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Health-on-Line - Personal Choice

SUMMARY OF THE ‘PERSONAL CHOICE’ PLAN
Essential Cover

The Essential Cover benefits provide cover for private in-patient and day-patient treatment at a hospital listed in the Directory of Hospitals including associated specialists’ charges. In addition it provides cover for out-patient surgical procedures and radiotherapy and chemotherapy.

In addition, specialist supervised computerised tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) scans are paid in full at a scanning centre that is listed in the Directory of Hospitals. An out of directory scanning cash benefit of £50 is available for scanning centres that are not listed in the Directory of Hospitals.

The principal exclusions are pre-existing medical conditions, chronic conditions, general dental procedures and specialist fees that fall outside the level detailed within our published schedule of procedures and fees. Out-patient consultation fees, diagnostic tests and clinical practitioner charges unless your client has Essential Extra, Option 1 or 2, complementary practitioners’ and physiotherapists’ charges unless your client has Option 3, general dental procedures unless your client has Option 7, routine pregnancy and childbirth, psychiatric treatment unless Option 4 has been chosen and Travel unless your client has chosen Option 8.

Essential Extra

In addition to the benefits available under Essential Cover, this option will also meet the cost of up to two out-patient Specialist Consultations per person, per policy year. Additionally, cover will also be provided for eligible out-patient diagnostic tests on Specialist referral.

Six Week Option

If this option is chosen there is no benefit for urgent or emergency treatment or if the National Health Service could provide the in-patient, day-patient treatment or out-patient surgical procedure within six weeks after the date on which the treatment should be undertaken.

Option 1 – Standard Out-patient Cover

This option meets the costs of out-patient specialist consultations, diagnostic tests on specialist referral and clinical practitioner charges up to a maximum of £1,000 a year.

Option 2 - Comprehensive Out-patient Cover

This option meets the costs of out-patient specialist consultations, diagnostic tests on specialist referral and clinical practitioner charges with no annual maximum.

Option 3 – Therapies

This option provides benefit for complementary practitioner charges and physiotherapist charges. These two benefits have a combined overall annual limit of £1000. Within the above limit, benefit is available for up to 10 sessions of treatment a year for GP referred physiotherapy and/or complementary practitioner treatment. Any further physiotherapy and/or complementary practitioner treatment must be under the control of the specialist.

Option 4 – Psychiatric Cover

This option provides cover for eligible in-patient and day-patient psychiatric treatment on a full refund basis at a private hospital or day-patient unit listed in the Directory of Hospitals. In addition, this option may provide cover for eligible out-patient psychiatric specialist consultations and clinical practitioners’ charges for psychiatric treatment.

Option 5 – Ancillary Benefits

This option provides cover for hospital-at-home, NHS Cash Benefit, specified oral surgical procedures and chiropody. Reference must be made to Health-on-Line’s membership handbook for a full list of all the benefits that are available under this option and the terms and conditions applicable.

Option 6 – Optional Excesses

This option gives the choice to include an optional excess of £100 or £250 or £500 in return for a discount.

In practice, this will result in the member assuming responsibility for the excess amount of any eligible claims made at a future date. The optional excess is applied per person, per policy year and is in addition to the £100 compulsory excess that applies to the policy per person, per policy year.

Option 7 – Dental and Optical Cash Benefit

This option provides cover for (a) 80% of the costs of eligible dental care up to a maximum of £150 each year and (b) 80% of the cost up to a maximum of £140 each year for prescribed spectacles and contact lenses needed to correct vision. This option also provides you with £25 of cover towards the cost of eye tests in each policy year.

Option 8 – Annual Travel Cover

This option provides cover towards the cost of emergency medical treatment abroad. The travel option has the major benefits of other annual travel insurance policies such as medical costs, additional expenses and delayed departure. Reference must be made to the Travel Membership Handbook which details the full terms and conditions applicable to this option.

Option 9 – Extended Cancer Cover

Option 2 of the policy includes cover for the out-patient investigation and treatment of cancer which arises after the start of the policy. This includes radiotherapy or chemotherapy, alone or in combination. In addition to the traditional cancer treatment covered by the plan under Essential Cover, members will also have up to 12 months cover, subject to the policy terms and conditions, for licensed chemotherapy drug treatments (such as Herceptin and Avastin) which may be needed for a prolonged period of time.

