bin company membership pack - tsitsopoulouins.gr

COMPANY

From 1 April 2016

YOUR MEMBERSHIP PACK This document is made up of two booklets; please keep it in a safe place. We will send you information about amended versions when your plan renews if we make any changes. You can download updated versions at any time from the MembersWorld website or contact us to request a new copy.

CONTENTS 1. QUICK REFERENCE GUIDEThis booklet contains a summary of all your important contact information; the sort of information you are likely to use on a regular basis.

2. MEMBERSHIP GUIDEThis booklet explains the terms and conditions of the plan. Detailed information such as pre-authorising treatment, making a claim and moving country can be found in this guide. It also explains your benefits, limits and exclusions with detailed rules on how to use them.

WHAT YOU NEED, THE WAY YOU NEED IT

Quick Reference Guide

This booklet summarises all of your important contact information.

bupa-intl.com

IMPORTANT MEMBERSHIP DOCUMENTSThe ‘Membership Guide’ must be read alongside your membership certificate and your application for cover, as together they set out the terms and conditions of your membership and form your plan documentation.

MEMBERSHIP GUIDEThis booklet explains the terms and conditions of the plan. Detailed information such as pre-authorising treatment, making a claim and moving country can be found in this guide. It also explains your benefits, limits and exclusions with detailed rules on how to use them.

QUICK REFERENCE GUIDEThis booklet contains a summary of all your important contact information; the sort of information you are likely to use on a regular basis.

WELCOME TO YOUR BUPA GLOBAL PLAN

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To make your life easier and save you time and hassle, MembersWorld is an exclusive and secure members website. You can log on to MembersWorld from anywhere in the world to manage your cover and access a comprehensive library of information and expert advice.

YOUR WEBSITEMEMBERSWORLD

Some of the benefits waiting for you online:

¡ you can check cover and pre-authorise in-patient and day-case treatment

¡ no need to carry documents around with you - access your documents 24 hours a day anywhere in the world

¡ know exactly when new documents are ready by signing up to receive SMS text alerts

¡ purchased your policy via a broker? You can now allow them access to view your policy information (except claim related documents)

¡ specify a preferred address for claim reimbursements - useful if you have multiple addresses or are travelling

¡ if you want a second medical opinion, simply complete the online form and one of our third party medical consultants will be in contact with you

¡ Webchat - instant access, 24 hours a day, to our experienced advisers, who will be able to chat with you in real time, wherever you are and whatever your needs

There are many more benefits online; log in to see for yourself.

START

Get set up in just six easy steps

ONE

Select ‘register now’

TWO

Enter your membership number and personal details

THREE

Choose your login name (please note: login and password are case sensitive)

FOUR

Choose your password

FIVE

Choose a security question

SIX

Click on ‘submit your details’

FINISH

That’s it... You’re registered!

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CONTACT US OPEN 24 HOURS A DAY, 365 DAYS A YEAR

GENERAL ENQUIRIES

Your Bupa Global customer services helpline.

¡ you can check cover and pre-authorise in-patient and day-case treatment

¡ membership and payment queries

¡ claims information

email: [email protected] * web: bupa-intl.com tel: +44 (0) 1273 323 563 fax: +44 (0) 1273 820 517

CORRESPONDENCE

Any correspondence, including your claims, should be sent to the following address:

Bupa Global Victory House Trafalgar Place Brighton, BN1 4FY United Kingdom

FURTHER HELP

We want to make sure that members with special needs are not excluded in any way. We also offer a choice of Braille, large print or audio for our letters and literature. Please let us know which you would prefer.

HEALTHLINE +44 (0) 1273 333 911

Some of the services that may be offered by our telephone advice line:

¡ Check cover and pre-authorise treatment

¡ General medical information and advice from a health professional

¡ Find local medical facilities ¡ Medical referrals to a physician or

hospital ¡ Medical service referral (ie locating a

physician) and assistance arranging appointments

¡ Inoculation and visa requirements information

¡ Emergency message transmission ¡ Interpreter and embassy referral

PRE-AUTHORISATION FAX: +44 (0) 1273 866 301

* Please note that we cannot guarantee the security of email as a method of communication. Some companies, employers and/or countries do monitor email traffic, so please bear this in mind when sending us confidential information.

CALL: +44 (0) 1273 333 911 FAX: +44 (0) 1273 866 301 Or via our secure MembersWorld website.

Important rules: please note that pre-authorisation is only valid if all the details of the authorised treatment, including dates and locations, match those of the treatment received. If there is a change in the treatment required, if you need to have further treatment, or if any other details change, then you or your consultant must contact us to pre-authorise this separately. We make our decision to approve your treatment based on the information given to us. We reserve the right to withdraw our decision if additional information is withheld or not given to us at the time the decision is being made.

PLEASE REMEMBER TOPRE-AUTHORISE YOUR TREATMENTIf we pre-authorise your treatment, this means that we will pay up to the limits of your plan provided that all the following requirements are met: the treatment is eligible treatment that is covered by your plan, you have an active membership at the time that treatment takes place, your subscriptions are paid up to date, the treatment carried out matches the treatment authorised, you have provided a full disclosure of the condition and treatment required, you have enough benefit entitlement to cover the cost of the treatment, your condition is not a pre-existing condition, the treatment is medically necessary, and the treatment takes place within 31 days after pre-authorisation is given. Please check the ‘How to use your plan’ book for more details.

This is a summary. Please ensure you read the full details in the ‘How to use your plan’ and ‘Table of benefits’ booklets, and your Membership Certificate, included in your membership pack.

HOW IT WORKS FOR YOU



HOW TO CLAIM

Contact Bupa Global customer service helpline: +44 (0) 1273 323 563 or [email protected]

Direct Settlement Pay and Claim

We will send pre-authorisation to you or to your hospital/clinic

We confirm your cover and benefit limits

Complete and sign the blank sections of the statement

including the patient declaration. The hospital/clinic will attach

invoices and send the claim to us

Your medical practitioner should complete the medical information

section of the claim form. You should complete all other

sections, attach invoices and send the claim to us

We pay hospital/clinic We pay you

We send your claim payment statement to you

You settle any shortfall with hospital, clinic or doctor

We’re always pleased to hear about aspects of your membership that you have particularly appreciated, or that you have had problems with. If something does go wrong, here is a simple procedure to ensure your concerns are dealt with as quickly and effectively as possible.

If you have any comments or complaints, you can call the Bupa Global customer helpline on +44 (0) 1273 323 563, 24 hours a day, 365 days a year. Alternatively you can email via bupa-intl.com/membersworld, or write to us at:

Bupa Global Victory House Trafalgar Place Brighton, BN1 4FY United KIngdom

MAKING A COMPLAINT

Bupa Global offers you:Global medical plans for individuals and groupsAssistance, repatriation and evacuation cover24-hour multi-lingual helpline

bupa-intl.com

The world of Bupa

Care homesCash plansDental insuranceHealth analyticsHealth assessmentsHealth at work servicesHealth centresHealth coachingHealth informationHealth insuranceHome healthcareHospitalsInternational health insurancePersonal medical alarmsRetirement villagesTravel insurance

General services: +44 (0) 1273 323 563Medical related enquiries:+44 (0) 1273 333 911Your calls may be recorded or monitored.

Bupa GlobalVictory HouseTrafalgar PlaceBrightonBN1 4FYUnited Kingdom

BIN-GENE-QREF-1604v2.1

COMPANYPLAN

Membership GuideThis Membership Guide explains the terms and conditions of theCompany Plan. Detailed information such as pre-authorisingtreatment, making a claim and moving country can be found in thisguide. It also explains your benefits, limits and exclusions withdetailed rules on how to use them.

From 1 April 2016

bupa-intl.com

Contents2 Welcome

2 How to use your Bupa Global group plan

3 About your Membership

3 What is covered?

5 Summary of Benefits and Exclusions

6 Table of Benefits

18 What is not covered?

24 Pre-authorisation

24 Making a Claim

26 Assistance Cover

27 Annual Deductibles

27 Your Membership

29 Adding Dependants

29 Making a Complaint

30 Glossary

32 Medical Words and Phrases

WelcomePlease keep your booklet in a safe place. If youneed another copy, you can call:

+44 (0) 1273 323 563 if you are Classic or Essentialcustomer+44 (0) 1273 718 441 if you are Gold customer

or view and print it online at:bupa-intl.com/membersworld

Bold wordsWords in bold have particular meanings in thisbooklet. Please check their definition in the Glossarybefore you read on. You will find the Glossary inthe back of this booklet.

Important membership documentsThis booklet must be read alongside yourmembership certificate and your application forcover, as together they set out the terms andconditions of your membership, and form yourplan documentation.

Membership GuideThis booklet explains how to use your plan,including; how to make a claim and other importantmembership information. It also talks about yourcover in full detail, including; what is covered, whatis not covered and details of USA cover (ifapplicable).

Quick reference guideThis booklet contains a summary of all yourimportant contact information; the sort ofinformation you are likely to use on a regular basis.

How to use yourBupa Global groupplanStep 1: Where to gettreatmentAs long as it is covered by your plan, you can haveyour treatment at any recognised hospital orclinic. If you dont know where to go, please contactour Healthline service for help and advice.

Participating hospitalsTo help you find a facility, we have also developeda global network of over 7,500 medical centres,called participating hospitals and clinics. The list isupdated regularly, so please visit bupa-intl.com forthe latest information. We can normally arrangedirect settlement with these facilities (see Step 3below).

Getting treatment in the USAYou must call our dedicated team on 844 369 3797(from inside the US), or +1 844 369 3797 (fromoutside the US) to arrange any treatment in theUSA.

Step 2: Contact usIf you know that you may need treatment, pleasecontact us first. This gives us the chance to check your cover, and to make sure that we can give youthe support of our global networks, ourknowledge and our experience.

Pre-authorising in-patient treatmentand day-case treatmentYou must contact us whenever possible before in-patient treatment or day-case treatment,for pre-authorisation. This means that we canconfirm to you and to your hospital that your treatment will be covered under your plan.

Pre-authorisation puts us directly in touch with your hospital, so that we can look after thedetails while you concentrate on getting well. ThePre-authorisation section contains all of the rulesand information about this.

When you contact us, please have yourmembership number ready. We will ask some or allof the following questions:

what condition are you suffering from?when did your symptoms first begin?when did you first see your family doctorabout them?what treatment has been recommended?on what date will you receive the treatment?what is the name of your consultant?where will your proposed treatment takeplace?

how long will you need to stay in hospital?

If we can pre-authorise your treatment, we willsend a pre-authorisation statement that will also actas your claim form (see Step 3 below).

Step 3: Making a claimPlease read the Making a claim section for fulldetails of how to claim. Here are some guidelinesand useful things to remember.

What to sendWe must receive a fully completed claim form andthe invoices for your treatment, within 2 years ofthe treatment date.

If this is not possible, please write to us with thedetails and we will see if an exception can be made.

Your claim formYou must ensure that your claim form is fullycompleted by you and by your medicalpractitioner. The claim form is important becauseit gives us all the information that we need.Contacting you or your medical practitioner formore information can take time, and an incompleteclaim form is the most common reason for delayedpayments.

You can download a claim form from ourMembersWorld website, or contact us to send youone. Remember that if your treatment ispre-authorised, your pre-authorisation statementwill act as your claim form.

How we make paymentsWherever possible, we will follow the instructionsgiven to us in the payment section of the claimform:

we can pay you or the hospitalwe can pay by cheque or by electronictransferwe can pay in over 80 currencies

To carry out electronic transfers, we need to knowthe full bank name, address, SWIFT code and (inEurope only) the IBAN number of your bankaccount. You can give us this information on theclaim form.

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Tracking a claimWe will process your claim as quickly as possible. You can easily check the progress of a claim youhave made by logging on to our MembersWorldwebsite.

Claim payment statement When your claim has been assessed and paid, wewill send a statement to you to confirm when andhow it was paid, and who received the payment. If you subscribe to our secure MembersWorldwebsite, you can view your documents online,upload your claims and view your claimsstatement.

About yourMembershipThe Bupa Global group plan is a group insuranceplan. You are therefore one of a group of members,which has a sponsor (normally the company that you, the principal member work for).

