premier 1 silver - bupalatinamerica.com · zone 2 | bolivia, chile, haiti, peru deductiblesage...
Post on 31-Aug-2019
1 Views
Preview:
TRANSCRIPT
PRE MIU M BOOKLET
PRE MIE R 1 S ILVE R
E F F E C TI V E JA N UA RY 1 , 2 017
ADMINISTRATIVE NOTES• Rates are in U.S. dollars and don’t include taxes.
• Maximum age to apply: 74 years old. No age limit for guaranteed renewability.
• Children 0-9 years old cannot be sole policyholders. The child will be registered with the same deductible as the insured parent with the highest deductible.
• Available payment modes: annual and semiannual.
• The insurer, USA Medical Services, and/or any of their applicable related subsidiaries and affiliates will not engage in any transactions with any parties or in any countries where otherwise prohibited by the laws in the United States of America and, solely with respect to the insurer, where otherwise prohibited by the laws in the United Kingdom and/or Denmark. Please contact USA Medical Services for more information about this restriction.
• Bupa reserves the right to correct any errors or omissions.
ZONE 1 | HONDURAS
PR
EM
IER
1 S
ILV
ER
PR
EM
IUM
BO
OK
LE
T, E
FF
EC
TIV
E J
AN
UA
RY
1,
20
17Deductibles US$1,000 US$2,500 US$5,000 US$10,000
Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual
0-9 US$1,259.00 US$654.68 US$842.00 US$437.84 US$572.00 US$297.44 US$361.00 US$187.72
10-19 2,311.00 1,201.72 1,471.00 764.92 1,052.00 547.04 708.00 368.16
20-29 6,103.00 3,173.56 3,925.00 2,041.00 3,031.00 1,576.12 2,277.00 1,184.04
30-39 6,758.00 3,514.16 4,688.00 2,437.76 3,801.00 1,976.52 3,064.00 1,593.28
40-49 7,642.00 3,973.84 5,273.00 2,741.96 4,224.00 2,196.48 3,380.00 1,757.60
50-59 10,991.00 5,715.32 7,751.00 4,030.52 6,196.00 3,221.92 5,375.00 2,795.00
60 14,347.00 7,460.44 9,890.00 5,142.80 8,292.00 4,311.84 7,516.00 3,908.32
61 14,711.00 7,649.72 10,148.00 5,276.96 8,508.00 4,424.16 7,710.00 4,009.20
62 15,087.00 7,845.24 10,407.00 5,411.64 8,723.00 4,535.96 7,912.00 4,114.24
63 15,391.00 8,003.32 10,612.00 5,518.24 8,902.00 4,629.04 8,069.00 4,195.88
64 15,697.00 8,162.44 10,821.00 5,626.92 9,075.00 4,719.00 8,228.00 4,278.56
65 31,233.00 16,241.16 21,785.00 11,328.20 17,632.00 9,168.64 16,926.00 8,801.52
66 32,045.00 16,663.40 22,347.00 11,620.44 18,091.00 9,407.32 17,356.00 9,025.12
67 32,863.00 17,088.76 22,915.00 11,915.80 18,549.00 9,645.48 17,799.00 9,255.48
68 33,520.00 17,430.40 23,377.00 12,156.04 18,920.00 9,838.40 18,157.00 9,441.64
69 34,187.00 17,777.24 23,845.00 12,399.40 19,297.00 10,034.44 18,521.00 9,630.92
70 and up 39,421.00 20,498.92 27,074.00 14,078.48 21,043.00 10,942.36 20,309.00 10,560.68
Additional coverage
Air ambulance US$487.00 US$253.00 US$487.00 US$253.00 US$487.00 US$253.00 US$487.00 US$253.00
ZONE 2 | BOLIVIA, CHILE, HAITI, PERU
PR
EM
IER
1 S
ILV
ER
PR
EM
IUM
BO
OK
LE
T, E
FF
EC
TIV
E J
AN
UA
RY
1,
20
17Deductibles US$1,000 US$2,500 US$5,000 US$10,000
Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual
0-9 US$1,227.00 US$638.04 US$819.00 US$425.88 US$555.00 US$288.60 US$353.00 US$183.56
10-19 2,250.00 1,170.00 1,431.00 744.12 1,025.00 533.00 689.00 358.28
20-29 5,941.00 3,089.32 3,821.00 1,986.92 2,946.00 1,531.92 2,213.00 1,150.76
30-39 6,578.00 3,420.56 4,562.00 2,372.24 3,696.00 1,921.92 2,980.00 1,549.60
40-49 7,438.00 3,867.76 5,130.00 2,667.60 4,109.00 2,136.68 3,287.00 1,709.24
50-59 10,699.00 5,563.48 7,542.00 3,921.84 6,025.00 3,133.00 5,228.00 2,718.56
60 13,966.00 7,262.32 9,624.00 5,004.48 8,065.00 4,193.80 7,312.00 3,802.24
61 14,317.00 7,444.84 9,877.00 5,136.04 8,274.00 4,302.48 7,499.00 3,899.48
62 14,685.00 7,636.20 10,128.00 5,266.56 8,484.00 4,411.68 7,695.00 4,001.40
63 14,983.00 7,791.16 10,325.00 5,369.00 8,657.00 4,501.64 7,849.00 4,081.48
64 15,279.00 7,945.08 10,532.00 5,476.64 8,826.00 4,589.52 8,004.00 4,162.08
65 30,406.00 15,811.12 21,197.00 11,022.44 17,150.00 8,918.00 16,465.00 8,561.80
66 31,194.00 16,220.88 21,745.00 11,307.40 17,598.00 9,150.96 16,883.00 8,779.16
67 31,990.00 16,634.80 22,299.00 11,595.48 18,045.00 9,383.40 17,313.00 9,002.76
68 32,630.00 16,967.60 22,745.00 11,827.40 18,403.00 9,569.56 17,662.00 9,184.24
69 33,280.00 17,305.60 23,200.00 12,064.00 18,773.00 9,761.96 18,014.00 9,367.28
70 and up 38,377.00 19,956.04 26,344.00 13,698.88 20,471.00 10,644.92 19,754.00 10,272.08
Additional coverage
Air ambulance US$487.00 US$253.00 US$487.00 US$253.00 US$487.00 US$253.00 US$487.00 US$253.00
ZONE 3 | COSTA RICA, DOMINICAN REPUBLIC, EL SALVADOR
Deductibles US$1,000 US$2,500 US$5,000 US$10,000
Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual
0-9 US$1,227.00 US$638.04 US$819.00 US$425.88 US$555.00 US$288.60 US$353.00 US$183.56
10-19 2,250.00 1,170.00 1,431.00 744.12 1,025.00 533.00 689.00 358.28
20-29 5,941.00 3,089.32 3,821.00 1,986.92 2,946.00 1,531.92 2,213.00 1,150.76
30-39 6,578.00 3,420.56 4,562.00 2,372.24 3,696.00 1,921.92 2,980.00 1,549.60
40-49 7,438.00 3,867.76 5,130.00 2,667.60 4,109.00 2,136.68 3,287.00 1,709.24
50-59 10,699.00 5,563.48 7,542.00 3,921.84 6,025.00 3,133.00 5,228.00 2,718.56
60 13,966.00 7,262.32 9,624.00 5,004.48 8,065.00 4,193.80 7,312.00 3,802.24
61 14,317.00 7,444.84 9,877.00 5,136.04 8,274.00 4,302.48 7,499.00 3,899.48
62 14,685.00 7,636.20 10,128.00 5,266.56 8,484.00 4,411.68 7,695.00 4,001.40
63 14,983.00 7,791.16 10,325.00 5,369.00 8,657.00 4,501.64 7,849.00 4,081.48
64 15,279.00 7,945.08 10,532.00 5,476.64 8,826.00 4,589.52 8,004.00 4,162.08
65 30,406.00 15,811.12 21,197.00 11,022.44 17,150.00 8,918.00 16,465.00 8,561.80
66 31,194.00 16,220.88 21,745.00 11,307.40 17,598.00 9,150.96 16,883.00 8,779.16
67 31,990.00 16,634.80 22,299.00 11,595.48 18,045.00 9,383.40 17,313.00 9,002.76
68 32,630.00 16,967.60 22,745.00 11,827.40 18,403.00 9,569.56 17,662.00 9,184.24
69 33,280.00 17,305.60 23,200.00 12,064.00 18,773.00 9,761.96 18,014.00 9,367.28
70 and up 38,377.00 19,956.04 26,344.00 13,698.88 20,471.00 10,644.92 19,754.00 10,272.08
Additional coverage
