BUPA WORLDWIDE. ADMINISTRATION
BUPA WORLDWIDE. DEFINICIONES
BUPA WORLDWIDE. BENEFITS See applicable sections of the policy for details, limitations, and restrictions. Unless otherwise stated herein, insureds under this policy are not required to obtain treatment from the preferred provider network. Maximum coverage is five million dollars ($5,000,000) per insured, per lifetime for all covered medical and hospital charges, while the policy is in force, subject to the limitations herein. The insurer, USA Medical Services, and/or any of their applicable related subsidiaries and affiliates will not engage in any transactions with any parties or in any countries where otherwise prohibited by the laws in the United States of America. Please contact USA Medical Services for more information about this restriction. SCHEDULE OF BENEFITS BENEFITS Coverage (per Insured) Maximum benefit Preferred Provider Network Non-Preferred Provider Network Standard private or semi-private hospital room and board No limit $800 per day Intensive care room and board No limit $2,000 per day The following maximum benefits apply to all Providers: Maternity care (except plans C Plus, D and E) (no deductible or coinsurance applies) $4,000 Newborn coverage (no deductible or coinsurance applies) $25,000 Congenital and hereditary disorders: Manifested before age 18 (per Insured, per lifetime) Manifested on or after age 18 (per Insured, per lifetime) $250,000 $5,000,000 Organ transplant (per Insured, per lifetime) $500,000 Air ambulance transportation (per Insured, per lifetime) $100,000 Ground ambulance transportation (per incident) $1,000 Companion of hospitalized child (per admission) $1,000 Repatriation of mortal remains $5,000 DEDUCTIBLE All insureds under the policy have Insured's deductible for the following policy year.
BUPA WORLDWIDE. BENEFICIOS Vea la sección correspondiente de la póliza para detalles, limitaciones y restric- ciones. Excepto si se menciona lo contrario, los asegurados bajo esta póliza no tienen el requisito de obtener tratamiento dentro de la Red de Proveedores Preferidos. La cobertura máxima es de cinco millones de dólares ($5,000,000) por asegu- rado, de por vida, por todos los gastos médicos y de hospitales cubiertos durante la vigencia de la póliza, sujeta a los límites que se indican a continuación Ni el Asegurador, ni USA Medical Services, ni ninguna de sus filiales o subsi- diarias pertinentes relacionadas participarán en transacciones con cualquier parte o país donde dichas transacciones estén prohibidas por las leyes de los Estados Unidos de América. Por favor comuníquese con USA Medical Services para obtener más información sobre esta restricción.
BUPA WORLDWIDE. The premium for the addi- tion is due at the time of the notification of birth. If such notification is not received within 90 days of birth, then an application for insurance is required on the addition and will be subject to under- writing.
BUPA WORLDWIDE. AGREEMENT
BUPA WORLDWIDE for transplantation has been determined by a provider, has been certified by a second surgical or medical opinion and has been approved by USA Medical Services, and is subject to all the terms, provisions and exclusions of the policy. This benefit includes:
BUPA WORLDWIDE. (b) The effective date of this policy commences within thirty (30) days of the expiration of the previous coverage; and
BUPA WORLDWIDE. (b) During the first ninety (90) days from the effective date of the change, benefits payable for any illness or injury not caused by accident or disease of infectious origin, will be limited to the lesser of benefits provided by the new plan or the prior plan.
BUPA WORLDWIDE. ACUERDO BUPA INSURANCE COMPANY (de ahora en adelante denominada el “Asegurador”) acuerda pagar a usted (de ahora en adelante denominado el “Asegurado Titular”) los beneficios estipulados en esta póliza. Todos los beneficios están sujetos a los términos y condiciones de esta póliza.
