Guide to Private Medical Insurance

Contents
About the Exeter

Why private medical insurance?

Product highlights

Cover and benefits

10

Getting the right premium

15

How to apply

16

Claims overview

21

Further information

22

www.the-exeter.com

Welcome to Private Medical

Insurance by The Exeter
Theres nothing more important in life than your health.
By choosing private medical insurance, youre choosing
not to compromise on the speed, quality or comfort
of your healthcare.
By choosing The Exeter, youre in the safe hands of
a mutual insurer that combines market-leading cover
with an efficient, personal service.

Private Medical Insurance

About The Exeter

At The Exeter, were passionate about private medical
insurance and the important role it can play in securing
your long term health.
Over half of our members have been with us for more
than 10 years, a statistic which is the envy of many of
our competitors. There are some good reasons why
people stay loyal to The Exeter.
Our plans are designed to deliver, our customers are
not penalised for using their policies.
When you call The Exeter, you talk to a real person
at our UK office, first time, every time.
We provide membership benefits that provide you with
valuable reassurance in addition to our core cover.
We paid 99% of private medical insurance claims
in 2014 - the true test of any insurance.
Were consistently recognised in the industry for our product
and service excellence, winning numerous awards.

www.the-exeter.com

Why private medical insurance?

Private medical insurance is designed to
give you quick and convenient access to
quality private medical facilities with the
highest levels of cleanliness.

By choosing private medical insurance,

you are getting reassurance that you and
your family are in the best possible hands
if your health takes a turn for the worse.

Beat the queues

Respect and dignity

For consultation and

diagnosis, for admission
and a bed.

Private hospitals scored 99%

for respect and dignity in the
2013/2014 State of Health
Care report by the Care
Quality Commission.

Hundreds of hospitals

Home comforts

Youre rarely more than a

short journey away from
quality care, at a location
you choose.

All private hospitals have

private rooms and en-suite
facilities, offering privacy
and comfort.

Theres nothing more important in life than the health of

you and your family. Choose private medical insurance
today and:
Get access to quality, comfortable and cutting edge
private facilities
Be in control of your own appointments, arrange
consultations and treatment at times that suit you
Be confident in the knowledge that you wont have
to wait for the treatment you need
Get access to types of treatments and drugs that
may not be available on the NHS.

Private Medical Insurance

Product highlights
We offer a range of products and options to suit every
budget and need.
In patient and day patient treatment
Our range of comprehensive plans all include unlimited cover for in patient
and day patient treatment - unlike some insurers who impose time or financial
limits that might leave you out of pocket after a claim. After an in patient stay,
any drugs or medical aids taken home from hospital to help your recovery are
always covered with The Exeter.

Cancer cover
Cancer cover is one of the most reassuring aspects of having private medical
insurance. So, with The Exeter you will either have unlimited cover for cancer
included as standard or have the option to include unlimited cancer cover as
part of your policy.

No penalty for claiming

We dont employ no claims discounts on any of our private medical insurance
plans. The result is cover that you can use safe in the knowledge that we will
never increase your premiums as a result of any claim you make - regardless
of its length or cost.

www.the-exeter.com

Hospital lists
Each of our plans has just one hospital list, detailing over 300 NHS and
private hospitals throughout the UK that you have access to with your cover.
The result - you can visit a hospital that offers the very best treatment and
procedures for any particular claim.

Unique underwriting option

We have a full range of underwriting options. So whether youre new to
private medical insurance or switching from another insurer, you can choose
the right options for your circumstances.
Our fixed moratorium underwriting option gives you a unique way to apply. For
the lowest monthly premiums apply through our Full Medical Underwriting option.
Please see How to apply on pages 16 - 20 for more details.

Health discounts
Your premiums will be 20% cheaper if you are a non-smoker and have a
healthy body mass index (BMI). If only one of these discounts applies,
your premiums will still be discounted by 10%.

Hospice donation
We make a donation of 250 to your hospice if you are admitted for care.
We know the vital role that hospices play for people later in life and we
think its only right that we support them.

Private Medical Insurance

Additional benefits
All of our plans offer a range of additional benefits
as standard which provide you with increased care,
support and flexibility.
Health Cover
for Me

Health Choices
for Me

Health Essentials
for Me

Private ambulance
Medically essential
travel to, between
or from hospital in a
private road ambulance
in connection with inpatient or day-patient
treatment.

