YOUR LIFE YOUR HEALTH YOUR BENEFIT. Welplan Health Care Scheme MEMBER SUMMARY. Effective from 1 April bupa.co.uk

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1 MEMBER SUMMARY YOUR LIFE YOUR HEALTH YOUR BENEFIT Welplan Health Care Scheme Effective from 1 April 2015 bupa.co.uk This is page 1 of 8 which should be read together in full. These pages are for the summary of the Bupa Select for Welplan Health Care Scheme from 1 April These pages only provide a brief summary of the cover and full details including general terms and conditions, exclusions and benefit limits are not set out on these pages. Further details are available from the helpline although you may need to contact Welplan Ltd for full details of the cover under the agreement.

2 Keep this bklet somewhere handy in it, you ll find a summary about the things you re covered for, the added benefits of being with Bupa, and what to do if you ever need to make a claim. And if there s anything else you d like to know about your Bupa membership, please call your Bupa helpline GETTING MORE FROM YOUR BUPA MEMBERSHIP bupa.co.uk If you like to research medical matters online, our website is always up to date and full of useful information. It is also one of the most popular health websites in the UK and has won awards for its presentation, clarity and use of plain English. When you visit, you will find an impressive library of fact sheets, health tips and a selection of latest news stories relating to health and wellbeing. You will also find a number of health hubs on topics like cancer, bones and joints, and mental health conditions. These are an invaluable source of information if you want to know more about the prevention, diagnosis, treatment and management of these conditions. Visit us: bupa.co.uk Smart phone apps Health information can now be accessed straight from a smart phone. Our Health Finder app helps members manage their health with lots of useful health information. Bupa HealthLine If you want advice on everyday healthcare matters, our Bupa HealthLine is here to offer help and support whenever it s needed. You can call any time of the day or night and speak directly to one of our experienced nurses in complete confidence and take as much time as you need. Nothing is t trivial and the call doesn t have to relate to illness or injury it could just as easily be about nutrition, fitness or lifestyle changes. The nurses will answer questions on anything from over-the-counter medication to managing a long-term condition like cancer or heart disease. So, whether you re a worried parent, a nervous traveller, or you just want to know the facts about a condition or treatment, they can be a great comfort. And, if they don t have the answer you re lking for, they will always point you in the right direction. You can call the Bupa HealthLine on: * or * We have free versions for both iphone and Android. Scan the codes below or download them online. Android iphone *Calls may be recorded and to maintain the quality of our Bupa HealthLine service a nursing manager may monitor some calls always respecting the confidentiality of the call. Calls may be recorded and may be monitored. This is page 2 of 8 which should be read together in full. These pages are for the summary of the Bupa Select for Welplan Health Care Scheme from 1 April These pages only provide a brief summary of the 2

3 YOU RE IN SAFE HANDS WITH BUPA Welcome to your private health insurance scheme, and to all the benefits and reassurance that being with Bupa brings. Illness can restrict your lifestyle, affect loved ones, and reduce your ability to work, so we know how important your health is to you it s important to us t. That s why you can rely on your health cover should you need to make a claim. From the moment you first speak to a highly trained member of staff in one of our UK-based call centres, you ll know you re in safe hands with Bupa. It s this commitment to the quality of our service that s contributed to Bupa being awarded Best Healthcare Provider at the Corporate Adviser Awards 2012 and Health Insurance Provider of the Year at the Consumer Moneyfacts Awards This bklet is intended as an introduction to your Bupa membership and provides a summary of your benefits. If you still have any questions or queries after reading it, simply call your Bupa helpline on Or, if you have speech or hearing difficulties and use a textphone, call GETTING IN TOUCH For all claims or cover queries please call your Bupa helpline on: Calls may be recorded and may be monitored. This is page 3 of 8 which should be read together in full. These pages are for the summary of the Bupa Select for Welplan Health Care Scheme from 1 April These pages only provide a brief summary of the 3

