Introduction

Welcome to the Hammond School Young Performers guide.

Hammond School have appointed us, Healix Health Services Ltd, to manage this trust. Our role is to assess and manage medical needs that your child might have as well as the care and treatment they receive.

The Hammond School trust is designed to cover students for the diagnosis and/or treatment of a short term medical condition, if the treatment is medically necessary.

The trust is not intended to cover all medical conditions. There are some medical conditions and treatments that are excluded from cover (please see trust exclusions and limitations for further details on this).

All treatment (including consultations and diagnostic tests) should be authorised in advance. Therefore it is essential that you call us before your child receives treatment, to ensure that the proposed treatment is eligible for cover under the trust.

Table of benefits

Your child's healthcare trust benefits are set out in the table below.

Benefit limits apply across the course of any one year of cover, unless otherwise stated.

The healthcare trust is in place for medical treatment for dance related injuries only.

The scheme will commence on the 1st September 2024 to 31st August 2025.

Outpatient Investigations and Treatment Level of cover Benefit note

Outpatient consultations with a specialist

Outpatient diagnostic tests and investigations following Hammond School GP or specialist referral

Outpatient treatment following specialist referral

 Full cover 1a

Outpatient surgical procedures

 Full cover 1b

Outpatient MRI, CT and PET scans 

 Full cover 1c
Inpatient and Daycase Treatment

Specialist fees and hospital charges for inpatient and daycase treatment

 Full cover 2
Therapies

Outpatient therapies following Hammond School approval (outpatient physiotherapy, preventative physiotherapy and acupuncture)

 Up to £750 per scheme year 3a

Outpatient physiotherapy following specialist referral

 Up to 10 sessions per scheme year 3b
Mental Health

Outpatient mental health treatment following Hammond School or specialist referral

 Up to 12 sessions per scheme year 4a

Inpatient and daycase mental health treatment

 Up to £10,000 per scheme year 4b
Cash Benefits

NHS cash benefit

 £200 per day or night up to £2,500 per scheme year 5
Additional Benefits

Vocal Health Assessment following Hammond School referral

 Up to £1,000 per scheme year 6a

Vocal Health Management including vocal physiotherapy following Hammond School referral

 Up to £250 per scheme year 6b

Nutritional support following Hammond School or self-referral

 1 appointment per term, up to 3 appointments per scheme year 6c

Note: The above benefits only apply when the covered person has treatment in the UK unless otherwise specified.

Note 1a: Outpatient Investigations and Treatment

We will pay for in full for:

  • outpatient consultations with a specialist following Hammond School referral (during term time)
  • outpatient consultations with a specialist following GP referral (outside of term time)
  • outpatient diagnostics and investigations following Hammond School or specialist referral
  • outpatient treatment following specialist referral 

Cover is subject to our reasonable and customary guidelines.

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Note 1b: Outpatient Surgical Procedures

We will pay in full for hospital charges and specialist fees for outpatient surgical procedures, and drugs and dressings used during an outpatient appointment.

Cover is subject to our reasonable and customary fees.

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Note 1c: Outpatient MRI, CT and PET Scans

We will pay in full for MRI scans on Hammond School or specialist referral.

We will pay in full for CT and PET scans at any private or NHS hospital following specialist referral.

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Note 2: Specialist Fees and Hospital Charges for Inpatient and Daycase Treatment

We will pay for specialist fees for inpatient and daycase treatment. Cover is subject to our reasonable and customary fees.

We will pay hospital charges in full for the following:

  • accommodation and nursing care for inpatient or daycase treatment
  • operating theatre and recovery room
  • prescribed medicines and dressings, for use whilst an inpatient or for daycase treatment
  • eligible surgical appliances - for example, a knee brace following ligament surgery
  • prosthesis or device which is inserted during eligible surgery
  • pathology, radiology, diagnostic tests, MRI, CT and PET scans
  • physiotherapy received during inpatient or daycase treatment
  • intensive care
  • short-term dialysis when needed temporarily for sudden kidney failure resulting from an eligible condition or treatment
  • skin and corneal grafts
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Note 3a: Outpatient Therapies

We will pay up to a combined limit of £750 per scheme year for the below therapies.

Outpatient physiotherapy
Treatment must take place following the Hammond School or GP referral, and must be carried out by the Hammond School's agreed provider.

Please contact us with details of your child's GP referral to ensure this is eligible prior to receiving pre-authorisation.

Outpatient preventative physiotherapy and physiotherapy review sessions
During term time we will pay for outpatient physiotherapy when taken for the purpose of preventing injuries related to Hammond School activities. This must have been referred by the Hammond School and be carried out by the Hammond School's agreed provider.

Outpatient acupuncture
Outpatient treatment with an acupuncturist following referral from the Hammond School. This must be carried out by the Hammond School's agreed provider.

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Note 3b: Outpatient Physiotherapy following Specialist Referral

We will pay for up to 10 sessions per scheme year for outpatient physiotherapy following specialist referral.

The physiotherapist must still be recognised by us for benefit purposes.

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Note 4a: Outpatient Mental Health Treatment

We will pay for up to 12 outpatient mental health sessions per scheme year following Hammond School or specialist referral and carried out by the Hammond School's agreed provider.

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Note 4b: Inpatient and Daycase Mental Health Treatment

We will pay up to £10,000 per scheme year for eligible inpatient and daycase mental health treatment. All treatment must be under the direct control and supervision of a consultant psychiatrist, and must be authorised by us in advance and in writing.

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Note 5: NHS Cash Benefit

In the event that you are admitted to an NHS hospital, or you elect to receive free treatment through the NHS we will pay an NHS cash benefit of £200 per night or day following inpatient or daycase treatment up to a maximum of £2,500 per scheme year. This benefit will only apply to claims for daycase or inpatient treatment what would otherwise have been eligible for benefit under your scheme.

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Note 6a: Vocal Health Assessment

We will pay up to £1,000 per scheme year for Vocal Health Assessments when referred by the Hammond School and provided by the Hammond School's agreed provider.

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Note 6b: Vocal Health Management

We will pay up to £250 per scheme year for Vocal Health Management when referred by the Hammond School and provided by the Hammond School's agreed provider.

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Note 6c: Nutritional Support

We will pay for 1 nutritional support appointment per term, up to a maximum of 3 appointments per scheme year following Hammond School or self-referral and when provided by the Hammond School's agreed provider.

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Second medical opinion

Should you decide that you would like to receive a second medical opinion to ensure you are fully confident with your specialists recommendations please contact us on the claims helpline to discuss pre-authorisation. Our experienced claims team will be able to advise and support you through this process.

Second medical opinions will be arranged with a specialist who is an expert in their field and is recognised for the purposes of providing such second opinions. Without written authorisation for a second opinion, payment cannot be made for any recommended or resulting treatment.

Section 9: Glossary

The words and phrases below have the following meanings. They will appear in bold in this guide.

Active treatment

- Treatment of an acute medical condition that leads to recovery or restoration of a previous state of health

Acute condition

- A disease, illness or injury which responds quickly to treatment that aims to return your child to the state of health they were in immediately before suffering the disease, illness or injury, or which leads them to recovering fully. We would consider that an acute condition would resolve within three months or less

Annual renewal date

- The anniversary of the start date each year or any other date which we and Elmhurst Ballet School may agree to in writing

Artificial life maintenance

- Any medical procedure, technique, medication or intervention delivered to a patient in order, to maintain life after the failure of one or more vital organs

Benefit

- Any payment we make shown in the list of benefits.

Benefits

- The benefits for which your child is entitled as an individual under the trust subject to the terms and conditions that apply to the membership including all exclusions

Cancer

- A malignant tumour, tissues or cells, characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue

Chronic condition

- a disease, illness or injury which has at least one of the following characteristics:

  • it needs ongoing or long term monitoring through consultations, examinations, check-ups and/or tests
  • it needs ongoing or long term control or relief of symptoms
  • it continues indefinitely
  • it comes back or is likely to come back
  • your child need to be rehabilitated or specially trained to cope with it
  • it has no known cure.

Please note: this will apply to all medical conditions, whether or not a diagnosis has been made. As we expect an acute condition to resolve completely within three months, we would begin to consider any condition lasting longer than this as chronic.

Complementary practitioner

- a practitioner who specialises in acupuncture who is registered under the relevant Act; and who, in all cases, meets our criteria for complementary practitioner recognition for benefit purposes in their field of practice:

  • Acupuncture practitioners must be registered with the BMAS (British Medical Acupuncture Society), BacC (British Acupuncture Council), AACP (Acupuncture Association of Chartered Physiotherapists) or AAC (The Association of Acupuncture Clinicians)
    • <

Curative intent

- treatment that is administered with a reasonable expectation both that it will restore the patient close to the state of health enjoyed prior to the disease being diagnosed, and expect the patient to be disease free 5 years after commencement of the treatment.

Daycase

- If your child is required to occupy a hospital bed for one day, for medical reasons

Daycase treatment

- Treatment for which your child is required to occupy a hospital bed for one day, for medical reasons

Dependant

- a member's partner (if a member gets divorced their husband or wife will no longer be considered as a dependant for the purposes of this plan).

- a member's unmarried dependant children if aged 25 or under when they first join the scheme. We will also accept them if they are aged 26 or over providing the main member is switching their cover to us on a CPME basis and that child is currently included on their parent's cover.

This should be evidenced by the current membership certificate. The dependant children must be living full-time at the same address as the main member, unless they are in full-time education.

Dependants

- a member's partner (if a member gets divorced their husband or wife will no longer be considered as a dependant for the purposes of this plan).

- a member's unmarried dependant children if aged 25 or under when they first join the plan. We will also accept them if they are aged 26 or over providing the main member is switching their cover to us on a CPME basis and that child is currently included on their parent's cover.

This should be evidenced by the current membership certificate. The dependant children must be living full-time at the same address as the main member, unless they are in full-time education.

Detoxification

- Treatment for withdrawal symptoms after your child has been abusing drugs or alcohol or both

Diagnostic tests

- investigations such as x-rays or blood tests required by your GP, or specialist, to find the cause of your symptoms. For the purpose of this policy, diagnostic tests are considered treatment.

Dialysis

>
  • Haemodialysis dialysis – the removal of waste matter from your child's blood by passing it through a kidney machine or dialyser
  • Peritoneal dialysis – the removal of waste matter from your child's blood by introducing fluid into your abdomen which acts as a filter
    • <

    Emergency

    - A serious medical condition or symptoms resulting from a disease, illness or injury which arises suddenly and requires immediate treatment, generally within hours of onset, and which would otherwise put your child’s health at risk

    Employer

    align="LEFT">-Markerstudy who is named as your employer.

