UltraCare
8
Adding group members
With
our
agreement the
plan administrator
may add
members
to the
UltraCare
plan
after the
plan start date
. The
plan administrator
must make the request as
follows, depending on the underwriting terms.
•
MHD
– the
plan administrator
must make the request in writing by letter,
fax or email.
•
Moratorium
– if a new
dependant
is being added the
plan administrator
must make the request in writing by letter, fax or email. If a new
main
member
is being added the
plan administrator
must send a group
application for the
main member
, and any
dependants
to be included.
•
CPME -
see the ‘Group member transfers’ section.
•
FMU
- the
plan administrator
must send a Group
member
application,
including the medical questionnaire.
With
our
agreement the
plan administrator
may also add
members
to any
add-on
plans
at the same time they are added to the
UltraCare plan
. The
plan
administrator
must request this in writing by letter, fax or email.
When making a request to add
members
, the
plan administrator
must also tell
us
all
material facts
. If there is any doubt about whether a fact is material, the
plan
administrator
should tell
us
. See general condition GC2 for more information.
With
our
agreement cover will begin as follows, depending on the underwriting
terms.
•
MHD
- as soon as
we
receive the request or on a future date given to
us
by the
plan administrator
.
•
Moratorium
– as soon as
we
receive the request or on a future date given
to
us
by the
plan administrator
.
•
CPME
- as soon as
we
receive acceptance of the special terms offered in
the quotation or on a future date the
plan administrator
has given and
we
have agreed, as long as there is no break in cover.
•
FMU
- as soon as
we
receive acceptance of the special terms offered in the
quotation.
Cover under any add-on
plans
will begin on the same day as the
UltraCare plan
.
We
will not backdate cover under any circumstances.
With
our
agreement the
plan administrator
may add newborn children as
dependants
during the
plan year
.When making a request the
plan administrator
must tell
us
all
material facts
.
If the
plan administrator
applies in writing before the newborn child is 30 days
old
we
will not apply any underwriting terms
to the newborn child’s cover on
the
UltraCare plan
and their
date of joining
will be their date of birth.
Benefit
condition BC5 and
benefit
exclusions BE1 and BE2 will not apply.
If the
plan administrator
applies in writing after the newborn child is 30 days old,
underwriting terms will apply. If the underwriting terms on the
UltraCare plan
are:
•
MHD
- cover will begin as soon as
we
receive the written request or on a
future date given to
us
by the
plan administrator.
•
Moratorium
- cover will begin as soon as
we
receive the written request
or on a future date given to us by the
plan administrator
.
•
FMU
- the
plan administrator
must send a Group
member
application,
including the medical questionnaire. Cover will begin as soon as
we
receive acceptance of the special terms offered in the quotation.
We
will not backdate cover for any requests received by
us
after the newborn
child is 30 days old.
Premiums may change in line with any agreed requests.
When adding any
dependants
,
we
will send the
plan administrator
a revised
Certificate of insurance and a new membership card, if this applies, showing the
changes and any special terms that may apply.
When adding any new
main members we
will send the
plan administrator
a
Certificate of insurance for the
main member
and any
dependants
included,
showing any special terms that may apply.
We
will also send membership cards
for the
main member
and their
dependants
.
Removing group members
With
our
agreement the
plan administrator
may remove a
member
from a
plan
after the
plan start date
. The
plan administrator
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
plan administrator
has given. If a
main member
is
removed from a
plan
, all of their
dependants
will also be removed.
When
members
are removed, the
plan administrator
is responsible for collecting
and destroying their Certificates of insurance and membership cards on or by the
end date
. If the
plan administrator
does not collect and destroy the Certificates
of insurance and membership cards and a removed
member
uses these to obtain
treatment
at a direct billing facility, the
planholder
will be responsible for paying
any costs to the
treatment
provider.
We
will not be responsible for any costs after
cover has ended.
If a
member
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.
When removing any
dependants
,
we
will send the
plan administrator
a revised
Certificate of insurance showing the changes and any special terms that may
apply.
Group member transfers
If a new person wants to transfer cover from another insurer to apply for
CPME
underwriting terms with
us
, a Group
member
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 acceptance of any special terms offered in the
quotation or on a future date the
plan administrator
has 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.
Continuing cover when leaving a group plan
If
your
cover is coming to an end, with
our
agreement
you
can be transferred to
an individual
UltraCare plan
, as long as there is no break in
your
cover with
us
and
you
meet
our
individual eligibility criteria.
You
must send
us your
application before
you
leave the group
plan
. If
we
accept
your
application to continue cover,
we
may charge an increased premium and
your
underwriting terms may change. The application will be governed by the
definitions,
benefits
, general conditions,
benefit
conditions and
benefit
exclusions
in force at
your
new
plan start date
.
The
start date
of
your
new individual
plan
will be the first day after
you
leave the
group
plan
.
Changing the cover and add-on plans for groups
When making any request for changes to a
plan
,
including add-on
plans
,
the
plan administrator
must also tell
us
all
material facts
. If there is any doubt about
whether a fact is material, for
your
own protection, the
plan administrator
should
tell
us
. See general condition GC2 for more information.
If
you
change
your
address the
plan administrator
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
plan administrator
tells
us
otherwise.
If a
main member
needs to change their
area of cover
on the
UltraCare plan
, the
plan administrator
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
plan
administrator
tells
us
or any future date they have given. Their
dependants
will
also change to the new
area of cover
on the same day.
If there is a change to the
country where a member lives
or their
area of cover
changes,
we
will send the
plan administrator
a revised Certificate of insurance. If
the
area of cover
changes
we
will also send new membership cards for the
main
member
and any
dependants
. The Certificate of insurance and membership cards
will show the changes and any special terms that may apply. Premiums, taxes and
benefit
limits may change in line with any agreed requests.
