Welcome to PHC

If your group policy starts between 1 April 2025 and 31 March 2026 please find your policy documents below.

• HealthCover4life handbook
• HealthCover4life specified hospital list handbook
• HealthCover4life directory of hospitals
• HealthCover4life specified directory of hospitals
• Plan 1 IPID
• Plan 2 IPID
• Plan 3 IPID
• Plan 4 IPID
• Combined benefits table Plans 1 - 4
• Moratorium underwriting explained
• PHC underwriting options explained

If you were a PHC member covered on HealthCover4life Plan 1, 2, 3 or 4 between 1 April 2024 and 31 March 2025 please refer to your plan's Important Changes Leaflet below. This details the significant changes that have been made to the benefits available under the plan.

• Important Changes Leaflet

If your group policy starts between 1 October 2024 and 30 September 2025 please find your policy documents below.

• HealthCover4life handbook
• HealthCover4life specified hospital list handbook
• HealthCover4life directory of hospitals
• HealthCover4life specified directory of hospitals
• Plan 1 IPID
• Plan 2 IPID
• Plan 3 IPID
• Plan 4 IPID
• Combined benefits table Plans 1 - 4
• Wellbeing Services flyer
• Moratorium underwriting explained
• PHC underwriting options explained

If you were a PHC member covered on HealthCover4life Plan 1, 2, 3 or 4 between 1 October 2023 and 30 September 2024 please refer to your plans Important Changes Leaflet below. This details the significant changes that have been made to the benefits available under the plan.

• Plans 1 - 3 Important Changes Leaflet
• Plan 4 Important Changes Leaflet

If your group policy starts between 1 April 2024 and 31 March 2025 please find your policy documents below.

• HealthCover4life handbook
• HealthCover4life specified hospital list handbook
• HealthCover4life directory of hospitals
• HealthCover4life specified directory of hospitals
• Plan 1 IPID
• Plan 2 IPID
• Plan 3 IPID
• Plan 4 IPID
• Combined benefits table Plans 1 - 4
• Wellbeing Services flyer
• Moratorium underwriting explained
• PHC underwriting options explained

If you were a PHC member covered on HealthCover4life Plan 1, 2, 3 or 4 between 1 April 2023 and 31 March 2024 please refer to your plans Important Changes Leaflet below. This details the significant changes that have been made to the benefits available under the plan.

• Plans 1 - 3 Important Changes Leaflet
• Plan 4 Important Changes Leaflet

If you would like alternative formats of these documents or should you have any queries, please contact support@thephc.co.uk.

Cancer cover

Cancer cover is available within the terms and conditions of the policy but is dependent on your plan and your underwriting. Please check your certificate of cover for that information. Further detail can be found in your Membership Handbook.

What isn't covered?

Like all insurance plans, there are some exclusions and limitations to your cover. The below are the most significant: 

• Charges when treatment is received outside of our Directory of Hospitals
• Dental treatment
• Routine pregnancy and childbirth
• Treatment of medical conditions that existed, or you had symptoms of, before joining (depending on the underwriting terms applied to your membership)
• Treatment of ongoing, recurrent and long-term conditions (also known as chronic conditions)
• Neurodiversity assessments, treatment and medication

For full details on what is and isn’t covered, alongside any limitations of cover, please refer to your Membership Handbook.

Underwriting Information

Medical underwriting is the process of assessing medical information and deciding which health conditions a member will be covered for, before taking out a policy.

Full Medical Underwriting (FMU)

• All members and their dependents will complete an application form declaring their medical history prior to joining the scheme.
• Exclusions for pre-existing conditions may be applied to their membership terms.

Medical History Disregarded (MHD)

• No medical history needs to be declared and we won’t apply any exclusions for specific medical conditions, though the general terms and conditions of the policy will still apply.

Moratorium Underwriting (MORI)

• Members who join on moratorium terms won't have cover for treatment of any conditions they had in the five years before they joined. This includes if they've had symtpoms of a condition that  hasn't been diagnosed. Once they've been trouble-free from that conditions for at least two years in a row after they joined, we can start covering treatment of these conditions.

Continuing Personal Medical Exclusions (CPME)

• Members transferring to PHC from another provider may be able to transfer over any existing underwriting terms, as long as there is no break in cover. 

1. What is private health insurance and how does it work?

Private health insurance, or private medical insurance (PMI), covers the costs of eligible private medical treatment. PHC policies also include an array of health and wellbeing benefits to support you to live life well. From seeing a specialist for diagnosis, to having a comfortable private hospital stay.

Private health insurance is designed to complement the care provided by the NHS.

2. Do I have an excess?

Your Certificate of Cover will tell you if you have an excess and how much it is. Excesses are applicable per person, per policy year. For further information on how your excess is applied, please refer to your Membership Handbook.

3. How do I make a claim?

You can contact PHC's claims helpline on 0800 068 7111 (or 01923 726 212 if calling from overseas). 

To make a claim follow the steps below:

1. Ask your GP for an open referral
   We will accept referrals from the AXA Doctor at Hand service or a GP at your GP practice. If your GP says you need specialist treatment, tell them you want to go private and ask for an ‘open referral’. With an open referral your GP doesn’t name a particular specialist, but instead gives you the type of specialist you need to see, for example a cardiologist. This means we can help you find a suitable specialist and make a convenient appointment for you. Occasionally the NHS will be best placed to provide care locally (for example specialist paediatric (children’s) care at an NHS centre of excellence). When this is the case, we will talk to you about your NHS options as well.
2. Contact us on 0800 068 7111 before you see the specialist
   Contact us as soon as you’ve seen your GP. It’s important you contact us before you see the specialist or have any treatment so that we can tell you what you’re covered for. This will mean you don’t end up having an unexpected bill for treatment that you’re not covered for.
3. We’ll check your cover and let you know what happens next
   We may ask you to provide more information, for example from your GP or specialist. You, your GP, or your specialist must provide us with the information we ask for by the date that we ask for it or you may not be covered for your claim.

