Selections Membership Guide

7/30/2019 Selections Membership Guide

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Taking good care

of your peoplewherever they are

Bupa International Selections Egypt Plan

Membership Guide

From 1 January 2011


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This Membership Guide contains the rules and benets ofyour

Bupa International Selections Egypt plan, and other important

information. You also need to check your Membership

Certicate for any personal exclusions that you may have.

Introduction

Your International Selections Egypt plan is administered by Bupa International on behalf of

your insurer, Bupa Egypt Insurance.

Your insurer can be contacted at:

Bupa Egypt Insurance

48 El Thawra Street

Dokki

Giza

Egypt

or you can call the Service Advisor number (from inside Egypt): 16816

Telephone: +20 23762 8685, or Fax: +20 23762 8684.

Ifyou would like to ask any questions about anything that you read here, please contact the

Bupa International customer services helpline. Our contact details are opposite, and are

repeated on each page.

Important

Please keep this Membership Guide

in a safe place. You can download an

updated version at any time from our

MembersWorld website or contact us

to request a new copy.

Bold words

Words in bold have particular meanings

in this Membership Guide. Please check

their definition in the Glossary before

you read on.


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Contact us

* Please note that we cannot guarantee the security of email as a method of communication.

Some companies do monitor email trafc, so please bear this in mind when sending us condential information.

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

Bupa Egypt Customer Sevices:Email: [email protected]* Web: www.bupa-intl.com

Tel: +20 23762 8685 Fax: +20 23762 8684

Tel from inside Egypt: 16816

General Enquiries:

Your Bupa International customer services helpline

z open 24 hours a day, 365 days a year

z membership and payment queries

z claims information

Email: [email protected]* Web: www.bupa-intl.com

Tel: +44 (0) 1273 323 563 Fax: +44 (0) 1273 820 517

Medical Enquiries:

Pre-authorisation and Healthline

z open 24 hours a day, 365 days a year

z check cover and pre-authorise treatment

z medical advice and information

z nd local medical facilities

z medical referrals

z embassy and visa information

z interpreter referral service

Tel: +44 (0) 1273 333 911 Fax: +44 (0) 1273 866 301

MembersWorld:

www.bupa-intl.com/membersworld

z view membership status z track claims online **

z update personal details z access hospital directory

z webchat zmuch more

z download claim forms

Any correspondence, including your claims, should be sent to the following address:

Bupa Egypt Insurance, 48 El Thawra Street, Dokki, Giza, Egypt


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Contents1. How to use your Bupa International Selection Egypt plan

2. What is covered?

3. What is not covered?

4. Assistance Cover

5. Pre-authorisation

6. Making a claim

7. Your membership

8. Making a complaint

9. Glossary

10. Medical words and phrases

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*Please note: due to the cost oftreatment in the USA, members must pre-authorise all treatment. This is to make sure that the

treatment you wish to have is eligible and so that we can advise you, in advance, ifyou will need to contribute to your own

treatment costs.6

Step 1: Where to get treatment

As long as it is covered by your plan, you

can have yourtreatment at any recognised

hospital or clinic. Ifyou dont know where to

go, please contact our Healthline service for

help and advice.

Participating hospitals

To help you nd a facility, we have also

developed a global network of over 7,500

medical centres, called participating hospitals

and clinics. The list is updated regularly, so

please visit www.bupa-intl.com for the latest

information. We can normally arrange direct

settlement with these facilities (see Step 3

below).

Getting treatment in the USA

You must call our Service Partner on800 554 9299 (from inside the US), or

+1 800 554 9299 (from outside the US)

to arrange any treatment in the USA*.

Step 2: Contact Bupa International

Ifyou 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 ofour globalnetworks, our knowledge and our experience.

Pre-authorising in-patient treatment

and day-case treatment

You must contact us whenever possible

before in-patient or day-case treatment,

for pre-authorisation. This means that we can

conrm to you and to yourhospital that your

treatment will be covered under your plan.

Pre-authorisation puts us directly in touch

with yourhospital, so that we can look after

the details while you concentrate on getting

well. Section 5 contains all of the rules and

information about pre-authorisation.

When you contact us, please have your

membership number ready. We will ask

some or all of the following questions:

z what condition are you suffering from?

z

when did your symptoms rst begin?z when did you rst see yourfamily doctor

about them?

z what treatment has been recommended?

z on what date will you receive the

treatment?

z what is the name ofyourconsultant?

z where will your proposed treatment take

place?

z how long will you need to stay in hospital?

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How to use your

Bupa InternationalSelections Egypt plan


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Ifwe can pre-authorise yourtreatment, we

will send a pre-authorisation statement that will

also act as your claim form (see Step 3 below).

Step 3: Making a claim

Please read Section 6 for full details of how

to claim. Here are some guidelines and useful

things to remember.

Direct settlement/pay and claim

Direct settlement is where the provider ofyour

treatment claims directly from us, making

things easier for you. The alternative is for youto pay and then claim back the costs from us.

We try to arrange direct settlement wherever

possible, but it has to be with the agreement

of whoever is providing the treatment. In

general, direct settlement can only be arrangedfor in-patient or day-case treatment.

Direct settlement is easier for us to arrange if

you pre-authorise yourtreatment rst, or if

you use a participating hospital or clinic.

What to send

We must receive a fully completed claim form

and the original invoices for yourtreatment,within six months of the treatment date.


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You can download a claim form from our

MembersWorld website, or contact us to send

you one. Remember that ifyourtreatment

is pre-authorised, your pre-authorisationstatement will act as your claim form.

How we make payments

Wherever possible, we will follow the

instructions given to us in the payment section

of the claim form:

z we can pay you or the hospital

z we can pay by cheque or by electronictransfer

we can pay in over 80 currencies

If this is not possible, please write to us with

the details and we will see if an exception can

be made.

Your claim form

You must ensure that your claim form is

fully completed by you and by yourmedical

practitioner. The claim form is important

because it gives us all the information that

we need. Contacting you or yourmedical

practitioner for more information can take

time, and an incomplete claim form is the most

common reason for delayed payments.

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To carry out electronic transfers, we need

to know the full bank name, address, SWIFT

code and (in Europe only) the IBAN number

ofyour bank account. You can give us thisinformation on the claim form.

Tracking a claim

We will process your claim as quickly as

possible. You can easily check the progress of

a claim you have made by logging on to our

MembersWorld* website.

Claim payment statementMyClaim

When 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 ifyou

have any questions about this information.

About your membership

The Bupa International Selections Egypt plan

is a group insurance plan. You are therefore

one of a group of members, which has a

sponsor (normally the company that you,

the principal member work for).

This plan is governed by an agreement

between yoursponsor and Bupa

International, which covers the terms and

conditions ofyour membership. This meansthat 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 enforce the agreement.

As a member of the plan, you do have access

to our complaints process. This includes the

use of any dispute resolution scheme we havefor our members.

All the following make up our agreement

and must be read together as they set

out the terms and conditions ofyour

membership:

z you, the principal members application

for cover: this includes any quote request,

applications for cover for you and your

dependants (if any) and the declarations

that you, the principal member made

during the application process

z your rules and benets in the

Membership Guide

z your Membership Certicate

The full name ofyour insurer is shown

on your Membership Certicate.

When your cover starts

The start date ofyour membership is

the effective from date shown on your

Membership Certicate.

Ifyoumove to a new country

You, the principal member must inform

your sponsor straight away ifyou change

your specifiedcountry of residence.

