Service excluded
The scheme says its rules exclude this kind of service from cover.
Words you might see
- “a general exclusion applies”
- “is excluded in terms of the rules”
- “not covered under this option”
Questions to ask
- Which exclusion in the registered rules was applied to this claim?
- Please provide that exclusion as it appears in the rules registered for the current year.
- Does the scheme apply that exclusion where the service is a Prescribed Minimum Benefit, and how was that assessed?
- When was that exclusion last amended, and was I notified of the amendment?
Details to have ready
- Whether the service was part of treating a condition you have registered.
Pryse is not a law firm and does not act for you. Nothing here is a determination of your rights or legal advice, and no registered scheme rule is quoted. The questions ask your scheme to provide its own.