Bupa Gold Membership Guide

7/29/2019 Bupa Gold Membership Guide

1/14

FSA-COMP-MEMB-11v10.2 How to use

Bpa Itratioa ors

o:Goba mdica pas or

idiidas ad grops

Assistac, rpatriatio adacatio cor

24-hor mti-iga hpi

bpa-it.com

Th ord o Bpa

Car homsCash pas

Dta isracHath aatics

Hath assssmtsHath at or srics

Hath ctrs

Hath coachigHath iormatio

Hath isracHom hathcar

HospitasItratioa hath israc

Prsoa mdica aarms

Rtirmt iagsTra israc

This boot xpais th trms ad coditios o th Compa,Maritim, Oi ad Gas ad Itratioa Schoos Grop Pas.Dtaid iormatio sch as pr-athorisig tratmt, maiga caim ad moig cotr ca b od i this boot.

.bpa-it.com

2. HOW TO USE YOUR PLAN

TAkInG GOODCARe O yOuwHeReveR yOuARe

Gra srics:

+44 (0) 1273 323 563Mdica ratd iris:

+44 (0) 1273 333 911

yor cas i b rcorddad ma b moitord.

Bpa Itratioa

victor Hos, TraagarPac, Brighto. Bn1 4y. uk


2/14

welCOMe

Pas p your boot i a sa pac. I you daothr cop, you ca ca +44 (0) 1273 323 563 or

i ad prit it oi at:

.bpa-it.com/mmbrsord.

Bold words

words i bod ha particar maigs i this

boot. Pas chc thir dfitio i th Gossar

bor you rad o. You i fd th Gossar i th

bac o this boot.

eropa brach addrsss:

Bupa Denmark 8 Palaegade DK-1261 Copenhagen K Denmark

Bupa in Malta 120 The Strand Gzira Malta

Bupa France Nice Etoile 30 Avenue Jean Mdecin F-06000 Nice France

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

Bupa Cyprus 3 I oannis Polemis Street PO Box 51160 3502 Limassol Cyprus

IMPORTAnT M eMBeRSHIPDOCuMenTS

Th Ho to s your pa ad Tab o bfts boots mst b rad

aogsid your Mmbrship Crtifcat ad your appicatio or cor, as

togthr th st ot th trms ad coditios o your mmbrship ad orm

your pa docmtatio.

HOw TO uSe yOuR Pl An

This boot xpais ho to s your pa, icdig; ho to ma a caim

ad othr importat mmbrship iormatio.

TABle O BeneITS

This boot tas abot your cor i dtai, icdig; hat is cord,

hat is ot cord ad dtais o uSA cor (i you ha icdd this

o your pa).

quICk ReeRenCe GuIDe

This boot cotais a smmar o a your importat cotact iormatio;

th sort o iormatio you ar i to s o a rgar basis.


3/14

54

Step 1: Where to get treatment

As long as it is covered by your plan, you can have

your treatment at any recognised hospital or clinic.

I you dont know where to go, please contact our

Healthline service or help and advice.

Participating hospitals

To help you nd a acility, we have also developed a

global network o over 7,500 medical centres, called

participating hospitals and clinics. The list is updated

regularly, so please visit www.bupa-intl.com or the

latest inormation. We can normally arrange direct

settlement with these acilities (see Step 3 below).

Getting treatment in the USA

You must call our Service Partner on 800 554 9299

(rom inside the US), or +1 800 554 9299 (rom

outside the US) to arrange any treatment in the USA.

Step 2: Contact us

I you know that you may need treatment, please

contact us rst. This gives us the chance to check

your cover, and to make sure that we can give you the

support o our global networks, our knowledge and

our experience.

Pre-authorising in-patient treatment and

day-case treatment

You must contact us whenever possible beore

in-patient treatment or day-case treatment, or

pre-authorisation. This means that we can conrm to

you and to your hospital that your treatment will be

covered under your plan.

Pre-authorisation puts us directly in touch with

your hospital, so that we can look ater the

details while you concentrate on getting well. The

Pre-authorisation section contains all o the rules and

inormation about this.

When you contact us, please have your membership

number ready. We will ask some or all o the ollowing

questions:

{ what condition are you suering rom?

{ when did your symptoms rst begin?

{ when did you rst see your family doctor about

them?

{ what treatment has been recommended?

{ on what date will you receive the treatment?

{ what is the name o your consultant?

{ where will your proposed treatment take place?

{ how long will you need to stay in hospital?

I we can pre-authorise your treatment, we will send a

pre-authorisation statement that will also act as your

claim orm (see Step 3 below).

Step 3: Making a claimPlease read the Making a claim section or ull details

o how to claim. Here are some guidelines and useul

things to remember.

HOw TO uSe yOuRBuPA InTeRnATIOnAlG R O u P P l A n

COnTenTS

5 Ho to s or Bpa Itratioa Grop Pa

7 Abot or mmbrship

8 Pr-athorisatio

10 Maig a caim

13 Assistac cor

16 Aa ddctibs

18 yor mmbrship

21 Addig dpdats

22 Maig a compait

23 Gossar

26 Mdica ords ad phrass


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76

Direct settlement/pay and claim

Direct settlement is where the provider o your

treatment claims directly rom us, making things

easier or you. The alternative is or you to pay and

then claim back the costs rom us.

