taking good care of you wherever you are - · pdf filetaking good care of you wherever you...

25
International Health and Hospital Plan Valid from 2015 • EUR/GBP/USD TAKING GOOD CARE OF YOU WHEREVER YOU ARE

Upload: phamdan

Post on 22-Mar-2018

213 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

International Health and Hospital Plan

Valid from 2015 • EUR/GBP/USD

TAKING GOOD CARE OF YOU WHEREVER YOU ARE

Page 2: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

23

We w

an

t to

make s

ure

that

cust

om

ers

wit

h s

pecia

l n

eed

s

are

no

t exclu

ded

in

any w

ay.

We

als

o o

7er

a c

ho

ice o

f B

raill

e, la

rge

pri

nt

or

aud

io f

or

our

lett

ers

an

d

litera

ture

. P

lease

let

us

kn

ow

whic

h

yo

u w

ould

pre

fer.

CO

NT

EN

TS

4

Pu

ttin

g y

ou

r h

ealt

h fi

rst

9

Exp

eri

en

ce t

he B

up

a G

lob

al d

iFere

nce

12

Tailo

rin

g y

ou

r p

lan

15

Wh

at

hap

pen

s if

yo

u n

eed

tre

atm

en

t

20

Yo

ur

Bu

pa G

lob

al o

nlin

e s

erv

ices

23

L

ist

of

Reim

bu

rsem

en

ts

29

P

olicy C

on

dit

ion

s

42

G

loss

ary

Page 3: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

45

Wh

eth

er

yo

u a

re in

yo

ur

ho

me c

ou

ntr

y o

r liv

ing

an

d w

ork

ing

ab

road

, it

is

imp

ort

an

t to

make s

ure

yo

ur

healt

h is

taken

care

of.

Yo

u a

nd

yo

ur

fam

ily n

eed

th

e r

eass

ura

nce t

hat

wh

ere

ver

yo

u a

re in

th

e w

orl

d a

nd

wh

ate

ver

hap

pen

s, y

ou

can

rely

on

receiv

ing

ass

ista

nce t

o o

bta

in p

rom

pt

access

to

exp

ert

med

ical tr

eatm

en

t an

d t

he a

pp

rop

riate

care

. Y

ou

need

th

e

co

nfi

den

ce o

f kn

ow

ing

th

at

yo

u w

ill b

e w

ell lo

oked

aft

er

an

d

treate

d a

s so

on

as

po

ssib

le a

nd

th

at

the c

ost

will b

e c

overe

d,

leavin

g y

ou

to

co

ncen

trate

on

gett

ing

bett

er. T

hat

is w

hy

ch

oo

sin

g t

he r

igh

t in

tern

ati

on

al h

ealt

h in

sura

nce f

or

yo

u a

nd

yo

ur

fam

ily is

on

e o

f th

e m

ost

im

po

rtan

t d

ecis

ion

s yo

u w

ill

ever

make.

Inte

rnati

on

al h

ealt

h in

sura

nce is

Bu

pa G

lob

al’s

sp

ecia

lity

.

We p

rovid

e c

ust

om

ers

all o

ver

the w

orl

d w

ith

an

excellen

t

serv

ice. W

e h

elp

ou

r cu

sto

mers

by c

overi

ng

th

e c

ost

of

treatm

en

t an

d p

rovid

e p

rofe

ssio

nal ass

ista

nce in

th

e e

ven

t o

f

illn

ess

an

d/o

r an

accid

en

t.

As

a B

up

a G

lob

al cu

sto

mer

yo

u c

an

tru

st u

s to

alw

ays

treat

yo

u

as

a v

alu

ed

in

div

idu

al ra

ther

than

a p

olicy n

um

ber

— w

e b

elieve

that

every

pers

on

an

d s

itu

ati

on

is

diF

ere

nt,

an

d w

e f

ocu

s o

n

fin

din

g a

nsw

ers

an

d s

olu

tio

ns

that

wo

rk s

pecifi

cally f

or

yo

u.

Wit

h a

Bu

pa G

lob

al h

ealt

h in

sura

nce p

lan

, yo

u c

an

feel

co

nfi

den

t th

at

yo

u a

nd

yo

ur

fam

ily h

ave t

he h

igh

qu

ality

healt

h

insu

ran

ce a

nd

exp

ert

su

pp

ort

sh

ou

ld y

ou

need

it.

PU

TT

ING

YO

UR

HE

ALT

H F

IRS

T

Yo

u h

ave guaranteed

lifetime renewability

reg

ard

less

of

yo

ur

ag

e a

nd

ch

an

ges

in

yo

ur

healt

h

Page 4: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

67

Bupa G

lobal — your expert health insure

r

Bu

pa G

lob

al is

part

of

the B

up

a g

rou

p, a w

orl

dw

ide

healt

hcare

org

an

isati

on

th

at 

help

s m

illio

ns

of

peo

ple

aro

un

d t

he w

orl

d t

o liv

e lo

ng

er, h

ealt

hie

r an

d h

ap

pie

r lives.

Ten

millio

n c

ust

om

ers

wo

rld

wid

e, in

clu

din

g 1

15 n

ati

on

aliti

es

in 1

90

co

un

trie

s re

ly o

n t

he o

rgan

isati

on

’s e

xcellen

t se

rvic

es

in p

rivate

healt

hcare

. A

nd

wit

h n

o s

hare

ho

lders

, w

e invest

ou

r p

rofi

ts b

ack in

to t

he b

usi

ness

.

Bu

pa G

lob

al h

as

many y

ears

of

exp

ert

ise in

cari

ng

fo

r th

e

healt

h in

sura

nce n

eed

s o

f exp

ats

, lo

cal n

ati

on

als

an

d t

heir

fam

ilie

s aro

un

d t

he g

lob

e, an

d in

th

at

tim

e w

e h

ave g

row

n

to b

eco

me a

tru

ly g

lob

al co

mp

any w

ith

o\

ces

in m

any

co

un

trie

s an

d a

n e

xte

nsi

ve n

etw

ork

of

bro

kers

an

d m

ed

ical

pro

vid

ers

.

It is

ou

r p

ass

ion

fo

r q

uality

an

d c

ust

om

er

sati

sfacti

on

th

at

has

mad

e t

he B

up

a G

lob

al n

am

e s

yn

onym

ou

s w

ith

gre

at

healt

h in

sura

nce.

Page 5: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

89

EX

PE

RIE

NC

E T

HE

BU

PA

GLO

BA

L D

IFF

ER

EN

CE

Tru

e flexibility and fre

e choice

In

tern

ati

on

al H

ealt

h a

nd

Ho

spit

al P

lan

is

tru

ly

flexib

le; yo

u c

ho

ose

th

e m

od

ule

s o

f co

ver

that

are

rig

ht

for

yo

u a

nd

each

of

yo

ur

fam

ily m

em

bers

.

Yo

u a

re f

ree t

o r

eceiv

e t

reatm

en

t anyw

here

in

th

e

wo

rld

, in

th

e c

ou

ntr

y y

ou

liv

e in

or

any o

ther

co

un

try

of

yo

ur

ch

oic

e.

Yo

u h

ave c

om

ple

te f

reed

om

to

ch

oo

se a

ny

reco

gn

ised

ho

spit

al,

clin

ic, d

octo

r o

r sp

ecia

list

yo

u

pre

fer.

Expert care

, expertly delivere

d

Bu

pa G

lob

al’s

sta

F p

rovid

e a

pers

on

al an

d

pro

fess

ion

al se

rvic

e.

A

gre

at

majo

rity

of

ou

r C

op

en

hag

en

-base

d s

taF

have h

ad

in

tern

ati

on

al tr

ain

ing

or

wo

rk e

xp

eri

en

ce

an

d w

e e

mp

loy s

taF

fro

m m

any c

ou

ntr

ies.

Th

e

resu

lt is

a t

ruly

in

tern

ati

on

al co

mp

any,

fam

ilia

r w

ith

the lan

gu

ag

es

an

d c

ult

ure

s in

co

un

trie

s aro

un

d t

he

wo

rld

wh

ere

yo

u m

ay n

eed

ou

r ass

ista

nce.

B

up

a G

lob

al em

plo

ys

many d

octo

rs a

nd

healt

hcare

pro

fess

ion

als

.

Page 6: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

1011

Advice and support aro

und the clock

W

e c

an

man

ag

e a

ll t

he p

racti

cal m

att

ers

wh

en

yo

u a

re

un

derg

oin

g t

reatm

en

t, s

o y

ou

can

co

ncen

trate

on

gett

ing

bett

er.

Yo

u h

ave a

ccess

to

ou

r 24

/7 C

op

en

hag

en

-base

d B

up

a

Glo

ab

al A

ssis

tan

ce, o

pen

36

5 d

ays

a y

ear

an

d s

taF

ed

by a

team

of

exp

eri

en

ced

ad

vis

ers

tra

ined

to

deal w

ith

pla

nn

ed

ho

spit

al st

ays

an

d e

merg

en

cie

s.

T

he d

octo

rs in

ou

r in

-ho

use

team

of

med

ical co

nsu

ltan

ts c

an

ad

vis

e a

nd

co

un

sel yo

u o

n e

very

thin

g f

rom

sim

ple

sym

pto

ms

to t

reatm

en

t o

f m

ore

co

mp

lex d

iag

no

ses.

O

ur

ad

vis

ers

an

d m

ed

ical co

nsu

ltan

ts a

re a

lways

here

to

ad

vic

e y

ou

on

ap

pro

pri

ate

tre

atm

en

t an

d c

are

.

W

e a

re a

lways

here

to

su

pp

ort

an

d g

uid

e y

ou

th

rou

gh

wh

at

co

uld

be a

co

mp

lex a

nd

so

meti

mes

co

nfu

sin

g t

ime.

Making it easy for you

W

e s

peak a

vari

ety

of

lan

gu

ag

es.

O

ur

po

licy w

ord

ing

, p

rem

ium

s an

d f

orm

s are

easy

to

un

ders

tan

d.

W

e o

Fer

access

to

myP

ag

e w

here

yo

u c

an

vie

w

yo

ur

pers

on

al p

olicy in

form

ati

on

on

lin

e a

nd

receiv

e

co

rresp

on

den

ce f

rom

Bu

pa G

lob

al.

W

hen

yo

u c

laim

we d

o n

ot

ask

fo

r a c

laim

fo

rm.

Pu

ttin

g y

ou

in

co

ntr

ol w

ith

on

line

serv

ices

C

hat

on

lin

e w

ith

ou

r cu

sto

mer

co

nsu

ltan

ts

V

iew

yo

ur

po

licy d

eta

ils

P

ay y

ou

r p

rem

ium

C

laim

on

lin

e

C

ho

ose

to

receiv

e a

ll y

ou

r d

ocu

men

ts a

nd

lett

ers

on

lin

e

an

d m

uch

mo

re

Even

if

yo

u a

re

dia

gn

ose

d w

ith

a congenital,

hereditary or chro

nic

condition

, yo

ur

cover

will

co

nti

nu

e

un

ch

an

ged

Page 7: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

1213

TA

ILO

RIN

G Y

OU

R P

LA

N

Ho

spit

al P

lan

Your core plan for treatm

ent

received w

hilst staying in hosp

ital

Th

e H

osp

ital P

lan

giv

es

yo

u t

he

reass

ura

nce o

f co

veri

ng

ess

en

tial

ho

spit

al tr

eatm

en

t yo

u m

ay n

eed

,

wh

eth

er

for

pla

nn

ed

tre

atm

en

t o

r in

an

em

erg

en

cy.

Yo

u m

ay c

ho

ose

th

is c

over

tog

eth

er

wit

h a

ded

ucti

ble

on

its

ow

n, o

r

in c

om

bin

ati

on

wit

h a

ny o

f o

ur

fou

r o

pti

on

al m

od

ule

s.

Ch

oo

se y

ou

r d

ed

ucti

ble

The deductible is th

e contribution

you m

ake toward

s th

e cost of your

treatm

ent each policy year befo

re

receiving reim

bursement

EU

RG

BP

US

D

Nil

Nil

Nil

35

02

50

40

0

1,0

50

75

01,

60

0

4,0

00

2,7

50

5,0

00

8,0

00

5,5

00

10,0

00

16,0

00

11,0

00

20

,00

0

Yo

u c

an

ch

oo

se t

o t

ake o

ut

yo

ur

pla

n

wit

h o

r w

ith

ou

t a d

ed

ucti

ble

, in

any

of

the t

hre

e c

urr

en

cie

s.

Takin

g o

ut

a d

ed

ucti

ble

lo

wers

yo

ur

pre

miu

m.

Th

e d

ed

ucti

ble

do

es

no

t ap

ply

to

Med

ical E

vacu

ati

on

an

d R

ep

atr

iati

on

an

d/o

r D

en

tal an

d O

pti

cal m

od

ule

s.

No

te: in

th

e L

ist

of

Reim

bu

rsem

en

ts

yo

u c

an

see in

deta

il w

hic

h b

en

efi

ts

are

co

vere

d u

nd

er

the d

i7ere

nt

mo

du

les

an

d t

he r

eim

bu

rsem

en

t

limit

s.

Yo

u c

an

ch

oo

se a

ny o

f o

ur

fou

r o

pti

on

al m

od

ule

s

Module 1

Non-H

osp

italisa

tion B

enefits

Med

ical tr

eatm

en

ts t

hat

do

no

t

req

uir

e a

ho

spit

al st

ay: co

nsu

ltati

on

s

wit

h a

do

cto

r, s

pecia

list

or

thera

pis

t

an

d a

nn

ual h

ealt

h c

heck-u

ps.

Module 2

Medicine and A

ppliances

Pre

scri

bed

med

icin

es,

heari

ng

aid

s

an

d r

en

t o

f ap

plian

ces

such

as

ren

tal

of

a w

heelc

hair.

Module 3

Medical Evacuation and

Repatriation

Med

ical E

vacuation w

hen t

here

is n

o

poss

ibili

ty o

f re

ceiv

ing

ap

pro

priate

qualit

y o

f tr

eatm

ent

locally

, eg

by

aero

pla

ne o

r helic

op

ter,

and

cover

for

an

accom

panyin

g friend

or

fam

ily m

em

ber.

Module 4A and 4B

Dental and O

ptical

Yo

u h

ave a

cho

ice b

etw

een t

wo

levels

of

cover. R

outi

ne a

nd

sp

ecia

l d

enta

l

treatm

ent,

gla

sses

and

co

nta

ct

lense

s

denta

l tr

eatm

ent,

gla

sses

and

co

nta

ct

lense

s and

eye c

heck p

erf

orm

ed

by

an o

pti

cia

n/o

pto

metr

ist.

Healt

h in

sura

nce r

eq

uir

em

en

ts d

i=er

fro

m c

ou

ntr

y t

o c

ou

ntr

y

an

d e

very

on

e h

as

ind

ivid

ual n

eed

s. T

his

is

why In

tern

ati

on

al

Healt

h a

nd

Ho

spit

al P

lan

allo

ws

yo

u t

he fl

exib

ility

of

tailo

rin

g

yo

ur

ow

n in

sura

nce p

lan

.

Your tailored

INT

ER

NA

TIO

NA

L

HE

ALT

H A

ND

HO

SP

ITA

L P

LA

N

Page 8: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

1415

Planned hospital treatm

ent

If y

ou

co

nta

ct

us

pri

or

to a

pla

nn

ed

or

no

n-a

cu

te a

dm

issi

on

,

we c

an

take c

are

of

all o

f th

e p

racti

cal d

eta

ils

in c

on

necti

on

wit

h a

ho

spit

al ad

mis

sio

n, allo

win

g y

ou

to

co

ncen

trate

on

gett

ing

well.

W

e w

ill ch

eck y

ou

r co

ver

an

d c

on

firm

th

at

yo

ur

treatm

en

t

is c

overe

d b

y y

ou

r p

lan

.

If

yo

u w

ish

, w

e c

an

help

yo

u fi

nd

th

e r

igh

t p

lace o

f

treatm

en

t —

ju

st s

en

d u

s m

ed

ical in

form

ati

on

on

yo

ur

co

nd

itio

n a

nd

we w

ill p

rovid

e y

ou

wit

h in

form

ati

on

on

ap

pro

pri

ate

pro

vid

ers

of

treatm

en

t o

r a s

pecia

list

in

th

e

co

un

trie

s an

d/o

r cit

ies

of

yo

ur

ch

oic

e.

