BFHI Frequently asked questions

They’ll be covered from the moment they’ve agreed the level of cover that's right for them and have set up their monthly Direct Debit (they can also pay annually). Once their cover has started, they can cancel it within 21 days of the cover starting or receipt of policy documents, (whichever is the latter), and receive a full refund providing no claims have been made. Once they’re a member they’ll be sent all of the documentation that details what is and isn't covered and how they can get in touch with us should they need to claim.

Before your client’s renewal we’ll send them renewal details including their new subscription price.

Your clients can add their partner and/or their children (including newborn or adopted children) as dependants on their membership at any time

We’ll write to your client at least 28 days before their renewal date, and your client's annual cover will automatically be renewed unless they decide to end their cover. Bupa Fundamental Health Insurance has some cover options that can be changed each year at renewal if their circumstances change.

Out-patient is when your client has an appointment at a hospital or clinic but they’re not admitted and do not have a bed.

Day-patient is when your client is admitted to hospital for an appointment that requires medical observation for a short period but doesn't need to stay overnight.

In-patient is when your client is required to stay overnight in a hospital or clinic for at least one night.

Consultations and therapies are only covered when they follow on from, and are related to, private day-patient treatment or in-patient treatment and they take place within 6 months of the discharge date of that treatment. Up to 2 consultations will be covered in that 6 month period following the discharge date. Up to £350 of therapies are covered each year when directly related to private day-patient or in-patient treatment and within six months of the discharge date of that treatment.

This means that if your client sees a consultant to support diagnosis of any health issue prior to private in-patient treatment or private day-patient treatment, this wouldn't be covered. Your client may choose to fund this themselves or use the NHS.

Out-patient surgical treatment, diagnostic scans and tests are covered in full (where eligible and within your clients chosen hospital list).

If your client required physiotherapy but this wasn’t to aid recovery from eligible private hospital treatment, it would not be covered. Your client would need to pay for this themselves or use the NHS.

For bone, muscle and joint conditions that aren’t following and related to private in-patient treatment and private day-patient treatment, your client may be able to access Bupa’s telephone assessment service. They can have a telephone consultation with a senior physiotherapist to assess their symptoms and recommend the most suitable course of treatment. The physiotherapist can provide self-management advice and tailored exercises.

Please note that face to face sessions, or treatment that doesn’t follow eligible private in-patient treatment or private day-patient treatment, wouldn't be covered by this policy and that eligibility for telephone assessment is subject to your client’s underwriting terms. Pre-existing conditions are normally excluded.

Bupa Fundamental Health Insurance provides two options for cancer cover as well as the option to have no cancer cover.

• Full cancer cover - all your clients eligible cancer treatment costs are paid in full with no time limits for as long as they have Bupa health insurance, provided they use a healthcare facility from their chosen Bupa network and a Bupa recognised consultant who agrees to charge within Bupa limits (a fee assured consultant).
• NHS Cancer Cover Plus – this option means your clients will be treated by the NHS if they develop cancer. Any requests for private cancer treatment such as chemotherapy, radiotherapy, drug therapy or a surgical operation would only be assessed for eligibility when the treatment is not available on the NHS and is being recommended by a Consultant.

Payments are usually made directly by Bupa when your client is treated by a fee assured consultant and their chosen Bupa hospital network for eligible treatment. So there’s no need to pay any costs themselves (except where an excess payment is applicable).

Bupa membership gives your clients access to eligible breakthrough cancer drugs and treatments often before they're available on the NHS or approved by NICE as long as they're evidence-based.

Our medical team will evaluate requests to fund drugs which are requested out of license or for new treatments.

Each request to administer CAR-T will now be reviewed by the US-based expert consultant haematologists at the world-renowned Mayo Clinic. They will advise on clinical suitability on a case by case basis.

As long as there is sound clinical evidence to demonstrate benefit and it is recommended by your consultant, we'll fund it.

Bupa provides treatment for the primary cancer (the cancer your clients are initially diagnosed with) and we’ll also cover them even if their cancer spreads.

If your client selects full cancer cover^†, we'll provide cover and support at every stage of their cancer, including palliative treatment, even if their cancer is incurable. If your client selects NHS Cancer Cover Plus, the NHS will provide palliative treatment but if the surgical operation, radiotherapy, chemotherapy or drug therapy recommended by their oncologist isn't available on the NHS, then Bupa will cover eligible treatment.

^†With Bupa full cancer cover, there are no limits on how long your treatment lasts or how much it costs, for as long as you have Bupa health cover. You must use a hospital or health centre from the Bupa network and a consultant that we recognise and charges within Bupa rates (a fee-assured consultant).

