Your life Your health Your benefts

Transcription

1 Bu~ MEMBER SUMMARY Your life Your health Your benefts Bupa HSBC Channel Islands and the Isle of Man Healthcare Plan Efective from 1 January 2018 bupa.co.uk In association with HSBCID ~

2 You re in safe hands with Bupa Welcome to your health insurance scheme, and to all the benefts and reassurance that we hope being with Bupa brings. Illness can restrict your lifestyle, afect loved ones, and reduce your ability to work, so we know how important your health is to you it s important to us too. That s why you can rely on your cover should you need to make an eligible claim. Help is just a phone call away One of the most direct ways we are able to help you is through our telephone support. Anytime HealthLine Whatever your health question or concern from advice about symptoms, to information on leading a healthier lifestyle you can speak to a nurse, 24 hours a day, seven days a week. You can ask us questions about anyone in your family, they don t have to be on your policy. For health advice Call * *Calls may be recorded and to maintain the quality of our Bupa HealthLine service a nursing manager may monitor some calls always respecting the confdentiality of the call. Getting in touch For all claims or cover queries please call your Bupa helpline on: Call and select option 1 We may record or monitor our calls. If you require correspondence and marketing literature in an alternative format, we ofer a choice of Braille, large print or audio. Please get in touch to let us know which you would prefer. Textphone Elderly Care Support Line If you re thinking about elderly care for a loved one, we have a dedicated support line to help you. We re on hand to ofer free advice on many aspects of elderly care from fnancial worries, to fnding a care home, to support with illnesses such as dementia. For elderly care advice Call We may record or monitor our calls. Lines are open 8am to 8pm Monday to Friday and 9am to 5pm on weekends. These pages are for the Bupa Select scheme and only provide a brief summary of the cover under the scheme. Full details including general terms and conditions, exclusions and beneft limits are not set out on these pages. Further details are available from the helpline although you may need to contact your employer for full details of your cover. 2

3 Health information at your fngertips We have an A to Z of health topics and tools that you and your family can easily access online. It s our goal to provide you with trusted information so you can make the right decisions about your health and wellbeing. Try our tools and calculators to give you an insight into your own health. Bupa.co.uk/health-information/ tools-calculators Supporting you when you need it most When you have a medical condition, speaking to someone who understands can make a big diference. We have specialist support teams in a range of key condition areas ofering you the help and advice you need, when you need it most. Our specialist support teams are made up of advisers, care coordinators and nurses. They ll help with everything from understanding your condition, to getting decisions on drugs, to supporting you and your family emotionally. Specialist support teams Cardiovascular Oncology Mental health Muscles, joints and bones Gastroenterology Eyecare or Ophthalmology Obstetrics and gynaecology How to access the team you need When you call the helpline, you ll be referred to the team who specialises in your particular medical condition. You ll be able to call your team directly, Monday to Friday, 8am to 8pm and on Saturdays 8am to 4pm. Find the facilities and expertise you need Our website is home to Finder an online resource that brings together information on all our people and places. You can use Finder to search for: recognised consultants therapists recognised dentists hospitals health and dental centres care homes retirement housing. Search online for our services Visit fnder.bupa.co.uk 3

4 A summary of your health insurance at a glance Recognised access is for partnership facilities. Your cover depends on you using certain Bupa recognised medical practitioners and treatment facilities. For more detailed information on what is and isn t covered by your scheme, call your Bupa helpline on and select option 1. Lines are open 8am to 8pm Monday to Friday, 8am to 4pm Saturday. BUPA PMI Jersey Benefts Diagnostics and out-patient treatment Out-patient consultations with a consultant Out-patient therapies and complementary medicine out-patient diagnostic tests on consultant referral Out-patient MRI, CT and PET scans on consultant referral Out-patient GP private services consultant therapist or complementary medicine practitioner (acupuncture, chiropractic and osteopathy only) for the type of scan you need beneft limits apply for a that is not a scheme recognised we pay fees for appointments with a GP or nurse carried out in the GP s surgery. We also pay for GP home visits when medically necessary. We may record or monitor our calls. 4

