POLICY DOCUMENT

‘INSPIRE’
PRIVATE
MEDICAL
INSURANCE
PLAN

www.april-uk.com
 POLICY SUMMARY /
KEY FACTS

This document summarises the main features, benefits of Axeria Insurance Limited is at Progetta House, Level 2,
and exclusions of the inSpire Private Medical Insurance Tower Road, Swatar, Birkirkara BKR 4012, Malta.
Plan. It does not contain the full terms and conditions
which are set out in the Policy Document. Please also
refer to your Certificate of Registration which will provide
you with details of who is covered under this policy, WHAT BENEFITS ARE AVAILABLE
details of any excess and specific exclusions which apply
UNDER THE INSPIRE PRIVATE MEDICAL
to your policy.
INSURANCE PLAN?
A summary is shown on the next page. Benefits are per
person per policy year unless stated. Please refer to the
Policy Document for full details. There is a total limit of
WHAT IS THE INSPIRE PRIVATE
£1m per person per policy year across all the benefits
MEDICAL INSURANCE PLAN?
payable under this policy.
The inSpire Private Medical Insurance Plan offers a
fresh and truly affordable approach to private medical To confirm all costs will be paid please contact the APRIL
insurance by providing you with access to Spire UK Claims Team in advance of any treatment.
Healthcare hospitals. All Spire Healthcare hospitals
are different and some medical procedures, including
paediatrics (treating children), may not be available at
your nearest Spire Healthcare Hospital. Private Medical
CANCER BENEFITS
Insurance is not designed to replace the NHS, but to work
alongside it and and to meet some or all of the costs of Please refer to Summary of Cancer Benefit in the Policy
private medical treatment for an acute illness or injury Document for more information.
on a short-term basis. In some instances an NHS facility
maybe the most suitable option for you.

SIGNIFICANT EXCLUSIONS AND

LIMITATIONS
WHO IS ELIGIBLE TO JOIN?
Benefit is not provided for the following:
You can take out the inSpire Private Medical Insurance Accident and Emergency treatment.
Plan if you are between the ages of 16 and 74 inclusive Alcoholism, alcohol, drug, substance abuse and
and are a permanent and lawful resident of the UK, Isle of other addictive conditions.
Man or Channel Islands. Any dependants to be covered Appliances, devices, aids or prosthesis.
must be aged 74 or under and a permanent and lawful Chronic and long-term medical conditions.
resident of the UK, Isle of Man or Channel Islands. If you Complementary medicine.
are between the ages of 0 and 15 inclusive, a parent or Cosmetic procedures except following an accident
guardian may take out a plan for you, on a moratorium or or surgery for cancer.
full medical underwriting basis, and pay your premiums. Costs where we have been unable to assess part
or all of your claim due to unavailable medical
information we have requested.
Dental, sight and hearing disorders.
Renal dialysis.
WHO PROVIDES THIS COVER?
Drugs and dressings.
The inSpire Private Medical Insurance Plan is provided by Experimental treatment and drugs.
Axeria Insurance Limited and governed by English Law. General Practitioner (GP) services, including any
Axeria Insurance Limited is authorised under the Insurance charges for completing a claim form.
Business Act (Cap.403 of the Laws of Malta) to carry on HIV/AIDS or any related medical condition.
General Business of Insurance and is regulated by the Pre-existing conditions, depending on
Malta Financial Services Authority. The registered address underwriting method chosen.

2
 SIGNIFICANT FEATURES AND BENEFITS COVER
In-patient and day-patient treatment Cover provided

Hospital accommodation and nursing care

Prescribed drugs and dressings

Operating theatre fees

Radiotherapy and chemotherapy

Consultations, radiology, pathology

Diagnostic tests including MRI/CT/PET scans

Physiotherapy

Surgeons, physicians and anaesthetists fees

Oral surgery (non dental)

Eligible prosthesis
All benefits listed are subject to terms and conditions

Other benefits Cover provided

Private ambulance between hospitals

NHS cash benefit £100 per day/night

(Up to 30 days per policy year)

NHS cancer cash benefit £300 per day/night

(Up to 30 days per policy year)

Out-patient benefits Cover provided

Specialist consultations, pathology, x-rays,

diagnostic tests, physiotherapy (Physiotherapy is limited to £500 per policy year)

MRI/CT/PET scans

Pregnancy, childbirth and fertility. Please refer to What is not covered? in the Policy
Preventative treatment. Document for full details about exclusions.
Professional and some amateur sports or
hazardous pursuits.
Psychiatric conditions or mental illness.
Routine medical examinations, screening and tests.
WHAT EXCESS PAYMENTS DO I HAVE
Self inflicted injury or illness.
TO PAY?
Sexually transmitted diseases.
Sleep apnoea, snoring, or any other sleep related There is no compulsory excess on this policy. However
breathing disorder. you may choose to have a £100, £250, £500 or £1,000
Transplantation operations. excess to reduce your premiums. This is payable per
Treatment outside of the United Kingdom. person on their first claim each policy year. Policies that
Treatment received in Health Resorts, Nature Cure started before January 2017 may not carry a compulsory
Clinics, or similar establishments. excess. Policies taken out between January 2017 and
War, terrorism and dangerous substance November 2017 may carry a compulsory excess. Please
contamination. check your Certificate of Registration for more details.

3
 treatment, consultation or test. Please refer to How to
WHAT HOSPITALS CAN I USE?
claim? in the Policy Document for full details.
You can choose any Spire Healthcare hospital or clinic in
the UK.

WHAT SHOULD I DO IF I HAVE

A COMPLAINT?
HOW LONG WILL MY COVER LAST?
We aim to provide the highest standards of service at all
Your policy will be arranged for 12 months from the start times. Should anything go wrong please follow the steps
date on your Certificate of Registration provided that below:
premiums have been paid by you. Before the end of your If you have a complaint about the administration of
policy year, we will contact you to tell you the premiums the policy, please contact APRIL UK, April House,
and terms the policy will continue on, if the policy is still Almondsbury Business Centre, Bradley Stoke,
available. We will renew the policy on the new terms Bristol, BS32 4QH, or telephone 01454 619500.
unless you ask us to make changes or tell us that you If you have a complaint about the claims handling
wish to cancel. If the policy is no longer available, we will of the policy please contact APRIL UK Claims
do our best to offer you an alternative. Team, Healix House, Esher Green, Esher, Surrey,
KT10 8AB, or telephone 0203 819 7159, or email
apriluk@healix.com. If your complaint addressed
to any of the above parties is not resolved to your
satisfaction, you may within 6 months of a final
REVIEWING YOUR COVER
decision contact the Financial Ombudsman Service.
From time to time your personal circumstances may If you have a complaint about the policy wording,
change. You should review your cover regularly to ensure please contact Axeria Insurance Limited, Progetta
that the policy and benefits are still suitable for you. House, Level 2, Tower Road, Swatar, Birkirkara
BKR 4012, Malta. Telephone: +356 21377107. If
your complaint is not resolved to your satisfaction,
you may contact the Office of the Arbiter for
Financial Services (Malta).
WHEN DOES MY POLICY END?
Your policy will cease: Please refer to What should I do if I have a complaint? in
If You, or your employer if a group scheme, the Policy Document for full details.
cancel the policy at any time by letting APRIL UK
know in writing, email or by telephone.
If You are no longer a resident of the UK, Isle of
Man or Channel Islands.
WHAT HAPPENS IF THE INSURER IS
You, or your employer if a group scheme, do not
UNABLE TO MEET ITS LIABILITIES?
maintain payment of your premiums.
At the end of the policy year, if the policy you In the unlikely event that Axeria Insurance Limited is
have is no longer available and we do not have unable to meet its obligations under this policy, you may
an alternative policy to offer you. be entitled to compensation under the Financial Services
Compensation Scheme (FSCS). Further details are
available from the FSCS at www.fscs.org.uk or telephone
0800 678 1100.
CAN I CANCEL THIS COVER?
You have the statutory right to cancel the policy within 30
days of the policy start date. Cancellations can be sent in
DISCLOSURES OF INTERESTS
writing to: APRIL UK, April House, Almondsbury Business
Centre, Bradley Stoke, Bristol, BS32 4QH. Or by email: In terms of the provisions of Directive 2002/92/EC of the
enquiries@april-uk.com. Or by telephone: 01454 619500 European Parliament and of the Council of 9 December
(Monday to Friday, 8am – 5pm, excluding public holidays). 2002 on insurance mediation, we wish to inform you that
APRIL S.A., a Company organised in terms of French Law
with registration number 377994553RCS of Immeuble
Aprilium, 114 Bd Vivier Merle, 69439 Lyon, France holds
more than 10% of the voting rights of both APRIL UK and
HOW DO I MAKE A CLAIM?
Axeria Insurance Limited. APRIL UK and Axeria Insurance
To make a claim, just call the APRIL UK Claims Team Limited are affiliates by virtue of the common shareholding
on 0203 819 7159. Please do this before arranging any of APRIL S.A. as outlined above.

