BUPA corporate/personal cover help please

duvl

I am seeking advice re a stance that Bupa has taken regarding moving from a corporate scheme to personal cover.
I only have until the end of this month to find a fix and so am desperately in need of some help.

Briefly - my corporate cover of which I make extensive use of as a terminal cancer patient....in the order of £3500 per month/ £40000 per year, is ending at the end of this month due to the company having been purchased by another company. The new company does have a corporate medical scheme but it in no way will provide the level of cover/costs that Bupa does.

I obtained a quote from Bupa to continue with personal cover on a like for like product that enabled me to maintain cover for my existing condition. (Comprehensive plan)

With somewhat relief I intended to start this new plan on 1st June. 3pm Fri Bupa called to say that the quote I was given was invalid.The reason being was that they had not been aware that the new company offered a corporate medical scheme. Despite me pointing out that the other scheme was of little/no use to me with my condition, they said that they are simply not allowed to offer me personal cover when a corporate plan is available through my employer...even though in my case it didn't meet my needs.

I need to know if they are correct in saying this or are they just blowing me of as a high claimant?

The fact that I am employed but medically retired (not working) is perhaps muddying the waters here. I am in receipt of a salary via an insurance company that in effect pays my employer who then pays me.(Permanent Health Insurance PHI)

Bupa said if I fully retired (in the next 3 weeks) then the personal plan would be ok to go ahead. I don't wish to fully retire as it would affect my PHI and Pension.

I am at a loss as to what to do and am very worried/not sleeping. In 3 weeks Bupa shut the door on me and my treatment effectively ends because the new company scheme is not able to give me the level of cover that Bupa does. I also can't afford to pay for my treatment myself. I also in the future won't be able to re-join Bupa and get cover again for what they used to cover in the past. I should have said that my Chemo is not available on the NHS and makes up 80% of the costs mentioned above.

Can anyone please point out if Bupa are correct or not and perhaps show me a way out of this mess?
Many thanks

zzzLazyDaisy

It depends what you mean by

" my corporate cover.... is ending at the end of this month due to the company having been purchased by another company"

If your company (A) has been taken over by another company (B) in the sense that the shares have been bought out, but the company retains its existing identity, then there is no change as your employer remains company A. In that scenario you and your colleagues are entitled to expect to remain on the existing Bupa insurance.

If what you mean is that your employment has been transferred to company B, so your employment with company A has terminated, and you have been given a P45, then your employment transfers under TUPE with your continuity of service and terms and conditions intact. In this case, the new employer is not required to keep the employees in the old scheme (and that may often be impossible) but is required to offer a similar package. So for many of your colleagues the new employer's arrangements may be adequate.

So the first thing you need to know is what exactly is the 'take over'. Is it a shares buyout? or a transfer of the business as a going concern? as they are two different animals with potentially two different outcomes.

duvl

zzzLazyDaisy wrote: »

It depends what you mean by

If what you mean is that your employment has been transferred to company B, so your employment with company A has terminated, and you have been given a P45, then your employment transfers under TUPE with your continuity of service and terms and conditions intact. In this case, the new employer is not required to keep the employees in the old scheme (and that may often be impossible) but is required to offer a similar package. So for many of your colleagues the new employer's arrangements may be adequate.

Spot on with above. My colleagues claims are negligible and so for them the transfer is ok. I'm the only one, who because of the numbers involved, will reach a cap level and then have my cover withdrawn, hence why I went down transferring to the Comprehensive cover at my expense with Bupa.

What are your thoughts on Bupa now withdrawing that offer purely on the fact that my new company has its own private scheme. (though unsuitable for my condition)

Thanks very much for your assistance here.

zzzLazyDaisy

AFAIK Bupa can do what they like. They have no obligation at all to offer you any insurance once your company insurance cover with them terminates. At the moment they have no contract with you, their contract is with your employer. Any future contract between you and them is a separate issue. I can't help you with that , but you may get a better response on the insurance board.

From my point of view, the question is, what obligation does your employer have - since the cover is provided as part of your employment contract. In order to examine that question, we need to know how exactly this take-over has been organised - by a share buyout, or by a transfer of the business but not the company. If it is a share buyout, the employer remains the original company and your contract remains with that company, which means that the company should endeavour to maintain the insurance with BUPA for you on the company scheme.

If it is a transfer of the business only (in other words your employment has passed from company A to company B, then this may not be the case. You have not answered this question. If it is a transfer of employment from one company to another you should have had consultation meetings, (through the union, or through an elected staff representative) and it should have been explained to you that this is a TUPE transfer, and what this means to you.

Without knowing which scenario we are dealing with, it is impossible to give any guidance.

Is there a union involved in this take-over?

duvl

My quoting you and referring to the quote as "spot on" was meant to impart to you that you had hit the nail on the head as to what had happened to me. Sorry I wasn't clearer.

As you said my employment was transferred to company B, so my employment with company A was terminated and I was given a P45. This employment transfer was under TUPE and my continuity of service and terms and conditions remained intact.

Company A having been acquired by B no longer exists but A had paid for the staff Bupa corporate cover in advance and this ends on May 31st. In essence all staff either have already, or will, effective June 1st, move to company B's scheme. I am the only one, who because of my high level of claims, will only derive a short period of cover on the new scheme because a level cap will be reached after which no further claims will be covered.

The three parties involved, company B, Union and myself have been trying to find a way forward and it looked like the personal cover that Bupa had offered me was the way forward. That was until Bupa's Friday phone call revoking the offer on the basis that Company B had its own scheme. I have raised a complaint with Bupa but time is short. As you might imagine I am very worried about potentially finding the door closed with Bupa in 3 weeks with no long term solution available to replace it.

