Schools Staff Medical Insurance Policy wording and terms and

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					            Schools Staff Medical Insurance


       Policy wording and terms and conditions




Please read this document carefully and keep in a safe place




                        Page 1 of 18
CONTENTS

1.    INTRODUCTION
      The Insurance Document
      The Scheme Administrators

2.    THE COVER
      Who is covered?
      What is covered?
      Payment of Benefit
      Private Hospital Benefits
      Fixed Price packages

3.    SCHEDULE OF PROCEDURES

4.    EXCLUSIONS – EVENTS THAT ARE NOT COVERED

5.    GENERAL CONDITIONS

6.    EMPLOYEE AMENDMENTS AND ADJUSTMENTS

7.    TERMINATION

8.    DEFINITIONS

9.    CLAIMS PROCEDURE
      Making a Claim under This Policy
      How to make a Claim
      Being treated in a Private Hospital
      Being treated in a NHS Hospital

10.   THE INSURERS

11.   CERTIFICATION

12.   DATA PROTECTION

13.   COMPLAINTS PROCEDURE




                                     Page 2 of 18
1.     INTRODUCTION

1.1    The Insurance Document

This is the Schools Protection Schools Staff Medical Insurance Plan which, combined
with the Insurance Schedule, contains the full insurance terms, limitations, conditions
and exclusions. Please read both documents carefully and keep them safe.

Throughout this contract words and phrases that appear in bold have special meaning.
Please refer to Section 8. Definitions for their meaning.



1.2.   The Scheme Administrators

Schools Protection are the scheme administrators and are authorised by the Insurer to
issue this contract and the Insurance Schedule. They will answer any questions
about the insurance cover and will also be responsible for collection of the Premium
due.

Claims will be negotiated and settled directly with the school by Global Claims Services
who act on behalf of the Insurer as Claims Administrator.

Their contact details are as follows:-


Global Claims Services Limited
P.O. Box 319
Croydon
CR9 4SA
Tel: +44 (0) 870 899 3363
Fax: +44 (0) 208 680 8703
E-mail: info@globalclaims.co.uk


Telephone calls may be monitored or recorded to help Us maintain a quality service.




                                         Page 3 of 18
2.     THE COVER

2.1    Who is covered?

All school staff under the age of 65 and who are employed by the school during the
period of this insurance and for at least 10 days beforehand, are eligible providing that
they reside in the UK and have been registered with a NHS GP for at least 180 days.

Unless otherwise specified, any Medical Condition or Related Medical Conditions
which an Insured Person knew about, or for which they had symptoms (whether or not
a diagnosis had been made), consultation, medication, monitoring, Advice or treatment
in the 2 year period prior to becoming insured under this Policy will not be covered.
These may become covered once they have been free of symptoms, treatment or
Advice for 2 continuous years from when they first became insured under this scheme.
Eligible new conditions will be covered immediately.

To effect this cover the school must provide the list of staff to be insured, with their date
of birth, to Schools Protection on or before the Commencement Date of this
insurance. For Insured Persons joining after the inception date, Schools Protection
must receive notification by the method prescribed within 14 days of the date that the
Insured Person’s employment begins.

An Insured Person’s cover will be deemed to commence at the Commencement
Date of insurance shown in the Insurance Schedule. If their employment began with
the Insured after the Policy Commencement Date, cover will commence from the
date Schools Protection accepted their inclusion to the list of Insured Persons.


2.2    What is covered?

This is an insurance Policy that provides benefits for an Insured Person requiring a
Medical Procedure in Hospital that is covered by this insurance.
Benefits are designed to enable an Insured Person to purchase Treatment at most
Private Hospitals for a Medical Procedure specified in the SCHEDULE OF
PROCEDURES. The Policy will pay for the costs of Treatment up to the level of
Customary Charges, using a Fixed-Price package arranged by Us or a third party
nominated by Us.
Should an Insured Person choose to use the NHS rather than a Private Hospital or
where a Fixed-Price package is not available; the Policy will pay You the applicable
NHS cash benefit as shown in the POLICY BENEFITS section under the TABLE OF
BENEFITS (NHS BENEFITS).
Claims are paid when an Insured Person receives Treatment in a Hospital. An
Insured Person can choose if they wish to be considered for Private Treatment or be
treated in the NHS and Global Claims Services (0870 899 3363) will assist an Insured
Person with their claim depending on their circumstances.




