Introduction

OcuPlan is a new type of health scheme which aims to make private health care more accessible and affordable for patients. It is very different to most pre-existing health insurance policies because there are no exclusions for pre-existing eye conditions and it also covers consultations for ongoing monitoring of stable or chronic conditions. In this way it is not a health insurance policy, it is a fixed-term, clearly defined and flexible package of shared care between optometrists and ophthalmologists. These packages provide a certain amount of consultations per year with recognised consultant eye surgeons and ocular investigations with recognised optometry partners. The services are tracked and paid for by scanning the Member’s OcuPlan membership card when they attend for their appointment. This automatically links to your OcuPlan account to start the payment process.

The medico legal responsibility for monitoring the patient’s condition, the frequency of consultations and investigations, and the interpretation of investigations rest with the consultant ophthalmologist for whom the patient is under their care, not with the optometrist. However, if when performing a scan or visual field test you notice a new urgent problem, then you are advised to act in a way that you would do normally and either contact their consultant directly or the local NHS eye emergency department in a timely manner.

OcuPlan makes private eye care more affordable for patients by providing a payment by instalments facility to spread the costs over the year. Members can access services after paying just one month’s instalment in advance and completing their 14-day cooling off period. At OcuPlan we have a set of minimum quality standards for new consultants and optometrists to become recognised partners, which help to maintain a high-quality service for our Members. The network of recognised consultants and independent or high street optometrists help to make private eye care more accessible.

About this Documentation

This documentation contains the Terms and Conditions for OcuPlan recognised optometrists and is the basis of an agreement between you and us, that you will become an OcuPlan Partner. By accepting your status as an OcuPlan Partner you are agreeing to these terms and conditions which shall apply to you when carrying out ocular investigations that we have pre-authorised for our Members. The cost of these investigations will be remunerated to you by OcuPlan as long as they are performed and charged for in line with this agreement. As you work through the document, we have set out what we are asking you to do and what we will do for you. Any ambiguous or important terms have the meanings given in the ‘Defined Terms’ section 14 at the end of this document. If there is anything which you do not understand or sounds incorrect, please do give us a call to get clarification.

Guidance for Optometrists

This section explains how patients can access OcuPlan and how optometrists can use and hopefully benefit from the OcuPlan scheme. OcuPlan provides defined packages of shared care between eye doctors in private hospitals and optometrists, who are able to perform the required ocular investigations. The scheme is designed to try and make private health care more affordable and accessible, whilst maintaining the highest quality of care possible. By providing patients with high quality investigations by their local optometrist and allowing them to see the same consultant at each private hospital visit, they are receiving excellent continuity of care. The success of the scheme in terms of providing patients with a valuable service relies on optometrists and consultants identifying which patients are more likely to benefit from OcuPlan.

Accessing the service

The OcuPlan care packages are only suitable for patients with a known ophthalmic diagnosis where regular monitoring is required. It is not suitable for new referrals of patients with new eye symptoms with an unknown diagnosis that requires investigation or for complex eye conditions that require more intensive eye hospital management. If patients have a known diagnosis either made in the NHS or private sector that requires long term monitoring, then they can access the OcuPlan scheme directly. Patients who enter the OcuPlan scheme are usually already under the care of the local NHS or private hospital, and so they should be aware of their pre-existing diagnosis, such as glaucoma, age-related macular degeneration, and diabetic retinopathy.

The below flow chart (figure 1) explains the route that patients can take to enter OcuPlan. If you see a patient in practice who currently has a known eye diagnosis that requires regular monitoring by an ophthalmologist, together with regular ocular investigations (visual field testing, or optical coherence tomography scans of the retina or optic nerve), then OcuPlan is likely to be relevant to them. As you know patients have the option of either attending the NHS for monitoring of these conditions, or they can choose to be seen in a private setting for this. One of the common barriers to private health care is the large upfront costs associated with it. OcuPlan helps to overcome this problem by allowing patients, if they choose, to pay by 12 monthly instalments over a year at no extra cost, and to be able to access services with yourself and the eye consultant after just paying their first month instalment.

Figure 1: Flow chart showing routes of access for patients in to OcuPlan

If you feel a patient may benefit from the OcuPlan scheme we ask please you give them the choice to consider it by looking at our website www.ocuplan.co.uk or provide them with one of our leaflets that we can supply. We always assess the new referrals to make sure they meet our criteria of having a known ocular diagnosis and be suitable to the scheme. The OcuPlan scheme is not appropriate for patients with new eye problems that require hospital investigation, diagnosis and possible treatment.