Group Travel Insurance Proposal Form

About you


The Expedition/Trip

Group details


To enable us to provide a quotation, please detail the number of people to be covered in the age bands below:

We will require a full list of participants when the policy is taken out.


Important Conditions Relating to Health

Note: If you are acting on behalf of a group, please ensure each person to be insured has read and understood the following.Any Medical Screening must be completed by the individual (or parent/guardian if child) with the Medical Condition(s). You must complete the Medical Screening before you proceed with your insurance application. Any medical conditions not declared to us will not be covered.

You will NOT be covered under section 1 - Cancellation or Curtailment Charges, section 2 - Emergency Medical & Other Expenses, section 3 - Hospital Inconvenience Benefit and Section 4 - Personal Accident.


For any trip where at the time of taking out or renewing this insurance you:

A) are waiting for an operation, hospital consultation (other than for regular check-ups for a stable well controlled condition) or other hospital treatment or investigations, or are awaiting the results of any tests or investigations; or

B) have received a terminal prognosis; or

C) travel against the advice of a medical practitioner or where you would have been if you had sought their advice before beginning your trip; or

D) know you will need treatment or consultation at any medical facility during your trip; or

E) are travelling specifically for the purpose of obtaining and/or receiving any elective surgery, procedure or hospital treatment; or

F) are aware of a medical condition for which you have not had a diagnosis; or

G) travel against any health requirements stipulated by the carrier, their handling agents or any other public transport provider.



Medical Screening

Not applicable if you reside in either the United Kingdom or the Isle of Man and your trip is to or within the United Kingdom or the Isle of Man.

The BCA travel policy does not provide cover for pre-existing health conditions. If any insured person answers yes to the following questions they must contact the medical screening line on 02392 419 896 (lines open 9am to 5pm Monday to Friday, excluding Bank Holidays) to see if cover is available.

• Within the last 6 months, have you been prescribed new medication or had a change in medication for any medical condition?

• Within the last 12 months, have you, for any medical condition, been treated as a hospital inpatient or been referred to, or in the care of, a specialist consultant except muscles, tendons, soft tissue injuries or fractures?

• Are you taking more than 2 prescribed medications for all your medical conditions?

• Have you been diagnosed or treated for a malignant condition (e.g. Cancer) within the last 5 years?

If, as a result of your call, we wish to impose special terms, such as an additional premium, this will be advised to you immediately and confirmed in writing. Any additional medical conditions not declared to us will not be covered.



Declaration

I/We confirm that the statements and particulars contained in this form are true and complete.

I/We will provide details of any alteration to this information as soon as possible prior to commencement of the Period of Insurance.

I/We have read the Important Conditions Relating to Health and the Medical Screening questions and contacted the Medical Screening Line, if applicable.

I/We confirm that all persons to be insured are:

• a member of the British Caving Association (BCA) or a member of an affiliated club or family of a member who is also covered under this insurance;

• permanently resident in the United Kingdom, the Channel Islands or the Isle of Man at the time of purchasing this insurance;

• registered with a Medical Practitioner in the United Kingdom, the Channel Islands or the Isle of Man;

I/We confirm that the trip starts and ends in the United Kingdom, the Channel Islands or the Isle of Man or from an HM Base or British Embassy.