W

e w

ill co

nfi

rm t

o t

he h

osp

ital th

at

yo

ur

treatm

en

t is

co

vere

d a

nd

iss

ue a

paym

en

t g

uara

nte

e, m

atc

hed

to

th

e

co

ver

un

der

yo

ur

pla

n.

O

ur

med

ical st

aF

can

als

o o

Fer

ad

vic

e a

nd

help

to

make

sure

yo

u a

re r

eceiv

ing

th

e m

ost

ap

pro

pri

ate

care

.

W

e w

ill se

ttle

th

e b

ill d

irectl

y w

ith

th

e h

osp

ital w

here

po

ssib

le.

Exp

en

ses

in c

on

necti

on

wit

h t

he n

oti

ficati

on

of

ho

spit

al

ad

mis

sio

n w

ill b

e r

efu

nd

ed

by B

up

a G

lob

al (e

g y

ou

r call

to B

up

a G

lob

al fr

om

an

oth

er

co

un

try).

WH

AT

HA

PP

EN

S IF

YO

U N

EE

D

TR

EA

TM

EN

T

Two children

un

der

ten

years

of

ag

e p

er

payin

g a

du

lt a

re

covere

d at no extra

cost

Page 9: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

1617

Emerg

ency admission

No

tify

us

as

soo

n a

s p

oss

ible

, eit

her

dir

ectl

y

or

thro

ug

h t

he a

tten

din

g p

hysi

cia

n o

r a f

am

ily

mem

ber. W

hen

co

nta

cti

ng

us,

ple

ase

sta

te

the d

ate

of

ad

mis

sio

n, d

iag

no

sis,

tre

atm

en

t

an

d e

xp

ecte

d d

ate

of

dis

ch

arg

e. W

e w

ill m

ake

sure

th

at

there

are

no

mis

un

ders

tan

din

gs

ab

ou

t th

e in

sura

nce c

over, a

nd

will w

ork

clo

sely

wit

h t

he h

osp

ital to

en

sure

th

at

yo

u

get

the a

pp

rop

riate

tre

atm

en

t.

Medical Evacuation

On

ly c

overe

d if

yo

u h

ave c

ho

sen

th

e

Med

ical E

vacu

ati

on

an

d R

ep

atr

iati

on

mo

du

le.

If t

he t

reatm

en

t re

qu

ired

in

co

nn

ecti

on

wit

h a

cu

te s

eri

ou

s illn

ess

an

d/o

r in

jury

is

no

t availab

le a

t yo

ur

locati

on

, B

up

a G

lob

al

will co

ver

exp

en

ses

in c

on

necti

on

wit

h

tran

spo

rtati

on

. M

ed

ical evacu

ati

on

an

d

rep

atr

iati

on

mu

st b

e p

re-a

pp

roved

an

d

arr

an

ged

by B

up

a G

lob

al.

Yo

u m

ust

in

form

us

befo

re t

he t

ran

spo

rt is

co

mm

en

ced

, eit

her

dir

ectl

y o

r th

rou

gh

th

e a

tten

din

g p

hysi

cia

n.

Ou

r m

ed

ical co

nsu

ltan

ts w

ill ch

oo

se a

n

ap

pro

pri

ate

pla

ce o

f tr

eatm

en

t an

d t

he

ap

pro

pri

ate

mean

s o

f tr

an

spo

rt (

eg

air

am

bu

lan

ce, aero

pla

ne, h

elico

pte

r, g

rou

nd

am

bu

lan

ce)

in c

on

sult

ati

on

wit

h t

he a

tten

din

g

physi

cia

n, an

d w

e w

ill arr

an

ge f

or

yo

ur

imm

ed

iate

evacu

ati

on

.

We a

rran

ge f

or

bed

to

bed

tra

nsp

ort

ati

on

s

such

as

co

llecti

ng

yo

u f

rom

a g

iven

locati

on

, arr

an

gin

g f

or

gro

un

d a

nd

air

tran

spo

rtati

on

an

d h

an

din

g y

ou

over

to t

he

receiv

ing

ho

spit

al.

We m

ake s

ure

th

at

yo

u

are

ad

eq

uate

ly a

cco

mp

an

ied

an

d a

rran

ge

for

med

ical o

r n

on

-med

ical esc

ort

s. A

nd

of

co

urs

e, w

e k

eep

th

e r

ele

van

t p

art

ies,

eg

 fam

ily a

nd

do

cto

rs, u

pd

ate

d a

t all t

imes.

Oth

er treatm

ent

On

ly c

overe

d if

yo

u h

ave c

ho

sen

No

n-H

osp

italisa

tio

n B

en

efi

ts, M

ed

icin

e

an

d A

pp

lian

ces,

an

d/o

r D

en

tal an

d

Op

tical m

od

ule

(s).

Sh

ou

ld y

ou

need

ou

tpati

en

t tr

eatm

en

t su

ch

as

co

nsu

ltin

g y

ou

r d

octo

r o

r a s

pecia

list

,

take p

resc

rib

ed

med

icin

e o

r h

ave y

ou

r te

eth

ch

ecked

yo

u s

ho

uld

pay t

he b

ill an

d t

hen

sen

d it

to u

s fo

r re

imb

urs

em

en

t. In

ord

er

for

us

to p

rocess

yo

ur

cla

im p

lease

pro

vid

e u

s

wit

h t

he f

ollo

win

g in

form

ati

on

:

p

olicy n

um

ber

it

em

ised

an

d r

eceip

ted

bill w

ith

:

- p

ati

en

t’s

nam

e in

dic

ate

d o

n e

ach

bill

- d

iag

no

sis

or

reaso

n f

or

treatm

en

t/vis

it

- d

ate

of

serv

ice

- ty

pe o

f se

rvic

e

if

med

icin

e/p

harm

acy b

ill:

co

py o

f d

octo

r’s

pre

scri

pti

on

Aft

er

the p

are

nt’s

po

licy

has

been

in

fo

rce f

or

12

mo

nth

s newborn

babies

are covered fro

m birth

,

irresp

ective of th

eir state of

health

, exclu

din

g a

do

pte

d

ch

ildre

n o

r ch

ildre

n b

ein

g

bo

rn a

s a r

esu

lt o

f fe

rtili

ty

treatm

en

t an

d/o

r b

orn

by a

surr

og

ate

mo

ther

Page 10: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

1819

How w

e calculate

your re

imbursement

Wh

en

we s

ett

le y

ou

r cla

im y

ou

r b

en

efi

ts

are

paid

in

lin

e w

ith

th

e lim

its

sho

wn

in

th

e

Lis

t o

f R

eim

bu

rsem

en

ts a

nd

an

y d

ed

ucti

ble

yo

u m

ay h

ave c

ho

sen

. T

he d

ed

ucti

ble

is

the

co

ntr

ibu

tio

n y

ou

make t

ow

ard

s th

e c

ost

of

yo

ur

treatm

en

t each

po

licy y

ear

befo

re

we w

ill st

art

reim

bu

rsin

g y

ou

r exp

en

ses.

Th

e d

ed

ucti

ble

ap

plies

sep

ara

tely

fo

r each

pers

on

on

yo

ur

po

licy.

It is

imp

ort

an

t th

at

yo

u s

en

d a

ll y

ou

r cla

ims

to u

s, e

ven

if

the v

alu

e o

f th

e c

laim

is

less

than

th

e r

em

ain

ing

ded

ucti

ble

. W

e w

ill n

ot

make a

ny p

aym

en

t, b

ut

the c

laim

will co

un

t

tow

ard

s yo

ur

ded

ucti

ble

.

If y

ou

sen

d u

s re

imb

urs

em

en

t st

ate

men

ts

an

d o

rig

inal b

ills

th

at

yo

u h

ave c

laim

ed

fro

m a

no

ther

pri

vate

healt

h in

sure

r (e

g a

local p

lan

) th

ese

will co

un

t to

ward

s yo

ur

ded

ucti

ble

if

the b

en

efi

ts w

ou

ld h

ave b

een

co

vere

d u

nd

er

yo

ur

Inte

rnati

on

al H

ealt

h a

nd

Ho

spit

al P

lan

.

Yo

u w

ill alw

ays

receiv

e a

Reim

bu

rsem

en

t

Sta

tem

en

t sh

ow

ing

ho

w m

uch

has

been

co

un

ted

to

ward

s yo

ur

ded

ucti

ble

an

d h

ow

mu

ch

has

been

paid

.

We c

an

reim

bu

rse y

ou

in

mo

st c

urr

en

cie

s.

Ple

ase

rem

em

ber

to s

tate

yo

ur

po

licy

nu

mb

er

in a

ll c

orr

esp

on

den

ce w

ith

Bu

pa G

lob

al.

Online claim

ing

It is

als

o p

oss

ible

to

su

bm

it y

ou

r cla

ims

on

lin

e

on

ou

r w

eb

site

ihi.com/healthclaim

.

All y

ou

need

to

do

is

to fi

ll o

ut

the o

nlin

e

cla

im f

orm

an

d a

ttach

yo

ur

bills

an

d

co

rresp

on

din

g r

eceip

ts a

s a p

df, t

iF, g

if o

r

jpeg

do

cu

men

t.

On

ce t

he c

laim

has

been

su

bm

itte

d, yo

u w

ill

receiv

e a

n e

mail a

s p

roo

f o

f su

bm

issi

on

.

Ple

ase

no

te t

hat

wh

en

yo

u c

laim

on

lin

e, yo

ur

reim

bu

rsem

en

t d

ocu

men

ts w

ill n

ot

be s

en

t

to y

ou

by p

ost

. W

hen

yo

ur

cla

im h

as

been

ass

ess

ed

yo

u w

ill b

e n

oti

fied

by a

n e

mail

sen

t to

th

e e

mail a

dd

ress

we h

ave o

n r

eco

rd.

Yo

ur

reim

bu

rsem

en

t d

ocu

men

ts w

ill th

en

be

availab

le o

n y

ou

r p

ers

on

al w

eb

site

, m

yP

ag

e.

Yo

u c

an

fin

d m

ore

in

form

ati

on

ab

ou

t

on

lin

e c

laim

ing

at ihi.com/healthclaim

un

der

the s

ecti

on

“FA

Q”.

Waiting Periods

Co

ver

will co

me in

to f

orc

e im

med

iate

ly o

n

the c

om

men

cem

en

t d

ate

:

in

th

e e

ven

t o

f an

acu

te, se

rio

us

illn

ess

or

inju

ry

if

yo

u s

wit

ch

to

Bu

pa G

lob

al fr

om

an

oth

er

eq

uiv

ale

nt

inte

rnati

on

al h

ealt

h in

sura

nce

pla

n w

ith

an

oth

er

co

mp

any

Oth

er waiting periods

T

here

is

a g

en

era

l w

ait

ing

peri

od

of

fou

r

weeks

fro

m t

he p

olicy’s

co

mm

en

cem

en

t

date

, w

hic

h m

ean

s th

at

we w

ill n

ot

reim

bu

rse a

ny c

laim

s o

ccu

rrin

g d

uri

ng

th

at

peri

od

of

tim

e.

T

he w

ait

ing

peri

od

is

12 m

on

ths

for

pre

gn

an

cy a

nd

ch

ild

bir

th.

If

yo

u c

ho

ose

to

ad

d t

he D

en

tal an

d

Op

tical m

od

ule

(M

od

ule

 4)

there

is

a 2

4

mo

nth

wait

ing

peri

od

fo

r o

rth

od

on

tics

fro

m t

he c

om

men

cem

en

t d

ate

of

this

mo

du

le.

Reg

ard

less

of

yo

ur

pro

fession, leisure and

sports activities

we d

o

no

t re

stri

ct

yo

ur

cover.

Even

pro

fess

ion

al an

d

hig

h-r

isk s

po

rts

are

covere

d

Page 11: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

20

21

YO

UR

BU

PA

GLO

BA

L O

NL

INE

SE

RV

ICE

S

Online serv

ices

On

www.ihi.com

yo

u h

ave a

ccess

to

a r

an

ge o

f se

rvic

es

an

d

a c

om

pre

hen

sive lib

rary

of

info

rmati

on

an

d e

xp

ert

ad

vic

e

such

as:

o

nlin

e liv

e c

hat

wit

h o

ur

cu

sto

mer

co

nsu

ltan

ts

call m

e b

ack s

erv

ice —

wri

te y

ou

r q

uest

ion

an

d w

e w

ill call

yo

u

u

se F

acilit

y F

ind

er

to g

uid

e y

ou

to

ho

spit

als

in

yo

ur

are

a

or

in a

sp

ecifi

c c

ou

ntr

y

fi

nd

in

form

ati

on

on

ho

w t

o c

laim

fi

nd

Qu

est

ion

s an

d A

nsw

ers

Manage your policy on m

yPage

Go

to

www.ihi.com

an

d r

eg

iste

r fo

r m

yP

ag

e a

nd

access

yo

ur

pers

on

al p

olicy in

form

ati

on

:

vie

w y

ou

r p

rod

uct

gu

ides

an

d f

orm

s

vie

w a

ll o

f yo

ur

do

cu

men

ts s

uch

as

po

licy s

ch

ed

ule

s,

ren

ew

al le

tters

, p

rem

ium

no

tices,

receip

ts a

nd

reim

bu

rsem

en

t le

tters

g

et

a c

om

ple

te o

verv

iew

of

yo

ur

po

licy

vie

w r

eim

bu

rsem

en

t st

ate

men

ts f

or

yo

ur

sett

led

cla

ims

p

ay y

ou

r p

rem

ium

As

a B

up

a G

lob

al cu

sto

mer

yo

u h

ave a

ccess

to

a r

an

ge o

f o

nlin

e s

erv

ices.

Page 12: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

22

23

23

Ple

ase

no

te t

hat

the L

ist

of

Reim

bu

rsem

en

ts is

part

of

the

Po

licy C

on

dit

ion

s. It

is t

here

fore

reco

mm

en

ded

to

read

bo

th t

he

Lis

t o

f R

eim

bu

rsem

en

ts a

nd

th

e P

olic

y C

on

dit

ion

s care

fully

.

Wo

rds

wri

tten

in

ita

lic in

th

e L

ist

of

Reim

bu

rsem

en

ts a

re

“defi

ned

term

s” w

hic

h a

re s

pecifi

c t

erm

s re

levan

t to

yo

ur

co

ver.

Ple

ase

ch

eck t

heir

mean

ing

in

th

e G

loss

ary

at

the e

nd

of

this

p

rod

uct

gu

ide.

LIS

T O

F R

EIM

BU

RS

EM

EN

TS

Become a paperless custo

mer

If y

ou

ch

oo

se t

o b

eco

me a

pap

erl

ess

cu

sto

mer

yo

u w

ill

receiv

e a

ll d

ocu

men

ts a

nd

co

rresp

on

den

ce f

rom

Bu

pa

Glo

bal via

yo

ur

pers

on

al m

yP

ag

e. W

e w

ill n

oti

fy y

ou

by e

mail

wh

en

yo

u h

ave u

pd

ate

s o

n m

yP

ag

e s

o y

ou

are

alw

ays

fully

info

rmed

. G

o t

o t

he m

yP

ag

e s

ecti

on

on

ihi.com

to

sig

n u

p.

Ple

ase

be a

ware

th

at

yo

u w

ill n

ot

receiv

e a

ny h

ard

co

pie

s

to y

ou

r p

ost

al o

r co

llecti

on

ad

dre

ss a

nd

th

at

it w

ill b

e y

ou

r

resp

on

sib

ilit

y t

o c

heck a

ll d

ocu

men

ts a

nd

co

rresp

on

den

ce

on

lin

e a

nd

to

in

form

us

of

any c

han

ges

to y

ou

r em

ail

ad

dre

ss.

Get up to a 15% discount on a

Bupa G

lobal travel plan

As

an

In

tern

ati

on

al H

ealt

h a

nd

Ho

spit

al P

lan

cu

sto

mer

yo

u g

et

10%

dis

co

un

t if

yo

u b

uy o

ur

Sin

gle

Tri

p o

r A

nn

ual

Tra

vel an

d a

fu

rth

er

5%

if

yo

u b

uy o

nlin

e. T

here

is

no

ded

ucti

ble

on

ou

r tr

avel p

lan

s. If

yo

ur

travel cla

ims

wo

uld

als

o b

e c

overe

d b

y y

ou

r In

tern

ati

on

al H

ealt

h a

nd

Ho

spit

al

Pla

n, th

e t

ravel cla

ims

will co

un

t to

ward

s th

e a

nn

ual

ded

ucti

ble

on

th

e In

tern

ati

on

al H

ealt

h a

nd

Ho

spit

al P

lan

.

