Slide4
Worldwide Health Options gives you comprehensive cover that can be tailored to your needs, even where these may not have been covered in the past, for example cover for long-term prescriptions or pre-existing conditions.


Of course, there are some things we don't cover. We want you to have all the information you need to make a decision about whether this plan is right for you, so we have listed the exclusions that apply to all options on the plan. You can find more detail in the membership pack.

Where possible, you should always contact us before you arrange or receive treatment so that we can confirm you're covered. In some cases (see notes, below) you must contact us for prior approval before treatment or your benefit will not be paid.


General exclusions


Artificial life maintenance:

  • including mechanical ventilation, where such treatment will not or is not expected to result in your recovery or restore you to your previous state of health

Example: We will not pay for artificial life maintenance when you are unable to feed or breathe independently and require percutaneous endoscopic gastrostomy (PEG) or nasal feeding for a period of more than 90 continuous days.


Birth control:

  • contraception
  • sterilisation
  • vasectomy
  • termination of pregnancy unless there is a threat to the mother’s health
  • family planning, such as meeting with your doctor to discuss becoming pregnant or contraception


Conflict and disaster:

  • nuclear or chemical contamination
  • war, riot, revolution, acts of terrorism
  • epidemics put under the control of the local public health authorities
  • any similar event

If:

  • you have put yourself in danger by entering a known area of conflict (as identified by an EU government, such as the British Foreign and Commonwealth Office)
  • you were an active participant
  • you have displayed a blatant disregard for your personal safety


Convalescence and admission for general care, or staying in hospital for:

  • convalescence, pain management, supervision
  • receiving only general nursing care
  • therapist or complementary therapist services
  • domestic/living assistance such as bathing and dressing
  • treatment that could take place as day-case or out-patient


Cosmetic treatment

Treatment to improve your appearance such as:

  • facelift or re-modelled nose
  • cosmetic dentistry such as the replacement of a sound, natural tooth with an implant, veneers, etc
  • orthodontic treatment over the age of 19 (we pay for orthodontic treatment under the age of 19 if you have bought the Worldwide Wellbeing option)
  • treatment related to or arising from the removal of non-diseased, or surplus or fat tissue, such as liposuction, whether or not it is needed for medical or psychological reasons
  • hair transplants for any reason
  • surgery to change the shape, enhance or reduce your breast(s) for any reason, except reconstruction following treatment for cancer. Examples: we do not pay for breast reduction for backache, or gynaecomastia (the enlargement of breasts in men)


If your doctor recommends cosmetic treatment to correct a functional problem, for example, excess eye tissue which is interrupting the visual field, your case will be assessed by our clinical teams on an individual basis. If approved, benefits will be paid in line with the rules and benefits of your plan.

We may pay for prophylactic surgery (surgery to remove an organ or gland that shows no signs of disease, in an attempt to prevent development of disease of that organ or gland) when:

  • there is a significant family history of the disease, for example ovarian cancer, which is part of a genetic cancer syndrome and/or
  • you have positive results from genetic testing (please note that we will not pay for the genetic testing)


Please contact us for prior approval before proceeding with treatment. It may be necessary for us to seek a second opinion as part of our approval process. Benefit will not be paid unless prior approval has been received. The limit shown under Worldwide Medical Insurance will apply for prophylactic surgery for congenital and hereditary conditions other than cancer.


Developmental problems:

  • learning difficulties, such as dyslexia
  • behavioural problems, such as attention deficit hyperactivity disorder (ADHD)
  • physical development problems, such as short height
  • developmental problems treated in an educational environment or to support educational development


Donor organs:

  • mechanical or animal organs, except where a mechanical appliance is temporarily used to maintain bodily function whilst awaiting transplant
  • purchase of a donor organ from any source
  • harvesting or storage of stem cells, when a preventive measure against possible future disease


Experimental treatment:

  • treatment or medicine which in our reasonable opinion is experimental based on acceptable evidence*
  • treatment or medicine which in our reasonable opinion is not effective based on acceptable evidence*
  • medicines and equipment used for purposes other than those defined under their licence


We will fund the costs of an experimental treatment or medicine if it is being undertaken as part of a registered clinical trial*.