    General Practitioner

    - A registered medical practitioner in general practice

    GP

    - A registered medical practitioner in general practice

    High dependency unit

    - Special department within a hospital designed for patients who require advanced post-operative care and/or support for a single failing organ system

    Home nursing

    - Visits from a registered nurse to your home to give your child expert/skilled nursing services immediately following eligible inpatient treatment in hospital under the control of a specialist

    Hospital

    >
  • NHS hospital - a National Health Service hospital with facilities for medical and surgical treatment, as defined in Section 1.28 of the National Health Service Act 1977 or in any future law
  • Private hospital - an independent hospital which can provide acute medical, surgical or mental health care. It must be registered under The Registered Homes Act (1984) and approved by the Healthcare Commission or any future law. It may also include a private bed in an NHS hospital
    • <

    Inpatient

    - If your child is required to occupy a hospital bed for one night or more, for medical reasons

    Inpatient treatment

    - Treatment for which your child is required to occupy a hospital bed for one night or more, for medical reasons

    Intensive care unit

    - A specialised department within a hospital designed for patients support for two or more organ systems and advanced respiratory support

    Medical condition

    - Any physical, mental or psychological disorder, including disease, illness, injury, genetic disorders and behavioural conditions

    Medical Necessity

    – treatment that is considered to be:

    • In accordance with professional standards of medical practice in the United Kingdom

    • Clinically appropriate, in terms of type, frequency, extent, site and duration of treatment

    • Required for reasons other than the comfort or convenience of the patient or specialist.

    • Provided at an appropriate facility, in an appropriate setting and at an appropriate level of care for the treatment of the patient’s medical condition.

    • Provided only for an appropriate duration of time.

    • no more costly than an alternative treatment at least as likely to produce the same therapeutic or diagnostic results.

    Please note, the trust is designed to treat acute medical conditions. It is not designed to cover all eventualities and therefore there will be some conditions which, whilst considered medically necessary, may not be eligible for cover.

    Medically necessary

    - Treatment that is considered to be:

    • In accordance with professional standards of medical practice in the United Kingdom
    • Clinically appropriate, in terms of type, frequency, extent, site and duration of treatment
    • Required for reasons other than the comfort or convenience of the patient or specialist.
    • Provided at an appropriate facility, in an appropriate setting and at an appropriate level of care for the treatment of the patient’s medical condition.
    • Provided only for an appropriate duration of time.
    • No more costly than an alternative treatment at least as likely to produce the same therapeutic or diagnostic results.

    Please note, the trust is designed to treat acute medical conditions. It is not designed to cover all eventualities and therefore there will be some conditions which, whilst considered medically necessary, may not be eligible for cover.

    Member

    - A current student of Hammond School

    Member (1)

    A current student of Hammond School.

    Mental health condition

    - A disorder that affects the mind, mental function, emotions or behaviour whether the cause is organic, traumatic or reactive

    Oro-surgical procedure

    - operations described in the schedule of surgical procedures (for example, removing an impacted or buried tooth by surgery).

    Outpatient

    - Where your child does not require a hospital bed for their treatment or consultation

    Outpatient treatment

    - Treatment for which your child does not require a hospital bed

    Palliative cancer treatment

    - cancer treatment, the primary effect of which is to alleviate symptoms rather than to achieve remission, cure or reduction in tumour size.

    Partner

    - a member’s husband or wife, or the person the member lives with in a relationship similar to that of husband or wife, whether the same sex or not.

    Physiotherapist

    - A physiotherapist regulated by and registered as practicing with the Health Professions& Care Council and recognised by us

    Pre-existing condition

    - any disease, illness or injury for which, in the five years before you joined the trust:

    • you have received medication, advice or treatment, or

    • you have experienced symptoms whether the condition was diagnosed or not.

      • <

    Private ambulance

    - a purpose-built vehicle run by a recognised private ambulance service.

    Prosthesis

    - An artificial body part or device which is inserted during surgery

    Psychological therapist

    – we recognise the following as psychological therapists.

    • a psychologist who is:

      • Registered with the Health and Care Professions Council (HCPC);

      • Registered with the British Psychological Society (BPS) as a chartered Psychologist

    • a therapist who is:

      • An accredited member of the British Association of Counselling and Psychotherapy (BACP); or

      • An Accredited Member of the British Association for Behavioural and Cognitive Psychotherapies (BABCP); or

      • An Accredited Member of Scotland’s Professional Body for Counselling and Psychotherapy (COSCA); or

      • A practitioner who is registered with the United Kingdom Council for Psychotherapy (UKCP) under one of the following Modality Sections

    1. Behavioural & Cognitive;
    2. Psychotherapies
    3. Humanistic & Integrative
    4. Psychotherapeutic
    5. Counselling
    6. Psychoanalytic & Psychodynamic
      7. <

    Registered nurse

    - A nurse who is on the register of the Nursing and Midwifery Council (NMC) and holds a valid NMC personal identification number

    Related condition

    - Any medical condition which is reasonably considered to be related to another medical condition

    Schedule of surgical procedures

    - the current schedule/list of surgical procedures approved for benefits by our Clinical Support Team. This list will change from time to time.

    Scheme

    class="western">- your employer’s Corporate Healthcare scheme, of which you are a member.

    Specialist

    We consider a specialist to be:

    • a medical practitioner with full current registration with the General Medical Council or
    • a dentist with full current registration with the General Dental Council and
    • a specialist in the treatment you are referred for
    • has a certificate of Higher Specialist Training in their specialty that is issued by the Higher Specialist Training Committee of the appropriate Royal College or Faculty
    • is or has been a National Health Service consultant or dentist
    • has been recognised for benefit purposes as a specialist by Healix
      • <

    Start date

    - The date the trust starts as shown in the trust schedule.

    Surgical appliance

    An artificial device or an artificial body part which is a necessary part of your child’s treatment immediately after surgery - for example a knee brace after your child has had ligament surgery.

    Targeted therapy

    - drugs or other substances that block the growth and spread of cancer by interfering with specific molecules that are involved in the growth, progression and spread of cancer. Targeted cancer therapies are sometimes called "molecularly targeted drugs","molecularly targeted therapies", "precision medicines" or similar names.

    Terminal care

    (end of life care) – treatment that concentrates on controlling pain and other symptoms when the patient is near or approaching the end of life and active treatment for the causative disease is no longer considered effective or appropriate. Holistic therapy aimed to relieve or reduce the symptoms of those with advanced cancer but not to produce a cure.

    The Scheme

    class="western">– The Markerstudy Healthcare Scheme

    The Trust

    The Hammond School Young Performers Trust

    Treatment

    - Surgical or medical services (including diagnostic tests and consultations).This includes but is not limited to diagnostic tests, scans, and surgical procedures

    Treatments

    - surgical or medical services (including diagnostic tests) that are needed to diagnose, relieve or cure an acute condition.

    Trust Deed

    - The trust deed (including the rules of the trust) constituting the healthcare trust, as amended from time to time

    Trustee(s)

    - Any trustee or trustees for the time being of the healthcare trust

    Trustee, Trustees

    - Any trustee or trustees for the time being of the healthcare trust

    United Kingdom

    - England, Scotland, Wales and Northern Ireland.

    Waiting Period

    - A specified period which follows the eligible member’s original trust joining date.

    We, Us, Our

    - Healix Health Services Ltd, Healix House, Esher Green, Esher, Surrey, KT10 8AB

    Year of cover

    - The 12 month period starting on the start date or annual renewal date

    You, Your

    - Parent or guardian of an eligible child

    Health and wellbeing team

    Elmhurst Ballet Schools in-house physiotherapy, nursing and mental health team. 

    Neurodevelopmental disorders

    A group of disorders that affect the development of the nervous system, leading to altered brain function which may affect emotion, language processing, learning ability and memory.  Including but not limited to Autism spectrum disorder, ADHD and dyslexia.

    Making a claim

    Healthcare benefits

    Always contact the claims team before arranging or receiving any treatment.

    Call the claims helpline:

    0208 629 3355
    Monday-Friday 08.00-19.00 (Excl. bank holidays)
    Saturday 09.00-13.00

    We will confirm:

    • whether the proposed treatment is eligible for cover under the trust

    • whether the proposed treatment costs will be covered under the trust

    • any benefit limits or excess that may apply to the claim

    Your trust underwriting

    Medical History Disregarded (MHD)
    We will not apply any personal medical exclusions to your child's scheme. However, eligibility for cover will be subject to the general terms of the scheme. Please refer to trust exclusions and limitations for further information.

    Reasonable and customary fees

    We adhere to a schedule of reasonable and customary (R&C) fees for specialist fees. These are based on a common set of codes and principles set out by the Clinical Classification and Schedule Development (CCSD) group. Our fee levels have been set after review of what the majority of specialist’s charge for medical and surgical services as well as a review by our clinical support team and our panel of specialist advisors.

    We have an open referral network which means you can be referred to the specialist of your choice. Should you choose to be referred to a specialist who charges above our fee schedule you can opt to pay the difference or we can assist you in identifying an alternative specialist that charges within our fee schedule. For further information please refer to our fee schedule, or contact the claims team.

    Hospital cover

    The Hammond School Trust will cover authorised treatment at the majority of private & NHS hospitals throughout the UK. However some treatments and consultations listed in your child's table of benefits will only be authorised at specific facilities or with specific providers.

    Please call the The Hammond School to arrange pre-authorisation for your child's treatment on 01244 305 350.

    What happens in an emergency?

    Most private hospitals are not set up to receive emergency admissions. In the event of an emergency you should:

    • call for an NHS ambulance
    • visit the accident and emergency department at the local NHS hospital.

    If you would like your child to be transferred to a private facility, please contact us to discuss this. We will then be able to confirm whether your child's proposed treatment is eligible under the healthcare turst. Please note you must contact us before you transfer to a private facility. 

    Your child will not be covered for:

    • the cost of emergency treatment in a private walk-in centre, accident and emergency department or clinic
    • the cost of treatment in an intensive care or high dependency unit if you have been transferred specifically to receive this care
    • the costs of the transfer to a private facility specifically to receive treatment in an intensive care or high dependency unit.

    Trust exclusions and limitations

    Exclusions and limitations

    The following are conditions and treatments which are not covered under the trust. If you are unsure about anything in this section, please contact us.

    Ageing, menopause and puberty

    We do not pay for treatment to relieve symptoms commonly associated with or caused by ageing, puberty or other natural physiological cause. This includes Hormone Replacement Therapy (HRT).

    Alcohol abuse, substance abuse and addiction

    We do not pay for any treatment required for alcohol, solvent or drug abuse, or any treatment arising from such abuse or addiction, this includes mental health treatment.

    Allergies and allergic disorders

    We do not pay for treatment to desensitise or neutralise any allergic condition or disorder.

    Appliances, physical aids and devices

    We do not pay for the supply or fitting of appliances, physical aids or devices (including but not limited to hearing aids, spectacles, contact lenses, crutches, walking sticks external prostheses and orthotics etc) which do not fall within our definition of surgical appliance. Any consultations relating to these are also not covered.

    Exception: We will pay for appliances that fall under our definition or a surgical appliance.

    Artificial life maintenance (life support)

    We do not pay for artificial life maintenance (including mechanical ventilation) where such treatment will not or is not expected to result in your child's recovery or to restore your child to their previous state of health.

