Tel: 0808 178 1179
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FAQs


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Am I eligible to join?

All UK residents aged from 16 up to and including 65 years can join. Existing members can continue with us after their 66th birthday on their existing plan at no extra cost.

How do I join?

Join our health plan today by completing and returning the application and direct debit forms at the back of one of our brochures , or by filling in the online forms on our downloads section.

If you would like to speak to one of our customer service representatives please call:
Tel: 01633 266152 / 250112
Freephone: 0808 178 1179

Do I have to complete a medical?

No medical examinations are required for you to join. You will need to complete and sign a health declaration when you apply. There is a qualifying period of three months before new members can make a claim and 12 months for known medical conditions at the date of joining.

Is there cover for my partner or children?

Under our Personal Customers Scheme, partners (not relations) and dependent children under 16 years of age and living at the same address as you are covered for hospital in-patient benefits – provided you have already registered them with us before you make a claim. If more comprehensive partner and child cover is required we can arrange this on an alternative plan. 

Under our Corporate scheme your partner can be enrolled on the same terms and conditions as you. Dependent children under 18 years of age can be covered on any chosen family plan.

Please contact our office on Freephone 0808 178 1179 for more information.

How do I claim?

Personal schemes: 

For benefits where you have to pay for the service received, such as dental, optical, medical specialist and therapies please send your original identifiable receipt to our office and we will arrange payment to you.

Receipts must be original (not copies), identifiable to you and in the case of handwritten or computer generated receipts they must also be signed, dated and stamped by the treatment provider.

For hospital related claims - in-patient, out-patient and day surgery - we provide claim forms which must be dated, signed and stamped by the hospital providing treatment.

With the exception of out-patient claims, for which we allow 12 months from the date of attendance, all claims must be made within three months of discharge from hospital or date of treatment received, or payment made.

 

Corporate schemes: 

For benefits where you have to pay for the service received, such as dental, optical, medical specialist and therapies please send your original identifiable receipt to our office and we will arrange payment to you.

Receipts must be original (not copies), identifiable to you and in the case of handwritten or computer generated receipts they must also be signed, dated and stamped by the treatment provider.

For hospital related claims - in-patient and day surgery - we provide claim forms which must be dated, signed and stamped by the hospital providing treatment.

All claims must be made within three months of discharge from hospital or date of treatment received, or payment made.

Where can I get a claim form?

Please contact our office for a claim form as soon as you know you are going into hospital. If your admittance is unexpected either ask a relative or friend to obtain a claim form on your behalf or contact us once you are discharged from hospital.

Alternatively hospital claim forms can be downloaded from our downloads section.

Where can I go for treatment?

Hospital benefit is payable for treatment received at registered UK hospitals. In-patient benefit is also available for emergency in-patient admission (including partner and children if registered with us before you make a claim) during temporary absence abroad (on proof of admission and discharge including the dates concerned).

Medical specialist fees are payable for consultation with a medical or surgical specialist holding consultant status in an NHS or registered private hospital in the U.K.

For other benefits where you have to pay for your treatment such as dentists, opticians and therapy providers, the practitioner must be qualified and registered with the appropriate U.K. registered professional body.

If in doubt please contact our office for details of the relevant professional bodies.

Can I upgrade my plan?

Yes, for members aged 65 or under, although requests to upgrade are subject to the approval of our management. Please contact our office to arrange this.

Fresh Health Declarations will be required in every case and upgrades are not permitted once a member reaches 66 years of age.

Please note hospital benefits will be paid at the original plan benefit level for the first 12 months from upgrading.

All other benefits will be available at the upgrade rates three months after upgrading and after 12 months for known medical conditions.

If my company pays into your health plan, can I contribute more and upgrade my plan?

Yes, usually your employer will deduct the extra contributions from your wages and pay direct to us.

Do contributions increase with age?

No. Your contributions will not change with any age increase. Should there be a need to make any changes to our overall contribution and benefit rates you will be given at least one month’s notice, by post, at your address as shown in our records. 

Will you recommend health services to me?

You will not receive advice or a recommendation from us for our health plans. You will need to make your own choice about how to proceed.

Are there qualifying periods?

For known medical conditions hospital benefits will not be paid in the first 12 months. You cannot claim for treatment received during the qualifying periods.

How is non-disclosure of existing medical conditions treated?

It is vitally important that you declare any pre-existing condition that you are aware of before joining. Future claims could be refused payment if the claim is found to be from a non-disclosed pre-existing condition.

How long after I join the plan can I claim for optical and dental benefits?

You can claim for dental and optical benefits three months after you join the plan, for treatment received after the initial three month period.

How long after I join the plan can I claim for hospital cash benefits?

All hospital benefits can only be claimed once you have been a plan member for three months, for treatment received after the initial three month period, unless as described above, there are known medical conditions, when the 12 months qualifying period applies. There is no qualifying period if a hospital admission or attendance is required because of an accident. Hospital benefit claim forms can be downloaded from our downloads section.

When can I claim increased benefits after upgrading?

Hospital benefit will be paid at the original plan benefit level for all known medical conditions for the first twelve months from upgrading. All other benefits will be available at the upgrade rates 3 months after upgrading.

How long after I join the plan can I claim maternity benefits?

You can claim maternity benefits 12 months after the date you join the plan.

Do you do family membership?

Personal plan:

Yes we do. We have alternative plans that will allow you to cover your family too. For further information
contact our office on Freephone: 0808 178 1179.

Corporate plan:

Yes we do. Your family can be enrolled under our Corporate Plan. In–patient cover is also available for your partner and children (if registered with us) under our Personal Plan.

For further information contact our office on Freephone: 0808 178 1179.

Claims for optical items purchased via the Internet

In all cases please contact our customer services representatives on Freephone 0808 178 1179 before making claims under this heading as different rules apply. Full details are contained in our terms and conditions, copies of which can be obtained from our office or downloaded from our downloads section.

What do I do if I have a complaint?

If you wish to register a complaint, please contact us either by writing to the Chief Executive, Plutus Health, 13 Cardiff Road, Newport NP20 2EH, or by telephoning 01633 266152.

If you cannot settle your complaint with us, you may be entitled to refer it to the:
Financial Ombudsman Service:
South Quay Plaza, 183 Marsh Wall, London , E14 9SR
Tel: 0300 123 9123
Freephone: 0800 023 4 567
Switchboard: 020 7964 1000
For calls from outside the UK: +44 20 7964 1000

Email: complaint.info@financial-ombudsman.org.uk
Website: www.financial-ombudsman.org.uk

Who are we regulated by?

Plutus Health is the trading name of The Gwent Hospitals Workmen’s and Contributory Fund and is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority.

Our register number is 202166. We are required to give this information to you. Please use the information provided to decide if our services are right for you.

You can check our details on the Financial Services Register by visiting their website www.fca.org.uk/register or by contacting the FCA on 0800 111 6768.

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