5 Being treated in hospital Consultants fees Parent accommodation surgical operations carried out as out-patient treatment day-patient treatment and in-patient treatment with a Bupa recognised consultant and in a scheme recognised one parent only, accompanying a child up to age 18 who is a member of and receiving eligible in-patient treatment in a scheme recognised beneft limits apply for a that is not a scheme recognised Cancer treatment Cancer cover - as for other treatment set out in this table except for: Out-patient consultations with a consultant consultant Out-patient therapies and complementary medicine on GP or consultant referral out-patient diagnostic tests on consultant referral eligible out-patient cancer drugs therapist or complementary medicine practitioner (acupuncture, chiropractic and osteopathy only) 5

6 Mental health treatment Mental health treatment up to a maximum of 28 days each year 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 day-patient and inpatient mental health treatment Additional benefts Treatment at home discretionary beneft up to and from within your available out-patient beneft limits above upon authorisation, paid in full for day-patient treatment and in-patient treatment combined and not individually consultant or mental health and wellbeing therapist with a Bupa recognised consultant and in a scheme recognised treatment provider, we pay for the charges that we agree to pay on your behalf Home nursing when immediately following private eligible in-patient treatment Private ambulance charges when medically necessary and related to private eligible day-patient or in-patient treatment 6

7 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, paid up to and from when temporarily travelling therapies, diagnostic within your available outside the UK tests and complementary out-patient limit above medicine Out-patient MRI, CT and up to 100 towards all when temporarily travelling PET scans the fees and charges outside the UK Consultants fees for paid up to the Bupa UK when temporarily travelling out-patient surgical monetary limits that outside the UK operations, day-patient and in-patient treatment Overseas charges for out-patient surgical operations Overseas charges for day-patient and in-patient treatment apply for Bupa recognised nonpartnership consultants up to 100 towards all the charges and not each charge individually up to 200 each day towards all the charges and not each charge individually Repatriation and evacuation assistance discretionary beneft Your repatriation/ evacuation Accompanying partner/ relative during your repatriation or evacuation Cash benefts NHS cash beneft for NHS in-patient treatment Family cash beneft upon authorisation, paid in full upon authorisation, up to 750 towards all the costs 100 a night for up to 91 nights each year 150 for each child born or adopted during the year when temporarily travelling outside the UK when temporarily travelling outside the UK when arranged by a Bupa recognised medical assistance company when arranged by a Bupa recognised medical assistance company for NHS in-patient treatment that would otherwise be covered under we pay Family cash beneft for a main member only 7

8 Cash benefts (continued) Optical cash beneft Accidental dental injury cash beneft Prescription cash beneft NHS cash beneft for NHS in-patient stays that you receive radiotherapy, chemotherapy or a surgical operation that is for cancer treatment NHS cash beneft for NHS out-patient or day-patient treatment or NHS home treatment for cancer up to 100 percent of your eligible claims up to a total amount of 100 each optical beneft period. This is the overall amount payable for all such goods and services and not each type of goods or service individually up to 900 each year up to 20 each year 100 each night 100 for each day you receive radiotherapy in a hospital setting 100 for each day you receive IV-chemotherapy and for each threeweekly interval of oral chemotherapy or part thereof 100 on the day of your surgical operation for goods and services when provided to or prescribed for you by an optician for dental treatment provided to you by a dentist or orthodontist and which you need as a result of an accidental dental injury for prescription charges you incur for prescribed medicines and/or devices used to treat a medical condition and /or alleviate symptoms for NHS in-patient treatment for cancer treatment that would otherwise be covered under for eligible NHS out-patient or day-patient treatment or NHS home treatment for cancer that would otherwise be covered under 8

