Bupa CarePro Consolidated 2014

BUPA CAREPRO

STAYING HEALTHY JUST GOT EASIER www.bupa.com.hk

4Bupa CarePro offers you exceptional medical protection at an affordable rate, so you have access to quality healthcare when you need it. And because you wont be compromising on your cover in order to support your budget, Bupa CarePro is a sustainable option. Whats more, we understand everyones health needs are different, so we give you the flexibility to add on optional extras to suit your individual needs.

INTRODUCTION TO BUPA CAREPRO

1OVERVIEW OF YOUR COVERCover at a glance

Basic benefit

Hospital and Surgical Benefit

Optional benefits

Full Cover BenefitSupplementary Major Medical BenefitHospital Cash Benefit Clinical BenefitMaternity Benefit

Free benefit

Free Bupa Worldwide Assistance Programme

Medical card

Yes (For members choosing Full Cover Benefit and/or Supplementary Major Medical Benefit)(/)

Choice of benefit levels

Private (Plan 1 or 4)

(1 4)Semi-private (Plan 2 or 5)

(2 5)Ward (Plan 3 or 6)

(3 6)

Eligibility

Issue age

18 years or above

18

Renewal of scheme

Renewal of your cover is guaranteed for life regardless of your claims or changes in

your health

Please refer to the Schedule of Benefits for more information.

There is no waiting period, meaning that you are protected as soon as your membership starts.

2Our healthcare expertise means that we are able to offer unparalleled benefits to our members, from higher cover to expert healthcare and a lifetime of support.

STEP INTO A WORLD OF BENEFITS

SUPPORTINg YOU ALWAYSHigher pay-out from a lump sum benefitThe optimal combination of our Hospital and Surgical

Benefit and Full Cover Benefit can cover your basic hospital expenses. The Full Cover Benefit guarantees that 100% of your hospital expenses will be paid, regardless of each

individual item limit, as long as the total bill falls within the

annual limit (from HK$200,000 to HK$700,000). To enjoy the

Full Cover Benefit, simply select an attending doctor from our network providers. And in seven renowned private hospitals

appointed by Bupa, you can receive quality treatment without

any payment or claims thanks to our pioneering medical card.

If you wish to consult a doctor outside our network, you will

still be covered under the Hospital and Surgical Benefit.

Top-up benefit to cover serious illnessesSome serious or long-term illnesses can rack up unexpected

costs. The Supplementary Major Medical Benefit will help

to reduce potential out-of-pocket expenses by boosting

your basic cover. It pays 80% of your medical expenses in excess of the amount covered by the Hospital and Surgical

Benefit or Full Cover Benefit. Similar to Full Cover Benefit,

you will receive a medical card. Before a hospital stay,

simply call us to complete a simple registration process and

present this card at any local private hospital. We will pay all

your eligible medical expenses directly up to your credit

limit, so you dont have to submit any claims.

No claims renewal bonusIf you do not claim within a specific period, you can enjoy an increasing renewal discount on your Hospital and Surgical

Benefit and Full Cover Benefit. You will receive 5% discount if you do not claim for two or three consecutive years, 10% discount for four or five consecutive years and 15% discount for six or more consecutive years.

No extra subscription Regardless of your claim history or changes in health after

joining Bupa CarePro, there will be no increase in subscription

on an individual basis when you renew your contract.

Please refer to the Question Time section for more details. Supplementary Major Medical Benefit is not applicable to

Pre-admission and Post-hospitalisation Out-patient Care and Emergency Out-patient Benefit for Accidents. A small

deductible is required.

3If you choose to add the Full Cover Benefit to your cover, we will pre-authorise your medical expenses before your hospital admission, so all you have to think about is getting better.

(2070)100%7

8

5%10%15%

4Higher cover thanks to per-surgery benefitMost insurance schemes pay for surgical fees per disability. This

means that all operations related to the same condition will be paid

out of a single maximum benefit limit. Once the limit is exhausted, you will need to pay the excess. With Bupa, you can claim up to the

maximum benefit limit for each operation, allowing you to enjoy higher cover if you require more than one operation.

Extra Cancer Treatment and Kidney Dialysis BenefitBupa group has been dealing with the diagnosis and treatment of

serious illness like cancer and kidney failure for over 60 years. As

we understand that they often require prolonged treatment, we

offer additional coverage of up to HK$100,000 per year, making

it easier for you to afford more costly and advanced treatment

options. Whats more, if this cover is fully claimed in any one year, it

will be reinstated in the following year for the rest of your lifetime.

Clinical surgery and day-case procedureWe know a lot of treatments do not require overnight hospital

stay such as endoscopies or colonoscopies, so we have not

included a minimum length of stay in your cover. Our Hospital

and Surgical Benefit covers you for both day-case surgery and clinical operations, increasing the value of your cover.

Cover for accidental injuriesAccidents such as bumps, bruises, burns and scalds can occur

anytime, so we now offer you Emergency Out-patient Benefit for Accidents, which covers emergency treatment received

at the out-patient department or accident and emergency

department of a hospital, from the result of an accident.

6010

WITH MEDICAL ExPERTISE

5Lifelong guaranteed renewal We guarantee that your cover can be renewed for life,

regardless of any changes in your health after joining.

Maternity BenefitTo take care of mums-to-be, we will cover medical expenses

related to your pregnancy needs including the obstetricians

fees, hospitalisation charges, prenatal and postnatal check-

up costs, and nursery care for newborn baby for normal

delivery, caesarean section and miscarriage. You will receive

reimbursement after your maternity cover takes effect for 9

months or more.

Up to 50% discount for family enrolmentWe want to support you as your family grows. If both you and

your children enrol together, each child can enjoy a discount

on Hospital and Surgical Benefit and Full Cover Benefit, if any, on Bupa Care Kid Health Insurance Scheme for as long as your

membership continues. If one parent enrols, each child will

receive a 25% discount and if both parents enrol, then they will receive a 50% discount.

Easy enrolment

No medical examinations are required.

SERVICE PLEDgENo claims procedure is required if you use the Bupa medical card. All other hospitalisation and consultation claims will be settled within 5 7 working days after full documentation is received.

5 7

THROUgHOUT YOUR LIFE

9

50%()25%50%

6

197630312,50017

2013101868100500www.qhms.com

BUPAS PRESENCE IN HONG KONGBupa is a leading provider in healthcare funding and provision with two independent units, Bupa Hong Kong and Quality HealthCare.

Bupa Hong KongBupa Hong Kong has been a health insurance specialist since 1976. Our expertise in healthcare has gained the trust of more than 310,000 individuals, 2,500 companies and the Hong Kong Government, who for 17 consecutive years has recommended Bupa as the provider of quality health insurance for civil servants.

We have applied our expertise to provide our members with comprehensive and flexible insurance plans to suit every life stage and lifestyle. Through our extensive provider network in Hong Kong, we offer our members a wide choice of doctors.

Quality HealthCareQuality HealthCare Medical Services Limited (QHMS), a leading private medical network in Hong Kong, became part of the Bupa group in October 2013. QHMS operations span diagnostics, primary healthcare and day care specialties.

With roots tracing back to 1868, QHMS serves the community through a network of 100 multi-specialty centres and approximately 500 affiliated clinics offering Western Medicine, Traditional Chinese Medicine, Diagnostics & Imaging, Dental, Physiotherapy and other healthcare services. For more information, please visit www.qhms.com.

Bupa GroupEstablished in the UK in 1947, Bupa is now a leading international healthcare group serving over 14 million customers in more than 190 countries. We are the largest health insurer in the UK.

Our diversified healthcare services include health insurance, hospitals, primary care and dental centres, workplace health services, home healthcare, health assessments, chronic disease management services, nursing and residential care for elderly people.

With no shareholders, we invest our profits to provide more and better healthcare and fulfill our purpose.

Bupa employs more than 62,000 people, principally in the UK, Australia, Spain, Poland, New Zealand and the USA, as well as Saudi Arabia, Hong Kong, India, Thailand, China and across Latin America.

19471901,400

62,000

THE WORLD OF BUPA

Bupas purpose is longer, healthier, happier lives.

7KEEPINg YOU HEALTHY

At Bupa, we use our healthcare expertise to

help people live longer, healthier and happier

lives. We understand that keeping you and

your family well is as important as protecting

you when you become unwell. Using the

expertise of consultants in the UK and Hong

Kong we have created a wealth of free and

easy to use information and tools to help you

take control of your health. These include:

online health information online health risk calculators and

assessments

fitness apps for your smartphone or iPad health videos online doctors advice health tips and member privileges on

Bupas Facebook page and Weibo page

iPad Facebook

Use our free services www.bupa.com.hk

Join Bupas community Facebook

Bupa Hong Kong

81 Is there any minimum length of hospital stay?

There is no minimum length of stay, meaning that procedures

such as endoscopy, a plaster cast, wound sutures,

radiotherapy and chemotherapy, which do not require

hospital confinement, are covered.

