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Issue 3 - Effective from 01/04/15onemedifund scheme handbook

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Section Page

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1 The medical helpline and authorisation 04

2 Your personalised ID card 05

3 Calling the medical helpline 05

4 How to use the scheme 04

4.1 If you are suffering from a musculoskeletal injury or think you may need treatment such as physiotherapy. 06

4.2 When your GP confirms your requirement for a diagnostic test or to see a specialist/therapist. 07

4.3 When you see the specialist. 08

4.4 If your specialist recommends diagnostic tests, treatment, nursing at home, or out-patient treatment. 08

4.5 If, or when you receive an invoice or receipt for treatment, or require reimbursement for payments made by yourself for treatment in accordance with the scheme. 08

5 Summary of what the Edge plan 09scheme will pay for

6 Changes to your registration 10

6.1 Adding a new-born 10

6.2 Maximum age dependants 10

6.3 Leaving the scheme 11

6.4 Death of member 11

6.5 Leaving the Edge plan and moving to another plan 11

Section Page

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7 General conditions 12

8 Payment and reimbursement 12

9 Claims procedure 14

10 Doctor@Hand 15

10.1 What the Doctor@Hand benefit allows 15

10.2 How to access Doctor@Hand 15

11 The Health Gateway 16

11.1 Who can use the Xavi Health Gateway 16

11.2 How to access the Xavi Health Gateway 16

12 Summary of benefits 17

13 Overriding effect of these conditions 17

14 Data Protection Act 1998 17

15 Medical information 18

16 Communication 18

17 Other notes on benefits 18

18 Complaints 19

19 Law 19

20 Useful contact details 20

21 Useful website links 20

Appendices 21

EA1 Table of benefits 22

EA2 Definitions 24

EA3 Exclusions 26

EA4 Subscribers’ duties 27

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Your onemedifund healthcare scheme will pay for fast access to privatetreatment by top consultants for eligible acute medical condi!ons,regardless of NHS wai!ng !mes. This includes consulta!ons, diagnos!ctests, physiotherapy and associated follow up treatment, subject to theterms and condi!ons and benefit limits.

Acute medical condi!ons are those condi!ons that are likely to respondquickly to treatment to return you to your normal state of health or a fullrecovery. They do not include long term or ongoing medical condi!ons forwhich there is currently no remedy.

The scheme is operated in accordance with the terms of the onemedifundhealthcare trust, which is a self funded trust set up specifically for thispurpose. The trust retains the services of a specialist healthcareadministrator to manage the benefits of the scheme on its behalf.

Your healthcare scheme does not cover every type of healthcare service ortreatment, therefore it is important that you read this handbook carefullyand check with our medical helpline on 03000 70 70 70.

Please keep this handbook somewhere safe for quick referenceand ensure you are using the latest version.See the handbook front cover for issue number and date.

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1 The medical helpline and authorisationThere is a dedicated medical helpline available to make accessingprivate treatment as easy as possible. As there are some healthcarecosts that your scheme will not pay for, it is important that you contactthe helpline before arranging treatment. This enables an experiencedadvisor or nurse to answer any ques!ons you may have, and check thatyour specialist and proposed treatment will be paid for by the scheme.

• You must get authorisa!on by calling the onemedifund medicalhelpline on 03000 70 70 70 prior to treatment. When you call youwill be asked some ques!ons to confirm your cover, such as:

­ What medical condi!on are you suffering from? ­ When did your symptoms begin? ­ When did you first see your GP about this condi!on? ­ What is the name of your specialist/therapist,

or do you not have one yet? ­ What treatment has been recommended? ­ When is your treatment due to take place?

• You must also check with the medical helpline at each stage ofyour diagnosis, treatment or ongoing care, as further authorisa!onor re­confirma!on may be required.

Authorisa!on is specific to each stage of your treatment or care so it isimportant that you re­confirm your authorisa!on with the helpline ateach stage of your treatment.

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• If your treatment stage is authorised you will be provided with anauthorisa!on code. The helpline team will also recommend whenyou should call back for further authorisa!on (if needed).

If you undergo treatment that has not been authorised you will beresponsible for any costs incurred.

Your personalised ID card includes the medical helpline number along with your personalised scheme iden!fica!on number.

3 Calling the medical helplineContact the medical helpline, quo!ng your personal iden!fica!onnumber, before you receive treatment or if you are unsure as to any aspect of the scheme benefits.

