Healthcare Scheme

The Healthcare Scheme is a discretionary scheme set up for members of the Police family. All the members pay in to the Scheme to provide cover when it's needed for each other.       

It's discretionary because each case is looked at on an individual basis to see what help is right for that member. To make sure decisions are fair, the Scheme has Rules that guide which treatments are covered and what's not. But unlike private medical insurance, there are no 'hidden' extras or payments for 'extra' cover. Just one simple price for each member.


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Healthcare Scheme

 

*The 3 month free offer period is proposed to those persons joining the healthcare scheme as offered by Police Mutual. 12 month commitment required. Read the full terms and conditions here.

Our scheme provides cover for over 15,000 Police Officers, staff and their family members.

  • No waiting - Speak to an adviser to arrange treatment straight away.
  • Up to £30,000 in-patient treatment per year
  • The treatment year runs from 1 January to 31 December
  • Choose your place of treatment
  • High quality medical facilities
  • Family cover for all children under 18 years old
  • Private rooms with en-suite facilities
  • 24/7 GP Consultation Service, available to Healthcare members on 0345 222 5802

It is important that you call the Helpline on 0345 606 9901 before you receive any medical treatment you think you may need to claim for. All claims are dealt with case by case.

Your claims process will depend on whether you're undergoing an inpatient or an outpatient treatment.


Inpatient Claims Procedure

  1. Ask your GP to provide you with an open referral
  2. Contact Police Mutual and request a claim form on 0345 606 9901
  3. The claim form must be completed by the consultant and returned by you, along with the necessary member contribution attached, to the office for authorisation.
    • Our claims office address is: Alexandra House, Queen Street, Lichfield, WS13 6QS
  4. On receipt of the claim form and payment for the member contribution amount we will send a letter to confirm authorisation and treatment can then be received

Outpatient Claims Procedure

  1. Contact Police Mutual and request a claim form on 0345 606 9901
  2. The claim form must be completed by your consultant and returned by you to the office for authorisation. A member contribution may be required and this can be made by phoning the claims line on 0345 606 9901
    • Our claims office address is: Alexandra House, Queen Street, Lichfield, WS13 6QS
  3. Upon receipt of the completed claim form, and payment for the member contribution amount, we will send a letter advising if authorisation is given and if treatment can then be received.

Learn how much it would cost to protect yourself and your family.

How old are you?

Unfortunately we are unable to offer cover to new customers aged 65 and over. If you are an existing customer aged 65 or over and wish to change your cover, please contact us for a personalised quote.

Prices are effective from 1 February 2018.

What type of cover would you like?

Your Quote

Your standard monthly rate is: £0

Other things you should know

There is a full list of exclusions in the Scheme Rules. You can read full list on our website or by calling the claims office on 0345 606 9901.

The full claims procedures can be found on our website or by simply telephoning the claims office on 0345 606 9901.

We cover consultations, tests and operations with a surgeon in relation to cancer but do not cover chemotherapy, radiotherapy or on-going consultations with an Oncologist, as these are readily available on the NHS.

We have preferred provider contracts with particular hospitals and will endeavour to use them in all circumstances. However, if a procedure is not available at one of these hospitals authorisation will be considered for elsewhere.

Cash benefits are only available for planned NHS admissions and must be at least a one-night stay.

The cash benefit is not payable following emergency admissions or if your NHS stay is due to a procedure that the Scheme would not cover privately.You can claim £250 per night up to a maximum of 21 nights in any financial year.

No, there is one level of cover only and the annual limits apply to every member of the scheme.

Spouse/Partner (co-habiting) and dependent children (including step-children) up to the age of 18 years.

They are invited to join the Scheme in their own right and are entitled to the same benefits as serving officers. If they enter into full time education they will only have to pay a reduced rate of £13.50 until the end of their course or until they are 21, whichever is earliest. 

The Scheme is open to all Police Officers, PCSOs, Special Constables, Police Staff and their immediate families. To be eligible for the Scheme you must be aged under 65 when joining.

Once your membership of the healthcare scheme starts, any new condition (normally covered by the scheme) would be considered for treatment. Any pre-existing condition that you had in the five years prior to joining the scheme will be excluded. If you remain free from advice, medication and treatment for a continuous period of two years after your membership starts, the pre-existing condition can be considered for treatment. We may write to your GP for information before we can authorise any treatment. See the Healthcare rule book for a more detailed definition.

No, we are not insurers. The Healthcare Scheme is a mutual, discretionary scheme. This means that the scheme has been set up by and for members of the Police family, with no shareholders looking to make a profit. All the members pay in to the Scheme to provide cover when its needed for each other.

It's discretionary, because each case is looked at on an individual basis to see what help is right for that member. To make sure decisions are fair, the Scheme has Rules that guide which treatments are covered and what's not. But unlike private medical insurance, there is no 'hidden' extras or payments for 'extra' cover. Just one simple price for each member. No medicals, no big bureaucracy. Just a friendly team here to help you with you and your family's healthcare.


Scheme Summary

Accommodation & nursing Fully covered in Nuffield Health, Spire and BMI hospitals under in-patient and day case treatment
Ancillary services Fully covered (operating theatre, drugs, dressing and surgical appliances used in connection with treatment and diagnostic procedures including pathology, X-rays and all medical scanning and imaging techniques)
Accompanying adult accommodation Including up to £25 per night for up to 10 nights per year for one parent or guardian accompanying a dependent under 10 years old
Surgeons’ & anaesthetists’ services Covered up to the level of current industry standard fee scales*
Physicians’ services Fully covered
Out-patient treatment Consultations covered up to £600 a year

Diagnostic procedures (including pathology, X-rays, ECGs and all medical scanning techniques covered up to £1,000 a year

Treatment (including physiotherapy, osteopathy, chiropractic, psychiatry and psychology where provided by a practitioner recognised by the Police Mutual Healthcare Scheme) covered up to £600 a year

Nursing at home Covered up to £1,000 a year (following in-patient or day case treatment and provided by a registered nurse under the direction of a specialist)
Cash benefit £250 per night (up to a maximum of 21 nights per year) when receiving non-emergency in-patient treatment

These products are provided by PMHC Limited trading as Police Mutual, more information is available on our legal page.