2 How do I pay my subscription?

You can pay your subscription monthly or annually according

to your preference.

3 How do I use my Bupa medical card to get the most from my

Full Cover Benefit?

You will need to visit a specialist and clinic appointed by

Bupa and present your medical card upon registration. The

specialist will then get pre-authorisation of the medical

expenses for you if hospital confinement is required. You can choose from one of the Bupa HealthCare Appointed

Hospitals where your specialist is registered. Once the pre-

authorisation is confirmed, we will issue you with a Pre-authorisation Confirmation / Guarantee of Payment Letter for your hospital confinement. You will need to show your medical card and this letter to your selected hospital to enjoy

cashless treatment. Upon discharge, all you need to do is

sign on the claim form provided by the hospital. You are not

required to submit any claims as Bupa will directly settle your

expenses with the hospital.

You can also use the medical card to settle the expenses

for medical procedure taken at the appointed specialists

designated clinic. If the expenses are under HK$4,000, pre-

authorisation is not required.

For emergency hospital confinement outside our office hours, the pre-authorisation can be arranged on the next

working day.

Step-by-step details will be provided in your Membership

guide.

4 If I opt for the Supplementary Major Medical Benefit only, how do I use my Bupa medical card?

Call us and submit a registration form before you

are admitted to hospital. We will then give you a

Pre-authorisation Confirmation / Guarantee of Payment Letter. For emergency hospital confinement outside our office hours, the registration can be submitted on the next working day.

5 How can I check my membership details or claim status?

You can log in to Bupa Active on our website to access

a host of 24-hour online services or call our dedicated

Customer Care helpdesk. If you have submitted a claim,

once it has been processed you will also receive our SMS

confirmation if you provide us with an up-to-date mobile phone number.

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QUESTION TIME

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We want to help you understand your coverage before enrolment. Below are the general exclusions:

Pre-existing conditions (whether they are known or unknown to the member or the subscriber, unless such conditions have been disclosed in the application and accepted by Bupa).

Treatment, medical service, medication or investigation which is not medically necessary.

Any illness or injury for which compensation is payable under any laws or regulations or any other insurance policy or any other sources except to the extent that such charges are not reimbursed by any such compensation, insurance policy or sources.

Any charges for accommodation, nursing and services received in health hydros, nature cure clinics, convalescent home, rest home, home for the aged or similar establishments.

Any charges in respect of surgical or non-surgical cosmetic treatment, or hearing tests, routine blood tests, general check-ups, vaccinations or inoculations, Hair Mineral Analysis (HMA), health supplements or body weight control, eye refraction including but not limited to routine eye tests or any costs of fitting of spectacles or lens.

Congenital conditions, developmental conditions or hereditary conditions.

Treatment that commenced during the first five years of the members coverage commencement date of this contract and which in any way arises from, is attributable to, or is consequential upon Human Immunodeficiency Virus infection.

Sexually transmitted (venereal) diseases or their sequel.

Treatment relating to pregnancy, including diagnostic tests for pregnancy or resulting childbirth, abortion or miscarriage (unless benefit is available); birth control or sterilisation of either sex; infertility including in-vitro fertilisation or any other artificial method of inducing pregnancy; sexual dysfunction including but not limited to impotence, erectile dysfunction, premature ejaculation, regardless of cause.

Misuse or overdose of drugs or being under the influence of alcohol, self-inflicted injuries or attempted suicide.

Treatment relating to any illness or injury resulting from participation in criminal activities.

Alternative treatment including but not limited to Chinese medicines treatment, acupuncture, acupressure, Tui Na, hypnotism, rolfing, massage therapy, aromatherapy, unless benefit is available.

Senile Dementia (including Alzheimers disease), Parkinsons disease, psychological or psychiatric condition(s) of any and all kinds, including but not limited to psychoses, neuroses, depression, anxiety, anorexia nervosa, schizophrenia, behavioural disorders, delirium, insomnia, neurasthenia.

Any charges for the procurement or use of special braces and appliances, including but not limited to spectacles, hearing aids and other equipments such as wheel chairs and crutches.

Any treatment or investigation related to dental or gum conditions except for emergency treatment arising from accidents or the extraction of impacted wisdom teeth during hospital confinement. Follow-up treatment from such hospital confinement shall not be covered.

Treatment arising from war, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or military or usurped power or terrorist acts.

Non-medical services, including but not limited to guest meals, radio, telephone, photocopy, taxes (except the Value-Added Tax or goods and Services Tax for medical services), medical report charges and the like.

Experimental and / or new medical technology or procedure not yet approved by Bupa.

If you have any pre-existing medical conditions, special exclusions may be added after underwriting.

gENERAL ExCLUSIONS

Bupa Carepro HealtH InsuranCe sCHeme

effective from 1 January 2014 201411 maximum limit (HK$) ()

AHospitalandSurgicalBenefit

Plan 1, 4Private

Plan 2, 5Semi-private

Plan 3, 6Ward

1 Room and Board(Maximum270dayseachContractYear) (270) 3,100 each day 1,530eachday 750eachday

2 Miscellaneous hospital Services (each Contract Year) () 36,100 21,500 13,600

3 intensive Care(SupplementtoRoomandBoard)(EachContractYear) ()() 26,000 22,000 20,500

4 Private Nursing(Maximum120dayseachContractYear) (120)

NursingservicesduringHospitalConfinementorathomeafterdischargefromHospitalrenderedbyaQualifiedNurse,subjecttowrittenreferral fromtheattendingRegisteredMedicalPractitioner

870eachday 520eachday 320eachday

5 Surgeon and Attendance fees(Forsurgicalcaseonly)(Eachoperation) ()()

Complex Major Intermediate minor

95,00049,000

21,1007,350

59,50033,30014,0506,000

46,50025,50010,3005,000

6 Anaesthetists fees (each operation) ()


29,90013,8506,4503,370

17,5009,4504,2002,190

13,5007,4503,2001,970

7 operating theatre fees (each operation) ()


31,10015,1007,1904,010

18,00010,4004,7002,400

13,7008,2703,6002,180

8 in-patient Physicians fees(Fornon-surgicalcaseonly) (Maximum270dayseachContractYear) ()(270)

2,460eachday 1,080eachday 630eachday

9 in-patient Specialists fees (each Contract Year) ()

Subjecttowrittenreferral fromtheattendingRegisteredMedicalPractitioner(exceptforservicesperformedbypathologist,radiologistorPhysiotherapistduringHospitalConfinement)

()

10,600 3,700 2,300

10 Cancer treatment and Kidney Dialysis (each Contract Year) ()

Chemotherapy,radiotherapy,cyberknifeorgammaknifeforcancertreatmentorkidneydialysisduringHospitalConfinementorinday-caseunitofaHospitalorclinicuponrecommendationbytheattendingRegisteredMedicalPractitioner

100,000 75,000 50,000

11 Companion Bed(Maximum270dayseachContractYear) (270) 1,540eachday 765eachday 375eachday

12 Pre-admission and Post-hospitalisation out-patient Care (each Contract Year) ()

Includingtwopre-admissionvisitsandallrelatedpost-hospitalisationfollow-upvisitsonanout-patientbasiswithinsixweeksafterdischargefromHospital

26

4,700 2,650 1,750

13 EmergencyOut-patientBenefitforAccidents (each Contract Year) ()

Coverexpensesforconsultation,WesternMedicaton,diagnosticimagingandlaboratorytests,aswellasotherrelatedmedicalfeesincurredonanout-patientbasisintheout-patientdepartmentoraccidentandemergencydepartmentofaHospitalasaresultofanAccident

10,000 8,000 6,000

overall Annual limit-Belowattainedageof65ontheContractEffectiveDate - 65 Unlimited

overall Annual limit-Attainedageof65oraboveontheContractEffectiveDate - 65 720,000 360,000 171,000

SCheDule of BeNefitS

Bupa(Asia)Limited()Address:18/F,BerkshireHouse,25WestlandsRoad,QuarryBay,HongKong:25 18Telephone:(852)25175175Facsimile:(852)25481848Website:www.bupa.com.hk

Bupa Hong Kong

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BFullCoverBenefit(Optional) ()

Plan 4Private

Plan 5Semi-private

Plan 6Ward

ThisBenefitispayableforeligibleexpensesofthefollowingitemsB1toB11incurredduringyourHospitalConfinement,ClinicalOperationorDayCaseSurgeryprovidedbytheHospitals,Specialistsandday-casecentresappointedbyBupasubjecttotheMaximumLimitperContractYear.YourtreatmentmustbereferredandattendedbyaBupaHealthCareAppointedSpecialist.B1B11

Bupa healthCare Appointed hospitals

CanossaHospitalHKAdventistHospitalHKBaptistHospitalHKSanatorium&HospitalStPaulsHospitalStTeresasHospitalUnionHospital

No.ofBupaHealthCareAppointedSpecialists Around600

1 Room and Board

2 Miscellaneous hospital Services 3 intensive Care

4 Private Nursing

NursingservicesduringHospitalConfinementorathomeafterdischargefromHospitalrenderedbyaQualifiedNurse,subjecttowrittenreferral fromtheattendingRegisteredMedicalPractitioner

5 Surgeon and Attendance fees

6 Anaesthetists fees

7 operating theatre fees

8 in-patient Physicians fees

9 in-patient Specialists fees

Subjecttowrittenreferral fromtheattendingRegisteredMedicalPractitioner(exceptforservicesperformedbypathologist,radiologistorPhysiotherapistduringHospitalConfinement)

()

10 Cancer treatment and Kidney Dialysis

11 Companion Bed

Fullcover

Fullcover

Fullcover

Maximum limit (each Contract Year) -Belowattainedageof65ontheContractEffectiveDate() - 65

700,000 400,000 200,000

Maximum limit (each Contract Year) -Attainedageof65oraboveontheContractEffectiveDate() - 65

400,000 250,000 150,000

FullCoverBenefitispayableforeligiblemedicalexpensesincurredduringHospitalConfinement,DayCaseSurgeryandClinicalOperationuptotheMaximumLimitperContractYear.Pre-admissionandPost-hospitalisationOut-patientCare,andEmergencyOut-patientBenefitforAccidentswillbepaidunderitemsA12andA13.

YourBupaHealthCare(BHC)CardcanbeusedtosettlepaymentforHospitalConfinementorClinicalOperation(s)attheBupaHealthCareAppointedHospitalsandSpecialistsclinics,subjecttoacreditlimitapprovedbyBupa.

AfterFullCoverBenefitisexhausted,youcanclaimtheHospitalandSurgicalBenefitforyournexttreatment.

a12a13


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CSupplementaryMajorMedicalBenefit(Optional) ()

Plan 1, 4Private

Plan 2, 5Semi-private

Plan 3, 6Ward

Reimbursement percentage 80%

Maximum limit (each Contract Year) () 550,000 280,000 110,000

LifetimeLimit(OnlyapplicabletoMemberswhoattaintheageof65orabove) (65) 800,000 400,000 200,000

ThisBenefitispayableafteranyitemofA1-A11underHospitalandSurgicalBenefitorFullCoverBenefit(ifapplicable)isexhaustedandissubjecttoHK$500deductibleperclaim. YourBupaHealthCare(BHC)CardcanbeusedtosettlepaymentforHospitalConfinementatanylocalprivateHospitals,subjecttoacreditlimitapprovedbyBupa. Incaseofoverseashospitalisation,onlymedicalEmergencycaseswillbecovered. Adjustmentfactorswillbeappliedifyouareconfinedinahigherroomlevelthanyourchosenlevel: -FromSemi-privateRoomtoPrivateRoom :50% -FromWardtoSemi-privateRoom :50% -FromWardtoPrivateRoom :25%

a1 - a11()500

- :50% - :50% - :25%

DHospitalCashBenefit(Optional) ()

Plan 1, 4 Plan 2, 5 Plan 3, 6

PayablefromthethirddayofHospitalConfinement(Maximum182dayseachContractYear)3 (182)

1,000eachday 500eachday 300eachday

EClinicalBenefit(Optional) ()


1 General Practitioner(Consultationfeeonly) () 415eachvisit 255eachvisit 195eachvisit

2 Specialist(Consultationfeeonly) ()

Subjecttowrittenreferral fromaRegisteredMedicalPractitioner695eachvisit 515eachvisit 375eachvisit

3 home Consultation(Consultationfeeonly) () 760eachvisit 540eachvisit 375eachvisit

4 Physiotherapist(Treatmentfeeonly) ()


5 Chiropractor(Treatmentfeeonly) ()


6 Chinese herbalist

Consultationfee(includingbasicMedicallyNecessaryChineseMedicinesprescribedattheRegisteredChineseMedicinePractitionersclinicandobtainedatalegitimatesourceonthesamedayofconsultation)

PayableforacupunctureperformedbyaRegisteredChineseMedicinePractitioner ()

285eachvisit 210eachvisit 170eachvisit

7 Chinese Bonesetter

Consultationfee(includingbasicMedicallyNecessaryChineseMedicinesprescribedattheRegisteredChineseMedicinePractitionersclinicandobtainedatalegitimatesourceonthesamedayofconsultation)

PayableforacupunctureperformedbyaRegisteredChineseMedicinePractitioner ()

285eachvisit 210eachvisit 170eachvisit

8 Prescribed Western Medication (each Contract Year) ()

MedicallyNecessaryWesternMedicationprescribedbyaRegisteredMedicalPractitionerandobtainedatalegitimatesource

4,800 2,930 1,840

9 Diagnostic imaging and laboratory tests (each Contract Year) ()

Subjecttowrittenreferral fromaRegisteredMedicalPractitioner 3,700 2,100 1,600

NumberofvisitsperContractYearforitemsE1E7aboveis30intotalandissubjecttoamaximumofonevisitperitemperday.NumberofvisitsperContractYearforitemsE6-E7aboveis10intotal.e1e730e6e710


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FMaternityBenefit(Optional) ()


Normal Delivery (per pregnancy) () 35,000 23,000 16,000

Caesarean Section (per pregnancy) () 52,500 34,500 24,000

Miscarriage (per pregnancy) () 17,500 11,500 8,000

TheMaternityBenefitshallcovermedicalexpensesincurredforthefollowingduringpregnancy: -HospitalConfinement -ConsultationofaRegisteredMedicalPractitionerandPrescribedWesternMedication -Diagnostictests,prenatalcheck-upandpostnatalcheck-up -Nurserycareofnewbornbaby ThisBenefitdoesnotcoveranymedicalexpensesincurredbythenewbornbabyduringHospitalConfinement. ThisBenefitispayableprovidedthatthepregnancycommencesafterthisBenefittakeseffectandyouhavebeencontinuouslycoveredunderthisBenefitfor9monthsormore.

- - - - 9

GFreeBupaWorldwideAssistanceProgramme(EachContractYear) ()

ProvidesadmissiondepositintheeventofhospitalisationoverseasandinMainlandChina,unlimitedcoverforemergencymedicalevacuationandrepatriation,andanextrahospitalbenefitofHK$120,000afterrepatriationtoHongKong.A24-hourhotlinefortravel,medicalorlegalinformationandassistanceisalsoavailable. 1224


notes

AboutHospitalandSurgicalBenefit ClinicalOperationorDayCaseSurgery,ifeligible,willbepaidunderHospitalandSurgicalBenefit.ClinicalOperationandDayCaseSurgerymeanMedicallyNecessary

surgicalprocedureswhichmaybecarriedoutataclinicorday-caseunitofaHospitalbyaRegisteredMedicalPractitionerwhereastayinHospitalisnotrequired,providedthatthesurgicalprocedureisclassifiedassuchbyBupa.

Referralletter Areferralletterisvalidforthesameorrelatedmedicalconditionforsixmonthsfromtheissuedate.Anotherreferralletterisrequiredfortreatmentofanewor

unrelatedmedicalcondition. AboutFullCoverBenefit PleasefollowtherequirementsbelowtoenjoyFullCoverBenefit: (i) Alwayspresentyourdoctorsreferralletter(exceptforgynaecology,paediatricsandfamilymedicine)andyourBHCCardtotheBupaHealthCareAppointed

Specialistuponregistration. (ii) Pre-authorisationconfirmationmustbeobtainedfromBupaforthefollowingsituations: - HospitalConfinementorDayCaseSurgery - ClinicalOperation(s)exceedingHK$4,000 - SpecialisttreatmentforwhichtherelevantspecialtyisnotpractisedbyanyBupaHealthCareAppointedSpecialist. (iii)Ifyouhavereceivedtreatmentoutsideourofficehours,pleaseobtainauthorisationfromBupaonthenextworkingday. (iv)YourtreatmentatanyBupaHealthCareAppointedServiceProvidersmustbereferredandattendedbytheBupaHealthCareAppointedSpecialist. (v) PleasepresentyourBHCCardwithBupasPre-authorisationConfirmation/GuaranteeofPaymentlettertotheBupaHealthCareAppointedHospitalupon

admissionanduseittopaythemedicalexpenses. (vi)Youmustbeconfinedattherestrictedroomlevelorlower. Iftheaboverequirementsarenotfollowed,yourclaims,ifeligible,willbepaidunderHospitalandSurgicalBenefit. Ifyoureceivetreatmentattheday-casecentreofanappointedHospital,thereisnoneedtoshowyourBHCCard.PleasesettleyourexpenseswiththeHospitaland

submityourclaimtous. Pleasesettleyourout-patientexpensesattheBupaHealthCareAppointedSpecialistsclinic,unlessHospitalConfinement,DayCaseSurgeryorClinicalOperationis

MedicallyNecessaryandpre-authorisation,ifrequired,isobtainedduringthesameclinicvisit. AboutSupplementaryMajorMedical(SMM)Benefit ThisBenefitissubjecttotheMaximumLimitperContractYearortheLifetimeLimit(ifapplicable),whicheverislower.TheSMMBenefit,whichispaidfromage65will

bedeductedfromtheLifetimeLimitandthebalancewillbecometheLifetimeLimitofthenextContractYear.AftertheLifetimeLimitisexhausted,thisBenefitshallautomaticallyterminate.