This plan is governed by an agreement between your sponsor and Bupa Global, which coversthe terms and conditions of your membership. Thismeans that there is no legal contract between youand Bupa Global. Only the sponsor and BupaGlobal have legal rights under the agreementrelating to your cover, and only they can enforcethe agreement.

As a member of the plan, you do have access to our complaints process. This includes the use of anydispute resolution scheme we have for ourmembers.

The following must be read together as they set outthe terms and conditions of your membership:

you, the principal members applicationfor cover: this includes any quote request,applications for cover for you and your dependants (if any) and the declarationsthat you, the principal member madeduring the application process your rules and benefits in this MembershipGuideyour membership certificate

The full name of your insurer is shown on yourmembership certificate.

When your cover startsThe start date of your membership is the effectivefrom date shown on your membership certificate.

If you move to a new country orchange your specified country ofnationalityYou, the principal member, must tell your sponsor straight away if your specified countryof residence or your specified country ofnationality changes.

Your new country may have different regulationsabout health insurance. You, the principalmember need to tell your sponsor of any changeso that we can make sure that you have the rightcover.

What is covered?Please read this important information about thekind of costs that we cover.

Treatment that we coverFor us to cover any treatment that you receive, itmust satisfy all of the following requirements:

it is at least consistent with generallyaccepted standards of medical practice inthe country in which treatment is beingreceivedit is clinically appropriate in terms of type,duration, location and frequency, andit is covered under the terms and conditionsof the plan

We will not pay for treatment which in ourreasonable opinion is inappropriate based onestablished clinical and medical practice, and weare entitled to conduct a review of your treatment, when it is reasonable for us to do so.

Active treatmentThis plan covers you for the costs of activetreatment only. By this we mean treatment of adisease, illness or injury that leads to your recovery,conservation of your condition or to restore you toyour previous state of health as quickly as possible.

Note: please see Wellness and Full Health Screeningin the table of benefits and Preventive and wellness treatment in the What is not covered? section forinformation on preventive treatment.

Reasonable and customary chargesWe will pay for reasonable and customary costs.This means that the costs charged by your treatment provider should not be more than theywould normally charge and be representative ofcharges by other treatment providers in the samearea*.

* Guidelines for fees and medical practice (includingestablished treatment plans, which outline themost appropriate course of care for a specificcondition, operation or procedure) may bepublished by a government or official medical body.In such cases, or where published insurance industrystandards exist, we may refer to these whenassessing and paying claims. Charges in excess ofpublished guidelines or reasonable and customarycosts may not be paid.

Table of benefitsThe table of benefits shows the benefits, limits andthe detailed rules that apply to your plan. You alsoneed to read the What is not covered? section sothat you understand the exclusions on your plan.

Variations to your benefitsYour sponsor may have agreed variations to thisbenefit table with your insurer. If so, your sponsor will inform you of these variations.

How to read the Table of benefitsThere are four levels of cover: Essential, Classic,Gold and Gold Superior. You need to read thecolumn in the Table of benefits that applies to yourlevel of cover, as shown on your membershipcertificate.

Benefit limitsThere are two kinds of benefit limits shown in thistable. The overall annual maximum is the maximum we will pay for all benefits in total for each person,each membership year. Some benefits also havea limit applied to them separately; for examplehome nursing.

Gold Superior cover only: on the Gold Superior level,this overall annual maximum also incorporates anannual maximum per condition.

All benefit limits apply per member. If a benefit limitalso applies per membership year, this meansthat once a benefit limit has been reached, thatbenefit will no longer be available until you, the principal member renew your plan and start anew membership year.

If a benefit limit applies for the whole of yourmembership, once this benefit limit has beenreached, no further benefits will be paid, regardlessof the renewal of your plan.

CurrenciesAll the benefit limits in this table of benefits andnotes are set out in three currencies: GBP, USD andEUR. The currency in which your sponsor pays ussubscriptions is the currency that applies to yourmembership for the purpose of the benefit limits.The currency applicable for your contract is asshown on your membership certificate.

For example, if your sponsor pays ussubscriptions in GBP then the benefit limits given inGBP apply to your membership and USD and EURlimits do not apply to you.

If you are unsure which level of cover you have,the currency that applies to your membership, orwhether you, the principal member have an annual deductible, you can either check on your membership certificate, through ourMembersWorld website or contact the customerservices helpline.

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Gold SuperiorGoldClassicEssentialSummary of benefitsOut-patient treatmentOverall annual maximum*Out-patient surgical operations

Wellness mammogram, PAP test, prostate cancer screening or colon cancer screening (after one years membership)Full Health Screening cholesterol, blood pressure, diabetes, anaemia, lung function, liver and kidney function, cardiac risk assessment and hearing tests (after one yearsmembership)Consultants fees for consultationsPathology, X-rays and diagnostic tests

Costs for treatment by therapists, complementary medicine practitioners and qualified nurses

Consultants fees, psychologists and psychotherapists fees for psychiatric treatment (after two years membership)VaccinationsCosts for treatment by a family doctor

Prescribed drugs and dressingsAccident-related dental treatment

In-patient and day-case treatmentHospital accommodationSurgical operations, including pre- and post-operative careNursing care, drugs and surgical dressingsPhysicians feesTheatre chargesIntensive care

Pathology, X-rays, diagnostic tests and therapiesProsthetic implants and appliances

Parent accommodationPsychiatric treatment (after two years membership, lifetime maximum 90 days)

Further benefitsAdvanced imagingCancer treatment

Healthline servicesHIV/AIDS drug therapy including ART (after five years membership)Home nursing after in-patient treatment

Hospice and palliative careIn-patient cash benefitLocal air ambulanceLocal road ambulanceMaternity cover (after 10 months membership)Newborn careProsthetic devicesRehabilitation

Transplant services

Optional benefits, if purchasedUSA coverDental treatment

Optical(Dental treatment and optical must be purchased together)Assistance cover (Evacuation and Repatriation)

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This is a summary of your plan. Please read the table of benefits and exclusions on the following pages for detailed rules and benefit limits.

Gold SuperiorGoldClassicEssentialSummary of exclusionsArtificial life maintenanceBirth controlConflict and disasterCongenital conditionsConvalescence and admission for general careCosmetic treatment

DeafnessDental treatment/gum diseaseDesensitisation and neutralisationDevelopmental problemsDonor organsDrugs and dressings (out-patient)Epidemics and pandemics:Experimental treatment

EyesightFamily doctor treatment

FootcareGenetic testingHarmful or hazardous use of alcohol, drugs and/or medicinesHealth hydros, nature cure clinics etc.Hereditary conditionsHIV/AIDSInfertility treatment

MaternityObesityPersistent vegetative state (PVS) and neurological damagePersonality disordersPhysical aids and devicesPre-existing conditions

Preventive and wellness treatment

Reconstructive or remedial surgerySelf-inflicted injuriesSexual problems/gender issuesSleep disordersSpeech disordersStem cellsSurrogate parentingTravel costs for treatment

Unrecognised medical practitioner, provider or facilityUSA treatment

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This is a summary of your plan. Please read the table of benefits and exclusions on the following pages for detailed rules and benefit limits.

Table of BenefitsOut-patient treatmentImportantThis is treatment which does not normally require a patient to occupy a hospital bed. The list below details the benefits payable for out-patient treatment only. If you are having treatment and you are not sure which benefitapplies, please call us and we will be happy to help.

Benefits Gold SuperiorGoldClassicEssential Explanation of benefits

GBP 6,000,000USD 10,200,000EUR 7,500,000**

GBP 1,200,000USD 2,000,000EUR 1,500,000

GBP 900,000USD 1,500,000EUR 1,000,000

GBP 600,000USD 1,000,000EUR 750,000

Overall annual maximum* * The currency applicable for your contract is as shown on your membership certificate.

** Up to a maximum of GBP 1,800,000, USD 3,000,000 or EUR 2,250,000 per condition

Paid in fullPaid in fullPaid in fullPaid in fullOut-patient surgical operations We pay for out-patient surgical operations when carried out by a consultant or a family doctor.

We pay up toGBP 1,200, USD 2,000 or EUR 1,500 each membershipyear

We pay up to GBP 600, USD 1,000 or EUR750 each membershipyear

We pay up to GBP 600, USD 1,000 or EUR750 each membershipyear

Not coveredWellness mammogram, PAP test,prostate cancer screening or coloncancer screening (after one yearsmembership)

We pay for these four preventive checks only, after you have been a member of the plan for one year.

Not coveredNot coveredNot coveredFull Health Screening cholesterol,blood pressure, diabetes, anaemia,lung function, liver and kidneyfunction, cardiac risk assessmentand hearing tests (after one yearsmembership)

We pay for these health checks only, after you have been a member of the plan for one year.

Paid in fullPaid in fullWe pay up to GBP 6,400, USD 10,900 or EUR 8,000 each membershipyear

Not coveredConsultants fees for consultations This normally means a meeting with a consultant to assess your condition. Such meetings may take place in the specialists ordoctors office, by telephone or using the internet.

Pathology, X-rays and diagnostictests

We pay for:

pathology, such as checking blood and urine samples for specific abnormalities,radiology, such as X-rays, anddiagnostic tests, such as electro-cardiograms (ECGs)

when recommended by your consultant or family doctor to help determine or assess your condition.

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Out-patient treatment (continued)


We pay in full forup to 60 visits eachmembershipyear



Not coveredCosts for treatment by therapists, complementarymedicine practitioners and qualified nurses

We pay for nursing charges for general nursing care, for example injections or wound dressings by a qualified nurse andconsultations and treatment with therapists and complementary medicine practitioners when they are appropriatelyqualified and registered to practice in the country where treatment is received.

This includes the cost of both the consultation and treatment, including any complementary medicine prescribed oradministered as part of your treatment.

Should any complementary medicines or treatments be supplied or carried out on a separate date to a consultation, these costswill be considered as a separate visit.

Note: for dieticians, we pay the initial consultation plus two follow-up visits when needed as a result of an eligible condition.

Please note that obesity is not covered.



We pay in full forup to 15 visits each membershipyear

Not coveredConsultants fees, psychologistsand psychotherapists fees for psychiatric treatment (after twoyears membership)

We will pay after you have been a member of the plan (or any Bupa administered plan which includes cover for psychiatrictreatment) for the whole of the two years leading up to the psychiatric treatment.

We pay up to GBP 600, USD1,000 or EUR 750each membershipyear

We pay up to GBP 180, USD 300or EUR 200 each membershipyear


Not coveredVaccinations We pay for vaccinations including vaccinations to aid the prevention of cancer, such as the human papilloma virus (HPV)vaccination, as and when such vaccines have completed medical trials and are approved for use in the country of treatment.

Paid in fullWe pay in full forup to 20 visits eachmembershipyear

Not coveredNot coveredCosts for treatment by a familydoctor

We pay for family doctor treatment.

Such meetings may take place in the specialists or doctors office, by telephone or using the internet.

Paid in fullWe pay up to GBP 1,200, USD2,000 or EUR 1,500each membershipyear

Not coveredNot coveredPrescribed drugs and dressings We pay for the cost of drugs and dressings prescribed for you by your medical practitioner for eligible treatment. Weonly pay for items which need a prescription.

Note: this benefit does not include costs for complementary medicine prescribed or administered, as these are paid under thebenefit described in the costs for treatment by therapists and complementary medicine practitioners benefit.



Not coveredNot coveredAccident-related dental treatment We pay for accident-related dental treatment that you receive from a dental practitioner for treatment during an emergency visit following accidental damage to any tooth.

We only pay any accident-related dental treatment which takes place up to 30 days after the accident.

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In-patient and day-case treatmentImportantFor all in-patient and day-case treatment costs:

it must be medically essential for you to occupy a hospital bed to receive the treatmentyour treatment must be provided, or overseen, by a consultantwe pay for accommodation in a room that is no more expensive than the hospitals standard single room with a private bathroom. This means that we will not pay the extra costs of a deluxe, executive or VIP suite etc.if the cost of treatment is linked to the type of room, we pay the cost of treatment at the rate which would be charged if you occupied a standard single room with a private bathroomthe hospital where you have your treatment must be recognised

Long in-patient stays: 10 nights or longerIn order for us to cover an in-patient stay lasting 10 nights or more, you must send us a medical report from your consultant before the eighth night, confirming:

your diagnosistreatment already giventreatment planneddischarge date


Paid in fullPaid in fullPaid in fullPaid in fullHospital accommodation We pay charges for your hospital accommodation, including all your own meals and refreshments. We do not pay forpersonal items such as telephone calls, newspapers, guest meals or cosmetics.

