What is health insurance?
Health insurance explained
Health insurance is an insurance policy covering the costs of private healthcare. It can also be called private medical insurance.
Customers pay via a monthly or annual premium. Usually, our policies only cover conditions that start after the insurance has begun. There may be some exceptions to this and that depends on the type of underwriting your client chooses.
What does Bupa cover?
We make choosing healthcare flexible. That’s why customers can decide between two cover options within our Bupa By You product. There are some exceptions to this which may apply to your clients. If they have a question about a specific condition it’s always worth speaking to us.
Most of the policies we offer cover:
- Treatment in private hospitals
- Private consultations
- Access to a digital GP app (such as Bupa Blua Health)
- Physiotherapy for muscle, bone or joint conditions
- Out-patient care
There are also some things we don’t cover. This includes:
- Chronic conditions (other than mental health or cancer) For example, a condition that needs ongoing or long-term control or relief of symptoms
- Pre-existing or special conditions
This could be anything a customer has received medication, advice, treatment or had symptoms of in the past seven years. It will then be listed as a special condition on their policy. It varies from person to person, and is based on their medical history - Natural ageing
- Allergies, allergic disorders or food intolerances
The basics of health insurance
What is it? What’s a policy? How much does it cost? Just ask a question to find the answers you need, from condition cover to costs.
Transcript
Who are you?
Hello, my name's Ed Reed. I've been at Bupa for 16 years.
Come and ask me about health insurance, what you're covered for,
and any other questions you might have.
What is health insurance?
Health insurance or private medical insurance,
often referred to as P M I is an insurance product that can cover
the cost of private treatment, anything from physiotherapy,
the smaller things to the larger things like cancer and everything in between.
And you can pay monthly or annually.
And health insurance is there for any new conditions that arise after the policy
has started.
How does health insurance work?
So health insurance works. It starts off if you have a problem, an ailment,
you would need a GP referral and you can either get a GP referral via your N H
S gp or you can use our digital GP app. Once you have a referral,
you would give us a call and speak to one of our friendly advisors who would
talk you through everything from your policy limits,
if you have an excess who and where to pay your excess.
And we can also help you find a consultant to see.
Once you have the consultant you need to see, you'd give them a call,
book your appointment. At the point that you've called us,
we'd give you an authorization number so we would pay bills directly.
Once you have seen the consultant,
you could then give us a call for any further treatment, but it's really,
really easy.
You just need to give us a call once you've got that referral and we will talk
you through everything to help you.
How much does health insurance cost?
That's a really good question and one we get asked a lot.
It depends on a few factors. One of the factors is your age,
so as you get older, you're more likely to make claims.
Also, your lifestyle can affect the price.
How many people you have on your policy, the policy makeup.
So whether you have a comprehensive policy or your excesses,
there's various different options that you can pick to adjust the price.
The best thing you can do is you can go on our website or you can give us a call
and speak to our friendly team who can go through all the options with you.
What's the difference between health insurance and the NHS?
Everybody has access to the N H s.
You would keep your N H Ss GP and in an accident and emergency situation,
again, you'd use the N H Ss.
Where it's really different is the access or speed of access to
consultations, your treatment, your diagnosis, and your care.
It's also convenient in the sense that you can pick your own appointments around
your schedule, and that's a really big factor.
What does health insurance cover and what cant it cover?
Health insurance covers any new conditions that started after the policy
starts. For any conditions that started before the policy starts,
they wouldn't be covered.
There are also general exclusions that apply to all of our policies,
and a few examples of the general exclusions are pregnancy, cosmetic surgery,
and chronic conditions.
And a chronic condition is a condition and that can't be cured,
and that would just be maintained. Two examples are asthma and diabetes.
You would typically use the N H S A full list of our general exclusions can be
found on our website.
Can I cover my children as well?
Yes, you can add a child up to the age of 21 or
24 in full-time education.
There is a discount sometimes for adding them to your policy.