Home nursing
Home nursing following
authorised in-patient &
day-patient treatment.

Parental
accommodation
(children up to 18)
You can stay in hospital
with your child (up to
the age of 18) if they
are having treatment
under the policy.

NHS Cash benefit

250 per night
Paid if you have free
in-patient treatment
under the NHS that
would be covered
under your policy.

www.the-exeter.com

Focus on cancer cover

We know how important offering quality cancer cover
is, which is why we have focused our energy getting
our cancer cover right.
We were one of the first private medical
insurers to offer truly unlimited cover for
cancer. Were proud of a benefit which
delivers when our members need it most.

Our unlimited cancer cover includes:

Weve gone into full detail of what

is included in the table below but it
is important to also highlight a few
crucial features:

No limits to cover, including NICE

approved treatments such as biological
and hormonal therapy

Cover for all clinically approved

chemotherapy, even if the NHS has
rejected a drug on the grounds of cost.

Stem cell and bone marrow transplants.

Treatment

What does this include?

Place of treatment

Treatment in hospitals and at home if you need to have

chemotherapy.

Surgery

Surgery including the removal of a tumour and consequent

reconstructive surgery that you need.

Drug therapy

All types of drug therapy for your cancer, including

chemotherapy & drugs to maintain any remission, providing
they have received NICE approval for clinical effectiveness.

Radiotherapy

Radiotherapy including when it is given for pain relief.

Palliative

Palliative treatment of cancer.

End of life care

Treatment of terminal cancer.

Monitoring

Follow up reviews related to the continuing care of your cancer.

Limits

We do not place a time or financial limit on your cancer cover.

Unlimited cancer cover comes as standard on Health Cover for Me and is a choice
on Health Choices and Health Essentials for Me.

If you select Health Choices for Me or

Health Essentials for Me, the cover you
have will be impacted by the choices
you make in setting up your policy.

Private Medical Insurance

Take a look at the individual products

Policy Document for more information.

Cover and benefits

We know that one size of cover doesnt suit everyone,
so at The Exeter we offer a range of plans and options
to suit different budgets and needs.
Comprehensive cover
Give you peace of mind that you have private medical treatment covered,
whatever life throws your way. We have two comprehensive plans:

Health Cover for Me

Has one simple theme, if its covered in our fee schedule there are no
financial or time limits to the amount we will pay at claim. The result
is total confidence and reassurance in having the flagship plan from
one of the UKs leading healthcare insurers.

Health Choices for Me

Is modular private medical insurance that lets you build the right cover
at a premium that works for you. Where some modular plans give you a
vast array of confusing choices, Health Choices for Me keeps it simple,
giving you confidence in your cover.

Treatment insurance
A new approach to private medical insurance, we have one plan which is
focused on cover for treatment.

Health Essentials for Me

Covers the cost of treatment, including the big medical bills that are hard
to budget for but without the big premiums to match. Health Essentials for
Me is a unique, innovative approach to cover - an approach that is designed
to limit your premiums, without giving you a policy with too many financial
or time limits on cover.

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www.the-exeter.com

Comprehensive cover
Our comprehensive plans enable you
to have full cover from diagnosis to
scans, test to treatment, with coverage
for all stages of cancer and manipulative
treatment. If you want full cover it is
always unlimited on our Health Cover
for Me plan.

However, if you want to add and remove

options, or put in place financial limits,
then look at Health Choices for Me. This
enables you to tailor your cover to get the
right price and coverage for your needs.
The coverage you get, at any hospital on
our hospital list, and the options you can
take are set out in 4 key areas:

Essential Cover
In Patient & Day Patient Treatment, including consultant & specialist fees,
diagnostic tests as an in-patient or day-patient, pre-admission tests and hospital
charges, including any necessary medical aids and take-home drugs.
CT, MRI and PET Scans including professional fees where appropriate.
Health Cover for Me
Unlimited

Health Choices for Me

Unlimited

Out-Patient
Including consultant & specialist fees, diagnostic tests such as X-rays,
ECGs and pathological tests.
Health Cover for Me
Unlimited

Health Choices for Me

Unlimited
1,000 per year
500 per year
No cover

Cancer cover
Extends the scope of benefits under Essential Cover (such as surgery and scans)
to include treatment for diagnosed cancer and adds unlimited benefit for oncology
and specialist consultations for cancer.
Health Cover for Me
Unlimited

Health Choices for Me

Unlimited
No cover

Manipulative Treatment
Includes costs for physiotherapy, osteopathy, podiatry and chiropractic treatment
received as an out-patient.
Health Cover for Me
Unlimited

Private Medical Insurance

Health Choices for Me

Unlimited
300 per year
No cover

11

Treatment insurance
Health Essentials for Me is a new type
of Health Insurance. It enables you to
protect yourself against the big costs
of treatment, without having to pay
the premiums that come with more
comprehensive private medical insurance.

