Premier 1 Diamond Valid from 2009 • USD Your guide

Contents

3 We put your health first

5 Your cover

9 Manage your policy online

10 USA Medical Services

13 How and when you can claim

18 List of Reimbursements

22 Policy Conditions (incl. Glossary)

2 We put your health first

Have you ever thought about what would happen to your family, career and financial situation if you had an unexpected illness?

Our experience shows that long-term ihi Bupa – a company you can trust illness may have serious financial and We have built up a global network of social consequences. business partners and well-respected medical consultants. We are regulated by At ihi Bupa, we put your health first by the strict standards set by the Danish and offering you the best suited insurance plan UK Insurance Authorities (FSA) and the and advising you on health and wellbeing. European supervisory authorities.

ihi Bupa is a part of the worldwide health and care organisation Bupa International, which has over 35 years' expertise in caring for the healthcare needs of expats, local nationals and their families around the globe.

Covering almost 800,000 people in 190 countries, Bupa International is the largest international health insurer in the world, providing quality individual and group medical cover to people who are in their home country or living abroad.

3 4 Your cover

Whether you are in your home country or living and working abroad, it’s important to make sure your health is taken care of. Our Diamond plan is designed to travel with you - giving you choice, flexibility and the peace of mind that comes with belonging to an internationally recognised organisation.

Premier 1  Diamond offers you You can be insured regardless of most comprehensive services, top benefits and conditions that you may have suffered worldwide cover for both inpatient and from before taking out the insurance. outpatient benefits. The yearly insurance sum ihi Bupa’s medical consultants will conduct is unlimited, giving you complete peace of an assessment of your condition and decide mind. Furthermore, you are covered both in the terms of your insurance policy. There may and out of ihi Bupa’s provider network giving be an additional premium or exclusion for a you freedom of choice when deciding which given condition. hsopital, or specialist to use. We take care of your children Lifetime cover When a parent is eligible for mater­­nity cover People of all nationalities under the age (after 10 months of cover), a newborn child is of 75 years can apply. Once accept­ed, we automatically enrolled in the parent’s policy guarantee that the policy can be renewed irrespective of the child’s state of health at for the rest of your life – regardless of your birth*. Furthermore, two children under the age and changes in your health. Even if you age of ten are insured free of charge. develop a long-term chronic illness, your cover will remain unchanged. Occupations and activities Whatever your work involves or wherever it may take you, you will be covered. There are no restrictions on hobbies or sports of any kind, even if conducted on a professional level.

* See Art. 8.2 h)

5 Supplementary option Lower your premium with deductibles With a Premier 1 plan your medical expenses We offer a range of annual deductible options are of course covered on travels outside to help you reduce the price you pay for your your country of residence but by taking out cover – the higher the deductible, the lower Worldwide Travel Options you get extra travel the premium. You can choose between the benefits; eg next of kin accompaniment and following deductibles: repatriation if relatives at home get seriously, acutely ill. Furthermore, there is no deductible Deductible (USD) on Worldwide Travel Options – your travel 250 500 1,000 2,000 5,000 10,000 claims count towards the annual deductible on Premier 1. If you take out Worldwide Travel Options in addition to Premier 1 you will There is only one deductible per person per receive a discounted rate on the travel plan. policy year and this applies to all services. However, to help you reduce your costs, as The Policy Conditions for Worldwide Travel a family you will only have to pay the sum of Options are described in a separate brochure. the two highest deductibles on your policy.

Please see the List of Reimbursements and the Policy Conditions for more details.

6 7 8 Manage your policy online

As an ihi Bupa customer you have access to a range of online services. Visit www.ihi.com and click on myPage, follow the guide and get access to:

zz A complete overview of your policy Sign up as online customer - free and easy zz All your documents (policy schedule, Our online customer solution is a service renewals, premium notices, receipts, for you who wish to avoid postal delays, reimbursement letters, etc.) letters lost in the mail, sorting of insurance documents and filing in binders. Sign up on zz Status on recent claims reimbursed www.ihi.com under myPage now and your policy will be serviced online exclusively. zz Online premium payment We will notify you by e-mail when we zz ihi Bupa’s medical consultants give you have updates related to your insurance. advice and guidance on treatment, That way you are always fully informed including second opinions. of your insurance status.

9 USA Medical Services

One of the advantages of being a customer at ihi Bupa is our medical centre – USA Medical Services. Our professional, careful and service minded staff are ready to assist you 24 hours a day, 365 days a year, and several of our own medical consultants are always on duty.

