Mainly Health Plans SL
1. How to use your lifeline plan ( Guide )
Lifeline membership guide (from 1.10.2008)
1. How to use your Lifeline plan
Step 1: Where to get treatment
As long as it is covered by your plan, you can have your treatment at any recognised hospital or clinic. If you don't know where to go, please contact our Healthline service for help and advice.
Participating hospitals
To help you find a facility, we have also developed a global network of nearly 5,500 medical centres, called our participating hospitals and clinics. The list is updated regularly, so please visit the website for the latest information. We can normally arrange direct settlement with these facilities (see Step 3 below).
Getting treatment in the USA
If you have purchased USA cover, you must call our Service partner on 800 554 9299 (from inside the US), or +1 972 461 5103 (from outside the US) to arrange any treatment.
Step 2: Contact BUPA International
If you know that you may need treatment, please contact us first. This gives us the chance to check your cover, and to make sure that we can give you the support of our global networks, our knowledge and our experience as the world's largest international health care company.
Pre-authorising in-patient treatment
You must contact us whenever possible before in-patient or day-case treatment , for pre-authorisation. This means that we can confirm to you and to your hospital that your treatment will be covered under your plan. Pre-authorisation puts us directly in touch with your hospital, so that we can look after the details while you concentrate on getting well. Section 5 contains all of the rules and information about pre-authorisation.
When you contact us, please have your membership number ready. We will ask some or all of the following questions:
- What condition are you suffering from?
- When did your symptoms first begin?
- When did you first see your family doctor about them?
- What treatment has been recommended?
- On what date will you receive the treatment?
- What is the name of your consultant?
- Where will your proposed treatment take place?
- How long will you need to stay in hospital ?
If we can pre-authorise your treatment, we will send a pre-authorisation statement that will also act as your claim form (see Step 3 below).
Step 3: Making a claim
Please read Section 6 for full details of how to make a claim. Here are some guidelines and useful things to remember.
Direct settlement / pay and claim
Direct settlement is where the provider of your treatment claims directly from us, making things easier for you. The alternative is for you to pay and then claim back the cost from us.
We try to arrange direct settlement wherever possible, but it has to be with the agreement of whoever is providing the treatment. In general, direct settlement can only be arranged for in-patient or day-case treatment. Direct settlement is easier for us to arrange if you pre-authorise your treatment first, or if you use a participating hospital or clinic.
What to send
We must receive a fully completed claim form and the original invoices for your treatment, within six months of the treatment date. If this is not possible, please write to us with the details and we will see if an exception can be made.
Your claim form
You must ensure that your claim form is fully completed by you and by your medical practitioner. The claim form is important because it gives us all the information that we need. Contacting you or your medical practitioner for more information can take time, and an incomplete claim form is the most common reason for delayed payments.
You can download a claim form from our Membersworld website, or contact us to send you one. Remember that if your treatment is pre-authorised, your pre-authorisation statement will act as your claim form.
How we make payments
Wherever possible, we will follow the instructions given to us in the payment section of the claim form:
- we can pay you, the principal member or the hospital
- we can pay by cheque or by electronic transfer
- we can pay in over 80 currencies
To carry out electronic transfers, we need to know the full bank name, address, SWIFT code and (in Europe only) the IBAN number of your bank account. You can give us this information on the claim form.
Tracking your claim
We will process your claim as quickly as possible. You can easily check the progress of a claim you have made by logging on to our Membersworld website.
Confirmation of your claim
When your claim has been assessed and paid, we will send a statement to you to confirm when and how it was paid, and who received the payment. Again, please contact us if you have any questions about this information.
About your membership
This Membership Guide forms part of your contract with us, along with your application form and your Membership Certificate. This is an annual contract.
The agreement between you and us
As a member of the Lifeline plan, you (the principal member ) have formed an agreement with BUPA International about your cover. Only you and BUPA International have legal rights under this agreement.
This means that only you and no other party may enforce the terms of this agreement, whether under the Contracts (Rights of Third Parties) Act 1999 or otherwise. We will of course allow anyone who is covered under your membership complete access to our complaints and dispute resolution process.
Your membership with us includes:
- your application form, if you completed one for you and for any dependants, and any declarations that you made during the enrolment process
- your rules and benefits in the Membership Guide
- your Membership Certificate
The full name of your insurer is shown on your Membership Certificate.
When your cover starts
The start date of your membership is the 'effective from' date shown on your Membership Certificate.
If you move to a new country
You must inform us straight away if you change your country of residence
Your new country may have different regulations about health insurance. You need to tell us of any change so that we can make sure that you have the right to cover and that all local regulations are being met.
How to claim (summary)
| Direct settlement | Pay and claim |
| Contact BUPA International customer service helpline | Contact BUPA International customer service helpline |
| BUPA International sends pre-authorisation to you or your hospital | BUPA International confirms your cover and benefit limits |
| Complete and sign the blank sections of the statement including the patient declaration. The hospital will attach invoices and send the claim to us | Your medical practitioner should complete the medical information section of the claim form. You should complete all other sections, attach invoices and send the claim to us |
| BUPA International pays hospital / clinic | BUPA International pays you |
| BUPA International sends your claim payment statement | BUPA International sends your claim payment statement |
| Your settle any shortfall with hospital, clinic or doctor | Your settle any shortfall with hospital, clinic or doctor |
Lifeline:
* provides international private medical insurance for people living or working abroad for at least six months of the year
* for individuals and their families
* three different levels of cover to meet any client's needs:
| Product description (and limits) | |
| Essential | Essential |
| Classic | Classic |
| Gold | Gold |
Company Scheme (Castellano Deutsch Français Português)
| For more information please contact me: | |
| davidharris@wanadoo.es / saniprof@mail.ddnet.es | |
| Fax: | (+ 34) 91 8032484 |
| 'phone: | (+ 34) 609 522 300 |
| Also more information on.. | www.e-healthinsuranceservices.com |
| Lifeline Essential | Lifeline Classic |
| Lifeline Gold |