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How does this plan work?

Who is Bupa Worldwide Health Options for? Hide

This policy is for expatriates as well as local nationals (where local regulations permit).

Where can I be treated? Hide

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

We also have a network of over 5,500 hospitals and clinics who we can often arrange to pay directly on your behalf (this is known as prior approval).

Our Medical Centre will help you find suitable medical facilities and to book appointments.

How do I arrange treatment? Hide

If for any reason you need treatment, we ask that you contact us first. We can then check your cover, talk through any concerns you have and arrange prior approval. This process also allows us to assist you with booking an appointment and to make direct contact with your hospital or clinic so that we can settle your bills for you.

How does the claims process work? Hide

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 give prior approval.
• We send pre-authorisation documents 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**.
• We send you a ‘payment statement’ advising when and how it was paid, and who received the payment.

How will my medical costs be paid? Hide

We always aim to settle your claim directly with your treatment provider. If we cannot do this for any reason, we ask that you send us a claim by post. A claim consists of a fully completed claim form and all the original invoices from your treatment.

• We can pay you, the principle member (applicant) or your medical provider.
• We can pay by cheque or by electronic bank transfer.

We will pay you in the currency you ask for in the payment section of the claim form, unless we are not allowed to due to international banking regulations. If this happens, we will pay you in the currency you use to pay your subscriptions in.

For further information, see our guide to how we arrange and pay for your treatment

How do deductibles work? Hide

A deductible is the amount you must pay towards covered expenses before we will start paying for your treatment.

Deductibles apply separately for treatment you have under each of the options. For example, if you chose Worldwide Medical Insurance and Worldwide Medical Plus, the deductible for each would be applied as follows:

You have physiotherapy for a broken leg (usually paid from your Worldwide Medical Plus option):

Cost: £300

Deductible applied: £100

Amount paid £200

You have treatment in hospital for a broken leg:

Cost: £1,000

Deductible applied: £500

(From Worldwide Medical Insurance, as this covers hospital treatment)

Amount paid £500

What treatment and conditions are not covered? Hide

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

For further details on any of the exclusions below, please read this plan’s membership guide or contact us. The exclusions below apply to all options available in this plan.

Addictive conditions and disorders:

• treatment for or as a result of addictive conditions and disorders
• treatment for or as a result of any kind of substance or alcohol use or misuse

Artificial life maintenance:

if this treatment is not intended or expected to bring about your recovery or restore you to your previous state of health

Birth control:

• contraception
• sterilisation
• vasectomy
• termination of pregnancy unless there is a threat to the mother’s health
• family planning, such as meeting with your doctor to discuss becoming pregnant or contraception

Conflict and disaster:

• nuclear or chemical contamination
• war, riot, revolution, acts of terrorism
• epidemics put under the control of the local public health authorities
• any similar event if:
• you have put yourself in danger by entering a known area of conflict (as identified by an EU
• government, such as the British Foreign and Commonwealth Office), or you were an active participant, or you have displayed a blatant disregard for your personal safety

Convalescence and admission for general care, or staying in hospital for:

• convalescence, pain management, supervision
• receiving only general nursing care
• therapist or complementary therapist services
• domestic/living assistance such as bathing and dressing
• treatment that could take place as day-case or out-patient

Cosmetic treatment

Treatment to improve your appearance such as:

• facelift or re-modelled nose
• cosmetic dentistry such as the replacement of a sound, natural tooth with an implant, veneers, etc
• orthodontic treatment over the age of 19 years (we pay for orthodontic treatment under the age of 19 years if you have bought the Worldwide Wellbeing option)
• removal of surplus fat tissue such as liposuction 
• hair transplants for any reason
• surgery to change the shape, enhance or reduce your breast(s) for any reason, except reconstruction following treatment for cancer

We may pay for prophylactic surgery (surgery to remove an organ or gland that shows no signs of disease, in an attempt to prevent development of disease of that organ or gland) when:

• there is a significant family history of the disease, for example ovarian cancer, which is part of a genetic cancer syndrome and/or:
•  you have positive results from genetic testing (please note that we will not pay for the genetic testing)

Developmental problems:

• learning difficulties, such as dyslexia, or behavioural problems, such as attention deficit disorder (ADHD), or:
• physical development problems, such as short height

Donor organs

mechanical or animal organs, except where a mechanical appliance is temporarily used to:

• maintain bodily function whilst awaiting transplant
• purchase of a donor organ from any source
• harvesting and storage of stem cells, when a preventive measure against possible future disease

Experimental treatment:

• treatment or prescribed medicines which in our reasonable opinion, based on advice of the
• local public authority in the country where your treatment takes place, are experimental or have not proved to be effective
• treatment or clinical trials which have not yet been approved in the country in which you are receiving treatment
• prescribed medicines used for purposes other than those defined under their license, which may vary from country to country

Eyesight:

• treatment or surgery to correct eyesight such as laser treatment, refractive keratotomy (RK) and photorefractive keratectomy (PRK)

We pay for eligible treatment of your eyesight if it is needed as a result of a disease, illness or injury such as cataracts or a detached retina.

Foetal surgery:

• surgery undertaken in the womb before birth

Footcare

Treatment for:

• corns
• calluses
• thickened or misshapen nails

Health hydros, nature cure clinics, etc

Treatment or services received in a:

• health hydro
• nature cure clinic
• spa, or
• any similar establishment that is not a hospital

Infertility treatment

Treatment to assist reproduction such as:

• in-vitro fertilisation (IVF)
• gamete intrafallopian transfer (GIFT)
• zygote intrafallopian transfer (ZIFT)
• artificial insemination (AI)
• prescribed drug treatment
• embryo transport (from one physical location to another)
• donor ovum and/or semen and related costs

We pay for investigations into the cause of infertility when your specialist believes there are symptoms and/or evidence to suggest a medical cause.

We will only pay when:

• both you and your partner have been members of this plan (or any Bupa plan which includes this cover) for two years before the investigations start, and:
• you were both unaware and had not been suffering any symptoms prior to joining

Obesity:

Treatment for or as a result of obesity such as:

• slimming aids or drugs
• slimming classes

We may pay for surgery such as gastric banding or a gastric bypass when:

• you have a body mass index (BMI) of 40 or over and/or
• you have a diagnosis of morbid obesity

Personality disorders

Any treatment for personality disorders, including but not limited to:

• affective personality disorder
• schizoid personality (not schizophrenia)
• histrionic personality disorder

Pre-existing conditions

Any treatment for a pre-existing condition, related symptoms, or any condition that results from or is related to a pre-existing condition, unless:

• we were given all the medical information that we asked for during your application for your current continuous period of membership, and:
• we did not specifically exclude cover for the pre-existing condition on your membership certificate under Special conditions
• you did not know about, or have any symptoms of, the pre-existing condition before the ‘Period of cover from’ date on the first membership certificate for your current continuous period of membership

Preventive treatment

Health screening, including routine health checks and vaccinations, or any preventive treatment, except:

• if you have bought the Worldwide Wellbeing option

We may pay for prophylactic surgery when:

• there is a significant family history of the disease for example ovarian cancer, which is part of a genetic cancer syndrome and/or:
• you have positive results from genetic testing (please note that we will not pay for the genetic testing)

Reconstructive or remedial surgery

treatment to restore your appearance after an illness, injury or surgery

We may pay for surgery when:

• the original illness, injury or surgery and the reconstructive surgery take place during your current continuous membership

Self-inflicted injuries:

• treatment for or as a result of an injury you have knowingly caused to yourself, such as in an attempted suicide

Sexual problems and gender issues:

• sexual problems, such as impotence, whatever the cause
• sex changes or gender reassignments

Sleep disorders:

• insomnia
• snoring
• sleep-related breathing problems
• sleep studies

We may pay for treatment of sleep apnoea when your specialist believes this to be life-threatening.

