Dental Guide for Employers - Denplan

Dental Guidefor EmployersDenplan Lucent

Denplan Lucent – Benefit TableThe limits stated below are the maximum reimbursement available per unit of treatment, unless otherwise statedBenefitsDenplanLucent 1DenplanLucent 2DenplanLucent 3DenplanLucent 4DenplanLucent 5DenplanLucent 61. Annual Policy LimitsAnnual Limit – Routine andRestorative Dental Treatment£ 600 £ 1,000 £ 1,400 £ 1,700 £ 2,100 £ 2,750Annual Limit – Injury and EmergencyDental Treatment£ 600 £ 1,000 £ 1,400 £ 1,700 £ 2,100 £ 2,7502. Preventive TreatmentNormal Examination 100% NHS £ 11.00 £ 15.00 £ 20.00 £ 25.00 £ 30.00Extensive/New Patient Examination 100% NHS £ 22.00 £ 30.00 £ 40.00 £ 52.00 £ 63.00Small (bitewing) x-ray 100% NHS £ 4.00 £ 5.00 £ 6.00 £ 7.00 £ 8.00Medium x-ray 100% NHS £ 7.00 £ 9.00 £ 12.00 £ 16.00 £ 20.00Large (panoral) x-ray 100% NHS £ 11.00 £ 15.00 £ 18.00 £ 21.00 £ 26.00Scale & polish 100% NHS £ 23.00 £ 30.00 £ 40.00 £ 52.00 £ 63.00Fissure Sealant 100% NHS £ 8.00 £ 10.00 £ 12.00 £ 14.00 £ 16.00Topical fluoride application 100% NHS £ 6.00 £ 12.00 £ 18.00 £ 24.00 £ 32.003. FillingsOne surface amalgam filling 100% NHS £ 12.00 £ 15.00 £ 25.00 £ 32.00 £ 40.00Two or more surface amalgam filling 100% NHS £ 17.00 £ 20.00 £ 34.00 £ 44.00 £ 54.00One surface composite anterior filling 100% NHS £ 16.00 £ 20.00 £ 33.00 £ 43.00 £ 53.00Two or more surface compositeanterior filling100% NHS £ 25.00 £ 36.00 £ 60.00 £ 78.00 £ 95.00One surface composite posterior filling 100% NHS £ 17.00 £ 21.00 £ 35.00 £ 45.00 £ 56.00Two or more surface compositeposterior filling100% NHS £ 23.00 £ 28.00 £ 46.00 £ 60.00 £ 73.004. Root Canal TreatmentRoot Canal Treatment – incisor/canine 100% NHS £ 40.00 £ 50.00 £ 60.00 £ 88.00 £ 108.00Root Canal Treatment – premolar 100% NHS £ 50.00 £ 60.00 £ 75.00 £ 110.00 £ 135.00Root Canal Treatment – molar 100% NHS £ 65.00 £ 82.00 £ 98.00 £ 148.00 £ 180.005. CrownsPorcelain jacket crown 100% NHS £ 91.00 £ 110.00 £ 125.00 £ 156.00 £ 204.00Metal bonded crown 100% NHS £ 98.00 £ 120.00 £ 135.00 £ 170.00 £ 220.00Dentine bonded crown / Full goldcrown100% NHS £ 110.00 £ 133.00 £ 152.00 £ 190.00 £ 247.00Zirconia crown 100% NHS £ 138.00 £ 166.00 £ 190.00 £ 237.00 £ 308.00Post 100% NHS £ 20.00 £ 30.00 £ 40.00 £ 50.00 £ 60.00Re-cement crown 100% NHS £ 15.00 £ 20.00 £ 25.00 £ 30.00 £ 35.00Continued over ...2

BenefitsDenplanLucent 1DenplanLucent 2DenplanLucent 3DenplanLucent 4DenplanLucent 5DenplanLucent 66. BridgeworkPrecious metal bonded / porcelainbridgework (any number of units) 100% NHS £ 260.00 £ 320.00 £ 400.00 £ 550.00 £ 700.00Adhesive bridge (any number of units) 100% NHS £ 130.00 £ 160.00 £ 220.00 £ 280.00 £ 350.00Inlay (per unit) 100% NHS £ 80.00 £ 90.00 £ 140.00 £ 200.00 £ 250.00Onlay (per unit) 100% NHS £ 80.00 £ 90.00 £ 140.00 £ 200.00 £ 250.00Veneer (per unit) 100% NHS £ 70.00 £ 80.00 £ 125.00 £ 160.00 £ 200.00Re-cement Bridge, Inlay, Onlay orVeneer 100% NHS £ 70.00 £ 20.00 £ 25.00 £ 30.00 £ 35.007. DenturesAcrylic - full single denture 100% NHS £ 140.00 £ 200.00 £ 238.00 £ 317.00 £ 397.00Acrylic - full upper and lower dentures 100% NHS £ 243.00 £ 348.00 £ 417.00 £ 557.00 £ 695.00Acrylic - partial denture 100% NHS £ 128.00 £ 182.00 £ 220.00 £ 292.00 £ 365.00Part metal denture 100% NHS £ 203.00 £ 290.00 £ 347.00 £ 463.00 £ 579.00Full metal denture 100% NHS £ 210.00 £ 300.00 £ 360.00 £ 480.00 £ 600.008. Denture Otherrepair 100% NHS £ 25.00 £ 30.00 £ 35.00 £ 40.00 £ 45.00NHS treatment100% reimbursementSimple extraction 100% NHS £ 15.00 £ 20.00 £ 25.00 £ 32.00 £ 40.00Surgical extraction 100% NHS £ 40.00 £ 50.00 £ 55.00 £ 60.00 £ 65.00Orthodontic treatment (children only) 100% NHS £ 250.00 £ 325.00 £ 400.00 £ 475.00 £ 550.00Periodontal treatment 100% NHS £ 55.00 £ 74.00 £ 84.00 £ 90.00 £ 100.00Mouthguard (excluding sports mouthguards)100% NHS £ 40.00 £ 45.00 £ 50.00 £ 55.00 £ 60.00Sedation 100% NHS £ 50.00 £ 60.00 £ 70.00 £ 75.00 £ 80.00Other emergency treatment chargesIncluding, but not limited to, prescriptioncharges, arrest of haemorrhageand costs of calling the emergencyhelpline (from overseas)100% NHS £ 25.00 £ 30.00 £ 35.00 £ 40.00 £ 45.009. OTHER BENEFITSClaims under the benefits listed below under section 9 do not count towards your annual maximum benefit entitlement as outlined in section 1 above.Mouth Cancer £ 12,000 £ 12,000 £ 12,000 £ 12,000 £ 12,000 £ 12,000Hospital Cash Benefit(£50 per night, up to £1,000 perpolicy year)✓ ✓ ✓ ✓ ✓ ✓Dentist Call-out Fees(£50 per incident, up to £100 perpolicy year)✓ ✓ ✓ ✓ ✓ ✓3