Air ambulance US$487.00 US$253.00 US$487.00 US$253.00 US$487.00 US$253.00 US$487.00 US$253.00
PR
EM
IER
1 S
ILV
ER
PR
EM
IUM
BO
OK
LE
T, E
FF
EC
TIV
E J
AN
UA
RY
1,
20
17
ZONE 4 | BELIZE, ECUADOR, GUATEMALA, GUYANA, NICARAGUA, PUERTO RICO, SURINAME, UNITED STATES VIRGIN ISLANDS, URUGUAY, REST OF THE CARIBBEAN
PR
EM
IER
1 S
ILV
ER
PR
EM
IUM
BO
OK
LE
T, E
FF
EC
TIV
E J
AN
UA
RY
1,
20
17
Deductibles US$1,000 US$2,500 US$5,000 US$10,000
Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual
0-9 US$1,238.00 US$643.76 US$827.00 US$430.04 US$561.00 US$291.72 US$356.00 US$185.12
10-19 2,270.00 1,180.40 1,444.00 750.88 1,035.00 538.20 695.00 361.40
20-29 5,996.00 3,117.92 3,855.00 2,004.60 2,973.00 1,545.96 2,234.00 1,161.68
30-39 6,639.00 3,452.28 4,604.00 2,394.08 3,731.00 1,940.12 3,008.00 1,564.16
40-49 7,507.00 3,903.64 5,178.00 2,692.56 4,147.00 2,156.44 3,317.00 1,724.84
50-59 10,798.00 5,614.96 7,612.00 3,958.24 6,081.00 3,162.12 5,276.00 2,743.52
60 14,095.00 7,329.40 9,713.00 5,050.76 8,140.00 4,232.80 7,379.00 3,837.08
61 14,449.00 7,513.48 9,968.00 5,183.36 8,351.00 4,342.52 7,569.00 3,935.88
62 14,821.00 7,706.92 10,221.00 5,314.92 8,561.00 4,451.72 7,766.00 4,038.32
63 15,122.00 7,863.44 10,420.00 5,418.40 8,737.00 4,543.24 7,921.00 4,118.92
64 15,420.00 8,018.40 10,629.00 5,527.08 8,907.00 4,631.64 8,077.00 4,200.04
65 30,686.00 15,956.72 21,392.00 11,123.84 17,308.00 9,000.16 16,617.00 8,640.84
66 31,482.00 16,370.64 21,945.00 11,411.40 17,760.00 9,235.20 17,039.00 8,860.28
67 32,284.00 16,787.68 22,504.00 11,702.08 18,211.00 9,469.72 17,473.00 9,085.96
68 32,930.00 17,123.60 22,955.00 11,936.60 18,573.00 9,657.96 17,824.00 9,268.48
69 33,586.00 17,464.72 23,414.00 12,175.28 18,947.00 9,852.44 18,181.00 9,454.12
70 and up 38,730.00 20,139.60 26,587.00 13,825.24 20,659.00 10,742.68 19,936.00 10,366.72
Additional coverage
Air ambulance US$487.00 US$253.00 US$487.00 US$253.00 US$487.00 US$253.00 US$487.00 US$253.00
ZONE 5 | VENEZUELA
PR
EM
IER
1 S
ILV
ER
PR
EM
IUM
BO
OK
LE
T, E
FF
EC
TIV
E J
AN
UA
RY
1,
20
17Deductibles US$1,000 US$2,500 US$5,000 US$10,000
Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual
0-9 US$1,122.00 US$583.44 US$750.00 US$390.00 US$511.00 US$265.72 US$321.00 US$166.92
10-19 2,062.00 1,072.24 1,307.00 679.64 936.00 486.72 631.00 328.12
20-29 5,445.00 2,831.40 3,499.00 1,819.48 2,699.00 1,403.48 2,026.00 1,053.52
30-39 6,028.00 3,134.56 4,177.00 2,172.04 3,383.00 1,759.16 2,728.00 1,418.56
40-49 6,819.00 3,545.88 4,699.00 2,443.48 3,760.00 1,955.20 3,009.00 1,564.68
50-59 9,807.00 5,099.64 6,906.00 3,591.12 5,515.00 2,867.80 4,786.00 2,488.72
60 12,800.00 6,656.00 8,813.00 4,582.76 7,383.00 3,839.16 6,693.00 3,480.36
61 13,124.00 6,824.48 9,041.00 4,701.32 7,572.00 3,937.44 6,866.00 3,570.32
62 13,461.00 6,999.72 9,274.00 4,822.48 7,767.00 4,038.84 7,043.00 3,662.36
63 13,731.00 7,140.12 9,454.00 4,916.08 7,924.00 4,120.48 7,183.00 3,735.16
64 14,004.00 7,282.08 9,644.00 5,014.88 8,080.00 4,201.60 7,326.00 3,809.52
