Insured and locally administered by. Internationally administered by LIFELINE. From 1 January 2014

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1 Insured and locally administered by Internationally administered by LIFELINE From 1 January 2014

2 Insured and locally administered by Internationally administered by YOUR MEMBERSHIP PACK This document is made up of three booklets; please keep it in a safe place. We may send you amended versions when your plan renews if we make any changes. You can download updated versions at any time from the MembersWorld website or contact us to request a new copy. CONTENTS 1. QUICK REFERENCE GUIDE This booklet contains a summary of all your important contact information; the sort of information you are likely to use on a regular basis. 2. HOW TO USE YOUR PLAN This booklet explains how to use your plan, including; how to make a claim and other important membership information. 3. TABLE OF BENEFITS This booklet talks about your cover in detail, including; what is covered, what is not covered and details of USA cover (if applicable).

3 Sales enquiries: Oman Insurance Company +(971) Registered in accordance with UAE Federal Law No. 6, 2007 (Registration No. 9) General services: Inside UAE: Outside UAE: +44 (0) Medical related enquiries: +44 (0) Your calls may be recorded or monitored. Bupa Global Victory House Trafalgar Place Brighton BN1 4FY United Kingdom Global medical plans for individuals and groups Assistance, repatriation and evacuation cover 24-hour multi-lingual helpline bupa-intl.com WHAT YOU NEED, THE WAY YOU NEED IT Insured and locally administered by Internationally administered by 1. Quick Reference Guide This booklet summarises all of your important contact information. UAE-GENE-QREF

4 WELCOME TO YOUR INTERNATIONAL PLAN IMPORTANT MEMBERSHIP DOCUMENTS The How to use your plan and Table of benefits booklets must be read alongside your Membership Certificate and your application for cover, as together they set out the terms and conditions of your membership and form your plan documentation. HOW TO USE YOUR PLAN This booklet explains how to use your plan, including; how to make a claim and other important membership information. TABLE OF BENEFITS This booklet talks about your cover in full detail, including; what is covered, what is not covered and details of USA cover (if you have included this on your plan). QUICK REFERENCE GUIDE This booklet contains a summary of all your important contact information; the sort of information you are likely to use on a regular basis.

5 START YOUR WEBSITE MEMBERSWORLD ONE TWO Enter your THREE Choose your login To make your life easier and save you time and hassle, MembersWorld is an exclusive and secure members website. You can log on to MembersWorld from anywhere in the world to manage your cover and access a comprehensive library of information and expert advice. Some of the benefits waiting for you online: you can check cover and pre-authorise in-patient and day-case treatment no need to carry documents around with you - access your documents 24 hours a day anywhere in the world know exactly when new purchased your policy via a broker? You can now allow them access to view your policy information (except claim related documents) specify a preferred address for claim reimbursements - useful if you have multiple addresses or are travelling if you want a second medical opinion, simply complete the online form and one of our third party medical consultants will be in contact with you Webchat - instant access, 24 hours a day, to our experienced advisers, who will be able to chat with you in real time, wherever you are and whatever your needs Select register now FOUR Choose your password membership number and personal details FIVE Choose a security question name (please note: login and password are case sensitive) SIX Click on submit your details FINISH documents are ready by signing up to receive SMS text alerts There are many more benefits online; log in to see for yourself - it s just six easy steps. That s it... You re registered!

6 CONTACT US OPEN 24 HOURS A DAY, 365 DAYS A YEAR HEALTHLINE +44 (0) GENERAL ENQUIRIES - OMAN INSURANCE COMPANY health@tameen.ae* web: tel: +(971) tel: +(971) GENERAL ENQUIRIES - BUPA GLOBAL Your Bupa Global customer services helpline you can check cover and pre-authorise in-patient and day-case treatment when outside of the UAE you can check cover for eligibility when inside the UAE membership and payment queries tel inside UAE: tel outside UAE: +44 (0) fax: +44 (0) CORRESPONDENCE Any correspondence, including your claims, should be sent to the following address: Bupa Global Victory House Trafalgar Place Brighton, BN1 4FY United Kingdom FURTHER HELP 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) We also offer a choice of Braille, large print or audio for our letters and literature. Please let us know which you would prefer. SOME OF THE SERVICES THAT MAY BE OFFERED BY OUR TELEPHONE ADVICE LINE Check cover and pre-authorise treatment General medical information and advice from a health professional Find local medical facilities Medical referrals to a physician or hospital Medical service referral (ie locating a physician) and assistance arranging appointments Inoculation and visa requirements information Emergency message transmission Interpreter and embassy referral PRE-AUTHORISATION FAX: +44 (0) * Please note that we cannot guarantee the security of as a method of communication. Some companies, employers and/or countries do monitor traffic, so please bear this in mind when sending us confidential information.

7 HOW IT WORKS FOR YOU PLEASE REMEMBER TO PRE-AUTHORISE YOUR TREATMENT If we pre-authorise your treatment, this means that we will pay up to the limits of your plan provided that all the following 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 full disclosure of the condition and treatment required, you have enough benefit entitlement to cover the cost of the treatment, your condition is not a pre-existing condition, the treatment is medically necessary, and the treatment takes place within 31 days after pre-authorisation is given. Please check the How to use your plan book for more details. CALL: +44 (0) FAX: +44 (0) Or via our secure MembersWorld website. Important rules: please note that pre-authorisation is only valid if all the details of the authorised treatment, including dates and locations, match those of the treatment received. If there is a change in the treatment required, if you need to have further treatment, or if 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 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. This is a summary. Please ensure you read the full details in the How to use your plan and Table of benefits booklets, and your Membership Certificate, included in your membership pack.

8 HOW TO CLAIM MAKING A COMPLAINT Contact our customer service helpline: from inside UAE: ; outside UAE: +44 (0) or info@bupa-intl.com Direct Settlement Pay and Claim We will send pre-authorisation to you or to your hospital/clinic We confirm your cover and benefit limits Complete and sign the blank sections of the statement including the patient declaration. The hospital/clinic will attach invoices and send the claim to us We pay hospital/clinic Your medical practitioner should complete the medical information section of the claim form. You should complete all other sections, attach invoices and send the claim to us We pay you We re always pleased to hear about aspects of your membership that you have particularly appreciated, or that you have had problems with. If something does go wrong, here is a simple procedure to ensure your concerns are dealt with as quickly and effectively as possible. If you have any comments or complaints, you can call us on: Inside the UAE: toll-free number or Outside the UAE: +44 (0) hours a day, 365 days a year. We send your claim payment statement to you You settle any shortfall with hospital, clinic or doctor This is a summary. Please ensure you read the full details in the How to use your plan and Table of benefits booklets, and your Membership Certificate, included in your membership pack. This is a summary. Please ensure you read the full details in the How to use your plan and Table of benefits booklets, and your Membership Certificate, included in your membership pack.

9 Sales enquiries: Contact Oman Insurance Company: +(971) General services: +44 (0) Medical related enquiries: +44 (0) Your calls may be recorded or monitored. Bupa Global Victory House Trafalgar Place Brighton BN1 4FY United Kingdom Global medical plans for individuals and groups Assistance, repatriation and evacuation cover 24-hour multi-lingual helpline bupa-intl.com LIFELINE 2. How to use your plan This booklet explains the terms and conditions of the Lifeline Plan. Detailed information such as pre-authorising treatment, making a claim and moving country can be found in this booklet. Insured and locally administered by Internationally administered by UAE-LIFE-MEMB

10 WELCOME Please keep your booklet in a safe place. If you need another copy, you can call +44 (0) or view and print it online at: Your International Lifeline plan is administered by Bupa Global on behalf of Oman Insurance Company (OIC), your insurer. You can contact your insurer by writing to: Oman Insurance Company (P.S.C) Health Department PO Box 5209 Dubai, UAE Tel: +(971) Fax +(971) *: health@tameen.ae Or visit our website: IMPORTANT MEMBERSHIP DOCUMENTS The How to use your plan and Table of benefits booklets must be read alongside your membership certificate and your application for cover, as together they set out the terms and conditions of your membership and form your plan documentation. HOW TO USE YOUR PLAN This booklet explains how to use your plan, including; how to make a claim and other important membership information. TABLE OF BENEFITS This booklet talks about your cover in full detail, including; what is covered, what is not covered and details of USA cover (if you have included this on your plan). Bold words Words in bold have particular meanings in this booklet. Please check their definition in the Glossary before you read on. You will find the Glossary in the back of this booklet. QUICK REFERENCE GUIDE This booklet contains a summary of all your important contact information; the sort of information you are likely to use on a regular basis. * Please note that we cannot guarantee the security of as a method of communication. Some companies do monitor traffic, so please bear this in mind when sending us confidential information. 2 3

