BUPA and pre-existing conditions - British Heart Fou...

British Heart Foundation

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BUPA and pre-existing conditions

The_Voice profile image
31 Replies

Hi all,

Recently started a new job, and one of the benefits is BUPA 100% paid for by the company.

I was quite keen on opting in because having a cardiac history (4 MIs almost 5 years ago) one of my pain points with the otherwise brilliant NHS that saved my life is waiting times for referrals to cardiologists, etc. Despite having to go to A&E almost a dozen times with frightening symptoms over the course of 3 years that no-one could explain, it took a random GP to recognise that something wasn’t right and that I needed a referral. I was able to see a wonderful cardiologist who referred me for an angiogram, but despite him saying that it was quite urgent, my estimated wait time of 10 weeks ended up being over 8 months. The angiogram discovered that my symptoms were caused by a > 50% blockage in OM1. I was stented in September last year, and have been on the mend since.

Back to BUPA being the end of my referral woes, I was a bit dismayed to read online that they won’t even cover me for pre-existing conditions. I can totally understand that as an insurer I’d present a guaranteed risk (even if I never have another cardiac event), so they wouldn’t be keen.

So, is there any point in me opting in with the above in mind?

31 Replies
Beta70 profile image

I understand your disappointment, but suggest you take advantage of the free offer, as supposing you needed a hip or knee replacement or any unrelated to the heart treatment you would be covered. It is a generous offer, you have nothing to lose.

The_Voice profile image
The_Voice in reply to Beta70

Thanks for the response. I guess given my cardiac history, I’ve almost convinced myself that it’s the only thing that could possibly affect me going forward. :)

So my cover for other stuff won’t be void because of my heart issues?

Beta70 profile image
Beta70 in reply to The_Voice

I doubt it, if it specifies pre existing conditions are not covered. Assume it would be like holiday/travel insurance but check it out with the provider for clarity.

LowerField profile image

If BUPA health insurance comes as a standard part of your employment package without the opportunity to opt out it's a done deal, you are in. However there will be a financial cost to you since HMRC will have agreed a 'benefit in kind' reduction with your employer in your annual tax personal allowance. Next it is not clear from your post whether your company scheme allows you to be covered for pre-existing conditions, or whether this only applies to individuals outside a company scheme. It is certainly not in your company's interests for pre-existing conditions to be excluded for you or indeed any other employees in the scheme. If you are not clear on this I suggest your talk to someone at your company who is responsible for the scheme (HR?). However if you do have reduced cover then you need to weigh up the advantages of being covered for future conditions against the tax cost, assuming of course you are able to opt out.

The_Voice profile image
The_Voice in reply to LowerField

Thanks for the response. I had to choose whether or not I wanted it, but because I’m also able to add my spouse to it, I’ve decided to opt in for her sake, too. Not sure what the exact amount is for the additional tax, but it’s definitely a lot lower than the cost of paying the monthly premium privately (especially with my wife added, too).

Disclaimer: Not being covered for pre-existing conditions was just something I saw online and figured I’d reach out to members here to see if they had any similar experiences (because my specific concern was my heart - though, as has already been pointed out, other stuff could go wrong further down the line not related to cardiology, too, so it’s better to have cover and not need it, than not have it and need it). I’ve not spoken to anyone from BUPA yet nor have I reached out to HR, either.

LowerField profile image
LowerField in reply to The_Voice

I suggest you talk to HR first. Your company will likely have negotiated a package with BUPA and your HR rep will be able to advise on that specifically rather than an an anonymous person at the end of a phoneline. Your contract of employment may also explain further .

The_Voice profile image
The_Voice in reply to LowerField

Will do.

LowerField profile image
LowerField in reply to The_Voice

You may find there are different levels of cover according to your pay grade which HR will know whereas BUPA may not.

Captain_Birdseye profile image

I had bupa cover at a previous employer and pre existing conditions were covered... definitely worth asking.