4
POLICY DOCUMENT

This Policy Document must be read as a whole and in

DEMANDS AND NEEDS
conjunction with the relevant Certificate of Registration.
The Certificate of Registration will provide you with This inSpire Private Medical Insurance Plan is to cover
details of who is covered under this policy, details of the costs of planned private medical treatment that is
any excess chosen and specific exclusions which apply medically necessary, for acute conditions that start
to your policy. after the policy begins, subject to the policy terms and
conditions.
The plan covers the cost of treatment as shown in the
current list of benefits on your Certificate of Registration
if:
You live permanently in the United Kingdom
DEFINITIONS
and have an acute surgical or medical
condition. Where the following expressions appear in the Policy
You are referred to a specialist who is Document, either in single or plural form, they have the
covered under the plan by: meaning set out below.
- Your General Practitioner
- A dentist for surgical treatment which
may be covered under the plan Acute condition – A disease, illness or injury that is likely
- An optician for eye treatment. to respond quickly to treatment which aims to return you
Treatment for an accidental dental injury is to the state of health you were in immediately before
received within six months of the injury, and suffering the disease, illness or injury, or which leads to
The treatment is medically necessary and your full recovery.
is covered in the detailed list of benefits on
your Certificate of Registration. Biological therapies – Drugs or other substances that
block the growth and spread of cancer by interfering
The policy will cover reasonable and customary with specific molecules that are involved in the
costs associated with your healthcare needs. To growth, progression and spread of cancer. Biological
confirm all costs will be fully covered please contact the therapies are sometimes called ‘molecularly targeted
APRIL UK Claims Team in advance of any treatment. drugs’, ‘molecularly targeted therapies’, ‘precision
It is important that: medicines’, or similar names.
You check that the excess you have
requested is included in Your Certificate of Cancer – A malignant tumour, tissues or cells,
Registration; characterised by the uncontrolled growth and spread of
You check that the information you have malignant cells and invasion of tissue.
given us is accurate;
You notify your adviser as soon as Chronic conditions – A disease, illness or injury that
practicable of any inaccuracies in the has one or more of the following characteristics:
information you have given us; It needs ongoing or long term monitoring
You comply with your duties under each through consultations, examinations, check-
section and under the insurance as a whole. ups and/or tests.
It needs ongoing or long term control or relief of
The policy is underwritten by Axeria Insurance Limited, symptoms
Progetta House, Level 2, Tower Road, Swatar, Birkirkara It continues indefinitely.
BKR 4012, Malta and administered by APRIL UK, It comes back or is likely to come back.
April House, Almondsbury Business Centre, Bradley You need to be rehabilitated or specially
Stoke, Bristol, BS32 4QH. Axeria Insurance Limited is trained to cope with it.
authorised under the Insurance Business Act (Cap.403 It has no known cure.
of the Laws of Malta) to carry on General Business
of Insurance and is regulated by the Malta Financial Congenital abnormalities – Any abnormalities,
Services Authority. disorders or medical conditions which you have had
from birth. This will apply whether these were diagnosed

5
 or known about in utero, at birth or become apparent General practitioner (GP) – A medical practitioner
later in life. holding a Certificate of General Practice Training and
who is registered by the General Medical Council.
Curative intent – Applies when treatment is
administered with a reasonable expectation both that Group member – An eligible employee detailed in the
it will restore the patient close to the state of health Group Policy Schedule.
enjoyed prior to the disease being diagnosed, and
expect the patient to be disease free 5 years after Hospital – A hospital or clinic in the UK under the Spire
commencement of the treatment. Healthcare network.

Day-patient – A patient is admitted to a hospital Hospital charges – (in-patient and day-patient)

or day-patient unit because they need a period of Includes:
medically supervised recovery but does not occupy a a Hospital accommodation in an eligible hospital,
bed overnight. which primarily relate to bed charges which are
directly related to the treatment received.
Dental treatment – Any dental condition or dentistry, b Ancillary charges, namely charges for
including oro-surgical procedures, gum conditions operating theatre, nursing, admission, resident
(periodontal treatment) and malocclusion (orthodontic medical officer, drugs, dressings, and eligible
treatment). appliances and eligible prostheses used by
a specialist as an integral part of a surgical
Dependant – A spouse or permanent partner of a procedure.
policyholder or group member and any unmarried c Diagnostic tests, namely charges for
dependant children, living with you and aged under 25. pathology, X-rays, ECG, computerised
tomography scans, magnetic resonance
Diagnostic tests – Investigations, such as x-rays or images, positron emission tomography and
blood tests, to find or to help find the cause of your the interpretation of results by a specialist,
symptoms. wherever such charges are incurred.

Eligible appliance – A post-operative knee brace In-patient – A patient who is admitted to hospital and
which is an essential and integral part of a cruciate who occupies a bed overnight or longer, for medical
ligament repair, or a post-operative spinal support reasons.
device which is an essential and integral part of surgery
to the spine. Insurer – Axeria Insurance Limited.

