HSF

Registration

Anyone may join up until their 66th birthday (providing they satisfy health requirements). Registration will continue for life, if the contributor so wishes, and if contribution payments are kept up-to-date and the rules and conditions are adhered to. Cover is provided continuously from month to month until it is cancelled or otherwise comes to an end. You will renew your policy every time you pay your contribution, so unless we change the terms and conditions of your policy you will not receive renewal documentation. When your application is accepted you will receive a Registration pack. Upon its receipt you have 14 days in which to change your mind (telephone 1890 473473 or write to HSF health plan health plan, Clare Road Mall, Clare Road, Ennis, Co Clare). You may also need to inform your pay office if deductions have started. If any contributions have been paid you will receive a full refund providing that no claims have been settled during this period. Any change of address should be notified to the HSF health plan office.

Qualifying periods and restrictions

Claims may be submitted at the conclusion of the qualifying periods stated under each benefit heading on this website. The symptoms relating to the consultation/episode of treatment must have started after the qualifying period has ended. There is a qualifying period of 10 months for the Birth and Adoption Grants and this time also applies to other benefit categories if the claim is related to pregnancy. You must complete the Application form and Medical Information form with as much detail as possible and read the Declaration carefully before signing it. Some medical conditions make it necessary to offer limited cover in our plans and you will be advised if this applies to your Registration. Claims cannot be accepted for anything related to: medical conditions existing at the time of joining or which arise during the stated qualifying periods; plastic surgery for cosmetic reasons; addictions (eg. alcohol, drugs); self harm or self inflicted injuries; HIV/AIDS. Conditions which begin during the qualifying period should be notified in writing and you will then be advised if any restrictions apply. Optical, Dental, chiropody/podiatry, General Practitioner, Prescription and Personal Injury are the only benefits not subject to the pre-existing condition rules, although some Personal Injury benefits may be limited if a disability or medical condition existed before the Accident. If any prospective contributor is already registered in another HSF health plan scheme this must be declared. You will then be advised of your Registration options.

Transfer of Cover

Registration of HSF health plan health plan does not need to cease when current employment ends. Enquiries should be made concerning the possibility of a deduction from pension, if you are retiring, or a payroll deduction facility from a new employer. If neither is possible or appropriate, then contributors should contact HSF health plan to make other arrangements.

Maternity leave / Unpaid leave

Contributors should ensure that their payments continue to be made through this period.

Payment of contributions

Contributors should check that payments have commenced in order that they are received regularly by HSF health plan. If contributions fall into arrears for more than three months, a qualifying period of one month will be imposed from the date of payment before entitlement to benefits is resumed. Contributors who fall into arrears for more than six months will normally be required to rejoin under the usual conditions of enrolment.

Increasing contributions

Any existing HSF health plan contributor is able to apply to increase to a higher scheme within the One Scheme range up until their 70th birthday. Qualifying periods are waived in all categories except the Birth and Adoption Grants. If Registration in total is less than three months at the time of any scheme transfer all qualifying periods will apply. The One Scheme is entirely separate from HSF health plan Family Schemes and contributors transferring to a One Scheme from a Family Scheme will be subject to rules for new contributors, particularly relating to medical conditions existing or likely to recur, at the time of transferring. Within the range of the One Scheme, claims related to medical conditions existing at the time of increasing or linked to previous medical conditions will be paid at the appropriate former scheme rate. Benefit restrictions already existing may be transferred. There may be circumstances where benefit categories are grouped together or flexibility (eg. Practitioners) when it is necessary to settle claims at a former scheme rate for all categories in that group. Due to the scheme groupings being separate it is not possible for the One Scheme contributor to have a claim settled at a former HSF health plan Family Scheme rate.

Decreasing or ceasing contributions

While it is possible to reduce contributions by transferring to a lower scheme, cover at the higher scheme should have been of at least six months' duration before such an application is made. Entitlement to benefit at the higher rate then ceases immediately upon transferring. If the benefit maximum has been reached in any category in the higher rate scheme, there will be a qualifying period of six months before claims may be submitted under the new lower rate scheme. Cover at the new lower rate scheme must be of at least 12 months' duration before increasing or decreasing again. Contributors who wish to cease contributions should provide written notification to HSF health plan. Past contributions may not be refunded. Two months' written notice of cancellation of cover is required. Contributions paid beyond the two months' notice period will be refunded, if requested. Entitlement to claim will continue throughout any period of time covered by contributions. Any errors in contribution payments must be notified to HSF health plan within two years of the occurrence for refunding to be possible.