4 A SUMMARY OF YOUR COVER AT A GLANCE Your cover depends on you using the Bupa recognised medical practitioners and treatment facilities that Bupa specifies for you when you call to pre-authorise your treatment. You must ask for an Open Referral letter from your GP and you must call Bupa before arranging a consultation or receiving treatment. Failure to call Bupa to obtain pre-authorisation for your treatment means that you will be responsible for paying for all such treatment. For more detailed information on what is and isn t covered by your scheme, call your Bupa helpline on Benefits Maximum benefit available Notes Finding out what is wrong and being treated as an out-patient Out-patient consultations with a consultant Out-patient therapies and complementary medicine Facility charges for out-patient diagnostic tests on consultant referral Out-patient MRI, CT and PET scans on consultant referral Being treated in hospital up to 1,250 combined limit each year this limit includes 250 for complementary medicine treatment with a recognised consultant we specify with a recognised therapist or complementary medicine practitioner (acupuncture, chiropractic and osteopathy only) we specify Consultants fees with a partnership consultant and in a recognised facility we specify Parent accommodation one parent only, accompanying a child up to age 16 who is a member of the scheme and receiving eligible in-patient treatment in a recognised facility we specify Facility charges for surgical operations carried out as out-patient treatment Facility charges for day-patient treatment and in-patient treatment Cancer treatment Cancer cover - as for other treatment set out in this table except for: Out-patient consultations with a consultant with a recognised consultant we specify Out-patient therapies and complementary medicine on GP or consultant referral Facility charges for out-patient diagnostic tests on consultant referral with a recognised therapist or complementary medicine practitioner (acupuncture, chiropractic and osteopathy only) we specify Facility charges for out-patient cancer drugs Calls may be recorded and may be monitored. This is page 4 of 8 which should be read together in full. These pages are for the summary of the Bupa Select for Welplan Health Care Scheme from 1 April These pages only provide a brief summary of the 4

5 Benefits Maximum benefit available Notes Mental health treatment Mental health treatment up to a maximum of 45 days each year for day-patient treatment and in-patient treatment combined and not individually Consultants fees, mental health and wellbeing therapists fees and diagnostic tests for out-patient mental health treatment Consultants fees for day-patient and in-patient mental health treatment Facility charges for day-patient and in-patient mental health treatment Additional benefits up to and from within your available out-patient benefit limits above with a recognised consultant or mental health and wellbeing therapist we specify with a partnership consultant and in a recognised facility we specify Treatment at home discretionary benefit upon authorisation, with a recognised treatment provider, we pay for the charges that we agree to pay on your behalf Home nursing up to 2,000 each year when immediately following private eligible in-patient treatment Private ambulance charges up to 80 each single trip up to a maximum of 320 each year when medically necessary and related to private eligible day-patient or in-patient treatment Overseas emergency treatment Please note: you will need to settle all accounts direct with the medical providers in the country of treatment. On return to the UK submit the itemised and dated receipted invoices to us for assessment. Out-patient consultations, therapies, diagnostic tests and complementary medicine paid up to and from within your available out-patient limit above when temporarily travelling outside the UK Out-patient MRI, CT and PET scans up to 100 towards all the fees and charges when temporarily travelling outside the UK Consultants fees for out-patient surgical operations, day-patient and in-patient treatment Overseas facility charges for out-patient surgical operations Overseas facility charges for day-patient and in-patient treatment paid up to the Bupa UK monetary limits that apply for Bupa recognised consultants up to 100 towards all the facility charges and not each charge individually up to 200 each day towards all the facility charges and not each charge individually when temporarily travelling outside the UK when temporarily travelling outside the UK when temporarily travelling outside the UK Repatriation and evacuation assistance discretionary benefit Your repatriation/evacuation upon authorisation, when arranged by a Bupa recognised medical assistance company Accompanying partner/relative during your repatriation or evacuation Cash benefits upon authorisation, up to 750 towards all the costs when arranged by a Bupa recognised medical assistance company NHS cash benefit for NHS in-patient treatment 100 a night for up to 100 nights each year for NHS in-patient treatment that would otherwise be covered under the scheme Family cash benefit NHS cash benefit for NHS in-patient stays that you receive radiotherapy, chemotherapy or a surgical operation that is for cancer treatment 150 for each child born or adopted during the year we pay Family cash benefit for a main member only who has been in continuous membership of the scheme for at least 10 months before the date of their child s birth or adoption 100 each night for NHS in-patient treatment for cancer treatment that would otherwise be covered under the scheme NHS cash benefit for NHS out-patient or day-patient treatment or NHS home treatment for cancer Procedure Specific NHS cash benefits 100 for each day you receive radiotherapy in a hospital setting 100 for each day you receive IV-chemotherapy and for each three-weekly interval of oral chemotherapy or part thereof 100 on the day of your surgical operation for eligible NHS out-patient or day-patient treatment or NHS home treatment for cancer that would otherwise be covered under the scheme Other NHS cash benefits are available to you under the scheme. These depend on the type of treatment you need. We only pay if your treatment would otherwise have been eligible for private treatment under the scheme. For information on Procedure Specific NHS cash benefits please call the helpline or go to These cash benefits may change from time to time. None of these Procedure Specific NHS cash benefits is payable at the same time as any other NHS cash benefit. This is page 5 of 8 which should be read together in full. These pages are for the summary of the Bupa Select for Welplan Health Care Scheme from 1 April These pages only provide a brief summary of the 5