If Options 2 – Comprehensive out-patient and Option 9 – Extended Cancer Cover have been chosen, members will have up to 36 months cover for these drugs.

Benefits

Option 1: Standard out-patient	All Yes No
Option 2: Comprehensive o/p	All Yes No
Option 3: Therapies	All Yes No
Option 4: Psychiatric	All Yes No
Option 5: Ancillary benefits	All Yes No
Option 7: Dental / Optical	All Yes No
Option 8: Annual Travel	All Yes No
Option 9: Extended Cancer	All Yes No
Essential Extra	All Yes No
Six Week Option	All Yes No

Key Facts - In-patient & Day Case Charges
Hospital accommodation charges including theatre fees, nursing costs, prosthesis, in-patient drugs & dressings
	Essential cover - No annual maximum
Surgeon / Consultant / Specialist & Anaesthetists fees
	Essential cover - No annual maximum
Physicians fees & diagnostic tests
	Essential cover - No annual maximum
Cancer Treatment Costs - Chemotherapy / Radiotherapy
	Essential cover - No annual maximum at a hospital listed in the directory of hospitals
Psychiatric treatment
Option 4: Psychiatric - No	Not covered
Option 4: Psychiatric - Yes	Option 4 - Psychiatric No annual maximum at a hospital listed in the directory of hospitals
Six week option
Six Week Option - No	Available but not selected
Six Week Option - Yes	Six week rule - if the NHS can not provide treatment within six weeks after the date on which treatment should be undertaken then private treatment can be sort. Immediate cover - AXA will pay for the following surgical procedures on an in-patient basis regardless of the fact that treatment could be obtained on the NHS within six weeks of the specialist confirming that this is needed: * varicose veins surgery * tonsillectomy * insertion of grommets * removal of bunions (hallux valgus) * removal of gall bladder - (laparoscopic chlolecystectomy) * haemorrhoidectomy * adenoidectomy * correction of squint * cataract surgery
Key Facts - Out-patient Charges
Complementary medicine
Option 3: Therapies - No	Not covered
Option 3: Therapies - Yes	Option 3 - Therapies up to £1,000 per person per policy (Max of 10 sessions of treatment a year for GP referred treatment with a complementary practitioner or Physiotherapist) Any further treatment must be under the control of a Specialist
Diagnostic tests (excluding scans)
	Not covered
Essential Extra - Yes	Essential Extra No annual maximum for diagnostic tests
Option 1: Standard out-patient - Yes	Option 1 - Standard Out-patient Paid from overall £1,000 annual out-patient limit Specialist consultations and diagnostic procedures including pathology and radiology
Option 2: Comprehensive o/p - Yes	Option 2 - Comprehensive Out-patient No annual maximum for Specialist consultations and diagnostic tests
GP referred consultations
	Not covered
Option 1: Standard out-patient - Yes	Option 1 - Standard Out-patient Paid from overall £1,000 annual out-patient limit
Option 2: Comprehensive o/p - Yes	Option 2 - Comprehensive Out-patient No annual maximum
Physiotherapy consultant referred
Option 3: Therapies - No	Not covered
Option 3: Therapies - Yes	Option 3 - Therapies Up to £1,000 per person, per policy year towards treatment by Physiotherapists, Chiropractors, Homeopaths or Acupuncturists
Physiotherapy GP referred
Option 3: Therapies - No	Not covered
Option 3: Therapies - Yes	Option 3 - Therapies up to £1,000 per person per policy (Max of 10 sessions of treatment a year for GP referred treatment with a complementary practitioner or Physiotherapist) Any further treatment must be under the control of a Specialist
Psychiatric cover
Option 4: Psychiatric - No	Not covered
Option 4: Psychiatric - Yes	Option 4 - Psychiatric No annual maximum for the in-patient, day-patient or out-patient treatment / investigations of psychiatric conditions at a hospital listed in the directory of hospitals
Radiotherapy / Chemotherapy
	Essential cover - No annual maximum
Scans - MRI / CT / PET
	Essential cover - Full refund for MRI, CT and PET scans if carried out at a scanning centre listed in the directory of hospitals
Surgical Procedures
	Essential cover - Full refund for out-patient surgery
Key Facts - Additional Benefits
NHS cash benefit
Option 5: Ancillary benefits - No	Not covered
Option 5: Ancillary benefits - Yes	Option 5 - Ancillary Benefits £100 per night (max 20 nights per person, per policy year under
Nursing at home
	Essential cover - Full cover (for administration of intravenous cytoxic chemotherapy or intravenous antibiotics which would otherwise require the member to be admitted for in-patient or day-case treatment)
Parental accommodation
	Essential cover - Full cover (child up to 14 years old)
Private ambulance
	Essential cover - Full cover between hospital in the UK
Additional Benefits
Alcohol & drug abuse
	Not covered
Annual maximum limit
	Essential cover - No annual maximum
Children covered
	Unmarried dependents can be insured under a parent’s policy up to the age of 25
Chiropractors & Osteopaths
Option 3: Therapies - No	Not covered
Option 3: Therapies - Yes	Option 3 - Therapies 10 sessions pa max for GP referred treatment within overall £1,000 limit
Dental treatment
	Not covered
Option 5: Ancillary benefits - Yes	Option 5 - Ancillary Benefits No annual maximum for certain oral surgical procedures only
Option 7: Dental / Optical - Yes	Option 7 - Dental & Optical Cash Benefit Limited cash benefit of £150 is available under the dental and optical cash benefit option
Hospice donation
	Not covered
Infertility investigations
	Not covered
Maternity cash benefit
	Not covered
Optional cash benefit
Option 7: Dental / Optical - No	Not covered
Option 7: Dental / Optical - Yes	Option 7 - Dental & Optical Cash Benefit * Dental care 80% of the costs incurred will be paid, up to £150 each year * Optical cover 80% of the costs incurred will be paid, up to £140 every year for prescribed spectacles and contact lenses needed to correct vision * Eye test Up to £25 each year for an eye test
Out of pocket expenses
	Not covered
Overseas cover
Option 8: Annual Travel - No	Not covered
Option 8: Annual Travel - Yes	Option 8 - Travel See the Health-on-Line travel cover handbook for details of the benefits
Personal & total disability benefit
	Not covered
Post hospital recovery bonus
	Not covered
Pregnancy
	Cover available for complications of pregnancy only. Please refer to the Personal Choice membership handbook for further details
Transplants
	Not covered

