How does private health insurance work?

Private health insurance is similar to other types of insurance. You pay a monthly or yearly fee called a premium.

1.

Getting Referred

If you have a health issue, see your GP and let them know that you have private insurance. They may refer you to a specialist, and you might choose to go to private hospitals or specialists not offered by the NHS.

2.

Informing Your Insurer

Tell your insurer that you want to make a claim. They'll check if your policy covers the treatment you need. If it does, your claim will be approved.

3.

Cost Coverage

Your GP will book your appointment, and your insurer will cover the cost as long as your policy is active. Depending on your policy, you may be required to pay an excess.

Bupa is a well-established name in UK health insurance, and it focuses not only on excellent coverage but also on promoting healthier lives. With over 43 million customers, many of them review Bupa highly and recommend their services.

In this independent review, let’s dive into Bupa’s offerings and discuss benefits, costs, and whether it’s worth it for you. By the end, you should have learned enough to make an informed decision about purchasing your insurance from this provider.

What Is Bupa?

Bupa, originally known as the British United Provident Association, was established in 1947 with the goal of offering healthcare funding to the UK public. Since then, it has evolved into a big player in the health insurance industry. It’s operated without shareholders as a private company limited by guarantee. Profits generated by Bupa are reinvested into the company to support its operations and employees.

Today, Bupa is the UK’s largest Private Medical Insurance provider in terms of policyholders. Its global headquarters are in the UK, and it operates in various countries, including Australia, Spain, Poland, New Zealand, and more. It also has a presence in Latin America, the Middle East, and Asia.

Is Bupa a Good Insurance Company?

Bupa has collected over 22,000 reviews on Trustpilot with a total rating of 4.2 stars out of 5. Most people review Bupa as Excellent, with just a few customers sharing an unsatisfactory experience. Looking at health insurance reviews with 5 stars, most customers praised Bupa for being easy to use, having friendly staff, getting things done quickly, and processing claims fast.

Bupa Global won the Queen’s Award for Enterprise in the International Trade Category. They also received the Best International Private Medical Insurance Provider award at the UK’s Health Insurance Award and the FT Business Offshore Excellence Award.

How Does Bupa Health Insurance Work?

Bupa’s health insurance plans have a monthly or yearly fee. When you need medical care, you can ask your insurance to cover some or all of the costs. This coverage is for new health problems that happen after you get the insurance.

To get the costs covered, most insurers ask you to see your GP first for a referral. Then, they help you find the right private medical treatment. You pick from a list of approved healthcare providers, and your insurer pays these providers directly, so you don’t have to deal with getting money back.

How Much Does Bupa Health Insurance Cost?

At Bupa, the price of your health insurance policy is calculated based on:

  • Rising healthcare costs — The cost of healthcare increases each year due to better treatments and technology.
  • Age — Older people pay more as healthcare needs increase with age.
  • Location — Costs vary by area.
  • Medical history and health status — Medical conditions typically result in higher premiums or limitations on coverage.
  • Claims history — Past claims may raise your price, while a clean record can lower it.
  • Excess level — Choosing a higher excess can lower your price.
  • Lifestyle — Habits like smoking impact your cost, and changes, like quitting, can save you money.

Here are a few examples of the coverage you can get at different ages and their corresponding prices:

AgeBasic CoverComprehensive Cover
35 years old~£40~£70
45 years old~£60~£100
55 years old~£90~£130

What Does Bupa Health Insurance Cover?

The first Bupa health insurance plan is called Bupa By You. It’s a 12-month private policy that provides comprehensive cover for both full diagnosis and private treatment. The Treatment and Care policy, on the other hand, covers private treatment for those diagnosed by the NHS. After you receive the diagnosis, you can use your Treatment and Care Cover to pay for private treatment.

Under both plans, Bupa covers a range of services, including:

  • Online GP consultations — Most Bupa plans include access to Bupa Blua Health or another digital GP service within 24 hours via video or phone call from any location.
  • Direct access to care — You work with a Direct Access team that you can call if you’re concerned about your health. They will assess your symptoms and provide clear guidance, including referrals to specialists if needed and later diagnostics like blood tests and PET scans.
  • Cancer cover — Bupa offers access to certain breakthrough cancer drugs and treatments before they’re available on the NHS.
  • Mental health — Bupa covers a wide range of mental health conditions, prioritising emotional well-being alongside physical health.

