Who are Healix?
The Healix Group of Companies has been providing healthcare and risk management solutions to clients around the world since 1992. They are our corporate partners with whom we have been in partnership with for over 10 years. In May 2017, we extended this partnership to provide electronic processing of our claims invoices, including the payment of hospitals and consultant bills.
Our members remain insured with CS Healthcare and we continue to administer your policies with our award-winning service from our office in Kingston-Upon-Thames. Healix process our claims invoices including the payment of hospital and consultant bills.
What is Private Medical Insurance?
Private Medical Insurance (also known as health insurance) is designed to cover the cost of treatment in the comfort of a private hospital facility if you become ill or injured. While the National Health Service (NHS) provides a vital service, one of the benefits of private medical insurance is that you can avoid lengthy waiting times and ensure you receive diagnosis and treatment sooner. It works to support the NHS by giving you additional choices and fast access to your chosen hospital or specialist.
With private treatment you may have access to specialist treatment which would not be available under the public health system. And if you were looking to fund this yourself, you may find that the costs soon mount up leaving you in financial difficulty, with some treatments and surgeries costing in excess of £10,000.
It’s important to note that health insurance varies depending on the provider and there may be different policy limits as well as cover available. With our tailored plan, your choice, for example, you can ensure you are covered for heart and cancer conditions, provided they are not confirmed to be pre-existing.
Here at CS Healthcare we provide health insurance to those working in the civil or public service and their families. Find out if you are eligible for cover.
What private medical plans do you offer?
Here at CS Healthcare, we offer a choice of two plans that cater for different needs and budgets.
HealthBridge is our lower-priced solution that helps to bridge the gap between the NHS and private healthcare. With a range of key benefits, HealthBridge provides support when you need it. Treatment is subject to an overall financial limit of £15,000 per person per policy year and is available at a local hospital guided by us.
your choice is designed to offer comprehensive cover and offers the flexibility to choose from a range of benefit options enabling you to create your own personalised plan. Asides from being able to tailor the plan to your specific needs, you also have the power to choose where you receive treatment from using our directory of over 300 UK independent and private hospitals.
Do you cover pre-existing medical conditions?
As with most health insurers, CS Healthcare does not cover you for pre-existing medical conditions that you are suffering from or developed before taking out your policy with us. In addition, we will not cover you for any chronic conditions which are unlikely to be cured by treatment or require indefinite or on-going monitoring and treatment.
Your policy will not usually cover conditions which are related to a pre-existing condition. By related condition, we are referring to one which is caused by, or could be the cause of, another condition.
What Underwriting options are available?
We offer two types of Underwriting methods and the option that you choose will determine how much information you need to send to us as well as the terms of your cover.
Full Medical Underwriting is based on completing a health questionnaire (also known as a Medical History Declaration). If you choose this option, you will be asked a number of questions about your health which you must answer in full. These will enable us to understand your medical history (and that of any dependant/s you wish to insure). We will review your details and inform you of the terms of insurance we are prepared to offer including whether there are any medical exclusions that we have put in place as a result of a pre-existing condition. If necessary, we may need to ask your doctor for further information and if this happens, you will be liable for any costs that we incur. With this option, we are able to make a more prompt decision as to whether you are eligible for cover at the point of claim.
Depending on the medical condition, you may be able to request that we remove a personal exclusion after two full years of membership or sooner if indicated on your Registration Certificate. For this to be considered, we will require a medical report from your GP or medical practitioner confirming that it has been cured and that you have no active signs or symptoms.
If you choose Moratorium Underwriting, you will only be required to provide basic information about you and any dependants that you wish to insure. However this does mean that you will automatically be excluded from any pre-existing conditions for which you (and any dependant included in your application) have received treatment and/or medication for, or asked advice on, or had symptoms of (whether diagnosed or otherwise), during the five years immediately before your insurance plan commences. If you do not have symptoms, treatment, medication, or advice for those pre-existing conditions, and any directly related conditions, for two continuous years after your policy starts, then we will reinstate cover for those conditions.
When making a claim under this option, we will require a copy of your GP’s referral letter to confirm whether the condition is new or pre-existing.
Please note HealthBridge is only available under Moratorium terms of underwriting.
Am I able to switch to CS Healthcare?