Key Facts - In-patient & Day Case Charges

Hospital accommodation charges including theatre fees, nursing costs, prosthesis, in-patient drugs & dressings

Essential cover - No annual maximum

Surgeon / Consultant / Specialist & Anaesthetists fees

Essential cover - No annual maximum

Physicians fees & diagnostic tests

Essential cover - No annual maximum

Cancer Treatment Costs - Chemotherapy / Radiotherapy

Essential cover - No annual maximum at a hospital listed in the directory of hospitals

Psychiatric treatment

Option 4: Psychiatric - No

Not covered

Option 4: Psychiatric - Yes

Option 4 - Psychiatric
No annual maximum at a hospital listed in the directory of hospitals

Six week option

Six Week Option - No

Available but not selected

Six Week Option - Yes

Six week rule - if the NHS can not provide treatment within six weeks after the date on which treatment should be undertaken then private treatment can be sort.
Immediate cover - AXA will pay for the following surgical procedures on an in-patient basis regardless of the fact that treatment could be obtained on the NHS within six weeks of the specialist confirming that this is needed:
* varicose veins surgery
* tonsillectomy
* insertion of grommets
* removal of bunions (hallux valgus)
* removal of gall bladder - (laparoscopic chlolecystectomy)
* haemorrhoidectomy
* adenoidectomy
* correction of squint
* cataract surgery

Key Facts - Out-patient Charges

Complementary medicine

Option 3: Therapies - No

Not covered

Option 3: Therapies - Yes

Option 3 - Therapies
up to £1,000 per person per policy (Max of 10 sessions of treatment a year for GP referred treatment with a complementary practitioner or Physiotherapist) Any further treatment must be under the control of a Specialist

