As the headquarters of ihi Bupa are moving from to the UK on 2nd December 2009, at that time the named insurer on your insurance policy, which is currently the Danish branch of Bupa Insurance Limited (called Bupa Denmark, filial af Bupa Insurance Limited, England) will revert to its UK parent company, Bupa Insurance Limited.

Your insurer will not be changing as both Bupa Insurance Limited and the Danish branch are parts of the same company. International Health and Hospital Plan  USD please refertoihiBupaoryourlocalrepresentative. premium notice.For moredetailedinformationonanytaxesinyourcountryofresidence, residence. Ifthisisthecase,amountofanytaxes,leviesorchargeswillbeshownonyour Your policypremiummaybesubjecttoInsurancePremium Tax basedonyourcountryof insurance cover. medical historymaycauseahigherpremium,andinsomeinstances,anexclusionthe increased. The insuranceplanmustbetakenoutbeforeyoureachtheageof80.Aprevious payment. Ifyouhavereachedtheageof60attimeapplication,premiumwillbe The premiumisage-related. The age-relatedpremiumisappliedatthefirstcoming Valid from1January2009 Your premium USD E. &O. E. * Nodeductible applies. *** Renewals only. ** Semi-annualpremiumpayments are53%ofannualpremium payments.Quarterlypremiumpaymentsare27% * Hospital Plan Plans availablewithoutdeductible Age brackets USD* in person per premium Annual Module 1Non-HospitalisationBenefits Module 2Medicine&Appliances Hospital Plan Plans availablewithUSD400deductible Module 1Non-HospitalisationBenefits Module 2Medicine&Appliances Hospital Plan Plans availablewithUSD1,600deductible Module 1Non-HospitalisationBenefits Module 2Medicine&Appliances Hospital Plan Plans availablewithUSD5,000deductible Module 1Non-HospitalisationBenefits Module 2Medicine&Appliances Hospital Plan Plans availablewithUSD10,000deductible Module 1Non-HospitalisationBenefits Module 2Medicine&Appliances Module 3MedicalEvacuation&Repatriation Supplementary covers*** Module 4ADental&Optical Module 4BDental&Optical of annualpremiumpayments. 0-9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2,959 1,832 2,009 1,292 1,468 1,162 10-25 543 543 380 380 611 611 485 485 872 872 365 365 339 339 491 491 934 934 25 20 15 4,640 2,656 3,630 2,051 2,661 1,035 2,109 1,581 1,347 26-44 914 914 722 722 820 820 616 616 572 572 708 708 51 38 30 5,573 3,291 1,336 4,518 2,718 1,091 3,388 1,343 2,693 1,048 2,020 1,650 45-59 785 785 669 669 874 874 62 48 37 5,858 3,579 1,377 4,878 3,016 1,152 3,655 1,494 2,795 1,144 2,096 1,650 60+**

859 859 669 669 874 874 64 48 37

211E9-31/05.33.2008 - ENGLISH USD How is the premium paid? 

If you have not stated your information on the Application Form, we will send you a premium notice. As ihi Bupa must receive payment before the cover can start, we advise you to pay the premium within 30 days. You can choose between the following payment options:

zz Credit card payment via ihi.com

zz International credit card: American Express, VISA, /MasterCard, JCB or Diners

zz International

zz Eurocheque

zz International bank transfer to our bank: International Health and Hospital Plan

Citibank N.A. London USD Account No.: 8237581 BIC / Swift Code: CITIGB2L Bank Sort Code: 18 50 08 IBAN: GB63CITI18500808237581 Account holder: Bupa Denmark, branch of Bupa Insurance Limited, England

Regardless of how you pay, we kindly ask you to always state your name and birthday or policy number. 211E9-31/ 05.33.2008 - ENGLISH

ihi Bupa ● 8 Palaegade ● DK-1261 Copenhagen K ● Denmark ● Tel: +45 33 15 30 99 ● Fax: +45 33 32 25 60 E-mail: [email protected] ● www.ihi.com ● Medical Centre: +45 33 15 33 00 / E-mail: [email protected]

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