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 digital GP, nurses, physios and mental health specialists through the My Bupa app
- outpatient care
- dental 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
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 or annual cost. This is also known as a premium. The higher the excess, the lower the monthly or annual premium.
How much does health insurance cost?
The cost of health insurance differs from person to person. Some of the 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
We use medical history information to confirm what cover we can offer before the policy starts. Medical conditions that started before insurance cover begins with us aren't usually covered.
Moratorium
A customers medical history isn't needed when they take out the policy. A pre-treatment form will need to be completed by your client and their GP each time they claim. This is so we can confirm that the condition they're claiming for is new, or if they had it before the policy started.
Ex-group scheme
If your client has been part of a company-paid Bupa group scheme within the last three months, 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 inpatients, outpatients and day-patients?
With a Bupa policy, inpatient, outpatient 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.
Inpatient cover
If your client goes to hospital and stays overnight they’re being treated as an inpatient. Inpatient benefits cover things including:
- consultant fees for surgeons
- hospital stays
- surgery
Outpatient 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 outpatient. Outpatient 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 inpatient 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 policyholder. Children do not have to share the same address as the policyholder.
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
- 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 pre-authorisation 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.
Yes, unless your client wants to end their cover.
We write to our customers at least 28 days before their renewal date. Their policy will be renewed automatically unless they decide to end their cover.
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?
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Call us
Looking to sell Bupa health insurance and don’t know where to start?
Give us a call on 0800 332 000.
We may record or monitor our phone calls. Lines are open Monday to Friday, 8am to 5pm.
† Add more than one child under 20 years old to a policy and your client will only pay for the eldest child, no matter how many more children they add. Children aged 20 or over cannot receive free cover or count as an eldest child for this offer. Cover must include at least two children aged 19 or under. Your client will still receive our 10% family discount if they 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 they renew.
Bupa Digital Services are not regulated by the Financial Conduct Authority or the Prudential Authority.
Bupa Digital GP services are provided by Bupa Occupational Health Limited. Registered in England and Wales with registration number 631336. Registered office: 1 Angel Court, London EC2R 7HJ.
The My Bupa App is provided by Bupa Insurance Services Limited which is authorised and regulated by the Financial Conduct Authority (FCA). Registered in England and Wales at 1 Angel Court, London, EC2R 7HJ. Its company number is 3829851. VAT Registration Number: 239731641.
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.
