Healthcare Scheme Membership Application

Your membership will not start until we have confirmed receipt of all of the required information and we will then be able to provide you with a joining date.

Please complete all sections before proceeding

Levels of membership

The healthcare scheme offers 4 levels of membership:

Individual - member only
Couple - member plus Spouse, Partner or Civil Partner (co-habiting)
Single Parent Family - member plus any dependent children residing at the same address as the member and under the age of 18
Family - member plus Spouse/Partner (co-habiting) and dependent children (including Step-Children) up to age 18

Please select your required membership level *

Individual

Couple

Single Parent Family

Family

Please select an option

Main Member Date of birth *
All adult members must be between 18 and 65

Please enter your date of birth (minimum age 17)

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Please complete the sections above to see your quote.

Please select your required cover option

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You must meet one of the requirements below to be eligible for this product.

Eligibility includes serving or retired police officers, police staff or specials; immediate family (including parents, brothers and sisters, children and grandchildren, parents-in-law, brothers and sisters-in-law, nieces and nephews) of a serving or retired Police Officer, Police Staff; or specials. See Scheme Rules.

Please select your eligibility: *

Please select an option

Force: *

Please select your force

Title *

Please select your title

First name *

Please enter your first name

Surname *

Please enter your surname

Email address *

Please enter your email address

Preferred contact number *

Please enter your contact number

Postcode *

Please enter your postcode

Error tings?

Select address Please select an address

Or, enter your address manually

Address line 1 *

Please enter the 1st line of your address

Address line 2

Address line 3

City *

Please complete this field

County

Additional applicant details

Add Additional Applicant

Title Please select a title

First Name Please enter additional applicants first name

Last Name Please enter additional applicants last name

Date of birth Please enter additional applicants date of birth

Save

Cancel

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PMHC Limited (Police Mutual) is committed to respecting and protecting your personal data. This section sets out what we will do with your information and explains your rights.

The information you have supplied will be used by Police Mutual to provide you with a quotation and administer your Healthcare membership if you choose to proceed.

To view our full privacy policy click here.

If you have any questions about our privacy policy, you can contact our Data Protection Officer directly at datacontroller@bspokegroup.co.uk or by writing to them at: 4th Floor, 24 Old Bond Street, London, W1S 4AW.

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PMHC Limited, trading as Police Mutual, would love to keep in touch about the great work we do to support the Police Service, our products and latest offers.

Other companies trading as Police Mutual would also like to let you know about their financial products and services. They are PMGI Limited, which is an insurance intermediary, provides a referral service for mortgage advice and independent financial advice, savings products, personal loans, wellbeing activities, car, home and breakdown insurance products.

Please let us know how you would like us to keep in touch, you can change your marketing preferences at any time:

Are you happy for us to do this by email?

Yes

No

Are you happy for us to do this by SMS?

Yes

No

Sometimes, a Group company trading as Police Mutual may contact you by post or telephone. We will give you the opportunity to choose not to receive further information by that method at the time. You can update your marketing preferences at any time by emailing nomarketing@pmas.co.uk or by calling 01543 441630. You can also use these details to ask us to stop contacting you by post and/or telephone.

To find out more about how your data is used and stored within Police Mutual and our promise to you visit: https://www.policemutual.co.uk/privacy-policy/

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The subscription for your chosen membership options are shown below.

Your subscription

per month (subject to review) for membership
( after the first 12 months)

Payment details

Please enter payment information below. Following this tab there will be a final section to agree to our Declaration before submitting your application.

To set up your direct debit online you must be the account holder and able to authorise debits from the account.

Account Name *

Please complete this field

Bank Account Number *

Please enter a valid bank account number

Sort Code *

Please enter a valid sort code

Please select your preferred direct debit payment date: *

1st of the month

25th of the month

Please select an option

Please enter valid bank account details

Instruction to your Bank or Building Society

Please pay PMHC Ltd direct debits from the account detailed subject to the safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with PMHC Ltd and, if so, details will be passed electronically to my Bank / Building Society.

To see the direct debit mandate and guarantee, please click here

Direct Debit Mandate

PMHC Ltd
3rd Floor
Exchange Station
Tithebarn Street
Liverpool
L2 2QP

Name(s) of account holder(s)

Bank/building Society account number

Branch sort code

Service user number

960224

Name and full postal address of your Bank or Building Society

To the manager

Instruction to your Bank or Building Society

Please pay PMHC Ltd direct debits from the account detailed subject to the safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with PMHC Ltd and, if so, details will be passed electronically to my Bank / Building Society.

Date

The Direct Debit Guarantee

This guarantee is offered by all Banks and Building Societies that accept instructions to pay Direct Debit.
If there are any changes to the amount, date or frequency of your Direct Debit, PMHC Ltd will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request PMHC Ltd to collect a payment, confirmation of the amount and date will be given to you at the time of the request.
If an error is made in the payment of your Direct Debit, by PMHC Ltd or your Bank or Building Society, you are entitled to a full and immediate refund of the amount paid from your Bank or Building Society. If you receive a refund you are not entitled to, you must pay it back when PMHC Ltd asks you to.
You can cancel a Direct Debit at any time by simply contacting your Bank or Building Society. Written confirmation may also be required. Please also notify us.

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Before we can complete your Healthcare Scheme Membership application, please confirm that the following statements are true:

I realise that I (and/or other family members) cannot claim for any pre-existing conditions;

Pre-Existing Condition means any injury, illness or condition, suffered in the 5 years prior to joining the health scheme:
(i) for which medical advice, attention or treatment has been received by the Beneficiary.
(ii) of which the Beneficiary was aware or ought reasonably to have been aware, but for which no medical advice has been sought.
I have reviewed the Terms & Conditions for the offer;
I confirm that I meet all of the eligibility criteria - see Terms & Conditions and Healthcare Scheme Rules;
I understand the content of this completed online application form and I wish to proceed to buy a subscription;
I confirm that the information I've provided is correct and accurate to the best of my knowledge and understanding;
I agree that if the information I've provided should change after I have purchased the subscription and during the period of the subscription, that I will let PMHC know. (Changes include change of address, membership level and eligibility status);
I accept that if the information provided by me is not correct and accurate, my membership may be cancelled or treated as if it never existed, and/or the insurer may refuse to pay all or part of any claim, or it may revise the subscription, and/or change any Member Contribution, or the extent of the membership;
I agree that if the application is accepted, I understand I must pay the monthly subscriptions for the membership to remain in place;
I am aware and agree that the subscription amount will be collected on the 1st or 25th of the month. I understand that subscriptions will be payable until either I or Police Mutual cancel the membership;
I understand that when I receive my member information, I have 30 days to change my mind and cancel my membership and have my subscriptions refunded (if no claims are made);

I confirm that the above statements are true

Please confirm the above statements are true

It's important you understand all of the Key Information for Healthcare Scheme Membership and check the Membership you are buying to ensure that it meets your needs. We recommend you read all of the Scheme Rules before you continue, and keep them in a safe place.

We will communicate with you regarding your membership and about Police Mutual Healthcare Scheme electronically. If you prefer to receive this information by paper please call us to discuss on 01543 441630.

I confirm that I have read the Scheme rules

Please confirm that you have read the documents

Healthcare Scheme Membership Application

Levels of membership

Your monthly subscription is ( after the first 12 months) subject to review
You have selected membership

Sorry, we are unable to complete your membership application online
Please call us on 01543 441 630 to discuss your requirements