Our medical centre gives you: The purpose of our team of medical consultants

zz Assistance in case of illness and is to give advise should you become ill and emergency - including arrangement ensure that immediate and correct treatment is of medical evacuations arranged. The team is carefully put together and includes 18 medical consultants.

zz Assistance in practical matters related to a hospitalisation We are often in contact with nurses and doctors at the before, during and

zz Guidance when finding the right place after the course of treatment, and we get many of treatment. You only need to send questions in connection with routine treatments, us medical information together with hospitalisations and evacuations which can be the diagnosis and we will provide answered immediately due to the experience and you with information on relevant knowledge of our doctors, nurses, and medical and appropriate places of treatment coordinators. in the countries of your choice. USA Medical Services has access to our policy and

zz Access to medically qualified service systems and co-operates closely with your representatives with extensive service team, meaning that the solution is tailored experience in the industry to help to your specific needs. We provide service to our you avoid or reduce unnecessary own customers exclusively and have in-depth medical expenses and overcharges knowledge about the specific different insurance products: We make the correct decisions – fast

zz Advice when planning journeys abroad and efficiently. USA Medical Services is your direct line to medical expertise.

zz Access to national and international networks of doctors, , ambulance companies, hospitals, etc.

10 11 12 How and when you can claim

Waiting periods Reimbursement In the event of an acute, serious illness or Reimbursements of costs incurred will injury, the cover will start immediately from be paid in accordance with the List of the policy commencement date. For other Reimbursements when the annual deductible conditions, there will be a waiting period of has been met. 4 weeks – with the following exceptions: In the event that a hospitalisation takes place

zz If you switch to ihi Bupa from another in the U.S.A., co-insurance will be deducted international plan with from the reimbursement. another company, the cover will come into force immediately on the policy Co-insurance commencement date. Co-insurance is the part of the medical bills that you must pay for each hospitalisation

zz The waiting period in connection with that takes place in the U.S.A. Once the pregnancy and childbirth is 10 months. deductible and the specific reimbursement rates have been applied, ihi Bupa will reimburse 80% of the first USD 5,000 and 100% of the remaining balance. This means that the maximum co-insurance you would have to pay for each hospitalisation in the U.S.A. is USD 1,000. There will be no co- insurance in connection with medical bills for maternity and serious accidents.

13 Day case and inpatient/hospitalisation and inpatient/hospitalisation benefits, after treatment in and out of network any deductible and co-insurance, will also be Please let us know of any admission to reimbursed in full. Please notice that it is a as soon as possible so that we can requirement that you contact ihi Bupa for pre- arrange for direct settlement of your bills and approval of any treatment within ihi Bupa’s leave you to concentrate on getting better. network of providers for reimbursement to When you contact us, please let us know: be paid in full. If, in case of an emergency, you are not reasonably able to contact us

zz Date of admission for pre-approval you must in any event let us know of any admission to a network hospital

zz D i a g ­n o s i s within 72 hours.

zz Treatment If the provider of your choice in the U.S.A. is not part of ihi Bupa’s network of providers,

zz Expected date of discharge the out of network limits in the valid List of Reimbursements will apply. Expenses in connection with the notification of a hospital admission will be refunded We have a quality assured network of by ihi Bupa (eg your call to ihi Bupa from providers including more than 400,000 another country). hos­pitals, clinics and medical practitioners. This means that you can rest assured that you You can freely choose to receive treatment in will receive the very best treatment within any hospital or clinic. Day case and inpatient/ ihi Bupa’s network of providers, and most of hospitalisation treatment that takes place your expenses can be settled directly with outside the U.S.A. will be reimbursed in full. If your medical facility. You can get further the treatment takes place in the U.S.A. within information regarding ihi Bupa’s network of ihi Bupa’s network of providers all day case providers by contacting USA Medical Services or visiting myPage on www.ihi.com.

14 15 16 Other treatment Medical evacuation You are also free to choose any provider Regardless of the circumstances, you must for outpatient treatment, such as medical inform us before the transportation is consultations and physiotherapy. These commenced, either directly or through the expenses should be paid by the insured attending physician. Medical evacuation before claiming reimbursement. services must be pre-approved and arranged by ihi Bupa. In consultation To claim reimbursement for expenses for with the attending physician, our medi­cal outpatient treatment, please submit: consultants will choose an alternative place of treatment. We will take care of every detail

zz Official, original and itemised bills and to ensure that the transportation and the receipts hospitalisation are managed as efficiently as possible.

zz A completed Claim Form

On receipt of the completed Claim Form we will process your claim and reimburse you in USD or any other convertible currency of your choice.

17 List of Reimbursements Valid from 1 January 2009

Expenses will be reimbursed according to the following rates. Reimbursement will be paid when the total reimbursable amount exceeds the selected deductible. The List of Reimbursements forms part of the Policy Conditions. It is therefore recommended to read both the List of Reimbursements and the Policy Conditions carefully.

Words written in italic in the List of relevant to your cover. Please check their Reimburse­ments and the Policy Conditions meaning in the Glossary at the end of this are ‘defined terms’ which are specific terms product guide.

