bupa select - bupalatinamerica.com · zone 1 mexico premium booklet, effective january 1, 2014 3...
TRANSCRIPT
PR E M I UM BO O K LE T
BUPA SELECT
E F F E C T I V E JA N UA RY 1, 2 014
ZONE X, COUNTRY
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ADMINISTRATIVE NOTES• Rates are in U.S. dollars and don’t include taxes.
• An annual $75 administration fee per policy applies.
• One deductible applies per insured, per policy year up to a maximum of the out-of-country deductible. If the in-country deductible has already been met, and treatment is later received out of country, the difference between both deductibles will be the insured’s responsibility. A maximum equivalent to two out-of-country deductibles per policy, per policy year applies.
• Maximum age to apply: 74 years old.
• For ages 65 and older, a Treating Physician Statement is required when applying for coverage.
• Available payment modes: annually, semiannually, and quarterly.
• The insurer, USA Medical Services, and/or any of their applicable related subsidiaries and affiliates will not engage in any transactions with any parties or in any countries where otherwise prohibited by the laws in the United States of America. Please contact USA Medical Services for more information about this restriction.
• Coinsurance: For Plans A, B and C, after meeting the deductible, 80% of the first US$5,000 in approved charges is covered; then 100% of approved charges up to US $5,000,000. One coinsurance per insured, per policy year applies. For Plans C Plus, D and E, no coinsurance applies.
• Bupa reserves the right to correct any errors or omissions.
NOTAS ADMINISTRATIVAS• Las tarifas están expresadas en dólares de los Estados
Unidos de América y no incluyen impuestos.
• Se aplica una tarifa administrativa anual de US$75 por póliza.
• Se aplica un deducible por asegurado, por año póliza hasta el máximo del deducible fuera del país de residencia. Si ya se ha cubierto el deducible dentro del país de residencia, y luego el asegurado recibe tratamiento fuera de su país de residencia, la diferencia entre ambos deducibles será responsabilidad del asegurado. Se aplica un máximo equivalente a dos deducibles fuera del país de residencia, por póliza, por año póliza.
• Para solicitantes de 65 o más, se requiere incluir el formulario Declaración del Médico Tratante al solicitar la cobertura.
• Opciones de pago disponibles: anual, semestral y trimestral.
• Ni la aseguradora, ni USA Medical Services, ni ninguna de sus filiales o subsidiarias pertinentes relacionadas participarán en transacciones con cualquier parte o país donde dichas transacciones estén prohibidas por las leyes de los Estados Unidos de América. Por favor comuníquese con USA Medical Services para obtener más información sobre esta restricción.
• Coaseguro: Para los Planes A, B y C, después de satisfacer el deducible, se cubre el 80% de los primeros US$5,000 en gastos aprobados; luego, el 100% de gastos aprobados hasta un máximo de US$5,000,000. Aplica un coaseguro por asegurado, por año póliza. Para los Planes C Plus, D y E, no se aplica coaseguro.
• Bupa se reserva el derecho de corregir cualquier error u omisión.
ZONE 1 MEXICO
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Deductibles Plan 1 Plan 2 Plan 5 Plan 7In country of residence US$1,000 US$2,000 US$5,000 US$10,000
Out of country of residence US$1,000 US$2,000 US$5,000 US$10,000
Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual
1 child US$1,432.00 US$758.96 US$1,026.00 US$543.78 US$717.00 US$380.01 US$615.00 US$325.95
2 children 2,253.00 1,194.09 1,620.00 858.60 1,131.00 599.43 967.00 512.51
3 or more children 3,278.00 1,737.34 2,352.00 1,246.56 1,639.00 868.67 1,406.00 745.18
19-25 3,457.00 1,832.21 2,503.00 1,326.59 1,762.00 933.86 1,522.00 806.66
26-29 3,968.00 2,103.04 2,869.00 1,520.57 2,019.00 1,070.07 1,743.00 923.79
30-34 4,506.00 2,388.18 3,258.00 1,726.74 2,290.00 1,213.70 1,975.00 1,046.75
35-39 5,022.00 2,661.66 3,623.00 1,920.19 2,546.00 1,349.38 2,193.00 1,162.29
40-44 5,694.00 3,017.82 4,113.00 2,179.89 2,885.00 1,529.05 2,483.00 1,315.99
45-49 6,643.00 3,520.79 4,789.00 2,538.17 3,359.00 1,780.27 2,890.00 1,531.70
50-54 7,294.00 3,865.82 5,262.00 2,788.86 3,688.00 1,954.64 3,170.00 1,680.10
55-59 8,665.00 4,592.45 6,248.00 3,311.44 4,371.00 2,316.63 3,760.00 1,992.80
60-64 11,520.00 6,105.60 8,299.00 4,398.47 5,801.00 3,074.53 4,986.00 2,642.58
65-69 15,594.00 8,264.82 11,229.00 5,951.37 7,841.00 4,155.73 6,736.00 3,570.08
70-74 22,722.00 12,042.66 16,349.00 8,664.97 11,410.00 6,047.30 9,801.00 5,194.53
