Effective from 6 April 2019

Tata Steel UK Private medical benefit summaryOptimum Referral

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About AvivaAviva is the largest insurer in the UK and provides 33 million customers with insurance, savings and investment products worldwide as well as expertise in administering private medical insurance and trust schemes.

Your private medical benefit with Aviva provides you with the peace of mind that you’ll receive prompt access to diagnostic tests and eligible medical treatment, should you need it. Along with comprehensive healthcare, we also provide you with additional benefits to help you look after your health and wellbeing.

Welcome to your Optimum Referral private medical schemeThis guide has been designed to provide you with the key information about your scheme, and it’s important that you read this and keep for your records. The guide doesn’t, however, contain the full terms, conditions, benefits and exclusions that apply to your scheme. These are contained in the full benefit wording, a copy of which is available on request from your company or by contacting Aviva.

Your healthcare scheme is designed to provide you with benefit for treatment of acute symptoms and conditions. An acute condition is a disease, illness or injury that’s likely to respond quickly to treatment which aims to return you to the state of health you were in immediately before suffering the disease, illness or injury, or which leads to your full recovery.

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If you need private medical support, you’ll need to ask the GP for an open referral. This means that they specify the required area of medicine (the specialty and sub-specialty), but not where you should go for treatment, or who you should see. Instead, we’ll discuss these choices with you based on your condition/symptoms, location and any preferences that you may have. This approach means we can guarantee that your treatment providers meet our quality criteria.

Choice of contact optionsOnce you’ve an open referral, you can contact us online via MyAviva or over the phone. If you start your claim online, you simply log the details and request a call back at a time and date to suit you. If you’d prefer, you can call one of our claims consultants.

A member of our claims team will discuss your options and provide you with the information you need to make an informed decision about who you want to see and where. This includes a wealth of hospitals and specialists; usually with multiple options for both in any one local area.

With Optimum Referral, we’ll do all the hard work for you. This includes:

• Seamless transfer of online data to our claims consultants

• Guidance and support every step of the way

• Direct handover to key hospital groups - from initial call

• Eligible bills paid in full and direct with treatment providers if the open referral process is followed.

How does an open referral affect my treatment?Your health and wellbeing is paramount and getting the right treatment for you is our priority. So you’ll be treated by specialists who’ve been independently verified as being qualified in their field of medical expertise, usually in a hospital that has been hand picked using the Care Quality Commission or Health Improvement Scotland ratings. With more control over which specialists and hospitals are eligible under your Optimum Referral scheme – we promise that if you follow the Optimum Referral claims process, you won’t have to pay any additional costs towards hospital charges or specialist fees for treatment that are eligible under the scheme.

Must I always get an open referral from my GP?For musculoskeletal (back, neck, muscle or joint) symptoms or conditions, use the BacktoBetter service. You don’t need to see your GP. Please just call the customer service helpline. Similarly, if you’re struggling with your mental health, there’s no need to see your GP. Just call the customer service helpline and use our mental health pathway.

In addition, you won’t need an open referral for children aged 15 and under. In this instance please ask your GP for a named referral. A named referral is where your GP specifically details the name of the specialist that should be seen.

What is Optimum Referral?Optimum Referral is designed to deliver quality private medical care at the right time, in the right place. You can use a choice of hospitals nationwide, many independently rated as ‘good’ or ‘outstanding’.

Quality assured

Our facility choices are underpinned by industry quality standards with the majority of hospitals having been hand picked based on Care Quality Commission and Health Improvement Scotland ratings. Patient safety is our key concern, which is why we’ll never actively guide to a hospital that is rated as inadequate, weak or unsatisfactory.

We’ll also only recommend specialists who meet the professional standards of the relevant governing bodies, including, but not limited to, the General Medical Council. Rest assured, we’ll only work with specialists who are trusted from a clinical perspective and whose charges are fair and reasonable.

What is Optimum Referral?

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If you have any questions or want to make a claim, call the customer service helpline:

0800 260 05678:00am - 8:00pm Monday to Friday8:00am - 1:00pm Saturday

Quoting scheme number:

981BCJCalls to and from Aviva may be monitored and/or recorded.