If you want the reassurance that

potential large costs of treatment
are covered, but are happy managing
the smaller costs yourself or utilising
the NHS, Health Essentials for Me
could be the policy for you.

How does it work?

It is very simple:
You visit your GP, who may refer you to a specialist to establish a diagnosis.
This can take place within the NHS, or by paying yourself for a private
consultation and tests.

Once you have your diagnosis, if you need treatment, you contact The Exeter.
We cover all eligible treatment at any hospital on our hospital list.

What is covered?
The key elements of your treatment coverage are listed below:
In-patient and
day-patient
Treatment

Consultant & specialist fees, diagnostic tests as an in-patient

or day-patient, pre-admission tests and hospital charges
(including any necessary medical aids or take-home drugs).

Post-diagnosis CT,
MRI & PET Scans

CT, MRI or PET scans, ordered by a specialist to further determine

or assess your condition after an initial diagnosis has been made.
Includes professional fees where appropriate.

Out-patient surgery

Surgical procedures performed by a specialist, including any

necessary medical aids or take-home drugs.

Post-operative
Physiotherapy

Up to 3 sessions of post-operative physiotherapy as an

out-patient following in-patient or day-patient surgery.

Cancer cover
With Health Essentials for Me you have
the option to add unlimited cancer cover
to your policy.

12

This extends the scope of benefits under

core cover (such as surgery and scans) to
include treatment for diagnosed cancer
and adds unlimited benefit for oncology
and specialist consultations for cancer.
www.the-exeter.com

Membership benefits
Whichever plan you choose, as a
customer of The Exeter, you will also
have access to a number of important
membership benefits to make your
life easier when it comes to accessing
primary care.

For some people getting an appointment

to see their GP, or simply accessing
expert health advice can be a frustrating
and lengthy process:

5.8 million patients visit

Over 30,000 calls were

A&E because they cannot get

a GP appointment.

made to the NHS 111 service

59 million patients

40% of patients are

wait 1 week or more for

an appointment.

unhappy waiting 10 minutes

on the phone to book an
appointment.

in England each
June 2015.

day in

Our current membership benefits,

provided by Medical Solutions - an
expert in their field, are designed to
bring you into more convenient contact
with healthcare professionals and
give you more convenient access
to prescription drugs.

These benefits are there for your

convenience but its important to note
that they are advisory only and cannot
be used as evidence for your claim.

GP Helpline

Private prescription service

Gives you free, unlimited access to a

large team of practising GPs, providing
information and advice about your
health concerns or those of your family.

During your GP Helpline consultation,

your doctor may offer you a private
prescription.

You have the option of a telephone

or webcam consultation.

Private Medical Insurance

This service provides a simple way of

getting private prescription medication
delivered to your home or office without
the hassle of waiting for an appointment
or taking time off work.

13

Exclusions
Weve tried to keep our exclusions to a minimum
but there are things that were unable to cover.
Weve listed significant exclusions on our products
below for a full list take a look at the individual
products Policy Summary or Policy Document.
Pre-existing conditions
Pre-existing conditions will either be excluded from cover altogether or excluded
for the moratorium period of your policy.
Emergency treatment
Emergency treatment is dealt with by the NHS. You are not covered until you are
transferred to private facilities and you have authorisation from us.
Ongoing or long term conditions (chronic)
Well pay for the treatment needed to stabilise the condition however we wont
pay for the treatment once it has been stabilised. Please note, we do not consider
cancer as a chronic condition.
Specialist fees in excess of those on our Fee Schedule
We publish a schedule which sets out the maximum fees we pay specialists
for the treatment they provide to you. Our most up-to-date schedule can be
found on our website.