9 Parent travel costs Travel costs for accompanying nurse or relative Travel costs for a pre or post-operative consultation Island Cover benefts full details are available from the helpline Patient travel costs up to a total amount of for you to travel to the UK 240 for all travel costs mainland to receive eligible for each outward and treatment covered under return journey combined, with taxi fares being limited to 20 for each single taxi trip up to a total amount of 240 for all travel costs for each outward and return journey combined, with taxi fares being limited to 20 for each single taxi trip if we agree, up to a total amount of 240 for all travel costs for each outward and return journey combined, with taxi fares being limited to 20 for each single taxi, if we agree, up to 100 for each single journey between the island and the UK mainland for nursing care provided by a nurse up to a total amount of 240 for all travel costs for each outward and return journey combined, with taxi fares being limited to 20 for each single taxi trip for a parent to travel to the UK mainland with their child for that child to receive eligible treatment covered under for a nurse, relative or carer to accompany you when you need to receive eligible treatment covered under for you to travel to the UK mainland for a pre or post-operative consultation carried out as out-patient treatment with your consultant for eligible treatment covered under 9

10 A summary of your health insurance at a glance Recognised access is for partnership facilities. Your cover depends on you using certain Bupa recognised medical practitioners and treatment facilities. For more detailed information on what is and isn t covered by your scheme, call your Bupa helpline on and select option 1. Lines are open 8am to 8pm Monday to Friday, 8am to 4pm Saturday. Bupa PMI Guernsey Benefts Diagnostics and out-patient treatment Out-patient consultations with a consultant Out-patient therapies and complementary medicine out-patient diagnostic tests on consultant referral Out-patient MRI, CT and PET scans on consultant referral Out-patient GP private services consultant therapist or complementary medicine practitioner (acupuncture, chiropractic and osteopathy only) for the type of scan you need beneft limits apply for a that is not a scheme recognised we pay fees for appointments with a GP or nurse carried out in the GP s surgery. We also pay for GP home visits when medically necessary. We may record or monitor our calls. 10

11 Being treated in hospital Consultants fees Parent accommodation surgical operations carried out as out-patient treatment day-patient treatment and in-patient treatment Cancer treatment with a Bupa recognised consultant and in a scheme recognised one parent only, accompanying a child up to age 18 who is a member of and receiving eligible in-patient treatment in a scheme recognised beneft limits apply for a that is not a scheme recognised Cancer cover - as for other treatment set out in this table except for: Out-patient consultations with a consultant consultant Out-patient therapies and complementary medicine on GP or consultant referral out-patient diagnostic tests on consultant referral eligible out-patient cancer drugs therapist or complementary medicine practitioner (acupuncture, chiropractic and osteopathy only) 11

12 Mental health treatment Mental health treatment up to a maximum of 28 days each year 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 day-patient and inpatient mental health treatment Additional benefts Treatment at home discretionary beneft up to and from within your available out-patient beneft limits above upon authorisation, paid in full for day-patient treatment and in-patient treatment combined and not individually consultant or mental health and wellbeing therapist with a Bupa recognised consultant and in a scheme recognised treatment provider, we pay for the charges that we agree to pay on your behalf Home nursing when immediately following private eligible in-patient treatment Private ambulance charges when medically necessary and related to private eligible day-patient or in-patient treatment 12

13 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, paid up to and from when temporarily travelling therapies, diagnostic within your available outside the UK tests and complementary out-patient limit above medicine Out-patient MRI, CT and up to 100 towards all when temporarily travelling PET scans the fees and charges outside the UK Consultants fees for paid up to the Bupa UK when temporarily travelling out-patient surgical monetary limits that outside the UK operations, day-patient and in-patient treatment Overseas charges for out-patient surgical operations Overseas charges for day-patient and in-patient treatment apply for Bupa recognised nonpartnership consultants up to 100 towards all the charges and not each charge individually up to 200 each day towards all the charges and not each charge individually Repatriation and evacuation assistance discretionary beneft Your repatriation/ evacuation Accompanying partner/ relative during your repatriation or evacuation Cash benefts NHS cash beneft for NHS in-patient treatment Family cash beneft upon authorisation, paid in full upon authorisation, up to 750 towards all the costs 100 a night for up to 91 nights each year 150 for each child born or adopted during the year when temporarily travelling outside the UK when temporarily travelling outside the UK when arranged by a Bupa recognised medical assistance company when arranged by a Bupa recognised medical assistance company for NHS in-patient treatment that would otherwise be covered under we pay Family cash beneft for a main member only 13

