Examples of chronic conditions
- Example 1: angina
- Example 2: breast cancer
- Example 3: hip pain
- Example 4: diabetes
- Example 5: asthma
Example 1: angina
Alan has been with the Exeter Friendly Society for many years. He develops chest pain and is referred by his GP to a specialist. He has a number of investigations and is diagnosed as suffering from angina. Alan is placed on medication to control his symptoms.
We do not consider angina to be a chronic condition. This means that as long as Alan's claim has been approved by us, and he has the necessary benefit in his policy and has not reached a benefit limit, we will pay benefits for these investigations. We will not, however, pay for the medication.
Two years later, Alan's chest pain recurs more severely and his specialist recommends that he has a heart bypass operation.
Providing Alan has the necessary benefit in his policy and has not reached a benefit limit, we will pay for the operation and any follow-ups needed.
Example 2: breast cancer
Carole develops a lump in her left breast which is diagnosed as breast cancer. Her specialist recommends that she has a mastectomy (breast removal) followed by a course of chemotherapy and radiotherapy.
We do not consider cancer to be a chronic condition. Providing this is a new condition, the claim has been approved by us, and and she has the necessary benefit in her policy and has not reached a benefit limit, we will pay for the initial consultation, operation, chemotherapy and radiotherapy, up to the benefit limits of her policy. Once Carole's course of treatment has been completed, her specialist recommends that she has regular check-ups to ensure that she remains free from a recurrence of the disease.
Providing Carole has benefits available under her policy, we will pay for these check-ups.
Example 3: hip pain
Bob has been with the Exeter Friendly Society for three years when he develops hip pain. His GP refers him to an osteopath who treats him every other day for two weeks and then recommends that he return once a month for additional treatment to prevent a recurrence of his original symptoms.
Once we have approved the claim, we will pay for the cost of the osteopathy treatment providing Bob has Complementary benefits in his policy and he has not reached his benefit limit.
Example 4: diabetes
Deidre has been with the Exeter Friendly Society for two years when she develops symptoms that indicate she may have diabetes. Her GP refers her to an endocrinology specialist who organises a series of investigations to confirm the diagnosis, and then she starts on oral medication to control the diabetes. After several months of regular consultations and some adjustments to the medication regime, the specialist confirms that the condition is now well controlled and explains that he would like to see her every four months to review the condition.
We consider diabetes to be a chronic condition. Providing the claim is approved by us, and Deidre has the necessary benefits in her policy, we will pay for the initial consultation and investigations, up to the benefit limits of the policy. We will pay for follow-up consultations until the condition has been stabilised providing Deidre has not reached her benefit limit. However, we will not pay for the medication prescribed.
One year later, Deidre's diabetes becomes unstable and her GP arranges for her to go into hospital for treatment.
We may consider this to be an acute episode. Under the standard terms of our UK plans, emergency treatment is not covered however, if Deidre's admission to hospital was not an emergency admission, we would consider paying up to the eligible benefit limits. We would usually request a medical report or ask for additional information in order to consider this.
Example 5: asthma
Eve has been with the Exeter Friendly Society for five years when she develops breathing difficulties. Her GP refers her to a specialist who arranges for a number of tests. These reveal that Eve has asthma. Her specialist puts her on medication and recommends a follow-up consultation in three months to see if her condition has improved. At that consultation Eve states her breathing has been much better. So the specialist suggests she has check-ups every four months.
Providing the claim is approved by us, and Eve has the necessary benefits in her policy, we will pay for the initial consultation and tests, up to the benefit limits of the plan. Once the condition has been stabilised, we will not pay for the check-ups.
Eighteen months later, Eve has a bad asthma attack.
We may consider this to be an acute episode. Under the standard terms of our UK plans, emergency treatment is not covered however, if Deidre's admission to hospital was not an emergency admission, we would consider paying up to the eligible benefit limits. We would usually request a medical report or ask for additional information in order to consider this.
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