Mainly Health Plans SL
7. Annual deductibles ( Guide )
Please read this section if you have an annual deductible on your plan.
7.1 What is an annual deductible?
The annual deductible is the total value that your eligible claims must reach each membership year before we will start to pay any benefit.
For example, if you have an annual deductible of £ sterling 500, the total value of your eligible claims must reach £ sterling 500 before we will start to pay any benefit.
The annual deductible applies separately to each person on your membership.
The amount of the annual deductible will be shown on your Membership Certificate. If you are unsure whether your cover includes an annual deductible please contact our customer services helpline.
At any point you can check the amount of your remaining annual deductible by contacting our customer services helpline.
7.2 How an annual deductible works
If a claim is smaller than your remaining annual deductible, you must still submit it to us as normal. We will not pay any benefit, but the claim will count towards reaching your annual deductible. We will send you a statement informing you how much is left.
If an eligible claim exceeds your remaining annual deductible, we will pay the amount of the claim less the remaining annual deductible.
Once your annual deductible is reached, we will pay all eligible claims in full, up to the benefit limits of your plan.
7.3 How claims are paid to you
If you submit a claim and have asked us to pay you:
* benefits will be paid less the amount of the annual deductible
* we will send you a statement showing how your claim has been settled, including any amounts set against the annual deductible.
7.4. How claims are paid direct to your medical provider
If you have asked us to make a payment direct to your medical provider:
* we will send payment to the provider for the full amount of the eligible claim, without deducting any annual deductible
* we will then collect any annual deductible from you using the direct debit mandate or credit card authority, depending on which is your usual method of payment
* we will also send you a statement showing the amount of the annual deductible that BUPA International will be collecting from your account.
You are responsible for paying the annual deductible in all circumstances.