MembersWorld 

To help things run smoothly and ensure that your treatment and treatment provider are covered by your plan before you get the treatment and make a claim for it, we recommend that you have your medical consultation or treatment pre-authorised.

Certain types of treatment and treatment from certain providers must be authorised in advance, so please always check your membership guide.

We can pre-authorise a scheduled medical appointment, or you can have it pre-authorised before you book it, if you have some details about the symptoms or condition that needs treatment.

Please keep in mind that your pre-authorised treatment must take place within 31 days of receiving our approval.

If you have a MembersWorld account, please log into it to request pre-authorisation there.

We aim to respond to pre-authorisation requests within 48 hours, but if you need urgent treatment, please call us.

For more information, go to MembersWorld.

Please see your membership guide for more details about who you can see for treatment or consultation.

Your guide is available in MembersWorld, within Manage your Plan. It will give you additional details about what you can claim for, along with limits and exclusions.

To help things run smoothly and ensure that your treatment and treatment provider are covered by your plan, we recommend that you have your medical consultation or treatment pre-authorised. Certain types of treatment and treatment from certain providers must be authorised in advance, so please always check your membership guide.

We can pre-authorise a scheduled medical appointment, or you can have it pre-authorised before you book it, as long as you can provide some details about the symptoms or condition that needs treatment. Also, your pre-authorised treatment must take place within 31 days of receiving our approval.

We aim to respond to pre-authorisation requests within 48 hours, but if you need urgent treatment, please call us.

You can see practitioners from any Bupa-recognised hospital, clinic or legally qualified medical professional. However, if you choose from our network of hospitals and clinics on Facilities Finder, we can often arrange to pay directly on your behalf. Visit this online directory to find and book appointments directly, and to see the latest list of providers that we do not recognise, and for whom we will not provide cover. We update this small list regularly.

If your intended appointment or treatment is likely to be in the U.S. please arrange pre-authorisation before it begins: call the Medical Centre at +1 844-369-3797 from inside the U.S. or +1 786-257-4741 from outside the U.S.

Please see your membership guide for more details about who you can see for treatment or consultation. Your guide is available within Manage Your Plan, and will give you additional details about what you can claim for, along with limits and exclusions.

Although you can receive treatment from any Bupa-recognised hospital, clinic or legally qualified medical practitioner, we also have a global network of hospitals and clinics, with whom we can often arrange to pay directly on your behalf (this is known as direct settlement). You can find these medical practitioners in Facilities Finder, our searchable online directory of all providers, hospitals and medical centres in the Bupa network.

By typing the name of the country you seek treatment in, or the name of a specific Provider into the search bar, you will be given a list of options to choose from. It's essential that you check which Providers are available to you in accordance with the health plan you have; please check your membership guide for details.

Occasionally, you may select facilities or providers that give you a message of ‘Restricted Network’. This means that your health plan may not cover you to receive treatment by this provider.

The easiest way to understand whether this applies to you and your chosen health plan is to follow the link provided in Facilities Finder for more information. If you are still unsure, give us a call.

If you are admitted for emergency medical treatment in the U.S, you must contact us within 48 hours of admission, or as soon as reasonably possible. Call (844) 369 3797 from inside the U.S. or +1 (844) 369 3797 from outside the U.S.

Please note that in order to be covered for emergency medical treatment in the U.S., you need to have already purchased U.S. cover.

Emergency cover does not apply in the following conditions:

• After the 28th day of your visit to the U.S. (Note: we need evidence of your arrival date when you submit your claim, such as a certified photocopy of your airline ticket or your passport visa stamp
• For any condition of which you were aware before your visit to the U.S.
• When we haven't authorised / approved the arrangements
• When we know or suspect that you travelled to the U.S. in order to receive treatment for a condition, the symptoms of which were apparent to you before travelling. This applies whether or not your treatment was the main or sole purpose of your visit.
• Our service partner in the U.S. operates a national provider network of hospitals, clinics and medical practitioners. Our team will help you to find a provider within this network

Please make sure you can provide details of your symptoms, diagnosis, procedure and planned admission date, if this is known. If your appointment or treatment is already booked, please also have the following details to hand:

• The date(s) of your appointment or treatment
• The name of the hospital or clinic where treatment will take place
• Details of your condition or symptoms
• The type of treatment you will be having (if known)
• The name(s) of the medical professional(s) treating you

To avoid any delays to your claim processing, please make sure you have the following items before you begin:

• Symptoms or diagnosis: Please explain the reason for visiting the medical practitioner. If the appointment was to gain a diagnosis, what were the symptoms and when were they first noticed?
• Treatment details: What was the nature of the treatment or medical appointment? If surgery was involved, please also detail any related treatment and care.
• Details of the treating practitioner and facility: Who did you see for your consultation and/or treatment, and where did you see them?
• Payment details: Please make sure we have your complete payment details and preferred currency details so we know how to settle your claim. We can either pay the provider directly or reimburse you for the eligible costs of treatment. If you have already paid the provider, please make sure you tick the option to reimburse you, or they will be paid twice. Please note that we cannot reimburse anyone other than the provider or a member of your policy.
• Invoices and other relevant documents: You can find details on the types of documents we need below.