Eligible prosthesis – A device which is intended to Medical condition – Any disease, illness or injury and/or
remain permanently part of the body and is surgically associated symptoms, other than a chronic condition.
implanted solely for one or more of the following
purposes: Medically necessary – Healthcare services necessary
a Replacing to evaluate, diagnose or treat an illness, injury, disease or
i a joint or ligament, or its symptoms, which are:
ii one of the heart valves, or In accordance with generally accepted
iii the aorta or an arterial blood vessel, or standards of medical practice.
iv a sphincter muscle, or Clinically appropriate, in terms of type,
v the lens or cornea of the eye or frequency, extent, site and duration and
b The control of urinary incontinence, or thought to be effective for the patient’s illness,
c The control of the electrical pathways of the injury or disease.
heart, or Not primarily for the patient’s or specialist’s
d The relief of raised intra-cranial pressure. convenience, and
No more costly than an alternative service(s)
Excess – Your excess option is shown in the at least as likely to produce the same
Certificate of Registration, the excess amount is therapeutic or diagnostic results.
applicable per person once every policy year of cover,
which means that you are responsible for treatment NHS cash benefit – In the event that you elect to
costs up to the value of the excess applicable. receive free treatment through the NHS we will pay an
The excess will be payable by you and will not be NHS Cash Benefit instead of any other benefit.
deducted from any benefit limit and will be applied to
the first eligible claim made by any eligible member This benefit will only apply to claims for day-patient or
or dependant in each policy year of cover. This is in-patient treatment that would otherwise have been
regardless of whether the treatment is for the same or eligible for benefit under your plan. If you choose to
a related condition, or for an entirely new condition. occupy an amenity bed whilst receiving NHS in-patient

6
treatment, this will not affect payment of this benefit. By no clinical symptoms are currently present. Surgical
amenity bed we mean a bed for which the NHS makes treatment to remove undiseased tissue to prevent
a charge but where treatment is being provided free of potential future disease, illness or injury.
charge.
Private ambulance – We will pay for transport by a
NHS cancer cash benefit – In the event that you elect private ambulance, operated by a recognised private
to receive free cancer treatment through the NHS, we ambulance service in between hospitals when ordered
will pay an NHS Cancer Cash Benefit following eligible for medical reasons.
out-patient (radiotherapy, chemotherapy, blood
transfusions or out-patient surgical procedures Reasonable and customary costs – We only pay
only. Outpatient drugs taken in tablet form are treatment charges that are reasonable and customary.
excluded), day-patient and in-patient treatment, This means the amount you are charged by medical
instead of any other benefit. This benefit will only be practitioners, other healthcare professionals and/
payable if the treatment you receive under the NHS or treatment facilities have to be in line with what the
would otherwise have been eligible for benefit under majority of our other members are charged for similar
your plan. These benefits would be paid to you on treatment or services.
receipt of the necessary documents which should be
submitted within 6 months of the treatment. Specialist – A medical practitioner registered under the
Medical Acts and given accreditation as a specialist in
Nurse – A qualified nurse who is on the register of the the treatment for which the patient has been referred
Nursing and Midwifery Council (NMC) and holds a valid by reason of holding or having held a consultant
NMC personal identification number. appointment in that speciality in an NHS hospital or by
reason of holding in that speciality a Certificate of Higher
Oral surgery – This benefit is payable for surgery Specialist Training or equivalent issued by the Higher
performed in a hospital by an oral and maxillofacial Specialist Training Committee of the appropriate Royal
surgeon and the surgery is not in respect of any dental College or Faculty.
condition or irreversible bone disease related to gum
disease or damage. Specified obstetric procedures – Ectopic pregnancy,
hydatidiform mole, evacuation of retained products,
Out-patient – A patient who attends a hospital, removal of retained placentas and post-partum
consulting room, or out-patient clinic and is not haemorrhage.
admitted as a day-patient or an in-patient.
Speech therapist – A Speech and Language Therapist
Physiotherapist – A practitioner of physiotherapy who who is a member of the Royal College of Speech and
is registered with the Health and Care Professions Language Therapists. The speech therapy must be
Council. recommended by a specialist in charge of treatment.

Policy – The contract of insurance issued for the Surgical procedure – An operation as classified in
inSpire Private Medical Insurance Plan, providing cover accordance with the Schedule of Surgical Procedures
as detailed in this Policy Document, the application and used by the APRIL UK Claims Team and approved by its
Certificate of Registration. medical advisor.

Policy year – An annual contract commencing from the Therapist – Any other practitioner who satisfies such
start date or annual renewal date on the policyholder’s criteria as specified or who has, on application to us,
Certificate of Registration. been granted restricted recognition as a therapist.

Policyholder – The first named person detailed on the Treatment – Surgical or medical services (including
Certificate of Registration. diagnostic tests) that are needed to diagnose, relieve
or cure a disease, illness or injury.
Pre-existing condition – Any disease, illness or injury
for which: United Kingdom (UK) – Great Britain, Northern Ireland,
You have received medication, advice or the Channel Islands and Isle of Man.
treatment, or
You have experienced symptoms; You / your – The person who has been accepted
whether the condition has been diagnosed or for insurance and is named on the Certificate of
not, before the start of your cover. Registration.

Preventative treatment – Medical or screening We, us, our – Axeria Insurance Limited.
services used to identify whether you are likely to suffer
from a disease, illness or injury in the future but where

7
 Alcoholism, alcohol, drug and substance abuse
BENEFITS REQUIREMENTS
and/or dependency or any treatment related to
To qualify for benefits the following requirements must be such conditions.
met: Appliances, devices, aids or prosthesis,
a All treatment must be under the control of a supplied or fitted which are not an eligible
specialist, arranged by the patient’s GP/dentist/ appliance or eligible prosthesis.
optician and be for a specific medical condition. Assisted Reproduction. Children who are born
b Nursing must be under the direction of a following assisted conception will not be eligible
specialist. for cover for the first 60 days.
c All expenditure must be necessarily incurred Chronic conditions or monitoring of chronic or
and be wholly and exclusively for the purpose of long-term medical conditions.
curing an acute condition and not to alleviate or Cochlea implants, or any related treatment.
monitor a chronic condition. Complementary medicine.
d In-patient, day-patient and out-patient Congenital abnormalities.
expenditure must be incurred in an eligible Cosmetic or reconstructive surgery - we do not
hospital. Benefits are not payable for any use pay for any form of treatment to change your
of hospital accommodation which is arranged appearance, plastic or reconstructive surgery,
or continued for purposes of convalescence, treatment of keloid scars or scar revision,
rehabilitation or general nursing, or is mainly for even when required for psychological reasons,
any custodial, supervisory or domestic reasons. unless it is medically necessary as a direct
e All out-patient diagnostic tests must be ordered result of you having an accident or because
or prescribed by a GP or specialist. MRI, CT and of other surgery or cancer, which itself would
PET scans must be on specialist referral and have been covered under the policy. We will
cannot be requested by the GP. only pay for the initial course of reconstructive
surgery if this was part of the original eligible
treatment from the accident or cancer, and
you have obtained our written authorisation
before receiving the treatment.
WHAT IS NOT COVERED?
We will not pay for breast enlargement or
Benefit is not payable under the policy for the treatment reduction or any treatment or procedure to
or diagnostic tests arising from or related to the change the shape or appearance of your
following: breast(s) whether or not it is required for
Accident and Emergency treatment - Most medical or psychological reasons, for example
private hospitals are not set up to receive back ache or enlarged breasts in males. We do
emergency admissions. In the event of an not pay for any treatment, including surgery:
emergency you should: - Which is for or involves the removal of healthy
- Call for an NHS ambulance. tissue (i.e. tissue which is not diseased),
- Visit the accident and emergency department surplus or fat tissue
at the local NHS hospital. - Where the intention of treatment, whether
directly or indirectly, is the reduction or
If you are admitted as an in-patient at an NHS removal of surplus or fat tissue including
hospital, please ask somebody to telephone weight loss.
APRIL UK Claims Team as you may be able
to claim for the NHS cash benefit shown on Deafness treatment for or arising from
the benefits table in the Key Facts. If you deafness caused by a congenital
subsequently wish to be transferred to a private abnormality, maturing or ageing.
facility for treatment of a condition eligible under Dental and oral treatment; the provision
the plan, cover will be provided if you receive of dental implants or dentures, repair or
approval from us in advance. You should replacement of damaged teeth (including
contact APRIL UK Claims Team on 0203 819 crowns, bridges, dentures or any dental
7159 to discuss this. You will not be covered for: prostheses). The management of or treatment
- The cost of emergency treatment in a private (including surgical operations) of jaw shrinkage
walk-in centre, accident and emergency or loss as a result of dental extractions or
department or clinic. gum disease. We also do not pay for surgical
- The cost of treatment in an intensive care operations for the treatment of bone disease
or high dependency unit if you have been when related to gum disease or tooth disease
transferred specifically to receive this care. or damage. We will pay for surgical operations
- The costs of the transfer to a private facility carried out by your specialist to:
specifically to receive treatment in an - Put a natural tooth back into a jaw bone after
intensive care or high dependency unit. it is knocked out or dislodged in an accident.

