Coronary artery bypass
Cardiac valve surgery
The implantation of a cardiac device, such as a defibrillator or pacemaker
Coronary angioplasty.
There are certain conditions that are likely to require ongoing treatment – such as Crohn’s
disease (inflammatory bowel disease) and long-term depressive illness – which require
management of recurrent episodes where the condition’s symptoms deteriorate. Because of the
ongoing nature of these conditions we will write to tell you when the benefit for that condition will
stop.
Where can I find out more about cover for chronic conditions?
We publish a leaflet which explains how we deal with payment for treatment of chronic
conditions. This is available on our website:
and can also be
obtained from us. You will also find further explanation of how we deal with payment for cancer
treatments on page
.
7.2
We pay for eligible:
(a)
Treatment of an acute condition and the short-term in-patient treatment intended to
stabilise and bring under control a chronic condition.
(b)
Kidney dialysis for up to six weeks during preparation for kidney transplant.
(c)
Long term monitoring, consultations, check-ups, scans and examinations for the following
surgical procedures for heart conditions:
Coronary artery bypass
Cardiac valve surgery
The implantation of a cardiac device, such as a defibrillator or pacemaker
Coronary angioplasty.
(d)
In-patient rehabilitation of up to 28 days when it is an integral part of treatment; and
it is carried out by a medical practitioner specialising in rehabilitation
it is carried out in a recognised rehabilitation hospital or unit
the costs have been agreed by us before the rehabilitation begins.
We will extend in-patient rehabilitation to a maximum of 180 days in cases of severe
central nervous system damage caused by an external trauma.
(e)
Hormone replacement therapy (HRT) only when it is medically indicated as a result of
medical intervention, when we will pay for the medical practitioner’s consultations and for
the cost of the implants (but not patches or tablets). We will only pay benefits for a
maximum of 18 months from the date of the medical intervention
.
Please see page 56 for an explanation of words that appear in bold
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