I take your point about Bupa's contract being with the company and hence are not obliged to offer me personal cover. However from what I have found out it is common place for people leaving a corporate scheme to then be offered a personal scheme to maintain continuity of treatment. This is why I received the quote and had it confirmed by various Bupa staff. What I did not know having told Bupa the scheme was ending and that I wished to carry on with personal cover was that I was supposed to tell them that my company offered an alternative scheme. I can't find in print a clause to that effect in Bupa's policy documents. If it's genuine then I accept my case is blown but until then I still think that this might be an easy escape option for Bupa of a high claimant.

This below is from Bupa's website:

"Leaving your company scheme?
If you’ve been part of a company health insurance scheme but you’re leaving it now, you can still keep your Bupa Health Insurance.
If you were asked to give details of your medical history on your company scheme we will (at our discretion) consider providing cover on Bupa By You without the need to provide any further medical details. However, anything that was excluded on your company scheme would remain excluded on Bupa By You."

I agree that my argument is weak but I have no option other than to explore it and thank you for your part in doing so.

Ian

zzzLazyDaisy

duvl wrote: »

This below is from Bupa's website:

"Leaving your company scheme?
If you’ve been part of a company health insurance scheme but you’re leaving it now, you can still keep your Bupa Health Insurance.
If you were asked to give details of your medical history on your company scheme we will (at our discretion) consider providing cover on Bupa By You without the need to provide any further medical details. However, anything that was excluded on your company scheme would remain excluded on Bupa By You."

I agree that my argument is weak but I have no option other than to explore it and thank you for your part in doing so.

Ian

I sympathise with your predicament, really I do, but I think you are clutching at straws.

The clue is in the highlighted bit. BUPA has no contract with you. They have no duty or obligation at all to offer you a replacement package. Their t&c's state that they will consider providing cover (which they have done), but even that is at their discretion. In other words, they really can pick and choose whether to offer you insurance or not.

Your rights lie with your employer. Under TUPE they have a duty to maintain the terms and conditions of employment that existed under your contract of employment with your previous employer. However, where health insurance is concerned, their duty is limited to offering an insurance that as near as possible matches the previous one. As you are in a union, they need to be liaising closely with the employer to find a way through this, but attempting to force BUPA to give you private cover does not seem to me to be the way forward.

Is there any possibility of the employer coming to a corporate arrangement with BUPA and transferring you that way? (AFAIK there only needs to be three employees in the scheme to have a corporate plan, so perhaps the new employer could consider ringfencing some/all of the transferring employees and keeping a corporate scheme under BUPA for those affected employees, even just for a transitional period (after all, who know who else may be struck down with an illness that would have been covered under the old scheme, but not under the new one?).

Whatever, you/the union need to be putting pressure on the new employer to uphold your former terms and conditions under TUPE, as it is their responsibility, not BUPA's.

One other thing to consider is the possibility of leaving your new employment by way of a Compromise Agreement. This would normally be negotiated by the union in these circumstances and would involve consideration of compensation for your losses as a result of having to leave work owing to their failure/inability to maintain the health insurance. So issues to look at would be loss of wages and (possibly) loss of death in service benefit for your family? However be aware that it takes two to tango and the employer may not wish to enter into such discussions, or offer a compromise agreement. However it would enable you to comply with BUPA's terms in order to get private insurance.

Do be aware, though, that any transition from corporate policy to private policy must be seamless - any gap and BUPA will almost certainly not entertain you.

One other thought does come to mind - I wonder if it is possible for the employer's existing insure to come to an arrangement with BUPA to keep you in the BUPA scheme? In a way, outsourcing your cover to BUPA? No idea if this is possible, but perhaps worth exploring?

I would also repeat my earlier suggestion that you post on the insurance forum if you have not already done so, as there are experts on there with knowledge of this area, who may be able to come up with some suggestions.

duvl

When company A gave staff Bupa cover I wasn't asked about pre existing conditions and in any case was fully fit. When the personal cover quote was recently given, I made it clear that it had to enable continuation of cover for the on-going treatment that Bupa have covered over the past few years. I asked for an email to accompany the quote to confirm this aspect as I wasn't comfortable with just a verbal agreement. It is copied below and note that it is from a colleague of the individual who supplied the quote:

"Dear Mr xxxx

With reference to our telephone conversation I can confirm that the quotes obtained from xxxx are a continuation of cover for yourself with no further underwriting and will carry over any existing exclusions or treatment received on your current policy. The only additional exclusions are general exclusions that apply to all of our policies which include the maintenance of chronic conditions such as asthma and diabetes, the natural aging process and cosmetic surgery.

Should you have any further questions in xxxx absence, please feel free to contact me and I will be happy to assist you.

Kind regards

xxxx"

Thanks for some very valid and thought provoking comments that I will explore further tomorrow both with the company and the union.

duvl

zzzLazydaisy

>repeat my earlier suggestion that you post on the insurance forum if you have not already done so....

I do not see what other forum you are suggesting here? This forum is:
mse -pure money - insurance and life assurance.

I'm new to forums so can you please be more specific and show me the path to this other insurance forum? Sorry if it's blazingly obvious!

duvl

Pleased to say that as a result of legal intervention my problem has gone away. Thanks everyone for listening.

FreddieFrugal

duvl wrote: »

Pleased to say that as a result of legal intervention my problem has gone away. Thanks everyone for listening.

Really good news, must be a relief. Well done.