Tesco Private Healthcare Plan. Effective from 1 March Administered by Bupa. bupa.co.uk

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1 Tesco Private Healthcare Plan Effective from 1 March 2016 Administered by Bupa bupa.co.uk This is page 1 of 10 which should be read together in full. These pages are for the Tesco Private Healthcare Plan from 1 March These pages only provide a brief summary

2 Welcome to the Tesco Private Healthcare Plan These pages are designed to provide a summary of the healthcare benefits payable under the Tesco Private Healthcare Plan (the trust ) and help explain the claiming process to you. If you still have any questions or queries after reading it, simply call the helpline on Or, if you have speech or hearing difficulties and use a textphone, call We may record or monitor our calls. The trust has been set up by Tesco Plc to provide you with healthcare benefits. The trustees of the trust have appointed Bupa Insurance Services Limited (Bupa) to help administer the trust on their behalf. Where you see the words we/our/us in this summary it means Bupa acting on behalf of the trustees. This is page 2 of 10 which should be read together in full. These pages are for the Tesco Private Healthcare Plan from 1 March These pages only provide a brief summary 2

3 As a beneficiary of a trust administered by Bupa you can access the Bupa HealthLine as well as other useful information. 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 ll find a library of fact sheets, health tips and a selection of latest news stories relating to health and wellbeing. You ll 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. We have free versions for both iphone and Android. Scan the codes below or download them online. 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 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 can 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 try to point you in the right direction. You can call the Bupa HealthLine on: * or * *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. Android iphone This is page 3 of 10 which should be read together in full. These pages are for the Tesco Private Healthcare Plan from 1 March These pages only provide a brief summary 3

4 Summary of benefits The type of treatment payable under the trust The trust only pays healthcare benefits for eligible treatment. By this we mean treatment of an acute condition together with the products and equipment used as part of the treatment that: are consistent with generally accepted standards of medical practice and representative of best practices in the medical profession in the UK are clinically appropriate in terms of type, frequency, extent, duration and the facility or location where the services are provided are demonstrated through scientific evidence to be effective in improving health outcomes, and are not provided or used primarily for the expediency of you or your consultant or other healthcare professional and the treatment, services or charges are not excluded under the trust rules. Treatment must, in most cases, follow an initial referral by your GP. The consultant in overall charge of your treatment must be a trust recognised consultant. Trust recognised practitioners and facilities The trust has adopted for its own use certain medical and other health practitioners and treatment facilities recognised by Bupa Insurance Limited for the purpose of their health insurance schemes. This trust recognition includes but is not limited to: Bupa recognised consultants, recognised facilities, therapists and complementary medicine practitioners. Further details are available from the helpline. The benefits payable under the trust depend on you using certain trust recognised medical practitioners and treatment facilities. Who you use can affect the level of healthcare benefits payable under the trust. Also, they may only be recognised by us for certain types of treatment or levels of benefits. The type of treatment and/or level of benefit that we recognise them for can change from time to time. What is not payable under the trust There are certain medical conditions and treatments that benefits are not payable for or are restricted for under the trust. There are some exceptions to the exclusions t. Please refer to your trust rules or call the helpline for more details. The excluded or restricted medical conditions and treatments include but are not limited to: treatment for ageing, menopause and puberty AIDS/HIV allergies birth control, conception, sexual problems or sex changes chronic conditions complications from excluded conditions treatment resulting from contamination, wars, riots or terrorist acts experimental drugs and treatment treatment resulting from any pandemic intensive care (other than routinely needed after private day-patient treatment or in patient treatment) learning difficulties, behavioural and developmental problems pregnancy and childbirth screening and preventive treatment sleep problems and disorders convalescence care, rehabilitation or general nursing care cosmetic, reconstructive or weight loss treatment treatment for deafness or to correct eyesight dental or oral treatment dialysis speech disorders remote consultations temporary relief of symptoms out-patient drugs and dressings physical aids and appliances chronic mental health conditions. This is page 4 of 10 which should be read together in full. These pages are for the Tesco Private Healthcare Plan from 1 March These pages only provide a brief summary 4