14 Cash benefts (continued) Optical cash beneft Accidental dental injury cash beneft Prescription cash beneft NHS cash beneft for NHS in-patient stays that you receive radiotherapy, chemotherapy or a surgical operation that is for cancer treatment NHS cash beneft for NHS out-patient or day-patient treatment or NHS home treatment for cancer up to 100 percent of your eligible claims up to a total amount of 100 each optical beneft period. This is the overall amount payable for all such goods and services and not each type of goods or service individually up to 900 each year up to 20 each year 100 each night 100 for each day you receive radiotherapy in a hospital setting 100 for each day you receive IV-chemotherapy and for each threeweekly interval of oral chemotherapy or part thereof 100 on the day of your surgical operation for goods and services when provided to or prescribed for you by an optician for dental treatment provided to you by a dentist or orthodontist and which you need as a result of an accidental dental injury for prescription charges you incur for prescribed medicines and/or devices used to treat a medical condition and /or alleviate symptoms for NHS in-patient treatment for cancer treatment that would otherwise be covered under for eligible NHS out-patient or day-patient treatment or NHS home treatment for cancer that would otherwise be covered under 14

15 Cash benefts (continued) Emergency private ambulance charges and Accident & Emergency fees for a medical emergency Island Cover benefts full details are available from the helpline Patient travel costs up to a total amount of 240 for all travel costs for each outward and return journey combined, with taxi fares being limited to 20 for each single taxi trip for you to travel to the UK mainland to receive eligible treatment covered under Parent travel costs Travel costs for accompanying nurse or relative Travel costs for a pre or post-operative consultation up to a total amount of 240 for all travel costs for each outward and return journey combined, with taxi fares being limited to 20 for each single taxi trip if we agree, up to a total amount of 240 for all travel costs for each outward and return journey combined, with taxi fares being limited to 20 for each single taxi, if we agree, up to 100 for each single journey between the island and the UK mainland for nursing care provided by a nurse up to a total amount of 240 for all travel costs for each outward and return journey combined, with taxi fares being limited to 20 for each single taxi trip 15 for a parent to travel to the UK mainland with their child for that child to receive eligible treatment covered under for a nurse, relative or carer to accompany you when you need to receive eligible treatment covered under for you to travel to the UK mainland for a pre or post-operative consultation carried out as out-patient treatment with your consultant for eligible treatment covered under

16 A summary of your health insurance at a glance Recognised access is for partnership facilities. Your cover depends on you using certain Bupa recognised medical practitioners and treatment facilities. For more detailed information on what is and isn t covered by your scheme, call your Bupa helpline on and select option 1. Lines are open 8am to 8pm Monday to Friday, 8am to 4pm Saturday. Bupa PMI Isle of Man Benefts Diagnostics and out-patient treatment Out-patient consultations with a consultant Out-patient therapies and complementary medicine out-patient diagnostic tests on consultant referral Out-patient MRI, CT and PET scans on consultant referral consultant therapist or complementary medicine practitioner (acupuncture, chiropractic and osteopathy only) for the type of scan you need beneft limits apply for a that is not a scheme recognised We may record or monitor our calls. 16