4. Where is your claims team based?

Our dedicated claims team is based in Croxley Park, Watford, Hertfordshire. We also have an out of hours/overflow service through our parent company, AXA Health, based in Tunbridge Wells, Kent.

5. Can I add my dependents to my policy?

Whether you can add family members, including babies, to your cover will depend on the agreement we have with your group/employer who has taken out this cover under a group insurance contract. Depending on the agreement with your group, there may be restrictions on when you can add family members. Please discuss this with your scheme administrator. 

You can normally add:

a. Your partner. You must be either married, in a civil partnership, or living together permanently in a similar relationship.
b. Any of your children or your partner’s children.

Children cannot stay on the plan after the renewal date following their 25th birthday.

6. Do I need a GP referral for all treatment?

You may not need a GP referral for certain conditions.

For musculoskeletal conditions, call PHC as soon as you develop a problem. We’ll check you’re covered and refer you to our muscles, bones and joints service who will arrange an initial clinical needs assessment with a physiotherapist. During the needs assessment the physiotherapist will listen to your concerns, take you through an initial assessment of the issues you're experiencing and then advise the most appropriate treatment for you.

In addition, you can get access to support and treatment for mental health conditions through our mental health assessments and support service, by speaking to a counsellor or psychologist who will assess your condition and recommend a treatment plan, without the need for a GP referral.

You also have access to our skin, prostate and breast cancer pathways.

For all other conditions, you will need a referral from our AXA Doctor at Hand services or a GP at your GP practice.

Please note: members under the age of 18 will need to see their GP for a referral for these conditions as these services are not available to them.

7. How do I register for AXA Doctor at Hand?

To register and activate your access to the AXA Doctor at Hand service, you’ll need:

1. Your membership number or activation code, found in your membership communications.
2. Photo ID – you can use a passport, driver’s licence, identity card or residence permit card.
3. Camera access – you’ll need to be able to take a selfie on the phone or computer you’re using.

Access using the link below to get started.

https://member.doctorcareanywhere.com/SignUp/axa/

8. How do I access the Counselling & Support service? 

Our Counselling and Support Service is available 24 hours a day, 365 days a year, to help you and the family members aged 16 and over living in your household deal with life’s ups and downs. To speak to somebody, call PHC’s dedicated Counselling and Support Service on 0800 316 1213. Please state that you are a PHC member when you call. To access the online portal, please visit axabesupported.co.uk and input the username and password found in your Membership Handbook.

9. Is dental treatment covered under my policy? 

HealthCover4life plans do not include cover for treating emergency dental problems or any routine dental care. This includes any fees for dental specialists, such as orthodontists, periodontists, endodontists or prosthodontists.

We will cover the costs of oral surgery when you are referred for treatment by a dentist, such as:

• reinserting your own teeth after an injury; or
• removing impacted teeth, buried teeth and complicated buried roots; or
• removal of cysts of the jaw (sometimes called enucleation).

10. Does my policy cover me for treatment abroad? 

We do not cover any costs for treatment you receive outside the UK or if you live outside the UK. If you move abroad, you won’t be able to keep your current membership and you will not be able to make any claims for treatment.

11. Can I add my newborn baby to my policy?

Newborn babies can be added to the policy from their date of birth (when added within 13 weeks) and are covered free of charge up to the first renewal. If your baby requires treatment in a Special Care Baby Unit or paediatric intensive care following birth, you may not be covered for the costs. Please contact us to confirm any cover available to you in this case.

12. Can I have a health check-up/assessment? 

As part of your healthcare cover, you are entitled to 25% off a range of Nuffield Health or Circle Health Group Health Assessments (terms and conditions apply). For more information about the health assessments available to you including prices, please visit Health assessment (axahealth.co.uk).

13. Can I have a hearing test? 

Routine hearing tests are not covered by the policy. You will need to contact the claims team to discuss specific circumstances.

14. Do you cover investigations or treatment to do with learning and developmental disorders? 

We do not cover any treatment, investigations, assessment or grading to do with learning and developmental disorders. This includes conditions such as dyslexia, dyspraxia, autism spectrum disorder and attention deficit hyperactive disorder (ADHD).

15. Can I have a psychiatric assessment?

As part of the mental health assessments and support service available to you through your healthcare cover, we can arrange an assessment with a counsellor or psychologist. Where appropriate, they may refer you to a psychiatrist for further assessment and treatment.

16. Do you cover emergency treatment?

Private hospitals are not set up to deal with life-threating illnesses or injuries and as such they do not have Accident & Emergency facilities. In an emergency, you should call an NHS ambulance or go to an NHS A&E department.

17. Do you have a mobile app?

Whilst we currently don’t have a mobile app, you do have access to a dedicated online platform, Your PHC. Your PHC is the dedicated area of our website where you can access all you need to know about your PHC cover, from membership literature, including your Membership Handbook and Directory of Hospitals, as well as discovering the value-added health and wellbeing services available to you and how to access them. Details of how to access this can be found on your membership communications.