Po/ic} sutv1,;,v1,ar} ClientChoice Plus. Effective from 1 January 2017

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1 Po/ic} sutv1,;,v1,ar} ClientChoice Plus Effective from 1 January 2017 Bu

2 This policy summary contains key information about Bupa ClientChoice Plus. You should read this carefully and keep it in a safe place afterwards. Please note that it does not contain the full terms and conditions and exclusions of cover. About your cover The provider Bupa ClientChoice Plus is provided by Bupa Insurance Limited (Bupa, we, us, our), a subsidiary of the British United Provident Association Limited. Other services are provided by or via other subsidiary companies. The insurance and the cover that it provides Bupa ClientChoice Plus offers you private medical health insurance which aims to fund eligible medical treatment. It will cover the costs of your eligible treatment in the UK, up to the limits of your chosen cover, by Bupa recognised consultants, therapists and practitioners. There is no overall maximum amount paid out in any year, although there are set limits for certain particular benefits. Bupa ClientChoice Plus provides cover for eligible hospital treatment in Bupa partnership facility hospitals. Bupa partnership facilities may change from time to time. The types of membership Bupa ClientChoice Plus is available as moratorium membership or underwritten membership. With moratorium membership you are not required to complete a medical questionnaire before you arrange cover. Each time you make a claim we will ask you to provide to us medical details, including medical information that you will need to ask your GP to provide to you. Each claim you make during your membership will be assessed on this information and any further information we ask you to provide. If you have chosen moratorium membership we do not provide cover for any pre-existing and related medical conditions that you have had in the five years before your start date, unless after two years of continuous membership you have not received any medication, advice or treatment, or experienced any symptoms related to those conditions, in which case you may become eligible for cover. You should not forgo any medical treatment in an attempt to become eligible for cover earlier than you would normally be. Page 2

3 With underwritten membership you are required to complete a medical questionnaire before you arrange cover. This means that any symptoms or conditions that have been present seven years prior to the start date of the policy may not be covered, and we may require further medical information to assess your claim, particularly where claims are made early in your policy. You will find any pre-existing conditions which you are not covered for listed on your membership certificate. Please note that where this medical information is not provided, we may not be able to process your claim. (See 'How your membership works' section of the membership guide for full details.) No claims discount Bupa ClientChoice Plus gives you the benefit of an immediate no claims discount on joining. Any claims you make during your membership year will be reflected in your no claims discount which applies in future years. You should not forgo any medical treatment due to concerns about losing your no claims discount. (See 'How your membership works' section of the membership guide for full details.) Summary of cover The summary of cover overleaf sets out the eligible treatments which are covered. Page 3

4 Summary of cover In-patient and day-patient treatment Hospital charges Consultants'/ specialists' fees Diagnostic tests Radiotherapy/ chemotherapy Mental health treatment Out-patient treatment Up to a maximum of 28 days In a Bupa partnership facility In a Bupa partnership facility - Bupa benefit limits apply if the consultant is not a Bupa partnership consultant In a Bupa partnership facility In a Bupa partnership facility. Benefit limits apply if the consultant is not a Bupa partnership consultant By a Bupa partnership consultant in a Bupa recognised facility. Benefit limits apply if the consultant is not a Bupa partnership consultant Page 4

5 Bupa ClientChoice Plus Consultation with a consultant/specialist Scans Radiotherapy/ chemotherapy Physiotherapy (and other therapies) Mental health treatment Complementary medicine Additional benefits Benefits Up to 1,000 a year II II Up to 1,000 a year Up to 1,000 a year" Up to 250 of available cover Notes On GP referral with a Bupa recognised consultant consultations with a Bupa recognised consultant will be paid in full up to and from within your available out-patient benefit limits MRI, CT and PET scans in a Bupa recognised facility In a Bupa partnership facility. Benefit limits apply if the consultant is not a Bupa partnership consultant On referral to a Bupa recognised therapist. This is a combined overall benefit limit for all therapies Consultants' fees paid as above. Bupa recognised mental health and wellbeing therapists' fees and recognised facility charges paid up to and from within your available out-patient benefit limits On GP or Bupa recognised consultant referral, with a Bupa recognised complementary medicine practitioner "Please note that this is the total amount we will pay for both consultations and physiotherapy (and other therapies) combined. This also includes the 250 complementary medicine benefit. Please note the out-patient benefit limit restrictions do not apply when the out-patient treatments are for eligible treatment of cancer. Page 5

