Page 9 - ALC Health

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 websitewww.alchealth.com/claims.htm
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 websitewww.alchealth.com
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 www.alchealth.com/claims.htm
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 www.alchealth.com/claims.htm
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:sales@alchealth.com. 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.