid. If you are claiming from another insurer wewill pay our proportionate share of the cost, subject tobenefit being available and the terms and conditions ofyour plan.

It is your responsibility to provide complete and accurateinformation with the claim. For audit purposes we willcarry out checks on the information you and

practitioners provide to us. If you submit a claim that isfalse we will terminate your policy and your benefits asa policyholder will end immediately. We will not refundpremiums paid for the plan and always take legal actionfor fraudulent claims.

How we pay youWe will pay your claims directly into your bank/buildingsociety account and email you a remittance advice asconfirmation.

Scanning FacilitiesTo access Scanning Facilities please refer to the BenefitRules section.

Surgery ChoicesPlease refer to the Surgery Choices leaflet for full details.

8. Worldwide coverIf a claim arises when you are temporarily travellingaway from home anywhere in the World, on business orfor pleasure, you can still make a claim. You must beresident in the UK for a minimum of 6 months each yearto be eligible for cover on this plan. When you submit areceipt for money that you have paid, we will use thecurrency exchange sell rate, supplied by our bank, onthe date we process the claim.

If we request it, you must provide us with evidence ofyour travel dates. All documentation supporting yourclaim should be in English. Entirely at our discretion wemay agree to accept an English translation accompanyingthe original documents, when you have provided this atyour own expense.

Policyholders can use their Consultation benefit towardsthe cost of MRI, CT or PET Scanning outside the UKsubject to pre-authorisation by Westfield Health.

Surgery Choices does not cover treatment you receiveoutside the UK: unless your operation has beenarranged through Surgery Choices.

This plan is not a travel insurance policy.

9. General ConditionsGoverning LawOnce your application to register for the plan has beenaccepted by us, the contract between us will be governedby the General Terms and Conditions and Benefit Rulesof the plan. That contract will also be subject to thepowers of the English Courts and those of no otherjurisdiction.

Changes to this ContractFrom time to time upon renewal it may be necessary forus to increase the amount of the premium for the plan,alter the benefits payable under the terms of the plan oramend the rules relating to the plan. If we decide tomake any such changes we will give you reasonablenotice to enable you to decide if you do not wish tocontinue your policy, except when it is not possible forus to do this, for example changes required by law. Anyrevisions will not extend the benefit period relating toeach separate benefit.

A person who is not a party to this agreement shall nothave any rights under or in connection with it.

We reserve the right to cancel the plan. If we intend tocompletely withdraw the plan, we shall provide you with

16 WESTFIELD EMPLOYEE PURCHASED HEALTH PLAN: TERMS AND CONDITIONS

reasonable notice. Where possible, we will try to offeryou an alternative Westfield Health plan.

Data Protection ActThe information you provide together with any furtherinformation concerning your plan will be used byWestfield Health to provide you with the benefits forwhich you apply and for maintaining your records. Thisinformation may be passed to selected third parties forunderwriting; claims handling procedures; to provideyou with the services included in the plan; to preventand detect fraud. For a small fee you are entitled to acopy of the details and information which we hold aboutyou if you apply, in writing, to the Data Subject RightsOfficer, Westfield Contributory Health Scheme Ltd.,87 Division Street, Sheffield S1 1HT. We may share yourcontact details with other selected organisations to sendyou information about other products and services. Ifyou do not wish us to do so please advise us in writingto the Data Subject Rights Officer at the above address.

In the interest of continuously improving our service tocustomers and for training purposes telephone calls toWestfield Health will be recorded and will be monitored.This will include the recording and monitoring ofSensitive Personal Data such as data relating to healthand medical conditions.

LanguageIn accordance with FSA regulatory guidance we confirmthe language we will use for communication purposes.It is: English.

The information contained within this leaflet is effectivefrom 1st May 2009.

WESTFIELD EMPLOYEE PURCHASED HEALTH PLAN: DEFINITIONS 17

DEFINITIONSWherever the following words or phrases appear in this document in bold type, they havethe special meaning for the purposes of the plan, as detailed below.

Acupuncturist A fully qualified practitioner who is a Member of the BritishAcupuncture Council or Fully Accredited Member of the British MedicalAcupuncture Society.

The Acupuncturist must not be you, your partner or a member ofyour family.

Benefit Period The period of time over which each separate benefit is available to claim.See section 6, General Terms and Conditions.

Chiropractor A fully qualified practitioner who is registered with the GeneralChiropractic Council.

The Chiropractor must not be you, your partner or a member ofyour family.

Consultant Physician/ A registered Consultant Physician or Consultant Surgeon, including anyConsultant Surgeon individual holding an appropriate consultant position within a private or

registered hospital, or registered treatment centre.

The Consultant must not be you, your partner or a member ofyour family.

