International Health and Hospital Plan

How we manage your claims

How does the claims process work?

There are two ways that your medical treatment can be paid:

Direct settlement

• You contact us to advise what treatment you intend to receive. We confirm that treatment is eligible and that we can give Payment Guarantee.
• We tell your provider of choice that your treatment is covered and issue a payment guarantee, matched to the cover under your plan.
• Your medical provider attaches the invoice(s) for your treatment and returns with the Payment Guarantee documents to us.
• We process the claim and pay your medical provider directly.
• We process the claim, pay you and send a ‘payment statement’ advising when and how it was paid, and who received the payment.
• You settle any shortfall with your medical provider.

 

Pay and claim

• You may contact us to advise what treatment you intend to receive.
• We confirm your cover and benefit limits.
• You receive treatment and pay your medical provider (usually at time of treatment).
• You and your medical provider fully complete a claim form and return the claim form to us.
• We process the claim, pay you and send a ‘payment statement’ advising when and how it was paid, and who received the payment.

How we calculate your reimbursement?

When we settle your claim your benefits are paid in line with the limits shown in the List of Reimbursements (p. 22 and onwards in the IHHP brochure) and any deductible you may have chosen. The deductible is the contribution you make towards the cost of your treatment each policy year before we will start reimbursing your expenses.

The deductible applies separately for each person on your policy.

It is important that you send all your claims to us, even if the value of the claim is less than the remaining deductible. We will not make any payment, but the claim will count towards your deductible.

You will always receive a Reimbursement Statement showing how much has been counted towards your deductible and how much has been paid.

We can reimburse you in most currencies.

How will my medical costs be paid?

We always aim to settle your claim directly with your treatment provider. If we cannot do this for any reason, we ask that you send us a claim by post. A claim consists of all the original invoices from your treatment with your policy number clearly stated on each document

You can choose to let us pay you or your medical provider.

We can pay by electronic bank transfer, cheque, reimburse your credit card or count it towards next year’s premium.

What if I have bills from another private health insurer?

If you send us reimbursement statements and original bills that you have claimed from another private health insurer (e.g. a local plan) these will count towards your deductible if the benefits would have been covered under your International Health and Hospital Plan.

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How the plan works

Who is International Health and Hospital Plan for?

This insurance policy is for expatriates who needs secure and reliable medical insurance abroad. IHHP is also ideal for local nationals (where local regulations permit) who wishes to invest in their health.

Where can I be treated?

You can receive treatment from any recognised hospital, clinic, or legally qualified medical practitioner of your choice. You will also benefit from our network of over 7,500 hospitals and clinics who we can often arrange to pay directly on your behalf. This is known as Payment Guarentee and it removes a lot of hassle from you so we always advise our customers to call us up prior treatment to arrange Payment Guarantee and secure you a positive experience.

Our Medical Centre can also help you find suitable medical facilities. Our advisers are specialists and will offer you valuable insights and even book appointments on your behalf.

We do not cover the costs of treatment carried out by unrecognised providers. View our list of unrecognised providers (PDF).

How do I arrange treatment?

If you contact us prior to a planned or non-acute admission, we will take care of all of the practical details in connection with a hospital admission. This allows you to concentrate on getting well. When you contact us we will:

• Check your cover and confirm that your treatment is covered by your plan.
• Help you find the right place of treatment if you wish. Just tell or send us medical information on your condition and we will provide you with information on appropriate providers of treatment or a specialist in the countries and/or cities of your choice.
• Confirm to the hospital that your treatment is covered and issue a payment guarantee, matched to the cover under your plan.
• Our medical staff can also offer advice and help to make sure you are receiving the most appropriate care. And we’ll off course settle the bill directly with the hospital where possible.

How do deductibles work?

A deductible is the amount you must pay towards covered expenses before we will start paying for your treatment.

Deductibles apply for treatment you receive under the Hospital Plan, Module 1 and Module 2. For claims made under Module 3 and Module 4A or 4B deductibles does not apply.

What treatment and conditions are not covered?