You can also cover your child independently on their own policy
if you are the parent or guardian.
Can each person on my policy have different options of cover?
Yes, different family members on the policy can have different levels of cover.
So if you, as a parent wanted one level of cover, say for example,
to have full outpatient cover and you wanted your child to have limited
outpatient cover, that's absolutely fine.
Can I use my cover straight away?
You can use your cover straight away.
You can speak to a nurse on the Anytime Healthline.
You can also speak to a GP on the digital GP app.
If you do need to make a claim straight away,
we may need a medical report from your gp.
And health insurance is designed to cover new conditions after the policy
started.
What is a pre-existing condition?
Preexisting condition is a symptom or a medical condition that you
had prior to joining us. To give you an example,
if I've got a mobile phone and I crack the screen and I don't have insurance for
it, and I try to get insurance,
that insurance wouldn't cover the crack screen As part of the cover,
you can speak to a nurse or a GP about preexisting
conditions.
If you have any questions about any preexisting conditions or to find
out what is or what isn't covered, please give us a call.
Can I pay extra to have a pre-existing condition covered?
You can't pay extra to have a preexisting condition covered as part of the
cover. You do have access to a nurse or a digital gp,
and if you've got any questions about what is and what isn't covered,
you can give us a call.
What is full medical underwriting?
Full medical underwriting means we'll ask you some questions about your health
before you join to help you understand what is and what isn't covered.
What is moratorium underwriting and how does it work?
Moratorium underwriting means we won't go through any health questions when you
join. However, when you do need to make a claim,
we will ask you some health questions at the point of claim,
and if we need further information from your gp,
you will need to get this permission for the GP to send us in any medical
reports. There may be a cost to this associated.
It's quicker to buy the policy,
but may slow things down ever so slightly when claiming.
Will my claim take longer if I have moratorium underwriting?
Sometimes yes, as every time you make a claim,
we may need to reach out to your doctor,
but please note your Dr. May charge for this.
Will the cost go up every year?
Yes, it's likely the cost will go up each year.
There's a few reasons for that.
The first reason would be age. So as you get older,
you are more likely to make claims, your risk goes up.
Another factor would be medical inflation.
So that is the advancement in technology of drugs and
treatments. And then another factor would be claims.
Claims can affect the cost of your policy.
At each renewal,
you have the option to review the cover and look at cost options,
and you can give our friendly team a call who can take you through those
options.
Can I change my cover once I have signed up?
You have 21 days from when you receive your paperwork to change your cover.
You can change your cover at your renewal, but you can cancel anytime.
Can I cancel at any time and will I be charged to do so?
Yes, you can cancel at any time. If you are thinking about canceling,
please give us a call.
Will I have access to private GP's?
Yes, you will have access to private gps.
You can access the private GPS via our digital GP app,
Bupa Blue Health.
You are able to speak to GPS over video or on the telephone.
You can access them night and day and 24 hours a day
and it's unlimited appointments.
If you do want to see a G P face-to-face,
you're able to use our pay as you go service.
This isn't included in your policy,
but full details can be found on our Bupa website.
What does out-patient cover mean?
Outpatient cover is well means when you don't occupy a bed in a
hospital, so you're not a day case or an inpatient.
Outpatient can consist of consultations, physiotherapy,
or mental health therapies.
You have different outpatient limits that you able to choose from.
You can cap the outpatient limit. You can have full outpatient,
or you can exclude it altogether and use the N H Ss for your diagnosis.
When you call us up to pre authorize your claim,
we can talk you through the limits that are available because if you are capping
your outpatient limit,
please bear in mind that that may only cover a few consultations.
What is an excess and how does it work?
An excess can make your policy more affordable.
There are a range of different excesses to choose from.
You don't have to have an excess in the policy. The higher the excess,
the lower the monthly subscriptions are.
The good thing about the excess is it's once per person, per policy year,
not for every single claim that you make.