Page 13: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

24

25

Valid fro

m 1 January 2015

All amounts are in EUR/G

BP/USD

Valid fro

m 1 January 2015

All amounts are in EUR/G

BP/USD

Childbirth

/ H

ome D

elivery

or delivery

at birth

ing centre

EUR

GBP

USD

Do

cto

r/sp

ecia

list,

mid

wif

e14

510

016

5

Ho

me n

urs

ing

in

co

nn

ecti

on

wit

h h

om

e d

elive

ry o

r d

elive

ry a

t b

irth

ing

 ce

ntr

e4

35

30

04

90

Pre

- an

d p

ostn

ata

l exam

inati

on

s are

re

imb

urs

ed

un

de

r M

od

ule

1 N

on

-Ho

sp

italisati

on

Be

ne

fits

Org

an Tra

nsplant

Org

an

tra

nsp

lan

t10

0%

100

%10

0%

Pe

r d

iag

no

sis

an

d c

ou

rse o

f tr

eatm

en

t p

er

life

tim

e, to

in

clu

de a

ll

rela

ted

co

sts

up

to

th

e fi

nan

cia

l m

axim

um

T

he in

su

ran

ce p

olicy m

ust

be v

alid

th

rou

gh

ou

t th

e c

ou

rse o

f tr

eatm

en

t.O

nly

hu

man

org

an

sT

he p

rocu

rem

en

t o

f th

e o

rgan

mu

st

be p

re-a

pp

rove

d b

y t

he C

om

pany

45

0,0

00

315

,00

05

00

,00

0

Emerg

ency R

oom Tre

atm

ent

Em

erg

en

cy r

oo

m t

reatm

en

t in

co

nn

ecti

on

wit

h a

n a

cu

te illn

ess

or

accid

en

t10

0%

100

%10

0%

Local Tra

nsport by A

mbulance

Me

dic

ally p

rescri

be

d t

ran

sp

ort

to

an

d f

rom

ho

sp

ital

100

%10

0%

100

%

Pe

r p

olicy y

ear, m

ax.

1,5

00

1,0

00

1,6

00

Inpatient Rehabilitation

Med

ically p

resc

rib

ed

in

pati

en

t re

hab

ilit

ati

on

at

an

au

tho

rise

d

reh

ab

ilit

ati

on

cen

tre f

ollo

win

g h

osp

italisa

tio

n f

or

treatm

en

t co

vere

d b

y

this

in

sura

nce (

mu

st b

e p

re-a

pp

roved

by t

he C

om

pany)

100

%10

0%

100

%

Max. p

er

day f

or

max. th

ree m

on

ths

pe

r illn

ess

33

02

20

35

5

Home N

ursing

Fo

r exp

en

ses

incu

rred

fo

r m

ed

ically p

resc

rib

ed

ass

ista

nce in

yo

ur

pri

vate

h

om

e b

y a

cert

ified

nu

rse (

mu

st b

e p

re-a

pp

roved

by t

he C

om

pany)

100

%10

0%

100

%

Max. p

er

day f

or

max. 4

0 d

ays

pe

r p

olicy y

ear

130

84

135

Hospital Cash B

enefit

If r

oo

m, b

oard

an

d t

reatm

en

t are

receiv

ed

fre

e o

f ch

arg

e, p

er

nig

ht

max.

90

60

100

Max. 6

0 n

igh

ts p

er

po

licy y

ear

(mu

st

be p

re-a

pp

rove

d b

y t

he C

om

pany)

Emerg

ency D

enta

l Tre

atm

ent

Acu

te e

me

rge

ncy d

en

tal tr

eatm

en

t d

ue t

o s

eri

ou

s accid

en

t re

qu

irin

g

ho

sp

italisati

on

100

%10

0%

100

%

In c

ase o

f d

ou

bt,

th

e d

ecis

ion

will b

e left

wit

h t

he C

om

pany

's d

en

tal co

nsu

ltan

t

Hospital Plan

Reim

bu

rsem

en

ts u

nd

er

the H

osp

ital P

lan

are

eF

ecte

d a

t 10

0%

of

the e

xp

en

ses,

un

less

yo

u h

ave c

ho

sen

a

ded

ucti

ble

. If

yo

u h

ave c

ho

sen

a d

ed

ucti

ble

, p

lease

no

te t

hat

the r

eim

bu

rsem

en

t ra

tes

for

the b

en

efi

ts lis

ted

in

th

e L

ist

of

Reim

bu

rsem

en

ts w

ill b

e r

ed

uced

by a

ny r

em

ain

ing

ded

ucti

ble

. O

nce y

ou

r d

ed

ucti

ble

has

been

re

ach

ed

, all c

overe

d e

xp

en

ses

will b

e p

aid

in

lin

e w

ith

yo

ur

reim

bu

rsem

en

t ra

tes.

Fo

r th

e H

osp

ital P

lan

an

d

any a

dd

itio

nal m

od

ule

s th

e r

eim

bu

rsem

en

ts w

ill n

ot

in a

ny e

ven

t exceed

th

e f

ollo

win

g a

mo

un

ts o

r th

e

overa

ll a

nn

ual m

axim

um

co

ver

per

pers

on

per

po

licy y

ear

of 

EU

R 1

,65

0,0

00

/GB

P 1

,35

0,0

00

/US

D 2

,00

0,0

00

.

Hospital Serv

ices — during H

ospitalisation

100%

Se

mi-

pri

vate

/pri

vate

ro

om

*10

0%

Inte

nsiv

e c

are

ro

om

100

%

Ro

om

an

d b

oard

fo

r a p

are

nt

acco

mp

an

yin

g a

n in

su

red

ch

ild

*10

0%

Su

rge

ry

100

%

Me

dic

al tr

eatm

en

t, lab

ora

tory

te

sts

, X

-rays

100

%

Me

dic

ine f

or

use d

uri

ng

ho

sp

italisati

on

an

d r

ele

van

t o

nly

fo

r th

e in

su

red

co

nd

itio

n b

ein

g t

reate

d10

0%

Pace

make

r10

0%

Psych

iatr

ic t

reatm

en

t10

0%

Pre

-exam

inati

on

s th

at

are

med

ically n

ecess

ary

in

ord

er

to p

erf

orm

th

e s

urg

ery

or

treatm

en

t w

hic

h is

to

take p

lace d

uri

ng

ho

spit

alisa

tio

n a

re c

overe

d u

p t

o 3

0 d

ays

pri

or

to h

osp

italisa

tio

n.

Ch

eck-u

ps

that

are

med

ically n

ecess

ary

in

ord

er

to v

eri

fy t

hat

the in

sure

d is

reco

veri

ng

su

ccess

fully f

rom

th

e s

urg

ery

or

treatm

en

t re

ceiv

ed

wh

ile h

osp

italise

d a

re c

overe

d u

p t

o 9

0 d

ays

aft

er

ho

spit

alisa

tio

n.

Ph

ysio

the

rap

y f

ollo

win

g s

urg

ery

mu

st

be e

valu

ate

d a

nd

pre

-ap

pro

ve

d b

y t

he C

om

pany.

Outp

atient Tre

atm

ent in a H

ospital or Clinic

Su

rge

ry10

0%

Ch

em

oth

era

py, ra

dio

the

rap

y10

0%

Dia

lysis

100

%

En

do

sco

pic

exam

inati

on

s10

0%

Oth

er

ou

tpati

en

t tr

eatm

en

t is

re

imb

urs

ed

un

de

r M

od

ule

1 -

No

n-H

osp

italisati

on

Be

ne

fits

Childbirth

Hospital Plan

Hospital Plan incl. M

odule 1

Non-H

ospita lisation

Benefits

EUR

GBP

USD

EUR

GBP

USD

No

rmal d

elive

ry, d

elive

ry w

ith

co

mp

licati

on

s an

d n

on

-med

ically

pre

scri

bed

caesa

rean

de

live

ry in

cl. p

re-

an

d p

ostn

ata

l tr

eatm

en

t fo

r m

oth

er

an

d

ch

ild

. M

ax. p

er

de

live

ry**

100

%5

,72

510

0%

3,9

25

100

%7,1

50

100

%9

,675

100

%6

,65

010

0%

12,1

00

Me

dic

ally p

rescri

be

d c

ae

sare

an

, in

cl. p

re-

an

d p

ostn

ata

l tr

eatm

en

t fo

r m

oth

er

an

d c

hild

.

Max. p

er

de

live

ry**

100

%10

,62

510

0%

7,3

25

100

%13

,20

010

0%

12,6

50

100

%8

,575

100

%15

,40

0

Delivery

/caesa

rean

of

on

e c

hild

fo

llo

win

g

fert

ilit

y t

reatm

en

t. E

xclu

din

g p

re-

an

d

po

stn

ata

l tr

eatm

en

t fo

r m

oth

er

an

d c

hild

(c

f als

o a

rt. 12

.2 h

). M

ax.

100

%4

,40

010

0%

3,0

25

100

%5

,50

010

0%

7,1

50

100

%4

,85

010

0%

8,8

00

*cf

als

o G

lossary

: “H

osp

ital acco

mm

od

ati

on

” **

cf

als

o a

rt. 7.1

.3

Page 14: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

26

27

Valid fro

m 1 January 2015

All amounts are in EUR/G

BP/USD

Valid fro

m 1 January 2015

All amounts are in EUR/G

BP/USD

Module 1

Non-H

ospitalisation B

enefits

Reim

bu

rsem

en

ts u

nd

er

this

su

pp

lem

en

tary

mo

du

le a

re e

Fecte

d a

t 10

0%

of

the e

xp

en

ses,

un

less

yo

u

have c

ho

sen

a d

ed

ucti

ble

. If

yo

u h

ave c

ho

sen

a d

ed

ucti

ble

, p

lease

no

te t

hat

the r

eim

bu

rsem

en

t ra

tes

for

the b

en

efi

ts lis

ted

in

th

e L

ist

of

Reim

bu

rsem

en

ts w

ill b

e r

ed

uced

by a

ny r

em

ain

ing

ded

ucti

ble

. O

nce y

ou

r d

ed

ucti

ble

has

been

reach

ed

, all c

overe

d e

xp

en

ses

will b

e p

aid

in

lin

e w

ith

yo

ur

reim

bu

rsem

en

t ra

tes.

Re

imb

urs

em

en

ts w

ill n

ot

in a

ny e

ve

nt

exce

ed

th

e f

ollo

win

g a

mo

un

ts o

r th

e a

nn

ual m

axim

um

lim

it o

f

EU

R 3

5,0

00

/GB

P 2

5,0

00

/U

SD

35

,00

0.

Genera

l Pra

ctitioners and Specialists

EUR

GBP

USD

GP

co

nsu

ltati

on

s, p

er

co

nsu

ltati

on

125

100

135

Ch

ine

se d

octo

r co

nsu

ltati

on

(if

ch

arg

ed

se

para

tely

), p

er

co

nsu

ltati

on

Max. E

UR

30

0/G

BP

22

0/U

SD

30

0 p

er

po

licy y

ear

30

22

30

Eye a

nd

ear

sp

ecia

lists

/oth

er

sp

ecia

lists

, p

er

co

nsu

ltati

on

125

100

135

Psych

iatr

ists

, p

er

co

nsu

ltati

on

12

58

013

0

Exp

en

se

s are

re

imb

urs

ed

fo

r a m

ax. o

f 15

co

nsu

ltati

on

s w

ith

in a

30

-day p

eri

od

Thera

pists

Die

teti

c g

uid

an

ce

, sp

ee

ch

th

era

py p

er

co

nsu

ltati

on

M

ax. fo

ur

co

nsu

ltati

on

s p

er

po

licy y

ear

50

40

50

Ph

ysio

the

rap

y, e

rgo

the

rap

y p

er

co

nsu

ltati

on

85

65

85

Max. p

er

po

licy y

ear

1,0

50

70

01,

20

0

Ch

iro

pra

cto

r/o

ste

op

ath

all in

clu

siv

e, p

er

co

nsu

ltati

on

65

50

65

Max. p

er

po

licy y

ear

1,0

50

70

01,

20

0

Medical Check-U

p all inclusive, per year

450

400

500

Examinations and oth

er Medical Assista

nce

Lab

ora

tory

te

st,

an

aly

sis

M

ax. p

er

test

45

03

05

50

0

X-r

ay

45

03

05

50

0

EC

G4

50

30

55

00

Scan

, p

er

exam

inati

on

8

50

65

01,

00

0

Inje

cti

on

an

d v

accin

ati

on

, p

er

inje

cti

on

/vaccin

ati

on

85

65

100

Acu

pu

nctu

re a

nd

ho

me

op

ath

ic t

reatm

en

t, p

erf

orm

ed

by a

ph

ysic

ian

Acu

pu

nctu

re a

nd

ho

me

op

ath

ic t

reatm

en

t sh

all o

nly

be c

ove

red

w

he

n p

erf

orm

ed

by a

ph

ysic

ian

/do

cto

r au

tho

rise

d in

th

e c

ou

ntr

y o

f p

racti

se

55

35

60

Surg

ical Inte

rvention

100%

100%

100%

Module 2

Medicine and A

ppliances

Re

imb

urs

em

en

ts u

nd

er

this

mo

du

le a

re a

cco

rdin

g t

o t

he lis

t b

elo

w. If

yo

u h

ave c

ho

se

n a

de

du

cti

ble

, p

lease n

ote

th

at

the r

eim

bu

rse

me

nt

rate

s fo

r th

e b

en

efi

ts lis

ted

in

th

e L

ist

of

Re

imb

urs

em

en

ts w

ill b

e

red

uce

d b

y a

ny r

em

ain

ing

de

du

cti

ble

. O

nce y

ou

r d

ed

ucti

ble

has

be

en

re

ach

ed

, all c

ove

red

exp

en

se

s w

ill b

e p

aid

in

lin

e w

ith

yo

ur

reim

bu

rse

me

nt

rate

s.

Hearing A

ids

50%

50%

50%

EUR

GBP

USD

Pre

scri

be

d h

eari

ng

aid

s, p

er

ap

plian

ce

, m

ax.

30

02

00

32

5

Max. tw

o a

pp

lian

ce

s are

re

imb

urs

ed

pe

r p

olicy y

ear

up

to

max.

60

04

00

65

0

Oth

er Appliances

Slin

gs

an

d b

an

dag

es

100

%10

0%

100

%

Arc

h s

up

po

rt10

0%

100

%10

0%

Re

nta

l o

f m

ed

ical ap

plian

ce

s10

0%

100

%10

0%

Medicine

Pre

scri

be

d m

ed

icin

e a

nd

tra

dit

ion

al C

hin

ese m

ed

icin

e

Tra

dit

ion

al C

hin

ese m

ed

icin

e a

dm

inis

tere

d b

y a

tra

dit

ion

al C

hin

ese

pra

cti

tio

ne

r u

p t

o 1

0 s

essio

ns

pe

r p

olicy y

ear, u

p t

o a

n a

nn

ual m

ax. o

f E

UR

25

0/G

BP

175

/U

SD

30

0

Lim

ite

d t

o r

eco

gn

ise

d t

rad

itio

nal C

hin

ese p

racti

tio

ne

rs r

eg

iste

red

to

p

racti

ce lo

cally

100

%10

0%

100

%

Th

ere

is

no

re

imb

urs

em

en

t fo

r h

om

eo

path

ic o

r n

atu

rop

ath

ic m

ed

icin

es

an

d m

ed

icin

e w

hic

h c

ou

ld

have b

ee

n p

urc

hase

d w

ith

ou

t a p

hysic

ian

’s p

rescri

pti

on

Me

dic

ine a

nd

oth

er

ap

plian

ce

s are

re

imb

urs

ed

up

to

an

an

nu

al m

ax.

2,7

00

1,8

00

3,0

00

Module 3

Medical Evacuation and R

epatriation

Me

dic

al E

vacu

ati

on

an

d R

ep

atr

iati

on

co

ve

rs t

ran

sp

ort

ati

on

to

th

e n

eare

st

ap

pro

pri

ate

pla

ce o

f tr

eatm

en

t if

yo

u h

ave a

se

rio

us

illn

ess

or

inju

ry.

