Glossary
Acute condition
A disease, illness or injury that is likely to respond quickly to treatment which aims to return you to the state of health you were in immediately before suffering the disease, illness or injury, or which leads to your full recovery.
Appliance
- 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.
- A hand splint which is an essential part of surgery to correct Dupuytren's contracture (thickening of the connective tissue of the hand).
Bupa
Bupa private medical insurance is provided by Bupa Insurance Limited. Registered in England and Wales NO3956433*
*Registered Office Bupa House 15-19 Bloomsbury Way London WC1A 2BA. Authorised and regulated by the Financial Services Authority.
Chronic condition
A disease, illness or injury which has at least one of the following characteristics:
- it continues indefinitely and has no known cure
- it comes back or is likely to come back
- it is permanent
- you need to be rehabilitated or specially trained to cope with it
- it needs long-term monitoring, consultations, check-ups, examinations or tests
Complementary medicine practitioner
An acupuncturist, chiropractor, homoeopath or osteopath who, at the time you receive your treatment is:
- under age 70 and is recognised by us as a complementary medicine practitioner for the purpose of the scheme
- is recognised by us for providing the type of treatment you need
You can contact us to find out if a practitioner is recognised by us as a complementary medicine practitioner and the type of complementary medicine we recognise them for.
Consultant
A registered medical or dental practitioner who, at the time you receive your treatment:
- is under age 70
- is recognised by Bupa as a consultant and has received written confirmation from us of this, unless we recognised him or her as being a consultant before 30 June 1996
- is recognised by us for providing the type of treatment you need
- You can contact us to find out if a medical or dental practitioner is recognised by us as a consultant and the type of treatment we recognise them for.
Consultant partnership
A network of consultants who agree to work within certain quality and service standards and whose fees, where applicable, Bupa will pay in full.
Consultant status
At Bupa we have thousands of consultants across the UK who we have recognised to treat our members. The Bupa status tells you what our agreement with the consultant is, based upon whether they are a recognised or a partner consultant.
Critical care unit
Any intensive care unit, intensive therapy unit, high dependency unit, coronary care unit or progressive care unit which is in our list of critical care units and recognised by us for the type of intensive care that you require at the time you receive your treatment. The units on the list and the type of intensive care that we recognise each unit for may change from time to time. Details of these critical care units are available on request.
Day-patient treatment
Treatment which, for medical reasons, means you have to go into a hospital or day-patient unit because you need a period of clinically-supervised recovery but do not have to stay overnight.
Dependant(s)
Your partner and any child of yours who is a member of the scheme and named on your membership certificate.
Diagnostic tests
Investigations, such as X-rays or blood tests, to find or to help to find the cause of your symptoms.
Eligible treatment
Treatment of an acute condition, together with the products and equipment used as part of the treatment that:are consistent with generally accepted standards of medical practice and representative of best practice in the medical profession in the UK; are clinically appropriate in terms of type, frequency, extent, duration and the facility or location where the services are provided; are demonstrated through scientific evidence to be effective in improving health outcomes; and are not provided or used primarily for the expediency of you or your consultant or other health care professionals; and the treatment, services or charges are not excluded under your benefits.
Excess
The amount that you have to pay towards the cost of treatment that you receive each membership year that would otherwise have been covered under your membership. This is the amount of your excess. The amount of your excess is shown on your membership certificate.
Hospital
This means any of the following at the time you receive treatment:
- a Bupa participating hospital
- any other establishment which we may decide to treat as a hospital for the purpose of the scheme
You can contact us if you would like details of any of these hospitals.
In-patient treatment
Treatment which, for medical reasons, means you have to stay in hospital overnight or for longer.Intensive care
Eligible treatment for intensive care, intensive therapy, high dependency care, coronary care or progressive care.
Main member
The person who has taken out the membership being the first named person on the membership certificate.
Membership year
The period beginning on your start date or renewal date and ending on the day before your next renewal date. By start date we mean the 'effective from' date on your first membership certificate for your current continuous period of membership.
Out-patient treatment
Treatment given at a hospital, consulting room or out-patient clinic where you do not go in for day-patient or in-patient treatment.
Participating hospital
Any hospital which is in our list of participating hospitals, at the time you receive your treatment. This list contains all the hospitals with whom we have an agreement for them to be treated as a participating hospital for the purpose of the scheme. The hospitals may change from time to time so you should contact us before you arrange any treatment to check that the hospital is listed. A copy of the current list is available on request.