11 CONTENTS YOUR LIFELINE PLAN IN THE UNITED ARAB EMIRATES (UAE) 5 Your Lifeline Plan in the UAE 6 How to use your OIC Network Access card in the UAE 9 How to use your Bupa Global membership card 11 About your membership 12 Pre-authorisation 14 Making a claim 18 Assistance cover 21 Annual deductibles 23 Paying subscriptions and other charges 25 Your membership 31 Making a complaint Oman Insurance Company (OIC) has a network over 1,200 healthcare providers in the UAE (excluding Abu Dhabi*), and Bupa Global has expertise in health insurance administration all over the world. This collaboration between the two companies ensures that members get full access to medical treatment throughout the UAE. Accessing OIC s network of healthcare providers enables you to receive direct settlement when receiving eligible treatment at one of the providers in the OIC network. *Due to regulations, you must pay and claim for all treatment in Abu Dhabi. If you reside or work in Abu Dhabi and require treatment there, please contact Bupa Global Customer Services first on: +44 (0) Who is eligible? You will have access to direct settlement for eligible in-patient and day-case treatment in the OIC network of providers in the UAE if you are covered under one of the following International Lifeline plans: How do I get access? You need to complete the UAE Local Network Access Request form in your welcome pack and return it to Bupa Global. You will then be sent an OIC Network Access card that enables you access to and direct settlement for eligible treatment at the OIC network of hospitals and providers in the UAE. What next? Once you receive your OIC Network Access card, please read the How to use your OIC Network Access card in the UAE section. For treatment outside of the UAE, read the How to use your Bupa Global membership card section. If you are not eligible for, or choose not to apply for an OIC Network Access card, please read the How to use your Bupa Global membership card section for all treatment. 32 Glossary 36 Medical words and phrases Lifeline Essential Lifeline Classic Lifeline Gold 4 5

12 HOW TO USE YOUR OIC NETWORK ACCESS CARD IN THE UAE This section and all information in dark blue in this booklet provides information on how to use your OIC Network Access card in the UAE. Claims for treatment received within OIC Network in the UAE will be managed by OIC, whilst claims for treatment received outside the UAE will be managed by Bupa Global. Please note, you should only use your OIC Network Access card in the UAE. If you are travelling outside of the UAE, please read How to use your Bupa Global membership card section for details on how to use your Bupa Global membership card. Membership Cards For treatment in the UAE When you have completed and returned your UAE Local Network Access Request form, you will receive an OIC Network Access card. When you receive treatment anywhere within the UAE, you should present this card. If you lose your OIC Network Access card or you forget to bring it with you when you receive treatment in the UAE, then the treatment provider may not agree to direct settlement of your claim. However, provided your treatment is covered, you can still pay the treatment provider and then claim with an OIC reimbursement claim form. Please read How to Claim below for further details. For treatment outside the UAE You should present the Bupa Global membership card that you received when you joined the plan when you receive treatment outside the UAE. This card includes your name and membership number. If you lose either of your membership cards then please contact us immediately. For details on how to claim in the UAE, read Making a claim further on in this section. For details on how to claim outside the UAE, read the Making a claim section further on in this booklet. Returning your OIC Network Access card You must return your OIC Network Access card in the following situations: if your residency is changed to an address outside the UAE if your level of cover changes if your membership ends Please also read Ending your membership in the Your membership section. Getting treatment in the UAE Through this International Lifeline Plan and OIC Network Access card you will have access to OIC s network of over 1,200 UAE healthcare providers, including hospitals, clinics, laboratories and pharmacies. This is the UAE provider network, which is continually being developed to offer you access to appropriate healthcare. If you receive in-patient treatment at a UAE network provider using your OIC Network Access card, your medical provider will pre-authorise your treatment with OIC and submit their bill for any eligible treatment to OIC for payment. Please read the following section, which lists the pay and claim benefits. Pay and claim means you must pay for the eligible treatment and then submit a claim for reimbursement to OIC for treatment in the UAE (or to Bupa Global for treatment outside the UAE). Please see Making a claim below for further details. Direct settlement is limited to eligible in-patient treatment only. If you receive out-patient treatment, you will be asked to pay and claim. In addition, some further benefits are excluded from direct settlement within the OIC Network and for these benefits, you will be asked to pay and claim. Pre-authorisation We want to make paying for your treatment as easy as possible. After all, when you aren t feeling well, the last thing you need is to have to worry about form filling and paying bills. Pre-authorisation by your in-network healthcare provider can take all of that stress away from you. We then pay your healthcare provider directly (direct settlement) and you do not need to be troubled. In-patient and day-case treatment must be pre-authorised. We will not be able to pre-authorise your treatment if it is not covered. Please contact Bupa Global on +44 (0) if you are unclear about why we could not pre-authorise your treatment. How does it work? Make sure you have your OIC Network Access card with you when you go for treatment, otherwise you may have to pay yourself and submit a claim for reimbursement. Give your card to your in-network healthcare provider or pharmacist when you arrive. The information needed is on the card. When necessary they will contact OIC directly for pre-authorisation. OIC will confirm whether the treatment you are having is covered and that your membership is in order, issue a pre-authorisation and arrange for direct settlement wherever possible. If your cover does not include direct settlement for the treatment you need, or your treatment is with a non-network provider, you will be asked to pay yourself and submit a claim for reimbursement. Please see below for details as to how to do this. Making a claim Direct settlement If your treatment is eligible for direct settlement you will not need to submit a claim. Instead, your healthcare providers will submit the claim and we will settle the bills directly with them on your behalf. If you need to make a claim If you have received any treatment marked pay and claim, or have received out-patient treatment you will need to make a claim. OIC reimbursement claim forms are available on request from OIC, and are also available from providers. If you need to submit a claim, this should be sent to the following address: Bupa Global Claims Administration Oman Insurance Company (P.S.C) Health Department PO Box 5209 Dubai UAE 6 7

13 HOW TO USE YOUR OIC NETWORK ACCESS CARD IN THE UAE HOW TO USE YOUR BUPA GLOBAL MEMBERSHIP CARD Direct settlement is not available for out-patient treatment. THE FOLLOWING BENEFITS ARE ONLY PAY AND CLAIM : Out-patient surgical operations Wellness mammogram, PAP test, prostate cancer screening or colon cancer screening (after one year s membership) 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. If you don t know where to go, please contact our Healthline service for help and advice. Pre-authorisation puts us directly in touch with your hospital, so that we can look after the details while you concentrate on getting well. The Pre-authorisation section contains all of the rules and information about this. Costs for treatment by therapists and complementary medicine practitioners. Consultants and psychologists fees for psychiatric treatment Pathology, X-rays and diagnostic tests Consultants fees for consultations Family doctor treatment Prescribed drugs and dressings Accident-related dental treatment HIV/AIDS drug therapy including ART (after five years membership) Home nursing after in-patient treatment Participating hospitals To help you find 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 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 on (from inside the US), or (from outside the US) to arrange any treatment in the USA. Step 2: Contact us If you know that you may need treatment, please contact us first. This gives us the chance to check your cover, and to make sure that we can give you the support of our global networks, our knowledge and our experience. Pre-authorising in-patient treatment and day-case treatment You must contact us whenever possible before in-patient treatment or day-case treatment, for pre-authorisation. This means that we can confirm to you and to your hospital that your treatment will be covered under your plan. When you contact us, please have your membership number ready. We will ask some or all of the following questions: what condition are you suffering from? when did your symptoms first begin? when did you first see your family doctor about them? what treatment has been recommended? on what date will you receive the treatment? what is the name of your consultant? where will your proposed treatment take place? how long will you need to stay in hospital? If we can pre-authorise your treatment, 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 the Making a claim section for full details of how to claim. Here are some guidelines and useful things to remember. 8 9

14 ABOUT YOUR MEMBERSHIP What to send How we make payments Oman Insurance Company is working together with your rules and benefits in the How to use your We must receive a fully completed claim form and Wherever possible, we will follow the instructions Bupa Global to bring you the International Lifeline plan booklet and Table of benefits booklet the original invoices for your treatment, within six given to us in the payment section of the claim form: Plan, which is insured by Oman Insurance Company, within your membership pack months of the treatment date. and administered by Bupa Global. your membership certificate we can pay you or the hospital If this is not possible, please write to us with the we can pay by cheque or by electronic transfer This booklet forms part of your contract with The full name of your insurer is shown on your details and we will see if an exception can be made. we can pay in over 80 currencies us, along with your application form and your membership certificate. membership certificate. This is an annual contract. Your claim form You must ensure that your claim form is fully To carry out electronic transfers, we need to know the full bank name, address, SWIFT code and (in The agreement between you and us When your cover starts The start date of your membership is the effective completed by you and by your medical practitioner. Europe only) the IBAN number of your bank account. As a member of the Lifeline plan, you (the principal from date shown on your membership certificate. The claim form is important because it gives us all You can give us this information on the claim form. member) have formed an agreement with Oman the information that we need. Contacting you or Insurance Company about your cover. Only you and If you move to a new country or change your medical practitioner for more information can Tracking a claim Oman Insurance Company have legal rights under your specified country of nationality take time, and an incomplete claim form is the most We will process your claim as quickly as possible. You this agreement. You, the principal member must tell us straight common reason for delayed payments. can easily check the progress of a claim you have away if your specified country of residence or your made by logging on to our MembersWorld* website. This means that only you and no other party may specified country of nationality changes. Your new You can download a claim form from our enforce the terms of this agreement, whether under country may have different regulations about health MembersWorld website, or contact us to send Confirmation of your claim the Contracts (Rights of Third Parties) Act 1999 or insurance. You, the principal member need to tell you one. Remember that if your treatment is When your claim has been assessed and paid, we otherwise. We will of course allow anyone who is us of any change so that we can make sure that you pre-authorised, your pre-authorisation statement will will send a statement to you to confirm when and covered under your membership complete access to have the right cover. act as your claim form. how it was paid, and who received the payment. our complaints and dispute resolution process. Again, please contact us if you have any questions about this information. If you subscribe to our The following must be read together as they set out secure MembersWorld website, you can view your the terms and conditions of your membership: documents online, upload your claims and view your claims statement. you, the principal member s 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 10 11

15 PRE-AUTHORISATION This section contains rules and information about what pre-authorisation means and how it works. What pre-authorisation means Direct settlement/pay and claim We have made special arrangements if you need to Out of network treatment If we pre-authorise your treatment, this means that Direct settlement is where the provider of your have treatment or be hospitalised or visit a doctor in If your treatment in the USA has been we will pay up to the limits of your plan provided treatment claims directly from us, making things the USA. These include access to a select network of pre-authorised, but you choose not to go to a that all of the following requirements are met: easier for you. The alternative is for you to pay and quality medical providers and direct settlement of all network hospital, we will only pay 80 percent then claim back the costs from us. covered expenses when you receive treatment in a towards the cost of covered treatment. the treatment is eligible treatment that network hospital. is covered by your plan We aim to arrange direct settlement with them, There may be times when it is not possible for you to you have an active membership at the time that wherever possible. Please note: as limits apply to Treatment which has not been pre- be treated at a network hospital. These include: treatment takes place out-patient treatment we cannot guarantee payment authorised your subscriptions are paid up to date on any remaining outstanding claims that have not If you choose not to get your treatment in the USA where there is no network hospital within 30 the treatment carried out matches the already been processed for the same membership pre-authorised, we will only pay 50 percent towards miles of your address, and treatment authorised period. the cost of covered treatment. when the treatment you need is not available in you have provided a full disclosure of the the network hospital condition and treatment required Direct settlement is easier for us to arrange if you Of course we understand that there are times when you have enough benefit entitlement to cover pre-authorise your treatment first, or if you use a you cannot get your treatment pre-authorised, such In these cases, we will not ask you to share the cost the cost of the treatment participating hospital or clinic. as in an emergency. If you are taken to hospital in of your treatment. your condition is not a pre-existing condition (see the What is not covered? section in your Length of stay (in-patient treatment) an emergency, it is important that you arrange for the hospital to contact us within 48 hours of your Important rules Table of benefits booklet) Your pre-authorisation will specify an approved length admission. We can then make sure you are getting Please note that pre-authorisation is only valid if all the treatment is medically necessary of stay for in-patient treatment. This is the number the right care, and in the right place. If you have been the details of the authorised treatment, including the treatment takes place within 31 days after of nights in hospital that we will cover you for. If your taken to a hospital which is not part of the network dates and locations, match those of the treatment pre-authorisation is given treatment will take longer than this approved length and, if it is the best thing for you, we will arrange for received. If there is a change in the treatment of stay, then you or your consultant must contact us you to be moved to a network hospital to continue required, if you need to have further treatment, Note: from time to time we may ask you for more for an extension to the pre-authorisation. your treatment once you are stable. or if any other details change, then you or your detailed medical information, for example, to rule out any relation to a pre-existing condition. Treatment in the USA If we have been notified within 48 hours of an consultant must contact us to pre-authorise this separately. We make our decision to approve your Treatment we can pre-authorise All in-patient treatment and day-case treatment, cancer treatment and MRI, CT or PET scans in emergency admission to hospital, we will not ask you to share the cost of your treatment. treatment based on the information given to us. We reserve the right to withdraw our decision if We can pre-authorise in-patient treatment and the USA must be pre-authorised. If you are going additional information is withheld or not given to us day-case treatment, cancer treatment and MRI, CT to receive any of these treatments, ask your at the time the decision is being made. or PET scans. medical provider to contact Bupa Global for pre-authorisation. All the information they need is on your membership card

16 MAKING A CLAIM 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. If you are an OIC Network Access card holder looking to make a claim for treatment in the UAE, please read the Your Lifeline plan in the UAE section of this guide. If you are making a claim for treatment outside of the UAE, please follow the directions below. How to make a claim the results of any medical examination False information We will not add any personal restrictions or Claim forms performed at our expense by an independent If there is reasonable evidence that any person has exclusions to your cover, for any disease, illness or Your claim form is important as it gives us the medical practitioner appointed by us misled us or attempted to mislead us, either at the injury that started after you joined the plan as long information that we need to process your claim. If it written confirmation from you as to whether you time of joining or when making a claim, by: as you: is not fully completed we may have to ask for more think you can recover the costs you are claiming information. This can delay payment of your claim. from another person or insurance company giving false information gave us all the information we asked for before keeping necessary information from us, or you joined, and You must complete a new claim form: If you do not provide the information that we ask for, working with another party to give false have not applied to add any new options to your we may not pay your claim in full. information either intentionally or carelessly and cover. for each member for each condition Please also read about correspondence in the Your which may influence us in deciding: whether you (or they) can join the plan Confirmation of your claim for each in-patient or day-case stay, and membership section. what subscription has to be paid, or We will always send confirmation of how we have for each currency of claim whether we have to pay any claim dealt with a claim. If applicable, for child dependants Important (those aged under 18 years), we will write to the If a condition continues over six months, we will ask When making a claim please note: We shall have the right, where appropriate and principal member. If the claim is for treatment for a further claim form to be completed. at our sole and absolute discretion to end your received by the principal member, or an adult you must have received the treatment while membership, including the membership of any dependant (those aged over 18 years), we will write What to send us covered under your membership additional people included in your plan and seek to directly to the individual concerned. You need to return the completed form to us by post, with the original invoices, as soon as possible. This payment of your claim will be under the terms of your membership and up to the benefit levels recover any claim payments which have previously been made. We may refund any subscriptions How your claim will be paid must be within six months of receiving the treatment shown, that apply to you at the time you receive you have paid which relate to a period after your Wherever possible, we will follow the instructions for which you are claiming. Invoices sent to us after the treatment membership ends. However, we are entitled to given to us in the Payment details section of the six months will not normally be paid. we will only pay for treatment costs actually deduct money you may owe us from any refund. We claim form. incurred by you, not deposits or advance may also refer the case for legal action and/or law Requests for further information invoices or registration/administration fees enforcement agencies. Who we will pay We may need to ask you for further information to charged by the provider of treatment We will only make payments to the member support your claim. If we do, you must provide this. we will only pay for treatment costs that are We may alternatively: who received the treatment, the provider of the Examples of things we might ask for include: reasonable and customary treatment, the principal member of the membership we do not return original documents such as add new personal restrictions or exclusions to or the executor or administrator of the member s medical reports and other information about the invoices or letters. However, we will be pleased your cover, and/or estate. We will not make payments to anyone else. treatment for which you are claiming to return copies if you ask us when you submit deny payment against any pending claims your claim

17 Payment method and bank charges Sometimes, the international banking regulations do Overpayment of claims company that we nominate may therefore be We will make payment where possible by electronic not allow us to make a payment in the currency you If we overpay you for your claim, we reserve the right subrogated to all your rights of recovery and of any transfer or by cheque. Payments made by electronic have asked for. If so, we will send a payment in the to deduct the overpaid amount from future claims or person entitled to the benefits of your coverage. You transfer are quick, secure and convenient. To receive currency of your subscriptions. seek repayment from you. will need to sign and deliver all documents or papers, payment by electronic transfer, we need the full bank and anything else that is required to secure these account, SWIFT code, bank address details and (in If we have to make a conversion from one currency to Claiming for treatment when others are rights. You must not take any action which could Europe only) IBAN number to be provided on the another we will use the exchange rate that applies on responsible damage or affect these rights. claim form. either the date on which the invoices were issued or You must complete the appropriate section of the the last date of the treatment, whichever is later. claim form if you are claiming for treatment that is Claiming with joint or double insurance We will instruct our bank to recharge the needed when someone else is at fault, for example in You must complete the appropriate section on the administration fee relating to the cost of making the The exchange rate used will be the average of the a road accident in which you are a victim. If so, you claim form, if you have any other insurance cover electronic transfer to us but we cannot guarantee buying and selling rates across a wide range of will need to take any reasonable steps we ask of you for the cost of the treatment or benefits you have that these charges will always be passed back for quoted rates by the banks in London on the date in to assist us to: claimed from us. If you do have other insurance us to pay. In the event that your local bank makes a question. If the date is not a working day we will use cover, this must be disclosed to us when claiming, charge for a wire transfer we will aim to refund this the exchange rate that applies on the last working recover from the person at fault (such as and we will only pay our share of the cost of the as well. Any other bank charges or fees, such as for day before that date. through their insurance company) the cost of the treatment or benefits claimed. currency exchange, are your responsibility, unless they are charged as a result of our error. Other claim information treatment paid for by OIC or Bupa Global, and claim interest if you are entitled to do so Discretionary payments Cheques are no longer valid if they are not cashed We may, in certain situations, make discretionary or Note: Subrogation within 12 months. If you have an out-of-date cheque, ex gratia payments towards your treatment. If we In certain circumstances, for example, if you are the please contact customer services, who will be happy make any payment on this basis, this will still count victim of an accident, your insurer (or any person or to arrange a replacement. towards the overall maximum amount we will pay company we nominate) will have the full right of under your membership. Making these payments subrogation. This means that we can assume your Payment currency and conversions does not oblige us to pay them in the future. right to recoup the cost of treatment(s) that we have We can pay in the currency in which you pay your paid from the person at fault (or their insurance subscriptions, the currency of the invoices you send We do not have to pay for treatment that is not company). In the event of any payment of any claim us, or the currency of your bank account. covered by your plan, even if we have paid an earlier under your membership, we or any person or claim for a similar or identical treatment. We cannot pay you in any other currency