We pay for accommodation in a room that is no more expensive than the hospitals standard single room with a privatebathroom. This means that we will not pay the extra costs of a deluxe, executive or VIP suite etc.

We pay for the length of stay that is medically appropriate for the procedure that you are admitted for.

Examples: unless medically essential, we do not pay for day-case accommodation for out-patient treatment (such as an MRIscan), and we do not pay for in-patient accommodation for day-case treatment (such as a biopsy).

Please also read convalescence and admission for general care in the What is not covered? section.

Paid in fullPaid in fullPaid in fullPaid in fullSurgical operations, includingpre- and post-operative care

We pay surgeons and anaesthetists fees for a surgical operation, including all pre- and post-operative care.

Note:

we do not pay for drugs and surgical dressings you receive for out-patient treatment or use at home unless youhave Company Gold or Gold Superior cover (see Prescribed drugs and dressings in this section and Drugs and dressingsin the What is not covered? section)this benefit does not include follow-up consultations with your consultant, as these are paid under the consultantsfees for consultations benefit

Paid in fullPaid in fullPaid in fullPaid in fullNursing care, drugs and surgicaldressings

We pay for nursing services, drugs and surgical dressings you need as part of your treatment in hospital.

Note:

we do not pay for drugs and surgical dressings you receive for out-patient treatment or use at home (for Essentialand Classic members only), and we do not pay for nurses hired in addition to the hospitals own staff. In the rare case where a hospital does notprovide nursing staff we will pay for the reasonable cost of hiring a qualified nurse for your treatment

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In-patient and day-case treatment (continued)


Paid in fullPaid in fullPaid in fullPaid in fullPhysicians fees We pay physicians fees for treatment you receive in hospital if this does not include a surgical operation, for example if you are in hospital for treatment of a medical condition such as pneumonia.

If your treatment includes a surgical operation we will only pay physicians fees if the attendance of a physician is medicallynecessary, for example, in the rare event of a heart attack following a surgical operation.

Paid in fullPaid in fullPaid in fullPaid in fullTheatre charges We pay for use of an operating theatre.

Paid in fullPaid in fullPaid in fullPaid in fullIntensive care We pay for intensive care in an intensive care unit/intensive therapy unit, high dependency or coronary care unit (or theirequivalents) when:

it is an essential part of your treatment and is required routinely by patients undergoing the same type of treatmentas yours, orit is medically necessary in the event of unexpected circumstances, for example if you have an allergic reaction duringsurgery

Paid in fullPaid in fullPaid in fullPaid in fullPathology, X-rays, diagnostictests and therapies

We pay for:

pathology, such as checking blood and urine samplesradiology (such as X-rays), anddiagnostic tests such as electrocardiograms (ECGs)

when recommended by your consultant to help determine or assess your condition when carried out in a hospital.

We also pay for treatment provided by therapists (such as physiotherapy) and complementary medicine practitioners(such as acupuncturists) if it is needed as part of your treatment in hospital.

Paid in fullPaid in fullPaid in fullPaid in fullProsthetic implants and appliances

We pay for a prosthetic implant needed as part of your treatment. By this, we mean an artificial body part or appliancewhich is designed to form a permanent part of your body and is surgically implanted for one or more of the following reasons:

to replace a joint or ligamentto replace one or more heart valvesto replace the aorta or an arterial blood vesselto replace a sphincter muscleto replace the lens or cornea of the eyeto act as a heart pacemakerto remove excess fluid from the brainto control urinary incontinence (bladder control)to reconstruct a breast following surgery for cancer when the reconstruction is carried out as part of the original treatment for the cancer and you have obtained our written consent before receiving the treatmentto restore vocal function following surgery for cancer

We also pay for the following appliances:

a knee brace which is an essential part of a surgical operation for the repair to a cruciate (knee) ligament, ora spinal support which is an essential part of a surgical operation to the spine

Paid in fullPaid in fullPaid in fullPaid in fullParent accommodation We pay for hospital accommodation for each night you need to stay with your child in the same hospital. This is limited toonly one parent each night.

Your child must be:

aged under 18, anda member of a Bupa Global administered plan receiving treatment for which he or she is covered under their plan

9

In-patient and day-case treatment (continued)


Paid in fullPaid in fullPaid in fullPaid in fullPsychiatric treatment (after twoyears membership, lifetimemaximum 90 days)

We pay for psychiatric treatment you receive in hospital after you have been a member of the plan (or any Bupaadministered plan which includes cover for psychiatric treatment) for two years before the psychiatric treatment.

We pay for a total of 90 days psychiatric treatment in hospital during your lifetime. This benefit applies to all treatmentrelated to the psychiatric condition. This applies to all Bupa administered plans you have been a member of in the past, or maybe a member of in the future, whether your membership is continuous or not.

Example: If we have paid for 45 days psychiatric treatment in hospital under another Bupa administered plan, we will onlypay for another 45 days psychiatric treatment in hospital under this plan.

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Further benefitsImportantThese are the additional benefits provided by your membership of the Company plan.These benefits may be in-patient, out-patient or day-case.


Paid in fullPaid in fullPaid in fullPaid in fullAdvanced imaging We pay for magnetic resonance imaging (MRI), computed tomography (CT) and positron emission tomography (PET) whenrecommended by your consultant or family doctor.

Paid in fullPaid in fullPaid in fullPaid in fullCancer treatment Once cancer is diagnosed, we pay fees that are related specifically to planning and carrying out treatment for cancer. Thisincludes tests, scans, consultations and drugs (such as cytotoxic drugs or chemotherapy).

IncludedIncludedIncludedIncludedHealthline services This is a telephone advice line which offers help 24 hours a day, 365 days a year. Please call +44 (0) 1273 333 911 at any timewhen you need to.

The following are some of the services that may be offered by telephone:

general medical information from a health professionalmedical referrals to a physician or hospitalmedical service referral (ie locating a physician) and assistance arranging appointmentsinoculation and visa requirements informationemergency message transmissioninterpreter and embassy referral

Note: treatment arranged through this service may not be covered under your plan. Please check your cover beforeproceeding.

We pay up to GBP 12,000, USD 20,000 or EUR 15,000 each membershipyear



Not coveredHIV/AIDS drug therapy includingART (after five years membership)

We pay for HIV/AIDS drug therapy after you have been a member of the plan for the whole of the five years leading up to the treatment.

Note: we pay for treatment that is not drug therapy or ART from your in-patient treatment or out-patient benefits if youhave been a member of the plan for five years.

Note (for Essential members only): We pay for in-patient treatment of HIV/AIDS if you have been a member of the plan forfive years. This does not include any drug therapy or ART.

We pay up to GBP 120, USD 200 or EUR 150 each dayup to a maximumof 30 days each membershipyear




Home nursing after in-patienttreatment

We pay for home nursing after eligible in-patient treatment. We pay if the home nursing:

is needed to provide medical care, not personal assistanceis necessary, meaning that without it you would have to stay in hospitalstarts immediately after you leave hospitalis provided by a qualified nurse in your home, andis prescribed by your consultant

We pay up to GBP 24,000, USD 41,000 or EUR 30,000maximum benefitfor the whole of your membership




Hospice and palliative care If you need in-patient, day-case or out-patient care or treatment following the diagnosis that your condition is terminal, when treatment can no longer be expected to cure your condition, we pay for your physical, psychological, social and spiritual careas well as hospital or hospice accommodation, nursing care and prescribed drugs. The amount shown here is the total amount we shall pay for these expenses during the whole of your membership of Bupa Global, whether continuous or not.

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Further benefits (continued)


We pay GBP 90, USD 150 or EUR 110 each nightup to 20 nightseach membershipyear




In-patient cash benefit This benefit is paid instead of any other benefit for each night you receive eligible in-patient treatment without charge.

To claim this benefit, please ask the hospital to sign and stamp your claim form. Then send the completed form to us with acovering letter stating that you were treated with no charge. Please note that you need to ensure that the medical section of your claim form is completed by your consultant.


Please also see thesection Assistancecover.







Local air ambulance We pay for medically necessary travel for you to be transported by local air ambulance such as a helicopter, when related toeligible in-patient treatment or day-case treatment, either:

from the location of an accident to hospital, orfor a transfer from one hospital to another

when it is appropriate for this method of transfer to be used to transport you over short journeys of up to 100 miles/160kilometres. This benefit does not include mountain rescue.

Note: this benefit does not include evacuation if the treatment you need is not available locally.

Paid in fullPaid in fullPaid in fullPaid in fullLocal road ambulance We pay for medically necessary travel by local road ambulance when related to eligible in-patient treatment or day-casetreatment.

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Maternity andchildbirth:


Childbirth at homeor birthingcentre:


Medically essentialCaesarean section:


Complications ofmaternity andchildbirth:

Paid in full








Paid in full








Paid in full

Not coveredMaternity cover (after 10 monthsmembership)

We pay maternity benefits only after you have been covered under the plan for 10 months.

Maternity and childbirth (after 10 months membership)

These benefits include for example:

ante natal care such as ultrasound scanshospital charges, obstetricians and midwives fees for pregnancy and childbirthpost natal care required by the mother immediately following normal childbirth, such as stitches

Treatment for

abnormal cell growth in the womb (hydatidiform mole) foetus growing outside the womb (ectopic pregnancy)

are not covered from this benefit but may be covered by your other benefits.

(Other conditions arising from pregnancy or childbirth which could also develop in people who are not pregnant are not coveredby this benefit but may be covered by your other benefits).

Note: routine care for your babyWe pay for routine care for the baby, for up to seven days following birth, from the mothers maternity benefit. Any non-routinecare, if eligible, is paid from the babys newborn care benefit, not from the mothers maternity benefit.

Your baby is also covered for up to seven days routine care following birth if your baby was born to a surrogate mother and you, as the intended parent, have been covered on the plan for 10 months when the baby is born.

Childbirth at home or birthing centre (after 10 months membership)This benefit includes obstetricians and midwives fees for delivering your baby at home or a birthing centre.

Medically Essential Caesarean Section (after 10 months membership)This benefit includes hospital, obstetricians and other medical fees for the cost of the delivery of your baby by Caesareansection when medically essential for example, non progression during labour leading to emergency Caesarean section (egdystocia, foetal distress, haemorrhage) provided the mother has been a member of this plan for at least 10 months beforedelivery.

Note: if we are unable to determine that your Caesarean section was medically essential, it will be paid from your maternity andchildbirth benefit limit.

Complications of maternity and childbirth (after 10 months membership)Treatment which is medically necessary as a direct result of pregnancy and childbirth complications.

By complications we mean those conditions which only ever arise as a direct result of pregnancy or childbirth for examplepre-eclampsia, threatened miscarriage, gestational diabetes, still birth.

Please contact us for pre-authorisation where possible. If you require an emergency admission as a direct result of pregnancyand childbirth complications, please contact us within 48 hours of your admission.

Please also see the section Adding dependants.

Please see surrogate parenting, congenital and hereditary conditions in the What is not covered? section.

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We pay GBP 90,000, USD 150,000 or EUR 110,000maximum benefitfor all treatmentreceived during thefirst 90 daysfollowing birth




Newborn care This benefit is paid instead of any other benefit for all treatment required by a newborn child during the first 90 days followingbirth.

Children must have their own membership and must be covered on their own plan before you can claim this benefit

We do not pay newborn care benefits for children born as a result of assisted reproduction technologies, ovulationinduction treatment, born to a surrogate or who have been adopted, as these children can only join once they are 91 days old.

Please see 'Adding dependants' section.

We pay amaximum benefitof GBP 2,400, USD 4,000, EUR 3,000 for each device




Prosthetic devices We pay for the initial prosthetic device needed as part of your treatment. By this we mean an external artificial body part,such as a prosthetic limb or prosthetic ear which is required at the time of your surgical procedure. We do not pay for anyreplacement prosthetic devices for adults including any replacement devices required in relation to a pre-existing condition. We will pay for the initial and up to two replacements per device for children under the age of 16 years.