Policy Terms and ConditionsThis document constitutes the full terms and conditions of the dental policy, which is for the policy term.1. DefinitionsThe words, which appear in this policy in bold, have specific meanings, which are explained below:appropriate mouth protection - a sports mouthguard.benefit table - the table of benefit limits for your chosen level of cover, as confirmed in your welcome or renewal letter issued by Denplan Limited.commencement date - the cover start date as shown in your welcome letter or other notices issued by Denplan Limited.contact sport - rugby, lacrosse, hockey, boxing, wrestling, ice hockey and any sport where it is common practice to wear mouth protection.country of residence - the country in which you are resident on a limited or unlimited secondment in agreement with your employer.dental call-out - the necessity for a dentist in the UK to re-open the practice between the hours of 6.00pm and 8.00am on weekdays or weekend and bank holidays oroutside the UK, outside the practice’s normal working hours.dental implant - a titanium root-shaped fixture designed to integrate with the bone, to replace the root of a tooth and support the replacement tooth(excluding the crown).dental injury - an injury to the teeth or supporting structures (including damage to dentures whilst being worn) which is directly caused suddenly andunexpectedly by means of a direct external impact.dental specialist - a specialist dental practitioner accredited by the General Dental Council (GDC) in the UK practising in one of the recognised dentalspecialist areas contained within ‘The Specialist List’ held by the GDC at www.gdc-uk.orgdentist - in the UK, a dental surgeon who is currently registered with the General Dental Council (GDC) together with any other regulatory authority. If thedentist is outside the UK, a dental surgeon who is currently registered with the appropriate national regulatory authority.diagnosed - treatment identified and recorded as necessary, to be completed in the future but not yet scheduled.mouth cancer - a malignant tumour, with its primary site being in the hard and soft palate, gland tissue (including accessory, salivary, lymph and other glandtissue) in the mucosal lining of the oral cavity but excluding the tonsils, which is characterised by the uncontrolled growth and spread of malignant cells andthe invasion of tissue. This excludes non-invasive cancer in situ and HIV related tumours.NHS price bandings - the prevailing Government rules will be adhered to for NHS treatment carried out in England, Wales, Scotland, Northern Ireland and the Isle ofMan. At the time of printing, the charge structure in England, Wales and the Isle of Man was based on three price bandings (details can be found at www.dh.gov.uk/dentistry). In Scotland and Northern Ireland, a schedule of treatment charges apply (see www.scotland.gov.uk/dentistry for Scotland and www.hscbusiness.hscni.net/services/2069.htm for Northern Ireland)permanent treatment - definitive treatment that is clinically necessary to secure and maintain oral health.policy term - the twelve month period immediately following the commencement date or, if shorter, the period of time between the commencement date andthe renewal date. In the case of a renewed policy the twelve month period immediately following the renewal date. This may also refer to a non twelve monthperiod as agreed by your employer and confirmed in your joining details.premium - the money due to us with regard to the provision of this policy.restorative dental treatment – clinically necessary dental treatment required to maintain the oral health of a patient in the opinion of your dentist. This mayinclude treatment such as fillings, crowns, bridges and dentures.specialist dental treatment - dental treatment carried out by a dental specialist, within their specialist area.temporary emergency dental treatment - temporary dental treatment provided at the initial emergency appointment urgently required for the relief of severepain, arrest of haemorrhage, the control of acute infection or a condition which causes a severe threat to your general health. For the avoidance of doubt anysubsequent treatment required after the initial emergency appointment is specifically excluded.United Kingdom (UK) - England, Wales, Scotland, Northern Ireland, Isle of Man and the Channel Islands.we, us, our - Simplyhealth Access trading as and referred to in this document as “Simplyhealth”.you, your - a person who has been accepted for cover under this policy.2. EligibilityYou can only be covered under the terms and conditions of this policy, from the commencement date, if you:a. are resident in the UK for at least 180 days during the policy term; andb. are entitled to enter the scheme in accordance with the eligibility rules defined by your employer; orc. are related to an eligible employee who is also covered on the corporate scheme.Your insurance cover under this policy will end at the earliest of the following:d. the expiry of the policy term; ore. when you are no longer eligible to remain in the scheme according to the eligibility rules defined by your employer; orf. in the case of a company funded scheme, the last day of the month in which your employment ceases, unless we have agreed otherwise with youremployer; org. If your employer’s group policy ceases.4

