Bupa Dental Plan To find out more or to apply over the telephone call 0845 230 1654
Overall annual limits Type of treatment Core Level 1 Level 2 Level 3 Level 4 Routine dental treatment Emergency dental treatment Dental injury treatment 100% NHS reimbursement No annual maximum limit. See benefit table below for individual treatment limits 400 600 600 1,000 3,000 5,000 5,000 5,000 Oral cancer treatment** N/A Paid in full* Cash benefit for hospital stay (up to a maximum of 1,000 per year) N/A 50 per night Type of treatment NHS Bands 1, 2 and 3 100% NHS treatment *When we say paid in full, we mean that all of the members eligible treatment expenses will be covered, provided that they are treated at one of our partnership facilities by one of our partnership consultants. Please refer to the relevant membership guide for more details. **Six month waiting period applies. Benefit limits Type of treatment Core Level 1 Level 2 Level 3 Level 4 Examination (up to a maximum of two ) 20 each 30 each 40 each 55 each Xrays up to 20 up to 30 up to 40 up to 50 Scale and polish (up to a maximum of two ) Fillings including root canal treatment Extractions Crowns, bridgework and dentures Anaesthetist fees 100% NHS reimbursement 40 each 50 each 80 each 80 each up to 150 up to 100 to 275 per year up to 30 up to 250 up to 150 to 400 per year up to 50 up to 300 up to 200 to 450 per year up to 60 up to 350 up to 200 to 2,000 per year up to 80 Terms and conditions apply. This is a summary of the insurance available - full details of insurance, exclusions and benefits are contained in the membership guide, copies of which are available on request. Scheme costs Rates are reviewed on 1st August with any policy or premium changes being applicable on this date. Core Level 1 Level 2 Level 3 Level 4 Single cover 8.13 9.12 12.60 17.60 25.50 Couples 16.30 18.20 25.10 35.20 51.00 Single parents 16.30 18.20 25.10 35.20 51.00 Family members 24.39 27.36 37.80 52.80 76.50
Your personal details Address Postcode Evening telephone Email Address Please tick cover required Daytime telephone Mobile telephone Core Level 1 Level 2 Level 3 Level 4 Please note that same cover level will apply for all family members. If you require different cover levels, please complete a separate application form or telephone Philip Williams and Company on 0845 230 1654 Your family s details whom you require to be covered Relationship to you INSTRUCTION TO YOUR BANK OR BUILDING SOCIETY TO PAY DIRECT DEBITS PLEASE COMPLETE SECTIONS 1 5 1. Name and full postal address of your Bank or Building Society branch To: The Manager Address Relationship to you Relationship to you If you require additional children to be covered, please telephone Philip Williams and Company on 0845 230 1654 Bank or Building Society COMPLETE ALL SECTIONS. POST FREE. Postcode 2. Name(s) of account holders 3. Branch sort code 4. Bank/Building Society account number 5. Instruction to your Bank or Building Society Please pay Philip Williams & Co Direct Debits from the account detailed in this instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this instruction may remain with Philip Williams & Co and, if so, details will be passed electronically to my Bank/Building Society. Signature(s) Philip Williams & Company REF. Originators Identification Number 7 5 3 2 9 4 BANKS AND BUILDING SOCIETIES MAY NOT ACCEPT DIRECT DEBIT INSTRUCTIONS FOR SOME TYPES OF ACCOUNT.
Policy Summary The Philip Williams Bupa Dental Plan provides a cost effective way to cover your dental expenses. You should pay your dentist for any treatment, get a receipt and then claim back from Bupa. You will be reimbursed quickly. You can see your regular dentist whether NHS or Private and claim back up to the levels of cover shown overleaf. Main policy exclusions The following are excluded: cosmetic treatment orthodontic treatment surgical implants or any dental treatment involving or making use of or in any way related to surgical implants sports mouthguards any dental treatment or services not normally provided by dentists in the United Kingdom the replacement of a prosthetic appliance which has been lost or stolen the replacement of a prosthetic appliance which could have been repaired according to generally accepted dental standards the replacement of a prosthetic appliance within five years (except dentures) of it having been fitted any dental treatment resulting from or related to any injury sustained whilst participating in a physical contact sport such as rugby or boxing any dental treatment resulting from or related to a self-inflicted injury any dental treatment received outside the United Kingdom which is not routine dental treatment or emergency dental treatment self-administered drugs such as antibiotics and painkillers or prescription charges any dental injury treatment arising as a direct or indirect result of an external impact which occurred before the date of enrolment of the scheme any dental injury treatment arising as a direct or indirect result of an external impact which occurred outside the UK dental procedures carried out by a hospital, for example wisdom teeth extractions dental consumables such as toothbrushes, mouthwash and dental floss treatment care or repair to gums, teeth, mouth or tongue in connection with mouth jewellery damage caused by toothbrushing or oral hygiene procedures The Direct Debit Guarantee This Guarantee is offered by all Banks and Building Societies that take part in the Direct Debit Scheme. The efficiency and security of the Scheme is monitored and protected by your own Bank or Building Society. If the amounts to be paid or the payment dates change, Philip Williams & Co will notify you 10 working days in advance of your account being debited or as otherwise agreed. If an error is made in the payment of your Direct Debit by Philip Williams & Co or your bank or building society you are entitled to a full and immediate refund of the amount paid from your bank or building society. If you receive a refund you are not entitled to, you must pay it back when asked. You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.
Claims If you need advice about making a claim simply call 0800 0121 271 or you can claim online at https://dentalclaims.bhwcloud.com. Claims should be made within 60 days of treatment. Where treatment costs apply, you must pay for treatment and submit receipts in order to make a claim for benefit. Making a complaint The helpline is always the first number to call if you have a complaint. If we are unable to resolve a problem and you wish to take the complaint further, you can contact the Customer Relations Department. Please write to: The Customer Relations Department, Bupa, Anchorage Quay, Salford Quays M50 3XL, or phone on 0845 606 6739.** It is very rare that we are unable to settle a complaint but if this does happen, you may refer your complaint to the Financial Ombudsman Service. You can write to them at: South Quay Plaza, 183 Marsh Wall, London E14 9SR or call them on 0800 023 4567. The Financial Services Compensation Scheme (FSCS) In the unlikely event that we cannot meet our financial obligations, you may be entitled to compensation from the Financial Services Compensation Scheme. This will depend on the type of business and the circumstances of your claim. The FSCS may arrange to transfer your policy to another insurer, provide a new policy or, where appropriate, provide compensation. Further information about compensation scheme arrangements is available from the FSCS on 0800 678 1100 or on its website http://www.fscs.org.uk/ www.philipwilliams.co.uk Calls are recorded for training and monitoring purposes. Philip Williams and Company is authorised and regulated by the Financial Conduct Authority for General Insurance mediation activities. PWIA1414A 01/14 v6/web