Get the most out of your private medical benefit with MyAvivaMyAviva brings together the products and services that help our customers protect their life, health, loved ones, future and possessions in one secure and simple-to-use online place.

• view details of your Aviva policies online, including scheme and benefit information and your hospital list

• monitor a wealth of details about your claim such as all invoices paid and the name of the treatment provider

• track any excess or out-patient limit spend

• start a claim online or update an existing claim online, at a time that suits you

• enjoy discounts when you buy a new product from a selected range. You should read the terms and conditions that apply to each product. These can be found on MyAviva.

How to make a claim

Your scheme includes the BacktoBetter service and mental health pathway

This means that if you need to claim for pain in the back, neck, muscles or joints (musculoskeletal conditions) or, if you need support with your mental health, you don’t need to see your GP, just call the customer service helpline. If your claim is eligible, we’ll put you through to independent clinical case management providers who will assess your symptoms and arrange the most appropriate treatment.

Making a claim for any other symptoms or conditions

For other symptoms or conditions, visit your GP in the usual way. If the GP recommends that you should see a specialist for further assessment or treatment, you’ll need to ask for an open referral. This means that they specify the required area of medicine (the specialty and sub-specialty), but not where you should go for treatment, or who you should see. Instead, we’ll discuss these choices with you based on your condition/symptoms, location and any preferences that you may have. This approach means we can guarantee that your treatment providers meet our quality criteria.

How to make a claim

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Your benefit – summaryBenefit limits shown below apply each member every scheme year and all treatment must be on referral by, and under the care of, a specialist unless otherwise stated.

As a member of the scheme you have your medical history disregarded which means that any pre-existing conditions you have will be eligible for benefit providing they fall within the terms and conditions of the scheme.

In-patient or day-patient treatment of acute conditions by the specialist and at the hospital selected by us

• Hospital accommodation charges

• Prescribed medicines, drugs and dressings

• Operating theatre fees

• Nursing care including intensive/high dependency care

• Specialists’ fees including surgeons’, anaesthetists’ and physicians’ fees

• Radiotherapy and chemotherapy

• Diagnostic tests including blood tests, X-rays, scans and ECG’s.

Out-patient treatment of acute conditions by the specialist and at the hospital selected by us

• Consultations with a specialist

• Treatment by a specialist as an out-patient

• CT, MRI and PET scans at a diagnostic centre recognised by us

• Radiotherapy and chemotherapy

• Diagnostic tests for example X-rays, blood tests and ECG’s

• Physiotherapy, osteopathy, acupuncture and chiropractic treatment (if directly referred by your GP limited to 10 sessions in combined total, per condition each member every scheme year for any condition other than pain in your back, neck, muscles or joints – musculoskeletal conditions)

Mental health benefits, through the mental health pathway, consisting of:

• In-patient and day-patient treatment up to 45 days each person every scheme year

• Out-patient treatment by a psychiatric specialist or psychiatric therapist

There’s no need to see your GP to claim for a mental health condition. All you need to do is call us and we’ll refer you through the mental health pathway.

BacktoBetter – In-patient, day-patient or out-patient treatment of acute musculoskeletal conditions, at a hospital or clinic within the clinical providers’ networks

• There’s no need to see your GP to claim for these conditions. All you need to do is call us and we'll refer you through the BacktoBetter service to access the most appropriate treatment for your condition.

Your benefit

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Additional benefits• Nursing at home up to £600 each member every

scheme year following eligible in-patient or day-patient treatment

• Private ambulance up to £320 each member every scheme year where medically necessary for transportation to the nearest hospital for the purpose of eligible treatment

• Parent accommodation costs when staying with a child aged 11 or under receiving eligible treatment; one parent only

• Minor surgery by a GP up to £100 per procedure; payable to the GP. To see what procedures are eligible visit: aviva.co.uk/gp-minor-surgery

• Hospice donation of £70 per day up to 10 days maximum

• Cash benefit of £200 per night where eligible in-patient treatment takes place as an NHS patient without charge. Benefit is limited to 35 nights. NHS cash benefit is not payable:

- where you have been admitted to the NHS hospital as a fee-paying patient of any kind

- if you claim for the cost of an NHS amenity bed for the same treatment, or

- for cancer treatment

• Treatment for complications of pregnancy and childbirth. Click here for the list of conditions that are eligible for benefit

• Surgical procedures on the teeth performed in a hospital.

