Home > Simplyhealth (Formerly known as Groupama Healthcare) - Club

Simplyhealth (Formerly known as Groupama Healthcare) - Club

Closed to new business customers

Club is a budget-style 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.

Club offers a full refund for all eligible inpatient treatments with limited cover for outpatient treatment. Club also offers benefits such as a cash benefit for NHS care, private ambulance and cover for certain pregnancy complications. There are also options to add other benefits such as worldwide travel insurance and an employee assistance programme.

There is also a choice of three hospital bands (A, B and C) and a range of excess and co-insurance options.

Benefits

Key Facts - In-patient & Day Case Charges
Hospital accommodation charges including theatre fees, nursing costs, prosthesis, in-patient drugs & dressings
	Full refund (within Groupama's fee schedule limits)
Surgeon / Consultant / Specialist & Anaesthetists fees
	Full refund (within Groupama's fee schedule limits)
Physicians fees & diagnostic tests
	Full refund
Cancer Treatment Costs - Chemotherapy / Radiotherapy
	Full refund
Psychiatric treatment
	Not covered
Key Facts - Out-patient Charges
Complementary medicine
	Not covered
Diagnostic tests (excluding scans)
	£1,500 per annum - The £1,500 benefit is the overall aggregate out-patient benefit payable
GP referred consultations
	£1,500 per annum - The £1,500 benefit is the overall aggregate out-patient benefit payable
Physiotherapy consultant referred
	£1,500 per annum - The £1,500 benefit is the overall aggregate out-patient benefit payable
Physiotherapy GP referred
	£1,500 annual limit, GP referral required. Forms part of the overall combined out-patient limit. Maximum of 12 sessions
Psychiatric cover
	Not covered
Radiotherapy / Chemotherapy
	Full refund
Scans - MRI / CT / PET
	Full refund
Surgical Procedures
	Full refund when carried out by Specialist
Key Facts - Additional Benefits
NHS cash benefit
	£100 per night (all bands) - maximum 28 days pa
Nursing at home
	Not covered
Parental accommodation
	Child under 16 - All bands £80 per night
Primary care
	Not covered
Private ambulance
	Full refund
Additional Benefits
Alcohol & drug abuse
	Not covered
Annual maximum limit
	None
Children covered
	Up to age 25 and unmarried
Chiropractors & Osteopaths
	£1,500 annual limit, GP referral required. Forms part of the overall combined out-patient limit. Maximum of 12 sessions
Dental treatment
	Oral surgery only (included under in-patient benefit)
GP minor surgery
	Not covered
GP Referred Chiropody, Podiatry or Homeopathy
	£1,500 annual limit, GP referral required. Forms part of the overall combined out-patient limit. Maximum of 12 sessions
Hospice care cash benefit
	Not covered
Infertility investigations
	Not covered
Maternity cash benefit
	Not covered
Optional cash benefit
	Not covered
Out of pocket expenses
	Not covered
Overseas cover
	Optional Extra: World-wide travel cover includes emergency repatriation, personal liability, lost luggage, personal cash, delayed departure/cancelled departure. Level 1, Level 2, Level 3 cover options to choose from
Personal & total disability benefit
	Not covered
Post hospital recovery bonus
	Not covered
Pregnancy
	Cover for specified abnormalities of pregnancy and childbirth
Stress counselling helpline
	Telephone counselling, unlimited calls
Transplants
	Covered for bone marrow and stem cell transplants as part of our cancer cover
Other benefits
	* Accidental dental injury - up to £10k pa (optional benefit only) * GP completing claim forms and medical reports - £25 per item * Health screenings (optional benefit only) * Access to private GP clinics in London (optional benefit only) * Full EAP (24-hour phone counsellor plus face-to-face counselling)

Key Facts - In-patient & Day Case Charges

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

Full refund (within Groupama's fee schedule limits)

Surgeon / Consultant / Specialist & Anaesthetists fees

Full refund (within Groupama's fee schedule limits)

Physicians fees & diagnostic tests

Full refund

Cancer Treatment Costs - Chemotherapy / Radiotherapy

Full refund

Psychiatric treatment

Not covered

Key Facts - Out-patient Charges

Complementary medicine

Not covered

Diagnostic tests (excluding scans)

£1,500 per annum - The £1,500 benefit is the overall aggregate out-patient benefit payable

GP referred consultations

£1,500 per annum - The £1,500 benefit is the overall aggregate out-patient benefit payable

Physiotherapy consultant referred

£1,500 per annum - The £1,500 benefit is the overall aggregate out-patient benefit payable

Physiotherapy GP referred

£1,500 annual limit, GP referral required. Forms part of the overall combined out-patient limit. Maximum of 12 sessions

Psychiatric cover

Not covered

Radiotherapy / Chemotherapy

Full refund

Scans - MRI / CT / PET

Full refund

Surgical Procedures

Full refund when carried out by Specialist

Key Facts - Additional Benefits

NHS cash benefit

£100 per night (all bands) - maximum 28 days pa

Nursing at home

Not covered

Parental accommodation

Child under 16 - All bands £80 per night

Primary care

Not covered

Private ambulance

Full refund

Additional Benefits

Alcohol & drug abuse

Not covered

Annual maximum limit

None

Children covered

Up to age 25 and unmarried

Chiropractors & Osteopaths

£1,500 annual limit, GP referral required. Forms part of the overall combined out-patient limit. Maximum of 12 sessions

Dental treatment

Oral surgery only (included under in-patient benefit)

GP minor surgery

Not covered

GP Referred Chiropody, Podiatry or Homeopathy

£1,500 annual limit, GP referral required. Forms part of the overall combined out-patient limit. Maximum of 12 sessions

Hospice care cash benefit

Not covered

Infertility investigations

Not covered

Maternity cash benefit

Not covered

Optional cash benefit

Not covered

Out of pocket expenses

Not covered

Overseas cover

Optional Extra: World-wide travel cover includes emergency repatriation, personal liability, lost luggage, personal cash, delayed departure/cancelled departure. Level 1, Level 2, Level 3 cover options to choose from

Personal & total disability benefit

Not covered

Post hospital recovery bonus

Not covered

Pregnancy

Cover for specified abnormalities of pregnancy and childbirth

Stress counselling helpline

Telephone counselling, unlimited calls

Transplants

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

Other benefits

* Accidental dental injury - up to £10k pa (optional benefit only)
* GP completing claim forms and medical reports - £25 per item
* Health screenings (optional benefit only)
* Access to private GP clinics in London (optional benefit only)
* Full EAP (24-hour phone counsellor plus face-to-face counselling)


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