We pay in full forup to 30 days of treatment(which may be in-patienttreatment, day-casetreatment or out-patienttreatment) each membershipyear



We pay in full forup to 30 days of treatment(which may be in-patienttreatment or day-casetreatment) each membershipyear

Rehabilitation We pay for rehabilitation, including room, board and a combination of therapies such as physical, occupational and speechtherapy after an event such as a stroke. We do not pay for room and board for rehabilitation when the treatment beinggiven is solely physiotherapy.

We pay for rehabilitation, only when you have received our written agreement before the treatment starts, for up to 30days treatment in each membership year. For in-patient treatment one day is each overnight stay and for day-casetreatment and out-patient treatment, one day is counted as any day on which you have one or more appointments for rehabilitation treatment.

We only pay for rehabilitation where it:

starts within 30 days of in-patient treatment which is covered by your membership (such as trauma or stroke), andarises as a result of the condition which required the in-patient treatment or is needed as a result of such treatmentgiven for that condition

Note: in order to give written agreement, we must receive full clinical details from your consultant; including your diagnosis,treatment given and planned, and proposed discharge date if you receive rehabilitation.

Note (for Essential members only): We do not pay for any out-patient rehabilitation.

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Paid in fullPaid in fullPaid in fullPaid in fullTransplant services We pay for transplant services that you need as a result of an eligible condition. We pay medical expenses if you need toreceive a cornea, small bowel, kidney, kidney/pancreas, liver, heart, lung, or heart/lung transplant. We also pay for bone marrowtransplants (either using your own bone marrow or that of a compatible donor) and peripheral stem cell transplants, with orwithout high dose chemotherapy.

We do not pay for costs associated with the donor or the donor organ.

Note (for Essential members only): We do not pay for any out-patient treatment associated with a transplant, either beforeor after that transplant takes place, including consultations, diagnostic tests etc, or drugs prescribed for use as an out-patient,including anti-rejection drugs.

Note (for Classic members only): We do not pay for any drugs prescribed for use as an out-patient, including anti-rejectiondrugs.

Note (for Gold and Gold Superior members only): Any drugs prescribed for use as an out-patient, including anti-rejection drugsare paid from your prescribed drugs and dressings benefit.

Please see donor organs in the What is not covered? section.

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Optional benefits, if purchased


100 percent ofcosts in network.

80 percent of costsout of network.

Treatment must be pre-authorised.










USA cover Pre-authorisation and the US provider network

If you have USA cover, then before any in-patient treatment or day-case treatment in the US, you must contact ourdedicated team for pre-authorisation.

Please contact them by calling 844 369 3797 (from inside the US), or +1 844 369 3797 (from outside the US).

In-patient treatment or day-case treatment received in the US without pre-authorisation may be ineligible. Anypre-authorised treatment costs are covered according to this table of benefits.

Our US Service Partner uses a national network of hospitals, clinics and medical practitioners. This is the US provider network. Our dedicated team can help you to find a hospital or clinic in the US provider network, when you contact themfor pre-authorisation. When eligible treatment takes place in the US using the US provider network, benefit is paid at 100percent. When eligible treatment takes place in the US but outside the US provider network, benefit is paid at 80 percent.

Emergency admissions

If you are admitted for emergency treatment you must contact our dedicated team within 48 hours of admission, or as soonas reasonably possible.

If your admission for emergency treatment is to a non-network hospital, our dedicated team may arrange to transfer youto a network hospital as soon as it is medically appropriate to do so.

If the transfer to a network hospital is carried out, benefit for all eligible treatment received at both facilities will be payableat 100 percent.

If you choose to stay in a non-network hospital after the date our dedicated team decides a transfer is medically appropriate,benefit for all eligible treatment received both before and after that date will be payable at 80 percent.

Please also see USA treatment in the What is not covered? section.

We pay up to GBP 2,400, USD 4,100 or EUR 3,000maximum benefitfor each membershipyear



Not coveredDental treatment We pay (Classic and Gold members):

100 percent of preventive treatment (such as check-ups, X-rays, scale and polishing)80 percent of routine treatment (such as fillings, extractions and root canal therapy)50 percent of major restorative (such as crowns, bridges or implants)50 percent of orthodontic treatment of overbite or under bite etc, up to the age of 19.

We pay (Gold Superior members):

100 percent of preventive treatment (such as check-ups, X-rays, scale and polishing)100 percent of routine treatment (such as fillings, extractions and root canal therapy)50 percent of major restorative (such as crowns, bridges or implants)50 percent of orthodontic treatment of overbite or under bite etc, up to the age of 19.

Note (for Gold Superior members only): This benefit is available only in conjunction with the optical benefit.

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Optional benefits, if purchased (continued)


We pay up to GBP 250, USD 425 or EUR 315 maximumbenefit for each membershipyear

Not coveredNot coveredNot coveredOptical(Dental treatment andoptical must be purchased together)

We pay (Gold Superior members):

maximum of one eye test each membership year, which includes the cost of your consultation and sight/visiontesting75 percent of eligible costs for spectacle and contact lenses which are prescribed to correct a sight/vision problem, suchas short or long sight75 percent of eligible costs of spectacle frames only if you have been prescribed spectacle lenses, your spectacle lensprescription or invoice will be required in support of your claim for spectacle frames

Note (for Gold Superior members only): This benefit is available only in conjunction with the dental treatment benefit.

Assistance cover (Evacuation andRepatriation)

Your membership certificate will show if you have purchased this cover. Please see Assistance cover section.

The overall annual maximum benefit limit does not apply.

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What is not covered?There are certain conditions and treatments that we do not cover. If you are unsure about anything in this section, please contact us for confirmation before you go for your treatment.

Important - please readPersonal exclusions

Please check your membership certificate to see if you have any personal exclusions or restrictions on your plan.The exclusions in this section apply in addition to and alongside any such personal exclusions and restrictions.

General note for all exclusionsFor all exclusions in this section, and for any personal exclusions or restrictions shown on your membership certificate,please note that:

we do not pay for conditions which are directly related to excluded conditions or treatmentswe do not pay for any additional or increased costs arising from excluded conditions or treatmentswe do not pay for complications arising from excluded conditions or treatments

Example:You have a personal exclusion for diabetes.

If your diabetes were to cause kidney problems, we would not pay for treatment of such kidney problems.If while receiving treatment for another condition, you need to stay extra nights in hospital because of your diabetes, we would not pay for these extra nights.

ExceptionsThis section describes some circumstances where exceptions can be made to exclusions or restrictions. Where this is the case, benefit is payable up to the limits set out in the table of benefits.

Exclusion Notes Rules

Artificial life maintenance Including mechanical ventilation, where such treatment will not or is not expected to result in your recovery or restore you to your previous state of health.

Example: We will not pay for artificial life maintenance when you are unable to feed or breathe independently and requirepercutaneous endoscopic gastrostomy (PEG) or nasal feeding for a period of more than 90 continuous days.

Birth control Any type of contraception, sterilisation, termination of pregnancy or family planning.

Conflict and disaster Treatment for any disease, illness or injury resulting from nuclear or chemical contamination, war, riot, revolution, acts ofterrorism or any similar event, if one or more of the following apply:

you have put yourself in danger by entering a known area of conflict where active fighting or insurrections are takingplaceyou were an active participantyou have displayed a blatant disregard for personal safety

Congenital conditions Please see the table ofbenefits for details of your Newborn carelimit.

Treatment received after the first 90 days following birth (or after the maximum benefit limit for Newborn care has beenreached) for any abnormality, deformity, disease, illness or injury present at birth, whether diagnosed or not, except cancer.

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Convalescence and admission for general care Hospital accommodation when it is used solely or primarily for any of the following purposes:

convalescence, supervision, pain management or any other purpose other than for receiving eligible treatment, of atype which normally requires you to stay in hospitalreceiving general nursing care or any other services which do not require you to be in hospital, and could be providedin a nursing home or other establishment that is not a hospitalreceiving services from a therapist or complementary medicine practitionerreceiving services which would not normally require trained medical professionals such as help in walking, bathing orpreparing meals

Cosmetic treatment Treatment undergone for cosmetic or psychological reasons to improve your appearance, such as a re-modelled nose, faceliftor cosmetic dentistry. This includes:

dental implants to replace a sound natural toothhair transplants for any reasontreatment related to or arising from the removal of non-diseased, or surplus or fat tissue, whether or not it is neededfor medical or psychological reasonsany treatment for a procedure to change the shape or appearance of your breast(s) whether or not it is needed formedical or psychological reasons: unless for reconstruction carried out as part of the original treatment for the cancer,when you have obtained our written consent before receiving the treatment (see Reconstructive or remedial surgeryin this section)

Examples: we do not pay for breast reduction for backache or gynaecomastia (the enlargement of breasts in men).

Note: If your doctor recommends cosmetic treatment to correct a functional problem, for example, excess eye tissue which isinterrupting the visual field, your case will be assessed by our clinical teams on an individual basis. If approved, benefits will bepaid in line with the rules and benefits of your plan.

Deafness Treatment for or arising from deafness or partial hearing loss caused by a congenital abnormality or ageing.

Dental treatment/gum disease Please see dental treatment in the tableof benefits. Please seeaccident related dental inthe table of benefits.

This includes surgical operations for the treatment of bone disease when related to gum disease or damage, or treatmentfor, or arising from disorders of the temporomandibular joint.

Examples: we do not pay for tooth decay, gum disease, jaw shrinkage or loss, damaged teeth, etc.

Exception: we pay for a surgical operation carried out by a consultant to:

put a natural tooth back into a jaw bone after it is knocked out or dislodged in an accidenttreat irreversible bone disease involving the jaw(s) which cannot be treated in any other way, but not if it is related togum disease or tooth disease or damagesurgically remove a complicated, buried or impacted tooth root, for example in the case of an impacted wisdom tooth

Desensitisation and neutralisation Treatment to de-sensitise or neutralise any allergic condition or disorder.

Developmental problems Treatment for, or related to developmental problems, including:

learning difficulties, such as dyslexiabehavioural problems, such as attention deficit hyperactivity disorder (ADHD) problems relating to physical development such as short height, ordevelopmental problems treated in an educational environment or to support educational development

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Donor organs Treatment costs for, or as a result of the following:

transplants involving mechanical or animal organsthe removal of a donor organ from a donorthe removal of an organ from you for purposes of transplantation into another personthe harvesting and storage of stem cells, when this is carried out as a preventive measure against future possiblediseases or illnessthe purchase of a donor organ

Drugs and dressings (out-patient) Exclusion applies toEssential and Classiccover only.

Any drugs or surgical dressings that are provided or prescribed for out-patient treatment, or for you to take home with youon leaving hospital, for any condition.

Epidemics and pandemics: We do not pay for treatment for or arising from any epidemic disease and/or pandemic disease and we do not pay forvaccinations, medicines or preventive treatment for or related to any epidemic disease and/or pandemic disease.

Experimental treatment We do not pay for any treatment or medicine which in our reasonable opinion is experimental based on acceptablecurrent clinical evidence and practiceWe do not pay for any treatment or medicine which in our reasonable opinion is not effective based on acceptablecurrent clinical evidence and practiceWe do not pay for medicines and equipment used for purposes other than those defined under their licence unless thishas been pre-authorised

Note: We do not cover any costs related to an experimental treatment or medicine if it is being undertaken as part of a registered clinical trial and these costs are met by the clinical trial sponsor.

Note: Please contact us for pre-authorisation before proceeding with your treatment. We reserve the right to ask for fullclinical details from your consultant before authorising any treatment, in which case you must receive our written agreement before the treatment takes place.

Eyesight Please see optical in thetable of benefits.

Treatment, equipment or surgery to correct eyesight, such as laser treatment, refractive keratotomy (RK) and photorefractivekeratotomy (PRK).

Examples: we will not pay for routine eye examinations, contact lenses or spectacles. We will pay for eligible treatment orsurgery of a detached retina, glaucoma, cataracts or keratoconus.

Family doctor treatment Exclusion applies toEssential and Classiccover only.

Treatment or services carried out by a family doctor, including vaccinations..

Footcare Treatment for corns, calluses, or thickened or misshapen nails.

