Practi A&E Dental Support Scheme

Important Information

What to do in a dental emergency?

If You are experiencing a dental emergency and are within 30 miles of Your own Dental Practice, You should contact them to access their emergency support in the first instance.  

If You are more than 30 miles away from Your Dental Practice, You may contact any GDC registered dentist.

Practi does not at this time work with dental practices overseas. Therefore if You have an emergency while abroad, You can see any registered and qualified dentist of Your choice.  

Important note – Whilst this A&E Dental Support Scheme (also referred to in this document as the ‘Discretionary Scheme’) supports certain emergency dental treatment it does not support treatment in a life-threatening situation, a dental or oral problem that might affect a medical condition, or severe or uncontrollable bleeding. If You believe that You, or any person You are assisting, needs treatment in such circumstances, You should immediately dial 999 or seek alternative emergency medical services.

How to contact Practi

Following emergency treatment, or if you need to request indicative approval for treatments, You can contact us easily in three ways:

• Online Live Support - Visit our Practi support site (open Monday to Friday, 9am to 5pm UK time)  
• Online Form Submission - Use our Practi online forms page, where You can submit a Request for Assistance (RFA) form
• Email to receive a form - Email us at support@practihealth.co.uk and we will send You an online form to complete

If You have complex needs and would benefit from speaking to someone, please contact us through one of the above channels and we’ll arrange a convenient call-back to guide You through the Discretionary Scheme.

What is the A&E Dental Support Scheme?

The A&E Dental Support Scheme is a discretionary scheme where Scheme Members can request financial assistance in the event of a dental emergency.

Practi will decide on such requests for assistance on a wholly discretionary basis. This means that, whilst the Discretionary Scheme aims to provide benefits for Scheme Members, the Discretionary Scheme has no obligation to provide any benefit unless Practi first decides (in its sole and absolute discretion) that the Discretionary Scheme will provide a benefit. Being a Scheme Member does not create an entitlement to benefit from the Discretionary Scheme, but rather gives rise to eligibility to request assistance from the Discretionary Scheme from Practi.

Practi will assess each request for a benefit from a Scheme Member individually, taking into account the circumstances of a request and the Discretionary Scheme's resources. When doing so:

• Practi may decide not to provide any benefit at all
• Practi may provide a benefit in some cases but decline to do so in other, same, or similar cases
• There are certain circumstances where the Discretionary Scheme will never provide a benefit, as explained in more detail below

Terms and Conditions

The Practi A&E Dental Support Scheme is a discretionary scheme established to offer support and assistance to Scheme Members who request treatment following a dental emergency. The A&E Dental Support Scheme is a wholly discretionary scheme, not an insurance scheme or an insurance policy. Under the Discretionary Scheme, Practi may make a discretionary payment of certain benefits at Our sole and absolute discretion, meaning that such benefits are not guaranteed. Further details are set out in this document. As this is a discretionary scheme, if it is possible for You to do so, You should consider contacting Us before incurring any costs.

1. Definitions

This document sets out the terms of the Practi A&E Dental Support Scheme.  

Access may be granted either through a dental Plan or by separate registration. The following definitions apply only within this document.

Commencement Date/ Start Date – The date Your access to the Practi Discretionary Scheme begins.

Contact Sport – Any sport, including training, that has an elevated dental trauma risk including but not limited to basketball, boxing, field hockey, ice hockey, martial arts, rugby, water polo and wrestling.

Dental Injury/ Injuries – An injury to the teeth or supporting structures (including damage to dentures whilst being worn) which is directly caused suddenly and unexpectedly by means of a direct external impact to the mouth.

Dental Practice – The legal entity that owns the dental practice that You are registered with as a Plan and/or Scheme Member. Examples include a Corporate Body, Goodwill Owner dentist as a sole trader, Limited Company or LLP.

Dental Care Professional/ Dentist – A person qualified to practice certain aspects of dental care that is registered with the General Dental Council (GDC) to work in the UK.

Discretionary Scheme – Practi’s A&E Dental Support Scheme as set out in this document.