For a child under 16 years old, any hospital that we agree in writing will be treated as a participating hospital in the case of treatment for that child which is not carried out in a participating hospital.
Partner
Your husband or wife, or the person you live with in a relationship similar to that of a husband or wife, whether the same sex or not.
Partner consultant
Partership consultants have entered into a voluntary agreement with Bupa, which is based upon a set of guiding principles with the aim of serving the best interests of Bupa members. These principles are:
- submit claims directly to Bupa where possible - because they do this members should not have to settle consultants' bills up front
- agree to charge within Bupa benefit levels - this means that we can guarantee Bupa members that the costs of their treatment will be covered in full by their Bupa cover
Partnership network hospitals
The scheme you chose when you joined Bupa will determine your level of hospital access. Some schemes will only cover you in full for treatment in a partnership network hospital. If you or your consultant wishes to use a hospital not in the network then you may have to pay for part of the treatment.
Occasionally the treatment you need may not be available in a partnership network hospital. If this is the case we may pay for treatment at a hospital which would normally be ineligible, as long as either you or your consultant calls Bupa to agree this arrangement before you receive the treatment.
Pre-existing condition
Any disease, illness or injury for which:
- you have received medication, advice or treatment; or
- you have experienced symptoms whether the condition was diagnosed or not before the start of your cover
Prosthesis
An artificial body part which is designed to form a permanent part of your 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
Psychiatric condition
A mental or addictive condition, including alcoholism, drug addiction or eating disorders.
Psychiatric network hospital
Any hospital which is a registered mental nursing home and is in our list of participating hospitals as a psychiatric network hospital at the time you receive your psychiatric treatment. The hospitals may change from time to time. Details of these hospitals are available on request.
Psychiatric treatment
Eligible treatment of a psychiatric condition.
Qualified nurse
A nurse who is on the register of the Nursing & Midwifery Council, and holds a valid NMC personal identification number.
Recognised consultant
All Bupa recognised consultants have met Bupa's specific criteria in order to be able to treat Bupa members. However, not all consultants have entered into a voluntary agreement with us regarding fees and may not charge within Bupa benefit levels. This means that members may need to pay something towards the cost of their treatment if it is higher than the amount Bupa agrees to pay.
Renewal date
Each anniversary of the date you joined the scheme. (If, however, you are a member of a BupaCare Group Scheme with a common renewal date for all members, your renewal date will be the common renewal date for the group. You will have been advised of this when you joined.)
Scale of cover
The scale which specifies your level of cover for hospital accommodation and certain monetary benefit limits. Your chosen scale of cover is shown on your membership certificate and is either scale A, B or C.
Specialist treatment centre
Any hospital which is in our list of specialist treatment centres at the time you receive your treatment. The hospitals on this list may change from time to time so you should contact us before you arrange any treatment to check that the hospital is listed. Details of these hospitals are available on request.
Specialty
Each Bupa-recognised consultant has had in-depth training in certain diseases, parts of the body or types of treatment. This is what is known as the specialty. For example, a consultant with a specialty of neurosurgery treats disorders of the brain, spinal cord and nerves.
Sub-specialty
Within each specialty, some consultants have more expertise in certain areas of that specialty, known as sub-specialty. For example, a consultant with a specialty of neurosurgery may have a sub-specialty of spinal surgery. We have provided this information when possible, to help GPs and members choose the most appropriate specialist for the condition being treated.
Surgical operation
A surgical procedure or complex investigative/diagnostic procedure including all medically necessary treatment related to the procedure and all consultations carried out from the time you are admitted to hospital until the time you are discharged, or if it is carried out as out-patient treatment, all medically necessary treatment related to the operation and any consultation on the same day which is integral to the operation.
Therapists
- A chartered or state registered physiotherapist, a state registered occupational therapist or orthoptist, a member of the Royal College of Speech and Language Therapists or a Chartered Psychologist registered with the British Psychological Society who at the time you receive your treatment is under age 70 and is recognised by us as a therapist for the purpose of the scheme.
- Any other practitioner who at the time you receive your treatment is under age 70 and has written confirmation from us that we recognise them as a therapist for the purpose of the scheme.
You can contact us to find out if a practitioner is recognised by us as a Therapist.
Treatment
Surgical or medical services (including diagnostic tests) that are needed to diagnose, relieve or cure a disease, illness or injury.
United Kingdom/UK
Great Britain, Northern Ireland, the Channel Islands and the Isle of Man.
You/your
This means the principal main member only.