• United Kingdom
• Change

Acute condition Hide

A disease, illness or injury that is likely to respond quickly to treatment which aims to return you to the state of health you were in immediately before suffering the disease, illness or injury, or which leads to your full recovery.

Agreement Hide

the agreement between the main member and us to provide cover for you and your dependants (if any) under the terms and conditions set out in the documents referred to under the heading 'The agreement between you and us' in the section 'How your membership works'.

Appliance Hide

any appliance which is in our list of appliances for your benefits at the time you receive your treatment. The list of appliances may change from time to time. Details of the appliances are available on request.

Benefits Hide

the benefits specified in your membership certificate for which you are entitled as an individual under the scheme subject to the terms and conditions that apply to your membership in this Bupa Membership Guide including all exclusions.

Bupa Hide

Bupa Insurance Limited. Registered in England and Wales No 3956433. Registered office: Bupa House, 15-19 Bloomsbury Way, London WC1A 2BA. Bupa provides the cover.

Bupa member/ Bupa members Hide

A member covered under one of the following Bupa products as shown on their membership certificate.

• BupaCare, LocalCare, EssentialCare, Local HospitalCare, SeniorCare, Senior EssentialCare, EmployeeChoice, EmployeeChoice Essential, LocalCare Direct, Fixed Price Cover
• Heartbeat-cover options Health care select 1, 2, 3 Plus, 3 and 4.

Cancer Hide

a malignant tumour, tissues or cells characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue.

Chiropodist Hide

a chiropodist who is a recognised practitioner. You can contact us to find out if a chiropodist is a recognised practitioner.

Chronic condition Hide

A disease, illness or injury which has at least one of the following characteristics:

• it needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests
• it needs ongoing or long-term control or relief of symptoms
• it requires rehabilitation or for you to be specially trained to cope with it
• it continues indefinitely
• it has no known cure
• it comes back or is likely to come back

Co-insurance Hide

the amount that you have to pay towards the cost of treatment that you receive that would otherwise have been payable under your benefits.

Complementary medicine practitioner Hide

An acupuncturist, chiropractor, homoeopath or osteopath who is a recognised practitioner. You can contact us to find out if a practitioner is a recognised practitioner and the type of treatment we recognise them for.

Consultant Hide

A registered medical or dental practitioner who, at the time you receive your treatment:

• is recognised by us as a consultant and has received written confirmation from us of this, unless we recognised him or her as being a consultant before 30 June 1996
• is recognised by us for providing the type of treatment you need, and
• is in our list of consultants that applies to your benefits

You can contact us to find out if a medical or dental practitioner is recognised by us as a consultant and the type of treatment we recognise them for.

Consultant fees schedule Hide

the schedule used by Bupa for the purpose of providing benefits which sets out the benefit limits for cosultants' fees based on:

• the type of treatment carried out
• for surgical operations, the type and complexity of the surgical operation according to the schedule of procedures-the benefits available for consultant surgeons and consultant anaesthetists may differ for the same surgical operation
• the Bupa recognition status of the consultant, and
• where the treatment is carried out both in terms of the treatment facility and the location

The schedule may change from time to time. Details of the schedule are available on request.

Consultant partnership Hide

A network of consultants who agree to work within certain quality and service standards and whose fees, where applicable, Bupa will pay in full.

Consultant status Hide

At Bupa we have thousands of consultants across the UK who we have recognised to treat our members. The Bupa status tells you what our agreement with the consultant is, based upon whether they are a recognised or a partner consultant.

Critical care unit Hide

Any intensive care unit, intensive therapy unit, high dependency unit, coronary care unit or progressive care unit which is in our list of critical care units and recognised by us for the type of intensive care that you require at the time you receive your treatment. The units on the list and the type of intensive care that we recognise each unit for may change from time to time. Details of these critical care units are available on request.

Day-patient Hide

a patient who is admitted to a hospital, treatment facility or day-patient unit because they need a period of medically supervised recovery but does not occupy a bed overnight.

Day-patient treatment Hide

eligible treatment, that, for medical reasons, is received as a day-patient.

Dependant(s) Hide

Your partner and any child of yours who is a member of the scheme and named on your membership certificate.

Diagnostic tests Hide

Investigations, such as X-rays or blood tests, to find or to help to find the cause of your symptoms.

Eligible surgical operation Hide

eligible treatment carried out as a surgical operation.

