Bupa DentalChoice Scheme Policy Summary

Transcription

1 Bupa DentalChoice Scheme Policy Summary Effective from 1 April 2010 Summary of cover and benefits This policy summary contains key information about the Bupa DentalChoice scheme. You should read this carefully and keep it in a safe place afterwards. Please note that it does not contain the full terms and conditions and exclusions of cover which you will find in the policy DentalChoice Membership Guide (Member Pay) DC/6074/JAN10. Also, please refer to your membership certificate. Copies of these documents are available on request. About your cover The provider Bupa DentalChoice is provided under an agreement between you and Bupa Insurance Limited, a subsidiary of the British United Provident Association Limited. Other services are provided by or via other subsidiary companies. Summary of cover The summary of cover overleaf sets out the eligible dental treatments which are covered. The type of treatment covered Bupa DentalChoice offers you cover for eligible dental treatment services set out in the membership guide. Please refer to pages two and three of this document for a summary of the dental treatment covered. By dental treatment we mean any dental treatment or examination provided by a dentist. 1

2 Summary of cover Type of treatment Core Classic Premier Platinum Prestige Overall annual limits All annual benefit limits are subject to the benefit schedule below Routine dental treatment 100% up to a total up to a total up to a total up to a total reimbursement for amount of 540 amount of 930 amount of 1800 amount of 2000 NHS treatment each year each year each year each year Emergency dental treatment 100% up to a total up to a total up to a total up to a total reimbursement for amount of 180 amount of 370 amount of 480 amount of 800 NHS treatment each year each year each year each year Dental injury treatment 100% up to a total up to a total up to a total up to a total reimbursement for amount of 360 amount of 555 amount of 720 amount of 800 NHS treatment each year each year each year each year 100% NHS treatment no annual benefit limits paid in full Oral cancer Up to a total Up to a total Up to a total Up to a total Up to a total amount of amount of amount of amount of amount of 15,000 15,000 15,000 15,000 15,000 each year each year each year each year each year Cash benefit for hospital stay 50 per night up 50 per night up 50 per night up 50 per night up 50 per night up 1000 each year 1000 each year 1000 each year 1000 each year 1000 each year NHS benefit limits Band 1 Band 2 Band 3 100% reimbursement 100% reimbursement 100% reimbursement Type of treatment Classic Premier Platinum Prestige Benefit limits All benefit limits in this schedule are subject to the overall annual limits above Examinations Examination (up to a maximum of two per year) Examination (new patient) (up to a maximum of once per year) X-rays Small X-ray (up to a maximum of four per year) Medium X-ray (per film) (up to a maximum of four per year) Panoral (up to a maximum of once per year) Scaling Simple (up to a maximum of four per year) Chronic periodontal per visit 1 to 4 teeth to 9 teeth to 16 teeth or more teeth Fillings Amalgam (1 surface) Amalgam (2 surface) Amalgam (3+ surface) Composite anterior 1 surface Composite anterior 2 surfaces or more Composite posterior 1 surface Composite posterior 2 surfaces or more

3 Type of treatment Classic Premier Platinum Prestige Benefit limits All benefit limits in this schedule are subject to the overall annual limits Root canal treatment Single root Two roots Multiple roots Surgical treatment Extraction (per tooth) Surgical extraction (flap raised) Apicectomy Incising of abscess Crowns, bridges etc. Inlay (per tooth) Veneer (per tooth) Full gold crown Porcelain crown Porcelain bonded to metal crown Bridge per unit Adhesive bridge Cast post and core Prefabricated post and core Refix or re-cement existing crown Re-cement adhesive bridge Re-cement any other bridge Dentures Acrylic partial upper or lower denture Acrylic partial upper and lower denture Metal partial upper or lower denture Metal partial upper and lower denture Acrylic full upper or lower denture Acrylic full upper and lower denture Reline denture Addition of tooth Repair denture Occlusal splint Anaesthetics fees Up to 30 Up to 50 Up to 60 Up to 80 each year each year each year each year Orthodontic cover Orthodontic cover for child dependants up to Up to 300 Up to 400 Up to 500 Up to years of age each year each year each year each year 3

