Frequently Asked Questions about Accident and Sickness Medical Recovery Insurance Personal Individual Plans
  • What is Medical Recovery Insurance?
    • Medical Recovery Insurance is an insurance protection product that provides cash benefits that are tiered to reflect the recovery time should you require a medical procedure.

      Medical Recovery Insurance policies provide a vital injection of cash which can be used to assist with out-of-pocket expenses and a reduced income to help individuals and their families manage until they’re expected to return to work.
  • What’s not covered by Medical Recovery Insurance?
      General Policy Exclusions

      Unless otherwise stated in your policy or your Policy Schedule, this insurance does not cover claims related to or in any way caused or contributed to by:


      Specific Policy Exclusions

      This insurance does not cover claims for, or in any way caused or contributed to by:

      • Planned treatment(s) which are defined as medical procedure(s) that in the 12 month period prior to an insured person first becoming insured under this policy or at the date that you increased their level of cover: a) an insured person had a date scheduled for such medical procedure(s) to be carried out; or b) an insured person was on a NHS waiting list for the medical procedure; or c) an insured person had been aware of or had been told by their GP or medical specialist that reasonable medical opinion would consider that a medical procedure may be required.
      • An insured person’s failure to seek or follow medical advice where such failure is unreasonable in the opinion of a medical specialist appointed by us.
      • Suicide, attempted suicide or intentional self- inflicted injuries.
      • An insured person’s own criminal act.
      • An insured person being under the influence of alcohol or drugs.
        • war or acts of terrorism
        • An insured person engaging in active war
        • nuclear risks
      • Any medical procedure directly or indirectly arising from or as a consequence of professional sports where a fee is received for training or playing.
      • Any medical procedure which is not listed in the SCHEDULE OF MEDICAL PROCEDURES AND BENEFITS in your Policy Document.
      • Any dental condition or dentistry, including gum diseases and wisdom tooth extraction.
      • Recurrent cancer.
      • Treatment for a specific cancer which exceeds a maximum of one episode of surgery, one course of chemotherapy and one course of radiotherapy. No further treatments will be covered during an insured person’s lifetime either for additional treatment of the original cancer or for a recurrence of that cancer in the same place or another place in the body or for the occurrence of another cancer anywhere else in the body.
      • Biopsies or endoscopic biopsies unless performed as a part of a listed surgical procedure such as arthroscopy, craniotomy, laparoscopy, nephroscopy or thoracostomy.
      • Drainage of fluids or other substances through a tube or needle unless performed as a part of a listed surgical procedure such as arthroscopy, craniotomy, laparoscopy, nephroscopy or thoracostomy.
      • Vasectomy or reversal of vasectomy.
      • Female sterilisation, reversal of sterilisation or IVF treatment.
      • Acquired Immune Deficiency Syndrome (AIDS) or Human Immunodeficiency Syndrome (HIV) or AIDS-related complex (ARC), howsoever this syndrome has been acquired or may be named.
      • Any sexually transmitted disease.
      • Cosmetic surgery other than for reconstruction after trauma or malignancy.
      • Obesity surgery and associated cosmetic surgery including abdominoplasty.
      • Obstetric surgery other than surgery for ectopic pregnancy, hydatidiform mole, selective feticide and surgery to treat a fetus in utero.
      • Childbirth, whether natural or by Caesarean section.
      • Gender reassignment or any related treatment whether or not it is for psychological purposes.
      • Any medical condition resulting from a heart attack.
  • Who can buy Medical Recovery Insurance?

      We will cover you, and if appropriate your spouse or partner residing with you, under this policy if you and your spouse or partner

      Subject to payment of the required premium by you, your children can be added to this policy once they have become three years old and until they reach the age of 18 years old (or twenty-five years old if they are in full-time education). Benefits for children under the age of 18 are reduced by 50%.

      • live in the United Kingdom, Channel Islands or Isle of Man for a minimum of 180 days a year
      • are aged at least 18.
      • are below the age of 75.
      • live in the United Kingdom, Channel Islands or Isle of Man for a minimum of 180 days a year
      • are aged at least 18.
      • Are below the age of 75.
  • How many operations and medical procedures can I claim for in each year?
    • Other than claims for the treatment of cancer (see “How We Cover Cancer” below), you may make up to 3 claims in any period of cover in relation to each insured person. As recovery times are not normally extended by having one operation shortly after another, there are restrictions if multiple operations are performed in quick succession and these are explained in the Policy Document.
  • How we cover Cancer
    • Cancer treatments will normally involve an episode of surgery plus a course of chemotherapy or radiotherapy. The episode of surgery will vary according to the operation but most cancer surgery will be classified as either Band B or Band C.

      We classify chemotherapy as a Band C procedure and radiotherapy, which has a shorter recovery time, as Band B.

      Medical Recovery Insurance policyholders can make one claim for the treatment of cancer during their lifetime unless the cancer is either a pre-existing condition or cancer in which case it is excluded. A treatment for cancer can include a maximum of one episode of surgery, one course of chemotherapy and one course of radiotherapy providing that the treatment is for the same cancer.

      No further treatments will be covered during the policy lifetime either for additional treatment of the original cancer or for a recurrence of that cancer in the same place or another place in the body or for the occurrence of another cancer anywhere else in the body.
       

  • How are Heart Surgery and Heart Attacks Covered?
  • Are Day Case and Accident and Emergency Treatments Covered?
    • Medical Recovery Insurance benefits are graded according to the recovery time of a procedure. Our plans do not distinguish as to where operations and medical procedures are carried out or how long they take.
  • What happens if my recovery time is longer than expected?
    • Medical Recovery Insurance benefits are graded according to the normal recovery times of operations that in most cases would allow a person to return to light manual work. The benefits will not increase if you take longer to recover and will not reduce if you get back to work more quickly than expected.
  • Can I use my Medical Recovery Insurance benefit to help pay for private treatment?
    • Whilst you are free to spend your benefits as you wish, it is important to note that Medical Recovery Insurance benefits are calculated according to the expected recovery time and not according to the cost of an operation. Some operations may have a short return to work and a high treatment cost whilst others may have a longer return to work and a lower treatment cost. Benefits should therefore not be relied on to pay for private treatment.
  • Can I increase my level of benefit once I have joined?
    • You can increase your level of cover once you have joined by contacting us to request a revision of cover form. Please note that the exclusion relating to planned treatment(s) also applies to any increase in cover.
  • Is there a maximum age limit above which cover ceases?
    • You can be covered until the expiry of your policy following your 75th birthday.

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