    Birth control, & contraception

    We do not pay for:

    • birth control
    • termination of pregnancy

    Blood and immune system conditions

    We do not pay for consultations, tests or treatment following the diagnosis of any blood immune system condition.

    Cancer

    We do not pay for any consultations, tests or treatment following the diagnosis of a malignancy.

    Cardiovascular disease

    We do not pay for any consultations, tests or treatment following the diagnosis of cardiovascular disease.

    Chronic conditions

    We do not pay for treatment of chronic conditions. By this we mean any medical condition which has at least one of the following characteristics:

    • it needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests
    • it needs ongoing or long-term control or relief of symptoms
    • it requires rehabilitation or for you to be specially trained to cope with it
    • it continues indefinitely
    • it has no known cure
    • it comes back or is likely to come back

    Please note: this will apply to all medical conditions, whether or not a diagnosis has been made.

    Exception: We will pay for eligible treatment arising out of a chronic condition, or for treatment of acute symptoms of a chronic condition that flare up. However, we will only pay if the treatment is likely to lead quickly to a complete recovery or to you being fully restored to your previous state of health, without you having to receive prolonged treatment. For example, we will pay for treatment following a heart attack arising out of chronic heart disease. This exception does not apply to a mental health condition.

    Please note: in some cases it might not be clear at the time of treatment, that the disease, illness or injury being treated is a chronic condition. We are not obliged to pay the ongoing costs of continuing, or similar, treatment. This is the case even where we have previously paid for this type of or similar treatment.

    Complications from excluded/restricted conditions or treatment

    We do not pay for treatment which arises from, or is related to any exclusion listed in the booklet or treatment which arises from or is related to a surgical procedure we do not cover.

    Congenital conditions

    We do not pay for treatment for conditions, including genetic conditions, which your child has had from birth, whether or not these were diagnosed or evident at birth.

    Contamination, wars, riots and terrorist acts

    We do not pay for treatment of any medical condition which is cause or contributed to by; nuclear, radioactive, biological or chemical contamination, war (whether declared or not), act of foreign enemy, riot, revolution, invasion, civil war, rebellion, insurrection, overthrow of a legally constituted government, explosion of war weapons, terrorist act or military activity. We will not pay for treatment of any medical condition which is received whilst you or your young dependants are carrying out army, naval or air service duties.

    Convalescence, rehabilitation and general nursing care

    We do not pay for treatment if it is primarily used for any of the following purposes:

    • convalescence or rehabilitation, (including treatment with a practitioner)
    • home nursing for domestic and/or social reasons.

    Cosmetic surgery

    We do not pay for any treatment to change your appearance even when required for psychological reasons.

    We do not pay for any treatment, including surgery:

    • where the intention of treatment, whether directly or indirectly, is the reduction or removal of health, surplus or fat tissue (for example, weight reduction surgery/treatment)
    • where the aim is to aesthetically enhance the appearance of the face or body where no functional condition is present (for example, botox, fillers or asymptomatic rhinoplasty)

    Exception: we will pay for medically necessary treatment to restore your appearance in the following circumstances:

    • where it results from an eligible underlying disease process
    • following eligible treatment
    • where the condition is causing a functional problem

    Please note: we use clinical guidance as a benchmark for deciding whether the exceptions above are eligible for cover. All requests for cover must be submitted in writing with supporting medical information.

    Dangerous or high risk activities

    We do not pay for any treatment which is directly or indirectly related to the participation of hazardous of high risk activities.

    Exception: We will pay for treatment of injuries sustained during Hammond School related activities.

    Deafness

    We do not pay for treatment for or arising from deafness caused by a congenital abnormality, maturing or ageing.

    Exception: We will pay for treatment for hearing impairment or deafness that arises as a result of an acute condition diagnosed within the previous 12 months. For example, glue ear or perforated eardrum.

    Dental or oral treatment

    We do not pay for any dental or oral treatment. Including, but not limited to:

    • fillings, extractions and treatment of gum disease
    • root canal treatment
    • consultations with dental specialists such as periodontists, orthodontists, endodontists, and hygienists
    • the provision of dental implants, or veneers, repair or replacement of damaged teeth (including crowns, bridges, dentures or any dental prostheses), or orthodontic braces (whether fixed or removable)
    • restoration of minor enamel, dentine and incisal edge fractures
    • the management of or treatment (including surgical operations) of jaw shrinkage or loss as a result of dental extractions or gum disease
    • treatment required for cosmetic reasons (for example orthognathic surgery and teeth whitening).
    • procedures to prepare for orthodontics or prosthetic surgery
    • mouth guards, gum shields, or dental appliances of any kind
    • surgical removal of a complicated, buried, infected or impacted tooth root
    • apicectomy or removal of the tip of a tooth’s root
    • enucleation of a cyst of the jaw (removing a cyst from the jaw bone)
    • surgical drainage of a fascial space (tracking) abscess

    Digestive tract conditions

    We do not pay for any consultations, tests or treatment following the diagnosis of any disorders of the Digestive Tract

    Disorders of the kidney, liver and bladder

    We do not pay for any consultations, tests or treatment following the diagnosis of any disorders of the kidney, liver or bladder.

    Drugs and dressings for outpatient or take-home use

    We do not pay for drugs and dressing provided or prescribed for use as an outpatient or for you to take home.

    Emergency treatment

    We do not pay for:

    • The cost of emergency treatment in a private walk-in centre, accident and emergency department or clinic
    • The cost of an emergency admission into a private hospital
    • The cost of treatment in an intensive care or high dependency unit if you have been transferred specifically to receive this care
    • The costs of the transfer to a private facility specifically to receive treatment in an intensive care or high dependency unit

    Experimental drugs and treatment

    We do not pay for treatments (including medication) which in our reasonable opinion are experimental or not yet approved by the National Institute for Health and Care Excellence (NICE), are being researched or lack of sufficient evidence to conclude that:

    • The harmful effects are outweighed by the beneficial ones
    • They are likely to lead to the same or better outcomes than available alternatives
    • They are based on established medical practice in the United Kingdom.

    Examples of the criteria we  use for considering an treatment as experimental include:

    • The treatment is still undergoing clinical trials and/or yet to undergo a phase III clinical trial for the indication in question
    • The treatment does not have approval from the relevant government body
    • The treatment does not conform to usual clinical practice in the view of the majority of medical practitioners in the relevant field
    • The treatment is being used in a way other than that previously studied or tat for which it had been granted approval by the relevant government body
    • The treatment is rarely used, novel, or unknown and there is a lack of authoritative evidence of safety and efficacy.

     We do not pay for any treatment required for complications arising or resulting from experimental treatment that you receive or for any subsequent treatment you may need as a result of you undergoing any experimental treatment.

    Eye conditions

    We do not pay for treatment to correct your child's sight, this includes routine eye examinations, contact lenses (including lenses following cataract surgery), spectacles or laser eye procedures.

    We do not pay for the treatment of any eye conditions. This is including but not limited to:

    • Glaucoma
    • Diabetic retinopathy
    • Occlusion therapy for squint
    • Astigmatism
    • Myopia
    • Amblyopia

    Fertility treatment

    We do not pay for:

    • Any type of infertility investigations
    • Fertility treatment
    • Assisted reproduction, surrogacy, harvesting of donor eggs or donor insemination
    • Sperm collection and storage
    • Complications from any of the above

    Gender dysphoria

    We do not pay for any treatment of gender dysphoria, or any treatment arising from or relating to gender dysphoria.

    General practitioner consultations

    We so not pay for any GP consultations or visits. We do not pay for any charges for the completion of claim forms or referral letters, unless we have requested these specifically to assess your claim.

    Holistic and alternative medicine

    We do not pay for holistic or alternative medicine or therapies, unless these are specifically listed in your table of benefits. For example yoga, massage, spas and health resorts.

    Holistic, alternative and complementary medicine

    We do not pay for:

    • any type of fertility investigations 
    • fertility treatment
    • assisted reproduction, surrogacy, harvesting of donor eggs or donor insemination 
    • sperm collection and storage
    • complications following any of the above

    Intensive care

    We do not pay for treatment received in intensive care, unless the treatment immediately follows and is required as a result of eligible pre-authorised treatment.

    Neurodevelopmental disorders

    We do not pay for the treatment (including assessment) of adult or childhood neurodevelopmental disorders.

    Overseas treatment

    We do not pay for treatment outside the United Kingdom including evacuation or repatriation.

    Pandemic and/or epidemic

    We do not pay for treatment for or arising from pandemic and/or epidemic disease.

    Personal comfort and convenience items

    We do not pay for personal comfort and convenience items or services including but not limited to travel expenses, television, WIFI, telephone costs, newspapers and guest meals.

    Pregnancy and childbirth

    We do not pay for treatment for pregnancy or childbirth, including (but not limited to):

    • Hyperemesis (excessive and prolonged nausea and vomiting)
    • Pelvic girdle pain (pelvic pain in pregnancy)
    • Diastasis recti (abdominal separation)
    • Pregnancy induced hypertension (high blood pressure in pregnancy)
    • Pre-eclampsia
    • Treatment of a foetus or embryo
    • Antenatal care
    • Termination of pregnancy
    • Any treatment arising from assisted conception
    • Any complications arising from the above condition

    Respiratory conditions

    We do not pay for any consultations, tests or treatment following the diagnosis of a respiratory condition.

    Screening and preventative treatment

    We do not pay for any form of genetic testing or screening, health screening, health checks or preventative treatment, procedures or medical services where no disease is present.

    We do not pay for treatment:

    • Recommended because of a genetic predisposition towards developing a medical condition
    • Recommended because of a family history of a medical condition

    Exception: We will pay for preventative treatment for dance related conditions as detailed in your child's table of benefits when recommended by the Hammond School Team.

    Self-inflicted illness or injury

    We do not pay for any treatment required directly or indirectly as a result of self-inflicted illness, or injury, or suicide attempt.

    Sleep disorders

    We do not pay for treatment for or arising from sleep disorders. This includes but is not limited to: sleep apnoea, snoring, insomnia, sleep walking, narcolepsy and night terrors.

    Speech disorders

    We do not pay for treatment for or relating to any speech disorder such as stammering. However we may pay for a short term speech therapy for an acute condition immediately following eligible treatment. The speech therapy must be recommended by the specialist in charge of your treatment.

    Transplants

    We do not pay for any transplants, adoptive cell transfer therapies, gene therapy and/or complications related to, or resulting from these treatments. This includes, but is not limited to CAR T cell therapy, tumour infiltrating lymphocyte therapy and stem cell/bone marrow treatments.

    We also do not pay for:

    • Donor costs
    • Harvesting
    • Storage
    • Administration
    • And/or any complications/treatment arising from any of the above

    Exception: We will pay for recipient costs for skin or corneal grafts when eligible for treatment.