5 Summary of benefits table for the Tesco Private Healthcare Plan Your benefits for eligible treatment costs depends on you using certain trust recognised medical and other health practitioners and recognised facilities. Your trust recognised facility access is for partnership facilities. By facility access we mean the network of trust recognised facilities for which benefits are available under your trust as shown in your benefit table. For more detailed information on what is and isn t payable under your trust, call the 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 with a trust recognised consultant with a trust recognised therapist or complementary medicine practitioner (acupuncture, chiropractic and osteopathy only) in a trust recognised partnership facility in a trust recognised partnership facility for the type of scan you need benefit limits apply for a facility that is not a trust recognised partnership facility Consultants fees with a trust recognised consultant and in a trust recognised partnership facility Parent accommodation one parent only, accompanying a child up to age 16 who is a beneficiary under the trust and receiving eligible in-patient treatment in a trust recognised partnership facility Facility charges for surgical operations carried out as out-patient treatment Facility charges for day-patient treatment and in-patient treatment Cancer treatment in a trust recognised partnership facility benefit limits apply for a facility that is not a trust recognised partnership facility in a trust recognised partnership facility Cancer cover - as for other treatment set out in this table except for: Out-patient consultations with a consultant with a trust recognised consultant Out-patient therapies and complementary medicine on GP or consultant referral Facility charges for out-patient diagnostic tests on consultant referral Facility charges for eligible out-patient cancer drugs with a trust recognised therapist or complementary medicine practitioner (acupuncture, chiropractic and osteopathy only) in a trust recognised partnership facility in a trust recognised partnership facility We may record or monitor our calls. This is page 5 of 10 which should be read together in full. These pages are for the Tesco Private Healthcare Plan from 1 March These pages only provide a brief summary 5

6 Benefits Maximum benefit available Notes Mental health treatment Mental health treatment up to a maximum of 28 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 up to and from within your available out-patient benefit limits above with a trust recognised consultant or mental health and wellbeing therapist with a trust recognised consultant and in a trust recognised partnership facility in a trust recognised partnership facility Additional benefits Treatment at home discretionary benefit upon authorisation, with a trust 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 Cash benefits NHS cash benefit for NHS in-patient treatment 50 a night for up to 35 nights each year for NHS in-patient treatment that would otherwise be eligible for benefit under the trust NHS cash benefit for NHS in-patient stays that you receive radiotherapy, chemotherapy or a surgical operation that is for cancer treatment NHS cash benefit for NHS out-patient or day-patient treatment or NHS home treatment for cancer 100 each night for NHS in-patient treatment for cancer treatment that would otherwise be eligible for benefit under the trust 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 eligible for benefit under the trust This is page 6 of 10 which should be read together in full. These pages are for the Tesco Private Healthcare Plan from 1 March These pages only provide a brief summary 6

7 Claiming Always call the helpline before arranging any consultations or treatment to check the benefits payable under the trust. 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. For more details please call the helpline on We may record or monitor our calls. This is page 7 of 10 which should be read together in full. These pages are for the Tesco Private Healthcare Plan from 1 March These pages only provide a brief summary of the healthcare benefits payable under the trust. Full details including the exclusions and benefit limits are not set out on these pages. Further details are available from the helpline although you may need to refer to the trust rules for full details. The details may be affected by changes to the trust terms and conditions which may be changed 7