75-79 28,443.00 15,074.79 20,459.00 10,843.27 14,275.00 7,565.75 12,258.00 6,496.74
80+ 40,087.00 21,246.11 28,810.00 15,269.30 20,087.00 10,646.11 15,335.00 8,127.55
Additional coverage
Maternity
complications$225 $119.25 $225 $119.25
Private pilot 125 66.25 125 66.25 125 66.25 $125 $66.25
Transplant procedures 250 132.50 250 132.50 250 132.50 250 132.50
ZONA 1 MÉXICO
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Deducibles Plan 1 Plan 2 Plan 5 Plan 7
Dentro del país de residencia US$1,000 US$2,000 US$5,000 US$10,000
Fuera del país de residencia US$1,000 US$2,000 US$5,000 US$10,000
Edad Anual Semestral Anual Semestral Anual Semestral Anual Semestral
1 hijo US$1,432.00 US$758.96 US$1,026.00 US$543.78 US$717.00 US$380.01 US$615.00 US$325.95
2 hijos 2,253.00 1,194.09 1,620.00 858.60 1,131.00 599.43 967.00 512.51
3 hijos o más 3,278.00 1,737.34 2,352.00 1,246.56 1,639.00 868.67 1,406.00 745.18
19-25 3,457.00 1,832.21 2,503.00 1,326.59 1,762.00 933.86 1,522.00 806.66
26-29 3,968.00 2,103.04 2,869.00 1,520.57 2,019.00 1,070.07 1,743.00 923.79
30-34 4,506.00 2,388.18 3,258.00 1,726.74 2,290.00 1,213.70 1,975.00 1,046.75
35-39 5,022.00 2,661.66 3,623.00 1,920.19 2,546.00 1,349.38 2,193.00 1,162.29
40-44 5,694.00 3,017.82 4,113.00 2,179.89 2,885.00 1,529.05 2,483.00 1,315.99
45-49 6,643.00 3,520.79 4,789.00 2,538.17 3,359.00 1,780.27 2,890.00 1,531.70
50-54 7,294.00 3,865.82 5,262.00 2,788.86 3,688.00 1,954.64 3,170.00 1,680.10
55-59 8,665.00 4,592.45 6,248.00 3,311.44 4,371.00 2,316.63 3,760.00 1,992.80
60-64 11,520.00 6,105.60 8,299.00 4,398.47 5,801.00 3,074.53 4,986.00 2,642.58
65-69 15,594.00 8,264.82 11,229.00 5,951.37 7,841.00 4,155.73 6,736.00 3,570.08
70-74 22,722.00 12,042.66 16,349.00 8,664.97 11,410.00 6,047.30 9,801.00 5,194.53
75-79 28,443.00 15,074.79 20,459.00 10,843.27 14,275.00 7,565.75 12,258.00 6,496.74
80+ 40,087.00 21,246.11 28,810.00 15,269.30 20,087.00 10,646.11 15,335.00 8,127.55
Cobertura adicional
Complicaciones de maternidad $225 $119.25 $225 $119.25
Piloto privado 125 66.25 125 66.25 125 66.25 $125 $66.25
Procedimientos de trasplante 250 132.50 250 132.50 250 132.50 250 132.50
ZONE 2 CENTRAL AMERICA
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Deductibles Plan 1 Plan 2 Plan 5 Plan 7In country of residence US$500 US$2,000 US$5,000 US$10,000
Out of country of residence US$1,000 US$2,000 US$5,000 US$10,000
Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual
1 child US$1,339.00 US$709.67 US$963.00 US$510.39 US$670.00 US$355.10 US$578.00 US$306.34
2 children 2,117.00 1,122.01 1,525.00 808.25 1,062.00 562.86 909.00 481.77
3 or more children 3,071.00 1,627.63 2,211.00 1,171.83 1,543.00 817.79 1,322.00 700.66
19-25 3,242.00 1,718.26 2,350.00 1,245.50 1,657.00 878.21 1,430.00 757.90
26-29 3,726.00 1,974.78 2,698.00 1,429.94 1,898.00 1,005.94 1,637.00 867.61
30-34 4,229.00 2,241.37 3,058.00 1,620.74 2,150.00 1,139.50 1,851.00 981.03
35-39 4,712.00 2,497.36 3,403.00 1,803.59 2,391.00 1,267.23 2,063.00 1,093.39
40-44 5,344.00 2,832.32 3,860.00 2,045.80 2,709.00 1,435.77 2,336.00 1,238.08
45-49 6,232.00 3,302.96 4,498.00 2,383.94 3,154.00 1,671.62 2,717.00 1,440.01
50-54 6,847.00 3,628.91 4,939.00 2,617.67 3,464.00 1,835.92 2,980.00 1,579.40
55-59 8,127.00 4,307.31 5,860.00 3,105.80 4,106.00 2,176.18 3,534.00 1,873.02
60-64 10,779.00 5,712.87 7,769.00 4,117.57 5,435.00 2,880.55 4,672.00 2,476.16
65-69 14,565.00 7,719.45 10,489.00 5,559.17 7,334.00 3,887.02 6,302.00 3,340.06
70-74 21,228.00 11,250.84 15,280.00 8,098.40 10,679.00 5,659.87 9,169.00 4,859.57
75-79 26,574.00 14,084.22 19,127.00 10,137.31 13,358.00 7,079.74 11,469.00 6,078.57
80+ 35,365.00 18,743.45 25,286.00 13,401.58 17,765.00 9,415.45 14,353.00 7,607.09
Additional coverage
Maternity
complications$225 $119.25 $225 $119.25
Private pilot 125 66.25 125 66.25 125 66.25 $125 $66.25
Transplant procedures 250 132.50 250 132.50 250 132.50 250 132.50
ZONA 2 CENTROAMÉRICA
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Deducibles Plan 1 Plan 2 Plan 5 Plan 7
Dentro del país de residencia US$500 US$2,000 US$5,000 US$10,000
Fuera del país de residencia US$1,000 US$2,000 US$5,000 US$10,000
Edad Anual Semestral Anual Semestral Anual Semestral Anual Semestral
1 hijo US$1,339.00 US$709.67 US$963.00 US$510.39 US$670.00 US$355.10 US$578.00 US$306.34
2 hijos 2,117.00 1,122.01 1,525.00 808.25 1,062.00 562.86 909.00 481.77
3 hijos o más 3,071.00 1,627.63 2,211.00 1,171.83 1,543.00 817.79 1,322.00 700.66
19-25 3,242.00 1,718.26 2,350.00 1,245.50 1,657.00 878.21 1,430.00 757.90