How are the premiums calculated?
For HealthBridge policies, your premium will be calculated using a number of factors including your age and location. If you move home during a policy year then you must tell us immediately and be aware that this may affect the amount of premium you pay. The first born child on the policy will not have to pay premiums until the renewal following their 18th birthday.
The Society will determine the amount of premium payable at the start of each policy year and you will also be advised within a reasonable timeframe before the renewal date of your policy.
We can increase or reduce the premiums you pay at any time if there is a change in the rate of Insurance Premium Tax or any other government or statutory change. If we do this we will only increase the premium to cover the costs we incur as a result of these tax changes or charges.
Under a your choice policy, premiums are calculated and charged according to the age of the individual for Essential, Expert Diagnostics and the Heart & Cancer options reflecting the fact that people are more likely to claim as they get older. However, age related premium increases currently cease once members reach the age of 80 years old.
Premiums for children are separated into two age bands; 1 to 11 years and 12 to 17 years. However, children under 1 years old and the eldest child under 18 years of age are covered for free.
Premiums for Therapy & Care and Cash Benefits are calculated at a flat rate and not affected by age.The prices of our plans are reviewed at the annual renewal date and these will reflect the overall cost of benefit expenditure and medical inflation, such as the availability of new treatments and improvements in medical technology.
Do you offer No Claims Discounts (NCDs)?
While No Claims Discounts may seem appealing at first glance, they can result in premiums rapidly increasing if you do need to make a claim. At CS Healthcare, we choose not to offer No Claims Discounts, and therefore do not penalise our members for making a claim.
How can I join?
We specialise in protecting the health and wellbeing of our members, no matter your occupation, we can help you to access the best products for your individual needs.
If you are looking to take out a policy then you must be aged 18 years and over but no older than 74 years and 11 months.
Get a quote today and find out how you can join approximately 25,000 members who have already chosen to take out private medical insurance with CS Healthcare.
How long will I be covered for?
Your membership will start on the agreed start date, following receipt and acceptance of your completed Proposal Form and when your premiums have been paid. Provided you continue to pay the premiums, and adhere to your member responsibilities (please refer to the Member responsibilities’ section of the Policy Document for further details) your cover can continue until you cancel your policy.
Premiums are payable monthly or annually. Each monthly premium buys cover for the calendar month in which it is paid. Each annual premium ensures you are covered for the following 12 calendar months after it is paid. However, if the premium is not received within 60 days from the date it was due, then cover will stop. No benefit will be payable during this period for which premiums have not been paid, unless a period of free cover applies.
Your policy is renewable on an annual basis at which time you have the opportunity to apply for a change to your level of cover. We will write to you within a reasonable timeframe before your renewal date to notify you of any changes that may apply.
Can I cancel my policy at any time?
You can cancel your membership within 15 days of receiving your policy documentation when you first join the Society, or within 15 days of receiving your renewal documentation. You will be entitled to a full refund, provided you notify us in writing and that no claims have been made.Thereafter, you can cancel your policy at any time in writing and cover will cease at the end of the period that the premium has been paid if you pay in monthly installments. If premiums are paid annually then we will refund them on a pro-rata basis for entire months only, minus any pre-payment or introductory discount available.
How do I make a claim?
If you need to make a claim you can telephone our Claims Helpline from Monday to Friday 8am - 6pm on 020 8410 0440†, alternatively you can write to us or email us with the details of your claim. However before you do this, you should visit your GP. If your GP refers you for tests or treatment and you wish to go private please ask your GP for a copy of the referral letter and then call the Claims Helpline. We will also need to see a copy of the referral letter so we can establish whether it is a new or pre-existing condition.
One of our friendly and experienced Claims Advisers will take details of your claim and talk you through your cover, what you can claim and the next steps.For further information you can also refer to the 'How to claim for Health Insurance' and 'Claim terms and conditions' section of the Policy Document.
Do you cover emergency admissions?
Emergency treatment is not covered under your policy and in an emergency you should call an NHS ambulance and/or visit an NHS accident and emergency department.
Emergency treatment is defined as an admission to:
- A hospital directly following an accident
- A hospital ward directly from the emergency department for urgent unplanned treatment
- A hospital to receive immediate life-saving surgery
Does my policy cover me for treatment abroad?
