HSF

Registration

Anyone may join up until their 66th birthday (providing they satisfy health requirements). Cover 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 your contribution is paid, 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 020 7202 1380 or write to HSF health plan health plan, 24 Upper Ground, London, SE1 9PD). If any contributions have been paid you will receive a full refund providing that no claims have been settled during this period.

One registration also covers a partner (under 66 at the time of joining) and dependent children under 18, residing at the same address (this does not include children in a fostering arrangement). 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 for cover on the parent's scheme.

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 Adoptions 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 you.

These restrictions include symptoms/illnesses which develop in the future as a consequence of those declared conditions, and any which previously existed but were not disclosed. It may also be necessary to refuse claims relating to a particular area or structureof the bosy where there has been a problem in the past.

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 and consultations/treatment for cosmetic reasons; addictions (eg. alcohol, drugs); self harm or self inflicted injuries; or 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 and Personal Accident are the only categories 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.

No contributor or dependant may be registered in both an Extra Cover and a Primary Scheme. It is, however, permissible to be a contributor in one Primary Scheme and a dependant in another Primary Scheme. These rules are based on the insurance principle of not being able to make a profit from the reimbursement of any expenditure.

Change of circumstances

When a contributor marries or re-marries, and wishes to register his or her partner (and any children under 18 residing at the same address) a further Application form must be completed and submitted to HSF health plan for approval and registration. The registration number should be shown and the form marked 'Change of Circumstances'.

A common-law or civil 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 partner, is completed and submitted for approval and registration.

Children born in the first 10 months of cover (when it has not been possible to pay a Birth Grant) may be added as dependants on completion of an Application form with medical information. An Application form is also required for children for whom an Adoption Grant has been paid.

A contributor will be able to make a claim relating to a partner or child when acceptance has been confirmed and terms and conditions will be as for a new contributor.

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

Death of a contributor

When a contributor dies, the partner may become the named contributor if already covered and qualify for continuity 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 claim 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 apply to increase to a higher scheme up until their 70th birthday by completing an Application form. Acceptance may be subject to a proviso or restriction for any new health condition which may have arisen.

In transfers to any scheme, qualifying periods are waived in all categories except the following: Birth and Adoption Grants; all other categories if the claim is associated with pregnancy; Eye Laser Treatment in the Dental and Optical category only when transferring from a Primary Scheme to the Extra Cover Scheme. If it is less than three months since registration at the time of any scheme transfer all qualifying periods will apply.

Extra Cover Schemes are entirely separate from the Primary Schemes and contributors transferring to an Extra Cover Scheme from a Primary 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 Primary Schemes and Extra Cover Schemes, 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. There may be circumstances where 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. Due to scheme groupings being separate it is not possible for an Extra Cover Scheme contributor to have a claim settled at a former Primary 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 at the higher rate then ceases immediately upon transferring. If the 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 will not be refunded. Two months' written notice of cancellation 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, 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 forms provided on request by telephoning 020 7202 1381, downloading from this website or writing to HSF health plan health plan, 24 Upper Ground, London, SE1 9PD. 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 3 contributor, having served the qualifying period, could have the following Dental/Optical record:

Claim received	Amount on receipt	Amount paid
August 2006	£100	£50
October 2006	£120	£60
December 2006	£130	£65
May 2007	£50	£25
August 2007	£100	£50

Within any 12 month period benefits have not exceeded £200 and the contributor and dependants would be entitled to benefit of £60 again in October 2007.

Claims will only be accepted where accumulated receipts total £5 or more. Benefit payments which relate to amounts paid for a service provided will be up to 50% of the cost in the Primary Schemes and up to 100% of the cost in the Extra Cover Schemes, depending on the maximum shown for the scheme. Payment will be by cheque made payable only to the named contributor. A £10 fee will be levied if a replacement cheque is required following the accidental loss or destruction of the original

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 (which will not be returned unless specifically requested) 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 a person registered as a contributor or dependant;
6. be for a service covered by the HSF health plan 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 the United Kingdom and Ireland. There are no such restrictions under the Personal Accident categories. 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 from Chubb for Personal Accident 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 contributors, the Board of Directors of the HSF health plan health plan reserves the right to:

1. vary the contribution rates by giving 28 days notice to the contributors last known home address
2. vary the range and rates of benefit and the conditions and terms relating thereto;
3. restrict or decline further payments;
4. refuse a new application or to refuse to increase or defer increase to a higher contribution without giving reasons for doing so;
5. terminate the cover of any contributor who is in breach of the rules and conditions, has refused to cooperate in the process of settling a claim or whose conduct has, in the opinion of the Board, been unacceptable;
6. take legal action against anyone who makes a fraudulent claim and terminate cover immediately;
7. use information provided on application and claim forms for the prevention and detection of crime;
8. make amendments to these rules with such changes applying at the time of registration or from any subsequent written notification to the contributor.

Complaints

HSF health plan health plan endeavours to provide a high standard of service 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 [HSF health plan contact details]. 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 0845 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 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, 24 Upper Ground, London, SE1 9PD.

Governing Law

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