Medical Evacuation and R

epatriation

Tra

nsp

ort

ati

on

exp

en

se

s b

y a

ero

pla

ne o

r h

elico

pte

r10

0%

Acco

mp

an

yin

g p

ers

on

100

%

Retu

rn jo

urn

ey t

o r

esid

en

tial ad

dre

ss

ab

road

/h

om

e c

ou

ntr

y w

ith

in t

hre

e

mo

nth

s aft

er

co

mp

leti

on

of

tre

atm

en

t10

0%

Sta

tuto

ry a

rran

ge

me

nts

in

case o

f d

eath

, su

ch

as

em

balm

ing

an

d z

inc

co

\n

Tra

nsp

ort

ati

on

of

the u

rn/c

o\

n10

0%

Exp

en

se

s are

co

ve

red

up

to

th

e o

ve

rall a

nn

ual in

su

ran

ce s

um

of

yo

ur

po

licy

In a

ll c

ircu

msta

nce

s, w

e m

ust

be n

oti

fie

d b

efo

re t

he t

ran

sp

ort

take

s p

lace

, e

ith

er

dir

ectl

y o

r th

rou

gh

th

e a

tte

nd

ing

ph

ysic

ian

Me

dic

al E

vacu

ati

on

an

d R

ep

atr

iati

on

mu

st

be p

re-a

pp

rove

d b

y t

he C

om

pany

Page 15: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

28

29

29

Wo

rds

wri

tten

in

ita

lic in

th

e P

olic

y C

on

dit

ion

s are

“d

efi

ned

te

rms”

wh

ich

are

sp

ecifi

c t

erm

s re

levan

t to

yo

ur

co

ver.

Ple

ase

 ch

eck t

heir

mean

ing

in

th

e G

loss

ary

at

the e

nd

of

this

p

rod

uct

gu

ide.

PO

LIC

Y C

ON

DIT

ION

SValid fro

m 1 January 2015

All amounts are in EUR/G

BP/USD

Modules 4A and 4B

Denta

l and O

ptical

Re

imb

urs

em

en

ts u

nd

er

the

se t

wo

mo

du

les

are

eF

ecte

d a

t 5

0-8

0%

, b

ut

they w

ill n

ot

in a

ny e

ve

nt

exce

ed

th

e f

ollo

win

g a

mo

un

ts o

r th

e r

esp

ecti

ve a

nn

ual m

axim

um

s o

f M

od

ule

4A

: E

UR

5,0

00

/G

BP

 3,5

00

/U

SD

 5,0

00

an

d M

od

ule

4B

: E

UR

7,5

00

/GB

P 5

,00

0/U

SD

7,5

00

.E

ye c

he

ck p

erf

orm

ed

by o

pti

cia

n/o

pto

metr

ist

max. tw

o v

isit

s p

er

po

licy y

ear

Mo

du

le 4

A m

ax. p

er

vis

it E

UR

40

/GB

P 2

5/

US

D 4

0 a

nd

Mo

du

le 4

B m

ax. p

er

vis

it /

EU

R 5

0/G

BP

35

/ U

SD

50

Module 4A

Module 4B

Routine D

enta

l Tre

atm

ent

80%

80%

80%

80%

80%

80%

EUR

GBP

USD

EUR

GBP

USD

Exam

inati

on

s, m

ax.

20

152

04

03

04

0

To

oth

cle

an

ing

, m

ax.

40

25

40

60

35

60

Fillin

gs

pe

r to

oth

, m

ax.

60

40

60

110

65

110

Ro

ot

tre

atm

en

t p

er

too

th, m

ax.

70

45

70

140

96

140

To

oth

extr

acti

on

s p

er

too

th, m

ax.

40

20

40

100

60

100

Su

rge

ry, m

ax.

73

5

08

117

412

019

5

X-r

ay, m

ax.

40

20

40

50

35

50

An

ae

sth

esia

, m

ax.

1510

152

015

20

Special Denta

l Tre

atm

ent

50%

50%

50%

50%

50%

50%

Bri

dg

ew

ork

Cro

wn

s D

en

tal im

pla

nts

Pe

rio

do

nti

tis

Ort

ho

do

nti

cs

(to

oth

ad

justm

en

t)D

en

ture

s

Sp

ecia

l d

en

tal tr

eatm

en

t p

er

po

licy y

ear, m

ax.

2,0

00

1,5

00

2,0

00

3,0

00

2,2

50

3,0

00

Module 4A

Module 4B

Glasses and C

onta

ct Lenses

80%

80%

80%

80%

80%

80%

On

e p

air

of

gla

sse

s (e

xcl. f

ram

es)

p

er

po

licy y

ear, m

ax.

160

100

160

22

015

02

20

Co

nta

ct

len

se

s, p

er

po

licy y

ear, m

ax.

100

60

100

130

80

130

Fra

me

s an

d s

un

gla

sse

s are

no

t co

ve

red

Eye check

Eye c

he

ck p

erf

orm

ed

by o

pti

cia

n/o

pto

metr

ist

max. tw

o v

isit

s p

er

po

licy y

ear

max. p

er

vis

itm

ax. p

er

vis

it

40

25

40

50

35

50

Page 16: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

30

31

Valid fro

m 1 January 2015

Index

Art

. 1

Accep

tan

ce o

f th

e in

sura

nce

Art

. 2

Co

mm

en

cem

en

t d

ate

Art

. 3

W

ait

ing

peri

od

s in

co

nn

ecti

on

wit

h n

ew

in

sura

nce c

on

tracts

an

d e

xte

nsi

on

of

co

ver

Art

. 4

W

ho

is

co

vere

d b

y t

he in

sura

nce?

Art

. 5

W

here

is

co

ver

pro

vid

ed

?

Art

. 6

W

hat

is c

overe

d b

y t

he in

sura

nce?

Art

. 7

Ho

spit

al P

lan

Art

. 8

M

od

ule

1: N

on

-Ho

spit

alisa

tio

n B

en

efi

ts

Art

. 9

M

od

ule

2: M

ed

icin

e a

nd

Ap

plian

ces

Art

. 10

M

od

ule

3: M

ed

ical E

vacu

ati

on

an

d R

ep

atr

iati

on

Art

. 11

M

od

ule

s 4

A a

nd

4B

: D

en

tal an

d O

pti

cal

Art

. 12

E

xcep

tio

ns

to c

over

Art

. 13

H

ow

to

rep

ort

a c

laim

Art

. 14

C

over

by t

hir

d p

art

ies

Art

. 15

P

aym

en

t o

f p

rem

ium

Art

. 16

In

form

ati

on

necess

ary

to

th

e C

om

pany

Art

. 17

A

ssig

nm

en

t, c

an

cellati

on

an

d e

xp

iry

Art

. 18

C

om

pla

ints

Art

. 19

C

on

fid

en

tiality

Art

. 20

T

he F

inan

cia

l S

erv

ices

Co

mp

en

sati

on

Sch

em

e (

FS

CS

)

Art

. 21

Ap

plicab

le law

Glo

ssary

Art. 1

Accepta

nce of th

e insura

nce

1.1:

Bu

pa In

sura

nce L

imit

ed

, h

ere

inaft

er

called

the C

om

pany, sh

all d

ecid

e w

heth

er

the

insu

ran

ce c

an

be a

ccep

ted

. In

ord

er

for

the

insu

ran

ce t

o b

e a

ccep

ted

an

d t

he C

om

pany t

o

beco

me t

he in

sure

r, t

he a

pp

licati

on

mu

st b

e

ap

pro

ved

by t

he C

om

pany a

nd

th

e n

ecess

ary

pre

miu

m p

aid

to

th

e C

om

pany.

1.2: In

ord

er

for

the in

sura

nce t

o b

e a

ccep

ted

by t

he C

om

pany o

n s

tan

dard

term

s, t

he

ap

plican

t m

ust

be o

f so

un

d h

ealt

h a

t th

e t

ime

of

accep

tan

ce a

nd

mu

st n

ot

suff

er

no

r h

ave

suff

ere

d f

rom

any r

ecu

rrin

g d

isease

, illn

ess

,

inju

ry, b

od

ily in

firm

ity o

r p

hysi

cal d

isab

ilit

y,

an

d t

he a

pp

lican

t m

ust

no

t h

ave a

ttain

ed

60

years

of

ag

e a

t th

e t

ime o

f accep

tan

ce.

If t

he c

on

dit

ion

s in

Art

. 1.2 a

re n

ot

met

an

d

the a

pp

lican

t h

as

no

t att

ain

ed

80

years

of

ag

e a

t th

e t

ime o

f accep

tan

ce, th

e C

om

pany

may o

ffer

the in

sura

nce o

n s

pecia

l te

rms.

If

the C

om

pany d

ecid

es

to o

ffer

the in

sura

nce

on

sp

ecia

l te

rms,

th

e p

olicyh

old

er

will re

ceiv

e

a p

olicy s

ch

ed

ule

in

wh

ich

th

ese

term

s are

state

d.

1.3: In

th

e e

ven

t o

f a c

han

ge in

th

e a

pp

lican

t’s

state

of

healt

h a

fter

the a

pp

licati

on

has

been

sig

ned

an

d b

efo

re t

he C

om

pany’s

ap

pro

val

there

of, t

he a

pp

lican

t sh

all b

e u

nd

er

the

ob

lig

ati

on

to

no

tify

th

e C

om

pany o

f su

ch

ch

an

ge im

med

iate

ly.

1.4: T

he c

urr

en

cy c

ho

sen

fo

r th

e in

sura

nce

can

no

t b

e c

han

ged

aft

er

the C

om

pany’s

accep

tan

ce o

f th

e a

pp

licati

on

.

Art. 2

Commencement date

2.1: T

he in

sura

nce s

hall b

e v

alid

as

of

the d

ate

on

wh

ich

th

e a

pp

licati

on

is a

pp

roved

by t

he C

om

pany.

Th

e c

om

men

cem

en

t d

ate

 is 

state

d in

th

e

po

licy s

ch

ed

ule

. Th

e C

om

pany m

ay a

gre

e o

n

an

oth

er

date

wit

h t

he p

olicyh

old

er.

Art. 3

Waiting periods in connection w

ith

new insura

nce contracts and exte

nsion

of cover

3.1: W

hen

a n

ew

in

sura

nce c

on

tract

is e

nte

red

into

, th

e r

igh

t to

reim

bu

rsem

en

t u

nd

er

the n

ew

in

sura

nce c

on

tract

shall o

nly

take

eff

ect

fou

r w

eeks

aft

er

the c

om

men

cem

en

t

date

of

the in

sura

nce. H

ow

ever, t

his

do

es

no

t ap

ply

wh

en

th

e p

olicyh

old

er

can

pro

ve

sim

ult

an

eo

us

tran

sfere

nce f

rom

an

eq

uiv

ale

nt

insu

ran

ce w

ith

an

oth

er

inte

rnati

on

al h

ealt

h

insu

ran

ce c

om

pany.

3.1.1: In

th

e e

ven

t o

f acu

te s

eri

ou

s illn

ess

an

d

seri

ou

s in

jury

, th

e r

igh

t to

reim

bu

rsem

en

t

shall, h

ow

ever, t

ake e

ffect

co

ncu

rren

tly w

ith

the c

om

men

cem

en

t d

ate

of

the in

sura

nce.

3.1.2: In

ad

dit

ion

, th

e w

ait

ing

peri

od

s list

ed

belo

w s

hall a

pp

ly f

or

the in

sura

nce c

on

tract:

a)

for

exp

en

ses

incu

rred

in

co

nn

ecti

on

wit

h p

reg

nan

cy a

nd

ch

ild

bir

th a

nd

co

nse

qu

en

ces

there

of, t

he r

igh

t to

reim

bu

rsem

en

t sh

all o

nly

take e

ffect

12

mo

nth

s aft

er

the c

om

men

cem

en

t d

ate

of

the in

sura

nce.

b)

for

exp

en

ses

incu

rred

fo

r o

rth

od

on

tics

the r

igh

t to

reim

bu

rsem

en

t sh

all o

nly

take

eff

ect

24

mo

nth

s aft

er

the c

om

men

cem

en

t

date

of

the in

sura

nce.

3.2: T

he in

sure

d m

ay c

han

ge h

is/h

er

insu

ran

ce c

over

to a

no

ther

typ

e o

f co

ver

as

fro

m a

po

licy a

nn

ivers

ary

by g

ivin

g o

ne

mo

nth

’s w

ritt

en

no

tice t

o t

he C

om

pany a

nd

sub

ject

to p

roo

f o

f in

sura

bilit

y a

cco

rdin

g t

o

Art

. 1.

Page 17: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

32

33

3.3: Th

e C

om

pany w

ill p

rocess

th

e e

xte

nsi

on

of

co

ver

as

a n

ew

ap

plicati

on

in

acco

rdan

ce

wit

h A

rt. 1.

3.4: If

exte

nd

ed

co

ver

is t

aken

ou

t u

nd

er

the in

sura

nce c

on

tract,

th

e r

igh

t to

reim

bu

rsem

en

t u

nd

er

such

exte

nsi

on

sh

all

on

ly b

eco

me e

ffecti

ve f

ou

r w

eeks

aft

er

the c

om

men

cem

en

t d

ate

of

the e

xte

nsi

on

.

Ho

wever, A

rt. 3

.1.2

a)

an

d b

) sh

all s

till a

pp

ly.

Du

rin

g t

he w

ait

ing

peri

od

, th

e p

revio

us

co

ver

shall a

pp

ly.

3.4.1: In

th

e e

ven

t o

f acu

te s

eri

ou

s illn

ess

an

d

seri

ou

s in

jury

, th

e r

igh

t to

reim

bu

rse m

en

t

un

der

the e

xte

nd

ed

co

ver

shall, h

ow

ever, t

ake

eff

ect

co

ncu

rren

tly w

ith

th

e c

om

men

cem

en

t

date

of

the e

xte

nsi

on

.

Art. 4

Who is covere

d by the insura

nce?

4.1: T

he in

sura

nce s

hall c

over

the in

sure

d

pers

on

(s)

nam

ed

in

th

e p

olicy s

ch

ed

ule

,

inclu

din

g c

hild

ren

reg

iste

red

th

ere

in.

4.2: C

hild

ren

un

der

10 y

ears

of

ag

e c

an

be

insu

red

at

no

extr

a c

ost

if

the r

eq

uir

em

en

ts

for

accep

tan

ce o

n s

tan

dard

term

s, c

f A

rt.

1.2, are

met.

A m

axim

um

of

two

ch

ild

ren

at

no

extr

a c

ost

per

payin

g a

du

lt, an

d a

to

tal

maxim

um

of

fou

r ch

ild

ren

at

no

extr

a c

ost

per

insu

ran

ce a

pp

ly.

4.2.1: C

over

at

no

extr

a c

ost

fo

r ch

ild

ren

sh

all

furt

herm

ore

be s

ub

ject

to:

th

e c

hild

bein

g r

eg

iste

red

wit

h t

he

Co

mp

any,

an

d

o

ne o

f th

e in

sure

d p

ers

on

s h

avin

g leg

al

cu

sto

dy o

f th

e c

hild

, an

d

th

e c

hild

bein

g r

eg

iste

red

at

the s

am

e

ad

dre

ss a

s th

e in

sure

d h

avin

g leg

al cu

sto

dy

of

the c

hild

.

4.3: A

n a

pp

licati

on

mu

st b

e s

ub

mit

ted

fo

r

new

bo

rn c

hild

ren

.

4.3.1: If

th

e in

sura

nce o

f o

ne o

f th

e p

are

nts

has

been

valid

fo

r a m

inim

um

of

12 m

on

ths,

new

bo

rn c

hild

ren

of

the p

are

nt

can

be

insu

red

, ir

resp

ecti

ve o

f A

rt. 1.2, w

ith

ou

t

sub

mit

tin

g a

n a

pp

licati

on

, cf 

ho

wever, A

rt. 12

.2

h).

A c

op

y o

f th

e b

irth

cert

ific

ate

mu

st,

ho

wever, b

e s

ub

mit

ted

wit

hin

th

ree m

on

ths

aft

er

the b

irth

.

