Health insurance jargon buster
These videos will help you understand some common health insurance terms. Learn more about our cover, from what counts as a chronic condition to how we calculate policy prices.
A chronic condition is an illness or disease which has at least one of the following characteristics
Examples of Chronic Conditions include arthritis, asthma, diabetes and psoriasis among many others.
Here are some examples.Your GP refers you to a consultant who diagnoses you with a chronic condition.
You then need regular medication and annual consultations as part of the ongoing care for your chronic condition.
These regular consultations would take place under the NHS, or you have the option to pay privately for this treatment yourself.
After a couple of years, you need to see a specialist consultant as you have suffered a sudden and untypical flare up of symptoms relating to your chronic condition that your GP can’t manage.
As a result, you need treatment to get you back to the same state of health before the flare up.
It’s worth noting, if your flare up is sudden and severe, you should call 999 and go to A&E. Emergency treatment like this isn’t covered under your Bupa policy.
Once your flare up has died down, you can continue with on-going medication and annual consultations through the NHS.
For any treatment that you’re not covered for, you should go back to your GP and the NHS for treatment.
You'll find more information in our document 'Important points about your cover', as well as your membership guide and membership certificate.
Understanding pre-existing conditions
Health insurance is designed to cover you for future risks. Any previous conditions you have will not be covered. Watch this video to find out more.
When you take out a health insurance policy with us, we’ll usually exclude cover for any symptoms, conditions, illnesses or injuries you had before you joined.
Your insurance is designed to cover future risk of acute conditions so any previous conditions are usually not covered. Acute conditions are those which are unexpected or sudden.
So, for example, if you injure your leg before taking out your policy and you then need further physio treatment after your policy has begun, this treatment would not be covered.
Or if you have a medical condition, such as a heart problem, before your policy begins, any health issues related to this condition that arise after you take out your policy will not be covered.
In this case you would need to seek treatment from the NHS or alternatively pay for private treatment yourself.
When you join Bupa, you can choose to be underwritten in a number of different ways. Most customers choose full medical underwriting.
In this scenario, we'll ask you to tell us about any previous health issues you've had when you join. It's important you answer these questions honestly or it may delay or invalidate a future claim.
When you make a claim, we may also check with your GP that you haven’t had the condition before.
You’ll be able to see any conditions that are excluded from your cover on your membership certificate. These will be under the section called special conditions.
The same process will also apply for any members of your family included on your policy.
New conditions which arise after you take out your policy would most likely be covered. Check your policy documents for details on what you are and aren’t covered for. Just give us a call before making a claim to check!
You can speak to us at renewal to apply to remove any pre-existing conditions from your policy. It depends on the condition and the length of time you have been symptom, treatment and advice free.
Your policy will have some general exclusions, such as pregnancies, cosmetic surgery and the maintenance of chronic conditions … and these usually aren’t covered. Check your membership guide for full details.
We take lots of different factors into account when working out the cost of your cover, like age and where you live. This video has more detail.
Many factors can affect the cost of your health insurance but these are the most significant.
The rising cost of healthcare
Advances in medical technology, drugs and treatments help lead to improved quality of life and recovery rates for many people.
Funding these new treatments typically increases costs each year.
We work closely with doctors and hospitals to make sure these costs are fair and provide you with value for money
Healthcare costs increase steadily with age and on almost all of our products, your price will be influenced by your age. Onscreen text: Claim costs for 60-64 year olds are on average, 87% higher than those for 40-44 year olds (based on cost per claimant). Mar 2019 – Feb 2020
Where you live - Healthcare costs are different around the country and they also change at different rates each year.
Onscreen text: Typical cost of a hip replacement £8,300, UK outside of London. Mar 2019 to Feb 2020.
To make prices fairer to everyone, they're linked to where you live and to the likely cost of treatments there.
Onscreen text: Typical cost of a hip replacement £10,900 within Central London. (+32% higher) Mar 2019 to Feb 2020.
Your claims - If you’ve claimed previously, your price may be higher than if you haven’t.
