‫‪Member Guide‬‬ ‫ﻛــﺘﻴـﺐ اﻟﻌﻀـﻮﻳـــﺔ‬

Start Using Your Card Now ‫اﺑﺪأ ﺑﺎﺳﺘﺨﺪام ﺑﻄﺎﻗﺘﻚ ان‬

Your Bupa card is your passport to comprehensive health cover. ‫ ﻓﻴﻤﺎ ﻳﻠﻲ ﺗﻮﺿﻴﺢ ﻳﺴﺎﻋﺪك‬.‫ﺑﻄﺎﻗﺔ ﺑﻮﺑﺎ اﳋﺎﺻﺔ ﺑﻚ ﻫﻲ ﺟﻮاز ﺳﻔﺮك ﻟﻠﺤﺼﻮل ﻋﻠﻰ ﻏﻄﺎء ﻃﺒﻲ ﺷﺎﻣﻞ‬
First, understand the information printed on your card. .‫ﻋﻠﻰ ﻣﻌﺮﻓﺔ ﺗﻔﺎﺻﻴﻞ اﳌﻌﻠﻮﻣﺎت اﳌﻄﺒﻮﻋﺔ ﻋﻠﻰ ﺑﻄﺎﻗﺘﻚ‬

Your Membership Number Policy Number ‫رﻗﻢ ﻋﻀﻮﻳﺘﻚ‬ ‫رﻗﻢ ﻏﻄﺎﺋﻚ اﻟﻄﺒﻲ‬
This is your Bupa membership number. This is the number of your ‫ ﺗﻘﻮم‬.‫ﻫﺬا ﻫﻮ رﻗﻢ ﻋﻀﻮﻳﺘﻚ – ﺑﻮﺑﺎ‬ ‫ﻫﺬا ﻫﻮ رﻗﻢ ﻏﻄﺎﺋﻚ اﻟﻄﺒﻲ‬
Your number is unique and hospitals use policy cover being used as ‫اﳌﺴﺘﺸﻔﻴﺎت واﳌﺴﺘﻮﺻﻔﺎت‬ ‫واﻟﺬي ﻳﺴﺘﺨﺪم ﻛﻤﺮﺟﻊ ﻟﻜﻞ ﻣﻦ‬
this number to verify your membership reference by both Bupa ‫ﺑﺎﺳﺘﺨﺪام ﻫﺬا اﻟﺮﻗﻢ ﳌﻌﺮﻓﺔ ﻣﺰاﻳﺎ‬ .‫ﺑﻮﺑﺎ واﳌﺴﺘﺸﻔﻰ اﳌﻌﺎﻟﺞ‬
benefits with us. .‫ﺗﻐﻄﻴﺘﻚ اﻟﻄﺒﻴﺔ – ﺑﻮﺑﺎ‬
and the hospitals

Your Scheme ‫اﳌﻮاﻓﻘﺎت‬

This is your scheme Name: Mohammed Abdul Aziz Khatani Name: Mohammed Abdul Aziz Khatani
Membership No.: 4567891 Policy No.: 12345678
‫ﻓﺌﺔ اﻟﺘﻐﻄﻴﺔ‬ Membership No.: 4567891 Policy No.: 12345678 ‫وﻣﺴﺘﻮى ا ﻗﺎﻣﺔ‬
level as agreed with Approval & Room ‫ﻫﺬه ﻫﻲ ﻓﺌﺔ اﻟﺘﻐﻄﻴﺔ اﳌﺘﻔﻖ‬
Scheme: Bupa Arabia - Blue NW: 5 Scheme: Bupa Arabia - Blue NW: 5 ‫ﻫﺬه ﻫﻲ ﺣﺪود اﻟﻌﻼﺟﺎت‬
your company. Shows the level ‫ وﻳﻠﻴﻬﺎ رﻗﻢ‬.‫ﻋﻠﻴﻬﺎ ﻣﻊ ﺷﺮﻛﺘﻚ‬
Approval & Room: Full Cover No Exclusions - Single Approval & Room: Full Cover No Exclusions - Single ‫اﻟﺘﻲ ﺗﺘﻄﻠﺐ ﻣﻦ‬
The number or letter when the hospital ‫ﺷﺒﻜﺔ اﳌﺴﺘﺸﻔﻴﺎت‬ ‫اﳌﺴﺘﺸﻔﻰ ﻃﻠﺐ ﻣﻮاﻓﻘﺔ‬
after it denotes your ID No.: 2114567822 Contribution: 20% O/P up to SR 100 needs to get Bupa .‫اﳌﻌﺘﻤﺪة ﻟﻚ‬ ID No.: 2114567822 Contribution: 20% O/P up to SR 100
.‫ﺑﻮﺑﺎ ﻗﺒﻞ اﻟﺒﺪء ﺑﺎ·ﺟﺮاءات‬
Staff No.: 123456789 YOB: 1982 Exp: 30/12/2014 Staff No.: 123456789 YOB: 1982 Exp: 30/12/2014
hospital network approval before ‫ﻣﺴﺘﻮى ا·ﻗﺎﻣﺔ ﻳﻮﺿﺢ‬
level. doing any treatment; ‫ﻣﺴﺘﻮى اﻟﻐﺮﻓﺔ اﻟﺘﻲ ﻧﻮﻓﺮﻫﺎ‬
room shows your – ‫ اﻟﺘﻨﻮﱘ‬³‫ﻟﻚ ﻋﻨﺪ اﳊﺎﺟﺔ إ‬
accommodation level .‫اﻟﻌﻴﺎدات اﻟﺪاﺧﻠﻴﺔ‬
should you require
Contribution in-patient service ‫ﻣﺒﻠﻎ اﳌﺸﺎرﻛﺔ‬
ID Number This is the amount you Expiry Date ‫وﻫﻮ اﳌﺒﻠﻎ اﻟﺬي ﻋﻠﻴﻚ دﻓﻌﻪ ﻣﺒﺎﺷﺮة‬ ‫ﺗﺎرﻳﺦ اﻻﻧﺘﻬﺎء‬
This is your Saudi or have to pay directly to This is the end date .‫ ﺧﺪﻣﺔ ﻃﺒﻴﺔ‬³‫ﻟﻠﻤﺴﺘﺸﻔﻰ ﻋﻨﺪ ﺣﺎﺟﺘﻚ إ‬
of your policy cover
‫ا ﻗﺎﻣﺔ‬/‫رﻗﻢ اﻟﻬﻮﻳﺔ اﻟﻮﻃﻨﻴﺔ‬ ‫ﻫﺬا ﻫﻮ ﺗﺎرﻳﺦ اﻧﺘﻬﺎء ﻏﻄﺎﺋﻚ‬
Iqama number as the hospital whenever .‫اﻟﻄﺒﻲ ﻣﻊ ﺑﻮﺑﺎ‬
with Bupa. ‫ أو رﻗﻢ‬،‫ﻫﺬا ﻫﻮ رﻗﻢ ﻫﻮﻳﺘﻚ اﻟﻮﻃﻨﻴﺔ‬
provided by your you require treatment. .‫إﻗﺎﻣﺘﻚ‬
employer

Our Privacy Policy can be found at www.bupa.com.sa/privacy www.bupa.com.sa/privacy ‫ﳝﻜﻨﻚ اﻻﻃﻼع ﻋﻠﻰ ﺳﻴﺎﺳﺔ اﳋﺼﻮﺻﻴﺔ اﳋﺎﺻﺔ ﺑﻨﺎ ﻋﻠﻰ‬
 800 244 0307
This is your dedicated 24/7
toll free number
International SOS Assistance
Our international partner in case you
require emergency medical advice or
emergency medical evacuation when
outside of Saudi Arabia.
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www.bupa.com.sa ٨٠٠ ٢٤٤ ٠٣٠٧ www.bupa.com.sa
Visit our website and enrol in our ‫ﻫﺬا ﻫﻮ رﻗﻢ ﺧﻂ اﳋﺪﻣﺔا¿ﺎ¾ ا½ﺼﺺ‬ ‫ﻧﺖ ﻟﻼﺳﺘﻔﺎدة‬Ç‫ﺗﻔﻀﻞ ﺑﺰﻳﺎرة ﻣﻮﻗﻌﻨﺎ ﻋﻠﻰ ﺷﺒﻜﺔ ا·ﻧ‬
innovative online services .‫ﳋﺪﻣﺘﻚ واﻟﺬي ﻳﻌﻤﻞ ﻋﻠﻰ ﻣﺪار اﻟﺴﺎﻋﺔ‬ .‫ﻣﻦ ﺧﺪﻣﺎﺗﻨﺎ اﳌﺒﺘﻜﺮة‬
+966 92002 3009 + ٩٦٦ ٩ ٢٠٠٢ ٣٠٠٩
This is the landline ‫ﻫﺬا ﻫﻮ رﻗﻢ اﳋﻂ اﻟﺜﺎﺑﺖ اﻟﺬي‬
number you can call to ،‫ﺗﺼﺎل ﺑﻨﺎ‬Å‫ﳝﻜﻨﻚ اﺳﺘﺨﺪاﻣﻪ ﻟ‬
.‫ﺧﺎﺻﺔ إذا ﻛﻨﺖ ﺧﺎرج اﳌﻤﻠﻜﺔ‬
reach us especially if
you are outside of
Saudi Arabia
‫ا ﺧﻼء اﻟﻄﺒﻲ اﻟﺪو‘ اﻟﻄﺎرئ‬
‫ﻫﺬا ﻫﻮ ﺷﺮﻳﻜﻨﺎ اﻟﻌﺎﳌﻲ اﻟﺬي ﻳﻮﻓﺮ ﻟﻚ اﻟﻨﺼﺢ اﻟﻄﺒﻲ أو ا·ﺧﻼء‬
‫اﻟﻄﺒﻲ اﻟﻄﺎرئ ﻋﻨﺪ اﳊﺎﺟﺔ ﻟﺬﻟﻚ ﺧﺎرج اﳌﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ‬
.‫اﻟﺴﻌﻮدﻳﺔ‬ ‫اﳋﻂ اﳌﺒﺎﺷﺮ šﻠﺲ اﻟﻀﻤﺎن‬
CCHI hotline
¡‫اﻟﺼﺤﻲ اﻟﺘﻌﺎو‬
The number you can call for any
‫اح أو‬Ç‫ي اﻗ‬É ‫ﻫﻮ اﻟﺮﻗﻢ اﻟﺬي ﳝﻜﻨﻚ ا·ﺗﺼﺎل ﺑﻪ‬
feedback or complaints .‫ﺑﻼغ ﻋﻦ ﺷﻜﻮى‬Å‫ﻟ‬
 Over 2,000,000 have used ‫ اﺳﺘﻔﺎدوا‬2,000,000 ‫أﻛ¬ ﻣﻦ‬
our exclusive Tebtom Program. .‫ﻣﻦ ﺑﺮﻧﺎﻣﺞ ﻃﺒﺘﻢ اﳊﺼﺮي‬
Have you? ‫ﻫﻞ أﻧﺖ ﻣﻨﻬﻢ؟‬

Bupa doctors do not provide any medical consultations nor medication prescriptions ‫أﻃﺒﺎء ﺑﻮﺑﺎ ﻻ ﻳﻘﺪﻣﻮن أي اﺳﺘﺸﺎرات أو وﺻﻔﺎت ﻃﺒﻴﺔ‬

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 Program Services ‫ﺧﺪﻣﺎت ﺑﺮﻧﺎﻣﺞ‬
Bupa Doctor ‫ﻃﺒﻴﺐ ﺑﻮﺑﺎ‬
Get the healthcare advice and guidance you seek from our specialized doctors, around ‫ ﻟﻠﺤﺼﻮل‬،‫ﺳﺒﻮع‬É‫ ﺳﺎﻋﺔ ﺧﻼل ﻛﻞ أﻳﺎم ا‬٢٤ ‫ﺘﺺ ﻣﻦ أﻃﺒﺎﺋﻨﺎ ﻋﻠﻰ ﻣﺪار‬â ‫ﺗﺘﻴﺢ ﻟﻚ ﻫﺬه اﳋﺪﻣﺔ اﻟﺘﻮاﺻﻞ ﻣﻊ ﻃﺒﻴﺐ‬
the clock (24/7), through Tebtom’s toll-free number 800 440 4040 or Doctor Chat .¾‫ وذﻟﻚ ﻣﻦ ﺧﻼل رﻗﻢ ﻃﺒﺘﻢ ا¿ﺎ‬.‫ﺘﻠﻒ ﺗﺴﺎؤﻻﺗﻚ اﻟﺼﺤﻴﺔ‬â ‫ ا·ﺟﺎﺑﺔ ﻋﻠﻰ‬³‫ﻋﻠﻰ اﻟﻨﺼﺢ وا·رﺷﺎد إﺿﺎﻓﺔ إ‬
service on (bupa.com.sa).