This is a summary of the scheme benefits. Full details are given in the full benefit wording, a copy of which is available upon request.

Eligible dependantsAn employee’s spouse, partner, civil partner. Unmarried children and step children under 21 years of age or under 24 years of age, whilst in full time education in the UK and who are included on the scheme.

ExcessAn excess of £100 per employee and £250 per retiree applies each member every scheme year. Benefits will only be paid once the excess amount has been exceeded and this should be settled directly with the relevant provider, for example a hospital or specialist.

The excess doesn't apply to treatment received through the mental health pathway or to physiotherapy for pain in the back, neck, muscles or joints (musculoskeletal conditions) managed by the BacktoBetter service.

If you claim for a benefit that has a limit, the excess will count towards the benefit limit.

24 hour stress counselling helplineIf you’re stressed and just want someone to talk to, whatever the reason, just call the stress counselling helpline on 0800 158 3349. It doesn’t matter what’s on your mind – work issues, relationships, social strains, bereavement, money worries, anything at all. Experienced counsellors are there for you 24 hours a day, 7 days a week. The stress counselling helpline is available for members aged 16 and over.

Private Healthcare Information Network

You can find independent information about the quality and cost of private treatment available from doctors and hospitals from the Private Healthcare Information Network: phin.org.uk

Your benefit

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Benefit for cancer treatmentWe understand the importance of providing extensive benefit and support at every stage of your cancer treatment. Our cancer pledge means we’ll provide benefit for the cancer treatment and palliative care you need, as recommended by your specialist.

We also want to make things as comfortable as possible for you following your cancer treatment, so we’ll provide extensive benefit for your aftercare, including consultations with a dietician, as well as money towards prostheses and a wig.

Extensive benefit

and support

Our cancer pledge

Benefit for cancer treatment

Our dedicated oncology team will be able to support you regarding treatment available at a recognised facility in your local area.

What’s eligible for benefit

• Hospital charges for surgery and medical admissions at a hospital recognised by Aviva

• Specialists’ fees

• NHS cancer cash benefit. This is payable where eligible treatment as an NHS patient takes place for cancer without charge

We’ll pay £100 for each day you receive treatment:

- as an in-patient

- as a day-patient.

We’ll pay £100 for each day you:

- receive out-patient radiotherapy, chemotherapy or blood transfusions

- undergo out-patient surgical procedures.

We’ll also pay £100 for:

- each day you receive intravenous (IV) chemotherapy at home

- each week whilst you're taking oral chemotherapy drugs at home.

You won’t be able to claim more than £100 in any one day, but there’s no limit on the amount of days you can claim.

NHS cancer cash benefit isn’t available for psychiatric treatment or if you claim for the cost of an NHS amenity bed for the same treatment.

We may need to contact your GP or specialist for details of your treatment before we can pay your claim.

We may also ask for the discharge summary from the hospital

• Post surgery services - includes specialist services immediately following surgery such as consultations with a dietician or stoma nurse, and insertion and replacement of a tube for artificial feeding

• Radiotherapy and chemotherapy, including targeted drug therapies for cancer. Hormone therapy is only eligible if you need it to shrink a tumour before surgery or radiotherapy

• Bone strengthening drugs (such as bisphosphonates) that are being used to treat metastatic bone disease

• Treatment prescribed by your specialist for side effects while you're receiving chemotherapy or radiotherapy

• Stem cell and bone marrow transplants. This includes collection, storage and implantation

• Monitoring for up to ten years after your treatment for cancer has finished. We don’t pay for monitoring after treatment for non-melanoma skin cancer

• Up to £100 towards a wig if you suffer hair loss caused by cancer treatment. We’ll pay £100 in total whilst you're a member of the scheme, not per scheme year

• Up to £5,000 towards the cost of the first external prosthesis following an amputation for cancer

• Ongoing needs, such as regular replacement of tubes or drains, for up to five years after your treatment for cancer has finished

• Preventative surgery, only if you’ve already had treatment for cancer that we’ve paid for. For example, we’ll pay for a mastectomy to a healthy breast in the event that you've been diagnosed with cancer in the other breast. (We won’t pay for surgery where you have no symptoms of cancer, for example where you have a strong family history of cancer)

• End of life care:

- we’ll pay for end of life care in a hospital if this is medically necessary

- hospice donation of £100 per night, up to £10,000 if you’re admitted to a hospice

- donation of £50 per day to a registered charity if you’re visited at home by one of their nurses, up to £10,000.