If you have a product with a low claims bonus, or a no claims discount, and haven't made any claims or only low value ones, this may help reduce any price increase.
Your selected level of excess -The amount of excess you choose to pay if you make a claim affects the price you pay. The more excess you choose to pay, the lower your price.
Lifestyle - Unhealthy lifestyle choices, like smoking for example, can also affect the price of your health insurance.
It's important that you tell us about these choices because if you don't it could affect a future claim. Or if you stop smoking then tell us. If you can prove that you've been smoke-free for a number of years, this may reduce the cost of your health insurance.
At Bupa, we don't have shareholders to pay.
We continue to invest in improving the healthcare you get from us and we aim to set your price as fairly as we can.
Out-patient benefit limits
This is a limit on how much you can claim for out-patient care. Out-patient treatment is treatment you may have in a hospital without being admitted for the day or staying overnight. You can choose your limits when you take out your cover. A lower limit reduces the cost of cover, and a higher limit increases it.
If you need treatment, your GP may refer you to a specialist for a further consultation or for certain conditions you may be able to speak to us directly for a referral without going to your GP†.
This sometimes means you need to go to a hospital as an outpatient for diagnostic tests, treatments or therapies. Always check your policy to see what you are covered for
An outpatient is a patient who attends a hospital, a consulting room, an out-patient clinic or a treatment facility but doesn’t occupy a bed or stay overnight.
When you take out a Bupa policy, you will be able to choose an annual outpatient benefit limit from a number of set options. A lower limit will reduce the cost of your cover, and a higher limit will increase the cost.
Here’s an example of how it works…
David has a £1,000 annual limit on his outpatient cover.
His GP recommends he sees a consultant so he visits a hospital for some treatment and tests.
The cost for his blood tests and ultrasound treatment is £1100 and there are further costs of £200 for consultation fees
The total cost for his outpatient treatment is £1300
As David is on a Bupa By You policy, Bupa will pay the £1,000 up to the benefit limit of his policy. David has agreed to pay an excess of £200 on his policy, so he will pay that plus the remaining £100.
If you don’t have a Bupa By You policy, the value of the excess that you pay may get taken out of your outpatient benefit allowance. You can check by either reviewing your policy documents or by calling us on 0345 609 0111
If David needs any further outpatient treatment for that year, he will either have to pay for this himself or use the NHS.
Standard outpatient limits don’t apply to treatments for cancer as these are usually covered in full by our ‘cancer promise’*. Always check your policy to see what you’re covered for
Your underwriting choices
Underwriting is how we decide what we ll cover you for, based on the information you give us when you take out your policy. You can choose between two types of underwriting. This helpful video tells you all about it.
Underwriting is the process by which we decide on what terms we will accept someone for cover based on the information they provide.
When you take out health insurance, you currently have two options; Full Medical Underwriting and Rolling Moratorium Underwriting.
Full medical underwriting means that your medical history is taken into account before we decide on what medical conditions we may or may not be able to cover.
As we usually don’t cover you for any pre-existing conditions, you’ll be asked questions about your medical history when you apply.
It’s essential that you give us all the information we ask for, even if you have symptoms that have not yet been diagnosed. We may ask for confirmation from your GP or Specialist that a condition is not pre-existing.
Full medical underwriting helps to ensure you know exactly what you’re covered for when you join and it may help speed up the pre-authorisation of a claim.
Also any new conditions that arise after the start of your policy will be covered, subject to your policy terms and as long as they’re not related to any prior underwriting already applied.
The second type of underwriting is called Rolling Moratorium.
With Rolling Moratorium underwriting, you won’t need to fill in a health questionnaire about your medical history when you join.
However, when you try to make a claim, you’ll have to complete a pre-treatment form each time so that we can confirm if the condition is new or pre-existing.
If your condition began after joining, this claim will be paid, provided it is eligible under your policy.
However, if you require a consultation or treatment during the first 2 years of your policy for a pre-existing condition, this would not be covered.
A pre-existing condition will not be covered until two continuous years have passed after joining without any symptoms, treatment or advice.
For example, in the five years before joining, John had a spinal problem and a lung problem.