Maternity & Child Care ‫رﻋﺎﻳﺔ اﳊﻤﻞ وا´ﻣﻮﻣﺔ‬

Tebtom's exclusive 'Maternity & Child Care' service will provide you with all the advice ‫ﺗﻘﺪم ﻟﻚ ﺧﺪﻣﺔ "رﻋﺎﻳﺔ اﳊﻤﻞ وا´ﻣﻮﻣﺔ“ ﻛﻞ ﻣﺎ ﲢﺘﺎﺟﻴﻨﻪ ﻣﻦ دﻋﻢ وﺗﻮﺟﻴﻪ وإﺟﺎﺑﺔ ﻋﻠﻰ ﺗﺴﺎؤﻻﺗﻚ ﻣﻦ أﺟﻞ ﲡﺮﺑﺔ‬
ّ
you seek by guiding you throughout your maternity journey towards a health and happy .‫ﺣﻤﻞ ﺳﻠﻴﻤﺔ وﺣﻴﺎة ﺻﺤﻴﺔ ﻟﻚ وﻟﻄﻔﻠﻚ‬
experience.

Chronic Care ‫رﻋﺎﻳﺔ ا´ﻣﺮاض اﳌﺰﻣﻨﺔ‬

'Chronic Care' allows you to manage your chronic condition(s) by providing specialized ‫ﺗﺴﺎﻋﺪك ﺧﺪﻣﺔ "رﻋﺎﻳﺔ ا´ﻣﺮاض اﳌﺰﻣﻨﺔ“ – إدارة اﳌﺮض واﻟﺘﺨﻔﻴﻒ ﻣﻦ آﺛﺎره ﻣﻦ ﺧﻼل ﺣﻠﻮل ﺻﺤﻴﺔ ﺷﺨﺼﻴﺔ‬
solutions such as personalized nutritional guidance, Chronic Medication Refill*, Home .**‫دوﻳﺔ‬É‫دوﻳﺔ* و ﺧﺪﻣﺎت اﻟﺘﺤﺎﻟﻴﻞ اﳌﻨﺰﻟﻴﺔ* و ﺗﻮﺻﻴﻞ ا‬É‫ﻣﺜﻞ ﺗﻘﺪﱘ اﺳﺘﺸﺎرات اﻟﺘﻐﺬﻳﺔ و إﻋﺎدة ﺻﺮف ا‬
Based Labs*, and Medication Delivery**.

Wellness Services ‫ﺧﺪﻣﺎت اﻟﺼﺤﺔ و اﻟﻠﻴﺎﻗﺔ‬

'Our 'Wellness Services' focus on enhancing the health and wellness of our members by :‫اﻣﺞ اﻟﺘﺎﻟﻴﺔ‬Ý‫ اﻫﺘﻤﺎﻣﺎﺗﻨﺎ ﻣﻦ ﺧﻼل اﻟ‬³‫ﻧﺤﻦ ﻧﻀﻊ ﺻﺤﺔ وﻟﻴﺎﻗﺔ أﻋﻀﺎﺋﻨﺎ ﺿﻤﻦ أو‬
encouraging them to adapt a healthier lifestyle and embrace beneficial habits through a
series of exclusive programs. ã‫ا·ﻗﻼع ﻋﻦ اﻟﺘﺪﺧﲔ ﺑﺎﺳﺘﺨﺪام ﺗﻘﻨﻴﺎت ﻣﻌﺘﻤﺪة ﻋﺎﳌﻴ‬
ä‫اﺳﺘﺸﺎرات اﻟﺘﻐﺬﻳﺔ واﻟﺮﺷﺎﻗﺔ ﻣﻦ ﺧﻼل ﺧﻄﻂ ﻟﻠﺘﻐﺬﻳﺔ ﺗﺴﺎﻋﺪ أﻋﻀﺎﺋﻨﺎ ﻋﻠﻰ ﲢﻘﻴﻖ اﻟﻮزن اﳌﺜﺎ‬
‫ﻋﻀﺎء اﻟﺘﻐﻠﺐ ﻋﻠﻰ اﻟﻀﻐﻮﻃﺎت اﻟﻴﻮﻣﻴﺔ ﻟﻠﺤﻴﺎة‬É‫اﻟﺘﺤﻜﻢ ﺑﺎﻟﺘﻮﺗﺮ ﳌﺴﺎﻋﺪة ا‬
Telemedicine*
Tebtom's exclusive 'Telemedicine'* service provides direct access to doctors from the
American Board covering more than 14 specialties via the Bupa App, phone, or online @‫اﻟﺘﻄﺒﻴﺐ ﻋﻦ ﺑﻌﺪ‬
video call for non-emergency cases by calling 800 244 4484. ‫ وﺿﻤﻦ اﻟﻌﺪﻳﺪ ﻣﻦ‬.‫ﺧﺪﻣﺔ "اﻟﺘﻄﺒﻴﺐ ﻋﻦ ﺑﻌﺪ“* ﲤﻨﺤﻚ إﻣﻜﺎﻧﻴﺔ اﻟﺘﺸﺎور اﳌﺒﺎﺷﺮ ﻣﻊ ﻃﺒﻴﺐ – اﻟﻮﻻﻳﺎت اﳌﺘﺤﺪة‬
، ‫ ﺗﻄﺒﻴﻖ ﺑﻮﺑﺎ أو ﺷﺎﺷﺔ اﻟﻬﺎﺗﻒ أو‬Ý‫ وذﻟﻚ ﻋ‬،‫اﻟﺘﺨﺼﺼﺎتﻟﺘﻘﺪم اﺳﺘﺸﺎراﺗﻬﺎ اﻟﺼﺤﻴﺔ – اﻟﻌﺪﻳﺪ ﻣﻦ ا¿ﺎﻻت‬
.800 244 4484 ‫اﳊﺎﺳﻮب ﺑﺎﻟﺘﻌﺎون ﻣﻊ أﻃﺒﺎء ﺑﻮﺑﺎ ﺑﺎﻻﺗﺼﺎل ﻋﻠﻰ‬
International Second Medical Opinion*
Tebtom's exclusive 'International Second Medical Opinion'* service allows our doctors to
evaluate health conditions based on pre-set medical criteria; helping you deal with
complex health cases using world-class experts operating at internationally renowned
centers. @‫اﻻﺳﺘﺸﺎرات اﻟﺪوﻟﻴﺔ‬
– ‫ وﻳﺴﺎﻋﺪك ذﻟﻚ‬،‫ﺪدة‬Ú
ّ Û‫ ﻣﻌﺎﻳ‬³‫ إ‬Ü‫ﲤﻜّ ﻦ ﺧﺪﻣﺔ "اﻻﺳﺘﺸﺎرات اﻟﺪوﻟﻴﺔ“* أﻃﺒﺎﺋﻨﺎ ﻣﻦ ﻣﺮاﺟﻌﺔ اﳊﺎﻻت اﺳﺘﻨﺎد‬
Elderly Care – ‫اء اﻟﻌﺎﳌﻴﲔ‬Ý‫ﻃﺒﺎء واﳋ‬É‫اﻟﺘﻌﺎﻣﻞ ﻣﻊ اﳊﺎﻻت اﻟﺼﺤﻴﺔ اﳌﻌﻘﺪة ﺣﻴﺚ ﻳﺘﻢ اﻟﺘﺄﻛﺪ ﻣﻦ اﻟﺘﺸﺨﻴﺺ واﻟﻌﻼج ﻣﻦ ا‬
Tebtom's exclusive 'Elderly Care' service will ensure the elderly's comfort through tailor .‫اﳌﺘﺨﺼﺼﺔ‬
ّ ‫اﳌﺮاﻛﺰ اﻟﺪوﻟﻴﺔ‬
made healthcare solutions such as elderly guidance and coaching, personalized
Nutritional Guidance, Chronic Medication Refill*, Home Based Labs* and Medication
Delivery**. ‫رﻋﺎﻳﺔ اﳌﺴﻨﲔ‬
‫ وﺗﺆﻣﻦ اﳊﻠﻮل اﻟﻜﺎﻓﻴﺔ ﻟﺮاﺣﺘﻬﻢ ﻣﺜﻞ ﺗﻘﺪﱘ اﳌﺸﻮرة واﻟﺘﻮﺟﻴﻪ‬،‫ﲤﻨﺢ ﺧﺪﻣﺔ "رﻋﺎﻳﺔ اﳌﺴﻨﲔ“ اﻟﺮﻋﺎﻳﺔ اﻟﻼزﻣﺔ ﻟﻬﻢ‬
‫ و ﺧﺪﻣﺔ ﺗﻮﺻﻴﻞ‬,*‫دوﻳﺔ* واﻟﺘﺤﺎﻟﻴﻞ اﳌﻨﺰﻟﻴﺔ‬É‫ و إﻋﺎدة ﺻﺮف ا‬،‫ و ﺗﻘﺪﱘ اﺳﺘﺸﺎرات اﻟﺘﻐﺬﻳﺔ‬،‫اﻟﻼزم ﻋﻨﺪ اﻟﺘﻘﺪم ﺑﺎﻟﺴﻦ‬
Cancer Care
Tebtom's 'Cancer Care' service aims to provide the confidence & strength to the patient .**‫دوﻳﺔ‬É‫ا‬
as well as their caregiver(s) to face the challenges ahead.
‫رﻋﺎﻳﺔ ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن‬
‫ ﺗﻌﺰﻳﺰ ﺛﻘﺔ اﳌﺮﻳﺾ ﺑﻨﻔﺴﻪ وﺗﻘﺪﱘ اﻟﺪﻋﻢ ﻟﻪ وﳌﻦ ﻳﻘﺪم ﻟﻪ اﻟﺮﻋﺎﻳﺔ ﺣﺘﻰ‬³‫ﺗﻬﺪف ﺧﺪﻣﺔ "رﻋﺎﻳﺔ ﻣﺮﺿﻰ اﻟﺴﺮﻃﺎن“ إ‬
.‫ﻳﺘﻐﻠّﺒﻮا ﻋﻠﻰ اﳌﺮض‬