Genetic testing Genetic tests, when such tests are solely performed to determine whether or not you may be genetically likely to develop amedical condition.

Example: we do not pay for tests used to determine whether you may develop Alzheimers disease, when that disease is notpresent.

Harmful or hazardous use of alcohol, drugs and/or medicines Treatment for or arising from the harmful, hazardous or addictive use of any substance including alcohol, drugs and/ormedicines.

Health hydros, nature cure clinics etc. Treatment or services received in health hydros, nature cure clinics or any establishment that is not a hospital.

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Hereditary conditions Treatment of abnormalities, deformities, diseases or illnesses that are only present because they have been passed downthrough the generations of your family, except cancer.

HIV/AIDS Please see HIV/AIDSdrug therapy in the tableof benefits.

Treatment for, or arising from, HIV or AIDS, including any condition that is related to HIV or AIDS, if your current period ofmembership is less than five years.

Infertility treatment Treatment to assist reproduction, including but not limited to IVF treatment.

Note: we pay for reasonable investigations into the causes of infertility if:

neither you nor your partner had been aware of any problems before joining, andyou have both been members of this plan (or any Bupa administered plan which included cover for this type ofinvestigation) for a continuous period of two years before the investigations start

Once the cause is confirmed, we will not pay for any additional investigations in the future.

Maternity Exclusion applies toEssential cover only

Treatment for maternity or for any condition arising from maternity except the following conditions and treatments:

abnormal cell growth in the womb (hydatidiform mole)foetus growing outside of the womb (ectopic pregnancy)other conditions arising from pregnancy or childbirth, but which could also develop in people who are not pregnant

Obesity Treatment for, or required as a result of obesity.

Persistent vegetative state (PVS) and neurological damage We will not pay for in-patient treatment for more than 90 continuous days for permanent neurological damage or if you arein a persistent vegetative state.

Personality disorders Treatment of personality disorders, including but not limited to:

affective personality disorderschizoid personality (not schizophrenia)histrionic personality disorder

Physical aids and devices Any physical aid or device which is not a prosthetic implant, prosthetic device, or defined as an appliance.

Examples: we will not pay for hearing aids, spectacles, contact lenses, crutches or walking sticks.

Pre-existing conditions Please note: thisexclusion does not applyif your sponsor haspurchased cover withmedical historydisregarded. If you areunsure whether youhave this cover, pleasecontact the customerservices helpline. For pre-existingconditions fornewborns, please see theexclusions for congenitaland hereditaryconditions in this section.

Any treatment for a pre-existing condition, related symptoms, or any condition that results from or is related to a pre-existing condition, unless:

we were given all the medical information that we asked for during your application for your current continuousperiod of membershipwe did not specifically exclude cover for the pre-existing condition on your membership certificate, andyou did not know about the pre-existing condition before the effective from date on the first membershipcertificate for your current continuous period of membership

Note: please contact us before your renewal date if you would like us to review a personal exclusion. We may remove yourexclusion if, in our opinion, no further treatment will be either directly or indirectly required for the condition, or for any relatedcondition. There are some personal exclusions that, due to their nature, we will not review.

To carry out a review, we must receive full current clinical details from your family doctor or consultant. Any costs incurredin obtaining these details are not covered under your plan and are your responsibility.

21


Preventive and wellness treatment Please see wellness andfull health screening inthe table of benefits.

Health screening, including routine health checks, or any preventive treatment.

Note: we may pay for prophylactic surgery when:

there is a significant family history of the disease for example ovarian cancer, which is part of a genetic cancersyndrome, and/oryou have positive results from genetic testing (please note that we will not pay for the genetic testing)

Please contact us for pre-authorisation before proceeding with treatment. It may be necessary for us to seek a second opinionas part of our pre-authorisation process.

Reconstructive or remedial surgery Treatment required to restore your appearance after an illness, injury or previous surgery, unless:

the treatment is a surgical operation to restore your appearance after an accident, or as the result of surgery forcancer, if either of these takes place during your current continuous membership of the planthe treatment is carried out as part of the original treatment for the accident or canceryou have obtained our written consent before the treatment takes place

Self-inflicted injuries Treatment for, or arising from, an injury that you have intentionally inflicted on yourself, for example during a suicide attempt.

Sexual problems/gender issues Treatment of any sexual problem including impotence (whatever the cause) and sex changes or gender reassignments.

Sleep disorders Treatment, including sleep studies, for insomnia, sleep apnoea, snoring, or any other sleep-related problem.

Speech disorders Treatment for speech disorders, including stammering or speech developmental delays, unless all of the following apply:

the treatment is short term therapy which is medically necessary as part of active treatment for an acute conditionsuch as a stroke,the speech therapy takes place during and/or immediately following the treatment for the acute condition, andthe speech therapy is recommended by the consultant in charge of your treatment, and is provided by a therapist

in which case we may pay at our discretion.

Stem cells We do not pay for the harvesting or storage of stem cells. For example ovum, cord blood or sperm storage.

Surrogate parenting Please also see maternitycover in the table ofbenefits.

Treatment directly related to surrogacy. This applies:

to you if you act as a surrogate, andto anyone else acting as a surrogate for you

Travel costs for treatment Any travel costs related to receiving treatment, unless otherwise covered by:

local air ambulance benefit,local road ambulance benefit, orAssistance cover

Examples:

we do not pay for taxis or other travel expenses for you to visit a medical practitionerwe do not pay for travel time or the cost of any transport expenses charged by a medical practitioner to visit you

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Unrecognised medical practitioner, provider or facility Treatment provided by a medical practitioner, provider or facility who is not recognised by the relevant authoritiesin the country where the treatment takes place as having specialised knowledge, or expertise in, the treatment of thedisease, illness or injury being treated.Treatment provided by Family Members or anyone with the same residence as you. Treatment provided by a medical practitioner, provider or facility to whom we have sent a written notice that weno longer recognise them for the purposes of our plans. Details of treatment providers we have sent written notice toare available on MembersWorld or by telephoning general enquiries. Please see the Quick reference guide booklet forhow to contact us.

USA treatment If USA cover has not been purchased, then any treatment received in the USA is ineligible:

after the 28th day of your visit to the USAfor any condition of which you were aware before your visit to the USAwhen arrangements were not authorised by our agents in the USA, andwhen we know or suspect that you travelled to the USA for the purpose of receiving treatment for a condition, whenthe symptoms of the condition were apparent to you before travelling. This applies whether or not your treatmentwas the main or sole purpose of your visit

Note: you can claim for unforeseen treatment received within 28 days of your arrival in the USA, you must send a photocopyof your airline ticket and stamped passport as evidence of your arrival date with your claim.

Our Service Partner in the US operates a national network of hospitals, clinics and medical practitioners. This is the US provider network. You must contact our dedicated team before you have treatment, and they can help to find a suitablenetwork provider for you.

For eligible treatment that takes place in the US using the US provider network, benefit is paid at 100 percent. When eligible treatment takes place in the US but outside the provider network, benefit is paid at 80 percent.

If USA cover has been purchased, then treatment received in the USA is ineligible when:

arrangements for the treatment were not authorised by our agents in the USA, andwe know or suspect that you purchased cover for and travelled to the USA for the purpose of receiving treatment fora condition, when the symptoms of the condition were apparent to you before buying the cover. This applies whetheror not your treatment was the main or sole purpose of your visit

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Pre-authorisationThis section contains rules and information aboutwhat pre-authorisation means and how it works.

What pre-authorisation meansIf we pre-authorise your treatment, this meansthat we will pay up to the limits of your planprovided that all of the following requirements aremet:

the treatment is eligible treatment thatis covered by your planyou have an active membership at the timethat treatment takes placeyour subscriptions are paid up to datethe treatment carried out matches the treatment authorisedyou have provided a full disclosure of thecondition and treatment requiredyou have enough benefit entitlement tocover the cost of the treatmentyour condition is not a pre-existingcondition (see the What is not covered?section)the treatment is medically necessarythe treatment takes place within 31 daysafter pre-authorisation is given

Note: from time to time we may ask you for moredetailed medical information, for example, to ruleout any relation to a pre-existing condition

Treatment we can pre-authoriseWe can pre-authorise in-patient treatment and day-case treatment, cancer treatment and MRI,CT or PET scans.

Direct settlement/pay and claimDirect settlement is where the provider of your treatment claims directly from us, making thingseasier for you. The alternative is for you to pay andthen claim back the costs from us.

We aim to arrange direct settlement whereverpossible, but it has to be with the agreement ofwhoever is providing the treatment. In general,direct settlement can only be arranged for in-patient treatment or day-case treatment.

Direct settlement is easier for us to arrange if youpre-authorise your treatment first, or if you use aparticipating hospital or clinic.

Length of stay (in-patient treatment)Your pre-authorisation will specify an approvedlength of stay for in-patient treatment. This isthe number of nights in hospital that we will coveryou for. If your treatment will take longer thanthis approved length of stay, then you or your consultant must contact us for an extension to thepre-authorisation.

Treatment in the USAAll in-patient treatment and day-casetreatment, cancer treatment and MRI, CT or PETscans in the USA must be pre-authorised. If you aregoing to receive any of these treatments, ask your medical provider to contact Bupa Global forpre-authorisation. All the information they need ison your membership card.

We have made special arrangements if you needto have treatment or be hospitalised or visit adoctor in the USA. These include access to a select network of quality medical providers and directsettlement of all covered expenses when youreceive treatment in a network hospital.

Treatment which has not beenpre-authorisedIf you choose not to get your treatment in theUSA pre-authorised, we will only pay 50 percenttowards the cost of covered treatment.

Of course we understand that there are times when you cannot get your treatment pre-authorised,such as in an emergency. If you are taken to hospital in an emergency, it is important that you arrange for the hospital to contact us within48 hours of your admission. We can then makesure you are getting the right care, and in the rightplace. If you have been taken to a hospital whichis not part of the network and, if it is the best thingfor you, we will arrange for you to be moved to a network hospital to continue your treatmentonce you are stable.

If we have been notified within 48 hours of an emergency admission to hospital, we will notask you to share the cost of your treatment.

Out of network treatmentIf your treatment in the USA has beenpre-authorised, but you choose not to go to a network hospital, we will only pay 80 percenttowards the cost of covered treatment.

There may be times when it is not possible for youto be treated at a network hospital. Theseinclude:

where there is no network hospital within30 miles of your address, andwhen the treatment you need is notavailable in the network hospital

In these cases, we will not ask you to share the costof your treatment.

Important rulesPlease note that pre-authorisation is only valid if allthe details of the authorised treatment, includingdates and locations, match those of the treatmentreceived. If there is a change in the treatmentrequired, if you need to have further treatment, orif any other details change, then you or your consultant must contact us to pre-authorise thisseparately. We make our decision to approve yourtreatment based on the information given to us. We reserve the right to withdraw our decision ifadditional information is withheld or not given to usat the time the decision is being made.

We reserve the right to withdraw or amend ourdecision if information is subsequently received thatmay be contradictory to the information initiallygiven to us at the time the decision is being made.Failure to comply with any request for additionalinformation may be deemed to be indicative offraudulent activities. Should such a failure occur,information may be disclosed to third parties(including other insurers) with the intention ofpreventing and detecting fraud.

Making a ClaimAt times of ill health, you want to concentrate ongetting well. We will do everything we can to makeyour claim as simple and straightforward aspossible.

How to make a claimClaim formsYour claim form is important as it gives us theinformation that we need to process your claim. Ifit is not fully completed we may have to ask formore information. This can delay payment of yourclaim.

You must complete a new claim form:

for each memberfor each conditionfor each in-patient or day-case stay, andfor each currency of claim

If a condition continues over six months, we will askfor a further claim form to be completed.

What to send usYou need to return the completed form to us bypost, with the invoices, as soon as possible. Thismust be within 2 years of receiving the treatmentfor which you are claiming. Invoices sent to us after2 years will not normally be paid.

Requests for further informationWe may need to ask you for further information tosupport your claim. If we do, you must providethis. Examples of things we might ask for include:

medical reports and other information aboutthe treatment for which you are claimingthe results of any medical examinationperformed at our expense by anindependent medical practitionerappointed by us written confirmation from you as to whetheryou think you can recover the costs youare claiming from another person orinsurance company

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If you do not provide the information that we askfor, we may not pay your claim in full.

