Glossary of terms
Acute conditions: Diseases, illnesses and injuries that respond quickly to medical or surgical care. We pay for treatment of acute conditions if this is likely to lead to a full recovery, or restore you to your previous state of health, without prolonged treatment.
Additional person/s: The other people who, with your or the sponsor’s approval (as the case may be), are members of the plan under the agreement and are named on your membership certificate.
Agreement: If you have personal membership this means the agreement between you and Bupa Malta under which you have arranged cover under the plan.
If you have group membership or bulk group membership this means the agreement between the sponsor and Bupa Malta under which we have accepted you into membership of the plan.
Appliance: A knee brace which is an essential part of a repair to a cruciate (knee) ligament or a spinal support which is an essential part of surgery to the spine.
Benefit plan: This table shows the overall total amount payable each membership year or for each incident where applicable.
Bulk Group: Membership which is based on an agreement between Bupa Malta and your sponsor and under which the sponsor has arranged your cover under the Plan. This agreement is based on an agreed amount of employees, all of which must then join the plan.
Bupa Malta UK hospital network: Hospitals in the United Kingdom with whom Bupa has an agreement. The list of hospitals may changefrom time to time and it is important to check that your chosen hospital is listed. A copy of the current list is available on request. In the event that the required treatment is not available, Bupa will find an alternative appropriate hospital.
Chronic conditions: A disease, illness or injury (including a mental condition) which has at least one of the following characteristics:
- has no known cure, or recurs
- leads to permanent disability
- is caused by changes to your body which cannot be reversed
- requires you to be specially trained or rehabilitated
- needs prolonged supervision, monitoring or treatment
Complementary medical practitioner: An acupuncturist, chiropractor, homeopath, osteopath, podiatrist, chiropodist, dietician or naturopath who is fully trained and legally qualified and permitted to practice by the relevant authorities in Malta.
Customary and reasonable: What you are charged for and how much you are charged is not more than what the majority of our members are charged for similar treatment, services or facilities.
Day-case treatment: Treatment which for medical reasons requires the patient to be admitted to hospital and normally requires them to occupy a hospital bed during the day, but not overnight.
Excluded / Exclusion: Any medical conditions which exist on applying to join a plan will not be covered.
General practitioner: A person who is:
- legally qualified in medical practice following attendance at a recognised medical school listed in the World Directory of Medical Schools as published from time to time by the World Health Organisation to provide medical treatment which does not require a specialist’s training, and
- licensed to practice medicine in the country where the treatment is received.
Group membership: Membership which is based on an agreement between Bupa Malta and your sponsor and under which the sponsor has arranged your cover under the plan.
See also ‘personal membership’.
Hospital: This means any of the following at the time you receive your treatment:
For Malta/UK cover:
For Malta/Overseas cover:
- for treatment in Malta
- for treatment outside Malta (excluding USA and Canada) an international hospital
Any other establishment that we may decide to treat as a hospital for the purpose of the plan.
Hospitalisation treatment: Treatment which for medical reasons normally requires you to be admitted to a hospital and to stay in a hospital bed overnight or longer.
International hospital: An establishment specifically recognised or registered under the laws of the territory in which it stands as existing primarily for:
Main member: The first person named on the membership certificate. See also ‘you/your’.
Malta: The Islands of Malta, Gozo and Comino
Membership year: The period beginning on your start date or renewal date and ending on the day before your next renewal date. The start date is the ‘effective from’ date on your first membership certificate for your current continuous period of membership under the agreement.
Non-participating hospital: A hospital / clinic recognized by Bupa Malta but with whom there is no agreement.
Out-patient treatment: Treatment which does not normally require you to be admitted to hospital or stay in a hospital bed.
Participating hospital: A hospital which is in the Bupa Malta list of participating hospitals at the time you receive your treatment. These hospitals may change from time to time so you should always contact us before arranging any treatment to check that your chosen hospital is a participating hospital. A copy of the current list is available on request. The direct settlement facility can be utilised.
Personal membership: Membership which is based on an agreement between Bupa Malta and the main member and under which the main member has arranged cover under the plan for him/herself and their additional person/s (if any). See also ‘group membership’.
Plan: Any Bupa Malta plan.
Policy deductible (excess): The amount you have to pay towards the cost of the treatment that you receive each membership year that would otherwise be covered under your membership. The amount of your policy deductible (excess) is shown on your membership certificate. The policy deductible (excess) applies separately to each person covered under your membership.
Pre-existing condition: Any disease, illness or injury which began either before the ‘effective from’ date on the first membership certificate for your current continuous period of membership which lists the person with the disease, illness or injury.
Prosthesis: An artificial body part which is designed to form a permanent part of your body. We only pay for those prostheses listed in the guidebooks.
Qualified nurse: A nurse who is currently listed on any register or roll of nurses maintained by any statutory nursing registration body in the country in which the treatment takes place.
Rehabilitation: Treatment aimed at restoring health or mobility, or to allow a person to live an independent life, such as after a stroke.
Renewal date: The agreed date each year on which your membership is due for renewal. This will be shown on your membership certificate.
Restriction / Restricted: When someone applies to increase their level of cover, any medical conditions which exist prior to joining the increased level of cover will be limited to the level of benefit applicable before the upgrade.
Schedule of Procedures: The Schedule of Procedures is used by Bupa Malta for the purpose of the plan and classifies the relative complexity of surgical and diagnostic procedures. This schedule may change from time to time.
Specialist:
For treatment in Malta
A medical practitioner such as a surgeon, gynaecologist, anesthetist, or physician and who is duly registered and authorised under the Laws of Malta to practice his specialty and whose name is listed in the appropriate specialist register kept by the by the Medical Council of Malta, and who has been recognised by Bupa as a specialist.
For treatment outside of Malta
A medical practitioner such as a surgeon, gynaecologist, anesthetist, or physician and who is duly registered and authorized to practice his specialty in the country where the client seeks medical treatment, and whose name is either listed in the appropriate specialist register kept by the appropriate certifying body in the country where a client seeks medical treatment or who is recognised as a specialist by the appropriate certifying body in that country, and who has been recognised by Bupa as a specialist.
Sponsor: The company firm or individual with whom we have entered into an agreement to provide you with cover under the plan.
Surgical operation: An operation, including consultations, immediately before and after the operation, and all essential aftercare before you leave hospital.
Therapists: A legally qualified physiotherapist, occupational therapist, orthoptist or speech therapist who is permitted to practice as such in the country where the treatment is received.
Treatment: Medical services you need to diagnose, cure or relieve an acute condition which, for medical reasons need to be provided by a specialist.
United Kingdom/UK: Great Britain and Northern Ireland,
You/your: When printed in bold italic type, ie you/your, it means you, the main member, only.
When printed in plain type, ie you/your, it means you, the main member and your additional person/s.
See also ‘main member’ and ‘additional person/s’.