                                        Page 4 of 18
2.3.    Payment of Benefit

This Policy covers an Insured Person for Medical Procedures which are listed in the
SCHEDULE OF PROCEDURES:
Medical Procedures are allocated a Classification of Medical Procedure according
to their complexity. Band A is the least complicated procedure and Band C the most
complicated. The SCHEDULE OF PROCEDURES contains a full listing of the category
allocations.

An Insured Person may claim for up to 3 Medical Procedures in any consecutive 12
month period for each Insured Person under this Policy.

If an Insured Person undergoes more than one planned Medical Procedure at the
same time, We will pay for the procedure in the highest band only.

The Policy does not cover an Insured Person for the cost of Complications which
are outside the scope of the Fixed-Price package unless the Complications are a
separate Medical Procedure as determined by the SCHEDULE OF PROCEDURES.
All costs must be reasonable and Customary Charges and necessary for the
treatment of an eligible Medical Procedure which is listed in the Schedule of
Procedures. We will not pay any part of the treatment charges which We think are too
high compared with those customarily charged in the United Kingdom for similar
treatment, services or supplies.
Any further Medical Procedures after the initial Treatment will be treated as a
separate claim.

Table of benefits

Private Hospital Benefits
If an Insured Person chooses to be considered for Treatment in a Private Hospital,
We will source a Fixed-Price package offering Customary Charges for their
Treatment to pay for their Hospital costs in accordance with the Classification of
Medical Procedures. Where a Fixed–Price package is not available then the NHS
benefits will apply.


Fixed-Price Packages explained
These are the costs of Treatment in a Private Hospital and for which the costs have
been negotiated by Us in advance, or by a third party nominated by Us. These are
normally available for uncomplicated surgical cases. In instances where a patient has a
complicated medical history or additional medical problems that increase the risk of
surgical intervention, a Fixed-Price package may not be available or indeed
appropriate.


NHS Benefits
If an Insured Person chooses to receive Treatment within the NHS or should a Fixed-
Price package of Private Treatment not be available, once We have all the necessary



                                     Page 5 of 18
paperwork, We will send You a cheque according to the Classification of Medical
Procedures as stated in the Table below:




                                      Classification of Medical Procedure                        NHS Benefits

                                    Band A                                                                   £1,000
                                    Band B                                                                   £2,000
                                    Band C                                                                   £3,000



3.          SCHEDULE OF PROCEDURES

         EVERYDAY NAME                                                                                                                         BAND

                                    C7123     Phakoemulsification of lens without implant - unilateral                                          A
                                    C7124     Phakoemulsification of lens without implant - bilateral                                           A
                                    C7122     Phakoemulsification of lens with implant - unilateral                                             A
              Cataract
                                    C7125     Phakoemulsification of lens with implant - bilateral                                              A
                                    C7180     Extracapsular extraction with implant - unilateral                                                A
                                    C7190     Extracapsular extraction with implant - bilateral                                                 B
                                    C7520     Lens implant/exchange                                                                             B

                 Ear                D1440     Combined approach tympanoplasty - intact canal wall tympanoplasty                                 B
                                    D1510     Myringotomy and insertion of tube through tympanic membrane (and bilateral)                       A

                                    E1220     Caldwell-Luc                                                                                      A
           Sinus Problems
                                    E1460     Trephining of frontal sinus                                                                       A
                                    E1500     Operation(s) on sphenoid sinus (including endoscopic)                                             A

               Tonsils
                                    F3440     Tonsillectomy - adult (and bilateral)                                                             A

                                    T2000     Primary repair of inguinal hernia                                                                 A
                                    T2200     Primary repair of femoral hernia                                                                  A
               Hernias
                                    T2500     Primary repair of incisional hernia                                                               B
                                    T2400     Repair of umbilical hernia                                                                        A
                                    G2320     Transthoracic repair of diaphragmatic hernia (acquired)                                           C

                                    J1800     Cholecystectomy (including mini-cholecystectomy)                                                  B
     Gall Bladder and Gall Stones   J2800     Excision of lesion of bile duct                                                                   B
                                    J3900     Therapeutic ERCP (including insertion of biliary or pancreatic prosthesis, sphincterotomy         A
                                              and stone extraction)