All amounts are in usd Maximum coverage Maximum cover, per person per policy year Unlimited

Day case and inpatient/hospitalisation benefits Treatment outside the U.S.A.: If treatment takes place outside the U.S.A., all the below day case and inpatient/hospitalisation benefits will be reimbursed in full

The below maximum days and rules of pre-approval still apply

Treatment in network of providers in the U.S.A.: 100% If the Company’s network of providers is chosen, all the below day case and inpatient/hospitalisation benefits will be reimbursed in full

The below maximum days and rules of pre-approval still apply

Treatment in network of providers must be pre-approved by the Company Treatment out of network in the U.S.A.: If a hospital or clinic in the U.S.A. not in the Company’s network of providers is chosen, reimbursement of the expenses will be made according to the following maximum reimbursement rates Doctors’ fees for surgical and medical services 100% Private or semi-private room, per day 2,000 Intensive care room, per day 4,000 Related services: nursing, theatre fees, medicine and dressings 100% Local calls, TV, guest meals and newspapers 100%

18 Day case and inpatient/hospitalisation benefits (Continued) Room and board at the hospital for a relative accompany­ing an insured person, 400 per day Medically prescribed inpatient rehabilitation (hospital or rehabilitation­ centre) due to serious accident/illness Max. per day all-inclusive 100% For max. 30 days per incident

Inpatient rehabilitation must be pre-approved by the Company Medical treatment and tests, including outpatient surgery 100% Emergency room treatment in connection with acute illness or accident 100% Prostheses, corrective devices and medical applian­ces which are medically required 100% and implanted during surgery Acute emergency dental treatment due to serious accident up to 30 days after discharge from hospital 100% In case of doubt the decision will be left with the Company’s dental consultant Co-insurance will be applied to each hospitalisation in the U.S.A.

Other benefits Chemotherapy/medicine and radiation for treatment of cancer 100% Dialysis for kidney failure 100% Organ transplant, lifetime max. per diagnosis and course of treatment, all-inclusive 750,000 Only cover for transplant of human organs. The procurement of the organ must be pre-approved by the Company Medically prescribed home nursing by a registered nurse following hospitalisation due to serious accident/illness Limited to 30 days per incident 100%

Home nursing must be pre-approved by the Company Hospice and terminal care: day case, inpatient or outpatient treatment 100% Hospice and terminal care must be pre-approved by the Company Emergency local road ambulance to and from hospital 100%

Maternity Normal delivery, complicated delivery and elective caesarean delivery, incl. pre- and 8,500 postnatal treatment Medically prescribed caesarean delivery, incl. pre- and postnatal treatment 13,000 There is a waiting period of ten months before the maternity benefits come into force

19 Outpatient benefits Doctors, specialists and/or psychiatrists Max. 30 consultations per policy year Surgical intervention Laboratory test, x-ray, endoscopy (eg gastroscopy, colonoscopy, cystoscopy), electro­cardiogram, echocardiography, biopsy and ultrasound mri, cat and pet scans 100% Therapy, incl. doctor’s consultations and treatment: physiotherapy, chiropractic treatment, osteopathy, acupuncture, homoeopathic treatment, occupational treatment and medic­ally prescribed short term speech therapy in connection with an illness or injury Max. 60 consultations in total per policy year Prescribed dietetic guidance by an authorised dietician Max. 4 consultations per policy year Full health assesment, all-inclusive Max. per policy year 600 Health screenings: mammogram, pap smear, prostate cancer screening and/or colorectal cancer screening Max. per policy year 500 Prescribed medicine following hospitalisation and outpatient surgery for the purpose of covered treatment Max. per person per policy year 4,000

The medicine must be related to the treated diagnosis and a hospital prescription must be enclosed with the Claim Form Prescribed medicine for the purpose of covered outpatient treatment Max. per person per policy year 700

A prescription must be enclosed with the Claim Form. There is no cover for medicines that are freely available for self-administration

Medical evacuation Evacuation services 100% Transportation to the nearest suitable location in the event of an acute serious 100% illness or serious in­jury where no qualified treatment can be obtained locally Expenses for a family member or a friend accompanying the insured during 100% the transportation Expenses for the return journey upon completion of the treatment to the place from where the insured was evacuated; for the insured and any 100% accompanying person In case of death, transportation of the deceased and statutory arrangements, 100% such as embalmment and zinc coffin Evacuation services must be pre-approved by the Company and the arrangements made by the Company

20 Online services yy Manage your policy online, eg online payments, status on recent claims yy General health advice and second opinions from ihi Bupa’s medical consultants yy Access to a range of health related information yy and much more...

Supplementary option Worldwide Travel Options (not automatically included) Annual insurance sum Unlimited yy Cover for sudden unexpected illness or injury when travelling outside your country of residence yy Next of kin accompaniment yy Repatriation in case of a relative falling seriously, acutely ill yy No deductible is applied The conditions regulating Worldwide Travel Options are found in a separate brochure

21 Policy Conditions Valid from 1 January 2009

In accordance with the Danish Insurance Contracts Act.

