Member Guide

START USING YOUR CARD NOW 

Your Bupa card is your passport to comprehensive health cover. .
First, understand the information printed on your card. .

Your Membership Number Policy Number

This is your Bupa membership number. This is the number of your .
Your number is unique and hospitals use policy cover being used as
this number to verify your membership reference by both Bupa .
benefits with us. .
and the hospitals

Your Scheme
This is your scheme Name: Mohammed Abdul Aziz Khatani Name: Mohammed Abdul Aziz Khatani
Membership No.: 4567891 Policy No.: 12345678
Membership No.: 4567891 Policy No.: 12345678 
level as agreed with Approval & Room
Scheme: Bupa Arabia - Blue NW: 5 Scheme: Bupa Arabia - Blue NW: 5
your company. Shows the level .
Approval & Room: Full Cover No Exclusions - Single Approval & Room: Full Cover No Exclusions - Single
The number or letter when the hospital
after it denotes your ID No.: 2114567822 Contribution: 20% O/P up to SR 100 needs to get Bupa . ID No.: 2114567822 Contribution: 20% O/P up to SR 100
.
Staff No.: 123456789 YOB: 1982 Exp: 30/12/2014 Staff No.: 123456789 YOB: 1982 Exp: 30/12/2014
hospital network approval before
level. doing any treatment;
room shows your
accommodation level .
should you require
Contribution in-patient service
ID Number This is the amount you Expiry Date
This is your Saudi or have to pay directly to This is the end date .
of your policy cover
/
Iqama number as the hospital whenever .
with Bupa.
provided by your you require treatment. .
employer

Our Privacy Policy can be found at www.bupa.com.sa/privacy www.bupa.com.sa/privacy

 www.bupa.com.sa 800 244 0307 www.bupa.com.sa
This is your dedicated 24/7 Visit our website and enrol in our
. . toll free number innovative online services

+ +966 92002 3009

This is the landline
number you can call to
.
reach us especially if
you are outside of
Saudi Arabia
 International SOS Assistance
Our international partner in case you
require emergency medical advice or
. emergency medical evacuation when CCHI hotline
outside of Saudi Arabia. The number you can call for any

. feedback or complaints

/
1 1
3 EASY STEPS
TO START USING CARD

Call your 24/7 helpline 800 244 0307 and follow simple instructions to
. avail of the various free services designed for a hassle-free use of your
health benefits.
www.bupa.com.sa 2 2 Log on to www.bupa.com.sa, register and enjoy our free online
. services

. / 3 3 Save the 24/7 helpline number on your mobile for easy access
to Bupa should you need assistance.

1 1
 Tebtom program from Bupa Arabia is a set of
unprecedented and unique healthcare services that
transcend regular healthcare coverage; created by us to

provide you and your family with complete healthcare in
your daily lives, helping you get the most out of them. .

To benefit from the Tebtom Program, call our Doctors on

800 440 4040 800 440 4040

2 2
 Program Services

Bupa Doctor
Get health advice and answers from our specialized doctors, around the clock (24/7),
24
through Tebtoms toll-free number 800 440 4040.
. .
'Bupa Doctor' is a free service available to all.
. "

Maternity & Child Care

'Maternity & Child Care' service will guide you and provide you with all the answers you
"
need for a healthy and happy maternity experience.
.

Chronic Care
Chronic Care' helps you manage your chronic conditions by providing personalized

solutions such as check ups*, medication refills** and periodic tests* * .
.** *

Elderly Care
Tebtom's 'Elderly Care' service* will ensure the elderly's comfort through tailor made
* "
healthcare such as elderly counseling, nutritional consultations, convenient chronic
** medications refilling** and chronic conditions monitoring**.
**

Cancer Care
Tebtom's 'Cancer Care' service aims to provide the confidence & strength to the patient
"
as well as their caregiver(s) to face the challenges ahead.
.

International Second Medical Opinion

Our 'International Second Medical Opinion' service allows our doctors to evaluate cases

"
based on pre-set medical criteria; helping you deal with complex health cases using
world-class experts operating at internationally renowned centers.
.