Health Essentials for Me only

Outpatient treatment, consultations, tests or scans, prior to an
initial diagnosis.
We do not cover any treatment, consultations, tests or scans received
as an out-patient with the purpose of establishing an initial diagnosis.

14

www.the-exeter.com

Getting the right premium

Calculating your premium
There are a number of factors that
influence your premium:

Whether you add a voluntary excess

The ages of everyone included

on the policy

Your height and weight

The underwriting option you choose

Whether you smoke.

Your address
The product and cover options
you choose

Voluntary excesses
Each of our plans includes a compulsory excess of
100 per person, per policy year which will be deducted
from eligible benefits on your policy.
You can choose to add a voluntary excess
to this compulsory excess to save you
money each month the higher the
excess, the lower your premiums will be.
The total excess (voluntary excess
plus compulsory excess) then applies
individually to each person to be covered
by your policy in each policy year.

If there are multiple claims or conditions

for one person within one policy year, then
the total excess is only deducted once.
Please note that Health Choices for Me
does not offer a 500 or 1,000
voluntary excess.

Your options are:

Voluntary excess

Your costs per policy year

Nil

You have to pay the first 100 of eligible treatment costs

for each person covered by your policy each year

100

You have to pay the first 200 of eligible treatment costs

for each person covered by your policy each year

250

You have to pay the first 350 of eligible treatment costs

for each person covered by your policy each year

500

You have to pay the first 600 of eligible treatment costs

for each person covered by your policy each year

1,000

You have to pay the first 1,100 of eligible treatment costs

for each person covered by your policy each year

Private Medical Insurance

15

How to apply
Once youve chosen your plan and, where applicable,
personalised your cover, you then need to decide on
the underwriting option best suited to your needs.
Underwriting options
You have a choice of how to apply
for cover, depending on the product
you select.
Health Cover
for Me

These are described in more detail on

pages 17 - 20.

Health Choices
for Me

Health Essentials
for Me

Full Medical Underwriting

Standard moratorium

Fixed moratorium
Continued Personal
Medical Exclusions
Continued moratorium

To apply for our products:

You must be a resident in the UK
You must be aged between 18 and 79
inclusive. Some of our underwriting
options have lower maximum ages,
see pages 18 - 20 for details.
Children from 3 months old to 21 may
be included on their parents policy.

16

Note for Health Cover for Me and

Health Choices for Me
Children under 25 if still in full time
education may be included on their
parents policy. Children aged 5 years
and under are covered for free.

www.the-exeter.com

If you are new to private medical insurance

If you dont currently have a private
medical insurance plan, weve outlined
the ways you can apply on this page.
The option thats best for you will depend
on your circumstances and needs.

If you choose full medical underwriting,

your premiums will be cheaper.

Full Medical Underwriting

Choosing Full Medical Underwriting
gives you our best price and certainty
of your cover.

If you choose this option, you will need

to complete a full medical declaration,
including details of the medical history
of all family applicants. Any preexisting conditions will be excluded
unless we agree to accept them.

Standard Moratorium
Our Standard Moratorium is common
to most medical insurers. If you
choose this, you will not have to
provide full medical details with your
application, but if you make a claim
we may request information from
your GP to determine whether the
condition was pre-existing or not.
Benefits will not be available for
treatment of any condition suffered
by an applicant if:

Any condition in the

5 years before joining
is excluded

5 Years

Private Medical Insurance

the applicant had symptoms,

medication, treatment or advice
in connection with that condition
in the five years before the start
of their policy; and
there has not been a clear two year
period after the start of their policy
during which the applicant has
been free of symptoms, medication,
treatment and advice in connection
with that condition.

Benefits will start after

a clear 2 year period

Join us

Free of previous
conditions

+2 Years

17

Fixed Moratorium
Unlike most insurers, we offer a fixed
length moratorium. Under this option,
benefits will not be available for
treatment of any condition suffered
if you had symptoms, medication,
treatment or advice in connection
with that condition in the five years
before the start of your policy.

However, we will cover a pre-existing

condition two years after the start
of your policy, even if it has recurred
during that two year period. If you
apply using Fixed Moratorium, your
premiums will be higher.

There are a few rules about who can

choose this option:

All applicants must never have

suffered from a heart condition,
stroke, cancer or had a joint
replacement or joint resurfacing.

All applicants must be 65 years

or younger.

See the diagram below.

