Each benefit has its own claiming year, which is 12 months from the date of the first treatment you receive or hospital stay you claim for. You can claim straight away for treatment received on or after your policy start date, however certain benefits (marked with a *) do have a qualifying period or a 6 month qualifying period for pre-existing conditions. Take a look at the policy terms and conditions for full details. Dependent children up to the age of 18 are covered for free at the same level as the policyholder for all benefits marked with a tick below.

Choose a level of cover to view more details

Levels of cover Level 2 Level 3 Level 4 Level 5 Level 6
Monthly premium (per adult) £10.92 £16.38 £21.84 £27.30 £32.76
Everyday essentials Payback
Dependent children up to the age of 18 covered for free
Dental including treatment, check-ups, x-rays and full or partial dentures
50% yes up to £90 up to£135 up to £180 up to £225 up to £270

We will refund half the amount paid by you to a qualified NHS or private dental practitioner up to the appropriate maximum in each benefit claiming year. This maximum is determined by your level of cover.

WE WILL PAY YOU FOR:

  1. Dental treatment including check ups and hygienist fees
  2. Full or partial dentures
  3. X-rays

WE WILL NOT PAY YOU FOR:

  1. Cosmetic dentistry
  2. Dental implants
  3. Non prescribed items or consumables e.g. mouthwash, dental floss, toothbrushes
  4. Registration/administration fees
  5. Dental maintenance or dental membership schemes e.g. Denplan premiums
  6. Missed appointment charges
Optical* including glasses, contact lenses and eye tests. 12 month qualifying period for all types of eye surgery
50% yes up to £90 up to£135 up to £180 up to £225 up to £270

We will refund half the amount paid by you to a qualified optical practitioner up to the appropriate maximum in each benefit claiming year. This maximum is determined by your level of cover.

WE WILL PAY YOU FOR:

  1. Sight tests
  2. Prescribed spectacles including frames, prescribed sunglasses and prescribed contact lenses
  3. Spectacle repairs
  4. Laser eye surgery or refractive eye surgery performed by a recognised hospital or laser eye clinic. This excludes consultation at any time and any treatment received within the first 12 months of the policy

WE WILL NOT PAY YOU FOR:

  1. Non prescription spectacles/sunglasses/contact lenses
  2. Optical sundry items or consumables e.g. any type of solutions, spectacle cases, cleaning materials
  3. Spectacle/contact lens insurance premiums
  4. Receipts where only a part payment or deposit has been paid, including receipts showing a balance outstanding for payment
  5. Laser eye surgery or refractive eye surgery consultations at any time
  6. Laser eye surgery or refractive eye surgery received within the first 12 months of the policy
  7. Missed appointment charges
Prescription charges including NHS or private prescription charges and NHS prepayment certificates
50% yes up to £18 up to£27 up to £36 up to £45 up to £54

We will refund half the amount paid by you for NHS or private prescription charges up to the appropriate maximum in each benefit claiming year. This maximum is determined by your level of cover. To make a valid claim for prescription charges, you must obtain an original, named receipt from a registered pharmacist on the day you pay for your prescription. When you send us your claim form, you must also send us this receipt. If you are claiming for an NHS prepayment certificate, a photocopy of your prepayment certificate card, clearly showing your name and the valid from date, must accompany your completed claim form.

WE WILL PAY YOU FOR:

  1. NHS prescription charges
  2. Private prescription charges
  3. An NHS prepayment certificate where multiple NHS prescriptions are needed

WE WILL NOT PAY YOU FOR:

  1. Prescriptions for sexual/contraceptive aids
  2. Prescriptions for lifestyle conditions i.e. to help stop smoking, drinking alcohol, weight loss etc
Help to keep you ticking over Payback
Dependent children up to the age of 18 covered for free
Physiotherapy / Osteopathy / Chiropractic*
6 month qualifying period for pre-existing conditions
50% yes up to £250 up to£375 up to £500 up to £625 up to £750

We will refund half the amount paid by you to a qualified and registered physiotherapist, osteopath or chiropractor up to the appropriate maximum in each benefit claiming year. This maximum is determined by your level of cover. The amount covered is not per therapy. It is a total amount which can be used against one, or a combination, of the therapy treatments detailed up to your cover level maximum.