We will consider requests for treatment within the European Economic Area (EEA), in line with the S2 scheme or Article 49 of the European Community provided there is a medical need. This could include an unacceptable waiting period to receive treatment within the UK or if there is a particular social need which requires an individual to have planned treatment within the EEA. This will also be dependent on approval from your UK based Specialist Consultant and you must be fit to travel.
The planned treatment will only ever be reimbursed up to the value of treatment of the same complexity and value, which would have been incurred at one of the hospitals on your hospital list.
Are you covered by the Financial Services Compensation Scheme (FSCS)?
We are covered by the Financial Services Compensation Scheme and you may be entitled to compensation from the scheme if we are unable to meet our obligations to you. The maximum level of compensation for valid claims with the Terms & Conditions of your policy is 90% of the claim, with no upper limit. Further information about compensation arrangements are available from:
The Financial Services Compensation Scheme
15 St Botolph Street
Phone: 0800 6781100 or 020 7741 4100
Are you regulated?
Civil Service Healthcare Society Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Our Financial Services Register number is 205346 and our registered office is: Civil Service Healthcare Society Limited, Princess House, Horace Road, Kingston upon Thames, Surrey, KT1 2SL.
Our permitted business is to provide private medical insurance contracts.
You can find out more on the Financial Services Register by visiting http://www.fca.org.uk/register or by contacting the FCA on 0800 111 6768.
What is the maximum annual limit for claims?
There are no financial limits when you take out a your choice policy however there may be some restrictions which will be highlighted in your policy document. It’s important to note that our HealthBridge policy does have a financial limit of £15,000 per person per policy year which cannot be carried over into subsequent years. If you exceed this limit, you can either fund the treatment yourself or go back to the National Health Service (NHS).
You may also wish to take advantage of the NHS Support Allowance to help preserve your benefit limit. This feature entitles you to receive a cash lump sum, which you can put towards costs you may have incurred from undergoing treatment on the NHS or for additional expenses encountered during recovery. Please refer to your policy document for details on the fixed limits.
Do you cover cancer?
Surgery and treatment for cancer is not covered under a HealthBridge plan, however you could still be covered for consultations and the cost of recovery and support. To make sure you are fully covered you would need to take out the Heart & Cancer option which can only be included within the your choice plan. You can choose from two levels of cover, including Heart & Cancer Comprehensive and Heart & Cancer Limited, which is limited to £50,000 per person per condition.
What hospitals can I use?
We have a network of hospitals including private and independent hospitals as well as selected NHS hospitals offering dedicated Private Patients Units (PPUs) which are chosen based on a strict criterion to ensure they provide the highest standards of care and service.
Policyholders have access to over 300 hospitals across the UK. Use our handy hospital search to find the nearest or most convenient hospital in your area.
With our your choice policy, you can also choose from two hospital lists - the Partnership list which features some of the well-known hospital groups such as Nuffield Health and the Extended list, which includes a broader selection as well as some of the more expensive hospitals.
How can I reduce my monthly premium?
You have a few options when it comes to reducing your premiums on a your choice policy. You can either select a voluntary excess to help reduce your monthly premiums (the bigger the excess the bigger the discount) or you can opt for one of our co-payment options.
With a co-payment option, you will pay a contribution of 15% towards each claim. While this shares the cost of treatment between you and ourselves, you will only have to pay up to a maximum of £1,000 or £3,000 per person, per policy year, dependent on the option you choose. If you select the £1,000 co-payment option then the discount will be approximately 30%, or if you opt for £3,000 then the discount will be about 40% (please note this is an approximation).
With a HealthBridge plan there is a compulsory co-payment where members must pay 15% of the claim and CS Healthcare will pay the remaining 85%. It’s important to note that the amount you pay is capped at £250 per claim.
What are customary and reasonable fees?
These are the maximum amount we will pay towards the fee your consultant and anaesthetist will charge for an operation/procedure/diagnostic test. These fees are listed on our Fee Schedule. Please click here to refer to the medical fees section of our website or call the Claims Helpline on 020 8410 0440^, where our friendly team will be happy to talk you through the fees.