8
 - Treat irreversible bone disease involving the includes any form of weight loss surgery such as
jaws which cannot be treated in any other gastric banding, gastric bypass or the removal
way, but not if it is related to gum disease, of surplus or fat tissue.
tooth disease or damage. Out-patient treatment unless it has been
- Surgically remove a complicated, buried or ordered or prescribed by a GP or specialist.
impacted tooth root, for example an impacted MRI, CT and PET scans must be on specialist
wisdom tooth. referral and cannot be requested by a GP.
Development delay, learning and behavioural Personal expenses including telephone calls,
difficulties or speech therapy for or relating newspapers, visitors meals and other such
to any speech disorder such as stammering. costs.
However we may pay for short-term speech Pre-existing conditions, depending on the
therapy which is medically necessary underwriting method chosen. Please refer to
immediately following eligible in-patient ‘Underwriting Choices’ in the Policy Document
treatment. for full details.
Dialysis for chronic renal failure or end stage Pregnancy, termination of pregnancy or
renal disease. childbirth (including ante-natal and post-
Drugs, medicines and dressings other than natal care), other than specified obstetric
those prescribed by a specialist for use procedures.
during the course of treatment as an in- Preventative treatment - treatment required
patient or day-patient and drugs, medicines for preventative reasons, to prevent disease
and dressings prescribed by a specialist for occurring (including, but not limited to
a surgical procedure during the course of prophylactic mastectomy or oophorectomy), as
treatment as an out-patient. part of health screening or health checks (e.g.
Expenditure arising from the release of weapons sight or hearing tests), to establish whether a
of mass destruction but not limited to nuclear/ medical condition is present when there are
biological and chemical weapons. no apparent symptoms, or as part of genetic
Expenditure arising from acts of war and tests undertaken in order to establish whether
terrorism (whether or not a declaration of war or not you may be genetically disposed to the
or terrorist act was made), acts of hostility from development of a medical condition.
foreign aggressors including invasion, riots and Psychiatric medical conditions or mental illness.
civil commotion, strikes and lockouts, revolution, Residential stay in a hospital arranged wholly
mutiny and rebellious acts and usurped power or partly for domestic reasons or which is not
(seizure and maintenance by a person or group directly related to the treatment of a medical
of an office of power by force). condition.
Experimental treatment and drugs which is Routine medical examinations, screening and
regarded as experimental or unproven based tests, including sight testing.
on established medical practice in the UK. Self inflicted injury, disability or disease,
Drugs which are not approved by NICE, are including treatment related to attempted
experimental or unproven based on established suicide.
medical practice in the UK. Drugs which are not Sexually transmitted diseases.
approved by NICE (National Institute for Health Short or long sight, astigmatism or any related
and Care Excellence) for clinical effectiveness. treatment.
Combinations of drugs which have not been Sleep apnoea, snoring, or any other sleep
proven to be effective in treating your medical related breathing disorder.
condition. Surrogacy treatment needed for any procedure
Fertility or infertility treatment or investigations, required to a mother or child as a result of a
assisted reproduction, any type of surrogate pregnancy until such time as the child
contraception, sterilisation or reversal of has been accepted as an eligible dependant by
sterilisation, or sexual dysfunction including the plan.
impotence. Transplantation operations including bone
Gender reassignment. marrow and autologous stem cell transfer, donor
GP services, including any charges a GP may costs or any related treatment except corneal
make for completing a claim form. or skin grafts.
Hormone Replacement Therapy (HRT) or bone Treatment arising from participation in
densitometry is not covered except where HRT hazardous pursuits - abseiling, bungee-
is for the treatment of menopause resulting jumping, combat sports, flying light aircraft,
from medical intervention, subject to the hang-gliding, horse racing or hunting or jumping
eligibility and terms and conditions of the plan. or polo, ice hockey, martial arts, motor sports
Obesity or any weight loss treatment or (both on land and on water), mountaineering
treatment required as a result of obesity. This and outdoor rock climbing, any form of aerial

9
 flight (except as a passenger or crew member Had symptoms for that pre-existing condition
travelling on a fully licensed standard type or any related condition for two continuous
aircraft owned and operated by a recognised years after the start of your cover.
airline over an established route), parachuting
and parascending, pot-holing, rugby, scuba or If you receive advice, medication, diagnostic tests or
sub aqua diving, all skiing (dry, snow, water, treatment for that medical condition within the first
jet), surf boarding, white water rafting and any 2 years of your start date then the moratorium is not
sport for which you receive remuneration or satisfied and you will only be covered after there has
any form of professional or semi professional been a continuous period of 2 years where you have
sport. been advice, medication and treatment free for that
Treatment which is in any way linked to Human condition.
Immunodeficiency Virus (HIV) or AIDS infection
or any related illness once the diagnosis has
been made. FULL MEDICAL UNDERWRITING
Treatment outside of the UK. (Ages 0 - 74)
Treatment that is not based on a referral route, Under this underwriting option you will be required
place of treatment or type of treatment that is to complete a medical questionnaire regarding
not covered by the plan. We do not pay for any your medical history, which will be assessed by
treatment that has not been referred by your our underwriter. All pre-existing conditions or
GP, an optician for eye treatment, or a dentist treatment you have received or suffered from before
for dental treatment. your insurance started under this policy, will not be
Treatment received in Health Resorts, Nature covered, unless you have declared this in the medical
Cure Clinics, or similar establishments. questionnaire and we have agreed to provide cover.
Treatment solely to temporarily relieve Your Certificate of Registration will detail any medical
symptoms or relieve symptoms associated with exclusions.
ageing, menopause or puberty.
Treatment to desensitise or neutralise an
allergic condition or disorder. CONTINUED PERSONAL MEDICAL
Treatment which arises from, or is related to EXCLUSIONS (CPME)
any exclusion listed in this Policy Document or (Ages 0-74)
your Certificate of Registration, or treatment If you have an existing policy you can use CPME
which arises from or is related to a surgical underwriting to transfer your private medical insurance
procedure we do not cover. cover over to us on your renewal date. Your cover will
Unlicensed drugs stay on the same individual underwriting terms that were
applied by the previous insurer, providing that continuous
cover is maintained.