03000 70 70 70Monday to Friday 8am to 8pm. Saturday 8am to 1pm.Your calls may be recorded and monitored fortraining and quality assurance purposes.

2 Your personalised ID card

Subscriber name

A. SUBSCRIBER

123456789Personal ID number

Rossmore House, Rossmore Road East, Ellesmere Port, CH65 3DA | www.onemedifund.com

Email: claims@onemedifund.com03000 70 70 70Medical Helpline

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4 How to use the schemeBe guided by your GP who provides a vital link to the privatehealthcare system. Your GP should always be consulted first exceptin an emergency or when you require physiotherapy (or osteopathicand/or chiroprac!c treatment from a recognised prac!!oner).

If you require treatment or care under your scheme, you shouldcontact the medical helpline for authorisa!on before each stage ofyour treatment. If you do not do this you will be responsible for anycosts incurred. The medical helpline is staffed by experienced advisorsand nurses who will guide you through your claim and advise youabout the terms and condi!ons and benefit limits of the scheme.

Remember that some treatments are available through the NHS.

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• Call the medical helpline on 03000 70 70 70 as soon as possible.

Your healthcare scheme has special arrangements for the treatmentof musculoskeletal injuries, through a managed network ofphysiotherapists, without the need for a GP referral.

A GP referral is also not required for physiotherapy, osteopathic andchiroprac!c treatment outside of the network as long as theprac!!oner is recognised by onemedifund/the scheme administrator.

Please call the medical helpline on 03000 70 70 70 beforecommencing physiotherapy, osteopathic and chiroprac!c treatmentoutside of the scheme network.

The scheme defini!on of a recognised therapist is as follows:

a) A Physiotherapist registered with the Health Care Professions Council.

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b) An Osteopath who is a professionally qualified member of The Statutory Register of Osteopaths administered by the General Osteopathic Council.

c) A Chiropractor who is a professionally qualified member of The Statutory Register of Chiropractors administered by the General Chiroprac!c Council.

d) An Acupuncturist registered with:i) The Bri!sh Acupuncture Council orii) The Bri!sh Medical Acupuncture Society oriii) The Acupuncture Associa!on of Chartered Physiotherapists.

e) A Homeopath who is a member of the Faculty of Homeopaths and who is medically qualified.

f) A Podiatrist registered with the Health Care Professions Council carrying out Gait Analysis or Biomechanical Studies on the referral of a specialist.

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• Inform your GP that you are part of a private healthcare scheme.

a) Advise your GP if you have a specialist and/or hospital that you would like to be referred to, or

b) Ask your GP if he/she can recommend a specialist and/or hospital, orc) If you want to go to your local private hospital ask your GP for an

open referral to that hospital.d) onemedifund cannot give a referral or make recommenda!ons

for specific hospitals and/or specialists, although we can supply alist of op!ons available in your area.

• Call the medical helpline on 03000 70 70 70 to discuss.

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wsb Ipaoecr7euaaenpaeuya.ltmluns• Take your authorisa!on le$er with you.

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• Call the medical helpline on 03000 70 70 70 for authorisa!on before arranging this.

• If the medical helpline is closed then it is vital that you contact usat the earliest opportunity on the next day the helpline is open toauthorise your treatment.

Medical helpline opening hours: Monday to Friday 8am ­ 8pm. Saturday 8am to 1pm.

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• You will need to forward these within six months of treatment. Scanned copies should be emailed to:claims@onemedifund.com

Alterna!vely documents can be posted to:onemedifund PO BOX 3070, BRISTOL, BS1 9FT

Please make sure to include your name, pa!ent’s name (if different)and your/their onemedifund personal ID number.

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5 Summary of what the Edge plan scheme will pay forYour scheme is designed to pay for the treatment of curable short­term disease, illness or injury (known as acute condi!ons). Please note that the Edge plan scheme has an annual maximumbenefit limit of £1000 per person.

For full details please refer to the:Table of benefits (sec"on EA1, pages 22­23). Condi"ons of the Edge plan scheme (sec"ons 7­19, pages 12­19). Details are also available on www.onemedifund.com

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6 Changes to your registrationIndividuals who are eligible to join the scheme are defined by theonemedifund trust rules.