8 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 the helpline or go to bupa.co.uk/policyinformation These details may be updated from time to time. STEP 2 BEING REFERRED If you need to see a consultant or healthcare professional, let your GP know that you are a beneficiary under a trust administered by Bupa. Your GP will either refer you to a consultant or healthcare professional or suggest that you contact us if you want a choice of consultants or healthcare professionals. STEP 3 CALL THE 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 payable under your benefits. We will let you know what you need to do next and send you any necessary claim or 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 registration number the condition you are suffering from details of the treatment that your GP has recommended date(s) on which you are to receive treatment the name of the consultant or other healthcare professional involved details of where your proposed treatment will take place your expected length of stay in hospital (if applicable) STEP 4 GET A PRE-AUTHORISATION NUMBER When we have confirmed that your treatment is eligible under your benefits, 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 eligible under your benefits. 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. This is page 8 of 10 which should be read together in full. These pages are for the Tesco Private Healthcare Plan from 1 March These pages only provide a brief summary 8

9 Important information The Tesco Private Healthcare Plan is a trust that has been set up by Tesco Plc to provide you with healthcare benefits. Benefits are only payable under the trust if the trustees have sufficient funds to meet the cost of your claim. These pages only contain a brief summary of the healthcare benefits payable under the trust. They do not set out full details of what is or isn t payable under the trust. The trust rules (which will override this summary in the event of inconsistencies) may change from time to time, particularly on 1 March. Such changes could affect, for example the amount and type of benefits payable and/or the exclusions set out in these summary pages. Full details of the trust rules are available on request from the helpline. Bupa Privacy Notice Confidentiality: The confidentiality of patient and beneficiary information is of paramount concern to the companies in the Bupa Group ( Bupa ). To this end, Bupa complies with Data Protection Legislation and Medical Confidentiality Guidelines. Bupa sometimes uses third parties to process data on its behalf. Such processing, which may be outside of the European Economic Area, is subject to contractual restrictions with regard to confidentiality and security, in addition to the obligations imposed by the Data. Medical information: Medical information will be kept confidential. It will only be disclosed to those involved with your treatment or care. Audit of medical and billing information: When we process claims or investigate complaints on your behalf, Bupa may request and obtain further details from your treatment provider. The information may be sought either at the time of processing, or subsequently, for the purposes of ensuring the accuracy of information and the quality of treatment and care. Please note it is a term and condition of your trust rules and benefits that Bupa may obtain medical and billing information from your treatment provider relating to claims or complaints you may make. Beneficiary details: All registration documents and confirmation of how we have dealt with any claim you may make will be sent to the main beneficiary. Your registration and contact details may be shared by the companies in Bupa to enable them to manage their relationship with you as a beneficiary under a trust and update and improve Bupa s records. Depending on how your scheme has been funded or introduced, Bupa may share information with the Trustees of your scheme and/or an appointed intermediary, solely for scheme administration purposes. Bupa does not make the names, addresses and other contact details of beneficiaries available to any other organisations to use for their own purposes. Telephone calls: In the interest of continuously improving Bupa s services to beneficiaries, calls may be recorded and may be monitored. Research: Anonymised or aggregated data may be used by Bupa, or disclosed to others, for research or statistical purposes. Fraud: Information may be disclosed to others with a view to detecting and/or preventing fraudulent or improper claims. Keeping you informed: Bupa would, on occasion, like to keep you informed of the Bupa products and services that it considers may be of interest to you. If you do not wish to receive information about such products and services, or have any other Data Protection queries, please write to: Bupa UK Information Governance Team, 4 Pine Trees, Chertsey Lane, Staines-upon-Thames, TW18 3DZ or contact us via at: DataProtection@bupa.com This is page 9 of 10 which should be read together in full. These pages are for the Tesco Private Healthcare Plan from 1 March These pages only provide a brief summary 9

10 Health Trusts are administered by Bupa Insurance Services Limited. Registered in England and Wales No Registered office: Bupa House, Blmsbury Way, London WC1A 2BA. Bupa 2016 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 bupa.co.uk Tesco Plc (Grades 1-4) CMCT/7998/Mar UNI This is page 10 of 10 which should be read together in full. These pages are for the Tesco Private Healthcare Plan from 1 March These pages only provide a brief summary of the healthcare benefits payable under the trust. Full details including the exclusions and benefit limits are not set out on these pages. Further details are available from the