Refer to the table for more details:

ServiceBupa By YouTreatment and Care
Diagnosis (pre-treatment appointments, tests, and scans)YesNo
Treatment (hospital treatment, mental health, outpatient therapies, tests, appointments, scans, Bupa Blua Health)YesYes
Three levels of cancer cover choiceYesYes
Three hospital network choices.YesYes

Comprehensive Medical Insurance Plan

Bupa By You, Bupa’s comprehensive policy, includes coverage for different areas.

Diagnosis:

  • Outpatient appointments — Covered in full unless subject to outpatient allowance limit. If the treatment costs more than £500, the insurance pays £500, and the patient pays the rest.
  • Tests before treatment — Same as above.
  • Scans before treatment — Covered in full. No outpatient allowance limit applies.

Treatment:

  • Hospital treatment — Covered for care in your network hospital. Insurance pays full costs for day, overnight, or outpatient stays, unless you’ve set an outpatient limit.
  • Mental health cover — Covered in full.
  • Outpatient therapies — Covered in full.
  • Tests, appointments, and scans after treatment are covered if they’re related to your care. They’re paid in full, and appointments are covered for up to 6 months after treatment or as per your outpatient limit.

On top of that, you get:

  • Anytime HealthLine — Access the 24/7 phone service to speak with GPs and nurses, with no call limits.
  • Parent accommodation — Bupa covers the cost for one parent to stay with their child (aged 17 or under) during hospital stays for eligible treatment.
  • Private ambulance — If medically necessary, they cover up to £60 for each journey to a private hospital by ambulance.
  • NHS cash benefit — You receive a cash benefit if they choose NHS treatment over using your health cover.
  • NHS cancer cash benefit — Members get cash benefits for NHS cancer treatments, including £100 for each overnight stay, £100 for treatments without overnight stays, and £100 every three weeks for oral treatments.

Bupa Comprehensive Cost Table

Here are a few combinations of Bupa By Your comprehensive health insurance:

ServicesExcessOutpatient CoverMonthly Premium
Essential + NHS plus + Essential Access hospitals£500£500~£25
Essential + NHS plus + Extended hospital choice£500£1,000~£28
Essential + NHS plus + Essential Access hospitals£100£500~£32
Essential + full cancer cover + Essential Access hospitals£100£1,000~£30
Essential + full cancer cover + Extended hospital choice£100£500~£35

Treatment and Care Medical Insurance Plan

Bupa’s Treatment and Care is technically smaller in scope, but it still provides broad coverage:

  • Hospital treatment — You’re covered for care in your network hospital, whether as an in-patient or outpatient. Basic health insurance pays the full hospital costs.
  • Outpatient therapies — Bupa pays in full unless you have an outpatient limit, in which case they pay up to that amount, and you cover any excess.
  • Tests, appointments, and scans after treatment — These are fully covered. Appointments are covered for up to 6 months post-treatment, as well as post-treatment tests.
  • Mental health treatment — You’re covered for therapies from a consultant or therapist.

Additional benefits in the Treatment and Care health insurance are the same as in Bupa By You: private ambulance, Anytime HealthLine, parent accommodation, NHS cash benefit treatment, and NHS cancer bash benefit.

Bupa Treatment and Care Cost Table

Here is how much you expect to pay for the Treatment and Care policy:

ServicesExcessOutpatient CoverMonthly Premium
Comprehensive + NHS plus + Essential Access£500£500~£28
Comprehensive + NHS plus + Extended choice£500£1,000~£38
Comprehensive + NHS plus + Essential Access£100£500~£42
Comprehensive + full cancer cover + Essential Access£100£1,000~£42
Comprehensive + full cancer cover + Extended choice£100£500~£45

Outpatient Cover

Outpatient policy covers all medical care that doesn’t require staying overnight in a hospital bed. Bupa gives you options for outpatient cover limits: £500, £750, £1,000, or unlimited. Once you reach your yearly outpatient limit, you’ll have to pay for any additional costs yourself.

Here’s a comparison between the two plans:

  • Comprehensive — Covers consultations, diagnostic tests and scans (like MRIs and X-rays), mental health treatment, and therapies (like physiotherapy).
  • Treatment and Care — Only covers consultations if directly related to or as a follow-up after in-patient treatment within 6 months of discharge.

Cancer Care

Cancer cover under Bupa health insurance includes diagnosis, surgery, therapies, and more. You can choose full cover, extra cover for treatments not available through the NHS, or rely on NHS care. Additional options include counselling, home chemotherapy, and palliative care.

