Plan guide
3
Your plan guide
This
Plan
guide, together with
your
Table of
benefits
, explains what is, and is not,
covered under the
UltraCare plan
and any of the following add-on
plans
that
have been chosen:
•
Maternity add-on
plan
;
•
Personal accident add-on
plan
;
•
Travel add-on
plan
.
Different terms and conditions apply to different underwriting terms. See the
‘Definitions’ section for more information on
your
underwriting terms, as shown
on
your
Certificate of insurance. Also see
benefit
exclusions BE1 and BE2 for more
information.
This
Plan
guide will also give
you
important information about managing these
plans
.
For information about how to make a
claim
and what to do in a medical
emergency please refer to
your Claims
procedures.
Please spend some time reading carefully through this
Plan
guide to make sure
that
you
are completely satisfied with the cover
we
are providing and that the
cover meets
your
needs. If
you
have any questions about the information in this
Plan
guide or any questions
you
think it does not answer, please contact
us
and
we
will be more than happy to help.
Some words and phrases used in this
Plan
guide,
your
Table of
benefits
and
your
Claims
procedures have specific meanings that are relevant to
your plans
.
We
have highlighted them in bold print and defined them in the ‘Definitions’ section
of this
Plan
guide.
Individual plans
The Individual application, Table of
benefits
, Certificate of insurance and this
Plan
guide form the
contract of insurance with
us
and
you
must read them together.
The
planholder
must choose the currency of
your UltraCare plan
from the
currencies available for that
plan
type. They must choose this at application or
renewal and it will apply throughout the entire
plan
year
. Any add-on
plans
that
have been chosen must be in the same currency as the
UltraCare plan
.
Premiums must be paid in the same currency as
your plans
.
We
can change any of the general conditions,
benefit
conditions,
benefit
exclusions or other terms and conditions in this
Plan
guide at the beginning of
the
plan year
.
We
can also change the premiums and any discounts or surcharges
at the beginning of the
plan year
.
We
will tell the
planholder
about any changes
before the
plan
renewal date
.
Cooling off period
If
you
feel a
plan
does not meet
your
needs, the
planholder
may cancel it. The
planholder
must tell
us
in writing by letter, fax or email within 30 days of receiving
the Table of
benefits
, Certificate of insurance and
Plan
guide, or the
date of
joining
, whichever is later. The
planholder
must return the Certificate of insurance
when they cancel the
plan
. If the
UltraCare plan
is cancelled all membership
cards must also be returned.
As long as no
claims
have been made by any
member
on the
plan
, the premium
received will be refunded in full.
If any
claims
have been made, no refund will be due and the premium will be
payable in full.
If the
UltraCare plan
is cancelled, any add-on
plans
will also be cancelled.
Premiums can only be refunded to the account they were originally paid from. The
planholder
will be responsible for:
•
any shortfall as a result of exchange rate differences; and
•
any associated bank charges.
If the
planholder
decides to cancel a
plan
after the 30-day period, the
cancellation will be governed by the ‘Cancellation’ section in this
Plan
guide.
Individual Eligibility
Your
eligibility depends on
us
accepting the application, including the medical
questionnaire if
your
underwriting terms are
FMU
.
The
UltraCare plans
and add-on
plans
are available to people of all nationalities,
including
dependants
, except citizens of the USA who live in the USA and people
who are governed by exchange controls or local licensing regulations.
Plans
may not meet specific visa requirements. Cover may also be illegal under
local laws. It is the
planholder’s
responsibility to ensure that any
plans
chosen
meet
your
needs.
All
dependant
children on a
plan
must be unmarried.
Dependant
children aged
18 to 24 must be in continuous full-time education at their
start date
.
The minimum age of a
planholder
is 18. If none of the
members
to be included
on the
plan
are 18 or above at the date of application, the application will be
subject to
our
acceptance, and their parent or legal guardian must apply for them.
The parent or legal guardian will act as the
planholder
, but will not have cover
under the
plan
.
UltraCare plan
premiums will be based on the adult rate of 18 to
25 years for all
members
included on the
plan
. No discounts will apply.
You
cannot be older than 74 at
your start date
.
The
planholder
and their
dependants
must have the same
area of cover
.
Add-on
plans
are only valid when the
UltraCare plan
is in force.
The Maternity add-on
plan
is only available with the same
area of cover
as the
UltraCare plan
. This
plan
is also only available to female
members
aged 18 to 44
at entry. Once
members
reach the age of 46 during a
plan year
,
their
cover on the
Maternity add-on
plan
will not be renewed.
The minimum age at entry for the Personal accident add-on
plan
is 18. The
maximum age at entry is 74. This
plan
can cover:
•
the
planholder
only; or
•
the
planholder
and any
dependants
, aged 18 and over, who are included
on their
UltraCare plan
.
The Personal accident add-on
plan
provides cover for managerial, clerical
and administrative occupations only. See
benefit
condition BCPA1 for more
information.
The Travel add-on
plan
can cover:
•
the
planholder
only; or
•
the
planholder
and all of the
dependants
who are
included on their
UltraCare plan
.
Additional eligibility criteria apply to some
plan
types. These are shown in
your
Individual application and Table of
benefits
where applicable.
We
can refuse cover on any of our
plans
for any reason.
We
may provide cover
under our
plans
with any special terms that
we
may set. Any special terms will be
shown on the Certificate of insurance.
Plan start date
With
our
agreement cover under the
UltraCare plan
will begin:
•
as soon as
we
receive the Individual application; or
•
on a future date given to
us
by the
planholder
;
unless
your
underwriting terms are
CPME
or
FMU
.
If
your UltraCare plan
underwriting terms are
CPME
, cover on the
UltraCare plan
will begin as soon as
we
receive the
planholder’s
acceptance of the special terms
offered in the quotation or on a future date the
planholder
has given and
we
have agreed, as long as there is no break in cover.
If
your UltraCare plan
underwriting terms are
FMU
, cover on the
UltraCare plan
will begin as soon as
we
receive the
planholder’s
acceptance of the special terms
offered in the quotation.
We
will tell the
planholder
the
start date
in writing.
Cover under any add-on
plans
will begin on the same day as the
UltraCare plan
or any future
UltraCare plan renewal date
.
We
cannot backdate cover under any circumstances. All
plans
will continue for 12
months until the next
renewal date
.
The premiums and
benefits
applied to a
plan
will be those in force at the
plan
start date
.
Premiums
Each
plan
is a yearly contract.
The
planholder
must choose how often
your UltraCare plan
premiums are paid
from the payment options available for that
plan
type. They must choose this at