Fs8 :hhlo1eteoaHO2rioA new­born child may be added to your scheme from their date ofbirth without the need to provide a health declara!on, providingonemedifund has received no!fica!on in wri!ng, (or emailadmin@onemedifund.com), within six months of their birth.

A new­born will have no qualifica!on period if it is registered withthe registra!on helpdesk within six months of its birth, subject tothe parents qualifica!on period.

FsC 3txl070et1aehayaohtonuChildren registered on the scheme will remain a part of it un!l theregistra!on renewal date following the earlier of their 25th birthdayor marriage.

Should they wish to con!nue their registra!on as an ‘adult’, thischange of registra!on will have no wai!ng period.

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Fsb &at5lo1enpaeu.pa0aIf you choose to cancel your registra!on (or you are no longereligible under the terms and condi!ons of the scheme), costsincurred a$er your leaving date will not be paid for by the schemeeven if they have been authorised by onemedifund before you leavethe scheme.

Should you wish to re­join the scheme, you will be treated as a newsubscriber and subject to the rules applicable.

Fsw GatnperMe0a02aiIf a member of a registra!on dies, please no!fy onemedifund inwri!ng (or email admin@onemedifund.com), advising the date of death.

FsW &at5lo1enpae4h1aeymtoetohe0r5lo1enretornpaieymtoYou can leave the Edge plan only at the scheme anniversary date(1st August) subject to giving onemedifund no!ce in wri!ng at least1 month in advance.

If you leave Edge and move to another onemedifund plan thestandard terms and condi!ons for that plan will apply.

Subscribers can NOT be registered on the Edge plan and the Goldor Silver plan at the same !me.

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7 General conditions7.1 Your benefits under the healthcare scheme will cease on the day

that you leave the scheme.

a) onemedifund reserves the right to discon!nue your benefits if asubscrip!on is more than 31 days in arrears, or if you are inbreach of the scheme’s terms and condi!ons.

b) onemedifund will not refund your subscrip!on to your executors on your death.

7.2 onemedifund reserves the right to refuse to renew, cancel or vary the healthcare scheme at any !me despite any other terms if you have:

a) not acted in good faith and/or misled onemedifund or the administrator by mis­statement and/or withheld material facts, or

b) breached the terms and condi!ons of this healthcare scheme.

7.3 Onemedifund will not pay benefits unless you have pre­authorisedyour treatment via the scheme’s medical helpline service.

If you incur treatment costs without authorisa!on in advancebenefits will not be paid.

8 Payment and reimbursement8.1 onemedifund will pay the actual cost of any treatment up to the

maximum amount (if any) specified in the table of benefitsapplicable at the !me treatment was received.

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8.2 onemedifund will reimburse you for the cost of podiatry orosteopathic/chiroprac!c treatment (that you may have outside theapproved network), subject to your treatment being eligible and inaccordance with the terms and condi!ons.

8.3 onemedifund will pay benefit for treatment of acute condi!onswhich sa!sfy the following condi!ons:

a) It must have been given for a specific medical condi!on and havebeen referred by the member’s GP, except where treatment hasbeen received through the physiotherapy network whenauthorised by the medical helpline.

b) In cases where it was not possible for your GP to have priorknowledge of the treatment because of an emergency,onemedifund will pay benefit for eligible treatment providedyour GP has been kept fully informed of the treatmentundertaken and supports the claim.

c) It must have been supervised by a specialist. In cases where thetreatment has been given by a therapist, onemedifund will paybenefit for the first eight sessions of treatment or as deemednecessary by the administrator without them having beensupervised by a specialist.

See sec"on EA1.1, page 22, Table of benefits.

d) It must be given by a specialist, nurse or therapist.

e) If it was for an allergy, it must have been given by a specialistwho holds a consultant posi!on within that specialty in an NHShospital at the !me such treatment was provided.

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9 Claims procedure9.1 If you require treatment funded by the scheme, you must no!fy the

onemedifund medical helpline about all treatment before it occurs.The administrator will confirm whether the proposed treatment iseligible under your scheme.

9.2 If you do not no!fy the onemedifund medical helpline about anytreatment, in advance of the treatment being provided, the costswill not be covered under the scheme.

9.3 If you are unable to obtain authorisa!on for treatment because it is an emergency, you must no!fy the medical helpline as soon aspossible a$er the event. Your GP must be kept informed of yourcircumstances to enable him/her to support your claim in retrospect.

