CHANGE OF PLAN OR DEDUCTIBLE. When the policyholder request to change a product or plan, the following conditions apply:
(a) The benefits earned by seniority of the insured will not be affected as long as the new product or plan contemplates them. If the previous product or plan did not include a benefit included in the new product or plan, the specific waiting period established in the Benefits Table of the Policy Cover must be met.
(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
(c) Benefits related to maternity, maternity complications and coverage of the newborn that occur during the ten (10) months following the effective date of the change, will be limited to the lesser of the benefit provided by either the new plan or prior plan.
(d) Benefits with insured sums per lifetime that occur during the six (6) months following the effective date of the change, will be limited to the lesser of the benefit provided by either the new plan or prior plan.
(e) The benefits with insured amounts per lifetime that have already had claims paid under the coverage of the previous product or plan, will be reduced in the proportion of the expense already paid. When the total benefit in the new product or plan is less than the amount already paid under the benefit in the previous product or plan, the benefit is considered exhausted and coverage under the new product or plan will no longer apply.
CHANGE OF PLAN OR DEDUCTIBLE. Through the Employer, at any anniversary date, the Certificate Holder can request to change plan or deductible. Some requests are subject to underwriting evaluation. The following conditions apply:
(a) The benefits earned by seniority of the insured will not be affected as long as the new product or plan contemplates them. If the previous product or plan did not include a benefit included in the new product or plan, the specific waiting period established in the Benefits Table of the Policy Cover must be met. DEFINITIONS
CHANGE OF PLAN OR DEDUCTIBLE. When the policyholder request to change aproduct or plan, the following conditions apply:
(a) The benefits earned by seniority of the insured will not be affected as long as the new product or plan contemplates them. If the previous product or plan did not include a benefit included in the new product or plan, the specific waiting period established in the Benefits Table of the Policy Cover must be met.
CHANGE OF PLAN OR DEDUCTIBLE. When the policyholder request to change a product or plan, the follow- ing conditions apply:
(a) The benefits earned by seniority of the insured will not be affected as long as the new product or plan contemplates them. If the previous product or plan did not include a benefit included in the new product or plan, the specific waiting period established in the Benefits Table of the Policy Cover must be met.
(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
(c) Benefits related to maternity, maternity complications and coverage of the newborn that occur during the ten (10) months following the effective date of the change, will be limited to the lesser of the benefit provided by either the new plan or prior plan.
(d) Benefits with insured sums per lifetime that occur during the six
CHANGE OF PLAN OR DEDUCTIBLE. At any anniversary date, the Policyholder can request to change plan or deductible. Some requests are subject to underwriting evaluation. EXCLUSIONS AND LIMITATIONS
1. Treatment of any illness, injury, or any charges arising from any treatment, service or supply which is:
a) not medically necessary; or
b) for an Insured who is not under the care of a physician, doctor or skilled professional; or
c) not authorized or prescribed by a physician or doctor; or
d) custodial care.
2. Any care or treatment, while sane or insane, received due to self-inflicted illness or injury, suicide, failed suicide, alcohol use or abuse, drug use or abuse, or the use of illegal substances or illegal use of controlled substances. This includes any accident resulting from any of the aforementioned criteria.
3. Routine eye and ear examinations, hearing aids, eyeglasses, contact lenses, radial keratotomy and/or other procedures to correct eye refraction disorders.
4. Any medical examination or diagnostic study which part of a routine physical examination is, including vaccinations and the issuance of medical certificates and examinations as to the suitability for employment or travel.
5. Chiropractic care, homeopathic treatment, acupuncture or any type of alternative medicine.
6. Elective or cosmetic surgery or medical treatment which is primarily for beautification, unless necessitated by injury, deformity or illness which first occurs while the Insured is covered under this policy. This also includes any surgical treatment for nasal or septal deformity that was not induced by trauma, except as provided for in this policy.
7. Any charges in connection with pre-existing conditions, except as defined and addressed in this policy.
8. Any treatment, service or supply that is not scientifically or medically recognized for the prescribed treatment or which is considered experimental and/or not approved for general use by the states food and health administration/ Ministry of Agriculture or Health.
9. Treatment in any governmental facility or any expense if the Insured would be entitled to free care. Service or treatment for which payment would not have to be made had no insurance coverage existed.
10. Any portion of any charge that is in excess of the usual, customary and reasonable charge for the particular service or supply for the geographical area.
11. Treatment or service for any medical, mental or dental condition related to or arising as a complication to those medical, mental or...
CHANGE OF PLAN OR DEDUCTIBLE. At any anniversary date, the Policyholder can request to change plan or deductible. Some requests are subject to underwriting evaluation. 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. During the first twelve (12) months after the effective date of the change, maternity, newborn, congenital and organ transplant benefits will be limited to the lesser benefit provided by either the new plan or prior plan. EXCLUSIONS AND LIMITATIONS
1. Treatment of any illness, injury, or any charges arising from any treatment, service or supply which is:
(a) not medically necessary; or
(b) for an Insured who is not under the care of a physician, doctor or skilled professional; or
(c) not authorized or prescribed by a physician or doctor; or
(d) custodial care.
2. Any care or treatment, while sane or insane, received due to self inflicted illness or injury, suicide, failed suicide, alcohol use or abuse, drug use or abuse, or the use of illegal substances or illegal use of controlled substances. This includes any accident resulting from any of the aforementioned criteria.
3. Routine eye and ear examinations, hearing aids, eye glasses, contact lenses, radial keratotomy and/or other procedures to correct eye refraction disorders.
