Bins 14217
Bins 14217
summary
Bupa Select Enhanced
Effective from 1 May 2024
Welcome to Bupa Select Enhanced. This policy
summary contains key information. You should read
this carefully and keep it in a safe place. Please note
that it does not contain the full terms and conditions
and exclusions of cover under the Agreement, which
you will find in the Bupa Select policy guide and
membership certificate.
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are demonstrated through scientific evidence to be effective in improving
health outcomes
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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 terms and conditions
of the Agreement between the group and Bupa.
Webchat
bupa.co.uk/contact-us
Bupa digital account
Visit bupa.co.uk or use the Bupa Touch app.
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Direct Access to treatment and care
You don’t always need to see a GP before contacting us. With our Direct Access service
you can call us if you’re worried about cancer, mental health or muscle bone and joint
problems. We’ll provide support, advice and a referral for consultations, tests or
treatment if you need them.
If you have a GP referral, we may also offer you a phone or video assessment with
a healthcare professional who specialises in your condition. This will allow you to explore
all your treatment options.
If you have a Direct Access phone or video assessment you won’t need to pay an excess
for it and we won’t take the cost from your outpatient benefit allowance (if either of
these apply to your policy). If our Direct Access service refers you for a consultation,
tests or treatment you may be able to claim for that consultation, test or treatment and
we’ll explain how to do this after your assessment.
You can find more information about our Direct Access service
at bupa.co.uk/direct-access.
Open referral
If you see a GP and you need a consultation, tests or treatment, ask for an open referral.
This means, your GP recommends the type of specialist you need to see instead of
naming a specific specialist. When you contact us, we’ll use your GP’s speciality
recommendation to help you choose a fee-assured consultant or healthcare professional
covered by your policy.
Need to know
Your membership certificate will show if guided care applies to you. (Look in the group
details section, under facility access).
If you have the guided care option, the following conditions apply.
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You must ask for an open referral from a GP or our Direct Access service (if this is
available for your condition).
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You must contact us before arranging any consultations, tests or treatment for
pre-authorisation.
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If you need to see a consultant, they need to be in our open-referral network – when
you contact us, we’ll help you find one.
For anyone aged 17 or under, please ask the GP for a named referral.
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Before you arrange consultations, tests or
treatment
Pre-authorisation
It’s important that you contact us before arranging any consultations, tests or treatment
or care so we can:
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confirm whether the consultation, test or treatment is eligible treatment and if it’s
covered by your policy
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confirm the consultants, healthcare professionals, hospitals or clinics covered by your
policy
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let you know how to claim for NHS cash benefits or health expenses benefits, if these
are covered, and
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give you a pre-authorisation number.
We may ask you for information about the history of your symptoms, including details
from your GP or consultant.
You can then contact the consultant, healthcare professional, hospital or clinic to arrange
an appointment. You’ll need to give them your pre-authorisation number so we can pay
them for your treatment that is covered by your policy. We will write to the main
member or to their dependant who is having treatment (if they are aged 16 or over), if
there is an amount for them to pay in relation to any claim (for example if they have to
pay an excess) to explain how much and who to pay.
Need to know
If you don’t get pre-authorisation from us, you’ll be responsible for paying all treatment
that we wouldn’t have pre-authorised if you’d contacted us before arranging it.
Cover for people aged 17 or under
We always need a named referral for a paediatric consultant. If someone aged 17 or
under who is covered on your policy needs to see a consultant, please ask their GP for a
named referral not an open referral. Some private hospitals don’t provide services for
children or have restricted services available so treatment may be at an NHS hospital.
Please visit finder.bupa.co.uk to see paediatric services available in your area and
contact us before any consultations, tests or treatment so we can confirm that these are
covered.
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The consultants, healthcare professionals, hospitals and facilities that your
policy covers
Your policy covers certain Bupa recognised consultants, healthcare professionals and
recognised facilities:
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The facility, consultant or the healthcare professional must be recognised by us for
treating the medical condition you have, and for providing the type of treatment you
need on the date you receive that treatment.
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If you need inpatient treatment or day-patient treatment (or both), the recognised
facility must be part of the facility access list which applies to your cover and is
shown on your membership certificate.
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The person who has overall responsibility for your treatment must be a consultant
unless a GP or our Direct Access service refers you for outpatient treatment
by a therapist, complementary medicine practitioner or mental health and
wellbeing therapist.