ThisBenefitwillnotbepayableforHospitalConfinementinthesuite,VIPordeluxeroomofaHospital.

6 (i) () (ii) - - 4,000 - (iii) (iv) (v) / (vi) ()65 / /

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BUPA CAREPRO HEALTH INSURANCE SCHEME

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TABLE OF SUBSCRIPTIONS Effective from 1 January 2014 201411

All figures in HK$

Plan 1Private

Annual Monthly

The subscriptions below are for renewal only

Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly

AttainedAge

Plan 2Semi-private

Plan 3Ward

Plan 4Private

Plan 5Semi-private

Plan 6Ward

18 5,370 515 2,981 286 1,617 155

19 5,437 521 3,020 290 1,637 157

20 5,513 529 3,060 293 1,661 159

21 5,618 539 3,121 299 1,693 162

22 5,667 543 3,149 302 1,708 164

23 5,717 548 3,176 305 1,723 165

24 5,767 553 3,204 307 1,738 167

25 5,849 561 3,248 311 1,761 169

26 5,963 572 3,313 318 1,791 172

27 6,078 583 3,375 324 1,830 175

28 6,200 595 3,442 330 1,867 179

29 6,355 609 3,527 338 1,915 184

30 6,774 650 3,780 363 2,049 196

31 7,460 715 4,154 398 2,252 216

32 7,564 725 4,203 403 2,300 221

33 7,651 734 4,242 407 2,325 223

34 7,779 746 4,310 413 2,353 226

35 7,913 759 4,385 421 2,392 229

36 8,076 774 4,477 429 2,439 234

37 8,274 793 4,587 440 2,496 239

38 8,533 818 4,729 454 2,568 246

39 8,787 843 4,869 467 2,653 254

40 9,128 875 5,058 485 2,743 263

41 9,462 907 5,244 503 2,844 273

42 9,775 937 5,417 519 2,937 282

43 10,121 971 5,609 538 3,042 292

44 10,415 999 5,772 554 3,131 300

45 10,762 1,032 5,964 572 3,228 310

46 11,047 1,059 6,121 587 3,326 319

47 11,334 1,087 6,281 602 3,413 327

48 11,663 1,118 6,466 620 3,507 336

49 12,008 1,152 6,657 638 3,610 346

50 12,450 1,194 6,934 665 3,719 357

51 13,899 1,333 7,625 731 4,136 397

52 15,095 1,448 8,368 802 4,558 437

53 15,312 1,468 8,470 812 4,631 444

54 15,630 1,499 8,646 829 4,728 453

55 15,919 1,527 8,808 845 4,817 462

56 16,240 1,557 9,001 863 4,908 471

57 16,722 1,604 9,269 889 5,025 482

58 17,331 1,662 9,662 927 5,210 500

59 18,091 1,735 10,076 966 5,413 519

6,028 578 3,225 309 1,749 168

6,102 585 3,267 314 1,770 170

6,186 594 3,309 317 1,796 172

6,301 604 3,374 323 1,830 175

6,355 609 3,404 326 1,847 177

6,410 614 3,433 330 1,862 178

6,464 620 3,462 332 1,878 180

6,554 629 3,509 336 1,902 183

6,679 641 3,578 343 1,935 186

6,803 653 3,644 350 1,975 189

6,935 665 3,714 356 2,015 193

7,104 681 3,804 365 2,065 198

7,701 739 4,287 412 2,233 214

8,396 805 4,665 447 2,436 234

8,509 816 4,718 452 2,486 239

8,605 825 4,761 457 2,513 241

8,746 839 4,835 463 2,543 244

9,328 895 4,981 478 2,715 260

9,512 912 5,082 487 2,767 265

9,737 933 5,203 499 2,830 271

10,035 962 5,362 515 2,911 279

10,331 991 5,519 529 3,005 288

10,826 1,038 5,952 571 3,107 298

11,205 1,074 6,162 591 3,217 309

11,565 1,109 6,359 609 3,321 319

11,957 1,147 6,576 631 3,435 330

12,297 1,179 6,763 649 3,534 339

12,809 1,228 6,979 669 3,778 363

13,148 1,260 7,162 687 3,890 373

13,490 1,294 7,349 704 3,993 383

13,882 1,331 7,565 725 4,104 393

14,292 1,371 7,789 747 4,224 405

16,203 1,554 8,667 831 4,470 429

17,706 1,698 9,383 900 4,899 470

18,957 1,818 10,152 973 5,331 511

19,255 1,846 10,291 987 5,420 520

19,648 1,884 10,501 1,007 5,533 530

20,657 1,981 10,699 1,026 5,637 541

21,901 2,100 10,936 1,049 5,748 552

22,551 2,163 11,262 1,080 5,890 565

23,406 2,245 11,740 1,126 6,106 586

24,463 2,346 12,255 1,175 6,345 608

25,660 2,461 13,315 1,277 6,582 631

26,612 2,552 13,980 1,340 6,836 656

27,843 2,670 14,742 1,413 7,134 684

29,366 2,816 15,663 1,502 7,421 711

31,204 2,992 16,511 1,583 7,779 746

35,304 3,386 17,648 1,692 8,725 837

37,108 3,559 18,434 1,768 9,565 917

39,301 3,769 19,458 1,866 10,181 976

41,403 3,971 20,119 1,929 10,530 1,010

43,377 4,160 20,524 1,969 10,783 1,034

45,241 4,339 21,775 2,089 10,964 1,052

47,521 4,557 22,084 2,118 11,596 1,112

49,947 4,790 22,467 2,154 11,763 1,128

52,458 5,031 22,821 2,188 11,957 1,147

54,987 5,273 23,144 2,220 12,128 1,163

57,534 5,518 24,229 2,323 12,493 1,198

59,804 5,735 24,376 2,338 12,833 1,230

62,372 5,981 24,612 2,360 13,129 1,259

64,964 6,230 24,809 2,379 13,231 1,269

67,573 6,480 24,975 2,395 13,544 1,299

71,254 6,833 25,454 2,441 13,801 1,324

60 18,999 1,822 10,582 1,015 5,618 539

61 19,906 1,909 11,088 1,063 5,828 559

62 21,092 2,023 11,694 1,121 6,088 584

63 22,225 2,131 12,440 1,193 6,334 607

64 23,538 2,257 13,050 1,251 6,639 637

65 24,808 2,379 13,880 1,331 7,023 674

66 26,192 2,512 14,515 1,392 7,794 747

67 27,819 2,668 15,369 1,474 8,333 799

68 29,307 2,811 15,891 1,524 8,619 827

69 30,748 2,949 16,211 1,555 8,834 847

70 32,292 3,097 16,617 1,594 8,966 860

71 33,966 3,257 16,853 1,616 9,165 879

72 35,700 3,424 17,145 1,644 9,289 891

73 37,495 3,596 17,415 1,670 9,444 906

74 39,302 3,769 17,662 1,694 9,579 919

75 41,123 3,944 17,885 1,715 9,698 930

76 42,746 4,099 17,993 1,726 9,804 940

77 44,581 4,275 18,167 1,742 9,852 945

78 46,433 4,453 18,313 1,756 9,929 952

79 48,298 4,632 18,435 1,768 9,998 959

80 or above

50,176 4,812 18,534 1,777 10,049 964

A Hospital and Surgical Benefit

A Hospital and Surgical Benefit +B Full Cover Benefit


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All figures in HK$

Plan 1Private

Annual Monthly

The subscriptions below are for renewal only

Annual Monthly Annual Monthly Annual Monthly Annual Monthly Annual Monthly

AttainedAge

Plan 2Semi-private

Plan 3Ward

Plan 4Private

Plan 5Semi-private

Plan 6Ward

A Hospital and Surgical Benefit +C Supplementary Major Medical Benefit

A Hospital and Surgical Benefit + B Full Cover Benefit +C Supplementary Major Medical Benefit

18 6,991 670 3,846 369 2,122 203

19 7,102 681 3,909 375 2,151 206

20 7,201 691 3,961 379 2,183 209

21 7,333 703 4,036 387 2,223 213

22 7,406 710 4,078 391 2,245 215

23 7,481 717 4,117 395 2,269 217

24 7,560 725 4,160 399 2,293 220

25 7,675 736 4,223 405 2,326 223

26 7,826 751 4,307 413 2,367 227

27 7,984 766 4,390 421 2,419 231

28 8,147 782 4,481 430 2,469 237

29 8,347 800 4,588 440 2,531 243

30 9,053 869 4,986 479 2,700 258

31 9,979 957 5,486 526 2,971 285

32 10,131 971 5,559 533 3,033 291

33 10,255 984 5,619 539 3,068 294

34 10,430 1,000 5,712 547 3,110 299

35 10,606 1,017 5,809 558 3,161 303

36 10,821 1,037 5,928 568 3,223 309

37 11,092 1,063 6,070 582 3,298 316

38 11,424 1,095 6,251 600 3,389 325

39 11,749 1,127 6,427 616 3,495 335

40 12,200 1,170 6,674 640 3,617 347

41 12,646 1,212 6,920 664 3,748 360

42 13,070 1,253 7,151 685 3,873 372

43 13,529 1,298 7,402 710 4,010 385

44 13,921 1,335 7,617 731 4,127 396

45 14,386 1,380 7,870 755 4,256 409

46 14,771 1,416 8,079 775 4,384 420

47 15,155 1,453 8,289 795 4,506 432

48 15,602 1,496 8,539 819 4,639 445

49 16,109 1,545 8,803 844 4,780 458

50 17,403 1,669 9,322 894 4,990 479

51 19,692 1,889 10,374 995 5,584 536

52 21,264 2,040 11,294 1,083 6,125 587

53 21,602 2,071 11,458 1,099 6,226 597

54 22,047 2,114 11,688 1,121 6,353 609

55 22,451 2,153 11,906 1,142 6,481 622

56 22,922 2,198 12,154 1,165 6,602 633

57 23,554 2,259 12,510 1,200 6,762 649

58 24,363 2,336 13,019 1,249 6,989 671

59 25,348 2,431 13,546 1,299 7,237 694

7,649 733 4,090 392 2,254 216

7,767 745 4,156 399 2,284 219

7,874 756 4,210 403 2,318 222

8,016 768 4,289 411 2,360 226

8,094 776 4,333 415 2,384 228

8,174 783 4,374 420 2,408 230

8,257 792 4,418 424 2,433 233

8,380 804 4,484 430 2,467 237

8,542 820 4,572 438 2,511 241

8,709 836 4,659 447 2,564 245

8,882 852 4,753 456 2,617 251

9,096 872 4,865 467 2,681 257

9,980 958 5,493 528 2,884 276

10,915 1,047 5,997 575 3,155 303

11,076 1,062 6,074 582 3,219 309

11,209 1,075 6,138 589 3,256 312

11,397 1,093 6,237 597 3,300 317

12,021 1,153 6,405 615 3,484 334

12,257 1,175 6,533 626 3,551 340

12,555 1,203 6,686 641 3,632 348

12,926 1,239 6,884 661 3,732 358

13,293 1,275 7,077 678 3,847 369

13,898 1,333 7,568 726 3,981 382

14,389 1,379 7,838 752 4,121 396

14,860 1,425 8,093 775 4,257 409

15,365 1,474 8,369 803 4,403 423

15,803 1,515 8,608 826 4,530 435

16,433 1,576 8,885 852 4,806 462

16,872 1,617 9,120 875 4,948 474

17,311 1,660 9,357 897 5,086 488

17,821 1,709 9,638 924 5,236 502

18,393 1,764 9,935 953 5,394 517

21,156 2,029 11,055 1,060 5,741 551

23,499 2,254 12,132 1,164 6,347 609

25,126 2,410 13,078 1,254 6,898 661

25,545 2,449 13,279 1,274 7,015 673

26,065 2,499 13,543 1,299 7,158 686

27,189 2,607 13,797 1,323 7,301 701

28,583 2,741 14,089 1,351 7,442 714

29,383 2,818 14,503 1,391 7,627 732

30,438 2,919 15,097 1,448 7,885 757

31,720 3,042 15,725 1,508 8,169 783

33,238 3,188 16,927 1,623 8,455 811

34,534 3,312 17,727 1,699 8,781 843

36,099 3,462 18,663 1,789 9,159 878

38,000 3,644 19,772 1,896 9,554 916

40,180 3,853 20,803 1,995 10,025 961

47,089 4,516 23,283 2,232 11,852 1,137

50,729 4,865 24,948 2,393 13,184 1,264

54,207 5,198 26,529 2,544 14,112 1,353

57,563 5,521 27,644 2,651 14,721 1,412

60,728 5,824 28,418 2,726 15,182 1,456

64,056 6,143 30,088 2,886 15,599 1,496

67,757 6,498 30,748 2,949 16,432 1,576

71,789 6,885 31,517 3,022 16,818 1,613

75,995 7,288 32,254 3,093 17,230 1,653

80,284 7,699 32,955 3,161 17,615 1,689

84,655 8,119 34,406 3,299 18,191 1,744

88,671 8,503 34,861 3,344 18,706 1,793

93,186 8,936 35,446 3,399 19,200 1,841

97,790 9,378 35,980 3,450 19,496 1,870

102,480 9,828 36,472 3,498 19,995 1,918

108,308 10,386 37,263 3,573 20,429 1,960

60 26,577 2,549 14,194 1,361 7,491 719

61 27,828 2,669 14,835 1,422 7,773 746

62 29,348 2,815 15,615 1,497 8,113 778

63 30,859 2,959 16,549 1,587 8,467 812

64 32,514 3,118 17,342 1,663 8,885 852

65 36,593 3,509 19,515 1,871 10,150 974

66 39,813 3,818 21,029 2,017 11,413 1,094

67 42,725 4,097 22,440 2,152 12,264 1,176

68 45,467 4,361 23,416 2,246 12,810 1,229

69 48,099 4,613 24,105 2,312 13,233 1,269

70 51,107 4,901 24,930 2,391 13,601 1,304

71 54,202 5,198 25,517 2,447 14,001 1,343

72 57,542 5,519 26,195 2,512 14,344 1,376

73 61,032 5,853 26,848 2,575 14,717 1,412

74 64,599 6,195 27,473 2,635 15,066 1,445

75 68,244 6,545 28,062 2,691 15,396 1,476

76 71,613 6,867 28,478 2,732 15,677 1,503

77 75,395 7,230 29,001 2,781 15,923 1,527

78 79,259 7,601 29,484 2,827 16,194 1,553

79 83,205 7,980 29,932 2,871 16,449 1,578

80 or above

87,230 8,365 30,343 2,909 16,677 1,600


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Additional Options All figures in HK$

Plan 1, 4

Annual

Monthly

Annual

Monthly

Annual

Monthly

Annual

Monthly

Annual

Monthly

Annual

Monthly

AttainedAge

AttainedAge

Plan 2, 5 Plan 3, 6 Plan 1, 4 Plan 2, 5 Plan 3, 6

18 753 72 369 35 221 21

19 758 73 372 36 223 21

20 764 73 374 36 225 22

21 770 74 377 36 226 22

22 776 74 380 36 228 22

23 782 75 383 37 230 22

24 789 76 386 37 232 22

25 795 76 389 37 234 22

26 805 77 394 38 237 23

27 814 78 399 38 239 23

28 820 79 402 39 241 23

29 827 79 405 39 243 23

30 1,036 99 508 49 295 28

31 1,045 100 512 49 298 29

32 1,055 101 517 50 302 29

33 1,064 102 521 50 305 29

34 1,074 103 526 50 307 29

35 1,083 104 531 51 310 30

36 1,093 105 535 51 313 30

37 1,102 106 540 52 316 30

38 1,115 107 547 52 321 31

39 1,130 108 554 53 326 31

40 1,145 110 562 54 331 32

41 1,162 111 569 55 335 32

42 1,179 113 577 55 341 33

43 1,197 115 585 56 348 33

44 1,217 117 594 57 352 34

45 1,237 119 602 58 357 34

46 1,260 121 610 58 362 35

47 1,282 123 618 59 366 35

48 1,304 125 626 60 372 36

49 1,324 127 636 61 378 36

50 1,823 175 892 86 536 51

51 1,835 176 899 86 540 52

52 1,848 177 910 87 543 52

53 1,872 180 920 88 550 53

54 1,896 182 930 89 558 54

55 1,921 184 941 90 565 54

56 1,957 188 956 92 574 55

57 1,986 190 973 93 584 56

58 2,037 195 998 96 596 57

59 2,105 202 1,032 99 610 58

60 2,168 208 1,062 102 622 60

61 2,260 217 1,107 106 638 61

62 2,344 225 1,148 110 654 63

63 2,452 235 1,202 115 672 64

64 2,590 248 1,269 122 694 67

65 3,397 326 1,648 158 989 95

66 3,523 338 1,701 163 1,023 98

67 3,630 348 1,752 168 1,056 101

68 3,724 357 1,799 173 1,082 104

69 3,807 365 1,830 175 1,103 106

70 3,872 371 1,860 178 1,118 107

71 3,919 376 1,884 181 1,131 108

72 3,964 380 1,906 183 1,142 110

73 4,003 384 1,927 185 1,155 111

74 4,036 387 1,946 187 1,167 112

75 4,067 390 1,961 188 1,178 113

76 4,097 393 1,972 189 1,184 114

77 4,120 395 1,983 190 1,187 114

78 4,137 397 1,991 191 1,192 114

79 4,153 398 1,997 192 1,199 115

80 or above

4,163 399 2,006 192 1,203 115

D Hospital Cash Benefit Additional Subscription

Plan 1, 4

Annual

Monthly

Annual

Monthly

Annual

Monthly

Annual

Monthly

Annual

Monthly

Annual

Monthly

AttainedAge

AttainedAge

Plan 2, 5 Plan 3, 6 Plan 1, 4 Plan 2, 5 Plan 3, 6

18 5,430 521 4,186 401 3,308 317

19 5,532 531 4,255 408 3,362 322

20 5,621 539 4,332 415 3,421 328

21 5,708 547 4,410 423 3,483 334

22 5,794 556 4,466 428 3,535 339

23 5,867 563 4,523 434 3,585 344

24 5,942 570 4,581 439 3,632 348

25 6,018 577 4,639 445 3,680 353

26 6,097 585 4,696 450 3,723 357

27 6,179 593 4,754 456 3,769 361

28 6,267 601 4,818 462 3,821 366

29 6,350 609 4,876 468 3,871 371

30 7,315 702 5,640 541 4,433 425

31 7,478 717 5,765 553 4,536 435

32 7,650 734 5,899 566 4,641 445

33 7,810 749 6,023 578 4,748 455

34 7,975 765 6,147 589 4,852 465

35 8,141 781 6,276 602 4,957 475

36 8,294 795 6,393 613 5,049 484

37 8,449 810 6,514 625 5,146 494

38 8,626 827 6,643 637 5,242 503

39 8,796 844 6,780 650 5,339 512

40 8,997 863 6,915 663 5,437 521

41 9,179 880 7,017 673 5,519 529

42 9,362 898 7,136 684 5,612 538

43 9,566 917 7,270 697 5,717 548

44 9,783 938 7,403 710 5,824 559

45 9,983 957 7,527 722 5,918 568

46 10,186 977 7,670 736 6,013 577

47 10,379 995 7,815 749 6,114 586

48 10,589 1,015 7,998 767 6,251 599

49 10,813 1,037 8,184 785 6,396 613

50 11,280 1,082 8,380 804 6,476 621

51 11,548 1,107 8,583 823 6,595 632

52 11,763 1,128 8,759 840 6,703 643

53 11,943 1,145 8,931 856 6,814 653

54 12,140 1,164 9,105 873 6,927 664

55 12,333 1,183 9,288 891 7,053 676

56 12,517 1,200 9,472 908 7,167 687

57 12,732 1,221 9,642 925 7,281 698

58 12,958 1,243 9,798 940 7,391 709

59 13,202 1,266 9,948 954 7,515 721

60 13,480 1,293 10,095 968 7,652 734

61 13,754 1,319 10,235 982 7,787 747

62 14,042 1,347 10,366 994 7,943 762

63 14,363 1,377 10,504 1,007 8,105 777

64 14,731 1,413 10,636 1,020 8,252 791

65 15,571 1,493 11,206 1,075 8,374 803

66 15,879 1,523 11,412 1,094 8,489 814

67 16,130 1,547 11,615 1,114 8,612 826

68 16,341 1,567 11,797 1,131 8,757 840

69 16,534 1,586 11,953 1,146 8,888 852

70 16,718 1,603 12,125 1,163 9,010 864

71 16,912 1,622 12,284 1,178 9,128 875

72 17,064 1,636 12,416 1,191 9,242 886

73 17,240 1,653 12,562 1,205 9,369 898

74 17,386 1,667 12,692 1,217 9,463 908

75 17,507 1,679 12,803 1,228 9,565 917

76 17,595 1,687 12,892 1,236 9,632 924

77 17,681 1,696 12,981 1,245 9,697 930

78 17,772 1,704 13,046 1,251 9,748 935

79 17,872 1,714 13,097 1,256 9,806 940

80 or above

17,948 1,721 13,177 1,264 9,869 946

E Clinical Benefit Additional Subscription


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Additional Options

No Claim Renewal Discount

All gures in HK$

Plan 1, 4

Annual Monthly Annual Monthly Annual Monthly

Attained Age

Plan 2, 5 Plan 3, 6

18 - 29 years 11,812 1,133 7,762 744 5,400 518 30 - 49 years 15,750 1,510 10,350 993 7,200 69050 - 54 years (For renewal only) 50 - 54 () 15,750 1,510 10,350 993 7,200 690

A no claim renewal discount will be applied to the next renewal subscription of Hospital and Surgical Benet and Full Cover Benet provided that no claims payment has been made or is payable under Hospital and Surgical Benet and Full Cover Benet during any one of the following periods: Period without claims payment

2 or 3 consecutive Contract Years23

4 or 5 consecutive Contract Years45

6 consecutive Contract Years or above6

F Maternity Benet (For Female Members with Maternity Benet only) ( Additional Subscription

No claim renewal discount

5%

10%

15%

Notes

This Table of Subscriptions is only applicable to Members who are aged 18 to 59 years (inclusive) on the Coverage Commencement Date. For those who are aged 60 years or above on the Coverage Commencement Date, please refer to other applicable Table of Subscriptions.

Any new applicant who is aged between 60 and 69 years has to pay an extra 50% subscription of Hospital and Surgical Benet and Full Cover Benet as shown in the table upon enrolment and renewal. If the applicant is aged 70 years or above, the subscription of Hospital and Surgical Benet and Full Cover Benet will be doubled. However, they only have to pay standard subscriptions for Hospital Cash Benet and Clinical Benet upon enrolment and renewal.

185960 606950%70

Subscription rates are not guaranteed and Bupa may adjust them on an annual basis.

In the event of any discrepancy in respect of meaning between the Chinese version and the English version, the English version shall prevail. All terms and conditions are subject to the Contract.

Bupa Hong Kong

Address: 18/F, Berkshire House, 25 Westlands Road, Quarry Bay, Hong Kong

Telephone : (852) 2517 5175 Facsimile : (852) 2548 1848 Website : www.bupa.com.hk

Bupa (Asia) Limited ()

: 2518

Surname

Given Name (Same as HKID Card)

Sex

Home Address

Flat / RoomBldg. / Mansion / HouseCourt / Estate / StreetDistrict

Floor

Kln / HK / NT

Block

Flat / RoomBldg. / Mansion / HouseCourt / Estate / Street

District

Floor

Kln / HK / NT

Block

CorrespondenceAddress(If different from Home Address)

Country of Residence # (If not in Hong Kong )

To ensure your cover can take effect on the first day of the following month, please send us the completed application form at least 5 working days prior to the end of the month. Applications are subject to underwriting.

c5ee

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BUPA CAREPRO HEALTH INSURANCE SCHEME APPLICATION FORM

Mobile Phone No.

Home / Office Fax No.

Please complete this form in ENGLISH and BLOCK LETTERS. Please tick as appropriate.

c e

Personal Details of Applicant (Applicant must be aged 18 or above 18)HKID Card No. / Passport No.

Date of BirthDD MM YY

Marital Status (Optional)

Smoker

Single Married With children

Yes No

FP

ft

kg

lb

Email Address

Home / Office Phone No.

Height

Weight

Spouses Name

Date of Birth

HKID Card No.

Membership No.

Childrens Name

Date of Birth

HKID Card No.

Membership No.

Childrens Name

Date of Birth

HKID Card No.

Membership No.

Please give details if your spouse is a Proposed / Existing Member of Bupa CarePro and / or your child(ren) is a Proposed / Existing Member of Bupa Care Kid:cci

Contract No. Effective Date

For Bupa use

only

Business Nature Job Position

Total Subscription paid with Application (HK$) ()

Choice of Cover Core Benefit

Hospital and Surgical Benefit

Optional Benefit

Clinical Benefit

Full Cover Benefit

Hospital Cash Benefit

Payment Method

Please attach a cheque made payable to Bupa (Asia) Limitedc

Please attach a cheque made payable to Bupa (Asia) Limited for the 1st years Subscription with a completed Direct Debit Authorisation Form cc

Payment Frequency Payment Method Remarks Autopay (From renewal payment only )

Please attach a completed Credit Card Authorisation Form

Credit Card

Yearly

Please attach a cheque made payable to Bupa (Asia) Limited for the first 2 months Subscription with a completed Direct Debit Authorisation Form cc

Autopay Monthly

Cheque Bank Name Cheque No.