Full Cancer Cover Features

Bupa’s full cancer cover provides:

  • No limits — There are no financial or time restrictions on your treatment duration or costs.
  • Breakthrough drugs — Patients have access to experimental drugs and treatments, even if they’re not available through the NHS or approved by NICE, as long as they’re evidence-based and covered by the policy.
  • Cancer recurrence — Full cover remains in place even if the cancer comes back.
  • Treatment options — Patients can access treatment at cancer specialist centres and hospitals nationwide, including the option for chemotherapy at home.
  • Specialist advisers — Speak to named specialist nurses or advisers who will help manage the patient’s care throughout your journey.
  • Qualified counsellors — Trained counsellors are available to provide emotional and psychological support when needed.

NHS Cancer Cover Plus Features

Under this option, if you’re diagnosed with cancer, you’ll initially receive treatment through the NHS. However, if specific treatments like radiotherapy, chemotherapy, drug therapy, or surgery aren’t available on the NHS and you meet certain criteria, Bupa will provide private treatment.

It’s important to note that simply being on an NHS waiting list doesn’t guarantee access to private cancer treatment through this policy.

Hospitals

You have three options for hospital networks with Bupa: Essential Access, Extended Choice, and Extended Choice with Central London. If you go to a hospital in your network and use a Bupa-approved doctor with agreed fees, they pay for everything. However, if you go to a hospital outside of your network, you’ll need to share the costs.

Medical Underwriting Options

There are two underwriting options at Bupa: full and moratorium. Full medical underwriting assesses your medical history before your policy starts, usually pre-existing conditions. You’ll know what’s covered right from the start, and Any new medical issues after your policy begins will be covered according to the policy terms.

As for the moratorium, this starts with a claim rather than before signing up for the policy. Bupa offers two options:

  • Rolling moratorium: conditions may be covered if symptom-free for two years
  • Fixed moratorium: conditions covered after two years

When transferring policies, existing conditions may be covered under a “no further underwriting” option. Here, any exclusions that applied to your previous policies will also apply.

Optional Extras

You have the option to enhance your care health insurance plan by paying extra for these services:

  • Complementary therapies — Covers treatments like acupuncture, chiropractic care, and osteopathy.
  • Cancer assist — Provides a cash benefit if you’re diagnosed with cancer.
  • Private ambulance — Offers a maximum benefit, typically up to £80 for each single trip.
  • Home nursing — Up to £2,000 each year when immediately following private eligible in-patient treatment or day patient treatment.
  • Dental 10 cash benefit — Reimburses 100% of the charges for NHS dental treatments, such as checkups, fillings, root canals, dentures, and more.
  • Dental 20 cash benefit — Pays a fixed cash amount towards dental treatments like checkups, fillings, crowns, bridges, and extractions.
  • Optical cash benefit — Helps cover costs for prescription glasses, contact lenses, and routine eye tests.
  • Prescriptions cash benefit — Offers cash assistance for prescription fees after a GP or dentist prescribes medication.

Are There Any Exclusions?

Yes, some of these exclusions include:

  • Pre-existing medical conditions — These are health issues that existed before the start of the policy.
  • Chronic conditions — This refers to conditions that require ongoing or long-term monitoring, control, or relief of symptoms and may include those requiring rehabilitation or special training to cope with, have no known cure, continue indefinitely, or are likely to recur.
  • Cosmetic surgery — Procedures performed for aesthetic purposes rather than medical necessity are not covered.

On top of that, Bupa has a list of additional exclusions:

  • Emergency treatment
  • Critical care (except in specific cases)
  • Allergic disorders or food intolerances
  • Contraception, fertility issues, and sexual health
  • Maternity care and childbirth
  • Hormonal changes during puberty, menopause, and ageing
  • Gender identity or affirmation procedures
  • Hearing impairments
  • Dental or oral procedures
  • Kidney dialysis
  • Varicose vein treatments for leg conditions
  • Sleep disorders and disturbances
  • Cognitive or developmental disorders
  • Speech impediments
  • Corrective eye surgeries (e.g., for nearsightedness or farsightedness)
  • Medical care abroad and repatriation services

Bupa Health Insurance Excess & Prices

Excess is the amount policyholders pay each year before insurance kicks in to cover additional costs. Bupa treatment plans offer excess options from £0 to £2000, and as always, a higher excess lowers your premium.

You only pay the excess once per year, even if you make multiple claims.

Bupa Family & Couples Health Insurance

Bupa’s family cover offers a 10% discount compared to buying individual policies for each family member. You receive all the usual benefits plus extra support services for children’s mental health. Similarly, if you choose a joint Bupa health insurance plan with your partner, the provider gives you a 5% discount.

