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Health Cover Optimiser

What is the Health Cover Optimiser?

This gives you a choice between taking the lump sum from your Serious Illness Cover, or a reduced lump sum plus private medical treatment, if you have a condition that is covered under both your Health Cover and your Serious Illness Cover.

If you have Serious Illness Cover and Health Cover in your plan, you can choose the Health Cover Optimiser too. The Health Cover Optimiser:

  • Links Serious Illness Cover and Health Cover - so that you’re covered for both private medical treatment for acute conditions and financial support for serious illnesses, with no overlap. No overlap means you won’t be covered twice for the same thing – so you only pay for the cover you need.

  • Costs up to 25% less than buying Health Cover and Serious Illness Cover separately from us, because you are not insured twice for the same illness (the maximum discount is available when you take out £60,000 or more Serious Illness Cover).

  • You choose how we pay you when you have a serious illness – you can either take the lump sum from your Serious Illness Cover, or take a smaller lump sum and get your private medical treatment paid for. Either way, you’ll always get the value of your Serious Illness Cover benefit, either as a lump sum, or a combination of a lump sum plus treatment. So you can make the choice when you have to claim and know what your needs are, rather than deciding in advance at the time of purchase.

  • Pays for the cost of any other eligible private medical treatment you need that isn’t related to a serious illness.

  • Lets you choose from three levels of cover, depending on what you can afford and what worries you most.
 

Health Cover Optimiser – how it works

This is how it works:

  • If you have a condition that is not covered under your Serious Illness Cover, then your Health Cover will pay for the cost of any treatment you need.
  • If you have a condition, such as multiple sclerosis that is covered under your Serious Illness Cover and is not covered under your Health Cover we’ll pay you the full lump sum from your Serious Illness Cover.
  • If you have a condition that is covered under your Serious Illness Cover and your Health Cover, you choose whether you would like to receive your Serious Illness Cover benefit as either:
  • Cash - the lump sum (in which case you won’t be covered for private medical treatment of that condition)
    or
  • Care - pay you a smaller lump sum and hold back the rest to contribute towards the cost of any private medical treatment you need.

So instead of being covered twice for the same condition, you’re just covered once. Because of that, you pay a lower premium than you would if you bought separate private medical insurance and protection cover from us.


 

Cash or care? What happens if you choose cash?

If you decide you want to take the lump sum from your Serious Illness Cover, you choose cash.

Once you’ve chosen, we’ll pay you the amount of your Serious Illness Cover benefit as a lump sum (less the cost of any previous private diagnosis or treatment for that condition). You can then arrange for any treatment yourself, either through the NHS, or privately.

If you have further treatment, then we won’t pay for any more private medical costs for the condition you claimed for until you’ve gone a year without having treatment for that condition. After that time, you’ll be covered again.

How choosing cash works if you have your treatment with the NHS

David has the Health Cover Optimiser. When he’s diagnosed with a heart condition, he’s entitled to a £50,000 lump sum under his Serious Illness Cover. We ask him how he wants to receive his benefit, and he chooses ‘cash’.

We pay David a lump sum of £50,000, minus the cost of any private medical treatment he’s had for his heart condition while it was being diagnosed. He decides he wants to be treated via the NHS and his treatment begins.

While he’s receiving treatment for his heart condition, David suffers an unrelated injury at work and needs to see a specialist. This is paid for by his Comprehensive Health Cover, with no impact on his Serious Illness Cover.

David makes a full recovery from his heart condition. After he’s been treatment free for a year, he is covered again. That means that he can make further claims if his condition occurs again.


 

Cash or care? What happens if you choose care?

If you want to take a smaller lump sum and have your treatment arranged and paid for from your Serious Illness Cover you choose care.

If you choose to have the cost of your care paid for we hold back an amount of your Serious Illness Cover to fund any treatment you need (this is known as the maximum contribution), and we pay you the rest as a lump sum. As with any Serious Illness Cover claim, the amount of Serious Illness Cover available for future claims will reduce by the amount we’ve paid.

There are some chronic conditions, such as rheumatoid arthritis, that aren’t covered under Health Cover. So if you suffer from one of these, you can’t choose the ‘care’ option. Instead, we’ll pay you the full amount of your Serious Illness Cover benefit as a lump sum.

How choosing care works in practice

David has the Health Cover Optimiser. When he’s diagnosed with a heart condition, he’s entitled to a £50,000 lump sum under his Serious Illness Cover. We ask him how he wants to receive his benefit, and he chooses to have the cost of his medical care covered.

The maximum contribution for his heart condition is £15,000. So we set this amount aside to pay for the treatment he needs, plus any previous costs e.g. for diagnosing his condition. We pay him the remaining £35,000 he’s entitled to as a lump sum.

We find him a specialist and his treatment begins. The eventual cost of that treatment is £20,000. This is covered in full - £15,000 from David’s maximum contribution, with the extra £5,000 paid for by his Comprehensive Health Cover.

While he’s receiving treatment for his heart condition, David suffers an unrelated injury at work and needs to see a specialist. This is paid for by his Health Cover with no impact on his Serious Illness Cover


If you choose to pay for private medical treatment yourself, you may be entitled to Health Cover from us, if your total cost of treatment is more than the maximum contribution. For more details see the Health Cover policy document.

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PruHealth is a trading name of Prudential Health Limited and Prudential Health Services Limited. Registered numbers 05051253 and 05933141 respectively. PruProtect is a trading name of Prudential Health Services Limited and Prudential is a trading name of The Prudential Assurance Company Limited, registered number 00015454. The Prudential Assurance Company Limited provides and manufactures benefits under the PruProtect Plan. Prudential Health Limited provides and manufactures benefits under the PruHealth product. Prudential Health Services Limited distributes and services the PruHealth and PruProtect product and issues the documentation. Companies registered in England and Wales. Registered offices at Laurence Pountney Hill, London EC4R 0HH. All companies authorised and regulated by the Financial Services Authority.
The companies are not affiliated in any manner with Prudential Financial, Inc, a company whose principal place of business is in the United States of America.