*Available for Bupa members covered in Network 5 and above. ‫ ﻓﻤﺎ أﻋﻠﻰ‬٥ ‫ﻋﻀﺎء ﺑﻮﺑﺎ اﻟﻌﺮﺑﻴﺔ اﳌﺸﻤﻮﻟﲔ – ﺷﺒﻜﺔ‬É ‫*ﻣﺘﻮﻓﺮة‬
** Available in select cities for members covered in Network 5 and above ‫ ﻓﻤﺎ أﻋﻠﻰ‬٥ ‫ﻋﻀﺎء ﺑﻮﺑﺎ اﻟﻌﺮﺑﻴﺔ اﳌﺸﻤﻮﻟﲔ – ﺷﺒﻜﺔ‬É ‫**ﻣﺘﻮﻓﺮة – ﻣﺪن ﻣﻌﻴﻨﺔ‬

Bupa doctors do not provide any medical consultations nor medication prescriptions ‫أﻃﺒﺎء ﺑﻮﺑﺎ ﻻ ﻳﻘﺪﻣﻮن أي اﺳﺘﺸﺎرات أو وﺻﻔﺎت ﻃﺒﻴﺔ‬

3 3
 Frequently
Asked Questions
Ü‫ ﺗﻜﺮار‬õ‫ﻛ‬É‫ﺳﺌﻠﺔا‬É‫ا‬

What type of benefits am I entitled to? ‫ﻣﺎ ﻫﻲ اﳌﺰاﻳﺎ اﻟﺘﻲ أﲤﺘﻊ ﺑﻬﺎ؟‬
Refer to the Table of Benefits enclosed with your pack to know what other benefits you are
entitled to. Preferably, enrol in our online services by visiting www.bupa.com.sa to get all the
‫ﻧﺖ‬Ç‫ ا·ﻧ‬Ý‫اك ﺑﺨﺪﻣﺎﺗﻨﺎ اﳌﺒﺎﺷﺮة ﻋ‬Ç‫ﻓﻀﻞ ﻟﻚ اﻻﺷ‬É‫ وﻣﻦ ا‬،‫ﺧﺮى اﻟﺘﻲ ﺗﺘﻤﺘﻊ ﺑﻬﺎ‬É‫ﻳﺒﲔ ﻟﻚ ﺟﺪول اﳌﺰاﻳﺎ اﳌﺮﻓﻖ ﲟﻠﻒ اﻟﻌﻀﻮﻳﺔ اﳌﺰاﻳﺎ ا‬
details of your scheme benefits. .‫ﻚ‬ç‫ ﻟﻼﻃﻼع ﻋﻠﻰ ﺗﻔﺎﺻﻴﻞ اﳌﺰاﻳﺎ اﻟﺘﻲ ﻳﺘﻴﺤﻬﺎ ﻟﻚ ﺑﺮﻧﺎ‬www.bupa.com.sa ‫ﻣﻦ ﺧﻼل زﻳﺎرة ﻣﻮﻗﻌﻨﺎ‬

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 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, enrol in our online services and you can print membership certificates in case you
lost your Bupa 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.
‫¿ أي ﻣﺴﺘﺸﻔﻰ أو ﻣﺴﺘﻮﺻﻒ أﺳﺘﻄﻴﻊ أن أﺗﻠﻘﻰ اﻟﻌﻼج؟‬
‫ن‬É‫ و‬.‫ أي ﻣﺴﺘﺸﻔﻰ أو ﻣﺴﺘﻮﺻﻒ ﻣﺬﻛﻮر – ﻗﺎﺋﻤﺔ اﳌﺴﺘﺸﻔﻴﺎت واﳌﺴﺘﻮﺻﻔﺎت اﳌﺮﻓﻖ ﲟﻠﻒ ﻋﻀﻮﻳﺘﻚ‬³‫ﺗﺴﺘﻄﻴﻊ اﻟﺬﻫﺎب إ‬
ä‫ﻧﺖ ﻋﻠﻰ اﻟﻌﻨﻮان اﻟﺘﺎ‬Ç‫ ﻧﺮﺟﻮ ﻣﻨﻚ زﻳﺎرة ﻣﻮﻗﻌﻨﺎ ﻋﻠﻰ ﺷﺒﻜﺔ ا·ﻧ‬،‫ﻫﺬه اﻟﻘﺎﺋﻤﺔ ﻗﺪ ﻳﻄﺎﻟﻬﺎ ﺑﻌﺾ اﻟﺘﺤﺪﻳﺚ ﺑﻌﺪ اﺳﺘﻼﻣﻚ ﻟﻬﺎ‬
.‫ ﻟﻠﺤﺼﻮل ﻋﻠﻰ اﻟﻘﺎﺋﻤﺔ اﶈﺪﺛﺔ‬bupa.com.sa
‫ﻋﻠﻲ أن اﻓﻌﻞ؟‬
ّ ‫ ﻓﻤﺎذا‬،‫ وأﺣﺘﺎج ﻟﺘﻠﻘﻲ اﻟﻌﻼج ¿ اﳌﺴﺘﺸﻔﻰ‬،‫ﻟﻘﺪ ﻧﺴﻴﺖ ﺑﻄﺎﻗﺔ ﻋﻀﻮﻳﺘﻲ‬
‫ ﻛﻤﺎ‬،‫ﺳﻞ ﺷﻬﺎدة ﺗﺄﻛﻴﺪ ﻋﻀﻮﻳﺘﻚ ﻟﻠﻤﺴﺘﺸﻔﻰ‬é‫ ﺧﻂ اﳋﺪﻣﺔ وﺳ‬Ý‫ اﺗﺼﻞ ﻋ‬،‫ ﺧﺪﻣﺔ ﻃﺒﻴﺔ‬³‫إذا ﻛﻨﺖ ﻗﺪ ﻓﻘﺪت ﺑﻄﺎﻗﺘﻚ وﲢﺘﺎج إ‬
.‫ﻧﺖ وﻃﺒﺎﻋﺔ ﺷﻬﺎدة اﻟﻌﻀﻮﻳﺔ‬Ç‫ ا·ﻧ‬Ý‫اك ﺑﺨﺪﻣﺎﺗﻨﺎ ﻋ‬Ç‫ﳝﻜﻨﻚ اﻻﺷ‬
‫أي ﻣﻦ ﻣﺴﺘﺸﻔﻴﺎت‬ ّ ‫ ﻟﺪﻓﻊ أي ﻣﺒﻠﻎ ﻧﻘﺪي ﻋﻨﺪﻣﺎ أﺳﺘﺨﺪم‬Æ‫ﻛﻨﺖ أﻋﺘﻘﺪ أﻧﻨﻲ ﻟﻦ أﻛﻮن ﻣﻀﻄﺮ‬
‫ ﻓﻤﺎ ﻫﻮ ﻣﺒﻠﻎ‬،‫ ﻣﺎ زال اﳌﺴﺘﺸﻔﻰ ﻳﻄﻠﺐ ﻣﻨﻲ دﻓﻊ ﺑﻌﺾ اﳌﺒﺎﻟﻎ‬،‫ﺷﺒﻜﺘﻲ اﳌﻌﺘﻤﺪة‬
‫ﻣﺸﺎرﻛﺔ اﻟﻌﻀﻮ؟‬
‫ وﻟﻜﻦ وﲟﻮﺟﺐ اﻟﻘﺎﻧﻮن وﺣﺴﺐ ﻣﺎ ﰎ اﻻﺗﻔﺎق ﻋﻠﻴﻪ ﻣﻊ‬،‫ ﻻ ﻳﺘﻮﺟﺐ ﻋﻠﻴﻚ دﻓﻊ أي ﻣﺒﺎﻟﻎ ﻧﻘﺪﻳﺔ – ﺣﺎﻻت اﻟﺘﻨﻮﱘ أو ﺣﺎﻻت اﻟﻴﻮم اﻟﻮاﺣﺪ‬،‫ﻧﻌﻢ‬
.‫ ﻋﻨﺪ ﺗﻠﻘﻲ اﻟﻌﻼج – اﻟﻌﻴﺎدات اﳋﺎرﺟﻴﺔ‬Ü‫ﺪد‬Ú ã‫ ﻓﺈﻧﻪ ﻳﺠﺐ ﻋﻠﻴﻚ أن ﺗﺪﻓﻊ ﻟﻠﻤﺴﺘﺸﻔﻰ ﻣﺒﻠﻐ‬،‫ﺷﺮﻛﺘﻚ‬
‫ﻠﺲ‬ç ‫ وﻫﺬه اﻟﻨﺴﺒﺔ ﰎ ﲢﺪﻳﺪﻫﺎ ﻣﻦ ﻗﺒﻞ‬،‫ رﻳﺎل‬١٠٠ ‫ ﻗﻴﻤﺔ اﻟﻔﺎﺗﻮرة وﺣﺘﻰ‬ä‫ ﻣﻦ إﺟﻤﺎ‬٪٢٠ ‫و– ﻣﻌﻈﻢ اﳊﺎﻻت ﻳﻜﻮن ﻣﺒﻠﻎ اﳌﺸﺎرﻛﺔ‬
.‫وﻫﻮ اﳉﻬﺔ اﳊﻜﻮﻣﻴﺔ اﳌﺴﺌﻮﻟﺔ ﻋﻦ إدارة اﻟﺘﺄﻣﲔ اﻟﺼﺤﻲ – اﳌﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬، ¾‫اﻟﻀﻤﺎن اﻟﺼﺤﻲ اﻟﺘﻌﺎو‬

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 bupa.com.sa. This will allow you to claim from Bupa the amount you are
eligible for according to your network price.
‫ ﺗﻠﻚ اﻟﺘﻲ ¿ ﺷﺒﻜﺘﻲ اﳌﻌﺘﻤﺪة ؟‬Ì‫ﻫﻞ أﺳﺘﻄﻴﻊ زﻳﺎرة ﻣﺴﺘﺸﻔﻴﺎت ﻏ‬
‫ وﻟﻜﻦ ﻋﻠﻴﻚ – ﻫﺬه‬،‫ ﳝﻜﻨﻚ زﻳﺎرة أي ﻣﺴﺘﺸﻔﻰ ﺗﺮﻳﺪه او اي ﻃﺒﻴﺐ ﺧﺎرج ﺷﺒﻜﺘﻚ اﳌﻌﺘﻤﺪة اذا ﻛﻨﺖ ﺗﺘﻤﺘﻊ ﲟﻴﺰة اﻟﺘﻌﻮﻳﺾ‬.‫ﻧﻌﻢ‬
.‫ واﻟﻘﻴﺎم ﺑﻌﺪ ذاﻟﻚ ﺑﺘﻘﺪﱘ ﻣﻄﺎﻟﺒﺘﻚ ﻟﺒﻮﺑﺎ ﺑﻌﺪ ﺗﻌﺒﺌﺔ ﳕﻮذج اﳌﻄﺎﻟﺒﺔ‬،‫اﳊﺎﻟﺔ دﻓﻊ ﺟﻤﻴﻊ ﺗﻜﺎﻟﻴﻒ ﻣﺒﺎﺷﺮة ﻟﻠﻤﺴﺘﺸﻔﻰ او اﳌﺴﺘﻮﺻﻒ‬
.‫ ﺳﻴﺴﻤﺢ ﻟﻚ ﲟﻄﺎﻟﺒﺔ اﻟﺘﻌﻮﻳﺾ ﻣﻦ ﺑﻮﺑﺎ ﺣﺴﺐ أﺳﻌﺎر ﺷﺒﻜﺘﻚ‬bupa.com.sa ‫ﳝﻜﻨﻚ ﲢﻤﻴﻞ اﻟﻨﻤﻮذج ﻣﻦ ﺧﻼل ﻣﻮﻗﻌﻨﺎ‬