Domiciliary Visit – A visit made for the purpose of providing Emergency Dental Treatment at a location other than the Dental Practice where You are currently registered.

Emergency Dental Treatment – Treatment provided at the initial emergency appointment, urgently required for the relief of severe pain, inability to eat, stop bleeding from the gums or teeth (which is not severe or uncontrollable), the control of acute infection or a condition which causes a severe threat to Your general health.

Fee/s – The money due to Us with regard to the provision of this Discretionary Scheme, either as a Scheme Member only or as part of a separate Plan.

Implant(s) – A titanium, zirconia, or ceramic root-shaped fixture designed to integrate with the bone, to replace the root of a tooth and support the replacement tooth or teeth.

Implant Upgrade Assistance – The optional add-on described in Section 8 that extends Dental Injury assistance for Implants.

Mouth Cancer – A malignant tumour, with its primary site being in the hard and/or soft palate, gland tissue (including accessory, salivary, lymph and other gland tissue) in the mucosal lining of the oral cavity but excluding the tonsils, which is characterised by the uncontrolled growth and spread of malignant cells and the invasion of tissue. This excludes non-invasive cancer in situ.

Permanent Dental Treatment – Definitive treatment that is clinically necessary to secure and maintain oral health.

Plan – A dental plan provided by Your Dental Practice, which you have agreed to separately. This plan may grant you access to this Discretionary Scheme as a Scheme Member.

Practice Team – A group of dental professionals who together provide care for a Scheme Member.

Scheme Member – An individual who has been granted access to the Discretionary Scheme, either as part of a dental plan or through separate registration.

Scheme Year – 1st January to 31st December or the period of time between the Commencement Date and 31st December

Temporary Dental Treatment – Such care and treatment that is immediately and necessarily required to stabilise the oral condition pending further definitive treatment.

United Kingdom (UK) – England, Wales, Scotland, and Northern Ireland.

We, Us, Our, Practi – means Simplyhealth Venture One Limited (company number 14603737) whose registered office address is at Anton House, Chantry Street, Andover, Hampshire, England, SP10 1DE.

You, Your – A Scheme Member who is eligible to make a request for benefits from Practi under this Discretionary Scheme.

All other terms not defined here, or in a separate Plan Agreement if You have one, take their plain-English meaning.  

2. Requests for Assistance – General

If Practi decides (in the exercise of its sole and absolute discretion) that the Discretionary Scheme should provide a benefit in response to a request for assistance, the request will be assessed against the benefit levels in force and the Discretionary Scheme resources at the date of the occurrence of the dental emergency. Practi will seek to maintain a reserve from payments made by Scheme Members. It will be used to assist Scheme Members making requests for assistance under the Discretionary Scheme. If there are insufficient funds available in the reserve, Practi will not be able to assist.