Eligible treatment Hide

treatment of an acute condition, together with the products and equipment used as part of the treatment that:

• are consistent with generally accepted standards of medical practice and representative of best practice in the medical profession in the UK.
• are clinically appropriate in terms of type, frequency, extent, duration and the facility or location where the services are provided.
• are demonstrated through scientific evidence to be effective in improving health outcomes, and
• are not provided or used primarily for the expediency of you or your consultant or other health care professionals

and the treatment, services or charges are not excluded under your benefits.

Excess Hide

The amount that you have to pay towards the cost of treatment that you receive that would otherwise have been payable under your benefits.

Extended access facility Hide

a hospital or a treatment facility, centre or unit that, at the time you receive your eligible treatment, is in our extended access facility list that applies to your benefits and is recognised by us or by both:

• treating the medical condition you have, and
• carrying out the type of treatment ou need

any other establishment which we may decide to treat as an extended access facility for the purpose of the scheme.

The hospitals, treatment facilities, centres and units in the list and the medical conditions and types of treatment we recognise them for may change from time to time. Details of the facilities in the list and the medical conditions and types of treatment we recognise them for are available on request.

Facility access Hide

the network of recognised facilities for which you are covered under
your benefits as shown on your membership certificate and being
either:

• participating facility
  
• partnership facility
  
• extended access facility
  
• local access facility, or
  
• national access facility

GP Hide

a doctor who, at the time he/she refers you for your consultation or treatment, is on the UK General Medical Council’s General Practitioner Register.

Group sponsor Hide

the company, association, organisation or group (of which the main member is an employee or member) for whose employees or members we have agreed to operate the scheme for the time being. Please contact your helpline to check if your cover has been arranged by a group sponsor.

Home Hide

• the place where you normally live, or
• any other establishment, including a non-healthcare setting, which we may decide to treat as a home for the purpose of your benefits.

Hospital Hide

This means any of the following at the time you receive treatment:

• a Bupa participating hospital
• any other establishment which we may decide to treat as a hospital for the purpose of the scheme

You can contact us if you would like details of any of these hospitals.

In-patient Hide

A patient who is admitted to a hospital or treatment facility and who occupies a bed overnight or longer for medical reasons.

Back to top

In-patient treatment Hide

eligible treatment that, for medical reasons, is received as an in-patient.

Intensive care Hide

Eligible treatment for intensive care, intensive therapy, high dependency care, coronary care or progressive care.

Local access facility Hide

a hospital or a treatment facility, centre or unit that, at the time you receive your eligible treatment, is in our local access facility list that applies to your benefits and is recognised by us for both:

• treating the medical condition you have, and
• carrying out the type of treatment you need.

any other establishment which we may decide to treat as a local access facility for the purpose of the scheme.

The hospitals, treatment facilities, centres and units in the list and the medical conditions and types of treatment we recognise them for may change from time to time. Details of the facilities in the list and the medical conditions and types of treatment we recognise them for are available on request.

Main member Hide

the person named as the main member on the membership certificate.

Medical treatment provider Hide

a person or company who is recognised by us as a medical treatment provider for the type of treatment at home that you need at the time you receive your treatment. These medical treatment providers and the type of treatment we recognise them for may change from time to time. Details of these medical treatment providers and the type of treatment we recognise them for are available on request.

Membership certificate Hide

the most recent membership certificate that we issue to you for your current continuous period of membership of the scheme.

Membership year Hide

The period beginning on your start date or renewal date and ending on the day before your next renewal date. By start date we mean the 'effective from' date on your first membership certificate for your current continuous period of membership.

Moratorium condition Hide

any disease, illness or injury or related condition, whether diagnosed
or not, which you:

• received medication for,
  
• asked for or received, medical advice or treatment for,
  
• experienced symptoms of, or
  
• were to the best of your knowledge aware existed
  

in the five years before your start date. By a related condition we mean any symptom, disease, illness or injury which reasonable medical opinion considers to be associated with another symptom, disease, illness or injury.
 

We may take the start date of your cover under a previous scheme into account when assessing whether a medical condition is a moratorium condition but only if we specifically agreed we would do this when you joined the scheme.

Moratorium member Hide

a member whose membership certificate shows the underwriting method applied to them is moratorium.

National access facility Hide

a hospital or a treatment facility, centre or unit that, at the time you receive your eligible treatment, is in our national access facility list that applies to your benefits and is recognised by us for both:

• treating the medical condition you have, and
• carrying out the type of treatment you need.

any other establishment which we may decide to treat as a national access facility for the purpose of the scheme.