26-29 3,726.00 1,974.78 2,698.00 1,429.94 1,898.00 1,005.94 1,637.00 867.61
30-34 4,229.00 2,241.37 3,058.00 1,620.74 2,150.00 1,139.50 1,851.00 981.03
35-39 4,712.00 2,497.36 3,403.00 1,803.59 2,391.00 1,267.23 2,063.00 1,093.39
40-44 5,344.00 2,832.32 3,860.00 2,045.80 2,709.00 1,435.77 2,336.00 1,238.08
45-49 6,232.00 3,302.96 4,498.00 2,383.94 3,154.00 1,671.62 2,717.00 1,440.01
50-54 6,847.00 3,628.91 4,939.00 2,617.67 3,464.00 1,835.92 2,980.00 1,579.40
55-59 8,127.00 4,307.31 5,860.00 3,105.80 4,106.00 2,176.18 3,534.00 1,873.02
60-64 10,779.00 5,712.87 7,769.00 4,117.57 5,435.00 2,880.55 4,672.00 2,476.16
65-69 14,565.00 7,719.45 10,489.00 5,559.17 7,334.00 3,887.02 6,302.00 3,340.06
70-74 21,228.00 11,250.84 15,280.00 8,098.40 10,679.00 5,659.87 9,169.00 4,859.57
75-79 26,574.00 14,084.22 19,127.00 10,137.31 13,358.00 7,079.74 11,469.00 6,078.57
80+ 35,365.00 18,743.45 25,286.00 13,401.58 17,765.00 9,415.45 14,353.00 7,607.09
Cobertura adicional
Complicaciones de maternidad $225 $119.25 $225 $119.25
Piloto privado 125 66.25 125 66.25 125 66.25 $125 $66.25
Procedimientos de trasplante 250 132.50 250 132.50 250 132.50 250 132.50
ZONE 3 BELIZE, CARIBBEAN ISLANDS, FRENCH GUIANA, GUYANA, SURINAME
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Deductibles Plan 1 Plan 2 Plan 5 Plan 7In country of residence US$500 US$2,000 US$5,000 US$10,000
Out of country of residence US$1,000 US$2,000 US$5,000 US$10,000
Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual
1 child US$1,104.00 US$585.12 US$791.00 US$419.23 US$549.00 US$290.97 US$474.00 US$251.22
2 children 1,745.00 924.85 1,254.00 664.62 874.00 463.22 748.00 396.44
3 or more children 2,531.00 1,341.43 1,818.00 963.54 1,265.00 670.45 1,086.00 575.58
19-25 2,681.00 1,420.93 1,939.00 1,027.67 1,368.00 725.04 1,184.00 627.52
26-29 3,078.00 1,631.34 2,226.00 1,179.78 1,566.00 829.98 1,354.00 717.62
30-34 3,492.00 1,850.76 2,524.00 1,337.72 1,776.00 941.28 1,529.00 810.37
35-39 3,889.00 2,061.17 2,810.00 1,489.30 1,972.00 1,045.16 1,700.00 901.00
40-44 4,413.00 2,338.89 3,182.00 1,686.46 2,231.00 1,182.43 1,923.00 1,019.19
45-49 5,143.00 2,725.79 3,708.00 1,965.24 2,599.00 1,377.47 2,237.00 1,185.61
50-54 5,647.00 2,992.91 4,070.00 2,157.10 2,850.00 1,510.50 2,453.00 1,300.09
55-59 6,705.00 3,553.65 4,827.00 2,558.31 3,378.00 1,790.34 2,905.00 1,539.65
60-64 8,902.00 4,718.06 6,406.00 3,395.18 4,476.00 2,372.28 3,850.00 2,040.50
65-69 12,018.00 6,369.54 8,642.00 4,580.26 6,031.00 3,196.43 5,186.00 2,748.58
70-74 17,437.00 9,241.61 12,530.00 6,640.90 8,739.00 4,631.67 7,505.00 3,977.65
75-79 21,824.00 11,566.72 15,682.00 8,311.46 10,930.00 5,792.90 9,387.00 4,975.11
80+ 29,044.00 15,393.32 20,726.00 10,984.78 14,535.00 7,703.55 12,481.00 6,614.93
Additional coverage
Maternity
complications$225 $119.25 $225 $119.25
Private pilot 125 66.25 125 66.25 125 66.25 $125 $66.25
Transplant procedures 250 132.50 250 132.50 250 132.50 250 132.50
ZONA 3 BELICE, GUAYANA FRANCESA, GUYANA, ISLAS DEL CARIBE, SURINAM
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Deducibles Plan 1 Plan 2 Plan 5 Plan 7
Dentro del país de residencia US$500 US$2,000 US$5,000 US$10,000
Fuera del país de residencia US$1,000 US$2,000 US$5,000 US$10,000
Edad Anual Semestral Anual Semestral Anual Semestral Anual Semestral
1 hijo US$1,104.00 US$585.12 US$791.00 US$419.23 US$549.00 US$290.97 US$474.00 US$251.22
2 hijos 1,745.00 924.85 1,254.00 664.62 874.00 463.22 748.00 396.44
3 hijos o más 2,531.00 1,341.43 1,818.00 963.54 1,265.00 670.45 1,086.00 575.58
19-25 2,681.00 1,420.93 1,939.00 1,027.67 1,368.00 725.04 1,184.00 627.52
26-29 3,078.00 1,631.34 2,226.00 1,179.78 1,566.00 829.98 1,354.00 717.62
30-34 3,492.00 1,850.76 2,524.00 1,337.72 1,776.00 941.28 1,529.00 810.37
35-39 3,889.00 2,061.17 2,810.00 1,489.30 1,972.00 1,045.16 1,700.00 901.00
40-44 4,413.00 2,338.89 3,182.00 1,686.46 2,231.00 1,182.43 1,923.00 1,019.19
45-49 5,143.00 2,725.79 3,708.00 1,965.24 2,599.00 1,377.47 2,237.00 1,185.61
50-54 5,647.00 2,992.91 4,070.00 2,157.10 2,850.00 1,510.50 2,453.00 1,300.09
55-59 6,705.00 3,553.65 4,827.00 2,558.31 3,378.00 1,790.34 2,905.00 1,539.65
60-64 8,902.00 4,718.06 6,406.00 3,395.18 4,476.00 2,372.28 3,850.00 2,040.50
65-69 12,018.00 6,369.54 8,642.00 4,580.26 6,031.00 3,196.43 5,186.00 2,748.58
70-74 17,437.00 9,241.61 12,530.00 6,640.90 8,739.00 4,631.67 7,505.00 3,977.65
75-79 21,824.00 11,566.72 15,682.00 8,311.46 10,930.00 5,792.90 9,387.00 4,975.11
80+ 29,044.00 15,393.32 20,726.00 10,984.78 14,535.00 7,703.55 12,481.00 6,614.93