6 CLAIMING Always call your Bupa helpline before arranging any consultations or treatment to check the benefits available to you under the scheme. Also, should you have any queries about your treatment, we can offer you the opportunity to speak to a nurse working in Bupa s care management team. A step-by-step guide to making a claim STEP 1 VISIT YOUR GP Your GP will advise you if you need to see a consultant or healthcare professional for your health needs. There are some conditions where a GP referral is not required and details of these are available from us on request. For information on these conditions please call your Bupa helpline or go to bupa.co.uk/policyinformation These details may be updated from time to time. STEP 2 ASK FOR A REFERRAL LETTER If you have a condition for which a GP referral to a consultant or healthcare professional is required, you must ask your GP for an Open Referral letter to ensure that your treatment is covered. An Open Referral letter will detail the care your GP would like you to have, but will not be addressed to a specific consultant, hospital or healthcare professional. An Open Referral letter needs to include your GP s assessment of your symptoms, the body area affected and the type of specialist your GP would like you to see. Alternatively, you can give your GP our simple Open Referral form to complete as an alternative to a standard referral letter. A copy of the form can be found at: bupa.co.uk/referral Important: you must call us to authorise any consultations or treatments. Failure to obtain pre-authorisation from us means that you will be responsible for paying for all such consultations and treatments. STEP 3 CALL YOUR BUPA HELPLINE BEFORE ARRANGING A CONSULTATION OR RECEIVING TREATMENT As sn as you have seen your GP, please call us so that we can discuss your options and explain which consultants and healthcare professionals are covered under your Bupa membership. We will let you know what you need to do next and send you any necessary pre-treatment forms you may need to complete. To help us to make the claims process as simple and swift as possible, please have the following information close to hand when you call to make a claim: your Bupa membership number the condition you are suffering from details of when your symptoms first began details of when you first consulted your GP about your condition details of the treatment that your GP has recommended This is page 6 of 8 which should be read together in full. These pages are for the summary of the Bupa Select for Welplan Health Care Scheme from 1 April These pages only provide a brief summary of the 6

7 STEP 4 GET A PRE-AUTHORISATION NUMBER When we have confirmed that your treatment is covered, we will discuss your claim with you and give you a pre-authorisation number. You can then contact your consultant or healthcare professional to arrange an appointment. We recommend that you give your pre-authorisation number to the consultant or healthcare professional you see so that the invoice for any treatment costs can be sent to us directly. Please call us to authorise any further consultations or treatment to ensure that they are covered under your Bupa membership. If for any reason you are sent the invoice, simply send it on to: Claims Department, Bupa, Salford Quays, M50 3XL Once we have paid the invoice on your behalf, we will send you a summary of your claim and treatment details. Please note that payment may take a few weeks depending on how quickly invoices are submitted to us. For more details please call your Bupa helpline on Calls may be recorded and may be monitored. This is page 7 of 8 which should be read together in full. These pages are for the summary of the Bupa Select for Welplan Health Care Scheme from 1 April These pages only provide a brief summary of the 7

8 Bupa health insurance is provided by Bupa Insurance Limited. Registered in England and Wales No Bupa Insurance Services Limited. Registered in England and Wales No Bupa Insurance Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Bupa Insurance Services Limited is authorised and regulated by the Financial Conduct Authority. Registered Office: Bupa House, Blmsbury Way, London WC1A 2BA. Bupa 2015 Care homes Cash plans Dental insurance Dental services Health assessments Health at work services Health coaching Health information Health insurance Home healthcare International health insurance Travel insurance Welplan Health Care Scheme (0007/0038) CMC/7998/OR/APR UNI This is page 8 of 8 which should be read together in full. These pages are for the summary of the Bupa Select for Welplan Health Care Scheme from 1 April These pages only provide a brief summary of the

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