4 ٤
 I’m going on vacation outside the Kingdom; ‫ ﻓﻬﻞ أﺳﺘﻄﻴﻊ أﺳﺘﺨﺪام ﺑﻄﺎﻗﺔ ﺑﻮﺑﺎ اﻟﻌﺮﺑﻴﺔ؟‬،‫ ﺧﺎرج اﳌﻤﻠﻜﺔ‬Í‫ﺳﻮف أﺳﺎﻓﺮ ¿ اﺟﺎزة ا‬
can I use my Bupa card?
.‫ ﺗﺴﺘﻄﻴﻊ اﺳﺘﺨﺪام ﺑﻄﺎﻗﺘﻚ – اي ﻣﺴﺘﺸﻔﻰ ﻟﺪﻳﻬﺎ اﺗﻔﺎﻗﻴﺔ ﻣﺴﺒﻘﺔ ﻣﻊ ﺑﻮﺑﺎ اﻟﻌﺮﺑﻴﺔ ﺧﻼل ﺳﻔﺮك او رﺣﻠﺘﻚ وﺣﺴﺐ ﺗﻐﻄﻴﺘﻚ‬.‫ﻧﻌﻢ‬
Yes, you can use your card at any of the specific providers that have prior contracts with
Bupa Arabia when traveling according to your network. Also, depending on your coverage if ‫ وﻟﻜﻦ ﻋﻠﻴﻚ – ﻫﺬه اﳊﺎﻟﺔ دﻓﻊ ﺟﻤﻴﻊ اﻟﺘﻜﺎﻟﻴﻒ ﻣﺒﺎﺷﺮة ﻟﻠﻤﺴﺘﺸﻔﻰ أو اﳌﺴﺘﻮﺻﻒ‬،(‫وأﻳﻀﺎ ﳝﻜﻨﻚ )اذا ﻛﻨﺖ ﺗﺘﻤﺘﻊ ﲟﻴﺰة اﻟﺘﻌﻮﻳﺾ‬
you are eligible for reimbursement outside KSA, you can get treatment at any hospital while .‫واﻟﻘﻴﺎم ﺑﺘﻘﺪﱘ ﻣﻄﺎﻟﺒﺘﻚ ﻟﺒﻮﺑﺎ ﺑﻌﺪ ﺗﻌﺒﺌﺔ ﳕﻮذج اﳌﻄﺎﻟﺒﺔ اﳌﺮﻓﻖ‬
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. ‫ﻣﺎ ﻫﻮ اﻟﺘﻌﻮﻳﺾ؟‬

What is claiming (reimbursement) ? ‫ﻫﻲ ﻋﻤﻠﻴﺔ ﺗﺴﻮﻳﺔ اﳌﺼﺎرﻳﻒ اﳌﺘﻌﻠﻘﺔ ﻣﻊ ﺑﻮﺑﺎ اﻟﻌﺮﺑﻴﺔ ﺑﺎﳌﻌﺎﳉﺎت اﻟﺘﻲ ﺗﺘﻠﻘﺎﻫﺎ ﺧﺎرج ﺷﺒﻜﺘﻚ اﳌﻌﺘﻤﺪة وﻓﻖ اﻟﺸﺮوط واﻻﺣﻜﺎم‬
.‫ ﻳﻮم ﻋﻤﻞ ﻣﻦ ﺗﺎرﻳﺦ ﺗﻠﻘﻲ اﻟﻌﻼج‬٩٠ ‫ وﻋﻠﻴﻚ ﺗﻌﺒﺌﺔ اﳌﻄﺎﻟﺒﺔ و ﺗﺴﻠﻴﻤﻬﺎ ﻟﺒﻮﺑﺎ ﺧﻼل‬.‫اﳌﻮﺿﺤﺔ – وﺛﻴﻘﺔ اﻟﺘﺄﻣﲔ اﻟﺼﺤﻲ اﳋﺎﺻﺔ ﺑﻚ‬
This is the process of settling medical expenses with Bupa provided outside of your approved
network of hospitals and clinics based on the terms and conditions of your insurance policy.
You need to file your claim form with Bupa within 90 days of your treatment. ‫ﻛﻴﻒ أﻗﻮم ﺑﺘﻌﺒﺌﺔ ﻣﻄﺎﻟﺒﺔ ﻟﻠﺘﻌﻮﻳﺾ؟‬
How do I file Reimbursement Claim? .‫ﺳﻌﺎر اﳌﻨﻄﻘﻴﺔ و اﳌﻘﺒﻮﻟﺔ ﻟﻨﻔﺲ اﳋﺪﻣﺔ – ﺷﺒﻜﺔ اﳌﺴﺘﺸﻔﻴﺎت و اﳌﺴﺘﻮﺻﻔﺎت اﳌﻌﺘﻤﺪة ﻟﻠﻌﻀﻮ‬É‫ﺳﻴﻜﻮن اﻟﺘﻌﻮﻳﺾ وﻓﻖ ا‬
Settlement of claims is based on the reasonable and customary cost of the same treatment or :ä‫ارﺳﻞ اﻟﻄﻠﺐ ﻟﻠﻌﻨﻮان اﻟﺘﺎ‬
procedure within the member’s approved network of the hospitals and clinics. Send your
claim to: Ñ‫اﳋ‬ ‫ﺟﺪة‬ ‫اﻟﺮﻳﺎض‬
،‫ ﻃﺮﻳﻖ اﳌﻠﻚ ﻓﻴﺼﻞ‬٣٣٣٩ ،‫ اﻟﻄﺎﺑﻖ اﻟﺴﺎدس‬،‫اﳌﺪﺧﻞ اﳋﻠﻔﻲ‬ ‫ﻋﻤﺎرة ﺑﻮﺑﺎ اﻟﻌﺮﺑﻴﺔ‬
RIYADH JEDDAH KHOBAR ٣٤٤٢٢ Ý‫ اﳋ‬،‫اﻟﺒﺴﺘﺎن‬ ‫ ﺣﻲ‬،‫ ﺳﻠﻄﺎن‬Û‫ﻣ‬É‫ﻃﺮﻳﻖ ا‬ ‫ﻃﺮﻳﻖ اﳌﻠﻚ ﻓﻬﺪ‬
Bupa Arabia Building, Back Entrance, 6th floor New Regional Office, ‫اﳌﻤﻠﻜﺔاﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬ ‫اﶈﻤﺪﻳﺔ ﺑﺠﻮار ﺳﺎﻛﻮ‬ ‫ﻣﻨﻄﻘﺔ اﻟﻌﻠﻴﺎ‬
King Fahad Road Prince Sultan St, 3339 King Faisal Road, ٠١٣ ٨٨١ ٢٢٣٠ :‫ﻫﺎﺗﻒ‬ .٢١٤١١ ‫ ﺟﺪة‬،٢٦٠ .‫ب‬.‫ص‬ ‫ اﳌﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬،١١٣٥١ ‫اﻟﺮﻳﺎض‬
Olaya District Al-Mohammadiah District AlBostan, Khobar 34422 ٠١٣ ٨٨١ ٢٢٤٠ :‫ﻓﺎﻛﺲ‬ ‫اﳌﻤﻠﻜﺔاﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬ ٩٢٠٠٠٠٤٥٦ :‫اﻟﻬﺎﺗﻒ‬
Riyadh 11351, Saudi Arabia (next to SACO) Saudi Arabia ٨٠٠ ٢٤٤ ٠٣٠٧ :¾‫ﺎ‬ç ‫ﻫﺎﺗﻒ‬
Tel: 920 000 456 P.O. Box 260 - Jeddah 21411 Tel. No. 013 881 2230 ٩٢٠ ٠٠٠ ٧٢٤ :‫ﻓﺎﻛﺲ‬
Saudi Arabia Fax: 013 881 2240
Toll free: 800 244 0307
Fax: 920 000 724
‫ﻣﺎ ﻣﻌﻨﻰ "ﻣﻨﻄﻘﻴﺔ وﻣﻘﺒﻮﻟﺔ“؟‬
What does ‘reasonable and customary’ mean?
‫ﺗﻌﻨﻲ ان ﺗﻜﻮن ﺗﻜﺎﻟﻴﻒ و رﺳﻮم اﳋﺪﻣﺔ اﻟﻄﺒﻴﺔ ﻣﺘﻤﺎﺷﻴﺔ ﻣﻊ ﺗﻠﻚ اﻟﺘﻲ ﺗﻄﻠﺒﻬﺎ ﺟﻤﻴﻊ اﳌﺴﺘﺸﻔﻴﺎت و اﳌﺴﺘﻮﺻﻔﺎت اﳌﺘﻔﻖ ﻋﻠﻴﻬﺎ‬
Reasonable and Customary means that all the claimed medical fees and expenses are .‫– اﻟﺸﺒﻜﺔ اﳌﻌﺘﻤﺪة ﻟﺪﻳﻜﻢ داﺧﻞ اﳌﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬
compatible with Bupa negotiated fee-for-service with providers in your assigned network of
hospitals and clinics in Saudi Arabia. Hence, we will match the billed cost of any medical ‫ ﺳﻴﺘﻢ اﺣﺘﺴﺎب اﻟﺘﻌﻮﻳﺾ ﺑﻨﺎء ﻋﻠﻰ ﺗﻜﻠﻔﺔ اﳋﺪﻣﺔ ﻧﻔﺴﻬﺎ – ﻣﺴﺘﺸﻔﻴﺎت‬،‫ﻓﻔﻲ ﺣﺎل اﺟﺮاء اﳋﺪﻣﺔ اﻟﻄﺒﻴﺔ ﺧﺎرج اﻟﺸﺒﻜﺔ اﳌﻌﺘﻤﺪة‬
service done outside your network with the negotiated fee-for-service cost of the same ‫و ﻋﻴﺎدات اﻟﺸﺒﻜﺔ اﳌﻌﺘﻤﺪة ﻟﺪﻳﻜﻢ ﺣﺴﺐ اﺗﻔﺎﻗﻴﺎﺗﻨﺎ ﻣﻊ ﻣﻘﺪﻣﻲ اﳋﺪﻣﺔ‬
service if it was done in your network based on the services rate agreement with our
providers.