Cobertura adicional
Complicaciones de maternidad $225 $119.25 $225 $119.25
Piloto privado 125 66.25 125 66.25 125 66.25 $125 $66.25
Procedimientos de trasplante 250 132.50 250 132.50 250 132.50 250 132.50
ZONE 4 BOLIVIA, COLOMBIA, PERU
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Deductibles Plan 1 Plan 2 Plan 5 Plan 7In country of residence US$500 US$2,000 US$5,000 US$10,000
Out of country of residence US$1,000 US$2,000 US$5,000 US$10,000
Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual
1 child US$1,036.00 US$549.08 US$740.00 US$392.20 US$514.00 US$272.42 US$443.00 US$234.79
2 children 1,637.00 867.61 1,168.00 619.04 808.00 428.24 702.00 372.06
3 or more children 2,378.00 1,260.34 1,698.00 899.94 1,177.00 623.81 1,017.00 539.01
19-25 2,521.00 1,336.13 1,819.00 964.07 1,278.00 677.34 1,117.00 592.01
26-29 2,896.00 1,534.88 2,082.00 1,103.46 1,462.00 774.86 1,274.00 675.22
30-34 3,284.00 1,740.52 2,362.00 1,251.86 1,658.00 878.74 1,439.00 762.67
35-39 3,654.00 1,936.62 2,628.00 1,392.84 1,837.00 973.61 1,602.00 849.06
40-44 4,148.00 2,198.44 2,979.00 1,578.87 2,083.00 1,103.99 1,812.00 960.36
45-49 4,839.00 2,564.67 3,473.00 1,840.69 2,425.00 1,285.25 2,106.00 1,116.18
50-54 5,309.00 2,813.77 3,808.00 2,018.24 2,658.00 1,408.74 2,310.00 1,224.30
55-59 6,303.00 3,340.59 4,519.00 2,395.07 3,148.00 1,668.44 2,735.00 1,449.55
60-64 8,402.00 4,453.06 6,019.00 3,190.07 4,186.00 2,218.58 3,625.00 1,921.25
65-69 11,364.00 6,022.92 8,135.00 4,311.55 5,650.00 2,994.50 4,892.00 2,592.76
70-74 16,516.00 8,753.48 11,813.00 6,260.89 8,201.00 4,346.53 7,089.00 3,757.17
75-79 20,676.00 10,958.28 14,786.00 7,836.58 10,256.00 5,435.68 8,869.00 4,700.57
80+ 27,506.00 14,578.18 19,664.00 10,421.92 13,636.00 7,227.08 11,909.00 6,311.77
Additional coverage
Maternity
complications$225 $119.25 $225 $119.25
Private pilot 125 66.25 125 66.25 125 66.25 $125 $66.25
Transplant procedures 250 132.50 250 132.50 250 132.50 250 132.50
ZONA 4 BOLIVIA, COLOMBIA, PERÚ
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Deducibles Plan 1 Plan 2 Plan 5 Plan 7
Dentro del país de residencia US$500 US$2,000 US$5,000 US$10,000
Fuera del país de residencia US$1,000 US$2,000 US$5,000 US$10,000
Edad Anual Semestral Anual Semestral Anual Semestral Anual Semestral
1 hijo US$1,036.00 US$549.08 US$740.00 US$392.20 US$514.00 US$272.42 US$443.00 US$234.79
2 hijos 1,637.00 867.61 1,168.00 619.04 808.00 428.24 702.00 372.06
3 hijos o más 2,378.00 1,260.34 1,698.00 899.94 1,177.00 623.81 1,017.00 539.01
19-25 2,521.00 1,336.13 1,819.00 964.07 1,278.00 677.34 1,117.00 592.01
26-29 2,896.00 1,534.88 2,082.00 1,103.46 1,462.00 774.86 1,274.00 675.22
30-34 3,284.00 1,740.52 2,362.00 1,251.86 1,658.00 878.74 1,439.00 762.67
35-39 3,654.00 1,936.62 2,628.00 1,392.84 1,837.00 973.61 1,602.00 849.06
40-44 4,148.00 2,198.44 2,979.00 1,578.87 2,083.00 1,103.99 1,812.00 960.36
45-49 4,839.00 2,564.67 3,473.00 1,840.69 2,425.00 1,285.25 2,106.00 1,116.18
50-54 5,309.00 2,813.77 3,808.00 2,018.24 2,658.00 1,408.74 2,310.00 1,224.30
55-59 6,303.00 3,340.59 4,519.00 2,395.07 3,148.00 1,668.44 2,735.00 1,449.55
60-64 8,402.00 4,453.06 6,019.00 3,190.07 4,186.00 2,218.58 3,625.00 1,921.25
65-69 11,364.00 6,022.92 8,135.00 4,311.55 5,650.00 2,994.50 4,892.00 2,592.76
70-74 16,516.00 8,753.48 11,813.00 6,260.89 8,201.00 4,346.53 7,089.00 3,757.17
75-79 20,676.00 10,958.28 14,786.00 7,836.58 10,256.00 5,435.68 8,869.00 4,700.57
80+ 27,506.00 14,578.18 19,664.00 10,421.92 13,636.00 7,227.08 11,909.00 6,311.77
Cobertura adicional
Complicaciones de maternidad $225 $119.25 $225 $119.25
Piloto privado 125 66.25 125 66.25 125 66.25 $125 $66.25
Procedimientos de trasplante 250 132.50 250 132.50 250 132.50 250 132.50
ZONE 5 ARGENTINA, CHILE, PARAGUAY, URUGUAY
PR
EM
IUM
BO
OK
LE
T, E
FF
EC
TIV
E J
AN
UA
RY
1,
20
14
11
Deductibles Plan 1 Plan 2 Plan 5 Plan 7In country of residence US$500 US$2,000 US$5,000 US$10,000
Out of country of residence US$1,000 US$2,000 US$5,000 US$10,000
Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual
1 child US$1,193.00 US$632.29 US$853.00 US$452.09 US$596.00 US$315.88 US$510.00 US$270.30
2 children 1,883.00 997.99 1,351.00 716.03 942.00 499.26 807.00 427.71
3 or more children 2,730.00 1,446.90 1,958.00 1,037.74 1,366.00 723.98 1,169.00 619.57
19-25 2,886.00 1,529.58 2,087.00 1,106.11 1,470.00 779.10 1,270.00 673.10
26-29 3,315.00 1,756.95 2,393.00 1,268.29 1,685.00 893.05 1,455.00 771.15
30-34 3,761.00 1,993.33 2,713.00 1,437.89 1,909.00 1,011.77 1,644.00 871.32