4. Any medical examination or diagnostic study which is part of a routine physical examination, including vaccinations and the issuance of medical certificates and examinations as to the suitability for employment or travel.
5. Chiropractic care, homeopathic treatment, acupuncture or any type of alternative medicine.
6. Any illness or injury not caused by an accident or a disease of infectious origin which first manifested within the first ninety (90) days from the effective date of the policy.
7. Elective or cosmetic surgery or medical treatment which is primarily for beautification, unless necessitated by injury, deformity or illness which first occurs while the Insured is covered under this policy. This also includes any surgical treatment for nasal or septal deformity that was not induced by trauma, except as provided for in this policy.
8. Any charges in connection with pre-existing conditions, except as defined and addressed in this policy.
9. Any treatment, service or supply that is not scientifically or medically recognized for the prescr...
CHANGE OF PLAN OR DEDUCTIBLE. At any anniversary date, the Policy- holder can request to change plan or deductible. Some requests are subject to underwriting evaluation. During the first ninety (90) days from the effective date of the change, ben- efits 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. During the first twelve (12) months after the effective date of the change, mater- nity, newborn and congenital benefits will be limited to the lesser benefit provided by either the new plan or prior plan. BUPA SELECT
1. ACCIDENT: An unfortunate inci- dent that occurs unexpectedly and suddenly, provoked by an external cause, always without the insured's intention, which causes injury or bodily trauma and requires immedi- ate ambulatory medical attention and/or patient's hospital admission. The medical information related to the accident will be evaluated by the insurer, and the compensabil- ity will be determined under the general policy's provisions.
2. AIR AMBULANCE TRANSPORTA- TION: Emergency air transportation from the hospital where the Insured is admitted to the nearest suitable hospital where treatment can be provided.
CHANGE OF PLAN OR DEDUCTIBLE. At any anniversary date, the Policyholder can request to change plan or deductible. Some requests are subject to underwriting evaluation. 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. During the first twelve (12) months after the effective date of the change, maternity, newborn, congenital and organ transplant benefits will be limited to the lesser benefit provided by either the new plan or prior plan.
1. Treatment of any illness, injury, or any charges arising from any treatment, service or supply which is:
(a) not medically necessary; or
(b) for an Insured who is not under the care of a physician, doctor or skilled professional; or
(c) not authorized or prescribed by a physician or doctor; or
(d) custodial care.
2. Any care or treatment, while sane or insane, received due to self inflicted illness or injury, suicide, failed suicide, alcohol use or abuse, drug use or abuse, or the use of illegal substances or illegal use of controlled substances. This includes any accident resulting from any of the aforementioned criteria.
3. Routine eye and ear examinations, hearing aids, eye glasses, contact lenses, radial keratotomy and/or other procedures to correct eye refraction disorders.
4. Any medical examination or diagnostic study which is part of a routine physical examination, including vaccinations and the issuance of medical certificates and examinations as to the suitability for employment or travel.
5. Chiropractic care, homeopathic treatment, acupuncture or any type of alternative medicine.
6. Any illness or injury not caused by an accident or a disease of infectious origin which first manifested within the first ninety (90) days from the effective date of the policy.
7. Elective or cosmetic surgery or medical treatment which is primarily for beautification, unless necessitated by injury, deformity or illness which first occurs while the Insured is covered under this policy. This also includes any surgical treatment for nasal or septal deformity that was not induced by trauma, except as provided for in this policy.
8. Any charges in connection with pre-existing conditions, except as defined and addressed in this policy.
9. Any treatment, service or supply that is not scientifically or medically recognized for the prescribed treatment or which is ...
CHANGE OF PLAN OR DEDUCTIBLE. Through the Employer, at any anniver- sary date, the Certificate Holder can request to change plan or deduct- ible. Some requests are subject to underwriting evaluation. The follow- ing conditions apply:
(a) The benefits earned by seniority of the insured will not be affected as long as the new product or plan contemplates them. If the previous product or plan did not include a benefit included in the new product or plan, the specific waiting period established in the Benefits Table of the Policy Cover must be met.
(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 infec- tious origin, will be limited to the lesser of benefits provided by the new plan or the prior plan.
(c) Benefits related to maternity, maternity complications and coverage of the newborn that occur during the ten (10) months following the effective date of the change, will be limited to the lesser of the benefit provided by either the new plan or prior plan.
(d) Benefits with insured sums per lifetime that occur during the six (6) months following the effective date of the change, will be limited to the lesser of the benefit provided by either the new plan or prior plan.
(e) The benefits with insured amounts per lifetime that have already had claims paid under the coverage of the previous product or plan, will be reduced in the proportion of the expense already paid. When the total benefit in the new product or plan is less than the amount already paid under the benefit in the previous product or plan, the benefit is considered exhausted and coverage under the new product or plan will no longer apply.
CHANGE OF PLAN OR DEDUCTIBLE. Through the Employer, at any anniver- sary date, the Certificate Holder can request to change plan or deductible. Some requests are subject to under- writing evaluation. 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. During the first twelve BUPA GROUP
1. ACCIDENT: An unfortunate inci- dent that occurs unexpectedly and suddenly, provoked by an external cause, always without the insured's intention, which causes injury or bodily trauma and requires immedi- ate ambulatory medical attention and/or patient's hospital admission. The medical information related to the accident will be evaluated by the insurer, and the compensabil- ity will be determined under the general policy's provisions.
2. AIR AMBULANCE TRANSPORTA- TION: Emergency air transportation from the hospital where the Insured is admitted to the nearest suitable hospital where treatment can be provided.