18 ASSISTANCE COVER (optional if purchased) This section contains the rules and information for Assistance cover, an optional benefit which helps you if you need to travel to get the treatment that you need. Note: there are two levels of Assistance cover: Evacuation and Repatriation. Your membership the treatment must be recommended by your consultant or family doctor and, for medical Evacuation cover: what we will pay for We will pay for either: certificate will show if you have Evacuation or reasons, not available locally If you have Evacuation cover it will be shown on your the reasonable cost of the return journey Repatriation but you can visit the MembersWorld the treatment must be eligible under your plan membership certificate. If you are still unsure you by the most direct route available by land website or contact the customer services helpline if you must have cover for the country you are can visit our MembersWorld website or contact the or sea, or you are unsure. being treated in, for example the USA customer services helpline. the cost of an economy class air ticket by What is Assistance cover? you must have the appropriate level of Assistance cover in place before you need the We will pay in full for your reasonable transport the most direct route available, whichever is the lesser amount The Evacuation and Repatriation options both cover treatment costs for in-patient treatment or day-case we will pay reasonable costs for the you for reasonable transport costs to the nearest treatment. It may also be authorised if you need transportation only of your body, subject appropriate place of treatment where the treatment Evacuation or Repatriation will not be eligible if advanced imaging or cancer treatment such as to airline requirements and restrictions, to that you need is available, if it is not available locally. you were aware of the symptoms of your condition radiotherapy or chemotherapy. your home country, in the event of your Repatriation also gives you the option of returning before applying for Assistance cover. We will only pay for Evacuation to the nearest death while you are away from home. to your specified country of nationality or your place where the required treatment is available. We do not pay for burial or cremation, specified country of residence. We will not approve a transfer which in our This could be to another part of the country that the cost of burial caskets etc, or the reasonable opinion is inappropriate based on you are in, and may not be your home country. transport costs for someone to collect or We may not be able to arrange Evacuation or established clinical and medical practice, and we We will pay for the reasonable travel costs for accompany your remains Repatriation in cases where the local situation makes are entitled to conduct a review of your case, another member to accompany you, but only if it it impossible, unreasonably dangerous or impractical when it is reasonable for us to do so. Evacuation or is medically necessary. Note: we do not pay for any other costs related to to enter the area; for example from an oil rig or Repatriation will not be authorised if this would be We will also pay for the reasonable costs of the evacuation such as hotel accommodation or within a war zone. against medical advice. your, and the accompanying member s, return taxis. Costs of any treatment you receive are not Assistance cover general rules The following rules apply to both the Evacuation and How to arrange your Evacuation or Repatriation journey to the place you were evacuated from. All arrangements for your return should be approved in advance by Bupa Global or our payable under Evacuation cover, but are payable from your medical cover as described in the What is covered? section of your Table of benefits booklet. Repatriation levels of cover: Arrangements for Evacuation or Repatriation will be appointed representatives and the journey must made by our appointed representatives and must be be made within fourteen days of the end of the Please also note that for medical reasons the you must contact our appointed representatives confirmed in advance by calling treatment. member receiving treatment may travel in a different for confirmation before you travel, on + 44 (0) You must provide us with any class from their companion. +44 (0) information or proof that we may reasonably ask you our appointed representatives must agree the for to support your request. We will only pay if all arrangements with you arrangements are agreed in advance by and Bupa Assistance cover is applicable for in-patient Global appointed representatives. treatment and day-case treatment only 18 19

19 ANNUAL DEDUCTIBLES Please read this section if you have an annual deductible on your plan. Please note that you cannot have access to the OIC network of providers if you have a deductible on your plan. Repatriation cover: what we will pay for We will pay either: Important please remember that: the annual deductible applies separately to each The annual deductible applies separately to each person on your, the principal member s If you have Repatriation cover it will be shown on the reasonable cost of the return journey person included on your membership membership. your membership certificate. If you are still unsure by the most direct route available by land as we may need to collect amounts from you by you can visit our MembersWorld website or contact or sea, or direct debit or credit card, you must have a valid The amount of your annual deductible will be shown the customer services helpline. Repatriation cover the cost of a scheduled return economy direct debit agreement or credit card authority on your membership certificate, which you can also includes Evacuation cover see above. class air ticket by the most direct route with us at all times. (We may suspend or view online at our MembersWorld website. If you available, whichever is the lesser amount terminate your cover if you do not have such an are unsure whether your cover includes an annual We will pay in full for your reasonable transport we will pay reasonable costs for the agreement or authority in place while you have deductible, please contact our customer services costs for in-patient treatment or day-case transportation only of your body, subject an annual deductible on your plan) helpline. treatment. to airline requirements and restrictions, to even if the amount you are claiming is less We will pay for repatriation to your specified your home country, in the event of your than the amount of the annual deductible, you At any point you can check the amount of your country of nationality or your specified country death while you are away from home. should still submit a claim to us remaining annual deductible by contacting our of residence. We do not pay for burial or cremation, this is an annual deductible. Therefore, if customer services helpline. We will pay for one repatriation for each illness or injury per lifetime. the cost of burial caskets etc, or the transport costs for someone to collect or your first claim is towards the end of your membership year, and treatment continues How an annual deductible works We will pay the reasonable costs for a relative accompany your remains over your renewal date, the annual deductible If a claim is smaller than your remaining annual or your partner to accompany you to your is payable separately for treatment received in deductible, you must still submit it to us as normal. specified country of nationality or your Note: we do not pay for any other costs related to each membership year We will not pay any benefit, but the claim will count specified country of residence if we have authorised this in advance of the repatriation. the repatriation such as hotel accommodation or taxis. Costs of any treatment you receive are not What is an annual deductible? towards reaching your annual deductible. We will send you a statement informing you how much is left. We will also pay an allowance of up to GBP 25, payable under Repatriation cover, but are payable The annual deductible is the total value that your USD 50 or EUR 37 per day for up to 10 days from your medical cover as described in the What is eligible claims must reach each membership year If an eligible claim exceeds your remaining annual to cover the living expenses of the person covered? section of your Table of benefits booklet. before we will start to pay any benefit. deductible, we will pay the amount of the claim less accompanying you. the remaining annual deductible. We will pay for you and the person Please also note that for medical reasons the For example, if you have an annual deductible of accompanying you to return to where you were member receiving treatment may travel in a different GBP 500, the total value of your eligible claims must Once your annual deductible is reached, we will pay repatriated from. All arrangements for your class from their companion. reach GBP 500 before we will pay any benefit. all eligible claims in full, up to the benefit limits of return must be approved in advance by Bupa your plan. Global or our appointed representatives and you must make the return journey within fourteen days of the end of the treatment you were repatriated for

20 PAYING SUBSCRIPTIONS AND OTHER CHARGES How claims are paid to you If you submit a claim and have asked us to pay you: benefit will be paid less the amount of 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 If you have asked us to make a payment direct to your medical provider: All references to you and your in this section refer to you, the principal member only, unless stated otherwise. Paying subscriptions You have to pay subscriptions to OIC in advance for you and your dependants throughout your membership. The amount you have agreed to pay, and the method of payment you have chosen are shown on your invoice. Your subscriptions must be paid in the currency of your contract, as shown on your invoice. Paying other charges In addition to paying subscriptions, there may be other charges that you also have to pay to us, depending on the laws of your residency country. These may include Insurance Premium Tax (IPT), or other taxes, levies or charges relating to your cover under the plan. If they apply to you, they will be included within the total that you have to pay on your invoice. The charges may apply from the effective date of your membership or your annual renewal date. You must pay any such charges to us when you pay your subscriptions, unless otherwise required by law. we will send payment to the provider for the full amount of the eligible claim, without deducting any annual deductible we will then collect any annual deductible from you using the direct debit mandate or credit card authority, depending on which is your usual method of payment we will also send you a statement showing the amount of the annual deductible that and Bupa Global will be collecting from your account You are responsible for paying the annual deductible in all circumstances. Your subscriptions should only be paid directly to OIC. If you pay your subscriptions to anyone else, such as an intermediary or insurance broker, then that person is acting on your behalf as your agent. OIC will not be responsible for any subscriptions paid to a third party. If you are unable to pay your subscriptions for any reason please contact the customer services helpline. If subscriptions and other charges are not paid If you do not pay subscriptions and other charges in full by the date they are due, you and your dependant s membership may be suspended and claims submitted whilst there are subscriptions and charges due will not be paid. You and your dependant s membership may also be suspended if you do not settle in full any annual deductible payable by you for a claim which has been paid direct to you and your dependant s medical provider. Claims submitted whilst repayment of an annual deductible is due will not be paid

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