General terms and conditions

Membership

Anyone may join up until their 66th birthday (providing they satisfy health requirements). Membership 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 premium, 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 membership 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). If any contributions have been paid you will receive a full refund providing that no claims have been settled during this period.

One membership also covers for benefits a spouse/partner (under 66 at the time of joining) and dependent children up to the age of 18, residing at the same address. Couples in a marriage/partnership may each have a separate membership (not necessarily in the same scheme) and both claim benefit for the same episode of treatment/consultation etc. Young people aged 16 and 17 may join in their own right but if either parent is a contributor as well, the young person will cease to be a dependant on the parent's membership.

Some medical conditions make it necessary to offer limited cover in our plans and you will be advised if this applies to your membership. Claims cannot be accepted for anything related to medical conditions existing at the time of joining or which arise during the stated qualifying periods. 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, Emergency Department, Prescription and Personal Accident are the only benefits not subject to the pre-existing condition rules, although some Personal Accident benefits may be limited if a disability or medical condition existed before the Accident.

Change of circumstances

When a contributor marries or re-marries, and wishes to include his or her spouse (and any children residing at the same address) under the membership, a further Application form must be completed and submitted to HSF health plan for approval and registration. The membership number should be shown and the form marked 'Change of Circumstances'.

A common-law spouse/partner residing at the same address is accepted by HSF health plan providing that an Application form, which also shows the full name of that spouse/partner, is completed and submitted for approval and registration.Children born in the first 10 months of membership (when it has not been possible to pay a Birth Grant) may be added as dependants on completion of an Application form. An Application form is also required for children for whom an Adoption Grant has been paid.

Any change of address must be notified to HSF health plan.

Death of a member

When a contributor dies, the spouse/partner may continue the membership if already covered and qualify for continuity of benefit as a full contributor. Any outstanding claims at the time of death will be settled as appropriate, payments being made on production of the required proof of entitlement.

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 contributor is able to increase to a higher scheme up until their 70th birthday, by completing an Application form. Qualifying periods are waived in all categories, (except the Birth and Adoption Grants) unless membership in total is less than three months. The Birth and Adoption Grants (and other benefit categories if the claim is associated with pregnancy) will still attract a 10 months' qualifying period. However, the Birth and Adoption Grants will be paid at the former scheme rate in the first ten months of membership of the new scheme, providing HSF health plan membership has exceeded 10 months at the time of the birth or adoption.

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 for flexibility (eg. Practitioners) when it is necessary to settle claims at a former scheme rate for all categories in that group.

Decreasing or ceasing contributions

While it is possible to reduce contributions by transferring to a lower scheme, membership 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. Membership of 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 membership 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 the HSF health plan within two years of the occurrence for refunding to be possible.

Claims for benefit

Claims must be made within six months of the date of the receipt or discharge from hospital, but all Personal Accident claims 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 a form provided on request by telephoning 1890 473473 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.

Claims for benefit will only be accepted where accumulated receipts total €7 or more. Benefit payments which relate to amounts paid for a service provided will be up to 50% of the cost, depending on the maximum shown. Payment will be by cheque made payable only to the named contributor.

Claims for benefit 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 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 a person registered under the membership;
  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 benefit 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 Accident 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 Accident claims

Any money due under this Policy 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 under this Policy shall be deemed a 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 membership, the Board of Directors of the Hospital Saturday Fund 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 membership or to refuse to increase or defer increase to a higher contribution without giving reasons for doing so;
  4. terminate the membership 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 membership 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 at either address [link to contact page]. 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 in the United Kingdom 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 membership 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

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