17 Being treated in hospital Consultants fees Parent accommodation surgical operations carried out as out-patient treatment day-patient treatment and in-patient treatment Cancer treatment with a Bupa recognised consultant and in a scheme recognised one parent only, accompanying a child up to age 18 who is a member of and receiving eligible in-patient treatment in a scheme recognised beneft limits apply for a that is not a scheme recognised Cancer cover - as for other treatment set out in this table except for: Out-patient consultations with a consultant consultant Out-patient therapies and complementary medicine on GP or consultant referral out-patient diagnostic tests on consultant referral eligible out-patient cancer drugs therapist or complementary medicine practitioner (acupuncture, chiropractic and osteopathy only) 17

18 Mental health treatment Mental health treatment up to a maximum of 28 days each year 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 day-patient and inpatient mental health treatment Additional benefts Treatment at home discretionary beneft up to and from within your available out-patient beneft limits above upon authorisation, paid in full for day-patient treatment and in-patient treatment combined and not individually consultant or mental health and wellbeing therapist with a Bupa recognised consultant and in a scheme recognised treatment provider, we pay for the charges that we agree to pay on your behalf Home nursing when immediately following private eligible in-patient treatment Private ambulance charges when medically necessary and related to private eligible day-patient or in-patient treatment 18

19 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, paid up to and from when temporarily travelling therapies, diagnostic within your available outside the UK tests and complementary out-patient limit above medicine Out-patient MRI, CT and up to 100 towards all when temporarily travelling PET scans the fees and charges outside the UK Consultants fees for paid up to the Bupa UK when temporarily travelling out-patient surgical monetary limits that outside the UK operations, day-patient and in-patient treatment Overseas charges for out-patient surgical operations Overseas charges for day-patient and in-patient treatment apply for Bupa recognised nonpartnership consultants up to 100 towards all the charges and not each charge individually up to 200 each day towards all the charges and not each charge individually Repatriation and evacuation assistance discretionary beneft Your repatriation/ evacuation Accompanying partner/ relative during your repatriation or evacuation Cash benefts NHS cash beneft for NHS in-patient treatment Family cash beneft upon authorisation, paid in full upon authorisation, up to 750 towards all the costs 100 a night for up to 91 nights each year 150 for each child born or adopted during the year when temporarily travelling outside the UK when temporarily travelling outside the UK when arranged by a Bupa recognised medical assistance company when arranged by a Bupa recognised medical assistance company for NHS in-patient treatment that would otherwise be covered under we pay Family cash beneft for a main member only 19

20 Cash benefts (continued) Optical cash beneft Accidental dental injury cash beneft Prescription cash beneft NHS cash beneft for NHS in-patient stays that you receive radiotherapy, chemotherapy or a surgical operation that is for cancer treatment NHS cash beneft for NHS out-patient or day-patient treatment or NHS home treatment for cancer up to 100 percent of your eligible claims up to a total amount of 100 each optical beneft period. This is the overall amount payable for all such goods and services and not each type of goods or service individually up to 900 each year up to 60 each year 100 each night 100 for each day you receive radiotherapy in a hospital setting 100 for each day you receive IV-chemotherapy and for each threeweekly interval of oral chemotherapy or part thereof 100 on the day of your surgical operation for goods and services when provided to or prescribed for you by an optician for dental treatment provided to you by a dentist or orthodontist and which you need as a result of an accidental dental injury for prescription charges you incur for prescribed medicines and/or devices used to treat a medical condition and /or alleviate symptoms for NHS in-patient treatment for cancer treatment that would otherwise be covered under for eligible NHS out-patient or day-patient treatment or NHS home treatment for cancer that would otherwise be covered under 20