5 * * Avilable for our members covered in Network 5 and above

5 ** ** Available for Bupa members covered in Network 5 and above in Al Nahdi, Al Dawaa and Al Mujtama'a pharmacies

Surrounding
You with Care
3 3
 Frequently Program Services
Asked Questions

Bupa Doctor
Get health advice and answers from our specialized doctors, around the clock (24/7),
24
through Tebtoms toll-free number 800 440 4040.
. .
'Bupa Doctor' is a free service available to all.
What type of benefits am I entitled to?
. "

Refer to the Table of Benefits enclosed with your pack to know what other
benefits you are Maternity
& Child
Care

entitled to. Preferably, enrol in our online services by visiting www.bupa.com.sa to get all the . www.bupa.com.sa
'Maternity & Child Care' service will guide you and provide you with all the answers you
of
details
your scheme "
benefits. need for a healthy and happy maternity experience.
.
Which hospital or clinic can I go for treatment? .
www.bupa.com.sa
You can go to any hospital or clinic included in the list enclosed in this pack. There are chances .
that your list has been updated from the first time you received
it. To get
an updated one, visit
Chronic Care
our website at www.bupa.com.sa. Chronic Care' helps you manage your chronic conditions by providing personalized


solutions such as check ups*, medication refills** and
periodic tests* * .
.** *
I forgot my Bupa card and I need treatment at the hospital.
What should I do? .

Call our member helpline and we will send the hospital a membership confirmation letter. Elderly Care

Alternatively, enrol in our online services and you can print membership certificates in case you
Tebtom's Care'
'Elderly will
service* ensure

the elderly's through
comfort
tailor made

lost your Bupa
card
and medical
you need *" "
treatment. healthcare such as elderly counseling, nutritional consultations, convenient chronic
** medications refilling** and chronic conditions monitoring**.
**
I thought there is no cash-out if I use any hospital in my list.
The hospital still asked me to pay some amount. What is member .

contribution? Cancer Care.
Tebtom's 'Cancer Care' service aims to provide the confidence & strength to the patient
"
Yes, you dont need to pay any cash for in-patient or day-case treatments. However, as as well as their caregiver(s) to face the challenges ahead.
.
required by law and as agreed with your company, you have to pay to the hospital a certain

amount for out-patient services.

In most cases, the level of membership contribution is 20% of the invoice amount up to SR 100, .
a level set forth by the Council of Cooperative Health Insurance (CCHI), the government body
International Second Medical Opinion
supervising the operation of health insurers in Saudi Arabia.
Our 'International Second Medical Opinion' service allows our doctors to evaluate cases

"
based on pre-set medical criteria; helping you deal with complex health cases using
I
Can go to
a hospital not
included
inmy
network?
world-class experts operating at internationally renowned centers.
.

Yes, if you have reimbursement benefit, you can go to any hospital, clinic or doctor of your
choice outside your hospital network. However, you will
have to
5 pay for all
costs
directly
*to the * Avilable for our members covered in Network 5 and above
hospital or clinic
and then file
a reimbursement
claim later
5using
the Bupa
claimform,which
** you ** Available for Bupa members covered in Network 5 and above in Al Nahdi, Al Dawaa and Al Mujtama'a pharmacies
can download at www.bupa.com.sa

Surrounding
You with Care
4
 Im going on vacation outside the Kingdom,
can I use my Bupa card?

. Depending on your cover, you can get treatment at any hospital while on vacation or business
trips anywhere in the world. However, you will have to pay for all costs directly to the hospital
and then file for a reimbursement claim.

What is claiming (reimbursement) ?

.
This is the process of settling medical claims done outside of your approved network of
hospitals and clinics. You need to file the claim with Bupa within 30 days of treatment date.

How do I file for a claim (reimbursement)?
:
Settlement of claims is based on the reasonable and customary cost of the same treatment or
procedure within the members approved network of hospitals and clinics. send your claim to:

RIYADH JEDDAH KHOBAR

Bupa Arabia Building, Bupa Arabia Building, Eastern Cement Tower, 8th Floor
.. .
King Fahad Road Al Rawdah Street, Khobar Dammam Express Way

Olaya District Al Khalediyah P.O. Box 23807, P.O. Box 75920 Al Khobar 31952,
: : :
Riyadh 11351, Saudi Arabia Jeddah 21436, Saudi Arabia Saudi Arabia
: :
Tel: 920 000 456 Toll free: 800 244 0307 Tel. No. 013 881 2230
Fax: 920 000 724 Fax: 013 881 2240
"
What does reasonable and customary mean?
"
Reasonable and Customary means that the medical expenses are compatible with the level
of fees charged by the majority of licensed doctors or hospitals within your network of
. hospitals and clinics in Saudi Arabia. For example, if a test costs SR100 in most of the
hospitals in your network, we will pay you up to SR100 for the same test done outside of your
 network.

What are the treatments, medications or procedures not

covered?
Based on CCHI ruling and on international practices and standards, there are certain
treatments, medications and procedures that are not covered. Refer to page 8 for details.

complaints@bupa.com.sa :
How do I file a complaint?
We can attend to all your issues by calling our 24/7 toll free helpline or by emailing us at
complaints@bupa.com.sa However, you can also send your written complaints to Customer
Service Manger on the above mentioned address.

5 5
 Understanding
Your Scheme

The importance of approval (pre-authorisation) process

Pre-authorisation is a necessary procedure for us to check that the required tests, procedures or
medications are:
:

Appropriate for your condition

Covered by your benefits
Within your benefit sub-limits

Dont worry, you do not need to wait long at the hospital or even come back the next day for
the treatment. Our electronic approval process ensures that you receive the needed medical
attention fast. The hospital staff will send the request to us on your behalf. (refer to proceeding
diagram) .( )

In each instance, we inform you of the status of your request by SMS if you are enrolled in our

Msg.Bupa service. Enrol now to Msg.Bupa, by follwing simple instructions on page 3.
. .
Should you encounter any delay or have any questions while at the hospital, call our 24/7
member helpline 800 244 0307 or 92002 3009. You can call this numbers using your mobile
phone 24 hours a day, 7 days a week.
/ :

Filling for a claim .

Depending on your scheme, you can file for claims (reimbursement) when you seek treatment
outside of your approved network of hospitals and clinics, or when you use your card outside of
Saudi Arabia.
.
To receive payment for the money you spent for all eligible medical treatment, make sure you
send your accomplished Bupa claim form which is enclosed in this guide book and can be
downloaded from our website.
To avoid any delay, make sure to submit to Bupa the following within 30 working days of
treatment date:
:

Bupa claim form completed, signed and stamped by the treating doctor.
Detailed medical report
Investigations and laboratory results
Original invoices and receipts

Pre-authorisation approval from Bupa, if applicable

You can check the status of your claim online by logging into www.bupa.com.sa
Bupa requires 10 working days to pay out a complete reimbursement claim.
.
www.bupa.com.sa

6
 Bupa member at hospital

Does not require Requires

Bupa approval Bupa approval

Member receives Hospital sends approval

treatment request to Bupa

Bupa receives and

Bupa sends
processes the request
: member 2 SMS:
-| 1- Receipt of request
- 2- Decision on request
Hospital treats member
after receiving approval

: Treatments requiring Bupa approval:

In-patient & day-case treatments
MRIs and CT scans
Benefits with sub-limits, ie dental, optical and maternity
Physiotherapy after the first session
Treatments estimated to exceed SR 1000
{{{|

Our electronic links with the hospitals and clinics within our network
. enables us to respond fast to most approval (pre-authorisation) requests.
. \| For standard benefits like dental, optical, maternity, including chronic
medication refills, our response rate is usually within 15 seconds. We usually
. {] ^\
respond to 95% of approval requests within 30 minutes.

