Healthcare

What's included?

• You can access our GP helpline 24 hours a day, 7 days a week to book an appointment for a GP consultation by calling the helpline or logging in to the Benenden Health App.

• Telephone GP consultations are available 24 hours a day, 7 days a week.

• Video consultations are available 8am to 10pm every day except Christmas Day and require an email address and access to an internet enabled device with a camera and microphone.

• You can access our 24/7 GP Helpline when travelling overseas.

• You can book a consultation for your immediate family by calling our helpline. It's not currently possible to book GP appointments for immediate family members via the Benenden Health App.

• If clinically appropriate, our GPs can prescribe some medications. Your private prescription can either be collected from a local pharmacy or delivered directly to you the next working day. Prescription costs aren't covered by your membership or your NHS entitlement.

What's excluded?

• We don't undertake the clinical triage of any presented symptoms or conditions disclosed to us electronically or by telephone prior to a consultation with a health professional. Therefore, you must not use this service for emergencies or urgent conditions as this may delay necessary treatment.

• Where clinically appropriate, the GP may refer you back to your registered GP practice.

• The 24/7 GP Helpline isn't designed to replace your registered GP practice as we don't have access to your medical records.

• This service can’t provide a referral that members can use to access any other Benenden Health services.

• The service doesn't provide ongoing treatment, repeat prescriptions, investigations or antenatal care.

• Our GPs can only issue private prescriptions so state funding or NHS exemptions don't apply. They are private prescriptions and separate charges apply for the cost of medication and delivery which you'll pay directly to the pharmacy.

• We're unable to provide prescriptions outside of the UK.

What's included?

• You can access our Mental Health helpline 24 hours a day, 7 days a week.

• Receive immediate guidance and reassurance that can guide you to the most appropriate services and resources to help you.

• You can access this service when travelling overseas.

• After six months of membership, you can also request structured short-term support for mild to moderate distress, including common mental health problems.

What's excluded?

• This helpline isn't intended to provide ongoing care or support for long-term conditions or difficulties requiring higher intensity therapies. There may be cases where we're unable to support you due to the nature of the psychological needs that you have, or your circumstances.

What's included?

These two services are designed to help you navigate the health and social care system.

You can request help if adult care and support is needed by you, your spouse or partner, parents, or children over the age of 21. And if you or your child requires advice in relation to any neurodiversity or disability need.

Adult Care Planning and Social Care Advice

Our care advisers can help you to make the right choices by talking you through all aspects of adult care, including:

• Assessing care requirements and selecting the best care provider.

• Short-term and convalescent care following treatment.

• The financial, legal, and practical aspects of adult care.

• Understanding the hospital discharge process and the workings of the NHS and Social Services.

• State funding of care, including all benefits and entitlements.

Neurodiversity and Disability Advice Service

You can request help if you require advice in relation to any neurodiversity or disability need, or if you're the parent or guardian of a child who may have these needs, including ADHD, autism, or any learning or physical disability. This service can help you to make the right choices by talking you through how to navigate information and signposting for support strategies, funding, rights of parents, carers or employees and care options including:

• How to navigate the available information.

• How to know what services are available.

• Understanding and knowing the duties and responsibilities of schools, GPs, and local authorities, including the SEND process.

• Identifying and finding the best services.

• Understanding your own employment rights as an employee, or as a parent of a child needing care.

• Knowing how to challenge decisions and make appeals.

How we choose our list of diagnostics

At Benenden Health, we’re on a mission to improve the nation’s health by making private healthcare services affordable and accessible. All our healthcare services are paid for by our members, so we have to make sure our cover provides the best possible value. We can’t cover everything, but we try to help with as much as we can. That’s why we offer a range of diagnostic tests and scans.

The Medical Diagnostics we help with are:

• Outpatient consultations and tests – such as MRI & CT scans, X-rays, blood tests and diagnostic camera investigations. Conducted at one of our approved diagnostic locations to ensure the highest quality care.

• Not a repeat test for the same set of symptoms.

• Able to help with a single injection for specific medical conditions (CCSD codes: W9030, W9040, A5743, and A5745).