Specialist/Consultants can legally charge a patient whatever they wish and while the majority will charge within our guidelines, a small minority may not. CS Healthcare will settle the fees on eligible claims, which we consider customary and reasonable, as per our Fee Schedule.
What are CCSD codes and why are they necessary?
Operations/procedures/diagnostic tests are classified using CCSD (Clinical Coding, Classification and Schedule Development) codes. These are a common set of codes and descriptions, used across the healthcare industry by all health insurers and providers. The code confirms the type of procedure you are due to have so that can be assessed against the terms and conditions of your policy.
If you are not familiar with some of the terms used, please refer to our helpful jargon buster tool.
How is my excess applied to my claim?
If you have chosen to have the option of an excess (voluntary contribution to lower your premiums), this is applicable to each insured person for each policy year for admissible claims made. Your excess will be deducted from your claim and a statement which outlines who to pay the excess to and the amount you need to pay will be provided.
An excess is not applied to the Therapy & Care or Cash Benefits option on the Your Choice Policy. Please note, if claims overlap two policy years (or more) any excess or benefit limits would need to apply again.
What type of claims do the Managed Care Team assess?
Our Managed Care Team (MCT) assesses the following claims; diagnosed heart conditions, diagnosed cancer conditions, hospital admissions for joint replacements and complications of planned treatment. In addition, hospital admissions where a transfer takes place from the NHS to a private ward or hospital.
How to join
Joining CS Healthcare is easy; in a few simple steps you can become a member.
- Decide which plan and level of cover suits you
- Check the cost of your plan by getting a quick quote. You can save the process at any stage and return to your quote at a later date
- Apply online or request the details by post
Once we have received your completed proposal form and payment instructions we will confirm your cover and forward your Registration Certificate and policy documents.
Alternatively you can contact a member of our Membership Services team on 0800 917 4325†.
Your Cancellation Rights
You can cancel your membership within 15 days of the start of your policy, or 15 days from the renewal date, and receive a full refund, provided you notify us in writing and no claims for benefit have been made against the policy. Thereafter, you can cancel your policy at any time in writing and cover will cease at the end of the period for which the premium has been paid. If premiums are paid annually then we will refund premiums on a pro-rata basis for whole months only.
Make a claim
If you need to make a claim, please call our Claims Helpline on 020 8410 0440†, Monday - Friday 8am - 6pm, where one of our dedicated claims advisers will be able to guide you through the claims process, alternatively you can email the claims team at: firstname.lastname@example.org.
You must always begin the claims process by seeing a GP. If your GP believes you need to be referred for consultation, tests or treatment, you can follow the necessary steps, which vary depending on your policy, as outlined below:
Claims process for:
Claims process for:
- Continued Personal Medical Exclusions (CPME) members (and Full Medical Underwriting members for symptoms that first occur after the first 12 months of membership).
Claims process for:
- Moratorium (MOR) or Continued Moratorium (CM) members (and Full Medical Underwriting members for symptoms that first occur in the first 12 months of membership).
Claims process for:
The Society makes every effort to ensure that members are satisfied with the level of service we provide. However, if things do go wrong we have an open and fair complaints procedure. In the event that you are unhappy with our service, please contact us to explain the reason for your dissatisfaction.
Write to:Civil Service Healthcare Society Limited
Kingston upon Thames
Telephone: Membership Services Team on 020 8410 0400†
We will investigate your complaint and provide you with a written response. If you are unhappy with the outcome you may refer the matter to the Financial Ombudsman Service.Financial Ombudsman Service
Telephone: 0845 080 1800
GP24 Advice Line
At CS Healthcare, we are always looking at ways to improve the products and services we offer to our members. We understand that accessing GP services quickly and at a time convenient for you can be challenging. This is why we are pleased to announce we are improving the advice line service that is available to all our members.
CS Healthcare has been providing private healthcare for 90 years and during that time, we’ve discovered there are some medical phrases and terms that cause confusion. Our Jargon Buster is designed to simplify any complicated terms that you may not be familiar with. Make sure you refer back to it any time you're feeling unsure about a word or meaning as you are browsing the site.
Confused? Take a look at our Jargon Buster
Our Jargon Buster is designed to simplify any complicated terms that you may not be familiar with. Make sure you refer back to it any time you're feeling unsure about a word or meaning as you're browsing the site.