Dentist A fully qualified dental practitioner holding current registration with theGeneral Dental Council, who works in a general dental practice.

The Dentist must not be you, your partner or a member of your family.

GP General Practitioner i.e. a physician registered with the General MedicalCouncil, who is currently in general practice.

The GP must not be you, your partner or a member of your family.

Homeopath A fully qualified Homeopath who is a member of one of the followingprofessional bodies:-• Member of the Faculty of Homeopathy• Licensed or Registered Member of the Society of Homeopaths• Registered Member of the UKHMA• Member of the Alliance of Registered Homeopaths

The Homeopath must not be you, your partner or a member ofyour family.

Optician A fully qualified Optician who is registered with the General Optical Council.

The Optician must not be you, your partner or a member of your family.

Osteopath A fully qualified practitioner who is registered with the GeneralOsteopathic Council.

The Osteopath must not be you, your partner or a member of your family.

18 WESTFIELD EMPLOYEE PURCHASED HEALTH PLAN: DEFINITIONS

Partner • A person you live with that you are married to, or a person that youpermanently live with as if you are married to them.

or• A person you live with in a civil partnership, or a person that youpermanently live with as if you are in a civil partnership.

Physiotherapist A fully qualified practitioner who is registered with the Health ProfessionsCouncil (HPC).

The Physiotherapist must not be you, your partner or a member ofyour family.

Plan The Westfield Employee Purchased Health Plan.

Policyholder The person in whose name the plan is held.

Pre-existing Medical Any medical condition whether fully diagnosed or not that you shouldCondition declare if you are unable to satisfy the application form declaration.

See section 1, General Terms and Conditions.

Qualifying Period The period that you must wait when you register for the plan, beforeyou can claim benefits. The qualifying periods are detailed in section 4,General Terms and Conditions.

Registration We will take your date of registration as:-The first day of the current month for application forms we receivebefore the 15th of that month.The first day of the following month for application forms we receiveon or after the 15th of the month.

UK/United Kingdom The United Kingdom of Great Britain and Northern Ireland i.e. England,Scotland, Wales and Northern Ireland.

We/us/our Westfield Contributory Health Scheme Ltd., or something belonging to us.

You/your The named Westfield policyholder or something belonging to you.

WESTFIELD EMPLOYEE PURCHASED HEALTH PLAN: APPLYING FOR COVER 19

APPLYING FOR COVERIS EASY...

OnlineSimply complete the online application process to apply for cover. If your partnerwishes to apply for cover, complete the online application form on their behalf.

Remember, you can apply for Surgery Choices cover at anytime.

Welcoming youWe will send you an email welcoming you to Westfield Health with a link toall the information you need to be able to enjoy your new cover!

A couple of things to remember...

Pre-existing medical conditionsIf you have any pre-existing medical conditions to declare, please provide full detailsof these with your application.

Get the most out of your coverThis leaflet will help you get the most out of your cover – so keep it safe and handy.

WESTFIELD HEALTHREGISTERED OFFICE.Westfield House 87 Division Street Sheffield South Yorkshire S1 1HTCUSTOMER HELPLINE. 0114 250 2000 TEXTPHONE. 0114 250 2020Available 8am-6pm, Mon-Fri (except Christmas Eve and Public Holidays)F. 0114 272 4950 E. enquiries@westfieldhealth.com

westfieldhealth.com

Westfield Health is a registered trademark of Westfield Contributory Health Scheme Ltd., which is authorised andregulated by the Financial Services Authority. Details of registration can be found at www.fsa.gov.uk/registeror by contacting the Financial Services Authority on 0845 606 1234. Westfield Health is registered and incorporatedin England as a company limited by guarantee. Registered no.303523.

AT NP 05/09 OLL002V1 © Westfield Health 2009

WESTFIELD HEALTHWestfield Health is one of the most successful and secure healthinsurers in the UK with 90 years’ experience and over a third of amillion policyholders enjoying cover with us. We’re sensitive to thevalues and wellbeing of our customers and dedicate ourselves to offeringexceptional value for money and first class service – every time.

We are proud of our not for profit status and every year make substantialdonations to the NHS and medically related charities. Our businessphilosophy is to embrace a spirit of social, ethical and environmentalresponsibility.

AWARD WINNINGCUSTOMER SERVICEThe standard of service we deliver to our customers has been recognised,for the second year running, as outstanding by 9 out of 10 customers inan independent survey*. We are also proud to have maintained theaccreditation of the Servicemark Award for Customer Service 2007-2008.In addition we have been voted Best Healthcare Cash Plan Provider 2007(Health Insurance Awards) for the fourth consecutive year.

* The Leadership Factor Customer Satisfaction Survey 2008