21 Parent travel costs Travel costs for accompanying nurse or relative Travel costs for a pre or post-operative consultation Island Cover benefts full details are available from the helpline Patient travel costs up to a total amount of for you to travel to the UK 240 for all travel costs mainland to receive eligible for each outward and treatment covered under return journey combined, with taxi fares being limited to 20 for each single taxi trip up to a total amount of 240 for all travel costs for each outward and return journey combined, with taxi fares being limited to 20 for each single taxi trip if we agree, up to a total amount of 240 for all travel costs for each outward and return journey combined, with taxi fares being limited to 20 for each single taxi, if we agree, up to 100 for each single journey between the island and the UK mainland for nursing care provided by a nurse up to a total amount of 240 for all travel costs for each outward and return journey combined, with taxi fares being limited to 20 for each single taxi trip for a parent to travel to the UK mainland with their child for that child to receive eligible treatment covered under for a nurse, relative or carer to accompany you when you need to receive eligible treatment covered under for you to travel to the UK mainland for a pre or post-operative consultation carried out as out-patient treatment with your consultant for eligible treatment covered under 21

22 Claiming For private medical insurance claims Always call your Bupa helpline before arranging any consultations or treatment to check the benefts available to you under your scheme. Also, should you have any queries about your treatment, we can ofer 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 If you need to see a medical professional using your health insurance scheme, you are normally required to see your GP frst. However there are some conditions where a GP referral is not usually required. We have developed direct access* pathways, in particular for muscle, joint or bone conditions and cancer symptoms, cataracts to provide fast and convenient access to the expertise of therapists who specialise in these felds. Just call your Bupa helpline. *Direct access telephone services are available as long as the symptoms are payable under. Chronic conditions are normally excluded. Please call us to allow us to check your eligibility for the direct access service. Your out-patient allowance will be used to fund treatment after your direct telephone consultation. STEP 2 Ask your GP for a referral to a consultant or healthcare professional for your consultations or treatments If you need to see a consultant or healthcare professional, let your GP know that you have Bupa cover. 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. 22

23 STEP 3 Call your Bupa helpline before arranging a consultation or receiving treatment Once you know the name of the consultant or healthcare professional you are going to see, please call us so we can confrm that your consultant, healthcare professional or treatment is Bupa recognised, that your recommended treatment is covered and which benefts you are entitled to under your Bupa membership. 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: o your Bupa membership number o the condition you are sufering from o details of the treatment that your GP has recommended o date(s) on which you are to receive treatment o the name of the consultant or other healthcare professional involved o details of where your proposed treatment will take place o your expected length of stay in hospital (if applicable) STEP 4 Get a pre-authorisation number When we have confrmed 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 Call and select option 1 We may record or monitor our calls. 23

24 Claiming For GP private services, optical, dental and prescription fee charges and emergency private ambulance charges and Accident & Emergency fees To make a claim for GP private services, optical, dental or prescription fee charges or for emergency private ambulance charges and Accident & Emergency fees the process is quick and simple. A step-by-step guide to making a claim STEP 1 Receive treatment Check your beneft details before you go for treatment to see what you can claim back for and how much. STEP 2 Pay the bill Settle your bill directly with the practitioner and don t forget to obtain a receipt. STEP 2 Send us the receipt Send your forms and original receipts to us by post and keep a copy for your records. You can send original receipts to: Claims Department, Bupa, Salford Quays, M50 3XL. Or you can scan your receipts and them to us at: HSBCHealthcare@bupa.com Claims checklist When making a claim the original receipt must be on ofcial headed paper and show: o the name of the patient, o the name, address and qualifcation of the person providing the treatment, o a description of the treatment, o the date of the treatment, and o the amount paid for the treatment. We will only pay claims that we receive within six months of the date of treatment. For more details please call your Bupa helpline on Call and select option 1 We may record or monitor our calls. 24

25 Privacy Notice Our Privacy Notice explains how we take care of your personal information and how we use it to provide your cover. A full version of the notice can be found in your membership guide or online at 25

26 Bupa health insurance is provided by Bupa Insurance 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. Arranged and administered by Bupa Insurance Services Limited, which is authorised and regulated by the Financial Conduct Authority. Registered in England and Wales No Registered ofce: 1 Angel Court, London EC2R 7HJ. Bupa 2018 bupa.co.uk HSBC CI & IOM CMC/6571/JAN UNI BHF00907