Benefit table

Below is the latest Benefit table for Preferential Private Health Cover.
 
We review our policy benefits regularly and any changes will take effect from your annual renewal date. There are not often large changes to benefits, but make sure you refer to the Benefit table that was applicable when you joined or renewed.

Start date after 01/10/2008?

Then refer to the Benefit table in this Policy Document.

  Benefits Level of cover Notes
 1

Hospital charges for in-patient and
day-patient treatment

  • Accommodation and nursing (including intensive care)
  • Operating theatre charges
  • Drugs and dressings prescribed for use whilst an
    in-patient or
    day-patient
  • Pathology, physiotherapy and diagnostic tests
  • Prostheses, when implanted as an integral part of a surgical procedure
 Full cover

Benefit 1 is payable for treatment received in a hospital which is listed in our Hospital Directory, either within your scale or a lower scale of cover.

If you receive treatment in a higher scale hospital, 'Out of scale' benefit (Benefit 3) will apply, and will more that likely fall short of the expenses incurred.
 2 Parent accommodation charges Full cover For one parent staying overnight in hospital while their child receives in-patient treatment. The child must be under the age of 12 and enrolled in their parents' membership.
 3 'Out of scale' benefit

Scale A
up to £380/day

Scale B
up to £340/day

Scale C
up to £275/day

Scale D
up to £210/day

 Paid instead of Benefit 1 if you receive treatment in a hospital classified within a higher scale than the scale on which you are covered. The benefit paid is likely to fall short of the expenses incurred and you will be responsible for paying the balance. The benefit paid will go towards the expenses for: Accommodation and nursing (including intensive care), operating theatre charges, drugs and dressings prescribed for use while an in-patient or day-patient, pathology, physiotherapy and diagnostic tests, prostheses, when implanted as an integral part of a surgical procedure.
 4 Surgeons' and Anaesthetists' fees Full cover Surgeons' and Anaesthetists' fees and other expenses must, in our opinion, be reasonable. We may refuse to pay any expenses that we consider to be in excess of those normally charged for similar treatment in the UK. Our helpline can confirm what is reasonable. 
 5

Specialists Physicians' fees

Full cover You must be under the regular care of a Specialist and, in respect of in-patient treatment, benefit would not normally be payable unless the Specialist attends you on at least 5 days each week. Paid for up to 91 days in any one Year.
 6 High cost scans including CT, MRI and PET scans Full cover  
 7

Psychiatric benefits

Full cover Paid provided the treatment is carried out under the care of a recognised Specialist and treatment has been agreed in advance by BCWA.
In-patient treatment must be in a hospital room which is listed in the BCWA Hospital Directory within your scale or a lower scale of cover. Maximum of 28 days cover per year for in-patient and day-patient treatment.
 8 Oncology including radiotherapy and chemotherapy Full cover Please refer to 'Cancer treatment' or read the Policy Document.
 9 Private ambulance Full cover Paid when an ambulance is required out of medical necessity and in connection with eligible in-patient or day-patient treatment.
 10 NHS cash benefit £100/night

Paid for each night when you receive
in-patient treatment free of charge under the NHS, up to 91 nights (28 nights for psychiatric benefit) in any one Year.

Also paid for procedures carried out free of charge under the NHS on a day-patient basis.
 11 Hospice benefit £100/night A payment to the hospice, up to 91 nights in any one Year.
 12 Maternity cash benefit £150/birth Paid once per child, provided the parent has been a member for more than one Year.  
 13 Home nursing Full cover Paid for the full-time services of qualified nurses, on a resident or daily basis, following an in-patient stay, when prescribed by a Specialist solely for medical reasons.
 14

Out-patient services

  • Specialist Consultations
  • Radiology
  • Pathology
  • Physiotherapy
  • Acupuncture
  • Chiropody
  • Chiropractic
  • Osteopathy
  • Podiatry
 Full cover Where referral to an acupuncturist, chiropodist, chiropractor, osteopath or podiatrist is by a GP, benefit is limited to a maximum of £500 per Year. Full cover is available when refered by a Specialist.
15 Emergency
in-patient treatment overseas 		BCWA Overseas Assistance Only available to members resident in the UK while travelling abroad. Payment of benefits outside the UK is made in Sterling.
Any claims for benefit submitted in other currencies will be converted to Sterling at the exchange rate prevailing on the date we receive the claim.
Benefits - important notes

1. Treatment expenses must in our opinion, be reasonable and exclusively for the treatment of an eligible Acute Condition.
2. Benefits are available if you are resident in any part of the UK, Channel Islands or Isle of Man.
3. Benefits may be adjusted from time to time. However any changes will only apply to your policy from your next annual renewal date.
4. Maximum limits of benefit apply to each person included in your policy.
5. Except in an emergency, all treatment for which benefit is claimed must be arranged with the knowledge and approval of your GP or of a Specialist that you have been referred to by your GP.
6. All treatment must be given by a Specialist or, for Physiotherapy benefits, by a qualified Physiotherapist.
7. We may refuse to pay any expenses in excess of those normally charged for similar treatment in the UK. We may require full itemisation of any charges giving rise to a claim. We will not pay more than the actual expenses incurred (except for payment of NHS, Hospice and Maternity benefit).
8. Benefit is only payable for treatment received, by an enrolled member, during a period for which premiums have been paid. Treatments are limited to those shown in the Benefit table.
9. For the assessment of all in-patient claims the days of admission and discharge shall count as one day.
10. Surgical operations are classified in accordance with a schedule of operations approved by our medical advisers.