Plan guide
9
The
planholder
cannot make changes to:
•
the
UltraCare plan
type;
•
the
UltraCare plan benefits
;
•
deductibles
or how often the premiums are paid on the
UltraCare 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
.
Renewing the group plan
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
about all
members
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
.
With
our
agreement the
planholder
can make changes to the
plan
at renewal.
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
governed by the definitions,
benefits
, general conditions,
benefit
conditions and
benefit
exclusions in force at their new
plan start date
.
We
will not renew the group
plan
automatically.
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
.
Cancelling the group plan
If the
planholder
wants to cancel a
plan
, they must confirm in writing by letter,
fax or email. The last day of cover will be the date that
we
receive the written
confirmation, or on a future date given to
us
.
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
.
As each
plan
is a yearly contract the
planholder
must pay any premium owed for
the rest of the
plan year
. No refunds will be issued and the
planholder
may have
to pay a cancellation charge.
The
plan administrator
must destroy all Certificates of insurance when they
cancel a
plan
.
The
plan administrator
must also destroy all membership cards if the
UltraCare
plan
is cancelled. If a membership card is used to obtain
treatment
at a
direct billing facility after the
plan
has been cancelled, the
planholder
will
be responsible for paying any costs to the
treatment
provider.
We
will not be
responsible for any costs after cover has been cancelled.
General conditions and benefit conditions
The
UltraCare plan
and all add-on
plans
, are governed by the general conditions
shown below. The
UltraCare plan
, Maternity and Travel add-on
plans
are
governed by the
benefit
conditions shown below. Some of these
benefit
conditions also apply to the Personal accident add-on
plan
. See the ‘Extra
benefit
conditions and
benefit
exclusions for add-on
plans
’ section for more information.
Claims
will only be paid under a
plan
if
you
meet these general conditions and
benefit
conditions.
Extra
benefit
conditions also apply to the Maternity, Personal accident and Travel
add-on
plans
. See the ‘Extra
benefit
conditions and
benefit
exclusions for add-on
plans
’ section for more information.
General conditions
GC1
The
planholder
or
plan administrator
must tell
us
immediately in writing by
letter, fax or email about any important change that affects information given in
connection with the application for cover under a
plan
, for example:
•
you
change
your
name or occupation;
•
there is a change to
medical practitioner
or
planholder
details;
•
you
plan to engage in any
hazardous pursuits
; or
•
you
change
your
address.
If
your
new address is in a different country,
we
will consider this to be the
country where you live
unless the
planholder
or
plan administrator
tell
us
otherwise.
After
we
have been told about a change,
we
have the right to reassess
your
cover.
We
can change any of the terms or cancel the
plan
. Any
claim
related to a change
in risk that the
planholder
or
plan administrator
has not told
us
about may be
reduced or rejected, or the
plan
may be cancelled.
GC2
The
planholder
or
plan administrator
must tell
us
all
material facts
before
we
accept an application, make changes to a
plan
or renew a
plan
. The
planholder
and
plan administrator
must check that any
material facts
are
correct.
You
must check that any
material facts
about
you
are correct.
If there is any doubt about whether a fact is material, for
your
own protection, the
planholder
or
plan administrator
should tell
us
.Where applicable the 24-month
moratorium
will still apply even if the
planholder
or
plan administrator
tells
us
about any
pre-existing medical conditions you
may have.
Individual plans
We
will avoid the part of the
plan
which provides
benefits
to
you
as the
planholder
or as a
dependant
(treat it as if it had not existed from the
start date
,
renewal date
or the date of any changes that were made to the
plan
), if
you
(or
the
planholder
on
your
behalf if
you
are a
dependant
):
•
deliberately or recklessly gave
us
inaccurate or incomplete
material facts
;
or
•
did not take reasonable care to give
us
accurate and complete
material
facts
and
we
would not have covered
you
under the
plan
at all had
we
known about such
material facts
.
If
we
avoid the part of the
plan
which applies to the
planholder
,
we
will offer
their
dependants
continued cover if a new
planholder
is appointed. The
plan
will
be suspended until a new
planholder
is appointed.
If any of the
dependants
are 18 years or over they must write to
us
by letter, fax or
email to appoint one of them as the new
planholder
to manage the
plan
.
If all of the
dependants
are under 18, the
planholder
must write to
us
by letter,
fax or email to appoint a new
planholder
to manage the
plan
. A parent or legal
guardian can be appointed to act as the
planholder
, but they will not have cover
under the
plan
.
If a new
planholder
is not appointed within seven days of the date
we
notify
removal of the
planholder
,
we
will cancel the entire
plan
from the date of the
removal of the
planholder
.
If
you
as the
planholder
or as a
dependant
(or the
planholder
on
your
behalf
if
you
are a
dependant
) did not take reasonable care to give
us
accurate and
complete
material facts
and
we
would have provided cover to
you
on different
terms under the
plan
had
we
known about the
material facts
,
we
may refuse to
pay all or part of any
claim you
make.
If
we
would have applied different terms, conditions and exclusions to
you
, then
the
plan
shall be treated as if it had contained such different terms, conditions and
exclusions and a
claim
will only be paid
if:
