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TRANSCRIPT
International Health and Hospital Plan
Valid from 2015 • EUR/GBP/USD
TAKING GOOD CARE OF YOU WHEREVER YOU ARE
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
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
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.
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
.
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
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
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
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
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
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
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.
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
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
.
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
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
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
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.
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
.
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,
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
.
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.
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
.
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
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
.
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
.
48
211E5-11v1.1_IHHP_ENG_Broc
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