    Unrecognised providers

    We do not pay for treatment carried out by a provider who we do not recognise as being qualified and/or registered to provide the type of treatment you need or for treating the medical condition you have.

    We do not pay for treatment with sports therapists, massage therapists, or anyone who does not meet our definition of a specialist.

    Section 9: Glossary

    The words and phrases below have the following meanings. They will appear in bold in this guide.

    Active treatment

    - Treatment of an acute medical condition that leads to recovery or restoration of a previous state of health

    Acute condition

    - A disease, illness or injury which responds quickly to treatment that aims to return your child to the state of health they were in immediately before suffering the disease, illness or injury, or which leads them to recovering fully. We would consider that an acute condition would resolve within three months or less

    Annual renewal date

    - The anniversary of the start date each year or any other date which we and Elmhurst Ballet School may agree to in writing

    Artificial life maintenance

    - Any medical procedure, technique, medication or intervention delivered to a patient in order, to maintain life after the failure of one or more vital organs

    Benefit

    - Any payment we make shown in the list of benefits.

    Benefits

    - The benefits for which your child is entitled as an individual under the trust subject to the terms and conditions that apply to the membership including all exclusions

    Cancer

    - A malignant tumour, tissues or cells, characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue

    Chronic condition

    - a disease, illness or injury which has at least one of the following characteristics:

    • it needs ongoing or long term monitoring through consultations, examinations, check-ups and/or tests
    • it needs ongoing or long term control or relief of symptoms
    • it continues indefinitely
    • it comes back or is likely to come back
    • your child need to be rehabilitated or specially trained to cope with it
    • it has no known cure.

    Please note: this will apply to all medical conditions, whether or not a diagnosis has been made. As we expect an acute condition to resolve completely within three months, we would begin to consider any condition lasting longer than this as chronic.

    Complementary practitioner

    - a practitioner who specialises in acupuncture who is registered under the relevant Act; and who, in all cases, meets our criteria for complementary practitioner recognition for benefit purposes in their field of practice:

    • Acupuncture practitioners must be registered with the BMAS (British Medical Acupuncture Society), BacC (British Acupuncture Council), AACP (Acupuncture Association of Chartered Physiotherapists) or AAC (The Association of Acupuncture Clinicians)
      • <

    Curative intent

    - treatment that is administered with a reasonable expectation both that it will restore the patient close to the state of health enjoyed prior to the disease being diagnosed, and expect the patient to be disease free 5 years after commencement of the treatment.

    Daycase

    - If your child is required to occupy a hospital bed for one day, for medical reasons

    Daycase treatment

    - Treatment for which your child is required to occupy a hospital bed for one day, for medical reasons

    Dependant

    - a member's partner (if a member gets divorced their husband or wife will no longer be considered as a dependant for the purposes of this plan).

    - a member's unmarried dependant children if aged 25 or under when they first join the scheme. We will also accept them if they are aged 26 or over providing the main member is switching their cover to us on a CPME basis and that child is currently included on their parent's cover.

    This should be evidenced by the current membership certificate. The dependant children must be living full-time at the same address as the main member, unless they are in full-time education.

    Dependants

    - a member's partner (if a member gets divorced their husband or wife will no longer be considered as a dependant for the purposes of this plan).

    - a member's unmarried dependant children if aged 25 or under when they first join the plan. We will also accept them if they are aged 26 or over providing the main member is switching their cover to us on a CPME basis and that child is currently included on their parent's cover.

    This should be evidenced by the current membership certificate. The dependant children must be living full-time at the same address as the main member, unless they are in full-time education.

    Detoxification

    - Treatment for withdrawal symptoms after your child has been abusing drugs or alcohol or both

    Diagnostic tests

    - investigations such as x-rays or blood tests required by your GP, or specialist, to find the cause of your symptoms. For the purpose of this policy, diagnostic tests are considered treatment.

    Dialysis

    >
  • Haemodialysis dialysis – the removal of waste matter from your child's blood by passing it through a kidney machine or dialyser
  • Peritoneal dialysis – the removal of waste matter from your child's blood by introducing fluid into your abdomen which acts as a filter
    • <

    Emergency

    - A serious medical condition or symptoms resulting from a disease, illness or injury which arises suddenly and requires immediate treatment, generally within hours of onset, and which would otherwise put your child’s health at risk

    Employer

    align="LEFT">-Markerstudy who is named as your employer.

    General Practitioner

    - A registered medical practitioner in general practice

    GP

    - A registered medical practitioner in general practice

    High dependency unit

    - Special department within a hospital designed for patients who require advanced post-operative care and/or support for a single failing organ system

    Home nursing

    - Visits from a registered nurse to your home to give your child expert/skilled nursing services immediately following eligible inpatient treatment in hospital under the control of a specialist

    Hospital

    >
  • NHS hospital - a National Health Service hospital with facilities for medical and surgical treatment, as defined in Section 1.28 of the National Health Service Act 1977 or in any future law
  • Private hospital - an independent hospital which can provide acute medical, surgical or mental health care. It must be registered under The Registered Homes Act (1984) and approved by the Healthcare Commission or any future law. It may also include a private bed in an NHS hospital
    • <

    Inpatient

    - If your child is required to occupy a hospital bed for one night or more, for medical reasons

    Inpatient treatment

    - Treatment for which your child is required to occupy a hospital bed for one night or more, for medical reasons

    Intensive care unit

    - A specialised department within a hospital designed for patients support for two or more organ systems and advanced respiratory support

    Medical condition

    - Any physical, mental or psychological disorder, including disease, illness, injury, genetic disorders and behavioural conditions

    Medical Necessity

    – treatment that is considered to be:

    • In accordance with professional standards of medical practice in the United Kingdom

    • Clinically appropriate, in terms of type, frequency, extent, site and duration of treatment

    • Required for reasons other than the comfort or convenience of the patient or specialist.

    • Provided at an appropriate facility, in an appropriate setting and at an appropriate level of care for the treatment of the patient’s medical condition.

    • Provided only for an appropriate duration of time.

    • no more costly than an alternative treatment at least as likely to produce the same therapeutic or diagnostic results.

    Please note, the trust is designed to treat acute medical conditions. It is not designed to cover all eventualities and therefore there will be some conditions which, whilst considered medically necessary, may not be eligible for cover.

    Medically necessary

    - Treatment that is considered to be:

    • In accordance with professional standards of medical practice in the United Kingdom
    • Clinically appropriate, in terms of type, frequency, extent, site and duration of treatment
    • Required for reasons other than the comfort or convenience of the patient or specialist.
    • Provided at an appropriate facility, in an appropriate setting and at an appropriate level of care for the treatment of the patient’s medical condition.
    • Provided only for an appropriate duration of time.
    • No more costly than an alternative treatment at least as likely to produce the same therapeutic or diagnostic results.

    Please note, the trust is designed to treat acute medical conditions. It is not designed to cover all eventualities and therefore there will be some conditions which, whilst considered medically necessary, may not be eligible for cover.

    Member

    - A current student of Hammond School

    Member (1)

    A current student of Hammond School.

    Mental health condition

    - A disorder that affects the mind, mental function, emotions or behaviour whether the cause is organic, traumatic or reactive

    Oro-surgical procedure

    - operations described in the schedule of surgical procedures (for example, removing an impacted or buried tooth by surgery).

    Outpatient

    - Where your child does not require a hospital bed for their treatment or consultation

    Outpatient treatment

    - Treatment for which your child does not require a hospital bed

    Palliative cancer treatment

    - cancer treatment, the primary effect of which is to alleviate symptoms rather than to achieve remission, cure or reduction in tumour size.

    Partner

    - a member’s husband or wife, or the person the member lives with in a relationship similar to that of husband or wife, whether the same sex or not.

    Physiotherapist

    - A physiotherapist regulated by and registered as practicing with the Health Professions& Care Council and recognised by us

    Pre-existing condition

    - any disease, illness or injury for which, in the five years before you joined the trust:

    • you have received medication, advice or treatment, or

    • you have experienced symptoms whether the condition was diagnosed or not.

      • <

    Private ambulance

    - a purpose-built vehicle run by a recognised private ambulance service.

    Prosthesis

    - An artificial body part or device which is inserted during surgery

    Psychological therapist

    – we recognise the following as psychological therapists.

    • a psychologist who is:

      • Registered with the Health and Care Professions Council (HCPC);

      • Registered with the British Psychological Society (BPS) as a chartered Psychologist

    • a therapist who is:

      • An accredited member of the British Association of Counselling and Psychotherapy (BACP); or

      • An Accredited Member of the British Association for Behavioural and Cognitive Psychotherapies (BABCP); or

      • An Accredited Member of Scotland’s Professional Body for Counselling and Psychotherapy (COSCA); or

      • A practitioner who is registered with the United Kingdom Council for Psychotherapy (UKCP) under one of the following Modality Sections

    1. Behavioural & Cognitive;
    2. Psychotherapies
    3. Humanistic & Integrative
    4. Psychotherapeutic
    5. Counselling
    6. Psychoanalytic & Psychodynamic
      7. <

    Registered nurse

    - A nurse who is on the register of the Nursing and Midwifery Council (NMC) and holds a valid NMC personal identification number

    Related condition

    - Any medical condition which is reasonably considered to be related to another medical condition

    Schedule of surgical procedures

    - the current schedule/list of surgical procedures approved for benefits by our Clinical Support Team. This list will change from time to time.

    Scheme

    class="western">- your employer’s Corporate Healthcare scheme, of which you are a member.

    Specialist

    We consider a specialist to be:

    • a medical practitioner with full current registration with the General Medical Council or
    • a dentist with full current registration with the General Dental Council and
    • a specialist in the treatment you are referred for
    • has a certificate of Higher Specialist Training in their specialty that is issued by the Higher Specialist Training Committee of the appropriate Royal College or Faculty
    • is or has been a National Health Service consultant or dentist
    • has been recognised for benefit purposes as a specialist by Healix
      • <

    Start date

    - The date the trust starts as shown in the trust schedule.

    Surgical appliance

    An artificial device or an artificial body part which is a necessary part of your child’s treatment immediately after surgery - for example a knee brace after your child has had ligament surgery.

    Targeted therapy

    - drugs or other substances that block the growth and spread of cancer by interfering with specific molecules that are involved in the growth, progression and spread of cancer. Targeted cancer therapies are sometimes called "molecularly targeted drugs","molecularly targeted therapies", "precision medicines" or similar names.

    Terminal care

    (end of life care) – treatment that concentrates on controlling pain and other symptoms when the patient is near or approaching the end of life and active treatment for the causative disease is no longer considered effective or appropriate. Holistic therapy aimed to relieve or reduce the symptoms of those with advanced cancer but not to produce a cure.

    The Scheme

    class="western">– The Markerstudy Healthcare Scheme

    The Trust

    The Hammond School Young Performers Trust

    Treatment

    - Surgical or medical services (including diagnostic tests and consultations).This includes but is not limited to diagnostic tests, scans, and surgical procedures

    Treatments

    - surgical or medical services (including diagnostic tests) that are needed to diagnose, relieve or cure an acute condition.

    Trust Deed

    - The trust deed (including the rules of the trust) constituting the healthcare trust, as amended from time to time

    Trustee(s)

    - Any trustee or trustees for the time being of the healthcare trust

    Trustee, Trustees

    - Any trustee or trustees for the time being of the healthcare trust

    United Kingdom

    - England, Scotland, Wales and Northern Ireland.

    Waiting Period

    - A specified period which follows the eligible member’s original trust joining date.

    We, Us, Our

    - Healix Health Services Ltd, Healix House, Esher Green, Esher, Surrey, KT10 8AB

    Year of cover

    - The 12 month period starting on the start date or annual renewal date

    You, Your

    - Parent or guardian of an eligible child

    Health and wellbeing team

    Elmhurst Ballet Schools in-house physiotherapy, nursing and mental health team. 

    Neurodevelopmental disorders

    A group of disorders that affect the development of the nervous system, leading to altered brain function which may affect emotion, language processing, learning ability and memory.  Including but not limited to Autism spectrum disorder, ADHD and dyslexia.

    End of cover

    We will stop cover for your child (the member) in the following situations:

    • if your child's attendance at Hammond School has come to an end for any reason
    • if for any reason you or Hammond School ask us to end cover.
    • if you have given us misleading information, have kept something from us, or have broken the conditions of this trust

    How to make a complaint

    It is always our intention to provide a first class standard of service: however, we recognise that on occasions, your requirements may not have been met.

    Should you have any cause for complaint, you should call the claims helpline or email thehammond@healix.com


    How your complaint will be handled

    Stage 1

    You will receive a written acknowledgement of your complaint within five business days of receipt. This will include the name and job title of the individual handling the complaint.


    Stage 2

    Within four weeks of receiving your complaint, you will receive either:

    • A final response or

    • A holding response, explaining why we are not yet in a position to resolve the complaint and indicating when we will be making further contact (this will be within eight weeks from receiving the complaint).

    Stage 3

    If you have not received a final response within four weeks, by the end of eight weeks after receipt of the complaint, you will receive either:

    • A final response.

    • A response explaining why we are still not in a position to provide a final response and explaining when we believe we will be able to do so.

    • If we are unable to provide a final response, due to the delay which has now occurred, you may refer your complaint to the Trustees.

    If, during stage 2 or 3, we issue our final response but you remain dissatisfied, you may refer your complaint to the Trustees. To do this, please set out your reasons fully in writing to the Operations Director, asking for referral to the trustees for further consideration.

    How to claim reimbursement

    How to claim for cash benefits

    If you have received eligible treatment free of charge on the NHS your child may be eligible to receive reimbursement of cash benefits as detailed in your child's table of benefits.

    These benefits will only be eligible if the treatment received would otherwise have been eligible for benefit under your child's scheme.

    Please note; only one cash benefit reimbursement can be claimed per admission.

    In order to claim these benefits you can register your child's claim via email on thehammond@healix.com 

    You will need to provide the following information for a claim to be processed:

    • a copy of the NHS discharge paperwork which should confirm the following information:
      • Date of admission and discharge from the NHS hospital
      • Name and date of birth of the person admitted to hospital
      • Summary of the reason for admission and the treatment received
    • Bank details for the reimbursement to be made to
      • Account holder’s name
      • Sort code
      • Account number

     

    How to claim reimbursement of medical expenses

    If you have paid a provider directly for eligible medical services received by your child, you can claim a reimbursement of these costs as long as the treatment received is eligible for cover as detailed in your child's table of benefits.

    In order to claim these benefits you can register your child's claim via email on thehammond@healix.com 

    You will need to provide the following information for a claim to be processed:

    • An itemised receipt confirming the following information:
      • Date treatment was received
      • Details of the treatment received
      • Amount paid for the treatment
    • Bank details for the reimbursement to be made to
      • Account holder’s name
      • Sort code
      • Account number

     

    Please note: 

    Once the claim has been confirmed as eligible by the claims team, reimbursement will be arranged via direct bank transfer.

    All reimbursement claims (including cash benefit claims) must be submitted within six months of your treatment date or within six months of the end of the scheme year you wish to claim against - whichever comes soonest.

    Additional information can be found in the payment of invoices page.

    Payment of invoices

    All treatment should be authorised in advance, so that we can place a guarantee of payment with your child's healthcare provider, subject to your benefit limits and our reasonable and customary guidelines. If you have pre-authorised your treatment, we will settle the bill (up to applicable limits) directly with your child's specialist, therapist or hospital. You are responsible for making sure we have all the information we need to pay your claims. 

    In some circumstances it may be necessary for you to pay for pre-authorised treatment yourself, and request a reimbursement from us for the cost of the treatment. In these cases please send us a copy of your receipt via email, along with your bank account details, and we will arrange reimbursement via bank transfer. All reimbursement claims (including cash benefit claims) must be submitted within six months of your treatment date or within six months of the end of the scheme year you wish to claim against - whichever comes soonest. Any claims submitted after this, will be assessed on a case by case basis, and paid at our discretion.

    We will not pay for claims:

    • if the invoice or reimbursement claim (including cash benefits) is submitted 6 months or more after the treatment date /within six months of the end of the scheme year you wish to claim against - whichever comes soonest.
    • if the treatment takes place after your child has left the trust
    • if you break any terms and conditions of the trust
    • if you incur a fee for non-attendance or late cancellations.

    Requests for additional information

    We may ask you to provide information to help us assess your child's claim. For example we may ask you for one or more of the following:

    • Medical reports and other information about the treatment for which your child is claiming. If we request a medical report from your child’s specialist and they charge for providing this we will pay the cost.
    • Original accounts and invoices in connection with the claim.
    • Results of an independent medical examination or second opinion we may ask your child to undergo with a specialist. We will pay for the cost of any independent medical examination or second opinion we require your child to have and we will authorise this in writing, in advance.
    • Results of any second opinion you have independently sought for your child, to obtain eligible treatment under the care of another specialist. On such occasions we may additionally request our own, independent, second opinion from an expert in that field to assess eligibility of cover. We will pay the costs of any second opinion we organise on your behalf, this includes the cost of the consultation and any tests undertaken as a result of that consultation.

    We will liaise with you and your child's medical specialists throughout their treatment and will request medical information, when we deem that this is required for the assessment of the claim. You will be asked for your consent before we do this.

    As your child undergoes treatment, we will make you aware of the options that are open to you. If your child's medical specialist recommends treatment, you should contact the helpline as soon as possible to be sure that continued treatment is covered.

    Our team of nurses will assess the level of cover available to your child for planned treatment within the terms and conditions of the trust. In some instances it may be necessary to refer the claim to our Clinical Support Team, along with our panel of independent specialist advisors, will advise on the level of cover available for (said) recommended treatment.

    Duplicate cover

    You must tell us if you are able to make a claim for the cost of any of your child's treatment from anyone else either under another healthcare scheme or under an insurance policy. For example, if your child received an injury that was caused by someone else such as a road traffic accident in which your child is a victim, the trust will only pay a share of the total costs as appropriate.

    If benefits are claimed for treatment to your child when the injury or medical condition was caused by a third party, the trust shall, at its own expense, have the right to pursue such claims in any way considered appropriate in your child's name. You must co-operate with all reasonable requests in this respect and advise us of any amount you recover directly from the third party.

    Healix privacy notice

    If you would like to know more about how Healix store and process your personal data, please find our Privacy Notice by clicking here.

    Section 9: Glossary

    The words and phrases below have the following meanings. They will appear in bold in this guide.

    Active treatment

    - Treatment of an acute medical condition that leads to recovery or restoration of a previous state of health

    Acute condition

    - A disease, illness or injury which responds quickly to treatment that aims to return your child to the state of health they were in immediately before suffering the disease, illness or injury, or which leads them to recovering fully. We would consider that an acute condition would resolve within three months or less

    Annual renewal date

    - The anniversary of the start date each year or any other date which we and Elmhurst Ballet School may agree to in writing

    Artificial life maintenance

    - Any medical procedure, technique, medication or intervention delivered to a patient in order, to maintain life after the failure of one or more vital organs

    Benefit

    - Any payment we make shown in the list of benefits.

    Benefits

    - The benefits for which your child is entitled as an individual under the trust subject to the terms and conditions that apply to the membership including all exclusions

    Cancer

    - A malignant tumour, tissues or cells, characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue

    Chronic condition

    - a disease, illness or injury which has at least one of the following characteristics:

    • it needs ongoing or long term monitoring through consultations, examinations, check-ups and/or tests
    • it needs ongoing or long term control or relief of symptoms
    • it continues indefinitely
    • it comes back or is likely to come back
    • your child need to be rehabilitated or specially trained to cope with it
    • it has no known cure.

    Please note: this will apply to all medical conditions, whether or not a diagnosis has been made. As we expect an acute condition to resolve completely within three months, we would begin to consider any condition lasting longer than this as chronic.

    Complementary practitioner

    - a practitioner who specialises in acupuncture who is registered under the relevant Act; and who, in all cases, meets our criteria for complementary practitioner recognition for benefit purposes in their field of practice:

    • Acupuncture practitioners must be registered with the BMAS (British Medical Acupuncture Society), BacC (British Acupuncture Council), AACP (Acupuncture Association of Chartered Physiotherapists) or AAC (The Association of Acupuncture Clinicians)
      • <

    Curative intent

    - treatment that is administered with a reasonable expectation both that it will restore the patient close to the state of health enjoyed prior to the disease being diagnosed, and expect the patient to be disease free 5 years after commencement of the treatment.

    Daycase

    - If your child is required to occupy a hospital bed for one day, for medical reasons

    Daycase treatment

    - Treatment for which your child is required to occupy a hospital bed for one day, for medical reasons

    Dependant

    - a member's partner (if a member gets divorced their husband or wife will no longer be considered as a dependant for the purposes of this plan).

    - a member's unmarried dependant children if aged 25 or under when they first join the scheme. We will also accept them if they are aged 26 or over providing the main member is switching their cover to us on a CPME basis and that child is currently included on their parent's cover.

    This should be evidenced by the current membership certificate. The dependant children must be living full-time at the same address as the main member, unless they are in full-time education.

    Dependants

    - a member's partner (if a member gets divorced their husband or wife will no longer be considered as a dependant for the purposes of this plan).

    - a member's unmarried dependant children if aged 25 or under when they first join the plan. We will also accept them if they are aged 26 or over providing the main member is switching their cover to us on a CPME basis and that child is currently included on their parent's cover.

    This should be evidenced by the current membership certificate. The dependant children must be living full-time at the same address as the main member, unless they are in full-time education.

    Detoxification

    - Treatment for withdrawal symptoms after your child has been abusing drugs or alcohol or both

    Diagnostic tests

    - investigations such as x-rays or blood tests required by your GP, or specialist, to find the cause of your symptoms. For the purpose of this policy, diagnostic tests are considered treatment.

    Dialysis

    >
  • Haemodialysis dialysis – the removal of waste matter from your child's blood by passing it through a kidney machine or dialyser
  • Peritoneal dialysis – the removal of waste matter from your child's blood by introducing fluid into your abdomen which acts as a filter
    • <

    Emergency

    - A serious medical condition or symptoms resulting from a disease, illness or injury which arises suddenly and requires immediate treatment, generally within hours of onset, and which would otherwise put your child’s health at risk

    Employer

    align="LEFT">-Markerstudy who is named as your employer.

    General Practitioner

    - A registered medical practitioner in general practice

    GP

    - A registered medical practitioner in general practice

    High dependency unit

    - Special department within a hospital designed for patients who require advanced post-operative care and/or support for a single failing organ system

    Home nursing

    - Visits from a registered nurse to your home to give your child expert/skilled nursing services immediately following eligible inpatient treatment in hospital under the control of a specialist

    Hospital

    >
  • NHS hospital - a National Health Service hospital with facilities for medical and surgical treatment, as defined in Section 1.28 of the National Health Service Act 1977 or in any future law
  • Private hospital - an independent hospital which can provide acute medical, surgical or mental health care. It must be registered under The Registered Homes Act (1984) and approved by the Healthcare Commission or any future law. It may also include a private bed in an NHS hospital
    • <

    Inpatient

    - If your child is required to occupy a hospital bed for one night or more, for medical reasons

    Inpatient treatment

    - Treatment for which your child is required to occupy a hospital bed for one night or more, for medical reasons

    Intensive care unit

    - A specialised department within a hospital designed for patients support for two or more organ systems and advanced respiratory support

    Medical condition

    - Any physical, mental or psychological disorder, including disease, illness, injury, genetic disorders and behavioural conditions

    Medical Necessity

    – treatment that is considered to be:

    • In accordance with professional standards of medical practice in the United Kingdom

    • Clinically appropriate, in terms of type, frequency, extent, site and duration of treatment

    • Required for reasons other than the comfort or convenience of the patient or specialist.

    • Provided at an appropriate facility, in an appropriate setting and at an appropriate level of care for the treatment of the patient’s medical condition.

    • Provided only for an appropriate duration of time.

    • no more costly than an alternative treatment at least as likely to produce the same therapeutic or diagnostic results.

    Please note, the trust is designed to treat acute medical conditions. It is not designed to cover all eventualities and therefore there will be some conditions which, whilst considered medically necessary, may not be eligible for cover.

    Medically necessary

    - Treatment that is considered to be:

    • In accordance with professional standards of medical practice in the United Kingdom
    • Clinically appropriate, in terms of type, frequency, extent, site and duration of treatment
    • Required for reasons other than the comfort or convenience of the patient or specialist.
    • Provided at an appropriate facility, in an appropriate setting and at an appropriate level of care for the treatment of the patient’s medical condition.
    • Provided only for an appropriate duration of time.
    • No more costly than an alternative treatment at least as likely to produce the same therapeutic or diagnostic results.

    Please note, the trust is designed to treat acute medical conditions. It is not designed to cover all eventualities and therefore there will be some conditions which, whilst considered medically necessary, may not be eligible for cover.

    Member

    - A current student of Hammond School

    Member (1)

    A current student of Hammond School.

    Mental health condition

    - A disorder that affects the mind, mental function, emotions or behaviour whether the cause is organic, traumatic or reactive

    Oro-surgical procedure

    - operations described in the schedule of surgical procedures (for example, removing an impacted or buried tooth by surgery).

    Outpatient

    - Where your child does not require a hospital bed for their treatment or consultation

    Outpatient treatment

    - Treatment for which your child does not require a hospital bed

    Palliative cancer treatment

    - cancer treatment, the primary effect of which is to alleviate symptoms rather than to achieve remission, cure or reduction in tumour size.

    Partner

    - a member’s husband or wife, or the person the member lives with in a relationship similar to that of husband or wife, whether the same sex or not.

    Physiotherapist

    - A physiotherapist regulated by and registered as practicing with the Health Professions& Care Council and recognised by us

    Pre-existing condition

    - any disease, illness or injury for which, in the five years before you joined the trust:

    • you have received medication, advice or treatment, or

    • you have experienced symptoms whether the condition was diagnosed or not.

      • <

    Private ambulance

    - a purpose-built vehicle run by a recognised private ambulance service.

    Prosthesis

    - An artificial body part or device which is inserted during surgery

    Psychological therapist

    – we recognise the following as psychological therapists.

    • a psychologist who is:

      • Registered with the Health and Care Professions Council (HCPC);

      • Registered with the British Psychological Society (BPS) as a chartered Psychologist

    • a therapist who is:

      • An accredited member of the British Association of Counselling and Psychotherapy (BACP); or

      • An Accredited Member of the British Association for Behavioural and Cognitive Psychotherapies (BABCP); or

      • An Accredited Member of Scotland’s Professional Body for Counselling and Psychotherapy (COSCA); or

      • A practitioner who is registered with the United Kingdom Council for Psychotherapy (UKCP) under one of the following Modality Sections

    1. Behavioural & Cognitive;
    2. Psychotherapies
    3. Humanistic & Integrative
    4. Psychotherapeutic
    5. Counselling
    6. Psychoanalytic & Psychodynamic
      7. <

    Registered nurse

    - A nurse who is on the register of the Nursing and Midwifery Council (NMC) and holds a valid NMC personal identification number

    Related condition

    - Any medical condition which is reasonably considered to be related to another medical condition

    Schedule of surgical procedures

    - the current schedule/list of surgical procedures approved for benefits by our Clinical Support Team. This list will change from time to time.

    Scheme

    class="western">- your employer’s Corporate Healthcare scheme, of which you are a member.

    Specialist

    We consider a specialist to be:

    • a medical practitioner with full current registration with the General Medical Council or
    • a dentist with full current registration with the General Dental Council and
    • a specialist in the treatment you are referred for
    • has a certificate of Higher Specialist Training in their specialty that is issued by the Higher Specialist Training Committee of the appropriate Royal College or Faculty
    • is or has been a National Health Service consultant or dentist
    • has been recognised for benefit purposes as a specialist by Healix
      • <

    Start date

    - The date the trust starts as shown in the trust schedule.

    Surgical appliance

    An artificial device or an artificial body part which is a necessary part of your child’s treatment immediately after surgery - for example a knee brace after your child has had ligament surgery.

    Targeted therapy

    - drugs or other substances that block the growth and spread of cancer by interfering with specific molecules that are involved in the growth, progression and spread of cancer. Targeted cancer therapies are sometimes called "molecularly targeted drugs","molecularly targeted therapies", "precision medicines" or similar names.

    Terminal care

    (end of life care) – treatment that concentrates on controlling pain and other symptoms when the patient is near or approaching the end of life and active treatment for the causative disease is no longer considered effective or appropriate. Holistic therapy aimed to relieve or reduce the symptoms of those with advanced cancer but not to produce a cure.

    The Scheme

    class="western">– The Markerstudy Healthcare Scheme

    The Trust

    The Hammond School Young Performers Trust

    Treatment

    - Surgical or medical services (including diagnostic tests and consultations).This includes but is not limited to diagnostic tests, scans, and surgical procedures

    Treatments

    - surgical or medical services (including diagnostic tests) that are needed to diagnose, relieve or cure an acute condition.

    Trust Deed

    - The trust deed (including the rules of the trust) constituting the healthcare trust, as amended from time to time

    Trustee(s)

    - Any trustee or trustees for the time being of the healthcare trust

    Trustee, Trustees

    - Any trustee or trustees for the time being of the healthcare trust

    United Kingdom

    - England, Scotland, Wales and Northern Ireland.

    Waiting Period

    - A specified period which follows the eligible member’s original trust joining date.

    We, Us, Our

    - Healix Health Services Ltd, Healix House, Esher Green, Esher, Surrey, KT10 8AB

    Year of cover

    - The 12 month period starting on the start date or annual renewal date

    You, Your

    - Parent or guardian of an eligible child

    Health and wellbeing team

    Elmhurst Ballet Schools in-house physiotherapy, nursing and mental health team. 

    Neurodevelopmental disorders

    A group of disorders that affect the development of the nervous system, leading to altered brain function which may affect emotion, language processing, learning ability and memory.  Including but not limited to Autism spectrum disorder, ADHD and dyslexia.

    The Healix Team

    Contact us

    We have a team of claims assessors available to advise and help you, who can be contacted on the helpline number below:

    Tel: 0208 629 3355
    Email: thehammond@healix.com
    Monday-Friday 08.00-19.00 (Excl. bank holidays)
    Saturday 09.00-13.00

    Telephone calls to and from our organisation are recorded for the purposes of quality and training.

    Any correspondence, including claims, should be sent to the following address:

    The Hammond School Young Performers Trust
    Claims Administration Department
    Healix House,
    Esher Green
    Esher,
    Surrey.
    KT10 8AB

    Section 9: Glossary

    The words and phrases below have the following meanings. They will appear in bold in this guide.

    Active treatment

    - Treatment of an acute medical condition that leads to recovery or restoration of a previous state of health

    Acute condition

    - A disease, illness or injury which responds quickly to treatment that aims to return your child to the state of health they were in immediately before suffering the disease, illness or injury, or which leads them to recovering fully. We would consider that an acute condition would resolve within three months or less

    Annual renewal date

    - The anniversary of the start date each year or any other date which we and Elmhurst Ballet School may agree to in writing

    Artificial life maintenance

    - Any medical procedure, technique, medication or intervention delivered to a patient in order, to maintain life after the failure of one or more vital organs

    Benefit

    - Any payment we make shown in the list of benefits.

    Benefits

    - The benefits for which your child is entitled as an individual under the trust subject to the terms and conditions that apply to the membership including all exclusions

    Cancer

    - A malignant tumour, tissues or cells, characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue

    Chronic condition

    - a disease, illness or injury which has at least one of the following characteristics:

    • it needs ongoing or long term monitoring through consultations, examinations, check-ups and/or tests
    • it needs ongoing or long term control or relief of symptoms
    • it continues indefinitely
    • it comes back or is likely to come back
    • your child need to be rehabilitated or specially trained to cope with it
    • it has no known cure.

    Please note: this will apply to all medical conditions, whether or not a diagnosis has been made. As we expect an acute condition to resolve completely within three months, we would begin to consider any condition lasting longer than this as chronic.

    Complementary practitioner

    - a practitioner who specialises in acupuncture who is registered under the relevant Act; and who, in all cases, meets our criteria for complementary practitioner recognition for benefit purposes in their field of practice:

    • Acupuncture practitioners must be registered with the BMAS (British Medical Acupuncture Society), BacC (British Acupuncture Council), AACP (Acupuncture Association of Chartered Physiotherapists) or AAC (The Association of Acupuncture Clinicians)
      • <

    Curative intent

    - treatment that is administered with a reasonable expectation both that it will restore the patient close to the state of health enjoyed prior to the disease being diagnosed, and expect the patient to be disease free 5 years after commencement of the treatment.