All adult applicants must never

have been diagnosed with diabetes.

Any condition in the

5 years before joining
is excluded

5 Years

18

Join us

Pre-exisiting conditions
will be covered following
the moratorium

2 Years

www.the-exeter.com

If you are thinking of switching your private

medical insurance to The Exeter
We have two underwriting options
designed solely for you. If you are
switching your cover from another insurer
and want to maintain your underwriting
- weve outlined both below.

The option thats right for you will

depend on your circumstances
and needs. Remember, you can apply
with any of our five underwriting
options; if you apply using Full Medical
Underwriting, detailed on page 17,
your premiums will be cheaper.

Continued Personal Medical Exclusions

This option is designed to allow you

the opportunity to carry across the
personal medical exclusions from
your existing policy. You will need
to provide a certificate from your
previous insurer with your application.

You will also need to answer a few

questions about recent or planned
medical conditions or treatment.

There are a few rules about who can

choose this option:

All applicants must never have

suffered from a heart condition,
stroke, cancer, or had a joint
replacement or joint resurfacing

All applicants must be covered

by a current policy which has been
underwritten based on a full
medical declaration
All applicants must be 70 years
or younger

Private Medical Insurance

All adult applicants must never

have been diagnosed with diabetes
Your cover with The Exeter must
commence the same day your cover
with your previous Insurer finishes
to ensure continuous cover.

19

Continued Moratorium

This option is designed to let you

continue the moratorium period
that applies to your existing private
medical insurance policy with another
insurer. You will need to provide a
certificate from your previous insurer
with your application.
You will also need to answer a few
questions about recent or planned
medical conditions or treatment.

There are a few rules about who can

choose this option:
All applicants must be covered
by a current policy which has
been underwritten on a
moratorium basis
All applicants must be 70 years
or younger

20

In line with most other insurers,

our continued moratorium works
on a two year rolling basis, similar
to our standard moratorium option
explained earlier in this section.
The only difference is that the
moratorium period will be from
the start date of your current policy,
not your new policy with The Exeter.
If you have had your current policy
for more than two years and have
not had a recurrence during that
time, we will cover that condition
immediately subject to the terms
of your policy.

All applicants must never have

suffered from a heart condition,
stroke, cancer, or had a joint
replacement or joint resurfacing
All adult applicants must never
have been diagnosed with diabetes
Your cover with The Exeter must
commence the same day your cover
with your previous Insurer finishes
to ensure continuous cover.

www.the-exeter.com

Claims overview
We know that the most important thing for you is
how we perform when you need us most - at claim.
At The Exeter, we make this process as easy as possible
to ensure you can concentrate on what is most
important, your health.
We pride ourselves on the service we
provide at claim. Our experienced team
are here to make sure that claims are
authorised quickly and without fuss.

The process is detailed fully in the

each Policy Document, but if you need
to make a claim you should always
contact us before you go ahead - claims
must be pre-authorised with us.

To register a claim, call us on 0300 123 3200.

Were open Monday to Friday, 8am to 6pm.

Private Medical Insurance

21

Further information
Contacting us
Members

Financial Advisers

General enquiries: 0300 123 3201

All enquiries: 0300 123 3203

Claims: 0300 123 3200

adviser@the-exeter.com

member@the-exeter.com

Opening times
Monday to Friday 8am 6pm

Visit our website

www.the-exeter.com

Making a claim
To register a claim, please contact us.
Claims must be authorised by us before
you go ahead with any consultations,
tests or treatment.

22

Telephone: 0300 123 3200

Email: member@the-exeter.com

www.the-exeter.com

Private Medical Insurance

23

Contact us
The Exeter, Lakeside House, Emperor Way, Exeter, EX1 3FD
Members
General enquiries: 0300 123 3201
Claims: 0300 123 3200

Financial Advisers
All enquiries: 0300 123 3203

member@the-exeter.com

adviser@the-exeter.com

www.the-exeter.com
Calls may be recorded and monitored.
The Exeter is a trading name of Exeter Friendly Society Limited, which is authorised by the Prudential Regulation Authority and regulated by
the Financial Conduct Authority and the Prudential Regulation Authority (Register number 205309) and is incorporated under the Friendly
Societies Act 1992 Register No. 91F with its registered office at Lakeside House, Emperor Way, Exeter, England EX1 3FD.
2015/1081