We will only pay for:

• an initial sleep study
• surgery, if medically appropriate
• equipment hire, such as a Continuous Positive Airway Pressure (CPAP) machine (only if you have bought the Worldwide Medicines and Equipment option)

Temporomandibular joint (TMJ) disorders :

• Travel costs for treatment
• any fares such as taxis or buses, unless otherwise specified
• expenses such as petrol or parking fees

Unrecognised physician or facility:

• treatment provided by a medical practitioner who is not recognised by the relevant authorities in the country where the treatment takes place as having specialised knowledge, or expertise in, the treatment of the disease, illness or injury being treated
• treatment provided by anyone with the same residence as you or who is a member of your immediate family
• treatment in any hospital, or by any medical practitioner or any other treatment provider, to whom we have sent a written notice that we no longer recognise them for the purposes of our plans

USA treatment

If you have not bought cover for the USA, then we will not pay for treatment received in the USA.

If you have bought cover for the USA, we will not pay for treatment received there when:

• prior approval for your treatment was not given by our service partner in the USA
• Bupa International knows or suspects that you purchased cover for and travelled to the USA for the purpose of receiving treatment for a condition, when you had already experienced symptoms of that condition.

This applies whether or not your treatment was the main or sole purpose of your visit.

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

Beyond the benefit limits of your plan, we only pay costs when the charges made by the provider of services are reasonable and customary. By this we mean that the charges are the same as those made to our members by the majority of other service providers in the same country; and also that they are not more than the provider would normally charge.

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Services available to you

How can I track the progress of my claim? Hide

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.

How can I contact Bupa International? Hide

As a Bupa International member, you can call our Medical Centre at any time of the day or night, and day of the year, and speak to medically trained 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.

Medical Centre: +44 (0)1273 333 911

General Enquiries: +44 (0)1273 323 563

Email us via our MembersWorld website

What is your complaints process? Hide

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 International customer helpline on +44 (0) 1273 323563, 24 hours a day, 365 days a year. Alternatively, you can email via www.bupa-intl.com/membersworld, or write to us at:

Bupa International

Russell Mews

Brighton

BN1 2NR

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 866 557.

We also offer a choice of Braille, large print, or audio for our letters and literature. Please let us know which you would prefer.

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 International customer helpline on +44 (0) 1273 323 563 or write to the Head of Customer Relations at:

Bupa International

Russell Mews

Brighton

BN1 2NR

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:

South Quay Plaza

183 Marsh Wall

London

E14 9JR

Call them on:

0845 080 1800 (from inside the UK only)

+44 (0) 20 7964 1000 (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 policy online? Hide

Yes, as a Bupa International 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*
• make payments online
• search our international hospital directory
• download claim forms and other useful documents
• talk to us online using our free webchat service

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Managing your plan

Can I change my plan? Hide

Your membership with us is an annual contract. This means that we can only add or remove options for you on your ‘anniversary’.

If you want to add or remove options, we ask that you contact us before your anniversary to discuss your choices. If you add options to your plan, your subscriptions will be higher. If you remove options from your plan, your subscriptions will be lower.

How can I cancel my membership? Hide

You can cancel your membership, and that of any additional people covered under your plan, within 28 days of receiving your first membership certificate. Should you wish to, simply write and let us know. Our address is in the Worldwide Health Options membership guide.

What happens if I can no longer pay for my plan? Hide

If you do not pay subscriptions and other charges when they are due, your membership may be suspended.

Claims submitted while your membership is suspended will not be paid. Once you have paid your subscriptions and your membership suspension has ended, we will be happy to re-consider your claim(s).

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

We are continuously adding information to this website and are sorry that you haven’t found the information you were looking for on this occasion.

For the information you require, please contact us on +44 (0)1273 718 306 or send an email enquiry

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