BUPA Claims

Before having treatment, the best thing to do is to call the Bupa Helpline to discuss your recommended treatment plan and clarify which areas of your health insurance policy can reimburse your costs.

To make the claims process easier, you can ask your general practitioner to refer you to a Bupa recognized specialist or health care provider.

The Bupa helpline will provide you with assistance throughout the claims process.

Contact the Bupa International Helpline on: +44 (0) 1273 333 911

Claims with Bupa are normally made through one of three ways:

Direct Settlement

• Some Bupa health plans will include direct settlement benefits.
• Direct settlement allows your treatment to be directly paid and settled between Bupa and the hospital or medical facility without the need to claim.
• Pre-authorisation of treatment may or may not be required.
• See section on direct settlement

Pre-authorisation

• Some treatment (eg. Hospital treatment) must be pre-authorised.
• Bupa authorizes your treatment and claim is settled between your health care provider and Bupa
• Pre authorisation can be done online with a 24 hours response
• See section on pre-authorsation
• Find out what treatment needs to be pre-authorised
• Find out how to pre-authorise your treatment

Pay and claim

• Treatment is paid for by the policy holder and a claim form is submitted for reimbursement.
• See section on pay and claim
• Find out how to submit a claim form

To find out how to claim with Bupa:

If you have a Bupa health plan with:

Bupa International

• Company plan
• Family/Individual plan

A local plan with:

• Bupa Hong Kong
• Bupa UK

Travel Health Insurance

• IHI Bupa travel health insurance
• IHI Bupa Medical Centre

Cash plans

• Bupa Health Cash Back and Bupa Patient Cash

Bupa Direct Settlement

Direct settlement is a benefit included on a health insurance plan. Many of Bupa's health insurance plans include this benefit, allowing policy holders to use a quick and efficient cashless claim service, providing ease of access to their plan entitlements.

There are two different methods of direct settlement with Bupa:

• Pre-authorisation is made by the policy holder (see section on pre-authorisation). A pre-authorisation letter is issued by Bupa and sent to the healthcare provider or the policy holder. The policy holder signs the declaration and the medical bill is paid and settled between the hospital and Bupa.
• OR
• The policy holder has a medical card service benefit (some of Bupa's health insurance plans have entitlements to a medical card service) which can be used at any Bupa network provider. Medical treatment is paid for directly using the medical card service, providing a cashless claims service.

Bupa Pre-authorization

Pre-authorization can be completed online with a 24 hour response (within business hours).

If you require an immediate pre-authorisation (in an event of an emergency) you can contact the Bupa Helpline for assistance.

The following treatment needs to be pre-authorised by Bupa:

• All hospital treatment
• All outpatient/day surgery
• Radiology scans: MRI, CT, PET scans
• Cancer treatment: Chemotherapy or radiotherapy

If you have been recommended any of the above treatments by your general practitioner or specialist you should contact the Bupa helpline to find out whether it will be covered on your health insurance plan.

How to pre-authorise your treatment with Bupa:

1. Policy holders can pre-authorise their treatment online by visiting the Bupa website.
2. Bupa will ask you to provide your membership details, verify your condition and the treatment that is proposed by your general practitioner or specialist.
3. Bupa may contact you to request further information. Some typical questions will include:
   
   
   • What condition or symptoms are you experiencing?
   • When did your symptoms begin?
   • Have you received any treatment in the past for this condition?
   • What is your doctors name?
   • Where will you receive treatment?
   • How long will you need to recover in hospital?
4. Once a decision is made, a pre-authorisation letter is issued and sent to the healthcare provider or the policy holder to complete.
   The pre-authorisation letter is completed by the hospital or physician and information is supplied:
   
   
   • Patient details (name, date of birth)
   • Symptoms
   • Diagnosis
   • Procedure
   • Planned admission date
5. The policy holder is required to sign the declaration.
6. Payment of the medical bill is organised between Bupa and the hospital or healthcare provider.

How will Bupa make a decision on authorisation?

Bupa will authorise the payment of your medical expenses, according to the entitlements of your health care plan and the following guidelines:

• Bupa will pay up to the limits of your plan
• Treatment must be included on your benefits
• Your Bupa health plan is active and payments have been made up to date
• The treatment you are having matches the treatment authorised by Bupa
• You have fully disclosed your health condition and any information required on claim form
• Your health condition is not a pre-existing condition *
• Treatment is reasonably necessary
• Treatment is used by policy holder within 31 days of authorization

* A pre-existing condition is a medical condition or injury which is present prior to the start of your health insurance policy.

Pay and claim

For policy holders that do not have a direct settlement benefit or medical card service, the policy holder may pay for their treatment and obtain a reimbursement from Bupa by making a claim.

Before having treatment, the policy holder should:

• Confirm their coverage benefits and limits by phoning the Bupa Helpine.
• Treatment may need to be pre-authorized
• Without pre-authorisation of treatments, policy holders may only receive

Claims should be submitted to Bupa within 90 days of treatment (or other medical benefit), unless this is not reasonably possible to do so.

How to make a claim with Bupa:

1. Download a claim form from Bupa website or MembersWorld.
2. Complete the claim form and attach the original receipts
3. Bupa may contact you to request additional information *
4. Once a decision is made on claim, Bupa will issue a letter
5. Reimbursement is made via cheque or payment to the policy holder's designated account

It takes approximately 5-7 days to settle a claim payment.

Click here to obtain a Bupa claim form.

To make a claim, you will need to provide the following details:

1. Bupa membership number
2. Name of your health care provider (ie. consultant, doctor, hospital, therapist)
3. Name of your condition and the prescribed treatment (if condition is unknown, provide a description of your symptoms).

Other advice on making a claim:

• A new claim form must be submitted for each medical condition, each member on plan, each treatment, and for each currency of claim.
• If the medical condition has not ceased after 6 months, a new claim form must also be submitted.

The Bupa Helpline will offer you assistance with your claim:

• Discuss your health insurance coverage and benefits
• Confirm if your treatment will be covered by your health insurance planv
• Confirm if your treatment provider or therapist is recognized by Bupa
• Find a health care provider that is recognized by Bupa
• Give you instructions on what to do next – such as procedure to make claim

The Bupa Helpline can also assistance with:

• Membership and payment queries
• Medical advice
• Locate medical facilities worldwide
• Emergency evacuation and repatriation assistance (if its included on your health plan benefits)
• Embassy and visa information
• Locate an interpreter

Contact the Bupa International Helpline on: +44 (0) 1273 333 911
Open 24 hours a day, 365 days a year

For more information about Bupa Health Insurance Plans, or to receive a free Bupa Health Insurance Quote, please contact one of our dedicated advisers today.