9.4 You must submit a completed claim form, if required to do so, andprovide suppor!ng itemised invoices/receipts within six months ofthe treatment being received.

Claim forms can be downloaded from:www.onemedifund.com/how­to­claim Or call the medical helpline.

9.5 onemedifund can pay any benefit due directly to the healthcareprovider, to you or to a legally appointed representa!ve.

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10 Doctor@HandDoctor@Hand is provided by Doctor Care Anywhere and is avirtual private GP service, offering you and your subscribed familymembers online video or telephone consultations wherever youmay be in the world.

8ds8 Iptnenpae2aoaMlnetmmrHueYou can use Doctor@Hand for any medical condition or concern.The benefit allows up to 3 (three) consultations, per familymember, per benefit year (1st August ­ 31st July). Additionalconsultations can be purchased at the member's own cost.

8dsC vrHenret..auueGr.nriBvtoha) Register using the link as soon as you receive the email

invitation from Doctor Care Anywhere.

b) Book an appointment online at: doctorcareanywhere.com­ For Android devices you can use the Doctor Care Anywhere

app available to download from the Google Play Store.­ For IOS devices you can use the Doctor Care Anywhere

app available to download from the App store.

c) Choose your appointment time: 8am to 10pm (UK time), 7 days/weeks, 365 days/year.

d) If the private GP has prescribed medication, this can be delivered to an address of your choice. Private prescription and delivery charges apply.

e) Should further treatment be required, Doctor Care Anywherewill arrange for a referral to be sent directly to the onemedifundMedical helpdesk and a personal care advisor will contact you toarrange your treatment, (based on the benefits available in theEdge subscrip!on plan).

For minimum IT system requirements see: www.onemedifund.com/doctorathand

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11 The Xavi Health GatewayThe Gateway is a single online health and wellbeing destination.It’s packed with tools and insight, and has the capability to learnabout your state of health and fitness and respond to your choicesand interests and offers.

88s8 Ipre.toe7uaenpae9t5levatmnpeRtnaHtceeThe Xavi Health Gateway is available to each subscribed familymember. However, the content, tools and health age calculatorare designed for adults. Therefore we recommend that gatewayusers are over 18 years.

To get the most from the service users should only ever login andaccess the gateway using their personal registration details.

88sC vrHenret..auue9t5levatmnpeRtnaHtca) Register at: www.axappphealthcare.co.uk/onemedifund

b) For the first ques!on “Are you registering with” select “Entitlement Code”.

c) Enter the Entitlement Code:29G4­JY11

d) Complete the remaining questions to finalise your personalregistration and begin calculating your health age.

For minimum IT system requirements see:www.onemedifund.com/gateway

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12 Summary of benefits12.1 Benefits can only be claimed for treatment specified in the table of

benefits of the scheme.

See sec"on EA1, pages 22­23, Table of benefits.

12.2 The table of benefits may change or be reviewed during thecon!nuance of the scheme.

13 Overriding effect of these conditions13.1 If any of these terms and conditions are inconsistent with the

current governing documentation of the scheme, then these termsand conditions amend the scheme in accordance with thegoverning documentation.

13.2 No amendments will be made to the scheme which are inconsistentwith the scheme requirements as defined in the trust deeds.

14 Data Protection Act 199814.1 Your informa!on (including informa!on you provide now or in the

future or that we already hold, as well as informa!on about thoseno longer in the scheme) will be held on a database.

14.2 Your informa!on will be used for claims se&lement andadministra!on purposes, research and sta!s!cal purposes, qualityassurance and all purposes rela!ng to the opera!on of the scheme.In the course of performing our obliga!ons to you, your informa!onmay be disclosed to third par!es, in the UK and beyond, appointedby onemedifund, including healthcare providers.

14.3 You have the right to access (subject to limited excep!ons) and ifnecessary rec!fy the informa!on that we hold about you.

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15 Medical information15.1 For the avoidance of doubt, onemedifund will not hold informa!on

about your specific medical condi!on, which will remainconfiden!al between you and your medical advisors

16 Communication16.1 All documents regarding your scheme registra!on and any claim will

be sent to the principal contributor.

17 Other notes on benefits17.1 Overseas treatment

The scheme provides cover for treatment in the UK only.