1. To submit a request for assistance, you must ensure the following:
   • Requests for assistance will only be accepted if received by Us via the official Practi Discretionary Scheme online request form, e-signed or attested to by You. Incomplete request assistance submissions will not be processed and may cause a delay in Your request being assessed. Request for assistance forms must be completed at Your own expense and should be received by Us within 60 days of the completion of Your dental treatment, if reasonably possible.
   • Your request for assistance must be supported by proof of treatment, detailing the dates and costs of each individual treatment. The proof must be on a receipt or an official document issued by the treating dental clinician.
   • Please note that it may be necessary to provide relevant x-rays and/or Your dental records in support of a Dental Injury request for assistance.
   • We may require You to be examined by a dentist or other medical specialist (at Our expense) in relation to Your request for assistance. In choosing a relevant dentist or specialist We will consider Your personal circumstances. You must co-operate with any dentist or specialist chosen by Us or We may not pay any benefit for Your request for assistance.
   • No benefit will be payable if We have not received proof of all facts relevant to Your request for assistance. This shall include but not be limited to:
     • proof of Your eligibility for assistance on the date of treatment;
     • proof of the dental treatment, this may be by way of a medical report (at Your own expense);
     • request for assistance under the worldwide Dental Injury benefit, details pertaining to the circumstances of the injury You have experienced.
2. In the event that You request compensation against a third party, We reserve the right to recover any treatment costs for which You have received a compensation payment.
3. If the treatment is received overseas and We agree at Our sole discretion to pay a benefit, then We will pay benefits in pounds sterling. We will convert the expenditure into sterling using Xe Currency Converter at https://www.xe.com. The exchange rate will be calculated at the rate in force on the date of the receipt.
4. We reserve the right to disclose requests for assistance information to Your registered Dental Practice.
5. If Practi decides (in the exercise of its sole and absolute discretion) that the Discretionary Scheme should provide a benefit in response to a request for assistance, such benefit will be payable from the Discretionary Scheme. Payment of the benefit is normally made direct to You, if You have directly and properly incurred costs (and can evidence the same with documentary proof of purchase of treatment as set out above).
6. You must tell Us if You are able to make a request for assistance in respect of any of the costs from another discretionary scheme, an insurance policy or other third party. If you are covered by an insurance policy in respect of such costs, We will not pay any benefit.
7. Any benefits that We, at Our absolute and sole discretion, agree to pay for dental treatment not strictly listed under this Discretionary Scheme will count towards Your annual maximum benefits. We shall not, by making any such payment, be liable to pay any future benefits in respect of such dental treatment.

If We at Our sole discretion agree to pay a benefit following a request for assistance, which is more than You are entitled to under the Discretionary Scheme, We can recover the overpayment. We will ask You to repay the overpayment or deduct that amount from any other request that You make.

3. Schedule of Benefits

The benefits shown below are available to You under this Discretionary Scheme provided that You, the Scheme Member, comply with the terms and conditions of the Discretionary Scheme.  All benefits are offered at Our discretion.

Benefit A: Emergency Dental Treatment in the UK

For the cost of Emergency Dental Treatment within the UK when You are more than 30 miles away from Your Dental Practice. You may request payment up to the following specified limits 1-16 shown below for temporary dental treatment up to a total of £450 per incident, subject to a maximum of £900 per Scheme Year. Any subsequent treatment required after the initial appointment is excluded. Payments will only be made for treatments in connection with emergencies that commence within a period of 14 days of the date of the accident occurring.

Benefit A Limits

Benefit B: Worldwide Dental Injury

You may request assistance worldwide with the cost of Permanent Dental Treatment received in connection with a Dental Injury which occurs after Your Commencement Date, subject to the limits set out below.

You may request that We pay up to the specified benefit limits under Benefit B for Permanent Dental Treatment (including appropriate temporary support). The overall limit for Dental Injuries is £4,000 per Scheme Year. If Your own contracted Dental Practice will not be providing this Permanent Dental Treatment, please contact Us prior to the commencement of the treatment. Prior indicative approval must be obtained from Us if the costs are likely to exceed £200.

Benefits will only be payable for treatments in connection with Dental Injuries that commence within a period of three months of the date of the original incident and/or notification of an intention to request for assistance, and while this Discretionary Scheme is in force. If this spans a Scheme Year, We will treat the request for assistance as a continuing request for assistance and We will continue to support Your treatment after the current Scheme Year has ended. However, in no event will any benefit be payable for treatment received more than 12 months after the date of the injury.  

We reserve the right to settle requests for assistance in line with the respective benefit limits only where, prior to the Dental Injury, the affected teeth and supporting structures were in a reasonable and stable oral condition. Evidence of maintaining oral health – such as regular dental check-ups and following recommended treatments – may be required, based on an assessment by a qualified dental practitioner (which we may appoint if needed).

Benefit B Limits

*If there are issues with the supply of materials for porcelain jacket crowns, please ask Your Practice Team to contact Us at support@practihealth.co.uk for advice on how to proceed. Where treatment involves replacing a crown, bridge, veneer or denture, any benefit paid will be according to the cost of a replacement of similar type and quality. Treatments 19-25 include all construction and fitting procedures, together with appropriate temporary support. If You do not have Discretionary Scheme Implant Upgrade Assistance and Implants are clinically required, you may request payment towards the cost of Implants up to the value of the equivalent bridgework within the specified benefit limits.