What's included

Dependent on authorisation, our service includes consultations with an appropriate consultant and may include diagnostic tests such as scans, X-rays, and can support your diagnostics up to the value of £2,500.

• All authorised medical costs will be settled directly by Benenden Health.

• It's important to liaise with your consultants and hospital to understand the costs of any services before proceeding. You'll be asked to pay for additional costs which you incur and any costs you incur without our prior authorisation.

• You must contact us for authorisation before you proceed with any appointments. We'll ask you to provide a copy of your referral letter from a qualified NHS practitioner confirming your consultant or test type. You'll also need to provide details of the NHS wait time for your appointment. Please refer to our current wait times or call us for guidance on how your NHS wait time is used to help determine whether your request for services could be supported.

• Where we're able to authorise your request, you'll be provided with authorisation to make your appointments with a consultant at an appropriate clinic or hospital we propose. Please note not all hospitals undertake all diagnostic services. Your qualified NHS practitioner will be able to guide and support you. Please note we may offer an initial assessment with a specialist clinician in the first instance to determine the most clinically relevant pathway for you.

Orthopaedic Care Service

Where you've been referred to an Orthopaedic Consultant for your symptoms by a qualified NHS practitioner, on receipt of your referral, we may organise an Orthopaedic Care Triage telephone appointment with a Specialised Physiotherapist who will determine the best course of treatment or onward referral for you. Depending on your clinical needs, this may be physiotherapy, imaging, or a consultation with an Orthopaedic Consultant.

What's excluded?

You'll be responsible for funding any unauthorised diagnostic costs, or any incurred costs over £2,500. To help manage these costs, you should request that the consultant and facility where you have your appointment provide you with a guide price which includes all associated fees. You must contact us for authorisation before you proceed with any appointments.

Please note we will not provide funding if you proceed with any appointments without our authorisation.

We won’t currently authorise diagnostic assistance for:

• Any appointments which are not for diagnosis purposes.
• Cosmetic concerns.
• Angiograms (cardiac catheterisation).
• Specialist assistance for pain management.
• Complementary therapy.
• Second opinion consultations.
• Any diagnosis where, in our view, it may be safer for you to remain on the NHS waiting list e.g. psychiatry and suspected cancer diagnosis or where the diagnosis may lead to a long-term medical requirement.

The above list is subject to change and you should always contact us for authorisation prior to making any appointments.

• All appointments we authorise must take place within six months of our initial authorisation.

• We won’t settle any expense that you incur more than six months after initial authorisation.

• We won’t pay for services relating to the same medical condition on the same body area within two years of us first authorising support.

• We’ll only authorise Physiotherapy, Medical Diagnostics or Medical Treatment assistance for one set of health concerns at any one time.

• We won’t pay for monitoring of any ongoing condition, including consultations or treatment.

• We’re unable to pay for any diagnostic services if you’re not a UK resident.

• You should always contact us before arranging any appointments to find out whether we can help you.

How we choose our list of surgical treatments

Like all the services included in our healthcare, the treatments we cover are paid by our membership fees and we make sure the ones we choose are the best possible value. We can't cover everything, but with 200 procedures included, we’ll help you get back to feeling your best where we can. The treatments we cover are:

• Relatively simple, not big, or complicated.

• Require less than 24 hours in hospital.

• Single operations that don’t need repeat procedures or additional monitoring.

• Carefully chosen to best support all of our members.

Examples of treatment we don't cover:

• Brain, heart and cancer, which the NHS already do well.

• Cosmetic, joint replacements, and varicose veins.

What's included?

Dependent on authorisation, we can support the full cost of any treatment on our approved procedures in our treatment network. This includes:

• fees for surgeons, anaesthetics, operating theatres, accommodation, nursing, medical admission, and specialist consultants;

• as well as pre-operative tests and post-operative physiotherapy, dressings or other consumables that are necessary.

Please note we won’t provide funding if you proceed with any appointments without our authorisation.

You must contact us for authorisation before you proceed with any appointments. We’ll ask you to provide a copy of a consultant’s report confirming the CCSD code for the procedure required and details of the NHS wait time for your appointment. Please refer to our current wait times or call us for guidance on how your NHS wait time is used to help determine whether your request for services could be supported.