17.2 Changes to the benefitsThe current benefits are valid from 01/08/2016 and are subject tochange. Subscribers will be advised in wri!ng should this occur.

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18 Complaints18.1 We have every reason to believe that you will be totally sa!sfied with

your healthcare scheme. However, should you have cause forconcern please write quo!ng your full name and your registra!onnumber, together with full details of your complaint, to:

onemedifund, Rossmore House, Rossmore Road East, Ellesmere Port, CH65 3DA

Or alterna!vely email: admin@onemedifund.com

19 Law19.1 The contract is governed by and subject to the relevant Laws of England.

19.2 It is not intended that any provision of this contract confers orpurports to confer any rights to enforce any of its terms on any ThirdParty pursuant to the Contracts (Rights of Third Par!es) Act 1999.

19.3 Data Protec!onBy par!cipa!ng in the Healthcare scheme, a Par!cipant consents tothe holding and processing of personal data rela!ng to thePar!cipant by onemedifund for all purposes rela!ng to the opera!onof the scheme, including but not limited to, administering andmaintaining Par!cipant records, providing informa!on to andreceiving informa!on from any person, including trustees, registrars,brokers or other third party administrators of the scheme andtransferring informa!on about the Par!cipant to a country orterritory outside the European Economic Area.

Par!cipants also consent to onemedifund processing informa!onabout claims. For the avoidance of doubt, onemedifund will not holdinforma!on about a Par!cipant's specific medical condi!on, whichwill remain confiden!al between the Par!cipant and his or hermedical advisors.

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20 Useful contact details

21 Useful website links

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:yyaohl.ausssSection Page

EA1 Table of benefits 22

EA1.1 Out-patient consultations, diagnosis and treatment 22

EA1.2 Online benefits 23

EA2 Definitions 24

EA3 Exclusions 26

EA4 Subscriber’s duties 27

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EA1 Table of benefits

Details Limit per Person per Benefit Year Notes on Benefits

Physiotherapy andComplementary TherapiesIni!al assessment andtherapy provided by arecognised therapist.

Full refund, up to aggregate limit of £1000*For physiotherapy provided throughthe onemedifund approvedMusculoskeletal Network.

No GP referral is required forphysiotherapy pre­authorised bythe medical helpline arranged viathe network.

Complimentary therapies musthave a GP referral.

Mental Health ConditionsIni!al assessment andtreatment provided by arecognised mental healthprofessional.

Full refund, up to aggregate limit of £1000*

Available through theonemedifund approved MentalHealth network. Also availablethrough a recognised mentalhealth professional outside thenetwork (subject to benefit limit).

Consultations with aSpecialist

Full refund, up to aggregate limit of £1000*

Always check your chosenspecialist with the medicalhelpline.

Diagnostic TestsIncluding pathology, radiologyand ultrasound scansrequested by your specialist.

Full refund, up to aggregate limit of £1000*

Hi-tech ScansIncluding MRI/ CT/PET scansrequested by your specialist.

Full refund, up to aggregate limit of £1000*

EA1.1 Out-patient consultations, diagnosis and treatment

PLEASE NOTE:*Total benefit allowance across all benefits is£1,000 per scheme year (1st August – 31st July)

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Details Limit per Person per Benefit Year Notes on Benefits

Doctor@HandVirtual private GP service.

3 consulta!ons Addi"onal consulta"ons can bepurchased at the subscriber’s owncost.

The service is delivered throughDoctor care Anywhere.

Xavi Health GatewayOnline health and wellbeingportal.

Full access Recommended for subscribers aged 18+ only.

The service is delivered throughAXA PPP.

EA1.2 Online benefits

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EA2.1 Acute condi!onA disease, illness or injury that is likely torespond quickly to treatment which aims toreturn you to the state of health you were inimmediately before suffering the disease, illnessor injury, or which leads to your full recovery.

EA2.2 AdministratorThe person or body for the !me being who isappointed by onemedifund as Administrator.

EA2.3 Alterna!ve therapyAcupuncture, chiroprac!c, homeopathic andosteopathic therapies administered by a therapist.

EA2.4 Authorisa!onPermission gained from the onemedifundmedical helpline before the commencement ofany consulta!ons, diagnos!c tests or treatment.

EA2.5 Benefit yearYear commencing 1st August to 31st July duringwhich benefits are payable, as defined in thetable of benefits, issued by onemedifund underthis scheme.