6 Bupa ClientChoice Plus Nursing at home Private ambulance Parent accommodation NHS cash benefit for NHS in-patient stay that you receive radiotherapy, chemotherapy or a surgical operation that is for cancer treatment 1 NHS cash benefit for NHS out-patient or day-patient cancer treatment or NHS home treatment for cancer 1 Benefits Up to 600 a year Up to 120 a year 100 each night 100 for each day you receive radiotherapy in a hospital setting 100 for each day you receive IV-chemotherapy and for each three-weekly interval of oral chemotherapy or part thereof 100 on the day of your surgical operation Notes Following eligible private in-patient treatment covered by your scheme 60 maximum for any one trip When staying with a child under 16 receiving eligible private in-patient treatment, one parent only NHS in-patient treatment that would otherwise be covered for private in-patient treatment under your scheme NHS out-patient, day-patient and home treatment for cancer that would otherwise be covered under your scheme +We only pay one NHS cash benefit even if you have more than one treatment on the same day or might have been entitled to the payment under separate 'Benefit' sections. See your membership guide for full details. Page 6

7 What your policy does not cover Exclusions (See What is not covered section of the membership guide for full details.) There are a number of conditions and treatments which Bupa ClientChoice Plus does not cover. Amongst these are: If you have chosen moratorium membership, any disease, illness or injury which existed in the five years before your cover started won't be covered initially. After two years' continuous cover, you will be covered for pre-existing conditions, provided you don't receive medication, advice or treatment or experience symptoms of that condition during this two year period If you have chosen a fully underwritten membership, conditions you had in the five years before your policy started (commonly known as 'pre-existing conditions') won't be covered services you receive from your GP long-term illnesses which cannot be cured (usually referred to as 'chronic conditions') accident and emergency admission treatment for conditions or symptoms arising from physiological or natural causes (such as ageing, menopause or puberty) or desensitisation of allergies convalescence routine health checks or dental/ oral treatment (such as fillings and treatment for gum disease) treatment relating to learning, behavioural and developmental problems sleep problems and disorders overseas treatment or repatriation intensive care, except when routinely needed after private treatment neo-natal care organ transplant surgery sexually transmitted diseases pandemic or epidemic disease screening, monitoring and preventative treatment pregnancy and childbirth cosmetic, reconstructive or weight loss treatment. Policy excesses (See Claiming section of the membership guide for full details.) You can choose to pay a policy excess, where you pay up to the first 100 or 250 of the eligible claims in any year and your Bupa ClientChoice Plus policy will then pay the rest. The excess is payable per person, per membership year on the cover. Details of the excess amount is shown in your membership certificate. 'We may record or monitor our calls. Page 7

8 How long your cover will last Bupa ClientChoice Plus is an annual contract that is automatically renewed each year and will continue until: you stop paying subscriptions to it you cease to live in the UK you die. Bupa has the right to make changes to the terms and conditions of your cover on any annual anniversary date after your policy has started or to end the scheme. Where cover extends to dependants' cover it may may have a different annual anniversary date to the main member's. Cover for dependants will always end when the main member's cover ends. (See 'How your membership works' section of the membership guide for full details.) Changing your mind (See 'How your membership works' section of the membership guide for full details.) You can change your mind within 21 days: of the day when your policy starts or, if later the day when you receive your membership guide and your membership certificate. As long as you have not made any claims, we will refund all your subscriptions paid. After this time, if you decide for any reason, that you do not want your Bupa ClientChoice Plus policy after all, we will refund any subscriptions you have paid which relates to a period after your cover ends. (See 'How your membership works' section of the membership guide for full details.) Getting in touch The Bupa helpline is always the first number to call if you need help or support. Please call us on *, alternatively you can write to us at: Bupa, Salford Quays, Salford M50 3XL For hearing and speech impaired members who have a textphone, please call on: *. We can also offer a choice of braille, large print or audio for correspondence. How to make a claim You should always call Bupa on * before you see a consultant or therapist and before your treatment begins. You will also need to have your Bupa membership number handy when you call. (See 'Claiming' section of the membership guide for full details.) 'We may record or monitor our calls. Page 8

