C. Cancellation of the policy
Information is material if it would have influenced the judgment of a prudent insurer in determining whether to cover a life assured or on what terms to have issued or continued with cover under this policy or in fixing the premium for this policy. A statement is substantially incorrect if the difference between what was stated and what is actually correct would have been considered material by a prudent insurer.
You wish to cancel your policy
You can cancel your policy at any time by giving Sovereign notice in writing. You are liable for all premiums due up to the date of the cancellation. Sovereign will refund any unused part of the premium already paid for any period more than one month beyond the date of cancellation. Otherwise there is no refund of any premiums . From the date Sovereign receives notice that you wish to cancel the policy, you will not be entitled to claim any benefits under this policy, other than for any health care service covered by this policy which was carried out prior to the date of cancellation, unless otherwise agreed to and confirmed in writing by Sovereign.
D. How to make a claim
Prior approval
We recommend you seek prior approval as soon as you are aware that you will need to make a claim. We need at least five working days to issue a prior approval. By seeking prior approval we are able to give you certainty of cover by addressing your eligibility prior to treatment taking place. There are some benefits for which prior approval is mandatory. These are listed in ‘ Part H: Benefits – what you are covered for ’ on pages 10 - 21.
When can Sovereign cancel your policy?
Sovereign can cancel this policy if the premium has not been paid within 31 days of the premium due date .
Sovereign can cancel this policy and decline liability for any claims made under this policy if you or any life assured , or anyone acting on your or any life assured ’ s behalf, makes a claim under this policy that is false or fraudulent in any respect. In the event that a false or fraudulent claim is established after payment of a claim, all amounts paid in relation to the false or fraudulent claim must be repaid by you to Sovereign.
Applying for prior approval
You can submit your prior approval request online or return the completed form to Sovereign as soon as you are aware that you will need to make a claim. You will also need to ask your registered medical practitioner to complete the relevant section of the claim form or to provide you with a referral letter as well as any relevant clinical notes that may be useful to assist us to assess whether the medical treatment or procedure is medically necessary and falls within the terms of this policy. The referral letter must include details of the initial consultation date, the history of the condition and details of any treatment received.
Non-disclosure or the provision of false or misleading information
Any information you or any life assured gives us, and any information given to us on your behalf, must be complete, true and correct. If you or any life assured fails to disclose material information to Sovereign prior to inception of this policy or any variation or reinstatement of this policy, or if you or any life assured has made a substantially incorrect statement in applying for this policy, Sovereign may, at its complete discretion either:
When you apply for prior approval we also need an estimate of the costs of treatment.
If your claim is pre-approved, Sovereign will allocate a claim number to your claim and will email, post or fax you or the life assured a letter confirming the claim has been pre-approved. The excess and any costs that are not covered, including costs which exceed the maximum cover will be clearly shown and you will need to pay these amounts directly to the health service provider. Sovereign will pay the health service provider directly upon receipt of the invoice or statement up to the maximum cover . Please ensure that the claim number is quoted on all claims correspondence and any invoices or accounts relating to the pre-approved claim that are sent to Sovereign. There may be certain costs, treatments or procedures that are not covered by this policy. Obtaining prior approval ensures you understand what will be covered and allows
> avoid this policy from its inception (this means the policy is deemed to have never existed); or
> alter the terms upon which cover is provided under your policy (such alteration of terms will be effective from the risk commencement date or such date of our choosing, at our discretion); or > remove from cover any life assured from inception but leave the policy in force for the remaining lives assured . If this policy is avoided or any terms altered or a life assured is removed from cover, we are entitled to retain all premiums paid in relation to the policy or that life assured .
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712 PH-UMB version 9 Effective 8 April 2022
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