Index Art. 1 Acceptance of the insurance Art. 2 Commencement date Art. 3 Waiting periods in connection with new insurance contracts Art. 4 Who is covered by the insurance? Art. 5 Where is cover provided? Art. 6 What is covered by the insurance? Art. 7 Medical evacuation Art. 8 Exceptions for reimbursement Art. 9 How to report a claim Art. 10 Cover by third parties Art. 11 Payment of premium Art. 12 Information necessary to the Company Art. 13 Assignment, cancellation and expiry Art. 14 Disputes, venue, etc. Glossary

22 Art. 1 Acceptance of the insurance 1.4: In the event of a change in the 1.1: Bupa Denmark, filial af Bupa Insurance applicant’s state of health after the Limited, England (Bupa Denmark, branch of application has been signed and before the Bupa Insurance Limited, England), hereinafter Com­pany’s approval thereof, the applicant called the Company, shall decide whether shall be under the obligation to notify the the insurance can be accepted. In order Company of such change immediately. for the insurance to be accepted and the Company to become liable, the application Art. 2 Commencement date must be approved by the Company and the 2.1: The insurance shall be valid as of the necessary premium paid to the Company. date on which the application is approved by the Company. The commencement 1.2: In order for the insurance to be accepted date is stated in the policy schedule. The by the Company, an application must be Company may agree on another date with submitted prior to the applicant attaining the policyholder. the age of 75 (seventy-five). The Company has the right to waive this requirement in exceptional cases. Art. 3 Waiting periods in connection with new insurance contracts 1.3: In order for the insurance to be accepted 3.1: When a new insurance contract is by the Company on standard terms, the entered into, the right to reimbursement applicant must be of sound health at the time under the new insurance contract shall of acceptance and must not suffer nor have only take effect 4 (four) weeks after the suffered from any recurring disease, illness, commencement date of the insurance. injury, bodily infirm­ity or physical disability. However, this does not apply when the policyholder can prove simultaneous 1.3.1: If the conditions in Art. 1.3 are not transference from an equivalent insurance met, the Company may offer the insurance with another international health insurance on special terms. If the Company decides company. to offer the insurance on special terms, the policyholder will receive a policy schedule in 3.1.1: In the event of acute serious illness and/ which these terms are stated. or serious injury, the right to reimbursement shall, however, take effect concurrently with 1.3.2: All underwriting and issuance the commencement date of the insurance. of policy schedules are made from the Company’s office in Copenhagen, Denmark. The Company may choose to have data processed in or outside the EU

23 3.1.2: However, for pregnancy and childbirth 4.3: An application must be submitted for and consequences thereof the right to newborn children. reimbursement shall only take effect 10 (ten) months after the commencement date of the 4.3.1: If the insurance of one of the parents insurance. has been valid for a minimum of 10 (ten) months, newborn children of the parent can 3.2: The insured may change his/her be insured, irrespective of Art. 1.3, without insurance cover to another type of cover as submitting an application, cf. however Art. from a policy anniversary by giving 1 (one) 8.2 h). A copy of the birth certificate must, month’s written notice to the Company and however, be submitted within 3 (three) subject to proof of insurability according to months after the birth. If the Company does Art. 1. not receive the birth certificate within 3 (three) months after the birth, the newborn 3.3: The Company will process an ex­tension child will have to undergo the standard of cover as a new application in accordance underwriting procedure, according to Art. 1. with Art. 1. 4.3.2: In case of adoption, the insured must submit a Medical Questionnaire for the Art. 4 Who is covered by the insurance? adopt­ed child. 4.1: The insurance shall cover the insured person(s) named in the policy schedule, including children registered therein. Art. 5 Where is cover provided? 5.1: The insurance shall provide worldwide 4.2: Per family, 2 (two) children under 10 cover unless otherwise stated in the policy (ten) years of age can be insured free of schedule. charge if the requirements for acceptance on standard terms, cf. Art. 1.3, are met. Art. 6 What is covered by the insurance? 4.2.1: Free cover of children shall be subject 6.1: The insurance shall cover the insured’s to: medical expenses in accordance with the cover chosen and the applicable reimbursement

zz the child being registered with the rates. The valid reimbursement rates are Company, and stated in the List of Reimbursements.

zz one of the insured persons having legal custody of the child. 6.2: Reimbursement shall be paid following the Company’s approval of the expenses