3. Schedule of benefitsa. Worldwide dental injuryWhat is coveredThe costs of dental treatment received by you carried out by a dentist inconnection with a dental injury which happens after the commencementdate, up to the limits stated in the benefit tableDental prescription charges are includedIf dental implants are clinically required following a dental injury, benefitswill be paid under the Implant Upgrade cover.If your chosen level of cover does not include the Implant Upgrade cover,we will pay up to £1,000 towards the cost of the equivalent bridgeworktreatment following your dental injuryWhat is not coveredGeneral exclusions (see section 4)You are only covered for treatments in connection with dental injuries thatcommence within a period of 6 months of the date of the original incidentand/or notification of an intention to claim, and while your policy is in force.You are only covered for treatment received within 24 months of thedate of the injury.Dental injury caused in the consumption of food (including foreign bodiescontained within the food).Dental injury caused whilst training for or participating in contact sports(including training) unless appropriate mouth protection is worn.Note: If your treatment under this benefit spans a renewal period, we will treat the claim as a continuing claim and we will continue to cover your treatmentafter the renewal date, with benefits subject to the policy limits of the policy term in which the incident took place.b. Worldwide emergency dental treatmentWhat is coveredThe cost of temporary emergency dental treatment carried out by a dentistwithin the UK and overseas, up to the limits stated in the benefit tableDental prescription charges are includedReimbursement of costs to the emergency helpline are covered, if callingfrom overseasWhat is not coveredGeneral exclusions (see section 4)Any subsequent treatment required after the initial appointment (however,you may have cover under section 3.h ‘Worldwide restorative dentaltreatment’ if your chosen level of cover includes this benefit)Permanent treatment (however, you may have cover under section 3.h‘Worldwide restorative dental treatment’ if your chosen level of coverincludes this benefit)c. Dentist call-out feesWhat is coveredThe cost of dental call-outs in the event of a dental injury or dentalemergency up to the limits stated in the benefit tableWhat is not coveredGeneral exclusions (see section 4)d. Hospital cash benefitWhat is coveredYou can claim hospital cash payments as described in the benefit table ifyou are admitted overnight as an in-patient to a licensed medical or surgicalhospital for dental treatment under the care of a consultant specialising indental or maxillofacial surgery in relation to a dental conditionWhat is not coveredGeneral exclusions (see section 4)5

e. Mouth cancer coverWhat is coveredTreatment charges up to the limits stated in the benefit table for treatmentof mouth cancerWhat is not coveredGeneral exclusions (see section 4)Mouth cancer diagnosed before or within 90 days of when you were firstprovided with mouth cancer cover by us or for which tests or consultationbegan within those 90 days, even if the diagnosis is not made until later.You are only covered for treatment received within 18 calendar months ofthe date of diagnosis.You are only covered for one course of treatment in connection with aspecific occurrence of mouth cancer. No further benefits are payable in theevent of a re-occurrence of this same cancer, either at the same site or at adifferent location.You are only covered for treatment given by a consultant who is recognisedas a specialist in cancer treatment by the NHS or the States of Guernseyand Jersey or your country of residence or treatment provided by anothermedical practitioner under referral from a consultant.Charges for consultations or tests for noninvasive tumours underthe mouth cancer cover benefit, or tests that don’t result in a diagnosisof mouth cancer.Mouth cancer which is related in any way to HIV infection or AIDS.Mouth cancer resulting from the chewing of tobacco products or betel nut,or from prolonged alcohol abuse.f. NHS treatmentWhat is covered100% reimbursement for treatment carried out under the NHS pricebandings (see definitions for further details).What is not coveredGeneral exclusions (see section 4)If you have selected Denplan Elementary, you will also be reimbursed forthe cost of private dental treatment up to the equivalent NHS price bandinglevel for the treatment you have receivedg. Worldwide routine dental treatmentWhat is coveredClinically necessary routine dental examinations, hygiene treatments anddental x-rays carried out by a private dentist, up to the maximum limitsstated in the benefit tableWhat is not coveredGeneral exclusions (see section 4)h. Worldwide restorative dental treatmentWhat is coveredClinically necessary restorative dental treatment and specialist dentaltreatment carried out by a private dentist to maintain your oral healthThese treatments include, but are not limited to;fillings, crowns, bridges, dentures, impressions, extractions, root canaltreatment, periodontal treatment, orthodontic treatment (grades 4 – 5 onthe IOTN scale), mouthguards for teeth grindingThe overall maximum reimbursement level for this benefit is stated in thebenefit table for your chosen level of coverWhat is not coveredGeneral exclusions (see section 4)Mouthguards for the purposes of sporting activitiesOrthodontic treatment that is not clinically necessary (grades 1 – 3 on theIOTN scale)Dental implants, and all costs associated with the preparation and fittingof such a device (although you may have cover under section 4.a – Dentalinjury if you require dental implants as the result of a dental injury)Note: Please consult the benefit table to confirm whether your chosen level of cover also includes cover under benefits 3.f (Worldwide routine dentaltreatment) and 3.g (Worldwide restorative dental treatment).For information on the Index of Orthodontic Treatment Need (IOTN) scale, see www.bos.org.uk or contact Denplan.6