35-39 4,191.00 2,221.23 3,022.00 1,601.66 2,125.00 1,126.25 1,830.00 969.90
40-44 4,756.00 2,520.68 3,431.00 1,818.43 2,408.00 1,276.24 2,071.00 1,097.63
45-49 5,548.00 2,940.44 3,996.00 2,117.88 2,800.00 1,484.00 2,410.00 1,277.30
50-54 6,090.00 3,227.70 4,385.00 2,324.05 3,071.00 1,627.63 2,643.00 1,400.79
55-59 7,224.00 3,828.72 5,201.00 2,756.53 3,641.00 1,929.73 3,130.00 1,658.90
60-64 9,555.00 5,064.15 6,874.00 3,643.22 4,804.00 2,546.12 4,128.00 2,187.84
65-69 12,997.00 6,888.41 9,339.00 4,949.67 6,525.00 3,458.25 5,605.00 2,970.65
70-74 18,870.00 10,001.10 13,555.00 7,184.15 9,461.00 5,014.33 8,121.00 4,304.13
75-79 23,625.00 12,521.25 16,966.00 8,991.98 11,838.00 6,274.14 10,157.00 5,383.21
80+ 31,439.00 16,662.67 22,573.00 11,963.69 15,743.00 8,343.79 14,304.00 7,581.12
Additional coverage
Maternity
complications$225 $119.25 $225 $119.25
Private pilot 125 66.25 125 66.25 125 66.25 $125 $66.25
Transplant procedures 250 132.50 250 132.50 250 132.50 250 132.50
ZONA 5 ARGENTINA, CHILE, PARAGUAY, URUGUAY
FO
LL
ET
O D
E T
AR
IFA
S E
FE
CT
IVA
S E
L 1
DE
EN
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O D
E 2
014
12
Deducibles Plan 1 Plan 2 Plan 5 Plan 7
Dentro del país de residencia US$500 US$2,000 US$5,000 US$10,000
Fuera del país de residencia US$1,000 US$2,000 US$5,000 US$10,000
Edad Anual Semestral Anual Semestral Anual Semestral Anual Semestral
1 hijo US$1,193.00 US$632.29 US$853.00 US$452.09 US$596.00 US$315.88 US$510.00 US$270.30
2 hijos 1,883.00 997.99 1,351.00 716.03 942.00 499.26 807.00 427.71
3 hijos o más 2,730.00 1,446.90 1,958.00 1,037.74 1,366.00 723.98 1,169.00 619.57
19-25 2,886.00 1,529.58 2,087.00 1,106.11 1,470.00 779.10 1,270.00 673.10
26-29 3,315.00 1,756.95 2,393.00 1,268.29 1,685.00 893.05 1,455.00 771.15
30-34 3,761.00 1,993.33 2,713.00 1,437.89 1,909.00 1,011.77 1,644.00 871.32
35-39 4,191.00 2,221.23 3,022.00 1,601.66 2,125.00 1,126.25 1,830.00 969.90
40-44 4,756.00 2,520.68 3,431.00 1,818.43 2,408.00 1,276.24 2,071.00 1,097.63
45-49 5,548.00 2,940.44 3,996.00 2,117.88 2,800.00 1,484.00 2,410.00 1,277.30
50-54 6,090.00 3,227.70 4,385.00 2,324.05 3,071.00 1,627.63 2,643.00 1,400.79
55-59 7,224.00 3,828.72 5,201.00 2,756.53 3,641.00 1,929.73 3,130.00 1,658.90
60-64 9,555.00 5,064.15 6,874.00 3,643.22 4,804.00 2,546.12 4,128.00 2,187.84
65-69 12,997.00 6,888.41 9,339.00 4,949.67 6,525.00 3,458.25 5,605.00 2,970.65
70-74 18,870.00 10,001.10 13,555.00 7,184.15 9,461.00 5,014.33 8,121.00 4,304.13
75-79 23,625.00 12,521.25 16,966.00 8,991.98 11,838.00 6,274.14 10,157.00 5,383.21
80+ 31,439.00 16,662.67 22,573.00 11,963.69 15,743.00 8,343.79 14,304.00 7,581.12
Cobertura adicional
Complicaciones de maternidad $225 $119.25 $225 $119.25
Piloto privado 125 66.25 125 66.25 125 66.25 $125 $66.25
Procedimientos de trasplante 250 132.50 250 132.50 250 132.50 250 132.50
ZONE 6
PR
EM
IUM
BO
OK
LE
T, E
FF
EC
TIV
E J
AN
UA
RY
1,
20
14
13
Deductibles Plan 1 Plan 2 Plan 5 Plan 7In country of residence US$500 US$2,000 US$5,000 US$10,000
Out of country of residence US$1,000 US$2,000 US$5,000 US$10,000
Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual
1 child US$1,308.00 US$693.24 US$937.00 US$496.61 US$653.00 US$346.09 US$561.00 US$297.33
2 children 2,063.00 1,093.39 1,481.00 784.93 1,033.00 547.49 884.00 468.52
3 or more children 2,994.00 1,586.82 2,148.00 1,138.44 1,499.00 794.47 1,284.00 680.52
19-25 3,159.00 1,674.27 2,287.00 1,212.11 1,611.00 853.83 1,391.00 737.23
26-29 3,632.00 1,924.96 2,623.00 1,390.19 1,849.00 979.97 1,594.00 844.82
30-34 4,119.00 2,183.07 2,973.00 1,575.69 2,091.00 1,108.23 1,801.00 954.53
35-39 4,594.00 2,434.82 3,314.00 1,756.42 2,327.00 1,233.31 2,005.00 1,062.65
40-44 5,212.00 2,762.36 3,761.00 1,993.33 2,637.00 1,397.61 2,270.00 1,203.10
45-49 6,076.00 3,220.28 4,383.00 2,322.99 3,069.00 1,626.57 2,640.00 1,399.20
50-54 6,672.00 3,536.16 4,807.00 2,547.71 3,367.00 1,784.51 2,897.00 1,535.41
55-59 7,921.00 4,198.13 5,703.00 3,022.59 3,990.00 2,114.70 3,431.00 1,818.43
60-64 10,475.00 5,551.75 7,538.00 3,995.14 5,270.00 2,793.10 4,526.00 2,398.78
65-69 14,245.00 7,549.85 10,242.00 5,428.26 7,157.00 3,793.21 6,146.00 3,257.38
70-74 20,688.00 10,964.64 14,870.00 7,881.10 10,378.00 5,500.34 8,907.00 4,720.71
75-79 25,900.00 13,727.00 18,612.00 9,864.36 12,986.00 6,882.58 11,140.00 5,904.20
80+ 34,467.00 18,267.51 24,763.00 13,124.39 17,270.00 9,153.10 15,692.00 8,316.76
Additional coverage
Maternity
complications$225 $119.25 $225 $119.25
Private pilot 125 66.25 125 66.25 125 66.25 $125 $66.25
