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How does this plan work?

Who is the Guernsey plan for? Hide

The Guernsey plan has been designed specifically for Guernsey residents who also require medical insurance coverage on the UK mainland as well as worldwide.

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 direct settlement.

Our Medical Centre service will help you find a suitable medical professional.

How do I arrange treatment? Hide

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.

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 ‘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.*
• We send you a ‘payment statement’ advising when and how it was paid, and who received the payment.

How does Bupa International make claim payments? Hide

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 over 80 currencies.

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.

Bupa International’s Guernsey plan covers you for the costs of specialist treatment of acute conditions. By this we mean treatment of diseases, illnesses or injuries which respond quickly to medical or surgical care and which is likely to lead to full recovery, or to restore you to your previous state of health, without you having to receive prolonged treatment.

This plan is intended to provide benefit for the treatment of acute conditions necessitating the services of a specialist.

Cover does not include treatment for chronic conditions. These are diseases, illnesses or injuries which are long-standing, such as diabetes or allergies.

For further details on any of the exclusions below, please read this policy’s membership guide or contact us.

The following conditions and services are not covered:

• home nursing
• pregnancy and childbirth
• cosmetic treatment
• routine dental treatment not involving an oral-surgical operation
• routine health checks
• congenital abnormalities
• sexually transmitted diseases
• alcoholism
• drug addiction
• out-patient drugs and dressings
• overseas transportation costs
• any known pre-existing conditions
• chronic conditions

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 track* the progress of your claims via our MembersWorld website or by contacting General Enquiries on  +44 (0) 1273 323 563.

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 866557.

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 plan online? Hide

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

• view your plan
• update your personal details
• make payments online
• 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

*MembersWorld may not track claims in the USA as we use a third party here.

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Managing your plan

Can I change my level of cover? Hide

If you want to change your level or type of cover, please contact our customer services helpline (+44 (0)1273 323563) before renewal to discuss your options.

How can I cancel my plan? Hide

You may cancel your membership of a policy for any reason by writing to us within 28 days of receiving your first membership certificate. In that case, you will be entitled to a full refund of all subscriptions paid, subject to no claims having been made.

You may also cancel the membership of any of your dependents (family members) for any reason by contacting us within 28 days of receiving your first membership certificate that names them as a dependent.

In that case, you will be entitled to a full refund of all your subscriptions paid relating to them, subject to no claims having been made on their behalf.

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

If you do not pay subscriptions and other charges in full by the date they are due, your membership may be suspended and claims submitted whilst there are subscriptions and charges due will not be paid.

Your membership may also be suspended if you do not settle in full any annual deductible payable by you for a claim which has been paid direct to your medical provider. Claims submitted whilst repayment of an annual deductible is due will not be paid.

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 us an email enquiry.

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