EA2.6 ContributorThose persons who have been accepted byonemedifund as covered under the scheme.

EA2.7 Customary clinical prac!ceClinical prac!ce falling within the pa&ern of care mostfrequently prac!ced by the majority of specialists forthe treatment of your medical condi!on.

EA2.8 Dependant(s)For the purpose of this scheme a dependant isdefined as: Your husband or wife and dependentchildren. Your child/children shall only be dependentun!l the renewal date following the earlier of theirtwenty­fi$h birthday or their marriage.

EA2.9 Diagnos!c testsInves!ga!ons, such as x­rays or blood tests, tofind or to help find the cause of your symptoms.

EA2.10 Experimental treatment and drugsTreatment or drugs which, in the opinion of theadministrator’s medical advisor, the safety andefficacy are unproven based on current andestablished prac!ce in the UK.

EA2.11 General Prac!!oner (GP)A Medical or Dental Prac!!oner in generalprac!ce who is registered under the MedicalActs and who is not a specialist.

EA2.12 HospitalA private hospital registered with the HealthcareCommission or an NHS hospital which haswri&en confirma!on that the hospital iscurrently recognised by the administrator.

EA2 Definitions

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EA2.13 Material factsAny informa!on that the administrator wouldregard as likely to influence acceptance of anapplica!on for cover or the authorisa!on of anypart of a claim. If there is any doubt if certaininforma!on is material, it should be declared.

EA2.14 Medical condi!onAny disease, illness or injury.

EA2.15 MusculoskeletalCondi!ons rela!ng to or involving the musclesand the skeleton.

EA2.16 Out­pa!ent treatmentTreatment given at a hospital, consul!ng roomor out­pa!ent clinic where you do not go in forday­pa!ent or in­pa!ent treatment.

EA2.17 Preventa!ve treatmentMedical services that are used to iden!fywhether you are likely to suffer from an illness,injury or disease in the future, but in a situa!onwhere no clinical symptoms are currentlypresent. This includes treatment to prevent theoccurrence of a specific medical condi!on.

EA2.18 Specialista) A doctor who holds an NHS Consultant Post

and is on the Specialist Register held by theGeneral Medical Council and holds a currentlicence to prac!ce, or

b) has received wri&en confirma!on that he/sheis currently recognised by the administrator.

EA2.19 Table of benefitsThe current table of benefits which sets out theamounts payable by onemedifund under thisscheme for treatment.

EA2.20 TherapistA therapist is one of the following:a) A Physiotherapist registered with the Health

Professions Council.b) An Osteopath who is a professionally

qualified member of The Statutory Registerof Osteopaths administered by the GeneralOsteopathic Council.

c) A Chiropractor who is a professionallyqualified member of The Statutory Registerof Chiropractors administered by theGeneral Chiroprac!c Council.

d) An Acupuncturist registered with:(i) The Bri!sh Acupuncture Council or(ii) The Bri!sh Medical Acupuncture Society or(iii) The Acupuncture Associa!on of

Chartered Physiotherapists.e) A Homeopath who is a member of the Faculty

of Homeopaths and who is medically qualified.f) A Podiatrist who is registered with the

Healthcare Professionals Council carryingout Gait Analysis or Biomechanical Studieson the referral of a specialist.

EA2.21 TreatmentMedical services (including diagnos!c tests),that are needed to diagnose, relieve or cure adisease, illness or injury.

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Your healthcare scheme is designed tocover treatment for curable, short­termdisease, illness or injury (known as acutecondi!ons). onemedifund will NOT paybenefits for:EA3.1 Addic!ve condi!onsTreatment for alcoholism, alcohol abuse,solvent abuse, drug abuse or addictiveconditions of any kind, and medical conditionsarising directly or indirectly from, or related to,any such abuse or addiction.

EA3.2 Contamina!on, wars and riotsTreatment directly or indirectly arising from orconsequent upon nuclear or chemicalcontamina!on, civil war, riot, invasion,terrorism, disturbance, rebellion, revolu!on,insurrec!on, military or usurped power.

EA3.3 Cosme!c treatmentCosme!c treatment, whether or not forpsychological reasons, except where treatmentis to correct an acute medical condi!on causedas a result of an accidental bodily injury orillness sustained during membership.Treatment of a medical condi!on which is relatedto previous cosme!c surgery which would nothave been covered under this scheme.