Benefit for cancer treatment

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• Long term or chronic conditions. This exclusion doesn't apply to treatment for cancer

• Treatment undertaken by a specialist without GP referral (except through BacktoBetter or the mental health pathway)

• Any musculoskeletal or mental health treatment that has not been pre-authorised by us

• Seeing a GP privately

• Prescription charges

• Charges by a GP, medical practitioner or specialist for completion of a claim form unless the claim is confirmed by us

• Take home drugs and dressings

• HIV/AIDS and related conditions

• Treatment received in a health hydro or similar establishment

• Cosmetic treatment (except following an accident or surgery for cancer)

• Routine medical examinations including eye tests and health screens etc. (If we’ve paid for you to have treatment for cancer, this exclusion won’t apply with regard to cancer)

• Sports injuries where you're paid or personally sponsored

• Convalescence

• Experimental treatment (limited benefit may be available - please contact us)

• Incidental hospital expenses such as newspapers and telephone calls

• Kidney dialysis

• Routine dental treatment

• Investigations into the causes of, and treatment for infertility

• Treatment for pregnancy or childbirth other than the complications specified by clicking here

• Overseas treatment other than as provided for in the limited emergency overseas benefit specified by clicking here

• Surgical or medical appliances such as neurostimulators (e.g cochlear implants) and crutches

• Alcoholism, alcohol abuse, solvent abuse, drug abuse and other addictive conditions; except as provided for under the Mental Health benefit

• Treatment for psycho-geriatric conditions

• Treatment required as a result of war,

terrorism, contamination by radioactivity, biological or chemical agents

• Varicose veins of the leg, unless they meet the criteria detailed in the full benefit wording

• Sleep disorders and sleep problems, such as snoring and sleep apnoea

• Treatment for warts, verrucas and skin tags

• Weight loss surgery

• Treatment for lipoedema

• Treatment that is not by a specialist and at a hospital selected or authorised by us.

This is a summary of the scheme benefits. Full details are given in the full benefit wording, a copy of which is available upon request.

What’s not eligible – summaryThere are some things which aren’t eligible for benefit so it’s important you speak to the customer service helpline before receiving any treatment. Some examples of what isn’t eligible include:

Chronic conditions explainedA chronic condition is a disease, illness or injury which has one or more of the following characteristics:

• it needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests

• it needs ongoing or long-term control or relief of symptoms

• it requires your rehabilitation or for you to be specially trained to cope with it

• it continues indefinitely

• it has no known cure

• it comes back or is likely to come back.

Psychiatric benefit explainedFor psychiatric treatment, we provide benefit for treatment that aims to lead to your full recovery. We don’t provide benefit for:

• treatment that's given solely to alleviate symptoms, or

• chronic psychiatric conditions.

We consider a psychiatric condition to be chronic if:

• it meets the definition of a chronic condition, or

• we’ve paid for treatment for that condition or a related psychiatric condition during three separate scheme years. This applies to acute flare-ups of a chronic condition, it will also apply if the treatment wasn't in consecutive scheme years.

We don’t provide benefit for treatment, including diagnostic tests to treat or assess learning difficulties or developmental or behavioural problems such as Attention Deficit Hyperactivity Disorder (ADHD) and Autistic Spectrum disorders.

What’s not eligible

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If you leave your companyYou’ll only be entitled to leave the scheme during the annual benefits window or following an appropriate lifestyle event. For more information please contact your company HR team.

