The Healthcare Scheme is set up for members of the Police family to help with the cost of private medical treatment when you need it, in the event of an illness. It allows you access to treatment at a range of private UK hospitals and facilities and can reduce time spent waiting for diagnosis or necessary medical procedures.
The Healthcare Scheme is a discretionary scheme financed by the subscriptions of the members and is not an insurance product. Whereas an insurance product has a set criteria for claims our discretionary scheme claims are assessed on a case by case basis in line with the scheme rules.
There are no medicals, just a friendly team to help you with you and your family’s healthcare.
The scheme currently provides cover for over 20,000 Police Officers, staff and their family members, with the following benefits:
- Up to £30,000 in-patient / day patients treatment per year
- The treatment year runs from 1 January to 31 December (for treatments that are covered by the scheme)
- High quality medical facilities
- Private rooms with en-suite facilities
- 24/7 GP Consultation Service, available to Healthcare members
The Healthcare Scheme is provided by PMHC Limited trading as Police Mutual, more information is available on our legal page.
50% Discount Offer*
50% discount off the subscription rate for the main member for the first 12 months. Prices depend on your age but, for example, an 18-24 year old would pay £13.50 per month for the first 12 months and then £27 per month thereafter.
Additional members are charged at the normal rate.
To find out how much your monthly subscription will be:
*50% Discount Offer: Terms & Conditions apply click here for full details.
The 50% discount offer is available to UK residents aged 18 to 65, You must be eligible for Police Mutual products. The offer is only open to customers who are new members of the PMHC scheme and who have not benefitted from a PMHC offer previously.
Important things you need to know
The Police Mutual Healthcare’s (PMHC) healthcare scheme is discretionary and is not an insurance product. It is not regulated by the Financial Conduct Authority or the Prudential Regulation Authority and therefore is not covered by the Financial Ombudsmen Service or the Financial Services Compensation scheme.
Levels of membership
The healthcare scheme offers 4 levels of membership:
- Individual – member only
- Couple – member plus Spouse, Partner or Civil Partner (co-habiting)
- Single Parent Family – member plus any dependent children residing at the same address as the member and under the age of 18
- Family – member plus Spouse/Partner (co-habiting) and dependent children (including Step-Children) up to age 18
What’s included
In-patient and day patient treatment
- Private hospital charges paid in full subject to annual benefit limit and a treatment covered by the scheme. Please refer to the PMHC Open Scheme Healthcare rules for details of what is not included in your membership
Consultation and treatment fees
- For surgeons, anaesthetists and physicians
Outpatient 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
- For non-emergency NHS treatment which is covered by the scheme, members can receive £250 per night (up to a maximum of 21 nights per year)
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, where the child is covered under their membership
What’s not included
Pre-existing conditions
- Any condition that you have had in the five years prior to joining the scheme (that has been treated, or you were aware of, but didn’t seek medical advice, attention or treatment before joining the scheme, or any illness, injury or condition as a result of a known untreated condition which arises at any time whether prior or after such date) 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
Cancer treatments
- We cover consultations, tests and operations with a surgeon in relation to cancer but don’t cover chemotherapy, radiotherapy or ongoing consultations with an Oncologist
Dental treatments
- Any dental procedure including orthodontics
Emergency treatments
- Any treatment following an emergency admission or transfer from an NHS hospital
Cosmetic surgery
- Any cosmetic or aesthetic surgery or treatment, or surgery or treatment which relates to or is connected because of a previous cosmetic or aesthetic surgery or treatment
For a full list of what is not covered please refer to the PMHC Open Scheme Healthcare Rules.
Healthcare Scheme documents
It is important you understand all of the Rules and exclusions of the Police Mutual Healthcare Scheme before considering applying.
Historical Product Documents
Your Healthcare Scheme questions answered
Are there treatments the scheme doesn’t include?
You’ll find a full list of exclusions in the Healthcare Scheme Rules. For the No1 Healthcare Scheme see Scheme Rules.
How do I claim?
You will need an open referral from your GP to attend a consultation. If you are in your first 2 years of membership you will also need a GP report to confirm your claim isn’t for a pre-existing condition*.
It is important you contact the Police Mutual Claims Service, which is run by Healix Healthcare, to request authorisation to attend a consultation by calling 0208 049 8383. Members requiring treatment in Northern Ireland please refer to your welcome letter for claims contact details.
Once agreed, the Police Mutual Claims Service will transfer you through to a booking line or arrange the appointment directly at one of the approved hospitals to arrange the appointment.
Where treatment is required, you should contact the Police Mutual Claims Service to request authorisation for the recommended treatments or tests on 0208 049 8383 or email policemutual@healix.com.
Once a claim is authorised, you will be informed about paying a member contribution directly to the provider. The authorisation letter will be emailed or posted to you. Treatment can then be received at an approved Clinic or Hospital that the Police Mutual Claims service propose.
If no Treatment is required at or following the appointment with the Specialist, or the procedure or operation suggested is not within the definition of Treatment then no further action is necessary and no further Benefits will be payable.
*A pre-existing condition is any medical condition that you were aware of, or ought reasonably to be aware of prior to joining the scheme, even if medical advice has not yet been sought. For the pre-existing condition to be eligible for cover you will need to have had a period of five years without medical attention for it.
Is cancer treatment included?
We cover consultations, tests and operations with a surgeon in relation to cancer but don’t cover chemotherapy, radiotherapy or on-going consultations with an Oncologist, as these are readily available on the NHS.
Can I use any private hospital?
The Police Mutual Claims Service use a number of hospitals across the UK. If a procedure is not available at one of these hospitals, they will try and find a convenient alternative for you.
Can I claim any cash benefits for being in a NHS hospital?
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, please refer to the Scheme rules for the full details
Can I increase my cover to entitle me to higher annual limits?
There’s only one level of cover only and the annual limits apply to every member of the scheme.
Who can I include on my membership?
You can include your spouse or partner you’re living with and dependent children including step-children, up to the age of 18 years.
What happens when a child reaches 18 years of age?
They are invited to join the scheme in their own right and are entitled to the same benefits as serving Officers.
Who can apply to join the Healthcare Scheme?
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.
Can I join the scheme and immediately receive treatment?
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 (that has been treated, or you were aware of, but didn’t seek medical advice, attention or treatment before joining the scheme, or any illness, injury or condition as a result of a known untreated condition which arises at any time whether prior or after such date) 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.
The Police Mutual Claims Service may write to your GP for information before they can authorise any treatment.
See the Healthcare Scheme Rules for a more detailed definition.
Is Healthcare the same as Health Insurance?
No, we’re not insurers. The Healthcare Scheme is a discretionary scheme. This means that the scheme has been set up by and for members of the Police family. All the members pay in 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.
How do I resign my membership to the Healthcare Scheme?
If you decide you would like to resign your Healthcare membership, you can do so by telephone, email or post. A notice period of 30 days will apply from the date that you notify us. Please refer to the Scheme Rules or contact us for full details on 0151 242 7640.
How do I complain?
If your complaint is regarding your healthcare membership please email healthcare@policemutual.co.uk or call 0151 242 7640.
If your complaint is regarding the Police Mutual Healthcare Claims Service please email policemutual@healix.com or call 0208 049 8383.
Find out more about private healthcare
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