The hospitals, treatment facilities, centres and units in the list and the medical conditions and types of treatment we recognise them for may change from time to time. Details of the facilities in the list and the medical conditions and types of treatment we recognise them for are available on request.

NHS Hide

• the national health service operated in Great Britain and Northern Ireland, or
• the healthcare scheme that is operated by the relevant authorities of the Channel Islands, or
• the healthcare scheme that is operated by the relevant authorities of the Isle of Man.

Nurse Hide

a qualified nurse who is on the register of the Nursing and Midwifery Council (NMC) and holds a valid NMC personal identification number.

Out-patient Hide

a patient who attends a hospital, consulting room, out-patient clinic or treatment facility and is not admitted as a day-patient or an in-patient.

Out-patient surgical operation Hide

an eligible surgical operation received as an out-patient.

Out-patient treatment Hide

eligible treatment that, for medical reasons, is received as an out-patient.

Participating facility Hide

a hospital or a treatment facility, centre or unit that, at the time you receive your eligible treatment, is in our participating facility list that applies to your benefits, and is recognised by us for both:

• treating the medical condition you have, and
• carrying out the type of treatment you need.

any other establishment which we may decide to treat as a participating facility for the purpose of the scheme.

The hospitals, treatment facilities, centres or units in the list and the categories of accommodation, medical conditions and types of treatment we recognise them for may change from time to time.
Details of the facilities in the list and the categories of accommodation, the medical conditions and types of treatment we recognise them for are available on request.

Partner Hide

your husband or wife, or the person you live with in a relationship similar to that of a husband or wife, whether the same sex or not.

Partnership consultant Hide

a hospital or a treatment facility, centre or unit that, at the time you receive your eligible treatment, is in our partnership facility list that applies to your benefits and is recognised by us for both:

• treating the medical condition you have, and  
• carrying out the type of treatment you need.

any other establishment which we may decide to treat as a partnership facility for the purpose of the scheme.

The hospitals, treatment facilities, centres and units in the list and the medical conditions and types of treatment we recognise them for may change from time to time. Details of the facilities in the list and the medical conditions and types of treatment we recognise them for are available on request.

Partnership network hospitals Hide

The scheme you chose when you joined Bupa will determine your level of hospital access. Some schemes will only cover you in full for treatment in a partnership network hospital. If you or your consultant wishes to use a hospital not in the network then you may have to pay for part of the treatment.

Occasionally the treatment you need may not be available in a partnership network hospital. If this is the case we may pay for treatment at a hospital which would normally be ineligible, as long as either you or your consultant calls Bupa to agree this arrangement before you receive the treatment.

Pre-existing condition Hide

any disease, illness or injury for which in the 7 years before your start date:

• you have received medication, advice or treatment, or
• you have experienced symptoms

whether the condition was diagnosed or not.

Previous scheme Hide

• another Bupa private medical insurance scheme, or
• a private medical insurance scheme or medical healthcare trust

provided or administered by another insurer that you were covered under without a break between that previous scheme and this scheme that we specifically agree will be treated as a previous scheme for the purpose of assessing waiting periods or continuous periods of cover.

Prosthesis Hide

any prosthesis which is in our list of prostheses for both your benefits and your type of treatment at the time you receive your treatment. The prostheses on the list may change from time to time. Details of the prostheses covered under your benefits for your type of treatment are available on request.

Psychiatric condition Hide

A mental or addictive condition, including alcoholism, drug addiction or eating disorders.

Psychiatric day-patient treatment Hide

psychiatric treatment which for medical reasons means you have to be admitted to a recognised facility because you need a period of clinically supervised psychiatric treatment as a day case but do not have to occupy a bed overnight and the psychiatric treatment is provided on either an individual or group basis.

Psychiatric in-patient treatment Hide

psychiatric treatment that, for medical reasons, is received as an in-patient.

Psychiatric network hospital Hide

Any hospital which is a registered mental nursing home and is in our list of participating hospitals as a psychiatric network hospital at the time you receive your psychiatric treatment. The hospitals may change from time to time. Details of these hospitals are available on request.

Psychiatric treatment Hide

Eligible treatment of a psychiatric condition.

Psychologist Hide

a Chartered Psychologist registered with the British Psychological Society who is a recognised practitioner. You can contact us to find out if a practitioner is a recognised practitioner and the type of treatment we recognise them for.