^††We offer a Personalised treatment support service, registered with the CQC, for our members across multiple condition areas, including Cancer. The service provides a range of interventions for customers and providers to ensure delivery of clinically appropriate treatment and best practice care. For patients whose care is more complex, we have dedicated and personalised support for their entire care journey. This one-to-one ongoing support is delivered from a named clinical specialist. In addition, we implement provider-facing support as another intervention layer to champion the needs of our customer.

Our clinical telephone services are available daily to provide support to our customers. We continue to be the sole PMI provider to be registered with the CQC, who have rated our clinical telephone services, “Good”

No - We don’t take family history of cancer into account when deciding whether or not to offer cover to a new customer.

We don’t pay for treatments that are not evidence-based.

Our support team is able to give members and their carers or family, advice related to their specific situation. They can discuss options for being treated at home (where your client’s consultant feels this is clinically appropriate). Our informed decision making service helps members understand the options available to them and the information they need to be able to make decisions about their own care. For complex cases, we provide ongoing dedicated and personalised support. You’ll receive this support from the same specialist clinician throughout your treatment.

If your clients are treated by a fee assured consultant in a Bupa recognised facility that is within their chosen Bupa hospital network, we'll fund all of their eligible diagnostic tests and investigations and following initial diagnosis all eligible treatment for cancer providing they've selected our full cancer cover^†. Initial diagnosis will be subject to any out-patient limits until the cancer is diagnosed.

^†With Bupa full cancer cover, there are no limits on how long your treatment lasts or how much it costs, for as long as you have Bupa health cover. You must use a hospital or health centre from the Bupa network and a consultant that we recognise and charges within Bupa rates (a fee-assured consultant).

If your client has full cancer cover^† and they opt to receive their cancer treatment in an NHS hospital or at home and the treatment is funded by the NHS, we offer an NHS cancer cash benefit which allows members to claim £100 for each day/night they receive eligible in-patient, day-patient or home cancer treatment. For oral drug treatment for cancer, an additional cash benefit is paid for each three weekly interval or part thereof. If they’ve selected NHS Cancer Cover Plus, being treated by the NHS is standard unless they need chemotherapy, radiotherapy, drug therapy or a surgical operation that the NHS can't provide.

^†With Bupa full cancer cover, there are no limits on how long your treatment lasts or how much it costs, for as long as you have Bupa health cover. You must use a hospital or health centre from the Bupa network and a consultant that we recognise and charges within Bupa rates (a fee-assured consultant).

Yes – if they have full cancer cover^† or they have NHS Cancer Cover Plus and the drug therapy treatment isn't provided by the NHS, Bupa gives them the option to receive their chemotherapy at home (where your client’s consultant feels this is clinically appropriate) safely and from a specialist nurse. Treatment at home means there is as little disruption to their life as possible. If they have NHS Cancer Cover Plus and the treatment isn't available at home on the NHS but is available in hospital, we won't pay for them to have this at home. We'll only pay if it is unavailable on the NHS.

^†With Bupa full cancer cover, there are no limits on how long your treatment lasts or how much it costs, for as long as you have Bupa health cover. You must use a hospital or health centre from the Bupa network and a consultant that we recognise and charges within Bupa rates (a fee-assured consultant).

Yes - If they have full cancer cover^†, we’ve developed Bupa accredited centres for treatment for the most commonly diagnosed cancers (breast, bowel and prostate) which can be used if on the customers hospital list. If they have NHS Cancer Cover Plus, they’ll have access to specialists through the NHS.

^†With Bupa full cancer cover, there are no limits on how long your treatment lasts or how much it costs, for as long as you have Bupa health cover. You must use a hospital or health centre from the Bupa network and a consultant that we recognise and charges within Bupa rates (a fee-assured consultant)

Specialist Centres for breast cancer commit to offering an appointment within two working days of calling to arrange. In one visit, customers can have initial diagnostic scans and tests using the latest equipment followed by a consultation to discuss their results – and could be given the all clear on the same day. If further diagnostic tests are required these can be completed during their visit with results available two working days later.

All eligible customers who have a diagnosis of breast cancer will be allocated a named Clinical Breast Nurse Specialist and will commence their treatment within 31 days of calling Bupa. This is half the published national target. All treatment decisions will be undertaken by a multidisciplinary team. Customers will also have access to clinical trials and genetic testing, if appropriate.

The KPIs and SLAs agreed with the 14 Specialist Centres which include The Cromwell, HCA UK and Spire sites will help us manage unwarranted variation in treatment. We believe that this approach can help reduce the need for more complex and invasive treatment, which helps control the cost of claims over time. To further manage inflation, we’ve negotiated new pricing agreements on drug costs.