Please also read about correspondence in the Yourmembership section.

ImportantWhen making a claim please note:

you must have received the treatmentwhile covered under your membershippayment of your claim will be under theterms of your membership and up to thebenefit levels shown, that apply to you atthe time you receive the treatmentwe will only pay for treatment costsactually incurred by you, not deposits oradvance invoices orregistration/administration fees charged bythe provider of treatmentwe will only pay for treatment costs thatare reasonable and customarywe do not return original documents such asinvoices or letters. However, we will bepleased to return copies if you ask us when you submit your claim.

Fraud prevention and detectionWe have the right, where appropriate, to check your details with fraud prevention agencies, otherinsurers and other relevant third parties for thepurpose of preventing and detecting falseinformation or fraudulent activity. If you give usfalse or inaccurate information and we suspectfraud, we may record this with a fraud preventionagency. We and other organisations may also useand search these records to:

help make decisions about benefit andbenefit related services for you andmembers of your planhelp make decisions on other insuranceproposals and claims for you and membersof your plan/grouptrace debtors, recover debt, prevent fraudand to manage your insurance plansestablish your identityundertake credit searches and additionalfraud searches.

Fraudulent ClaimsYou and any dependant (or anyone acting onbehalf of you or any dependant) must not:

make a fraudulent or exaggerated claimunder this plan;send us fake or forged documents or otherfalse evidence, or make a false statement insupport of a claim; and/orprovide us with information which you orany dependant knows would otherwiseenable us to refuse to pay a claim under thisplan.

Failure to comply with the above will give us theright to:

refuse to pay the whole of the claim; recover any payments we have alreadymade in respect of the claim; and/ornotify you that this plan (or if the fraudulentclaim is made by or on behalf of a particular dependant, the cover under this plan forthat particular dependant) has terminatedfrom the date of any of the acts or omissionsset out above, and we will not refund thepremium.

Confirmation of your claimWe will always send confirmation of how we havedealt with a claim. If applicable, for child dependants (those aged under 18 years), we willwrite to the principal member. If the claim is for treatment received by the principal member, oran adult dependant (those aged over 18 years), we will write directly to the individual concerned.

How your claim will be paidWherever possible, we will follow the instructionsgiven to us in the Payment details section of theclaim form.

Who we will payWe will only make payments to the member whoreceived the treatment, the provider of the treatment, the principal member of themembership or the executor or administrator of themembers estate. We will not make payments toanyone else.

Payment method and bank chargesWe will make payment where possible by electronictransfer or by cheque. Payments made by electronictransfer are quick, secure and convenient. To receivepayment by electronic transfer, we need the fullbank account, SWIFT code, bank address details and(in Europe only) IBAN number to be provided onthe claim form.

We will instruct our bank to recharge theadministration fee relating to the cost of making theelectronic transfer to us but we cannot guaranteethat these charges will always be passed back for usto pay. In the event that your local bank makes acharge for a wire transfer we will aim to refund thisas well. Any other bank charges or fees, such as forcurrency exchange, are your responsibility, unlessthey are charged as a result of our error.

Cheques are no longer valid if they are not cashedwithin 6 months. If you have an out-of-date cheque,please contact customer services, who will be happyto arrange a replacement.

Payment currency and conversionsWe can pay in the currency in which your sponsor pays your subscriptions, the currency ofthe invoices you send us, or the currency of yourbank account.

We cannot pay you in any other currency.

Sometimes, the international banking regulations donot allow us to make a payment in the currency you have asked for. If so, we will send a payment inthe currency of your sponsors subscriptions.

If we have to make a conversion from one currencyto another we will use the exchange rate thatapplies on either the date on which the invoiceswere issued or the last date of the treatment,whichever is later.

The exchange rate used will be the average of thebuying and selling rates across a wide range ofquoted rates by the banks in London on the date inquestion. If the date is not a working day we willuse the exchange rate that applies on the lastworking day before that date.

Other claim informationDiscretionary paymentsWe may, in certain situations, make discretionary orex gratia payments towards your treatment. If we make any payment on this basis, this will stillcount towards the overall maximum amount we willpay under your membership. Making thesepayments does not oblige us to pay them in thefuture.

We do not have to pay for treatment that is notcovered by your plan, even if we have paid anearlier claim for a similar or identical treatment.

Overpayment of claimsIf we overpay you for your claim, we reserve theright to deduct the overpaid amount from futureclaims or seek repayment from you.

Claiming for treatment when others areresponsibleYou must complete the appropriate section of theclaim form if you are claiming for treatment thatis needed when someone else is at fault, forexample in a road accident in which you are avictim. If so, you will need to take any reasonablesteps we ask of you to assist us to:

recover from the person at fault (such asthrough their insurance company) the costof the treatment paid for by Bupa Global, andclaim interest if you are entitled to do so

Note: SubrogationIn certain circumstances, for example, if you are thevictim of an accident, your insurer (or any personor company we nominate) will have the full right ofsubrogation. This means that we can assume yourright to recoup the cost of treatment(s) that wehave paid from the person at fault (or theirinsurance company). In the event of any payment ofany claim under your membership, we or anyperson or company that we nominate maytherefore be subrogated to all your rights ofrecovery and of any person entitled to the benefitsof your coverage. You will need to sign and deliverall documents or papers, and anything else that isrequired to secure these rights. You must not takeany action which could damage or affect these

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rights.

Claiming with joint or double insuranceYou must complete the appropriate section on theclaim form, if you have any other insurance coverfor the cost of the treatment or benefits you haveclaimed from us. If you do have other insurancecover, this must be disclosed to us when claiming,and we will only pay our share of the cost of the treatment or benefits claimed.

Assistance Cover(optional if purchased)

This section contains the rules and information forAssistance cover, an optional benefit which helps you if you need to travel to get the treatmentthat you need.

Note: there are two levels of Assistance cover:Evacuation and Repatriation. Your membershipcertificate will show if you have Evacuation orRepatriation but you can visit the MembersWorldwebsite or contact the customer services helpline if you are unsure.

What is Assistance cover?The Evacuation and Repatriation options both coveryou for reasonable transport costs to the nearestappropriate place of treatment where the treatment that you need is available, if it is notavailable locally. Repatriation also gives you theoption of returning to your specified country ofnationality or your specified country ofresidence.

We may not be able to arrange Evacuation orRepatriation in cases where the local situationmakes it impossible, unreasonably dangerous orimpractical to enter the area; for example from anoil rig or within a war zone.

Assistance covergeneral rulesThe following rules apply to both the Evacuationand Repatriation levels of cover:

you must contact our appointedrepresentatives for confirmation before youtravel, on +44 (0) 1273 333 911

our appointed representatives must agreethe arrangements with youAssistance cover is applicable for in-patient treatment and day-casetreatment onlythe treatment must be recommended by your consultant or family doctor and,for medical reasons, not available locallythe treatment must be eligible under yourplanyou must have cover for the country youare being treated in, for example the USAyou must have the appropriate level ofAssistance cover in place before you needthe treatment

Evacuation or Repatriation will not be eligible if youwere aware of the symptoms of your conditionbefore applying for Assistance cover.

We will not approve a transfer which in ourreasonable opinion is inappropriate based onestablished clinical and medical practice, and weare entitled to conduct a review of your case, whenit is reasonable for us to do so. Evacuation orRepatriation will not be authorised if this would beagainst medical advice.

How to arrange yourEvacuation or RepatriationArrangements for Evacuation or Repatriation will bemade by our appointed representatives and mustbe confirmed in advance by calling + 44 (0) 1273333 911. You must provide us with any informationor proof that we may reasonably ask you for tosupport your request. We will only pay if allarrangements are agreed in advance by BupaGlobals appointed representatives.

Evacuation cover: What we will pay forIf you have Evacuation cover it will be shown on your membership certificate. If you are still unsure you can visit our MembersWorld website orcontact the customer services helpline.

We will pay in full for your reasonabletransport costs for in-patient treatmentor day-case treatment. It may also beauthorised if you need advanced imaging or

cancer treatment such as radiotherapy orchemotherapy.We will only pay for Evacuation to thenearest place where the required treatment is available. This could be toanother part of the country that you are in,and may not be your home country.We will pay for the reasonable travel costsfor a relative or your partner to accompany you, but only if it is medically necessary.We will also pay for the reasonable costs of your, and the accompanying members,return journey to the place you wereevacuated from. All arrangements for yourreturn should be approved in advance by Bupa Global or our appointedrepresentatives and the journey must bemade within fourteen days of the end of the treatment.

We will pay for either: the reasonable cost of the return journey bythe most direct route available by land orsea, orthe cost of an economy class air ticket by themost direct route available, whichever is thelesser amountwe will pay reasonable costs for thetransportation only of your body, subject toairline requirements and restrictions, to yourhome country, in the event of your deathwhile you are away from home. We do notpay for burial or cremation, the cost of burialcaskets etc, or the transport costs forsomeone to collect or accompany yourremains

Note: we do not pay for any other costs related tothe evacuation such as hotel accommodation ortaxis. Costs of any treatment you receive are notpayable under Evacuation cover, but are payablefrom your medical cover as described in the Whatis covered? section.

Please also note that for medical reasons themember receiving treatment may travel in adifferent class from their companion.

Repatriation cover: What we will pay forIf you have Repatriation cover it will be shown on your membership certificate. If you are still unsure you can visit our MembersWorld website orcontact the customer services helpline. Repatriationcover also includes Evacuation cover see above.

We will pay in full for your reasonabletransport costs for in-patient treatmentor day-case treatment.We will pay for repatriation to your specified country of nationality or your specified country of residence.We will pay for one repatriation for eachillness or injury per lifetime.We will pay the reasonable costs for arelative or your partner to accompany youto your specified country ofnationality or your specified countryof residence if we have authorised this inadvance of the repatriation.We will also pay an allowance of up to GBP25, USD 50 or EUR 37 per day for up to 10days to cover the living expenses of theperson accompanying you.We will pay for you and the personaccompanying you to return to where youwere repatriated from. All arrangements for your return must be approved in advanceby Bupa Global or our appointedrepresentatives and you must make thereturn journey within fourteen days of theend of the treatment you were repatriatedfor.

We will pay for either: the reasonable cost of the return journey bythe most direct route available by land orsea, orthe cost of a scheduled return economy classair ticket by the most direct route available,whichever is the lesser amountwe will pay reasonable costs for thetransportation only of your body, subject toairline requirements and restrictions, to yourhome country, in the event of your deathwhile you are away from home. We do notpay for burial or cremation, the cost of burialcaskets etc, or the transport costs for

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someone to collect or accompany yourremains

Note: we do not pay for any other costs related tothe repatriation such as hotel accommodation ortaxis. Costs of any treatment you receive are notpayable under Repatriation cover, but are payablefrom your medical cover as described in the Whatis covered? section.

Please also note that for medical reasons themember receiving treatment may travel in adifferent class from their companion.

Annual DeductiblesPlease read this section if you have an annualdeductible on your plan.

Important please rememberthat:

the annual deductible applies separatelyto each person included on yourmembershipeven if the amount you are claiming is lessthan the annual deductible, you shouldstill submit a claim to usthis is an annual deductible, therefore, if your first claim is towards the end of your membership year, and treatmentcontinues over your renewal date, the annual deductible is payable separatelyfor treatment received in each membership yearif your claims are paid direct to yourmedical provider, you are responsible forpaying any deductible shortfall to theprovider after the claim has been assessedand paid

What is an annual deductible?The annual deductible is the total value that your eligible claims must reach each membershipyear before we will start to pay any benefit.

For example, if you have an annual deductibleof GBP 500, the total value of your eligible claimsmust reach GBP 500 before we will pay any benefit.

The annual deductible applies separately to eachperson on your, the principal membersmembership.

The amount of your annual deductible will beshown on your membership certificate, which youcan view online at our MembersWorld website. If you are unsure whether your cover includes an annual deductible, please contact our customerservices helpline.

At any point you can check the amount of yourremaining annual deductible by contacting ourcustomer services helpline.

