Frequently Asked Questions

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Medical Recovery Insurance is an insurance protection product that provides cash benefits that are tiered to reflect the recovery time should you require a medical procedure.

Medical Recovery Insurance policies provide a vital injection of cash which can be used to assist with out-of-pocket expenses and a reduced income to help individuals and their families manage until they’re expected to return to work.

Main Cover Restrictions

No benefit will be paid for:

• · any medical procedure that takes place during the waiting period. See Section 4.2 
• · any medical condition, illness, injury, or related treatment that is classed as a pre-existing condition, unless cover is later reinstated under Section 4.3 (Pre-existing Conditions) 
• · any claim arising directly or indirectly from any planned treatment or any related condition under Section 4.4 (Planned Treatments).
• · any medical procedure not listed in the “SCHEDULE OF MEDICAL PROCEDURES AND BENEFITS,” unless the insurer agrees in writing.

Waiting Period

Unless your policy schedule states otherwise, no benefit will be paid if treatment takes place within 90 days of the insured person’s start date under their current level of cover.

This waiting period does not apply if the claim is only due to an accident that happens after the start date.

Pre-existing Conditions 

No benefit will be paid for any claim linked to a pre-existing condition or a related condition. 

An exception applies if certain conditions are met after the insured person’s start date under their current level of cover. The insured person must complete a continuous period of at least 24 months with all of the following:

• · no symptoms 
• · no medical advice sought 
• · no treatment received 
• · no medication taken 

After this 24-month period, the condition and any related conditions will be eligible for cover, subject to the terms and conditions of this policy. 

Planned Treatments

No benefit will be paid for any claim arising directly or indirectly from any planned treatment or any related condition.This exclusion applies:

• · whether or not a formal diagnosis has been made; and 
• · whether the treatment or medical procedure takes place before or after the insured person’s start date.

General Exclusions 

This policy does not cover any claim arising directly or indirectly from:

1. Suicide, attempted suicide, or intentional self-inflicted injury 

2. Injury that happens while committing or attempting a criminal act 

3. The use of alcohol or non-prescribed drugs, if this contributed to the event 

4. War, invasion, civil war, rebellion, insurrection, terrorism, or nuclear risks 

5. Taking part in active war 

6. Taking part in professional sports where the insured person is paid 

7. Taking part in hazardous activities and sports, if this contributed to the event 

Specific Medical Exclusions

Medical Recovery Insurance does not cover:

1. Medical procedures that are not listed in the “SCHEDULE OF MEDICAL PROCEDURES AND BENEFITS” on pages 7–11, unless we agree in writing
2. Diagnostic, investigative, or preventive treatment that is not a covered medical procedure.
3. Treatment that is not medically necessary or not supported by accepted medical practice
4. Cosmetic or elective procedures, unless they are needed due to injury or cancer
5. Dental treatment, including treatment of gums or teeth, unless it is directly caused by an accident
6. Procedures related to fertility, sterilisation, contraception, or assisted reproduction
7. Pregnancy and childbirth, except for specific medical complications that are covered under this policy
8. Treatment for obesity or weight loss, including related surgery
9. Recurrent cancer or any cancer for which a claim has already been paid under this policy 
10. Treatment that goes beyond the cancer treatment limits set in this policy 
11. Any medical condition caused by a heart attack for which a benefit has already been paid 
12. Heart attacks if the insured person was diagnosed with ischemic heart disease before the start dateof their current level of cover

Other than claims for the treatment of cancer, a person can make up to 3 claims in any period of cover in relation to each insured person. As recovery times are not normally extended by having one operation shortly after another, there are restrictions if multiple operations are performed in quick succession and these are explained in the policy document.

Cancer treatments will normally involve an episode of surgery plus a course of chemotherapy or radiotherapy. The episode of surgery will vary according to the operation but most cancer surgery will be classified as either Band B or Band C.

We classify chemotherapy as a Band C procedure and radiotherapy, which has a shorter recovery time, as Band B.

Medical Recovery Insurance policyholders can make one claim for the treatment of cancer during their lifetime unless the cancer is either a pre-existing condition or cancer in which case it is excluded. A treatment for cancer can include a maximum of one episode of surgery, one course of chemotherapy and one course of radiotherapy providing that the treatment is for the same cancer.

No further treatments will be covered during the policy lifetime either for additional treatment of the original cancer or for a recurrence of that cancer in the same place or another place in the body or for the occurrence of another cancer anywhere else in the body. 

Heart Surgery is included in the Medical Recovery Insurance Schedule of Procedures. Heart Attacks may not require surgery but will virtually always lead to time off work, these are also covered as a Band C benefit. Please see our definition of a Heart Attack in your Policy Document.

Medical Recovery Insurance benefits are graded according to the recovery time of a procedure. Our plans do not distinguish as to where operations and medical procedures are carried out or how long they take.

Whilst you a person is free to spend their benefits as they wish, it is important to note that Medical Recovery Insurance benefits are calculated according to the expected recovery time and not according to the cost of an operation. Some operations may have a short return to work and a high treatment cost whilst others may have a longer return to work and a lower treatment cost. Benefits should therefore not be relied on to pay for private treatment.