1. All UK residents up to the age of 60 years may join our Health Cash Plan. Once a member, your membership may continue up to any age.
2. Persons wishing to re-join the fund will be subject to a review of past claims prior to re-admittance. Re-joining less than 12 months from cancelling is not permitted, unless payment of back dues is made.
3. We reserve the right to decline applications for membership. We also reserve the right to terminate membership by giving one month’s notice.
4. Other than for known medical conditions at the time of joining, there is no qualifying period before claims can be made for hospital admissions and/or treatment. There is a qualifying period of 3 months before any other claim can be made with the exception of claims for known medical conditions on joining, where no hospital claims will be paid for the first 12 months of membership. Hospital benefits will be paid at the original rate for all known medical conditions for the first 12 months from upgrading. There is no qualifying period if a hospital admission or attendance is required because of an accident.
5. Maternity benefits are neither payable within 12 months of joining the Fund nor at the increased rate within 12 months of upgrading from an existing scheme. In the case of upgrading, the benefit will be paid at the previous scheme benefit level.
6. We do not pay for any amounts that a hospital or doctor or other persons may charge for completing your claim form and/or for medical information requested by us in support of your claim. These charges will be your responsibility.
7. Benefits: - a. Will only be paid when contributions are paid up to date at the date of a claim. b. Will only be paid to UK residents. c. Are reviewed periodically by the Fund’s Directors. d. Will not be paid where the amount payable is less than £1.00.
8. All claimants will need to satisfy the Fund with validity of their membership and claims. Personal and/or employment details may be requested.
9. To claim Hospital In-Patient (partner)/(child) benefit, the contributor and legitimate spouse/partner/child must reside at the same address. The contributor cannot claim this benefit for any other member of their family residing at the same address.
10. Hospital In-patient – Member’s Child Benefit will cease on the child’s 16th birthday.
11. It is your responsibility to ensure that your contributions are paid at the correct rate and frequency (not applicable to corporate members).
12. We reserve the right to recover any overpayment of benefits paid to you.
13. Maximum Rule: For In-patient (Member), Out-patient, Hospital Day Surgery and Medical Specialist Fees, the maximum amount of benefit payable, dependent on the plan chosen, is the equivalent of ten weeks In-patient benefit in any five year treatment period. The same limitation applies to the maximum amount of benefit payable for In-patient (Partner) and In-patient (Member’s Child).
14. Changing your mind: - You have 14 days from receipt of your welcome pack in which to change your mind and cancel your membership. This is provided no claims have been made within this period. After this period standard cancellation rights apply.
15. Should you subsequently wish to cancel, we require one month’s notice of cancellation in writing to the Fund’s office at 13 Cardiff Road, Newport NP20 2EH.
16. We will give you one month’s notice by post, at the address shown in our records, of any increase in contributions or any changes made to your benefits and conditions.
17. To protect all members, if we feel it is appropriate we will take legal action against anyone who makes a dishonest or fraudulent claim.
18. Complaints: - Gwent Hospitals Contributory Fund strives to provide all members with the highest levels of customer service. We hope you never have reason to complain about our service, but if you do, in the first instance please write to our Chief Executive at 13 Cardiff Road, Newport NP20 2EH. If you are not happy with our Chief Executive’s response your complaint will be forwarded to the Fund’s Executive Board of Directors. If you are not happy with the Board’s response you may have the right to refer your complaint to the Financial Ombudsman Service: - Telephone: 0845 080 1800
E-mail: complaint.info@financial-ombudsman.org.uk Letter: Financial Ombudsman Service, South Quay Plaza, 183 Marsh Wall, London E14 9SR For further information, website: www.financial-ombudsman.org.uk
Terms and Conditions for Corporate Customers
1. All UK residents up to the age of 60 years may join our Health Cash Plan. Once a member, your membership may continue up to any age.
2. Persons wishing to re-join the fund will be subject to a review of past claims prior to re-admittance. Re-joining less than 12 months from cancelling is not permitted, unless payment of back dues is made.
3. We reserve the right to decline applications for membership. We also reserve the right to terminate membership by giving one month’s notice.
4. There is a qualifying period of 3 months before any claim can be made against a new membership. For known medical conditions on joining, no hospital claims will be paid for the first 12 months. Hospital benefits will be paid at the original rate for all known medical conditions for the first 12 months from upgrading. There is no qualifying period if a hospital admission or attendance is required because of an accident.
5. Maternity benefits are neither payable within 12 months of joining the Fund nor at the increased rate within 12 months of upgrading from an existing scheme. In the case of upgrading, the benefit will be paid at the previous scheme benefit level.
6. We do not pay for any amounts that a hospital or doctor or other persons may charge for completing your claim form and/or for medical information requested by us in support of your claim. These charges will be your responsibility.
7. Benefits: - a. Will only be paid when contributions are paid up to date at the date of a claim. b. Will only be paid to UK residents. c. Are reviewed periodically by the Fund’s Directors. d. Will not be paid where the amount payable is less than £1.00.
8. All claimants will need to satisfy the Fund with validity of their membership and claims. Personal and/or employment details may be requested.
9. For Partner/Family membership to claim Hospital In- Patient (partner)/(child) benefit, the contributor and legitimate spouse/partner/child must reside at the same address. The contributor cannot claim this benefit for any other member of their family residing at the same address.
10. Benefit for contributors’ enrolled children will cease on their 18th birthday.
11. It is your responsibility to ensure that your contributions are paid at the correct rate and frequency (not applicable to corporate members).
12. We reserve the right to recover any overpayment of benefits paid to you.
13. Changing your mind: - You have 14 days from receipt of your welcome pack in which to change your mind and cancel your membership. This is provided no claims have been made within this period. After this period standard cancellation rights apply.
14. Should you subsequently wish to cancel, we require one month’s notice of cancellation in writing to the Fund’s office at 13 Cardiff Road, Newport NP20 2EH.
15. We will give you one month’s notice by post, at the address shown in our records, of any increase in contributions or any changes made to your benefits and conditions.
16. To protect all members, if we feel it is appropriate we will take legal action against anyone who makes a dishonest or fraudulent claim.
17. Complaints: - Gwent Hospitals Contributory Fund strives to provide all members with the highest levels of customer service. We hope you never have reason to complain about our service, but if you do, in the first instance please write to our Chief Executive at 13 Cardiff Road, Newport NP20 2EH. If you are not happy with our Chief Executive’s response your complaint will be forwarded to the Fund’s Chairman. If you are not happy with the Chairman’s response you may have the right to refer your complaint to the Financial Ombudsman Service: - Telephone: 0845 080 1800 complaint.info@financial-ombudsman.org.uk Letter: Financial Ombudsman Service, South Quay Plaza, 183 Marsh Wall, London E14 9SR For further information, website: www.financial-ombudsman.org.uk
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