65 27,865.00 14,489.80 19,412.00 10,094.24 15,697.00 8,162.44 15,072.00 7,837.44
66 28,586.00 14,864.72 19,912.00 10,354.24 16,105.00 8,374.60 15,451.00 8,034.52
67 29,320.00 15,246.40 20,419.00 10,617.88 16,515.00 8,587.80 15,843.00 8,238.36
68 29,904.00 15,550.08 20,829.00 10,831.08 16,844.00 8,758.88 16,167.00 8,406.84
69 30,501.00 15,860.52 21,245.00 11,047.40 17,181.00 8,934.12 16,489.00 8,574.28
70 and up 35,170.00 18,288.40 24,125.00 12,545.00 18,736.00 9,742.72 18,080.00 9,401.60
Additional coverage
Air ambulance US$487.00 US$253.00 US$487.00 US$253.00 US$487.00 US$253.00 US$487.00 US$253.00
ZONE 6 | ARGENTINA, COLOMBIA, PANAMA, PARAGUAY
PR
EM
IER
1 S
ILV
ER
PR
EM
IUM
BO
OK
LE
T, E
FF
EC
TIV
E J
AN
UA
RY
1,
20
17Deductibles US$1,000 US$2,500 US$5,000 US$10,000
Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual
0-9 US$1,182.00 US$614.64 US$790.00 US$410.80 US$535.00 US$278.20 US$340.00 US$176.80
10-19 2,169.00 1,127.88 1,379.00 717.08 988.00 513.76 664.00 345.28
20-29 5,727.00 2,978.04 3,683.00 1,915.16 2,840.00 1,476.80 2,134.00 1,109.68
30-39 6,341.00 3,297.32 4,398.00 2,286.96 3,563.00 1,852.76 2,873.00 1,493.96
40-49 7,170.00 3,728.40 4,946.00 2,571.92 3,961.00 2,059.72 3,168.00 1,647.36
50-59 10,314.00 5,363.28 7,271.00 3,780.92 5,808.00 3,020.16 5,040.00 2,620.80
60 13,463.00 7,000.76 9,277.00 4,824.04 7,775.00 4,043.00 7,048.00 3,664.96
61 13,801.00 7,176.52 9,521.00 4,950.92 7,976.00 4,147.52 7,229.00 3,759.08
62 14,156.00 7,361.12 9,763.00 5,076.76 8,178.00 4,252.56 7,417.00 3,856.84
63 14,443.00 7,510.36 9,953.00 5,175.56 8,345.00 4,339.40 7,566.00 3,934.32
64 14,729.00 7,659.08 10,152.00 5,279.04 8,508.00 4,424.16 7,716.00 4,012.32
65 29,311.00 15,241.72 20,433.00 10,625.16 16,532.00 8,596.64 15,871.00 8,252.92
66 30,070.00 15,636.40 20,961.00 10,899.72 16,964.00 8,821.28 16,275.00 8,463.00
67 30,837.00 16,035.24 21,495.00 11,177.40 17,395.00 9,045.40 16,689.00 8,678.28
68 31,454.00 16,356.08 21,925.00 11,401.00 17,740.00 9,224.80 17,026.00 8,853.52
69 32,081.00 16,682.12 22,364.00 11,629.28 18,097.00 9,410.44 17,365.00 9,029.80
70 and up 36,994.00 19,236.88 25,394.00 13,204.88 19,733.00 10,261.16 19,042.00 9,901.84
Additional coverage
Air ambulance US$487.00 US$253.00 US$487.00 US$253.00 US$487.00 US$253.00 US$487.00 US$253.00
ZONE 7
PR
EM
IER
1 S
ILV
ER
PR
EM
IUM
BO
OK
LE
T, E
FF
EC
TIV
E J
AN
UA
RY
1,
20
17Deductibles US$1,000 US$2,500 US$5,000 US$10,000
Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual
0-9 US$1,308.00 US$680.16 US$857.00 US$445.64 US$564.00 US$293.28 US$357.00 US$185.64
10-19 2,396.00 1,245.92 1,495.00 777.40 1,041.00 541.32 704.00 366.08
20-29 6,327.00 3,290.04 3,994.00 2,076.88 3,002.00 1,561.04 2,261.00 1,175.72
30-39 7,005.00 3,642.60 4,774.00 2,482.48 3,769.00 1,959.88 3,043.00 1,582.36
40-49 7,918.00 4,117.36 5,368.00 2,791.36 4,189.00 2,178.28 3,356.00 1,745.12
50-59 11,391.00 5,923.32 7,891.00 4,103.32 6,140.00 3,192.80 5,335.00 2,774.20
60 14,868.00 7,731.36 10,071.00 5,236.92 8,220.00 4,274.40 7,459.00 3,878.68
