Business Plan

How does it work?

This page contains answers to a variety of common questions about our Business plan.

If you have a question that you don't see answered here, please contact us

How does this plan work?

Where can I be treated?

You can receive treatment from any recognised hospital, clinic, or legally qualified medical practitioner.

If your plan includes U.S. cover, we can settle directly with all 1.2m providers.

Our Healthline service will help you find a suitable medical professional.

How do I arrange treatment?

When you know that you need to seek medical advice and/or treatment, we ask that you contact us first. This allows us to check your cover, confirm that your proposed treatment is eligible for payment, and in many cases, contact your medical provider to arrange direct settlement.

We would like to make you aware that there are certain benefits which you must receive pre-authorisation for. These are detailed in your ‘Table of Benefits’. Benefits may not be paid unless pre-authorisation has been provided.

How does the claims process work?

There are two ways that your medical treatment can be paid:

Direct settlement

You contact us to advise what treatment you intend to receive.
We confirm that treatment is eligible and that we can ‘pre-authorise’ (guarantee payment) of it.
We send pre-authorisation to you and the provider of your treatment.
You complete and sign the pre-authorisation form.
Your medical provider attaches the invoice(s) for your treatment and returns with the pre-authorisation documents to us.
We process the claim and pay your medical provider directly.
We send you a ‘payment statement’ advising when and how it was paid, and who received the payment.
You settle any shortfall with your medical provider.

Pay and claim

You contact us to advise what treatment you intend to receive.
We confirm your cover and benefit limits.
You receive treatment and pay your medical provider (usually at time of treatment).
You and your medical provider fully complete a claim form and return the claim form to us.
We process the claim and pay you, via cheque or electronic bank transfer, as applicable.
We send you a ‘payment statement’ advising when and how it was paid, and who received the payment. 

How does Bupa Global make claim payments?

Wherever possible, we will follow the instructions given to us in the payment section of the claim form.

We can pay you, the principle member (applicant) or your medical provider.
We can pay by cheque or by electronic bank transfer.
We can pay in more than 80 currencies. The claim will be paid in the currency in which your sponsor pays your subscriptions, the currency of the invoices you send us, or the currency of your bank account.

How does co-insurance work?

How does co-insurance work?

If your sponsor has chosen a co-insurance this will be shown on your membership card. The co-insurance on this health plan is the percentage of all out-patient day to day care expenses that you share with us - please refer to your 'Table of Benefits'.

Example

With 15% co-insurance, you always pay 15% of your out-patient day to day care. For instance, if you have a consultation with your doctor that costs £80, by applying 15% out-patient day to day care co-insurance, you will see you have to pay £12 directly to your doctor. We will pay the remainder, which is £68 in this case.

If, for example, later in the year you stay in hospital for 5 days and it costs £8,000, you will pay nothing to the hospital, as this is in-patient care. We will pay the full £8,000 as there is no co-insurance applied to in-patient care.

Please note that the benefit limits shown in the 'Table of Benefits' is the maximum paid including, if chosen, your co-insurance.

This means that if you have chosen a 15% co-insurance and your benefit limit for out-patient Wellness and Full Health Screening is GBP 1,000, we will only reimburse a maximum of GBP 850 (85% of the annual maximum) in total for out-patient day to day care.

No co-insurance is available on Business Select or Business Ultimate. An optional 15% or 25% available on Business Premier and Business Elite.

What treatment and conditions are not covered?

There are certain conditions and treatments that we do not pay for on any level of coverage.

We always ask that you contact us before arranging or receiving any treatment so we can confirm coverage.

Excluded conditions and treatments:

  • artificial life maintenance
  • birth control
  • Chinese medicine
  • conflict and disaster
  • congenital and hereditary conditions***
  • convalescence, nursing home and admission for general care
  • cosmetic treatment
  • deafness
  • dental treatment/gum disease*
  • desensitisation and neutralisation
  • developmental problems
  • donor organs
  • drugs and dressing (out-patient)**
  • epidemics and pandemics
  • experimental treatment
  • eyesight
  • family doctor treatment**
  • footcare
  • gender issues
  • genetic testing
  • harmful or hazardous use of alcohol, drugs and/or medicines
  • health hydros, nature cure clinics and related treatments
  • infertility treatments 
  • infertility treatment
  • maternity and childbirth**
  • mechanical or animal donor organs
  • obesity***
  • persistent vegetative state (PVS) and neurological damage
  • personality disorders
  • physical aids and devices
  • pre-existing conditions
  • preventive and wellness treatment
  • reconstructive or remedial surgery
  • self-inflicted injuries
  • sexual problems
  • sleep disorders
  • speech disorders
  • stem cells
  • surrogacy
  • temporomandibular joint (TMJ) disorders
  • travel costs for treatment
  • unrecognised medical practitioner, provider or facility
  • U.S. treatment*

* Included for Business Ultimate.

** Excluded only for Business Select.

***We may cover costs associated with this benefit as detailed in the 'Table of Benefits'.

This is a summary of your plan. Please read the ‘Table of Benefits’ and ‘General Exclusions’ on the product pages for detailed rules and benefit limits.

Do you have a limit for the cost of treatment I may receive?

We will pay for reasonable and customary costs. This means that the costs charged by your treatment provider should not be more than they would normally charge and be representative of charges by other treatment providers in the same area.

Guidelines for fees and medical practice (including established treatment plans, which outline the most appropriate course of care for a specific condition, operation or procedure) may be published by a government or official medical body. In such cases, or where published insurance industry standards exist, Bupa Global may refer to these when assessing and paying claims. Charges in excess of published guidelines or reasonable and customary costs may not be paid.

Services available to you

How can I track the progress of my claim?