7 7
 Conditions
Not Covered
Consistent with the guidelines issued by 13. Hair falling, boldness or fake hair. (
the CCHI, the following cases and .
conditions are not covered by your 14. Psychological, mental or neurological .
healthcare scheme/s: treatment except those depicted in the (
schedule.
. :
This list of non-covered conditions is set by
the CCHI under the health regulation law 15. Allergy tests of all kinds except those
related to medicine prescribed for ( . (
1. Intentional self-injury treatment of allergy.
(
2. Diseases resulting from abuse of some 16. Family planning apparatus, means,
medicines, boosters, stimulating or due .
medicines, procedures or Harmon or
to alcohol drinking or drugs usage or contraceptives or infertility, impotence .
alike. or pipe or any other artificial (
reproductive means. . (
3. Plastic surgery, unless such is needed .
due to an accidental injury not 17. Weakness or disfiguration unless such
exempted by this chapter. impacts the insured' life. (
(
4. Comprehensive checkups, vaccinations, 18. Any costs or additional expenses
drugs or protective means that is incurred by the insured during )
required for treatment hence depicted hospitalization or stay at a hospital .(
herein (except protective measures except bed and board costs in the
determined by the ministry of health hospital for one companion (escort), .
such as vaccinations, child and mother such as a mother stays with her child up .(
care). to the age of 12, or as deemed ( ) (
appropriate by the attending doctor. . (
5. Free of charge treatment an insured .
received. 19. Treatment of acne or any treatment of
obesity or corpulence, except medicines (
6. Rest & relaxation, general physical covered. (
health programs and treatment at social . .
care centers. 20. Origins transplant, bone morrow, or
substitute artificial organs as substitutes ( (
7. Any ailment or injury as a result of the for any parts of the body, totally or
profession of the insured individual. partially. . .

8. Reproductive system diseases 21. Personal hazards listed in the definition ( )(

treatment or sexual contracted chapter herein. . HIV HIV (
diseases.
) (
22. Alternative medicines, drugs or
9. Expenses of the period follows a treatment, and any other drugs not ( .
diagnosis of HIV or related HIV related licensed by the Saudi Food and Drug
diseases including AIDS, and other Authority. . (
forms related thereto.
23. Artificial or substitute origins except ( .
10. All costs related to dental plantation or those needed depending on the insured
artificial dental dentures or fixed or condition as per a medical report from .
movable bridges, dental rectification approved health facility. (
except that resulting from an accident. ?
24. Menopause natural changes for the .
11. Sight rectification tests and surgeries insured including monthly period
or hearing or visual and hearing means changes.
unless not prescribed by the doctor. (
.
12. The insured in-Saudi Arabia travel .(
expenses using unpermitted
transportation means.
8
 This policy- will not cover the health benefits and repatriation of the remains
: to country of origin if claims are directly arising- from the following:

( ( )( 1. War, invasion and foreign aggression 4. If the insured works in military, police or
. .? (declared or undeclared). their operations,
. ( ( 2. Ionic radiation radioactive pollution related 5. Riots, strikes, terrorism or alike.
( . to nuclear fuel, or nuclear waste resulting 6. Chemical, biological or bacteria-logical
( from nuclear fuel combustion, accidents and reactions, if such related to a
. . 3. Radioactive or poisonous or explosive or job-related injury or occupational hazards.
hazardous materials of any nuclear facility or
components.

9 9
 One Last Thing
.
Your Bupa card is your passport to comprehensive medical cover. But before :
closing this booklet, here are some useful reminders:

Save the bupa 24/7 helpline number on your mobile phone ^{ {]{{^ {{= {]{ /
800 244 0307 or 920 02 3009

Enrol to benefit from our online services.

Log on now to www.bupa.com.sa and complete a short and simple www.bupa.com.sa 
registration process.
.
Always carry your bupa membership card with you

Register with msg.bupa by sending your membership number to
0550 222 700

Thats It.
Your card is activated to provide you not only medical cover but a host of 
services designed to give you worry-free convenience when you need it most. .

We wish you and your family the best of health. .

Bupa, with you for better health
...
For feedback on service, call CCHI hotline: 920001177


Bupa Arabia for Cooperative Insurance .
PO Box 23807, Jeddah 21436, Saudi Arabia :
Toll free: 800 244 0307 :
Fax: 920 000 724

bupa.com.sa blog.bupa.com.sa blog.bupa.com.sa bupa.com.sa

Follow us on our social media channels to get updates on our latest products,
healthcare services and health tips. :
@BupaArabia @BupaArabia
/BupaArabia /BupaArabia @BupaArabia /Company/BupaArabia /Company/BupaArabia @BupaArabia /BupaArabia /BupaArabia
@BupaArabiaCare @BupaArabiaCare

10
 Member Guide
 START USING YOUR CARD NOW 
Your Bupa card is your passport to comprehensive health cover. .
First, understand the information printed on your card. .

Your Membership Number Policy Number

This is your Bupa membership number. This is the number of your .
Your number is unique and hospitals use policy cover being used as
this number to verify your membership reference by both Bupa .
benefits with us. .
and the hospitals

Your Scheme
This is your scheme Name: Mohammed Abdul Aziz Khatani Name: Mohammed Abdul Aziz Khatani
Membership No.: 4567891 Policy No.: 12345678
Membership No.: 4567891 Policy No.: 12345678 
level as agreed with Approval & Room
Scheme: Bupa Arabia - Blue NW: 5 Scheme: Bupa Arabia - Blue NW: 5
your company. Shows the level .
Approval & Room: Full Cover No Exclusions - Single Approval & Room: Full Cover No Exclusions - Single
The number or letter when the hospital
after it denotes your ID No.: 2114567822 Contribution: 20% O/P up to SR 100 needs to get Bupa . ID No.: 2114567822 Contribution: 20% O/P up to SR 100
.
Staff No.: 123456789 YOB: 1982 Exp: 30/12/2014 Staff No.: 123456789 YOB: 1982 Exp: 30/12/2014
hospital network approval before
level. doing any treatment;
room shows your
accommodation level .
should you require
Contribution in-patient service
ID Number This is the amount you Expiry Date
This is your Saudi or have to pay directly to This is the end date .
of your policy cover
/
Iqama number as the hospital whenever .
with Bupa.
provided by your you require treatment. .
employer

Our Privacy Policy can be found at www.bupa.com.sa/privacy www.bupa.com.sa/privacy

 www.bupa.com.sa 800 244 0307 www.bupa.com.sa
This is your dedicated 24/7 Visit our website and enrol in our
. . toll free number innovative online services

+ +966 92002 3009

This is the landline
number you can call to
.
reach us especially if
you are outside of
Saudi Arabia
 International SOS Assistance
Our international partner in case you
require emergency medical advice or
. emergency medical evacuation when CCHI hotline
outside of Saudi Arabia. The number you can call for any

. feedback or complaints

/
1 1
3 EASY STEPS
TO START USING CARD

Call your 24/7 helpline 800 244 0307 and follow simple instructions to
. avail of the various free services designed for a hassle-free use of your
health benefits.
www.bupa.com.sa 2 2 Log on to www.bupa.com.sa, register and enjoy our free online
. services

. / 3 3 Save the 24/7 helpline number on your mobile for easy access
to Bupa should you need assistance.

1 1
 Tebtom program from Bupa Arabia is a set of
unprecedented and unique healthcare services that
transcend regular healthcare coverage; created by us to

provide you and your family with complete healthcare in
your daily lives, helping you get the most out of them. .

To benefit from the Tebtom Program, call our Doctors on

800 440 4040 800 440 4040

2 2
 Program Services

Bupa Doctor
Get health advice and answers from our specialized doctors, around the clock (24/7),
24
through Tebtoms toll-free number 800 440 4040.
. .
'Bupa Doctor' is a free service available to all.
. "

Maternity & Child Care

'Maternity & Child Care' service will guide you and provide you with all the answers you
"
need for a healthy and happy maternity experience.
.

Chronic Care
Chronic Care' helps you manage your chronic conditions by providing personalized

solutions such as check ups*, medication refills** and periodic tests* * .
.** *

Elderly Care
Tebtom's 'Elderly Care' service* will ensure the elderly's comfort through tailor made
* "
healthcare such as elderly counseling, nutritional consultations, convenient chronic
** medications refilling** and chronic conditions monitoring**.
**

Cancer Care
Tebtom's 'Cancer Care' service aims to provide the confidence & strength to the patient
"
as well as their caregiver(s) to face the challenges ahead.
.

International Second Medical Opinion

Our 'International Second Medical Opinion' service allows our doctors to evaluate cases

"
based on pre-set medical criteria; helping you deal with complex health cases using
world-class experts operating at internationally renowned centers.
.

5 * * Avilable for our members covered in Network 5 and above

5 ** ** Available for Bupa members covered in Network 5 and above in Al Nahdi, Al Dawaa and Al Mujtama'a pharmacies

Surrounding
You with Care
3 3
 Frequently Program Services
Asked Questions

Bupa Doctor
Get health advice and answers from our specialized doctors, around the clock (24/7),
24
through Tebtoms toll-free number 800 440 4040.
. .
'Bupa Doctor' is a free service available to all.
What type of benefits am I entitled to?
. "

Refer to the Table of Benefits enclosed with your pack to know what other
benefits you are Maternity
& Child
Care

entitled to. Preferably, enrol in our online services by visiting www.bupa.com.sa to get all the . www.bupa.com.sa
'Maternity & Child Care' service will guide you and provide you with all the answers you
of
details
your scheme "
benefits. need for a healthy and happy maternity experience.
.
Which hospital or clinic can I go for treatment? .
www.bupa.com.sa
You can go to any hospital or clinic included in the list enclosed in this pack. There are chances .
that your list has been updated from the first time you received
it. To get
an updated one, visit
Chronic Care
our website at www.bupa.com.sa. Chronic Care' helps you manage your chronic conditions by providing personalized


solutions such as check ups*, medication refills** and
periodic tests* * .
.** *
I forgot my Bupa card and I need treatment at the hospital.
What should I do? .

Call our member helpline and we will send the hospital a membership confirmation letter. Elderly Care

Alternatively, enrol in our online services and you can print membership certificates in case you
Tebtom's Care'
'Elderly will
service* ensure

the elderly's through
comfort
tailor made

lost your Bupa
card
and medical
you need *" "
treatment. healthcare such as elderly counseling, nutritional consultations, convenient chronic
** medications refilling** and chronic conditions monitoring**.
**
I thought there is no cash-out if I use any hospital in my list.
The hospital still asked me to pay some amount. What is member .

contribution? Cancer Care.
Tebtom's 'Cancer Care' service aims to provide the confidence & strength to the patient
"
Yes, you dont need to pay any cash for in-patient or day-case treatments. However, as as well as their caregiver(s) to face the challenges ahead.
.
required by law and as agreed with your company, you have to pay to the hospital a certain

amount for out-patient services.

In most cases, the level of membership contribution is 20% of the invoice amount up to SR 100, .
a level set forth by the Council of Cooperative Health Insurance (CCHI), the government body
International Second Medical Opinion
supervising the operation of health insurers in Saudi Arabia.
Our 'International Second Medical Opinion' service allows our doctors to evaluate cases

"
based on pre-set medical criteria; helping you deal with complex health cases using
I
Can go to
a hospital not
included
inmy
network?
world-class experts operating at internationally renowned centers.
.

Yes, if you have reimbursement benefit, you can go to any hospital, clinic or doctor of your
choice outside your hospital network. However, you will
have to
5 pay for all
costs
directly
*to the * Avilable for our members covered in Network 5 and above
hospital or clinic
and then file
a reimbursement
claim later
5using
the Bupa
claimform,which
** you ** Available for Bupa members covered in Network 5 and above in Al Nahdi, Al Dawaa and Al Mujtama'a pharmacies
can download at www.bupa.com.sa

Surrounding
You with Care
4
 Im going on vacation outside the Kingdom,
can I use my Bupa card?

. Depending on your cover, you can get treatment at any hospital while on vacation or business
trips anywhere in the world. However, you will have to pay for all costs directly to the hospital
and then file for a reimbursement claim.

What is claiming (reimbursement) ?

.
This is the process of settling medical claims done outside of your approved network of
hospitals and clinics. You need to file the claim with Bupa within 30 days of treatment date.