4. General exclusionsThis policy does not provide cover for:a. Any treatment not deemed to be clinically necessary.b. Any dental treatment which was prescribed, planned, diagnosed or is currently taking place at the commencement date.c. Damage caused by toothbrushing or other oral hygiene procedures.d. Loss of, or damage to dentures, other than whilst in the mouth.e. Reimbursement for travelling expenses, incidental expenses or telephone calls (unless to the emergency helpline from overseas).f. Treatment, care or repair to teeth, gums, mouth or tongue in connection with “mouth jewellery”.g. Dental consumables, such as toothbrushes, mouthwash and dental floss.h. Dental procedures carried out by a hospital, for example, wisdom teeth extractions.In addition, no benefit will be payable under section 3 as a result or consequence of any of the following:i. Self-inflicted dental injury.j. Dental injury caused by laparoscopic procedures.5. Claims generalWhen determining claims Denplan act on behalf of the underwriter, Simplyhealth. Denplan have the delegated authority to do so, and in this instance are notacting as your intermediary, but as the agent of Simplyhealth.a. (i) Your claim must be notified to Denplan by you fully completing and signing the official claim form. Incomplete claim forms will be returned and maycause a delay in your claim being assessed. In any event claim forms must be completed at your own expense and should be received by Denplanwithin 60 days of receiving your dental treatment, if reasonably possible.(ii) Your claim must be supported by proof of treatment detailing the dates and costs of each individual treatment. The proof must be a fully itemisedreceipt or an official document issued by the treating practice in English, if reasonably possible. Where a receipt or an official document isunobtainable the treating dental surgery must sign and stamp the completed claim form.(iii) Please note it may be necessary to provide relevant x-rays and/or your dental records in support of a claim.b. No benefit will be payable if Denplan have not received proof of all facts relevant to your claim. This shall include but not be limited to:(i)proof of your eligibility for cover on the date of treatment;(ii) proof of the dental treatment, including the type of treatment received and date of treatment. This may be by way of amedical report (at your own expense);(iii) proof of payment for the dental treatment being claimed for;(iv) for claims under the worldwide dental injury benefit, details pertaining to the circumstances of the injury you have experienced.c. In all cases we reserve the right to recover any incurred costs as a result of a third party’s involvement. In addition if you have another dental insurancepolicy we reserve the right to pay an appropriate apportionment of the claim.d. Claims settlement will be made payable to the policyholder, or any other third party as specified by the policyholder on the claim form. All chequesettlements must be sent to a UK address, and all direct credit settlements must be paid into a UK clearing bank account.e. If the treatment is received abroad then we will pay benefits in pounds sterling. This means we will need to convert the expenditure into sterling usingFXConverter at www.oanda.com. The exchange rate will be calculated at the rate in force at the date of the receipt, and will be thebasis of the settlement.f. There may be instances where we are uncertain about the eligibility of a claim. If this is the case we may at our own cost ask a dentist or other medicalspecialist, chosen by us, to advise us about the medical facts relating to a claim or to examine you in connection with the claim. In choosing a relevantdentist or specialist we will take into account your personal circumstances. You must co-operate with any dentist or specialist chosen by us or we will notpay your claim.g. Any benefits we pay for dental treatment to which you or any of your eligible dependants are not strictly entitled shall count towards your annualmaximum benefits available under the policy, but we shall not, by making any such payment, be liable to pay any future benefits in respect ofsuch dental treatment.7

6. Generala. This contract between you and us is made up of these terms and conditions, your schedule of cover and any endorsement provided by us in yourwelcome or renewal letter.b. Where applicable, family members and dependent children may also be included in the dental scheme on the same dental plan. Dependent children arethose aged up to 21 (or 24 if in full time education).c. Non payment of premium will result in us suspending your benefits, and taking all necessary action to recover monies outstanding.d. You and we are free to choose the law that applies to this policy. In the absence of an agreement to the contrary, the law of England and Wales will apply.e. The policy is written in English and all other information and communications to you relating to the policy will also be in English.f. All policyholders must provide an up-to-date mailing address.g. If you (or anyone acting on your behalf) make a claim under your policy or obtain cover knowing it to be false or fraudulent, we can refuse to makebenefit payments for that claim and may declare the policy void, as if it never existed. If we have already paid benefit we can recover those from you.Where we have paid a claim later found to be fraudulent, (whether in whole, or in part), we will be able to recover those sums from you and/or take theappropriate legal action against you.How is my personal data protected?Please ensure that you show the following information to others covered under your policy, or make them aware of its contents. Denplan will deal with allpersonal information supplied in the strictest confidence as required by the Data Protection Act 1998. Denplan may send personal and sensitive personalinformation in confidence for processing by other companies and intermediaries and to Simplyhealth as the underwriter of this policy. Denplan will extendthe same duty of confidentiality to any third parties to whom it may subcontract the administration of your policy, including those based outside the EuropeanEconomic Area.Denplan will hold and use information about you and any family members covered by your policy, supplied by you, any family members and your employer (ifapplicable) to provide the services set out under the terms of this policy, administer your policy and develop customer relationships and services. In certaincircumstances Denplan may ask medical service providers (or others) to supply Denplan with further information. When you give Denplan information aboutfamily members Denplan will take this as confirmation that you have their consent to do so. As the policyholder is acting on behalf of any family member coveredby this policy, Denplan will send all correspondence about the policy, including any claims correspondence, to the policyholder unless advised to do otherwise.Denplan are required by law, in certain circumstances, to disclose information to law enforcement agencies about suspicions of fraudulent claims and othercrime. Denplan will disclose information to third parties including other insurers for the purposes of prevention or investigation of crime including reasonablesuspicion about fraud or otherwise improper claims.If you have agreed, Denplan may use the information you have provided to Denplan to contact you by post, telephone or electronically with details of otherproducts and services. With your agreement Denplan may also share some of your details with other Simplyhealth Group companies and other carefullyselected companies based in the European Economic Area to enable them to contact you about their products and services. If you change your mind pleasecontact Denplan on 0800 838 951 otherwise Denplan will assume that, for the time being, you are happy to be contacted in this way.What regulatory protection do I have?Denplan Limited is an appointed representative of Simplyhealth, which is authorised and regulated by the Financial Services Authority (FSA). The FSA wasestablished by government to provide a single statutory regulator for financial services. The FSA is committed to securing the appropriate degree of protectionfor consumers and promoting public understanding of the financial system. The FSA have set out rules which regulate the sale and administration of generalinsurance which Simplyhealth and Denplan must follow when dealing with you. Simplyhealth’s registration number is 202183. This information can be accessedby visiting the FSA register which is on their website: www.fsa.gov.uk/register or by contacting the FSA on 0845 606 1234.In the unlikely event that Simplyhealth becomes insolvent and is unable to pay the benefits under your group scheme, you may be entitled to claimcompensation from the Financial Services Compensation Scheme (the FSCS). You will need to meet specific FSCS criteria depending on your particularcircumstances. Further information about the operation of the scheme is available on the FSCS website: www.fscs.org.uk. To find out whether you would beeligible to claim under the scheme you should contact the FSCS (0207 892 7300).How to complainIt is always the intention of Simplyhealth and Denplan to provide a first class standard of service. However, should you have reason to complain you can doso in the following way:a. In the first instance, you should document your complaint and send it to Denplan at:Corporate Customer Service Manager,Denplan Corporate,Denplan Court,Victoria Road,WinchesterSO23 7RGEmail: corporate@denplan.co.ukPlease quote your personal policy or claim number so that your enquiry can be dealt with quickly.b. Should the matter still not be resolved to your satisfaction, you have the right to refer your complaint to:Financial Ombudsman ServiceSouth Quay Plaza,183 Marsh Wall,LondonE14 9SREmail: complaint.info@financial-ombudsman.org.ukThis procedure will not prejudice your right to take legal proceedings. However, please note that there are some instances when the Financial OmbudsmanService cannot consider complaints.8

