Add Your Heading Text Here British Acupuncture Federation Affinity Scheme - UK BALENS HEALTH PROFESSIONALS COMBINED LIABILITY INSURANCE Thank you for your enquiry and welcome to Balens. This pack will help you assess if the Individual Professional, Public & Products Liability product is suitable for your needs and guide you through the process to get insured. Our team is on hand to help if you need us – just call 01684 580771 or email info@balens.co.uk WHAT’S IN THE PACK? Guidance notes to help you through the process of getting insured The declaration form you need to complete to apply for cover An activities list of common therapies we insure A premium guide which may enable you to work out how much you will need to pay Our Key Points & Terms of Business document summarising who we are, who regulates us, the service weoffer, insurance companies we use and other important information such as the complaints process A summary of the Insurance Act 2015, including your responsibilities to make a fair presentation of the risk atinception, renewal and whenever you request changes to your policy SOME IMPORTANT LEGAL INFORMATION BEFORE YOU GET STARTED: Please note the completion and submission of the declaration form does not bind you or us to enter a contract of insurance. More information may be required from you. In order to minimise the need for further clarification please answer all questions fully. Based upon your Insurance Act 2015 responsibilities, you must make a fair presentation of the risk to us when completing the declaration form, at inception, renewal and whenever you request changes to your policy. This means you must tell us about all facts and circumstances which may be material to the risks covered by the policy in a clear and accessible manner and must not misrepresent any material facts. A material fact is one which would influence our acceptance or assessment of the risk. If you have any doubt about facts considered material, it is in your interest to disclose them. If you do not make a fair presentation of the risk the policy may be avoided, written on different terms or a higher premium may be charged, depending on the circumstances of the failure to present the risk fairly. Balens Ltd. is authorised & regulated by the Financial Conduct Authority. Copyright Balens Ltd. © 2014. All Rights Reserved.Authorised and Regulated by the Financial Conduct Authority in the United Kingdom – Balens Limited Registration Number FRN 305787 and regulated by the Central Bank of Ireland for Conduct of Business rules. Balens Financial Ltd (FRN 630456) is an Appointed Representative of Go IFA who are Authorised and Regulated by the Financial Conduct Authority under the FRN 530741.Balens Finance Services Ltd (Bifs) is authorised and regulated by the Financial Conduct Authority under the FRN 721566. You can check this on the FCA’s Register by visiting the FCA’s website www.fca.org.uk/register or by contacting the FCA on 0800 111 6768. Balens Limited has passporting rights enabling us to carry out insurance transactions within EEA states. This business may not be regulated by the Financial Conduct Authority, however, we apply the same compliance protocol across all of our business. GUIDANCE NOTES IS THIS THE RIGHT INSURANCE FOR ME? This policy is to cover you, and you alone, as a practicing therapist, irrespective of whether your business is set up as sole trader, partnership or limited company. If you employ or use other Health and Wellbeing Professionals, or take payments, bookings or advertise for them you will need a different type of policy – please contact Balens for guidance on 01684 580771 or info@balens.co.uk HOW DO I GET INSURED? Easily – in a few simple steps: 1) Complete the declaration form and read the key points and Balens terms of business document: • Answer all questions in full • List all therapies you: • currently perform • are a student in and for which you require cover for case study work • Confirm agreement to the Balens terms & conditions • You must be a current member of the British Acupuncture Federation in order to take out this policy. If you are not your insurance cover could be declared void. 2) Get a premium: Send the declaration form to us for a quote if: Any therapy you perform is NOT on the activities list, and/or The list states an endorsement applies, and/or You have non-UK qualifications You practice an activity for which there is no recognised qualification and you would like us to consider insuring you on the basis of your experience We will get back to you to confirm if we can offer cover, the premium and if any special terms/endorsements will apply – we may request more information to do this If you have non-UK qualifications we will need you to complete an additional form All your therapies are on the activities list, and No endorsements apply, and all your qualifications were taken in the UKYour price will be based on: The limit of indemnity you select; and Whether you select the optional sections of cover forPersonal Accident and/or Business Equipment ‘AllRisks’ cover. 