What's excluded?

Types of procedures not on our approved procedures list include:

This list isn’t exhaustive and is subject to change.

• We can only provide treatment from our approved procedures list. Anything not included on our approved procedures list is excluded. Any treatment where, in our view, it may be safer for you to remain on the NHS waiting list, for example, complex surgeries that may lead to ongoing consultations and treatment is excluded. Examples of excluded procedures include surgeries related to cancer, heart or brain conditions, joint replacements or anything not on our approved procedures list.

• All treatments we authorise must take place within eight weeks of our initial authorisation. We won’t settle any expense that you incur more than eight weeks after initial authorisation.

• We won’t pay for services relating to the same medical condition on the same body area within two years of us first authorising support.

• NHS wait times will be considered before authorising any treatment services and are subject to change. Please refer to our guidance on how your NHS wait time is used to help determine whether your request for services could be supported.

• We’ll only authorise Physiotherapy, Medical Diagnostics or Treatment assistance for one set of health concerns at any one time.

• We won’t pay for monitoring of any ongoing condition, including consultations or treatment for the same reoccurring symptoms.

• We’re unable to pay for any treatment services if you’re not a UK resident.

• You should always contact us before arranging any appointments to find out whether we can help you.

• Whilst Benenden Health provides authorisation for the treatment services you require at one of our approved hospitals, it may be that following a clinical review, a decision could be made that it isn’t appropriate to provide the treatment support you require. The clinicians at the facility will be able to guide you back to your GP or the NHS for continuation of the care you need.

• We are unable to provide any authorisation for treatment services at Benenden Hospital or within the Bupa network where an allowable and excluded CCSD code is required to be undertaken at the same time.

What's included?

If treatment is recommended, the type of treatment you may receive will involve either guided self-managed exercise, virtual or face-to-face sessions with a physiotherapist in our network.

Guided self-managed exercise

For symptoms that can be managed through exercise, your physiotherapist will design a bespoke programme to address your needs. The physiotherapist will support your journey by case management calls.

Your exercises can be accessed through your personalised Online Digital Rehabilitation programme, accessible on a tablet, computer or app, or we can send you with a paper copy in the post. The programme will record your activity to help inform your physiotherapist on your progress and they'll use this to support your recovery.

Virtual or face-to-face physiotherapy

The number of virtual or face-to-face sessions will be based on clinical guidance and will be up to six sessions. You may also be advised to complete exercises at home. Between October 2021 and October 2022, the average number of sessions recommended by physiotherapists were 4.4 per case.

Physiotherapists are fully active members of the Chartered Society of Physiotherapy (CSP) or full active members of the British Association of Sport Rehabilitators and Trainers (BASRaT). Physiotherapists will be registered with the Health and Care Professions Council (HCPC).

What's excluded?

• We won’t pay for services relating to the same medical condition on the same body area within two years of us first authorising support.

• We’ll only authorise Physiotherapy, Medical Diagnostics or Medical Treatment assistance for one set of health concerns at any one time.

• We won’t pay for monitoring of any ongoing condition, including consultations or treatment for the same reoccurring symptoms.

• We’re unable to provide support if your physiotherapist determines your condition can’t be treated via guided self-management or within a six-session model.

• If we’re unable to provide physiotherapy via our network, we may offer an alternative solution.

• We’re unable to pay for any physiotherapy services if you're not a UK resident.

• Please note we won’t provide funding if you proceed with any appointments without our authorisation.

What's included?

Before treatment can be offered, an assessment is carried out over the phone to determine if the support we offer may be appropriate for you. If brief therapy is clinically appropriate, this can be either Structured Wellbeing Counselling or Supported Self Help.

Structured Wellbeing Counselling

This could include up to six sessions of Structured Wellbeing Counselling which may be delivered by phone, face-to-face or video calls with a counsellor in our network.

