FSA-MARI-EMG-11v05.1 Maritime MemGuideThe world of Bupabupa.co.ukBupa International offers youGlobal medical plans forindi...
32This Membership Guide contains the rules and benefits of yourBupa International Company Maritime Plan cover, and other i...
ContentsPage number Section5 How to use your Bupa International Company Maritime Plan9 What is covered?22 What is not cove...
This plan is governed by an agreementbetween your sponsor and BupaInternational, which covers the terms andconditions of y...
How to claim - summary What is covered?This section contains your table of benefits and the accompanying notes.Before you ...
CurrenciesAll the benefit limits in this table of benefitsand notes are set out in three currencies:£Sterling, US$ and €Eu...
1312Table of benefitsOverall annual maximum - £500, 000 / US$900, 000 / €750, 000Out-patient treatmentImportantThis is tre...
1514In-patient and day-case treatmentImportantFor all in-patient and day-case treatment costs:zz it must be medically esse...
1716In-patient and day-case treatment (continued)Benefits Limits RulesPathology, X-rays, diagnostic tests and therapies Pa...
1918Further benefitsImportantThis is the additional benefits provided by your membership of the Maritime plan.These benefi...
2120Further benefits (continued)Benefits Limits RulesHealthline services Included This is a telephone advice line which of...
2322What is not covered?Important - please readPersonal exclusionsPlease check your Membership Certificate to see if you h...
2524Exclusion Notes RulesConvalescence and admission for general care Hospital accommodation when it is used solely or pri...
2726Exclusion Notes RulesEyesight Treatment to correct eyesight, unless required as the result of an injury or acute condi...
2928Exclusion Notes RulesPre-existing conditions Any treatment for a pre-existing condition, related symptoms, or any cond...
3130Exclusion Notes RulesTravel costs for treatment Any travel costs related to receiving treatment, unless otherwise cove...
3332CustomerServices	e:info@bupa-intl.com	t:+44(0)1273323563	www.bupa-intl.com/membersworldAssistance cover  (optional if ...
3534CustomerServices	e:info@bupa-intl.com	t:+44(0)1273323563	www.bupa-intl.com/membersworldPre-authorisationThis section c...
3736CustomerServices	e:info@bupa-intl.com	t:+44(0)1273323563	www.bupa-intl.com/membersworldHow to make a claimClaim formsY...
3938CustomerServices	e:info@bupa-intl.com	t:+44(0)1273323563	www.bupa-intl.com/membersworldOther claim informationDiscreti...
4140CustomerServices	e:info@bupa-intl.com	t:+44(0)1273323563	www.bupa-intl.com/membersworldIf you change your citizenship ...
4342CustomerServices	e:info@bupa-intl.com	t:+44(0)1273323563	www.bupa-intl.com/membersworldMaking a complaintWe’re always ...
4544CustomerServices	e:info@bupa-intl.com	t:+44(0)1273323563	www.bupa-intl.com/membersworldGlossaryThis explains what we m...
4746CustomerServices	e:info@bupa-intl.com	t:+44(0)1273323563	www.bupa-intl.com/membersworldDefined term DescriptionPersist...
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Bupa Maritime Plan 2014

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Bupa Maritime Medical Insurance, Maritime Medical Insurance by Bupa International.
Email to bupamaritime@gmail.com. Bupa Maritime Plan 2014

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Bupa Maritime Plan 2014

  1. 1. FSA-MARI-EMG-11v05.1 Maritime MemGuideThe world of Bupabupa.co.ukBupa International offers youGlobal medical plans forindividuals and groupsAssistance, repatriation and evacuation cover24-hour multi-lingual helplineCall us:New business enquiries:General services:Medical related enquiries:+44 (0) 1273 208 200+44 (0) 1273 323 563+44 (0) 1273 333 911bupa-intl.comYour calls will be recordedand may be monitoredMaritime planMembership GuideFrom 1 May 2011
  2. 2. 32This Membership Guide contains the rules and benefits of yourBupa International Company Maritime Plan cover, and other importantinformation.IntroductionIf you would like to ask any questions about anything that you read here, please contact theBupa International customer services helpline. Our contact details are opposite, and are repeatedon each page.ImportantPlease keep this Membership Guide in a safe place. We may send you amendments whenyour plan renews. If so, please read them and keep them with this Membership Guide. You candownload an updated version at any time from our MembersWorld website or contact us torequest a new copy.Bold wordsWords in bold have particular meanings in this Membership Guide. Please check their definition inthe Glossary before you read on.Contact us* Please note that we cannot guarantee the security of email as a method of communication.Some companies do monitor email traffic, so please bear this in mind when sending us confidential information.** MembersWorld may not track claims in the USA as we use a third party here.General Enquiries:Your Bupa International customer services helplinezz open 24 hours a day, 365 days a yearzz membership and payment querieszz claims informationEmail: info@bupa-intl.com* Web: www.bupa-intl.comTel: +44 (0) 1273 323 563 Fax: +44 (0) 1273 820 517Medical Enquiries:Pre-authorisation, Healthline, Evacuation and Repatriationzz open 24 hours a day, 365 days a yearzz check cover and pre-authorise treatmentzz medical advice and informationzz find local medical facilitieszz medical referralszz authorise evacuation or repatriationzz embassy and visa informationzz interpreter referral serviceTel: +44 (0) 1273 333 911 Fax: +44 (0) 1273 866 301MembersWorld:www.bupa-intl.com/membersworldzz view membership status  track claims online **zz update personal details  access hospital directoryzz webchat  much morezz download claim formsAny correspondence, including your claims, should be sent to the following address:Bupa International, Russell House, Brighton, UK, BN1 2NRFurther helpWe want to make sure that members with special needs are not excluded in any way. For hearingor speech impaired members with a textphone, please call +44 (0) 1273 866 557. We also offera choice of Braille, large print or audio for our letters and literature. Please let us know which youwould prefer.European branch addresses:Bupa Denmark  8 Palaegade  DK-1261 Copenhagen K  DenmarkBupa in Malta  120 The Strand  Gzira  MaltaBupa France  Nice Etoile 30  Avenue Jean Médecin  F-06000  Nice  FranceBupa Spain  Edif. Santa Rosa 1-D  C/. Santa Rosa 20  Los Boliches, E-29640 Fuengirola (Málaga)  SpainBupa Cyprus  3 Ioannis Polemis Street  PO Box 51160  3502 Limassol  Cyprus
  3. 3. ContentsPage number Section5 How to use your Bupa International Company Maritime Plan9 What is covered?22 What is not covered?32 Assistance cover35 Pre-authorisation37 Making a claim40 Your membership43 Making a complaint44 Glossary47 Medical words and phrases5CustomerServices e:info@bupa-intl.com t:+44(0)1273323563 www.bupa-intl.com/membersworld4How to use your Bupa InternationalCompany Maritime planStep 1: Where to get treatmentAs long as it is covered by your plan, youcan have your treatment at any recognisedhospital or clinic. If you don’t know where togo, please contact our Healthline service forhelp and advice.Participating hospitalsTo help you find a facility, we have alsodeveloped a global network of over 7,500medical centres, called participating hospitalsand clinics. The list is updated regularly, soplease visit www.bupa-intl.com for the latestinformation. We can normally arrange directsettlement with these facilities (see Step 3).Step 2: Contact Bupa InternationalIf you know that you may need treatment,please contact us first. This gives us thechance to check your cover, and to makesure that we can give you the support of ourglobal networks, our knowledge and ourexperience as the world’s largest internationalhealthcare company.Pre-authorising in-patient treatmentand day-case treatmentYou must contact us whenever possiblebefore in-patient or day-case treatment,for pre-authorisation. This means that we canconfirm to you and to your hospital thatyour treatment will be covered under yourplan.Pre-authorisation puts us directly in touchwith your hospital, so that we can lookafter the details while you concentrate ongetting well. The ‘pre-authorisation’ sectioncontains all of the rules and information aboutpre-authorisation.When you contact us, please have yourmembership number ready. We will asksome or all of the following questions:zz what condition are you suffering from?zz when did your symptoms first begin?zz when did you first see your familydoctor about them?zz what treatment has been recommended?zz on what date will you receive thetreatment?zz what is the name of your consultant?zz where will your proposed treatmenttake place?zz how long will you need to stay inhospital?If we can pre-authorise your treatment, wewill send a pre-authorisation statement thatwill also act as your claim form (see Step 3below).
  4. 4. This plan is governed by an agreementbetween your sponsor and BupaInternational, which covers the terms andconditions of your membership. This meansthat there is no legal contract between youand Bupa International. Only the sponsorand Bupa International have legal rightsunder the agreement relating to your cover,and only they can enforce the agreement.As a member of the plan, you do have accessto our complaints process. This includes theuse of any dispute resolution scheme we havefor our members.All the following make up our agreementand must be read together as they set out theterms and conditions of your membership:zz you, the principal member’s applicationfor cover (this includes any quote request,applications for cover for you and thedeclarations that you, the principalmember made during the applicationprocess)zz your rules and benefits in the MembershipGuidezz your Membership CertificateThe full name of your insurer is shownon your Membership Certificate.When your cover startsThe start date of your membership isthe ‘effective from’ date shown on yourMembership Certificate.If you move to a new countryYou, the principal member must inform yoursponsor straight away if you change yourspecified country of residence.Your new country may have differentregulations about health insurance. You, theprincipal member need to tell your sponsorof any change so that we can make sure thatyou have the right cover and that all localregulations are being met.76CustomerServices e:info@bupa-intl.com t:+44(0)1273323563 www.bupa-intl.com/membersworldStep 3: Making a claimPlease read the ‘making a claim’ section forfull details of how to claim. Here are someguidelines and useful things to remember.Direct settlement/pay and claimDirect settlement is where the providerof your treatment claims directly from us,making things easier for you. The alternativeis for you to pay and then claim back thecosts from us.We try to arrange direct settlement whereverpossible, but it has to be with the agreementof whoever is providing the treatment. Ingeneral, direct settlement can only be arrangedfor in-patient or day-case treatment.Direct settlement is easier for us to arrangeif you pre-authorise your treatment first, orif you use a participating hospital or clinic.What to sendWe must receive a fully completed claimform and the original invoices for yourtreatment, within six months of thetreatment date. If this is not possible, pleasewrite to us with the details and we will seeif an exception can be made.Your claim formYou must ensure that your claim form is fullycompleted by you and by your medicalpractitioner. The claim form is importantbecause it gives us all the information thatwe need. Contacting you or your medicalpractitioner for more information can taketime, and an incomplete claim form is the mostcommon reason for delayed payments.You can download a claim form from ourMembersWorld website, or contact us to sendyou one. Remember that if your treatmentis pre-authorised, your pre-authorisationstatement will act as your claim form.How we make paymentsWherever possible, we will follow theinstructions given to us in the payment sectionof the claim form:zz we can pay you, the principal memberor the hospitalzz we can pay by cheque or by electronictransferzz we can pay in over 80 currenciesTo carry out electronic transfers, we need toknow the full bank name, address, SWIFT codeand (in Europe only) the IBAN number of yourbank account. You can give us this informationon the claim form.Tracking a claimWe will process your claim as quickly aspossible. You can easily check the progressof a claim you have made by logging on to ourMembersWorld website.Claim payment statement - MyClaimWhen your claim has been assessed and paid,we will send a statement to you to confirmwhen and how it was paid, and who receivedthe payment. Again, please contact us if youhave any questions about this information.About your membershipThe Bupa International Company Maritimeplan is a group insurance plan. You aretherefore one of a group of members, whichhas a sponsor, (normally the company thatyou, the principal member work for).
  5. 5. How to claim - summary What is covered?This section contains your table of benefits and the accompanying notes.Before you look at these however, please read the important information belowabout the kind of costs that we cover.Treatment that we coverBupa International covers you for the costsof specialist treatment of acute conditions.Your cover does not include treatmentfor chronic conditions. These are diseases,illnesses or injuries which are long-standing,such as diabetes or multiple sclerosis. Unlesswe specifically state otherwise, we will onlypay benefits for treatment provided by aconsultant.We will not pay for treatment which in ourreasonable opinion is inappropriate basedon established clinical and medical practice,and we are entitled to conduct a review ofyour treatment, when it is reasonable forus to do so.Reasonable and customary chargesWe will pay for reasonable and customarycosts. This means that the costs chargedby your treatment provider should notbe more than they would normally chargeand be representative of charges by othertreatment providers in the same area*.Table of benefitsThe table of benefits shows the benefits,limits and the detailed rules that apply toyour plan. You also need to read the ‘what isnot covered?’ section so that you understandthe exclusions on your plan.Benefit limitsThere are two kinds of benefit limit shown inthis table. The ‘overall annual maximum’ isthe maximum we will pay for all benefits intotal for each person each membership year.Some benefits also have a limit applied tothem separately; for example family doctortreatment.All benefit limits apply per member. If abenefit limit also applies per membershipyear, this means that once a benefit limit hasbeen reached that benefit will no longer beavailable until you, the principal memberrenew your plan and start a new membershipyear. If a benefit limit applies for the whole ofyour membership, once this benefit limit hasbeen reached, no further benefits will be paid,regardless of the renewal of your plan.* Guidelines for fees and medical practice (including established treatment plans, which outline the most appropriate course of carefor a specific condition, operation or procedure) may be published by a government or official medical body. In such cases, or wherepublished insurance industry standards exist, Bupa International may refer to these when assessing and paying claims. Charges inexcess of published guidelines or reasonable and customary costs may not be paid.98CustomerServices e:info@bupa-intl.com t:+44(0)1273323563 www.bupa-intl.com/membersworldDirect settlement Pay and claimYou settle any shortfall with hospital,clinic or doctorBupa International sends your claimpayment statementContact the Bupa International helpline:+44 (0) 1273 333 911info@bupa-intl.comBupa International confirms yourcover and benefit limitsYour medical practitionershould complete the medicalinformation section of the claimform. You should complete all othersections, attach invoices and sendthe claim to usBupa International pays youBupa International sendspre-authorisation to you orto your hospitalComplete and sign the blanksections of the statementincluding the patient declaration.The hospital will attach invoices andsend the claim to usBupa International payshospital/clinic
  6. 6. CurrenciesAll the benefit limits in this table of benefitsand notes are set out in three currencies:£Sterling, US$ and €Euros. The currency inwhich your sponsor pays us subscriptions isthe currency that applies to your membershipfor the purpose of the benefit limits.For example, if your sponsor pays ussubscriptions in £Sterling then the benefitlimits given in £Sterling apply to yourmembership and US$ and €Euro limits do notapply to you.This is a summary of your plan. Please read the table of benefits and exclusionson the following pages for detailed rules and benefit limits.Summary of benefits Summary of exclusionsOut-patient treatmentzz Out-patient surgical operationszz Consultants’ fees for consultationszz Pathology, X-ray and diagnostic testszz Costs for treatment by therapists andcomplementary medicine practitionerszz Consultants’ fees and psychologists’ fees forpsychiatric treatment (after two years’ membership)In-patient and day-case treatmentzz Hospital accommodationzz Surgical operations, including pre- and post-operativecarezz Nursing care, drugs and surgical dressingszz Physicians’ feeszz Theatre chargeszz Intensive care, intensive therapy, coronary care andhigh dependency unitzz Pathology, X-rays, diagnostic tests and therapieszz Prosthetic implants and applianceszz Parent accommodation(staying with a child under 18)zz Psychiatric treatment (after two years’ membership,lifetime maximum 90 days)Further benefitszz Advanced imagingzz Cancer treatmentzz Emergency dental treatment (received during yourfirst visit to your dentist for each dental emergency)zz Family doctor treatment and prescribed drugs anddressingszz Healthline serviceszz Local road ambulanceOptional benefits (if purchased)Assistance cover (Evacuation and Repatriation)zz Addictive conditions and disorderszz Ageing and pubertyzz Allergies and allergic disorderszz Artificial life maintenancezz Birth controlzz Chronic conditionszz Conflict and disasterzz Congenital conditionszz Convalescence and admission for general carezz Cosmetic treatmentzz Deafnesszz Dental treatment / gum diseasezz Developmental problemszz Donor organszz Experimental treatmentzz Eyesightzz Footcarezz Genetic testingzz Health Hydros, nature cure clinics etczz Hereditary conditionszz HIV / AIDSzz Infertility treatmentzz Maternityzz Persistant vegatitive state (PVS) and neurologicaldamagezz Obesityzz Personality disorderszz Physical aids and deviceszz Pre-existing conditionszz Preventive and wellness treatmentzz Reconstructive or remedial surgeryzz Self-inflicted injurieszz Sexual problems / gender issueszz Sleep disorderszz Speech disorderszz Surrogate parentingzz Travel costs for treatmentzz Treatment onboard a shipzz Unrecognised physician or facilityzz USA treatmentYour plan - summary1110CustomerServices e:info@bupa-intl.com t:+44(0)1273323563 www.bupa-intl.com/membersworld
  7. 7. 1312Table of benefitsOverall annual maximum - £500, 000 / US$900, 000 / €750, 000Out-patient treatmentImportantThis is treatment which does not normally require a patient to occupy a hospital bed. The list below details the benefitspayable for out-patient treatment only. If you are having treatment and you are not sure which benefit applies, please call usand we will be happy to help.Benefits Limits RulesOut-patient surgical operations Paid in full We pay for out-patient surgical operations when carried out by a consultant or a family doctor.Consultants’ fees for consultations We pay up to £1,000,US$1,800 or €1,500as applicable eachmembership yearThis normally means a meeting with a consultant to assess your condition.Pathology, X-rays and diagnostic tests We pay for:zz pathology, such as checking blood and urine samples for specific abnormalities,zz radiology, such as X-rays, andzz diagnostic tests, such as electro­cardiograms (ECGs)when recommended by your consultant or family doctor to help determine or assess your condition.Costs for treatment by therapists and complementary medicine practitioners For dieticians, we pay the initial consultation plus two follow-up visits when needed as a result of an eligible condition. Please notethat obesity is not covered.Consultants’ fees and psychologists’ fees for psychiatric treatment (after two years’membership)We will pay after you have been a member of the plan (or any Bupa administered plan which includes cover for psychiatrictreatment) for the whole of the two years leading up to the psychiatric treatment.
  8. 8. 1514In-patient and day-case treatmentImportantFor all in-patient and day-case treatment costs:zz it must be medically essential for you to occupy a hospital bed to receive the treatmentzz your treatment must be provided, or overseen, by a consultantzz we pay for accommodation in a room that is no more expensive than the hospital’s standard single room with a privatebathroom. This means that we will not pay the extra costs of a deluxe, executive or VIP suite etc.zz if the cost of treatment is linked to the type of room, we pay the cost of treatment at the rate which would be charged ifyou occupied a standard single room with a private bathroomzz the hospital where you have your treatment must be recognisedLong in-patient stays: 10 days or longerIn order for us to cover an in-patient stay lasting 10 days or more, you must send us a medical report from your consultantbefore the eighth night, confirming:zz your diagnosiszz treatment already givenzz treatment plannedzz discharge dateBenefits Limits RulesHospital accommodation Paid in full We pay charges for your hospital accommodation, including all your own meals and refreshments. We do not pay for personalitems such as telephone calls, newspapers, guest meals or cosmetics.We pay for accommodation in a room that is no more expensive than the hospital’s standard single room with a privatebathroom. This means that we will not pay the extra costs of a deluxe, executive or VIP suite etc.We pay for the length of stay that is medically appropriate for the procedure that you are admitted for.Examples: unless medically essential, we do not pay for day-case accommodation for out-patient treatment (such as an MRIscan), and we do not pay for in-patient accommodation for day-case treatment (such as a biopsy).Please also read convalescence and admission for general care in the ‘what is not covered?’ section.Surgical operations, including pre- and post-operative care Paid in full We pay surgeons’ and anaesthetists’ fees for a surgical operation, including all pre- and post-operative care.Note: this benefit does not include follow-up consultations with your consultant, as these are paid under the benefit‘Consultants’ fees for consultations’Nursing care, drugs and surgical dressings Paid in full We pay for nursing services, drugs and surgical dressings you need as part of your treatment in hospital.Note: we do not pay for nurses hired in addition to the hospital’s own staff. In the rare case where a hospital does not providenursing staff we will pay for the reasonable cost of hiring a qualified nurse for your treatment.Physicians’ fees Paid in full We pay physicians’ fees for treatment you receive in hospital if this does not include a surgical operation, for example if youare in hospital for treatment of a medical condition such as pneumonia.If your treatment includes a surgical operation we will only pay physicians’ fees if the attendance of a physician is medicallynecessary, for example, in the rare event of a heart attack following a surgical operation.Theatre charges Paid in full We pay for use of an operating theatre.Intensive care Paid in full We pay for intensive care in an intensive care unit/intensive therapy unit, high dependency or coronary care unit (or theirequivalents) when:zz it is an essential part of your treatment and is required routinely by patients undergoing the same type of treatment asyours, orzz it is medically necessary in the event of unexpected circumstances, for example if you have an allergic reaction during surgery
  9. 9. 1716In-patient and day-case treatment (continued)Benefits Limits RulesPathology, X-rays, diagnostic tests and therapies Paid in full We pay for:zz pathology, such as checking blood and urine sampleszz radiology (such as X-rays), andzz diagnostic tests such as electrocardiograms (ECGs)when recommended by your consultant to help determine or assess your condition when carried out in a hospital.We also pay for treatment provided by therapists (such as physiotherapy) and complementary medicine practitioners (such asacupuncturists) if it is needed as part of your treatment in hospital.Prosthetic implants and appliances Paid in full We pay for a prosthetic implant needed as part of your treatment. By this, we mean an artificial body part or appliance which isdesigned to form a permanent part of your body and is surgically implanted for one or more of the following reasons:zz to replace a joint or ligamentzz to replace one or more heart valveszz to replace the aorta or an arterial blood vesselzz to replace a sphincter musclezz to replace the lens or cornea of the eyezz to act as a heart pacemakerzz to remove excess fluid from the brainzz to control urinary incontinence (bladder control)zz to reconstruct a breast following surgery for cancer when the reconstruction is carried out as part of the original treatmentfor the cancer and you have obtained our written consent before receiving the treatmentzz to restore vocal function following surgery for cancerWe also pay for the following appliances:zz a knee brace which is an essential part of a surgical operation for the repair to a cruciate (knee) ligament, orzz a spinal support which is an essential part of a surgical operation to the spineParent accommodation Paid in full We pay for hospital accommodation for each night you need to stay with your child in the same hospital. This is limited to onlyone parent each night.Your child must be:zz aged under 18, andzz a member of a Bupa International administered plan receiving treatment for which he or she is covered under their planPsychiatric treatment (after two years’ membership, lifetime maximum 90 days) Paid in full We pay for psychiatric treatment you receive in hospital after you have been a member of the plan (or any Bupa administeredplan which includes cover for psychiatric treatment) for two years before the psychiatric treatment.We pay for a total of 90 days’ psychiatric treatment in hospital during your lifetime. This applies to all Bupa administered plansyou have been a member of in the past, or may be a member of in the future, whether your membership is continuous or not.Example: If we have paid for 45 days’ psychiatric treatment in hospital under another Bupa administered plan, we will only payfor another 45 days’ psychiatric treatment in hospital under this plan.
  10. 10. 1918Further benefitsImportantThis is the additional benefits provided by your membership of the Maritime plan.These benefits may be in-patient, out-patient or day-case.Benefits Limits RulesAdvanced imaging Paid in full We pay for magnetic resonance imaging (MRI), computed tomography (CT) and positron emission tomography (PET) whenrecommended by your consultant or family doctor.Cancer treatment Paid in full Once cancer is diagnosed, we pay fees that are related specifically to planning and carrying out treatment for cancer. Thisincludes tests, scans, consultations and drugs (such as cytotoxic drugs or chemotherapy).When the acute phase of cancer treatment (by which we mean surgery, radiotherapy or chemotherapy) has been completed, wewill continue to pay this benefit for all cancer treatment specifically related to the original diagnosis for up to a further five years.The five years will begin on the first out-patient consultation following completion of the acute phase of treatment. Cover duringthis period includes any follow-up tests, scans and consultations you may require. It also includes any drugs that may be requiredto keep the cancer in remission or to prevent relapse, for up to five years.If your treatment needs to continue for more than five years, please contact us for pre-authorisation before proceeding. It maybe necessary for us to seek a second opinion as part of our pre-authorisation process.Emergency dental treatment (received during your first visit to your dentist for each dentalemergency)We will pay 80 percentof the amount you arecharged up to a totalamount of £400, US$700or €600 as applicableeach membership yearWe will pay for eligible emergency dental treatment that you receive each membership year. By eligible emergency dentaltreatment we mean emergency dental treatment consisting of:zz dental examinationzz radiography (for example an X-ray)zz extraction of a tooth (or tooth root)zz stopping abnormal heavy bleeding (haemorrhage)zz cutting into an abscesszz dressing a tooth root canalzz prescribed antibioticszz re-cementing a crown, bridge or inlayzz adjustment or repair of a denturezz construction and fitting of a temporary crownzz call-out chargeWe will only pay for eligible emergency dental treatment that you receive during your first visit to your dental practitionerfor each separate dental emergency. We will not pay for follow up visits for emergency dental treatment relating to the samedental injury or condition.Family doctor treatment and prescribed drugs and dressings We will pay 80 percentof the amount you arecharged up to a totalamount of £400, US$700or €600 as applicableeach membership yearWe pay for family doctor treatment and for the cost of drugs and dressings prescribed for you by your medical practitioner foreligible treatment. We only pay for items which need a prescription.
  11. 11. 2120Further benefits (continued)Benefits Limits RulesHealthline services Included This is a telephone advice line which offers help 24 hours a day, 365 days a year. Please call +44 (0) 1273 333 911 at any timewhen you need to.The following are some of the services that may be offered by telephone:zz general medical information from a health professionalzz medical referrals to a physician or hospitalzz medical service referral (ie locating a physician) and assistance arranging appointmentszz inoculation and visa requirements informationzz emergency message transmissionzz interpreter and embassy referralNote: treatment arranged through this service may not be covered under your plan. Please check your cover before proceeding.Local road ambulance We pay up to £300,US$600, or €450as applicable eachmembership yearWe pay for medically necessary travel by local road ambulance when related to eligible in-patient or day-case treatment.Optional benefits, if purchasedBenefits Limits RulesAssistance cover (Evacuation and Repatriation) Your Membership Certificate will show if you have purchased this cover.The overall annual maximum benefit limit does not apply.
  12. 12. 2322What is not covered?Important - please readPersonal exclusionsPlease check your Membership Certificate to see if you have any personal exclusions or restrictions on your plan.The exclusions in this section apply in addition to and alongside any such personal exclusions and restrictions.General note for all exclusionsFor all exclusions in this section, and for any personal exclusions or restrictions shown on your Membership Certificate,please note that:zz we do not pay for conditions which are directly related to excluded conditions or treatmentszz we do not pay for any additional or increased costs arising from excluded conditions or treatmentszz we do not pay for complications arising from excluded conditions or treatmentsExample:You have a personal exclusion for diabetes.zz If your diabetes were to cause glaucoma, we would not pay for treatment for the glaucoma.zz If while receiving treatment for another condition, you need to stay extra days in hospital because of your diabetes, wewould not pay for these extra days.zz If complications arise from excluded treatment such as cosmetic or refractive eye procedures, we will not pay to treat thesecomplications.ExceptionsThis section describes some circumstances where exceptions can be made to exclusions or restrictions. Where this is the case,benefit is payable up to the limits set out in the table of benefits.Exclusion Notes RulesAddictive conditions and disorders Treatment for, or arising from, addictive conditions and disorders, or from any kind of substance or alcohol use or misuse.Example: we do not pay to help you to stop smoking.Ageing and puberty Treatment to relieve symptoms caused by ageing, puberty, or other natural physiological cause.Allergies and allergic disorders Treatment to de-sensitise or neutralise any allergic condition or disorder.Artificial life maintenance Including mechanical ventilation, where such treatment will not result in your recovery or restore you to your previous state ofhealth.Birth control Any type of contraception, sterilisation, termination of pregnancy or family planning.Chronic conditions We do not pay for treatment for chronic conditions.Conflict and disaster Treatment for any disease, illness or injury resulting from nuclear or chemical contamination, war, riot, revolution, acts ofterrorism or any similar event, if one or more of the following apply:zz you have put yourself in danger by entering a known area of conflict where active fighting or insurrections are taking placezz you were an active participantzz you have displayed a blatant disregard for personal safetyCongenital conditions Treatment received after the first 90 days following birth (or after the maximum benefit limit for Newborn care has beenreached) for any abnormality, deformity, disease, illness or injury present at birth, whether diagnosed or not, except cancer.There are certain conditions and treatments that we do not cover. If you are unsureabout anything in this section, please contact us for confirmation before you go foryour treatment.
  13. 13. 2524Exclusion Notes RulesConvalescence and admission for general care Hospital accommodation when it is used solely or primarily for any of the following purposes:zz convalescence, supervision, pain management or any other purpose other than for receiving eligible treatment, of a typewhich normally requires you to stay in hospitalzz receiving general nursing care or any other services which do not require you to be in hospital, and could be provided in anursing home or other establishment that is not a hospitalzz receiving services from a therapist or complementary medicine practitionerzz receiving services which would not normally require trained medical professionals such as help in walking, bathing orpreparing mealsCosmetic treatment Treatment undergone for cosmetic or psychological reasons to improve your appearance, such as a re-modelled nose, facelift orcosmetic dentistry. This includes:zz dental implants to replace a sound natural toothzz hair transplants for any reasonzz treatment related to or arising from the removal of non-diseased, or surplus or fat tissue, whether or not it is needed formedical or psychological reasonszz any treatment for a procedure to change the shape or appearance of your breast(s) whether or not it is needed for medicalor psychological reasons: unless for reconstruction carried out as part of the original treatment for the cancer, when you haveobtained our written consent before receiving the treatment (see ‘reconstructive or remedial surgery’ in this section)Examples: we do not pay for breast reduction for backache or gynaecomastia (the enlargement of breasts in men).Deafness Treatment for or arising from deafness or partial hearing loss caused by a congenital abnormality, maturing or ageing.Dental treatment / gum disease Please seeemergency dental inthe table of benefits.This includes surgical operations for the treatment of bone disease when related to gum disease or damage, or treatment for,or arising from disorders of the temporomandibular joint.Examples: we do not pay for tooth decay, gum disease, jaw shrinkage or loss, damaged teeth, etc.Exception: we pay for a surgical operation carried out by a consultant to:zz put a natural tooth back into a jaw bone after it is knocked out or dislodged in an accidentzz treat irreversible bone disease involving the jaw(s) which cannot be treated in any other way, but not if it is related to gumdisease or tooth disease or damagezz surgically remove a complicated, buried or impacted tooth root, for example in the case of an impacted wisdom toothDevelopmental problems Treatment for, or related to developmental problems, including:zz learning difficulties, such as dyslexiazz behavioural problems, including attention deficit hyperactivity disorder (ADHD), orzz problems related to physical development, including (but not restricted to) short heightDonor organs Treatment costs for, or as a result of the following:zz transplants involving mechanical or animal organszz the removal of a donor organ from a donorzz the removal of an organ from you for purposes of transplantation into another personzz the harvesting and storage of stem cells, when this is carried out as a preventive measure against future possible diseases orillnesszz the purchase of a donor organExperimental treatment Treatment or prescribed medicines which in our reasonable opinion, based on advice of the local public authority in the countrywhere your treatment takes place, are experimental or have not proved to be effective.Treatment or clinical trials which have not yet been approved in the country in which you are receiving treatment.Prescribed medicines used for purposes other than those defined under their licence, which may vary from country to country.Note: if you are unsure whether your treatment may be experimental, please contact us. We reserve the right to ask for fullclinical details from your consultant before approving any treatment, in which case you must receive our written agreementbefore the treatment takes place.
  14. 14. 2726Exclusion Notes RulesEyesight Treatment to correct eyesight, unless required as the result of an injury or acute condition.Examples: we will not pay for routine eye examinations, contact lenses, spectacles or refractive eye procedures. We will pay fortreatment of a detached retina, glaucoma or cataracts.Footcare Treatment for corns, calluses, or thickened or misshapen nails.Genetic testing Genetic tests, when such tests are solely performed to determine whether or not you may be genetically likely to develop amedical condition.Example: we do not pay for tests used to determine whether you may develop Alzheimer’s disease, when that disease is notpresent.Health hydros, nature cure clinics etc. Treatment or services received in health hydros, nature cure clinics or any establishment that is not a hospital.Hereditary conditions Treatment of abnormalities, deformities, diseases or illnesses that are only present because they have been passed downthrough the generations of your family, except cancer.HIV / AIDS Treatment for, or arising from, HIV or AIDS, including any condition that is related to HIV or AIDS, if your current period ofmembership is less than five years.Infertility treatment Treatment to assist reproduction, including but not limited to IVF treatment.Note: we pay for reasonable investigations into the causes of infertility if:zz neither you nor your partner had been aware of any problems before joining, andzz you have both been members of this plan (or any Bupa administered plan which included cover for this type of investigation)for a continuous period of two years before the investigations startOnce the cause is confirmed, we will not pay for any additional investigations in the future.Maternity Treatment for maternity or for any condition arrising from maternity except the following conditions and treaments:zz abnormal cell growth in the womb (hydatiform mole)zz foetus growing outisde of the womb (ectopic pregnancy)zz other conditions arising from pregnancy or childbirth, but which could also develop in people who are not pregnantObesity Treatment for, or required as a result of obesity.Persistent vegetative state (PVS) and neurological damage We will not pay for in-patient treatment for more than 90 continuous days for permanent neurological damage or if you are ina persistent vegetative state.Personality disorders Treatment of personality disorders, including but not limited to:zz affective personality disorderzz schizoid personality (not schizophrenia)zz histrionic personality disorderPhysical aids and devices Any physical aid or device which is not a prosthetic implant, prosthetic device or defined as an appliance.Examples: we will not pay for hearing aids, spectacles, contact lenses, crutches or walking sticks.
  15. 15. 2928Exclusion Notes RulesPre-existing conditions Any treatment for a pre-existing condition, related symptoms, or any condition that results from or is related to a pre-existingcondition, unless:zz we were given all the medical information that we asked for during your application for your current continuous period ofmembershipzz we did not specifically exclude cover for the pre-existing condition on your Membership Certificate, andzz you did not know about the pre-existing condition before the ‘effective from’ date on the first Membership Certificate foryour current continuous period of membershipNote: please contact us before your renewal date if you would like us to review a personal exclusion. We may remove yourexclusion if, in our opinion, no further treatment will be either directly or indirectly required for the condition, or for any relatedcondition. There are some personal exclusions that, due to their nature, we will not review.To carry out a review, we must receive full current clinical details from your family doctor or consultant. Any costs incurred inobtaining these details are not covered under your plan and are your responsibility.Please note: this exclusion does not apply if your sponsor has purchased cover with medical history disregarded. If you areunsure whether you have this cover, please contact the customer services helpline.For pre-existing conditions for newborns, please see the exclusions for congenital and hereditary conditions in this section.Preventive and wellness treatment Health screening, including routine health checks, or any preventive treatment.Note: we may pay for prophylactic surgery when:zz there is a significant family history of the disease for example ovarian cancer, which is part of a genetic cancer syndrome, and/orzz you have positive results from genetic testing (please note that we will not pay for the genetic testing)Please contact us for pre-authorisation before proceeding with treatment. It may be necessary for us to seek a second opinion aspart of our pre-authorisation process.Reconstructive or remedial surgery Treatment required to restore your appearance after an illness, injury or previous surgery, unless:zz the treatment is a surgical operation to restore your appearance after an accident, or as the result of surgery for cancer, ifeither of these takes place during your current continuous membership of the planzz the treatment is carried out as part of the original treatment for the accident or cancerzz you have obtained our written consent before the treatment takes placeSelf-inflicted injuries Treatment for, or arising from, an injury that you have intentionally inflicted on yourself, for example during a suicide attempt.Sexual problems/gender issues Treatment of any sexual problem including impotence (whatever the cause) and sex changes or gender reassignments.Sleep disorders Treatment for insomnia, sleep apnoea, snoring, or any other sleep-related breathing problem.Speech disorders Treatment for speech disorders, including stammering, unless the following all apply:zz the treatment is short term therapy which is medically necessary as part of active treatment for an acute condition such asa strokezz the speech therapy takes place during and/or immediately following the treatment for the acute conditionzz the speech therapy is recommended by the consultant in charge of your treatment, and is provided by a therapistin which case we may pay at our discretion.Surrogate parenting Treatment directly related to surrogacy. This applies:zz to you if you act as a surrogate, andzz to anyone else acting as a surrogate for you
  16. 16. 3130Exclusion Notes RulesTravel costs for treatment Any travel costs related to receiving treatment, unless otherwise covered by:zz local road ambulance benefit, orzz Assistance coverExamples:zz we do not pay for taxis or other travel expenses for you to visit a medical practitionerzz we do not pay for travel time or the cost of any transport expenses charged by a medical practitioner to visit youTreatment onboard a ship We do not pay for any treatment onboard a ship.Unrecognised physician or facility Treatment provided by a medical practitioner who is not recognised by the relevant authorities in the country where thetreatment takes place as having specialised knowledge, or expertise in, the treatment of the disease, illness or injury beingtreated.Treatment in any hospital, or by any medical practitioner or any other provider of services, to whom we have sent a writtennotice that we no longer recognise them for the purposes of our plans.Treatment provided by anyone with the same residence as you or who is a member of your immediate family.USA treatment If USA cover has not been purchased, then any treatment received in the USA is ineligible:zz after the 28th day of your visit to the USAzz for any condition of which you were aware before your visit to the USAzz when arrangements were not authorised by our agents in the USAzz when we know or suspect that you travelled to the USA for the purpose of receiving treatment for a condition, when thesymptoms of the condition were apparent to you before travelling. This applies whether or not your treatment was the mainor sole purpose of your visitNote: you can claim for unforeseen treatment received within 28 days of your arrival in the USA, you must send evidence ofyour arrival date with your claim. Examples include a certified photocopy of your airline ticket or your visa stamp.Our Service Partner in the US operates a national network of hospitals, clinics and medical practitioners. This is the USprovider network. You must contact our US Service Partner before you have treatment, and they can help to find a suitablenetwork provider for you.For eligible treatment that takes place in the US using the US provider network, benefit is paid at 100 percent. When eligibletreatment takes place in the US but outside the provider network, benefit is paid at 80 percent.If USA cover has been purchased, then treatment received in the USA is ineligible when:zz arrangements for the treatment were not authorised by our agents in the USA, andzz we know or suspect that you purchased cover for and travelled to the USA for the purpose of receiving treatment for acondition, when the symptoms of the condition were apparent to you before buying the cover. This applies whether or notyour treatment was the main or sole purpose of your visit
  17. 17. 3332CustomerServices e:info@bupa-intl.com t:+44(0)1273323563 www.bupa-intl.com/membersworldAssistance cover  (optional if purchased)This section contains the rules and information for Assistance Cover, anoptional benefit which helps you if you need to travel to get the treatmentthat you need.Note: there are two levels of Assistance Cover: Evacuation and Repatriation. Your certificatewill show if you have Evacuation or Repatriation but you can visit the MembersWorld websiteor contact the Customer Services helpline if you are unsure.What is Assistance Cover?The Evacuation and Repatriation options bothcover you for reasonable transport coststo the nearest medical facility where thetreatment that you need is available, if it isnot available locally. Repatriation also givesyou the option of returning to your specifiedcountry of nationality or your specifiedcountry of residence.We may not be able to arrange evacuation orrepatriation in cases where the local situationmakes it impossible, unreasonably dangerousor impractical to enter the area; for examplefrom an oil rig or within a war zone.Assistance Cover - general rulesThe following rules apply to both theEvacuation and Repatriation levels of cover:zz You must contact our appointedrepresentatives for confirmation beforeyou travel, on +44 (0) 1273 333 911.zz Our appointed representatives mustagree the arrangements with you.zz Assistance Cover is applicable forin-patient and day-case treatment only.zz The treatment must be recommended byyour consultant or family doctor and,for medical reasons, not available locally.zz The treatment must be eligible underyour plan.zz You must have cover for the country youare being treated in, for example the USA.zz You must have the appropriate level ofAssistance Cover in place before youneed the treatment.zz Evacuation or Repatriation will not beeligible if you were aware of thesymptoms of your condition beforeapplying for Assistance Cover.We will not approve a transfer which in ourreasonable opinion is inappropriate basedon established clinical and medical practice,and we are entitled to conduct a review ofyour case, when it is reasonable for us todo so. Evacuation or Repatriation will notbe authorised if it would be against medicaladvice.How to arrange your Evacuationor RepatriationArrangements for evacuation will bemade by our appointed representativesand must be confirmed in advance bycalling + 44 (0) 1273 333 911. You mustprovide us with any information or proofthat we may reasonably ask you for tosupport your request. We will only pay if allarrangements are agreed in advance by BupaInternational’s appointed representatives.Evacuation cover:what we will pay forIf you have Evacuation cover it will be shownon your Membership Certificate. If you arestill unsure you can visit our MembersWorldwebsite or contact the customer serviceshelpline.zz We will pay in full for your reasonabletransport costs for day-case or in-patienttreatment. It may also be authorised ifyou need advanced imaging or cancertreatment such as radiotherapy orchemotherapy.zz We will only pay for evacuation tothe nearest place where the requiredtreatment is available. This could be toanother part of the country that you arein, and may not be your home country.zz We will pay for the reasonable travel costsfor another Bupa International memberto accompany you, but only if it ismedically necessary.zz We will also pay for the reasonable costsof your, and the accompanying member’s,return journey to the place you wereevacuated from. All arrangementsfor your return should be approvedin advance by Bupa International orour appointed representatives and thejourney must be made within fourteendays of the end of the treatment. We willpay for either:zz the reasonable cost of the returnjourney by the most direct routeavailable by land or sea, orzz the cost of an economy class air ticketby the most direct route available,whichever is the lesser amount.zz We will pay reasonable costs for thetransportation only of your body, subjectto airline requirements and restrictions,to your home country, in the event ofyour death while you are away fromhome. We do not pay for burial orcremation, the cost of burial caskets etc,or the transport costs for someone tocollect or accompany your remains.Note: we do not pay for any other costsrelated to the evacuation such as hotelaccommodation or taxis. Costs of anytreatment you receive are not payable underEvacuation cover, but are payable from yourmedical cover as described in your table ofbenefits and the ‘what is covered?’ section ofthis guide. Please also note that for medicalreasons the member receiving treatmentmay travel in a different class from theircompanion.Repatriation cover:what we will pay forIf you have Repatriation cover it will be shownon your Membership Certificate. If you arestill unsure you can visit our MembersWorldwebsite or contact the customer serviceshelpline. Repatriation cover also includesEvacuation cover - see above.zz We will pay in full for your reasonabletransport costs for day-case or in-patienttreatment.zz We will pay for repatriation to yourspecified country of nationality or yourspecified country of residence.zz We will pay for one repatriation for eachillness or injury per lifetime.zz We will pay the reasonable costs for arelative or your partner to accompanyyou to your specified country of
  18. 18. 3534CustomerServices e:info@bupa-intl.com t:+44(0)1273323563 www.bupa-intl.com/membersworldPre-authorisationThis section contains rules and information about what pre-authorisationmeans and how it works.What pre-authorisation meansIf we pre-authorise your treatment, thismeans that we will pay up to the limits ofyour plan provided that all of the followingrequirements are met:zz the treatment is eligible treatment thatis covered by your planzz you have an active membership at thetime that treatment takes placezz your subscriptions are paid up to datezz the treatment carried out matches thetreatment authorisedzz you have provided a full disclosure of thecondition and treatment requiredzz you have enough benefit entitlement tocover the cost of the treatmentzz your condition is not a pre-existingcondition (see the ‘what is not covered?’section for more details)zz the treatment is medically necessaryzz the treatment takes place within 31 daysafter pre-authorisation is givenTreatment we can pre-authoriseWe can pre-authorise in-patient and daycasetreatment, cancer treatment and MRI, CTor PET scans.Length of stay(in-patient treatment)Your pre-authorisation will specify an approvedlength of stay for in-patient treatment. Thisis the number of days in hospital that wewill cover you for. If your treatment will takelonger than this approved length of stay, thenyou or your consultant must contact us foran extension to the pre-authorisation.Treatment in the USAAll in-patient and daycase treatment, cancertreatment and MRI, CT or PET scans in theUSA must be pre-authorised. If you are goingto receive any of these treatments, askyour medical provider to contact Bupa forpre-authorisation. All the information theyneedis on your membership card.We have made special arrangements if youneed to be hospitalised in the USA. Theseinclude access to a select network of qualitymedical providers and direct settlementof all covered expenses when you receivetreatment in a network hospital.Treatment which has not beenpre-authorisedIf you choose not to get your treatmentpre-authorised, we will only pay 50 percenttowards the cost of covered treatment.nationality or your specified country ofresidence if we have authorised this inadvance of the repatriation.zz We will also pay an allowance of up to£Sterling25, US$50 or €Euro37 per dayfor up to 10 days to cover the livingexpenses of the person accompanyingyou.zz We will pay for you and the personaccompanying you to return towhere you were repatriated from.All arrangements for your returnmust be approved in advance byBupa International or our appointedrepresentatives and you must makethe return journey within fourteen daysof the end of the treatment you wererepatriated for. We will pay either:zz the reasonable cost of the returnjourney by the most direct routeavailable by land or sea, orzz the cost of a scheduled returneconomy class air ticket by the mostdirect route availablewhichever is the lesser amountzz We will pay reasonable costs for thetransportation only of your body, subjectto airline requirements and restrictions,to your home country, in the event ofyour death while you are away fromhome. We do not pay for burial orcremation, the cost of burial caskets etc,or the transport costs for someone tocollect or accompany your remains.Note: we do not pay for any other costsrelated to the repatriation such as hotelaccommodation or taxis. Costs of anytreatment you receive are not payable underRepatriation cover, but are payable from yourmedical cover as described in your table ofbenefits and the ‘what is covered?’ sectionof this guide.Please also note that for medical reasons themember receiving treatment may travel in adifferent class from their companion.
  19. 19. 3736CustomerServices e:info@bupa-intl.com t:+44(0)1273323563 www.bupa-intl.com/membersworldHow to make a claimClaim formsYour claim form is important as it gives us theinformation that we need to process yourclaim. If it is not fully completed we may haveto ask for more information. This can delaypayment of your claim.You must complete a new claim form:zz for each memberzz for each conditionzz for each in-patient or day-case stay, andzz for each currency of claimIf a condition continues over six months,we will ask for a further claim form to becompleted.What to send usYou need to return the completed form to usby post, with the original invoices, as soon aspossible. This must be within six months ofreceiving the treatment for which you areclaiming. Invoices sent to us after six monthswill not normally be paid.Requests for further informationWe may need to ask you for furtherinformation to support your claim. If we do,you must provide this. Examples of things wemight ask for include:Making a claimAt times of ill health, you want to concentrate on getting well. We will doeverything we can to make your claim as simple and straightforward aspossible.zz medical reports and other informationabout the treatment for which you areclaimingzz the results of any medical examinationperformed at our expense by anindependent medical practitionerappointed by uszz written confirmation from you as towhether you think you can recover thecosts you are claiming from anotherperson or insurance companyzz If you do not provide the information thatwe ask for, we may not pay your claim infullPlease also read ‘Correspondence’in the ‘your membership’ section.ImportantWhen making a claim please note:zz you must have received the treatmentwhile covered under your membershipzz payment of your claim will be under theterms of your membership and up to thebenefit levels shown, that apply to you atthe time you receive the treatmentzz we will only pay for treatment costsactually incurred by you, not deposits,advance invoices or registration/administration fees charged by theprovider of treatmentOf course we understand that there aretimes when you cannot get your treatmentpre-authorised, such as in an emergency. Ifyou are taken to hospital in an emergency, itis important that you arrange for the hospitalto contact us within 48 hours of youradmission. We can then make sure you aregetting the right care, and in the right place.If you have been taken to a hospital which isnot part of the network and, if it is the bestthing for you, we will arrange for you to bemoved to a network hospital to continueyour treatment once you are stable.If we have been notified within 48 hours of anemergency admission to hospital, we will notask you to share the cost of your treatment.Out of network treatmentIf your treatment has been pre-authorised,but you choose not to go to a networkhospital, we will only pay 80 percent towardsthe cost of covered treatment.There may be times when it is not possiblefor you to be treated at a network hospital.These include:zz there is no network hospital within30 miles of your addresszz the treatment you need is not availablein the network hospitalIn these cases, we will not ask you to share thecost of your treatment.Important rulesPlease note that pre-authorisation is only validif all the details of the authorised treatment,including dates and locations, match those ofthe treatment received. If there is a changein the treatment required, if you need tohave further treatment, or if any other detailschange, then you or your consultant mustcontact us to pre-authorise this separately.We make our decision to approve yourtreatment based on the information givento us. We reserve the right to withdraw ourdecision if additional information is withheldor not given to us at the time the decision isbeing made.
  20. 20. 3938CustomerServices e:info@bupa-intl.com t:+44(0)1273323563 www.bupa-intl.com/membersworldOther claim informationDiscretionary paymentsWe may, in certain situations, makediscretionary or ‘ex gratia’ payments towardsyour treatment. If we make any paymenton this basis, this will still count towards theoverall maximum amount we will pay underyour membership. Making these paymentsdoes not oblige us to pay them in the future.We do not have to pay for treatment thatis not covered by your plan, even if we havepaid an earlier claim for a similar or identicaltreatment.Overpayment of claimsIf we overpay you for your claim, wereserve the right to deduct the overpaidamount from future claims or seekrepayment from you.Claiming for treatment when others areresponsibleYou must complete the appropriate sectionof the claim form if you are claiming fortreatment that is needed when someoneelse is at fault, for example in a road accidentin which you are a victim. If so, you will needto take any reasonable steps we ask of youto:zz recover from the person at fault (suchas through their insurance company)the cost of the treatment paid for byBupa International, andzz claim interest if you are entitled to do soNote: SubrogationIn the event of any payment of any claimunder your membership, Bupa Internationalor any person or company that it nominatesmay be subrogated to all rights of recoveryof the member and any person entitled to thebenefits of this coverage. The member shallsign and deliver all documents and papers anddo whatever else is necessary to secure suchsubrogated rights to Bupa Internationalor its nominated party. The member shalldo nothing after the claim to prejudice suchrights.Claiming with joint or double insuranceYou must complete the appropriate sectionon the claim form, if you have any otherinsurance cover for the cost of the treatmentor benefits you have claimed from us. If youdo have other insurance cover, this mustbe disclosed to us when claiming, and wewill only pay our share of the cost of thetreatment or benefits claimed.zz we will only pay for treatment costs thatare reasonable and customaryzz we do not return original documents suchas invoices or letters. However, we will bepleased to return certified copies if youask us when you submit your claimConfirmation of your claimWe will always send confirmation of howwe have dealt with a claim. If the claim isfor treatment received by the principalmember, we will write directly to theindividual concerned.How your claim will be paidWherever possible, we will follow theinstructions given to us in the ‘paymentdetails’ section of the claim form.Who we will payWe will only make payments to the memberwho received the treatment, the provider ofthe treatment, the principal member of themembership or the executor or administratorof the member’s estate. We will not makepayments to anyone else.Payment method and bank chargesWe will make payment where possible byelectronic transfer or by cheque. Paymentsmade by electronic transfer are quick, secureand convenient. To receive payment byelectronic transfer, we need the full bankaccount, SWIFT code, bank address details and(in Europe only) IBAN number to be providedon the claim form.We will instruct our bank to recharge theadministration fee relating to the cost ofmaking the electronic transfer to us but wecannot guarantee that these charges willalways be passed back for us to pay. In theevent that your local bank makes a charge fora wire transfer Bupa International will aim torefund this as well. Any other bank charges orfees, such as for currency exchange, are yourresponsibility, unless they are charged as aresult of our error.Cheques are no longer valid if they are notcashed within 12 months. If you have anout-of-date cheque, please contact customerservices, who will be happy to arrange areplacement.Payment currency and conversionsWe can pay in the currency in which youpay your subscriptions, the currency of theinvoices you send us, or the currency of yourbank account.We cannot pay you in any other currency.Sometimes, the international bankingregulations do not allow us to make apayment in the currency you have asked for.If so, we will send a payment in the currencyof your subscriptions.If we have to make a conversion from onecurrency to another we will use the exchangerate that applies on either the date on whichthe invoices were issued or the last date of thetreatment, whichever is later.The exchange rate used will be the averageof the buying and selling rates across a widerange of quoted rates by the banks in Londonon the date in question. If the date is not aworking day we will use the exchange ratethat applies on the last working day beforethat date.
  21. 21. 4140CustomerServices e:info@bupa-intl.com t:+44(0)1273323563 www.bupa-intl.com/membersworldIf you change your citizenship to a countrywhere we have a local partner, in most casesyou will be able to transfer to our partner’sinsurance policy without further medicalunderwriting. You may also be entitled toretain your continuity of your membership;which means that for those benefits whicharen’t covered until you have been a memberfor a certain period, the time you were amember with us will count towards that.Please note that if you request a transfer toa local partner, we will have to share yourpersonal information and medical history withthe local partner.If you change your residency or citizenship,please call our customer services helplineso we can confirm if your membership isaffected, and, if so, whether we can offer youa transfer service.Important - please readBupa International can end a person’smembership if there is reasonable evidence thatany person concerned has misled, or attemptedto mislead us. By this, we mean giving falseinformation or keeping necessary informationfrom us, or working with another party togive us false information, either intentionallyor carelessly, which may influence us whendeciding:zz whether you (or they) can join the planzz what subscriptions you have to payzz whether we have to pay any claimAfter your Company membership endsYou, the principal member can apply totransfer to a personal Bupa International planif your membership of your group plan ends.Please contact the customer service helpline formore information.Making changes to your coverThe terms and conditions of your membershipmay be changed from time to time byagreement between your sponsor and BupaInternational.Amending your Membership CertificateWe will send you, the principal member anew Membership Certificate if we need torecord any other changes requested by yoursponsor or that we are entitled to make.Your new Membership Certificate will replaceany earlier version you possess as from theissue date shown on the new MembershipCertificate.General informationOther partiesNo other person is allowed to make or confirmany changes to your membership on ourbehalf, or decide not to enforce any of ourrights.No change to your membership will bevalid unless it is confirmed in writing. Anyconfirmation of your cover will only be valid if itis confirmed in writing by Bupa International.If you, the principal member change yourcorrespondence address, please contactyour sponsor as soon as reasonablypossible, as we will send any correspondenceto the address you lastgave us.Your membershipThis section contains the rules about your membership, including when itwill start and end, renewing your plan, how you, the principal member canchange your cover and general informationPaying subscriptions and other chargesYour sponsor has to pay any and allsubscriptions due to Bupa Internationalunder the agreement, together with anyother charges (such as insurance premium tax)that may be payable.Starting and renewing yourmembershipWhen your cover startsYour membership starts on the ‘effectivedate’ shown on the first MembershipCertificate that we sent you, the principalmember for your current continuous periodof Bupa International Company Maritimemembership.Renewing your membershipThe renewal of your membership is subjectto your sponsor renewing your membershipunder the agreement.Ending your membershipYour sponsor can end your membershipfrom the first day of a month by writing to us.We cannot backdate the cancellation of yourmembership.Your membership will automatically end:zz if the agreement between BupaInternational and your sponsor isterminatedzz if your sponsor does not renew yourmembershipzz if your sponsor does not paysubscriptions or any other payment dueunder the agreement for you or for anyother personzz if the membership of the principalmember endszz upon the death of the principalmemberSpecified country of residence /citizenshipYou, the principal member must tell yoursponsor if your specified country ofresidence or your country of citizenshipchanges. We may need to end yourmembership if the change results in a breachof regulations governing the provision ofhealthcare cover to local nationals, residentsor citizens.The details of regulations vary from country tocountry and may change at any time.In some countries Bupa International haveother local partners who are licensed toprovide insurance cover but which are alsoadministered by Bupa International. Thismeans that customers experience the samequality Bupa International service.
  22. 22. 4342CustomerServices e:info@bupa-intl.com t:+44(0)1273323563 www.bupa-intl.com/membersworldMaking a complaintWe’re always pleased to hear about aspects of your membership that you’veparticularly appreciated, or that you have had problems with. If something doesgo wrong, here is a simple procedure to ensure your concerns are dealt with asquickly and effectively as possible.The Bupa International helpline is always thefirst number to call if you have any commentsor complaints. Please call us on+44 (0)1243 323 563 anytime 24 hours aday, 365 days a year. Alternatively you canemail us at info@bupa-intl.com, fax us at+44 (0)1273 820 517 or write to us at:Bupa InternationalRussell MewsBrighton. BN1 2NR, UKWe want to make sure that members withspecial needs are not excluded in any way.For hearing and speech impaired memberswho have a textphone, please call+44 (0) 1273 866 557.We can also offer a choice of Braille, large printor audio for correspondence and marketingliterature.Please let us know which you would prefer.Taking it furtherIt’s very rare that we can’t settle a complaint,but if this does happen, you may refer yourcomplaint to the Financial OmbudsmanService. You can:zz write to them at South Quay Plaza,183 Marsh Wall, London, E14 9JR, UKzz call them on 0845 080 1800 (from insideUK only), +44 (0) 20 7964 1000,zz or find details at their website:www.financial-ombudsman.org.ukPlease let us know if you want a full copyof our complaints procedure.If something has gone wrong, we want to doeverything we can to put it right. But none ofthese procedures affects your legal rights.ConfidentialityThe confidentiality of patient and memberinformation is of paramount concern to thecompanies in the Bupa group. To this end,Bupa fully complies with Data ProtectionLegislation and Medical ConfidentialityGuidelines. Bupa sometimes uses third partiesto process data on its behalf. Such processing,which may be undertaken outside the EEA, issubject to contractual restrictions with regardto confidentiality and security in additionto the obligations imposed by the DataProtection Act.CorrespondenceLetters between us must be sent by postand with the postage paid. We do not returnoriginal documents, with the exception ofofficial documents such as birth or deathcertificates. However, if you ask us at the timeyou send any original documents to us, suchas invoices, we can provide certified copies.Applicable lawYour membership is governed by English law.Any dispute that cannot otherwise be resolvedwill be dealt with by courts in the UK.If any dispute arises as to interpretation ofthis document then the English version of thisdocument shall be deemed to be conclusiveand taking precedence over any otherlanguage version of this document.This can be obtained at all times by contactingthe customer services helpline.LiabilityBupa shall not be responsible for any loss,damage, illness and/or injury whatsoever, thatmay occur as a result of any action carriedout directly or through a third party, to assistin the provision of services covered by theserules.
