Designed for Arranged and provided by Your Bupa membership guide for platinum private medical cover plan The Royal Bank of Scotland Effective from 1 October 2017 Essential information explaining your Bupa cover Please retain 1 ABOUT THIS GUIDE Welcome to your Bupa membership guide. At Bupa, we know that insurance can be hard to follow. That’s why we’ve made this guide as simple as possible. You’ll find individual chapters that deal with each aspect of your Bupa cover, including a step-by-step guide to making a claim. Please make sure that you keep this guide somewhere safe. You’ll need it when you come to claim. If any of the terms or language used leave you confused – don’t worry, we’ve also included a glossary featuring clear definitions of words that are in bold and italic in the text. If you require correspondence and marketing literature in an alternative format, we offer a choice of Braille, large print or audio. Please get in touch to let us know which you would prefer. HOW DO I KNOW WHAT I’M COVERED FOR? The precise details of the cover you have chosen are listed in your benefit table. Please read this membership guide together with your membership certificate, as together they set out full details of how your health insurance works. These pages must be read together as a whole and in their entirety, applying to people who join and renew from the renewal date as defined in the glossary. The details in this Membership Guide may be altered by changes agreed between your employer and Bupa, so please always call the helpline to check your cover before arranging any treatment. 2 HOW DO I CONTACT BUPA? We’re always on hand to help. For queries about your cover we have provided a dedicated number which you will find on your membership certificate. You can also write to us at Bupa, Salford Quays, Manchester, M50 3XL. BUPA HEALTHLINE If you have any questions or worries about your health call our confidential Bupa HealthLine on0345 607 7777†. Our qualified nursing team is on hand 24 hours a day, so whatever your health question or concern, they have the skills and practical, professional experience to help. †Calls may be recorded and to maintain the quality of our Bupa HealthLine service a nursing manager may monitor some calls always respecting the confidentiality of the call. 3 CONTENTS AT A GLANCE Page Your rules and benefits effective from 1 October 2017 5 Your benefit table 7 How your membership works 11 • The agreement between the sponsor and us • Payment of benefits • When your membership starts, renews and ends • Making changes • General information • Private Healthcare Information Network • Making a complaint Claiming 16 • Making a claim • How we will deal with your claim • If you want to withdraw a claim • Ex-gratia payments • Your excess or co-insurance Benefits 21 • What you are covered for Cash benefits 33 What is not covered 35 Glossary 42 Privacy Notice 52 Financial Crime and Sanctions 56 4 YOUR RULES AND BENEFITS EFFECTIVE FROM 1 OCTOBER 2017 These are the rules and benefits that apply to the Platinum Private Medical Cover Plan o For anyone joining the scheme they apply from their start date. o For anyone whose membership of the scheme is renewed by the sponsor they apply for the period from the firstrenewal date on or after the ‘effective from’ date. Words and phrases in bold and italic in this membership guide are defined terms which have a specific meaning. You should check their meaning in the glossary. 5 Important note – please read this note before you read the rest of this membership guide as it explains how this membership guide and your benefit table work together. This Bupa Membership Guide – which contains your benefit table – and your membership certificate together set out full details of your benefits. They should not be read as separate documents. This membership guide is divided into two parts: the section ‘Your benefit table’ and the general membership terms. Your benefit table sets out the elements of your cover that are specific to yourscheme . It is your membership certificate together with your benefit table that shows the cover that is specific to yourbenefits and scheme. Any elements of cover in this membership guide that are either: o shown in your benefit table as ‘not covered’ or o do not appear in your benefit table you are not covered for and you should therefore ignore them when reading this membership guide. Also, your benefit table could show some changes to the general membership terms in this guide particularly in the ‘Further details’ section. Your membership certificate could also show some limitations or exclusions to the terms of cover set out in this membership guide and your benefit table. When reading this membership guide and your membership certificate, it is your membership certificate which is personal to you and your benefit table that details your cover under your scheme. This means that if there is any contradiction between your membership certificate, your benefit table and the general membership terms, your membership certificate will take priority. Always call the helpline if you are unsure of your cover. 