Contractual Terms & Conditions1. AppointmentThese terms and conditions set out the terms upon which the companyshall arrange for the provision of dental insurance under the Group Policy toincluded employees. The company reserves the right at all times and in itssole discretion not to accept an included employee for dental insurance.2. Definitions and Interpretationcommencement date - means the date from which cover under the GroupPolicy is confirmed in writing by the company.company - means Denplan Limited.customer - means the named policyholder of the Group Policy whose includedemployees are insured under that Group Policy.dental insurance - means a policy of general insurance relating to emergency,routine and/or restorative dental treatment (as prescribed by the policyschedule) underwritten by Simplyhealth.DPA - means the Data Protection Act 1998.employee month - means a month during which an included employee iscovered under this agreement.Group Policy - means the policy of dental insurance which the customer entersinto on behalf of the included employees who are or shall be provided withdental insurance by virtue of their employment.included employees - means those customer’s employees who are includedby the customer as eligible for such dental insurance and who wish to receivethe same as a benefit of their employment in accordance with the terms ofthe Group Policy.IPT - means insurance premium tax as provided for by the Finance Act 1994and all subsequent legislation, regulation and published practice of HMRevenue & Customs relative to the taxation of insurance premiums and anyother similar tax payable in respect of insurance premiums which replaces oris introduced in addition thereto.parties - means both the company and the customer.person insured - means an included employee, and any spouse or dependantshaving the benefit of such Group Policy, who has been accepted for insuranceunder the Group Policy.personal data - has the meaning given to such term in the DPA.Simplyhealth - means Simplyhealth Access.year - means twelve calendar months from the commencement date.The singular shall include the plural, the masculine gender shall includethe feminine and vice versa. The headings are for convenience only andshall not affect the construction of this agreement. Any reference in thisagreement to a clause or sub-clause shall be construed as a reference to aclause or sub-clause of this agreement.3. BenefitSubject to the customer paying to the company the insurance premium(plus IPT) shown and provided the customer complies with these terms andconditions, the company shall provide the level of cover shown in the GroupPolicy to each person insured.4. Duties of the customerThe customer shall:i. only offer dental insurance under the Group Policy to such employees ofthe customer that meet the eligibility criteria set out in the Group Policy oras advised in writing by the company from time to time;ii. if directed by the company, complete and issue to persons insuredinsurance documents in the form supplied and within the time periodprescribed by the company;iii. observe and comply with the terms of this agreement and any otherrelevant rules or regulations which the company may from time to timestipulate in connection with this agreement or the businessesof the company;iv. pay, by the due date, to the company in Pounds Sterling the full premiumsplus IPT payable in relation to all funded and/or voluntary policies andcomply with the terms of clause 13 in the absence of such payments;v. retain in safe keeping any unissued policy documents providedby the company;vi. give to the company such information as the company may reasonablyrequest which is acquired by the customer in connection with the issue ofinsurance cover and relating to any business transacted by the customerpursuant to this Agreement and/or to any persons insured;vii. comply with all applicable statutes, laws and regulations affecting theGroup Policy and the subject matter of this agreement;viii. accept direct responsibility for any breaches by the customer of the termsand conditions of this agreement;ix. accept that premiums detailed on the application form are inclusive of IPTat the prevailing rate at the date of this agreement;x. accept that the company reserves the right to vary the amount of IPTcharged in respect of premiums; andxi. bear the cost of any bank charges applicable to the payment of thepremiums plus IPT. For the avoidance of doubt such bank charges shallinclude but are not limited to any charges relating to the conversion ofcurrency or the electronic transfer of money to the company.5. Limit of customer’s authorityWithout prejudice to its duties as set out in clause 4 above, the customershall not and has no authority to do any of the following:i. offer insurance cover to a person insured if and to the extent that benefitsexceeding those set out in a Group Policy would be payable to an includedemployee (whether under the Group Policy or under any other insurancepolicy issued by the company to the customer);ii. offer insurance cover under the Group Policy to such included employeesthat do not meet the eligibility criteria set out in the Group Policy or asadvised in writing by the company from time to time;iii. vary the company’s standard copy Group Policy documents, Certificate ofInsurance, Terms and Conditions of Business or sales literature or vary ordischarge any contract to which the company is a party;iv. commence or attempt to defend any legal action in the name of or onbehalf of the company;v. cause any advertisement, circular, form or any document or materialswhatsoever relating to the business of the company to be published orprinted without the prior written consent of the company; orvi. on a ‘funded’ plan the customer may not recover from any includedemployee the whole or any part of the premium payable.6. Included employees and person insuredi. In respect of each of the customer’s included employees, the customershall advise the company in writing or electronic media (including, for theavoidance of doubt, by email), as specified by the company of:(a) the employee’s title, forename, surname, address, date of birth,gender and email address (where email fulfilment has been selected bythe customer).(b) the selected plan.ii. Unless otherwise agreed, the customer shall provide the informationprescribed in sub-clause (i)(a) above to the company on a monthly basis,due on the same day each month as determined by the date of thecustomer’s first monthly submission. Subject to clause 23 below, in theevent that the customer fails to provide such information within 5 workingdays of the monthly due date, the company may at any time suspendbenefits and claims payments for persons insured, unless otherwiseagreed with the customer. In the event that such failure to provide suchinformation continues for more than 1 month, the company may in itsabsolute discretion either cancel the Group Policy or pursue the customerfor payment by all available legal means.iii. The customer is responsible for setting any eligibility criteria for itsemployees to join the Group Policy and the company shall not monitor orenforce the eligibility set by the customer, either in service ordocument provision.iv. The customer warrants that all information it supplies to the companyconcerning included employees shall be complete and accurate.v. Where an employee becomes an included employee other than at thecommencement of a year, the customer shall notify to the company theinformation specified in paragraph (i) within 5 working days of the end ofthe month in which the employee becomes an included employee. Theincluded employee shall be insured as from the 1st of the month followingthe customer’s notice. Premiums shall be calculated by reference to wholecalendar months.vi. Where a person insured is to be withdrawn:(a) other than at the end of a year, the customer shall notify the companyin writing or electronic media (including for the avoidance of doubt, byemail), within 5 working days of the end of the month when the includedemployee is to be withdrawn; and(b) the customer shall remain liable for subscription and any premiumplus IPT due in respect of the employee until the withdrawal takes effect.9