Your new country may have different

regulations about health insurance. You,the principal member need to tell your

sponsor of any change so that we can make

sure that you have the right cover and that

all local regulations are being met.

*MembersWorld may not track claims in the USA as

we use a third party here.

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How to claim(summary)

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Direct settlement Pay and claim

You settle any shortfall with hospital,

clinic or doctor

Bupa International sends your claimpayment statement

Contact the Bupa Egypt helpline on:+20 23762 8685 or from inside Egypt: 16816

[email protected]

Bupa International confirms yourcover and benefit limits

Yourmedical practitioner

should complete the medicalinformation section of the claimform. You should complete all othersections, attach invoices and send

the claim to us

Bupa International pays you

Bupa International sendspre-authorisation to you or

to yourhospital

Complete and sign the blank

sections of the statementincluding the patient declaration.

The hospital will attach invoices andsend the claim to us

Bupa International payshospital/clinic


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This section contains your Table of Benets and the accompanying notes.

Before you look at these, please read the important information below about

the kind of costs that we cover.

2.1 Treatment that we cover

For us to cover any treatment that you

receive, it must satisfy all of the following

requirements:

z it is at least consistent with generally

accepted standards of medical practice in

the country in which treatment is being

received

z it is clinically appropriate in terms of type,

duration, location and frequency, and

z it is covered under the terms and

conditions of the plan

We will not pay for treatment which in our

reasonable opinion is inappropriate based on

established clinical and medical practice, and

we are entitled to conduct a review ofyour

treatment, when it is reasonable for us todo so.

2.2 Conditions that we cover

Acute conditions

This plan covers you for treatment of acute

conditions. Acute conditions are diseases,

illnesses or injuries that respond to medical

care without the need for long term or

prolonged treatment. The treatment thatyou receive should be likely to lead to a

complete recovery, or restore you as closely

as possible to your previous state of health.

Please note that this denition above means

that you do not have cover for treatment for

chronic conditions (please see Section 3 for

more information about chronic conditions).

Acute and chronic conditions -

how it works in practice

1. We will cover an acute condition until we

become aware that it is chronic

2. Ifyou develop a condition which is known

to be chronic, we will pay for treatment

to:

z diagnose your condition

z stabilise your condition

but we will not pay for ongoing treatmentor drugs to maintain your health or

control the condition.

3. Ifyou suffer an acute are-up of a chronic

condition we will pay for treatment

you receive during this period. Example:

a chronic condition such as angina is

usually controlled by medication. We

will not pay for drugs, consultations orother treatment to control this condition.

What is covered?

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However, angina could lead to severe

chest pains and the need for a heart

bypass; this is an acute are-up of a

chronic condition. In this situation we

would pay costs associated with the heart

by-pass according to the Table of Benets

(section 2) and the notes (section 2.5).

Please contact the customer services

helpline ifyou have any questions about

acute and chronic conditions.

2.3 Reasonable and customary charges

We will pay for reasonable and customary

costs. This means that the costs charged by

yourtreatment provider should not be more

than they would normally charge and be

representative of charges by other treatment

providers in the same area*.

2.4 Table of Benefits

The Table of Benets shows the benets and

limits that apply to your plan. The notes that

follow it in section 2.5 contain the detailedrules for each benet. You also need to read

Section 3 What is not covered? so that you

understand the exclusions on your plan.

Variations to your benefits

Yoursponsor may have agreed variations to

this benet table with Bupa International.

If so, yoursponsor will inform you of these

variations.

Benefit limits

There are three kinds of benet limits

shown in this table. The per night , the per

operation, and the per procedure limits.

These are the maximum we will pay for

these benets in total for each person each

membership year. This means that once a

benet limit has been reached that benet will

no longer be available until you, the principal

member renew your plan and start a new

membership year.

Currencies

All the benet limits in this Table of Benets

and notes are set out in two currencies:

Sterling and US$. The currency in which

yoursponsor pays us subscriptions is the

currency that applies to your membership for

the purpose of the benet limits.

For example, ifyoursponsor pays us

subscriptions in Sterling then the benet

limits given in Sterling apply to your

membership and US$ limits do not apply

to you.

Ifyou are unsure which level of cover you

have, the currency that applies to your

membership, you can either check on

your Membership Certicate, through

our MembersWorld website or contact thecustomer services helpline.

* Guidelines for fees and medical practice (including established treatment plans, which outline the most appropriate course

of care for a specic condition, operation or procedure) may be published by a government or ofcial medical body. In such

cases, or where published insurance industry standards exist, Bupa International may refer to these when assessing and

paying claims. Charges in excess of published guidelines or reasonable and customary costs may not be paid.

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Note 1: In-patient and day-case treatment

Hospital accommodation and nursing care Note 1aWe pay up to 50 or US$85

each night

Theatre fees, drugs and dressings, prosthetic implants andappliances

Note 1bWe pay up to 300 or US$510each in-patient or day-case stay

Intensive care, intensive therapy, coronary care andhigh dependency unit Note 1c

We pay up to 100 or US$170

each night up to 14 nights eachmembership year

Pathology, X-rays, diagnostic tests therapies andpsychiatric treatment

Note 1dWe pay up to 600 or US$1,020

each membership year

Parent accommodation Note 1eWe pay up to 50 or US$85

each night

Surgeons and anaesthetist fees, includingpre and post-operative care

Note 1fWe pay up to 750 or US$1,275

for each operation

Surgeons and anaesthetist fees for complex majoroperations (in addition to benefit in note 1f)

Note 1gWe pay up to 2,000 or US$3,400

for each operation

Physicians fees Note 1hWe pay up to 250 or US$425

for each procedure

Note 2: Out-patient treatment

Consultants fees for consultations, pathology X-raysdiagnostic tests, therapies and psychiatric treatment

Note 2aWe pay up to 300 or US$510


Table of Benefits2.4


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www.bupa-intl.co

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Note 3: Further benefits

Advanced imaging Note 3aWe pay up to 100 or US$170


Cancer treatment Note 3bWe pay up to 1,000 or US$1,700


Healthline services Note 3c Included

Local road ambulance Note 3dWe pay up to 75 or US$128


Note 4: Optional benefits (if purchased)

Primary care; costs for treatment by family doctor andprescribed drugs and dressings

Note 4aWe pay up to 600 or US$1,020


Dental treatment Note 4b

We pay 80 percent up to 150or US$255 each membership year

(See notes for details of eligible costs forpreventive, routine, major restorative and

emergency dental treatment)

Optical(Dental treatment and optical must be purchased together

Note 4c

We pay 80 percent up to 100or US$170 each membership year

(See notes for details of eligible costs of eye tests,spectacle lenses, frames and contact lenses)

Maternity cover (after 10 months membership) Note 4dWe pay up to 1,000 or US$1,700


Assistance cover (Evacuation and Repatriation) Section 4

See Section 4 for details of the optionalassistance cover. Your Membership

Certificate will show ifyou have purchasedthis cover. The overall annual maximum

benefit limit does not apply.


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Notes to the Table of Benefits

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Each benet described in this section is payable according to the limits

set out in the Table of Benets (Section 2.4).