If you are in doubt about your cover then contact us prior to a planned or non-acute treatment. We will check your cover and confirm whether or not your treatment is covered by your plan.

For further details on any of the exclusions below please read this plan’s product guide or contact us.

Do you have a limit for the cost of treatment I may receive?

Beyond the benefit limits of your plan, we only pay costs when the charges made by the provider of services are reasonable and customary. By this we mean that the charges are the same as those made to our members by the majority of other service providers in the same country. It also mean that they should not be more than the provider would normally charge.

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Service

How can I track the progress of my claim?

We will process your claim as quickly as possible. You can check the progress of claims you have made by contacting your service team.

How can I contact Bupa International?

As an ihi Bupa member, you can call our Medical Centre at any time of the day or night, and day of the year, and speak to medically trained people who understand your situation and can give you the healthcare advice, support and assistance you need.

Medical Centre:

Tel: +45 70 23 24 60
Fax: +45 33 32 25 60
Email: emergency@ihi.com

Call ihi Bupa’s Customer Service for questions on your policy, payments, coverage etc:

Open 8am-9pm (CET) weekdays

Tel: +45 70 23 00 42
Fax: +45 33 32 25 60
Email: ihi@ihi.com

What is your complaints process?

We are always pleased to hear about any aspect of your insurance cover that you have particularly appreciated, or that you have had problems with. If something does go wrong, we have a simple procedure to ensure your concerns are dealt with as quickly and effectively as possible.

If you have any comments or complaints, you can call the ihi Bupa Customer Service on +45 33 15 30 99, alternatively you can email at ihi@ihi.com, or write to us at:

ihi Bupa
Palægade 8
K-1261 Copenhagen K
Denmark

Taking it further

If we have not been able to resolve the problem and you wish to take your complaint further, please call the ihi Bupa Complaint Manager on +45 33 15 30 99 or write to

ihi Bupa
Palægade 8
K-1261 Copenhagen K
Denmark

You can also send an email to Complaints-Global@ihi.com

It is very rare that we cannot settle a complaint, but if this does happen, you may be entitled to refer your complaint to an independent organisation for review. Which organisation it will be depends on the nature of the complaint and the location of the ihi Bupa office where the cause of the complaint occured. We will advise you at the time. In most cases this will be either the Danish Insurance Complaints Board or the UK Financial Ombudsman Service.

If you would like further information about the Danish Insurance Complaints Board you can:

• write to them at Anker Heegaards Gade 2, 1. DK-1572 Copenhagen V, Denmark
• call them on +4533158900
• find details on their website www.ankeforsikring.dk

If you would like further information about the UK Financial Ombudsman Service you can:

• write to them at South Quay Plaza, 183 Marsh Wall, London E14 9JR, UK
• call them on 0845 080 1800 or +44 (0) 20 7964 1000
• find details on their website www.financial-ombudsman.org.uk

Please let us know if you want a full copy of our complaints procedure. (None of these procedures affect your legal rights.)

Can I access my policy online?

Yes, as a ihi Bupa member you will have access to our MyPage website where you can:

• view your product guides and forms
• view all of your documents such as policy schedules, renewal letters, premium notices, receipts and reimbursement letters
• get a complete overview of your policy e.g. who is on the policy and what combination of modules they have
• view Reimbursement Statements for your settled claims

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Manage your plan

Can I change my plan?

Your insurance with us is an annual contract. This means that we can only add or remove options for you on your commencement date.

If you want to add or remove options, we ask that you contact us before your commencement date to discuss your choices. If you add options to your plan, your premiums will be higher. If you remove options from your plan, your premiums will be lower.

How can I cancel my insurance plan?

The insurance plan may be terminated by the policyholder with effect from the end of a calendar month with one month’s prior written notice.

What happens if I can no longer pay for my plan?

If you do not pay subscriptions and other charges when they are due, the Company’s liability shall cease.

I haven't been able to find the answer to my question

For the information you require, please contact your service team on +45 33 15 33 00 or email: ihi@ihi.com.

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