         Heart Blood Vessels        K4900     Percutaneous transluminal angioplasty of coronary artery(ies) (including laser)                   B
                                    K4910     Percutaneous transluminal angioplasty of coronary artery(ies) with stent insertion                C

                                    L8530     Operations for recurrent varicose veins with re-exploration of groin - unilateral                 A
           Varicose Veins
                                    L8700     Ligation/stripping of long and short saphenous veins (including local excision/multiple           A
                                               phlebectomy)

                                    M4210     Endoscopic resection of lesion of bladder (including cystoscopy)                                  A
                                    M5100     Combined abdominal and vaginal operations to support outlet of female bladder (including sling    B
               Bladder                        procedures)
                                    M5180     Combined abdominal and vaginal operations to support outlet of female bladder (including sling    B
                                              procedures) - redo operation
                                    M5220     Retropubic suspension of neck of bladder (including colposuspension)                              B




                                                               Page 6 of 18
                     M6100   Open excision of prostatic adenoma                                                                 B
                     M6180   Radical prostatectomy, reconstruction of bladder neck including bilateral pelvic lymphadenectomy   C
  Men’s Health

                     M6580   Endoscopic biopsy of prostate                                                                      A
                     M6720   Transurethral microwave therapy                                                                    B

                     P0600   Excision of lesion of vulva                                                                        A
                     P2210   Anterior +/- posterior colporrhaphy and amputation of cervix uteri (including primary repair of    B
                             enterocele)
                     P2310   Anterior +/- posterior colporrhaphy (including primary repair of enterocele)                       B
                     P2230   Posterior colporrhaphy                                                                             A
                     Q0740   Total abdominal hysterectomy (+/- oopherectomy)                                                    B
 Women’s Health      Q0750   Subtotal abdominal hysterectomy (+/- oopherectomy)                                                 B
                     Q0800   Vaginal hysterectomy (including laparoscopically assisted)                                         B
                     Q0920   Myomectomy (including laparoscopically)                                                            B
                     Q1700   Therapeutic endoscopic operations on uterus (including endometrial ablation)                       B
                     Q2230   Oophorectomy and salpingectomy (as sole procedure) (including bilateral)                           B
                     Q3800   Laparoscopy and therapeutic procedures including laser,diathermy and destruction                   B
                             e.g.endometriosis,adhesiolysis,tubal surgery
                     Q4400   Ovarian cystectomy (as sole procedure) (and bilateral)                                             B

                     V2200   Posterior decompression +/- foraminotomy (cervical region)                                         C
                     V2300   Revisional posterior decompression +/- foraminotomy (cervical region)                              C
                     V2402   Posterior decompression (thoracic region)                                                          C
                     V2430   Revisional posterior decompression with fusion (thoracic region)                                   C
Spine/Slipped Disc   V3340   Primary anterior discectomy, decompression and anterior fusion (lumbar region)                     C
                     V2900   Anterior discectomy (cervical region)                                                              C
                     V2902   Revisional anterior discectomy (cervical region)                                                   C
                     V2430   Revisional posterior decompression with fusion (thoracic region)                                   C
                     V2540   Posterior excision of disc prolapse including microdiscectomy (lumbar region)                      C
                     V2543   Revision of posterior excision of disc prolapse with undercutting facetectomy (lumbar region)      C

                     W3712   Primary total hip replacement with or without cement                                               C
                     W3713   Complex primary total hip replacement requiring bone grafting or femoral osteotomy                 C
                     W3714   Total hip replacement, with or without cement, after excision arthroplasty or arthrodesis,         C
      Joints                 including conversion of hemiarthroplasty or revision of other previous hip surgery which
                             involved internal fixation
                     W4210   Total prosthetic replacement of knee joint, with or without cement, +/- patella                    C
                     W8500   Multiple arthroscopic operation on knee (including meniscectomy, chondroplasty, drilling or        B
                             microfracture)




                                                 Page 7 of 18
4.       EXCLUSIONS – EVENTS THAT ARE NOT COVERED

We will not pay claims which arise from any of the following:
     1. Procedures which are not listed in the SCHEDULE OF PROCEDURES.

     2. Pre-Existing Conditions – Unless otherwise specified, any Medical Condition
        or Related Medical Conditions which an Insured Person knew about, or for
        which they had symptoms (whether or not a diagnosis had been made),
        consultation, medication, monitoring, Advice or treatment in the 2 year period
        prior to becoming insured under this Policy will not be covered. These may
        become covered once they have been free of symptoms, treatment or Advice
        for 2 continuous years from when they first became insured under this scheme.
        Eligible new conditions will be covered immediately.

