BUPA membership guide - page 30

42
43
Exclusion
Notes
rules
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).
Note: 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)
{
{
problems relating to physical development such as short height, or
{
{
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, or
{
{
harvesting and storage of stem cells, when this is carried out as a preventive measure against possible future disease
Experimental
treatment
{
{
We
do not pay for any
treatment
or medicine which in
our
reasonable opinion is experimental based on
acceptable
evidence
{
{
We
do not pay for any
treatment
or medicine which in
our
reasonable opinion is not effective based on
acceptable
evidence
{
{
We
do not pay for medicines and equipment used for purposes other than those defined under their licence
Note:
We
will fund the costs of an experimental
treatment
or medicine if it is being undertaken as part of a registered
clinical trial.
Note: If
you
are unsure whether
your treatment
may be experimental, please contact
us. We
reserve the right to ask for
full clinical details from
your consultant
before authorising any
treatment
, in which case
you
must receive
our
written
agreement
before the
treatment
takes place.
Eyesight
Treatment
, equipment or surgery to correct eyesight, such as laser
treatment
, refractive keratotomy (RK) and
photorefractive keratotomy (PRK).
Exceptions: If
you
have bought Worldwide Wellbeing cover,
your
optical benefits will be shown.
Foetal surgery
Treatment
or surgery undertaken in the womb before birth.
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