EA3.4 Criminal ac!vityTreatment of an illness, injury or condi!onwhich arises from your own criminal act.

EA3.5 Dangerous sports and hobbiesTreatment for injuries sustained from anydangerous sports or hobbies.

EA3.6 DialysisRegular and/or long­term dialysis in respect ofchronic or end stage renal failure.

EA3.7 Drugs and dressingsDrugs, dressings and medicines.

EA3.8 Experimental treatment and drugsTreatment whose safety and efficacy, in theopinion of the administrator’s medical advisor, isunproven based on current and establishedmedical prac!ce in the UK.Drugs which have not been fully trialled and areconsidered by the administrator’s medical advisorto be experimental or unproved based on currentand established medical prac!ces in the UK.

EA3.9 Eye treatmentSurgery or treatment where the sole purpose isto correct short (myopia), or long(hypermetropia) sightedness, as!gma!sm orany other refrac!ve error.

EA3.10 General Prac!!oner (GP) servicesGeneral prac!!oner services, or services fromany person who is ac!ng in such a capacity,except for a contribu!on towards the cost ofyour GP comple!ng a claim form.

EA3.11 HRTHormone Replacement Therapy.

EA3.12 Infer!lityTreatment related to infer!lity or any form ofassisted reproduc!on except for inves!ga!onsinto the causes of infer!lity.

EA3.13 Learning difficul!es andbehavioural/developmental problemsTreatment related to learning difficul!es such asdyslexia or behavioural problems such asA&en!on Deficit Disorder (ADD) ordevelopmental problems such as shortness ofstature or delayed speech.

EA3.14 Medical reportsCharges in obtaining medical reports or for thecomple!on of claim forms.

EA3 Exclusions

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EA3.15 Non medical treatment and addi!onalcare for domes!c reasonsAccommoda!on or treatment received in ahealth hydro, nature clinic or similarestablishment even if the establishment isregistered as a private hospital.A residen!al stay in hospital wholly or partly fordomes!c reasons and which is not directlyrelated to the treatment of a medical condi!on.

EA3.16 Nursing at homeNursing at home arranged wholly or partly fordomes!c reasons and which is not directly relatedto the treatment of an acute medical condi!on.

EA3.17 ObesitySurgical or medical treatment in connec!onwith, or is in any way related to obesity orweight problems.EA3.18 Outside of the schemeTreatment received a$er the day you leave thescheme regardless of whether the treatmenthas been authorised.

EA3.19 Overseas treatmentTreatment received outside the UnitedKingdom.

EA3.20 Physical aids and devicesHearing aids and other appliances unlessavailable under the table of benefits.

EA3.21 Pregnancy and childbirthTreatment arising from pregnancy, childbirthand any related medical condi!on.

EA3.22 Preventa!ve treatmenta) Preventa!ve treatment, for example, regular

monitoring, consulta!ons, check­ups,examina!ons or tests to assess your state ofhealth, screening and follow up appointmentsunless the treatment is available under thetable of benefits.

b) Preventa!ve surgery or medical treatment toprevent the occurrence of a specific medicalcondi!on.

EA3.23 Self­inflicted illness and injuryTreatment required directly or indirectly as aresult of self­inflicted illness or injury.

EA3.24 Surgical appliances and prosthesesProstheses and surgical or dental appliancesexcept when they are used as an integral part ofa surgical procedure and when, generally butnot always, they are implanted within the bodyfor treatment purposes.

EA3.25 TransplantsTreatment involving:a) Donor or transplanta!on opera!ons or

treatment associated with such opera!onsother than corneal or skin gra$ing, coronaryartery bypass gra$s or mosaicoplasty.

b) Autologous plasmapheresis, transplants ofbone marrow or stem cells, autologous bloodtransfusions or similar procedures.

EA4 Subscriber’s dutiesYou must advise the administrator if the cost of treatment is covered under any other medical expenseplan or by a third party. onemedifund reserves the right to pursue an alterna!ve medical expense planor third party in the name of our subscriber to recover these costs. If onemedifund chooses to do so,the subscriber must provide all reasonable assistance to the trustees and account to the trustees forany amount recovered.

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OMF-EPHB-0816-ISSUEE161

Registration helpdesk:

03000 70 60 60admin@onemedifund.com

www.onemedifund.com