Annual deductibles are only available on thefollowing levels of cover:

EssentialClassic Gold

The following levels of cover do not qualify for annual deductibles:

Classic with dentalGold with dentalGold SuperiorGold Superior with optical and dental

How an annual deductible worksIf a claim is smaller than your remaining annualdeductible, you must still submit it to us asnormal. We will not pay any benefit, but the claimwill count towards reaching your annualdeductible. We will send you a statementinforming you how much is left.

If an eligible claim exceeds your remaining annualdeductible, we will pay the amount of the claimless the remaining annual deductible.

Once your annual deductible is reached, we willpay all eligible claims in full, up to the benefit limitsof your plan.

How claims are paid to youIf you submit a claim and have asked us to pay you:

your benefit will be paid less the amount ofthe annual deductiblewe will send you a statement showing how your claim has been settled, including anyamounts set against the annualdeductible

How claims are paid direct to yourmedical providerIf you have asked us to make a payment direct to your medical provider:

we will send payment to the medicalprovider for the eligible claim. We willdeduct from this payment the remaining annual deductible on your membershipwe will send you a statement as usual,confirming the amount that we have paidtowards your claimyou are responsible for paying any shortfallto the provider after your claim has beenassessed and paid

You are responsible for paying the annualdeductible in all circumstances.

Your MembershipThis section contains the rules about yourmembership, including when it will start and end,renewing your plan, how you, the principalmember can change your cover and generalinformation.

Paying subscriptions andother chargesYour sponsor has to pay any and all subscriptionsdue under the agreement, together with any othercharges (such as insurance premium tax) that maybe payable.

Starting and renewing yourmembershipWhen your cover startsYour membership starts on the effective dateshown on the first membership certificate that wesent you, the principal member for your currentcontinuous period of Bupa Global Companymembership.

Renewing your membershipThe renewal of your membership is subject to yoursponsor renewing your membership under the agreement.

Ending your membershipYour sponsor can end your, the principalmembers membership, or that of any of your dependants (if applicable), from the first day of amonth by writing to us. We cannot backdate thecancellation of your membership.

Your membership will automatically end:

if the agreement between Bupa Globaland your sponsor is terminatedif your sponsor does not renew yourmembershipif your sponsor does not pay subscriptionsor any other payment due under the agreement for you or for any other personif the membership of the principalmember endsupon the death of the principal member

If you move to a new country orchange your specified country ofnationalityYou, the principal member must tell your sponsor straight away if your specified countryof residence or your specified country ofnationality changes. We may need to end yourmembership if the change results in a breach ofregulations governing the provision of healthcarecover to local nationals, residents or citizens.

The details of regulations vary from country tocountry and may change at any time.

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In some countries we have local partners who arelicensed to provide insurance cover but which areadministered by Bupa Global. This means thatcustomers experience the same quality BupaGlobal service.

If you change your specified country ofresidence to a country where we have a localpartner, in most cases you will be able to transfer toour partners insurance policy without furthermedical underwriting. You may also be entitled toretain your continuity of Bupa Globalmembership; which means that for those benefitswhich arent covered until you have been a memberfor a certain period, the time you were a memberwith us will count towards that. Please note that if you request a transfer to a local partner, we willhave to share your personal information andmedical history with the local partner.

If you change your specified country ofresidence or your specified country ofnationality, please call the Bupa Globalcustomer services helpline so we can confirm if your Bupa Global membership is affected, and, ifso, whether we can offer you a transfer service.

Important please readBupa Global can end a persons membership andthat of all the other people listed on themembership certificate if there is reasonableevidence that any person concerned has misled, orattempted to mislead us. By this, we mean givingfalse information or keeping necessary informationfrom us, or working with another party to give usfalse information, either intentionally or carelessly,which may influence us when deciding:

whether you (or they) can join the planwhat subscriptions you have to paywhether we have to pay any claim

After your Company membership endsYou, the principal member can apply to transferto a personal Bupa Global plan if yourmembership of your group plan ends. You can alsoapply for your dependants (if applicable) totransfer with you. Please contact the customerservice helpline for more information.

Making changes to yourcoverThe terms and conditions of your membership maybe changed from time to time by agreementbetween your sponsor and Bupa Global.

Amending your membership certificateWe will send you, the principal member a newmembership certificate if:

with the sponsors approval, you, the principal member add a new dependantto your membership (if applicable)we need to record any other changesrequested by your sponsor or that we areentitled to make

Your new membership certificate will replace anyearlier version you possess as from the issue dateshown on the new membership certificate.

General informationOther partiesNo other person is allowed to make or confirm anychanges to your membership on our behalf, ordecide not to enforce any of our rights.

No change to your membership will be valid unlessit is confirmed in writing. Any confirmation of yourcover will only be valid if it is confirmed in writingby us.

If you, the principal member change yourcorrespondence address, please contact us as soonas reasonably possible, as we will send anycorrespondence to the address you last gave us.

CorrespondenceLetters between us must be sent by post and withthe postage paid. We do not return originaldocuments, with the exception of official documentssuch as birth or death certificates. However, if youask us at the time you send any original documentsto us, such as invoices, we can provide certifiedcopies.

Financial Services CompensationSchemeWe are covered by the (FSCS). In the unlikely eventthat we cannot meet our financial obligations, youmay be entitled to compensation from the FSCS, if you are usually resident in the EEA (EuropeanEconomic Area). More information is available fromthe FSCS by calling +44 (0) 20 7892 7301 or on itswebsite fscs.org.uk.

Applicable lawYour membership is governed by English law. Anydispute that cannot otherwise be resolved will bedealt with by courts in England.

If any dispute arises as to interpretation of thisdocument then the English version of this documentshall be deemed to be conclusive and takingprecedence over any other language version of thisdocument.

This can be obtained at all times by contacting thecustomer services helpline.

MisrepresentationYou and any dependant must take reasonablecare to make sure that all facts and information that you (or anyone acting on your or their behalf)provide to us are accurate and complete at the timeyou take out this plan and at each renewal,extension and variation of this plan.

A. If you or any dependant (or anyone acting on your or their behalf) :

deliberately or recklessly give us inaccurateor incomplete information; and/ordo not take reasonable care to give usaccurate and complete information incircumstances where we would not haveissued, renewed, extended or varied this planto you at all, had we known about suchinformation,

then we reserve the right:

where it is you or someone acting on yourbehalf who has failed to comply with theobligations above, to avoid this plan - thismeans that we will treat it as if it had notexisted from the start date, renewal date

or the date that any changes were made tothe plan, as the case may be; where it is a dependant or someone actingon their behalf who has failed to comply withthe obligations above, to avoid that part ofthis plan which applies to the dependant -this means that we will treat it as if the dependant was not covered by this planfrom the start date, renewal date or thedate that any changes were made to theplan, as the case may be

B. Where A. above does not apply and you (orsomeone acting on your behalf) has failed toexercise reasonable care in providing us withinformation, we may refuse to pay all or part of aclaim:

if we would have provided cover to you ondifferent terms, had we been provided withaccurate and complete information, then thisplan will be treated as if it had containedsuch term - in such circumstances, we willonly pay a claim if the claim would havebeen covered by a plan containing thedifferent terms that we would have applied;andif we would have provided you with coverunder this plan at a higher premium, theamount payable on any claim will bereduced proportionally, based on theamount of premium that we would havecharged. For example, we will only pay halfof the claim, if we would have chargeddouble the premium

Where A. above does not apply and a dependant(or someone acting on their behalf) has failed toexercise reasonable care in providing us withinformation we may refuse to pay all or part of aclaim for treatment received by that dependant:

if we would have provided cover for the dependant on different terms, had webeen provided with accurate and completeinformation, then this plan will be treated asif it had contained such terms in suchcircumstances, we will only pay a claim ifthe claim would have been covered by aplan containing the different terms that we

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would have applied; andif we would have provided the dependantwith cover under this plan at a higherpremium, the amount payable on any claimwill be reduced proportionally, based on theamount of premium that we would havecharged. For example, we will only pay halfof the claim, if we would have chargeddouble the premium

We may alternatively add new personal restrictionsor exclusions to your plan for you or any dependant. We will not add any personalrestrictions or exclusions to your cover, for anydisease, illness or injury that started after you or theapplicable dependant joined the plan as long as you:

gave us all the information we asked forbefore you or the applicable dependantjoined, andhave not applied to add any new options to your cover

We reserve the right to withdraw or amend ourdecision if information is withheld, or not given to us at the time the decision is being made. Wereserve the right to withdraw or amend ourdecision if information is subsequently received thatmay be contradictory to the information initiallygiven to us at the time the decision is being made.Failure to comply with any request for additionalinformation may be deemed to be indicative offraudulent activities. Should such a failure occur,information may be disclosed to third parties(including other insurers) with the intention ofpreventing and detecting fraud.

LiabilityOur role under this policy is to provide you withinsurance cover and sometimes to makearrangements (on your behalf) for you to receiveany covered benefits. It is not our role to provide you with the actual covered benefits.

You the principal member, on behalf of yourselfand the dependants, appoint us to act as agentfor you, to make appointments or arrangements foryou to receive covered benefits which you request.We will use reasonable care when acting as your

agent.

We (and our Bupa group of companies andadministrators) shall not be liable to you or anyoneelse for any loss, damage, illness and/or injury thatmay occur as a result of your receiving any coveredbenefits, nor for any action or failure to act of anybenefits provider or other person providing youwith any covered benefits. You should be able tobring a claim directly against such benefits provideror other person.

Your statutory rights are not affected.

Sanction clauseWe will not provide cover nor pay claims under thispolicy if our obligations (or the obligations of ourgroup companies and administrators) under thelaws of any relevant jurisdiction, including UK,European Union, the United States of America, orinternational law, prevent us from doing so. We willnormally tell you if this is the case unless this wouldbe unlawful or would compromise our reasonablesecurity measures. This policy does not providecover to the extent that such cover would expose us (or our group companies and administrators) toany sanction, prohibition or restriction under UnitedNations resolutions or the trade or economicsanctions, laws or regulations of the EuropeanUnion, UK or United States of America, or underother relevant international law.

AddingDependantsIf your sponsor agrees, you, the principalmember may apply to include any of your familymembers under your membership as one of yourdependants. To apply you, the principalmember will need to complete an AddingMembers form.

Newborn children can only be included on yourmembership from their date of birth if you havecompleted an Adding Members form, and we havereceived the form before your child is 90 days old,provided the child has not been born as a result of assisted reproduction technologies, ovulation induction treatment, adopted orborn to a surrogate.

Newborn children born as a result of assistedreproduction technologies, ovulationinduction treatment, adopted or born to asurrogate can be included from their 91st day oncompletion of an Additional members or Applicationform.

The medical history for any newborn children youapply to include on your membership will bereviewed by our medical underwriters. This mayresult in special restrictions or exclusions which willapply from the childs 91st day of life, or we maydecline to offer cover.

This also applies to newborn children who havebeen born as a result of assisted reproductiontechnologies, ovulation induction treatment,adopted or born to a surrogate or being enrolled ontheir own membership who can be included fromtheir 91st day on completion of an AdditionalMembers or Application form.

When cover starts for others on yourmembershipIf any other person is included as a dependantunder your, the principal members membership,their membership will start on the effective date onthe first membership certificate we sent you for your current continuous period of Bupa GlobalCompany membership which lists them as a dependant. Their membership can continue for aslong as you, the principal member remain amember of the plan.

If your, the principal members membershipceases, your dependants can then, of course,apply for membership in their own right.

Making aComplaintWe are always pleased to hear about aspects of your membership that you have particularlyappreciated, or that you have had problems with. Ifsomething does go wrong, we have a simpleprocedure to ensure your concerns are dealt withas quickly and effectively as possible.

If you have any comments or complaints, you cancall the Bupa Global customer helpline on:+44 (0) 1273 323 563 if you are Classic or Essentialcustomer+44 (0) 1273 718 441 if you are Gold customer,24 hours a day, 365 days a year. Alternatively, youcan email or write to the Head of CustomerRelations via bupa-intl.com/membersworld or


We want to make sure that members with specialneeds are not excluded in any way. We also offer achoice of Braille, large print or audio for our lettersand literature. Please let us know which you wouldprefer.