     3. Emergency Procedures.

     4. Services or Treatment at any long term care facility, nursing home, spa hydro-
        clinic or sanatorium that is not a Hospital.

     5. Medical Conditions either directly or indirectly arising from or associated with
        alcohol, drug or solvent use or abuse, other than drugs taken in accordance
        with treatment prescribed and directed by the Insured Person’s Doctor but not
        for the treatment of drug or alcohol addiction, or alcohol, solvent or drug
        dependency.

     6. An Insured Person’s failure to seek and follow the medical Advice of a
        Medical Specialist relating to the Treatment of a specific condition.

     7. Self-inflicted injuries, illness, disease or any condition intentionally self-inflicted
        or self-inflicted or arising from suicide attempts, including treatment required as
        a result of attempted suicide.

     8. Psychiatric Treatment - treatment associated with psychiatric conditions and/or
        any Related Medical Condition.

     9. Treatment, directly or indirectly arising from, or as a consequence of:
           a. War, invasion, acts of foreign enemy, hostilities (whether war be
              declared or not), civil war, rebellion, revolution, insurrection, terrorism,
              military or usurped power.
           b. Any criminal action, including provoked assault, fighting (except in bona
              fide self defence).
           c. Chemical contamination or contamination by radioactivity from any
              nuclear material whatsoever or from the combustion of nuclear fuel.

     10. Treatment directly or indirectly arising from or as a consequence of:
            a. Work that involves handling explosives, toxic chemicals, deep sea diving
               or outdoor activity at heights above 50 feet.
            b. Professional Sports where a fee is received for training or playing.
            c. Injury sustained whilst participating in dangerous or hazardous sporting
               activity including, but not limited to: mountaineering; rock climbing;
               motor sports including motor cycle sport; aviation; other than as a fare
               paying passenger; ballooning; bungee jumping; hang gliding; micro
               lighting; parachuting; paragliding or parascending; potholing or caving;



                                         Page 8 of 18
                power boat racing; white water rafting; competitive yachting or sailing;
                bobsleighing; competitive canoeing or kayaking; judo or martial arts;
                scuba diving or extreme sports such as free-diving; base jumping, ski-
                racing and ice climbing.

     11. Any sexually transmitted disease.

     12. We will not pay any charges which We consider are too high compared with
         those customarily charged in the United Kingdom for similar treatment, services
         or supplies.

5.      GENERAL CONDITIONS

     1. This is a group Policy and must be purchased by You for all staff that teach
        and are under the age of 65.

     2. Claims –This Policy provides cover for Treatment received only while a an
        Insured Person is covered under this Policy.

     3. All Medical Procedures and covered Medical Conditions under this Policy
        are graded into Bands A, B, C in accordance with the SCHEDULE OF
        PROCEDURES.

     4. An Insured Person can make up to 3 separate claims in any consecutive 12
        month period under this Policy.

     5. The maximum amount that an Insured Person may claim under this Policy,
        over all Policy years, is limited to £100,000.

     6. Payment of cash sums will be made to You.

     7. Premiums – Premium together with the Insurance Premium Tax (IPT) is
        payable by You at the Commencement Date of this Policy. We reserve the
        right to cancel this Policy should the Premium not be paid within 30 days of the
        normal due date.

     8. Moratorium - Unless otherwise specified, any Medical Condition or Related
        Medical Conditions which an Insured Person knew about, or for which they
        had symptoms (whether or not a diagnosis had been made), consultation,
        medication, monitoring, Advice or treatment in the 2 year period prior to
        becoming insured under this Policy will not be covered. These may become
        covered once they have been free of symptoms, treatment or Advice for 2
        continuous years from when they first became insured under this scheme.
        Eligible new conditions will be covered immediately.

     9. Revision of terms - We may vary the TABLE OF BENEFITS and SCHEDULE
        OF PROCEDURES to reflect any changes in technology and inflation. We will
        notify You of any changes which shall become effective at each Annual
        Review Date of this Policy. Any such notification will be made in writing.

     10. At each Annual Review Date of this Policy We will notify You of any changes
         to the premiums payable under this Policy. Any such notification will be made
         in writing.


