Health Insurance

Your Membership
Booklet

bupa.com.sa
Start using
your card now
Your membership card is your passport to a comprehensive health care.
First, understand the information printed on your card.

Your Scheme
The number or letter after it Policy Number
denotes your hospital network This is the number of your
level. company's policy coverage
being used as reference by us
and the hospitals.This is your
coverage level as agreed with
your company.

Mohammad Ahmed Mohammed

Scheme: Bupa Arabia - Gold
Membership No: 4883645 100634001
Contribution
Hospital: 20% up to SR 300
Approval Limit: Full Cover - No Exclusions
ID No: 0123456789 NW: 7
Approval & Room
Polyclinic: 20% up to SR 100 Exp: 30/11/16 Staff No: 12345678
MPN: 20% up to SR 75
Policy Holder: Bupa Arabia for Cooperative Insurance
Shows your coverage levels to
the hospital before sharing
your approval requests with
us. Room shows your
accommodation level in case
Contribution of an in-patient service.

It defines how much you have to pay

directly to the hospital whenever you
require treatment. MPN means Minimum Expiry Date
Provider Network. This is the end date
of your policy cover with us.
Your Membership Number
This is your unique number that hospitals
use to verify your membership benefits
with us. ID Number
 ‫اﺑـﺪأ ﺑﺎﺳﺘﺨـــﺪام‬
‫ﺑﻄﺎﻗـﺘــﻚ ان‬
‫ﺑﻄﺎﻗﺔ ﻋﻀﻮﻳﺘﻚ ﻫﻲ ﺟﻮاز ﺳﻔﺮك ﻟﻠﺤﺼﻮل ﻋﻠﻰ رﻋﺎﻳﺔ ﺻﺤﻴﺔ ﺷﺎﻣﻠﺔ‪.‬‬
‫‪+966 9 2002 3009‬‬ ‫ﻓﻴﻤﺎ ﻳﻠﻲ ﺷﺮح ﻟﻠﻤﻌﻠﻮﻣﺎت اﳌﺬﻛﻮرة ﻋﻠﻰ ﺑﻄﺎﻗﺘﻚ‪.‬‬
‫‪This is the landline number you‬‬
‫‪can call to reach us when you‬‬
‫‪are outside of Saudi Arabia‬‬
‫ﻓﺌﺔ اﻟﺘﻐﻄﻴﺔ‬
‫ﻫﺬه ﻫﻲ ﻓﺌﺔ اﻟﺘﻐﻄﻴﺔ اﳌﺘﻔﻖ ﻋﻠﻴﻬﺎ ﻣﻊ‬
‫رﻗﻢ وﺛﻴﻘﺔ اﻟﺘﺄﻣﲔ‬
‫ﺷﺮﻛﺘﻚ‪ .‬وﻳﻠﻴﻬﺎ رﻗﻢ ﺷﺒﻜﺔ اﳌﺴﺘﺸﻔﻴﺎت‬ ‫اﻟﺬي ﻳﺴﺘﺨﺪم ﻛﻤﺮﺟﻊ ﺑﻴﻨﻨﺎ وﺑﲔ اﳌﺴﺘﺸﻔﻰ‬
‫اﳌﻌﺘﻤﺪة ﻟﻚ‪.‬‬ ‫اﻟﺘﻲ ﺗﺰورﻫﺎ‪.‬‬
‫‪bupa.com.sa‬‬
‫‪Visit our website and register‬‬
‫‪to benefit from our innovative‬‬
‫‪online services.‬‬
‫‪For local and intl. assistance‬‬ ‫ﻟﻠﻤﺴﺎﻋﺪة داﺧﻞ و ﺧﺎرج اﳌﻤﻠﻜﺔ‬
‫‪+966 9 2002 3009‬‬ ‫‪+٩٦٦ ٩ ٢٠٠٢ ٣٠٠٩‬‬
‫‪Mohammad Ahmed Mohammed‬‬
‫‪For international assistance‬‬ ‫اﺧﻼء اﻟﻄﺒﻲ اﻟﺪو
اﻟﻄﺎرئ‬
‫‪Scheme:‬‬
‫‪Dubai‬‬‫‪Bupa‬‬
‫‪+9714‬‬ ‫‪Arabia‬‬ ‫‪- Gold‬‬
‫‪601 8777‬‬ ‫دﺑﻲ‪+٩٦٦ ٩ ٢٠٠٢ ٣٠٠٩ :‬‬
‫‪Membership‬‬
‫‪Bupa Ref. No.: No:‬‬ ‫‪4883645‬‬
‫‪SB89993347‬‬ ‫‪100634001‬‬
‫ﻣﺮﺟﻊ ﺑﻮﺑﺎ رﻗﻢ‪SB89993347 :‬‬
‫‪Contribution‬‬
‫‪Hospital:‬‬ ‫‪20%‬‬
‫‪Valid only for the‬‬ ‫‪up insured‬‬
‫‪named‬‬ ‫‪to SR person‬‬
‫‪300‬‬
‫‪Approval Limit: Full Cover - No Exclusions‬‬
‫‪ID‬‬ ‫ﻣﺪة‪No:‬‬
‫اﻟﻌﻀﻮﻳﺔ‪.‬‬ ‫‪0123456789‬‬ ‫‪NW:‬‬
‫ﻟﻠﺘﺤﻮﻳﻞ و ﻳﺠﺐ إﺗﻼﻓﻬﺎ إذا اﻧﺘﻬﺖ‬ ‫ﻫﺬة اﻟﺒﻄﺎﻗﺔ ﻏš‪7‬‬
‫ﻗﺎﺑﻠﺔ‬
‫اﳌﻮاﻓﻘﺎت وﻣﺴﺘﻮى اˆﻗﺎﻣﺔ‬
‫‪Polyclinic:‬‬
‫‪when accompanied‬‬
‫‪MPN:‬‬
‫‪20% with‬‬
‫‪up to‬‬ ‫‪SR 100‬‬
‫‪ID documents‬‬
‫‪20% up to SR 75‬‬
‫‪Exp:‬‬ ‫‪30/11/16‬‬
‫اﻟﻌﻀﻮﻳﺔ‪.‬‬ ‫ﺻﻼﺣﻴﺔ اﻟﺒﻄﺎﻗﺔ ﺗﺘﻮﻗﻒ ﻋﻠﻰ ﺷﺮوط‬‫‪Staff‬‬‫‪No: 12345678‬ﻛﻤﺎ أن‬
‫‪CCHI‬‬ ‫‪hotline‬‬
‫ﻣﻨﺎﻓﻌﻚ‬ ‫وﻫﻲ ﻣﺮﺟﻊ اﳌﺴﺘﺸﻔﻰ ﳌﻌﺮﻓﺔ‬
‫‪Policy‬‬ ‫‪Holder:‬‬ ‫‪Bupa‬‬ ‫‪Arabia‬‬ ‫‪for‬‬ ‫‪Cooperative‬‬
‫‪For remarks about the service provided‬‬ ‫‪Insurance‬‬
‫ﻟﻠﻤﻼﺣﻈﺎت ﺣﻮل اﳋﺪﻣﺔ اﳌﻘﺪﻣﺔ‬
‫‪please call 920 00 11 77‬‬ ‫اﻟﺮﺟﺎء اﺗﺼﺎل ﻋﻠﻰ ‪٩٢٠٠٠١١٧٧‬‬
‫‪The‬‬ ‫‪number‬‬
‫ا®ﻗﺎﻣﺔ‬ ‫ﻃﻠﺐ‪you can‬‬
‫اﳌﻮاﻓﻘﺔ‪ .‬ﻣﺴﺘﻮى‬ ‫ارﺳﺎل‪call‬‬
‫ﻗﺒﻞ ‪for‬‬
‫‪any‬‬
‫‪feedback‬ﻋﻨﺪ‬ ‫اﻟﻐﺮﻓﺔ‪or‬‬
‫اﻟﺘﻲ ﻧﻮﻓﺮﻫﺎ ﻟﻚ‬ ‫‪complaints.‬‬
‫ﻳﻮﺿﺢ ﻣﺴﺘﻮى‬
‫اﳊﺎﺟﺔ إ§ اﻟﺘﻨﻮﱘ‪.‬‬