7. Inspectioni. The company reserves the right to examine and inspect the customer’sprocedures for the offering of insurance cover under the Group Policy,including but not limited to procedures in respect of the issuing ofCertificates of Insurance and the payment of premium for the relevantnumber of persons insured.ii. The customer shall provide all such information as is reasonably requiredby the company to conduct the inspection set out above within tenbusiness days of a written request from the company.8. Documents and Materialsi. During the continuance of this agreement the company shall issue to allincluded employees policy documents, Certificates of Insurance and salesliterature required in providing the benefit of the Group Policy and for anyother purposes as the company shall consider appropriate.ii. The customer shall submit the form and content of any and all materials(including, for the avoidance of doubt, internal marketing materials)produced by it under the terms of or in relation to this agreement and/orthe Group Policy to the company for approval in writing prior to its use.iii. These and all other documents, items and materials supplied by thecompany shall, as between the customer and the company, remainthe property of the company and shall be destroyed or returned to thecompany immediately upon written request.9. Confidentialityi. The company shall keep the names and addresses of all the personsinsured private and confidential.ii. The parties shall treat the terms of this agreement and allinformation received by them in connection with this agreement asstrictly confidential.iii. Subject to the DPA, this clause 9 shall not prevent disclosure which ismade for a proper purpose, including but not limited to disclosure made inaccordance with any applicable legislation or regulation to:(a) a public authority or regulatory body;(b) a court of law in any legal proceedings; or(c) the auditors of or any lawyer, insurer or professional person acting onbehalf of the parties.iv. For the avoidance of doubt, the company shall not provide any claimsor premiums data to the customer other than where such information isreasonably requested by the customer for a proper purpose as set out iniii. above (excluding, for the avoidance of doubt, any information relatingto the issue of Form P11D to included employees) or as otherwise agreedand accepted by the company.10. Data Protectioni. Both parties shall comply with the DPA as amended, re-enacted,modified or supplemented and in connection with the subject matterof this agreement.ii. Where personal data is supplied in connection with this agreement bothparties shall:(a) ensure that such personal data is only used for the purposesauthorised by the revealing party;(b) ensure that personal data which is connected in relation to the GroupPolicy can be lawfully used or disclosed in the manner anticipated by thereceiving party; and(c) advise the relevant party of any request it receives from data subjectsfor subject access or changes to the personal data under the DPA.iii. Each party shall keep the other fully and effectively indemnified against alllosses, costs, actions or demands which may be incurred or made againstthe other as a result, directly or indirectly of that party failing to complywith the DPA.iv. Both parties shall be considered Data Controllers for the purposesof the DPA.v. The company shall ensure that any personal data supplied by email to thecustomer is appropriately encrypted.11. Intellectual Propertyi. The customer shall not use the “Denplan” or “Simplyhealth” name orlogo or other trademark licensed to or owned by Denplan, Simplyhealthand/or the Simplyhealth group of companies, nor shall any intellectualproperty rights in the same be transferred to the Intermediary as aresult of this agreement.ii. All intellectual property rights in policy documentation and marketingmaterials relating to the Group Policy shall remain with and vest inSimplyhealth and/or the Simplyhealth group of companies.12. Accounts and RecordsThe customer shall maintain true and accurate accounts and records ofall matters connected with its appointment (for a minimum period of sixyears) and shall permit the company (or any person authorised by it) at allreasonable times to inspect such accounts and records and any papersrelating in whole or in part to the subject matter of this agreement.13. Non-paymenti Subject to sub-clause ii below, if the customer does not pay any invoicefrom the company in respect of premium in full within 30 days of suchinvoice being raised, unless otherwise agreed, the company shall treatsuch outstanding amounts as overdue and the following processshall apply:(a) if the full amount outstanding has not been received within 90 days ofthe relevant invoice being raised, the company may at any time suspendbenefits and claims payments for persons insured; and(b) if the full amount outstanding has not been received within 21 days ofthe company suspending benefits for persons insured pursuant tosub-clause a. above, the company may in its absolute discretion eithercancel the Group Policy or pursue the customer for payment by allavailable legal means.ii. If the customer disputes an invoice from the company in respect ofpremium, whether in whole or in part, either within 30 days of such invoicebeing raised or at any time during which such invoice is being treated bythe company as outstanding in accordance with sub-clause i. above, thefollowing process shall apply:(a) the customer shall provide details of the reasonable grounds (includingbut not limited to joiners/leavers, members list reconciliation andpremium amounts) on which it disputes such invoice in writing (including,for the avoidance of doubt, by email) to the company;(b) the company shall provide all reasonably necessary information to thecustomer to justify the amount of the invoice;(c) if the customer can evidence that such invoice is incorrect, itshall respond to the company within 10 working days of receiving theinformation set out in sub-clause b. above to request a corrected invoiceand the company shall issue such corrected invoice (which shall bepayable within 30 days in accordance with sub-clause a. above; and(d) if the customer cannot, in Denplan’s reasonable opinion, evidence thatsuch invoice is incorrect and/or does not respond within 10 workingdays of receiving the information set out in sub-clause i above shallcontinue to apply.14. Indemnityi. Subject to clause 15 below, the customer shall keep the companyfully and effectively indemnified against all costs, claims, actions ordemands which may be incurred by or made against the company andwhich may arise as a result of a breach of any term of this agreement bythe customer or as a result of any act of the customer in excess of theauthority given to it pursuant to this Agreement.ii. The customer agrees that the company may withhold any sums due to thecustomer that the customer is liable to pay under this indemnity.iii. For the avoidance of doubt, the company shall indemnify the customeragainst any claim brought by an employee of the customer arising from thefailure of the company to provide dental cover and or to process an includedemployee’s claim for treatment costs in line with the terms and conditionsof the relevant policy.15. Liabilityi. Neither of the parties (which for the purposes of this clause 15 shallinclude the customer’s assignees) limits its liability:(a) for fraud or theft by it or its employees;(b) for death and/or personal injury caused by its negligence or that of itsemployees, agents or subcontractors as applicable;(c) for which liability may not otherwise lawfully be limited or excluded;(d) in the case of the customer, for the indemnity provided to the companyunder this agreement;(e) for any regulatory losses, fines, expenses, or other losses arising froma breach by that party of any law or regulation under this agreement.ii. Subject to i. above, neither of the parties shall be liable to the other inrespect of any indirect or consequential loss or damage suffered arisingout of or in connection with the other’s acts and/or omissions in relationto this agreement, including, without limitation, any indirect loss ofbusiness or profits in each case whether arising from negligence, breachof contract or otherwise.10