WE WILL PAY YOU FOR:

  1. Physiotherapy, osteopathy or chiropractic treatment supplied by a practitioner who is qualified and registered with an appropriate professional body recognised by Sovereign Health Care, these include:
    • Physiotherapists registered with the Health & Care Professions Council (HCPC)
    • Osteopaths registered with the General Osteopathic Council (GOsC)
    • Chiropractors registered with the General Chiropractic Council (GCC)
  2. A Private Medical Insurance (PMI) excess that has been paid by you to your PMI provider in order to access physiotherapy, osteopathy or chiropractic treatment
  3. Sports massage treatment supplied by a therapist recognised by Sovereign Health Care

WE WILL NOT PAY YOU FOR:

  1. Any treatment supplied by a practitioner who is not qualified and registered with an appropriate professional body recognised by Sovereign Health Care
  2. Any other treatment that is not physiotherapy, osteopathy or chiropractic. Examples of treatments that we do not cover are; aromatherapy, herbal therapies, Indian head massage, Reiki, Alexander Technique, Bowen Therapy and cranial sacro therapy. This list is not exhaustive
  3. Appliances and supporting materials including but not limited to lumber roll, spinal pillows/cushions, flexiband, tape, ice packs, books/literature etc
  4. Medical reports
  5. Treatment received for pre-existing conditions in the first 6 months from the date of joining or upgrading a policy
  6. Missed appointment charges
Chiropody / Podiatry
50% yes up to £50 up to£75 up to £100 up to £125 up to £150

We will refund half the amount paid by you to a qualified and registered chiropodist or podiatrist up to the appropriate maximum in each benefit claiming year. This maximum is determined by your level of cover. The amount covered is not per therapy. It is a total amount which can be used against one, or a combination, of the therapy treatments detailed up to your cover level maximum.

WE WILL PAY YOU FOR:

  1. Chiropody or podiatry treatment supplied by a qualified practitioner registered with the Health & Care Professions Council (HCPC)

WE WILL NOT PAY YOU FOR:

  1. Any treatment supplied by a practitioner who is not qualified and registered with the HCPC
  2. Cosmetic procedures and pedicures
  3. X-rays
  4. Consumable items including but not limited to corn plasters and dressings
  5. Surgical footwear or appliances including but not limited to arch supports and orthotic insoles although you may be able to claim for these under the ‘specialist medical aids’ benefit
  6. Missed appointment charges
Acupuncture / Homeopathy / Reflexology
50% yes up to £150 up to£225 up to £300 up to £375 up to £450

We will refund half the amount paid by you to a qualified and registered acupuncturist, homeopath or reflexologist up to the appropriate maximum in each benefit claiming year. This maximum is determined by your level of cover. The amount covered is not per therapy. It is a total amount which can be used against one, or a combination, of the therapy treatments detailed up to your cover level maximum.

WE WILL PAY YOU FOR:

  1. Acupuncture, homeopathy or reflexology treatment supplied by a practitioner who is qualified and registered with an appropriate professional body recognised by Sovereign Health Care, these include:

Acupuncture

  • British Acupuncture Council
  • British Medical Acupuncture Society (BMAS)
  • The Modern Acupuncture Association
  • The Association of Traditional Chinese Medicine and Acupuncture UK

Homeopathy

  • The Faculty of Homeopathy
  • ITEC qualified
  • The Society of Homeopaths
  • Alliance of Registered Homeopaths

Reflexology

  • Federation of Holistic Therapists
  • British Reflexology Association
  • Association of Reflexologists
  • International Institute of Reflexologists
  • British School of Reflexology
  • International Federation of Reflexologists
  • Complimentary Therapists Association

WE WILL NOT PAY YOU FOR:

  1. Any treatment supplied by a practitioner who is not qualified and registered with an appropriate professional body recognised by Sovereign Health Care
  2. Homeopathic medicines purchased in isolation e.g. from a chemist, health food shop, mail order or the internet
  3. Any other treatment that is not acupuncture, homeopathy or reflexology. Examples of treatments that we do not cover are aromatherapy, herbal therapies, Indian head massage, Reiki, Alexander Technique, Bowen Therapy and cranial sacro therapy. This list is not exhaustive
  4. Sundry items
  5. Missed appointment charges
Health screening including well man, well woman, osteoporosis and mammogram screening
50% yes up to £70 up to£105 up to £140 up to £175 up to £210

We will refund half the amount paid by you after receiving an approved health screening check, undertaken by medically qualified staff up to the appropriate maximum in each benefit claiming year. This maximum is determined by your level of cover.

WE WILL PAY YOU FOR:

  1. Well man or well woman screening
  2. Osteoporosis and mammogram screening

WE WILL NOT PAY YOU FOR:

  1. Screening for legal, employment, insurance, emigration or similar purposes e.g. HGV/PSV
  2. Home testing kits
  3. Diagnostic procedures or tests
  4. Missed appointment charges
Support if you need NHS or private hospital treatment Payback
Dependent children up to the age of 18 covered for free
Hospital in-patient*
6 month qualifying period for pre-existing conditions
Max 30 nights yes £20 per night £30 per night £40 per night £50 per night £60 per night

We will pay you at the relevant fixed nightly amount up to a maximum of 30 nights per benefit claiming year, each time you are admitted to a ward (but not accident and emergency) to receive treatment as an in-patient. For the purpose of clarity an in-patient stay is classed as a full night only if you are admitted as an in-patient before 12 midnight. The amount paid is determined by your level of cover. The claim form must be completed and signed by the hospital where you were admitted for treatment.