MummaSoap profile image

My employer offers the option to opt in for “free” healthcare with BUPA (for certain job levels) and when I had it my pre-existing health conditions weren’t covered. It was my understanding that they could be on an upgraded policy but naturally that would incur a fee.

I would recommend chatting with someone within your HR department who may be in a position to answer your queries and also to contact BUPA directly just to cover all bases.

Also, it’s worth asking what their qualifying criteria for pre-existing conditions pertains to. It might be that you would still be covered for some cardiac issues (should they come into play - hopefully not!)

It’s also worth mentioning that you will need to fill out a tax declaration each year to continue to be eligible for the scheme, otherwise the cover will be lost if the relevant paperwork isn’t kept up to date. It’s also my understanding that it’s the responsibility of the employee to ensure that the tax declaration is completed and not the employer - I could be wrong but I would also ask questions about this to you HR department and make sure you’re in the know so you don’t lose out 🙂

Good luck in your new role, wishing you every success!


uzininemm profile image
uzininemm in reply to MummaSoap

You are wrong about losing the cover if you don't fill in a tax declaration each year.

I used to check these as part of my job with HMRC.

MummaSoap profile image
MummaSoap in reply to uzininemm

Oh really? That’s really helpful to know, thank you. Apologies if I have unnecessarily caused anyone confusion.

At my company it has to be “renewed” with a new tax declaration annually to keep the cover. I was on the receiving end of many calls from employees who were unaware that this was the case until having contacted BUPA to make a claim. I wonder why we had to do it at ours then 🤔

LowerField profile image
LowerField in reply to MummaSoap

You have raised an interesting point. As I understand it healthcare cover is provided by the employer as part of a contract of employment with an employee, with the actual provision for those who qualify being contracted out to a provider like BUPA with stipulations on the type of cover afforded to each employee. And secondly all personal tax matters including an annual tax declaration is a matter between an individual and HMRC and nothing to do with an employer who only feeds data into the system, which means that the employer has no responsibility in the individual's tax affairs only the data it supplies to HMRC . So it seems to me that your employer should be contacting those within the scheme, at the commencement of service and at the beginning of each tax year, to confirm that they intend to advise HMRC of the healthcare benefit they are receiving at the rate the HMRC has agreed with the employer (which may vary from year to year in my experience), which then entitles them to join or continue. If that doesn't happen the contract of employment should stipulate that it is up to the employee to advise the employer of their intentions one way or another, rather than allow a default of someone not being included, which may not be of benefit to employer and employee alike.

uzininemm profile image
uzininemm in reply to LowerField

Lowerfield not sure from your explanation that you are 100% right.

HMRC does not agree a rate with the employer.

Technically whilst the employer provides the data for the individuals benefit (p11D ) there is a cost to the employer as well as they have to pay the NIC Class1A on the medical benefit which is declared on a P11Db as a total for all employees.

The P11D's are sent to HMRC with the P11Db and if the employee is a basic rate taxpayer would adjust the tax code (if allowances available) to cover the tax due. For a higher rate taxpayer or someone who completes a self assessment tax return they would declare the P11D details on that and the rax could possibly be coded in or paid as a lump sum.

Just to add more potential complication some benefits can like medical benefit can now be dealt with through payroll. But it is something I wouldn't do or recommend myself.

LowerField profile image
LowerField in reply to uzininemm

You obviously have a much better understanding than me if you are currently and directly involved in all of this, and its good to get more background. 👍

When I was subject to all of this (no longer since I am retired) the benefit rate did change from year to year and I was led to believe it was an arrangement the employer had with HMRC and something I had to be made aware of since I was doing an annual tax return, which is also now a thing of the past, and thank goodness for that!

uzininemm profile image
uzininemm in reply to LowerField

I would suspect it changed each year due to the cost of the medical insurance changing. Arrangements between HMRC and employers not on my watch😍

I can totally believe that you are glad you now don't have to do it😀

Smileyian profile image

If your employer is paying the premiums then it is worth considering. Just wonder if you can cover the Cardiac pre existing conditions with a rider. It is so difficult to get PECs covered these days

firstlight40 profile image

So to answer some questions.