It's not like car insurance excess where you pay it on every single claim.
It is just that once per person, per policy year.
Can I change my excess part way through the year?
You can't change your excess partway through the year.
You do have the ability to change your excess 21 days after receiving your
documents.
You also have the ability to change your excess at your policy renewal,
and you can find details of your excess on your policy documents.
When/ how do I pay my excess?
We will let you know who and when to pay your access to when you speak to us.
Please don't pay a provider unless we tell you to do so.
What is a no claims discount and how does it work?
No claims discount affects the price at renewal,
so depending on the size of the claim,
a small claim wouldn't affect the no claims discount as much as a large claim
would. Everyone on the policy has their own no claims discount,
and there are some services that don't affect the no claims discount,
such as the anytime Healthline to speak to a nurse or the digital GP
to speak to a GP or pharmacist.
Those services wouldn't affect the no claims discount.
What does fee assured mean?
Fear Assured means that the consultant work within our agreed
limits, so there'll be no shortfalls or hidden costs for you.
If you do have an excess, this may apply.
You can find Fear Assured Consultants on our Bupa Consultant and Facilities
Finder. That's finder dot Bupa dot co uk,
and within the finder,
there'll be a banner indicating that they're fear assured.
Can I use health insurance abroad?
Bupa Bayou Health Insurance is a UK only product.
If you work or live abroad,
then you can look at our Bupa global suite of products.
If you are going on holiday, then you should look at travel insurance.
Which policy is right for my client?
When your client is choosing a Bupa health insurance policy there are four factors to consider. These are:
- if they have pre-existing conditions
- the cost of the policy
- the maximum costs of specific benefits that Bupa will cover (benefit allowances)
- the level of excess they choose
Our customers can also add partners or family members to their policy. This is something for your clients to consider, too.
What is excess?
An excess is the amount of money a customer pays towards their treatment when they make a claim on their policy. The excess lasts for the full 12 months of the policy and will reset when a policy is renewed.
For example, a customer has treatment that costs £3,000 and they have an excess of £500. The customer will pay £500 and Bupa will pay the remaining £2,500.
Having an excess gives customers greater control of their monthly cost. This is also known as a premium. The higher the excess, the lower the monthly premium.
How much does health insurance cost?
The cost of health insurance differs from person to person. The two deciding factors are:
- personal circumstances - for example, a customer’s age or if they smoke
- cover choice - for example, benefit allowances or the amount of excess a customer would be comfortable with paying
How can my client reduce the cost of their policy?
Our policies can be customised to each client, that means there are options to suit all budgets. Things like increasing excess and reducing optional extras will help to keep monthly costs down.
We also offer multi-person discounts if your client is covering their partner or family, too.
Underwriting
Underwriting is a method used to decide whether we can offer a policy to a customer, what we can cover them for, and the cost of cover. We look at a customer’s age, medical history, and if they’ve made any claims in the past.
There are four types of underwriting methods a customer can choose from.
Full medical
This gives a possibility for pre-exisiting conditions to be covered. If it can’t, our customers know what they will and won’t be covered for.
Moratorium
This is when a customer doesn’t tell us their full medical history. Instead, when they make a claim, we will tell them if they’re covered or not.
Ex-group scheme
If your client has been part of a company-paid Bupa group scheme historically, they can move with ex-group scheme (XGS) cover.
Switch
This refers to a customer moving from another UK health insurance provider to Bupa. They must have had 12 months of continuous cover with their previous insurer.
What are in-patients, out-patients and day-patients?
With a Bupa policy, in-patient, out-patient and day-patient cover comes as standard. Your client can amend the benefit levels to suit their needs, but it’s important to understand the differences between the two.