9 Making a complaint We're committed to providing you with a first class service at all times and will make every effort to meet the high standards we've set. If you feel that we've not achieved the standard of service you would expect or if you are unhappy in any other way, then please get in touch. If Bupa, or any representative of Bupa, did not sell you this policy and your complaint is about the sale of your policy, please contact the party who sold the policy. Their details can be found on the status disclosure document or the terms of business document they provided to you. If you are a member of a company or corporate scheme please call your dedicated Bupa helpline, this will be detailed on your membership certificate. For any other complaint our member services department is always the first number to call if you need help or support or if you have any comments or complaints. You can contact us in several ways: By phone: * In writing: Customer Relations, Bupa, Salford Quays, Salford MS0 3XL By customerrelations@bupa.com Please be aware information submitted to us via is normally unsecure and may be copied, read or altered by others before it reaches us. via our website: bupa.co.uk/ members/member-feedback Or via How will we deal with your complaint and how long is this likely to take? If we can resolve your complaint within three working days after the day you made your complaint, we'll write to you to confirm this. Where we're unable to resolve your complaint within this time, we'll promptly write to you to acknowledge receipt. We'll then continue to investigate your complaint and aim to send you our final written decision within four weeks from the day of receipt. If we're unable to resolve your complaint within four weeks following receipt, we'll write to you to confirm that we're still investigating it. Within eight weeks of receiving your complaint we'll either send you a final written decision explaining the results of our investigation or we'll send you a letter advising that we have been unable to reach a decision at this time. If you remain unhappy with our response, or after eight weeks you do not wish to wait for us to complete our review, you may refer your complaint to the Financial Ombudsman Service. You can write to them at: Exchange Tower, London E14 9GE or contact them via at complaint.info@financialombudsman.org.uk or call them on calls to this number are now free on mobile phones and landlines or (free for mobile phone users who pay a monthly charge for calls to numbers starting 01 or 02). For more information you can visit Page 9

10 Your complaint will be dealt with confidentially and will not affect how we treat you in the future. Whilst we are bound by the decision of the Financial Ombudsman Service, you are not. The European Commission also provides an online dispute resolution (ODR) platform which allows consumers who purchase online to submit complaints through a central site which forwards the complaint to the relevant Alternative Dispute Resolution (ADR) scheme. For Bupa, complaints will be forwarded to the Financial Ombudsman Service and you can refer complaints directly to them using the details above. For more information about ODR please visit /ec.europa.eu/consumers/odr / The Financial Services Compensation Scheme (FSCS) In the unlikely event that we cannot meet our financial obligations, you may be entitled to compensation from the Financial Services Compensation Scheme. This will depend on the type of business and the circumstances of your claim. The FSCS may arrange to transfer your policy to another insurer, provide a new policy or, where appropriate, provide compensation. Further information about compensation scheme arrangements is available from the FSCS on or or on its website at Privacy notice Our Privacy Notice explains how we take care of your personal information and how we use it to provide your cover. A full version of the notice can be found in your membership guide or online at bupa.co.uk/privacy Page 10

11 Notes Page 11

12 Bupa health insurance is provided by Bupa Insurance Limited. Registered in England and Wales No 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 Registered office: Bupa House, Bloomsbury Way, London WClA 2BA. Bupa bupa.co.uk CLCP/5631/NOV16 BUPA 0564