Home > Simplyhealth (Formerly known as Groupama Healthcare) - Santé for You

Simplyhealth (Formerly known as Groupama Healthcare) - Santé for You

Santé for You is a private medical insurance plan that covers the cost of private medical treatment needed as a result of an unexpected acute illness or injury. The terms, conditions and exclusions contained in the policy booklet apply to the cover.

The benefits in section 1 provide basic medical insurance with cover for inpatient and outpatient treatment, home nursing, private ambulance, a cash benefit for NHS care and access to an advice and information helpline. All Santé for You policies must contain section 1 benefits as a minimum level of cover.

Santé for You also offers two optional benefit packages (section 2 and section 3), a choice of two hospital bands (London and Provincial) and a range of excess and co-insurance options.

The core benefits of Santé for You are:
* Specialist fees - full refund
* Hospital charges - full refund
* Outpatient treatment on GP referral - £750
* Outpatient treatment on specialist referral - full refund
* Home nursing - full refund
* Private ambulance - full refund
* NHS cash benefit - £150 per night (unlimited nights)

Benefits

Benefit Level	All Section 1 only Section 1 + 2 Section 1 + 3 Section 1 + 2 + 3

Key Facts - In-patient & Day Case Charges
Hospital accommodation charges including theatre fees, nursing costs, prosthesis, in-patient drugs & dressings
	Full cover (within chosen hospital scale)
Surgeon / Consultant / Specialist & Anaesthetists fees
	Full refund (in accordance with Groupama schedule of procedures)
Physicians fees & diagnostic tests
	Full refund (in accordance with Groupama schedule of procedures)
Cancer Treatment Costs - Chemotherapy / Radiotherapy
	Full refund
Psychiatric treatment
Benefit Level - Section 1 only Benefit Level - Section 1 + 3	Not covered
Benefit Level - Section 1 + 2 Benefit Level - Section 1 + 2 + 3	Section 2 28 days in-patient cover per policy year
Six week option
	Not available
Key Facts - Out-patient Charges
Complementary medicine
	Section 1 GP referral for Osteopathy, Chiropractic, Homeopathy, Acupuncture, Reflexology and Aromotherapy within overall benefit of £750. Specialist referral for Osteopathy, Chiropractic, Homeopathy and Acupuncture = Full refund
Diagnostic tests (excluding scans)
	Section 1 GP referral for diagnostic tests (excluding MRI / CT / PET Scans) within overall benefit of £750. Specialist referral for diagnostic tests = Full refund
GP referred consultations
Benefit Level - Section 1 only Benefit Level - Section 1 + 2	Section 1 GP referred treatment (diagnostic tests and specified therapies) = £750 maximum Specialist consultations on GP referral = Full refund
Benefit Level - Section 1 + 2 + 3 Benefit Level - Section 1 + 3	Section 1 GP referred treatment (diagnostic tests and specified therapies) = £750 maximum Specialist consultations on GP referral = Full refund Section 3 (Private) GP consultations = £150 Specialist consultations for chronic conditions = £150
Physiotherapy consultant referred
	Full refund
Physiotherapy GP referred
	Section 1 GP referral for physiotherapy within overall benefit of £750
Psychiatric cover
	Not covered
Benefit Level - Section 1 + 2 Benefit Level - Section 1 + 2 + 3	Section 2 Specialist Psychiatric treatment (out-patient) = £1,000
Radiotherapy / Chemotherapy
	Full refund (on Specialist referral)
Scans - MRI / CT / PET
	Full refund (on Specialist referral)
Surgical Procedures
Benefit Level - Section 1 only Benefit Level - Section 1 + 2	Section 1 Out-patient surgical procedures carried out by a Specialist = Full refund
Benefit Level - Section 1 + 2 + 3 Benefit Level - Section 1 + 3	Section 1 Out-patient surgical procedures carried out by a Specialist = Full refund Section 3 Out-patient surgical procedures carried out by a GP in own surgery = £150
Key Facts - Additional Benefits
NHS cash benefit
Benefit Level - Section 1 only Benefit Level - Section 1 + 2	Section 1 £150 per night (unlimited nights)
Benefit Level - Section 1 + 2 + 3 Benefit Level - Section 1 + 3	Section 3 £300 per night (unlimited nights)
Nursing at home
	Section 1 Full refund (for up to 13 weeks) on recommendation by Specialist and by a qualified nurse immediately following discharge from hospital
Parental accommodation
	Full cover (child under 16 years of age)
Private ambulance
	Full refund (where medically necessary) during course of treatment
Additional Benefits
Alcohol & drug abuse
	Not covered
Annual maximum limit
	No annual maximum
Children covered
	Up to age 25 and unmarried
Chiropractors & Osteopaths
	Section 1 GP referral for Osteopathy, Chiropractic, Homeopathy, Acupuncture, Reflexology and Aromotherapy within overall benefit of £750. Specialist referral for Osteopathy, Chiropractic, Homeopathy and Acupuncture = Full refund
Dental treatment
Benefit Level - Section 1 only Benefit Level - Section 1 + 3	Not covered
Benefit Level - Section 1 + 2 Benefit Level - Section 1 + 2 + 3	Section 2 Cover for specified oral-surgical procedures only Cover for accidental dental injury up to £10,000 maximum
Hospice donation
	Not covered
Infertility investigations
	Not covered
Maternity cash benefit
	Not covered
Benefit Level - Section 1 + 2 + 3 Benefit Level - Section 1 + 3	Section 3 £250 per child
Optional cash benefit
	Not covered
Out of pocket expenses
	£5 per night up to a maximum of £30 per hospital stay
Overseas cover
	Not covered
Personal & total disability benefit
	Not covered
Post hospital recovery bonus
	Not covered
Pregnancy
	Not covered
Benefit Level - Section 1 + 2 Benefit Level - Section 1 + 2 + 3	Section 2 Cover for specified maternity / pregnancy complications only
Transplants
	Covered for bone marrow and stem cell transplants as part of our cancer cover
Other benefits
Benefit Level - Section 1 + 2 + 3 Benefit Level - Section 1 + 3	GP completing claim forms and medical reports - £25 per item