4 What your policy does not cover This section explains the dental treatment services and charges that are not covered under the scheme. This section does not contain all the limits and exclusions to your cover. For example, you are only covered for dental treatment services set out in the benefit schedules; anything not set out there is not covered. You should also note the benefit schedule sets out some limitations and restrictions for particular types of dental treatment. (See Exclusion on benefit in the General rules on benefits section of the membership guide for full details). The following are excluded: cosmetic treatment; in-patient treatment, expect when claiming for oral cancer; out-patient treatment in a hospital, consulting room, out-patient clinic or day-patient unit, except when claiming for oral cancer and cash benefit for hospital stay; dental treatment, which in Bupa s reasonable opinion based on established dental and medical practice in the United Kingdom, is experimental or unproven, or not normally supplied by a dentist in the United Kingdom; dental treatment resulting from self-inflicted injury; charges by a dentist or other person for completing your claim form or the submission of a claim; surgical implants; mouthguards; oral cancer treatment where oral cancer was diagnosed prior to joining the scheme or within the fist six months of current continuous membership of the scheme; pre-existing dental injury treatment ongoing as a direct or indirect result of an external impact; any dental treatment resulting from or related to any injury sustained whilst participating in a physical contact sport such as Rugby or Boxing; any dental injury treatment arising as a direct or indirect result of an external impact which occurred outside the UK any dental treatment received outside the United Kingdom which is not routine dental treatment or emergency dental treatment; How long your cover will last Bupa DentalChoice is an annual contract that is renewed each year and will continue until: you stop paying subscriptions to it; you cease to live in the UK (See the How your membership works section of the policy membership guide). Bupa has the right to make changes to the terms and conditions of your cover on any annual anniversary date after your policy has started or end the scheme. (See the How your membership works section of the policy membership guide) Where cover extends to dependants their cover may end at a different date but will always end when the main member s cover ends. Changing your mind You can change your mind within 21 days: of the day when your policy starts or, if later, the day when you receive your policy membership guide and your membership certificate As long as you have not made any claims, we will refund all your subscriptions. After this time, if you decide for any reason, that you do not want your Bupa DentalChoice policy after all, we will refund any subscriptions you have paid (however, we may at our discretion deduct an appropriate amount for covering you up to the date of cancellation). (See the How your membership works section of the policy membership guide). 4

5 Getting in touch The Bupa helpline is always the first number to call if you need help or support, or if you have any comments or complaints. Please call us on between 8am and 6pm, Monday to Friday and 8am to 1pm on Saturdays. Alternatively, you can write to us at Bupa Dental, Anchorage Quay, Salford Quays, M50 3XL or fax us on What to do if you need treatment If your dental treatment is likely to be less than 500 you are recommended to call the helpline before arranging any dental treatment to check your cover and the benefits available to you. If your dental treatment is likely to exceed 500 you must call the helpline with full details of your intended dental treatment. How to make a claim If your dental treatment is likely to be less than 500 you are recommended to call the helpline before arranging any dental treatment to check your cover and the benefits available to you. If your dental treatment is likely to exceed 500 you must call the helpline with full details of your intended dental treatment (See the Claiming section of the policy membership guide). Helpline number: Lines are open 8am to 6pm Monday to Friday, 8am to 1pm Saturday. Making a complaint The helpline is always the first number to call if you have a complaint. If we are unable to resolve a problem and you wish to take the complaint further, you can contact the Customer Relations Department. Please write to: The Customer Relations Department, Bupa, Anchorage Quay, Salford Quays M50 3XL, or phone on , between 8am and 5pm Monday to Friday. It is very rare that we are unable to settle a complaint but if this does happen, you may refer your complaint to the Financial Ombudsman Service. You can write to them at: South Quay Plaza, 183 Marsh Wall, London E14 9SR or call them on For members with special needs For hearing and speech impaired members who have a textphone, please call on: between 9am to 5pm Monday to Friday. We can also offer a choice of braille, large print or audio for correspondence. The Financial Services Compensation Scheme (FSCS) In the unlikely event that we cannot meet our financial obligations, you may be entitled to compensation from the Financial Services Compensation Scheme. This will depend on the type of business and the circumstances of your claim. The FSCS may arrange to transfer your policy to another insurer, provide a new policy or, where appropriate, provide compensation. Further information about compensation scheme arrangements is available from the FSCS on or on its website 5

6 Medical cover Financial health protection T ravel cover International medical cover Dental cover Home healthcare Care homes Health information Health coaching The world of Bupa Call the Bupa Dental Helpline on for information on Bupa Dental Choice. Lines are open open 8am to 6pm Monday to Friday and 8am to 1pm Saturday. Call for information on all other Bupa services. Lines are open 24 hours. Calls to this number may be recorded and may be monitored. Bupa DentalChoice is provided by Bupa Insurance Limited. Registered in England and Wales No #. Bupa Insurance Services Limited. Registered in England and Wales No # Registered Office Bupa House Bloomsbury Way London WC1A 2BA. #Authorised and regulated by the Financial Services Authority. Bupa Bupa and the heartbeat symbol are trade marks of The British United Provident Association Limited. DC/5276/JAN UNI