If you are unsure whether your treatment may be experimental, please contact us.

*For full definitions, please consult the membership pack.


Eyesight

Treatment, equipment or surgery to correct your eyesight such as laser treatment, refractive keratotomy and photorefractive keratectomy, or treatment for keratoconus.

If you have bought Worldwide Wellbeing cover, your optical benefits will be shown.


Foetal surgery

Treatment or surgery undertaken in the womb before birth.


Footcare

Treatment for:

  • corns
  • calluses
  • thickened or misshapen nails


Harmful or hazardous use of alcohol, drugs and/or medicines

Treatment for or arising from the harmful, hazardous or addictive use of any substance including alcohol, drugs and/or medicines.


Health hydros, nature cure clinics, etc

Treatment or services received in:

  • a health hydro
  • a nature cure clinic
  • a spa
  • any similar establishment that is not a hospital


Infertility treatment

Treatment to assist reproduction such as:

  • in-vitro fertilisation (IVF)
  • gamete intrafallopian transfer (GIFT)
  • zygote intrafallopian transfer (ZIFT)
  • artificial insemination (AI)
  • prescribed drug treatment
  • embryo transport (from one physical location to another)
  • donor ovum and/or semen and related costs


We pay for investigations into the cause of infertility when your specialist believes there are symptoms and/or evidence to suggest a medical cause. We will only pay when:

  • both you and your partner have been members of this plan (or any Bupa plan which includes this cover) for two years before the investigations start, and
  • you were both unaware and had not been suffering any symptoms prior to joining


Obesity

Treatment for or as a result of obesity such as:

  • slimming aids or drugs
  • slimming classes
  • obesity surgery


Persistent vegetative state (PVS) and neurological damage

We will not pay for treatment whilst staying in hospital for more than 90 continuous days for permanent neurological damage or if you are in a persistent vegetative state.


Personal exclusions

Please check your membership certificate to see if you have any personal exclusions or restrictions on your plan. The exclusions in this section apply in addition to and alongside any such personal exclusions and restrictions.

For all exclusions in this section, and for any personal exclusions or restrictions shown on your membership certificate, please note that:

  • we do not pay for conditions which are directly related to excluded conditions or treatment
  • we do not pay for any additional or increased costs arising from excluded conditions or treatments
  • we do not pay for complications arising from excluded conditions or treatments


Please refer to the membership pack for full details.


Personality disorders

Any treatment for personality disorders, including but not limited to:

  • affective personality disorder
  • schizoid personality (not schizophrenia)
  • histrionic personality disorder


Pre-existing conditions

Any treatment for a pre-existing condition, related symptoms, or any condition that results from or is related to a pre-existing condition, unless:

  • we were given all the medical information that we asked for during your application for your current continuous period of membership before we sent you your first membership certificate which lists the person with the pre-existing condition
  • you have been sent your membership certificate which lists the person with the pre-existing condition and the option(s) to which that applies, and
  • we did not specifically exclude cover for the costs of treatment of the pre-existing condition on your membership certificate under the 'pre-existing conditions' section


Please contact us before your next renewal date if you have previously disclosed a pre-existing condition of yours to us but believe that there will be no further treatment for that pre-existing condition after your next renewal date. In order for us to review whether to remove the pre-existing condition, we must receive full current clinical details from your medical practitioner. There are some pre-existing conditions that, due to their nature, we will not review.

For more information on buying cover for pre-existing conditions, see the Pre-existing conditions cover option.


Preventive treatment

Health screening, including routine health checks and vaccinations, or any preventive treatment, except if you have bought the Worldwide Wellbeing option.