How do I file for a claim (reimbursement)?
:
Settlement of claims is based on the reasonable and customary cost of the same treatment or
procedure within the members approved network of hospitals and clinics. send your claim to:

RIYADH JEDDAH KHOBAR

Bupa Arabia Building, Bupa Arabia Building, Eastern Cement Tower, 8th Floor
.. .
King Fahad Road Al Rawdah Street, Khobar Dammam Express Way

Olaya District Al Khalediyah P.O. Box 23807, P.O. Box 75920 Al Khobar 31952,
: : :
Riyadh 11351, Saudi Arabia Jeddah 21436, Saudi Arabia Saudi Arabia
: :
Tel: 920 000 456 Toll free: 800 244 0307 Tel. No. 013 881 2230
Fax: 920 000 724 Fax: 013 881 2240
"
What does reasonable and customary mean?
"
Reasonable and Customary means that the medical expenses are compatible with the level
of fees charged by the majority of licensed doctors or hospitals within your network of
. hospitals and clinics in Saudi Arabia. For example, if a test costs SR100 in most of the
hospitals in your network, we will pay you up to SR100 for the same test done outside of your
 network.

What are the treatments, medications or procedures not

covered?
Based on CCHI ruling and on international practices and standards, there are certain
treatments, medications and procedures that are not covered. Refer to page 8 for details.

complaints@bupa.com.sa :
How do I file a complaint?
We can attend to all your issues by calling our 24/7 toll free helpline or by emailing us at
complaints@bupa.com.sa However, you can also send your written complaints to Customer
Service Manger on the above mentioned address.

5 5
 Understanding
Your Scheme

The importance of approval (pre-authorisation) process

Pre-authorisation is a necessary procedure for us to check that the required tests, procedures or
medications are:
:

Appropriate for your condition

Covered by your benefits
Within your benefit sub-limits

Dont worry, you do not need to wait long at the hospital or even come back the next day for
the treatment. Our electronic approval process ensures that you receive the needed medical
attention fast. The hospital staff will send the request to us on your behalf. (refer to proceeding
diagram) .( )

In each instance, we inform you of the status of your request by SMS if you are enrolled in our

Msg.Bupa service. Enrol now to Msg.Bupa, by follwing simple instructions on page 3.
. .
Should you encounter any delay or have any questions while at the hospital, call our 24/7
member helpline 800 244 0307 or 92002 3009. You can call this numbers using your mobile
phone 24 hours a day, 7 days a week.
/ :

Filling for a claim .

Depending on your scheme, you can file for claims (reimbursement) when you seek treatment
outside of your approved network of hospitals and clinics, or when you use your card outside of
Saudi Arabia.
.
To receive payment for the money you spent for all eligible medical treatment, make sure you
send your accomplished Bupa claim form which is enclosed in this guide book and can be
downloaded from our website.
To avoid any delay, make sure to submit to Bupa the following within 30 working days of
treatment date:
:

Bupa claim form completed, signed and stamped by the treating doctor.
Detailed medical report
Investigations and laboratory results
Original invoices and receipts

Pre-authorisation approval from Bupa, if applicable

You can check the status of your claim online by logging into www.bupa.com.sa
Bupa requires 10 working days to pay out a complete reimbursement claim.
.
www.bupa.com.sa

6
 Bupa member at hospital

Does not require Requires

Bupa approval Bupa approval

Member receives Hospital sends approval

treatment request to Bupa

Bupa receives and

Bupa sends
processes the request
: member 2 SMS:
-| 1- Receipt of request
- 2- Decision on request
Hospital treats member
after receiving approval

: Treatments requiring Bupa approval:

In-patient & day-case treatments
MRIs and CT scans
Benefits with sub-limits, ie dental, optical and maternity
Physiotherapy after the first session
Treatments estimated to exceed SR 1000
{{{|

Our electronic links with the hospitals and clinics within our network
. enables us to respond fast to most approval (pre-authorisation) requests.
. \| For standard benefits like dental, optical, maternity, including chronic
medication refills, our response rate is usually within 15 seconds. We usually
. {] ^\
respond to 95% of approval requests within 30 minutes.