If you leave your company, your membership of the scheme will cease immediately, even if treatment was pre-authorised by Aviva. However you’re entitled to benefit from continued medical benefit on an individual policy. Benefits, exclusions, terms and conditions on an individual policy may be different to those on this scheme. If you’d like to discuss this further, please contact our sales advice line on: 0800 142 142 (calls to and from Aviva may be monitored and/or recorded).

To qualify for continued benefit without affecting your underwriting you need to apply within 45 days from the date your membership under the scheme ceases.

Claims for childrenChildren aged 12 and older can use our BacktoBetter service and our mental health pathway without seeing their GP. For any other symptoms or conditions, consult their GP in the usual way and contact the customer service helpline to let us know what they have recommended. Children aged 15 and under won't require an open referral. Please ask their GP for a named referral where they specify the name of the specialist the should see.

Income tax liabilityUnder current UK tax rules, the contribution that’s paid to us for your inclusion on the scheme arises from your employment and is therefore a taxable benefit. Please contact your company HR team if you require further information.

Change of personal detailsPlease advise your company immediately should any of your personal details change, e.g. address, name, etc. If you wish to add new dependants, for example, a newborn baby, please notify your HR team as soon as possible.

If you have any cause for complaint Our aim is to provide a first class standard of service to our customers, and to do everything we can to ensure you’re satisfied. However, if you ever feel we’ve fallen short of this standard and you’ve cause to make a complaint, please let us know.

Our contact details are:

Aviva Health UK Ltd Complaints Department PO Box 540 Eastleigh SO50 0ET Telephone: 0800 051 7501 Email: hcqs@aviva.com

We’ve every reason to believe that you’ll be totally satisfied with your healthcare scheme, and with our service. It’s very rare that matters cannot be resolved amicably. However, if you’re still unhappy with the outcome after we’ve investigated it for you and you feel that there’s additional information that should be considered, you should let us have that information as soon as possible so that we can review it.

Please note, as the scheme is a healthcare trust and not an insurance contract, the Financial Ombudsman Service will not consider referrals from members of this scheme. If you disagree with our complaints decision and wish to pursue the matter further, as a final recourse you can write to the trustees of the scheme via the Aviva complaints department, their contact details can be found above.

Clinical complaintsClinical complaints are not subject to our complaints process. Any clinical complaints about the conduct or competency of your specialist or facility should be directed to the specialist or hospital/clinic directly. Please see the full benefit wording for details.

Benefit outside the UKYour healthcare scheme provides benefit for treatment in the United Kingdom with only limited benefit for emergency treatment overseas (more detail is available in the full benefit wording). If you need to travel outside of the United Kingdom, you should consider taking out a travel insurance policy.

Points to remember

Points to remember

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Personal Information We collect and use personal information about you so that we can provide benefit for your company private medical scheme. This notice explains the most important aspects of how we use your information but you can get more information about the terms we use and view our full privacy policy at aviva.co.uk/privacypolicy or request a copy by writing to us at Aviva, Freepost, Mailing Exclusion Team, Unit 5, Wanlip Road Ind Est, Syston, Leicester, LE7 1PD

The data controller(s) responsible for this personal information is Aviva Insurance Limited as the provider of your company’s private medical scheme. Additional controllers are Aviva Health UK Limited who administers the scheme and your company’s intermediary (if applicable), who are responsible for the sale and distribution of the scheme and any applicable reinsurers.

Personal information we collect and how we use it We will use your personal information:

• to provide you with the benefit of your company’s private medical benefit: we need this to decide if we can offer private medical benefit and if so on what terms and also to administer the scheme, handle any claims and manage any renewal;

• to support legitimate interests that we have as a business: we need this to manage arrangements we have with reinsurers, for the detection and prevention of fraud and to help us better understand our customers and improve our customer engagement (this includes marketing, customer analytics and profiling),

• to meet any applicable legal or regulatory obligations: we need this to meet compliance requirements with our regulators (e.g. Financial Conduct Authority), to comply with law enforcement and to manage legal claims; and

• to carry out other activities that are in the public interest: for example we may need to use personal information to carry out anti-money laundering checks.

As well as collecting personal information about you, we may also use personal information about other people, for example your eligible dependants who you wish to benefit from your company’s private medical scheme.