Supported Self Help

This is guided self help based on Cognitive Behavioural Therapy (CBT). The therapy we offer is low intensity and aims to help with mild to moderate depression and anxiety by developing personal coping strategies. You'll receive a set of supportive materials and exercises to complete either online or paper based. You'll work through your programme and have up to six support sessions, either over the phone or via video call from a Psychological Wellbeing Practitioner.

This will give you an opportunity to explore the exercises and techniques further and review your progress in a supportive way. This type of approach offers practical ways of improving mood and wellbeing.

Guided Self-Help via Computerised Cognitive Behavioural Therapy (cCBT)

cCBT is a therapy that aims to help with depression and anxiety by developing personal coping strategies. Essentially it helps you look at the problems you're experiencing, the impact they're having on your life at that moment in time and what you’d want to be different.

cCBT is a structured therapy with a focus on change and the steps you can take to get there. How we think (cognition), how we act (behaviour), how we feel (emotion) and what’s happening in our bodies (physiology) all link together and influence how we see ourselves, the world and other people. By understanding those links cCBT can help you to make changes to how you think and act. cCBT is an active therapy that requires you to work through your assigned self-help materials alongside your therapist. You'll be working to develop practical skills and tools to help you manage your own health and wellbeing.

cCBT through Benenden Health will provide you with secure digital content, or a workbook, which will include self-help materials personal to you to support your treatment, with over 30 issue specific modules, programmes and mood diaries.

You’ll also be supported by sessions with an assigned therapist over the telephone or video and, much like a coach, your therapist will help you use the workbook or digital tools to support you, guiding you towards your specific goals and recovery.

What's excluded?

• This service isn’t intended to provide ongoing care or support for more severe, long-term conditions or difficulties requiring higher intensity therapies as determined by the counsellor. As a result, there may be cases where we’re unable to support you due to the nature of the psychological needs that you have, or your circumstances.

• This service will not initiate, monitor or review any mental health medications.

• We’re unable to provide mental health support for children under the age of 11.

• We can’t provide support when you’re receiving other types of support from another service (such as the NHS or a private therapist, community psychiatric nurse, psychiatrist, psychologist and recovery programmes).

• If we’re unable to provide mental health support via our network, we may offer an alternative solution.

What's included?

We’ll provide you with access to a dedicated nurse for telephone support. Your nurse will call or email you as agreed to discuss concerns or questions you have in relation to your illness. This service will continue for as long as your nurse feels their support is required.

The type of support and information provided will be tailored to your specific needs and may include:

• Understanding your diagnosis and its potential consequences.

• Helping you to prepare questions ahead of consultations or supporting you afterwards to understand what’s been discussed.

• Helping you to access services available from the NHS and other organisations.

• Supporting you emotionally.

• Practical advice on dealing with the implications of cancer.

• Helping with the adjustment to life after cancer.

• Preparing you to return to work and supporting you after your return.

Your nurse will offer their assistance where they can and, in their clinical discretion, may:

• Identify, arrange and pay* for services or therapies delivered by third parties to help you with issues related to your condition including short-term home care and complementary therapies.

• Arrange and pay* for specialised clothing, head coverings and prosthesis.

• Signpost you to one of the other membership services provided by Benenden Health such as the 24/7 Mental Health Helpline, Mental Health Support, or Physiotherapy.

• Signpost you to the Benenden Charitable Trust, which can provide grants towards any other items which may help you. Please note, as a member, you can apply directly to the Charitable Trust with enquiries about financial help. Learn more about what may be available to you and how to apply through the Benenden Charitable Trust.

• Signpost you to local and national charities, organisations and support groups.

* This is subject to a per case budget agreed with our Service Partner.

What's excluded?

• We won’t provide Cancer Support relating to the same medical condition on the same body area within two years of us first authorising support.

• Cancer Support is not available for basal cell carcinomas (BCCs).

• Third-party services/therapies, specialist clothing, head coverings and prosthesis are arranged and paid* for at the clinical discretion of your nurse. We won’t pay for any services or items which you purchase direct.

Please note that this service is designed to supplement, not replace, primary consultant-led care provided by the NHS or privately. Your primary care remains the responsibility of the NHS or private consultant.

* This is subject to a per case budget agreed with our Service Partner.