Before you submit or upload your claim, please make sure that you have included all relevant documents, including:

• All itemised, detailed invoices which should include cost, date and description of each treatment.
• If your claim includes medication, a copy of the prescription or letter from your medical practitioner, confirming the medication they have prescribed for you.
• If it's an optical claim, please include a copy of the prescription for your glasses or contact lenses.

You can upload your documents from scans saved to your computer, or even take photos of them during the online claim process in MembersWorld to upload using your mobile.

Please make sure that they’re clear and legible to prevent any delays to your claim. Also, please make sure your documents meet the following criteria:

• Files must be no larger than 10MB each, with a 30MB maximum per claim
• We can accept the following formats: bmp, gif, jpeg, jpg, txt and pdf. Please note that we can’t accept locked pdfs, so please check before uploading.
• Also, if your filenames are longer than 30 characters, please rename them before uploading them, as they will not be accepted otherwise.

With these details to hand, making your claim should take less than 10 minutes. Please note that you won’t be able to save your claim and return to it once you’ve started it, but you can print it out mid-way through to record the details you have already entered. Also, you can't edit your claim once you've submitted it, so please review it carefully.

You don't need to send the documents in the post, but please make sure you keep any hard copies digital versions for your own records in case we need these in the future.

We repay your claims by bank transfer, so make sure we have your preferred bank details in MembersWorld. If you are unable to receive payment by bank transfer, please contact us.

If you have followed all the recommendations here, your claim should be processed within 10 working days. If you've chosen to be paid by electronic bank transfer, any payments due should appear in your nominated bank account 3-5 days after we process the claim.

You can see the status of your claims – along with your claims history – in MembersWorld.

• When you log in, you should see the latest status of submitted claims and treatment authorisations.
• More detailed information sits in Manage Your Plan.

Please call us at +1 844-369-3797 (from inside the U.S.) or +1 786-257-4741 (from outside the U.S.) to let us know what diagnostics or treatment you require.

We will generally then confirm cover for the eligible treatment directly with the provider and settle the claim with them directly.

We will send you a summary of the payment details and your remaining benefits. You will also be able to find this document in Manage Your Plan, in MembersWorld.

We may have rejected your claim because:

• You have to pay a deductible / excess toward your treatment before we release our payment. Please check your plan details to see if this is the case.
• You’ve reached the maximum annual limit for the benefit you’re claiming for. You can see this information in MembersWorld, in Manage Your Plan
• The condition you claimed for isn’t covered under your plan, or there may be a specific exclusion for it. To prevent this from happening, you should always try to get treatment pre-authorisation in advance
• There’s a qualifying length of membership before you’re eligible for the benefit – for instance, for maternity – which hasn’t been reached. Again, we recommend that you get prior approval for the treatment to avoid this happening
• Your plan has been suspended or cancelled. If this is the case, we will contact you.

Sometimes we suspend your claim if we need more information, so we may contact you and / or your medical provider for this. Some other common reasons for a claim to be suspended are:

• We’re waiting for documents to be translated
• We need more medical information from our specialists and / or your medical provider, such as a medical report
• We're requesting fully completed or further documents, such as a claim form or invoice

Or if there is an outstanding issue with your membership, we’ll get in touch with you to resolve it.

The most common reason that claims are delayed is missing information. So you can make sure your claim has all the key details when you submit it, here's a list of the most frequently missing or incomplete information that we contact customers for:

• Diagnosis: Please explain the reason you have been seen by a medical practitioner. What were your presenting symptoms and when did you first notice these?
• Treatment details: What treatment did you have? If you required surgery, please explain the type of procedure and any subsequent related treatment.
• Missing payment details: If we aren't paying the medical provider directly, the payee must be somebody who is listed on your policy.
  For the repayment details, we need your full, current payment details and currency so we know how to settle your claim. Full bank details should include:
  
  • The name and address of your bank
  • Your name as it appears on the account
  • The BIC/SWIFT code for the bank (ABA number for USA. BSB for Australia).
  • Your account number / IBAN - Please make sure the IBAN number is the full one and the payee is included.
• Missing detailed invoice: Please submit an invoice that includes the date(s) of treatment and the cost of each service provided. It must also clearly define who has provided the treatment.
• Legibility of invoice: It may sound obvious, but it’s key that we can read you documents. If we can't, it will cause delays.
• Copies of prescriptions: We need copies of any prescriptions from your medical practitioner. If you don't have these, we are happy to accept a letter or email from your medical practitioner, confirming the medication they have prescribed you.
• Medical reports: The medical report from the treating medical practitioner should include the following details:
• Presenting symptoms / diagnosis
• Original onset date of these symptoms
• Copy of admission notes or referral letter
• Details of previous treatments for this condition (and results if known)
• Admission date
• Discharge date
• Investigation details (and the results if known)
• Procedure details
• Prognosis
• Copy of nursing notes
• Daily treatment plan: A detailed summary of the active treatment that has taken place on a day-to-day basis for the period of the admission

The preferred way of making a claim is online in MembersWorld, where you can fill out the information about your claim and upload all the necessary documents. 

You can find these in Your Documents, which is in Manage Your Plan in MembersWorld. You can print it, fill it out, and upload the completed version along with your supporting invoices and other documents.