What are the treatments, medications or procedures not ‫ اﳌﻐﻄﺎة؟‬Ì‫ ا ﺟﺮاءات أو ا´دوﻳﺔ ﻏ‬،‫ﻣﺎ ﻫﻲ اﻟﻌﻼﺟﺎت‬
covered?
Û‫دوﻳﺔ ﻏ‬É‫ ا·ﺟﺮاءات أو ا‬،‫ ﻓﺈن ﻫﻨﺎك اﻟﻌﺪﻳﺪ ﻣﻦ اﻟﻌﻼﺟﺎت‬،‫ﻠﺲ اﻟﻀﻤﺎن اﻟﺼﺤﻲ اﻟﺘﻌﺎو¾ واﳌﻘﺎﻳﻴﺲ اﻟﺪوﻟﻴﺔ‬ç ‫ﺣﺴﺐ ﺗﻌﻠﻴﻤﺎت‬
Based on CCHI ruling and on international practices and standards, there are certain ٨ ‫اﳌﻐﻄﺎة ﺣﺴﺐ اﻟﺘﻔﺎﺻﻴﻞ اﻟﻮاردة – اﻟﺼﻔﺤﺔ رﻗﻢ‬
treatments, medications and procedures that are not covered. Refer to page 8 for details.

How do I file a complaint? ‫ﻛﻴﻒ أﻗﺪم ﺷﻜﻮى؟‬

We can attend to all your issues by calling our 24/7 toll free helpline or by emailing us at ‫ ﻣﺪﻳﺮ ﺧﺪﻣﺔ‬³‫ ﻛﻤﺎ ﳝﻜﻨﻚ ﺗﻘﺪﱘ ﺷﻜﺎوى ﺧﻄﻴﺔ إ‬،‫ﺳﺒﻮع ﻟﺘﻘﺪﱘ أي ﺷﻜﻮى‬É‫ﻧﺴﺘﺠﻴﺐ ﳉﻤﻴﻊ اﺗﺼﺎﻻﺗﻚ ﺑﺎﻟﺮﻗﻢ ا¿ﺎ¾ ﻋﻠﻰ ﻣﺪار اﻟﻴﻮم وا‬
complaints@bupa.com.sa However, you can also send your written complaints to Customer
Service Manger on the above mentioned address. complaints@bupa.com.sa :¾‫و‬Ç‫ﻳﺪ ا·ﻟﻜ‬Ý‫ اﻟ‬Ý‫اﻟﻌﻤﻼء ﻋﻠﻰ اﻟﻌﻨﻮان اﳌﺬﻛﻮر أﻋﻼه أو ﻋ‬

5 5
 In submitting reimbursement claims, what documents do I need ‫ ﺗﻘﺪﳝﻬﺎ؟‬Í‫ ﻣﺎ ﻫﻲ اﻟﻮﺛﺎﺋﻖ اﻟﺘﻲ أﺣﺘﺎج إ‬،‫ﻋﻨﺪ ﺗﻘﺪﱘ ﻣﻄﺎﻟﺒﺎت اﻟﺘﻌﻮﻳﺾ‬
to provide?
‫ اﻟﻮﺛﺎﺋﻖ‬.‫ وﺗﻮﻗﻴﻊ اﻟﻌﻀﻮ‬،‫ ﻣﺒﻠﻎ اﻟﺘﻌﻮﻳﺾ‬،‫ رﻗﻢ اﻟﻌﻀﻮﻳﺔ‬:‫ وﻣﻦ اﳌﻬﻢ ﺗﻌﺒﺌﺔ اﳊﻘﻮل اﻟﺘﺎﻟﻴﺔ‬.‫ﻳﺠﺐ ﺗﻌﺒﺌﺔ ﳕﻮذج اﻟﻄﻠﺐ ﺑﻄﺮﻳﻘﺔ ﺻﺤﻴﺤﺔ‬
Claim form should be properly filed-in. It is a must that the fields on membership number,
.‫اﳌﻄﻠﻮﺑﺔ ﺗﻌﺘﻤﺪ ﻋﻠﻰ ﻧﻮع اﻟﻄﻠﺐ‬
amount and member’s signature should be filled-in

The document required is dependent on the type of claim. ‫ﻣﺎﻫﻲ أﻧﻮاع دﻟﻴﻞ اﻟﺪﻓﻊ؟‬
What are the forms of “Proof of Payment”?
:‫ﻗﺪ ﻳﺘﻀﻤﻦ إﺛﺒﺎت اﻟﺪﻓﻊ ﻣﺎ ﻳﻠﻲ‬

A proof of payment may include the following: ‫• ﻓﺎﺗﻮرة رﺳﻤﻴﺔ ﺗﺬﻛﺮ اﳌﺒﻠﻎ اﳌﺪﻓﻮع وﺗﻈﻬﺮ اﻟﺮﺻﻴﺪ‬
• An official invoice with mention of amount paid and shows the balance ‫• إﻳﺼﺎل ﻧﻘﺎط اﻟﺒﻴﻊ ﻣﻦ اﻟﺼﻴﺪﻟﻴﺎت‬
• POS slip if purchased from pharmacies ً
‫ ﻳﺠﺐ أن ﻳﻈﻬﺮ ﻛﺸﻒ اﳊﺴﺎب اﺳﻢ اﻟﺒﺎﺋﻊ‬.‫ﻧﺖ‬Ç‫ ا·ﻧ‬Ý‫ﺷﻴﻜﺎ أو ﻋ‬ ‫• ﻧﺴﺨﺔ ﻣﻦ ﻛﺸﻒ اﳊﺴﺎب اﳌﺼﺮ– إذا ﻛﺎﻧﺖ ﻃﺮﻳﻘﺔ اﻟﺪﻓﻊ‬
• Copy of bank statement if the mode of payment is Cheque or online. The bank
.‫واﳌﺒﻠﻎ‬
statement must show the name of the vendor and the amount

Should I secure translation for documents that are not written in ‫ اﳌﻜﺘﻮﺑﺔ ﺑﺎ ﳒﻠﻴﺰﻳﺔ أو اﻟﻌﺮﺑﻴﺔ؟‬Ì‫أؤﻣﻦ ﺗﺮﺟﻤﺔ ﻟﻠﻮﺛﺎﺋﻖ ﻏ‬
ّ ‫ﻫﻞ ﻳﺠﺐ أن‬
English or Arabic?
.‫ ﻳﺠﺐ ﺗﺮﺟﻤﺔ اﻟﻮﺛﺎﺋﻖ ﺑﺎﻟﻠﻐﺔ ا·ﳒﻠﻴﺰﻳﺔ أو اﻟﻌﺮﺑﻴﺔ ﻣﻦ ﻗﺒﻞ ﺷﺮﻛﺔ ﺗﺮﺟﻤﺔ ﻣﻌﺘﻤﺪة ﻗﺒﻞ ﺗﻘﺪﱘ اﻟﻄﻠﺐ‬،‫ﻧﻌﻢ‬
Yes, these should be translated in English or Arabic by an official translation company before
submitting the claim
‫ﻛﻴﻒ ﳝﻜﻨﻨﻲ اﻟﺘﺤﻘﻖ ﻣﻦ ﺣﺎﻟﺔ اﳌﻄﺎﻟﺒﺔ؟‬
How can I check the status of my claim?
‫ة ﺑﺸﺮط أن ﺗﻜﻮن ﺷﺮﻛﺎﺗﻬﻢ ﻗﺪ ﻗﺪﻣﺖ أرﻗﺎم ﻫﻮاﺗﻔﻬﻢ‬Û‫ﻋﻀﺎء ﺑﺤﺎﻟﺔ ﻃﻠﺒﺎﺗﻬﻢ ﻋﻦ ﻃﺮﻳﻖ اﻟﺮﺳﺎﺋﻞ اﻟﻘﺼ‬É‫ﺗﻘﻮم ﺑﻮﺑﺎ اﻟﻌﺮﺑﻴﺔ ﺑﺈﺑﻼغ ا‬
Bupa Arabia notifies members of the status of their claim through SMS provided. To update
ً ‫ وﳝﻜﻨﻚ‬.‫ أرﺟﻮ اﻟﺘﻮاﺻﻞ ﻣﻊ ﺧﺪﻣﺔ اﻟﻌﻤﻼء‬،‫ ﻟﺘﺤﺪﻳﺚ رﻗﻢ ﻫﺎﺗﻔﻚ‬.‫اﻟﻨﻘﺎﻟﺔ‬
‫ﻧﺖ ﻋﻦ ﻃﺮﻳﻖ ﺗﺴﺠﻴﻞ اﻟﺪﺧﻮل‬Ç‫ ا·ﻧ‬Ý‫أﻳﻀﺎ ﺗﺘﺒﻊ ﺣﺎﻟﺔ ﻃﻠﺒﻚ ﻋ‬
your mobile number, please contact our customer service. Alternatively, you could monitor
the status of your claim through the online by logging in at bupa.com.sa. .bupa.com.sa ³‫إ‬

What happens if incomplete document is submitted? ‫ ﻣﻜﺘﻤﻠﺔ؟‬Ì‫ﻣﺎذا ﻳﺤﺪث إذا ﰎ ﺗﻘﺪﱘ وﺛﻴﻘﺔ ﻏ‬
Assessment of your claim is dependent on the completeness of your document. If not
ً
‫ أن ﻳﻜﻤﻞ ﺻﺎﺣﺐ اﻟﻄﻠﺐ اﻟﻮﺛﺎﺋﻖ – ﻣﺪة ﻻ‬³‫ﻣﻌﻠﻘﺎ إ‬ ‫ ﻳﺒﻘﻰ اﻟﻄﻠﺐ‬،‫ ﺗﻜﻦ اﻟﻮﺛﺎﺋﻖ ﻛﺎﻣﻠﺔ‬ÿ ‫ إن‬.‫ﻳﻌﺘﻤﺪ ﺗﻘﻴﻴﻢ وﻣﺮاﺟﻌﺔ اﻟﻄﻠﺐ ﻋﻠﻰ اﻛﺘﻤﺎل اﻟﻮﺛﺎﺋﻖ‬
complete, this shall be put in pending and you are required to comply within 90 days of
.‫ وإﻻ ﺳﻮف ﻳﺘﻢ رﻓﺾ اﻟﻄﻠﺐ ﺑﻌﺪ ذﻟﻚ‬،‫ﻳﻮﻣﺎ ﻣﻦ اﻟﺘﻘﺪﱘ‬
ً ‫ﺗﺘﺠﺎوز اﻟﺘﺴﻌﲔ‬
submission; thereafter, it will be rejected.

What is the required “Official Invoice”? ‫ﻣﺎ ﻫﻲ اﻟﻔﺎﺗﻮرة اﻟﺮﺳﻤﻴﺔ اﳌﻄﻠﻮﺑﺔ؟‬

The required official invoice shall contain at least the name and file number of member. It ً
‫ ﻟﻬﺎ‬Û‫وأﻳﻀﺎ ﻳﺠﺐ أن ﺗﺒﲔ اﳋﺪﻣﺎت اﻟﺘﻲ ﰎ اﺻﺪار ﻓﻮاﺗ‬ .‫ﻗﻞ‬É‫اﻟﻔﺎﺗﻮرة اﻟﺮﺳﻤﻴﺔ اﳌﻄﻠﻮﺑﺔ ﻳﺠﺐ أن ﺗﺘﻀﻤﻦ اﺳﻢ اﻟﻌﻀﻮ ورﻗﻢ ﻣﻠﻔﻪ ﻋﻠﻰ ا‬
should also show breakdown of billed services with corresponding fee for each service. .‫ ﻣﻊ اﻟﺮﺳﻮم اﳌﻘﺎﺑﻠﺔ ﻟﻜﻞ ﺧﺪﻣﺔ‬،‫ﺑﺎﻟﺘﻔﺼﻴﻞ‬

6 6
 Understanding ‫ﻚ‬ç‫اﻋﺮف ﺑﺮﻧﺎ‬
Your Scheme

Pre-authorization is a necessary procedure – Based on CCHI process and procedures - to check

that the required tests, procedures or medications are: :‫دوﻳﺔ اﳌﻄﻠﻮﺑﺔ إذا ﻛﺎﻧﺖ ﺿﻤﻦ‬É‫إن إﺟﺮاءات اﳌﻮاﻓﻘﺔ اﳌﺴﺒﻘﺔ ﺿﺮورﻳﺔ ﺑﻨﺎء ﻋﻠﻰ ﻣﺒﺪأ ا¿ﻠﺲ اﻟﺘﻌﺎو¾ ﻟﻠﺘﺄﻣﲔ اﻟﺼﺤﻲ ﻟﻠﺘﺄﻛﺪ ﻣﻦ اﻻﺧﺘﺒﺎرات وا‬

• Covered by your benefits’ list ‫• ﻗﺎﺋﻤﺔ اﳌﺰاﻳﺎ اﳋﺎﺻﺔ ﺑﻚ‬

• Within your benefit sub-limits ‫• ﺿﻤﻦ ﺣﺪ ﻣﺴﺘﻮى اﻟﺘﻐﻄﻴﺔ اﳋﺎص ﺑﻚ‬

The insurance office in your visited hospital will send the request to us online on your behalf.
.(‫ﻧﺖ ﻧﻴﺎﺑﺔ ﻋﻨﻚ )اﻃﻠﻊ ﻋﻠﻰ اﻟﺮﺳﻢ اﻟﺒﻴﺎ¾ – اﻟﺼﻔﺤﺔ اﻟﺘﺎﻟﻴﺔ‬Ç‫ ا·ﻧ‬Ý‫ﺳﻴﻘﻮم ﻣﻜﺘﺐ اﻟﺘﺄﻣﲔ – اﳌﺴﺘﺸﻔﻰ ﺑﺈرﺳﺎل اﻟﻄﻠﺐ إﻟﻴﻨﺎ ﻋ‬
(refer to proceeding diagram on next page)

• All Bupa members entertain the following ; :‫• ﺟﻤﻴﻊ أﻋﻀﺎء ﺑﻮﺑﺎ اﻟﻌﺮﺑﻴﺔ ﻳﺤﻈﻮن ﺑﺎﺗﻲ‬
• Automated answer on the received requests specially for sublimit benefits. ‫ ﻋﻠﻰ اﻟﻄﻠﺒﺎت ﺧﺼﻮﺻﺎ ﳌﺰاﻳﺎ اﳊﺪود اﻟﻔﺮﻋﻴﺔ‬ä‫• اﳉﻮاب ا‬
• Exemption of preapproval as long as the cost of requested medical services are below the ‫•ا·ﻋﻔﺎء ﻣﻦ اﳌﻮاﻓﻘﺔ اﳌﺴﺒﻘﺔ ﻃﺎﳌﺎ ﻛﺎﻧﺖ اﻟﺘﻜﻠﻔﺔ ﻟﻠﺨﺪﻣﺔ أﻗﻞ ﻣﻦ اﻟﺘﻜﻠﻔﺔ ا½ﺼﺼﺔ ﻟﻜﻞ زﻳﺎرة ﻛﻤﺎ ﻫﻮ ﻣﺬﻛﻮر – ﺑﻄﺎﻗﺔ اﻟﻌﻀﻮﻳﺔ اﳋﺎﺻﺔ‬
assigned cost per visit as mentioned on your membership card.
.‫ﺑﻚ‬

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 ‫وﻧﻴﺔ ﺗﻠﺒﻲ اﺣﺘﻴﺎﺟﺎﺗﻚ اﻟﻄﺒﻴﺔ‬Ç‫ن اﳌﻮاﻓﻘﺔ ا·ﻟﻜ‬É ‫ ذﻟﻚ‬.‫ ﻟﺘﻠﻘﻲ اﻟﻌﻼج‬ä‫ أو ﺣﺘﻰ اﻟﻌﻮدة اﻟﻴﻮم اﻟﺘﺎ‬،‫ة ﻃﻮﻳﻠﺔ – اﳌﺴﺘﺸﻔﻰ‬Ç‫ﻻ ﺗﻘﻠﻖ ﻟﻦ ﺗﻨﺘﻈﺮ ﻟﻔ‬
attention fast. .‫وﺗﻀﻤﻦ ﻟﻚ اﻟﺴﺮﻋﺔ واﻟﺮاﺣﺔ‬

7 ٧
 Bupa member at hospital ‫ﻋﻀﻮ ﺑﻮﺑﺎ ¿ اﳌﺴﺘﺸﻔﻰ‬

Does not require Requires

Bupa approval Bupa approval ‫ﻳﺤﺘﺎج ﳌﻮاﻓﻘﺔ ﺑﻮﺑﺎ‬ ‫ﻻ ﻳﺤﺘﺎج ﳌﻮاﻓﻘﺔ ﻣﻦ ﺑﻮﺑﺎ‬

Member receives Hospital sends approval ‫ﻳﺮﺳﻞ اﳌﺴﺘﺸﻔﻰ‬

treatment request to Bupa ‫ﻟﺒﻮﺑﺎ ﻃﻠﺐ اﳌﻮاﻓﻘﺔ‬ ‫ﻳﺘﻠﻘﻰ اﻟﻌﻀﻮ اﻟﻌﻼج‬

Bupa receives and

Bupa sends ‫ﺗﺴﺘﻠﻢ ﺑﻮﺑﺎ اﻟﻄﻠﺐ وﺗﻨﻔﺬه‬
processes the request ‫ﺗﺮﺳﻞ ﺑﻮﺑﺎ‬
member 2 SMS: :‫ﺗﲔ‬Û‫رﺳﺎﻟﺘﲔ ﻗﺼ‬
1- Receipt of request ‫ ﻋﻨﺪ اﺳﺘﻼم اﻟﻄﻠﺐ‬-}
2- Decision on request ‫ ﻋﻨﺪ اﺗﺨﺎذ اﻟﻘﺮار‬-|
Hospital treats member ‫ﻳﻘﺪم اﳌﺴﺘﺸﻔﻰ اﻟﻌﻼج ﻟﻠﻌﻀﻮ‬
after receiving approval ‫ﺑﻌﺪ اﺳﺘﻼم اﳌﻮاﻓﻘﺔ‬

Treatments requiring Bupa approval: : ‫اﳋﺪﻣﺎت اﻟﺘﻲ ﲢﺘﺎج ﳌﻮاﻓﻘﺔ ﺑﻮﺑﺎ‬

• In-patient & day-case treatments ‫• اﻟﺘﻨﻮﱘ وﺣﺎﻻت اﻟﻴﻮم اﻟﻮاﺣﺪ‬
• MRIs and CT scans ‫• اﻟﺘﺼﻮﻳﺮ اﻟﻄﺒﻘﻲ واﻟﺮﻧﲔ اﳌﻐﻨﺎﻃﻴﺴﻲ‬
• Benefits with sub-limits, ie dental, optical and maternity ‫ اﻟﻨﻈﺮ واﳊﻤﻞ واﻟﻮﻻدة‬،‫ﺳﻨﺎن‬É‫• اﳌﺰاﻳﺎ اﻟﺘﻲ ﻟﻬﺎ ﺣﺪود ﻓﺮﻋﻴﺔ ﻣﺜﻞ ا‬
• Physiotherapy after the first session ³‫و‬É‫• اﻟﻌﻼج اﻟﻄﺒﻴﻌﻲ ﺑﻌﺪ اﳉﻠﺴﺔ ا‬
• Treatments estimated to exceed SR 1000
‫• اﳋﺪﻣﺎت اﻟﺘﻲ ﻳﺘﻮﻗﻊ أن ﺗﺰﻳﺪ ﻗﻴﻤﺘﻬﺎ ا·ﺟﻤﺎﻟﻴﺔ ﻋﻦ {{{} رﻳﺎل‬

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.
‫وﻧﻴﺔ ﻣﻊ اﳌﺴﺘﺸﻔﻴﺎت واﳌﺴﺘﻮﺻﻔﺎت – ﺷﺒﻜﺘﻨﺎ اﳌﻌﺘﻤﺪة ﻣﻦ اﻟﺮد اﻟﺴﺮﻳﻊ ﻋﻠﻰ ﻣﻌﻈﻢ‬Ç‫ﲤﻜﻨﻨﺎ اﻟﺮواﺑﻂ ا·ﻟﻜ‬
‫ وﻳﺒﻠﻎ اﻟﺰﻣﻦ اﳌﻌﺘﺎد ﻟﻠﺮد ﻋﻠﻰ ﻃﻠﺒﺎت اﳌﻮاﻓﻘﺎت اﳌﺴﺒﻘﺔ اﳌﺘﻌﻠﻘﺔ ﺑﺎﳌﺰاﻳﺎ‬.‫ﻃﻠﺒﺎت اﳌﻮاﻓﻘﺎت اﳌﺴﺒﻘﺔ‬
‫ ﻛﻤﺎ أﻧﻨﺎ ﳒﻴﺐ‬.‫ [} ﺛﺎﻧﻴﺔ‬ä‫ﻣﺮاض اﳌﺰﻣﻨﺔ ﺣﻮا‬É‫ اﳊﻤﻞ واﻟﻮﻻدة وﻋﺎدة ﺻﺮف أدوﻳﺔ ا‬،‫ اﻟﻨﻈﺮ‬،‫ﺳﻨﺎن‬É‫ﺳﺎﺳﻴﺔ ﻣﺜﻞ ا‬É‫ا‬
.‫ ﻣﻦ اﻟﻄﻠﺒﺎت اﻟﻮاردة إﻟﻴﻨﺎ ﺧﻼل {\ دﻗﻴﻘﺔ‬٪][ ‫ﻋﻠﻰ ﻣﺎ ﻧﺴﺒﺘﻪ‬