    Daycase

    - If your child is required to occupy a hospital bed for one day, for medical reasons

    Daycase treatment

    - Treatment for which your child is required to occupy a hospital bed for one day, for medical reasons

    Dependant

    - a member's partner (if a member gets divorced their husband or wife will no longer be considered as a dependant for the purposes of this plan).

    - a member's unmarried dependant children if aged 25 or under when they first join the scheme. We will also accept them if they are aged 26 or over providing the main member is switching their cover to us on a CPME basis and that child is currently included on their parent's cover.

    This should be evidenced by the current membership certificate. The dependant children must be living full-time at the same address as the main member, unless they are in full-time education.

    Dependants

    - a member's partner (if a member gets divorced their husband or wife will no longer be considered as a dependant for the purposes of this plan).

    - a member's unmarried dependant children if aged 25 or under when they first join the plan. We will also accept them if they are aged 26 or over providing the main member is switching their cover to us on a CPME basis and that child is currently included on their parent's cover.

    This should be evidenced by the current membership certificate. The dependant children must be living full-time at the same address as the main member, unless they are in full-time education.

    Detoxification

    - Treatment for withdrawal symptoms after your child has been abusing drugs or alcohol or both

    Diagnostic tests

    - investigations such as x-rays or blood tests required by your GP, or specialist, to find the cause of your symptoms. For the purpose of this policy, diagnostic tests are considered treatment.

    Dialysis

    >
  • Haemodialysis dialysis – the removal of waste matter from your child's blood by passing it through a kidney machine or dialyser
  • Peritoneal dialysis – the removal of waste matter from your child's blood by introducing fluid into your abdomen which acts as a filter
    • <

    Emergency

    - A serious medical condition or symptoms resulting from a disease, illness or injury which arises suddenly and requires immediate treatment, generally within hours of onset, and which would otherwise put your child’s health at risk

    Employer

    align="LEFT">-Markerstudy who is named as your employer.

    General Practitioner

    - A registered medical practitioner in general practice

    GP

    - A registered medical practitioner in general practice

    High dependency unit

    - Special department within a hospital designed for patients who require advanced post-operative care and/or support for a single failing organ system

    Home nursing

    - Visits from a registered nurse to your home to give your child expert/skilled nursing services immediately following eligible inpatient treatment in hospital under the control of a specialist

    Hospital

    >
  • NHS hospital - a National Health Service hospital with facilities for medical and surgical treatment, as defined in Section 1.28 of the National Health Service Act 1977 or in any future law
  • Private hospital - an independent hospital which can provide acute medical, surgical or mental health care. It must be registered under The Registered Homes Act (1984) and approved by the Healthcare Commission or any future law. It may also include a private bed in an NHS hospital
    • <

    Inpatient

    - If your child is required to occupy a hospital bed for one night or more, for medical reasons

    Inpatient treatment

    - Treatment for which your child is required to occupy a hospital bed for one night or more, for medical reasons

    Intensive care unit

    - A specialised department within a hospital designed for patients support for two or more organ systems and advanced respiratory support

    Medical condition

    - Any physical, mental or psychological disorder, including disease, illness, injury, genetic disorders and behavioural conditions

    Medical Necessity

    – treatment that is considered to be:

    • In accordance with professional standards of medical practice in the United Kingdom

    • Clinically appropriate, in terms of type, frequency, extent, site and duration of treatment

    • Required for reasons other than the comfort or convenience of the patient or specialist.

    • Provided at an appropriate facility, in an appropriate setting and at an appropriate level of care for the treatment of the patient’s medical condition.

    • Provided only for an appropriate duration of time.

    • no more costly than an alternative treatment at least as likely to produce the same therapeutic or diagnostic results.

    Please note, the trust is designed to treat acute medical conditions. It is not designed to cover all eventualities and therefore there will be some conditions which, whilst considered medically necessary, may not be eligible for cover.

    Medically necessary

    - Treatment that is considered to be:

    • In accordance with professional standards of medical practice in the United Kingdom
    • Clinically appropriate, in terms of type, frequency, extent, site and duration of treatment
    • Required for reasons other than the comfort or convenience of the patient or specialist.
    • Provided at an appropriate facility, in an appropriate setting and at an appropriate level of care for the treatment of the patient’s medical condition.
    • Provided only for an appropriate duration of time.
    • No more costly than an alternative treatment at least as likely to produce the same therapeutic or diagnostic results.

    Please note, the trust is designed to treat acute medical conditions. It is not designed to cover all eventualities and therefore there will be some conditions which, whilst considered medically necessary, may not be eligible for cover.

    Member

    - A current student of Hammond School

    Member (1)

    A current student of Hammond School.

    Mental health condition

    - A disorder that affects the mind, mental function, emotions or behaviour whether the cause is organic, traumatic or reactive

    Oro-surgical procedure

    - operations described in the schedule of surgical procedures (for example, removing an impacted or buried tooth by surgery).

    Outpatient

    - Where your child does not require a hospital bed for their treatment or consultation

    Outpatient treatment

    - Treatment for which your child does not require a hospital bed

    Palliative cancer treatment

    - cancer treatment, the primary effect of which is to alleviate symptoms rather than to achieve remission, cure or reduction in tumour size.

    Partner

    - a member’s husband or wife, or the person the member lives with in a relationship similar to that of husband or wife, whether the same sex or not.

    Physiotherapist

    - A physiotherapist regulated by and registered as practicing with the Health Professions& Care Council and recognised by us

    Pre-existing condition

    - any disease, illness or injury for which, in the five years before you joined the trust:

    • you have received medication, advice or treatment, or

    • you have experienced symptoms whether the condition was diagnosed or not.

      • <

    Private ambulance

    - a purpose-built vehicle run by a recognised private ambulance service.

    Prosthesis

    - An artificial body part or device which is inserted during surgery

    Psychological therapist

    – we recognise the following as psychological therapists.

    • a psychologist who is:

      • Registered with the Health and Care Professions Council (HCPC);

      • Registered with the British Psychological Society (BPS) as a chartered Psychologist

    • a therapist who is:

      • An accredited member of the British Association of Counselling and Psychotherapy (BACP); or

      • An Accredited Member of the British Association for Behavioural and Cognitive Psychotherapies (BABCP); or

      • An Accredited Member of Scotland’s Professional Body for Counselling and Psychotherapy (COSCA); or

      • A practitioner who is registered with the United Kingdom Council for Psychotherapy (UKCP) under one of the following Modality Sections

    1. Behavioural & Cognitive;
    2. Psychotherapies
    3. Humanistic & Integrative
    4. Psychotherapeutic
    5. Counselling
    6. Psychoanalytic & Psychodynamic
      7. <

    Registered nurse

    - A nurse who is on the register of the Nursing and Midwifery Council (NMC) and holds a valid NMC personal identification number

    Related condition

    - Any medical condition which is reasonably considered to be related to another medical condition

    Schedule of surgical procedures

    - the current schedule/list of surgical procedures approved for benefits by our Clinical Support Team. This list will change from time to time.

    Scheme

    class="western">- your employer’s Corporate Healthcare scheme, of which you are a member.

    Specialist

    We consider a specialist to be:

    • a medical practitioner with full current registration with the General Medical Council or
    • a dentist with full current registration with the General Dental Council and
    • a specialist in the treatment you are referred for
    • has a certificate of Higher Specialist Training in their specialty that is issued by the Higher Specialist Training Committee of the appropriate Royal College or Faculty
    • is or has been a National Health Service consultant or dentist
    • has been recognised for benefit purposes as a specialist by Healix
      • <

    Start date

    - The date the trust starts as shown in the trust schedule.

    Surgical appliance

    An artificial device or an artificial body part which is a necessary part of your child’s treatment immediately after surgery - for example a knee brace after your child has had ligament surgery.

    Targeted therapy

    - drugs or other substances that block the growth and spread of cancer by interfering with specific molecules that are involved in the growth, progression and spread of cancer. Targeted cancer therapies are sometimes called "molecularly targeted drugs","molecularly targeted therapies", "precision medicines" or similar names.

    Terminal care

    (end of life care) – treatment that concentrates on controlling pain and other symptoms when the patient is near or approaching the end of life and active treatment for the causative disease is no longer considered effective or appropriate. Holistic therapy aimed to relieve or reduce the symptoms of those with advanced cancer but not to produce a cure.

    The Scheme

    class="western">– The Markerstudy Healthcare Scheme

    The Trust

    The Hammond School Young Performers Trust

    Treatment

    - Surgical or medical services (including diagnostic tests and consultations).This includes but is not limited to diagnostic tests, scans, and surgical procedures

    Treatments

    - surgical or medical services (including diagnostic tests) that are needed to diagnose, relieve or cure an acute condition.

    Trust Deed

    - The trust deed (including the rules of the trust) constituting the healthcare trust, as amended from time to time

    Trustee(s)

    - Any trustee or trustees for the time being of the healthcare trust

    Trustee, Trustees

    - Any trustee or trustees for the time being of the healthcare trust

    United Kingdom

    - England, Scotland, Wales and Northern Ireland.

    Waiting Period

    - A specified period which follows the eligible member’s original trust joining date.

    We, Us, Our

    - Healix Health Services Ltd, Healix House, Esher Green, Esher, Surrey, KT10 8AB

    Year of cover

    - The 12 month period starting on the start date or annual renewal date

    You, Your

    - Parent or guardian of an eligible child

    Health and wellbeing team

    Elmhurst Ballet Schools in-house physiotherapy, nursing and mental health team. 

    Neurodevelopmental disorders

    A group of disorders that affect the development of the nervous system, leading to altered brain function which may affect emotion, language processing, learning ability and memory.  Including but not limited to Autism spectrum disorder, ADHD and dyslexia.

    Trust Year 2024-25

    The new scheme year will renew on 1st September 2024. There will be no changes to the scheme for this year.

    Trust Year 2023-24

    The new scheme year will renew on 1st September 2023. There will be no changes to the scheme for this year.

    Section 9: Glossary

    The words and phrases below have the following meanings. They will appear in bold in this guide.

    Active treatment

    - Treatment of an acute medical condition that leads to recovery or restoration of a previous state of health

    Acute condition

    - A disease, illness or injury which responds quickly to treatment that aims to return your child to the state of health they were in immediately before suffering the disease, illness or injury, or which leads them to recovering fully. We would consider that an acute condition would resolve within three months or less

    Annual renewal date

    - The anniversary of the start date each year or any other date which we and Elmhurst Ballet School may agree to in writing

    Artificial life maintenance

    - Any medical procedure, technique, medication or intervention delivered to a patient in order, to maintain life after the failure of one or more vital organs

    Benefit

    - Any payment we make shown in the list of benefits.