Need to know
If you have the guided care option, any consultant you see needs to be in our
open-referral network.
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Summary of cover
This table sets out a high level summary of the type of charges for eligible treatment that
are covered and the allowances available for certain benefits. It also shows certain
options that are available for the groups to select. For full details of your cover see your
policy guide which shows the general terms and your membership certificate that shows
the cover that your group has selected and is available to you. This means you may not
have all the cover set out in the policy summary.
Unless otherwise specified, the amounts shown in the table are for each member.
Facility access
partnership facilities
or
guided care
Outpatient consultations with a consultant paid in full up to £1,500 each membership year
for these outpatient benefits combined and not
Outpatient therapies and complementary medicine individually
Facility or consultant charges for outpatient
diagnostic tests
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When you are admitted to hospital
Type of treatment depending on your cover under Allowances depending on your cover under
the Agreement the Agreement
Consultants’ fees for surgical and medical hospital If the guided care option has not been chosen
treatment J
consultants who are fee-assured consultants:
paid in full
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recognised consultants who are not fee-assured
consultants: up to the rates of the Bupa schedule
of procedures
If the guided care option has been chosen
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fee-assured consultants in our list of Open Referral
Network consultants: paid in full
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consultants in our list of Open Referral Network
consultants who are not fee-assured consultants:
up to the rates of the Bupa schedule of procedures
Additional benefits
Type of treatment depending on your cover under Allowances depending on your cover under
the Agreement the Agreement
Private ambulance (when medically necessary and up to £80 each single trip
related to private eligible day-patient or inpatient
treatment)
Treatment at home - instead of inpatient treatment, paid in full with a recognised treatment provider
day-patient treatment or chemotherapy as an
outpatient
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Cash benefits
Type of treatment depending on your cover under Allowances depending on your cover under the
the Agreement Agreement
NHS cash benefit for NHS inpatient treatment £50 a night for up to 35 nights a year
NHS cash benefit for NHS inpatient treatment for £100 each night
cancer
NHS cash benefit for oral drug treatment for cancer £100 for each three-weekly interval
Cash benefit for wigs or hairpieces related to £100 payable each time:
cancer - a new cancer is diagnosed
- a previous cancer comes back
Cash benefit for mastectomy bras £200 paid once per mastectomy operation
Procedure Specific NHS cash benefit available for certain eligible treatments. Contact us
or go to bupa.co.uk/pscb for more information
Cancer treatment
Type of treatment depending on your cover under Allowances depending on your cover under the
the Agreement Agreement
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Cancer treatment
Type of treatment depending on your cover under Allowances depending on your cover under the
the Agreement Agreement
Consultants’ fees for surgical and medical If the guided care option has not been chosen
hospital treatment J
consultants who are fee-assured consultants:
paid in full
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recognised consultants who are not fee-assured
consultants: up to the rates of the Bupa schedule
of procedures
If the guided care option has been chosen
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fee-assured consultants in our list of Open Referral
Network consultants: paid in full
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consultants in our list of Open Referral Network
consultants who are not fee-assured consultants:
up to the rates of the Bupa schedule of procedures
Consultant psychiatrists’ fees and mental health paid in full up to and from within your available
and wellbeing therapists’ fees for outpatient outpatient benefits combined allowances specified
treatment above in this table
Consultant psychiatrists’ fees for day-patient and If the guided care option has not been chosen
inpatient treatment J
consultants who are fee-assured consultants:
paid in full
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recognised consultants who are not fee-assured
consultants: up to the rates of the Bupa schedule
of procedures
If the guided care option has been chosen
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fee-assured consultants in our list of Open Referral
Network consultants: paid in full
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consultants in our list of Open Referral Network
consultants who are not fee-assured consultants:
up to the rates of the Bupa schedule of procedures
up to a maximum of 45 days each membership
year for mental health day-patient and inpatient
treatment combined and not individually
Facility charges for day-patient and inpatient paid in full up to a maximum of 45 days each
treatment year for mental health day-patient and inpatient
treatment combined and not individually
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Add-on – family cash benefit
(available when purchased via an insurance intermediary, or to customers
whose policy was purchased direct from Bupa and already includes it)
Type of treatment depending on your cover under Allowances depending on your cover under the
the Agreement Agreement
Family cash benefit (this cover applies to the main £200 for each birth or adoption
member only)
The following benefits are available to members who are aged 16 or over at the start of the policy year
(see the Cash Benefit section in the Bupa Select policy guide for details)
Island cover – for residents of Jersey, Guernsey or the Isle of Man only. It can’t be selected together with
the guided care option
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Options to manage costs
Name of option Choice available
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What your policy does not cover
There are certain medical conditions and treatments that you’re not covered for. There
are some exceptions to some exclusions. The Bupa Select policy and your membership
certificate together provide the details of your cover and they are also available from
the helpline.