7 7
 Conditions
Not Covered
Consistent with the guidelines issued by 13. Hair falling, boldness or fake hair. (
the CCHI, the following cases and .
conditions are not covered by your 14. Psychological, mental or neurological .
healthcare scheme/s: treatment except those depicted in the (
schedule.
. :
This list of non-covered conditions is set by
the CCHI under the health regulation law 15. Allergy tests of all kinds except those
related to medicine prescribed for ( . (
1. Intentional self-injury treatment of allergy.
(
2. Diseases resulting from abuse of some 16. Family planning apparatus, means,
medicines, boosters, stimulating or due .
medicines, procedures or Harmon or
to alcohol drinking or drugs usage or contraceptives or infertility, impotence .
alike. or pipe or any other artificial (
reproductive means. . (
3. Plastic surgery, unless such is needed .
due to an accidental injury not 17. Weakness or disfiguration unless such
exempted by this chapter. impacts the insured' life. (
(
4. Comprehensive checkups, vaccinations, 18. Any costs or additional expenses
drugs or protective means that is incurred by the insured during )
required for treatment hence depicted hospitalization or stay at a hospital .(
herein (except protective measures except bed and board costs in the
determined by the ministry of health hospital for one companion (escort), .
such as vaccinations, child and mother such as a mother stays with her child up .(
care). to the age of 12, or as deemed ( ) (
appropriate by the attending doctor. . (
5. Free of charge treatment an insured .
received. 19. Treatment of acne or any treatment of
obesity or corpulence, except medicines (
6. Rest & relaxation, general physical covered. (
health programs and treatment at social . .
care centers. 20. Origins transplant, bone morrow, or
substitute artificial organs as substitutes ( (
7. Any ailment or injury as a result of the for any parts of the body, totally or
profession of the insured individual. partially. . .

8. Reproductive system diseases 21. Personal hazards listed in the definition ( )(

treatment or sexual contracted chapter herein. . HIV HIV (
diseases.
) (
22. Alternative medicines, drugs or
9. Expenses of the period follows a treatment, and any other drugs not ( .
diagnosis of HIV or related HIV related licensed by the Saudi Food and Drug
diseases including AIDS, and other Authority. . (
forms related thereto.
23. Artificial or substitute origins except ( .
10. All costs related to dental plantation or those needed depending on the insured
artificial dental dentures or fixed or condition as per a medical report from .
movable bridges, dental rectification approved health facility. (
except that resulting from an accident. ?
24. Menopause natural changes for the .
11. Sight rectification tests and surgeries insured including monthly period
or hearing or visual and hearing means changes.
unless not prescribed by the doctor. (
.
12. The insured in-Saudi Arabia travel .(
expenses using unpermitted
transportation means.
8
 This policy- will not cover the health benefits and repatriation of the remains
: to country of origin if claims are directly arising- from the following:

( ( )( 1. War, invasion and foreign aggression 4. If the insured works in military, police or
. .? (declared or undeclared). their operations,
. ( ( 2. Ionic radiation radioactive pollution related 5. Riots, strikes, terrorism or alike.
( . to nuclear fuel, or nuclear waste resulting 6. Chemical, biological or bacteria-logical
( from nuclear fuel combustion, accidents and reactions, if such related to a
. . 3. Radioactive or poisonous or explosive or job-related injury or occupational hazards.
hazardous materials of any nuclear facility or
components.

9 9
 One Last Thing
.
Your Bupa card is your passport to comprehensive medical cover. But before :
closing this booklet, here are some useful reminders:

Save the bupa 24/7 helpline number on your mobile phone ^{ {]{{^ {{= {]{ /
800 244 0307 or 920 02 3009

Enrol to benefit from our online services.

Log on now to www.bupa.com.sa and complete a short and simple www.bupa.com.sa 
registration process.
.
Always carry your bupa membership card with you

Register with msg.bupa by sending your membership number to
0550 222 700

Thats It.
Your card is activated to provide you not only medical cover but a host of 
services designed to give you worry-free convenience when you need it most. .

We wish you and your family the best of health. .

Bupa, with you for better health
...
For feedback on service, call CCHI hotline: 920001177


Bupa Arabia for Cooperative Insurance .
PO Box 23807, Jeddah 21436, Saudi Arabia :
Toll free: 800 244 0307 :
Fax: 920 000 724

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Follow us on our social media channels to get updates on our latest products,
healthcare services and health tips. :
@BupaArabia @BupaArabia
/BupaArabia /BupaArabia @BupaArabia /Company/BupaArabia /Company/BupaArabia @BupaArabia /BupaArabia /BupaArabia
@BupaArabiaCare @BupaArabiaCare

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