We will process your claim as quickly as possible. You can check the progress of claims you have made via our MembersWorld website or by contacting General Enquiries on +44 (0) 1273 323 563.

MembersWorld may not track claims in the U.S. as we use a third party here.  

How can I contact Bupa Global?

As a Bupa Global member, you can call our Healthline at any time of the day or night, and day of the year, and speak to people who understand your situation and can give you the healthcare advice, support and assistance you need.

We also have a team of expertly trained people ready to help with any general enquiries you may have.

Healthline: +44 (0)1273 333 911

General Enquiries: +44 (0)1273 323 563

Email us via our MembersWorld website.

What is your complaints process?

We are always pleased to hear about aspects of your membership that you have particularly appreciated, or that you have had problems with. If something does go wrong, here is our simple procedure to ensure your concerns are dealt with as quickly and effectively as possible.

Getting in touch

If you have any comments or complaints, you can call the Bupa Global customer helpline on +44 (0) 1273 323563, 24 hours a day, 365 days a year. Alternatively, you can email via MembersWorld, or write to us at:

Bupa Global
Victory House
Trafalgar Place
Brighton
BN1 4FY
UK

We want to make sure that members with special needs are not excluded in any way. For hearing and speech impaired members who have a textphone, please call +44 (0) 1273 866557.

Taking it further

If we have not been able to resolve the problem and you wish to take your complaint further, please call the Bupa Global customer helpline on +44 (0) 1273 323 563 or write to the Head of Customer Relations at:

Bupa Global
Victory House
Trafalgar Place
Brighton
BN1 4FY
UK

It’s very rare that we can’t settle a complaint, but if this does happen, you may refer your complaint to the Financial Ombudsman Service.

You can write to them at:

The Financial Ombudsman Service
Exchange Tower
London
E14 9SR

Call them on:
0845 023 4567 or 0300 123 9123 (from inside the UK only)
+44 (0) 20 7964 0500 (from outside the UK)

Find details at their website:
www.financial-ombudsman.org.uk

Please let us know if you want a full copy of our complaints procedure. (None of these procedures affect your legal rights.)

Can I access my plan online?

Yes, as a Bupa Global member you will have access to our MembersWorld website where you can:

  • view your policy
  • update your personal details
  • track the progress of your claims*
  • search our international hospital directory
  • download claim forms and other useful documents
  • talk to us online using our free Webchat service

As a group secretary, can I manage the group plan online?

Yes, as a group secretary of a Business policy, you will have access to our CorporateWorld website where you can:

  • manage employee details
  • manage payment details
  • access useful documents such as membership guides and claim forms

Managing your plan

How are subscriptions paid?

Your sponsor (your organisation) has to pay any and all subscriptions due to Bupa Global, together with any other charges (such as insurance premium tax) that may be payable.

How can I renew my plan?

The renewal of your membership is subject to your sponsor renewing your membership.

Can I add other people to my plan?

Adding a dependant? 

If your sponsor agrees, you, the principal member may apply to include any of your dependants under your membership. To apply, you, the principal member will need to complete a Business Health Plan Employee Application form (later referred to as 'application form') which can be downloaded easily from bupaglobal.com/membersworld.

When you apply, the dependant’s medical history will be reviewed by our medical team which may result in cover for pre-existing conditions, special restrictions or exclusions, or we may decline to offer cover. Any special restrictions or exclusions are personal to the person you add and will be shown on your membership certificate. This does not apply if your sponsor has purchased cover with medical history disregarded. Please contact the customer services helpline if you are not sure if this applies to you.

Adding your newborn child?

Congratulations on your new arrival!

If you have a Business Select Health Plan

To apply to add your newborn, you, the principal member will need to complete an application form. We must have received the form before cover can commence and the child must not have been born as a result of assisted reproduction technologies, ovulation induction treatment, adopted or born to a surrogate.

If your child is born as a result of assisted reproduction technologies, ovulation induction treatment, adopted or born of a surrogate, the earliest you can apply for cover is from the child's 91st day of life.

If you have a Business Premier Health Plan, Business Elite Health Plan or Business Ultimate Health Plan

Your newborn can be included on this health plan from birth without completing an application form and will be covered regardless of any health conditions when at least one parent has been covered on this health plan for 10 months or more prior to the child's birth, and a copy of the birth certificate is submitted within 30 days of the birth, and when none of the below apply.

We will request a fully completed application form if the birth certificate is not submitted within 30 days as indicated above neither parent has been covered on this health plan for 10 months or more prior to the child's birth, or the child is born as a result of assisted reproduction technologies, ovulation induction treatment, adopted or born to a surrogate.

In these cases where you have to submit an application form for the newborn child, the process described for adding a dependant will be followed.

If there are any changes to the information you provided on the application form after you sign it and before we accept the application, please let us know straight away.

What is a group insurance plan?

The Bupa Global Business plan is a group insurance plan. You are therefore one of a group of members, which has a sponsor (normally the company you work for). The person who runs the membership within your organisation is usually referred to as the group secretary.

The plan is governed by an agreement between your sponsor and Bupa Global, which covers the terms and conditions of your membership. This means that there is no legal contract between you and Bupa Global. Only the sponsor and Bupa Global have legal rights under the agreement relating to your cover, and only they can enforce the agreement.

As a member of the plan, you do have access to our complaints process. This includes the use of any dispute resolution scheme we have for our members.

How is the plan cancelled?

Your sponsor (organisation) can end your membership, or that of any of your dependants, at any date by writing, emailing or phoning us. We cannot backdate the cancellation of your membership.

 

Can I transfer to a personal plan if my group plan ends?

Yes, if for whatever reason your group policy ends, you can apply to transfer to a personal Bupa Global plan. You can also apply for your dependents to transfer with you.

I haven't been able to find the answer to my question

Please contact us where an adviser will be ready to help.