8 8
 Conditions
Not Covered
Consistent with the guidelines issued by
the CCHI, the following cases and
conditions are not covered by your
healthcare scheme/s:
This list of non-covered conditions is set by
the CCHI under the health regulation law
1. Intentional self-injury
2. Diseases resulting from abuse of some
medicines, boosters, stimulating or due
to alcohol drinking or drugs usage or
alike.
3. Plastic surgery, unless such is needed
due to an accidental injury not
exempted by this chapter.
4. Comprehensive checkups, vaccinations,
drugs or protective means that is
required for treatment hence depicted
herein (except protective measures
determined by the ministry of health
such as vaccinations, child and mother
care).
5. Free of charge treatment an insured
received.
6. Rest & relaxation, general physical
health programs and treatment at social
care centers.
7. Any ailment or injury as a result of the
profession of the insured individual.
8. Reproductive system diseases
treatment or sexual contracted
diseases.
9. Expenses of the period follows a
diagnosis of HIV or related HIV related
diseases including AIDS, and other
forms related thereto.
10. All costs related to dental plantation or
artificial dental dentures or fixed or
movable bridges, dental rectification
except that resulting from an accident.
11. Sight rectification tests and surgeries
or hearing or visual and hearing means
unless not prescribed by the doctor.
12. The insured in-Saudi Arabia travel
expenses using unpermitted
transportation means.
9 ٩
13. Hair falling, boldness or fake hair.
14. Psychological, mental or neurological
treatment except those depicted in the
schedule.
15. Allergy tests of all kinds except those
related to medicine prescribed for
treatment of allergy.
16. Family planning apparatus, means,
medicines, procedures or Harmon or
contraceptives or infertility, impotence
or pipe or any other artificial
reproductive means.
17. Weakness or disfiguration unless such
impacts the insured' life.
18. Any costs or additional expenses
incurred by the insured during
hospitalization or stay at a hospital
except bed and board costs in the
hospital for one companion (escort),
such as a mother stays with her child up
to the age of 12, or as deemed
appropriate by the attending doctor.
19. Treatment of acne or any treatment of
obesity or corpulence, except medicines
covered.
20. Origins transplant, bone morrow, or
substitute artificial organs as substitutes
for any parts of the body, totally or
partially.
21. Personal hazards listed in the definition
chapter herein.
22. Alternative medicines, drugs or
treatment, and any other drugs not
licensed by the Saudi Food and Drug
Authority.
23. Artificial or substitute origins except
those needed depending on the insured
condition as per a medical report from
approved health facility.
24. Menopause natural changes for the
insured including monthly period
changes.
‫اﳊﺎﻻت اﳌﺴﺘﺜﻨﺎة ﻣﻦ‬
‫اﻟﺘﻐﻄﻴﺔ وﻓﻖ اﻟﻨﻈﺎم‬
‫( اﳌﻌﺎﳉﺔ اﻟﻨﻔﺴﻴﺔ أو اﻻﺿﻄﺮاﺑﺎت اﻟﻌﻘﻠﻴﺔ أو اﻟﻌﺼﺒﻴﺔ ﻣﺎﻋﺪا‬١٤
.‫اﳊﺎﻻت اﳊﺎدة ﺣﺴﺐ ﺟﺪول اﻟﻮﺛﻴﻘﺔ‬
‫ ﺑﺨﻼف ﺗﻠﻚ‬،‫( اﺧﺘﺒﺎرات اﳊﺴﺎﺳﻴﺔ ﻣﻬﻤﺎ ﻛﺎﻧﺖ ﻃﺒﻴﻌﺘﻬﺎ‬١٥
.‫اﳌﺘﻌﻠﻘﺔ ﺑﻮﺻﻒ أدوﻳﺔ اﻟﻌﻼج‬
‫ وا·ﺟﺮاءات أو اﳌﻌﺎﳉﺔ‬Û‫ﺟﻬﺰة واﻟﻮﺳﺎﺋﻞ واﻟﻌﻘﺎﻗ‬É‫( ا‬١٦
‫ﺑﺎﻟﻬﺮﻣﻮﻧﺎت ﺑﻬﺪف ﺗﻨﻈﻴﻢ اﻟﻨﺴﻞ أو ﻣﻨﻊ اﳊﻤﻞ أو ﺣﺼﻮﻟﻪ‬
‫أو اﻟﻌﻘﻢ أو اﻟﻌﺠﺰ اﳉﻨﺴﻲ أو ﻧﻘﺺ اﳋﺼﻮﺑﺔ أو اﻟﺘﺨﺼﻴﺐ‬
.‫ﻧﺎﺑﻴﺐ أو أﻳﺔ وﺳﻴﻠﺔ أﺧﺮى ﻟﻠﺘﻠﻘﻴﺢ اﻻﺻﻄﻨﺎﻋﻲ‬É‫ﺑﻮاﺳﻄﺔ ا‬
‫( ﺣﺎﻻت اﻟﻀﻌﻒ أو اﻟﺘﺸﻮه اﳋﻠﻘﻲ إﻻ إذا ﻛﺎﻧﺖ ﺗﺸﻜﻞ ﺧﻄﻮرة‬١٧
.‫ﻋﻠﻰ ﺣﻴﺎة اﳌﺆﻣﻦ ﻟﻪ‬
‫( أي ﺗﻜﺎﻟﻴﻒ أو ﻣﺼﺎرﻳﻒ إﺿﺎﻓﻴﺔ ﻳﺘﻜﺒﺪﻫﺎ اﳌﺮاﻓﻖ ﻟﻠﻤﺆﻣﻦ ﻟﻪ‬١٨
‫أﺛﻨﺎء ﺗﻨﻮﳝﻪ أو إﻗﺎﻣﺘﻪ ﺑﺎﳌﺴﺘﺸﻔﻰ ﻋﺪا ﻧﻔﻘﺔ ا·ﻗﺎﻣﺔ‬
،‫وا·ﻋﺎﺷﺔ – اﳌﺴﺘﺸﻔﻰ ﳌﺮاﻓﻖ واﺣﺪ ﻟﻠﻤﺆﻣﻦ ﻟﻪ‬
‫ أو ﺣﻴﺜﻤﺎ‬،‫م ﻟﻄﻔﻠﻬﺎ ﺣﺘﻰ ﺳﻦ اﻟﺜﺎﻧﻴﺔ ﻋﺸﺮة‬É‫ﻛﻤﺮاﻓﻘﺔ ا‬
‫ﺗﻘﺘﻀﻲ اﻟﻀﺮورة اﻟﻄﺒﻴﺔ ذﻟﻚ ﺣﺴﺐ ﺗﻘﺪﻳﺮ اﻟﻄﺒﻴﺐ‬
.‫اﳌﻌﺎﻟﺞ‬
‫( ﻣﻌﺎﳉﺔ اﻟﺒﺜﻮر )ﺣﺐ اﻟﺸﺒﺎب( أو أﻳﺔ ﻣﻌﺎﳉﺔ ﺗﺘﻌﻠﻖ ﺑﺎﻟﺴﻤﻨﺔ‬١٩
.‫دوﻳﺔ اﳌﻐﻄﺎة‬É‫ ﻋﺪا ا‬،‫أو اﻟﺒﺪاﻧﺔ‬
‫ﻋﻀﺎء‬É‫ﻋﻀﺎء اﳌﻨﻘﻮﻟﺔ واﻟﻨﺨﺎع اﻟﻌﻈﻤﻲ أو زرع ا‬É‫( ﺣﺎﻻت زرع ا‬٢٠
‫ﻞ أي ﻋﻀﻮ ﺑﺎﳉﺴﻢ ﺑﺸﻜﻞ‬Ú ‫اﻻﺻﻄﻨﺎﻋﻴﺔ اﻟﺒﺪﻳﻠﺔ اﻟﺘﻲ ﲢﻞ‬
.‫ﻛﻠﻲ أو ﺟﺰﺋﻲ‬
‫ﺧﻄﺎر اﻟﺸﺨﺼﻴﺔ اﻟﻮاردة – ﻗﺴﻢ اﻟﺘﻌﺮﻳﻔﺎت ﻣﻦ ﻫﺬه‬É‫( ا‬٢١
.‫اﻟﻮﺛﻴﻘﺔ‬
‫ ﻣﺮﺧﺼﺔ‬Û‫( أدوﻳﺔ ووﺳﺎﺋﻞ اﻟﻌﻼج ﺑﺎﻟﻄﺐ اﻟﺒﺪﻳﻞ أو أي أدوﻳﺔ ﻏ‬٢٢
.‫ﻣﻦ ﻗﺒﻞ ﻫﻴﺌﺔ اﻟﻐﺬاء واﻟﺪواء‬
‫ ﻣﺎ ﻋﺪا ﺗﻠﻚ اﻟﺘﻲ‬،‫ﻃﺮاف اﳌﺴﺎﻋﺪة‬É‫ﻃﺮاف اﻟﺼﻨﺎﻋﻴﺔ وا‬É‫( ا‬٢٣
‫ﺗﺘﻄﻠﺒﻬﺎ ﺣﺎﻟﺔ اﳌﺆﻣﻦ ﻟﻪ ﲟﻮﺟﺐ ﻗﺮار ﻃﺒﻲ ﺑﺎﳌﺮﻓﻖ اﻟﺼﺤﻲ‬
.‫اﳌﻌﺘﻤﺪ ﻣﻦ ا¿ﻠﺲ‬
‫ات اﻟﻄﺒﻴﻌﻴﺔ ﻟﺴﻦ اﻟﻴﺄس ﻟﻠﻤﺆﻣﻦ ﻟﻬﺎ وﻳﺸﻤﻞ ذﻟﻚ‬Û‫( اﻟﺘﻐ‬٢٤
.‫ات اﻟﻄﻤﺚ‬Û‫ﺗﻐ‬
‫( اﺧﺘﺒﺎرات وﻋﻤﻠﻴﺎت ﺗﺼﺤﻴﺢ اﻟﻨﻈﺮ أو اﻟﺴﻤﻊ أو أو اﻟﻮﺳﺎﺋﻞ‬١١
‫ﻠﺲ اﻟﻀﻤﺎن اﻟﺼﺤﻲ‬ç ‫ ﻣﻊ اﻟﺘﻌﻠﻴﻤﺎت اﻟﺘﻲ أﺻﺪرﻫﺎ‬ã‫اﻧﺴﺠﺎﻣ‬
‫ ﻣﻐﻄﺎة ﺿﻤﻦ ﺑﺮﻧﺎﻣﺞ اﻟﺮﻋﺎﻳﺔ‬Û‫ ﻓﺈن اﳊﺎﻻت اﻟﺘﺎﻟﻴﺔ ﻏ‬،¾‫اﻟﺘﻌﺎو‬
.‫اﻟﺼﺤﻴﺔ اﳋﺎص ﺑﻜﻢ‬
:‫ﻫﺬه اﻟﻮﺛﻴﻘﺔ ﻟﻦ ﺗﻐﻄﻲ اﳌﻄﺎﻟﺒﺎت اﻟﺘﻲ ﺗﻨﺸﺄ ﻋﻤﺎ ﻳﻠﻲ‬
.Ü‫ا·ﺻﺎﺑﺔ اﻟﺘﻲ ﻳﺴﺒﺒﻬﺎ اﻟﺸﺨﺺ ﻟﻨﻔﺴﻪ ﻣﺘﻌﻤﺪ‬ (١
‫دوﻳﺔ أو‬É‫ﻣﺮاض اﻟﺘﻲ ﺗﻨﺸﺄ ﺑﻔﻌﻞ إﺳﺎءة اﺳﺘﺨﺪام ﺑﻌﺾ ا‬É‫( ا‬٢
‫اﳌﻨﺸﻄﺎت أو اﳌﻬﺪﺋﺎت أو ﺑﻔﻌﻞ ﺗﻌﺎﻃﻲ اﳌﻮاد اﻟﻜﺤﻮﻟﻴﺔ أو‬
.‫ا½ﺪرات أو ﻣﺎ ﺷﺎﺑﻪ ذﻟﻚ‬
‫( اﳉﺮاﺣﺔ أو اﳌﻌﺎﳉﺔ اﻟﺘﺠﻤﻴﻠﻴﺔ إﻻ إذا اﺳﺘﺪﻋﺘﻬﺎ إﺻﺎﺑﺔ‬٣
.‫ ﻣﺴﺘﺜﻨﺎة – ﻫﺬا اﻟﻘﺴﻢ‬Û‫ﺟﺴﺪﻳﺔ ﻋﺮﺿﻴﺔ ﻏ‬
‫ أو اﻟﻮﺳﺎﺋﻞ‬Û‫( اﻟﻔﺤﻮﺻﺎت اﻟﺸﺎﻣﻠﺔ واﻟﻠﻘﺎﺣﺎت أو اﻟﻌﻘﺎﻗ‬٤
– ‫اﻟﻮﻗﺎﺋﻴﺔ اﻟﺘﻲ ﻻ ﺗﺘﻄﻠﺒﻬﺎ ﻣﻌﺎﳉﺔ ﻃﺒﻴﺔ ﻣﻨﺼﻮص ﻋﻠﻴﻬﺎ‬
‫ﻫﺬه اﻟﻮﺛﻴﻘﺔ )ﺑﺎﺳﺘﺜﻨﺎء ا·ﺟﺮاءات اﻟﻮﻗﺎﺋﻴﺔ اﻟﺘﻲ ﲢﺪدﻫﺎ وزارة‬
.(‫ﻣﻮﻣﺔ واﻟﻄﻔﻮﻟﺔ‬É‫اﻟﺼﺤﺔ ﻣﺜﻞ اﻟﺘﻄﻌﻴﻤﺎت ورﻋﺎﻳﺔ ا‬
.‫( اﳌﻌﺎﳉﺔ اﻟﺘﻲ ﻳﺘﻠﻘﺎﻫﺎ اﳌﺆﻣﻦ ﻟﻪ ﺑﺪون ﻣﻘﺎﺑﻞ‬٥
‫( اﻻﺳﺘﺠﻤﺎم وﺑﺮاﻣﺞ اﻟﺼﺤﺔ اﻟﺒﺪﻧﻴﺔ اﻟﻌﺎﻣﺔ واﻟﻌﻼج – دور‬٦
.‫اﻟﺮﻋﺎﻳﺔ اﻻﺟﺘﻤﺎﻋﻴﺔ‬
‫( أﻳﺔ ﻋﻠﺔ أو إﺻﺎﺑﺔ ﺗﻨﺸﺄ ﻛﻨﺘﻴﺠﺔ ﻣﺒﺎﺷﺮة ﳌﻬﻨﺔ اﻟﺸﺨﺺ‬٧
.‫اﳌﺆﻣﻦ ﻟﻪ‬
‫ﻣﺮاض اﻟﺘﻨﺎﺳﻠﻴﺔ أو اﻟﺘﻲ ﺗﻨﺘﻘﻞ ﺑﺎﻻﺗﺼﺎل اﳉﻨﺴﻲ‬É‫( ﻣﻌﺎﳉﺔ ا‬٨
.ã‫اﳌﺘﻌﺎرف ﻋﻠﻴﻬﺎ ﻃﺒﻴ‬
‫وس ﻧﻘﺺ‬Û‫ة اﻟﻼﺣﻘﺔ ﻟﺘﺸﺨﻴﺺ )ﻓ‬Ç‫( ﻣﺼﺎرﻳﻒ ﻋﻼج اﻟﻔ‬٩
‫ ﲟﺎ ﻓﻴﻬﺎ‬HIV‫ أو ذات اﻟﺼﻠﺔ ﺑﺎﻟـ‬HIV (‫اﳌﻨﺎﻋﺔ اﻟﺒﺸﺮﻳﺔ‬
‫ﻣﺮض ا·ﻳﺪز )ﻧﻘﺺ اﳌﻨﺎﻋﺔ اﳌﻜﺘﺴﺒﺔ( أو ﻣﺸﺘﻘﺎﺗﻬﺎ أو‬
.‫ﺧﺮى‬É‫ﻣﺮادﻓﺎﺗﻬﺎ أو أﺷﻜﺎﻟﻬﺎ ا‬
‫ﺳﻨﺎن‬É‫ﺳﻨﺎن أو ﺗﺮﻛﻴﺐ ا‬É‫( ﺟﻤﻴﻊ اﻟﺘﻜﺎﻟﻴﻒ اﳌﺘﻌﻠﻘﺔ ﺑﺰرع ا‬١٠
‫ا·ﺻﻄﻨﺎﻋﻴﺔ أو اﳉﺴﻮر اﻟﺜﺎﺑﺘﺔ أو اﳌﺘﺤﺮﻛﺔ أو اﻟﺘﻘﺎوﱘ‬
.‫ﺑﺎﺳﺘﺜﻨﺎء ﺗﻠﻚ اﻟﺘﻲ ﻧﺘﺠﺖ ﻋﻦ ﺣﺎدث‬
‫ ﺗﻜﻦ ﻣﻄﻠﻮﺑﺔ ﺑﺄﻣﺮ‬ÿ‫اﻟﺒﺼﺮﻳﺔ أو اﻟﺴﻤﻌﻴﺔ اﳌﺴﺎﻋﺪة ﻣﺎ‬
.‫اﻟﻄﺒﻴﺐ ا½ﺘﺺ‬
‫( ﻣﺼﺎرﻳﻒ اﻧﺘﻘﺎل اﻟﺸﺨﺺ اﳌﺆﻣﻦ ﻟﻪ داﺧﻞ وﺑﲔ ﻣﺪن‬١٢
.‫ ﻣﺮﺧﺼﺔ‬Û‫اﳌﻤﻠﻜﺔ ﺑﻮﺳﺎﺋﻞ ﻧﻘﻞ ﻏ‬
.‫( ﺗﺴﺎﻗﻂ اﻟﺸﻌﺮ أو اﻟﺼﻠﻊ أو اﻟﺸﻌﺮ اﳌﺴﺘﻌﺎر‬١٣
 This policy- will not cover the health benefits and repatriation of the remains ‫ اﳌﻮﻃﻦ ا´ﺻﻠﻲ ¿ ﺣﺎﻟﺔ‬Í‫ﻫﺬه اﻟﻮﺛﻴﻘﺔ ﻟﻦ ﺗﻐﻄﻲ اﳌﻨﺎﻓﻊ اﻟﺼﺤﻴﺔ وإﻋﺎدة اﳉﺜﻤﺎن إ‬
to country of origin if claims are directly arising- from the following: :‫اﳌﻄﺎﻟﺒﺎت اﻟﻨﺎﺷﺌﺔ ﻣﺒﺎﺷﺮة ﻋﻦ‬

