Initial Disclosure Document

1 Policy Summary

This policy summary provides key information about your Work Assured, Back to Work Private Medical Insurance which you should read. It does not contain the full terms and conditions of the policy, which can be found in the policy document. Your cover will be valid for twelve months.

This policy is a medical insurance contract. It will help you by providing an employee who is covered under the plan, access to privately funded healthcare if that treatment facilitates a return to work and is cost effective.

 2 Name of the insurance undertaking

This Plan is underwritten by LAMP Insurance Company Limited, whose registered office is 260/262 Main Street, Gibraltar. LAMP Insurance Company Limited is licensed by the Chief Executive of the Financial Services Commission of Gibraltar under the Insurance Companies Act to carry out insurance business. 

3 The Product

Work Assured provides access to private treatment for employees that are covered by the plan, when an Absence Trigger has been hit and the initial consultation or diagnostics are not avaiable within 20 days , and where treatment is not available on the NHS within 45 days.

4 How to make a Claim

To make a claim, contact Health Assured on 01823 413003. Our detailed claims procedure can be found in the Policy Wording.

 5 Claims limitation

Claim eligibility is determined by the following formula:

• Length of Anticipated Absence without Private Intervention multiplied by salary (plus 30%); compared with the Cost of Private Treatment + Salary Costs (plus 30%) for the re-calculated period of Absence.
• If a difference, greater than 20% is realised then Private Treatment (subject to the policy terms and conditions is authorised).
• In most cases, it will be necessary to reach a point of diagnosis, in order to establish the cost benefit of any treatment available under the Work Assured Medical Plan.

Individuals covered are able to pay a "top up" premium, and on doing so, will be eligible for traditional Private Medical Insurance benefits even if a claim is not admissible when the above formula is applied, they will still be eligible for treatment, subject to the general policy terms and conditions.

Full details and examples of claims eligibility can be found in the Policy Wording

6 Cancellation Right

We trust you will be happy with the cover this policy provides. However, you have the right to cancel it within 14 days of receiving the policy. If that happens, we will refund your premium, first deducting a charge for the cover provided from the beginning of the contract until the policy is cancelled. If you have not made a claim on the policy we will refund your premiums in full.

If you do not exercise your right to cancel within the cancellation period, the contract will remain in force and all premiums will be payable in accordance with the terms of the policy. A full explanation of the conditions for cancelling cover can be found in the Plan Wording.

7 Other Restrictions

The Work Assured Back to Work Medical Insurance plan can only be purchased in conjunction with The Health Assured EAP Plus plan. Details of the cover are provided in the policy wording document.

8 Making a complaint

Complaints about Health Assured's handling of your policy:

Our aim is to provide you at all times with a first class standard of service. However, there may be occasions when you feel that this objective has not been achieved and you are not satisfied with the way we explained or arranged your policy. If you have a complaint about us in relation to this insurance policy,

Please contact, in writing: The Managing Director, Health Assured Ltd, Unit 2, Procters Farm, Monkton Heath, Taunton, Somerset TA2 8QN 

Tel: +44 (0) 01823 413003. E phil@healthassured.co.uk

Complaints about Lamp Insurance Company Limited's  underwriting of your policy;

Lamp Insurance Company Limited is the underwriter (i.e. insurance company) responsible for this policy and, in this capacity, they look after the handling and payment of claims. If you wish to complain about Lamp Insurance or require further information relating to their complaint handling procedures, then please contact, in writing;

The Chief Executive  LAMP Insurance Company Limited, 260/262 Main Street, Gibraltar.

We are covered by the Financial Ombudsman Service so in the event that you have made a complaint that we are unable to resolve, you may then be entitled to refer it to this independent body. Our full complaints procedure can be found in the Plan Guide.

9  Are we covered by the Financial Services Compensation Scheme (FSCS)?

We are covered by the FSCS. You may be entitled to compensation from the scheme if we are unable to meet our obligations; this depends on the type of business & the circumstances of the scheme.

For further information please contact the FSCS.