Bupa Business Health Insurance

Bupa Business has options for businesses of different sizes:

  • For micro businesses with under 10 employees, they offer coverage to prevent disruptions.
  • They also provide comprehensive health coverage for businesses with up to 249 employees.
  • There are also products and services for enterprise customers (Over 250 employees).

Bupa’s corporate healthcare solutions include services like health assessments, private consultations, cash plans, employee assistance programs, flu vaccines, specialised plans for menopause and menstrual periods, and more.

Bupa Private Healthcare

In addition to providing private health insurance, Bupa offers a range of private healthcare services in the UK. These include care homes, specialised dementia care, health centres, and retirement villages. Bupa also has a large network of recognised consultants, therapists, and hospitals.

What Is Not Covered on Bupa Health Insurance?

Bupa only covers sudden and severe health issues, known as acute conditions, rather than long-term or recurring conditions like diabetes. Acute flare-ups may be covered unless excluded during underwriting.

Policies also exclude coverage for outpatient medications and dressings (except for cancer-related treatments), treatment in dental centres, ageing-related care, routine health screenings and tests, and complementary or alternative therapies. Find the detailed list of what’s not insured here.

Will I Be Covered If I Have an Existing Medical Condition?

Bupa health insurance doesn’t include coverage for pre-existing conditions, as its primary focus is on providing coverage for new health issues that arise after the policy begins.

However, there’s a possibility for coverage of pre-existing conditions. If there haven’t been any symptoms, treatment, or medical advice for that condition in two years since the policy started, you will be considered. This decision depends on you providing a health declaration when applying.

When Does Bupa Health Insurance Reset?

Bupa health insurance policies reset every January 1st. This means that your coverage and any early claim limits start fresh at the beginning of each calendar year. If you haven’t used up your yearly limit for Bupa’s treatment by December 31st, it doesn’t carry over to the next year.

Also, Bupa has a lifetime limit for orthodontic coverage per individual. Once this limit is reached, further claims for orthodontic treatment are not possible, even if you switch plans.

Can I Switch My Existing Health Insurance Cover to Bupa?

Yes, you can switch in three steps:

  1. Compare your health insurance options and select a level of cover that meets your needs.
  2. Bupa’s representative will ask about your previous health cover and take care of all the paperwork for you. They’ll contact your old fund and handle the clearance certificate process.
  3. If you’ve already served waiting periods with your previous health fund, you won’t have to serve them again when you switch to Bupa. You can start new coverage right away.

As for pre-existing conditions from the previous provider, the process is managed through Bupa’s customer service team. They will guide you through any exclusions and how they may affect your coverage.

How Can You Lower the Cost of Bupa Health Insurance?

Private health insurance doesn’t have to cost a lot; you can change your Bupa coverage to make it cheaper:

  • Consider choosing a plan that covers basic services like hospital stays.
  • Agreeing to pay more towards your excess also reduces your monthly payments, but remember, you’ll have to pay this amount if you need treatment.
  • Lower the amount you can claim for outpatient care.
  • Only add optional extras like dental or eyecare cover if you need them.
  • Select a hospital network that includes the facilities you’re most likely to use.
  • Take advantage of Bupa rewards: save on various insurance policies and enjoy discounts on e-gift cards, dining, cinema vouchers, and cashback rewards.
  • Maintain a healthy lifestyle.

How to Cancel Bupa Health Insurance UK

To cancel your Bupa policy, you can either fill out an online health declaration form or call customer support. You’ll need to provide your policy number and details, and clearly request cancellation. To get a full refund, make sure to request cancellation within 21 days of getting your yearly policy and if you haven’t made any claims.

Once you cancel your membership, you’ll get an email to confirm it’s done.

Bupa Contact Information

To learn more about Bupa treatment options and policy plans, it’s best to contact them directly. New customers can get a quote by calling 0808 231 8067.

Existing Bupa health insurance customers can call 03456 090 111 for support and renewals.

You can also reach out through the Contact page or chat with the virtual assistant on the website.

Summary

The takeaway from this Bupa health insurance review is that Bupa is a highly respected brand known for its reliable services that millions of people trust and benefit from.

Whether this particular health insurance provider is right for you depends on your situation. If it’s within your budget and the coverage suits your needs, it’s worth considering! Plus, keep in mind that you can customize your coverage to fit your needs without necessarily opting for the most expensive choice.

Before you decide and commit to Bupa, the best thing to do right now is to seek expert advice. This way, you won’t get lost in policies and lose track of what you need.