We try to arrange direct settlement wherever possible,

but it has to be with the agreement o whoever is

providing the treatment. In general, direct settlement

can only be arranged or in-patient treatment or

day-case treatment.

Direct settlement is easier or us to arrange i you

pre-authorise your treatment rst, or i you use a

participating hospital or clinic.

What to send

We must receive a ully completed claim orm and the

original invoices or your treatment, within six months

o the treatment date.

I this is not possible, please write to us with the

details and we will see i an exception can be made.

Your claim ormYou must ensure that your claim orm is ully

completed by you and by your medical practitioner.

The claim orm is important because it gives us all

the inormation that we need. Contacting you or

your medical practitioner or more inormation can

take time, and an incomplete claim orm is the most

common reason or delayed payments.

Youcan download a claim orm rom our

MembersWorld website, or contact us to send

you one. Remember that i your treatment is

pre-authorised, your pre-authorisation statement will

act as your claim orm.

How we make payments

Wherever possible, we will ollow the instructions

given to us in the payment section o the claim orm:

{ we can pay you or the hospital

{ we can pay by cheque or by electronic transer

{ we can pay in over 80 currencies

To carry out electronic transers, we need to know the

ull bank name, address, SWIFT code and (in Europe

only) the IBAN number o your bank account. You can

give us this inormation on the claim orm.

Tracking a claim

We will process your claim as quickly as possible. You

can easily check the progress o a claim you have

made by logging on to our MembersWorld* website.

Claim payment statementMyClaimWhen your claim has been assessed and paid, we will

send a statement to you to conrm when and how

it was paid, and who received the payment. Again,

please contact us i you have any questions about this

inormation.

* MembersWorld may not track claims in the USA as we use a third party

here.

The Bupa International Group Plan is a group

insurance plan. You are thereore one o a group

o members, which has a sponsor (normally the

company that you, the principal member work or).

This plan is governed by an agreement between

your sponsor and Bupa International, which covers

the terms and conditions o your membership.

This means that there is no legal contract between

you and Bupa International. Only the sponsor and

Bupa International have legal rights under the

agreement relating to your cover, and only they can

enorce the agreement.

As a member o the plan, you do have access to

our complaints process. This includes the use o any

dispute resolution scheme we have or our members.

The ollowing must be read together as they set out

the terms and conditions o your membership:

{ you, the principal members application

or cover: this includes any quote request,

applications or cover or you and your

dependants (i any) and the declarations thatyou, the principal member made during the

application process

{ your rules and benets in th e How to use your

plan booklet and Table o benets booklet

within your membership pack

{ your Membership Certicate

Th am o or isrr is sho o or

Mmbrship Crtifcat.

When your cover starts

The start date o your membership is the eective

rom date shown on your Membership Certicate.

I you move to a new country or change

your speciied country o nationality

You, the principal member must tell your sponsor

straight away i your specified country of residence

or your specified country of nationality changes.

Your new country may have dierent regulations

about health insurance. You, the principal member

need to tell your sponsor o any change so that we

can make sure that you have the right cover and that

all local regulations are being met.

ABOuT yOuR MeMBeRSHIP


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98

What pre-authorisation means

I we pre-authorise your treatment, this means that

we will pay up to the limits o your plan provided that

all o the ollowing requirements are met:

{ the treatment is eligible treatment that

is covered by your plan

{ you have an active membership at the time that

treatment takes place

{ your subscriptions are paid up to date

{ the treatment carried out matches the

treatment authorised

{ you have provided a ull disclosure o thecondition and treatment required

{ you have enough benet entitlement to cover

the cost o the treatment

{ your condition is not a pre-existing condition

(see the What is not covered? section in your

Table o benets booklet)

{ the treatment is medically necessary

{ the treatment takes place within 31 days ater

pre-authorisation is given

Treatment we can pre-authorise

We can pre-authorise in-patient treatment andday-case treatment, cancer treatment and MRI, CT or

PET scans.

Length o stay (in-patient treatment)

Your pre-authorisation will speciy an approved length

o stay or in-patient treatment. This is the number

o days in hospital that we will cover you or. I your

treatment will take longer than this approved length

o stay, then you or your consultant must contact us

or an extension to the pre-authorisation.

Treatment in the USA

All in-patient treatment and day-case treatment,

cancer treatment and MRI, CT or PET scans in the USA

must be pre-authorised. I you are going to receive

any o these treatments, ask your medical provider

to contact Bupa International or pre-authorisation.

All the inormation they need is on your membership

card.

We have made special arrangements i you need to

be hospitalised in the USA. These include access to a

select network o quality medical providers and direct

settlement o all covered expenses when you receive

treatment in a networkhospital.

Treatment which has not been pre-

authorised

I you choose not to get your treatment in the USA

pre-authorised, we will only pay 50 percent towards

the cost o covered treatment.

O course we understand that there are times when

you cannot get your treatment pre-authorised, such

as in an emergency. I you are taken to hospital in

an emergency, it is important that you arrange or

the hospital to contact us within 48 hours o your

admission. We can then make sure you are getting

the right care, and in the right place. I you have been

PRe-AuTHORISATIOnThis sctio cotais rs ad iormatio abot hat pr-athorisatio

mas ad ho it ors.

taken to a hospital which is not part o the network

and, i it is the best thing or you, we will arrange or

you to be moved to a networkhospital to continue

your treatment once you are stable.

I we have been notied within 48 hours o an

emergency admission to hospital, we will not ask you

to share the cost o your treatment.

Out o network treatment

I your treatment in the USA has been pre-authorised,

but you choose not to go to a networkhospital, we

will only pay 80 percent towards the cost o coveredtreatment.

There may be times when it is not possible or you to

be treated at a networkhospital. These include:

{ where there is no networkhospital within 30

miles o your address, and

{ when the treatment you need is not available in

the networkhospital

In these cases, we will not ask you to share the cost o

your treatment.

Important rules

Please note that pre-authorisation is only valid i all

the details o the authorised treatment, including

dates and locations, match those o the treatment

received. I there is a change in the treatment

required, i you need to have urther treatment, or i

any other details change, then you or your consultant

must contact us to pre-authorise this separately. We

make our decision to approve your treatment based

on the inormation given to us. We reserve the right

to withdraw our decision i additional inormation is

withheld or not given to us at the time the decision is

being made.


6/14

1110

How to make a claim

Claim orms

Your claim orm is important as it gives us the

inormation that we need to process your claim. I it

is not ully completed we may have to ask or more

inormation. This can delay payment o your claim.

You must complete a new claim orm:

{ or each member

{ or each condition

{ or each in-patient or day-case stay, and

{ or each currency o claim

I a condition continues over six months, we will ask

or a urther claim orm to be completed.

What to send us

You need to return the completed orm to us by post,

with the original invoices, as soon as possible. This

must be within six months o receiving the treatment

or which you are claiming. Invoices sent to us ater six

months will not normally be paid.

Requests or urther inormationWe may need to ask you or urther inormation to

support your claim. I we do, you must provide this.

Examples o things we might ask or include:

{ medical reports and other inormation about the

treatment or which you are claiming

{ the results o any medical examination

perormed at our expense by an independent

medical practitioner appointed by us

{ written conrmation rom you as to whether you

think you can recover the costs you are claiming

rom another person or insurance company

I you do not provide the inormation that we ask or,

we may not pay your claim in ull.

Please also read about correspondence in the Your

membership section.

Important

When making a claim please note:

{ you must have received the treatment while

covered under your membership

{ payment o your claim will be under the terms

o your membership and up to the benet levels

shown, that apply to you at the time you receive

the treatment

{ we will only pay or treatment costs actually

incurred by you, not deposits or advance

invoices or registration/administration ees

charged by the provider o treatment

{ we will only pay or treatment costs that are

reasonable and customary{ we do not return original documents such as

invoices or letters. However, we will be pleased

to return certied copies i you ask us when you

submit your claim

Conirmation o your claim

We will always send conrmation o how we have

dealt with a claim. I applicable, or child dependants

(those aged under 18 years), we will write to the

principal member. I the claim is or treatment

received by the principal member, or an adult

dependant (those aged over 18 years), we will write

directly to the individual concerned.

How your claim will be paid

Wherever possible, we will ollow the instructions

given to us in the Payment details section o the

claim orm.

Who we will pay

We will only make payments to the member who

received the treatment, the provider o the treatment,the principal member o the membership or the

executor or administrator o the members estate. We

will not make payments to anyone else.

Payment method and bank charges

We will make payment where possible by electronic

transer or by cheque. Payments made by electronic

transer are quick, secure and convenient. To receive

payment by electronic transer, we need the ull bank

account, SWIFT code, bank address details and (in

Europe only) IBAN number to be provided on the

claim orm.

We will instruct our bank to recharge the

administration ee relating to the cost o making the

electronic transer to us but we cannot guarantee that

these charges will always be passed back or us to

pay. In the event that your local bank makes a charge

or a wire transer we will aim to reund this as well.

Any other bank charges or ees, such as or currency

exchange, are your responsibility, unless they are

charged as a result o our error.

Cheques are no longer valid i they are not cashed

within 12 months. I you have an out-o-date cheque,

please contact customer services, who will be happy

to arrange a replacement.

Payment currency and conversions

We can pay in the currency in which your sponsor

pays your subscriptions, the currency o the invoices

you send us, or the currency o your bank account.

We cannot pay you in any other currency.

Sometimes, the international banking regulations do

not allow us to make a payment in the currency you

have asked or. I so, we will send a payment in the

currency o your sponsors subscriptions.

I we have to make a conversion rom one currency to

another we will use the exchange rate that applies on

either the date on which the invoices were issued or

the last date o the treatment, whichever is later.

The exchange rate used will be the average o the

buying and selling rates across a wide range o

quoted rates by the banks in London on the date in

question. I the date is not a working day we will use

the exchange rate that applies on the last working day

beore that date.

M A k I n G A C l A I MAt tims o i hath, you at to coctrat o gttig . We i do

rthig we ca to ma your caim as simp ad straightorard as

possib.


7/14

1312

Other claim inormation

Discretionary payments

We may, in certain situations, make discretionary or

ex gratia payments towards your treatment. I we

make any payment on this basis, this will still count

towards the overall maximum amount we will pay

under your membership. Making these payments does

not oblige us to pay them in the uture.

We do not have to pay or treatment that is not

covered by your plan, even i we have paid an earlier

claim or a similar or identical treatment.

Overpayment o claims

I we overpay you or your claim, we reserve the right

to deduct the overpaid amount rom uture claims or

seek repayment rom you.

Claiming or treatment when others are

responsible

You must complete the appropriate section o the

claim orm i you are claiming or treatment that is

needed when someone else is at ault, or example in

a road accident in which you are a victim. I so, you

will need to take any reasonable steps we ask o youto assist us to:

{ recover rom the person at ault (such as

through their insurance company) the cost o the

treatment paid or by Bupa International, and

{ claim interest i you are entitled to do so

Note: Subrogation

In the event o any payment o any claim under your

membership, Bupa International or any person

or company that it nominates may be subrogated

to all rights o recovery o the member and any

person entitled to the benets o this coverage. The

member shall sign and deliver all documents and

papers and do whatever else is necessary to secure

such subrogated rights to Bupa International or its

nominated party. The member shall do nothing ater

the claim to prejudice such rights.

Claiming with joint or double insuranceYoumust complete the appropriate section on the

claim orm, i you have any other insurance cover

or the cost o the treatment or benets you have

claimed rom us. I you do have other insurance cover,

this must be disclosed to us when claiming, and we

will only pay our share o the cost o the treatment or

benets claimed.

Note: there are two levels o Assistance cover:

Evacuation and Repatriation. Your Membership

Certicate will show i you have Evacuation or

Repatriation but you can visit the MembersWorld

website or contact the customer services helpline i

you are unsure.

What is Assistance cover?

The Evacuation and Repatriation options both cover

you or reasonable transport costs to the nearest

medical acility where the treatment that you need is

available, i it is not available locally. Repatriation also

gives you the option o returning to your specifiedcountry of nationality or your specified country of

residence.

We may not be able to arrange Evacuation or

Repatriation in cases where the local situation makes

it impossible, unreasonably dangerous or impractical

to enter the area; or example rom an oil rig or within

a war zone.

Assistance covergeneral rules

The ollowing rules apply to both the Evacuation and

Repatriation levels o cover:

{ you must contact our appointed representatives

or conrmation beore you travel, on

+44 (0) 1273 333 911

{ our appointed representatives must agree the

arrangements with you

{ Assistance cover is applicable or in-patient

treatment and day-case treatment only

{ the treatment must be recommended by your

consultant or family doctor and, or medical

reasons, not available locally

{ the treatment must be eligible under your plan

{ you must have cover or the country you are

being treated in, or example the USA

{ you must have the appropriate level o

Assistance cover in place beore you need the

treatment

Evacuation or Repatriation will not be eligible i you

were aware o the symptoms o your condition beore

applying or Assistance cover.

We will not approve a transer which in our reasonable

opinion is inappropriate based on established clinical

and medical practice, and we are entitled to conduct a

review o your case, when it is reasonable or us to do

so. Evacuation or Repatriation will not be authorised i

this would be against medical advice.

How to arrange your Evacuation or

Repatriation

Arrangements or Evacuation or Repatriation will be

made by our appointed representatives and must beconrmed in advance by calling

+ 44 (0) 1273 333 911. You must provide us with

any inormation or proo that we may reasonably

ask you or to support your request. We will only

pay i all arrangements are agreed in advance by

Bupa Internationals appointed representatives.

ASSISTAnCe COveR(optional i purchased)

This sctio cotais th rs ad iormatio or Assistac cor,

a optioa bft hich hps you i you d to tra to gt th

treatment that you d.


8/141514

Evacuation cover:

what we will pay or

I you have Evacuation cover it will be shown on your

Membership Certicate. I you are still unsure you

can visit our MembersWorld website or contact the

customer services helpline.

{ We will pay in ull or your reasonable transport

costs or in-patient treatment or day-case

treatment . It may also be authorised i you need

advanced imaging or cancer treatment such as

radiotherapy or chemotherapy.

{ We will only pay or Evacuation to the nearestplace where the required treatment is available.

This could be to another part o the country that

you are in, and may not be your home country.

{ We will pay or the reasonable travel costs

or another Bupa International member to

accompany you, but only i it is medically

necessary.

{ We will also pay or the reasonable costs o

your, and the accompanying members, return

journey to the place you were evacuated rom.

All arrangements or your return should be

approved in advance by Bupa International orour appointed representatives and the journey

must be made within ourteen days o the end o

the treatment .

We will pay or either:

{ the reasonable cost o the return journey

by the most direct route available by land

or sea, or

{ the cost o an economy class air ticket by

the most direct route available, whichever

is the lesser amount

{ we will pay reasonable costs or the

transportation only o your body, subject

to airline requirements and restrictions, to

your home country, in the event o your

death while you are away rom home.We do not pay or burial or cremation,

the cost o burial caskets etc, or the

transport costs or someone to collect or

accompany your remains

Note: we do not pay or any other costs related to

the evacuation such as hotel accommodation or taxis.

Costs o any treatment you receive are not payable

under Evacuation cover, but are payable rom your

medical cover as described in the What is covered?

section o your Table o benets booklet.

Please also note that or medical reasons the member

receiving treatment may travel in a dierent class

rom their companion.

Repatriation cover:

what we will pay or

I you have Repatriation cover it will be shown on

your Membership Certicate. I you are still unsure

you can visit our MembersWorld website or contact

the customer services helpline. Repatriation cover also

includes Evacuation cover see above.

{ We will pay in ull or your reasonable transport

costs or in-patient treatment or day-case

treatment .

{ We will pay or repatriation to your specified

country of nationality or your specified countryof residence.

{ We will pay or one repatriation or each illness

or injury per lietime.

{ We will pay the reasonable costs or a relative

or your partner to accompany you to your

specified country of nationality or your

specified country of residence i we have

authorised this in advance o the repatriation.

{ We will also pay an allowance o up to GBP 25,

USD 50 or EUR 37 per day or up to 10 days

to cover the living expenses o the person

accompanying you.{ We will pay or you and the person

accompanying you to return to where you

were repatriated rom. All arrangements or

your return must be approved in advance

by Bupa International or our appointed

representatives and you must make the return

journey within ourteen days o the end o the

treatment you were repatriated or.

We will pay or either:

{ the reasonable cost o the return journey

by the most direct route available by land

or sea, or

{ the cost o a scheduled return economy

class air ticket by the most direct route

available, whichever is the lesser amount

{ we will pay reasonable costs or the

transportation only o your body, subject

to airline requirements and restrictions, to

your home country, in the event o your

death while you are away rom home.We do not pay or burial or cremation,

the cost o burial caskets etc, or the

transport costs or someone to collect or

accompany your remains

Note: we do not pay or any other costs related to the

repatriation such as hotel accommodation or taxis.

Costs o any treatment you receive are not payable

under Repatriation cover, but are payable rom your

medical cover as described in the What is covered?

section o your Table o benets booklet.

Please also note that or medical reasons the member

receiving treatment may travel in a dierent class

rom their companion.


9/141716

The amount o your annual deductible will be shown

on your Membership Certicate, which you can

view online at our MembersWorld website. I you

are unsure whether your cover includes an annual

deductible, please contact our customer services

helpline.

At any point you can check the amount o your

remaining annual deductible by contacting our

customer services helpline.

Annual deductibles are only available on the

ollowing levels o cover:

{ Essential

{ Classic

{ Gold

The ollowing levels o cover do not qualiy or annual

deductibles:

{ Classic with dental

{ Gold with dental

{ Gold Superior

{

Gold Superior with optical and dental

The ollowing products do not qualiy or annual

deductibles:

{ Maritime

{ Oil and Gas

Important please remember that:

{ the annual deductible applies separately to

each person included on your membership

{ even i the amount you are claiming is less than

the annual deductible, you should still submit a

claim to us

{ this is an annual deductible, thereore, i

your rst claim is towards the end o your

membership year, and treatment continues

over your renewal date, the annual deductible

is payable separately or treatment received

in each membership year

{ i your claims are paid direct to your medicalprovider, you are responsible or paying any

deductible shortall to the provider ater the

claim has been assessed and paid

What is an annual deductible?

The annual deductible is the total value that your

eligible claims must reach each membership year

beore we will start to pay any benet.

For example, i you have an annual deductible o

GBP 500, the total value o your eligible claims must

reach GBP 500 beore we will pay any benet.

The annual deductible applies separately to each

person on your, the principal members membership.

How an annual deductible works

I a claim is smaller than your remaining annual

deductible, you must still submit it to us as normal.

We will not pay any benet, but the claim will count

towards reaching your annual deductible. We will

send you a statement inorming you how much is let.

I an eligible claim exceeds your remaining annual

deductible, we will pay the amount o the claim less

the remaining annual deductible.

Once your annual deductible is reached, we will pay

all eligible claims in ull, up to the benet limits o yourplan.

How claims are paid to you

I you submit a claim and have asked us to pay you:

{ your benet will be paid less the amount o the

annual deductible

{ we will send you a statement showing how your

claim has been settled, including any amounts

set against the annual deductible

How claims are paid direct to your

medical provider

I you have asked us to make a payment direct to your

medical provider:

{ we will send payment to the medical provider

or the eligible claim. We will deduct rom this

payment the remaining annual deductible on

your membership

{ we will send you a statement as usual,

conrming the amount that we have paid

towards your claim

{ you are responsible or paying any shortall tothe provider ater your claim has been assessed

and paid

Youare responsible or paying the annual deductible

in all circumstances.

AnnuAl DeDuCT IBleSPas rad this sctio i you ha a annual deductible o your pa.


10/141918

Paying subscriptions and other charges

Your sponsor has to pay any and all subscriptions

due under the agreement, together with any other

charges (such as insurance premium tax) that may be

payable.

Starting and renewing your

membership

When your cover starts

Your membership starts on the eective date shown

on the rst Membership Certicate that we sent you,

the principal member or your current continuous

period o Bupa International Company membership.

Renewing your membership

The renewal o your membership is subject to your

sponsor renewing your membership under the

agreement.

Ending your membership

Your sponsor can end your, the principal members

membership, or that o any o your dependants (i

applicable), rom the rst day o a month by writing

to us. We cannot backdate the cancellation o your

membership.

Your membership will automatically end:

{ i the agreement between Bupa International

and your sponsor is terminated

{ i your sponsor does not renew your

membership

{ i your sponsor does not pay subscriptions or

any other payment due under the agreement or

you or or any other person

{ i the membership o the principal member ends

{ upon the death o the principal member

I you move to a new country or change

your speciied country o nationality

You, the principal member must tell your sponsor

straight away i your specified country of residence

or your specified country of nationality changes.

We may need to end your membership i the

change results in a breach o regulations governingthe provision o healthcare cover to local nationals,

residents or citizens.

The details o regulations vary rom country to country

and may change at any time.

In some countries we have local partners who are

licensed to provide insurance cover but which are

administered by Bupa International. This means

that customers experience the same quality

Bupa International service.

I you change your specified country of residence

to a country where we have a local partner, in most

cases you will be able to transer to our partners

insurance policy without urther medical underwriting.

Youmay also be entitled to retain your continuity o

Bupa International membership; which means that

or those benets which arent covered until you have

been a member or a certain period, the time you

were a member with us will count towards that. Please

note that i you request a transer to a local partner,

we will have to share your personal inormation and

medical history with the local partner.

I you change your specified country of residence or

your specified country of nationality, please call the

Bupa International customer services helpline so we

can conrm i your Bupa International membership

is aected, and, i so, whether we can oer you a

transer service.

Important please read

Bupa International can end a persons membership

and that o all the other people listed on the

Membership Certicate i there is reasonable

evidence that any person concerned has misled, or

attempted to mislead us. By this, we mean giving

alse inormation or keeping necessary inormation

rom us, or working with another party to give us alse

inormation, either intentionally or carelessly, which

may inuence us when deciding:

{

whether you (or they) can join the plan{ what subscriptions you have to pay

{ whether we have to pay any claim

Ater your Company membership ends

You, the principal member can apply to transer to a

personal Bupa International plan i your membership

o your group plan ends. You can also apply or your

dependants (i applicable) to transer with you.

Please contact the customer service helpline or more

inormation.

Making changes to your cover

The terms and conditions o your membership may

be changed rom time to time by agreement between

your sponsor and Bupa International.

Amending your Membership Certiicate

We will send you, the principal member a new

Membership Certicate i:

{ with the sponsors approval, you, the principalmember add a new dependant to your

membership (i applicable)

{ we need to record any other changes requested

by your sponsor or that we are entitled to make

Your new Membership Certicate will replace any

earlier version you possess as rom the issue date

shown on the new Membership Certicate.

General inormation

Other parties

No other person is allowed to make or conrm anychanges to your membership on our behal, or decide

not to enorce any o our rights.

No change to your membership will be valid unless it

is conrmed in writing. Any conrmation o your cover

will only be valid i it is conrmed in writing by

us.

yOuR MeMBeRSHIPThis sctio cotais th rs abot your mmbrship, icdig h

it i start ad d, rig your pa, ho you, th principal member

ca chag your cor ad gra iormatio.


11/142120

I you, the principal member change your

correspondence address, please contact us as

soon as reasonably possible, as we will send any

correspondence to the address you last gave us.

Correspondence

Letters between us must be sent by post and with the

postage paid. We do not return original documents,

with the exception o ofcial documents such as birth

or death certicates. However, i you ask us at the

time you send any original documents to us, such as

invoices, we can provide certied copies.

Applicable law

Your membership is governed by English law. Any

dispute that cannot otherwise be resolved will be

dealt with by courts in England.

I any dispute arises as to interpretation o this

document then the English version o this document

shall be deemed to be conclusive and taking

precedence over any other language version o this

document.

This can be obtained at all times by contacting thecustomer services helpline.

Liability

We shall not be responsible or any loss, damage,

illness and/or injury whatsoever, that may occur as

a result o any action carried out directly or through

a third party, to assist in the provision o services

covered by these rules.

Important - please read

You will not be able to add dependants on the

ollowing products:

{ Maritime

{ Oil and Gas

Adding dependants

I your sponsor agrees, you, the principal member

may apply to include any o your amily members

under your membership as one o your dependants.

To apply you, the principal member will need to

complete an Adding Members orm.

Newborn children can only be included on your

membership rom their date o birth i you have

completed an Adding Members orm, and we have

received the orm beore your child is 90 days old,

provided the child has not been born as a result

o assisted reproduction technologies,ovulation

inductiontreatment, adopted or born to a surrogate.

Newborn children born as a result o assisted

reproduction technologies, ovulation induction

treatment, adopted or born to a surrogate can beincluded rom their 91st day on completion o an

Additional members or Application orm.

The medical history or any newborn children you

apply to include on your membership will be reviewed

by our medical underwriters. This may result in special

restrictions or exclusions which will apply rom the

childs 91st day o lie, or we may decline to oer

cover.

This also applies to newborn children who have been

born as a result o assisted reproduction technologies,

ovulation induction treatment, adopted or born to a

surrogate or being enrolled on their own membership

who can be included rom their 91st day on

completion o an Additional Members or Application

orm.

When cover starts or others on your

membership

I any other person is included as a dependant under

your, the principal members membership, theirmembership will start on the eective date on the

rst Membership Certicate we sent you or your

current continuous period o Bupa International

Company membership which lists them as a

dependant. Their membership can continue or as

long as you, the principal member remain a member

o the plan.

I your, the principal members membership ceases,

your dependants can then, o course, apply or

membership in their own right.

ADDInG DePenDAnTS


12/142322

I something does go wrong, we have a simple

procedure to ensure your concerns are dealt with as

quickly and eectively as possible.

I you have any comments or complaints, you can call

the Bupa International customer helpline on

+44 (0) 1273 323 563, 24 hours a day, 365 days a year.

Alternatively, you can email or write to the Head o

Customer Relations via

www.bupa-intl.com/membersworld or

Bupa International

Victory HouseTraalgar Place

Brighton

BN1 4FY, UK

We want to make sure that members with special

needs are not excluded in any way. For hearing or

speech impaired members with a textphone, please

call +44 (0) 1273 866 557. We also oer a choice

o Braille, large print or audio or our letters and

literature. Please let us know which you would preer.

Taking it urther

Its very rare that we cant settle a complaint, but

i this does happen, you may be able to reer your

complaint to the Financial Ombudsman Service. You

can:

{ write to them at South Quay Plaza, 183 Marsh

Wall, London E14 9JR, UK

{ call them on 0845 080 1800 or

+44 (0) 20 7964 1000

{ nd details at their website

www.nancial-ombudsman.org.uk

Please let us know i you want a ull copy o our

complaints procedure. (None o these procedures

aect your legal rights.)

Conidentiality

The condentiality o personal health inormation

is o paramount concern to the companies in the

Bupa group. To this end, Bupa ully complies with

applicable data protection legislation and medical

condentiality guidelines. Bupa sometimes uses third

parties to process data on our behal. Such processing,

which may be undertaken outside the EEA (European

Economic Area), is subject to contractual restrictions

with regard to condentiality and security obligations

in addition to the minimum requirements imposed by

data protection legislation in the UK.

MAkInG A COMPlAInTWe ar aas pasd to har abot aspcts o your mmbrship that

you ha particar apprciatd, or that you ha had probms ith.

D e I ne D T eR M D e SC RI P TI On

Acceptable evidence: International medical and scientic evidence which include peer-reviewed scienticstudies published in or accepted or publication by medical journals that meet

internationally recognised requirements or scientic manuscripts. This does not include

individual case reports, studies o a small number o people, or clinical trials which are not

registered.

Active treatment: Treatment rom a medical practitioner o a disease, illness or injury that leads toyourrecovery, conservation o your condition or to restore you to your previous state o health

as quickly as possible.

Agreement: The agreement between Bupa International and the sponsor under which we haveaccepted you into membership o the plan.

Appliance: A knee brace which is an essential part o a repair to a cruciate (knee) ligament or a spinalsupport which is an essential part o surgery to the spine.

Annual deductible: The amount you, the principal member have to pay towards the cost o the treatment

that you receive each membership year that would otherwise be covered underyourmembership. The amount o your annual deductible is shown on your Membership

Certicate. The annual deductible applies separately to each person covered underyour

membership.

Assisted ReproductionTechnologies:

Technologies including but not limited to in-vitro ertilisation (IVF) with or without

intra-cytoplasmic sperm injection (ICSI) gamete intra-allopian transer (GIFT), zygote

intra-allopian transer (ZIFT), egg donation and intra-uterine insemination (IUI) with

ovulation induction.

Birthing centre: A medical acility oten associated with a hospital that is designed to provide a homelikesetting during childbirth.

Bupa International: Bupa Insurance Limited or any other insurance subsidiary or insurance partner o theBritish United Provident Association Limited.

Complementarymedicine practitioner:

An acupuncturist, chiropractor, homeopath, osteopath or traditional Chinese medicine

practitioner who is ully trained and legally qualied and permitted to practice by the

relevant authorities in the country in which thetreatment is received.

Consultant: A surgeon, anaesthetist or physician who:

{ is legally qualied to practice medicine or surgery ollowing attendance at a

recognised medical school, and

{ is recognised by the relevant authorities in the country in which thetreatment takes

place as having specialised qualication in the eld o, or expertise in, thetreatment

o the disease, illness or injury being treated

By recognised medical school we mean a medical school which is listed in the World

Directory o Medical Schools, as published rom time to time by the World Health

Organisation.

GlOSSARyThis xpais hat we ma b arios ords ad phrass i your

mmbrship pac. words ritt i bod ar particar importat as

th ha spcifc maigs.


13/14

2524


Day-case treatment: Treatment which or medical reasons requires you to stay in a bed in hospital during theday only. We do not require you to occupy a bed or day-case psychiatric treatment.

Dentalpractitioner:

A person who:

{ is legally qualied to practice dentistry, and

{ is permitted to practice dentistry by the relevant authorities in the country where the

dental treatment takes place

Dependants: The other people named on your Membership Certicate as being members o the planand who are eligible to be members, including newborn children.

Diagnostic tests: Investigations, such as X-rays or blood tests, to nd the cause o your symptoms.

Emergency: A serious medical condition or symptoms resulting rom a disease, illness or injurywhich arises suddenly and, in the judgment o a reasonable person, requires immediate

treatment, generally within 24 hours o onset, and which would otherwise putyour health

at risk.

Family doctor: A person who:

{ is legally qualied in medical practice ollowing attendance at a recognised medical

school to provide medical treatment which does not need a consultants training,

and

{ is licensed to practice medicine in the country where thetreatment is received

By recognised medical school we mean a medical school which is listed in the World

Directory o Medical Schools as published rom time to time by the World Health

Organisation.

Hospital: A centre o treatment which is registered, or recognised under the local countrys laws, asexisting primarily or:

{ carrying out major surgical operations, and

{ providing treatment which only consultants can provide

In-patient treatment: Treatment which or medical reasons normally means thatyou have to stay in a hospitalbed overnight or longer.

Intensive care: Intensive care includes:

{ High Dependency Unit (HDU): a unit that provides a higher level o medical care and

monitoring, or example in single organ system ailure.