Benefit C: Consultation for dental emergency or Dental Injury

You may ask Us to pay the fees below when a dentist re-opens their practice to provide Emergency Dental Treatment or for a Dental Injury in the UK within the following specified times. Please note that You will be responsible for the first £20 of each and every call-out request for assistance under this benefit, e.g. the maximum that We will pay for an out of hours consultation on Christmas Day is £180.

Benefit C Limits

Benefit D: Hospital Cash Benefit

You may ask Us to pay the fees below when a dentist re-opens their practice to provide Emergency Dental Treatment or for a Dental Injury in the UK within the following specified times. Please note that You will be responsible for the first £20 of each and every call-out request for assistance under this benefit, e.g. the maximum that We will pay for an out of hours consultation on Christmas Day is £180.

Benefit D Limits

Benefit E: Overseas Temporary Emergency Dental Treatment

Practi does not work with dental practices overseas, and You may therefore see any dentist of Your choice. If, while overseas, You require Emergency Dental Treatment, you may ask us to pay up to the limits specified below for Temporary Dental Treatment or for Permanent Dental Treatment where indicative approval has been given by us.

Benefit E Limits

Benefit F: Mouth Cancer Support

If We, at Our sole and absolute discretion, agree that the Discretionary Scheme will make payment of a benefit following Your request for assistance, We will only pay the benefit once the Scheme Member has been referred to a specialist by their general practitioner or dentist. This benefit supports You for:

• Treatment charges up to £3,000 for treatment of Mouth Cancer
• Up to 14 days hospital cash benefit

Conditions:

The benefit will be paid only for treatment received within 12 calendar months of the date of diagnosis while Your Discretionary Scheme membership is active. Payment will be paid for one course of treatment only, in connection with a specific occurrence of Mouth Cancer. No further benefits are payable in the event of a re-occurrence of this same cancer, either at the same site or at a different location.

This benefit will be paid only for treatment given by a consultant who is recognised as a specialist in cancer treatment by the UK’s National Health Service (NHS), or treatment provided by another medical practitioner under referral from a consultant.

The hospital cash benefit will only be paid for overnight stays directly relating to the initial occurrence of Mouth Cancer.

4. Eligibility

You can only be assisted under the terms and conditions of this Discretionary Scheme from the Commencement Date if You are a UK resident and a Scheme Member.

5. Exclusions

This Discretionary Scheme does not provide assistance for:

Benefit A: Emergency Dental Treatment in the UK

1. Emergency Dental Treatment in the UK carried out by Your own Practice Team, a dentist acting on behalf of Your Dental Practice or a dental practice within 30 miles of Your Dental Practice.
2. Permanent Dental Treatment without indicative approval given by us.

Benefit B: Worldwide Dental Injury

1. Injury caused by the consumption of food (including foreign bodies contained within the food) or by other foreign objects in the mouth, such as but not limited to piercings, jewellery and bottles.
2. Treatment following Dental Injury more than 12 months after the date of the injury to which the treatment relates.
3. Damage caused by tooth brushing or other oral hygiene procedures.
4. Implants and all costs associated with the preparation and fitting of such a device unless registered for Discretionary Scheme Implant Upgrade Assistance as shown in the payment schedule.
5. Dental Injury caused whilst participating in any form of Contact Sport where You have not worn a suitable protective gum shield; or extreme sports, including cliff jumping, horse riding, polo, river rafting, sky diving and white-water kayaking.
6. Loss of, or damage to dentures, other than whilst being worn.
7. Normal Wear and tear.

Benefit E: Overseas Temporary Emergency Dental Treatment

1. Permanent Dental Treatment without indicative approval given by Us.

Benefit F: Mouth Cancer Support

1. Mouth Cancer which is diagnosed before or within 90 days of Your Commencement Date or for which tests or consultation began within those 90 days, even if the diagnosis is not made until later.
2. Charges for consultations or tests for non-invasive tumours under the Mouth Cancer Support benefit.
3. Mouth Cancer resulting from the use of tobacco products or betel nut, or from prolonged alcohol abuse.
4. Mouth Cancer which is found in the tonsils.
5. Mouth Cancer which would not have occurred had You followed medical advice, including from any dental practitioner.