Please attach a completed Credit Card Authorisation Form

Credit Card

If the cheque issuer is not the applicant, please fill in the following information. ce Relationship with the applicant

Reason for paying Subscription on behalf of the applicant

# Unless otherwise specified by Member in writing, Inter Partner Assistance Hong Kong Limited will consider Hong Kong as the Country of Residence of the Member and repatriate the Member to Hong Kong when Medically Necessary. cceUnless requested below, Bupa will provide the List of Bupa HealthCare Appointed Hospitals and Specialists via our online service, Bupa Active, and we will not provide any printed copy (If you have chosen the Full Cover Benefit). ce

The Full Cover Benefit is payable up to the Maximum Limit per Contract Year. e

Please send me printed copies of the claims statement and Shortfall invoice, if applicable. e

Please send me a printed copy of the List of Bupa HealthCare Appointed Hospitals and Specialists. e

Supplementary Major Medical Benefit (applicable to Plan 4, 5 and 6 4, 56)

Maternity Benefit (age must be below 50 50)

Benefit Level (Choose one ) Plan 1 / 4 Private Plan 2 / 5 Semi-private Plan 3 / 6 Ward

* Unless requested below, Bupa will send the claims statement and Shortfall invoice, if applicable, by email only. No printed copy will be provided.cce

(age must be below 60 60)

PAAP

P

WONGCLOUTypewritten Text

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Health Declaration

Declaration and Authorisation

Bank Account for Reimbursement

I hereby agree and authorise Bupa (Asia) Limited to reimburse claims payment to the account below. e

Account Holders Name Personal Hong Kong savings / current account number (HK$ only)

HKID Card No.

Bank Name

Bank No.

Account No.

Claims payment will be reimbursed by autopay only. e

If the above account holder is not the applicant, please fill in the following information. ceRelationship with the applicant (Applicable to spouse, parents or children only d)

Reason for receiving claims payment on behalf of the applicant

I enrol as a Member of Bupa CarePro Health Insurance Scheme (Scheme) and acknowledge that Benefit is not payable under this Scheme for any costs of treatment arising from any existing illnesses, injuries or other conditions presented before the Coverage Commencement Date unless complete current details are fully disclosed by me in this Application and accepted by Bupa. I declare that, to the best of my knowledge and belief, the statements contained in this Application are true and complete. I acknowledge that Bupa reserves the right to ask for submission of more details of health status or medical reports of me at my own cost. I have read and agreed to be bound by the terms and conditions of the Contract of this Scheme and I agree that this Health Declaration and the answers given in this Application shall be the basis of the Contract between me and Bupa.

I hereby authorise Bupa to appoint Registered Medical Practitioners, Hospitals, cancer centres, day case centres, diabetic centres and other service providers to provide Full Cover Benefit (if applicable) and to do all things and acts incidental to such appointment for me. I acknowledge and agree that such appointment shall be made on such terms and conditions as Bupa shall think fit at its absolute discretion. Bupa shall not be liable for any claim whatsoever which may be made against Bupa HealthCare Appointed Service Providers by me.

cdccecccececeddddeeceApplicable to Application through authorised insurance brokerI understand, acknowledge and agree that, as a result of me purchasing and taking up the policy to be issued by Bupa, Bupa will pay the authorised insurance broker commission during the continuance of the policy including renewals, for arranging the said policy.I further understand that the above agreement is necessary for Bupa to proceed with the Application.

dccecePersonal Information Collection StatementI have read and understand the Personal Information Collection Statement on the last page of this application form. I understand that I have the right to request Bupa to cease using my Personal Information for direct marketing purposes by writing to Bupa's Data Protection Officer or calling the Customer Care helpdesk at 2517 5333.

c2517 5333ce

Subject to Bupa's approval of membership transfer, eligible claims related to any sicknesses or injuries that were covered under the previous Contract and commenced before the effective date of coverage under this Contract will be payable up to the Maximum Limit of the Contract with the lower Benefit level.cccce

Please note that non-disclosure of health information may result in your Contract being void and / or disqualify your claim(s) from assessment and / or reimbursement.ce At any time during the past seven years from the time of this Application, have you: ci 1 had any chronic or recurrent diseases, had any injuries not completely recovered or been diagnosed as a Hepatitis B carrier? dj 2 exhibited any of the following symptoms in a repeated / persistent way? j Fever, headache, dizziness, chest pain or discomfort, shortness of breath, blood spitting, hoarseness or cough, night sweating, loss of consciousness, seizure, indigestion, vomiting, abdominal pain, diarrhea, jaundice, blood in the stool or urine, abnormal vaginal bleeding, dysuria, incontinence, allergy, back and / or leg pain, joint pain / swelling, or unintentional body weight change in the past 12 months, etc? ddddddddddddddddd dddd12j 3 received any in-patient treatment / operation / physiotherapy? j 4 had any medical investigations / examinations or is there a foreseeable need for these in future? j 5 taken any regular medications? j If you answered YES to any of the above questions, please give details of the medical condition(s) in the table below and also provide a copy of the relevant medical report(s). If the space below is insufficient, please fill in the Supplementary Health Declaration Form.

Yes No

Agent's / Broker's / Telesales' Name (If applicable and must be completed by the applicant)

Agent's / Broker's / Telesales' Code Agent's / Broker's / Telesales' Contact Tel. No.

X X

Applicant's Signature

Signed in Hong Kong on

(Name i ) DD / MM / YY

Investigation and its result / Treatment / Operation / MedicationDate of onset Date of recovery

Fully recovered? (Yes / No) "Name, Address and Tel. No. of Doctor d

Symptom / Diagnosis

For Transfer Contract OnlyPrevious Bupa Membership No.:i

Date(DD / MM / YY) Applicant's Signature

X X

with attachment

MP

05

3/1

1/11

13/1

8K

Pri

nte

d o

n r

ecycle

d p

ap

er

BUPA CAREPRO HEALTH INSURANCE SCHEME DIRECT DEBIT AUTHORISATION FORM

BUPA CAREPRO HEALTH INSURANCE SCHEME CREDIT CARD AUTHORISATION FORM

Visa MasterCard Diners Club American Express

I hereby authorise and direct Bupa (Asia) Limited to debit the Subscription due from my credit card account on an annual /monthly basis until further notice. ce

Total Annual / Monthly Subscription (HK$)

Cardholders Name

Annual / Monthly Payment Annual Payment Only

HKID Card No.

Credit Card Account No.

Credit Card Expiry Date (MM / YY)

X

Contact Phone No. Date(DD / MM / YY) Cardholder's Signature

Authorised Code :Subscription (HK$) : Date(DD / MM / YY) :

If the Cardholder is not the applicant / Subscriber, please fill in the following information. ceRelationship with the applicant / Subscriber Reason for paying Subscription on behalf of the applicant / Subscriber

I hereby confirm to pay the Subscription due of Bupa CarePro Health Insurance Scheme for the applicant / Subscriber below

(Mr / Mrs / Ms) with HKID Card No.

For Bupa use onlyBupa CarePro Membership No. i

If autopay is chosen as the payment method, please complete this form, sign where marked "X" and return the original copy to Bupa with a cheque for the Subscription. c;ceIf you choose to return this form by mail, please photocopy the Personal Information Collection Statement on the back of this page for your reference. This information can also be found on our website. cee

If credit card payment is chosen as the payment method, please complete this form, sign where marked X and return this form to Bupa by mail or by fax. If you have faxed this form to Bupa, please do not return it to us by mail again. c;ceceIf you choose to return this form by mail, please photocopy the Personal Information Collection Statement on the back of this page for your reference. This information can also be found on our website. cee

Name of party to be credited (The beneficiary)

BUPA (ASIA) LIMITED

Bank No.

Branch No.

Account No.

0 0 4 4 9 9 2 1 5 0 0 2 0 0 1

i 1.2. eeNotes: 1. The box marked Membership No. is to be completed by Bupa.

2. The signature on this authorisation form must be the same as the signature of your Bank Account.

My / Our Bank and Branch Name

My / Our Signature(s)

Debtor's Name (If other than account holder)()

My / Our name as recorded on Statement / Passbook

X

Membership No. (Debtor's Reference)()

Bank No.

My / Our Account No.

HKID Card No. / Passport No.

Date ( DD / MM / YY)

For bank use only

Signature Verified

If the account holder is not the applicant / Subscriber, please fill in the following information. / ceRelationship with the applicant / Subscriber

Reason for paying Subscription on behalf of the applicant / Subscriber

I / We hereby authorise my / our below named Bank to effect transfers from my / our account to that of the above named beneficiary in accordance with such instructions as my / our Bank may receive from the beneficiary from time to time. I / We agree that my / our Bank shall not be obliged to ascertain whether or not notice of any such transfer has been given to me / us. I / We jointly and severally accept full responsibility for any overdraft (or increase in existing overdraft) on my / our account which may arise as a result of any such transfer(s). I / We agree that should there be insufficient funds in my / our account to meet any transfer hereby authorised, my / our Bank shall be entitled, in its discretion, not to effect such transfer in which event the Bank may make the usual charge and that it may cancel this authorisation at any time on one week's written notice. This authorisation shall have effect until further notice. I / We agree that any notice of cancellation or variation of this authorisation which I / we may give to my / our Bank shall be given at least two working days prior to the date on which such cancellation / variation is to take effect.

c e ecec cceecce

My / Our address as recorded on Statement / Passbook

Tel No.