In-patient cover
If your client goes to hospital and stays overnight they’re being treated as an in-patient. In-patient benefits cover things including:
- consultant fees for surgeons
- hospital stays
- surgery
Out-patient cover
If your client isn’t admitted to hospital and they don’t stay overnight or use a bed for the day, they’re an out-patient. Out-patient benefits cover things including:
- minor diagnostic tests. For example X-rays, blood tests and ultrasound scans
- physiotherapy
Day-patient cover
Day-patient cover is similar to in-patient cover. If your client is admitted to hospital but doesn’t stay overnight, they’re a day-patient. Usually they’ll have a bed or a room for the day. Day-patient benefits cover things including:
- less invasive surgery
Yes.
Your clients can add partners and children to the same policy. Usually your client will receive a multi-person discount, too. Partners must live at the same address as the policy holder. Children do not have to share the same address as the policy holder.
When you add more than one child under 20 years old to your policy, you'll only pay for the eldest, no matter how many children you add.††
If your client already has a Bupa policy, they can update it with dependants at any time.
Once your client has set up their Direct Debit and agreed on a cover level, they’ll be insured for eligible treatment. If they change their mind, they can cancel their policy within 21 days. If they haven’t made any claims, they’ll receive a full refund for anything they’ve paid for that month or year.
Your clients will receive documents with more information about what is and isn’t covered, too. It will also let them know how to get in touch with us should they need to.
There are four steps to making a claim with us.
1. Identify a customer's health concern
Customers can call us using our Direct Access service for symptoms related to:
- cancer
- mental health
- skin care
- muscles, bones and joints
For any other symptoms, policyholders should book a Bupa Blua Health digital GP appointment or see their own doctor.†
2. Referral
If a customer requires an onward referral, we recommend asking for an open referral letter. This letter tells us what treatment or care the customer requires. We can then offer a choice of specialists to arrange an appointment with.
3. Contact us
Once a customer receives their referral letter, it’s time to give us a call. We can discuss their options over the phone. We’ll advise them on which specialists or healthcare they have access to. We can also send them the appropriate pre-treatment forms, if necessary.
Next we’ll confirm whether treatment is covered or not. If it’s confirmed, we’ll discuss the claim with your client and give them a preauthorisation number. They can use this when contacting their consultant or healthcare professional.
4. Choose a consultant or healthcare professional
To give our customers more freedom, they can decide on a healthcare professional in line with their level of cover. This can be done using our online directory, Finder.
An intermediary’s guide to healthcare
Keep us to hand. Find more information about the ins, outs and benefits of Bupa health insurance.
Why sell health insurance with Bupa?
Explore why you should start selling health insurance with us. Be it our unique tools or client testimonials, learn more about how we work together.
What’s next?
Not a Bupa intermediary yet?
With our range of tools and support we can help you every step of the way.
Call us
Looking to sell Bupa health insurance and don’t know where to start?
Give us a call on 0800 332 000.
Lines are open Monday to Friday, 8am to 5pm. We may record or monitor our calls.
† Customers who have a Bupa Standard, Bupa Premium or Bupa Your Choice policy don’t have access to our Bupa Blua Health digital GP service. Instead, you can access GP24 provided by HealthHero.
†† Add more than one child under 20 years old to your policy and you’ll only pay fox the eldest child, no matter how many more children you add. Children aged 20 or over cannot receive free cover or count as an ‘eldest child’ fox this offer. Cover must include at least two children aged 19 ox under. You’ll still receive our 10% family discount if you have free child cover. Children do not have to live at the same address as the main member. This offer may change or be unavailable when you renew.
Bupa Blua Health is provided by Bupa Insurance Services Limited, registered in England and Wales with number 3829851. Digital GP services are powered by eMed Healthcare UK Limited, registered in England and Wales with number 15086104, Registered Office: 184-192 Drummond Street, London, England, NW1 3HP
Bupa health insurance is provided by Bupa Insurance Limited. Registered in England and Wales with Registration number 3956433. Bupa Insurance Limited is authorised by the Prudential Regulation Authority and regulated by the FinancialConduct 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 with registration number 3829851. Registered office: 1 Angel Court, London, EC2R 7HJ.