General

1. Any dental treatment which was prescribed, planned, diagnosed as necessary or is currently taking place at the Commencement Date.
2. Cosmetic treatment, or any dental treatment not clinically necessary for the establishment or maintenance of oral health.
3. Reimbursement for travelling expenses or telephone calls (unless to the 24-Hour Worldwide Dental Emergency Helpline from overseas).
4. Specialist treatment, meaning any form of dental care or treatment beyond the scope of the average competent dental practitioner, unless as a result of a Dental Injury.
5. Treatment, care or repair of teeth, gums, mouth or tongue in connection with ‘mouth jewellery’.
6. Self-inflicted injury.
7. Mouth guards, gum shields or any dental appliances unless in conjunction with a Dental Injury.
8. Teeth and supporting structures that were not in a reasonable and stable oral condition prior to the Dental Injury.
9. Missed appointment fees.
10. Dental Injury resulting from a hospital surgical procedure with or without the administration of general anaesthetic.

6. Cancellation

6.1 Cancellation by You

1. If you access the Discretionary Scheme through a Plan, it cannot be cancelled separately.
2. Cooling-off: The 14-day cooling-off period in Section 9 of Your Plan Agreement applies. Cancelling Your Plan within that period will also end Your access to the Discretionary Scheme.
3. After the cooling-off period: You may cancel Your Plan in line with Section 9 of the Plan Agreement. If you do, Your access to the Discretionary Scheme will also end.

6.2 Cancellation by Practi or Your Dental Practice

‍Practi and/or Your Dental Practice may terminate Your Plan for any reason and in the manner set out in sections 9 and 10 of the Plan Agreement (including fraud, abuse, breach of terms, or non-payment). Termination of the Plan automatically ends this Discretionary Scheme benefit.

6.3 Cancellation of Optional Implant Upgrade Assistance

If you have purchased the Implant Upgrade Assistance (see Section 8):

• Cooling-off: You may cancel it within 14 days of purchase by emailing support@practihealth.co.uk or using the cancellation web form referenced in Section 15 of Your Plan Agreement. ‍
• After the cooling-off period: You may cancel Your Implant Upgrade Assistance at any time by giving 30 days’ notice via the same channels.
• Cancelling the Implant Upgrade Assistance does not cancel Your underlying Plan or the core Discretionary Scheme. However, if Your Plan ends for any reason, the Implant Upgrade Assistance ends automatically on the same date.