If t

he b

irth

cert

ific

ate

is

no

t su

bm

itte

d t

o t

he

Co

mp

any w

ith

in t

hre

e m

on

ths

aft

er

the b

irth

,

a M

ed

ical Q

uest

ion

nair

e m

ust

be s

ub

mit

ted

for

the c

hild

wh

o h

as

to u

nd

erg

o t

he s

tan

dard

un

derw

riti

ng

pro

ced

ure

acco

rdin

g t

o A

rt. 1.2.

Reg

istr

ati

on

of

the c

hild

will ta

ke p

lace f

rom

the d

ate

th

e M

ed

ical Q

uest

ion

nair

e h

as

been

sig

ned

.

4.3.2: In

case

of

ad

op

tio

n, th

e in

sure

d m

ust

sub

mit

a M

ed

ical Q

uest

ion

nair

e f

or

the

ad

op

ted

ch

ild

.

Art. 5

Where

is cover pro

vided?

5.1: T

he in

sura

nce s

hall p

rovid

e w

orl

dw

ide

co

ver

un

less

oth

erw

ise s

tate

d in

th

e p

olicy

sch

ed

ule

.

Art. 6

What is covere

d by the insura

nce?

6.1: T

he in

sura

nce s

hall c

over

the m

ed

ical

exp

en

ses

incu

rred

by t

he in

sure

d in

acco

rdan

ce w

ith

th

e c

over

ch

ose

n a

nd

th

e

ap

plicab

le L

ist

of

Reim

bu

rsem

en

ts. T

he

ben

efi

ts f

or

wh

ich

exp

en

ses

are

co

vere

d a

nd

the r

eim

bu

rsem

en

t ra

tes

are

sta

ted

in

th

e L

ist

of

Reim

bu

rsem

en

ts.

6.2: R

eim

bu

rsem

en

t sh

all b

e p

aid

fo

llo

win

g

the C

om

pany’s

ap

pro

val o

f th

e e

xp

en

ses

as

bein

g c

overe

d b

y t

he in

sura

nce a

fter

the

receip

ted

an

d ite

mis

ed

bills

, p

rovid

ed

wit

h

the p

olicy n

um

ber, h

ave b

een

receiv

ed

by t

he

Co

mp

any. (c

f als

o p

ag

e 1

7).

6.3: O

nce t

he c

overe

d e

xp

en

ses

have m

et

the a

nn

ual d

ed

ucti

ble

, th

e r

eim

bu

rsab

le

am

ou

nt

will b

e p

aid

. T

he d

ed

ucti

ble

sh

all

be r

ed

uced

by a

mo

un

ts n

ot

exceed

ing

th

e

maxim

um

rate

s sp

ecif

ied

in

th

e v

alid

Lis

t o

f

Reim

bu

rsem

en

ts. T

he d

ed

ucti

ble

sh

all a

pp

ly

per

pers

on

per

po

licy y

ear.

6.3.1: In

case

of

accid

en

t w

here

th

ree o

r m

ore

fam

ily m

em

bers

in

sure

d w

ith

th

e C

om

pany

are

invo

lved

, o

nly

on

e d

ed

ucti

ble

, th

e h

igh

est

,

is a

pp

lied

.

6.4: P

hysi

cia

ns,

sp

ecia

list

s, d

en

tist

s, e

tc.

perf

orm

ing

th

e t

reatm

en

t m

ust

have

au

tho

risa

tio

n in

th

e c

ou

ntr

y o

f p

racti

ce (

cf

als

o a

rt. 12

.2 p

).

6.5: In

no

even

t sh

all t

he a

mo

un

t o

f

reim

bu

rsem

en

t exceed

th

e a

mo

un

t sh

ow

n o

n

the b

ill.

If t

he in

sure

d r

eceiv

es

reim

bu

rsem

en

t

fro

m t

he C

om

pany in

excess

of

the a

mo

un

t to

wh

ich

he/s

he is

en

titl

ed

, th

e in

sure

d s

hall b

e

un

der

the o

blig

ati

on

to

rep

ay t

he C

om

pany

the e

xcess

am

ou

nt

imm

ed

iate

ly, o

therw

ise t

he

Co

mp

any w

ill se

t o

ff t

he e

xcess

am

ou

nt

in a

ny

oth

er

acco

un

t b

etw

een

th

e in

sure

d a

nd

th

e

Co

mp

any.

6.6: R

eim

bu

rsem

en

ts s

hall b

e lim

ited

to

th

e

usu

al,

cu

sto

mary

an

d r

easo

nab

le c

harg

es

in

the a

rea o

r co

un

try in

wh

ich

th

e t

reatm

en

t is

pro

vid

ed

.

6.7: A

ny d

isco

un

t w

hic

h h

as

been

neg

oti

ate

d

dir

ectl

y b

etw

een

th

e C

om

pany a

nd

pro

vid

ers

will b

e s

pecif

ically u

sed

by t

he C

om

pany f

or

the o

vera

ll b

en

efi

t o

f th

e in

sure

d p

ers

on

s

wit

hin

th

e in

sura

nce p

rod

uct

as

a w

ho

le.

6.8: A

ny e

x-g

rati

a p

aym

en

ts a

re a

t th

e

Co

mp

any’s

dis

cre

tio

n. If

th

e C

om

pany m

akes

a p

aym

en

t to

wh

ich

th

e in

sure

d is

no

t en

titl

ed

un

der

the in

sura

nce, th

is w

ill st

ill co

un

t to

ward

the a

nn

ual m

axim

um

co

ver

per

pers

on

per

po

licy y

ear.

Art. 7

Hospital Plan

7.1: T

he H

osp

ital P

lan

mu

st b

e t

aken

ou

t

befo

re a

ny o

ther

sup

ple

men

tary

mo

du

le(s

)

can

be a

dd

ed

. T

he f

ollo

win

g t

erm

s sh

all a

lso

ap

ply

:

7.1.1: T

he H

osp

ital P

lan

sh

all c

over

the

med

ical exp

en

ses

incu

rred

by t

he in

sure

d’s

ho

spit

alisa

tio

n in

acco

rdan

ce w

ith

th

e

ded

ucti

ble

ch

ose

n a

nd

th

e a

p p

licab

le

reim

bu

rsem

en

t ra

tes

as

state

d in

th

e L

ist

of

Reim

bu

rsem

en

ts. It

is

req

uir

ed

th

at

the in

sure

d is

ho

spit

alise

d in

ord

er

to g

et

reim

bu

rsem

en

t u

nd

er

this

pla

n.

7.1.2: Th

e C

om

pany s

hall b

e n

oti

fied

imm

ed

iate

ly o

f any s

tays

in h

osp

ital in

acco

rdan

ce w

ith

Art

. 13

.3.

7.1.3: M

ate

rnit

y b

en

efi

ts a

re c

overe

d in

acco

rdan

ce t

o t

he b

en

efi

t lim

its

list

ed

in

the L

ist

of

Reim

bu

rsem

en

ts a

nd

in

clu

de

rou

tin

e p

ost

nata

l care

fo

r th

e n

ew

bo

rn.

Ro

uti

ne p

ost

nata

l care

in

clu

des

treatm

en

t

of

physi

olo

gic

al ja

un

dic

e if

no

t cau

sed

by

an

un

derl

yin

g d

isease

an

d t

he n

ew

bo

rn’s

ho

spit

al st

ay d

oes

no

t exceed

th

e m

oth

er’

s

ho

spit

al st

ay.

Art. 8

Module 1: Non-H

ospitalisation B

enefits

8.1: If

th

e in

sura

nce h

as

been

exte

nd

ed

to

inclu

de M

od

ule

1, th

e f

ollo

win

g t

erm

s sh

all

als

o a

pp

ly:

8.1.1: M

od

ule

1 c

an

on

ly b

e t

aken

ou

t as

a

sup

ple

men

t to

th

e H

osp

ital P

lan

.

Page 18: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

34

35

8.1.2: M

od

ule

1 s

hall c

over

the in

sure

d’s

exp

en

ses

in a

cco

rdan

ce w

ith

th

e d

ed

ucti

ble

ch

ose

n a

nd

th

e a

pp

licab

le r

eim

bu

rsem

en

t

rate

s as

state

d in

th

e L

ist

of

Reim

bu

rsem

en

ts.

8.1.3: A

ny b

ill fo

r exp

en

ses

incu

rred

by

ou

tpati

en

t tr

eatm

en

t sh

all b

e r

ep

ort

ed

by

sub

mit

tin

g t

he r

eceip

ted

an

d ite

mis

ed

bills

pro

vid

ed

wit

h t

he p

olicy n

um

ber

to t

he

Co

mp

any. P

hysi

cia

n’s

bills

mu

st a

lso

in

clu

de

a d

iag

no

sis

of

the illn

ess

bein

g t

reate

d.

Art. 9

Module 2: Medicine and A

ppliances

9.1: If

th

e in

sura

nce h

as

been

exte

nd

ed

to

inclu

de M

od

ule

2, th

e f

ollo

win

g t

erm

s sh

all

als

o a

pp

ly:

9.1.1: M

od

ule

2 c

an

on

ly b

e t

aken

ou

t as

a

sup

ple

men

t to

th

e H

osp

ital P

lan

.

9.1.2: M

od

ule

2 s

hall c

over

the e

xp

en

ses

in

acco

rdan

ce w

ith

th

e d

ed

ucti

ble

ch

ose

n a

nd

the a

pp

licab

le r

eim

bu

rsem

en

t ra

tes

as

state

d

in t

he L

ist

of

Reim

bu

rsem

en

ts.

9.1.3: A

ny b

ill fo

r exp

en

ses

incu

rred

by

ou

tpati

en

t m

ed

icin

e a

nd

ap

plian

ces

shall

be r

ep

ort

ed

by s

ub

mit

tin

g t

he r

eceip

ted

an

d ite

mis

ed

bills

pro

vid

ed

wit

h t

he p

olicy

nu

mb

er

to t

he C

om

pany. B

ills

fo

r m

ed

icin

e

sho

uld

als

o b

e a

cco

mp

an

ied

by a

co

py o

f th

e

pre

scri

pti

on

.

Art. 10

Module 3: Medical Evacuation and

Repatriation

10.1: If

th

e in

sura

nce h

as

been

exte

nd

ed

to

inclu

de M

od

ule

3, th

e f

ollo

win

g t

erm

s sh

all

als

o a

pp

ly:

10.1.1: M

od

ule

3 c

an

on

ly b

e t

aken

ou

t as

a

sup

ple

men

t to

th

e H

osp

ital P

lan

.

10.1.2: M

od

ule

3 s

hall c

over

the r

easo

nab

le

exp

en

ses

incu

rred

fo

r th

e in

sure

d’s

med

ical

evacu

ati

on

/rep

atr

iati

on

in

th

e e

ven

t o

f

acu

te s

eri

ou

s illn

ess

, se

rio

us

inju

ry o

r

death

in

acco

rdan

ce w

ith

th

e a

pp

licab

le

reim

bu

rsem

en

t ra

tes

as

state

d in

th

e L

ist

of

Reim

bu

rsem

en

ts.

10.1.3: C

over

shall b

e p

rovid

ed

su

bje

ct

to

the a

tten

din

g p

hysi

cia

n a

nd

th

e C

om

pany’s

med

ical co

nsu

ltan

t ag

reein

g o

n t

he n

ecess

ity

of

tran

sferr

ing

th

e in

sure

d a

nd

ag

reein

g

wh

eth

er

the in

sure

d s

ho

uld

be t

ran

sferr

ed

to

his

/her

co

un

try o

f re

sid

en

ce/h

om

e c

ou

ntr

y o

r

to t

he n

eare

st a

pp

rop

riate

pla

ce o

f tr

eatm

en

t.

In c

ase

of

dis

ag

reem

en

t, t

he d

ecis

ion

of

the

Co

mp

any’s

med

ical co

nsu

ltan

t sh

all p

revail.

Th

e e

vacu

ati

on

exp

en

ses

for

an

elig

ible

tran

spo

rtati

on

are

on

ly c

overe

d if

the

tran

spo

rtati

on

is

arr

an

ged

or

pre

-ap

pro

ved

by

the C

om

pany.

10.1.4: T

he e

xp

en

ses

for

tran

spo

rtati

on

co

vere

d u

nd

er

the in

sura

nce, b

ut

no

t

arr

an

ged

by t

he C

om

pany,

sh

all o

nly

be

co

mp

en

sate

d w

ith

an

am

ou

nt

eq

uiv

ale

nt

to t

he e

xp

en

ses

the C

om

pany w

ou

ld h

ave

incu

rred

, h

ad

th

e C

om

pany a

rran

ged

th

e

tran

spo

rtati

on

.

10.1.5: T

he in

sura

nce s

hall c

over

reaso

nab

le

an

d n

ecess

ary

tra

nsp

ort

ati

on

exp

en

ses

for

on

e p

ers

on

acco

mp

anyin

g t

he in

sure

d.

10.1.6: O

ne t

ran

spo

rtati

on

is

co

vere

d in

co

nn

ecti

on

wit

h o

ne c

ou

rse o

f an

illn

ess

.

10.1.7: M

od

ule

3 s

hall o

nly

ap

ply

if

the illn

ess

is c

overe

d u

nd

er

the in

sura

nce.

10.1.8: In

th

e e

ven

t th

at

the in

sure

d is

evacu

ate

d/r

ep

atr

iate

d f

or

the p

urp

ose

of

receiv

ing

tre

atm

en

t, h

e/s

he a

nd

th

e

acco

mp

anyin

g p

ers

on

, if

any,

sh

all b

e

reim

bu

rsed

fo

r th

e e

xp

en

ses

for

a r

etu

rn

jou

rney t

o t

he in

sure

d’s

pla

ce o

f re

sid

en

ce/

ho

me c

ou

ntr

y. T

he r

etu

rn jo

urn

ey s

hall b

e

mad

e w

ith

in t

hre

e m

on

ths

aft

er

treatm

en

t h

as

been

co

mp

lete

d. C

over

shall o

nly

be p

rovid

ed

for

travel exp

en

ses

eq

uiv

ale

nt

to t

he c

ost

of

an

aero

pla

ne t

icket

on

eco

no

my c

lass

, as

a

maxim

um

.

10.1.9: In

th

e e

ven

t th

at

the in

sure

d h

as

receiv

ed

tre

atm

en

t co

vere

d b

y t

he in

sura

nce,

bu

t n

ow

has

reach

ed

th

e t

erm

inal p

hase

, h

e/

she a

nd

th

e a

cco

mp

anyin

g p

ers

on

, if

any,

sh

all

be r

eim

bu

rsed

fo

r th

e e

xp

en

ses

of

the r

etu

rn

jou

rney t

o t

he in

sure

d’s

pla

ce o

f re

sid

en

ce.

10.1.10: In

th

e e

ven

t o

f d

eath

, exp

en

ses

shall

be r

eim

bu

rsed

fo

r h

om

e t

ran

spo

rtati

on

of

the d

ecease

d a

nd

fo

r st

atu

tory

arr

an

gem

en

ts

such

as

em

balm

ing

an

d a

zin

c c

off

in.

Th

e n

ext

of

kin

have t

he f

ollo

win

g o

pti

on

s:

a)

cre

mati

on

of

the d

ecease

d a

nd

ho

me

tran

spo

rtati

on

of

the u

rn, o

r

b)

ho

me t

ran

spo

rtati

on

of

the d

ecease

d.

10.1.11:

Th

e C

om

pany c

an

no

t b

e h

eld

lia

ble

for

any d

ela

ys

or

rest

ricti

on

s in

co

nn

ecti

on

wit

h t

he t

ran

spo

rtati

on

cau

sed

by w

eath

er

co

nd

itio

ns,

mech

an

ical p

rob

lem

s, r

est

ricti

on

s

imp

ose

d b

y p

ub

lic a

uth

ori

ties

or

by t

he p

ilo

t

or

any o

ther

co

nd

itio

n b

eyo

nd

th

e C

om

pany’s

co

ntr

ol.

Art. 11

Modules 4A and 4B: Denta

l and

Optical

11.1: If

th

e in

sura

nce h

as

been

exte

nd

ed

to

inclu

de M

od

ule

4, th

e f

ollo

win

g t

erm

s sh

all

als

o a

pp

ly:

11.1.1: M

od

ule

4 c

an

on

ly b

e t

aken

ou

t as

a

sup

ple

men

t to

th

e H

osp

ital P

lan

.