Key Facts - In-patient & Day Case Charges

Hospital accommodation charges including theatre fees, nursing costs, prosthesis, in-patient drugs & dressings

Full cover (within chosen hospital scale)

Surgeon / Consultant / Specialist & Anaesthetists fees

Full refund (in accordance with Groupama schedule of procedures)

Physicians fees & diagnostic tests

Full refund (in accordance with Groupama schedule of procedures)

Cancer Treatment Costs - Chemotherapy / Radiotherapy

Full refund

Psychiatric treatment

Benefit Level - Section 1 only

Benefit Level - Section 1 + 3

Not covered

Benefit Level - Section 1 + 2

Benefit Level - Section 1 + 2 + 3

Section 2
28 days in-patient cover per policy year

Six week option

Not available

Key Facts - Out-patient Charges

Complementary medicine

Section 1
GP referral for Osteopathy, Chiropractic, Homeopathy, Acupuncture, Reflexology and Aromotherapy within overall benefit of £750.
Specialist referral for Osteopathy, Chiropractic, Homeopathy and Acupuncture = Full refund

Diagnostic tests (excluding scans)

Section 1
GP referral for diagnostic tests (excluding MRI / CT / PET Scans) within overall benefit of £750.
Specialist referral for diagnostic tests = Full refund

GP referred consultations

Benefit Level - Section 1 only

Benefit Level - Section 1 + 2

Section 1
GP referred treatment (diagnostic tests and specified therapies) = £750 maximum
Specialist consultations on GP referral = Full refund

Benefit Level - Section 1 + 2 + 3

Benefit Level - Section 1 + 3

Section 1
GP referred treatment (diagnostic tests and specified therapies) = £750 maximum
Specialist consultations on GP referral = Full refund
Section 3
(Private) GP consultations = £150
Specialist consultations for chronic conditions = £150

Physiotherapy consultant referred

Full refund

Physiotherapy GP referred

Section 1
GP referral for physiotherapy within overall benefit of £750

Psychiatric cover

Not covered

Benefit Level - Section 1 + 2

Benefit Level - Section 1 + 2 + 3

Section 2
Specialist Psychiatric treatment (out-patient) = £1,000

Radiotherapy / Chemotherapy

Full refund (on Specialist referral)

Scans - MRI / CT / PET

Full refund (on Specialist referral)

Surgical Procedures

Benefit Level - Section 1 only

Benefit Level - Section 1 + 2

Section 1
Out-patient surgical procedures carried out by a Specialist = Full refund

Benefit Level - Section 1 + 2 + 3

Benefit Level - Section 1 + 3

Section 1
Out-patient surgical procedures carried out by a Specialist = Full refund
Section 3
Out-patient surgical procedures carried out by a GP in own surgery = £150

Key Facts - Additional Benefits

NHS cash benefit

Benefit Level - Section 1 only

Benefit Level - Section 1 + 2

Section 1
£150 per night (unlimited nights)

Benefit Level - Section 1 + 2 + 3

Benefit Level - Section 1 + 3

Section 3
£300 per night (unlimited nights)

Nursing at home

Section 1
Full refund (for up to 13 weeks) on recommendation by Specialist and by a qualified nurse immediately following discharge from hospital

Parental accommodation

Full cover (child under 16 years of age)

Private ambulance

Full refund (where medically necessary) during course of treatment

Additional Benefits

Alcohol & drug abuse

Not covered

Annual maximum limit

No annual maximum

Children covered

Up to age 25 and unmarried

Chiropractors & Osteopaths

Dental treatment

Benefit Level - Section 1 only

Benefit Level - Section 1 + 3

Not covered

Benefit Level - Section 1 + 2

Benefit Level - Section 1 + 2 + 3

Section 2
Cover for specified oral-surgical procedures only
Cover for accidental dental injury up to £10,000 maximum

Hospice donation

Not covered

Infertility investigations

Not covered

Maternity cash benefit

Not covered

Benefit Level - Section 1 + 2 + 3

Benefit Level - Section 1 + 3

Section 3
£250 per child

Optional cash benefit

Not covered

Out of pocket expenses

£5 per night up to a maximum of £30 per hospital stay

Overseas cover

Not covered

Personal & total disability benefit

Not covered

Post hospital recovery bonus

Not covered

Pregnancy

Not covered

Benefit Level - Section 1 + 2

Benefit Level - Section 1 + 2 + 3

Section 2
Cover for specified maternity / pregnancy complications only

Transplants

Covered for bone marrow and stem cell transplants as part of our cancer cover

Other benefits

Benefit Level - Section 1 + 2 + 3

Benefit Level - Section 1 + 3

GP completing claim forms and medical reports - £25 per item


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