                                      Page 9 of 18
      11. This Policy, along with the Insurance Schedule and Application Form are
          evidence of the insurance contract and are governed by and subject to the
          Laws of England.

      12. The Insurers, Schools Protection and the Insured will keep true and accurate
          accounts and records of all matters relating to the Insurance under this Contract
          and each will permit the others or their duly appointed representative upon
          reasonable notice and in compliance with the Data Protection Act to inspect
          and/or take copies of the same.

      13. The Insured will, at the request of the Scheme Administrators or the Insurers,
          supply such information concerning the Insured or the Insured Persons as
          may reasonably be required for the purposes of the insurance under this
          Contract.

      14. Any fraud, mis-statement or concealment in relation to any matter affecting this
          insurance or in connection with the making of any claim shall render this cover
          null and void and all claims shall be forfeited.


6.       EMPLOYEE AMENDMENTS AND ADJUSTMENTS

6.1      You shall, within 14 days of any changes affecting the list of Insured Persons
         previously supplied by the Insured, inform Schools Protection, on the
         prescribed form or via their website of any amendment to the list of Insured
         Persons. A premium adjustment will be calculated for the changes accepted by
         Schools Protection and an additional or return premium will be charged or
         allowed to the Insured as appropriate. No return premium will be given if an
         Insured Person has claimed benefit under this Policy.

6.2      Failure by the Insured to provide the information specified in 6.1, within the
         prescribed time and/or on the form required, may nullify an Insured Person’s
         right to benefit under this contract if an Insured Person’s information has not
         been included or amended.

6.3      Premiums for new Insured Persons that join mid-term will be one monthly
         premium for each month or part-month that they become covered under this
         Policy.

6.4      Premiums for Members that cease to be insured under this Policy will be paid
         up until the end of the month in which they cease to be covered under this
         Policy.


7.       TERMINATION

7.1      All insurance and benefits under this Policy will terminate at the expiry of this
         contract and You must pay the premiums that are due until this date.

7.2      All Insurance will cease in respect of an insured an Insured Person
         immediately upon their 65th birthday or the date they cease to be employed by
         the Insured, whichever is the earlier.




                                        Page 10 of 18
8.     DEFINITIONS

“Advice”
Any consultation regarding a Pre-Existing Condition or Related Medical Condition
from a General Practitioner, Medical Specialist or therapist including the issue of any
prescription or repeat prescription.

“Annual Review Date”
The anniversary of the Commencement Date.


“Application Form”
The Application Form for this Policy.


“Bands A,B,C”
The Bands numbered A, B, C relate to NHS claim benefits payable in accordance with
the SCHEDULE OF PROCEDURES.


“Claims Administrator”


Global Claims Services Limited
P.O. Box 319
Croydon
CR9 4SA
Tel: +44 (0) 870 899 3363
Fax: +44 (0) 208 680 8703
E-mail: info@globalclaims.co.uk


“Classification of Medical Procedure”

Means either Band A, B, C as listed in the TABLE OF BENEFITS and SCHEDULE OF
PROCEDURES.


“Commencement Date”
The date that this Policy starts.


“Complication(s)”
An unexpected and unforeseen event that is the result of the original Medical
Procedure or complaint or which arises after admission to Hospital.


“Customary Charges”



                                        Page 11 of 18
Costs which We consider are within the amount customarily charged in the United
Kingdom for similar treatment, services or supplies.


“Diagnosed”
The unequivocal discovery and identification of a Medical Condition from the
examination of symptoms using investigations such as X-rays or blood tests, by a
Medical Specialist.


“Emergency Procedures”
Procedures usually carried out in an Accident and Emergency Department or
procedures carried out following admission into a Hospital via an Accident and
Emergency Department or procedures carried out following same-day referral to the
Hospital by a General Practitioner or Medical Specialist or any other person.


“Fixed-Price (Treatment)”
Treatment in a Private Hospital and for which the costs have been negotiated by Us
in advance or by a third party nominated by Us.


“General Practitioner”
A medical doctor in general practice who is registered with the General Medical Council
and who is not a Medical Specialist.


“Hospital”:
   1. “Private Hospital”
       A rivate hospital registered under the United Kingdom’s Registered Homes Act
       1984 or the Care Standards Act 2000.
   2. “NHS Hospital”
       A hospital run by the National Health Service which provides specialist facilities
       for treatment.


