Add a member to your policy

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Please tick this box to confirm you are the main policyholder

Your details

Please complete with the information we hold on file for you as the main policyholder

Please enter the date in the format dd/mm/yyyy

If the email address you have provided isn’t the one we hold on our records we will get in touch with you by phone or post

The details of the member you would like to add

Please enter the date in the format dd/mm/yyyy

Please enter the date in the format dd/mm/yyyy

Please select an underwriting option

More about underwriting types:

Moratorium underwriting

 You won’t be able to claim for any condition you had during the five years before your cover started.

If you have had a pre-existing condition in the five years before your start date, you’ll only be covered for it once you’ve been free from medication, treatment, diagnostic tests or advice for the condition for two continuous years after your cover started.

We will, of course, take care of any new health conditions from your start date.

Full medical underwriting

We consider your past health, and we may exclude any pre-existing conditions or any related or associated conditions unless we choose to accept them.

Please note: If you select full medical underwriting, we will add the member for you. However, you’ll still need you fill out an application form to make sure we have the person's most up-to-date medical history. If you don't complete the form, it could affect any future claims.

Child under 3 months old

If the member you’d like to add is under 3 months old, we’ll automatically add them from birth regardless of their health (on a medical disregarded basis)

If you are unsure

If you’re not sure, we can get in touch to discuss which option would be best.

Do you want to include a protected no claims discount (NCD)? (optional)

Each person covered on the policy has their own no claim discount. There are 15 levels and each person’s level increases by one level each year if they don’t claim, up to a maximum of 75%.

The NCD will stay at the same level for any new claims made, if the total we pay in a year is £250 or less.

If the total we pay is more than £250 in a year, the NCD discount will reduce by three levels

The NCD will never reduce by more than three levels in any one year.

NCD protection is available for a small additional premium.

NCD protection means your premium will not increase because you make a claim, it will just be your NCD protection that is lost. The NCD will apply in the usual way at your renewal.

Once you've been claim-free for a year, you can ask us to protect your NCD again.

Do you want a quote only, or to add the member?

If you want to add the member, we’ll send you confirmation of the premium by post

 

Additional dependent details

If you want to add other dependents please complete the following questions, otherwise you can simply submit the form

Dependent 2

Please enter the date in the format dd/mm/yyyy

Please only confirm their address if it is different to the employee's otherwise you can leave this blank.

Please select an underwriting option (optional)

More about underwriting types:

Moratorium underwriting

 You won’t be able to claim for any condition you had during the five years before your cover started.

If you have had a pre-existing condition in the five years before your start date, you’ll only be covered for it once you’ve been free from medication, treatment, diagnostic tests or advice for the condition for two continuous years after your cover started.

We will, of course, take care of any new health conditions from your start date.

Full medical underwriting

We consider your past health, and we may exclude any pre-existing conditions or any related or associated conditions unless we choose to accept them.

Please note: If you select full medical underwriting, we will add the member for you. However, you’ll still need you fill out an application form to make sure we have the person's most up-to-date medical history. If you don't complete the form, it could affect any future claims.

Child under 3 months old

If the member you’d like to add is under 3 months old, we’ll automatically add them from birth regardless of their health (on a medical disregarded basis)

If you are unsure

If you’re not sure, we can get in touch to discuss which option would be best.

Do you want to include a protected no claims discount (NCD)? (optional)

Each person covered on the policy has their own no claim discount. There are 15 levels and each person’s level increases by one level each year if they don’t claim, up to a maximum of 75%.

The NCD will stay at the same level for any new claims made, if the total we pay in a year is £250 or less.

If the total we pay is more than £250 in a year, the NCD discount will reduce by three levels

The NCD will never reduce by more than three levels in any one year.

NCD protection is available for a small additional premium.

NCD protection means your premium will not increase because you make a claim, it will just be your NCD protection that is lost. The NCD will apply in the usual way at your renewal.

Once you've been claim-free for a year, you can ask us to protect your NCD again.

Dependent 3

Please enter the date in the format dd/mm/yyyy

Please only confirm their address if it is different to the employee's otherwise you can leave this blank.

Please select an underwriting option (optional)

More about underwriting types:

Moratorium underwriting

 You won’t be able to claim for any condition you had during the five years before your cover started.

If you have had a pre-existing condition in the five years before your start date, you’ll only be covered for it once you’ve been free from medication, treatment, diagnostic tests or advice for the condition for two continuous years after your cover started.

We will, of course, take care of any new health conditions from your start date.

Full medical underwriting

We consider your past health, and we may exclude any pre-existing conditions or any related or associated conditions unless we choose to accept them.

Please note: If you select full medical underwriting, we will add the member for you. However, you’ll still need you fill out an application form to make sure we have the person's most up-to-date medical history. If you don't complete the form, it could affect any future claims.

Child under 3 months old

If the member you’d like to add is under 3 months old, we’ll automatically add them from birth regardless of their health (on a medical disregarded basis)

If you are unsure

If you’re not sure, we can get in touch to discuss which option would be best.

Do you want to include a protected no claims discount (NCD)? (optional)

Each person covered on the policy has their own no claim discount. There are 15 levels and each person’s level increases by one level each year if they don’t claim, up to a maximum of 75%.

The NCD will stay at the same level for any new claims made, if the total we pay in a year is £250 or less.

If the total we pay is more than £250 in a year, the NCD discount will reduce by three levels

The NCD will never reduce by more than three levels in any one year.

NCD protection is available for a small additional premium.

NCD protection means your premium will not increase because you make a claim, it will just be your NCD protection that is lost. The NCD will apply in the usual way at your renewal.

Once you've been claim-free for a year, you can ask us to protect your NCD again.

Dependent 4

Please enter the date in the format dd/mm/yyyy

Please only confirm their address if it is different to the employee's otherwise you can leave this blank.

Please select an underwriting option (optional)

More about underwriting types:

Moratorium underwriting

 You won’t be able to claim for any condition you had during the five years before your cover started.

If you have had a pre-existing condition in the five years before your start date, you’ll only be covered for it once you’ve been free from medication, treatment, diagnostic tests or advice for the condition for two continuous years after your cover started.

We will, of course, take care of any new health conditions from your start date.

Full medical underwriting

We consider your past health, and we may exclude any pre-existing conditions or any related or associated conditions unless we choose to accept them.

Please note: If you select full medical underwriting, we will add the member for you. However, you’ll still need you fill out an application form to make sure we have the person's most up-to-date medical history. If you don't complete the form, it could affect any future claims.

Child under 3 months old

If the member you’d like to add is under 3 months old, we’ll automatically add them from birth regardless of their health (on a medical disregarded basis)

If you are unsure

If you’re not sure, we can get in touch to discuss which option would be best.

Do you want to include a protected no claims discount (NCD)? (optional)

Each person covered on the policy has their own no claim discount. There are 15 levels and each person’s level increases by one level each year if they don’t claim, up to a maximum of 75%.

The NCD will stay at the same level for any new claims made, if the total we pay in a year is £250 or less.

If the total we pay is more than £250 in a year, the NCD discount will reduce by three levels

The NCD will never reduce by more than three levels in any one year.

NCD protection is available for a small additional premium.

NCD protection means your premium will not increase because you make a claim, it will just be your NCD protection that is lost. The NCD will apply in the usual way at your renewal.

Once you've been claim-free for a year, you can ask us to protect your NCD again.

This can be things like needing your documents in an alternative format, or requiring additional support with communications due being hard of hearing or needing a translator.

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