3) Sign the declaration form and send to us with copies of your qualifications Important things to note: Make sure you have answered all questions fully and agreed the terms & conditions We need copies of your qualifications for ALL activities performed If you are currently insured elsewhere we must receive your documentation BEFORE the expiry date of your current policy to ensure continuous cover. You can provide documents: Scanned and emailed to info@balens.co.uk – remember to sign the declaration before scanning, OR By post to Balens Limited, Bridge House, Portland Road, Malvern, WR14 2TA 4) Get confirmation of cover:We will start your policy from the date we receive your documents subject to your declaration being complete, agreeing thepremium and (if applicable) special terms/endorsements. 5) Pay the premium: your payment options are:TELEPHONE – when we call to confirm your price, or call us on 01684 580771 once we have received your form. We can:o Take a single payment by debit/credit card, oro Provide our account details and a reference for payment by online banking/BACS, oro Set up an annual or monthly Direct Debit facility – please contact us for more information on these optionsCHEQUE – payable to Balens Ltd, to Balens Limited, Bridge House, Portland Road, Malvern, WR14 2TA.Note, if you know your price from using the premium guide, please include your cheque with the signed declaration form Premium Information BALENS HEALTH PROFESSIONALS COMBINED LIABILITY INSURANCE: SECTION A: PROFESSIONAL LIABILITY ANDMALPRACTICE INSURANCE COMMERCIAL LEGAL PROTECTION INSURANCE POLICY RUNS FROM 1 JUNE 2021 TO 31 MAY 2022As an ethical, regulated business we wish to be clear and transparent about the breakdown of the cost of your insurance policyarranged through us. The tables below aim to achieve this. If you are joining the scheme after the first quarter the rates willreduce as shown. This policy is to cover you, and you alone, as a practicing individual, irrespective of whether your business is set up as sole trader, partnership or limited company. If you employ or use other Health and Wellbeing Professionals, or take payments, bookings or advertise for them you will need a different type of policy – please contact Balens for guidance.Please tick to confirm you require cover as an individual practitioner: *ConfirmI can confirm I am a current member of British Acupuncture Federation and understand it is a condition of my insurance I maintain my membership *ConfirmCompany Type *Sole TraderLimited Company (Ltd)Public Limited Company (Plc)PartnershipLimited Partnership (LP)Limited Liability Partnership (LLP)What is the name of your business? *TitleMr.Mrs.Ms.Mx.MissDr.Prof.First Name *Last Name *Message0 / 180Street Address *Apartment, suite, etcCityCountyPostal CodeCountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChina, People's Republic ofChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrance, MetropolitanFrench GuianaFrench PolynesiaFrench South TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island And Mcdonald IslandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJohnston IslandJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre & MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and South SandwichSpainSri LankaStateless PersonsSudanSudan, SouthSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwan, Republic of ChinaTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks And Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of America (USA)UruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis And Futuna IslandsWestern SaharaYemenZambiaZimbabwePhone Number *Email Address *Membership Number *Date Of Birth *Date you require the policy to start *Your ActivitiesPlease state in the boxes below the activities you require insurance cover for and please provide us with copies of your qualifications. Cover will be provided subject to suitable qualifications held.ActivityUpload Qualifications *Drag and Drop (or) Choose FilesYour PremiumHave you ever been convicted of, or charged (but not yet tried) with any criminal offence, other than motoring offences, or offences that are spent under the Rehabilitation of Offenders Act 