61 15,245.00 7,927.40 10,335.00 5,374.20 8,432.00 4,384.64 7,651.00 3,978.52
62 15,637.00 8,131.24 10,598.00 5,510.96 8,645.00 4,495.40 7,850.00 4,082.00
63 15,952.00 8,295.04 10,806.00 5,619.12 8,822.00 4,587.44 8,005.00 4,162.60
64 16,268.00 8,459.36 11,020.00 5,730.40 8,995.00 4,677.40 8,165.00 4,245.80
65 32,370.00 16,832.40 22,182.00 11,534.64 17,477.00 9,088.04 16,796.00 8,733.92
66 33,209.00 17,268.68 22,754.00 11,832.08 17,932.00 9,324.64 17,221.00 8,954.92
67 34,058.00 17,710.16 23,335.00 12,134.20 18,387.00 9,561.24 17,660.00 9,183.20
68 34,738.00 18,063.76 23,803.00 12,377.56 18,753.00 9,751.56 18,018.00 9,369.36
69 35,430.00 18,423.60 24,282.00 12,626.64 19,125.00 9,945.00 18,378.00 9,556.56
70 and up 40,856.00 21,245.12 27,572.00 14,337.44 20,858.00 10,846.16 20,150.00 10,478.00
Additional coverage
Air ambulance US$487.00 US$253.00 US$487.00 US$253.00 US$487.00 US$253.00 US$487.00 US$253.00
ZONE 8 | MEXICO
PR
EM
IER
1 S
ILV
ER
PR
EM
IUM
BO
OK
LE
T, E
FF
EC
TIV
E J
AN
UA
RY
1,
20
17Deductibles US$1,000 US$2,500 US$5,000 US$10,000
Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual
0-9 US$1,397.00 US$726.44 US$933.00 US$485.16 US$632.00 US$328.64 US$400.00 US$208.00
10-19 2,564.00 1,333.28 1,630.00 847.60 1,167.00 606.84 785.00 408.20
20-29 6,770.00 3,520.40 4,353.00 2,263.56 3,358.00 1,746.16 2,522.00 1,311.44
30-39 7,500.00 3,900.00 5,199.00 2,703.48 4,210.00 2,189.20 3,396.00 1,765.92
40-49 8,477.00 4,408.04 5,845.00 3,039.40 4,685.00 2,436.20 3,746.00 1,947.92
50-59 12,192.00 6,339.84 8,596.00 4,469.92 6,869.00 3,571.88 5,961.00 3,099.72
60 15,916.00 8,276.32 10,968.00 5,703.36 9,193.00 4,780.36 8,332.00 4,332.64
61 16,318.00 8,485.36 11,254.00 5,852.08 9,428.00 4,902.56 8,548.00 4,444.96
62 16,736.00 8,702.72 11,542.00 6,001.84 9,669.00 5,027.88 8,770.00 4,560.40
63 17,076.00 8,879.52 11,764.00 6,117.28 9,866.00 5,130.32 8,945.00 4,651.40
64 17,414.00 9,055.28 12,003.00 6,241.56 10,060.00 5,231.20 9,121.00 4,742.92
65 34,652.00 18,019.04 24,157.00 12,561.64 19,545.00 10,163.40 18,764.00 9,757.28
66 35,550.00 18,486.00 24,779.00 12,885.08 20,052.00 10,427.04 19,239.00 10,004.28
67 36,458.00 18,958.16 25,411.00 13,213.72 20,563.00 10,692.76 19,729.00 10,259.08
68 37,188.00 19,337.76 25,922.00 13,479.44 20,974.00 10,906.48 20,128.00 10,466.56
69 37,929.00 19,723.08 26,442.00 13,749.84 21,393.00 11,124.36 20,531.00 10,676.12
70 and up 43,735.00 22,742.20 30,023.00 15,611.96 23,328.00 12,130.56 22,512.00 11,706.24
Additional coverage
Air ambulance US$487.00 US$253.00 US$487.00 US$253.00 US$487.00 US$253.00 US$487.00 US$253.00
ZONE 9 | CANADA, UNITED STATES OF AMERICA
PR
EM
IER
1 S
ILV
ER
PR
EM
IUM
BO
OK
LE
T, E
FF
EC
TIV
E J
AN
UA
RY
1,
20
17Deductibles US$1,000 US$2,500 US$5,000 US$10,000
Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual
0-9 US$1,410.00 US$733.20 US$930.00 US$483.60 US$626.00 US$325.52 US$396.00 US$205.92
10-19 2,585.00 1,344.20 1,624.00 844.48 1,154.00 600.08 780.00 405.60
20-29 6,824.00 3,548.48 4,339.00 2,256.28 3,324.00 1,728.48 2,498.00 1,298.96