11.1.2: M

od

ule

4 s

hall c

over

the in

sure

d’s

exp

en

ses

for

den

tal tr

eatm

en

ts a

nd

gla

sses

an

d len

ses

in a

cco

rdan

ce w

ith

th

e a

pp

licab

le

reim

bu

rsem

en

t ra

tes

as

state

d in

th

e L

ist

of

Reim

bu

rsem

en

ts.

11.1.3: A

ny b

ill fo

r exp

en

ses

incu

rred

by

den

tal tr

eatm

en

t an

d g

lass

es

an

d len

ses

shall

be r

ep

ort

ed

by s

ub

mit

tin

g t

he r

eceip

ted

an

d ite

mis

ed

bills

pro

vid

ed

wit

h t

he p

olicy

nu

mb

er

to t

he C

om

pany.

Art. 12

Exceptions to

cover

12.1: T

he in

sura

nce s

hall n

ot

co

ver

exp

en

ses

incu

rred

fo

r any d

isease

, illn

ess

or

inju

ry

kn

ow

n t

o t

he p

olicyh

old

er

an

d/o

r th

e in

sure

d

at

the t

ime o

f ap

plicati

on

, u

nle

ss a

gre

ed

up

on

wit

h t

he C

om

pany.

12.2: F

urt

herm

ore

, th

e C

om

pany s

hall n

ot

be

liab

le t

o p

ay r

eim

bu

rsem

en

t fo

r exp

en

ses

wh

ich

co

ncern

, are

du

e t

o o

r are

in

cu

rred

as

a

resu

lt o

f:

a)

no

n-m

ed

ically e

ssen

tial an

d c

osm

eti

c

surg

ery

an

d t

reatm

en

t u

nle

ss m

ed

ically

pre

scri

bed

an

d p

re-a

pp

roved

by t

he

Co

mp

any,

b)

ob

esi

ty s

urg

ery

an

d t

reatm

en

t (i

nclu

din

g

die

t p

ills

),

c)

ven

ere

al d

isease

s, A

IDS

, A

IDS

-rela

ted

dis

ease

s an

d d

isease

s re

lati

ng

to

HIV

an

tib

od

ies

(HIV

po

siti

ve).

Ho

wever,

dis

ease

s re

lati

ng

to

AID

S a

nd

HIV

an

tib

od

ies

(HIV

po

siti

ve)

are

co

vere

d, if

pro

ven

to

be c

au

sed

by a

blo

od

tra

nsf

usi

on

receiv

ed

aft

er

the c

om

men

cem

en

t o

f

the p

olicy.

Th

e H

IV-v

iru

s w

ill als

o b

e

co

vere

d if

pro

ven

to

be c

on

tracte

d

as

the r

esu

lt o

f an

accid

en

t o

ccu

rrin

g

du

rin

g t

he c

ou

rse o

f o

nly

th

e f

ollo

win

g

occu

pati

on

s: d

octo

rs, d

en

tist

s, n

urs

es,

Page 19: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

36

37

lab

ora

tory

pers

on

nel,

an

cilla

ry h

os p

ital

wo

rkers

, m

ed

ical an

d d

en

tal ass

ista

nts

,

am

bu

lan

ce p

ers

on

nel,

mid

wiv

es,

fir

e

bri

gad

e p

ers

on

nel,

po

licem

en

/-w

om

en

,

an

d p

riso

n o

ffic

ers

. T

he in

sure

d s

hall n

oti

fy

the C

om

pany w

ith

in 1

4 d

ays

aft

er

such

accid

en

t an

d a

t th

e s

am

e t

ime p

rovid

e a

neg

ati

ve H

IV a

nti

bo

dy t

est

,

d)

any u

se o

r m

isu

se o

f alc

oh

ol,

dru

gs

an

d/

or

med

icin

es

un

less

it

can

be d

ocu

men

ted

that

the illn

ess

or

inju

ry is

un

rela

ted

there

to,

e)

inte

nti

on

al se

lf-i

nfl

icte

d b

od

ily in

jury

,

f)

co

ntr

acep

tio

n, in

clu

din

g s

teri

lisa

tio

n,

g)

ind

uced

ab

ort

ion

un

less

med

ically

pre

scri

bed

,

h)

any k

ind

of

fert

ilit

y t

est

an

d/o

r tr

eatm

en

t,

inclu

din

g h

orm

on

e t

reatm

en

t, in

sem

inati

on

or

exam

inati

on

s an

d a

ny p

roced

ure

s

rela

ted

here

to, in

clu

din

g e

xp

en

ses

for

pre

gn

an

cy,

pre

- an

d p

ost

nata

l tr

eatm

en

ts

of

the m

oth

er

an

d t

he n

ew

bo

rn c

hild

/

ch

ild

ren

. A

n a

pp

licati

on

mu

st t

here

fore

be s

ub

mit

ted

fo

r ch

ild

ren

bo

rn a

s a

resu

lt o

f fe

rtilit

y t

reatm

en

t an

d/o

r b

orn

by a

su

rro

gate

mo

ther. T

he a

pp

licati

on

will u

nd

erg

o t

he s

tan

dard

un

derw

riti

ng

pro

ced

ure

, acco

rdin

g t

o A

rt. 1,

i)

sexu

al p

rob

lem

s an

d g

en

der

issu

es:

sexu

al

pro

ble

ms,

su

ch

as

imp

ote

nce, w

hate

ver

the c

au

se, o

r se

x c

han

ges

or

gen

der

re-a

ssig

nm

en

ts,

j)

ho

spit

al acco

mm

od

ati

on

wh

en

it

is u

sed

sole

ly o

r p

rim

ari

ly f

or

any o

f th

e f

ollo

win

g

pu

rpo

ses:

receiv

ing

gen

era

l n

urs

ing

care

or

any o

ther

serv

ices

wh

ich

do

no

t

req

uir

e t

he in

sure

d t

o b

e in

a h

osp

ital

an

d c

ou

ld b

e p

rovid

ed

in

a n

urs

ing

ho

me

or

oth

er

est

ab

lish

men

t th

at

is n

ot

at

ho

spit

al;

receiv

ing

serv

ices

wh

ich

wo

uld

no

t n

orm

ally r

eq

uir

e t

rain

ed

med

ical

pro

fess

ion

als

(eg

help

in

walk

ing

an

d

bath

ing

) an

d p

ain

man

ag

em

en

t,

k)

treatm

en

t b

y n

atu

rop

ath

s o

r h

om

oeo

-

path

s an

d n

atu

rop

ath

ic o

r h

om

oeo

path

ic

med

icati

on

s an

d o

ther

alt

ern

ati

ve m

eth

od

s

of

treatm

en

t, u

nle

ss s

pecif

ied

in

th

e L

ist

of

Reim

bu

rsem

en

ts,

l)

healt

h c

ert

ific

ate

s,

m) tr

eatm

en

t o

f d

isease

s d

uri

ng

milit

ary

serv

ice,

n)

treatm

en

t fo

r si

ckn

ess

or

inju

ries

dir

ectl

y o

r

ind

irectl

y c

au

sed

wh

ile a

cti

vely

en

gag

ing

in:

w

ar, invasi

on

, acts

of

a f

ore

ign

en

em

y,

ho

stilit

ies

(wh

eth

er

war

has

been

decla

red

or

no

t), civ

il w

ar, t

err

ori

st a

cts

, re

bellio

n,

revo

luti

on

, in

surr

ecti

on

, civ

il c

om

mo

tio

n,

milit

ary

or

usu

rped

po

wer, m

art

ial la

w,

rio

ts o

r th

e a

cts

of

any law

fully c

on

stit

ute

d

au

tho

rity

, o

r arm

y, n

aval o

r air

serv

ices

op

era

tio

ns

wh

eth

er

war

has

been

decla

red

or

no

t,

o)

nu

cle

ar

reacti

on

s o

r ra

dio

acti

ve f

allo

ut,

p)

treatm

en

t p

erf

orm

ed

by a

n u

nre

co

gn

ised

med

ical p

racti

tio

ner, p

rovid

er

or

facilit

y,

q)

ep

idem

ics

wh

ich

have b

een

pla

ced

un

der

the d

irecti

on

of

pu

blic a

uth

ori

ties,

r) tr

eatm

en

t b

y a

psy

ch

olo

gis

t,

s) tr

eatm

en

t o

r su

rgery

to

co

rrect

refr

acti

ve

err

ors

in

th

e e

yesi

gh

t (d

ue t

o e

g m

yo

pia

,

hyp

ero

pia

/hyp

erm

etr

op

ia, ast

igm

ati

sm

an

d p

resb

yo

pia

) su

ch

as

lase

r tr

eatm

en

t,

refr

acti

ve k

era

toto

my a

nd

ph

oto

refr

acti

ve

kera

tecto

my,

cle

ar

len

s extr

acti

on

, o

r

acco

mm

od

ati

ve in

trao

cu

lar

len

ses,

t) any t

reatm

en

t o

r m

ed

icin

e w

hic

h is

exp

eri

men

tal b

ase

d o

n a

ccep

tab

le

evid

en

ce, u

nle

ss u

nd

ert

aken

as

part

of

a

ph

ase

3 o

r p

hase

4 r

eg

iste

red

clin

ical tr

ial

(th

e C

om

pany r

ese

rves

the r

igh

t to

ask

fo

r

full c

lin

ical d

eta

ils

befo

re a

uth

ori

sin

g a

ny

treatm

en

t an

d t

he in

sure

d m

ust

receiv

e t

he

Co

mp

any’s

wri

tten

ag

reem

en

t b

efo

re t

he

treatm

en

t ta

kes

pla

ce),

u)

any t

reatm

en

t o

r m

ed

icin

e w

hic

h is

no

t

pro

ven

to

be e

ffecti

ve b

ase

d o

n a

ccep

tab

le

evid

en

ce,

v)

med

icati

on

an

d e

qu

ipm

en

t u

sed

fo

r

pu

rpo

ses

oth

er

than

th

ose

defi

ned

un

der

their

lic

en

ce.

Art. 13

How to report a claim

13.1: A

ny c

laim

fo

r re

imb

urs

em

en

t o

f

exp

en

ses

incu

rred

fo

r tr

eatm

en

t b

y a

physi

cia

n o

r sp

ecia

list

as

well a

s h

osp

ital

treatm

en

t an

d m

ed

icin

e s

hall b

e r

ep

ort

ed

by s

ub

mit

tin

g r

eceip

ted

an

d ite

mis

ed

bills

pro

vid

ed

wit

h t

he p

olicy n

um

ber

to t

he C

om

pany. (c

f als

o p

ag

e 1

7).

Th

e C

om

pany s

can

s su

bm

itte

d b

ills

 up

on

receip

t. A

ny r

etr

ieval o

f th

e s

ub

mit

ted

bills

is

no

t p

oss

ible

.

Th

e C

om

pany r

ese

rves

the r

igh

t at

any t

ime

to r

eq

uir

e p

rovis

ion

of

ori

gin

al b

ills

fro

m

the in

sure

d. If

an

ori

gin

al b

ill is

no

t p

rovid

ed

up

on

req

uest

th

e C

om

pany m

ay d

eny

reim

bu

rsem

en

t o

f th

e e

xp

en

ses

to w

hic

h t

he

bill re

late

s.

13.2: A

ny c

laim

sh

all b

e r

ep

ort

ed

to

th

e

Co

mp

any im

med

iate

ly a

nd

no

late

r th

an

th

ree

mo

nth

s aft

er

the c

ircu

mst

an

ces

un

derl

yin

g

the c

laim

have b

eco

me k

no

wn

to

th

e in

sure

d.

13.3: Th

e C

om

pany s

hall b

e n

oti

fied

im

med

i-

ate

ly o

f any s

tays

in h

osp

ital,

an

d s

uch

no

tifi

cati

on

mu

st in

clu

de t

he p

hysi

cia

n’s

dia

gn

osi

s. A

ll n

oti

ficati

on

s sh

ou

ld b

e m

ad

e

by t

ele

ph

on

e, fa

x o

r em

ail; th

e C

om

pany

shall d

efr

ay a

ll e

xp

en

ses

incu

rred

in

th

is

co

nn

ecti

on

.

Art. 14

Cover by third parties

14.1: W

here

th

ere

is

co

ver

by a

no

ther

insu

ran

ce p

olicy o

r h

ealt

hcare

pla

n, th

is m

ust

be d

isclo

sed

to

th

e C

om

pany w

hen

cla

imin

g

reim

bu

rsem

en

t, a

nd

th

e c

over

un

der

this

insu

ran

ce s

hall b

e s

eco

nd

ary

to

any s

uch

oth

er

insu

ran

ce p

olicy o

r h

ealt

hcare

pla

n.

14.2: In

th

ese

cir

cu

mst

an

ces,

th

e C

om

pany

will co

-ord

inate

paym

en

ts w

ith

oth

er

co

mp

an

ies

an

d t

he C

om

pany w

ill n

ot

be lia

ble

for

mo

re t

han

its

rate

ab

le p

rop

ort

ion

.

14.3: If

th

e c

laim

is

co

vere

d in

wh

ole

or

in p

art

by a

ny s

ch

em

e, p

rog

ram

me o

r si

milar, f

un

ded

by a

ny G

overn

men

t, t

he C

om

pany s

hall n

ot

be

liab

le f

or

the a

mo

un

t co

vere

d.

14.4: T

he p

olicyh

old

er

an

d a

ny in

sure

d p

ers

on

un

dert

ake t

o c

o-o

pera

te w

ith

th

e C

om

pany

an

d t

o n

oti

fy t

he C

om

pany im

med

iate

ly o

f

any c

laim

or

rig

ht

of

acti

on

ag

ain

st t

hir

d

part

ies.

14.5: F

urt

herm

ore

, th

e p

olicyh

old

er

an

d a

ny

insu

red

pers

on

sh

all k

eep

th

e C

om

pany f

ully

info

rmed

an

d s

hall t

ake a

ny r

easo

nab

le s

tep

in m

akin

g a

cla

im u

po

n a

no

ther

part

y a

nd

to

safe

gu

ard

th

e in

tere

sts

of

the C

om

pany.

14.6: In

any e

ven

t, t

he C

om

pany s

hall h

ave t

he

full r

igh

t o

f su

bro

gati

on

.

Page 20: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

38

39

Art. 15

Payment of pre

mium

15.1: P

rem

ium

s are

dete

rmin

ed

by t

he

Co

mp

any a

nd

sh

all b

e p

ayab

le in

ad

van

ce.

Th

e C

om

pany a

dju

sts

the p

rem

ium

s o

nce

a y

ear

as

fro

m t

he a

nn

ivers

ary

date

on

th

e

basi

s o

f ch

an

ges

in t

he c

over

an

d/o

r th

e lo

ss

exp

eri

en

ce in

th

e in

sura

nce c

lass

du

rin

g t

he

pre

vio

us

cale

nd

ar

year.

15.2: T

he p

rem

ium

is

ag

e-r

ela

ted

an

d w

ill

there

fore

als

o b

e a

dju

sted

on

th

e f

irst

du

e

date

aft

er

the in

sure

d’s

bir

thd

ay.

In

th

e c

ase

of

a c

hild

tu

rnin

g 1

0, a p

ro r

ata

pre

miu

m w

ill b

e

ch

arg

ed

on

th

e d

ue d

ate

pri

or

to t

he c

hild

’s

10th

bir

thd

ay.

15.3: T

he in

itia

l p

rem

ium

sh

all f

all d

ue o

n t

he

co

mm

en

cem

en

t d

ate

. T

he p

olicyh

old

er

may

ch

oo

se b

etw

een

qu

art

erl

y, s

em

i-an

nu

al an

d

an

nu

al p

aym

en

t.

15.4: C

han

ges

in t

he t

erm

s o

f p

aym

en

t can

on

ly b

e m

ad

e a

t 3

0 d

ays’

wri

tten

no

tice p

rio

r

to t

he p

olicy a

nn

ivers

ary

.

15.5: T

here

are

10

days

of

gra

ce o

n e

ach

pre

miu

m d

ue d

ate

.

