Our ALC Health Prima plans are available to individuals and companies (except Prima Iberica) 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 basic 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.
With this option, we ask you to give only basic information about yourself and any members of your family you wish to insure. We will not ask you to give details of your medical history, but it relies on you to understand that we will not cover treatment of any medical condition which was in existence at any time during the five years immediately before your policy started or treatment of a specified related condition to a pre-existing condition.
This relates not only to those conditions for which you had already received a firm diagnosis but also to treatment of any medical condition for which you actually had symptoms, even though no diagnosis had been attached to those symptoms. All that matters is that you know, or ought reasonably to have known, that something was wrong even if you had not consulted a doctor.
• After that two year period has elapsed, if you need treatment for those medical conditions which were not covered in the first two years then you will be able to claim; but only if you have not had any medical treatment or any medical advice, or taken any drugs or medicine, or followed any special diets in respect of those pre-existing medical conditions for the period of two consecutive years immediately before the need for treatment starts.
• If you have had any such treatment for the pre-existing condition within the period of two years then you won’t be able to claim for that medical condition or any specified related conditions in the circumstances shown above until you have gone for a period of two consecutive years without any treatment or advice or help or drugs.
• 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.
Full Medical Underwriting (FMU)
If you’d prefer, you can tell us about your medical history and we will use that to decide whether or not we can cover you for any past diagnosis or medical condition. You can then decide whether or not to continue to purchase the policy with these specific conditions.
After two consecutive years of membership where you have not had any trouble from the specified conditions, you can ask for them to be reviewed and included as part of your cover. Please note that there are some medical conditions that may be completely excluded from cover for all time.
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 the 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.