We may pay for prophylactic surgery when:

  • there is a significant family history of the disease for example ovarian cancer, which is part of a genetic cancer syndrome and/or
  • you have positive results from genetic testing (please note that we will not pay for the genetic testing)


The limit shown under Worldwide Medical Insurance will apply for prophylactic surgery for congenital and hereditary conditions other than cancer.

Please contact us for prior approval before proceeding with treatment. It may be necessary for us to seek a second opinion as part of our approval process. Benefit will not be paid unless prior approval has been received.


Reconstructive or remedial surgery

Treatment to restore your appearance after an illness, injury or surgery.

We may pay for surgery when the original illness, injury or surgery and the reconstructive surgery take place during your current continuous membership.

Please contact us for prior approval before proceeding with treatment. It may be necessary for us to seek a second opinion as part of our approval process. Benefit will not be paid unless prior approval has been received.


Self-inflicted injuries

  • Treatment for or as a result of an injury you have knowingly caused to yourself, such as in an attempted suicide.


Sexual problems and gender issues:

  • sexual problems, such as impotence, whatever the cause
  • sex changes or gender reassignments


Sleep disorders:

  • insomnia
  • snoring
  • sleep-related disorders including sleep apnoea
  • participation in sleep studies beyond the initial study


We may pay for treatment of sleep apnoea when your specialist believes this to be life-threatening. We will only pay for:

  • an initial sleep study
  • surgery, if medically appropriate
  • equipment hire, such as a continuous positive airway pressure (CPAP) machine (only if you have bought the Worldwide Medicines and Equipment option)


Please contact us for prior approval before proceeding with treatment. It may be necessary for us to seek a second opinion as part of our approval process. Benefit will not be paid unless prior approval has been received.


Stem cells

  • We do not pay for the harvesting or storage of stem cells, for example ovum, core blood or sperm storage.


Temporomandibular joint (TMJ) disorders


Travel costs for treatment

Any travel costs related to receiving treatment. For example:

  • taxis or other travel expenses for you to visit a medical practitioner
  • travel time or the cost of any transport expenses charged by a medical practitioner to visit you


Exceptions:

  • road ambulance cover
  • air ambulance cover
  • you have bought Worldwide Evacuation cover and your travel meets the qualifying conditions of that cover


Unrecognised medical practitioners, providers or facilities

Treatment provided:

  • by a medical practitioner, provider or facility who is not recognised by the relevant authorities in the country where the treatment takes place as having specialised knowledge, or expertise in, the treatment of the disease, illness or injury being treated
  • by anyone with the same residence as you or who is a member of your immediate family
  • by a medical practitioner, provider or facility to whom we have sent written notice that we no longer recognise them for the purposes of our plans. Details of treatment providers we have sent written notice to are available on MembersWorld or by calling us on +44 (0) 1273 323 563


USA treatment

If you have not bought cover for the USA, then we will not pay for treatment received in the USA.

If you have bought cover for the USA, we will not pay for treatment received there when:

  • prior approval for your treatment was not given by our service partner in the USA
  • we know or suspect that you purchased cover and travelled to the USA for the purpose of receiving treatment for a condition, when you had already experienced symptoms of that condition. This applies whether or not your treatment was the main or sole purpose of your visit


If you have previously disclosed a pre-existing condition to us which is listed on your membership certificate and we have not specifically excluded cover for the costs of treatment of the pre-existing condition, this will not apply for any treatment you receive in the USA in respect of that pre-existing condition. If you receive treatment in the USA for a pre-existing condition which is shown on your membership certificate, you will not be covered for the costs of such treatment irrespective of whether the pre-existing condition was disclosed to us and is shown on your membership certificate.


GLOBALCAPITAL HEALTH INSURANCE AGENCY

GlobalCapital Health Insurance Agency Limited acts as an insurance agent and is regulated by the Malta Financial Services Authority (MFSA). Registered address: GlobalCapital Health Insurance Agency Limited, Testaferrata Street, Ta’ Xbiex XBX 1403, Malta.

id trans

© 2014 Bupa Malta / GlobalCapital Health Insurance Agency Ltd