WE WILL PAY YOU FOR:

  1. Admission as an in-patient for treatment of a medical condition or as the result of an accident. Where admission is the result of an accident, the in-patient stay begins when you are formally admitted to a ward and does not start from the time you arrived at the hospital
  2. Maternity in-patient admission including caesarean section, where hospital confinement is for the insured mother only. Benefit is not payable where the mother remains in hospital to accompany her child in the post natal period until her child is discharged from hospital

WE WILL NOT PAY YOU FOR:

  1. Admission to hospital/nursing/residential homes/sanatoriums and accommodation arranged wholly or partly for domestic or respite reasons
  2. Nights when a patient is allowed out of hospital for whatever reason
  3. Alcohol, chemical, drug dependency, self inflicted illness/injury or conditions arising as a result of such dependency or illness/injury
  4. Emergency admission due to excessive intake of alcohol or alcohol poisoning or intake of any illegal substance or drugs or solvent abuse
  5. Hotel ward accommodation costs
  6. Out-patient treatment
  7. Nursing treatment plans, Community Matron Service or virtual ward treatment
  8. Ante or post natal admission for a dependent child who you register on your policy
  9. Parental stay where you accompany a dependent child who is admitted as an in-patient
  10. In-patient stays for pre-existing conditions in the first 6 months from the date of joining or upgrading a policy
Recuperation*
6 month qualifying period for pre-existing conditions
Fixed
amount
yes £90 £135 £180 £225 £270

We will pay a fixed amount, determined by your level of cover, if you spend a minimum of 14 consecutive nights in hospital as an in-patient and a valid claim has been made under the hospital in-patient benefit. This is payable once in each benefit claiming year and only after you have been discharged from hospital. We will not pay the recuperation benefit in the first 6 months from the date of joining or upgrading a policy where the in-patient stay was for a pre-existing condition.

Hospital day case admission*
6 month qualifying period for pre-existing conditions
Max 10 days yes £18 per day £27 per day £36 per day £45 per day £54 per day

We will pay you at the relevant fixed daily amount up to a maximum of 10 days per benefit claiming year, each time you are treated in a recognised hospital or medical centre (with surgical facilities) where the patient signs an admission form. For the purpose of clarity, day case admission is where you are admitted and discharged on the same day. The amount paid is determined by your level of cover. The claim form must be completed and signed by the hospital or medical centre where you were admitted for treatment.

WE WILL PAY YOU FOR:

  1. An admission to a day case ward or unit for treatment of a medical condition
  2. The first 10 occasions in each benefit claiming year

WE WILL NOT PAY YOU FOR:

  1. Attending hospital as an outpatient or for accident and emergency visits
  2. Maternity, geriatric and psychiatric treatments and hospice care
  3. Pre-admission appointments
  4. Cancelled operations or procedures
  5. Day case admission immediately prior to or following an overnight stay in hospital for which a claim may be payable under the hospital in-patient benefit
  6. Day case admission for pre-existing conditions in the first 6 months from the date of joining or upgrading a policy
Hospital consultant fees and diagnostic tests*
6 month qualifying period for pre-existing conditions
50% yes up to £250 up to£375 up to £500 up to £625 up to £750

We will refund half the amount paid by you to a specialist hospital consultant up to the appropriate maximum in each benefit claiming year. This maximum is determined by your level of cover. To make a valid claim you must have a formal referral from your GP or qualified health care practitioner to see a specialist hospital consultant to support diagnosis of an illness/condition. The GP or health care practitioner making the referral should not be linked to the hospital consultant in a way which creates a conflict of interest. Referral should not be related to treatment sought as a result of a lifestyle choice.

WE WILL PAY YOU FOR:

  1. An appointment with a specialist hospital consultant
  2. Treatment from a specialist hospital consultant
  3. X-rays and diagnostic tests, investigations and/or scans ordered by a specialist hospital consultant to aid diagnosis
  4. A Private Medical Insurance (PMI) excess that has been paid by you to your PMI provider in relation to you seeing or being treated by a specialist hospital consultant

WE WILL NOT PAY YOU FOR:

  1. Charges made by a hospital/clinic for use of their facilities such as theatre, dressings and equipment
  2. Ambulance or taxi charges
  3. Consultation and diagnostic tests as a result of a lifestyle choice such as vasectomy, sterilisation, infertility, cosmetic surgery, emigration, medical and/or insurance related reports
  4. Dietician/nutritional services
  5. Termination of pregnancy
  6. Referrals to a hospital consultant for pre-existing conditions in the first 6 months from the date of joining or upgrading a policy
  7. Missed appointment charges
Support when you need a helping hand Payback
Dependent children up to the age of 18 covered for free
Birth/adoption of a child*
6 month qualifying period
Fixed
amount
no £100 per child £150 per child £200 per child £250 per child £300 per child

We will pay a fixed amount for the birth/adoption of a child or children in each benefit claiming year providing that premiums have been paid at the relevant rate for the 6 month qualifying period. The birth/adoption benefit is only payable upon sight of a photocopy of the full birth certificate/adoption papers showing the name of the policyholder(s) and child’s name. The amount payable is per child and is determined by your level of cover.

WE WILL PAY YOU FOR:

  1. The birth of a child whether at home or in hospital
  2. The legal adoption of a child under the age of 5
  3. The birth of a child stillborn after 24 weeks gestation (upon submission of a stillbirth certificate)

WE WILL NOT PAY YOU FOR:

  1. A miscarriage of up to 24 weeks gestation
  2. Foster children
  3. Pregnancy termination
  4. The legal adoption of a child who is already related to you or your partner prior to the adoption taking place
  5. Claims in the first 6 months from the date of joining or upgrading a policy
Home care for local authority or accredited agency care services such as cleaning, laundry and shopping
50% no up to £250 up to£375 up to £500 up to £625 up to £750

We will refund half the amount paid by you for local authority or accredited agency charges to provide care services up to the appropriate maximum in each benefit claiming year. This maximum is determined by your level of cover.

WE WILL PAY YOU FOR:

  1. Cleaning, laundry and shopping services provided to you

WE WILL NOT PAY YOU FOR:

  1. Home nursing and day/night sitting
  2. Day centre attendance
  3. Maternity charges
Hearing aids*
6 month qualifying period for pre-existing conditions
50% no up to £100 up to£150 up to £200 up to £250 up to £300

We will refund half the amount paid by you to a recognised hearing aid dispenser for new hearing aids up to the appropriate maximum in each benefit claiming year. This maximum is determined by your level of cover. If you enter into a credit agreement to pay for your hearing aid, the date of your credit agreement will then also become the start date of your benefit claiming year.

WE WILL PAY YOU FOR:

  1. New hearing aids

WE WILL NOT PAY YOU FOR:

  1. Hearing aid contract schemes
  2. Hearing aid repairs
  3. Replacement hearing aid batteries
  4. Any other type of amplifying aid or device
  5. Hearing aids to treat a pre-existing condition in the first 6 months from the date of joining or upgrading a policy
  6. Missed appointment charges
Specialist medical aids*
6 month qualifying period for pre-existing conditions
50% no up to £250 up to£375 up to £500 up to £625 up to £750

We will refund half the amount paid by you for specialist medical aids and surgical appliances prescribed to you by a registered practitioner up to the appropriate maximum in each benefit claiming year. This maximum is determined by your level of cover.

WE WILL PAY YOU FOR:

  1. Abdominal, lumber supports, surgical corsets, trusses
  2. Mastectomy items
  3. Surgical stockings
  4. Arch supports and orthotic insoles
  5. Nebulisers
  6. Wigs when supplied through a medical prescription

WE WILL NOT PAY YOU FOR:

  1. Surgical implants
  2. Mobility aids including but not limited to wheelchairs and crutches
  3. Sexual and contraceptive aids
  4. Surgical shoes
  5. Repairs and batteries
  6. Specialist medical aids prescribed for a pre-existing condition in the first 6 months from the date of joining or upgrading a policy
Telephone helpline Available 24 hours a day, 365 days a year. Provided by Optum. Includes a medical helpline, telephone counselling, specialist legal, financial and debt information as well as online support on a wide range of life issues.

The telephone helpline accessible through your policy is provided by Optum which is a separate and independent service provider to Sovereign Health Care. If you’re going through difficult times or experiencing one of life’s major events, you can call Optum and benefit from the wealth of experience, knowledge, practical advice and emotional support they can offer.

THE TELEPHONE HELPLINE COMPRISES OF A RANGE OF SERVICES, INCLUDING:

  • Telephone counselling
  • Medical helpline
  • Financial information
  • Money management
  • Legal information
  • General citizens information

You can access these services via a 24-hour, year round confidential telephone helpline however not all of the services are available 24 hours a day.

Levels of cover Level 2 Level 3 Level 4 Level 5 Level 6
Monthly premium (per adult) £10.92 £16.38 £21.84 £27.30 £32.76

Premiums are inclusive of Insurance Premium Tax (IPT).

Choose a level of cover to view more details

 

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