Changes to our policy from 1 January 2022

22 October 2021

We regularly review our cover to make sure it continues to meet our customers’ needs, takes account of new medical developments and that our policy and health trust terms are clear and consistently applied.

This results in enhancements such as expanding our cover for cancer drugs and genetic tests as new evidence and technology emerge.

This year, we’ve refined our policy and health trust terms in some areas that don’t adequately meet customers’ needs or require greater clarity to ensure fairness for all our customers. This also helps us control premium increases.

Here are the three changes from 1 January 2022:

Inpatient rehabilitation

  • We’re removing the exception to our general exclusion for convalescence, rehabilitation and general nursing. This means we’ll no longer fund inpatient rehabilitation.
  • Our cover for mental health rehabilitation programmes, such as inpatient addiction programmes, is unaffected by this change.

Why are we making this change?

  • The British Society of Rehabilitation Medicine says that people typically require more than six weeks of inpatient rehabilitation, and in some cases up to six months. Our current cover means that after 21 days’ inpatient rehabilitation, customers need to transfer their care to the NHS part way through their rehabilitation programme, causing disruption and sometimes delays. This is not in line with best practice.
  • There is limited private provision of inpatient rehabilitation. This means customers in some regions must either travel to receive their treatment, which can be disruptive, or they cannot access private inpatient rehabilitation.
  • These challenges, and how they impact the customer, are reflected in a high number of customer complaints for this treatment.

How many customers will be affected by this change?

Very few customers require inpatient rehabilitation. Currently, we fund this for less than 1 in 40,000 customers per year.

Varicose veins

  • We’re introducing a new general exclusion for varicose veins.
  • We’ll cover one procedure to treat varicose veins per leg per lifetime of the policy or health trust, and only when acute symptoms are present.
  • For this treatment only, the lifetime will begin when the customer renews in 2022 (and the new terms apply).
  • Any previous varicose vein treatments before their 2022 renewal won’t be taken into account.

Why are we making this change?

  • The NHS states that most varicose veins don’t require treatment. Often, they’re a cosmetic concern and treatment to improve appearance isn’t covered by our policies or health trusts.
  • Some people’s varicose veins will reoccur, meaning they may meet our definition of a chronic condition, and treatment of a chronic condition is not covered by our policies or health trusts.
  • Through this change we’re clearly defining what is and isn’t covered, aligning to the principles of our existing general exclusions, as well as to the position of a number of other insurers in the market.

How many customers will be affected by this change?

We estimate approximately 0.03% of customers will be affected by this change each year; 80% of claimants for varicose vein treatment only claim one procedure per leg and therefore will be unaffected by the change.

Chronic conditions

We’re refining our chronic conditions exclusion to explain that acute flare-ups of chronic conditions aren’t covered when these are expected and for some conditions, such as those of a relapsing-remitting nature, flare-ups are an expected part of the natural course of the disease and are therefore not covered.

Why are we making this change?

  • Our policies and health trusts are primarily designed to cover unexpected health costs, and don’t cover expected, ongoing treatment of a chronic condition.
  • For conditions, where there are expected, regular flare-ups which require repeated or long-term treatment, there is a distinction between discrete treatment of an acute flare-up (which we do cover) and ongoing treatment and management of the condition (which we don’t cover).
  • We assess requests for cover on a case-by-case basis and the individual circumstances.
  • We found that there is a risk of inconsistency and lack of clarity for the customer about how treatment for these expected, repeated flare-ups is covered. It can also lead to customer dissatisfaction with no warning that treatment may not be covered until they request treatment.
  • The new wording clearly explains what is and isn’t covered to address these issues.

This change will mostly apply to customers with one of the following relapsing-remitting conditions: rheumatoid arthritis, Crohn’s, ulcerative colitis, psoriasis, multiple sclerosis and myasthenia gravis.

Following renewal, the first time a customer is wanting to claim for one of these conditions, we’ll explain their cover and let them know that their cover for the condition will end after three months. During this time, we’ll continue to cover treatment to give them time to stabilise their condition and make alternative arrangements for their care.

After three months, we’ll no longer cover treatment of the condition, unless it’s to permanently treat the condition or resolve the symptoms (for example, a joint replacement or bowel resection). This is because all other treatment is the expected, ongoing treatment required to manage flare-up of symptoms or for the monitoring and management of the condition.

If the customer has Chronic Cover, they can continue to claim their outpatient monitoring and management for their condition under this benefit.

How many customers will be affected by this change?

We estimate approximately 0.05% of customers each year claim for an expected flare-up of one of these conditions, outside of the initial three-month period, and therefore would be affected by this change.

If you have any queries, please speak to your Bupa Account Manager.