Note 1: In-patient and day-case treatment

Importantfor all in-patient andday-case treatment costs:

z it must be medically essential for

you to occupy a hospital bed to

receive the treatment

z yourtreatment must be provided,

or overseen, by a consultant

z we pay for accommodation in a

room that is no more expensive than

the hospitals standard single room

with a private bathroom. This means

that we will not pay the extra costs

of a deluxe, executive or VIP suite

etc.

z if the cost oftreatment is linked

to the type of room, we pay the

cost oftreatment at the rate which

would be charged ifyou occupied astandard single room with a private

bathroom

z the hospital where you have your

treatment must be recognised

2.5

Long in-patient stays: 10 daysor longer

In order for us to cover an in-patient

stay lasting 10 days or more, you must

send us a medical report from your

consultant before the eighth night,

conrming:

z your diagnosis

z treatment already given

z treatment planned

z discharge date

1a: Hospital accommodation and nursing

care

We pay charges for yourhospital

accommodation, including all your own mealsand refreshments, and nursing services, you

need as part ofyourtreatment in hospital.

We do not pay for personal items such as

telephone calls, newspapers, guest meals or

cosmetics.

Note: we do not pay for nurses hired in

addition to the hospitals own staff. In the

rare case where a hospital does not providenursing staffwe will pay for the reasonable

cost of hiring a qualified nurse for your

treatment


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We pay for accommodation in a room that

is no more expensive than the hospitals

standard single room with a private bathroom.

This means that we will not pay the extra

costs of a deluxe, executive or VIP suite etc.We pay for the length of stay that is medically

appropriate for the procedure that you are

admitted for.

Examples: unless medically essential, we

do not pay for day-case accommodation

for out-patient treatment (such as

an MRI scan), and we do not pay forin-patient accommodation for day-case

treatment (such as a biopsy).

Please also read Convalescence and

admission for general care in the What is not

covered? section.

1b: Theatre charges, drugs and dressings,

prosthetic implants and appliances

We pay for use of an operating theatre.

We pay for a prosthetic implant needed as

part ofyourtreatment. By this, we mean

an articial body part or appliance which is

designed to form a permanent part ofyour

body and is surgically implanted for one or

more of the following reasons:

z to replace a joint or ligament

z to replace one or more heart valves

z to replace the aorta or an arterial blood

vessel

z to replace a sphincter muscle

z to replace the lens or cornea of the eye

z to act as a heart pacemaker

z to remove excess uid from the brainz to control urinary incontinence (bladder

control)

z to reconstruct a breast following surgery

for cancer when the reconstruction

is carried out as part of the original

treatment for the cancer and you have

obtained our written consent beforereceiving the treatment

z to restore vocal function following

surgery for cancer

We also pay for the following appliances:

z a knee brace which is an essential part

of a surgical operation for the repair to

a cruciate (knee) ligament, or

z a spinal support which is an essential part

of a surgical operation to the spine

1c: Intensive care

We pay for intensive care in an intensive care

unit/intensive therapy unit, high dependency

or coronary care unit (or their equivalents)

when:

z it is an essential part ofyourtreatment

and is required routinely by patients

undergoing the same type oftreatment

as yours, or

z it is medically necessary in the event of

unexpected circumstances, for example

ifyou have an allergic reaction during

surgery

1d: Pathology, x-rays, diagnostic tests,

therapies and psychiatric treatment

We pay for:

z pathology, such as checking blood and

urine samples

z radiology, such as X-rays, and

z diagnostic tests, such aselectrocardiograms (ECGs)


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when recommended by yourconsultant

to help determine or assess your condition,

when carried out in a hospital..

We pay for treatment provided bytherapists (such as physiotherapists) and

complementary medicine practitioners

(such as acupuncturists) if it is needed as part

ofyourtreatment in hospital.

We also pay for psychiatric treatment

you receive in hospital after you have

been a member of the plan (or any Bupa

administered plan which includes cover for

psychiatric treatment) for two years before

the psychiatric treatment.

1e: Parent accommodation

We pay for hospital accommodation for each

night you need to stay with your child in the

same hospital. This is limited to only one

parent each night.

Your child must be:

z aged under 18, and

z a Bupa International member receiving

treatment for which he or she is covered

under their plan

1f: Surgeons and anaesthetist fees,including pre and post-operative care

We pay surgeons and anaesthetists fees for

a surgical operation and all pre- and

postoperative care required during the

in-patient or day-case stay.

Note: this benefit does not include follow-up

consultations with yourconsultant, as these

are paid under benefit Note 2a.

1g: Surgeons and anaesthetist fees for

complex major operations

We pay additional fees for surgeons

and anaesthetists for complex surgical

operations.

1h: Physicians fees

We pay physicians fees for treatment you

receive in hospital if this does not include a

surgical operation, for example ifyou are in

hospital for treatment of a medical condition

such as pneumonia.

Ifyourtreatment includes a surgical

operationwe will only pay physicians fees

if the attendance of a physician is medically

necessary, for example, in the rare event of a

heart attack following a surgical operation.

Note 2: Out-patient treatment

This is treatment which does not normally

require a patient to occupy a hospital bed.

Note 2 details the benets payable for

out-patient treatment only. Ifyou are having

treatment and you are not sure which benet

applies, please call us and we will be happy to

help. Please check the Table of Benets to see

the limits that apply

2a: Consultants fees for consultations,

pathology, X-rays, diagnostic tests,therapies and psychiatric treatment

We pay for consultants fees for consultations,

you receive as an out-patient, this normally

means a meeting with a consultant to assess

your condition.

We pay for:

z pathology, such as checking blood andurine samples, for specic abnormalities

z radiology (such as X-rays), and


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z diagnostic tests such as

electrocardiograms (ECGs)

when recommended by yourconsultant to

help determine or assess your condition.

We pay for costs by therapists and

complementary medicine practitioners for

therapies including acupuncture, osteopathy,

chiropractic and homeopathy.

We pay for consultants fees and

psychologists fees for psychiatric treatment.

We will pay after you have been a member of

the plan (or any Bupa administered plan which

includes cover for psychiatric treatment) for

the whole of the two years leading up to the

psychiatric treatment.

Note 3: Further benefits

Note 3 covers additional benets provided by

your membership of the Selections Egypt plan.

These benets may be in-patient, out-patient or

day-case. Please check the Table of Benets to

see the limits that apply.

3a: Advanced imaging, for example MRI, CT

and PET scans (head and body scanning)

We pay for magnetic resonance imaging (MRI),

computed tomography (CT) and positron

emission tomography (PET) when recommendedby yourconsultant or family doctor.

3b: Cancer treatment

Once cancer is diagnosed, we pay fees that are

related specically to planning and carrying out

treatment for cancer. This includes tests, scans,

consultations and drugs (such as cytotoxic

drugs or chemotherapy).

When the acute phase of cancer treatment

(by which we mean surgery, radiotherapy

or chemotherapy) has been completed, we

will continue to pay this benet for all cancer

treatment specically related to the originaldiagnosis for up to a further ve years.

The ve years will begin on the rst out-patient

consultation following completion of the

acute phase oftreatment. Cover during this

period includes any follow-up tests, scans and

consultations you may require. It also includes

any drugs that may be required to keep the

cancer in remission or to prevent relapse, for

up to ve years.

Ifyourtreatment needs to continue

for more than ve years, please contact

us for pre-authorisation (see Section 5,

Pre-authorisation) before proceeding. It may

be necessary for us to seek a second opinion

as part ofour pre-authorisation process.

3c: Healthline services

This is a telephone advice line which offers

help 24 hours a day, 365 days a year. Please

call +44 (0) 1273 333 911 at any time when

you need to.

The following are some of the services that

may be offered by telephone:

z general medical information from

a health professional

z medical referrals to a physician or

hospital

z medical service referral (ie locating

a physician) and assistance arranging

appointments

z inoculation and visa requirementsinformation

z emergency message transmission

z interpreter and embassy referral


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Note:treatment arranged through this

service may not be covered under your plan.

Please check your cover before proceeding.

3d: Local road ambulanceWe pay for medically necessary travel by

local road ambulance when related to eligible

in-patient or day-case treatment.

Note 4: Optional benefits (if purchased)

4a: Primary care

We pay for costs for treatment by a family

doctor and for the cost of drugs and

dressings prescribed for you by yourmedical

practitioner for eligible treatment. We only

pay for items which need a prescription.

Note: this benet does not include costs

for complementary medicine prescribed or

administered, as these are paid under the

benet described in Note 2a.

4b: Dental treatment

We pay up to 80 percent of eligible costs for

preventive treatment (such as check-ups,

X-rays, scale and polishing), routine

treatment (such as fillings, extractions and

root canal therapy), major restorative or

orthodontic treatment (such as crowns,

bridges or implants), or orthodontic

treatment of overbite or under bite etc.

We pay for emergency dental treatment

that you receive from yourdental

practitioner during your first visit and the

14 days immediately following that first visit

for each dental emergency you have during

the membership year. We do not have to

pay for any dental treatment, related to that

dental emergency, that you receive after the14 days.

By eligible emergency dental treatmentwe

mean emergency dental treatment consisting

of:

z dental examinationz radiography (for example an X-ray)

z replacement of a lost filling

z extraction of a tooth (or tooth root)

z stopping abnormal heavy bleeding

(haemorrhage)

z cutting into an abscess

z dressing a root canal

z prescribed antibiotics

z re-cementing a crown, bridge or inlay

z adjustment or repair to a denture

z construction and fitting of a temporary

crown

z call-out charge

This benefit is available only in conjunction

with the optical benefit.

4c: Optical

We pay up to 80 percent of eligible costs for

one eye test each membership year, which

includes the cost ofyour consultation and

sight/vision testing, eligible costs for spectacle

and contact lenses which are prescribed to

correct a sight/vision problem such as short or

long sight and eligible costs of spectacle frames

only ifyou have been prescribed spectaclelenses.

Your spectacle lens prescription will be required

in support ofyour claim for spectacle frames.

This benet is available only in conjunction with

the dental treatment benet.


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4d: Maternity cover

(after 10 months membership)

We pay maternity benets only after you

have been covered under the Selections

Egypt plan for 10 months.

These benets include for example:

z ante natal care such as ultrasound scans

z hospital charges, obstetricians and

midwives fees for pregnancy and

childbirth (this includes hospital,

obstetricians and other medical fees for

the cost of the delivery ofyour baby by

Caesarean section)

z obstetricians and midwives fees for

delivering your baby at home or birthing

centre

z post natal care required by the mother

immediately following normal childbirth,

such as stitches

z pregnancy and childbirth complications,

by which we mean those conditions

which only ever arise as a direct result of

pregnancy or childbirth

Pregnancy and childbirth complications

include pre-eclampsia, miscarriage,

threatened miscarriage, gestational

diabetes, when the foetus has died and

remains with the placenta in the womb,still birth, heavy bleeding in the hours and

days immediately after childbirth (post

partum haemorrhage), afterbirth left in the

womb after delivery of the baby (retained

placental membranes) and complications

following any of the above conditions.

(Other conditions arising from pregnancy

or childbirth which could also develop

in people who are not pregnant are notcovered by this benet but may be covered

by your other benets).

Note: routine care for your baby

We pay for routine care for the baby, for up to

seven days following birth, from the mothers

maternity benet. Your baby is also covered

for up to seven days routine care followingbirth ifyour baby was born to a surrogate

mother and you, as the intended parent, have

been covered on the Selections Egypt plan for

10 months when the baby is born. Please also

see Section 7.3 Adding dependants. Please

refer to Surrogate parenting, congenital and

hereditary conditions in the What is not

covered section.


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22

3

There are certain conditions and treatments that we do not cover. Ifyou

are unsure about anything in this section, please contact us for conrmation

before you go for your treatment.

The table below lists the exclusions with any

comments that may apply, and the page

number where you can nd the full rule.

Please note that this table is only a guide, and

that you must read the full rules to make sure

that you understand your cover.

Exclusion Comments See page

1 Addictive conditions and disorders 24

2 Ageing and puberty 24

3 Allergies and allergic disorders 24

4 Articial life maintenance 24

5 Birth control 24

6 Chronic conditions 24

7 Conict and disaster 25

8 Congenital conditions 25

9Convalescence and admission for generalcare

25

10 Cosmetic treatment 25

11 Deafness 25

12 Dental treatment / gum disease 26

13 Developmental problems 26

14 Donor organs 26

15 Experimental treatment 26

16 Eyesight 27

17 Footcare 27

18 Genetic testing 27

19 Health hydros, nature cure clinics etc. 27

20 Hereditary conditions 27

What is not covered?


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Exclusion Comments See page

21 HIV / AIDS 27

22 Infertility treatment 27

23 Obesity 27

24 Persistent vegetative state (PVS)and neurological damage

27

25 Personality disorders 27

26 Physical aids and devices 28

27 Pre-existing conditions 28

28 Preventive and wellness treatment 28

29 Reconstructive or remedial surgery 29

30 Self-inicted injuries 29

31 Sexual problems/gender issues 29

32 Sleep disorders 29

33 Speech disorders 29

34 Surrogate parenting 29

35 Travel costs for treatment 29

36 Unrecognised physician or facility 29

37 Renal failure 30

38 USA treatment 30

39 Vaccinations 30


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24

The following conditions and treatments

are excluded from your plan.

1. Addictive conditions and disorders

Treatment for, or arising from, addictive

conditions and disorders, or from any kind of

substance or alcohol use or misuse.

Example: we do not pay to help you to

stop smoking.

2. Ageing and puberty

Treatment to relieve symptoms caused by

ageing, puberty, or other natural physiological

cause.

3. Allergies and allergic disordersTreatment to de-sensitise or neutralise any

allergic condition or disorder.

4. Artificial life maintenance

Including mechanical ventilation, where such

treatment will not result in your recovery or

restore you to your previous state of health.

5. Birth control

Any type of contraception, sterilisation,

termination of pregnancy or family planning.

6. Chronic conditions

Treatment of chronic conditions. By this, we

mean a disease, illness or injury (including a

mental condition) which has at least one of

the following characteristics:

z has no known cure or recurs

z leads to permanent disabilityz is caused by changes to the body which

cannot be reversed

Important please read

Personal exclusions

- please check your Membership Certicate

to see ifyou have any personal exclusions or

restrictions on your plan. The exclusions inthis section apply in addition to and alongside

any such personal exclusions and restrictions.

General note for all exclusions

For all exclusions in this section, and for any

personal exclusions or restrictions shown on

your Membership Certicate, please note that:

1. we do not pay for conditions which are

directly related to excluded conditions

or treatments

2. we do not pay for any additional or

increased costs arising from excluded

conditions or treatments

3. we do not pay for complications arising

from excluded conditions or treatments

Example:

You have a personal exclusion for

diabetes.

1. Ifyour diabetes were to cause

glaucoma, we would not pay fortreatment for the glaucoma.

2. If while receiving treatment for another

condition, you need to stay extra days

in hospital because ofyour diabetes,

we would not pay for these extra days.

3. If complications arise from excluded

treatment such as cosmetic or

refractive eye procedures, we will

not pay to treat these complications.

Exceptions

This section describes some circumstances

where exceptions can be made to exclusions

or restrictions. Where this is the case, benet

is payable up to the limits set out in your

Table of Benets in Section 2.


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z requires the person with the condition to

be specially trained or rehabilitated

z needs prolonged supervision, monitoring

or treatment

7. Conflict and disaster

Treatment for any disease, illness or

injury resulting from nuclear or chemical

contamination, war, riot, revolution, acts

of terrorism or any similar event, if one

or more of the following apply:

z you have put yourself in danger by

entering a known area of conict where

active ghting or insurrections are taking

place

z you were an active participant

z you have displayed a blatant disregard

for personal safety

8. Congenital conditions

Treatment received after the rst 14 days

following birth for any abnormality, deformity,

disease, illness or injury present at birth,

whether diagnosed or not, except cancer.

9. Convalescence and admission for

general care

Hospital accommodation when it is used solely

or primarily for any of the following purposes:

z convalescence, supervision, pain

management or any other purpose other

than for receiving eligible treatment, of a

type which normally requires you to stay

in hospital

z receiving general nursing care or any other

services which do not require you to be

in hospital, and could be provided in a

nursing home or other establishment thatis not a hospital

z receiving services from a therapist or

complementary medicine practitioner

z receiving services which would not

normally require trained medical

professionals such as help in walking,bathing or preparing meals

10. Cosmetic treatment

Treatment undergone for cosmetic or

psychological reasons to improve your

appearance, such as a re-modelled nose,

facelift or cosmetic dentistry. This includes:

z dental implants to replace a sound

natural tooth

z hair transplants for any reason

z treatment related to or arising from the

removal of non-diseased, or surplus or

fat tissue, whether or not it is needed for

medical or psychological reasons

z any treatment for a procedure to change

the shape or appearance ofyour breast(s)

whether or not it is needed for medical

or psychological reasons: unless for

reconstruction carried out as part of the

original treatment for the cancer, when

you have obtained our written consent

before receiving the treatment

(see Reconstructive or remedial surgery

in this section)

Examples: we do not pay for breast

reduction for backache or gynaecomastia

(the enlargement of breasts in men).

11. Deafness

Treatment for or arising from deafness or

partial hearing loss caused by a congenital

abnormality, maturing or ageing.


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12. Dental treatment/gum disease

This includes surgical operations for the

treatment of bone disease when related

to gum disease or damage, or treatment

for, or arising from disorders of thetemporomandibular joint.

This also includes emergency dental

treatment.

Examples: we do not pay for tooth decay,

gum disease, jaw shrinkage or loss,

damaged teeth, etc.

Please see Note 4b in the What is

covered? section for details ofyour

dental benefit

Exception: We pay for a surgical operation

carried out by a consultant to:

z put a natural tooth back into a jaw bone

after it is knocked out or dislodged in an

accident

z treat irreversible bone disease involving

the jaw(s) which cannot be treated in any

other way, but not if it is related to gum

disease or tooth disease or damage

z surgically remove a complicated, buried

or impacted tooth root, for example inthe case of an impacted wisdom tooth

13. Developmental problems

Treatment for, or related to developmental

problems, including:

z learning difculties, such as dyslexia

z behavioural problems, including

attention decit hyperactivity disorder(ADHD), or

z problems related to physical

development, including (but not

restricted to) short height

14. Donor organsTreatment costs for, or as a result of the

following:

z transplants involving mechanical or

animal organs

z the removal of a donor organ from a

donor

z the removal of an organ from you for

purposes of transplantation into another

person

z the harvesting and storage of stem cells,

when this is carried out as a preventive

measure against future possible diseases

or illness

z the purchase of a donor organ

15. Experimental treatment

Treatment or prescribed medicines which in

our reasonable opinion, based on advice of

the local public authority in the country where

yourtreatment takes place, are experimental

or have not proved to be effective.

Treatment or clinical trials which have not yet

been approved in the country in which you

are receiving treatment.

Prescribed medicines used for purposes other

than those dened under their licence, which

may vary from country to country.

Note: ifyou are unsure whether your

treatment may be experimental, please

contact us.We reserve the right to ask for full

clinical details from yourconsultant beforeapproving any treatment, in which case you

must receive our written agreement before

the treatment takes place.


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16. Eyesight

Treatment to correct eyesight, unless

required as the result of an injury or acute

condition.

Examples: we will not pay for routine

eye examinations, contact lenses,

spectacles or refractive eye procedures.

We will pay for treatment of a detached

retina, glaucoma or cataracts.

Please see Note 4c in the What is covered?

section for details ofyouroptical benefit.

17. Footcare

Treatment for corns, calluses, or thickened

or misshapen nails.

18. Genetic testing

Genetic tests, when such tests are solely

performed to determine whether or not you

may be genetically likely to develop a medical

condition.

Example: we do not pay for tests used

to determine whether you may develop

Alzheimers disease, when that disease

is not present.

19. Health hydros, nature cure

clinics etc.

Treatment or services received in

health hydros, nature cure clinics or any

establishment that is not a hospital.

20. Hereditary conditions

Treatment of abnormalities, deformities,diseases or illnesses that are only present

because they have been passed down through

the generations ofyour family, except cancer.

21. HIV and AIDS

Treatment for, or arising from, HIV or AIDS,

including any condition that is related to HIV

or AIDS, ifyour current period of membership

is less than ve years.

22. Infertility treatment

Treatment to assist reproduction, including

but not limited to IVF treatment.

Note:we pay for reasonable investigations

into the causes of infertility if:

z neither you nor your partner had been

aware of any problems before joining, and

z you have both been members of this

plan (or any Bupa administered plan

which included cover for this type of

investigation) for a continuous period of

two years before the investigations start

Once the cause is conrmed, we will not pay

for any additional investigations in the future.

23. Obesity

Treatment for, or required as a result of

obesity.

24. Persistent vegetative state (PVS) and

neurological damage

We will not pay for in-patient treatment formore than 90 continuous days for permanent

neurological damage or ifyou are in a

persistent vegetative state.

25. Personality disorders

Treatment of personality disorders, including

but not limited to:

z affective personality disorderz schizoid personality (not schizophrenia)

z histrionic personality disorder


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26. Physical aids and devices

Any physical aid or device which is not a

prosthetic implant, prosthetic device, or

dened as an appliance.

Examples: we will not pay for hearing

aids, spectacles, contact lenses, crutches

or walking sticks.

27. Pre-existing conditions

Any treatment for a pre-existing condition,

related symptoms, or any condition that

results from or is related to a pre-existing

condition, unless:

z we were given all the medical information

that we asked for during your application

for your current continuous period of

membership

z we did not specically exclude cover

for the pre-existing condition on your

Membership Certicate, and

z you did not know about the pre-existing

condition before the effective from

date on the rst Membership Certicate


membership

Note: please contact us before yourrenewal

date ifyou would like us to review a personalexclusion. We may remove your exclusion if,

in our opinion, no further treatment will be

either directly or indirectly required for the

condition, or for any related condition. There

are some personal exclusions that, due to their

nature, we will not review.

To carry out a review, we must receive full

current clinical details from yourfamily

doctor or consultant. Any costs incurred in

obtaining these details are not covered under

your plan and are your responsibility.

Please note: this exclusion does not

apply ifyoursponsor has purchased

cover with medical history disregarded.

Ifyou are unsure whether you have

this cover, please contact the customer

services helpline.

For pre-existing conditions for newborns,

please see the exclusions for congenital and

hereditary conditions in this section.

28. Preventive and wellness treatment

Health screening, including routine health

checks, or any preventive treatment.

Note:we may pay for prophylactic surgery

when:

z there is a signicant family history of the

disease for example ovarian cancer, which

is part of a genetic cancer syndrome, and/

or

z you have positive results from genetic

testing (please note that we will not payfor the genetic testing)

Please contact us for pre-authorisation (see

Section 5) before proceeding with treatment.

It may be necessary for us to seek a second

opinion as part ofour pre-authorisation

process.


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29. Reconstructive or remedial surgery

Treatment required to restore your

appearance after an illness, injury or

previous surgery, unless:

z the treatment is a surgical operation

to restore your appearance after an

accident, or as the result of surgery

for cancer, if either of these takes

place during your current continuous

membership of the plan

z the treatment is carried out as part of

the original treatment for the accident

or cancer

z you have obtained our written consent

before the treatment takes place

30. Self-inflicted injuries

Treatment for, or arising from, an injury that

you have intentionally inicted on yourself,

for example during a suicide attempt.

31. Sexual problems and gender issues

Treatment of any sexual problem including

impotence (whatever the cause) and sex

changes or gender reassignments.

32. Sleep disorders

Treatment for insomnia, sleep apnoea,

snoring, or any other sleep-related breathing

problem.

33. Speech disorders

Treatment for speech disorders, including

stammering, unless the following all apply:

z the treatment is short term therapy

which is medically necessary as part of

active treatment for an acute condition

such as a strokez the speech therapy takes place during

and/or immediately following the

treatment for the acute condition

z the speech therapy is recommended

by the consultant in charge ofyour

treatment, and is provided by a therapist

in which case we may pay at our discretion.

34. Surrogate parenting

Treatment directly related to surrogacy.

This applies:

z to you ifyou act as a surrogate, and

z to anyone else acting as a surrogate for you

35. Travel costs for treatmentAny travel costs related to receiving

treatment, unless otherwise covered by:

z local road ambulance benet (see note 3d)

Example:

z we do not pay for taxis or other travel

expenses for you to visit a medical

practitioner

z we do not pay for travel time or the

cost of any transport expenses charged

by a medical practitioner to visit you

36. Unrecognised physician or facility

z

Treatment provided by a medicalpractitioner who is not recognised by the

relevant authorities in the country where

the treatment takes place as having

specialised knowledge, or expertise in,

the treatment of the disease, illness or

injury being treated.

z Treatment in any hospital, or by any

medical practitioner or any other

provider of services, to whom we havesent a written notice that we no longer

recognise them for the purposes ofour

plans.


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*Please note: due to the cost oftreatment in the USA, members must pre-authorise all treatment. This is to make sure that the

treatment you wish to have is eligible and so that we can advise you, in advance, ifyou will need to contribute to your own

treatment costs.30

z Treatment provided by anyone with

the same residence as you or who is a

member ofyour immediate family.

37. Renal failureSupportive treatment for renal failure,

including dialysis.

This exclusion will not apply if:

Treatment directly related to surrogacy.

This applies:

z the patient had been in hospital for the

immediate purpose of receiving a kidney

transplant, or

z the costs were incurred in connection with

acute secondary failure when the dialysis

was part of intensive care

38. USA treatment

If USA cover has not been purchased, then any

treatment received in the USA is ineligible*:

z after the 28th day ofyour visit to the USA

z for any condition of which you were

aware before your visit to the USA

z when arrangements were not authorised

by our agents in the USA, and

z when Bupa International knows or

suspects that you travelled to the USA forthe purpose of receiving treatment for

a condition, when the symptoms of the

condition were apparent to you before

travelling. This applies whether or not

yourtreatment was the main or sole

purpose ofyour visit

Note: you can claim for unforeseen

treatment received within 28 days ofyour

arrival in the USA, you must send evidence of

your arrival date with your claim. Examples

include a certied photocopy ofyour airlineticket or your visa stamp.

Bupa InternationalsService Partner in the

USoperates a national network ofhospitals,

clinics and medical practitioners. This is the

USprovider network. You must contact

our US Service Partner before you have

treatment, and they can help to nd a

suitable network provider for you.

For eligible treatment that takes place in the

USusing theUSprovider network, benet is

paid at 100 percent. When eligible treatment

takes place in theUSbut outside the provider

network, benet is paid at 80 percent.

If USA cover has been purchased, then

treatment received in the USA is ineligible

when:

z arrangements for the treatment were not

authorised by our agents in the USA, and

z Bupa International knows or suspects

that you purchased cover for and travelled

to the USA for the purpose of receiving

treatment for a condition, when thesymptoms of the condition were apparent

to you before buying the cover. This

applies whether or not yourtreatment

was the main or sole purpose ofyour visit

39. Vaccinations

Vaccinations, as these are not active

treatment of acute illness, they are not eligible

for benet.


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4

Assistance cover(optional if purchased)

This section contains the rules and information for Assistance Cover, an

optional benet which helps you ifyou need to travel to get the treatment

that you need.

Note: there are two levels of Assistance Cover: Evacuation and Repatriation. Your Membership

Certicate will show ifyou have Evacuation or Repatriation but you can visit the MembersWorld

website or contact the customer services helpline ifyou are unsure.

What is Assistance Cover?

The Evacuation and Repatriation options both

cover you for reasonable transport costs

to the nearest medical facility where the

treatment that you need is available, if it is

not available locally. Repatriation also gives

you the option of returning to yourspecified

country of nationality or yourspecified

country of residence.

We may not be able to arrange Evacuation or

Repatriation in cases where the local situation

makes it impossible, unreasonably dangerousor impractical to enter the area; for example

from an oil rig or within a war zone.

4.1 Assistance Covergeneral rules

The following rules apply to both the

Evacuation and Repatriation levels of cover:

z you must contact our appointed

representatives for conrmation beforeyou travel, on +44 (0) 1273 333 911

z our appointed representatives must

agree the arrangements with you

z Assistance Cover is applicable for

in-patient and day-case treatment only

z the treatment must be recommended by

yourconsultant or family doctor and,

for medical reasons, not available locally

z the treatment must be eligible under

your plan.

z you must have cover for the country you

are being treated in, for example the USA

z you must have the appropriate level of

Assistance Cover in place before you

need the treatment

Evacuation or Repatriation will not be eligible

ifyou were aware of the symptoms ofyour

condition before applying for Assistance Cover.

We will not approve a transfer which in our

reasonable opinion is inappropriate based

on established clinical and medical practice,

and we are entitled to conduct a review of

your case, when it is reasonable for us todo so. Evacuation or Repatriation will not be

authorised if this would be against medical

advice.


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4.2 How to arrange your Evacuation or

Repatriation

Arrangements for Evacuation 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 information or proof that we may

reasonably ask you for to support your request.

We will only pay if all arrangements are agreed

in advance by Bupa Internationals appointed

representatives.

4.3 Evacuation cover:what we will pay for

Ifyou have Evacuation cover it will be shown

on your Membership Certicate. Ifyou are still

unsure you can visit our MembersWorld website

or contact the customer services helpline.

z We will pay in full for your reasonable

transport costs for day-case or in-patient

treatment. It may also be authorised ifyou

need advanced imaging or cancer treatment

such as radiotherapy or chemotherapy.

z We will only pay for Evacuation to the nearest

place where the required treatment is

available. This could be to another part of the

country that you are in, and may not be your

home country.

z

We will pay for the reasonable travel costsfor another Bupa International member to

accompany you, but only if it is medically

necessary.

z We will also pay for the reasonable costs

ofyour, and the accompanying members,

return journey to the place you were

evacuated from. All arrangements for your

return should be approved in advance

by Bupa International or our appointedrepresentatives and the journey must be

made within fourteen days of the end of the

treatment. We will pay for either:

z the reasonable cost of the return journey

by the most direct route available by land

or sea, or

z the cost of an economy class air ticket bythe most direct route available, whichever

is the lesser amount.

z we will pay reasonable costs for the

transportation only ofyour body, subject

to airline requirements and restrictions,

to your home country, in the event of

your death while you are away from

home. We do not pay for burial or

cremation, the cost of burial caskets etc,

or the transport costs for someone to

collect or accompany your remains

Note: we do not pay for any other costs related

to the evacuation such as hotel accommodation

or taxis. Costs of any treatment you receive

are not payable under Evacuation cover, but are

payable from your medical cover as described

in your Table of Benets and the What is

covered? section of this guide.

Please also note that for medical reasons the

member receiving treatment may travel in a

different class from their companion.

4.4 Repatriation cover:

what we will pay forIfyou have Repatriation cover it will be shown

on your Membership Certicate. Ifyou are

still unsure you can visit our MembersWorld

website or contact the customer services

helpline. Repatriation cover also includes

Evacuation cover see 4.3 above.

z We will pay in full for your reasonable

transport costs for day-case or in-patienttreatment.


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z We will pay for repatriation to your

specified country of nationality or your

specified country of residence.

z We will pay for one repatriation for eachillness or injury per lifetime.

z We will pay the reasonable costs for a

relative or your partner to accompany

you to yourspecified country of

nationality or your specified country of

residence ifwe have authorised this in

advance of the repatriation.

z We will also pay an allowance of up to

Sterling25, US$50 or Euro37 per day

for up to 10 days to cover the living

expenses of the person accompanying

you.

z We will pay for you and the person

accompanying you to return to

where you were repatriated from.

All arrangements for your return

must be approved in advance by

Bupa International or our appointed

representatives and you must make

the return journey within fourteen days

of the end of the treatment you were

repatriated for. We will pay either:

z the reasonable cost of the return

journey by the most direct route

available by land or sea, orz the cost of a scheduled return

economy class air ticket by the most

direct route available, whichever is the

lesser amount

z we will pay reasonable costs for the

transportation only ofyour body,

subject to airline requirements and

restrictions, to your home country, inthe event ofyour death while you are

away from home. We do not pay for

burial or cremation, the cost of burial

caskets etc, or the transport costs for

someone to collect or accompany your

remains

Note:we do not pay for any other costs

related to the repatriation such as hotel

accommodation or taxis. Costs of any

treatment you receive are not payable under

Repatriation cover, but are payable from your

medical cover as described in your Table of

Benets and the What is covered? section of

this guide.

Please also note that for medical reasons the

member receiving treatment may travel in a

different class from their companion.


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5

This section contains rules and information about what pre-authorisation

means and how it works.

5.1 What pre-authorisation meansIfwe pre-authorise yourtreatment, this

means that we will pay up to the limits of

your plan provided that all of the following

requirements are met:

z the treatment is eligible treatment that

is covered by your plan

z you have an active membership at the

time that treatment takes place

z your subscriptions are paid up to date

z the treatment carried out matches the

treatment authorised

z you have provided a full disclosure of the

condition and treatment required

z you have enough benet entitlement to

cover the cost of the treatment

z

your condition is not a pre-existingcondition (see Section 3, What is not

covered?)

z the treatment is medically necessary

z the treatment takes place within 31 days

after pre-authorisation is given

5.2 Treatment we can pre-authorise

We can pre-authorise in-patient and

day-case treatment, cancer treatment andMRI, CT or PET scans.

5.3 Length of stay(in-patient treatment)

Your pre-authorisation will specify an

approved length of stay for in-patient

treatment. This is the number of days in

hospital that we will cover you for. Ifyour

treatment will take longer than this approved

length of stay, then you or yourconsultant

must contact us for an extension to the

pre-authorisation.

5.4 Treatment in the USA

All in-patient and day-case treatment,

cancer treatment and MRI, CT or PET scans

in the USA must be pre-authorised. Ifyou are

going to receive any of these treatments,

ask your medical provider to contact

Bupa International for pre-authorisation.All the information they need is on your

Membership Card.

We have made special arrangements ifyou

need to be hospitalised in the USA. These

include access to a select network of quality

medical providers and direct settlement

of all covered expenses when you receive

treatment in a networkhospital.

Pre-authorisation


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Treatment which has not been

pre-authorised

Ifyou choose not to get yourtreatment

pre-authorised, we will only pay 50 percenttowards the cost of covered treatment.

Of course we understand that there are

times when you cannot get yourtreatment

pre-authorised, such as in an emergency. If

you are taken to hospital in an emergency, it

is important that you arrange for the hospital

to contact us within 48 hours ofyour

admission. We can then make sure you are

getting the right care, and in the right place.

Ifyou have been taken to a hospital which is

not part of the network and, if it is the best

thing for you,we will arrange for you to be

moved to a networkhospital to continue

yourtreatment once you are stable.

Ifwe have been notied within 48 hours of an

emergency admission to hospital, we will not

ask you to share the cost ofyourtreatment.

Out of network treatment

Ifyourtreatment has been pre-authorised,

but you choose not to go to a network

hospital, we will only pay 80 percent towards

the cost of covered treatment.

There may be times when it is not possible

for you to be treated at a networkhospital.

These include:

z where there is no networkhospital

within 30 miles ofyour address, and

z when the treatment you need is not

available in the networkhospital

In these cases, we will not ask you to share

the cost ofyourtreatment.

5.5 Important rules

Please note that pre-authorisation is only valid

if all the details of the authorised treatment,

including dates and locations, match those ofthe treatment received. If there is a change

in the treatment required, ifyou need to

have further treatment, or if any other details

change, then you or yourconsultant must

contact us to pre-authorise this separately. We

make our decision to approve yourtreatment

based on the information given to us. We

reserve the right to withdraw our decision if

additional information is withheld or not given

to us at the time the decision is being made.


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6.1 How to make a claimClaim forms

Your claim form is important as it gives us the

information that we need to process your

claim. If it is not fully completed we may have

to ask for more information. This can delay

payment ofyour claim.

You must complete a new claim form:

z for each member

z for each condition

z for each in-patient or day-case stay, and

z for each currency of claim

If a condition continues over six months,

we will ask for a further claim form to be

completed.

What to send us

You need to return the completed form to

us by post, with the original invoices, as soon

as possible. This must be within six months of

receiving the treatment for which you are

claiming. Invoices sent to us after six months

will not normally be paid.

6

At times of ill health, you want to concentrate on getting well. We will do

everything we can to make your claim as simple and straightforward as

possible.

Requests for further information

We may need to ask you for further

information to support your claim. Ifwe do,

you must provide this. Examples of things we

might ask for include:

z medical reports and other information

about the treatment for which you are

claiming

z the results of any medical examination

performed at our expense by an

independent medical practitioner

appointed by us

z written conrmation from you as to

whether you think you can recover the

costs you are claiming from another

person or insurance company

Ifyou do not provide the information that we

ask for, we may not pay your claim in full.

Please also see Correspondence in

Section 7.6.

Making a claim


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Important

When making a claim please note:

z you must have received the treatmentwhile covered under your membership

z payment ofyour claim will be under the

terms ofyour membership and up to the

benet levels shown, that apply to you at

the time you receive the treatment

z we will only pay for treatment costs

actually incurred by you, not deposits

or advance invoices or registration/

administration fees charged by the

provider oftreatment

z we will only pay for treatment costs that

are reasonable and customary

z we do not return original documents such

as invoices or letters. However, we will be

pleased to return certied copies ifyou

ask us when you submit your claim

Confirmation of your claim

We will always send conrmation of how we

have dealt with a claim. For child dependants

(those aged under 18 years), we will write

to the principal member. If the claim is

for treatment received by the principal

member, or an adult dependant (those aged

over 18 years), we will write directly to the

individual concerned.

6.2 How your claim will be paid

Wherever possible, we will follow the

instructions given to us in the Payment

details section of the claim form.

Who we will pay

We will only make payments to the member

who received the treatment, the provider ofthe treatment, the principal member of the

membership or the executor or administrator

of the members estate. We will not make

payments to anyone else.

Payment method and bank charges

We will make payment where possible by

electronic transfer or by cheque. Payments

made by electronic transfer are quick, secure

and convenient. To receive payment by

electronic transfer, we need the full bank

account, SWIFT code, bank address details and

(in Europe only) IBAN number to be provided

on the claim form.

We will instruct our bank to recharge the

administration fee relating to the cost of

making the electronic transfer to us but we

cannot guarantee that these charges will

always be passed back for us to pay. In the

event that your local bank makes a charge for

a wire transfer we will aim to refund this as

well. Any other bank charges or fees, such as

for currency exchange, are your responsibility,

unless they are charged as a result ofour

error.

Cheques are no longer valid if they are not

cashed within 12 months. Ifyou have an

out-of-date cheque, please contact customer

services, who will be happy to arrange areplacement.

Payment currency and conversions

We can pay in the currency in which your

sponsor pays your subscriptions, the currency

of the invoices you send us, or the currency of

your bank account.

We cannot pay you in any other currency.


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Sometimes, the international banking

regulations do not allow us to make a

payment in the currency you have asked for.

If so, we will send a payment in the currencyofyoursponsors subscriptions.

Ifwe have to make a conversion from 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 of the

treatment, whichever is later.

The exchange rate used will be the average

of the buying and selling rates across a wide

range of quoted rates by the banks in London

on the date in question. If the date is not a

working day we will use the exchange rate

that applies on the last working day before

that date.

6.3 Other claim information

Discretionary payments

We may, in certain situations, make

discretionary or ex gratia payments towards

yourtreatment. Ifwe 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 future.

We do not have to pay for treatment that

is not covered by your plan, even ifwe have

paid an earlier claim for a similar or identical

treatment.

Overpayment of claims

Ifwe overpay you for your claim, we reserve

the right to deduct the overpaid amount from

future claims or seek repayment from you.

Claiming for treatment when others are

responsible

You must complete the appropriate section

of the claim form ifyou are claiming fortreatment that is needed when someone else

is at fault, for example in a road accident in

which you are a victim. If so, you will need to

take any reasonable steps we ask ofyou to:

z recover from the person at fault (such as

through their insurance company) the

cost of the treatment paid for by Bupa

International, and

z claim interest ifyou are entitled to do so

Note: Subrogation

In the event of any payment of any claim

under your membership, we or any person

or company that it nominates may be

subrogated to all rights of recovery of the

member and any person entitled to the

benets of this coverage. The member shall

sign and deliver all documents and papers

and do whatever else is necessary to secure

such subrogated rights to us or its nominated

party. The member shall do nothing after the

claim to prejudice such rights.

Claiming with joint or double insurance

You must complete the appropriate sectionon the claim form, ifyou have any other

insurance cover for the cost of the treatment

or benets you have claimed from us. Ifyou

do have other insurance cover, this must

be disclosed to us when claiming, and we

will only pay our share of the cost of the

treatment or benets claimed.


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7

This section contains the rules about your membership, including when it

will start and end, renewing your plan, how you, the principal membercan

change your cover and general information.

7.1 Paying subscriptions and othercharges

Your sponsor has to pay any and all

subscriptions due to Bupa International

under the agreement, together with any

other charges (such as insurance premium tax)

that may be payable.

7.2 Starting and renewing your

membership

When your cover starts

Your membership starts on the effective

date shown on the rst Membership

Certicate that we sent you, the principal

member for your current continuous period

ofBupa International Selections Egypt plan

membership.

When cover starts for others on your

membership

If any other person is included as a

dependant under your, the principal

members membership, their membership

will start on the effective date on the

rst Membership Certicate we sent you


Bupa International Selections Egypt planmembership which lists them as a dependant.

Their membership can continue for as long

as you, the principal member remain a

member of the plan.

Ifyour, the principal members membership

ceases, your dependants can then, of course,

apply for membership in their own right.

Renewing your membership

The renewal ofyour membership is subject

to your sponsor renewing your membership

under the agreement.

7.3 Adding dependants

Ifyour sponsor agrees, you, the principal

member may apply to include any ofyour

family members under your membership as

one ofyour dependants. To apply you, theprincipal member will need to complete an

Additional Members form.

7.4 Ending your membership

1. Your sponsor can end your, the principal

members membership, or that of any

ofyour dependants, from the rst

day of a month by writing to us.We

cannot backdate the cancellation ofyourmembership.

Your membership


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2. Your membership will automatically end:

z if the agreement between Bupa

International and your sponsor isterminated

z ifyour sponsor does not renew your

membership

z ifyour sponsor does not pay

subscriptions or any other payment due

under the agreement for you or for any

other person

z if the membership of the principal

member ends

z upon the death of the principal member

Specified country of residence

You, the principal member must tell your

sponsor ifyourspecified country of

residence or your country of citizenship

changes. We may need to end your

membership if the change results in a breach

of regulations governing the provision of

healthcare cover to local nationals, residents

or citizens.

The details of regulations vary from country to

country and may change at any time.

In some countries we have local partners

who are licensed to provide insurancecover but which are administered by

Bupa International. This means that

customers experience the same quality

Bupa International service.

Ifyou change your citizenship to a country

where we have a local partner, in most cases

you will be able to transfer to our partners

insurance policy without further medicalunderwriting. You may also be entitled to

retain your continuity ofBupa International

membership; which means that for those

benets which arent covered until you have

been a member for a certain period, the

time you were a member with us will count

towards that. Please note that ifyou requesta transfer to a local partner, we will have to

share your personal information and medical

history with the local partner.

Ifyou change your residency or citizenship,

please call the customer services helpline

so we can conrm ifyourmembership is

affected, and, if so, whether we can offer you

a transfer service.

Important please read

Bupa International can end a persons

membership and that of all the other

people listed on the Membership

Certicate if there is reasonable evidence

that any person concerned has misled,

or attempted to mislead us. By this,

we mean giving false information or

keeping necessary information from us,

or working with another party to give us

false information, either intentionally or

carelessly, which may inuence us when

deciding:

z

whether you (or they) can join theplan

z what subscriptions you have to pay

z whether we have to pay any claim

After your Selections Egypt membership

ends

You, the principal member can apply to

transfer to a personal Bupa Internationalplan ifyour membership ofyour group

plan ends. You can also apply for your


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dependants to transfer with you. Please

contact the customer service helpline for

more information.

7.5 Making changes to your cover

The terms and conditions ofyour

membership may be changed from time to

time by agreement between your sponsor

and Bupa International.

Amending your Membership Certificate

We will send you, the principal member a

new Membership Certicate if:

z with the sponsors approval, you, the

principal member add a new dependant

to your membership

z we

Documents

Selections Membership Guide