AIMS AND OBJECTIVES
1. To provide members of the New Zealand Firefighters’ Welfare Society and their families with assistance in health care during any illness by providing a mutual fund to assist in meeting medical costs
TRUSTEESHIP AND CLAIMS MANAGEMENT
2. The Trustee of Healthcare ’99 shall be the New Zealand Firefighters’ Welfare Society.
3. The Claims Manager of Healthcare ’99 shall be determined from time to time by the Trustee but shall initially be Gallagher Bassett NZ Ltd.
MEMBERSHIP
4. All members of the New Zealand Firefighters’ Welfare Society are eligible to become members of Healthcare ’99 upon completion and submission of the application form to the Trustee provided no pre-existing medical conditions exist. If pre-existing medical conditions exist applicants will only be accepted for membership if approved by the Trustee.
5. Existing members of Healthcare ’99 may terminate their own membership from the fund by giving fourteen (14) days’ notice in writing to the Trustee of that member’s intention to cease membership of the fund.
6. Membership of the fund shall cease immediately upon that member’s termination of membership of the New Zealand Firefighters’ Welfare Society.
7. The Trustee may give notice to any member that their membership shall be terminated by the Trustee if arrears of contributions are not paid in full to the Trustee within fourteen (14) days of the date such notice is sent to the member by ordinary post to the last known address of the member. In the event that the member fails to pay all arrears of contributions within the time allowed the Trustee may terminate that member’s membership at any time from expiry of that date and notify the member accordingly by notice in writing to the last known address of the member.
CONTRIBUTIONS
8. The level of contributions shall be determined from time to time by the Trustee after obtaining professional advice. The level of contributions is set out on the back page.
9. The contributions may be made to provide benefits for the member, his or her spouse and dependent children, which shall be based upon the option chosen by the member.
10. Contributions are deducted fortnightly, monthly or annually in advance from wages, salary or by direct debit from a bank account.
CONSIDERATION OF CLAIMS AND PAYMENT OF BENEFITS
11. After payment of all expenses and other charges related to the fund the Trustee may in its absolute discretion, at any time or times:
11.1 Accumulate all or any part of the contributions as an addition to the capital of the fund;
11.2 Retain out of, or charge against the contributions for a financial period any reserves or other provisions that the Trustee thinks fit against any liabilities of the fund;
11.3 Consider claims by financial members for assistance with the costs of medical treatment and determine in its absolute discretion whether to accept any claim and the amount of any benefits to be paid.
12. In exercising its discretion, the Trustee may obtain and consider
Professional advice and may be guided by:
12.1 The contributions available;
12.2 The nature and extent of the claims received; and
12.3 The advice of the Claims Manager
13. A member is not a financial member If contributions are in arrears
CLAIMS
14. Members must claim within 30 days of the date of the treatment or event.
15. Claims will only be considered upon receipt of a full completed official claim form. Please download a form from www.firefighters.org.nz and email to nz.healthcare99@gbtpa.co.nz. Alternatively, you can complete your claim online.
16. For small reimbursement claims, the member is expected to pay for the service and seek reimbursement. For higher value claims, Gallagher Bassett can pay the provider directly on your behalf.
17. Whenever a member expects the cost of medical treatment or hospitalisation to exceed his or her own financial resources the member may apply for urgent consideration of the member’s claim.
18. In the event that the Trustee or the Claims Manager acting as the Trustee’s agent declines a claim made by a member, that member may appeal by notice in writing to within twenty-eight (28) days of the decision, to the Trustee for reconsideration of the member’s claim.
Upon receiving notice of such an appeal, the Trustee shall reconsider the claim of the member and either declines it or accepts in whole or in part as the Trustee in exercise of its absolute discretion deems appropriate. The decision of the Trustee shall be final.
DISPUTE RESOLUTION
Unless any dispute or difference is resolved by mediation or other agreement the same shall be submitted to the arbitration of one arbitrator who shall conduct the arbitral proceedings in accordance with the Arbitration Act 1996 and any amendment thereof or any other alternative statutory provision then relating to arbitration.
TERMS AND CONDITIONS
Consideration for benefits under this mutual fund are available only to persons who have been accepted and remain acceptable by the Society for participation in Healthcare 99 and at all times during the currency of the fund are current with all contributions required.
Contributions are payable in advance.
All benefits are payable in New Zealand currency.