During the first two years of his policy, the spinal condition required treatment but his lung condition didn’t.
So after two years, because he had no symptoms, treatment or advice for his lung condition, John was able to get this covered and removed as an exclusion by medical underwriting at renewal. John’s spinal condition will be covered once he’s been symptom, treatment and advice free for 2 years.
If you’re ever unclear about any aspect of a policy then please refer to your membership guide go online or call your usual member services helpline.
When you take out your health insurance with Bupa, you can select the amount of excess you’re willing to pay….to help set the cost of your premium to a level you’re comfortable with.
Paying an excess will help to reduce your premium
Having an excess means that you have to pay your treatment costs up to the amount of your excess.
You pay this on your first eligible claims per member, per membership year.
You will only ever need to pay the total amount of your excess once per membership year, even if you make more than one claim and for more than one condition.
For example, if your treatment costs £3,000 and you have agreed an excess of £500, you will pay £500 and we’ll pay the remaining £2500
Your excess re-starts at the beginning of each membership year even if your treatment is ongoing. So, your excess could apply twice to a single claim if your treatment begins in one membership year…and continues into the next membership year.
You can amend the amount of excess you choose to pay at each annual renewal.
You pay any excess directly to the person treating you, not to Bupa.
We’ll write to the member claiming to let them know the amount payable and who it should be paid to.
You should always make a claim if you have any treatment so we can keep track of how much you've contributed towards your excess.
This will mean you're not out of pocket for any future claims.
There are some conditions where it’s possible to get direct access to our support, usually without the need for an appointment with your GP, helping you get back to good health as quickly as possible.
If you think you might have symptoms relating to cancer, you can discuss these over the phone with one of our dedicated advisers.
They can help you get over any worry or uncertainty more quickly.
Depending on the nature of your symptoms, they’ll either refer you to a specialist for tests or advise you to contact your GP for further assessment.
If you are advised to see your GP, our advisers will offer to call you back within two weeks to give you further support if needed, helping put your mind at rest.
For support with a bad back, sore knee or any other muscle, bone and joint condition, give us a call.
If your symptoms are covered, we’ll arrange for you to have a phone call with a physiotherapist. You’ll be able to discuss your symptoms with them and they’ll either give you a referral straight away … … or suggest some exercises you can do yourself, such as digital home exercise programs, to help improve your condition, and getting you back to doing the things you love sooner.
If you’re suffering with stress, anxiety or any other mental health concern, we’re here to listen.
Our specialist mental health advisers will arrange a telephone appointment with one of our Mental Wellbeing Practitioners.
The practitioner will listen to you describe your symptoms and guide you to the most appropriate option to help. If the symptoms are covered it is likely to be either telephone counselling, online CBT or a referral to an approved therapist to give you the help and care you need to make a full recovery as quickly as possible.
Using direct access will not erode your out-patient benefit limits or require the payment of an excess.
However, if you require further consultations, tests or treatment following the use of our direct access service, these will be treated as a normal claim under your policyFor direct access to our support, usually without the need to see a GP, please call our member services helpline to check your eligibility. You’ll find this number on your membership certificate.
When you’re unwell, it’s important that you get the right treatment.
Which is why your GP may refer you to a specialist consultant.
As medical consultants may have different charges for their services.
It’s important that you can choose to see those whose charges are within Bupa agreed limits.
If you don't, you may need to pay the difference yourself.
Bupa has over 16,000 consultants nationwide who agree to work within fee limits, set by Bupa in conjunction with independent medical professionals. We call these fee assured consultants.
Costs are guaranteed to be met in full for any consultations and treatments.
In all cases, even when using a Bupa Fee Assured Consultant, you will still need to pay any excess, and any additional fees beyond your outpatient benefit limit that you have agreed within your personal policy.
All Bupa Fee Assured consultants are assessed to the same standard as any other medical practitioner and meet our high standards of care.
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Bupa health insurance is provided by Bupa Insurance Limited. Registered in England and Wales No. 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 No. 3829851. Registered office: 1 Angel Court, London, EC2R 7HJ.