15.6: T

he p

olicyh

old

er

shall b

e r

esp

on

sib

le

for

pu

nctu

al p

aym

en

t o

f th

e p

rem

ium

to

th

e

Co

mp

any, an

d if

a p

rem

ium

is

no

t re

ceiv

ed

by

the C

om

pany w

ith

in t

he 1

0 d

ays’

gra

ce p

eri

od

at

any d

ue d

ate

, th

e C

om

pany’s

lia

bilit

y s

hall

cease

.

15.7: T

he p

olicyh

old

er’

s att

en

tio

n is

dra

wn

to

Art

. 6

.5 r

eg

ard

ing

paym

en

t o

f o

uts

tan

din

g

am

ou

nts

.

15.8: O

ther

ch

arg

es,

su

ch

as

Insu

ran

ce

Pre

miu

m T

ax (

IPT

), o

r o

ther

taxes,

levie

s

or

ch

arg

es,

dep

en

din

g o

n t

he law

s o

f th

e

po

licyh

old

er’

s co

un

try o

f re

sid

en

ce m

ay a

pp

ly.

If t

hey a

pp

ly t

o t

he p

olicyh

old

er’

s in

sura

nce

pre

miu

m, th

ey w

ill b

e in

clu

ded

wit

hin

th

e

tota

l th

at

has

to b

e p

aid

on

th

e p

rem

ium

no

tice. T

he c

harg

es

may a

pp

ly f

rom

th

e

co

mm

en

cem

en

t d

ate

or

the a

nn

ivers

ary

of

the c

om

men

cem

en

t d

ate

. T

he p

olicyh

old

er

mu

st p

ay t

hese

ch

arg

es

to u

s w

hen

payin

g

the p

rem

ium

s, u

nle

ss o

therw

ise r

eq

uir

ed

by law

.

Art. 16

Info

rmation necessary

to the C

ompany

16.1: T

he p

olicyh

old

er

an

d/o

r th

e in

sure

d

shall b

e u

nd

er

the o

blig

ati

on

to

no

tify

th

e

Co

mp

any in

wri

tin

g o

f any c

han

ges

of

nam

e

or

ad

dre

ss a

nd

ch

an

ges

in h

ealt

h in

sura

nce

co

ver

wit

h a

no

ther

co

mp

any,

in

clu

din

g a

co

nso

lid

ate

d c

om

pany.

Th

e C

om

pany m

ust

als

o b

e n

oti

fied

in

th

e e

ven

t o

f d

eath

of

the

po

licyh

old

er

or

an

in

sure

d. Th

e C

om

pany

shall n

ot

be lia

ble

fo

r th

e c

on

seq

uen

ces

if t

he

po

licyh

old

er

an

d/o

r th

e in

sure

d f

ails

to n

oti

fy

the C

om

pany in

su

ch

even

ts.

16.2: T

he p

olicyh

old

er

an

d/o

r th

e in

sure

d

shall a

lso

be u

nd

er

the o

blig

ati

on

to

pro

vid

e

the C

om

pany w

ith

all in

form

ati

on

reaso

nab

ly

req

uir

ed

fo

r th

e C

om

pany’s

han

dlin

g o

f th

e

po

licyh

old

er’

s an

d/o

r th

e in

sure

d’s

cla

ims

ag

ain

st t

he C

om

pany, in

clu

din

g p

rovis

ion

of

ori

gin

al b

ills

up

on

req

uest

fro

m t

he C

om

pany.

16.3: In

ad

dit

ion

, th

e C

om

pany s

hall b

e

en

titl

ed

to

seek in

form

ati

on

ab

ou

t th

e

insu

red

  ’s s

tate

of

healt

h a

nd

to

co

nta

ct

any

ho

spit

al,

physi

cia

n, etc

. w

ho

is

treati

ng

or

has

been

tre

ati

ng

th

e in

sure

d f

or

physi

cal o

r

men

tal illn

ess

es

or

dis

ord

ers

. F

urt

herm

ore

,

the C

om

pany s

hall b

e e

nti

tled

to

ob

tain

any

med

ical re

co

rds

or

oth

er

wri

tten

rep

ort

s an

d

state

men

ts c

on

cern

ing

th

e in

sure

d’s

sta

te

of 

healt

h.

Art. 17

Assignment, cancellation and expiry

17.1: W

ith

ou

t th

e p

rio

r w

ritt

en

co

nse

nt

of

the

Co

mp

any, n

o p

art

y s

hall b

e e

nti

tled

to

cre

ate

a c

harg

e o

n o

r ass

ign

th

e r

igh

ts u

nd

er

the

insu

ran

ce.

17.2: T

he in

sura

nce is

au

tom

ati

cally r

en

ew

ed

on

each

po

licy a

nn

ivers

ary

.

17.2.1: T

he in

sura

nce m

ay b

e t

erm

inate

d b

y

the p

olicyh

old

er

wit

h e

ffect

fro

m t

he e

nd

of

a c

ale

nd

ar

mo

nth

wit

h o

ne m

on

th’s

pri

or

wri

tten

no

tice.

17.2.2: T

he p

olicyh

old

er

can

can

cel th

e

insu

ran

ce, an

d t

hat

of

any a

dd

itio

nal in

sure

d

co

vere

d u

nd

er

the in

sura

nce, w

ith

in 2

8 d

ays

of

receiv

ing

th

e f

irst

po

licy d

ocu

men

ts.

Sh

ou

ld t

he p

olicyh

old

er

wis

h t

o c

an

cel th

e

insu

ran

ce u

po

n r

eceip

t o

f th

e f

irst

po

licy

do

cu

men

ts, th

e p

olicyh

old

er

need

s to

do

th

at

in w

riti

ng

(b

y lett

er, f

ax o

r em

ail).

Th

e a

dd

ress

an

d c

on

tact

info

rmati

on

can

be f

ou

nd

on

the b

ack p

ag

e o

f th

is p

rod

uct

gu

ide. If

th

e

po

licyh

old

er

or

any a

dd

itio

nal in

sure

d h

ave

no

t m

ad

e a

ny c

laim

s, t

he C

om

pany w

ill re

fun

d

any p

rem

ium

paym

en

t alr

ead

y p

aid

.

17.3: W

here

up

on

takin

g o

ut

the in

sura

nce

or

sub

seq

uen

tly,

th

e p

olicyh

old

er

an

d/o

r th

e

insu

red

has

frau

du

len

tly c

han

ged

ori

gin

al

do

cu

men

ts o

r d

isclo

sed

in

co

rrect

info

rmati

on

or

wit

hh

eld

facts

wh

ich

may b

e r

eg

ard

ed

as

bein

g o

f im

po

rtan

ce t

o t

he C

om

pany, th

e

insu

ran

ce c

on

tract

shall b

e v

oid

an

d s

hall n

ot

be b

ind

ing

on

th

e C

om

pany.

17.4: W

here

up

on

takin

g o

ut

the in

sura

nce

or

sub

seq

uen

tly,

th

e p

olicyh

old

er

an

d/o

r th

e

insu

red

has

dis

clo

sed

in

co

rrect

info

rmati

on

,

the in

sura

nce c

on

tract

shall b

e v

oid

, an

d t

he

Co

mp

any s

hall n

ot

be lia

ble

if

the C

om

pany

wo

uld

no

t h

ave a

ccep

ted

th

e in

sura

nce if

the c

orr

ect

info

rmati

on

had

been

dis

clo

sed

.

If t

he C

om

pany w

ou

ld h

ave a

ccep

ted

th

e

insu

ran

ce b

ut

on

oth

er

term

s, t

he C

om

pany

shall b

e lia

ble

to

th

e e

xte

nt

to w

hic

h t

he

Co

mp

any w

ou

ld h

ave u

nd

ert

aken

th

e

ob

lig

ati

on

s in

acco

rdan

ce w

ith

th

e a

gre

ed

pre

miu

m.

17.4.1: In

th

e e

ven

t th

at

the in

sura

nce c

on

tract

is c

on

sid

ere

d v

oid

, acco

rdin

g t

o A

rt. 17

.3 o

r

Art

 17.

4, th

e C

om

pany s

hall b

e e

nti

tled

to

a s

erv

ice c

harg

e w

hic

h is

set

as

a s

pecif

ied

perc

en

tag

e o

f th

e p

rem

ium

paid

.

17.5: W

here

up

on

takin

g o

ut

the in

sura

nce, th

e

po

licyh

old

er

an

d/o

r th

e in

sure

d n

eit

her

kn

ew

no

r sh

ou

ld h

ave k

no

wn

th

at

the in

form

ati

on

dis

clo

sed

by h

im/h

er

was

inco

rrect,

th

e

Co

mp

any s

hall b

e lia

ble

as

if s

uch

in

co

rrect

info

rmati

on

had

no

t b

een

 dis

clo

sed

.

17.6: Th

e C

om

pany c

an

sto

p o

r su

spen

d a

n

insu

ran

ce p

rod

uct

at

thre

e m

on

ths’

no

tice

pri

or

to t

he p

olicy a

nn

ivers

ary

, an

d o

ffer

the

insu

red

an

eq

uiv

ale

nt

insu

ran

ce c

over.

17.7: Th

e C

om

pany’s

lia

bilit

y in

co

nn

ecti

on

wit

h t

he in

sura

nce, in

clu

din

g lia

bilit

y f

or

reim

bu

rsem

en

t fo

r m

ed

ical exp

en

ses

for

on

go

ing

tre

atm

en

t, a

fter-

eff

ects

or

co

nse

qu

en

tial d

am

ag

es

in c

on

necti

on

wit

h a

n

inju

ry o

r illn

ess

in

cu

rred

or

treate

d d

uri

ng

th

e

insu

ran

ce p

eri

od

, sh

all a

uto

mati

cally c

ease

up

on

exp

iry,

can

cellati

on

or

term

inati

on

of

the

insu

ran

ce.

Acco

rdin

gly

, u

po

n e

xp

iry,

can

cellati

on

or

term

inati

on

of

the in

sura

nce, an

in

sure

d’s

rig

ht

to c

laim

reim

bu

rsem

en

t sh

all c

ease

. C

laim

s

for

reim

bu

rsem

en

t o

f m

ed

ical exp

en

ses

incu

rred

du

rin

g t

he in

sura

nce p

eri

od

mu

st b

e

file

d w

ith

in s

ix m

on

ths

of

the d

ate

of

exp

iry,

can

cellati

on

or

term

inati

on

of

the in

sura

nce in

ord

er

to b

e e

lig

ible

fo

r re

imb

urs

em

en

t.

Page 21: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

40

41

Art. 18

Complaints

18.1: H

ow

to

file a

co

mp

lain

t

We a

re a

lways

ple

ase

d t

o h

ear

ab

ou

t any

asp

ect

of

the in

sura

nce c

over

that

the in

sure

d

has

part

icu

larl

y a

pp

recia

ted

, o

r w

hic

h m

ay

have c

au

sed

th

e in

sure

d a

ny p

rob

lem

s.

If s

om

eth

ing

do

es

go

wro

ng

, w

e h

ave a

sim

ple

pro

ced

ure

to

en

sure

th

at

all c

on

cern

s

are

dealt

wit

h a

s  q

uic

kly

an

d e

ffecti

vely

as

po

ssib

le.

Fo

r an

y c

om

men

ts o

r co

mp

lain

ts, th

e B

up

a

Glo

bal C

ust

om

er

Serv

ice c

an

be c

on

tacte

d

at

the p

ho

ne n

um

ber

+4

5 7

0 2

3 0

0 4

2, b

y

em

ail a

t C

om

pla

ints

- Glo

bal@

ihi.c

om

, o

r b

y

wri

tin

g t

o u

s at:

Bu

pa G

lob

al

Palæ

gad

e 8

DK

-126

1 C

op

en

hag

en

K

Den

mark

18.2: E

xte

rnal ap

peal

It’s

very

rare

th

at

we c

an

’t s

ett

le a

co

mp

lain

t,

bu

t if

th

is d

oes

hap

pen

, th

e c

om

pla

inan

t

may b

e e

nti

tled

to

refe

r th

e c

om

pla

int

to

an

in

dep

en

den

t o

rgan

isati

on

fo

r re

vie

w.

Wh

ich

org

an

isati

on

it

will b

e d

ep

en

ds

on

the n

atu

re o

f th

e c

om

pla

int

an

d t

he lo

cati

on

of

the B

up

a G

lob

al o

ffic

e w

here

th

e c

au

se

of

the c

om

pla

int

occu

red

. W

e w

ill ad

vis

e

the c

om

pla

inan

t at

the t

ime. In

mo

st c

ase

s

this

will b

e e

ith

er

the D

an

ish

In

sura

nce

Co

mp

lain

ts B

oard

or

the U

K F

inan

cia

l

Om

bu

dsm

an

 Serv

ice.

Fu

rth

er

info

rmati

on

ab

ou

t th

e D

an

ish

Insu

ran

ce C

om

pla

ints

Bo

ard

can

be

req

uest

ed

by:

w

riti

ng

to

th

em

at

An

ker 

Heeg

aard

s G

ad

e 2

, 1.

DK

-1572 C

op

en

hag

en

V, D

en

mark

callin

g t

hem

on

+4

5 3

3 1

5 8

9 0

0

Mo

re d

eta

ils

can

be f

ou

nd

on

th

eir

web

site

ww

w. a

nkefo

rsik

rin

g.d

k

Fu

rth

er

info

rmati

on

ab

ou

t th

e U

K F

inan

cia

l

Om

bu

dsm

an

Serv

ice c

an

be r

eq

uest

ed

by:

w

riti

ng

to

th

em

at

Exch

an

ge T

ow

er, L

on

do

n

E14

9S

R, U

K

callin

g t

hem

on

08

00

023

4 5

67 f

rom

a

UK

lan

dlin

e, o

r 0

30

0 1

23

9 1

23

fro

m a

UK

mo

bile t

ele

ph

on

e, o

r fo

r calls

fro

m o

uts

ide

of

the U

K +

44

20

79

64

05

00

Mo

re d

eta

ils

can

be f

ou

nd

on

th

eir

web

site

ww

w. fin

an

cia

l-o

mb

ud

sman

. org

.uk

A f

ull c

op

y o

f o

ur

co

mp

lain

ts p

roced

ure

can

be r

eq

uest

ed

by c

on

tacti

ng

Bu

pa G

lob

al.

(No

ne o

f th

ese

pro

ced

ure

s aff

ect

the

co

mp

lain

an

t’s

leg

al ri

gh

ts.)

Art. 19

Confidentiality

19.1: T

he c

on

fid

en

tiality

of

pati

en

t an

d

cu

sto

mer

info

rmati

on

is

of

para

mo

un

t

co

ncern

to

th

e c

om

pan

ies

in t

he B

up

a g

rou

p.

To

th

is e

nd

, B

up

a G

lob

al fu

lly c

om

plies

wit

h

ap

plicab

le d

ata

pro

tecti

on

leg

isla

tio

n a

nd

med

ical co

nfi

den

tiality

gu

idelin

es.

Bu

pa

Glo

bal so

meti

mes

use

s th

ird

part

ies

to

pro

cess

data

on

ou

r b

eh

alf. S

uch

pro

cess

ing

,

wh

ich

may b

e u

nd

ert

aken

ou

tsid

e t

he E

EA

(Eu

rop

ean

Eco

no

mic

Are

a),

is

sub

ject

to

co

ntr

actu

al re

stri

cti

on

s w

ith

reg

ard

to

co

nfi

den

tiality

an

d s

ecu

rity

in

ad

dit

ion

to

th

e

ob

lig

ati

on

s im

po

sed

by t

he a

pp

licab

le d

ata

pro

tecti

on

leg

isla

tio

n.

Art. 20

The Financial Serv

ices Compensation

Scheme (FSCS)

20.1: T

he C

om

pany is

co

vere

d b

y t

he F

SC

S.

In t

he u

nlikely

even

t th

at

the C

om

pany c

an

no

t

meet

the C

om

pany’s

fin

an

cia

l o

blig

ati

on

s,

the in

sure

d m

ay b

e e

nti

tled

to

co

mp

en

sati

on

fro

m t

he F

SC

S, if

th

e in

sure

d is

usu

ally a

resi

den

t o

f th

e E

EA

(E

uro

pean

Eco

no

mic

Are

a).