Diagnostic tests (excluding scans)

Not covered

Essential Extra - Yes

Essential Extra
No annual maximum for diagnostic tests

Option 1: Standard out-patient - Yes

Option 1 - Standard Out-patient
Paid from overall £1,000 annual out-patient limit Specialist consultations and diagnostic procedures including pathology and radiology

Option 2: Comprehensive o/p - Yes

Option 2 - Comprehensive Out-patient
No annual maximum for Specialist consultations and diagnostic tests

GP referred consultations

Not covered

Option 1: Standard out-patient - Yes

Option 1 - Standard Out-patient
Paid from overall £1,000 annual out-patient limit

Option 2: Comprehensive o/p - Yes

Option 2 - Comprehensive Out-patient
No annual maximum

Physiotherapy consultant referred

Option 3: Therapies - No

Not covered

Option 3: Therapies - Yes

Option 3 - Therapies
Up to £1,000 per person, per policy year towards treatment by Physiotherapists, Chiropractors, Homeopaths or Acupuncturists

Physiotherapy GP referred

Option 3: Therapies - No

Not covered

Option 3: Therapies - Yes

Psychiatric cover

Option 4: Psychiatric - No

Not covered

Option 4: Psychiatric - Yes

Option 4 - Psychiatric
No annual maximum for the in-patient, day-patient or out-patient treatment / investigations of psychiatric conditions at a hospital listed in the directory of hospitals

Radiotherapy / Chemotherapy

Essential cover - No annual maximum

Scans - MRI / CT / PET

Essential cover - Full refund for MRI, CT and PET scans if carried out at a scanning centre listed in the directory of hospitals

Surgical Procedures

Essential cover - Full refund for out-patient surgery

Key Facts - Additional Benefits

NHS cash benefit

Option 5: Ancillary benefits - No

Not covered

Option 5: Ancillary benefits - Yes

Option 5 - Ancillary Benefits
£100 per night (max 20 nights per person, per policy year under

Nursing at home

Essential cover - Full cover (for administration of intravenous cytoxic chemotherapy or intravenous antibiotics which would otherwise require the member to be admitted for in-patient or day-case treatment)

Parental accommodation

Essential cover - Full cover (child up to 14 years old)

Private ambulance

Essential cover - Full cover between hospital in the UK

Additional Benefits

Alcohol & drug abuse

Not covered

Annual maximum limit

Essential cover - No annual maximum

Children covered

Unmarried dependents can be insured under a parent’s policy up to the age of 25

Chiropractors & Osteopaths

Option 3: Therapies - No

Not covered

Option 3: Therapies - Yes

Option 3 - Therapies
10 sessions pa max for GP referred treatment within overall £1,000 limit

Dental treatment

Not covered

Option 5: Ancillary benefits - Yes

Option 5 - Ancillary Benefits
No annual maximum for certain oral surgical procedures only

Option 7: Dental / Optical - Yes

Option 7 - Dental & Optical Cash Benefit
Limited cash benefit of £150 is available under the dental and optical cash benefit option

Hospice donation

Not covered

Infertility investigations

Not covered

Maternity cash benefit

Not covered

Optional cash benefit

Option 7: Dental / Optical - No

Not covered

Option 7: Dental / Optical - Yes

Option 7 - Dental & Optical Cash Benefit
* Dental care 80% of the costs incurred will be paid, up to £150 each year
* Optical cover 80% of the costs incurred will be paid, up to £140 every year for prescribed spectacles and contact lenses needed to correct vision
* Eye test Up to £25 each year for an eye test

Out of pocket expenses

Not covered

Overseas cover

Option 8: Annual Travel - No

Not covered

Option 8: Annual Travel - Yes

Option 8 - Travel
See the Health-on-Line travel cover handbook for details of the benefits

Personal & total disability benefit

Not covered

Post hospital recovery bonus

Not covered

Pregnancy

Cover available for complications of pregnancy only. Please refer to the Personal Choice membership handbook for further details

Transplants

Not covered


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