Transplant procedures 250 132.50 250 132.50 250 132.50 250 132.50
ZONA 6
FO
LL
ET
O D
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AR
IFA
S E
FE
CT
IVA
S E
L 1
DE
EN
ER
O D
E 2
014
14
Deducibles Plan 1 Plan 2 Plan 5 Plan 7
Dentro del país de residencia US$500 US$2,000 US$5,000 US$10,000
Fuera del país de residencia US$1,000 US$2,000 US$5,000 US$10,000
Edad Anual Semestral Anual Semestral Anual Semestral Anual Semestral
1 hijo US$1,308.00 US$693.24 US$937.00 US$496.61 US$653.00 US$346.09 US$561.00 US$297.33
2 hijos 2,063.00 1,093.39 1,481.00 784.93 1,033.00 547.49 884.00 468.52
3 hijos o más 2,994.00 1,586.82 2,148.00 1,138.44 1,499.00 794.47 1,284.00 680.52
19-25 3,159.00 1,674.27 2,287.00 1,212.11 1,611.00 853.83 1,391.00 737.23
26-29 3,632.00 1,924.96 2,623.00 1,390.19 1,849.00 979.97 1,594.00 844.82
30-34 4,119.00 2,183.07 2,973.00 1,575.69 2,091.00 1,108.23 1,801.00 954.53
35-39 4,594.00 2,434.82 3,314.00 1,756.42 2,327.00 1,233.31 2,005.00 1,062.65
40-44 5,212.00 2,762.36 3,761.00 1,993.33 2,637.00 1,397.61 2,270.00 1,203.10
45-49 6,076.00 3,220.28 4,383.00 2,322.99 3,069.00 1,626.57 2,640.00 1,399.20
50-54 6,672.00 3,536.16 4,807.00 2,547.71 3,367.00 1,784.51 2,897.00 1,535.41
55-59 7,921.00 4,198.13 5,703.00 3,022.59 3,990.00 2,114.70 3,431.00 1,818.43
60-64 10,475.00 5,551.75 7,538.00 3,995.14 5,270.00 2,793.10 4,526.00 2,398.78
65-69 14,245.00 7,549.85 10,242.00 5,428.26 7,157.00 3,793.21 6,146.00 3,257.38
70-74 20,688.00 10,964.64 14,870.00 7,881.10 10,378.00 5,500.34 8,907.00 4,720.71
75-79 25,900.00 13,727.00 18,612.00 9,864.36 12,986.00 6,882.58 11,140.00 5,904.20
80+ 34,467.00 18,267.51 24,763.00 13,124.39 17,270.00 9,153.10 15,692.00 8,316.76
Cobertura adicional
Complicaciones de maternidad $225 $119.25 $225 $119.25
Piloto privado 125 66.25 125 66.25 125 66.25 $125 $66.25
Procedimientos de trasplante 250 132.50 250 132.50 250 132.50 250 132.50
PR
EM
IUM
BO
OK
LE
T, E
FF
EC
TIV
E J
AN
UA
RY
1,
20
14F
OL
LE
TO
DE
TA
RIF
AS
EF
EC
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AS
EL
1 D
E E
NE
RO
DE
20
14
15
PUERTO RICO
Deducibles Plan 2 Plan 5Dentro del país de residencia US$2,000 US$5,000
Fuera del país de residencia US$2,000 US$5,000
Edad Anual Semestral Anual Semestral
1 hijo US$880.00 US$466.40 US$610.00 US$323.30
2 hijos 1,392.00 737.76 967.00 512.51
3 hijos o más 2,096.00 1,110.88 1,479.00 783.87
19-25 2,156.00 1,142.68 1,524.00 807.72
26-29 2,475.00 1,311.75 1,742.00 923.26
30-34 2,802.00 1,485.06 1,974.00 1,046.22
35-39 3,123.00 1,655.19 2,191.00 1,161.23
40-44 3,537.00 1,874.61 2,482.00 1,315.46
45-49 4,119.00 2,183.07 2,888.00 1,530.64
50-54 4,522.00 2,396.66 3,172.00 1,681.16
55-59 5,363.00 2,842.39 3,752.00 1,988.56
60-64 7,114.00 3,770.42 4,970.00 2,634.10
65-69 9,593.00 5,084.29 6,695.00 3,548.35
70-74 13,912.00 7,373.36 9,706.00 5,144.18
75-79 17,412.00 9,228.36 12,138.00 6,433.14
80+ 23,012.00 12,196.36 16,137.00 8,552.61
Cobertura adicional
Complicaciones de maternidad $225 $119.25
Piloto privado 125 66.25 125 66.25
Procedimientos de trasplante 250 132.50 250 132.50
Deductibles Plan 2 Plan 5In country of residence US$2,000 US$5,000
Out of country of residence US$2,000 US$5,000
Age Annual Semiannual Annual Semiannual
1 child US$880.00 US$466.40 US$610.00 US$323.30
2 children 1,392.00 737.76 967.00 512.51
3 or more children 2,096.00 1,110.88 1,479.00 783.87
19-25 2,156.00 1,142.68 1,524.00 807.72
26-29 2,475.00 1,311.75 1,742.00 923.26
30-34 2,802.00 1,485.06 1,974.00 1,046.22
35-39 3,123.00 1,655.19 2,191.00 1,161.23
40-44 3,537.00 1,874.61 2,482.00 1,315.46
45-49 4,119.00 2,183.07 2,888.00 1,530.64
50-54 4,522.00 2,396.66 3,172.00 1,681.16
55-59 5,363.00 2,842.39 3,752.00 1,988.56
60-64 7,114.00 3,770.42 4,970.00 2,634.10
65-69 9,593.00 5,084.29 6,695.00 3,548.35
70-74 13,912.00 7,373.36 9,706.00 5,144.18
75-79 17,412.00 9,228.36 12,138.00 6,433.14
80+ 23,012.00 12,196.36 16,137.00 8,552.61
Additional coverage
Maternity
complications$225 $119.25
Private pilot 125 66.25 125 66.25
Transplant procedures 250 132.50 250 132.50
PR
EM
IUM
BO
OK
LE
T, E
FF
EC
TIV
E J
AN
UA
RY
1,
20
14
16
ECUADOR
Deductibles Plan 1 Plan 2 Plan 5 Plan 7In country of residence US$500 US$2,000 US$5,000 US$10,000
Out of country of residence US$1,000 US$2,000 US$5,000 US$10,000
Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual
1 child US$945.00 US$500.85 US$673.00 US$356.69 US$469.00 US$248.57 US$341.00 US$180.73
2 children 1,495.00 792.35 1,065.00 564.45 738.00 391.14 541.00 286.73
3 or more children 2,166.00 1,147.98 1,548.00 820.44 1,071.00 567.63 785.00 416.05