Subscribers Name

Tel No.

Subscribers Name

Personal Information Collection Statement Bupa (Asia) Limited (the Company)Personal Information Collection Statement (the Statement) relating to the Personal Data (Privacy) Ordinance (the Ordinance)In compliance with the Ordinance, the Company would like to inform you of the following:1. From time to time, it is necessary for you, or the member, to supply the Company with certain personal information including without limitation your name,

identity card number (and copy of identity card), passport number, contact information, health and medical information(including family history)and nancial information ("Personal Information") when you apply for insurance or nancial products and services from the Company, or when you apply to make changes to your policy, or when you renew a policy ;

2. Failure to supply Personal Information requested by the Company may result in the Company being unable to process your Application and/or provide products, services and other related services to you, or the member;

3. During the course of your relationship with the Company, further Personal Information relating to you, or the member, may also be collected in the ordinary course of our business, for example, when you lodge insurance claims with the Company.

4. Personal Information relating to you, or the member, may be used for the following purposes: a. processing, assessing and determining any Applications for insurance products and services; b. offering and providing products and services to you, or the member, and processing requests made by you, or the member, from time to time, including

but not limited to requests for addition, alteration, deletion, maintenance, management and operation of insurance benets or insured members; c. any purposes in connection with any claims made by or against or otherwise involving you, or the member, in respect of any products and/or services

provided by the Company including, without limitation, making, defending, analysing, investigating, processing, assessing, determining or responding to such claims;

d. performing any functions and activities related to the products and/or services provided by the Company including, without limitation, audit, reporting, market research, general servicing, maintenance of online and other services, identity verication, data matching, research and statistical analysis, and reinsurance arrangements;

e. provision and design of products and services of the Company; f. exercising the Companys rights in connection with provision of insurance products and services to you, or the member, from time to time, for example,

to determine any amount of indebtedness from you, and collecting and recovering owing from you or any person who has provided any security or undertaking for your liabilities;

g. communication with you or the member in relation to any of the purposes set out in this Statement; h. enabling an actual or proposed assignee, transferee, participant or sub-participant of all or a substantial part of the Companys rights or business to

evaluate the transaction intended to be the subject of the assignment, transfer, participation or sub-participation; and i. making disclosure to satisfy the requirements of any laws, rules and regulations, codes of practice, guidance notes or guidelines binding on the Company.5. Personal Information collected or held by the Company relating to you, or the member, will be kept confidential but the Company may provide such

Personal Information inside or outside the Hong Kong Special Administrative Region, for the purposes specified in paragraph (4) and (6) to the following classes of transferees:

a. British United Provident Association Limited and Bupa International Limited (Group Company); b. any insurance intermediaries authorised by you and the Company c. any re-insurance companies authorised by the Company; d. any agent, contractor or third party service providers who provide administrative, telecommunications, computer, payment, data processing or storage,

printing, research or other services to the Company in connection with the operation of business (including without limitation insurers, banks, lawyers, accountants, claims investigators, debt collection agencies, data processing companies, research agencies and professional advisors);

e. any actual or proposed assignee, transferee, participant or sub-participant of all or a substantial part of the Companys rights or business; f. any person to whom the Company is under an obligation to make disclosure under the requirements of any law, rules, regulations, codes of practice or

guidelines binding on the Company including, without limitation, any applicable regulators, governmental bodies, industry recognised bodies, credit reference agencies, the Courts, and where otherwise required by law.

6. The Company may use your, or the members, Personal Information to provide you, or the member with Marketing Communications relating to the following products and services of the Company or Group Company, including but not limited to:

a. insurance and related services and products; and b. rewards, member activities, loyalty or privileges programmes and related services and products. The Company will not disclose Personal Information relating to you, or the member to third parties for marketing purposes without your consent.7. Under and in accordance with the terms of the Ordinance, you have the following rights: a. to check whether the Company holds Personal Information relating to you or the member and to access such Personal Information; b. to require the Company to correct any Personal Information relating to you or the member which is inaccurate; c. to ascertain our policies and practices in relation to personal data and to be informed of the kind of personal data held by the Company, and d. to request the Company to cease using your Personal Information for direct marketing purposes. Requests can be made in writing to the Companys Data Protection Ofcer at the following address: Data Protection Ofcer, 18/F, Berkshire House, 25 Westlands Road, Quarry Bay, Hong Kong8. In accordance with the terms of the Ordinance, the Company has the right to charge a reasonable fee for the processing of any Personal Information access

or correction request.9. For any enquiries about this Statement, please do not hesitate to contact our Customer Care helpdesk at 2517 5333.10. Nothing in this Statement shall limit the rights of customers under the Ordinance.11. In case of discrepancies between the English and Chinese versions of this Statement, the English version shall prevail.()()1.

() ()2. /3. 4. a. b. c. d. /

e. f.

g. h. i. 5. (4)(6) a. British United Provident Association Limited Bupa International Limited() b. c. d.

e. f.

6. : a. b. 7. , a. b. c. d. 2518 8. 9. 2517 533310. 11.

To help us process your Application

quickly, please ensure that you have:

enclosed payment of the correct

Subscription amount and a copy of your

HKID Card or Passport

initialled any amendments on this

application form

Reminder

Address: 18/F, Berkshire House, 25 Westlands Road, Quarry Bay, Hong Kong

Telephone : (852) 2517 5175 Facsimile : (852) 2548 1848 Website : www.bupa.com.hk

Bupa (Asia) Limited

: 2518

Bupa Hong Kong

1 Bupa Membership Important Notes

To help you understand the key aspects of this scheme clearly, we would like to call your attention to the following:

Please take some time to study the general exclusions in your contract, as well as the additional exclusion(s) listed on your Membership Certificate, if any.

This contract will last for 1 year and Bupa guarantees that your cover can be renewed for your whole life, regardless of any changes in your health after

joining. We also understand that your health needs may change throughout

your life and thus you have the flexibility to change your benefits every year

upon renewal. If you wish to upgrade your plan or add any benefit in future, you

are required to complete a health declaration form for medical underwriting

purposes.

The Bupa Healthcare (BHC) Card is provided to members who are entitled to Supplementary Major Medical Benefit or Full Cover Benefit. You do not need to

make payment when discharged or submit claims if you have the BHC Card.

However, we will place a temporary hold on your credit card for HK$500 until

the claim assessment is completed.

If you have enrolled for our Full Cover Benefit, please read through the relevant section in your Membership Guide to make the most of your benefit. You will

need to choose a Bupa CarePro / Bupa Care Kid appointed specialist and clinic

for consultation. Please present your referral letter and BHC card upon your

visit.

Your renewal subscription will be automatically collected at the next renewal if you choose to pay by autopay or credit card, unless we have received any

instructions from you to the contrary.

There is no waiting period for your cover and you are protected as soon as your membership starts. However, you have the right to cancel this contract. If you

choose to do so, please send us a written notice within 21 days from the

Coverage Commencement Date that is shown on your Membership Certificate

and we will refund you the full subscription paid.

Bupa Membership Important Notes

1

500

/

21

Bupa CarePro Scheme Overview and Features / Company Background / Frequently Asked Questions / General Exclusions / Schedule of Benefits / Table of Subscriptions / Application From / Bupa Membership Important Notes /

Contract No: Effective Date: Surname: Given Name: Sex: DD: MM: YY: Height-CM: Height-FT: Weight-KG: Weight-LB: Maital Status -a:

Maital Status -b: Smoker:

Home - Flat/Room: Home - Floor: Home - Block: Home - Bldg: / Mansion / House:

Home - Court / Estate / Street: Home - District: Home - KLN/HK/NT: Corres: - Flat/Room: - Floor: - Block: - Bldg: / Mansion / House:

- Court / Estate / Street: - District: - KLN/HK/NT:

Business Nature: Home/Office Phone No: Email: Job Position: Home/Office Fax No: Mobile Phone: Country: Spouse's name: Spouse- Date of Birth: Spouse-Membership No: Children1 Name: Children1- Date of Birth: Children1 - Membership No: Children2 Name: Children2- Date of Birth: Children2 - Membership No: Please send me printed copies: Please send me printed copies2: Plan:

Full Cover Benefit: Supplementary Major Medical Benefit: Hospital Cash Benefit: Clinical Benefit: Maternity Benefit: Total Subscription paid with Application: Payment Method:

Bank Name: Cheque No: Payment Frequency:

Relationship with the applicant: Reason for paying Subscription on behalf of the applicant: Applicant Name: Agent's / Broker's / Telesales' Name: Agent's / Broker's / Telesales' Code: Agent's / Broker's / Telesales' Contact Tel: No:

Previous Bupa Membership No:

Documents

Bupa CarePro Consolidated 2014