This means that we will continue to provide cover for

UNDERWRITING CHOICES
all medical conditions that were covered under your
MORATORIUM previous policy. However any medical exclusions or
(Ages 0 - 74) restrictions that were imposed on your private medical
Under this underwriting option, the policy will not pay for insurance cover by your previous insurer will also
treatment of any medical condition or related condition continue under your cover with us. Please note: if you
for which you: have received medical treatment for, are transferring on a CPME basis we reserve the right to
had symptoms of, have asked advice on, or to the best exclude additional symptoms or conditions according to
of your knowledge were aware existed in the five years the information provided in the declaration.
before the start of cover. This is called a pre-existing
condition. Where this option is chosen, you will be required to
answer a few brief medical questions as detailed in the
However, subject to the policy terms and conditions, a application form.
pre-existing condition can become eligible for cover
providing that when you first receive treatment you have If you currently have a policy that is written on a
not: moratorium basis, we will apply our moratorium
Consulted anyone (e.g. a GP, dental conditions starting from the date of your current policy
practitioner, optician or therapist, or anyone start date, provided there has been no break in cover.
acting in such a capacity) for medical treatment
or advice (including check-ups), or For individual policies:
Taken medicines (including prescription or over- It is important that you understand that any information,
the-counter drugs, medicines, special diets or statements or answers made by you to us are your
injections), or responsibility. You must take reasonable care not to

10
make misrepresentations when answering our questions. If you have a medical emergency or require immediate
If you are careless in answering our questions or treatment outside the Claims Team opening hours, please
deliberately make a misrepresentation, this may render refer to Accident and Emergency treatment detailed in
the insurance void from inception (the start of the policy) ‘What is not Covered’.
and enable the insurer to repudiate liability (entitle the
insurer not to pay your claims). You are advised to Always call the APRIL UK Claims Team before arranging
keep copies of documentation sent to or received from or receiving any treatment. We will confirm:
us for your own protection. Please do consult us if you 1 Whether costs for your proposed treatment,
are in doubt of any aspect. The requirement for correct specialist or treatment facility will be covered
information not only applies at commencement and under the plan
renewal of your policy, but also at any time during the 2 Any limits that may apply in the benefits provided
period of insurance. 3 Whether we require any supporting medical
documentation in respect of the claim, and if the
For group policies: treatment cost will be subject to a deduction in
If the insurance is arranged wholly or mainly for the respect of any plan excess.
purposes of your trade, business or profession, e.g.
Group Private Medical Insurance then you have a duty In most cases we will treat your call to us as a claim once
of “fair presentation of the risk”. This means that you we are notified that you have received or are about to
have to: receive your consultation or treatment. In some cases
Disclose to us every material circumstance to we may be notified of this by your specialist, treatment
which you know or ought to have known, this facility or other healthcare provider.
includes information that can be revealed by a
reasonable search of information available to In most cases, if you have contacted us to pre-authorise
you including information held by your broker; your treatment, we will settle all approved bills (subject
or to to the excess applicable and up to agreed limits) directly
Provide us with sufficient information to put us with your medical specialist or hospital; or if you have
on notice that we need to make further enquiries already paid for the treatment, then we will reimburse
into those material circumstances. you. If you pay for treatment you must send all bills or
invoices to us within six months of the date treatment
A material circumstance is a circumstance which may was delivered. We will only accept original bills; we cannot
influence the insurer’s decision to cover a risk and/ accept photocopies or originals with alterations on them.
or the terms that are applied. Examples of a material Failure to submit original invoices may result in the claim
circumstance are where a member of the scheme being denied.
has pre-existing conditions, is undergoing medical
treatment or awaiting tests or has made claims under a
private medical insurance policy. IMPORTANT INFORMATION WHEN MAKING
A CLAIM
The requirement for fair presentation of risk not only We may ask you to provide information to help us assess
applies at commencement and renewal of your policy, your claim. For example, we may ask you for one or
but also anytime during the period of insurance. more of the following:
Medical reports and other information about
We do not offer Medical History Disregarded the treatment for which you are claiming. If we
underwriting. Babies up to three months can be accepted request a medical report from your specialist
without underwriting. However any exclusions detailed in and they charge for providing this we will pay
‘What is not Covered’ will still be applied. the cost.
Results of an independent medical examination
we may ask you to undergo. We will pay for the
cost of any independent medical examination
we require you to have.
HOW TO MAKE A CLAIM
Original accounts and invoices in connection
You should always call the APRIL UK Claims Team on with your claim including any related treatment
0203 819 7159 to pre-authorise your treatment, and cost covered by your excess.
we can help you to find a specialist and hospital or A referral letter and/or medical notes from your
facility if required. The team can also ensure that they GP.
fully explain the extent of your benefits before you incur
any treatment costs with your specialist or hospital. If If any of the requested information is not available, this
you do not obtain authorisation from us before receiving may affect our ability to assess your claim resulting in
treatment, your claim may be denied and you will be part or all of the claim being declined.
liable for all treatment costs incurred.

11
 Please note 6 In response to a claim, we may:
We will only pay for an independent medical examination 6.1 Require a medical report giving such
or second opinion from a specialist if we deem it to be information as we reasonably require, and/or
medically necessary and we have authorised this in 6.2 Appoint an independent medical examiner,
advance and in writing. and/or
6.3 Require written confirmation from any parties
The APRIL UK Claims Team will liaise with you and your whose charges are being claimed as to their
medical specialist throughout your treatment and will customary levels of charge.
request medical information, when we deem that this is 7 If you have any other insurance covering the
required for the assessment of your claim. You will be benefits which have been provided, the APRIL UK
asked for your consent before we do this. Claims Team must be notified of that fact in writing
at the time of making a claim and we reserve
the right to decline payment of a claim in such
CANCELLATION OF TREATMENT OR NON- circumstances.
ATTENDANCE 8 The insurer reserves the right to revise or
We will pay claims under the following conditions: discontinue any or all of the Rules or the Schedule
As per the rules and benefits of the plan of Benefits from any renewal date. These changes
applied to you on the date you received your will reflect any past or foreseeable changes in
treatment. medical practice or procedures and the nature
If treatment was received whilst still a member and extent of claims made or likely to be made
of the plan. generally under the policy. Any such changes
Only eligible costs actually incurred by you for will be notified to the policyholder by giving
treatment you receive will be paid. thirty days notice in writing and upon renewal, the
We may not pay a claim if you break any terms policyholder will be bound by those terms.
and conditions of your membership. 9 The premium is payable on the same day each
You may be charged for non-attendance which month or annually in advance. The premium
is not recoverable under this policy. rate applying to the policy may be varied at any
renewal by the insurer giving the policyholder
written notice. The premiums are subject to
Insurance Premium Tax at the current rate and
this rate has already been included in the premium
GENERAL RULES
payable. Thirty days notice in writing will be given
All expenditure must be necessarily incurred in line with if the premium payable is affected. It is important
agreed hospital and consultant charges and wholly and to continue to pay the premium while benefits are
exclusively for the purpose of curing an acute condition. being paid under this insurance in order to maintain
1 Certificate of Registration will be issued upon the cover. In the event that any premium is not
acceptance, outlining the terms and conditions of paid on the date due, the policy will terminate
the policy. automatically.
2 Eligibility for enrolment depends upon the proposed 10 You must give us written notification of any claim
insured person being between the ages of 0 and 74 or right of action against any party which gives
inclusive and being a permanent and lawful resident rise to the claim under this policy. You must take
of the UK, Isle of Man or Channel Islands. Where all steps we reasonably require in making a claim
the insured person is between the ages of 0 and upon that other party. We shall be entitled to pursue
15 inclusive, their application must be authorised in any policyholders name for our own benefit
by a parent or guardian who must also pay the any claim for indemnity or damages or otherwise
premiums. which relates to any benefits and costs paid or
3 Cover for employees enrolled under an inSpire payable under this policy. We shall have full
Private Medical Insurance Plan group scheme discretion in the conduct of any proceedings and
will cease immediately upon their leaving the in the settlement of any such claim, but we shall
employment of the company. have no responsibility for any claim for uninsured
4 All claims are assessed by reference to these Rules losses, in respect of which the policyholder and/
and the Schedule of Benefits applicable as at the or dependants should ensure that legal advice is
date the treatment was received. The claimant taken.
must have been eligible at the time of receiving the 11 Currently all benefits under this policy are non-
treatment in respect of which the claim is made. taxable although this may change in line with any
5 Benefit in respect of each claim is subject to any amendments to legislation.
maximum amounts stated in the Policy Document, 12 The benefits under the policy cannot be assigned
up to an aggregate limit of £1m per person per and the policy has no surrender value.
policy year. 13 If the policyholder dies then the dependants will
be given continuation options provided that there is

