BUPA HeartbeatBUPA

Provider: BUPA

Product: BUPA Heartbeat is a menu-driven private medical insurance (PMI) plan which comprises the following cover options:

Health care select 1

• Outpatient consultations and diagnostics ' full refund.

• Therapies (such as physiotherapy) ' £1,000 per year.

• Complementary medicine ' £250 per year.

Health care select 2

• Outpatient consultations and diagnostics ' full refund.

• Therapies (such as physiotherapy) ' £500 per year.

Health care select 3

• Outpatient diagnostics full refund.

• Outpatient consultations and therapies covered up to £500 per year ' only when following and directly related to an inpatient/day-patient treatment.

Health care select 4

• Outpatient consultations and diagnostics ' excluded.

• Outpatient therapies covered up to £250 per year ' only when following and directly related to an inpatient/day-patient treatment.

Health care select HC

• Outpatient consultations and diagnostics full refund.*

• Therapies (such as physiotherapy) ' £500 per year.*

*These benefits are for cancer and acute eligible heart conditions only.

In order to tailor the plan further, customers also have the choice of five additional cover options.

Acceptable age at commencement: 18. New applications cannot be accepted for anybody who has reached the age of 100.

Maximum age for a dependant child to be covered: None

Premiums paid by direct debit: Annual payments may be made by cheque, cash, variable direct debit or credit card. Monthly payments may be made only by variable direct debit or credit card.

Annual direct debit payments attract a 5% discount on premiums.

Plan is fully underwritten: Yes

Optional excess available: Voluntary excess ' choice of £100, £150, £200, £250, £500, £1,000 and £2,000 per person per year. Each member on the plan can choose a different excess level.

There is no set discount for different excesses as each excess has its own rate structure.

Claims pre-authorisation service: Yes

Claims settled direct with hospital: Yes, where possible.

Complex major operation fees: Theatre fees: full cover for BUPA participating hospitals according to scale C.

If performed by a BUPA partnership consultant then fees will

be paid in full, if not then:

Surgeon's and anaesthetist's fees: Surgeon fees £837 - £2,030, anaesthetist fees £523 - £954.

Major plus operation fees: Theatre fees: full cover for BUPA participating hospitals according to scale C.

If performed by a BUPA partnership consultant then fees will be paid in full, if not then:

Surgeon's and Anaesthetists' fees: Surgeon fees £665 - £782, anaesthetist fees £270 - £447.

Major operation fees: Theatre fees: full cover for BUPA participating hospitals according to scale C.

If performed by a BUPA partnership consultant then fees will be paid in full, if not then:

Surgeon's and anaesthetists' fees: Surgeon fees £452 - £619, anaesthetist fees £165 - £235.

Intermediate operation fees: Theatre fees: full cover for BUPA participating hospitals according to scale C.

If performed by a BUPA partnership consultant then fees will be paid in full, if not then:

Surgeon's and anaesthetists' fees: Surgeon fees £208 - £386, anaesthetist fees £102 - £145.

Minor operation fees: Theatre fees: full cover for BUPA participating hospitals according to scale C.

If performed by a BUPA partnership consultant then fees will be paid in full, if not then:

Surgeon's and anaesthetists' fees: Surgeon fees £91 - £167, anaesthetist fees up to £102.

Cover for cost of maternity complications: Pregnancy and childbirth: BUPA do not pay for treatment for, or any condition arising from, pregnancy or childbirth.

However, BUPA have clarified that they will pay for treatment costs for delivering a baby by caesarean section if it is medically necessary, provided the mother has been covered by the scheme for at least 12 months before the delivery.

Cover for cost of ambulance services: BUPA pays for private road ambulance (up to £60 for each trip) if a person needs private day-patient or inpatient treatment for which they are covered under the plan, and it is medically necessary for them to travel by ambulance:

• From their home or place of work to hospital.

• Between hospitals when they are discharged from one hospital and admitted to a hospital for inpatient treatment.

• From hospital to home.

• Between an airport or seaport and hospital.

Other benefits available: Healthy woman and healthy man.

The healthy woman and healthy man additional cover options provide essential health management and advice, in order to help manage health now and in the future. There are three core elements:

• Cash benefits ' for optical and hearing services and hospital stays.

• Health assessment.

• Enhanced HealthLine information and support.

Health Check: This additional cover option offers cover for the health assessments featured in the healthy woman and healthy man options, but excludes the cash benefit and enhanced healthline. The health check option is designed not just to detect health problems, but also to set benchmarks to look after future health.

Get Fit, Keep Fit: This additional cover option provides a fitness assessment and a range of cash benefits designed to help the policyholder stay fit and healthy. There are three core elements to this option:

• Cash benefits ' for complementary medical treatment, footcare, dietetics and nutrition.

• A fitness assessment.

• Enhanced HealthLine information and support.

Convalescence care: The convalescence care option is designed to provide help for those recovering from a stay in hospital, particularly the elderly or frail, or people living on their own. Convalescence care offer the following core benefits:

• Cash benefits ' for domestic help, convalescence care and transport.

• Enhanced HealthLine information and support.

There is a six-month waiting period from joining before cover on these four options starts.

Maximum annual benefit amount: Subject to the above benefit limits there is no overall maximum to the total benefits

payable to each person in any year.

Prosthesis covered: BUPA will pay hospital charges for a prosthesis or appliance required as part of a person's inpatient or day-patient treatment in a BUPA Heartbeat hospital.

A prosthesis means an artificial body part that is designed to form a permanent part of a person's body and is surgically implanted for one or more of the following purposes:

• To replace a joint or ligament.

• To replace one or more heart valves.

• To replace the aorta or an arterial blood vessel.

• To replace a sphincter muscle.

• To replace the lens or cornea of the eye.

• To control urinary incontinence (bladder control).

• To act as a heart pacemaker.

• To remove excess fluid from the brain.

• To reconstruct a breast following surgery for cancer.

An appliance means:

• A knee brace which is an essential part of a repair to a cruciate (knee) ligament.

• A spinal support which is an essential part of surgery to the spine.