19-25 2,305.00 1,221.65 1,663.00 881.39 1,170.00 620.10 873.00 462.69
26-29 2,643.00 1,400.79 1,904.00 1,009.12 1,338.00 709.14 994.00 526.82
30-34 3,001.00 1,590.53 2,161.00 1,145.33 1,515.00 802.95 1,125.00 596.25
35-39 3,337.00 1,768.61 2,400.00 1,272.00 1,682.00 891.46 1,248.00 661.44
40-44 3,784.00 2,005.52 2,722.00 1,442.66 1,904.00 1,009.12 1,411.00 747.83
45-49 4,415.00 2,339.95 3,170.00 1,680.10 2,215.00 1,173.95 1,637.00 867.61
50-54 4,846.00 2,568.38 3,478.00 1,843.34 2,426.00 1,285.78 1,794.00 950.82
55-59 5,751.00 3,048.03 4,124.00 2,185.72 2,877.00 1,524.81 2,121.00 1,124.13
60-64 7,666.00 4,062.98 5,492.00 2,910.76 3,820.00 2,024.60 2,802.00 1,485.06
65-69 10,364.00 5,492.92 7,420.00 3,932.60 5,156.00 2,732.68 3,772.00 1,999.16
70-74 15,061.00 7,982.33 10,774.00 5,710.22 7,482.00 3,965.46 5,453.00 2,890.09
75-79 18,853.00 9,992.09 13,482.00 7,145.46 9,352.00 4,956.56 6,815.00 3,611.95
80+ 25,076.00 13,290.28 17,931.00 9,503.43 12,434.00 6,590.02 8,963.00 4,750.39
Additional coverage
Maternity
complications$225 $119.25 $225 $119.25
Private pilot 125 66.25 125 66.25 125 66.25 $125 $66.25
Transplant procedures 250 132.50 250 132.50 250 132.50 250 132.50
FO
LL
ET
O D
E T
AR
IFA
S E
FE
CT
IVA
S E
L 1
DE
EN
ER
O D
E 2
014
17
ECUADOR
Deducibles Plan 1 Plan 2 Plan 5 Plan 7
Dentro del país de residencia US$500 US$2,000 US$5,000 US$10,000
Fuera del país de residencia US$1,000 US$2,000 US$5,000 US$10,000
Edad Anual Semestral Anual Semestral Anual Semestral Anual Semestral
1 hijo US$945.00 US$500.85 US$673.00 US$356.69 US$469.00 US$248.57 US$341.00 US$180.73
2 hijos 1,495.00 792.35 1,065.00 564.45 738.00 391.14 541.00 286.73
3 hijos o más 2,166.00 1,147.98 1,548.00 820.44 1,071.00 567.63 785.00 416.05
19-25 2,305.00 1,221.65 1,663.00 881.39 1,170.00 620.10 873.00 462.69
26-29 2,643.00 1,400.79 1,904.00 1,009.12 1,338.00 709.14 994.00 526.82
30-34 3,001.00 1,590.53 2,161.00 1,145.33 1,515.00 802.95 1,125.00 596.25
35-39 3,337.00 1,768.61 2,400.00 1,272.00 1,682.00 891.46 1,248.00 661.44
40-44 3,784.00 2,005.52 2,722.00 1,442.66 1,904.00 1,009.12 1,411.00 747.83
45-49 4,415.00 2,339.95 3,170.00 1,680.10 2,215.00 1,173.95 1,637.00 867.61
50-54 4,846.00 2,568.38 3,478.00 1,843.34 2,426.00 1,285.78 1,794.00 950.82
55-59 5,751.00 3,048.03 4,124.00 2,185.72 2,877.00 1,524.81 2,121.00 1,124.13
60-64 7,666.00 4,062.98 5,492.00 2,910.76 3,820.00 2,024.60 2,802.00 1,485.06
65-69 10,364.00 5,492.92 7,420.00 3,932.60 5,156.00 2,732.68 3,772.00 1,999.16
70-74 15,061.00 7,982.33 10,774.00 5,710.22 7,482.00 3,965.46 5,453.00 2,890.09
75-79 18,853.00 9,992.09 13,482.00 7,145.46 9,352.00 4,956.56 6,815.00 3,611.95
80+ 25,076.00 13,290.28 17,931.00 9,503.43 12,434.00 6,590.02 8,963.00 4,750.39
Cobertura adicional
Complicaciones de maternidad $225 $119.25 $225 $119.25
Piloto privado 125 66.25 125 66.25 125 66.25 $125 $66.25
Procedimientos de trasplante 250 132.50 250 132.50 250 132.50 250 132.50
PR
EM
IUM
BO
OK
LE
T, E
FF
EC
TIV
E J
AN
UA
RY
1,
20
14
18
VENEZUELA
Deductibles Plan 1 Plan 2 Plan 5 Plan 7In country of residence US$500 US$2,000 US$5,000 US$10,000
Out of country of residence US$1,000 US$2,000 US$5,000 US$10,000
Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual
1 child US$801.00 US$424.53 US$579.00 US$306.87 US$404.00 US$214.12 US$344.00 US$182.32
2 children 1,268.00 672.04 919.00 487.07 638.00 338.14 548.00 290.44
3 or more children 1,839.00 974.67 1,330.00 704.90 927.00 491.31 795.00 421.35
19-25 1,966.00 1,041.98 1,439.00 762.67 1,022.00 541.66 884.00 468.52
26-29 2,254.00 1,194.62 1,647.00 872.91 1,167.00 618.51 1,009.00 534.77
30-34 2,556.00 1,354.68 1,867.00 989.51 1,318.00 698.54 1,136.00 602.08
35-39 2,845.00 1,507.85 2,073.00 1,098.69 1,462.00 774.86 1,262.00 668.86
40-44 3,224.00 1,708.72 2,347.00 1,243.91 1,657.00 878.21 1,427.00 756.31
45-49 3,759.00 1,992.27 2,734.00 1,449.02 1,923.00 1,019.19 1,659.00 879.27
50-54 4,125.00 2,186.25 3,000.00 1,590.00 2,106.00 1,116.18 1,816.00 962.48
55-59 4,892.00 2,592.76 3,556.00 1,884.68 2,494.00 1,321.82 2,147.00 1,137.91
60-64 6,501.00 3,445.53 4,722.00 2,502.66 3,304.00 1,751.12 2,842.00 1,506.26
65-69 8,791.00 4,659.23 6,374.00 3,378.22 4,455.00 2,361.15 3,829.00 2,029.37
70-74 12,776.00 6,771.28 9,257.00 4,906.21 6,460.00 3,423.80 5,550.00 2,941.50
75-79 15,989.00 8,474.17 11,583.00 6,138.99 8,078.00 4,281.34 6,936.00 3,676.08
80+ 21,265.00 11,270.45 15,402.00 8,163.06 10,736.00 5,690.08 9,213.00 4,882.89
Additional coverage
Maternity
complications$225 $119.25 $225 $119.25