12
 a remaining adult who will be responsible for paying time terminate or cancel the policy or amend the terms
the premium. of his/her cover if at any time the policyholder or
14 Waiver by us of any term or condition of this policy dependant has:
will not prevent us from relying on such terms and 1 Deliberately misled us by mis-statement or
conditions thereafter. concealment of any material information;
15 If any claim under this policy is in any respect 2 Misled us by mis-statement or concealment of
fraudulent or unfounded, all benefit paid and/or any material information, and that has led to us
payable in relation to the claim shall be forfeited by offering you cover. If this is the case a refund of
you and recoverable by us. premiums will be provided;
16 This policy provides benefit for treatment incurred 3 Knowingly claimed payment of any sum under this
during the policy period only. In the event that this policy for any purpose other than as are provided
policy is not renewed, we will cease paying for for under this policy;
expenses incurred after the expiry date. 4 Agreed to any wrongful attempt by a third party to
17 If you choose a specialist who does not hold obtain a financial advantage to our detriment:
practising rights at a Spire Healthcare hospital 5 Otherwise failed to observe the terms and
an alternative would be recommended to avoid a conditions of this policy.
shortfall in a claim.
18 All Spire Healthcare hospitals are different and
some medical procedures, including paediatrics
(treating children), may not be available at your
LAW AND JURISDICTION
nearest Spire Healthcare hospital. Private medical
insurance is not designed to replace the NHS, Unless specifically agreed to the contrary this policy
but to work alongside it and provide you with the shall be governed by the laws of England and Wales
healthcare that you need. In some instances an and subject to the exclusive jurisdiction of the courts
NHS facility maybe the most suitable option for of England.
you.
19 For the purposes of calculating your premium, we
will use your residential address which is registered
with your GP. For Group business, the Company
SANCTIONS ENDORSEMENT
address will be used to calculate your premium.
The insurer shall not be deemed to provide cover
and shall not be liable to pay any claim or provide
any benefit hereunder to the extent that the provision
of such cover, payment of such claim or provision
USE OF HOSPITALS OUTSIDE THE SPIRE
of such benefit would expose the insurer to any
HEALTHCARE NETWORK
sanction, prohibition or restriction under United Nations
Where you choose to use an alternative hospital or clinic resolutions or the trade or economic sanctions, laws or
for any medical service that could have taken place within regulations of the European Union, United Kingdom or
a Spire facility, your costs may not be covered in full and United States of America.
you may have to pay the incurred shortfall. Where Spire
Healthcare are unable to provide the treatment needed,
we will refer you to an alternative hospital or clinic and
provide cover as specified in this Policy Document. If you
RIGHTS OF THIRD PARTIES
choose not to use this alternative hospital or clinic that we
have referred you to, your costs may not be covered in A person who is not a party to this policy has no right
full and you may have to pay the incurred shortfall. under the Contracts (Rights of Third Parties) Act 1999 to
enforce any term of this policy but this does not affect
any right or remedy of a third party which exists or is
available apart from that Act.
HOW TO CANCEL YOUR POLICY
You may cancel this policy at any time. If a policy is
cancelled no premium will be refunded to either the
HOW TO MAKE A COMPLAINT
policyholder or his/her dependants and all benefits
will immediately cease for the policyholder and his/her If you have a complaint about the administration of
dependants. This policy will be automatically cancelled the policy, please contact APRIL UK, April House,
on the due date for payment of premium, upon non Almondsbury Business Centre, Bradley Stoke, Bristol
payment of any part of the premium, although we may BS32 4QH, telephone 01454 619500 (Monday to Friday,
at our discretion reinstate the cover if the premium 8am – 5pm, excluding public holidays) and you will be
is paid within 30 days of its due date. We may at any provided with details of their complaints procedure.

13
 If you have a complaint about the claims handling of
the policy please contact APRIL UK Claims Team,
Healix House, Esher Green, Esher, Surrey KT10 8AB, or
telephone 0203 819 7159, or email apriluk@healix.com.

If your complaint addressed to any of the above parties

is not resolved to your satisfaction, you may within
6 months of a final decision contact: The Financial
Ombudsman Service, Exchange Tower, London E14
9SR. Tel: 0800 023 4567 / 0300 123 9 123. Email:
complaint.info@financial-ombudsman.org.uk. Website:
www.financial-ombudsman.org.uk

If you have a complaint about the policy wording,

please contact Axeria Insurance Limited, Progetta
House, Level 2, Tower Road, Swatar, Birkirkara BKR
4012, Malta. Telephone: +356 21377107. After this
action, if you are still not satisfied with the way your
complaint has been dealt with, you can ask the Office of
the Arbiter for Financial Services (Malta) to review your
case. Their contact details are the Office of the Arbiter
for Financial Services, First Floor, St Calcedonius
Square, Floriana FRN1530, Malta. Telephone +356
2124 9245.
Email: complaint.info@financialarbiter.org.mt
Website: www.financialarbiter.org.mt

Both the Financial Ombudsman Service and the Office

of the Arbiter for Financial Services (Malta) have been
set up by law to help settle individual disputes between
consumers and financial firms. They can decide if we
have acted wrongly and if you have lost out as a result.
If this is the case they will tell us how to put things right
and whether this involves compensation. The Financial
Ombudsman Service is an independent body, and
we will always abide by their decisions. The Office
of the Arbiter for Financial Services (Malta) is also
independent. The making of a complaint does not affect
your right to take legal proceedings.

Leaflets explaining the functions of the Financial

Ombudsman Service and the Office of the Arbiter for
Financial Services (Malta) are also available on request.

14
CHRONIC CONDITIONS
EXPLAINED

If you are thinking about buying a private medical as acute complications of the disease and are not
insurance policy, or have already bought one, you may eligible for benefit.
have heard the term ‘chronic condition’.
Please note that in some cases it might not be clear, at
Private Medical Insurance is designed to provide benefit the time of treatment that the disease, illness or injury
towards the cost of short-term treatment of an acute being treated is a chronic condition. We may not
condition, which starts after you have taken out your pay the ongoing costs of continuing treatment, or for
policy. It does not provide benefit for the treatment of similar treatment even where we have previously paid
long-term or chronic conditions. for this type of or similar treatment.

This section explains how APRIL UK manages inSpire If after a full review of all the medical information
Private Medical Insurance Plan policyholders whose available, a condition is considered to have become
medical condition becomes a ‘chronic condition’. a chronic condition, you will be given written
There are benefit limits and exclusions on all policies and notification that the plan will no longer pay benefits for
you should check your Policy Document and contact us the continuing or recurrent treatment of the chronic
before incurring any costs. condition.

