Individual & Family

To join the plan you must be a resident of Ireland.

The contract will last until the renewal date specified on your membership certificate.

As soon as we receive your first payment, you will be covered from the commencement date under your Hibernian Aviva Health plan subject to the terms and conditions of your plan.

We have a direct payment arrangement with a number of hospitals. This means we will settle the bill directly with the hospital if the claim is for eligible in patient, day case or maternity treatment or for a scan performed in our listed approved treatment centres for scans.

You may call us on 1850 717 717 to find out whether a specific hospital has a direct payment arrangement with us. A hospital that has a direct payment arrangement will provide you with the claim form to sign at the end of your stay in hospital. The hospital will then submit the claim form to us for settlement. If the hospital does not have a direct payment arrangement with Hibernian Aviva Health you will need to complete the claim form and pay the bill. The hospital will supply you with a claim form or alternatively you can contact us to request one or you can download one from our website at www.HibernianAviva. ie/health. You will have to settle the claim directly with the hospital and get the treating hospital, doctor or consultant (as appropriate) to complete the form.

Please ensure that you send the completed claim form and all receipts to us when you are discharged from hospital. In this manner we can swiftly assess the claim and reimburse you for all eligible treatment.

If you are in any doubt about whether or not you are covered, you should contact us, prior to undergoing treatment. We can then confirm your level of cover which will assist you with your claim. Please provide your membership number when you contact us. Please forward all claims that you have settled to us within 3 months following the end of your policy year.

If you are making a claim for out patient benefits under the ‘Level 1 Hospital’, you should settle directly with your health care provider. You must retain your receipts. At the end of your policy year you must call us to register your claim.

After this call, you must send all original receipts to us to ensure that we can reimburse you for all eligible treatment. There is no claim form to fill out.

Please check that all original receipts state:

• the full name of the member receiving treatment,
• the type of treatment received,
• the date the treatment was received and
• the signature and contact details of the treating consultant and the hospital or centre where you were attended.

All receipts must be sent to Hibernian Aviva Health, PO Box 764, Togher, Cork within 3 months after your renewal date. If you have also purchased a day-today 50 plan, remember that many out patient benefit claims will be processed by us from this plan rather than as an out patient benefit. Please note a benefit cannot be claimed twice as both an out patient benefit and a day-to-day benefit.

Please note, receipts will not be returned following assessment of your claim. Therefore we recommend you retain copies of your original receipts.

If you are making a claim for outpatient benefits under the Level 1 Everyday then you will need to settle directly with your doctor or health care provider. You must retain your receipts.

At the end of your policy year you must call us to register your claim. After this call you must send all receipts to us to ensure that we can reimburse you for all eligible treatment.

Please ensure that all original receipts state:

• the full name of the member receiving treatment,
• the type of practitioner that you attended,
• the date the treatment was received and
• the name, address and qualifications of the practitioner providing the care on the practitioner’s headed paper.

All receipts must be sent to Hibernian Aviva Health, PO Box 764, Togher, Cork within 3 months after your renewal date.

Receipts will not be returned following assessment of your claim. Therefore we recommend you retain copies of your original receipts.

Hibernian Aviva Health will only pay for services under this benefit where a member uses the international assistance number stated on the membership card in advance of receiving any treatment and follows the advice given.

We shall make our best endeavours to pay your in patient hospital or professional bills directly. However, in the event we cannot do so, please retain all original receipts and contact us on your return.

When Hibernian Aviva Health pre-authorises your overseas treatment we will send you an international claim form.

This claim form must be fully completed and signed by both you and your treating consultant. You will need to settle the claim directly with the hospital but once we have received the completed international claim form and all corresponding receipts we can reimburse you swiftly for all eligible treatment.

We will pay for the cost of the procedure, associated hospital charges and the reasonable costs of unforeseen, additional and medically necessary procedures up to the level of benefit that we would have paid for the most similar procedure and related charges for you in Ireland in a hospital and accommodation type for which you are covered as set out in the pre-authorisation. Travelling costs are not included.

To renew your membership at the end of your policy year all you have to do is continue paying your premiums.

The cover provided under the plan and the premiums requested may change from time to time. If this happens, we will let you know in advance. Your premium payments will only change at your renewal date.

If you are paying by direct debit or by salary deduction or your premium is paid by the Company, and you wish to continue cover, no action is required. Where you are paying by direct debit we will collect your monthly payment from your bank at the then current premium rate.

Hibernian Aviva Health has a range of plans designed to respond to different needs.

Please be aware that as policyholder you are the only person who is allowed to make changes to the plan unless you have told us that a 3rd party has permission to act on your behalf. If you are part of a company plan the scheme administrator will have the authority to make changes. Should any change occur to your plan you will be notified directly by Hibernian Aviva Health.

If you wish to change your plan, add or remove dependants and have the authority to change your plan, you may do so by notifying us in advance and we will then amend your plan as appropriate. Please note that if this is a company plan paid by your employer you will have to pay for any additional cover not agreed to by your employer.

If you do change your plan please be aware that a supplementary exclusion period for upgrade of cover may apply.

As soon as we have received all information about the change to your plan and you have paid the premium, we will send you a new membership certificate outlining your new plan details.

It is important to let us know when there are any changes in your personal information, such as a new address, name change or banking details, to ensure we can give you the best possible customer care.

If you wish to cancel your plan for whatever reason, you must notify us in writing.

If you have made an in patient and/or day case claim you will not be entitled to any refund of premium.

If you have made only out patient claims, we shall refund your premium, on a pro rata basis from the date your cancellation becomes effective. In addition, early cancellation will result in your eligible out patient and day-to-day claims only being reimbursed on a pro rata basis, up to the date of cancellation and the full policy excess will apply.

We reserve the right to unilaterally terminate your cover in certain circumstances as outlined in this document. We may cancel this policy by giving you at least 14 days notice in writing at your last known address. If we do terminate your policy we shall refund the appropriate premiums you have paid. This shall be determined by the type of claim you have made during the current policy year as specified above.

In order to ensure that you are fully covered at all times, premiums must be paid in advance according to your agreed payment method.

Payments must be made in accordance with Hibernian Aviva Health conditions or they may not be accepted. All payments must be paid in euros and must be either by direct debit, Laser card or credit card, cheque, cash or salary deduction. Credit card and Laser card payments will only be accepted in three circumstances:

a) as a deposit on your first premium
b) if your monthly premium is late and we informed you of such or
c) to pay your yearly premium in advance.

If you do not pay annually, your first payment in any policy year may be slightly more or less than the subsequent payments as a result of rounding.

Hibernian Aviva Health premiums may vary from time to time. Should there be a change in premium you will be notified in advance of your next renewal date. If you do not pay your premium on time Hibernian Aviva Health may cancel your policy with effect from the date the first missed payment was due and not received.

Income tax relief is currently available on your premium. We will give you relief at source at the standard rate of income tax. Our premiums are published both net and gross of the standard rate of tax.