24 as being covered by the insurance after a authorities, but under scientific research will fully completed Claim Form with original, only be covered if approved in advance by the receipted and itemised bills enclos­ed has Company’s medical consultants. been submitted to the Company. 6.5: In no event shall the amount of 6.3: Once the covered expenses have met reimbursement exceed the amount shown on the annual deductible, the reimbursable the bill. If the insured receives compensation amount will be paid. The deductible shall be from the Company in excess of the amount reduced with amounts not exceeding the to which the insured is entitled, the insured maximum reimbursement rates specified shall be under the obligation to repay the in the valid List of Reimbursements. The Company for the excess amount immediately, deductible shall apply per person per otherwise the Company will set off the excess policy year. However, a maximum of 2 amount in any other account between the (two) deductibles per family per policy year insured and the Company. shall apply. (The sum of the two highest deductibles on the policy is the maximum 6.6: Reimbursements shall be limited to the deductible drawn on the policy per policy usual, customary and reasonable charges year). Each hospitalisation in the U.S.A. is in the area or the country in which the subject to co-insurance. Once the applicable treatment is provided. deductible and spe­cific limits have been met, the Company will reimburse 80% of 6.7: Any discount, which has been negotiated the first USD 5,000 and 100% of sums in directly between the Company and providers, excess of USD 5,000 up to the relevant will be specifically used by the Company for reimbursement rates. the overall benefit of the insured persons within the insurance product as a whole. 6.3.1: In case of serious accident, no deductible or co-insurance shall apply for the 6.8: Any ex-gratia payments are at the period of the first hospitalisation. Company’s discretion. If the Company makes a payment to which the insured is not entitled 6.4: Physicians, specialists, etc. performing under the insurance, this will still count toward the treatment must have authorisation the annual maximum ­cover per person per in the country of practice. Furthermore, policy year. the method must be approved as being suitable for the given diagnosis by the public health authorities in the country where the Art. 7 Medical evacuation treatment takes place. Methods of treatment 7.1: For cover of medical evacuation the not yet approved by the public health conditions listed below shall apply.

25 7.1.1: Reimbursement shall be paid for 7.1.7: In the event that the insured is reasonable expenses incurred by the insured transported for the purpose of receiving for air ambulance transportation in the event treatment, he/she and the accompanying of acute serious illness or serious injury. person, if any, shall be reimbursed for the Transportation shall be to the nearest suitable expenses for a return journey to the place place of treatment and only if no qualified from where the insured was evacuated. The treatment can be obtained locally. return journey shall be made at the latest 90 (ninety) days after the treatment has been 7.1.2: The evacuation expenses for completed. Cover shall only be provided for a transportation covered under the travelling expenses equivalent to the cost of insurance shall only be compensated if the an aeroplane ticket on economy class, as a transportation is arranged by the Company. maximum.

7.1.3: Cover shall be provided subject to the 7.1.8: In the event that the insured has attending physician and the Com­pany’s received treatment covered by the insurance, medical consultants agreeing on the necessity but has reached the terminal phase, he/she of transferring the insured, and agreeing on and the accompanying person, if any, shall whether the insured should be transferred to be reimbursed for the expenses of the return his/her country of residence/home country or journey to the insured’s place of residence. to the nearest suitable place of treatment. 7.1.9: In the event of death, expenses shall 7.1.4: The insurance shall cover reason­ be reimbursed for home transportation of the able and medically necessary transportation deceased and for the statu­tory arrangements expenses only for 1 (one) person such as embalming and a zinc coffin. The next- accompanying the insured. of-kin have the following options:

7.1.5: Only 1 (one) transportation is covered a) cremation of the deceased and home in connection with one course of an illness. transportation of the urn, or

7.1.6: Medical evacuation cover shall only b) home transportation of the deceased. apply if the illness is covered under the insurance and if the insured’s cover includes 7.1.10: The Company cannot be held liable the country to which the insured is being for any delays or restrictions in connection transported. with the transportation caused by weather conditions, mechanical problems, restrictions imposed by public authorities or by the pilot or any other condition beyond the Company’s control.

26 Art. 8 Exceptions for reimbursement e) intentional self-inflicted bodily injury, 8.1: The insurance shall not cover medical expenses incurred for any disease, illness or f) contraception, including sterilisation, injury known to the policyholder and/or the insured at the time of application, unless g) induced abortion unless medically agreed upon with the Company. prescribed,

8.2: Furthermore, the Company shall not be h) any kind of fertility test and/or liable to pay reimbursement for expenses treatment, including hormone treatment, which concern, are due to or are incurred as insemination, or examinations and any a result of: procedures related hereto. An application must be submitted for children born as a a) cosmetic surgery and treatment, result of fertility treatment and/or born unless medically prescribed and by a surrogate mother. The application approved by the Company, will under­go the standard underwriting procedure, according to Art. 1, b) obesity surgery, unless approved by the Company, i) treatment of sexual dysfunction,

c) venereal diseases, AIDS, AIDS- j) any kind of care which is experimental, related diseases and diseases relating not part of a medical or surgical to HIV antibodies (HIV positive). treatment, including stays in long- However, diseases relating to AIDS term care establishments, health and HIV antibodies (HIV positive) are resorts, convalescent homes and similar covered if proven to be caused by a institutions, blood transfusion received after the commencement date. The HIV virus will k) treatment by naturopaths or also be covered if proven to be contracted homoeopaths and naturopathic or as the result of an accident occurring homoeopathic medications and other during the course of a normal occupation. alternative methods of treatment, unless The insured shall notify the Company specified in the List of Reimbursements, within 14 (fourteen) days after such and mental health inpatient stay that is accident and at the same time provide a purely for the purpose of treatment by a negative HIV antibody test, psychologist,

d) abuse of alcohol, drugs and/or medicines,

27 l) routine medical examinations, unless s) medicine, whether given by injection specified in the List of Re­imbursements, or otherwise, medical articles and vaccinations, the issuing of medical auxiliary appliances which have not been certificates and attestations and administered during hospital­isation, unless examinations as to suitability for specified in the List of Reimbursements, employment or travel, t) hospitalisation if the sole purpose is m) treatment of diseases during military administration of medicine, treatment by service, a therapist or complementary medical practitioner or any ­other treatment n) treatment for sickness or injuries directly when this could take place as outpatient or indirectly caused while actively treatment. engaging in:

war, invasion, acts of a foreign ­enemy, Art. 9 How to report a claim hostilities (whether war has been declared 9.1: For each claim, a fully completed Claim or not), civil war, terrorist acts, rebellion, Form must be submitted to the Company. revolution, insurrection, civil commotion, The Claim Form must be completed and military or usurped power, martial signed by the attending phys­ician and law, riots or the acts of any lawfully accompanied by the official, ori­ginal and constituted authority, or army, naval or itemis­ed bills and receipts for the treatment air services operations, whether war has received. The bills and receipts shall be been declared or not, denominated in the currency of the country, where the treatment is provided. Photocopies o) nuclear reactions or radioactive fallout, shall not be regarded as acceptable documentation. p) treatment performed by the insured and/ or his/her family or any enterprise owned The Company scans original bills upon by or connected with one of the aforesaid receipt. Any retrieval of the original invoice persons, is not possible. The scanned bill stamped ‘Certified as a true Copy’ represents the q) epidemics which have been placed under original. the direction of public author­ities, 9.2: Written proof of claim must be r) treatment by psychologists, submitted to the Company immediately and at the latest within 90 (ninety) days of the insured event for which the claim is brought.

28 9.2.1: Complaints regarding the Com­pany’s Art. 10 Cover by third parties claims handling shall be filed not later than 10.1: Where there is cover by another 30 (thirty) days after receipt of the amount of insurance policy or healthcare plan, this must reimbursement. be disclosed to the Company when claiming reimbursement. 9.3: The Company shall be notified immediately of any stays in hospital, and 10.2: In these circumstances the Com­ such notification must include the physician’s pany will co-ordinate payments with other diagnosis. All notifications should be made companies and the Company will not be by telephone, fax or e-mail; the Company liable for more than its ratable proportion. shall defray all expenses incurred in this connection. 10.3: If the claim has been covered in whole or in part by any scheme, programme or 9.3.1: All day case and inpatient/ similar, funded by any Government, the hospi­ talisation­ treatment within the Company shall not be liable for the amount Company’s network of providers in the U.S.A. covered. must be pre-approved by the Company. If the Company is not contacted for pre-­approval, 10.4: The policyholder and any insured the expenses will be reimbursed according to person undertake to co-operate with the the out of network limits stated in the valid List Company and to notify the Company of Reimbu rsements. If, due to an emergency, immediately of any claim or right of action the insured is not reasonably able to contact against third parties. the Company for pre-approval the insured must let the Company know of any admission 10.5: Furthermore, the policyholder and any to hospital within 72 hours. insured person shall keep the Com­pany fully informed and shall take any reasonable steps 9.3.2: If, during the approval phase, it in making a claim upon another party and to becomes evident that the Company’s safeguard the interests of the Company. network of provi­ders in the U.S.A. cannot offer the treatment in question, the 10.6: In any event the Company shall have Company will in any event reimburse the the full right of subrogation. expenses as if the treatment had taken place within the network of providers.

29 Art. 11 Payment of premium 11.7: In the event of the death of a policy­ 11.1: Premiums are determined by the holder, who is also insured on the policy, Company and shall be payable in advance. the premium on the policy may be waived The Company adjusts the premiums once for a period of 12 (twelve) months from the a year as from the anniversary date on the upcoming premium due date. The death basis of changes in the covers and/or the loss must have been caused by a condition experience in the insurance class during the which would have been covered under this previous calendar year. policy had the policy­holder survived. The waiver applies only to the spouse or partner 11.2: The premium is age-related and and their children under the age of 24 who will therefore also be adjusted on the first remain insured ­under the existing policy and premium due date after the insured’s will automatically terminate in the event birthday. of marriage of the remaining spouse or partner. The waiver does not apply to any 11.2.1: In the case of a child turning supplementary ­insurance. 10 (ten) a pro rata premium will be charged on the due date prior to the child’s 10th 11.8: The policyholder’s attention is drawn (tenth) birthday. to Art. 6.5 regarding payment of outstanding amounts. 11.3: The initial premium shall fall due for payment on the commencement date. The policyholder may choose between quarterly, Art. 12 Information necessary to the semi-annual and annual premium­ payments. Company 12.1: The policyholder and/or the insured 11.4: Changes in the term of payment can shall be under an obligation to notify the only be made at 30 (thirty) days’ written Company in writing of any changes of name notice prior to the policy anniversary. or address and changes in health insurance cover with another company, including a 11.5: There are 10 (ten) days of grace on consolidated company. If the policyholder each premium due date. and/or the insured change address to a different premium zone, the premium 11.6: The policyholder shall be respon­sible applicable to the new zone will apply from the for punctual payment to the Company and, first coming anniversary date. The Company if a premium is not received by the Company must also be notified in the event of the within the 10 (ten) days’ grace period at any death of the policyholder or an insured. premium due date, the Company’s liability The Company shall not be liable for the shall lapse. consequences if the policyholder and/or the insured fail to notify the Company of such events.

30 12.2: The insured shall also be under the insurance contract shall be void and shall not obligation to provide the Company with be binding on the Company. all obtainable information required for the Company’s handling of the insured’s claims 13.4: Where upon taking out the insurance against the Company. or subsequently, the policyholder and/or the insured has disclosed incorrect information, 12.3: In addition, the Company is entitled to the insurance contract shall be void, and the seek information about the insured’s state of Company shall not be liable if the Company health and to contact any hospital, physician, would not have accepted the insurance if the etc. who is treating or has been treating correct information had been disclosed. If the the insured for physical or mental illnesses Company­ would have accepted the insurance or disorders. Furthermore, the Company is but on other terms, the Company shall be entitled to obtain any medical records or other liable to the extent ­to which the Company written reports and statements concerning the would have under­taken the obligations in insured’s state of health. accordance with the agreed premium.

13.4.1: In the event that the insurance Art. 13 Assignment, cancellation and contract is considered void, according to Art. expiry 13.3 or Art. 13.4, the Company shall be 13.1: Without the prior written consent of the entitled to a service charge which is set as a Company, no party shall be entitled to create specified percentage of the premium paid. a charge on or assign the rights under the insurance. 13.5: Where, upon taking out the insurance, the policyholder and/or the insured neither 13.2: The insurance is automatically renewed knew nor should have known that the on each policy anniversary date. information disclosed by him/her was incorrect, the Company shall be liable as if such incorrect 13.2.1: The insurance can be cancelled by information had not been disclosed. the policyholder as from the anniversary date with 3 (three) month’s written notice. The 13.6: The Company can stop or suspend an insurance shall be effective for 12 (twelve) insurance product at 3 (three) month’s notice months as a minimum. prior to the policy anniversary, and offer the insured an equivalent insurance cover. 13.3: Where, upon taking out the insurance or subsequently, the policyholder and/or the 13.7: Upon expiry of the insurance, the insured has fraudulently changed original right to compensation shall cease. How­ever, documents or disclosed incorrect information expenses covered under the insurance and or withheld facts which may be re­garded as defrayed during the insurance period shall be being of importance to the Company, the reimbursed up to 3 (three) months after the

31 expiry of the insurance. After-effects of an injury or illness incurred during the insurance period shall not be covered after the expiry of the insurance.

Art. 14 Disputes, venue, etc. 14.1: Any disputes arising out of or in connection with the insurance contract shall be settled in accordance with Danish law, with Copenhagen as the agreed venue. The Company is affiliated to: Ankenævnet for Forsikring Anker Heegaards Gade 2 1572 Copenhagen V, Denmark (The Danish Insurance Complaints Board).

32 Glossary

This glossary with definitions is part of the Policy Conditions.

Acute serious illness: an acute serious illness Company, the: Bupa Denmark, filial af Bupa shall be determined to exist only after Insurance Limited, England (Bupa Denmark, review and agreement by both the attending branch of Bupa Insurance Limited, England). physician and the Company’s medical consultants. Commencement date: the date indi­cated in the policy schedule on which the insurance Anniversary date: 12 (twelve) months from commences, unless otherwise stated in the the commencement date and the same date Policy Conditions. in each year thereafter. Day case: treatment which, for medical Applicant: a person named on the Appli­cation reasons, normally requires a patient to Form and the Medical Questionnaire as an occupy a bed in hospital or clinic for less applicant for insurance. than 24 (twenty-four) hours.

Application: the Application Form and Medical Deductible: the amount of money noted in Questionnaire. the policy schedule which each insured agrees to pay each policy year before being Claim: the financial demand covered in whole compensated by the Company. or in part by the insurance. In the Company’s evaluation/determination of the claim, the Documents: any written information related to time of treatment is de­cisive, not the time of the insurance including original bills, policy the occurrence of the injury/illness. schedules, and the like.

Co-insurance: the part of the medical Due date: date on which a premium is due to expenses the insured must pay if be paid. hospitalised in the U.S.A.