1974? *YesNoHave you ever had a proposal or renewal for insurance declined or cancelled; a policy voided, withdrawn or suspended, or special terms imposed by an insurer? *YesNoHave you ever had any claims, or are you aware of any circumstances which could give rise to a claim, under the policy involving negligence, error or omission? *YesNoHave you ever had any disciplinary hearings made against you, or are you aware of any circumstances which may result in a claim or suit being made against you? *YesNoHave you or any director or partner been the subject of, or have proceedings or applications pending for, any winding up order, receivership, debt relief, liquidation, administration, county court judgement (CCJ), company or individual voluntary agreement, bankruptcy or insolvency? *YesNoIf the answer is Yes to any of the above questions, please disclose full information to us in a clear and accessible manner below:Have you read, understood and agree to accept the Balens Terms of Business letter enclosed? *Yes Balens Terms of BusinessSigned *Dated *Premium InformationAs an ethical, regulated business we wish to be clear and transparent about the breakdown of the cost of your insurance policyarranged through us. The tables below aim to achieve this. If you are joining the scheme after the first quarter the rates willreduce as shown. To select your premium please choose:1. The type of acupuncture/activities you require2. The limit of indemnity you require (£4M or £6M)3. The date you require your policy to start. The types of Policy are - ACUPUNCTURE PREMIUMAlso includes cover for Cupping & Moxibustion, Phlebotomy, Electro Acupuncture, Gua Sha, Tui Na (excluding spinalmanipulations) and Standard Beauty Therapy (Level 3 modules) subject to suitable qualifications held TRADITIONAL CHINESE MEDICINE PREMIUMAlso includes cover for Tui Na (including spinal manipulations), Plum Blossom, NMR, PNF, FSN Acupuncture and TraditionalChinese Herbal Medicine subject to suitable qualifications held STUDENT PREMIUMProvides cover for case studies and other work performed prior to gaining your qualification. The conditions of cover are asfollows: Ongoing case consultation with your tutor, clients must be told that you are not qualified, you cannot practice outside thescope of what you have been taught and any charges/expenses made must be less than a qualified therapist. AURICULAR ACUPUNCTURE PREMIUMFor Auricular, Battlefield, Nada and other Ear related Acupuncture.The type of acupuncture/activities you require *Select...AURICULAR ACUPUNCTURE PREMIUMACUPUNCTURE PREMIUMTRADITIONAL CHINESE MEDICINE PREMIUMSTUDENT PREMIUMThe limit of indemnity you require *Select...£4,000,000 Full practitioner£6,000,000 Full practitionerThe date you require your policy to start *Select...Jun 01 - Aug 31Sep 01 - Nov 30Dec 01 - Feb 28Mar 01 - May 31Auricular £4 Jun - AugInsurance Costs Full Practitioner(£4M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Jun 01 - Aug 31 £21.23 £8.19 £29.42 £3.53 £20.00 £52.95 Auricular £4 Sep - NovInsurance Costs Full Practitioner(£4M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Sep 01 - Nov 30 £15.92 £8.19 £24.11 £2.89 £15.00 £42.00 Auricular £4 Dec - FebInsurance Costs Full Practitioner(£4M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Dec 01 - Feb 28 £10.62 £4.10 £14.72 £1.77 £10.00 £26.48 Auricular £4 Mar - MayInsurance Costs Full Practitioner(£4M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Mar 01 - May 31 £5.31 £4.10 £9.41 £1.13 £5.00 £15.54 Auricular £6 Jun - AugInsurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Jun 01 - Aug 31 £26.54 £8.19 £34.73 £4.17 £20.00 £58.90 Auricular £6 Sep - NovInsurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Sep 01 - Nov 30 £19.90 £8.19 £28.09 £3.37 £15.00 £46.46 Auricular £6 Dec 01 - Feb 28Insurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Dec 01 - Feb 28 £13.24 £4.10 £17.34 £2.08 £10.00 £29.42 Auricular £6 Mar 01 - May 31Insurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Mar 01 - May 31 £6.64 £4.10 £10.74 £1.29 £5.00 £17.03 Acupuncture Premium £4 Jun 01 - Aug 31Insurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Jun 01 - Aug 31 £24.87 £8.19 £33.06 £3.97 £20.00 £57.02 Acupuncture Premium £4 Sep 01 - nov 31Insurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Sep 01 - Nov 30 £18.65 £8.19 £26.84 £3.22 £15.00 £45.06 Acupuncture Premium £4 Dec 01 - Feb 28Insurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Dec 01 - Feb 28 £12.44 £4.10 £16.54 £1.98 £10.00 £28.52 Acupuncture Premium £4 Mar 01 - May 31Insurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Mar 01 - May 31 £6.22 £4.10 £10.32 £1.24 £5.00 £16.56 Acupuncture Premium £6 JUNEInsurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Jun 01 - Aug 31 £31.09 £8.19 £39.28 £4.71 £20.00 £63.99 Acupuncture Premium £6 SEPInsurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Sep 01 - Nov 30 £23.31 £8.19 £31.50 £3.78 £15.00 £50.28 Acupuncture Premium £6 DECEMBERInsurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Dec 01 - Feb 28 £15.55 £4.10 £19.65 £2.36 £10.00 £32.01 Acupuncture Premium £6 Mar 01 - May 31Insurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Mar 01 - May 31 £7.77 £4.10 £11.87 £1.24 £5.00 £18.29 TRADITIONAL CHINESE MEDICINE PREMIUM £4 Mil JUNEInsurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Jun 01 - Aug 31 £75.05 £8.19 £83.24 £9.99 £20.00 £113.23 TRADITIONAL CHINESE MEDICINE PREMIUM £4 Mil SEPTEMBERInsurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Sep 01 - Nov 30 £56.29 £8.19 £64.48 £7.74 £15.00 £87.21 TRADITIONAL CHINESE MEDICINE PREMIUM £4 Mil DECEMBERInsurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Dec 01 - Feb 28 £37.53 £4.10 £41.63 £5.00 £10.00 £56.62 TRADITIONAL CHINESE MEDICINE PREMIUM £4 Mil MARCHInsurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Mar 01 - May 31 £18.76 £4.10 £22.86 £2.74 £5.00 £30.60 TRADITIONAL CHINESE MEDICINE PREMIUM £6 Mil JUNEInsurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Jun 01 - Aug 31 £93.81 £8.19 £102.00 £12.24 £20.00 £134.24 TRADITIONAL CHINESE MEDICINE PREMIUM £6 Mil SEPTEMBERInsurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Sep 01 - Nov 30 £70.36 £8.19 £78.55 £9.43 £15.00 £102.98 TRADITIONAL CHINESE MEDICINE PREMIUM £6 Mil DECEMBERInsurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Dec 01 - Feb 28 £46.91 £4.10 £51.01 £6.12 £10.00 £67.13 TRADITIONAL CHINESE MEDICINE PREMIUM £6 Mil MARCHInsurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Mar 01 - May 31 £23.45 £4.10 £27.55 £3.31 £5.00 £35.86 STUDENT PREMIUM £4 Mil JUNEInsurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Jun 01 - Aug 31 £8.00 £3.10 £11.10 £1.33 £4.33 £16.76 STUDENT PREMIUM £4 Mil SEPTEMBERInsurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Sep 01 - Nov 30 £6.00 £3.10 £9.10 £1.27 £3.25 £13.44 STUDENT PREMIUM £4 Mil DECEMBERInsurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Dec 01 - Feb 28 £4.00 £1.55 £5.55 £0.67 £2.16 £8.38 STUDENT PREMIUM £4 Mil MARCHInsurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Mar 01 - May 31 £2.00 £1.55 £3.55 £0.43 £1.08 £5.06 STUDENT PREMIUM £6 Mil JUNEInsurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Jun 01 - Aug 31 £10.00 £3.10 £13.10 £1.57 £4.33 £19.00 STUDENT PREMIUM £6 Mil SEPTEMBERInsurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Sep 01 - Nov 30 £7.50 £3.10 £10.60 £1.27 £3.25 £15.12 STUDENT PREMIUM £6 Mil DECEMBERInsurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Dec 01 - Feb 28 £5.00 £1.55 £6.55 £0.79 £2.16 £9.50 STUDENT PREMIUM £6 Mil MARCHInsurance Costs Full Practitioner(£6M Auricular Acupuncture) Malpractice Premium Legal Expenses Net Insurance Cost Insurance Premium Tax (IPT) @ 12% Balens Admin Fee Total Premium Payable Mar 01 - May 31 £2.50 £1.55 £4.05 £0.49 £1.08 £5.62 Please enter your Total Premium Payable without the £ Symbol *Additional CoverSection B: Personal Accident Insurance (optional cover) Do you require Personal Accident Insurance? *YesNoCover for Blood Letting *RequiredNot RequiredBlood Letting Blood Letting Insurance To include cover for Blood Letting on your policy you must be qualified in Acupuncture and hold an additional qualification in the blood letting technique. There will be an additional premium of £56.00 (Professional Liability premium £50.00, Insurance Premium Tax £6.00). Blood Letting Premium Insurance Premium Tax (IPT) @ 12% Total premium payable £50.00 £6.00 £56.00 The following endorsement will apply to cover: Claims are subject to the Insured following best current practices and the recommended rules and guidelines as taught by their college or Association in the treatment of patients. Pre and post treatment information must be given to patients as laid down by the professional body or college and recorded in the patient notes. The following hygiene procedures must be adhered to in order for a claim to be admitted: Use of blades: Disposable needles must be used. Disinfectants: An appropriate dilution of currently the best recommended disinfectant must be used after any suspected contamination. Practice preparation: Overall cleanliness of the practice must be maintained on a daily basis. The couch must be clean, disinfected and freshly covered for each patient. An accident book should be kept to record any unusual incidents. Operator