If you are providing information about another person we expect you to ensure that they know you are doing so. You might find it helpful to show them this privacy notice and if they have any concerns please contact us in one of the ways described below.

The personal information we collect and use will include name, address, date of birth, current state of health and any existing conditions of each person included in the application. If a claim is made we will also collect personal information about the claim from you and any relevant third parties. We recognise that information about health is particularly sensitive information. Where appropriate, we will ask for consent to collect and use this information.

If we need your consent to use personal information, we will make this clear to you when you complete an application or submit a claim. If you give us consent to using personal information, you are free to withdraw this at any time by contacting us. Please note that if consent to use information is withdrawn we may not be able to continue to process your claims and we may need to cancel your benefit under the scheme.

Of course, you don’t have to provide us with any personal information, but if you don’t provide the information we need we may not be able to proceed with your application or any claim you make.

Some of the information we collect may be provided to us by a third party. This may include information already held about you within the Aviva group, including details from previous quotes and claims, information we obtain from publicly available records, our trusted third parties and from industry databases, including fraud prevention agencies and databases.

How we share your personal information with othersWe may share your personal information:

• with the Aviva group, our agents and third parties who provide services to us, your company’s intermediary (if applicable) and other insurers (either directly or via those acting for the insurer such as loss adjusters or investigators) to help us administer our products and services;

• with clinicians, including hospitals, and third party case managers from whom you and others under the scheme receive eligible treatment or who manage your care or treatment pathway;

Use of personal information

Use of personal information

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• With regulatory bodies and law enforcement bodies, including the police, e.g. if we are required to do so to comply with a relevant legal or regulatory obligation;

• With other organisations including insurers, public bodies and the police (either directly or using shared databases) for fraud prevention and detection purposes;

Some of the organisations we share information with may be located outside of the European Economic Area (“EEA”). We’ll always take steps to ensure that any transfer of information outside of Europe is carefully managed to protect your privacy rights. For more information on this please see our Privacy Policy or contact us.

How long we keep your personal information forWe maintain a retention policy to ensure we only keep personal information for as long as we reasonably need it for the purposes explained in this notice. We need to keep information for the period necessary to administer your benefit and deal with claims and queries on the scheme. We may also need to keep information after our relationship with you has ended, for example to ensure we have an accurate record in the event of any complaints or challenges, carry out relevant fraud checks, or where we are required to do so for legal, regulatory or tax purposes.

Your rightsYou have various rights in relation to your personal information, including the right to request access your personal information, correct any mistakes on our records, erase or restrict records where they are no longer required, object to use of personal information based on legitimate business interests, and data portability. For more details in relation to your rights, including how to exercise them, please see our full privacy policy or contact us.

Contacting usIf you have any questions about how we use personal information, or if you want to exercise your rights stated above, please contact our Data Protection Team by either emailing them at dataprt@aviva.com or writing to the Data Protection Officer, Level 4, Pitheavlis, Perth PH2 9NH.

If you have a complaint or concern about how we use your personal information, please contact us in the first instance and we will attempt to resolve the issue as soon as possible. You also have the right to lodge a complaint with the Information Commissioners Office at any time.

Use of personal information

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GEN5143 03/2019 REG002 © Aviva plc

Aviva Health UK Limited. Registered in England Number 2464270. Registered Office 8 Surrey Street Norwich NR1 3NG. Authorised and

regulated by the Financial Conduct Authority. Firm Reference Number 308139. Aviva Health UK Limited Head Office: Chilworth House,

Hampshire Corporate Park, Templars Way, Eastleigh, Hampshire, SO53 3RY.

aviva.co.uk/health

Useful contacts

Customer service helpline

0800 260 05678:00am - 8:00pm Monday to Friday 8:00am - 1:00pm Saturday

Calls to and from Aviva may be monitored and/or recorded.

Scheme number: 981BCJ

24 hour stress counselling helpline

To talk to an experienced counsellor, phone

0800 158 3349This benefit is available for members aged 16 and over.

This brochure is also available in braille, large print and audio format.

If required, please contact the customer service helpline to request a version in a format more suitable for you.

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