  23. 23. 4544CustomerServices e:info@bupa-intl.com t:+44(0)1273323563 www.bupa-intl.com/membersworldGlossaryThis explains what we mean by various words and phrases in this MembershipGuide. Words written in bold are particularly important as they have specificmeanings.Defined term DescriptionAcute treatment: A disease, illness or injury that is likely to respond quickly to treatment which aims toreturn you to the state of health you were in immediately before suffering the disease,illness or injury, or which leads to your full recovery.Agreement: The agreement between Bupa International and the sponsor under which we haveaccepted you into membership of the plan.Appliance: A knee brace which is an essential part of a repair to a cruciate (knee) ligament, or a spinalsupport which is an essential part of surgery to the spine.Bupa International: Bupa Insurance Limited or any other insurance subsidiary or insurance partner of theBritish United Provident Association Limited.Chronic conditions: A disease, illness or injury (including a mental condition) which has at least one of thefollowing characteristics:zz it continues indefinitely and has no known curezz it comes back or is likely to come backzz it is permanentzz you need to be rehabilitated or specially trained to copewith itzz it needs long term monitoring, consultations, check-ups, examinations or testsComplementarymedicine practitioner:An acupuncturist, chiropractor, homeopath, osteopath or Chinese medicine practitionerwho is fully trained and legally qualified and permitted to practice by the relevantauthorities in the country in which the treatment is received.Consultant: A surgeon, anaesthetist or physician who:zz is legally qualified to practice medicine or surgery following attendance at arecognised medical school, andzz is recognised by the relevant authorities in the country in which the treatment takesplace as having specialised qualification in the field of, or expertise in, the treatmentof the disease, illness or injury being treatedBy recognised medical school we mean a medical school which is listed in the WorldDirectory of Medical Schools, as published from time to time by the World HealthOrganisation.Day-case treatment: Treatment which for medical reasons requires you to stay in a bed in hospital during theday only. We do not require you to occupy a bed for day-case psychiatric treatment.Dental practitioner: A person who:zz is legally qualified to practice dentistry, andzz is permitted to practice dentistry by the relevant authorities in the country where thedental treatment takes placeDefined term DescriptionDiagnostic tests: Investigations, such as X-rays or blood tests, to find the cause of your symptoms.Emergency: A serious medical condition or symptoms resulting from a disease, illness or injurywhich arises suddenly and, in the judgement of a reasonable person requires immediatetreatment, generally within 24 hours of onset, and which would otherwise put yourhealth at risk.Emergency dentaltreatment:Treatment which you urgently require to alleviate pain, inability to eat or an acute dentalcondition, which presents an immediate and serious threat to your general health.Family doctor: A person who:zz is legally qualified in medical practice following attendance at a recognised medicalschool to provide medical treatment which does not need a consultant’s training,andzz is licensed to practice medicine in the country where the treatment is receivedBy recognised medical school we mean a medical school which is listed in the WorldDirectory of Medical Schools as published from time to time by the World HealthOrganisation.Hospital: A centre of treatment which is registered, or recognised under the local country’s laws, asexisting primarily for:zz carrying out major surgical operations, orzz providing treatment which only consultants can provideIn-patient treatment: Treatment which for medical reasons normally means that you have tostay in a hospitalbed overnight or longer.Intensive care: Intensive Care includes:zz High Dependency Unit (HDU): a unit that provides a higher level of medical care andmonitoring, for example in single organ system failurezz Intensive Therapy Unit / Intensive Care Unit (ITU/ICU): a unit that provides the highestlevel of care, for example in multi-organ failureor in case of intubated mechanical ventilation.zz Coronary care unit (CCU): a unit that provides a higher level of cardiac monitoringMedical practitioner: A complementary medicine practitioner, consultant, dental practitioner, familydoctor, psychologist or therapist who provides active treatment of a known condition.Membership year: The period beginning on your start date or renewal date and ending on the day beforeyour next renewal date. By start date we mean the ‘effective from’ date on your firstmembership certificate for your current continuous period of membership.Network: A hospital, or similar facility, or medical practitioner which has an agreement in effectwith Bupa International or service partner to provide you with eligible treatment.Out-patient treatment: Treatment given at a hospital, consulting room, doctors’ office or out-patient clinicwhere you do not go in for day-case or in-patient treatment
  24. 24. 4746CustomerServices e:info@bupa-intl.com t:+44(0)1273323563 www.bupa-intl.com/membersworldDefined term DescriptionPersistent vegetativestate:zz a state of profound unconsciousness, with no sign of awareness or a functioning mind,even if the person can open their eyes and breathe unaided, andzz the person does not respond to stimuli such as calling their name, or touchingThe state must have remained for at least four weeks with no sign of improvement, whenall reasonable attempts have been made to alleviate this condition.Pre-existing condition: Any disease, illness or injury for which:zz you have received medication, advice or treatment, orzz you have experienced symptomswhether the condition has been diagnosed or not in the four years before the start ofyour cover.Principal member: The person who has taken out the membership, and is the first person named on theMembership Certificate. Please refer to ‘you/your’.Prophylactic surgery: Surgery to remove an organ or gland that shows no signs of disease, in an attempt toprevent development of disease of that organ or gland.Psychiatric treatment: Treatment of mental conditions, including eating disorders.Psychologist: A person who is legally qualified and is permitted to practice as such in the country wherethe treatment is receivedQualified nurse: A nurse whose name is currently on any register or roll of nurses maintained by anystatutory nursing registration body in the country in which the treatment takes place.Rehabilitation: Treatment in the form of a combination of therapies such as physical, occupational andspeech therapy aimed at either restoring full function or the ability to live independentlyafter an acute event such as a stroke.Renewal date: Each anniversary of the date you, the principal member joined the plan. (If however youare a member of a Bupa International Company Maritime group plan with a commonrenewal date for all members, your renewal date will be the common renewal date forthe group. (We tell you the group renewal date when you join.)Service Partner: A company or organisation that provides services on behalf of Bupa International. Theseservices may include approval of cover and location of local medical facilities.Specified country ofnationality:The country you, the principal member gave on your application form.Specified country ofresidence:Any country where you are considered by the relevant authorities to be resident. Asshown on your membership certificate or as advised to us in writing whichever is the later.Sponsor: The company, firm or individual with whom we have entered into an agreement toprovide you with cover under the plan.Defined term DescriptionSubrogated: The assumption of the member’s right by Bupa International to recover from an at faultparty the costs of any claims paid by Bupa International for treatment to the member.Surgical operation: A medical procedure involving an incision into the body.Therapists: A physiotherapist, occupational therapist, orthoptist, dietician or speech therapist who islegally qualified and is permitted to practice as such in the country where the treatmentis received.­Treatment: Surgical or medical services (including diagnostic tests) that are needed to diagnose,relieve or cure an acute condition, disease, illness or injury.United Kingdom/UK: Great Britain and Northern Ireland.We/us/our: Bupa InternationalYou/your: This means you, the principal member and your dependants unless we have expresslystated otherwise that the provisions only refer to the principal member.Here are some everyday descriptions of some medical words and phrases used in this membership guideCytotoxic drugs: Drugs that are used specifically to kill off cancerous cells in the body.Diseased tissue: Unhealthy or abnormal cells in the human body.Ectopic pregnancy: When a foetus is growing outside the womb.Hormone ReplacementTherapy:Hormone replacement therapy (HRT) is the use of synthetic or natural hormones totreat a hormone deficiency. Most commonly, this is used in the treatment of symptomsaccompanying the menopause.Pathology: Tests carried out to help determine or assess a medical condition, for example blood tests.Post-partumhaemorrhage:Heavy vaginal bleeding in the hours and days immediately after childbirth.Retained placentalmembrane:When the afterbirth is left in the womb after delivery of the baby.Sleep apnoea: Temporarily stopping breathing during sleep.

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