Preexisting conditions may be covered under a company scheme, they most likely won't be under an individual policy. The reason is a company scheme will have a mix of people who should resemble the general population with good and bad health and so it is is easier to calculate risk and premiums. However even if not you may find that a preexisting condition is covered in year 2 or 3.

The cost of the scheme is taxable but there are different ways this can be handled by the company, for mine this is done by increasing your taxable salary, in other cases you will get a reduced tax allowance. Do find out to avoid getting an unexpected tax bill.

Even if your previous MI is not covered quite often there are other benefits such as back and neck care, a counselling line or a private doctor telephone line which might also be useful.

Wooodsie profile image

Check with your HR department. Works scheme's are different than individual schemes in that they often cover preexisting risks due to block policies. Or ask your boss.

benjijen profile image

Even with pre existing conditions excluded it is well worth having especially if you can add you wife. Even the tax implications are small compared with what's on offer.

Mermaids80 profile image

personally as an older person than you I’d opt in what harm can it do, especially as it’s free?! And without wishing to sound negative unfortunately the older we get the more likelihood is that things go wrong !

Muso20 profile image

Huge NHS fan but thanks to the Government its on its knees! I have insurance through my Company and it saved my life plus going forwards Ive had physio etc within two days privately. I hate having to do it but its just the reality we live in. Take the private insurance.

Frimley profile image

I would check with your employer . I started a job last year with BUPA cover and my existing conditions are covered .

Legend2 profile image

I have bupa but my heart Condition has always been managed through nhs

Why because bupa do not do emergency situations

You may have both running along side each other of which you will feel reassured believe me there are many other health matters that you will need as you get older

I was lucky to have this insurance before my heart attack but nhs look after me superbly

Bupa payed for my hip replacement and other ops and minor ailments

Medications are not covered with insurance either and my Repatha injections for hyper cholesterolemia are £800 pounds each and that’s fortnightly so the security of both to me is worth it’s weight in gold

Go for it for sure

ula1run profile image

Unfortunately this is the 'small print' every private health insurance company covers its back with.

BridBoy profile image

My twin brother had BUPA cover with his job and used it several times.He developed a heart condition, a condition that took his life whilst he was on the list for a transplant.

Fairly early on his heart failure journey BUPA actually told him that he would get better care for his condition with the specialists within the NHS....the NHS were indeed brilliant in caring for him.

The_Voice profile image
The_Voice in reply to BridBoy

NHS is amazing and saved my life 5 years ago when I had my MIs. But it took me almost 3 years to get a referral to see a cardiologist, and then another 8 months to have an angiogram/angioplasty - I was again walking around with a blocked artery, and if I hadn’t managed to get the stent done after constantly having to chase up people, I probably would’ve had another MI.

The NHS is amazing for emergency care, and the consultants are wonderful - the severe delays in getting to see them isn’t, though.

LadyZ13 profile image

Do it, do it, do it. ( I know you will anyway). My congential heart defect was only discovered 3 months ago and since the initial collapse that lead to the discovery I've had a Cardiologist appointment, an MRI and 20 hours of counselling all through BUPA. I hope to also deploy it for surgery too to speed things up.

It's my husband's policy and without it I suspect we'd be in the dark and in a mess. And he's also had an X-ray on an ankle injury. Even if for some reason you're not eligible to claim for certain things, it's such a valuable safety net. Love the NHS, hate what it's been reduced to.

wischo profile image

Are you sure there is not a system where pre existing conditions are not covered for a specified time 2 years to 5 years without any more episodes. It would be foolish to opt out if only for your wifes security and well being. God forbid any of you need scans or whatever for a potentially dangerous condition then there is virtually little or no waiting period.

Andyman profile image

Of course you should. Just think of all the issue you could have that are not heart related.

The_Voice profile image

Just a note to thank everyone for all the responses. I have opted in for my wife and I. Better to have it and not need it, than need it and not have it.

@Mods: please lock this thread, I have all the answers I needed. 😊

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