The excluded medical conditions and treatments include:
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ageing, menopause and puberty
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accident and emergency treatment
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advanced therapies and specialist drugs
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allergies, allergic disorders or food intolerances
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benefits that are not covered and/or are above your allowances
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birth control, conception and sexual problems
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chronic conditions
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contamination, wars, riots and some terrorist acts
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convalescence, rehabilitation and general nursing care
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cosmetic, reconstructive or weight loss treatment
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deafness
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dental/oral treatment
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dialysis
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gender dysphoria or gender affirmation
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excluded treatment or medical conditions
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eyesight
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intensive care (other than routinely needed after private day-patient treatment or
inpatient treatment)
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learning difficulties, behavioural and developmental conditions
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leg varicose veins
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moratorium conditions for moratorium members: any disease, illness or injury which
existed in the five years before cover started, unless after two years continuous
membership, you haven’t received medication, advice or treatment or experienced
symptoms of that disease, illness or injury
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outpatient drugs, dressings, complementary and alternative products
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overseas treatment
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pandemic or epidemic disease
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physical aids and devices
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pre-existing conditions for underwritten members: by underwritten members we
mean a member who as part of his/her application to join was required to provide
details of his/her medical history to us for the purpose of underwriting
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pregnancy and childbirth
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screening, monitoring and preventive treatment
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sleep problems and disorders
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special conditions
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speech disorders
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temporary relief of symptoms
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treatment or medical conditions that are not covered, and their complications
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treatment in a treatment facility that is not a recognised facility
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unproven drugs and treatment
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unrecognised medical practitioners, providers and facilities.
Call
0345 604 0623
Lines are open between 8am and 8pm Monday to Friday and 8am to 4pm Saturday.
We may record or monitor phone calls.
Webchat
bupa.co.uk/contact-us
Bupa digital account
Visit bupa.co.uk or use the Bupa Touch app.
Write to us at: Bupa, Bupa Place, 102 The Quays, Salford M50 3SP
If you have hearing or speech difficulties
You can use the Relay UK service, visit www.relayuk.bt.com for more information.
If you have sight difficulties
We have documents in braille, large print or audio.
Please let us know if you’d like us to send you some.
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How to complain
We work hard to provide a great service to our customers, but occasionally things can
go wrong and when this happens we’ll do our best to put things right quickly.
How to get in touch
Call us: using your Bupa helpline number, which you can find on your membership
certificate or call our Customer Relations team on 0345 606 6739. (We may record or
monitor phone calls.)
Chat to us online: bupa.co.uk/complaints.
Email us: [email protected].
If you need to send us sensitive information you can email us using Egress, which is a
free secure email service. Visit switch.egress.com.
Write to us: Customer Relations, Bupa, Bupa Place, 102 The Quays, Salford M50 3SP
If we can’t resolve your complaint straight away, we’ll email or write to you within five
business days to explain the next steps.
You may be able to refer your complaint to the Financial Ombudsman Service for a free,
independent and impartial review.
You can:
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visit financial-ombudsman.org.uk
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call them on 0800 023 4567
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email them at [email protected].
If you refer your complaint to the Financial Ombudsman Service, they will ask for your
permission to access information about you and your complaint. We will only give them
information that is necessary to investigate your complaint, but this may include medical
information. If you’re concerned about this, please contact us.
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, pay compensation. You can get more information at www.fscs.org.uk
or by calling the FSCS on 0800 678 1100 or 020 7741 4100.
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Privacy notice
Our privacy notice explains how we take care of your personal information and how we
use it to provide your cover. An in brief version of the notice can be found in your policy
guide or the full version online at bupa.co.uk/privacy.
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Notes
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Notes
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Notes
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Bupa health insurance is provided by:
Bupa Insurance Limited. Registered in England
and Wales with registration number 3956433.
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 with registration number 3829851.
Registered office: 1 Angel Court,
London EC2R 7HJ
© Bupa 2024
bupa.co.uk