You will also be given reasonable time to make other

WHAT IS A CHRONIC CONDITION arrangements for continued treatment, and the plan will
A chronic condition is defined as: A disease, illness or assist you and your GP to transfer management of your
injury that has one or more of the following characteristics: chronic condition to the NHS.
It needs ongoing or long term monitoring
through consultations, examinations, check-ups
and/or tests WHAT IF MY CONDITION GETS WORSE?
It needs ongoing or long term control or relief of Although we may withdraw cover because your condition
symptoms has become a chronic condition, it does not necessarily
It continues indefinitely mean that cover is permanently withdrawn.
It comes back or is likely to come back
You need to be rehabilitated or specially trained
to cope with it EXAMPLES OF CHRONIC CONDITIONS
It has no known cure The following examples are intended to illustrate the
cover you might expect from your inSpire Private Medical
Insurance Plan if you develop a medical condition that
WHAT DOES THIS MEAN IN PRACTICE? may become a chronic condition. You should always
We will pay for eligible treatment arising out of contact us prior to receiving any treatment to ensure that
a chronic condition, or for treatment of acute you do not incur costs which you cannot recover.
symptoms of a chronic condition that flare up.
However, we only pay if the treatment is likely to lead Example 1 – Angina and Heart Disease
to a complete recovery or to you being fully restored Alan has been with APRIL UK for many years. He
to your previous state of health, without you having to develops chest pain and is referred by his GP to a
receive prolonged treatment. This exception does not specialist. He has a number of investigations and
apply to treatment of a psychiatric condition. diagnosed as suffering from angina. Alan is placed on
medication to control his symptoms.
For example, we pay for treatment following a heart
attack arising out of chronic heart disease. However, APRIL UK covers the investigations and specialist
many chronic conditions are of a relapsing and consultations required to diagnose Alan’s chest
remitting nature, requiring management of recurrent pain. We would not cover the cost of the outpatient
episodes where symptoms deteriorate e.g. multiple medication. Once the condition is diagnosed, we
sclerosis, Crohn’s disease, long-term depressive advise Alan that we are unable to provide further
illness, psoriasis etc. The relapses are part of the cover to monitor his condition.
normal illness course and therefore cannot be classed

15
 Two years later, Alan’s chest pain recurs more One year later, Deirdre’s diabetes becomes unstable
severely and his specialist recommends that he have and her GP arranges for her to go into hospital for
a heart by-pass operation. treatment.

APRIL UK would cover the cost of the surgery and As this is an acute flare-up which is likely to respond
eligible treatment afterwards because its aim is to quickly to treatment aiming to restore Deirdre to her
return Alan to his state of health immediately before previous state of health, we agree to cover the cost
suffering from angina. We will also cover the cost of a of the hospital treatment to stabilise her condition.
specialist post-operative check-up to ensure that his We also agree to cover the cost of one follow-up to
surgery has been successful. ensure that Deirdre’s symptoms are controlled.

Example 2 – Asthma
Eve has been with APRIL UK for five years when she
develops breathing difficulties. Her GP refers her to a
specialist who arranges for a number of tests. These
reveal that Eve has asthma. Her specialist puts her on
medication and recommends a follow-up consultation
in three months, to see if her condition has improved.
At that consultation Eve states that her breathing has
been much better, so the specialist suggests she have
check-ups every four months.

APRIL UK covers Eve’s consultations and tests

until the diagnosis is made. We also agree, on
this occasion, to pay for her first routine check-up.
However, we advise her that we will not be able
to cover the regular check-ups after this, because
the condition is well controlled, and has become a
chronic condition.

Eighteen months later, Eve has a bad asthma attack.

As this is an acute flare-up which is likely to respond

quickly to treatment aiming to restore Eve to her
previous state of health, we agree to cover the cost
of the hospital treatment to stabilise her condition.
We also agree to cover the cost of one follow-up to
ensure that Eve’s symptoms are controlled.

Example 3 – Diabetes
Deidre has been with APRIL UK for two years
when she develops symptoms that indicate she
may have diabetes. Her GP refers her to an
endocrinology specialist who organises a series of
investigations to confirm the diagnosis, and she then
starts on oral medication to control her diabetes.
After several months of regular consultations and
some adjustments made to her medication regime,
the specialist confirms the condition is now well
controlled and explains he would like to see her every
four months to review the condition.

APRIL UK covers Deirdre’s consultations and tests

until the diagnosis is made. We also agree, on
this occasion, to pay for her first routine check-up.
However, we advise her that we will not be able
to cover the regular check-ups after this, because
the condition is well controlled, and has become a
chronic condition.

16
SUMMARY OF
CANCER BENEFIT

This section explains how we manage inSpire Private

BENEFIT FOR CANCER
Medical Insurance Plan policyholders or their
dependants who have cancer. It should be read We use NICE (National Institute for Health and Care
in conjunction with the Policy Document, Certificate Excellence) as our main benchmark for deciding
of Registration, hospital directory and any other whether treatment and drugs are eligible under
documentation issued to you. this plan. Treatments that have been approved
by NICE for clinical effectiveness are covered,
The inSpire Private Medical Insurance Plan will cover regardless of any decision by NICE regarding it’s
you for investigation and treatment of cancer within the cost effectiveness.
benefit limits of your policy. This includes new cancers
as well as a recurrence of a previous cancer (where it is EXPERIMENTAL AND PREVENTATIVE
not excluded under a pre-existing exclusion). To confirm HEALTH SCREENING
all costs will be paid please contact the APRIL UK Claims This plan does not provide cover for preventative
Team in advance of any treatment. screening, on-going health checks, or treatments
including medication, which are experimental,
unproved based on established medical practice in
the United Kingdom or not yet approved by NICE
CANCER RELATED BENEFITS (National Institute for Health and Care Excellence),
(in, day and out-patient basis) are being researched or that do not yet have
sufficient peer-reviewed evidence to conclude that:
Consultations and specialist
The harmful effects are outweighed by the
fees - prior and post diagnosis beneficial effects
They are likely to lead to the same or better
outcomes than available alternatives
Diagnostic tests and scans They are based on established medical
- including Bone scan, CT/MRI/PET
practice in the United Kingdom.
scans, Endoscopy, Ultrasound, X-ray
This also includes medical procedures (including the
use of unlicensed drugs or drugs which are not available
Cancer drugs and therapy - including under the NHS, even if they are on clinical trial).
Chemotherapy, Hormone
therapies, Bisphosphonates

CANCER TREATMENT
Biological therapies (‘super drugs’)
We will pay up to the policy limit, for in-patient, day-
(Reviewed after 12 months of authorised use - see Biological Therapies below) patient or out-patient treatment for a diagnosed
malignancy. Cover includes palliative treatment up to a
Radiotherapy maximum limit of £10,000 for the lifetime of the plan.
Ongoing check-ups will be covered providing they
Surgery and hospital charges are medically necessary and recommended by a
- including removal of a tumour specialist.
or reconstructive surgery

Wigs Up to £300 PALLIATIVE TREATMENT

Cancer treatment, the primary effect of which is to
During the lifetime of the plan
alleviate symptoms rather than to achieve remission,
External prostheses Up to £5,000 cure or reduction in tumour size.
During the lifetime of the plan

Palliative treatment - including CONSULTATIONS AND SPECIALIST FEES

Up to £10,000
side effects and sickness drugs We will pay up to the policy limit, for in-patient, day-
patient or out-patient treatment for a diagnosed
During the lifetime of the plan
malignancy until treatment is deemed, by us, to be