preparation: Must follow hygiene procedures as taught and laid down by the college or Association e.g. Hydrex, Mediscrub, Videne should be used in all appropriate phases of the treatment. Waste disposal: Clinical waste should be disposed of according to the College or Association guidelines using the professional services of an approved disposal company including the disposal of all human fluid, equipment and sharps used. ASP Needles/Battlefield Acupuncture *RequiredNot RequiredI agree toI can confirm that I follow standard acupuncture hygiene removal procedures in our codes of conduct for the removal of needles from clients and safe disposal in a sharps disposal box. I can confirm my semi-permanent needles are sourced from a reputable UK/EU manufacturer or supplier. I can confirm that I follow my training and the manufacturers guidelines for usage of the products.Cover for Derma Pen/Stamp/Roller: *RequiredNot RequiredTo include cover for Derma Pen/Stamp/Roller you must be qualified in Acupuncture and hold a qualification in the technique. This can be covered under the premium for Acupuncture. The following endorsement will apply to cover: A new unit is used for each new client and is allocated to that client only by a numbering system. Such units are to have been irradiated before delivery to the salon by the supplier or maker. After each use such items are to be sanitized according to the makers specifications and instructions. Client to be given adequate pre and post treatment information as to potential side effects and aftercare instructions. Maker's consultation and consent forms signed by the client and Makers own leaflets to be used and be kept for a minimum period of 7 years. Manufacturer's guidance and recommendations to be followed. Maximum Needle Lengths: 1mm Roller or 1.5mm Stamp for facials treatment or 3mm for Body Treatments. Cover for Skin Peels: *RequiredNot RequiredSkin PeelsTo include cover for Medik8 Skin Peels therapists must have completed a BAF approved course in Medik8 Skin Peels, this course includes theory and live practical training in the technique. If the therapist is not Beauty Therapy qualified (Level 3) they must also have completed a BAF approved introductory skin and beauty course prior to training. There will be an additional premium of £44.80 (Professional Liability premium £40.00, Insurance Premium Tax £4.80).Cover for Cosmeceuticals: *RequiredNot RequiredcosmeceuticalsTo provide cover for the use of cosmeceuticals in treatments and retail sale to clients for home use therapists must have completed a BAF approved product knowledge course in Medik8 Skin products and If the therapist is not Beauty Therapy qualified (Level 3) they must also have completed a BAF approved introductory skin and beauty course prior to training. The techniques include the use of vitamin C, B5 and Hyaluronic acid as well the full range of Medik8 skin care products.Cover for training and teaching: *RequiredNot RequiredTeaching and TrainingThe policy will cover you as an individual practitioner responsible for teaching and training in the activities covered by the policy, providing you are not responsible for the delivery of a certificate of competence or a qualification. If you are working as an individual practitioner who is running training and is personally responsible for the delivery of a certificate of competence or a qualification, we can extend this policy to cover you to train and certificate up to 40 students per year with an annual turnover of up to £20,000. To include this option on your policy, there will be an additional premium load of 50%. Please contact Balens for guidance. If you run a separate training establishment with additional teachers/trainers who are responsible for delivering training under the school or college you, or if you are an individual teacher who exceeds the above limits, you may require a separate training school policy – please contact Balens for further guidance.Total Premium - Including Addons£Consent *By submitting the form below I declare that the statements and particulars in this proposal are true andcomplete. I have made a fair presentation of the risk and have not misrepresented or suppressed anymaterial facts. I agree to the contract of insurance being prepared using the information I have supplied inthis form along with any associated information I have supplied. I shall inform you of any material alterationto those facts and/or the information supplied before completion of the contract of Insurance.A copy of the policy wording is attached for your attention.Send MessageSave as DraftPlease do not fill in this field.