Taking it furtherIts very rare that we cant settle a complaint, but ifthis does happen, you may be able to refer yourcomplaint to the Financial Ombudsman Service. You can:

write to them at Exchange Tower, London,E14 9SR, UKcall them on 0800 023 4 567 (free frommost landlines), 0300 123 9 123 or fromoutside the UK +44 (0) 20 7964 0500find details at their websitefinancial-ombudsman.org.uk

Please let us know if you want a full copy of ourcomplaints procedure. (None of these proceduresaffect your legal rights.)

ConfidentialityThe confidentiality of personal health information isof paramount concern to the companies in the Bupagroup. To this end, Bupa fully complies withapplicable data protection legislation and medicalconfidentiality guidelines. Bupa sometimes usesthird parties to process data on our behalf. Suchprocessing, which may be undertaken outside theEEA (European Economic Area), is subject tocontractual restrictions with regard toconfidentiality and security obligations in addition

29

to the minimum requirements imposed by dataprotection legislation in the UK.

Personal data collected about you may be used byBupa to process your claims, administer yourpolicy, make suggestions about clinicallyappropriate treatment, for research and analytics,in the course of undertaking audits, and to detectand prevent fraud. For further information, pleasesee the Bupa Global Privacy Policy atwww.bupaglobal.com/privacypolicy.

Please note that we may share any dependantsinformation with the principal member (beingthe person named as the main applicant on theapplication for the policy), including in relation to treatment and services received, claims paid, theamount of any deductible used and, if relevant, anymedical history which impacts on the provision ofthe policy.

In accordance with data protection law, if youwould like a copy of your personal information (forwhich a small fee may be payable) or you wouldlike to update your personal information, or if youhave any other data processing queries please callthe Bupa Global service team on +44 (0)1273 718379. Alternatively you can email or write to theteam via [email protected]; or BupaGlobal, Victory House, Trafalgar Place, BrightonBN1 4FY, United Kingdom.

GlossaryThis explains what we mean by various words andphrases in your membership pack. Words written inbold are particularly important as they have specificmeanings.

Defined term Description

Acceptablecurrent clinicalevidence:

International medical and scientificevidence which includepeer-reviewed scientific studiespublished in or accepted forpublication by medical journals thatmeet internationally recognisedrequirements for scientificmanuscripts. This does not includeindividual case reports, studies of asmall number of people, or clinicaltrials which are not registered.

Active treatment: Treatment from a medicalpractitioner of a disease, illness orinjury that leads to your recovery,conservation of your condition orto restore you to your previousstate of health as quickly aspossible.

Agreement: The agreement between BupaGlobal and the sponsor underwhich we have accepted you intomembership of the plan.

Appliance: A knee brace which is an essentialpart of a repair to a cruciate (knee)ligament or a spinal support which isan essential part of surgery to thespine.

Annualdeductible:

The amount you, the principalmember have to pay towards thecost of the treatment that youreceive each membership yearthat would otherwise be coveredunder your membership. Theamount of your annualdeductible is shown on yourmembership certificate. The annualdeductible applies separately toeach person covered under yourmembership.

AssistedReproductionTechnologies:

Technologies including but notlimited to in-vitro fertilisation (IVF)with or without intra-cytoplasmicsperm injection (ICSI) gameteintra-fallopian transfer (GIFT),zygote intra-fallopian transfer(ZIFT), egg donation andintra-uterine insemination (IUI) withovulation induction.


Birthing centre: A medical facility often associatedwith a hospital that is designed toprovide a homelike setting duringchildbirth.

Bupa Global: Bupa Insurance Limited or any otherinsurance subsidiary or insurancepartner of the British UnitedProvident Association Limited.

Complementarymedicinepractitioner:

An acupuncturist, chiropractor,homeopath, osteopath or traditionalChinese medicine practitioner whois fully trained and legally qualifiedand permitted to practice by therelevant authorities in the country inwhich the treatment is received.

Consultant: A surgeon, anaesthetist or physicianwho:

is legally qualified topractise medicine orsurgery followingattendance at a recognisedmedical school, andis recognised by therelevant authorities in thecountry in which the treatment takes place ashaving specialisedqualification in the field of,or expertise in, the treatment of the disease,illness or injury beingtreated

By recognised medical school wemean a medical school which islisted in the World Directory ofMedical Schools, as published fromtime to time by the World HealthOrganisation.

Day-casetreatment:

Treatment which for medicalreasons requires you to stay in abed in hospital during the dayonly. We do not require you tooccupy a bed for day-case psychiatric treatment.

Dentalpractitioner:

A person who:

is legally qualified topractice dentistry, andis permitted to practicedentistry by the relevantauthorities in the countrywhere the dental treatment takes place


Dependants: The other people named on yourmembership certificate as beingmembers of the plan and who areeligible to be members, includingnewborn children.

Diagnostic tests: Investigations, such as X-rays orblood tests, to find the cause of your symptoms.

Emergency: A serious medical condition orsymptoms resulting from a disease,illness or injury which arisessuddenly and, in the judgment of areasonable person, requiresimmediate treatment, generallywithin 24 hours of onset, and whichwould otherwise put your health atrisk.

Epidemic: The occurrence of more cases ofdisease, injury, or other healthcondition than expected in a givenarea or among a specific group ofpersons during a particular period.Usually, the cases are presumed tohave a common cause or to berelated to one another in some way.

Family doctor: A person who:

is legally qualified inmedical practice followingattendance at a recognisedmedical school to providemedical treatment whichdoes not need a consultants training, andis licensed to practicemedicine in the countrywhere the treatment isreceived

By recognised medical school wemean a medical school which islisted in the World Directory ofMedical Schools as published fromtime to time by the World HealthOrganisation.

Family Members: Persons of a family relationship(related to you by blood or by lawor otherwise). A full list of the familyrelationships falling within thisdefinition is available on request.

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Hospital: A centre of treatment which isregistered, or recognised under thelocal countrys laws, as existingprimarily for:

carrying out major surgical operations, andproviding treatmentwhich only consultantscan provide

In-patienttreatment:

Treatment which for medicalreasons normally means that youhave to stay in a hospital bedovernight or longer.

Intensive care: Intensive care includes:

High Dependency Unit(HDU): a unit that providesa higher level of medicalcare and monitoring, forexample in single organsystem failure.Intensive Therapy Unit / Intensive Care Unit(ITU/ICU): a unit thatprovides the highest levelof care, for example inmulti-organ failure or incase of intubatedmechanical ventilation.Coronary Care Unit (CCU): aunit that provides a higherlevel of cardiac monitoring.

Medicalpractitioner:

A complementary medicinepractitioner, consultant, dentalpractitioner, family doctor, psychologist, psychotherapistor therapist who provides activetreatment of a known condition.

Membership year: The period beginning on your startdate or renewal date and endingon the day before your next renewal date. By start date wemean the effective from date on your first membership certificatefor your current continuous periodof membership.

Network: A hospital, or similar facility, or medical practitioner which hasan agreement in effect with BupaGlobal or service partner toprovide you with eligible treatment.

Out-patienttreatment:

Treatment given at a hospital,consulting room, doctors office orout-patient clinic where you do notgo in for in-patient treatment or day-case treatment.


OvulationInductionTreatment:

Treatment including medication tostimulate production of follicles inthe ovary including but not limitedto clomiphene and gonadotrophintherapy.

Pandemic: An epidemic occurring over awidespread area (multiple countriesor continents) and usually affectinga substantial proportion of thepopulation.

Persistentvegetative state:

a state of profoundunconsciousness, with nosign of awareness or afunctioning mind, even ifthe person can open theireyes and breathe unaided,andthe person does notrespond to stimuli such ascalling their name, ortouching

The state must have remained for atleast four weeks with no sign ofimprovement, when all reasonableattempts have been made toalleviate this condition.

Pre-existingcondition:

Any disease, illness or injury forwhich:

you have receivedmedication, advice or treatment, oryou have experiencedsymptoms

whether the condition wasdiagnosed or not in the four yearsbefore the start of your currentcontinuous period of cover.

Principal member: The person who has taken out themembership, and is the first personnamed on the membershipcertificate. Please refer to you/your.

Prophylacticsurgery:

Surgery to remove an organ orgland that shows no signs ofdisease, in an attempt to preventdevelopment of disease of thatorgan or gland.

Psychiatrictreatment:

Treatment of mental conditions,including eating disorders.

Psychologist and psychotherapist:

A person who is legally qualifiedand is permitted to practise as suchin the country where the treatment is received.


Qualified nurse: A nurse whose name is currently onany register or roll of nursesmaintained by any statutory nursingregistration body in the countrywhere the treatment takes place.

Registeredclinical trial:

An ethically approved and clinicallycontrolled trial that is registered ona national or international databaseof clinical trials (eg clinicaltrials.gov,ISRCTN.ORG orhttp://public.ukcrn.org.uk).

Rehabilitation: Treatment in the form of acombination of therapies such asphysical, occupational and speechtherapy aimed at restoring fullfunction after an acute event suchas a stroke.

Renewal date: Each anniversary of the date you,the principal member joined theplan. (If however you are a memberof a Bupa Global group plan witha common renewal date for allmembers, your renewal date willbe the common renewal date forthe group. We tell you the group renewal date when you join.)

Service partner: A company or organisation thatprovides services on behalf of BupaGlobal. These services may includeapproval of cover and location oflocal medical facilities.

Sound naturaltooth / Soundnatural teeth:

A natural tooth that is free of activeclinical decay, has no gum diseaseassociated with bone loss, no caps,crowns, or veneers, that is not adental implant and that functionsnormally in chewing and speech.

Specified countryof nationality:

The country of nationality specifiedby you in your application form oras advised to us in writing, whichever is the later.

Specified countryof residence:

The country of residence specifiedby you in your application andshown in your membershipcertificate, or as advised to us inwriting, which ever is the later. Thecountry you specify must be thecountry in which the relevantauthorities (such as tax authorities)consider you to be resident for theduration of the policy.

Sponsor: The company, firm or individual withwhom we have entered into an agreement to provide you withcover under the plan.


Subrogated: The assumption of the membersright by Bupa Global to recoverfrom an at fault party the costs ofany claims paid by Bupa Globalfor treatment to the member.

Surgicaloperation:

A medical procedure that involvesthe use of instruments orequipment.

Therapists: A physiotherapist, occupational therapist, orthoptist, dietician orspeech therapist who is legallyqualified and is permitted topractice as such in the countrywhere the treatment is received.

Treatment: Surgical or medical services(including diagnostic tests) thatare needed to diagnose, relieve orcure a condition, disease, illness orinjury.

UK: Great Britain and Northern Ireland.

We/us/our: Bupa Global.

You/your: This means you, the principalmember and your dependantsunless we have expressly statedotherwise that the provisions onlyrefer to the principal member.

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Medical Words andPhrasesHere are some everyday descriptions of somemedical words and phrases used in yourmembership pack.

Term Description

Cytotoxic drugs: Drugs that are used specifically tokill off cancerous cells in the body.

Diseased tissue: Unhealthy or abnormal cells in thehuman body.

Ectopic pregnancy: When a foetus is growing outsidethe womb.

HormoneReplacementTherapy:

Hormone replacement therapy(HRT) is the use of synthetic ornatural hormones to treat ahormone deficiency. Mostcommonly, this is used in thetreatment of symptomsaccompanying the menopause.

Pathology: Tests carried out to help determineor assess a medical condition, forexample blood tests.

Post-partumhaemorrhage:

Heavy vaginal bleeding in the hoursand days immediately afterchildbirth.

Retained placentalmembrane:

When the afterbirth is left in thewomb after delivery of the baby.

Sleep apnoea: Temporarily stopping breathingduring sleep.

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BIN-COMP-MEMB-1604v1.1

General services: +44 (0) 1273 323 563 for Classic and Essentialcustomers+44 (0) 1273 718 441 for Gold customers

Medical related enquiries:+44 (0) 1273 333 911Your calls may be recorded or monitored.


Bupa Global offers you:Global medical plans forindividuals and groupsAssistance, repatriation andevacuation cover24-hour multi-lingual helpline

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European branch addresses:Bupa Denmark8 Palaegade,DK-1261 Copenhagen K,Denmark

Bupa in MaltaTestaferrata StreetTa Xbiex XBX 1403Malta

Bupa Cyprus3 Ioannis Polemis Street,PO Box 51160,3502 Limassol,Cyprus

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