6 YOUR BENEFIT TABLE This section contains the benefit table that applies to your scheme. All the limits in the following table are subject to your overall annual maximum benefit and any maximum annual benefit limits and/orexcess or co-insurance that applies. Call the helpline if you are unsure of your benefits. Type of benefit Benefit note Cover Limits for each member (subject to benefit note(s)) Finding out what is wrong and being treated as an out-patient out-patient consultations and 1.1, 1.4 yes paid in full diagnostic tests yes paid in full subject to: out-patient therapies 1.2 sports massage a maximum of 2 sessions each year for podiatry is not covered for dependants a maximum of 2 consultations each year with a dietician out-patient complementary 1.3 yes paid in full medicine out-patient MRI, CT and PET 1.5 yes treatment facility: paid in full scans GP fees: paid in full GP fees and GP home visits 1.6 yes GP home visits: up to £50 each visit prescribed drugs and 1.7 yes paid in full dressings medical aids 1.8 yes up to £2,000 each year Being treated in hospital consultants’ fees 2 yes consultants in a treatment facility: paid in full facility access 3 treatment facilities parent accommodation 3.2.2 yes under 16 facility charges for surgical operations carried out as 3 yes treatment facility: paid in full out-patient treatment facility charges for day-patient treatment and 3 yes treatment facility: paid in full in-patient treatment 7 YOUR BENEFIT TABLE continued Type of benefit Benefit note Cover Limits for each member (subject to benefit note(s)) Cancer treatment out-patient consultations, 4 yes paid in full therapies and diagnostic tests out-patient 4 yes paid in full complementary medicine out-patient cancer drugs 4 yes treatment facility charges: paid in full Mental health treatment up to a maximum of 28 days each year for mental health mental health treatment 5 yes day-patient treatment and mental health in-patient treatment combined and not individually consultants’ fees, mental health and wellbeing therapists’ fees and 5 yes paid in full diagnostic tests for out -patient mental health treatment consultants’ fees for mental health day-patient consultants in a treatment facility: 5 yes treatment and mental paid in full health in-patient treatment facility charges for mental health day-patient 5 yes treatment facility: paid in full treatment and mental health in-patient treatment Additional benefits if we agree, we pay in full for the charges that we treatment at home 6 discretionary benefit agree to pay on your behalf home nursing 7 yes paid in full up to a maximum of 180 days each year private ambulance charges 8 yes paid in full Repatriation and evacuation assistance your repatriation/evacuation 9 yes paid in full accompanying partner/ 9 yes paid in full relative repatriation of mortal 9 yes up to £7500 remains burial expenses 9 yes up to £7500 8 YOUR BENEFIT TABLE continued Type of benefit Benefit note Cover Limits for each member (subject to benefit note(s)) Pregnancy and childbirth routine maternity and up to £10,000 each year 10 yes baby care co-insurance: 20% of eligible treatment costs each year Dental treatment up to £750 each year routine dental treatment 11 yes excess: £50 each year accidental dental injury 11 yes paid in full treatment Cash benefits NHS cash benefit for £50 each night up to a maximum of 100 nights CB1 yes in-patient treatment each year NHS cash benefit for NHS in-patient stays that you receive radiotherapy, CB6.1 yes £100 each night chemotherapy or a surgical operation that is for cancer treatment £100 for each day you receive radiotherapy in a NHS cash benefit for hospital setting NHS out-patient or £100 for each day you receive IV-chemotherapy and day-patient treatment or CB6.2 yes for each three-weekly interval of oral chemotherapy NHS home treatment or part thereof for cancer £100 on the day of your surgical operation Procedure Specific up to the amount we pay for each specific procedure CB7 yes cash benefits you receive for eligible treatment Type of benefit Benefit note/rule Waiting period that applies to underwritten members Waiting periods for a new member: 10 months Routine maternity Benefit 10 for a returning member: 24 months 9 YOUR BENEFIT TABLE continued BENEFIT LIMITS o The overall annual maximum benefit is the maximum amount we will pay up to each year.