12
Assistance & Claims Procedure
POLICY DOCUMENTS
Within
your policy
pack
you
will have
your Certificate of Insurance
which tells
you
the plan
you
have selected, who is insured under
your policy
, which benefits
you
have chosen, and
your policy
excess
. Also any Special Endorsements applicable to
your
cover
will be noted.
MEMBERSHIP CARDS
We
also supply personalised memberships cards to every
insured
person
, which provides
our
essential contact numbers and
addresses. This means that
you
and
your
family are only a phone
call away from help.
We
suggest
you
keep
your
card with
you
at
all times.
CLAIMS DEPARTMENT CONTACT DETAILS
All claims queries, pre-authorisation and document uploads can be
submitted through
our
website
or call
us
on +44 (0) 1892 504234
or fax
us
on +44 (0) 1892 508256
or write to
us
ALC Health Claims
AXA PPP International
PO Box 428
Tunbridge Wells
TN2 9ND
United Kingdom
HOW TO MAKE A CLAIM
Please note that on
your
membership card
you
will find
your
policy
and customer number. Full details of how to claim or make
an enquiry can be found on
our
website
OUT-PATIENT CLAIMS
You
may go to
your
Doctor or
Specialist
for consultations or
treatment
and submit
your
claim for reimbursement, which
we
call
Self-Certification.
You
will need to complete a Self-Certification Claim
Formwhich
you
can send together with
your
invoices and receipts.
by fax +44 (0) 1892 508256
or by submission online
Please note that if
you
self-certify there may be times when
we
need more detailed medical information in order to establish
that
your policy
with ALC Health provides
you
with cover for the
treatment you
have received.
On these occasions
we
will send
you
a Medical Information Form.
You
may also download a Medical Information Form from
our
website
You
will need to complete part of the form and then pass it to
your
Doctor or
Specialist
to complete their section and then please
submit by fax or online.
If
you
wish to pre-authorise
your
claim before
you
visit
your
Doctor or
Specialist you
may give
us
a call on the number below
and
we
will confirm how much
you
are able to claim and what
you
should do next.
Please follow the guidelines below to help us process
your
claims promptly and efficiently.
The
policyholder
may cancel this
policy
by contacting
us
during
the 14 day cooling off period. The 14 day cooling off period
commences on the day that the contract is concluded or the day
that full
policy
terms and conditions are received, whichever is the
later. The 14 day cooling off period also applies from each
renewal
date
. If the
policy
is cancelled during the 14 day cooling off period
we
will return any premium paid for the
policy
providing no claims
have been made on the
policy
in relation to the
period of cover
before cancellation (being no more than 14 days’ cover). If
you
incur eligible claims costs within that
period of cover we
reserve
the right to require the
policyholder
to pay for the services
we
have actually provided in connection with the
policy
to the extent
permitted by law and any return of premium is subject to this. If the
policyholder
does not cancel the
policy
during the cancellation
period the
policy
will continue on the terms described in this
Policy Wording for the remainder of the
policy
year.
7
Governing Law
You
and
we
are free to choose the law that applies to this
policy
. In
the absence of any agreement to the contrary, the law of England
and Wales will apply.
8
Policy language
This
policy
is written in English and all other information and
communications to
you
relating to this
policy
will also be in English
unless
we
have agreed otherwise in writing.
9
Other Insurance
If there is any other insurance
policy
covering any of the same
benefits as provided by this
policy
,
you
must disclose or ensure that
the relevant
insured person
discloses the same to
us
.
We
shall not
be liable to pay or contribute more than
our
rateable proportions.
10
Third Party Rights
Only the
policyholder
and
we
have legal rights under this
policy
and it is not intended that any clause or term of this
policy
should
be enforceable, by virtue of the Contract (Rights of Third Parties)
Act 1999, by any other person including any
dependant
.
11
International Sanctions
We
and other service providers will not provide cover or pay
claims under this
policy
if doing so would expose
us
or the service
provider to a breach of international economic sanctions, laws or
regulations, including but not limited to those provided for by
the European Union, United Kingdom, United States of America
or under any United Nations resolution. If a potential breach is
discovered, where possible
we
will advise
you
in writing as soon
as
we
can.
12
Changing your level of cover
If
you
effect
Out-patient Treatment
at a
renewal date
after
your
date of entry
, any existing
medical condition
or related condition
will be limited to
In-patient Treatment
only.
13
Adding a Newborn Child
Children will be accepted from birth without the need for medical
underwriting, provided that
we
receive notification of their arrival
within 30 days from birth. Please ensure
you
submit
your
request
in writing to
us
at:
. Notification received after
this period will result in children being accepted for cover from the
date of such notification.
14
Contacting Dependants
If
we
need to make contact in relation to a
dependant
on
your
policy
(e.g. where further information is required to process a claim),
the
policyholder
, acting for and on behalf of the
dependant
, will
be contacted by
us
and asked to provide the relevant information.
Similarly, all information in relation to any person covered by the
insurance
policy
, for the purpose of administering claims, will be
sent directly to the
policyholder
.