‫ﻣﺒﻠﻎ اﳌﺸﺎرﻛﺔ‬
‫‪International SOS Assistance‬‬
‫وﻫﻮ اﳌﺒﻠﻎ اﻟﺬي ﻋﻠﻴﻚ دﻓﻌﻪ ﻣﺒﺎﺷﺮة ﻟﻠﻤﺴﺘﺸﻔﻰ ﻋﻨﺪ‬
‫‪Our international‬‬
‫‪partner‬اﳊﺪ ا‪£‬دﻧﻰ ﳌﺰودي‬
‫‪ MPN‬ﺗﻌﻨﻲ‬‫ﻃﺒﻴﺔ‪in.‬‬
‫ﺧﺪﻣﺔ‪case‬‬
‫‪require‬إ§‪you‬‬
‫ﺣﺎﺟﺘﻚ‬ ‫ﺗﺎرﻳﺦ اﻻﻧﺘﻬﺎء‬
‫‪emergency medical advice or emergency‬‬ ‫اﳋﺪﻣﺔ‪.‬‬ ‫ﺗﺎرﻳﺦ اﻧﺘﻬﺎء ﺗﺄﻣﻴﻨﻚ اﻟﺼﺤﻲ ﻣﻌﻨﺎ‪.‬‬
‫‪medical evacuation when outside of‬‬
‫‪Saudi Arabia.‬‬ ‫رﻗﻢ ﻋﻀﻮﻳﺘﻚ‬
‫ﻫﺬا ﻫﻮ رﻗﻢ ﻋﻀﻮﻳﺘﻚ ﻣﻌﻨﺎ‪ .‬ﺗﻘﻮم اﳌﺴﺘﺸﻔﻴﺎت‬
‫واﳌﺴﺘﻮﺻﻔﺎت ﺑﺎﺳﺘﺨﺪام ﻫﺬا اﻟﺮﻗﻢ ﳌﻌﺮﻓﺔ ﻣﻨﺎﻓﻊ ﺗﺄﻣﻴﻨﻚ‬
‫رﻗﻢ اﻟﻬﻮﻳﺔ اﻟﻮﻃﻨﻴﺔ‪/‬اˆﻗﺎﻣﺔ‬
‫اﻟﺼﺤﻲ‪.‬‬
 Over 2,000,000 have
used our Tebtom Program.
Have you?

Bupa doctors do not provide any medical consultations nor medication prescriptions
Tebtom Program
Services
Specialized International
Bupa Doctor
Services

questions?
‫ اﺳﺘﻔﺎدوا‬2,000,000 ‫أﻛ ﻣﻦ‬
Do you have a lot of healthcare Telemedicine:***
Live consultation with US based doctors
.‫ﻣﻦ ﺑﺮﻧﺎﻣﺞ ﻃﺒﺘﻢ‬
Female & male doctors available
Communicating through app, live video
chat, or by calling 9 2002 3009
Access using toll free number
‫ﻫﻞ أﻧﺖ ﻣﻨﻬﻢ؟‬
Access to specialized doctors 24/7
Travel health coaching

International Second Medical

Opinion:**
Diagnosis from International doctors at
Chronic Care world-renowned centers
Approval based on pre-set medical
Frustrated with dealing with criteria
your chronic case?

Chronic Medication Refill***

Chronic Medication Delivery* Wellness Services
Home-based Laboratory visits
at home or office* Struggling to lead a healthier
lifestyle?

Stress Management Support

Maternity & Child Care Smoking Cessation Guidance
Weight Management
Are you getting the correct
guidance for you and your baby?

Assured privacy with female doctors

Home-based child vaccinations*
Healthcare advice and guidance
pre & post natal

* For members with Network 5 and above & in specific cities.

** For non-emergency cases & for members with Network 5 and above.
*** For members with Network 5 and above. ‫أﻃﺒﺎء ﺑﻮﺑﺎ ﻻ ﻳﻘﺪﻣﻮن أي اﺳﺘﺸﺎرات أو وﺻﻔﺎت ﻃﺒﻴﺔ‬
 Over 500,000 have benefited from our
Rahatkom Program at hospitals.
Have you?

*Available in limited hospitals only

Rahatkom Program
Services
The Rahatkom program is designed to make your hospital experiences easier and
less stressful through supporting you when and where it matters, focusing on
on-site case management, quick coverage responsiveness and post-admission
services.
‫ اﺳﺘﻔﺎدوا ﻣﻦ ﺧﺪﻣﺎت‬500,000 ‫أﻛ ﻣﻦ‬
Waiting times can be reduced by 50%
.‫ﺑﺮﻧﺎﻣﺞ راﺣﺘﻜﻢ
اﳌﺴﺘﺸﻔﻴﺎت‬
Far from being just an insurance office, you will find Bupa Arabia delegates
across various locations and specialties within hospitals.
‫ﻫﻞ أﻧﺖ ﻣﻨﻬﻢ؟‬
We even have mobile Bupa Arabia delegates to help you where it matters the
most.

We position experienced Bupa doctors across top hospitals to represent you

with the hospital physicians.

‫ﺪدة‬  ‫*ﻣﺘﻮﻓﺮة
ﻣﺴﺘﺸﻔﻴﺎت‬
Frequently
Asked Question
How to know my benefits?
Refer to the Table of Benefits enclosed
with your pack to know all the details of
benefits you are entitled to. We advise you
to register in our online services by visiting
member.bupa.com.sa to get all the details
of your benefits.
Which hospital or clinic can I go for
treatment?
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 our website at
member.bupa.com.sa.
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. Alternatively, login to our online
services and you can print membership
certificates in case you lost your
membership card and you need medical
treatment.
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?
Yes, you don’t need to pay any cash for
in-patient or day-case treatments.
However, as 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 supervising
the operation of health insurers in
Saudi Arabia.
Can I go to a hospital not included in my
network?
Yes, if you are eligible for reimbursement,
you can go to any hospital, clinic or doctor
of your choice outside your hospital
network. However, you will have to pay for
all costs directly to the hospital or clinic.
You can then file for reimbursement later,
using the Bupa claim form, which you can
download at member.bupa.com.sa. This
will allow you to claim from us the amount
you are eligible for according to your
network price.
I’m going on vacation outside the
Kingdom; can I use my Bupa Arabia card?
Yes, you can use your card at any of the
specific providers that have prior contracts
with with us when traveling according to
your network. Also, depending on your
coverage if you are eligible for
reimbursement outside KSA, you can get
treatment at any hospital while on vacation
or on business at any provider of your
choice. However, you will have to pay for
all costs directly to the hospital. You can
then file for reimbursement and will be
compensated as per our policy.
Q
A
‫?)‪What is claiming (reimbursement‬‬
‫‪This is the process of settling medical‬‬
‫‪expenses with Bupa provided outside of‬‬
‫?‪mean‬‬ ‫اﺳﺌﻠـــﺔ‬
‫’‪What does ‘reasonable and customary‬‬

‫‪Reasonable and Customary means that all‬‬

‫اﻛﺜــﺮ ﺗﻜـــﺮار‬
‫‪your approved network of hospitals and‬‬ ‫‪the claimed medical fees and expenses are‬‬
‫‪clinics based on the terms and conditions‬‬ ‫‪compatible with our negotiated‬‬
‫‪of your insurance policy. You need to file‬‬ ‫‪fee-for-service with providers in your‬‬
‫‪your claim form with Bupa within 90 days‬‬ ‫‪assigned network of hospitals and clinics in‬‬
‫ﺷﺒﻜﺘﻲ‪of‬‬
‫ˆ ‪your‬‬‫‪treatment.‬‬
‫ﻫﻞ أﺳﺘﻄﻴﻊ زﻳﺎرة ﻣﺴﺘﺸﻔﻴﺎت ﻏ‪ ª‬ﺗﻠﻚ اﻟﺘﻲ‬ ‫ﺑﻬﺎ؟ ‪Saudi Arabia. Hence,‬‬ ‫‪we will‬‬
‫‪match‬أﲤﺘﻊ‬ ‫ﻣﺎ ﻫﻲ‪the‬‬
‫اﳌﺰاﻳﺎ اﻟﺘﻲ‬
‫اﳌﻌﺘﻤﺪة ؟‬ ‫‪billed‬‬ ‫‪cost‬‬ ‫‪of‬‬ ‫‪any‬‬ ‫‪medical‬‬ ‫‪service‬‬ ‫‪done‬‬
‫ﻳﺒﲔ ﻟﻚ ﺟﺪول اﳌﺰاﻳﺎ اﳌﺮﻓﻖ ﲟﻠﻒ اﻟﻌﻀﻮﻳﺔ اﳌﺰاﻳﺎ اﺧﺮى‬
‫?‪How do I file Reimbursement Claim‬‬ ‫‪outside your network with the negotiated‬‬
‫ﻧﻌﻢ‪ .‬ﳝﻜﻨﻚ زﻳﺎرة أي ﻣﺴﺘﺸﻔﻰ ﺗﺮﻳﺪه او اي ﻃﺒﻴﺐ ﺧﺎرج‬ ‫اﻟﺘﻲ ﺗﺘﻤﺘﻊ ﺑﻬﺎ‪ ،‬ﻧﻨﺼﺤﻚ ﺑﺎﻟﺘﺴﺠﻴﻞ  ﺧﺪﻣﺎﺗﻨﺎ اﻟﻜوﻧﻴﺔ‬
‫‪Settlement of claims is based on the‬‬ ‫‪fee-for-service cost of the same service if it‬‬
‫ﺷﺒﻜﺘﻚ اﳌﻌﺘﻤﺪة اذا ﻛﻨﺖ ﺗﺘﻤﺘﻊ ﲟﻴﺰة اﻟﺘﻌﻮﻳﺾ‪ ،‬وﻟﻜﻦ‬
‫‪reasonable and customary cost of the‬‬
‫‪ member.bupa.com.sa‬ﻟﻼﻃﻼع ﻋﻠﻰ ﻛﻞ ﺗﻔﺎﺻﻴﻞ‬
‫‪was done in your network based on the‬‬
‫ﺗﻜﺎﻟﻴﻒ ﻣﺒﺎﺷﺮة‬
‫‪same treatment‬‬ ‫اﳊﺎﻟﺔ دﻓﻊ ﺟﻤﻴﻊ‬
‫‪or procedure‬‬ ‫ ﻫﺬه‬
‫‪within‬‬ ‫ﻋﻠﻴﻚ‪the‬‬ ‫أﺧﺮى‪services rate agreement.‬‬ ‫ﺧﺪﻣﺎت‪with‬‬
‫ﺗﺄﻣﻴﻨﻚ وﻋﻠﻰ ‪our‬‬
‫ذاﻟﻚ ﺑﺘﻘﺪﱘ‬
‫‪member’s‬‬ ‫‪network‬واﻟﻘﻴﺎم ﺑﻌﺪ‬
‫‪approved‬‬ ‫اﳌﺴﺘﻮﺻﻒ‪،‬‬‫او ‪of‬‬ ‫ﻟﻠﻤﺴﺘﺸﻔﻰ‬
‫‪hospitals‬‬ ‫‪providers.‬‬
‫ﲢﻤﻴﻞ ‪and‬‬ ‫ﳝﻜﻨﻚ‬
‫‪clinics.‬‬ ‫‪Send‬‬‫اﳌﻄﺎﻟﺒﺔ‪.‬‬
‫ﳕﻮذج ‪your‬‬
‫ﺗﻌﺒﺌﺔ‪claim‬‬
‫ﻣﻄﺎﻟﺒﺘﻚ ﻟﻨﺎ ﺑﻌﺪ ‪to:‬‬ ‫ˆ أي ﻣﺴﺘﺸﻔﻰ أو ﻣﺴﺘﻮﺻﻒ أﺳﺘﻄﻴﻊ أن أﺗﻠﻘﻰ اﻟﻌﻼج؟‬
‫اﻟﻨﻤﻮذج ﻣﻦ ﺧﻼل ﻣﻮﻗﻌﻨﺎ ‪member.bupa.com.sa‬‬ ‫‪What‬‬ ‫‪are‬‬
‫ﻣﺬﻛﻮر‬ ‫‪the treatments,‬‬
‫ﻣﺴﺘﻮﺻﻒ‬ ‫‪medications‬ﻣﺴﺘﺸﻔﻰ أو‬ ‫‪or‬‬
‫ﺗﺴﺘﻄﻴﻊ اﻟﺬﻫﺎب إž أي‬
‫‪Riyadh‬‬ ‫وﺳﻴﺘﻢ ﺗﻌﻮﻳﻀﻚ ﺣﺴﺐ اﺳﻌﺎر  ﺷﺒﻜﺘﻚ‪.‬‬ ‫‪procedures‬‬
‫‪not‬اﳌﺮﻓﻖ ﲟﻠﻒ‬ ‫ ﻗﺎﺋﻤﺔ اﳌﺴﺘﺸﻔﻴﺎت?‪covered‬‬
‫واﳌﺴﺘﻮﺻﻔﺎت‬
‫‪Bupa Arabia Building, King Fahad Road‬‬ ‫‪Based‬‬ ‫‪on CCHI‬‬
‫اﻟﺘﺤﺪﻳﺚ ﺑﻌﺪ‬ ‫ﻗﺪ‪ruling‬‬
‫ﻳﻄﺎﻟﻬﺎ ﺑﻌﺾ‬ ‫‪and‬‬ ‫ﻫﺬه ‪on‬‬
‫اﻟﻘﺎﺋﻤﺔ‬ ‫‪international‬‬
‫ﻋﻀﻮﻳﺘﻚ‪ .‬ون‬
‫‪Olaya‬‬ ‫‪District‬‬
‫أﺳﺘﻄﻴﻊ‬ ‫ﺧﺎرج‪Riyadh‬‬
‫اﳌﻤﻠﻜﺔ‪ ،‬ﻓﻬﻞ‬ ‫‪11351,‬‬ ‫‪Saudi‬‬
‫إﺟﺎزة ا®‬ ‫‪ˆ Arabia‬‬
‫ﺳﻮف أﺳﺎﻓﺮ‬ ‫‪practices‬‬ ‫‪and‬‬ ‫‪standards,‬‬ ‫‪there‬‬ ‫ﻟﻬﺎ‪are،‬‬
‫ﻧﺮﺟﻮ ﻣﻨﻚ زﻳﺎرة ﻣﻮﻗﻌﻨﺎ ﻋﻠﻰ ﺷﺒﻜﺔ اﻧﻧﺖ‬ ‫‪certain‬‬
‫اﺳﺘﻼﻣﻚ‬
‫‪Telephone: 9 2002 3009‬‬‫أﺳﺘﺨﺪام ﺑﻄﺎﻗﺔ ﺑﻮﺑﺎ اﻟﻌﺮﺑﻴﺔ؟‬ ‫‪treatments,‬‬ ‫‪medications and procedures‬‬
‫‪ member.bupa.com.sa‬ﻟﻠﺤﺼﻮل‬ ‫ﻋﻠﻰ اﻟﻌﻨﻮان اﻟﺘﺎ‪±‬‬
‫‪that are not covered. Refer to page 8 for‬‬
‫ﻧﻌﻢ‪ .‬ﺗﺴﺘﻄﻴﻊ اﺳﺘﺨﺪام ﺑﻄﺎﻗﺘﻚ  اي ﻣﺴﺘﺸﻔﻰ ﻟﺪﻳﻨﺎ‬ ‫ﻋﻠﻰ اﻟﻘﺎﺋﻤﺔ اﶈﺪﺛﺔ‪.‬‬
‫‪Jeddah‬‬ ‫‪details.‬‬
‫اﺗﻔﺎﻗﻴﺔ ﻣﺴﺒﻘﺔ ﻣﻊ ﻣﻌﻬﺎ ﺧﻼل ﺳﻔﺮك او رﺣﻠﺘﻚ وﺣﺴﺐ‬
‫‪Claims Reimbursement Center‬‬
‫‪(Back‬‬‫اﻟﺘﻌﻮﻳﺾ(‪،‬‬ ‫ﺗﻐﻄﻴﺘﻚ‪ .‬وأﻳﻀﺎ ﳝﻜﻨﻚ )اذا ﻛﻨﺖ ﺗﺘﻤﺘﻊ ﲟﻴﺰة‬
‫)‪entrance‬‬ ‫ﻟﻘﺪ ﻧﺴﻴﺖ ﺑﻄﺎﻗﺔ ﻋﻀﻮﻳﺘﻲ‪ ،‬وأﺣﺘﺎج ﻟﺘﻠﻘﻲ اﻟﻌﻼج ˆ‬
‫ﻣﺒﺎﺷﺮة ‪6th‬‬ ‫ﺟﻤﻴﻊ اﻟﺘﻜﺎﻟﻴﻒ‬
‫‪floor Prince‬‬ ‫‪St,‬دﻓﻊ‬
‫‪Sultan‬‬ ‫وﻟﻜﻦ ﻋﻠﻴﻚ  ﻫﺬه اﳊﺎﻟﺔ‬ ‫ﻋﻠﻲ أن اﻓﻌﻞ؟‬
‫اﳌﺴﺘﺸﻔﻰ‪ ،‬ﻓﻤﺎذا ّ‬
‫واﻟﻘﻴﺎم ﺑﺘﻘﺪﱘ ﻣﻄﺎﻟﺒﺘﻚ ﻟﻨﺎ‬
‫‪Al-Mohammadiah‬‬ ‫ﻟﻠﻤﺴﺘﺸﻔﻰ أو اﳌﺴﺘﻮﺻﻒ‬
‫‪District‬‬ ‫إذا ﻛﻨﺖ ﻗﺪ ﻓﻘﺪت ﺑﻄﺎﻗﺘﻚ وﲢﺘﺎج إž ﺧﺪﻣﺔ ﻃﺒﻴﺔ‪ ،‬اﺗﺼﻞ‬
‫ﺑﻌﺪ ﺗﻌﺒﺌﺔ ﳕﻮذج اﳌﻄﺎﻟﺒﺔ اﳌﺮﻓﻖ‪(next to SACO) .‬‬ ‫ﻋﻠﻰ ﺧﺪﻣﺔ اﻟﻌﻤﻼء وﺳ¸ﺳﻞ ﺷﻬﺎدة ﺗﺄﻛﻴﺪ ﻋﻀﻮﻳﺘﻚ‬
‫‪P.O. Box 260 - Jeddah 21411‬‬ ‫ﻟﻠﻤﺴﺘﺸﻔﻰ‪ ،‬ﻛﻤﺎ ﳝﻜﻨﻚ اﻻﺷاك ﺑﺨﺪﻣﺎﺗﻨﺎ ﻋ‪ º‬اﻧﻧﺖ‬
‫‪Saudi Arabia‬‬ ‫وﻃﺒﺎﻋﺔ ﺷﻬﺎدة اﻟﻌﻀﻮﻳﺔ ﺑﺜﻮان ﻓﻘﻂ‪.‬‬
‫‪Telephone: 9 2002 3009‬‬
‫‪Fax: 9 2000 0724‬‬ ‫ﻛﻨﺖ أﻋﺘﻘﺪ أﻧﻨﻲ ﻟﻦ أﻛﻮن ﻣﻀﻄﺮ ﻟﺪﻓﻊ أي ﻣﺒﻠﻎ ﻧﻘﺪي‬
‫أي ﻣﻦ ﻣﺴﺘﺸﻔﻴﺎت ﺷﺒﻜﺘﻲ اﳌﻌﺘﻤﺪة‬ ‫ﻋﻨﺪﻣﺎ أﺳﺘﺨﺪم ّ‬
‫‪Khobar‬‬
‫‪New Regional Office,‬‬
‫وﻟﻜﻦ‪ ،‬ﻣﺎ زال اﳌﺴﺘﺸﻔﻰ ﻳﻄﻠﺐ ﻣﻨﻲ دﻓﻊ ﺑﻌﺾ اﳌﺒﺎﻟﻎ‪،‬‬
‫‪3339 King Faisal Road,‬‬ ‫ﻓﻤﺎ ﻫﻮ ﻣﺒﻠﻎ ﻣﺸﺎرﻛﺔ اﻟﻌﻀﻮ؟‬
‫‪AlBostan, Khobar 34422‬‬ ‫ﻧﻌﻢ‪ ،‬ﻻ ﻳﺘﻮﺟﺐ ﻋﻠﻴﻚ دﻓﻊ أي ﻣﺒﺎﻟﻎ ﻧﻘﺪﻳﺔ  ﺣﺎﻻت اﻟﺘﻨﻮﱘ أو‬
‫‪Saudi Arabia‬‬ ‫ﺣﺎﻻت اﻟﻴﻮم اﻟﻮاﺣﺪ‪ ،‬وﻟﻜﻦ وﲟﻮﺟﺐ اﻟﻘﺎﻧﻮن وﺣﺴﺐ ﻣﺎ ﰎ‬
‫‪Telephone: 9 2002 3009‬‬ ‫اﻻﺗﻔﺎق ﻋﻠﻴﻪ ﻣﻊ ﺷﺮﻛﺘﻚ‪ ،‬ﻓﺈﻧﻪ ﻳﺠﺐ ﻋﻠﻴﻚ أن ﺗﺪﻓﻊ‬
‫‪Fax: 013 881 2240‬‬ ‫ﻟﻠﻤﺴﺘﺸﻔﻰ ﻣﺒﻠﻐ‪Í Î‬ﺪد‪ Ì‬ﻋﻨﺪ ﺗﻠﻘﻲ اﻟﻌﻼج  اﻟﻌﻴﺎدات‬
‫اﳋﺎرﺟﻴﺔ‪.‬‬

‫و ﻣﻌﻈﻢ اﳊﺎﻻت ﻳﻜﻮن ﻣﺒﻠﻎ اﳌﺸﺎرﻛﺔ ‪ %20‬ﻣﻦ إﺟﻤﺎ‪±‬‬

‫ﻗﻴﻤﺔ اﻟﻔﺎﺗﻮرة وﺣﺘﻰ ‪ 100‬رﻳﺎل‪ ،‬وﻫﺬه اﻟﻨﺴﺒﺔ ﰎ ﲢﺪﻳﺪﻫﺎ‬
‫ﻣﻦ ﻗﺒﻞ ‪Ö‬ﻠﺲ اﻟﻀﻤﺎن اﻟﺼﺤﻲ اﻟﺘﻌﺎو‪، Ô‬وﻫﻮ اﳉﻬﺔ‬
‫اﳊﻜﻮﻣﻴﺔ اﳌﺴﺌﻮﻟﺔ ﻋﻦ إدارة اﻟﺘﺄﻣﲔ اﻟﺼﺤﻲ  اﳌﻤﻠﻜﺔ‬
‫اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‪.‬‬

‫‪Q‬‬
‫‪A‬‬
How do I file a complaint?
We can attend to all your issues by calling
our 24/7 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.
What are the forms of “Proof of
Payment”?
A proof of payment may include the
following:
• An official invoice with mention of
amount paid and shows the balance
• POS slip if purchased from pharmacies
• Copy of bank statement if the mode of
payment is Cheque or online. The bank
statement must show the name of the
vendor and the amount
What happens if incomplete document is
submitted?
Assessment of your claim is dependent on
the completion of your documents. If not
complete, this shall be put in pending and
you are required to complete within 90
days of submission; thereafter, it will be
rejected.
What is the required “Official Invoice”?
The required official invoice shall contain
at least the name and file number of
member. It should also show breakdown of
billed services with corresponding fee for
each service.

Should I secure translation for documents

that are not written in English or Arabic?
Yes, these should be translated in English
or Arabic by an official translation
company before submitting the claim.

How can I check the status of my claim?

We notify members of the status of their
claim through automated SMS. To update
your mobile number, please send your
membership number to 0550 222 700.
Alternatively, you could monitor the status
of your claim online by logging in at
member.bupa.com.sa.
Understanding
Your Scheme
Pre-authorization is a necessary procedure based on CCHI process and procedures - to
check that the required tests, procedures or medications are:
• Covered by your benefits’ list
• Within your benefit sub-limits

The insurance office in your visited hospital will send the request to us online on your
behalf. (refer to proceeding diagram on next page)

All our members benefit from the following ;

• Automated approvals on the received requests specially for sublimit benefits.
• Exemption of pre-approval as long as the cost of requested medical services are below
the assigned cost per visit as mentioned on your membership card.

Don’t 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.
Your Hospital Journey
When service You receive
does not require treatment
approval immediately

When service Hospital sends We receive

requires approval and process
approval request to us the request

Hospital treats you We send you 2 SMS:

after receiving the 1- Receipt of request
approval 2- Decision on request

Treatments requiring our approval - for example but not limited to:
• In-patient treatment & day-case surgeries.
• MRI and CT scans
• Physiotherapy after first session
• Benefits with sub limits, i.e. dental, optical, maternity, disability cases, hearing aids,
autism, acute psychiatric, treatment for acquired heart values disease, obesity,
Alzheimer’s disease and dialysis
• Treatments estimated to exceed SR1000
• New born screening hearing test and new born congenital heart anomalies screening
• Artificial milk when medically indicated up to the age of 2 years
• Respiratory syncytial virus (RSV) prophylaxis

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 10
minutes.

Send your membership number to 0550 222 700

to stay updated with your approval request status
Conditions
Not Covered
The policy shall not cover claims arising
from:

1. Intentional self-inflicted injury. 14. Allergy tests of any nature, unless

relating to prescribed medicine.
2. Illness resulting from abuse of some
medicines, stimulants or tranquilizers, or 15. Equipment, means, drugs and procedures
from substance abuse. or hormone treatment aimed at
regulating reproduction, contraception,
3. Cosmetic treatment or surgery unless
fertility, infertility, impotence, secondary
necessitated by a bodily injury not
sterility, in-vitro fertilization or any other
excluded in this section.
method of artificial fertilization.
4. General examinations, inoculations, drugs
16. Any congenital weakness or deformity
or preventive measures not required for
unless it is life threatening.
medical treatment provided for in the
policy (excluding preventive measures 17. Any costs or additional expenses
determined by the Ministry of Health, incurred by the insured's companion
such as vaccination and maternity and during hospitalization, except for hospital
child care). room and board charges for one
companion, such as a mother
5. Treatment received by the insured free of
accompanying a child up to the age of
charge.
twelve or if medically necessary as
6. Recreational therapy, general physical assessed by the attending physician.
health programs and treatment in social
18. Treatment of acne
welfare institutions.
19. Any treatment relating to obesity or
7. Any illness or injury directly resulting from
overweight, except The cost of covering
the insured's profession.
obesity treatment by Sleeve gastrostomy
8. Medically recognized venereal or sexually (Sleeve) only if the BMI as over 45 as per
transmitted diseases. the limits specified in the policy’s Table
of Benefits.
9. Costs of treatment following diagnosis of
HIV or any disease related to HIV, 20. Organ or marrow transplant, or implant
including AIDS and its derivatives, of artificial organs to wholly or partially
alternatives or other forms. replace any organ of the body.
10. Costs related to tooth implant, dentures, 21. Personal risks set forth in Section One
fixed or movable bridges or orthodontic (Definitions) of the Policy.
treatment, unless resulting from an
22. Alternative medicine procedures and
accident.
medications.
11. Vision or hearing correction tests and
23. Artificial and prosthetic limps.
visual or hearing aids.
24. Natural changes related to menopause,
12. The expenses of the insured's
including menstrual disorders.
transportation within and between cities
of the Kingdom by other than licensed
means of transportation.
13. Hair loss, baldness or artificial hair.
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 their
(declared or undeclared). operations,
2. Ionic radiation radioactive pollution related to 5. Riots, strikes, terrorism or alike.
nuclear fuel, or nuclear waste resulting from 6. Chemical, biological or bacteria-logical
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.

Important Reminders
• The insurance card should be used only by the insured member. If it’s used by individual
other than the insured member, this exposes you to a legal liability and can lead to the
withdrawal of the insurance card and termination of the insurance policy.

• Please notify us immediately whenever your insurance card is lost or damaged, so the card
can be cancelled & replaced.

• Misusing the insurance card to gain dishonest or unlawful advantages.

• Examples of fraud:
o Allowing someone else use your own card.
o Providing false or inaccurate claims for money reimbursement.
o Visiting same or multiple medical providers to receive unnecessary medications.

• You can use the below channels to report any incidents of fraud or abuse.
o Through our website: www.bupa.com.sa/customer-care/report-a-fraud-or-abuse, or
o Through e-mail BAReport.Abuse@bupa.com.sa
View Your Healthcare
Providers Network
On the Go!

Through the “Bupa Arabia” application, you can get access to your latest network of
healthcare providers.

You can also:

1. View your membership details & coverage limits
2. Track pre-authorisation requests
3. Check reimbursement claims status and history
4. Send membership certificates to your email or fax

Download the “Bupa Arabia” Application Now:

One Last Thing
Your membership card is your passport to a comprehensive healthcare.
But before closing this booklet, here are some useful reminders:

Save the Bupa Arabia 24/7 helpline Register to member.bupa.com.sa

number on your mobile phone to benefit from all your insurance
9 2002 3009 online services.

Register with our SMS service by

sending your membership number
Always carry your Bupa Arabia
to 0550 222 700 and get instant
membership card with you
updates on your approvals

That’s It.
Your card is activated to provide you not just a 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.

For feedback on service, call CCHI hotline: 9 2000 1177

Bupa Arabia for Cooperative Insurance
3538 Al-Khalidiyah-Nour Al Ehsan, Unit 1
Jeddah 7505-23423, Kingdom of Saudi Arabia
24/7 Helpline: 9 2002 3009
Fax: 9 2000 0724

bupa.com.sa customer.care@bupa.com.sa
To download our app, please visit: bupa.com.sa/ar/app

Follow us on our social media channels to get updates on our latest products,
healthcare services and health tips.
 ‫وأﺧ ‪ ،‬ﺗﺬﻛﺮ داﺋﻤ‬
‫ﺑﻄﺎﻗﺔ ﺗﺄﻣﻴﻨﻚ ﻫﻲ ﺟﻮاز ﺳﻔﺮك ﻟﺮﻋﺎﻳﺔ ﺻﺤﻴﺔ ﺷﺎﻣﻠﺔ‪ .‬وﻗﺒﻞ أن ﺗﻨﺘﻬﻲ ﻣﻦ ﻗﺮاءة ﻫﺬا اﻟﻜﺘﻴﺐ وﺗﻐﻠﻘﻪ‪،‬‬
‫إﻟﻴﻚ ﺑﻌﺾ ا“ﻣﻮر ﻟﺘﺘﺬﻛﺮﻫﺎ داﺋﻤŠ ‪:‬‬

‫ﺳﺠﻞ — ﺧﺪﻣﺎﺗﻨﺎ ا‪²‬ﻟﻜ‪±‬وﻧﻴﺔ ﻟ¯ﺳﺘﻔﺎدة ﻣﻦ‬ ‫اﺣﻔﻆ رﻗﻢ ﺧﺪﻣﺔاﻟﻌﻤﻼء — ﺟﻮاﻟﻚ‬

‫ﺟﻤﻴﻊ ﺧﺪﻣﺎﺗﻨﺎ أوﻧﻼﻳﻦ‬ ‫‪ 9 2002 3009‬واﳌﺘﻮﻓﺮ ﻋﻠﻰ ﻣﺪار‬
‫‪member.bupa.com.sa‬‬ ‫اﻟﺴﺎﻋﺔ‬

‫إرﺳﻞ رﻗﻢ ﻋﻀﻮﻳﺘﻚ إ© ‪0550 222 700‬‬ ‫اﺣﺘﻔﻆ ﺑﺒﻄﺎﻗﺘﻚ ﻣﻌﻚ دوﻣŠ ﻓﺴﻮف ﲢﺘﺎج ﻟﻬﺎ‬
‫ﻟﺘﺒﻘﻰ ﻋﻠﻰ إﻃﻼع ﻓﻮري ﺑﻜﻞ ﻃﻠﺒﺎﺗﻚ‬ ‫ﻛﻞ ﻣﺎ اﺣﺘﺠﺖ ﻟﺮﻋﺎﻳﺔ ﺻﺤﻴﺔ‬

‫ﻫﺬا ﻛﻞ ﻣﺎﲢﺘﺎج إﻟﻴﻪ‬

‫وأﺻﺒﺤﺖ ﺑﻄﺎﻗﺘﻚ ا‪º‬ن ﻓﻌﺎﻟﺔ ﻟﺘﻘﺪم ﻟﻚ ﻟﻴﺲ ﻓﻘﻂ رﻋﺎﻳﺔ ﺻﺤﻴﺔ‪ ،‬ﺑﻞ اﻟﻌﺪﻳﺪ ﻣﻦ اﳋﺪﻣﺎت اﻟﺘﻲ ﰎ‬
‫ﺗﺼﻤﻴﻤﻬﺎ ﺧﺼﻴﺼŠ ﻟﺮاﺣﺘﻚ‪.‬‬

‫ﻧﺘﻤﻨﻰ ﻟﻚ و ﻟﻌﺎﺋﻠﺘﻚ دوام اﻟﺼﺤﺔ‪.‬‬

‫ﳌﻼﺣﻈﺎﺗﻚ وﺗﻌﻠﻴﻘﺎﺗﻚ ﻋﻠﻰ اﳋﺪﻣﺎت اﳌﻘﺪﻣﺔ ﻟﻚ‪ ،‬ﳝﻜﻨﻚ اﻟﺘﻮاﺻﻞ ﻣﻊ ½ﻠﺲ اﻟﻀﻤﺎن اﻟﺼﺤﻲ اﻟﺘﻌﺎو¼ ﻋﻠﻰ ‪9 2000 1177‬‬
‫ﺷﺮﻛﺔ ﺑﻮﺑﺎ اﻟﻌﺮﺑﻴﺔ ﻟﻠﺘﺄﻣﲔ اﻟﺘﻌﺎو¼‬
‫‪ 3538‬اﳋﺎﻟﺪﻳﻪ ‪ ،‬ﻧﻮر ا‪²‬ﺣﺴﺎن‪ ،‬وﺣﺪه رﻗﻢ ‪1‬‬
‫ﺟﺪة ‪ ،23423-7505‬اﳌﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬
‫رﻗﻢ ﺧﺪﻣﺔاﻟﻌﻤﻼء )‪ ٢٤‬ﺳﺎﻋﺔ(‪9 2002 3009 :‬‬
‫ﻓﺎﻛﺲ‪9 2000 0724 :‬‬

‫‪customer.care@bupa.com.sa‬‬ ‫‪bupa.com.sa‬‬
‫ﻟﺘﺤﻤﻴﻞ ﺗﻄﺒﻴﻘﻨﺎ ا‪²‬ﻟﻜ‪±‬و¼‪ ،‬ﻗﻢ ﺑﺰﻳﺎرة‪:‬‬
‫‪bupa.com.sa/ar/app‬‬

‫ﺗﺎﺑﻌﻮﻧﺎ ﻋﻠﻰ ﺣﺴﺎﺑﻨﺎ — اﻟﺸﺒﻜﺎت اﻻﺟﺘﻤﺎﻋﻴﺔ ﻟﻠﺤﺼﻮل ﻋﻠﻰ أﺣﺪث أﺧﺒﺎر ﺧﺪﻣﺎﺗﻨﺎ واﻟﻨﺼﺎﺋﺢ اﻟﺼﺤﻴﺔ‪:‬‬