UltraCare
6
governed by the definitions,
benefits
, general conditions,
benefit
conditions and
benefit
exclusions in force at their new
plan start date
.
Automatic renewal
If the premiums are paid by
card
or direct debit,
we
will automatically renew the
UltraCare plan
and any add-on
plans
, unless
we
tell the
planholder
otherwise.
Renewal premiums will be taken from the named account as long as the payment
details are still valid at the
renewal date
.
If the
card
details provided previously are not valid for at least three months after
the
renewal date
, then new
card
details must be provided by
logging on to the
secure payment system at
or completing,
and faxing or posting, the Credit
card
authority form.
If the
planholder
does not want to renew the
plan
they must tell
us
in writing by
letter, fax or email before the
renewal date
.
No-claims discount
As long as no
claims
are made by the
planholder
or any
dependant
on the
UltraCare plan
,
we
will give no-
claims
discounts on the
UltraCare plan
renewal
premiums. These are based on the amount of time the
plan
has been
claim
free.
If the
planholder
or any
dependant
has any
claims
paid during a
plan year
, the
no-
claims
discount will be lost until the
UltraCare plan
has been
claim
free for at
least one
plan year
.
The following discounts will apply to the
UltraCare plan
after it has been
claim
free for the amount of time shown.
•
For less than one
plan year
: no discount.
•
For one
plan year
: 10% discount.
•
For two
plan years
: 15% discount.
•
For three
plan years
: 20% discount.
•
For four or more
plan years
: 25% discount.
The maximum no-
claims
discount is 25%.
Any
claims
made for the Wellness or Hospital cash
benefits
, or on any add-on
plans
will not affect the no-
claims
discount.
If a
claim
relating to a previous
plan year
is made on the
UltraCare plan
after
we
have given a no-
claims
discount, the full premium will be due for the
plan year
to
which the discount was given.
We
will also recalculate the amount of no-
claims
discount that applies to the following
plan years
and any additional premiums
that become due as a result of this will be charged.
The no-
claims
discount does not apply to the premiums of any add-on
plans
.
Cancellation
Please see the ‘Cooling off period’ section if a
plan
is being cancelled within 30
days of receiving the Table of
benefits
, Certificate of insurance and
Plan
guide, or
the
date of joining
, whichever is later.
If the
planholder
is cancelling a
plan
at any other time, they must confirm in
writing by letter, fax or email if there are any
claims
to be made by any
member
on the
plan
. The last day of cover will be the date that
we
receive the written
confirmation, or on a future date given to
us
.
•
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 the
UltraCare plan
is cancelled, any add-on
plans
will also be cancelled. The last
day of cover on any add-on
plans
will be the same as the last day of cover on the
UltraCare plan
.
No
claims
will be paid on a
plan
after it
is cancelled.
An administration fee of $170, £100 or €150 will be charged for cancelling
your
UltraCare plan
, depending on the currency of
your plan
.
We
reserve the right to
make an additional charge if
we
incur any further or unexpected costs as a result
of the cancellation.
If more than one
plan
is cancelled, 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.
The
planholder
must return the Certificate of insurance when they cancel a
plan
.
They must also return all membership cards if the
UltraCare plan
is cancelled.
Death
If the
planholder
dies
we
will offer their
dependants
continued cover if
we
receive a signed Individual application from them within four weeks of the date
of death.
If the
planholder’s dependants
do not want to continue cover, they must tell
us
in
writing by letter, fax or email.
We
will then cancel the
plan
and a pro-rata refund
will be issued in line with the instructions received from the
planholder’s
personal
representative, as long as no
claims
have been made and accepted by
us
. If
we
have accepted a
claim
, no refund will be paid.
We
will ask to see a certified copy of the death certificate before any refund is
issued.
Group plans
The
plan
terms apply to
you
and the
planholder
.
You
must read the Group
member
application (if this applies), Table of
benefits
,
Certificate of insurance, membership cards and this
Plan
guide.
The Group application, Group
member
applications (if these apply), Group
declaration of health (if this applies), Group membership census, Corporate
agreement, Table of
benefits
, Certificates of insurance and this
Plan
guide form
the contract of insurance between
us
and the
planholder
. The
planholder
must
read these together.
The
planholder
must choose the currency of the
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 the
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
.
Group eligibility
Eligibility depends on
us
accepting the Group application, Group
member
applications if the underwriting terms are
moratorium
or
CPME
, previous
certificates of insurance if the underwriting terms are
CPME
, Group
member
applications including the medical questionnaires if the underwriting terms
are
FMU
, Group declaration of health (if this applies) and a complete Group
membership census.
Plans
must be made up of a group of employees of the same company or
members of an existing affinity group. The size of a group
UltraCare plan
at the
start date
must be at least three
main members
(employees or affinity members).
If there are less than three
main members
at the
start date
or at a
renewal date
,
the group cannot continue and
we
will offer individual
plans
to the remaining
members
.
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