16. No assignments or delegationThis agreement and all rights arising hereunder are and shall be personalto the parties and neither party shall assign, charge or deal with thesame without the previous written consent of the other and in particularthe customer shall not, without such consent, appoint any delegates,subcontractors or grant any rights pursuant to this Agreement to othersexcept as set out hereunder.17. No WaiverNo forbearance or indulgence by any party in enforcing any term or conditionof this agreement shall prejudice or restrict such parties rights under thisagreement and no waiver of any breach shall operate as a waiver of anysubsequent or continuing breach of such term or condition.18. Commencement, Renewal and Termination of this agreementi. This agreement shall operate from the commencement date subject topayment of the first amount of premium.ii. This agreement is initially for one year and, subject to sub-clausesiii. to v. inclusive below, continues thereafter for one year from eachanniversary of the commencement date by the customer paying therelevant renewal premium.iii. Renewal is subject to the terms of this agreement as amended from timeto time and this agreement, together with any addendums attached, shallbe reviewed at the time of such renewal.iv. The company reserves the right to refuse to renew this agreementin its absolute discretion (including but not limited to for reasonsof non-payment, outstanding debt, high risk profile or adverseclaims performance).v. If the company offers renewal terms in writing (including, for the avoidanceof doubt, by email) then this agreement shall automatically renew for ayear on those renewal terms unless the customer shall have advised thecompany in writing of its unwillingness to renew on such terms within tenbusiness days of the date such terms were sent to the customer.vi. The company reserves the right to terminate this agreement, immediatelyon the giving of written notice (including, for the avoidance of doubt, byemail), if;(a) any part of the premium remains unpaid for more than thirty days afterit has become due and payable; or(b) the customer has misled the company in any way; or(c) the customer has committed a material breach of any of its obligationsarising under this agreement.vii. Any termination or the non-renewal of this agreement shall be withoutprejudice to any accrued rights and obligations of both parties and, inparticular (but without limitation), the customer shall remain liable forpremium due and payable under this agreement.viii. The customer has the right to terminate this agreement, immediately ongiving of written notice (including, for the avoidance of doubt, by email), if:(a) the company has misled the customer in any way; or(b) the company has committed a material breach of any of its obligationsarising under this agreement.ix. This agreement may also be terminated immediately by either partyon the liquidation, (voluntary or not) administration, appointment ofadministrative receiver, bankruptcy or petition for bankruptcy of theother party.x. If the customer wishes to terminate this agreement at any other time andfor any other reason, it shall provide written notice of the same to thecompany and such termination shall be at the discretion of the companysubject to the company reserving the right to deem all premium in respectof the remainder of the contract year, calculated by reference to thoseincluded employees having the benefit of the Group Policy as detailed inthe most recent membership listing submitted to the company prior totermination, as immediately due, outstanding and payable in accordancewith the process outlined in sub-clause 4 iv. above.20. NoticesAny notice or document to be given pursuant to or in connection with thisagreement may be served by sending the same by prepaid first-class postaddressed to the relevant party at its address or by facsimile or by email (orsuch other address as such party shall have given in accordance with thisclause 19 for the purpose). Any notice or document so sent shall be deemedto have been served on the second day following the date of posting or sameday in the case of facsimile or email.21. Whole AgreementThis agreement constitutes the entire agreement and understanding betweenthe parties as to its subject matter and the parties acknowledge that theyhave not entered into this agreement in reliance upon any representation,warranty or undertaking which is not set out in this agreement.22. Variationi. The company reserves the right to vary the terms of business containedherein subject to thirty days’ written notice (including, for the avoidanceof doubt, by email) being given to the customer except in circumstanceswhere changes in the rules of a relevant self-regulating organisation arerequired to take effect earlier than that date, in which event written noticeof variation shall be given as soon as reasonably practicable.ii. In any event, these terms and conditions, together with any addendum,shall be reviewed one year from the commencement date23. Force MajeureNo party shall be considered in default in the performance of its obligationsunder this agreement or be responsible for any delay in the carrying out ofsuch obligations if its performance is prevented or delayed wholly or partlyas a consequence of any cause beyond the reasonable control of the partyaffected (including but not limited to acts of god, hurricane, flood, washout,explosion, fire, acts of public enemy, war, riot, sabotage, blockage embargo,civil disturbances, acts, orders, legislation, regulations or directives of anygovernmental or other public authorities, strikes, lockouts or other labour orindustrial disturbances).24. Contracts (Rights of Third Parties) Act 1999This agreement shall not create any rights enforceable by any person otherthan the customer, the company and Simplyhealth under the Contracts(Rights of Third Parties) Act 1999 or otherwise.25. SeverabilityEach of the provisions contained in each clause and sub-clause of thisagreement shall be enforceable independently of each of the others and itsvalidity shall not be affected if any of the others is invalid. If any of thoseprovisions is void but would be valid if some part of the provision wasdeleted, the provision in question shall apply with such modification as maybe necessary to make it valid.26. Governing Law and JurisdictionThis agreement shall be governed by the law of England and Wales andthe customer hereby irrevocably and unconditionally accepts the exclusivejurisdiction of the courts of England and Wales.19. Commencement, Renewal and Termination of the Group Policyi. The Group Policy cannot be assigned or charged in anymanner whatsoever.ii. The Group Policy shall not acquire a surrender value.iii. The Group Policy shall be governed by the law of England and Wales.iv. The company may change this policy by making an endorsement and thecustomer shall be told at least thirty days before the change takes effect.v. The company reserve the right to refuse renewal of the Group Policy.11