30-39 7,558.00 3,930.16 5,185.00 2,696.20 4,168.00 2,167.36 3,363.00 1,748.76
40-49 8,545.00 4,443.40 5,830.00 3,031.60 4,633.00 2,409.16 3,707.00 1,927.64
50-59 12,293.00 6,392.36 8,570.00 4,456.40 6,795.00 3,533.40 5,897.00 3,066.44
60 16,043.00 8,342.36 10,938.00 5,687.76 9,098.00 4,730.96 8,245.00 4,287.40
61 16,450.00 8,554.00 11,222.00 5,835.44 9,332.00 4,852.64 8,459.00 4,398.68
62 16,873.00 8,773.96 11,510.00 5,985.20 9,568.00 4,975.36 8,680.00 4,513.60
63 17,212.00 8,950.24 11,730.00 6,099.60 9,765.00 5,077.80 8,852.00 4,603.04
64 17,552.00 9,127.04 11,968.00 6,223.36 9,957.00 5,177.64 9,029.00 4,695.08
65 34,927.00 18,162.04 24,089.00 12,526.28 19,344.00 10,058.88 18,569.00 9,655.88
66 35,834.00 18,633.68 24,711.00 12,849.72 19,846.00 10,319.92 19,040.00 9,900.80
67 36,748.00 19,108.96 25,342.00 13,177.84 20,352.00 10,583.04 19,524.00 10,152.48
68 37,484.00 19,491.68 25,846.00 13,439.92 20,755.00 10,792.60 19,921.00 10,358.92
69 38,231.00 19,880.12 26,367.00 13,710.84 21,172.00 11,009.44 20,320.00 10,566.40
70 and up 44,081.00 22,922.12 29,940.00 15,568.80 23,088.00 12,005.76 22,278.00 11,584.56
Additional coverage
Air ambulance US$487.00 US$253.00 US$487.00 US$253.00 US$487.00 US$253.00 US$487.00 US$253.00
HOW IS THE PREMIUM PAID?Bupa must receive payment before the coverage can take effect. Please submit payment with your application. You can choose among the following payment options:
Online payment by credit card through our website www.bupasalud.com
Credit card MasterCard, VISA, American Express, or Diners Club
Personal check in U.S. dollars drawn on an American bank, cashier’s check, money order, traveler’s check
Bank transfer:
Procedure for ACH’sWells Fargo Bank200 South Biscayne Blvd, FL6011Miami, FL 33131Account # 2000037371881ABA # 067006432Account Name: Bupa Worldwide Premium TrustReference: Policyholder Name and Policy Number
Procedure for domestic wire transfersWells Fargo Bank200 South Biscayne Blvd, FL6011Miami, FL 33131Account # 2000037371881ABA # 121000248Account Name: Bupa Worldwide Premium TrustReference: Policyholder Name and Policy Number
Procedure for international wire transfersWells Fargo Bank200 South Biscayne Blvd, FL6011Miami, FL 33131Account # 2000037371881ABA # 121000248CHIPS # 0407SWIFT # WFBIUS6SAccount Name: Bupa Worldwide Premium TrustReference: Policyholder Name and Policy Number
BINS_PB_P1S_eng_V17.01
Bupa Insurance LimitedBupa House, 15-19 Bloomsbury Way, London, WC1A 2BA, UK
Registered in England No. 3956433.Bupa Insurance Limited is authorizedby the Prudential RegulationAuthority and regulated by theFinancial Conduct Authority and thePrudential Regulation Authority. TheFinancial Conduct Authority doesnot regulate the activities of BupaInsurance Limited that take placeoutside of the United Kingdom.
Administration:17901 Old Cutler Road, Suite 400Palmetto Bay, Florida 33157Tel. +1 (305) 270 3944Fax +1 (305) 270 3948www.bupasalud.compremier1@bupalatinamerica.com
top related