Plan guide
5
Removing dependants
With
our
agreement the
planholder
may remove a
dependant
from a
plan
after
the
plan start date
. The
planholder
must make the request in writing by letter, fax
or email. The last day of cover will be the date that
we
receive the request, or a
future date the
planholder
has given.
The
planholder
must also confirm in writing by letter, fax or email, if there are any
claims
to be made by any
member
on the
plan
for
treatment
or services
received,
or costs incurred, on or before the
dependant’s end date
.
•
If no
claims
have been made, or will be made, for any
member
on the
plan
, a pro-rata refund will be issued.
•
If no
claims
have been paid, but any
member
on the
plan
has made
claims
that
we
have not yet approved, or has
claims
to be made,
we
will
not approve or pay these costs unless all premiums have been received
for the entire
plan year
. A pro-rata refund will be issued if the
planholder
confirms in writing by letter, fax or email that they do not want
us
to
approve the
claim
.
•
If no
claims
have been paid, but any
member
on the
plan
has made
claims
that
we
have approved, the
planholder
must confirm in writing by
letter, fax or email:
•
whether any costs have been incurred; and if so
•
whether the
planholder
will pay these costs or the
planholder
expects
us
to pay the
claim
.
The
claim
will only be paid when all premiums have been received for the
entire
plan year
. A pro-rata refund will only be issued if the
planholder
pays these costs, or no costs have been incurred.
•
If any
member
on the
plan
has made any
claims
that
we
have approved
and paid, no refund will be issued and all premiums must be paid for the
entire
plan year
.
If a
dependant
is removed from an
UltraCare plan
they will also be removed from
any add-on
plans
. The last day of cover on any add-on
plans
will be the same as
their last day of cover on the
UltraCare plan
.
Premiums may change in line with any agreed requests.
If
dependants
are removed from more than one
plan
, any pro-rata refund or
outstanding premium due on each
plan
will be combined.
If any refund is due, this can only be refunded to the account it was originally paid
from. The
planholder
will be responsible for:
•
any shortfall as a result of exchange rate differences; and
•
any associated bank charges.
When removing any
dependants
from a
plan
, the
planholder
must return the
Certificate of insurance. If a
dependant
is being removed from an
UltraCare plan
,
the
planholder
must also return the
dependant’s
membership card.
We
will send the
planholder
a revised Certificate of insurance showing the
changes and any special terms that may apply.
Transfers
If a new person wants to transfer cover from another insurer to apply for
CPME
underwriting terms with
us
, an Individual application for
CPME
must
be completed, and
we
will need an original certificate of insurance from their
previous insurer, which shows:
•
their original start date with that insurer;
•
their underwriting terms; and
•
any special terms that may have applied.
If there is a break in cover between the end date of the previous insurance plan
and the application to
us
,
we
will not offer a transfer of previous underwriting
terms.
If
we
accept the application
we
may charge an increased premium. Cover will
begin as soon as
we
receive the
planholder’s
acceptance of any special terms
offered in the quotation or on a future date they have given and
we
have agreed,
as long as there is no break in cover.
Our plan
terms, conditions and
benefits
may be different to those of the previous
insurer.
Making plan changes
When making any request for changes to a
plan
,
including add-on
plans
,
the
planholder
must also tell
us
all
material facts
. If there is any doubt about
whether a fact is material, for
your
own protection, the
planholder
should tell
us
.
See general condition GC2 for more information.
If
you
change
your
address the
planholder
must tell
us
in writing by letter, fax or
email. If
your
new address is in a different country,
we
will consider this to be the
country where you live
unless the
planholder
tells
us
otherwise.
If the
planholder
wants to change the
area of cover
on the
UltraCare plan
and
any Maternity add-on
plan
, they must tell
us
in writing by letter, fax or email
giving the reason for the change in circumstances.With
our
agreement this
change can be made at any time during the
plan year
.
We
will make this change
from the date the
planholder
tells
us
or any future date they have given.
We
will send the
planholder
a revised Certificate of insurance if
your
new address
is in a different country or
your area of
cover
changes. If
your area of
cover
changes,
we
will also send a new membership card. The Certificate of insurance
and membership card will show the changes and any special terms that may
apply. Premiums, taxes and
benefit
limits may change in line with any agreed
requests.
The
planholder
cannot make changes to:
•
the
UltraCare plan
type;
•
deductibles
or how often the premiums are paid on the
UltraCare plan
or
Maternity add-on
plan
;
•
the number of units on a Personal accident add-on
plan
; or
•
the currency of any
plan
;
during the
plan year
.With
our
agreement these changes can be made at the next
plan renewal date
. The
planholder
must tell
us
about the changes in writing by
letter, fax or email before the
plan renewal date
. Premiums, taxes and
benefit
limits may change in line with any agreed requests.
Add-on
plans
cannot be added during the
plan year
.With
our
agreement these
can be included from the next
plan renewal date
. The
planholder
must apply in
writing by letter, fax or email before the
plan renewal date
.
When making the
application
the
planholder
must also tell
us
all
material facts
. If there is any
doubt about whether a fact is material, for
your
own protection, the
planholder
should tell
us
.
Renewal
With
our
agreement the
planholder
may renew the
UltraCare plan
and any add-
on
plans
each year.
If the
planholder
wants to renew, they must tell
us
in writing by letter, fax or email
before the
renewal date
.
The
planholder
must tell
us
all
material facts
before the
renewal date
. If there
is any doubt about whether a fact is material, for
your
own protection, the
planholder
should tell
us
. See general condition GC2 for more information.
We
may change the definitions,
benefits
, general conditions,
benefit
conditions
and
benefit
exclusions that apply to the
UltraCare plan
and any add-on
plans
.
Any changes will be sent to the
planholder
together with the renewal quotation
at least six weeks before the
renewal date
. Renewal premiums must be paid on or
before the
renewal date
.
UltraCare plan
renewal premiums are based on the age of the
planholder
and
each
dependant
at the
renewal date
, the countries where they live, increases in
medical inflation and the
plan
type chosen.
Maternity add-on
plan
renewal premiums are based on the age of any female
members
included at the
renewal date
, the countries where they live and
increases in medical inflation.
Personal accident add-on
plan
renewal premiums are based on the number of
units chosen for each
member
at the
renewal date
.
Travel add-on
plan
renewal premiums are based on the
planholder
and any
dependants
included at the
renewal date
.
All cover is subject to
our
eligibility criteria.
A child will no longer be eligible as a
dependant
under any
plan
at the next
renewal date
if any one or more of the following apply:
•
they marry;
•
they are not in continuous full-time education and they are 18 to 24; or
•
they reach the age of 25.
With
our
agreement they can apply to have their own
UltraCare plan
and add-on
plans
by completing an Individual application. As long as there is no break in their
cover with
us
, their
date of joining
will stay the same. Their application will be