“Insurance Premium Tax”
The Insurance Premium Tax payable at the rate applicable from time to time.


“Insurance Schedule”

The document accompanying this Policy which lists the Insured Persons covered, the
Commencement Date and Period of Cover any special provisions relating to Your
insurance.

“Insured Person(s)”

Persons covered under this Policy as listed in the Insurance Schedule.




                                     Page 12 of 18
“Medical Condition”

Any disease, illness or injury.


“Medical Procedure”

A procedure that is listed in the SCHEDULE OF PROCEDURES.


“Medical Specialist”

A Doctor who:
·     Holds an NHS Consultant post and;
·       Is on the Specialist Register held by the General Medical Council and;
·       Is under the age of 70 when Treatment is provided;
Or
·       who is otherwise approved by Us prior to any Treatment being administered.


“NHS”
Means the free-to-use public health service. For the purposes of this Policy patients
who undergo NHS-funded procedures at either independent hospitals or Independent
Sector Treatment Centres (ISTC’s) will be deemed to have received NHS Treatment.


“Period of Cover”

The duration of this Policy as detailed in the Insurance Schedule.


“Policy”

The contract between You and Us.


“Pre-Existing Condition”

Any disease, illness or injury for which:

·       An Insured Person has received consultation, medication, monitoring Advice
or treatment

Or
·       An Insured Person has experienced symptoms

In the 2 years prior to becoming insured under this Policy, whether the condition has
been Diagnosed or not.


“Premium(s)”




                                       Page 13 of 18
The gross annual premium, including Insurance Premium Tax, payable by You.
Premium may, where appropriate, include additional or return premiums as calculated.


“Private Hospital”

An independent Hospital or NHS pay bed, or any other establishment which We may
decide to treat as a Private Hospital for the purpose of this Policy.


“Private Treatment”

Treatment not funded by the NHS, whether in a NHS Hospital or a Private Hospital.


“Related Medical Condition”

 Any symptom, disease, illness or injury, which reasonable medical opinion considers
to be associated with another symptom, disease, illness or injury.


“Schedule of Procedures”

The SCHEDULE OF PROCEDURES classifying Medical Procedures according to
their complexity. Band A is the least complicated procedure and B and C the most
complicated. We reserve the right from time to time, and without notice, to adjust the
allocated banding of individual procedures either up or down to reflect changes in
technology or the cost of treatment.

“Table Of Benefits”

The benefits which are payable by Us under this Policy.


“Treatment”

The provision of a Medical Procedure as defined in the Policy.


“We, Us, Our, Insurers”

Professional Travel Insurance Company Limited.


“You, Your, Insured”

The School that is purchasing this Policy as stated on the Insurance Schedule.



9.     CLAIMS PROCEDURE


9.1    Making a Claim under This Policy




                                      Page 14 of 18
Schools Protection are the Administrator for this insurance Policy. Should an Insured
Person wish to make a claim or have any queries about whether a condition is covered
by this Policy, they should call Schools Protection’s Claims Administrator, Global
Claims Services on 0870 899 3363 between 9am to 4.30pm Monday to Friday.

They will assist the Insured Person in determining whether an Insured Person’s
claim is covered and will help them locate a suitable Hospital for their Treatment.

When calling the Helpline please be aware that the Claims Administrator will need to
ask certain questions so that they can confirm cover. It will help Us if an Insured
Person has the following information ready:

•     Your Policy Number.
•     The name and details of the person making the claim.
•     What Medical Condition the person claiming is suffering from and when symptoms
      began.

In order to validate a claim an Insured Person must telephone the Global Claims
Services Helpline on 0870 899 3363 prior to Treatment to ensure that they have a
valid claim and can be made aware of what level of assistance the Insured Person will
be entitled to.

In some cases, it may be necessary to obtain additional Medical information to enable
the Claims Administrator to confirm the benefit available to an Insured Person. An
Insured Person will be asked to give the Claims Administrator permission on the
claim form in accordance with the Access to Medical Records Act (1988). Any costs
associated with obtaining this information will be paid by the Insured Person. No
benefit will be payable until such additional information has been obtained.

Please note that calls to the Helpline may be monitored or recorded as part of the
Claims Administrator’s training and quality assurance programs.