{ Intensive Therapy Unit / Intensive Care Unit (ITU/ICU): a unit that provides the

highest level o care, or example in multi-organ ailure or in case o intubated

mechanical ventilation.

{ Coronary Care Unit (CCU): a unit that provides a higher level o cardiac monitoring.

Medical practitioner: A complementary medicine practitioner, consultant , dental practitioner, family doctor,psychologist or therapist who provides active treatment o a known condition.

Membership year: The period beginning on your start date or renewal date and ending on the day beoreyour next renewal date. By start date we mean the eective rom date on your rst

Membership Certicate or your current continuous period o membership.

Network: A hospital, or similar acility, or medical practitioner which has an agreement in eectwith Bupa International or service partner to provide you with eligible treatment.

Out-patient treatment: Treatment given at a hospital, consulting room, doctors ofce or out-patient clinic whereyou do not go in or in-patient treatment or day-case treatment.

Ovulation InductionTreatment:

Treatment including medication to stimulate production o ollicles in the ovary including

but not limited to clomiphene and gonadotrophin therapy.


Persistent vegetativestate:

{ a state o proound unconsciousness, with no sign o awareness or a unctioning

mind, even i the person can open their eyes and breathe unaided, and

{ the person does not respond to stimuli such as calling their name, or touching

The state must have remained or at least ourweeks with no sign o improvement, when

all reasonable attempts have been made to alleviate this condition.

Pre-existing condition: Any disease, illness or injury or which:

{ you have received medication, advice or treatment, or

{ you have experienced symptoms

whether the condition was diagnosed or not in the our years beore the start oyourcurrent continuous period o cover.

Principal member: The person who has taken out the membership, and is the rst person named on theMembership Certicate. Please reer to you/your.

Prophylactic surgery: Surgery to remove an organ or gland that shows no signs o disease, in an attempt toprevent development o disease o that organ or gland.

Psychiatric treatment: Treatment o mental conditions, including eating disorders.

Psychologist: A person who is legally qualied and is permitted to practise as such in the country wherethe treatment is received.

Qualifed nurse: A nurse whose name is currently on any register or roll o nurses maintained by anystatutory nursing registration body in the country where thetreatment takes place.

Registered clinicaltrial:

An ethically approved and clinically controlled trial that is registered on a national or

international database o clinical trials (eg www.clinicaltrials.gov, www.ISRCTN.ORG) or

http://public.ukcrn.org.uk)

Rehabilitation: Treatment in the orm o a combination o therapies such as physical, occupational andspeech therapy aimed at restoring ull unction ater an acute event such as a stroke.

Renewal date: Each anniversary o the date you, the principal member joined the plan. (I howeveryouare a member o a Bupa International Group Plan with a common renewal date or all

members, your renewal date will be the common renewal date or the group. We tell you

the group renewal date when youjoin.)

Service partner: A company or organisation that provides services on behal oBupa International. Theseservices may include approval o cover and location o local medical acilities.

Sound natural tooth/teeth:

A natural tooth that is ree o active clinical decay, has no gum disease associated with

bone loss, no caps, crowns, or veneers, that is not a dental implant and that unctions

normally in chewing and speech.

Specifed country onationality:

The countryo nationality speciied by you in your application orm or as advised to us inwriting, which ever is the later.

Specifed country oresidence:

The country o residence specied by you in your application and shown in yourmembership certicate, or as advised to us in writing, which ever is the later. The country

you speciy must be the country in which the relevant authorities (such as tax authorities)

consider you to be resident or the duration o the policy.

Sponsor: The company, rm or individual with whom we have entered into an agreement toprovide you with cover under the plan.

Subrogated: The assumption o the members right by Bupa International to recover rom an at aultparty the costs o any claims paid by Bupa International or treatment to the member.

Surgical operation: A medical procedure involving an incision into the body.


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2726

T eR M D e SC R I P TI O n

Cytotoxic drugs: Drugs that are used specically to kill o cancerous cells in the body.

Diseased tissue: Unhealthy or abnormal cells in the human body.

Ectopic pregnancy: When a oetus is growing outside the womb.

Hormone Replacement

Therapy:

Hormone replacement therapy (HRT) is the use o synthetic or natural hormones to

treat a hormone deciency. Most commonly, this is used in the treatment o symptoms

accompanying the menopause.

Pathology: Tests carried out to help determine or assess a medical condition, or example blood tests.

Post-partum haemorrhage: Heavy vaginal bleeding in the hours and days immediately ater childbirth.

Retained placental

membrane:

When the aterbirth is let in the womb ater delivery o the baby.

Sl eep ap noea : Temp orar il y s toppi ng brea th in g du ri ng sl eep .

MeDICAl wORDS

A n D P H R A S e SHr ar som rda dscriptios o som mdica ords ad phrass

sd i your mmbrship pac.

nOTeSD e I neD T eR M D e SC RI P TI OnTherapists: A physiotherapist, occupational therapist, orthoptist, dietician or speech therapist who is

legally qualied and is permitted to practice as such in the country where thetreatment

is received.

Treatment: Surgical or medical services (including diagnostic tests) that are needed to diagnose,relieve or cure an acute condition, disease, illness or injury.

UK: Great Britain and Northern Ireland.

We/us/our: Bupa International.

You/your: This means you, the principal member and your dependants unless we have expresslystated otherwise that the provisions only reer to theprincipal member.

Documents

Bupa Gold Membership Guide