17
 palliative. If you require ongoing or continuing treatment required further reconstructive operations, these
that is palliative, it will be subject to the limits in the would be covered providing they were medically
cancer table of benefits. When benefit is no longer necessary and required as a result of the original
payable, where possible the nursing team will provide breast cancer.
guidance on making other arrangements for continued
treatment. Beverley would then be covered for her course
of radiotherapy and chemotherapy provided that
these are within normal clinical practice and the
BIOLOGICAL THERAPIES (‘SUPER DRUGS’) chemotherapy drugs have been approved by NICE
We will pay for biological therapies under the following (National Institute for Health and Care Excellence) for
conditions: clinical effectiveness.
They are licensed for use by the European
Medicines Agency or the Medicines and Beverley’s hormone therapy tablets would not be
Healthcare products Regulatory Agency and covered as these are prescription drugs and Beverley
are used within the terms of that licence. would need to obtain these from her GP.
Their use is justified by a substantial body of
published evidence specific to the particular
clinical situation; and Example 2
They are being given with curative intent in Cara has previously had breast cancer which
the acute, active phase of cancer treatment; was treated by lumpectomy, radiotherapy and
and chemotherapy under her existing policy. She
We explicitly agree to pay for their use in now has a recurrence in her other breast and has
advance. decided to have a mastectomy, radiotherapy and
chemotherapy. Will her insurance cover this and are
We will pay for a course of treatment with biological there any limits to cover?
therapies (Advanced Therapeutics) for cancer lasting
up to a total of 12 calendar months providing you have Cara would be covered for her mastectomy,
an annual policy in force. This may be extended for radiotherapy and chemotherapy. Cover for
active treatment and not for maintenance of remission, chemotherapy and radiotherapy would be provided
subject to expert advice from your specialist that there as long as these are within normal clinical practice
is evidence of continuing disease and clinical benefit and and the chemotherapy drugs have been approved
the drug continues to be given with curative intent. by NICE (National Institute for Health and Care
Excellence) for clinical effectiveness.
If extended after 12 months, funding for biological
therapies will be reviewed by us at 3 monthly intervals.
Example 3
Monica, who was previously treated for breast
cancer under her existing policy, has a recurrence
which has unfortunately spread to other parts of the
EXAMPLES OF CANCER COVER
body. Her specialist has recommended the following
The following examples are intended to illustrate the treatment plan:
cover you might expect from the inSpire Private Medical A course of six cycles of chemotherapy aimed
Insurance Plan if you develop cancer. You should at destroying cancer cells to be given over the
always contact us before receiving any treatment to next six months.
ensure that you do not incur costs which you cannot Monthly infusions of a drug to help protect the
recover. bones against pain and fracture. This infusion is
to be given for as long as it is working (hopefully
Example 1 years).
Beverley has been with APRIL UK for five years
when she is diagnosed with breast cancer. Following Will her insurance cover this treatment plan and are
discussion with her specialist, she decides to there any limits on the cover?
have her breast removed followed by breast
reconstruction. Her specialist also recommends a Monica will be covered for the six cycles of
course of radiotherapy and chemotherapy. In addition chemotherapy provided that these are within normal
she is to have hormone therapy tablets for several clinical practice and the chemotherapy drugs have
years. Will her insurance cover this treatment plan been approved by NICE (National Institute for Health
and are there any limits to the cover? and Care Excellence) for clinical effectiveness.

APRIL UK would cover the cost of the mastectomy The monthly infusion to help protect bones against
and breast reconstruction operations. If Beverley pains and fractures will be covered during the policy

18
 period, provided that these are within normal clinical with you again at the time that any claim is made the fact
practice and have been approved by NICE (National that this processing will take place. We will also obtain
Institute for Health and Care Excellence) for clinical any consent needed from you for us to obtain medical
effectiveness. information from your GP or other medical practitioner in
relation to a claim.

Medical information will be kept confidential and will

only be disclosed to those involved in your treatment
DATA PROTECTION ACT
or care, including as appropriate your GP, dentist,
For the purposes of the Data Protection Act 1998, the or their agents, and if applicable, to any person or
Data Controller(s) in relation to any personal data you organisation who may be responsible for meeting your
supply are APRIL UK and Axeria Insurance Limited. treatment expenses, or their agents. Only in exceptional
circumstances will we disclose medical information to
other third parties or family members without the patient’s
INSURANCE ADMINISTRATION explicit consent. APRIL UK Claims Team will not disclose
Your information may be used for the purposes of medical information about you or your dependants to
insurance administration by the insurer, its associated your employer. (Group schemes)
companies, agents, reinsurers and APRIL UK. It may
be disclosed to regulatory bodies for the purposes of
monitoring and/or enforcing the insurer’s compliance SAFEGUARDING YOUR PREMIUM AND
with any regulatory rules/codes. Your information CLAIM PAYMENTS
may also be used for offering renewal, research and All premium payments from you and due to the insurer
statistical purposes and crime prevention. It may be for this policy will be held by APRIL UK on behalf of the
transferred to any country, including countries outside insurer. APRIL UK will hold any premium refund that is
the European Economic Area for any of these purposes due to you from the insurer and the claims administrator
and for systems administration. Where this happens, will hold any claim benefits that are due to you from the
we will ensure that anyone to whom we pass your insurer.
information agrees to treat your information with the
same level of protection as if we were dealing with it. In this capacity APRIL UK and the claims administrator
act as authorised agents of the insurer. This means that
If you give us information about another person, once a premium is paid to APRIL UK it is deemed to have
in doing so you confirm that they have given you been received by the insurer and that all claims benefits
permission to provide it to us and for us to be able to and premium refunds from the insurer are not deemed
process their personal data (including any sensitive to have been paid until you have actually received them.
personal data) and also that you have told them who
we are and what we will use their data for, as set out
in this notice. In the case of personal data, with limited
exceptions, and on payment of the appropriate fee, you
have the right to access and, if necessary, to rectify
information held about you.
Information may also be shared with other insurers either
directly or via those acting for the insurer (such as loss
adjusters or investigators).

SENSITIVE PERSONAL DATA

If you or your dependant make a claim under the
policy,as part of our assessment of the terms of the
policy, including any specific medical exclusions
and claims administration, we may collect data which
includes sensitive personal data as defined by the Data
Protection Act.

Under the Data Protection Act we are required to obtain

your explicit consent before we process this type of
information. By participating in the policy and making
a claim, APRIL UK and APRIL UK Claims Team will be
entitled to take these actions as you are giving consent
to the processing of your sensitive medical information
for the purposes set out above. However, we will confirm

19
April House, Almondsbury Business Centre,
Bradley Stoke, Bristol BS32 4QH
Tel: 01454 619500 | www.april-uk.com

APRIL UK is a trading name of APRIL UK (Insurance Services) Ltd (registered in England No 3179382), who is authorised and
regulated by the Financial Conduct Authority, registered number 308655.

This product is insured by Axeria Insurance Limited (Malta Company Registration number C 55905), which is a company authorised
under the Maltese Insurance Business Act, 1998 to carry out general business and is regulated by the Malta Financial Services Authority.
Registered office: Progetta House, Level 2, Tower Road, Swatar, Birkirkara BKR 4012, Malta. Tel: (+356) 2137 7107.

DISCLOSURE OF INTERESTS: In terms of the provisions of Directive 2002/92/EC of the European Parliament and of the Council
of 9 December 2002 on insurance mediation, please note that APRIL S.A., a Company organised in terms of French Law with
registration number 377994553RCS of Immeuble Aprilium, 114 Bd Vivier Merle, 69439 Lyon, France holds more than 10% of the
voting rights of both Axeria Insurance Limited and APRIL UK. Axeria Insurance Limited and APRIL UK are affiliates by virtue of the
common shareholding of APRIL S.A. as outlined above. INSPD 0218