9.2      How to make a claim
If an Insured Person believes that they have a claim under this Policy:


1. The Insured Person must contact the Claims Administrator as soon as
   reasonably possible by telephone.

2. The Claims Administrator will then send the Insured Person a claim form, which
   must be signed and dated by the Medical Specialist who considers the procedure
   necessary and returned to them with any costs met by the Insured Person.

3. An Insured Person will need to tell the Claims Administrator whether the
   Insured Person wishes to seek Private Treatment or Treatment under the NHS.



9.3. Being treated in a Private Hospital
 As soon as an Insured Person’s claim has been approved and the Insured Person
decides to be treated in a Private Hospital then the Claims Administrator, or one of



                                     Page 15 of 18
their representatives, will locate a suitable Private Hospital and arrange a Fixed-Price
package with Customary Charges for the Treatment.
The Insured Person will be responsible for paying any further invoices incurred
outside those included in the Fixed-Price package or any charges We do not consider
as Customary Charges.
Should a Fixed-Price package of Treatment, with Customary Charges be
unavailable then We will recommend that the Member has Treatment in the NHS.


9.4. Being treated in a NHS Hospital

Once the claim has been approved by Us and We have been presented with evidence
of the Insured Person having undergone the Medical Procedure within the NHS, We
will pay the appropriate benefit applicable to the Classification of Medical Procedure
as shown in the Table of Benefits. Payment will be made by cheque directly
to You within 10 working days.


10.    THE INSURERS

       The School(s) insured are shown on the Insurance Schedule. Professional
       Travel Insurance Company Limited being the Insurers have authorised Schools
       Protection to bind and assign individual policies to schools. Professional Travel
       Insurance Company Limited have agreed to allow Schools Protection to pay the
       benefits provided with respect to school(s) insured subject to all terms and
       conditions of the contract.


11.    CERTIFICATION

       This Contract together with the Insurance Schedule certifies that Insurance
       has been affected between You and the Insurers. In return for payment of the
       premium specified, the Insurers agree to provide insurance in accordance with
       the terms and conditions contained in and endorsed on this document. The
       Insurers have entered into a contract which authorises Schools Protection to
       issue this Policy and the Insurance Schedule on their behalf.

       There is a choice of law applicable to this insurance but unless agreed
       otherwise by the Insurers English Law will be used.


12.    DATA PROTECTION

       In the course of performing Our obligations to an Insured Person, an Insured
       Person’s information may be disclosed to agents and service providers
       appointed by Us, including other insurers, consultants, market research and
       quality assurance companies. An Insured Person’s information may be
       transferred to any country including countries outside the European Economic
       Area for any of these purposes and for systems administration. Such
       information may include ‘sensitive data’.

       The Data Protection Act 1998 defines sensitive data as information about an
       Insured Person’s racial or ethnic origin, political opinions, religious beliefs or


                                       Page 16 of 18
  beliefs of a similar nature, trade union membership, physical condition or mental
  health, sexual life, criminal record, pending court proceedings or sentence or
  any alleged offence.

  An Insured Person has the right to access (subject to limited exceptions) and if
  necessary rectify the information that We hold about them.



13. COMPLAINTS PROCEDURE


  It is always the intention to provide a first class service. However, if the
  Insured or the Insured Person has cause for complaint the procedure
  described here should be followed and Schools Protection will be pleased to
  give any additional information or advice that may be needed.

  In the first instance the complaint should be addressed to:

  The Complaints Officer
  Schools Protection
  1st Floor
  17 Devonshire Square
  London
  EC2M 4SQ
  Tel: 0870 890 3645

  If Your complaint cannot be settled at this stage please write to:

  The Complaints Officer
  Professional Travel Insurance Company Limited’s Representative
  11 Century House
  Priestley Road
  Basingstoke
  Hampshire
  RG24 9RA


  You need to clearly and concisely give the reason for Your complaint. Please
  also make sure that You give Us all Your contact details and Your Policy and
  claim number.


  If We cannot settle Your complaint with Us, You may be entitled to refer it to
  the Financial Ombudsman Service. You can write to them at:

                 Financial Ombudsman Service
                 Insurance Division
                 South Quay Plaza
                 183 Marsh Wall
                 London
                 E14 9SR

  Please note that the Financial Ombudsman Service will not consider Your
  complaint until You have received a final decision from the Insurer.


                                Page 17 of 18
The existence of these internal arrangements does not affect Your right to take
immediate legal action against the Insurer.




                             Page 18 of 18

				
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