Mo

re in

form

ati

on

is

availab

le f

rom

th

e

FS

CS

by c

allin

g +

44

(0

) 20

78

92 7

30

1 o

r o

n

its

web

site

fsc

s.o

rg.u

k

Art. 21

Applicable Law

21.1:

Th

e p

olicy is

go

vern

ed

by D

an

ish

law

. A

ny d

isp

ute

th

at

can

no

t o

therw

ise

be r

eso

lved

will b

e d

ealt

wit

h b

y c

ou

rts

in

Den

mark

. If

any d

isp

ute

ari

ses

as

to t

he

inte

rpre

tati

on

of

this

do

cu

men

t, t

hen

th

e

En

glish

vers

ion

of

this

do

cu

men

t sh

all

be d

eem

ed

to

be c

on

clu

sive a

nd

takin

g

pre

ced

en

ce o

ver

any o

ther

lan

gu

ag

e v

ers

ion

of

this

do

cu

men

t. A

co

py c

an

be o

bta

ined

at

any t

ime b

y c

on

tacti

ng

ou

r C

ust

om

er

Serv

ice

on

+4

5 7

0 2

3 0

0 4

2 o

r w

rite

an

em

ail t

o

ihi@

ihi.c

om

.

Page 22: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

43

42

42

Th

is G

loss

ary

wit

h d

efi

nit

ion

s is

part

of

the P

olic

y C

on

dit

ion

s.

GLO

SS

AR

Y

A Acceptable evidence

Inte

rnati

on

al m

ed

ical an

d s

cie

nti

fic e

vid

en

ce

wh

ich

in

clu

de p

eer-

revie

wed

scie

nti

fic s

tud

ies

pu

blish

ed

in

or

accep

ted

fo

r p

ub

licati

on

by

med

ical jo

urn

als

th

at

meet

inte

rnati

on

ally

reco

gn

ised

req

uir

em

en

ts f

or

scie

nti

fic

man

usc

rip

ts. T

his

do

es

no

t in

clu

de in

div

idu

al

case

rep

ort

s, s

tud

ies

of

a s

mall n

um

ber

of

peo

ple

an

d c

lin

ical tr

ials

wh

ich

are

no

t

reg

iste

red

.

Acute serious illness

An

“acu

te s

eri

ou

s illn

ess

” sh

all b

e d

ete

rmin

ed

to e

xis

t o

nly

aft

er

revie

w a

nd

ag

reem

en

t

by b

oth

th

e a

tten

din

g p

hysi

cia

n a

nd

th

e

Co

mp

any’s

med

ical co

nsu

ltan

t.

Anniversary date

Th

e r

en

ew

al o

f th

e in

sur a

nce.

Appliances

Du

rab

le m

ed

ical eq

uip

men

t th

at:

can

be u

sed

mo

re t

han

on

ce

is

no

t d

isp

osa

ble

is

use

d t

o s

erv

e a

med

ical p

urp

ose

is

no

t u

sed

in

th

e a

bse

nce o

f a d

isease

,

illn

ess

or

inju

ry

is

fit

for

use

in

th

e h

om

e

Applicant

A p

ers

on

nam

ed

on

th

e A

pp

licati

on

Fo

rm a

nd

the M

ed

ical Q

uest

ion

nair

e a

s an

ap

plican

t fo

r

insu

ran

ce.

Application

Th

e A

pp

licati

on

Fo

rm a

nd

Med

ical

Qu

est

ion

nair

e.

B Birth

ing centre

A m

ed

ical fa

cilit

y o

ften

ass

ocia

ted

wit

h

a h

osp

ital th

at

is d

esi

gn

ed

to

pro

vid

e a

ho

melike s

ett

ing

du

rin

g c

hild

bir

th.

Bupa G

lobal (incl. w

e/u

s/our)

Bu

pa In

sura

nce L

imit

ed

. B

up

a G

lob

al is

a

trad

ing

nam

e o

f B

up

a In

sura

nce L

imit

ed

.

C Claim

Th

e f

inan

cia

l d

em

an

d c

overe

d in

wh

ole

or

in p

art

by t

he in

sura

nce. In

th

e C

om

pany’s

evalu

ati

on

/dete

rmin

ati

on

of

the c

laim

, th

e

tim

e o

f tr

eatm

en

t is

de cis

ive, n

ot

the t

ime o

f

the o

ccu

rren

ce o

f th

e in

jury

/illn

ess

.

Commencement date

Th

e d

ate

in

dic

ate

d in

th

e p

olicy s

ch

ed

ule

on

wh

ich

th

e in

sura

nce c

om

men

ces,

un

less

oth

erw

ise s

tate

d in

th

e P

olicy C

on

dit

ion

s.

Valid fro

m 1 January 2015

Page 23: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

44

45

Company, th

e:

Bu

pa In

sura

nce L

imit

ed

, a c

om

pany

reg

iste

red

in

En

gla

nd

No

. 39

56

43

3. O

ur

ad

dre

ss is:

Bu

pa H

ou

se, 15

-19

Blo

om

sbu

ry

Way,

Lo

nd

on

 WC

1A 2

BA

, U

K.

Country of residence

Th

e c

ou

ntr

y w

here

th

e in

sure

d is

livin

g/

spen

din

g m

ost

of

his

/her

tim

e. T

his

sh

ou

ld b

e

the c

ou

ntr

y in

wh

ich

th

e r

ele

van

t au

tho

riti

es

(su

ch

as

tax a

uth

ori

ties)

will co

nsi

der

the

insu

red

to

be r

esi

den

t fo

r th

e d

ura

tio

n o

f th

e

insu

ran

ce.

D Deductible

Th

e t

ota

l am

ou

nt

of

mo

ney n

ote

d in

th

e

po

licy s

ch

ed

ule

wh

ich

each

in

sure

d a

gre

es

to

pay e

ach

po

licy y

ear

befo

re b

ein

g r

eim

bu

rsed

by t

he C

om

pany.

Documents

Any w

ritt

en

in

form

ati

on

rela

ted

to

th

e

insu

ran

ce in

clu

din

g b

ills

, p

olicy s

ch

ed

ule

s an

d

the lik

e.

Due date

Date

on

wh

ich

a p

rem

ium

is

du

e t

o b

e p

aid

.

H Hosp

italisa

tion

Su

rgery

or

med

ical tr

eatm

en

t in

a h

osp

ital

or

clin

ic a

s an

in

pati

en

t w

hen

it

is m

ed

ically

necess

ary

to

occu

py a

bed

overn

igh

t.

Hosp

ital accommodation

Co

vera

ge o

f a r

oo

m t

hat

is n

o m

ore

exp

en

sive

than

th

e h

osp

ital’s

sta

nd

ard

sin

gle

ro

om

wit

h

a p

rivate

bath

roo

m. C

harg

es

for

the in

sure

d’s

stan

dard

meals

an

d r

efr

esh

men

ts a

re a

lso

co

vere

d. T

he c

harg

es

will b

e p

aid

fo

r th

e

len

gth

of

stay t

hat

is m

ed

ically a

pp

rop

riate

for

the p

roced

ure

th

e in

sure

d is

ad

mit

ted

fo

r

an

d a

ny a

cco

mp

anyin

g r

ela

tive (

if c

overe

d

un

der

the in

sura

nce p

lan

).

Hosp

ital cash

benefit

Th

is b

en

efi

t is

paid

in

stead

of

any o

ther

ben

efi

t fo

r each

nig

ht

yo

u r

eceiv

e e

leg

ible

in-p

ati

en

t tr

eatm

en

t w

ith

ou

t ch

arg

e.

To

cla

im t

his

ben

efi

t, p

lease

ask

th

e h

osp

ital

to s

ign

an

d s

tam

p a

lett

er

stati

ng

th

at

yo

u

were

tre

ate

d w

ith

no

ch

arg

e.

I Insu

rance

Th

e P

olicy C

on

dit

ion

s an

d p

olicy s

ch

ed

ule

rep

rese

nti

ng

th

e in

sura

nce c

on

tract

wit

h

the C

om

pany a

nd

sett

ing

ou

t th

e s

co

pe o

f

the in

sura

nce t

erm

s, t

he p

rem

ium

payab

le,

ded

ucti

ble

an

d r

eim

bu

rsem

en

t ra

tes.

Insu

red

Th

e p

olicyh

old

er

an

d/o

r all o

ther

insu

red

pers

on

s as

list

ed

in

th

e v

alid

po

licy s

ch

ed

ule

.

O Outp

atient

Tre

atm

en

t p

rovid

ed

at

a h

osp

ital,

ou

tpati

en

t

clin

ic o

r ass

ocia

ted

facilit

y w

here

it

is

no

t m

ed

ically n

ecess

ary

to

occu

py a

bed

overn

igh

t.

P Policy C

onditions

Th

e t

erm

s an

d c

on

dit

ion

s o

f th

e in

sura

nce

pu

rch

ase

d.

Policyholder

Th

e p

ers

on

id

en

tifi

ed

as

the p

olicyh

old

er

on

the A

pp

licati

on

Fo

rm.

Policy schedule

Po

licy d

eta

ils

sho

win

g t

he t

yp

e o

f in

sura

nce

pu

rch

ase

d, d

ed

ucti

ble

an

d a

ny s

pecia

l te

rms.

Pre-existing condition

Th

e m

ed

ical h

isto

ry, in

clu

din

g t

he illn

ess

es

an

d c

on

dit

ion

s list

ed

in

th

e M

ed

ical

Qu

est

ion

nair

e, w

hic

h m

ay a

ffect

the

Co

mp

any’s

decis

ion

to

in

sure

or

no

t to

in

sure

or

to im

po

se s

pecia

l te

rms.

R Registered clinical trial

An

eth

ically a

pp

roved

an

d c

lin

ically c

on

tro

lled

tria

l th

at

is r

eg

iste

red

on

a n

ati

on

al o

r

inte

rnati

on

al d

ata

base

of

clin

ical tr

ials

.

Rehabilitation (Multidisciplinary

rehabilitation)

Tre

atm

en

t in

th

e f

orm

of

a c

om

bin

ati

on

of

thera

pie

s su

ch

as

physi

cal,

occu

pati

on

al

an

d s

peech

th

era

py a

imed

at

rest

ori

ng

fu

ll

fun

cti

on

aft

er

an

acu

te e

ven

t su

ch

as

a s

tro

ke.

Reim

bursement rates

Th

e m

axim

um

am

ou

nt

of

mo

ney w

hic

h

will b

e p

aid

by w

ay o

f re

imb

urs

em

en

t

of

med

ical exp

en

ses

in o

ne y

ear

fro

m

the c

om

men

cem

en

t d

ate

or

fro

m e

ach

an

niv

ers

ary

date

, as

furt

her

deta

iled

in

th

e

Po

licy C

on

dit

ion

s.

Renewal

Th

e a

uto

mati

c r

en

ew

al o

f th

e in

sura

nce a

s p

er

the a

nn

ivers

ary

date

.

S Serious injury

A “

seri

ou

s in

jury

” sh

all b

e d

ete

rmin

ed

to

exis

t

on

ly a

fter

revie

w a

nd

ag

reem

en

t b

y b

oth

the a

tten

din

g p

hysi

cia

n a

nd

th

e C

om

pany’s

med

ical co

nsu

ltan

t.

Special term

s

Rest

ricti

on

s, lim

itati

on

s o

r co

nd

itio

ns

ap

plied

to t

he C

om

pany’s

sta

nd

ard

term

s as

deta

iled

in t

he p

olicy s

ch

ed

ule

.

Page 24: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

46

47

Standard

term

s

Th

e C

om

pany’s

sta

nd

ard

in

sura

nce t

erm

s

wit

h n

o s

pecia

l re

stri

cti

on

s, lim

itati

on

s o

r

co

nd

itio

ns.

Subro

gation

Th

e in

sure

r’s

rig

ht

to e

nfo

rce a

rem

ed

y w

hic

h

the in

sure

d h

as

ag

ain

st a

th

ird

part

y a

nd

th

e

insu

rer’

s ri

gh

t to

req

uir

e t

he in

sure

d t

o r

ep

ay

the in

sure

r if

th

e in

sure

r h

as

paid

exp

en

ses

reco

up

ed

by t

he in

sure

d f

rom

a t

hir

d p

art

y.

Surg

ery

A m

ed

ical p

roced

ure

th

at

invo

lves

the u

se o

f

inst

rum

en

ts o

r eq

uip

men

t w

hic

h a

re in

sert

ed

into

th

e b

od

y. T

his

do

es

no

t ap

ply

to

min

or

surg

ical p

roced

ure

s e.g

. re

mo

val o

f w

art

.

T Term

inal phase

Wh

en

th

e a

dven

t o

f d

eath

is

hig

hly

pro

bab

le

an

d m

ed

ical o

pin

ion

has

reje

cte

d a

cti

ve

thera

py in

favo

ur

of

the r

elief

of

sym

pto

ms

an

d s

up

po

rt o

f b

oth

pati

en

t an

d f

am

ily.

Th

is d

ecis

ion

mu

st b

e c

on

firm

ed

by t

he

Co

mp

any’s

med

ical co

nsu

ltan

ts.

Tre

atm

ent

Su

rgic

al o

r m

ed

ical se

rvic

es

(in

clu

din

g

dia

gn

ost

ic t

est

s) t

hat

are

need

ed

to

dia

gn

ose

,

relieve o

r cu

re a

co

nd

itio

n, d

isease

, illn

ess

or

inju

ry.

U Unrecognised m

edical practitioner,

pro

vider or facility

An

un

reco

gn

ised

med

ical p

racti

tio

ner,

pro

vid

er

or

facilit

y in

clu

des:

tr

eatm

en

t p

rovid

ed

by a

med

ical

pra

cti

tio

ner, p

rovid

er

or

facilit

y w

ho

is

no

t

reco

gn

ised

by t

he r

ele

van

t au

tho

riti

es

in

the c

ou

ntr

y w

here

th

e t

reatm

en

t ta

kes

pla

ce a

s h

avin

g s

pecia

lise

d k

no

wle

dg

e, o

r

exp

ert

ise in

, th

e t

reatm

en

t o

f th

e d

isease

,

illn

ess

or

inju

ry b

ein

g t

reate

d.

tr

eatm

en

t b

y a

ny m

ed

ical p

racti

tio

ner,

pro

vid

er

or

in a

ny f

acilit

y t

o w

ho

m w

e h

ave

sen

t a w

ritt

en

no

tice t

hat

we n

o lo

ng

er

reco

gn

ise t

hem

fo

r th

e p

urp

ose

s o

f o

ur

pla

ns.

tr

eatm

en

t p

rovid

ed

by a

nyo

ne w

ith

th

e

sam

e r

esi

den

ce a

s th

e in

sure

d o

r w

ho

is

a

mem

ber

of

the in

sure

d’s

im

med

iate

fam

ily

or

an

en

terp

rise

ow

ned

by o

ne o

f th

e

ab

ove m

en

tio

ned

pers

on

s.

W Waiting period

A p

eri

od

of

tim

e f

rom

th

e c

om

men

cem

en

t

date

wh

ere

th

e in

sura

nce p

rovid

es

no

co

ver

un

less

as

per

specif

icati

on

in

Art

. 3

.

Page 25: TAKING GOOD CARE OF YOU WHEREVER YOU ARE - · PDF fileTAKING GOOD CARE OF YOU WHEREVER YOU ARE. 2 3 ... When you claim we do not ask for a claim form. ... Module 4A and 4B Dental and

48

211E5-11v1.1_IHHP_ENG_Broc

ihi.combupa-intl.com

Call Bupa Global Customer Service for questions on your policy, payment, coverage etc.

Open 8am - 9pm (CET) weekdays

Tel: +45 70 23 00 42Fax: +45 33 32 25 60Email: [email protected]

Palægade 8DK-1261 Copenhagen KDenmark

Call Bupa Global Assistancefor 24-hour emergency service and medical help

Tel: +45 70 23 24 60

Fax: +45 33 32 25 60Email: [email protected]

Calls will be recorded and may be monitored.

European addresses

Bupa GlobalRussell HouseRussell MewsBrighton BN1 2NRUK

Bupa Cyprus3 Ioannis Polemis StreetPO Box 51160 3502 LimassolCyprus

Bupa Denmark, filial af Bupa Insurance Limited, England  Palægade 8DK-1261Copenhagen KDenmark

Bupa France8 avenue Félix Faure06000 Nice France

Bupa Malta120 The StrandGzira Malta

Bupa Spain Edif. Santa Rosa 1-D C/. Santa Rosa 20 Los Boliches E-29640 Fuengirola (Málaga) Spain