^†With Bupa full cancer cover, there are no limits on how long your treatment lasts or how much it costs, for as long as you have Bupa health cover. You must use a hospital or health centre from the Bupa network and a consultant that we recognise and charges within Bupa rates (a fee-assured consultant).

Our online cancer health hub contains information which has been developed to provide our members and their friends and families with helpful information about how and why cancer develops and details of the range of cancer treatments available.

No. However, we'll need to ask some questions about:

• their age, gender and medical history
• whether they smoke
• their current state of health
• their occupation

Health insurance doesn't generally cover pre-existing conditions. If they’ve never had health insurance, we’ll need to base our decision on the cover we can offer your clients on their past seven years’ medical history. So, if they have symptoms which they know could cause problems in the future, they’ll need to tell us straightaway.

For clients joining with Moratorium underwriting the applicant isn't required to complete the medical history declaration as part of their application on the understanding that they’ll not be immediately covered for any medical conditions that existed in the five years prior to joining. New medical conditions arising after the start of the policy will be covered immediately subject to the policy terms and conditions.

When your client makes a claim we’ll ask them questions about their (or their dependant’s) health and medical history. We may ask for a medical report (which we don’t pay for).

For clients who are switching their individual cover from another provider, we may offer continuation of their current underwriting terms. In this case any pre-existing conditions that were excluded on their previous cover, would continue to be excluded on their individual Bupa cover. A number of medical questions will be asked to determine if additional exclusions must be applied. These, if any, would appear on your clients’ membership certificate.

The No Claims Discount scale below shows the levels available and discounts which apply to each level. If we have paid no claims during the 12 months prior to the renewal subscription being calculated the No Claims Discount will increase by one level on the scale. The maximum No Claims Discount available is level 14 (70% discount).

The calculation period

As we calculate your subscriptions prior to your renewal date, we will assess all eligible claims paid by us for you:

• in the first 10 months of your first year, and
• for subsequent years, in months 11 and 12 of the previous year plus months 1 to 10 of the current year.

Please note that payment may take a few weeks from the date of your treatment, depending on how quickly invoices are submitted to us.

The entry level for Full Medical Underwriting (FMU) and Moratorium underwriting is level 12. Please note this may vary for Switch.

The maximum number of levels you can decrease at renewal is three.

The No Claims Discount only applies to subscriptions for your clients’ core health insurance. Claims made in relation NHS Cash Benefit don’t count as claims in the assessment of the No Claims Discount. In addition, claims we pay that fall entirely within any excess will not be counted.

No claims discount level	Discount applied on premium
1	0%
2	10%
3	20%
4	27.5%
5	35%
6	40%
7	45%
8	50%
9	55%
10	59%
11	62%
12	65%
13	68%
14	70%

The No Claims Discount scale works as follows:

Claims payments made during the year before we calculate the premium for the next insurance year	Movement on the scale at the next renewal date (subject to a maximum of level 14 and a minimum of level 1)
£0 paid	Move up the scale by one level
Between £0.01 - £250 paid	Move down the scale by one level
Between £250.01 - £500 paid	Move down the scale by two levels
More than £500 paid	Move down the scale by three levels

If your client has a current Bupa corporate policy they can’t switch to Bupa Fundamental Health Insurance. You can make a new business application for these clients, or Group Leaver terms are available for Bupa By You.

No, for all polices your client must have at least 12 months continuous cover with their existing provider to be eligible for Switch terms. A new business application must be made.

Your client can include their family in a switch application, but each individual must also have been on a previous policy for at least 12 months.<sup>*

*</sup>Where the person not covered for 12 months is a baby who has been covered on the previous policy from birth, a switch application would be allowed.

We'll ask some medical questions to assess if additional exclusions need to be applied. If this is the case, these will be detailed on your clients’ confirmation of special conditions. If your client would like information on what will be covered before they buy, please call us on 0800 289 577^{^}

If your customer wishes to move to Bupa By You from Bupa Fundamental Health Insurance, they’ll need to apply as New Business. Please be aware that your client will be re-underwritten when they move and pre-existing conditions may not be covered on the new policy.

Yes, however you can’t transfer into this scheme on a continuation basis from your individual policy. A new business application must be made for Bupa Fundamental Health Insurance.

Bupa Fundamental Health Insurance has been designed to be a straightforward lower cost product versus Bupa By You. As a result, add-ons are not available on Bupa Fundamental Health Insurance. Dental is available as a standalone policy.