Recognised practitioner Hide

a healthcare practitioner who at the time of your treatment:

• is recognised by us for the purpose of our private medical insurance schemes for treating the medical condition you have and for providing the type of treatment you need, and
  
• is in our list of recognised practitioners that applies to your benefits.

Recognised consultant Hide

All Bupa recognised consultants have met Bupa's specific criteria in order to be able to treat Bupa members. However, not all consultants have entered into a voluntary agreement with us regarding fees and may not charge within Bupa benefit levels. This means that members may need to pay something towards the cost of their treatment if it is higher than the amount Bupa agrees to pay.

Back to top

Renewal date Hide

• each anniversary of your start date, or
  
• if you are a member under a group scheme arrangement with a common renewal date for all members of the group, your renewal date will be the common renewal date for the group.

Scale of cover Hide

the scale that specifies which:

• participating facility
  
• partnership facility,
  
• national access facility,
  
• local access facility, or
  
• extended network facility

list applies to your benefits

• the category of accommodation for recognised facilities that applies to your benefits
• the practitioner lists that apply to your benefits.

Your membership certificate shows if a scale of cover applies to your
benefits.

Schedule of procedures Hide

the schedule used by Bupa for the purpose of providing benefits which classifies surgical operations according to their type and complexity. The schedule may change from time to time. Not all procedures listed in the schedule are covered under Bupa schemes. Further information on the schedule is available on request.

Scheme Hide

the cover and benefits we provide as shown on your membership certificate together with this Bupa membership guide subject to the terms and conditions of the agreement.

Session Hide

periods of 24 hours during which the specified type of treatment is received for an acute condition.

Special condition Hide

any exclusions or restrictions to cover that are personal to an individual based on the medical history given to us for that individual. If special conditions apply to an underwritten member’s cover these are shown in the ‘Special conditions’ section for that underwritten member in your membership certificate.

Specialist treatment centre Hide

Any hospital which is in our list of specialist treatment centres at the time you receive your treatment. The hospitals on this list may change from time to time so you should contact us before you arrange any treatment to check that the hospital is listed. Details of these hospitals are available on request.

Specialty Hide

Each Bupa-recognised consultant has had in-depth training in certain diseases, parts of the body or types of treatment. This is what is known as the specialty. For example, a consultant with a specialty of neurosurgery treats disorders of the brain, spinal cord and nerves.

Start date Hide

the date you started your current continuous period of cover under the scheme as shown on your membership certificate.

Subscription review date Hide

• if you have agreed a five year subscription review option with us, every fifth renewal date after the date we agreed the five year subscription review with you, or
• if you have agreed a ten year subscription review option with us, every tenth renewal date after the date that we agreed the ten year subscription review with you.

Sub-specialty Hide

Within each specialty, some consultants have more expertise in certain areas of that specialty, known as sub-specialty. For example, a consultant with a specialty of neurosurgery may have a sub-specialty of spinal surgery. We have provided this information when possible, to help GPs and members choose the most appropriate specialist for the condition being treated.

Surgical operation Hide

a surgical procedure or complex investigative/diagnostic procedure including all medically necessary treatment related to the procedure and all consultations carried out from the time you are admitted to a recognised facility until the time you are discharged, or if it is carried out as out-patient treatment, all medically necessary treatment related to the operation and any consultation on the same day which is integral to the operation.

Therapist Hide

• a chartered physiotherapist 
• a British Association of Occupational Therapists registered occupational therapist
• a British and Irish Orthoptic Society registered orthoptist, or
• a Royal College of Speech and Language Therapists registered speech and language therapist

who is Health Professions Council Registered and is a recognised practitioner. You can contact us to find out if a practitioner is a recognised practitioner and the type of treatment we recognise
them for.

Treatment Hide

surgical or medical services (including diagnostic tests) that are needed to diagnose, relieve or cure a disease, illness or injury.

Underwritten member Hide

a member whose membership certificate shows the underwriting method applied to them is underwritten.

United Kingdom/UK Hide

Great Britain, Northern Ireland, the Channel Islands and the Isle of Man.

Waiting period Hide

a period of continuous cover during which benefits are not payable. The length of any waiting periods that apply to your benefits are shown under the ‘Waiting periods’ section in your membership certificate.

We/our/us Hide

Bupa.

Year Hide

the period beginning on your start date and ending on the day before your renewal date.

You/your Hide

this means the main member only.

Back to top

Back to top