Claims

Claims must be made within six months of the date of the receipt or discharge from hospital, except all Personal Injury claims which must be made within three months of the Accident taking place. It may be necessary to ask you for additional medical information in connection with any claim. All benefits are tax free and easy to claim with forms provided on request by telephoning 1890 473473, downloading from this website or writing to HSF health plan health plan, Clare Road Mall, Clare Road, Ennis, Co Clare. Payment of benefit in most categories is made on a 'rolling balance' principle over any 12 months. There is no fixed term period eg. beginning and ending on the anniversary of joining or increasing or a calendar year. Example: a Scheme 12 contributor, having served the qualifying period, could have the following Dental/Optical record:

Claim received	Benefit paid
September 2006	€100
November 2006	€200
February 2007	€150
April 2007	€150
September 2007	€100

Within any 12 month period benefits have not exceeded €600 and the contributor would be entitled to benefit of €200 again in November 2007. Claims will only be accepted where accumulated receipts total €7 or more. Payments which relate to amounts paid for a service provided will be up to 100% of the cost, depending on the maximum shown on this website. Payment will be by Direct Credit into the contributor's nominated account or cheque made payable only to the contributor. Claims will not be paid unless the appropriate contributions are up-to-date, even if the hospital stay or treatment date was before contributions fell into arrears.

The receipts must:

1. be originals, not photocopies;
2. include the practitioner's stamp/name, qualifications and date of issue;
3. include the patient's name;
4. state the type of service and items provided;
5. be for a service for which payment has been met directly by the person registered under the Registration;
6. be for a service covered by the HSF health plan benefit categories only and not for any insurance premiums paid to cover that service.

In circumstances where part of the amount stated on a receipt has been met by another organisation, HSF health plan will limit its payment to ensure that overall a contributor does not receive more than the total amount paid. If the full cost has been met by another organisation the claim cannot be accepted by HSF health plan. Claims cannot be accepted for treatment or services provided outside Ireland and the United Kingdom. There are no such restrictions under the Personal Injury benefits. Should any overpayment be made in respect of any of the benefits, the amount in question will be set against any future claims, or a repayment may be requested. Any fee paid by a contributor to a practitioner for any type of medical statement or to a hospital for a statement concerning admission/attendance cannot be reimbursed by HSF health plan.

Payment of benefit from Chubb for Personal Injury claims

Any money due will be paid to the contributor, if living, otherwise to his/her personal representative(s) within 21 days of the claim being substantiated to the satisfaction of Chubb. Any receipt which the contributor or anyone acting on the contributor's behalf or his/her representative(s) may give to Chubb for benefits payable shall be deemed final and complete discharge of all liability of Chubb in respect of such benefit.

General Conditions

Regardless of any amendments, the Birth and Adoption Grants will remain available to all contributors in the form outlined on this website for a minimum of 13 calendar months from the date of joining or changing schemes. This applies to all existing contributors. In the interest of the majority of the Registration, the Board of Directors of the HSF health plan health plan reserves the right to:

1. vary the range and rates of benefit and the conditions and terms relating thereto;
2. restrict or decline further payments;
3. refuse Registration or to refuse to increase or defer increase to a higher contribution without giving reasons for doing so;
4. terminate the Registration of any contributor who is in breach of the rules and conditions;
5. take legal action against anyone who makes a fraudulent claim and terminate Registration immediately;
6. use information provided on application and claim forms for the prevention and detection of crime;
7. make amendments to these rules.

In all medical matters the decision of the HSF health plan Medical Referee will be final.

Complaints

HSF health plan health plan endeavours to provide a high standard of services to contributors and welcomes comments and suggestions. Should you find it necessary to make a complaint you should write in the first instance to the Chief Executive. If your complaint is not resolved to your satisfaction it may be considered by the Board of Directors. If you are unable to accept a decision made by the Board you may request consideration by an independent complaints panel appointed by the British Health Care Association. Any complaint which cannot be settled may be referred to the Financial Ombudsman Service at South Quay Plaza 2, 183 Marsh Wall, London, E14 9SR or telephone them on 0044 845 080 1800. Full details of our complaints procedures are automatically sent on receipt of a complaint and at each stage relevant addresses are provided. Such details are available on request at all times.

Data Protection

Information which you provide to HSF health plan or Chubb at the outset of your Registration and in support of any claim will be used in the processing of claims and maintaining your records. The information may be passed to third parties to prevent and detect fraud. For a small fee you may request a copy of the details and information which we hold about you. You may apply to Data Request, HSF health plan health plan, Clare Road Mall, Clare Road, Ennis, Co Clare.

Governing Law

Cover in your scheme within this HSF health plan health plan will be governed by and interpreted in accordance with Irish Law.