    Benefits

    - The benefits for which your child is entitled as an individual under the trust subject to the terms and conditions that apply to the membership including all exclusions

    Cancer

    - A malignant tumour, tissues or cells, characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue

    Chronic condition

    - a disease, illness or injury which has at least one of the following characteristics:

    • it needs ongoing or long term monitoring through consultations, examinations, check-ups and/or tests
    • it needs ongoing or long term control or relief of symptoms
    • it continues indefinitely
    • it comes back or is likely to come back
    • your child need to be rehabilitated or specially trained to cope with it
    • it has no known cure.

    Please note: this will apply to all medical conditions, whether or not a diagnosis has been made. As we expect an acute condition to resolve completely within three months, we would begin to consider any condition lasting longer than this as chronic.

    Complementary practitioner

    - a practitioner who specialises in acupuncture who is registered under the relevant Act; and who, in all cases, meets our criteria for complementary practitioner recognition for benefit purposes in their field of practice:

    • Acupuncture practitioners must be registered with the BMAS (British Medical Acupuncture Society), BacC (British Acupuncture Council), AACP (Acupuncture Association of Chartered Physiotherapists) or AAC (The Association of Acupuncture Clinicians)
      • <

    Curative intent

    - treatment that is administered with a reasonable expectation both that it will restore the patient close to the state of health enjoyed prior to the disease being diagnosed, and expect the patient to be disease free 5 years after commencement of the treatment.

    Daycase

    - If your child is required to occupy a hospital bed for one day, for medical reasons

    Daycase treatment

    - Treatment for which your child is required to occupy a hospital bed for one day, for medical reasons

    Dependant

    - a member's partner (if a member gets divorced their husband or wife will no longer be considered as a dependant for the purposes of this plan).

    - a member's unmarried dependant children if aged 25 or under when they first join the scheme. We will also accept them if they are aged 26 or over providing the main member is switching their cover to us on a CPME basis and that child is currently included on their parent's cover.

    This should be evidenced by the current membership certificate. The dependant children must be living full-time at the same address as the main member, unless they are in full-time education.

    Dependants

    - a member's partner (if a member gets divorced their husband or wife will no longer be considered as a dependant for the purposes of this plan).

    - a member's unmarried dependant children if aged 25 or under when they first join the plan. We will also accept them if they are aged 26 or over providing the main member is switching their cover to us on a CPME basis and that child is currently included on their parent's cover.

    This should be evidenced by the current membership certificate. The dependant children must be living full-time at the same address as the main member, unless they are in full-time education.

    Detoxification

    - Treatment for withdrawal symptoms after your child has been abusing drugs or alcohol or both

    Diagnostic tests

    - investigations such as x-rays or blood tests required by your GP, or specialist, to find the cause of your symptoms. For the purpose of this policy, diagnostic tests are considered treatment.

    Dialysis

    >
  • Haemodialysis dialysis – the removal of waste matter from your child's blood by passing it through a kidney machine or dialyser
  • Peritoneal dialysis – the removal of waste matter from your child's blood by introducing fluid into your abdomen which acts as a filter
    • <

    Emergency

    - A serious medical condition or symptoms resulting from a disease, illness or injury which arises suddenly and requires immediate treatment, generally within hours of onset, and which would otherwise put your child’s health at risk

    Employer

    align="LEFT">-Markerstudy who is named as your employer.

    General Practitioner

    - A registered medical practitioner in general practice

    GP

    - A registered medical practitioner in general practice

    High dependency unit

    - Special department within a hospital designed for patients who require advanced post-operative care and/or support for a single failing organ system

    Home nursing

    - Visits from a registered nurse to your home to give your child expert/skilled nursing services immediately following eligible inpatient treatment in hospital under the control of a specialist

    Hospital

    >
  • NHS hospital - a National Health Service hospital with facilities for medical and surgical treatment, as defined in Section 1.28 of the National Health Service Act 1977 or in any future law
  • Private hospital - an independent hospital which can provide acute medical, surgical or mental health care. It must be registered under The Registered Homes Act (1984) and approved by the Healthcare Commission or any future law. It may also include a private bed in an NHS hospital
    • <

    Inpatient

    - If your child is required to occupy a hospital bed for one night or more, for medical reasons

    Inpatient treatment

    - Treatment for which your child is required to occupy a hospital bed for one night or more, for medical reasons

    Intensive care unit

    - A specialised department within a hospital designed for patients support for two or more organ systems and advanced respiratory support

    Medical condition

    - Any physical, mental or psychological disorder, including disease, illness, injury, genetic disorders and behavioural conditions

    Medical Necessity

    – treatment that is considered to be:

    • In accordance with professional standards of medical practice in the United Kingdom

    • Clinically appropriate, in terms of type, frequency, extent, site and duration of treatment

    • Required for reasons other than the comfort or convenience of the patient or specialist.

    • Provided at an appropriate facility, in an appropriate setting and at an appropriate level of care for the treatment of the patient’s medical condition.

    • Provided only for an appropriate duration of time.

    • no more costly than an alternative treatment at least as likely to produce the same therapeutic or diagnostic results.

    Please note, the trust is designed to treat acute medical conditions. It is not designed to cover all eventualities and therefore there will be some conditions which, whilst considered medically necessary, may not be eligible for cover.

    Medically necessary

    - Treatment that is considered to be:

    • In accordance with professional standards of medical practice in the United Kingdom
    • Clinically appropriate, in terms of type, frequency, extent, site and duration of treatment
    • Required for reasons other than the comfort or convenience of the patient or specialist.
    • Provided at an appropriate facility, in an appropriate setting and at an appropriate level of care for the treatment of the patient’s medical condition.
    • Provided only for an appropriate duration of time.
    • No more costly than an alternative treatment at least as likely to produce the same therapeutic or diagnostic results.

    Please note, the trust is designed to treat acute medical conditions. It is not designed to cover all eventualities and therefore there will be some conditions which, whilst considered medically necessary, may not be eligible for cover.

    Member

    - A current student of Hammond School

    Member (1)

    A current student of Hammond School.

    Mental health condition

    - A disorder that affects the mind, mental function, emotions or behaviour whether the cause is organic, traumatic or reactive

    Oro-surgical procedure

    - operations described in the schedule of surgical procedures (for example, removing an impacted or buried tooth by surgery).

    Outpatient

    - Where your child does not require a hospital bed for their treatment or consultation

    Outpatient treatment

    - Treatment for which your child does not require a hospital bed

    Palliative cancer treatment

    - cancer treatment, the primary effect of which is to alleviate symptoms rather than to achieve remission, cure or reduction in tumour size.

    Partner

    - a member’s husband or wife, or the person the member lives with in a relationship similar to that of husband or wife, whether the same sex or not.

    Physiotherapist

    - A physiotherapist regulated by and registered as practicing with the Health Professions& Care Council and recognised by us

    Pre-existing condition

    - any disease, illness or injury for which, in the five years before you joined the trust:

    • you have received medication, advice or treatment, or

    • you have experienced symptoms whether the condition was diagnosed or not.

      • <

    Private ambulance

    - a purpose-built vehicle run by a recognised private ambulance service.

    Prosthesis

    - An artificial body part or device which is inserted during surgery

    Psychological therapist

    – we recognise the following as psychological therapists.

    • a psychologist who is:

      • Registered with the Health and Care Professions Council (HCPC);

      • Registered with the British Psychological Society (BPS) as a chartered Psychologist

    • a therapist who is:

      • An accredited member of the British Association of Counselling and Psychotherapy (BACP); or

      • An Accredited Member of the British Association for Behavioural and Cognitive Psychotherapies (BABCP); or

      • An Accredited Member of Scotland’s Professional Body for Counselling and Psychotherapy (COSCA); or

      • A practitioner who is registered with the United Kingdom Council for Psychotherapy (UKCP) under one of the following Modality Sections

    1. Behavioural & Cognitive;
    2. Psychotherapies
    3. Humanistic & Integrative
    4. Psychotherapeutic
    5. Counselling
    6. Psychoanalytic & Psychodynamic
      7. <

    Registered nurse

    - A nurse who is on the register of the Nursing and Midwifery Council (NMC) and holds a valid NMC personal identification number

    Related condition

    - Any medical condition which is reasonably considered to be related to another medical condition

    Schedule of surgical procedures

    - the current schedule/list of surgical procedures approved for benefits by our Clinical Support Team. This list will change from time to time.

    Scheme

    class="western">- your employer’s Corporate Healthcare scheme, of which you are a member.

    Specialist

    We consider a specialist to be:

    • a medical practitioner with full current registration with the General Medical Council or
    • a dentist with full current registration with the General Dental Council and
    • a specialist in the treatment you are referred for
    • has a certificate of Higher Specialist Training in their specialty that is issued by the Higher Specialist Training Committee of the appropriate Royal College or Faculty
    • is or has been a National Health Service consultant or dentist
    • has been recognised for benefit purposes as a specialist by Healix
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    Start date

    - The date the trust starts as shown in the trust schedule.

    Surgical appliance

    An artificial device or an artificial body part which is a necessary part of your child’s treatment immediately after surgery - for example a knee brace after your child has had ligament surgery.

    Targeted therapy

    - drugs or other substances that block the growth and spread of cancer by interfering with specific molecules that are involved in the growth, progression and spread of cancer. Targeted cancer therapies are sometimes called "molecularly targeted drugs","molecularly targeted therapies", "precision medicines" or similar names.

    Terminal care

    (end of life care) – treatment that concentrates on controlling pain and other symptoms when the patient is near or approaching the end of life and active treatment for the causative disease is no longer considered effective or appropriate. Holistic therapy aimed to relieve or reduce the symptoms of those with advanced cancer but not to produce a cure.

    The Scheme

    class="western">– The Markerstudy Healthcare Scheme

    The Trust

    The Hammond School Young Performers Trust

    Treatment

    - Surgical or medical services (including diagnostic tests and consultations).This includes but is not limited to diagnostic tests, scans, and surgical procedures

    Treatments

    - surgical or medical services (including diagnostic tests) that are needed to diagnose, relieve or cure an acute condition.

    Trust Deed

    - The trust deed (including the rules of the trust) constituting the healthcare trust, as amended from time to time

    Trustee(s)

    - Any trustee or trustees for the time being of the healthcare trust

    Trustee, Trustees

    - Any trustee or trustees for the time being of the healthcare trust

    United Kingdom

    - England, Scotland, Wales and Northern Ireland.

    Waiting Period

    - A specified period which follows the eligible member’s original trust joining date.

    We, Us, Our

    - Healix Health Services Ltd, Healix House, Esher Green, Esher, Surrey, KT10 8AB

    Year of cover

    - The 12 month period starting on the start date or annual renewal date

    You, Your

    - Parent or guardian of an eligible child

    Health and wellbeing team

    Elmhurst Ballet Schools in-house physiotherapy, nursing and mental health team. 

    Neurodevelopmental disorders

    A group of disorders that affect the development of the nervous system, leading to altered brain function which may affect emotion, language processing, learning ability and memory.  Including but not limited to Autism spectrum disorder, ADHD and dyslexia.