7. General

1. This contract between the Scheme Member and Us is made up of these terms and conditions, the payment schedule and any other notices provided by us.
2. Non-payment of Your subscription under the Discretionary Plan or Your membership fees under Your Plan will result in Us suspending Your benefits, and taking all necessary action to recover monies outstanding.
3. The Discretionary Scheme is operated by Simplyhealth Venture One Limited (14603737), trading as Practi. The Discretionary Scheme makes payments to fund treatment at the sole and absolute discretion of Practi. Practi will seek to maintain a reserve from payments from Scheme Members or dental practitioners. It will be used to assist Scheme Members making requests for assistance under the Discretionary Scheme. If there are insufficient funds available in the reserve, Practi will not be able to assist. Practi uses internal expertise to regularly review the levels of resource it has and uses past experience to determine what requests for assistance might arise in the future and how much the Discretionary Scheme can afford to pay in response to requests for assistance. Practi is not a fund manager and the reserve is not a regulated fund or collective investment scheme.
4. This terms and conditions of this Discretionary Scheme are governed by and construed in accordance with the laws of England and Wales.
5. The Discretionary Scheme is written in English and all other information and communications to the Scheme Member relating to the Discretionary Scheme will also be in English. Receipts and evidence of purchases must be translated correctly (at Your cost) in English.
6. Practi reserves the right to vary, amend or supplement this Discretionary Scheme, the Implant Upgrade Assistance, and accompanying schedules at any time. In particular, We will review the limits in the schedules at least once a year, as well as any exclusions and geographic scope of any assistance. Any such alterations shall not affect the benefit for an eligible, notified request for assistance in respect of which Practi has decided (in the exercise of its sole and absolute discretion and prior to the date of the said alterations) that the Discretionary Scheme should provide a benefit. The latest version of this Discretionary Scheme, including Benefit levels, will be available at Your Dental Practice and on the Practi website (https://www.practihealth.co.uk).
7. If You (or anyone acting on Your behalf) make a request under Your Plan or obtain support knowing it to be false or fraudulent, We can refuse to pay Your request for assistance. If We have already paid Your request for assistance We can recover those sums from You. Where We have paid a request for assistance later found to be fraudulent (whether in whole, or in part), We will be able to recover those sums from You and/or take the appropriate legal action against You.  
8. If you are on a separate Plan, Your monthly Fee may change in line with the Plan’s terms. If You are a standalone Scheme member, Your monthly Fee may be changed at any time by giving at least 30 days’ notice.
9. Payment for this Discretionary Scheme benefit is collected with Your monthly Plan fee by Direct Debit. The payment schedule, failed-payment process and any resulting cancellation follow section 10 of Your Plan Agreement.
10. All Scheme Members must provide an up-to-date email address, though by exception postal addresses may be accepted.
11. We will not provide assistance or pay requests for assistance under this Discretionary Scheme if doing so would expose Us to a breach of international economic sanctions, laws or regulations, including but not limited to those provided for by the European Union, United Kingdom, United States of America or under a United Nations resolution. If a potential breach is discovered, where possible We will advise You in writing as soon as We can.

8. Discretionary Scheme Implant Upgrade Assistance

This section is only applicable to You if You or the Scheme Member has registered for Discretionary Scheme Implant Upgrade Assistance to be added to this Discretionary Scheme. The terms and conditions in this section show Your eligibility for requesting benefits to be paid for dental implant treatment costs necessary as a direct result of a Dental Injury. This is an upgrade product providing eligibility to request specific extra Dental Injury benefit, additional to Your existing Discretionary Scheme. This section provides the additional terms and conditions of Discretionary Scheme Implant Upgrade Assistance. Should there be any discrepancy between the contents of this section and the other sections within the Discretionary Scheme, the following replaces it.

Schedule of Benefits

If You sustain a Dental Injury, and Practi decides at its sole and absolute discretion that the Discretionary Scheme will provide a benefit, that benefit will be paid for the actual cost of treatment described below up to the limits specified.

Before submitting Your request for assistance under this Discretionary Scheme Implant Upgrade Assistance in connection with Benefit B, please note that should Implants be clinically required, following a Dental Injury, We will pay for an implant fixture to replace an existing tooth root or existing Implant up to the specified limits below.

Benefit B Worldwide Dental Injury Benefit Limits

Exclusions

In addition to the exclusions shown in Section 5 ‘Exclusions’ the Discretionary Scheme Implant Upgrade Assistance does not provide benefits in relation to:

• Implant placement where the Dental Injury occurred within 28 days of the Commencement Date of the Implant Upgrade Assistance.
• Placement of an implant into a pre-existing  space where a tooth is missing or where a Dentist deems it not clinically appropriate, or replacement following the failure of an implant to integrate.
• Any implant treatment which was prescribed, planned or is currently taking place at the Commencement Date of the Implant Upgrade Assistance.
• Teeth and supporting structures that were not in a reasonable and stable condition prior to the Dental Injury.

9. Personal Data

Practi, as part of the Simplyhealth Group, is the data controller in respect of any personal data processed in connection with Your plan and is responsible for processing Your personal data in order to administer and manage Your Plan and, where You have eligibility under the Discretionary Scheme, We will also act as controller in administering this benefit.

Please refer to the current Practi Privacy Policy, which can be found on our website at https://www.practihealth.co.uk/privacy, for a full understanding of how We collect, store, or use Your personal data.