33 Family: mother and/or father and children hospitalisation treatment takes place using under the age of 24 (twenty-four). Children the Company’s network of providers, benefits aged 24 (twenty-four) and older will be are paid at 100% after any deductible and co- transferred to a separate policy. insurance. Information regarding the network of providers­ can be obtained by contacting the ihi Bupa (incl. we/us/our): Bupa Denmark, Company or visiting myPage on www.ihi.com. filial af Bupa Insurance Limited, England (Bupa Denmark, branch of Bupa Insurance Normal occupation: normal occupation ­in Limited, England). accordance with Art. 8.2 c) includes only the following professions: doctors, dentists, Inpatient/hospitalisation treatment: nurses, laboratory personnel, ancillary surgery or medical treatment in a hospital hospital workers, medical and dental or clinic when it is medically necessary to assistants, ambulance personnel, midwives, occupy a bed overnight. fire brigade personnel, policemen/-women, and prison ­officers. Inpatient rehabilitation: treatment aimed at restoring physical health and/or mobility Out of network: eligible treatment that takes taking place during hospitalisation or place in the U.S.A. with other providers than as inpatient treatment at an authorised those participating in the Company’s network rehabilitation centre following of providers. When treatment takes place hospitalisation due to serious accident/ out of network, benefits are paid according illness. to the valid List of Reimbursements after any deductible and co-insurance. Insurance: the Policy Conditions and policy schedule representing the insurance Policy Conditions: the terms and conditions of contract with the Company and setting the insurance purchased. out the scope of the insurance terms, the premium payable, deductible and Policyholder: the person identified as the reimbursement rates. policyholder on the Application Form.

Insured: the policyholder and/or all other Policy schedule: policy details showing the insured persons as listed in the valid policy type of insurance purchased, premium, schedule. deductible and any special terms.

Network of providers: the Company’s Pre-existing condition: the medical history, service partner in the U.S.A. This service including the illnesses and conditions listed in partner operates a national network of the Medical Questionnaire, which may affect hospitals, clinics and medical practitioners. the Company’s decision to insure or not to When eligible day case and inpatient/ insure or to impose special terms.

34 Reimbursement rates: the maximum Surgery: a surgical treatment/intervention, amount of money which will be paid which does not include endoscopies and by way of reimbursement of medical scans even though these examinations expenses in one year from the may require anaesthesia. commencement date or from each anniversary date, as further detailed in the Terminal care: care that the insured receives Policy Conditions. following diagnosis of a terminal condition, including physical, psychological and Renewal: the automatic renewal of the social care, as well as accommodation in insurance as per the anniversary date. a bed, nursing care and prescribed drugs. This care must be pre-approved by the Serious accident: a fortuitous serious Company. injury occurring without the insured’s intention which has a sudden external Terminal phase: when the advent of death and violent impact on the body, resulting is highly probable and medical opinion in demonstrable bodily injury, and which has rejected active therapy in favour of requires immediate hospitalisation. relief of symptoms and support of both patient and family. This decision must Serious injury: a serious injury shall be be confirmed by the Company’s medical determined to exist only after review consultant. and agreement by both the attending physician and the Company’s medical Waiting period: a period of time from consultant. the commencement date where the insurance provides no cover unless as per Special terms: restrictions, limitations or specification in Art. 3. conditions applied to the Company’s standard terms as detailed in the policy schedule.

Standard terms: the Company’s insurance terms with no special restrictions, limitations or conditions.

Subrogation: the insurer’s right to enforce a remedy which the insured has against a third party and the insurer’s right to require the insured to repay the insurer if the insurer has paid expenses recouped Valid from 1 January 2009 by the insured from a third party. E. & O. E.

35 The world of Bupa  Health assessment  Medical cover  Travel cover  Financial health protection  International medical cover  Home healthcare  Care homes  Childcare  Health and care assistance 20XE9-11/ 28.11.2008 - ENGLISH

Administration 7001 SW 97th Avenue Miami, Florida 33173, USA

Customer Service General enquiries Open 9am - 5pm (EST) weekdays Tel: +1 305 270 3944 Fax: +1 305 270 3948 Toll free: +1 (888) 532-66275

Email: [email protected]

USA Medical Services 24 hour emergency Tel: +1 305 275 1500 Fax: +1 305 275 1518 Toll free: +1 (800) 726-1203 Email: [email protected]

ihi Bupa 8, Palaegade DK-1261 Copenhagen K Denmark Tel: +45 33 15 30 99 Email: [email protected]

Calls will be recorded and may be monitored.

www.ihi.com • www.bupa.com

ihi Bupa is the trading identity of Bupa Denmark, filial af Bupa Insurance Limited, England (Bupa Denmark, branch of Bupa Insurance Limited, England) CVR 31602742 Bupa Insurance limited is registered in England No 3956433

The British United Provident Association Limited, Registered in England and Wales No. 432511 Registered office: Bupa House, 15-19 Bloomsbury Way, WC1A 2BA Bupa and the heartbeat symbol are registered trademarks © Bupa 2008. All rights reserved