Membership Guide - Bupasalud
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Membership Guide B U PA PRESTIGE
BUPA PRESTIGE
2DEFINITIONS
INDEX
AGREEMENT ................................................ 2
BENEFITS ...................................................... 6
Schedule of benefits ............................... 7
Policy provisions ...................................... 8
EXCLUSIONS AND LIMITATIONS ...... 12
ADMINISTRATION .................................... 14
DEFINITIONS .............................................. 18
SPANISH VERSION.................................... 25
3BUPA PRESTIGE
AGREEMENT
BUPA INSURANCE COMPANY (herein- ELIGIBILITY: This policy can only be
after referred to as the “Insurer”) agrees issued to residents of Latin America or
to pay you (hereinafter referred to as the Caribbean who are a minimum of
the “Policyholder”) the benefits pro- eighteen (18) years of age (except for eli-
vided by this policy for any treatment, gible dependents) through a maximum
service or medical supply provided in of seventy-three (73) years of age. There
Latin America, the Caribbean and the is no maximum age for coverage under
United States of America. All benefits the same terms and conditions of this
are subject to the terms and conditions policy for those Insureds renewing a
of this policy. policy.
TEN (10) DAY RIGHT TO EXAMINE THE Eligible dependents include the
POLICY: This policy may be returned Policyholder’s spouse or concubine,
within ten (10) days of receipt for a natural born children, legally adopted
refund of all premiums paid, less an children, stepchildren, or children
administrative fee of seventy-five dollars to whom the Policyholder has been
($75). The policy may be returned to the appointed legal guardian by a court of
Insurer or to the Policyholder’s agent. If competent jurisdiction, who have been
returned, the policy is void as though no identified on the application and for
policy had been issued. whom coverage is provided for under
IMPORTANT NOTICE ABOUT THE the policy.
APPLICATION: This policy is issued Dependent coverage is available for
based on the application and payment the Policyholder’s dependent children
of the premium. If any information up to their nineteenth (19th) birthday,
shown on the application is incorrect or if single, or up to their twenty-fourth
incomplete, or any information has been (24th) birthday, if single and full-time
omitted, the policy may be rescinded, (minimum twelve (12) credits per
cancelled, or coverage may be modified, semester) students of an accredited
at the sole discretion of the Insurer. college or university at the time that the
2AGREEMENT
policy is issued and renewed. Coverage Dependents who were covered under
for such dependents continues through a prior policy with the Insurer and, who
the next anniversary date of the policy are otherwise eligible for coverage
following the attainment of nineteen (19) under their own separate policy, will be
years of age, if single, or twenty-four approved without underwriting for the
(24) years of age if single and a full-time same or higher deductible plan and with
student. the same conditions and restrictions in
If a dependent child marries, discon- existence under the prior policy which
tinues being a full-time student after afforded them coverage with the Insurer.
the nineteenth (19th) birthday, moves The application of the former dependent
to another country, or if a dependent must be received before the end of the
spouse ceases to be married to the grace period of the policy which previ-
Policyholder by reason of divorce or ously afforded the dependent coverage.
annulment, coverage for such dependent
will terminate on the next anniversary
date of the policy.
3BUPA PRESTIGE
COMMENCEMENT AND ENDING OF COVERAGE
Coverage begins at 00:01 hours Eastern Standard Time (U.S.A.) on the policy’s
effective date and terminates at 24:00 hours Eastern Standard Time (U.S.A.):
(a) On the expiration date of the policy; (d) Upon written request from the Poli-
or cyholder to terminate a dependent’s
(b) Upon non-payment of the premium; coverage; or
or (e) Upon written notification from the
(c) Upon written request from the Poli- Insurer, as allowed by the conditions
cyholder to terminate the Policy- of this policy.
holder’s coverage; or
REQUIREMENT TO NOTIFY THE INSURER
The Insured must contact Bupa Insurance Company’s Claims Administrator, USA
Medical Services, at least seventy-two (72) hours in advance of receiving any
medical care. Emergency treatment must be notified within forty-eight (48) hours
of commencement of such treatment.
If the Insured fails to contact USA Medical Services as stated herein, the Insured
will be responsible for thirty percent (30%) of all covered medical and hospital
charges related to the claim, in addition to the plan’s deductible and coinsurance
(if applicable).
USA Medical Services can be contacted 24 hours a day, 365 days a year at the
following telephone numbers:
In the U.S.A.: (305) 275-1500
Free of charge from the U.S.A.: 1-800-726-1203
Fax: (305) 275-1518
Visit My Bupa in our display options: www.bupasalud.com/MyBupa
Outside the USA: Phone number can be
located on your ID card, or
at www.bupasalud.com
4YOUR HEALTHCARE PARTNER
ONLINE TO MAKE YOUR LIFE EASIER!
Log in to www.bupasalud.com, search for "My Bupa" in our display options and
follow the registration steps with your email to manage your policy from the
comfort of your home or office. Enjoy our online services:
• Access to your policy documents and ID cards
• Payments
• Changes request
• Claim request and update information
• Pre-authorization services request
• Costumer Service
• Virtual Care (Telemedicine)
You are responsible for checking all documents and correspondence online.
5BUPA PRESTIGE
BENEFITS
•
• Insurance for high risk disorders.
• 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 two million dollars ($2,000,000) per insured, per lifetime
for all covered illnesses and injuries while the policy is in force.
• This policy only covers the disorders or medical necessities in the Schedule of
Benefits, subject to the limitations herein, for any treatment, service and supply
provided in Latin America, the Caribbean, and the United States of America.
• 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.
6BENEFITS
SCHEDULE OF BENEFITS
Coverage (per Insured, per Policy Year) Maximum benefit
Neurological disorders, including cerebrovascular accidents $150,000
Cardiac surgery and angioplasty $150,000
Cancer treatment, including chemotherapy, radiotherapy and
$200,000
reconstructive surgery
Severe trauma (multiple trauma), including rehabilitation $150,000
Chronic renal insufficiency (dialysis) $100,000
Severe burns, including reconstructive surgery $300,000
Major infectious disorder (Septicemia) $150,000
Organ transplants (per insured, per lifetime)
• Heart $300,000
• Heart / Lung $300,000
• Lung $250,000
• Pancreas $250,000
• Pancreas / Kidney $300,000
• Kidney $200,000
• Liver $200,000
• Bone Marrow $250,000
Air ambulance (per Insured, per lifetime) $25,000
In Providers Network Not in Providers Network
Regular room and board No limit $500 per day
Intensive care room
No limit $1,000 per day
and board
DEDUCTIBLE towards that insured’s deductible for
the following policy year, as long as
• All insureds under the policy have a there are no expenses incurred during
deductible responsibility per policy the first nine (9) months of the policy
year according to the plan selected year. If the benefit is granted to carry
by the Policyholder. When applicable, over the insured's deductible to the
the corresponding deductible amount following policy year, and subse-
is applied per Insured, per policy year quently the insured submits claims
before benefits are paid or reimbursed or requests for reimbursement for
to the insured. All deductible amounts eligible expenses that occurred during
paid accumulate towards the corre- the first nine (9) months of the policy
sponding maximum deductible per year, the benefit will be reversed, and
policy, which is equivalent to the sum the insured will be responsible for the
of two individual deductibles. All following policy year's deductible.
insureds under the policy contribute
to meeting the maximum deduct- COINSURANCE
ible amount of the policy. Once the
maximum deductible amount of the • The Insured is responsible for twenty
policy is met, the insurer will consider percent (20%) of approved charges for
all individual deductible responsibili- the first five thousand dollars ($5,000)
ties as met. after satisfaction of the applicable
• Any eligible charges incurred by deductible (Except plan PL3, PL4,
an insured during the last three (3) PL5, PL6).
months of the policy year will apply • One (1) coinsurance liability per
to that policy year’s deductible and Insured, per policy year.
will also be carried over to be applied
7BUPA PRESTIGE
POLICY PROVISIONS
1. COVERED EXPENSES: For the (d) Special rates established for an
effects of this policy and subject to area or country as determined
all the stipulations in these Policy by the Insurer.
Provisions and all the other disposi- 3. ASSISTING PHYSICIAN/SURGEON
tions and conditions of the policy, it FEES: Assisting physician/surgeon
is understood that covered expenses fees are covered only when an
are the usual, customary and rea- assisting physician/surgeon is medi-
sonable expenses described below, cally necessary for that operation
incurred by an insured person while and approved in advance by USA
the policy was in force, for treat- Medical Services. Assisting physi-
ments, services or supplies, as a cian/surgeon fees are limited to the
result of or in relation to the treat- lesser of:
ment of illnesses or covered medical
necessities. (a) Twenty percent (20%) of the
usual, customary and reason-
Covered charges are those incurred able surgeon’s fee for the actual
for: surgical procedure; or
a) Medical, surgical or hospital (b) Twenty percent (20%) of the
services fee approved for the principal
b) Outpatient services as defined surgeon for the surgical proce-
in this policy dure; or
c) Diagnostic tests (c) If more than one assisting physi-
d) Medications, medical supplies cian/surgeon is necessary, the
and surgical implants maximum coverage for all
assisting physicians/surgeons
2. ANESTHESIOLOGIST FEES: Assist- together shall not exceed twenty
ing physician/surgeon fees are percent (20%) of the principal
covered only when an assisting phy- surgeon’s fee for the actual
sician/surgeon is medically necessary surgical procedure; or
for that operation and approved in
advance by USA Medical Services. (d) Special rates established for an
Assisting physician/surgeon fees are area or country as determined
limited to the lesser of: by the Insurer.
(a) Twenty percent (20%) of the 4. SURGEON’S FEES: Surgeon’s fees
usual, customary and reason- are limited to the lesser of:
able surgeon’s fee for the actual (a) Hundred percent (100%) of the
surgical procedure; or usual, customary and reason-
(b) Twenty percent (20%) of the able fee for the actual surgical
fee approved for the principal procedure; or
surgeon for the surgical proce- (b) Hundred percent (100%) of the
dure; or fee approved for the surgeon for
(c) If more than one assisting physi- the surgical procedure; or
cian/surgeon is necessary, the (c) Special rates established for an
maximum coverage for all area or country as determined
assisting physicians/surgeons by the Insurer
together shall not exceed twenty (d) When performing a surgical
percent (20%) of the principal procedure, if it is determined
surgeon’s fee for the actual that another procedure is
surgical procedure; or needed and it must be done
through the same surgical field
or natural orifice, the full fee of
8BENEFITS
the main procedure will be paid any negligence resulting
as stated above and 50% of the from such services, or for
second procedure. delays or restrictions on
5. HOME HEALTH CARE AND OUT- flights caused by mechan-
PATIENT PHYSICAL THERAPY: An ical problems, by govern-
initial period of up to thirty (30) mental restrictions, or by
days will be covered if approved the pilot, due to operational
in advance by USA Medical Ser- conditions, or from any
vices. Any extension of up to thirty negligence resulting from
(30) days must also be approved in such services.
advance or the claim will be denied. (b) Ground ambulance transpor-
Updated evidence of medical neces- tation: The maximum amount
sity and a treatment plan is required payable for this benefit is one
in advance to obtain each approval. thousand dollars ($1,000) per
6. EMERGENCY DENTAL TREAT- incident.
MENT: Only emergency dental 8. NEWBORN COVERAGE: To be
treatment that takes place within covered under the terms of this
ninety (90) days of the date of a policy a newborn must be added
covered accident will be covered to the policy. The application and
under this policy. the premium for the addition of a
7. EMERGENCY TRANSPORTATION: newborn must be received within
Emergency transportation (by thirty one (31) days of birth. If the
ground and air ambulance) is only application is received after thirty
covered if related to a covered con- one (31) days of birth, the applica-
dition for which treatment cannot be tion will be subject to underwriting.
provided locally and transportation 9. CONGENITAL CONDITIONS: Con-
by any other method would result in ditions that are a consequence
loss of life or limb. Emergency trans- of a congenital disorder will only
portation must be provided by a be covered up to ten (10)% of the
licensed and authorized transporta- covered expenses shown in the
tion company to the nearest medical Schedule of Benefits and are subject
facility. The vehicle or aircraft used to all policy provisions including
must be staffed by medically trained deductible and coinsurance.
personnel and must be equipped to 10. ORGAN TRANSPLANTS: Cover-
handle a medical emergency. age for transplantation of human
(a) Air ambulance transportation: organs and tissues is provided only
i. All air ambulance trans- within the Insurer’s Organ Trans-
portation must be pre- plant Provider Network. There is no
approved and coordinated coverage outside the Organ Trans-
by USA Medical Services. plant Provider Network. Coverage
is only for the medically necessary
ii. The maximum amount transplant of the following human
payable for this benefit is organs or tissues or a combination
twenty five thousand dollars of these as explained in the Schedule
($25,000) per insured, per of Benefits:
lifetime.
• Heart
iii. The Insured agrees to hold
• Heart / Lung
the Insurer, USA Medical
• Lung
Services, and any company
• Pancreas
affiliated with the Insurer
• Pancreas / Kidney
or USA Medical Services by
• Kidney
way of similar ownership or
• Liver
management, harmless from
• Bone Marrow
9BUPA PRESTIGE
This organ transplant benefit begins maximum period of six (6) months,
once the need for transplantation unless the Insurer approves an exten-
has been determined by a provider, sion. In all cases, a copy of the pre-
has been certified by a second surgi- scription from the attending physi-
cal or medical opinion and has been cian must accompany the claim.
approved by USA Medical Services, 12. SPECIAL TREATMENTS: Prosthesis,
and is subject to all the terms, provi- orthotic devices, durable medical
sions and exclusions of the policy. equipment, implants, radiation
This benefit includes: therapy, chemotherapy and highly
(a) Pre-transplant care, which specialized drugs (e.g. Interferon,
includes those services directly Procrit, Avonex, Embrel, etc.) will
related to evaluation of the need be covered, but must be approved
for transplantation, evaluation and coordinated in advance by USA
of the Insured for the transplant Medical Services. Special treatments
procedure, and preparation and will be provided by the Insurer or
stabilization of the Insured for reimbursed at the cost that the
the transplant procedure. Insurer would have incurred if pur-
chased from its providers.
(b) Pre-surgical workup, including
all laboratory and X-ray exams, 13. REQUIRED SECOND SURGICAL
CT scans, Magnetic Resonance OPINION: If a surgeon has recom-
Imaging (MRI’s), ultrasounds, mended that an Insured undergo any
biopsies, scans, medications and non-emergency surgical procedure,
supplies. the Insured must notify USA Medical
Services at least seventy-two (72)
(c) The costs of organ procurement, hours prior to the scheduled pro-
transportation, and harvesting cedure. If a second surgical opinion
up to a maximum of ten thou- is deemed necessary by either the
sand dollars ($10,000), which is Insurer or USA Medical Services, it
included as part of the maximum must be conducted by a physician
organ transplant benefit. chosen and arranged by USA Medical
(d) Post-transplant care including, Services. Only those second surgical
but not limited to any follow-up, opinions required and coordinated by
medically necessary treatment USA Medical Services are covered. In
resulting from the transplant, the event the second surgical opinion
and any complications that arise contradicts or does not confirm the
after the transplant procedure, need for surgery, the Insurer will also
whether a direct or indirect pay for a third surgical opinion from
consequence of the transplant. a physician chosen by USA Medical
(e) Any medication or therapeutic Services. If the second or third sur-
measure used to ensure the gical opinion confirms the need for
viability and permanence of the surgery, benefits for the surgery will
transplanted organ. be paid according to this policy.
(f) Any home health care, nursing IF THE INSURED DOES NOT OBTAIN
care (e.g. wound care, infusion, A REQUIRED SECOND SURGICAL
assessment, etc.), emergency OPINION, THE INSURED WILL BE
transportation, medical atten- RESPONSIBLE FOR THIRTY PER-
tion, clinic or office visits, trans- CENT (30%) OF ALL COVERED
fusions, supplies, or medications MEDICAL AND HOSPITAL CHARGES
related to the transplant. RELATED TO THE CLAIM IN ADDI-
TION TO THE PLAN DEDUCT-
11. PRESCRIPTION DRUGS: Prescrip-
IBLE AND COINSURANCE (IF
tion drugs are only covered if first
APPLICABLE).
prescribed during a hospitalization
or after outpatient surgery and for a
10BENEFITS
14. OUTPATIENT SERVICES: Coverage i. The policy provides for emer-
is only provided when medically gency medical treatment
necessary. outside of the “Preferred
15. MAXIMUM HOSPITAL STAY: The Providers Network” in those
maximum hospital stay for any spe- cases where medical treat-
cific illness or injury or any related ment is required to avoid
treatment is one hundred and eighty loss of life or limb. Covered
(180) days during the next three charges related to an emer-
hundred and sixty five (365) days gency admission to a non-
after the first admission. network provider will be
paid up to twenty five thou-
16. DIAGNOSIS: For a condition to be sand dollars ($25,000) with
considered an illness or covered the normal plan deductible
disorder, copies of laboratory tests and coinsurance if appli-
results, X-Rays, or any other report cable. To have coverage
or result of clinical examinations on under this provision the
which the diagnosis was based, will beginning and nature of
be required as part of the positive the emergency must have
diagnosis by a physician. been such that it was impos-
17. WAITING PERIOD: All insureds have sible for the Insured or the
a right to the benefits provided by medical provider to contact
this policy once the following waiting USA Medical Services before
periods have elapsed and which will treatment.
start on the policy effective date or ii. There is no coverage for
for the new insureds on the date they disorders or injuries not
were added to the policy: related to an emergency
a) During the first ninety (90) days outside the “Preferred
after the effective date of the Providers Network”.
policy or the addition of a new (b) Maximum benefit of the policy
insured only injuries cause by will be modified as follows:
accident or disease of infectious
origin will be covered. Age Maximum
b) Illnesses known or diagnosed benefit
after the first ninety (90) days 70-75 $500,000
of coverage from the effective years old
date of the policy or ninety (90) lifetime
days from the addition of a new 76 years old $250,000
Insured will be covered from the and over lifetime
date of the diagnosis.
19. TREATMENT AT URGENT CARE
c) Covered diseases diagnosed
FACILITIES OR WALK-IN CLINICS:
within ninety (90) days after the
Treatment at urgent care facilities or
effective date of the policy will
walk-in clinics in the United States of
be covered after two (2) years.
America are covered at a hundred
d) Congenital disorders will be percent (100%) with a fifty-dollar
covered after two (2) years of (US$50) co-payment. These treat-
the effective date of the policy. ments are not subject to deductible.
18. BENEFITS AFTER AGE 69:
(a) After age sixty nine (69) all
covered illnesses and injuries
must be treated by a provider
within the “Preferred Providers
Network” except as provided
below:
11BUPA PRESTIGE
EXCLUSIONS
AND
LIMITATIONS
This policy does not provide coverage or benefits for any of the following:
1. Cancer in-situ of the cervix. 8. Chiropractic care, homeopathic
2. Skin cancer with the exception of treatment, acupuncture or any type
melanoma. of alternative medicine.
3. Treatment of any illness, injury, or any 9. Any illness or injury not caused by
charges arising from any treatment, an accident, which first manifested
service or supply which is: within the first ninety (90) days from
the effective date of the policy.
(a) Not medically necessary; or
10. Elective or cosmetic surgery or
(b) For an Insured who is not under medical treatment which is primar-
the care of a physician, doctor ily for beautification, unless neces-
or skilled professional; or sitated by injury, deformity or illness
(c) Not authorized or prescribed by which first occurs while the Insured
a physician or doctor; or is covered under this policy, except
reconstructive surgery secondary to
(d) Custodial care. cancer or severe burns.
4. Any care or treatment, while sane or 11. Any charges in connection with pre-
insane, received due to self inflicted existing conditions, except as defined
illness or injury, suicide, failed suicide, and addressed in this policy.
alcohol use or abuse, drug use or
abuse, or the use of illegal sub- 12. Any treatment, service or supply that
stances or illegal use of controlled is not scientifically or medically rec-
substances. This includes any acci- ognized for the prescribed treatment
dent resulting from any of the afore- or which is considered experimental
mentioned criteria. and/or not approved for general use
by the Food and Drug Administration
5. Routine eye and ear examinations, of the U.S.A.
hearing aids, eye glasses, contact
lenses, radial keratotomy and/or 13. Treatment in any governmen-
other procedures to correct eye tal facility or any expense if the
refraction disorders. Insured would be entitled to free
care. Service or treatment for which
6. Any cardiovascular procedure not payment would not have to be made
requiring surgery with the exception had no insurance coverage existed.
of balloon angioplasty.
14. Any portion of any charge that is in
7. Any organ or tissue transplant not excess of the usual, customary and
covered by this policy. reasonable charge for the particular
service or supply for the geographi-
cal area.
12EXCLUSIONS AND LIMITATIONS
15. Treatment or service for any medical, muscles, nerves and other tissue
mental or dental condition related relating to that joint.
to or arising as a complication to 23. Treatment by the spouse, father,
those medical, mental or dental ser- mother, brother, sister or child of
vices or other conditions specifically any insured under this policy.
excluded by an amendment to or not
covered by this policy. 24. “Over the counter” or non-prescrip-
tion drugs, prescription medications
16. Treatment for injuries resulting which are not first prescribed while
from participation in any hazard- the Insured is admitted in a hos-
ous activities as a professional or pital and prescription medications
for compensation. which are not prescribed as part of
17. Any congenital or hereditary disor- follow-up treatment after outpatient
der or illness, except as provided for surgery.
under the provisions of this policy. 25. Personal or home-based artificial
18. Any dental treatment or services kidney equipment, unless authorized
not related to a covered accident in writing by the Insurer.
or beyond 90 days from the date 26. Treatment for injury sustained while
of such accident. traveling as a pilot or crewmember
19. Treatment of injuries resulting while in a private aircraft.
in service as a member of a police 27. Cost relating to the acquisition
or military unit, or from participation and implantation of artificial heart,
in war, riot, civil commotion, or any mono or bi-ventricular devices, other
illegal activity, including resultant artificial or animal organs and all
imprisonment. expenses of any cryopreservation
20. Acquired Immune Deficiency Syn- of more than twenty-four (24) hours
drome (AIDS), HIV positive or AIDS duration.
related illnesses, including tumors in 28. Charges related to brain syndrome,
the presence of AIDS. or custodial care in cases of senility
21. An elective admission more than of brain deterioration.
twenty-three (23) hours before a 29. Injury or illness caused by, or related
planned surgery, unless authorized to ionized radiation, pollution or con-
in writing by the Insurer. tamination, radioactivity from any
22. Treatment of the upper maxilla, the nuclear material, nuclear waste, or
jaw or jaw joint disorders, including, the combustion of nuclear fuel or
but not limited to, jaw anomalies, nuclear devices.
malformations, temporomandibular 30. Treatment for or arising from any
joint syndrome, craniomandibular epidemic and/or pandemic disease,
disorders, or other conditions of and vaccinations, medicines, or pre-
the jaw or jaw joint linking the jaw ventive treatment for or related to
bone and the skull and complex of any epidemic and/or pandemic
disease are not covered.
13BUPA PRESTIGE
ADMINISTRATION
1. AUTHORITY: No agent has the be coordinated. All claims incurred
authority to change the policy or in the country of residence must be
to waive any of its provisions. After made in the first instance against the
issue, no change in the policy shall other policy. This policy shall only
be valid unless approved in writing provide benefits when such other
by an officer or the Chief Underwriter benefits payable under the other
of the Insurer and such approval is policy have been exhausted. Outside
endorsed by an amendment to the the country of residence, Bupa Insur-
policy. ance Company will function as the
2. CHANGES OF COUNTRY OF RESI- primary Insurer and retains the right
DENCE: The Insured must notify the to collect any payment from local or
Insurer in writing of any change of other insurers.
the Insured’s country of residence 5. ENTIRE CONTRACT/CONTROL-
within thirty (30) days of its occur- LING CONTRACT: The policy, the
rence. Changes of residence outside application, the Certificate of Cover-
the Insured’s stated country of resi- age and any riders or amendments
dence will, at the Insurer’s discretion, thereto, shall constitute the entire
result in modification of coverage or contract between the parties. The
cancellation of the policy. Changes of Spanish translation is provided for
residence to the U.S.A. will result in the convenience of the Insured. The
non-renewal of the policy. Failure to English version of this policy will
notify the Insurer of any change of the prevail and is the controlling con-
Insured’s country of residence may tract in the event of any question or
result in cancellation of the policy or dispute regarding this policy.
modification of coverage on the next 6. PAYMENT OF CLAIMS: It is the
anniversary date, at the Insurer’s dis- Insurer’s policy to make payments
cretion. THE INSURED’S COUNTRY directly to physicians and hospitals
OF RESIDENCE CANNOT BE THE worldwide. When this is not possible,
UNITED STATES OF AMERICA. the Insurer will reimburse the Policy-
3. COMMENCEMENT OF INSURANCE: holder the contractual rate given to
Subject to the provisions of this the Insurer by the provider involved
policy, benefits begin on the Effec- and/or in accordance with the usual,
tive Date of the policy and not on customary, and reasonable fees for
the date of application for insurance. that geographical area, whichever
4. OTHER INSURANCE COVERAGE: is less. Any charges or portions of
When another policy is in exis- charges in excess of these amounts
tence which provides benefits also are the responsibility of the Insured.
covered by this policy, benefits will If a Policyholder is not living, the
14ADMINISTRATION
Insurer will pay any unpaid benefits rates, deductibles or benefits, gen-
to the estate of the deceased Poli- erally and specifically, if the Insured
cyholder. USA Medical Services must changes country of residence,
receive the complete medical and regardless of how many years the
non-medical information they require policy has been in force.
in order to determine compensability If an Insured resides in the U.S.A. on
before: 1) Approve a direct payment; a continuous basis for more than
or 2) Reimburse the policyholder. one hundred and eighty (180) days
The insurer, USA Medical Services, during any three hundred and sixty
and/or any of their applicable related five (365) day period regardless of
subsidiaries and affiliates will not the type of visa issued to the Insured
engage in any transactions with any for that purpose, then coverage for
parties or in any countries where oth- any condition will be limited to the
erwise prohibited by the laws in the Insurer’s Preferred Provider Network
United States of America. Please con- until the policy’s next renewal date at
tact USA Medical Services for more which time the policy will automati-
information about this restriction. cally terminate.
7. CURRENCY: All currency values Submission of a fraudulent claim is
stated in this policy are in U.S. dollars. also grounds for rescission or cancel-
8. PHYSICAL EXAMINATIONS: The lation of the policy.
Insurer, at its own expense, shall have The Insurer retains the right to can-
the right and opportunity to examine cel, non-renew or modify a policy
any Insured whose illness or injury on a “class” basis as defined in this
is the basis of a claim, when and as policy.
often as considered necessary by No individual Insured shall be inde-
the Insurer during the pendency of pendently penalized by cancellation
the claim. In the case of death, the or modification of the policy due
Insurer has the right to request an solely to a poor claim record.
autopsy at a facility of its choice.
11. POLICY ISSUANCE: This policy
9. DUTY TO COOPERATE: The Insured cannot be issued or delivered in the
shall make available to the Insurer U.S.A., except as may be specifically
all medical reports and records and, permitted under the laws of the State
when requested by the Insurer, shall of Florida. The policy is deemed
sign all authorization forms neces- issued or delivered upon receipt of
sary for the Insurer to obtain such the policy by the Policyholder in his/
medical reports and records. Failure her country of residence.
to cooperate with the Insurer or
failure to authorize the release of 12. POLICY MODE: All policies are
all medical records requested by deemed annual policies. Premiums
the Insurer may cause a claim to be are to be paid annually, unless the
denied. Insurer authorizes other modes of
payment.
10. POLICY CANCELLATION OR NON-
RENEWAL: The Insurer retains the 13. PREMIUM PAYMENT: Payment of the
right to cancel, modify or rescind the premium on time is the responsibility
policy if statements on the applica- of the Policyholder. The premium is
tion are found to be misrepresenta- due on the renewal date of the policy
tions, incomplete or that fraud has or other due dates if authorized by
been committed, leading the Insurer the Insurer. Premium notices are pro-
to approve an application when, with vided as a courtesy and the Insurer
the correct or complete informa- provides no guarantee of delivering
tion, the Insurer would have issued premium notices. If a Policyholder
a policy with restricted coverage or has not received a premium notice
declined to provide insurance. thirty (30) days prior to the due date
and the Policyholder does not know
The Insurer retains the right to can- the amount of the premium payment,
cel or modify a policy in terms of the Policyholder should contact
15BUPA PRESTIGE
his/her agent or the Insurer. are non-refundable. The unearned
Payment may also be made online portion of the premium is based on
(www.bupasalud.com). the number of days corresponding
14. PREMIUM RATE CHANGES: The to the payment mode, minus the
Insurer retains the right to change number of days the policy was in
the premium at the time of each force.
renewal date. This right will be exer- 17. GRACE PERIOD: If premium is not
cised on a “class” basis only upon received by the due date, the Insurer
the renewal date of each respective will allow a grace period of thirty
policy. (30) days from the due date for the
15. PROOF OF CLAIM: Written proof of premium to be paid. If the premium
loss consisting of ORIGINAL item- is not received by the Insurer prior
ized bills, medical records and claim to the end of the grace period, this
form properly completed and signed policy and all of its benefits will be
must be furnished to USA Medical deemed terminated as of the original
Services at 17901 Old Cutler Road, due date of the premium. Benefits
Suite 400, Palmetto Bay, Florida are not provided under the policy
33157, within one hundred and during the grace period.
eighty (180) days after the treat- 18. REINSTATEMENT: If the policy was
ment or service date. Failure to not renewed within the Grace Period,
do so will result in the claim being it can be reinstated in the following
denied. A completed claim form is 60 (sixty) days after the grace period
required for all claims submitted per ends if the insured provides new evi-
incident. Claim forms are furnished dence of insurability consisting of a
with the policy or may be obtained new application and any other infor-
by contacting your agent or USA mation or document required by the
Medical Services at the address Insurer. All policies reinstated after
shown herein or through our website the thirty (30) day grace period are
(w w w. b u p a s a l u d . co m). Bills deemed new policies with no antiq-
received in currencies other than U.S. uity or credit being afforded to the
dollars will be processed in accor- Insured. All medical conditions exist-
dance with the official exchange rate, ing prior to the date of reinstatement
as determined by the Insurer, on the of the policy shall be deemed and
date of service. Additionally, the treated as pre-existing conditions
insurer reserves the right to issue under this policy. No reinstatement
the payment or reimbursement in will be authorized ninety (90) days
the currency in which the service after the date of termination of the
or treatment was invoiced. After policy.
their nineteenth (19th) birthday 19. CLAIMS APPEALS: In the event
dependent insureds must provide of any disagreement between the
a certificate or affidavit from the Insured and the Insurer regarding
college or university as evidence this Insurance Policy and/or its pro-
that they were full-time students visions, the Insured, before com-
at the time the policy was issued or mencing any arbitration or legal
renewed, AND written statement proceedings, shall request a review
signed by the Policyholder that the of the matter by the “Bupa Insur-
dependent’s marital status is single. ance Company Appeals Commit-
16. REFUNDS: If a Policyholder or the tee”. In order to begin such a review,
Insurer cancels the policy after it has the Insured must submit a written
been issued, reinstated or renewed, request to the Appeals Committee.
the Insurer will refund the unearned This request shall include copies of
portion of the premium, less admin- all relevant information sought to be
istrative charges and policy fees, to a considered, as well as an explanation
maximum of sixty-five percent (65%) of what decision should be reviewed
of the premium. The policy fee, USA and why. Said appeals shall be sent to
Medical Services fee and thirty-five the attention of the Bupa Insurance
percent (35%) of the base premium Company Appeals Coordinator, c/o
16ADMINISTRATION
USA Medical Services. Upon the sub- each party will pay their own attor-
mission of a request for review, the neys’ fees and costs, including those
Appeals Committee will determine incurred in arbitration.
whether any further information and/ 21. SUBROGATION AND INDEMNITY:
or documentation is needed and act The Insurer has a right of subrogation
to timely obtain such. Within thirty or reimbursement from an Insured
(30) days thereafter, the Appeals to whom it has paid any claims to
Committee will notify the Insured or on behalf of, if such Insured has
of its decision and the underlying recovered all or part of such pay-
rationale. ments from a third party. Further-
20. ARBITRATION, LEGAL ACTIONS, more, the Insurer has the right to
AND JURY WAIVER: Any disagree- proceed at its own expense in the
ment that may persist upon comple- name of the Insured, against third
tion of the claims appeal as deter- parties who may be responsible for
mined herein, must first be submitted causing a claim under this policy or
to arbitration. In such cases, the who may be responsible for providing
Insured and the Insurer will submit indemnity of benefits for any claim
their difference to three (3) arbiters: under this policy.
Each party selecting an arbiter, and 22. TERMINATION OF COVERAGE
the third arbiter to be selected by UPON TERMINATION OF POLICY: In
the arbiters named by the parties the event a policy terminates for any
herein. In the event of disagreement reason, coverage ceases on the effec-
between the arbiters, the decision tive date of the termination and the
will rest with the majority. Either the Insurer will only be responsible for
Insured or the Insurer may initiate treatment covered under the terms
arbitration by written notice to the of the policy that took place before
other party demanding arbitration the effective date of termination of
and naming its arbiter. The other the policy. There is no coverage for
party shall have twenty (20) days any treatment that occurs after the
after receipt of said notice within effective date of the termination,
which to designate its arbiter. The regardless of when the condition first
two (2) arbiters named by the parties, occurred or how much additional
within ten (10) days thereafter, shall treatment may be required.
choose the third arbiter and the arbi-
tration shall be held at the place here- 23. CHANGE OF PLAN OR DEDUCTIBLE:
inafter set forth ten (10) days after When the policyholder request to
the appointment of the third arbiter. change a product or plan, the follow-
If the other party does not name its ing conditions apply:
arbiter within twenty (20) days, the (a) The benefits earned by seniority
complaining party may designate the of the insured will not be
second arbiter and the other party affected as long as the new
shall not be aggrieved thereby. Arbi- product or plan contemplates
tration shall take place in Miami-Dade them. If the previous product
County, Florida, U.S.A. or if approved or plan did not include a benefit
by the Insurer, in the Policyholder’s included in the new product or
country of residence. The expenses of
plan, the specific waiting period
the arbitration shall be shared equally
between the parties. established in the Benefits Table
of the Policy Cover must be met.
The Insured confers exclusive juris-
diction in Miami-Dade County, Flor- (b) During the first ninety (90) days
ida for determination of any rights from the effective date of the
under this policy. The Insurer and any change, benefits payable for
Insured covered by this policy hereby any illness or injury not caused
expressly agree to trial by judge in by accident or disease of infec-
any legal action arising directly or tious origin, will be limited to
indirectly from this policy. The Insurer the lesser of benefits provided
and the Insured further agree that by the new plan or the prior plan
17BUPA PRESTIGE ADMINISTRATION
(c) Benefits related to maternity, already had claims paid under
maternity complications and the coverage of the previous
coverage of the newborn that product or plan, will be reduced
occur during the ten (10) months in the proportion of the expense
following the effective date of already paid. When the total
the change, will be limited to the benefit in the new product or
lesser of the benefit provided by plan is less than the amount
either the new plan or prior plan. already paid under the benefit
(d) Benefits with insured sums per in the previous product or
lifetime that occur during the plan, the benefit is considered
six (6) months following the exhausted and coverage under
effective date of the change, the new product or plan will no
will be limited to the lesser of longer apply.
the benefit provided by either (f) Nevertheless, the insurer reserve
the new plan or prior plan. the right to to carry out standard
(e) The benefits with insured underwriting procedures.
amounts per lifetime that have
18BUPA PRESTIGE DEFINITIONS
DEFINITIONS
1. ACCIDENT: An unfortunate incident used by the Insurer to determine
that occurs unexpectedly and sud- acceptance or denial of the risk.
denly, provoked by an external cause, Application includes any medical
always without the insured's inten- history, questionnaire, and other
tion, which causes injury or bodily documents provided to or requested
trauma and requires immediate by the Insurer prior to the issuance
ambulatory medical attention and/ of the policy.
or patient's hospital admission. The 8. ASSISTING PHYSICIAN/SURGEON
medical information related to the FEES: Charges made by a physician
accident will be evaluated by the or physicians who assist the princi-
insurer, and the compensability will pal surgeon in the performance of a
be determined under the general surgical procedure.
policy's provisions.
9. CALENDAR YEAR: January 1st
2. AIR AMBULANCE TRANSPORTA- through December 31st of any given
TION: Emergency air transportation year.
from the hospital where the Insured
is admitted to the nearest suitable 10. CERTIFICATE OF COVERAGE: Doc-
hospital where treatment can be ument of the policy that specifies the
provided. commencement, conditions, extent
and any limitations of the coverage,
3. AMENDMENT: A document added and lists each covered person.
by the Insurer to the policy that clari-
fies, explains or modifies the policy. 11. CLASS: The Insureds of all policies
of the same type, including but not
4. ANESTHESIOLOGIST FEES: Charges limited to benefits, deductibles, age
made by an anesthesiologist for the group, country, plan, year groups or
administration of anesthesia during a combination of any of these.
the performance of a surgical pro-
cedure or for medically necessary 12. COINSURANCE: The portion of the
services for pain control. covered medical bills an Insured must
pay in addition to the deductible.
5. ANNIVERSARY DATE: Annual
occurrence of the effective date of 13. CONGENITAL AND HEREDITARY
the policy. DISORDERS OR ILLNESSES: Any
disorder or illness existing before
6. APPLICANT: The individual who exe- birth, regardless of its cause, whether
cuted the application for coverage. or not manifested or diagnosed at
7. APPLICATION: Written statements birth, after birth or years later.
on a form by an Applicant about 14. CONTINUITY OF COVERAGE (NO
themselves and/or their dependents, LOSS-NON-GAIN): Continuity
19BUPA PRESTIGE DEFINITIONS
of coverage ensures that there is 18. DIAGNOSTIC MEDICAL CENTER:
no coverage period when chang- Medical facility licensed to perform
ing from one product or plan to comprehensive medical physical
another within the same company examinations.
or for transfers between Bupa group 19. DUE DATE: The date on which the
companies. However, changes and premium is due and payable.
transfers are subject to a non-loss-
no-profit provision, whereby the 20. EFFECTIVE DATE: The date on
least of the benefits payable between which coverage under this policy
the products or plans involved in begins and which is stated in the
the exchange or transfer are applied Certificate of Coverage. This date will
during a given period in advance. The only be effective after delivery of the
benefits earned by seniority of the insurance policy to the Policyholder
insured will not be affected as long and the expiration of the Ten (10) Day
as the new product or plan contem- Right to Examine the Policy.
plates them. If the previous product 21. EMERGENCY: A medical condition
or plan did not contemplate a benefit manifesting itself by acute signs or
included in the new product or plan, symptoms which could reasonably
the specific waiting period of that result in placing the Insured’s life
benefit established in the Benefits or physical integrity in immediate
Table must be met. Granting continu- danger, if medical attention is not
ity of coverage does not mean that provided within twenty-four (24)
they do not apply the corresponding hours.
risk assessment procedures. 22. EMERGENCY DENTAL TREAT-
15. COUNTRY OF RESIDENCE: The MENT: Treatment necessary to
country: restore or replace sound natural
(a) Where the Insured resides the teeth, damaged or lost in a covered
majority of any calendar or accident.
policy year; or 23. EMERGENCY TREATMENT: Medi-
(b) Where the Insured has resided cally necessary treatment due to an
more than one hundred and emergency.
eighty (180) continuous days 24. EPIDEMIC: The occurrence of more
during any three hundred and cases than expected of a disease
sixty five (365) day period while or other health condition in a given
the policy is in force. area or among a specific group of
16. CUSTODIAL CARE: Assistance with persons during a particular period,
the activities of daily living that can and declared as such by the World
be provided by non-medical/nursing Health Organization (WHO), or the
trained personnel (bathing, dressing, Pan American Health Organization
grooming, feeding, toileting, etc.). (PAHO) in Latin America, or the
United States Centers for Disease
17. DEDUCTIBLE: The individual deduct- Control and Prevention (CDC), or a
ible is the amount of covered charges local government or equivalent body
that must be paid by each insured (i.e. local ministry of health) where
each policy year before policy ben- the epidemic is developing. Usually,
efits are payable, except when oth- the cases are presumed to have a
erwise stated. The family deducible common cause or to be related to
is the maximum deductible amount one another in some way.
per policy for covered charges equiv-
alent to the sum of two individual 25. GRACE PERIOD: The period of time
deductibles per policy year Charges of thirty (30) days after the policy
incurred in the country of residence due date during which the Insurer
are subject to an in-country deduct- will allow the policy to be renewed.
ible. Charges incurred outside of the 26. GROUND AMBULANCE TRANSPOR-
country of residence are subject to TATION: Emergency transportation
an out-of-country deductible. to a hospital by ground ambulance.
20BUPA PRESTIGE DEFINITIONS
27. HAZARDOUS ACTIVITIES: Any 32. INJURY: Damage inflicted to the
activity that exposes the partici- body by an external cause.
pant to any foreseeable danger or 33. INSURED: An individual for whom
risk. Examples of hazardous activi- an application has been completed,
ties include but are not limited to: the premium paid, and for whom
Aviation sports, rafting or canoeing coverage has been approved by the
involving white water rapids in excess Insurer and commenced. The term
of grade 5, tests of velocity, scuba “Insured” includes the Policyholder
diving at a depth of more than 30 and all dependents covered under
meters, bungee jumping, participa- this policy.
tion in any extreme sport or partici-
pation in any sport for compensation 34. LABORATORY AND X-RAY SER-
or as a professional. VICES: Medically necessary X-ray
services and laboratory testing
28. HOME HEALTH CARE: Care of the used to diagnose or treat medical
Insured in the Insured’s home, which conditions.
is prescribed and certified in writing
by the Insured’s attending physician, 35. MEDICALLY NECESSARY: A treat-
as required for the proper treatment ment, service or medical supply
of the illness or injury, and used in which is determined by USA Medical
place of inpatient treatment in a hos- Services to be necessary and appro-
pital. Home Health Care includes the priate for the diagnosis and/or treat-
services of a skilled licensed profes- ment of an illness or injury. A treat-
sional (nurse, therapist, etc.) outside ment, service or supply will not be
of the hospital and does not include considered medically necessary if:
Custodial Care. (a) It is provided only as a conve-
29. HOSPITAL: Any institution which is nience to the Insured, the
legally licensed as a medical or sur- Insured’s family, or the provider
gical facility in the country in which (e.g. private nurse, standard
it is located, which is a) primarily private room upgrade to junior
engaged in providing diagnostic and suite or suite, etc.); or
therapeutic facilities for clinical and (b) It is not appropriate for the
surgical diagnosis, treatment and Insured’s diagnosis or treatment;
care of injured and sick persons by or
or under the supervision of a staff (c) It exceeds the level of care which
of physicians; and b) not a place of is needed to provide adequate
rest, a place for the aged or nursing and appropriate diagnosis or
or convalescent home or institution treatment; or
or a long term care facility.
(d) Falls outside the standard of
30. HOSPITAL SERVICES: Hospital practice, as established by
staff nurses, scrub nurses, standard Professional Boards by discipline
private or semi-private room and (MD, Physical Therapy, Nursing).
board and other medically neces-
36. NEWBORN: An infant from the
sary treatments or services ordered
moment of birth through the first
by a physician for the Insured who
thirty-one (31) days of life.
is admitted to a hospital. Private
nurse and standard private room 37. NURSE: An individual legally licensed
upgrade to junior suite or suite are to provide nursing care.
not included in Hospital Services. 38. ORGAN TRANSPLANT PROVIDER
31. ILLNESS: An abnormal condition NETWORK: A group of hospitals and
of the body, manifested by signs, physicians contracted on behalf of
symptoms and/or abnormal findings the Insurer for the purpose of pro-
in medical exams, which makes this viding organ transplant benefits to
condition different than the normal the Insured. The list of hospitals and
state of the body. physicians in the Organ Transplant
21BUPA PRESTIGE DEFINITIONS
Provider Network is available from 45. PREFERRED PROVIDER NETWORK:
USA Medical Services and may A group of hospitals and physicians
change at any time without prior approved and contracted to treat
notice. Insureds on behalf of the Insurer. The
39. OUTPATIENT SERVICES: Medical list of hospitals and physicians in
treatments or services provided the Preferred Provider Network is
or ordered by a physician for the available from USA Medical Services
Insured when the Insured is not and may change at any time without
admitted at a Hospital. Outpatient prior notice.
services may include services per- 46. PRESCRIPTION MEDICATIONS:
formed in a hospital or emergency Medications whose sale and use are
room. legally restricted to the order of a
40.PANDEMIC: An epidemic occurring physician.
over a widespread area (multiple 47. PRIVATE AIRCRAFT: Any aircraft in
countries or continents) and usually a flight that is not regularly sched-
affecting a substantial proportion of uled or chartered by a commercial
the population. airline.
41. PHYSICIAN OR DOCTOR: A person 48. RENEWAL DATE: The first day of
who is legally licensed to practice the next policy year. The renewal
medicine in the country where treat- date occurs only on the anniversary
ment is provided and while acting date of the policy.
within the scope of their practice. 49. SECOND SURGICAL OPINION: The
“Physician” or “Doctor” shall also medical opinion of a physician other
include a person legally licensed to than the current attending physi-
practice as a dentist. cian (approved and required by USA
42. POLICYHOLDER: The named appli- Medical Services).
cant on the application for health 50. USUAL, CUSTOMARY AND REA-
insurance. This individual is the SONABLE: The usual, customary
person entitled to receive reimburse- and reasonable charges for provided
ment for covered medical expenses medical services in a geographical
and the return of any unearned area, regardless of whether direct
premium. payment or reimbursement was
43. POLICY YEAR: The period of twelve used.
(12) consecutive months beginning 51. WELL BABY CARE: Routine medical
on the effective date of the policy care provided to a healthy newborn.
and any subsequent twelve month
period thereafter. 52. TREATMENT: Medical or surgical
care of a patient.
44. PRE-EXISTING CONDITION: A
condition: 53. TRANSLUMINAL PERCUTANEOUS
ANGIOPLASTY: The dilation of a
(a) Which was diagnosed by a physi- blood vessel by inserting a catheter
cian prior to the effective date of through the skin to the area of nar-
the policy or its reinstatement; rowing, where a balloon is inflated to
or flatten the plaques against the wall
(b) For which medical advice or of the artery.
treatment was recommended 54. EXPERIMENTAL OR INVESTIGA-
by or received from a physician TIVE: A medical or surgical proce-
prior to the effective date of the dure, equipment or medication that:
policy or its reinstatement; or
(a) Has not been approved for the
(c) For which any symptom and/or treatment of an illness or lesion
sign, if presented to a physician by official authorities.
prior to the effective date of the
policy would have resulted in the (b) It is under investigation and its
diagnosis of an illness or medical use limited to controlled clinical
condition. investigations.
22BUPA PRESTIGE DEFINITIONS
55. CANCER: Illness manifested by and relevant changes in the electro-
the presence of a malignant tumor, cardiogram (EKG), and an increase in
characterized by growth and prolif- the levels of cardiac enzymes.
eration of malignant cells, capable 63. NEUROLOGIC DISEASES: Diseases
of cell transfers and invasion of during which the Central Nervous
other organs not directly related. System and/or the Peripheral
The capacity to make metastasis Nervous System are affected by a
is a characteristic of all malignant pathological process with origin
tumors. and location within the structures of
56. CHEMOTHERAPY: Use of chemical Central Nervous System and/or the
agents prescribed by a physician for Peripheral Nervous System. It will not
the treatment and control of cancer. be considered a neurological disease
57. RADIOTHERAPY: Treatment of ill- to the effects of this insurance any
nesses by way of radiations for the disease or disorder which affects in
purpose of stopping the proliferation a secondary way the Central Nervous
of malignant cells. System or the Peripheral Nervous
System or which was caused by con-
58. SEVERE TRAUMA (MULTIPLE ditions or factors not related to the
TRAUMA): A severe trauma of nervous system.
several organs and tissues of the
human body as a consequence of 64. CEREBROVASCULAR ACCIDENT:
an external physical action for which Disorder consisting in the abrupt and
the patient suffers temporal or per- violent suspension of the fundamen-
manent incapacity or even death. tal brain functions, either by ischemia
or hemorrhage.
59. RENAL INSUFFICIENCY: Terminal
stage of a chronic bilateral kidney 65. NEUROSURGERY: Any surgical pro-
disease which means the total and cedure of the Central or Peripheral
irreversible loss of the renal func- Nervous Systems, which includes
tion. A regular renal dialysis or a the brain, the spinal cord, peripheral
kidney transplant will then become nerves and the blood vessels of the
necessary. brain and the spinal medulla.
60. SEVERE BURNS: Injury of tissues 66. CARDIOVASCULAR SURGERY:
caused by the action of physical or Surgery of two or more coronary
chemical agents. This policy will only arteries with the purpose of correct-
consider severe burns those classi- ing a narrowing or obstruction by
fied as Third (III) Degree Burns. means of revascularization (by-pass),
performed after symptoms of angina
61. SEVERE INFECTIOUS DISORDER or myocardial infarction.
(SEPTICEMIA): A disorder cause by
the proliferation of bacteria and the 67. DONOR: Person dead or alive from
presence of its toxins in the blood whom one or more of the organs or
that manifests itself with at least four tissues of his body has been removed
of the following conditions: Positive with the purpose of transplant-
blood culture, rectal temperature ing to the body of another person
over 38.50 degrees, anemia, leu- (receptor).
kocytosis (>12,000) or Leucopoe- 68. RECEPTOR: The person who has
nia (You can also read
