Our Global Prima Medical Insurance plans are available to individuals and companies and offer a choice of underwriting terms, areas of cover and benefits.
When applying for a policy with ALC Health, you will be asked to provide some information to enable us to assess the appropriate annual premium for the cover you have chosen and the medical underwriting terms that will be applied.
Full Medical Underwriting (FMU)
This is where we ask for details of your full medical history. Based on the information received we will confirm what terms we are able to offer you and any exclusions that may apply. You can then decide whether or not to continue to purchase the policy.
Moratorium (MORI)With this option, we ask you to give only basic information and minimal medical details about yourself and any members of your family you wish to insure. It relies on you understanding that we will not cover treatment of any medical condition which you had in the five (5) years prior to joining the plan, or any other specified condition. These are known as pre-existing medical conditions. Once you have been on cover under the policy for two (2) continuous years your pre-existing medical condition may become eligible for cover provided, in that two (2) year period, you have not:
a. experienced and or suffered from any signs or symptoms, whether you went to a doctor or not;
b. sought or received advice; or
c. been recommended to have or had received medical treatment, including lifestyle changes and special diets, drugs, medication and injections;
If any of the above apply in the first two (2) year period, you will have to wait until you have completed a continuous period of two (2) years when none of these apply before we consider covering your pre-existing medical condition. You must ensure you follow medical advice provided to you in relation to your condition, even if this means you will be unable to obtain cover.
• There are some medical conditions – those which continue or keep recurring – for which you will never be able to make a claim. This is because you will always need to have medical advice or take medication and therefore you will never be able to go for the period of two consecutive years without advice or medication.
Please note that there are some medical conditions that may be completely excluded from cover for all time.
Bronze plan
This option excludes cover for any pre-existing medical conditions. We will not cover treatment for any medical conditions (or specified condition) that existed before the start or your policy.
Continuation of Personal Medical Exclusions (CPME)
This option is available to both individuals and groups transferring from a fully underwritten or moratorium policy with another insurer. If you join this plan on the basis of ‘continuation of medical exclusions’, this means that we will transfer any medical underwriting terms for medical conditions you had before joining that previous insurer to your new policy.
It is important to remember, however, that this relates only to the specific underwriting terms. Your policy will be subject to our general terms including the exclusions and benefit limitations, which you will find in our Policy Wording.
Continuation of medical exclusions only applies at the point of switching to ALC Health and subsequent new joiners must be underwritten. If a group has selected ‘medical history disregarded’ underwriting with their current provider and wishes to continue on this basis with ALC Health, they should consider our ‘medical history disregarded’ option.
Medical History Disregarded (MHD)
This option - the most expensive and only available to groups covering more than 10 employees - allows members to be enrolled without any exclusions relating to their previous medical history. Your policy will be subject to our general terms including the exclusions and limitations which you will find in our policy wording. ‘Medical history disregarded’ terms are extended to any subsequent joiners to the group, this is subject to a satisfactory application form.
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