Application Form

✁Application FormPlease complete the application form and send it to:Denplan Corporate, Denplan Limited, Denplan Court, Victoria Road, Winchester, SO23 7RGCompany detailsName:Main contact & Title:Address:Email:Contact number:Invoice details (if different from above)Main contact & Title:Address:Email:Contact number:Intermediary details (if applicable)Name:Office address:Consultant:Email:Contact number:Scheme detailsCommencement date:0 1Cover for EmployeesFunding Option Products PremiumCompany Paid Denplan Lucent 1 £Flexible Benefit Denplan Lucent 2 £Salary Deduct Denplan Lucent 3 £Denplan Lucent 4 £Denplan Lucent 5 £Denplan Lucent 6 £Cover for DependantsAre dependants to be covered? Yes NoFunding OptionCompany PaidFlexible BenefitSalary Deduct✁

✁✁Application Form continuedScheme AdministrationEmployee welcome packs (please tick one)Fulfilled Electronically (via email)Fulfilled by postCompany Communications (please tick one)Direct to CompanyDirect to IntermediaryDirect DebitGuarantee• This Guarantee is offeredby all Banks and BuildingSocieties that takepart in the Direct DebitScheme. The efficiencyand security of theScheme is monitored andprotected by your ownBank or Building Society.Invoicing Instructions (please tick one)Monthly Direct Debit (we would prefer payment of premiums by this method)Annual Invoice• If the amounts to be paidor the payment dateschange, Denplan Ltd willnotify you three workingdays in advance of youraccount being debited oras otherwise agreed.Data Protection Act – you will see this sign where we ask you to give personal information.Denplan Limited is a member of the Simplyhealth Group. To set up and administer your policywe will hold and use information about you, and any family members covered by your policy,supplied by you or those family members and by medical providers. We may send it in confidencefor processing to other companies in the Simplyhealth Group (or companies acting on ourinstructions) including those located outside the European Economic Area. By signing this formyou and any family members covered by your policy consent to such use of this personal data.You may be contacted by post, telephone, or electronically if appropriate. If you do not wish us todo this please tick the appropriate box(es).SignatureDenplan Limited may send you details of our other products and services . To enable themto send you details of their services we may also share some of your details with otherSimplyhealth Group companies based within the European Economic Area and with othercarefully selected companies based within the European Economic Area .All prices quoted include insurance premium tax charged at the prevailing rate (excluding residentsof the Channel Islands and the Isle of Man). This application form must be signed by the payer whois purchasing the plan.I have read, understood and accepted the policy and contractual terms and conditions.Name (printed)• If an error is made byDenplan Ltd or your Bankor Building Society, youare guaranteed a fulland immediate refundfrom your branch of theamount paid.• You can cancel a DirectDebit at any time bywriting to your Bank orBuilding Society. Pleasealso send a copy of yourletter to Denplan forgroups at Denplan Ltd.This Guarantee should bedetached and retained bythe Payer.PositionDateDirect Debit - Instruction to your bank or building society to pay by Direct DebitOriginator’s Reference (to be completed by Denplan)Originator’s Identification Number: 4 0 2 4 1 6Name and full postal address of your bank or building societyTo the Manager:Bank/Building SocietyAddress:Postcode:Name(s) of Account Holder(s):Branch Sort Code:Bank/Building Society Account Number:Instruction to your Bank or Building Society - Please pay Denplan Ltd Direct Debits from the account detailed in this instructionsubject to the safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with Denplan Ltdand, if so, details will be passed electronically to my Bank/Building Society.Signature(s)DateBanks and Building Societies may not accept Direct Debit instructions from some types of accounts

EMPR2-0412Denplan Limited, Denplan Court, Victoria Road, Winchester, SO23 7RG, UK.Tel: +44 (0) 1962 828000. Fax: +44 (0) 1962 840846. Email: corporate@denplan.co.ukRegistered in England No. 1981238.Registered address Hambleden House, Waterloo Court, Andover, Hampshire SP10 1LQ.Part of the Simplyhealth Group, Denplan Limited is an Appointed Representative of Simplyhealth Access which is authorised and regulated bythe Financial Services Authority. This information can be checked by visiting the FSA register which is on their website:www.fsa.gov.uk or by contacting the FSA on 0845 606 1234. Denplan Limited is regulated by the Jersey Financial Services Commission.This policy is underwritten by Simplyhealth Access. Denplan Limited only arranges dental insurance from Simplyhealth Access.Premiums received are held by Denplan as agent of this insurer.Your calls may be recorded and monitored for training and quality assurance purposes.