Private pilot 125 66.25 125 66.25 125 66.25 $125 $66.25
Transplant procedures 250 132.50 250 132.50 250 132.50 250 132.50
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Deducibles Plan 1 Plan 2 Plan 5 Plan 7
Dentro del país de residencia US$500 US$2,000 US$5,000 US$10,000
Fuera del país de residencia US$1,000 US$2,000 US$5,000 US$10,000
Edad Anual Semestral Anual Semestral Anual Semestral Anual Semestral
1 hijo US$801.00 US$424.53 US$579.00 US$306.87 US$404.00 US$214.12 US$344.00 US$182.32
2 hijos 1,268.00 672.04 919.00 487.07 638.00 338.14 548.00 290.44
3 hijos o más 1,839.00 974.67 1,330.00 704.90 927.00 491.31 795.00 421.35
19-25 1,966.00 1,041.98 1,439.00 762.67 1,022.00 541.66 884.00 468.52
26-29 2,254.00 1,194.62 1,647.00 872.91 1,167.00 618.51 1,009.00 534.77
30-34 2,556.00 1,354.68 1,867.00 989.51 1,318.00 698.54 1,136.00 602.08
35-39 2,845.00 1,507.85 2,073.00 1,098.69 1,462.00 774.86 1,262.00 668.86
40-44 3,224.00 1,708.72 2,347.00 1,243.91 1,657.00 878.21 1,427.00 756.31
45-49 3,759.00 1,992.27 2,734.00 1,449.02 1,923.00 1,019.19 1,659.00 879.27
50-54 4,125.00 2,186.25 3,000.00 1,590.00 2,106.00 1,116.18 1,816.00 962.48
55-59 4,892.00 2,592.76 3,556.00 1,884.68 2,494.00 1,321.82 2,147.00 1,137.91
60-64 6,501.00 3,445.53 4,722.00 2,502.66 3,304.00 1,751.12 2,842.00 1,506.26
65-69 8,791.00 4,659.23 6,374.00 3,378.22 4,455.00 2,361.15 3,829.00 2,029.37
70-74 12,776.00 6,771.28 9,257.00 4,906.21 6,460.00 3,423.80 5,550.00 2,941.50
75-79 15,989.00 8,474.17 11,583.00 6,138.99 8,078.00 4,281.34 6,936.00 3,676.08
80+ 21,265.00 11,270.45 15,402.00 8,163.06 10,736.00 5,690.08 9,213.00 4,882.89
Cobertura adicional
Complicaciones de maternidad $225 $119.25 $225 $119.25
Piloto privado 125 66.25 125 66.25 125 66.25 $125 $66.25
Procedimientos de trasplante 250 132.50 250 132.50 250 132.50 250 132.50
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HOW IS THE PREMIUM PAID?Bupa must receive payment before the coverage can take effect. Please submit payment with your application. You can choose among the following payment options:
Online payment by credit card through our website www.bupasalud.com
Credit card MasterCard, VISA, American Express, or Diners Club
Personal check in U.S. dollars drawn on an American bank, cashier’s check, money order, traveler’s check
Bank transfer:
Procedure for ACH’sWells Fargo Bank200 South Biscayne Blvd, FL6011Miami, FL 33131Account # 2000037371881ABA # 067006432Account Name: Bupa Worldwide Premium TrustReference: Policyholder Name and Policy Number
Procedure for domestic wire transfersWells Fargo Bank200 South Biscayne Blvd, FL6011Miami, FL 33131Account # 2000037371881ABA # 121000248Account Name: Bupa Worldwide Premium TrustReference: Policyholder Name and Policy Number
Procedure for international wire transfersWells Fargo Bank200 South Biscayne Blvd, FL6011Miami, FL 33131Account # 2000037371881ABA # 121000248CHIPS # 0407SWIFT # WFBIUS6SAccount Name: Bupa Worldwide Premium TrustReference: Policyholder Name and Policy Number
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CÓMO PAGAR LA PRIMABupa debe recibir el pago de la prima para que la cobertura entre en vigencia. Por favor efectúe su pago al momento de presentar la solicitud. Usted puede elegir cualquiera de las siguientes opciones de pago:
Pago online mediante tarjeta de crédito a través de nuestro sitio web www.bupasalud.com
Tarjeta de crédito MasterCard, VISA, American Express, o Diners Club
Cheque personal en dólares de los Estados Unidos de América pagadero contra un banco estadounidense, cheque de caja, giro postal, cheque de viajero
Transferencia bancaria:
Cobranza de Cámara de Compensación Automatizada (CCA)Wells Fargo Bank200 South Biscayne Blvd, FL6011Miami, FL 33131Número de cuenta: 2000037371881ABA #: 067006432Nombre de la cuenta: Bupa Worldwide Premium TrustReferencia: nombre del asegurado principal y número de póliza
Transferencia bancaria domésticaWells Fargo Bank200 South Biscayne Blvd, FL6011Miami, FL 33131Número de cuenta: 2000037371881ABA #: 121000248Nombre de la cuenta: Bupa Worldwide Premium TrustReferencia: nombre del asegurado principal y número de póliza
Transferencia bancaria internacionalWells Fargo Bank200 South Biscayne Blvd, FL6011Miami, FL 33131Número de cuenta: 2000037371881ABA #: 121000248CHIPS # 0407SWIFT # WFBIUS6SNombre de la cuenta: Bupa Worldwide Premium TrustReferencia: nombre del asegurado principal y número de póliza
PB-BSE 2014 ENG-ESP
17901 Old Cutler Road, Suite 400Palmetto Bay, Florida 33157Tel. +1 (305) 398 7400Fax +1 (305) 275 [email protected]