1. War, invasion and foreign aggression
(declared or undeclared).
2. Ionic radiation radioactive pollution related
to nuclear fuel, or nuclear waste resulting
from nuclear fuel combustion,
3. Radioactive or poisonous or explosive or
hazardous materials of any nuclear facility or
components.
4. If the insured works in military, police or
their operations,
5. Riots, strikes, terrorism or alike.
6. Chemical, biological or bacteria-logical
accidents and reactions, if such related to a
job-related injury or occupational hazards.
‫( ﻣﺰاوﻟﺔ اﻟﺸﺨﺺ اﳌﺆﻣﻦ ﻟﻪ أو ﻣﺸﺎرﻛﺘﻪ – ﺧﺪﻣﺔ اﻟﻘﻮات‬٤ ‫ ﺳﻮاء أﻋﻠﻨﺖ اﳊﺮب أم‬،(‫ﺟﻨﺒﻲ‬É‫ اﻟﻐﺰو وأﻋﻤﺎل اﻟﻌﺪوان )ا‬،‫( اﳊﺮب‬١
.‫اﳌﺴﻠﺤﺔ أو اﻟﺸﺮﻃﺔ أو ﻋﻤﻠﻴﺎﺗﻬﺎ‬ .‫ ﺗﻌﻠﻦ‬ÿ
.‫ ا·رﻫﺎب أو ﻣﺎ ﻳﺸﺎﺑﻬﻬﺎ ﻣﻦ أﻋﻤﺎل‬،‫ ا·ﺿﺮاب‬،‫( أﻋﻤﺎل اﻟﺸﻐﺐ‬٥ ‫ﻳﻮﻧﻴﺔ أو اﻟﺘﻠﻮث ﺑﺎﻟﻨﺸﺎط ا·ﺷﻌﺎﻋﻲ ﻣﻦ أي وﻗﻮد‬É‫( ا·ﺷﻌﺎﻋﺎت ا‬٢
‫ إذا ﻛﺎﻧﺖ‬،‫ﻳﻮﳉﻴﺔ‬Ç‫( اﳊﻮادث أو اﻟﺘﻔﺎﻋﻼت اﻟﻜﻴﻤﺎوﻳﺔ أو اﻟﺒﻴﻮﻟﻮﺟﻴﺔ أو اﻟﺒﻜ‬٦ .‫اق وﻗﻮد ﻧﻮوي‬Ç‫ﻧﻮوي أو أﻳﺔ ﻧﻔﺎﻳﺎت ﻧﻮوﻳﺔ ﻧﺎﲡﺔ ﻋﻦ اﺣ‬
‫ﻫﺬه اﳊﻮادث أو اﻟﺘﻔﺎﻋﻼت ﻧﺎﲡﺔ ﻋﻦ إﺻﺎﺑﺎت ﻋﻤﻞ أو ﺑﺴﺒﺐ‬ ‫( اﳋﺼﺎﺋﺺ اﳌﺸﻌﺔ أو اﻟﺴﺎﻣﺔ أو اﳌﺘﻔﺠﺮة أو أي ﺧﺼﺎﺋﺺ‬٣
.‫ﺎﻃﺮ ﻣﻬﻨﻴﺔ‬â .‫ي ﻣﻦ ﻣﺮﻛﺒﺎﺗﻬﺎ اﻟﻨﻮوﻳﺔ‬É ‫ي ﲡﻤﻌﺎت ﻧﻮوﻳﺔ أو‬É ‫ﺧﻄﺮة أﺧﺮى‬

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 One Last Thing ã‫ ﺗﺬﻛﺮ داﺋﻤ‬، ÜÛ‫وأﺧ‬
‫ إﻟﻴﻚ‬،‫ وﻗﺒﻞ أن ﺗﻨﺘﻬﻲ ﻣﻦ ﻗﺮاءة ﻫﺬا اﻟﻜﺘﻴﺐ وﺗﻐﻠﻘﻪ‬.‫ ﻏﻄﺎء ﻃﺒﻲ ﺷﺎﻣﻞ‬³‫ﺑﻄﺎﻗﺔ ﺑﻮﺑﺎ ﻫﻲ ﺟﻮاز ﺳﻔﺮك إ‬
Your Bupa card is your passport to comprehensive medical cover. But before : ã‫ﻣﻮر اﻟﺘﻲ ﻣﻦ اﳌﻔﻴﺪ ﺗﺬﻛﺮﻫﺎ داﺋﻤ‬É‫ﺑﻌﺾ ا‬
closing this booklet, here are some useful reminders:

Save the bupa 24/7 helpline number on your mobile phone ]|{ {|\{{] ‫? – ﺟﻮاﻟﻚ ?{\{ @@| {{` أو‬/|@ ‫اﺣﻔﻆ رﻗﻢ ﺧﻂ ﺧﺪﻣﺔ ﺑﻮﺑﺎ اﻟﻌﺎﻣﻞ‬
800 244 0307 or 920 02 3009

Enrol to benefit from our online services.

،‫ﻧﺖ‬Ç‫ ا· ﻧ‬Ý‫ك ﻟﻼﺳﺘﻔﺎدة ﻣﻦ ﺧﺪﻣﺎﺗﻨﺎ اﳌﺒﺎﺷﺮة ﻋ‬Ç‫اﺷ‬
Log on now to www.bupa.com.sa and complete a short and simple ‫ وأﻛﻤﻞ ﻋﻤﻠﻴﺔ اﻟﺘﺴﺠﻴﻞ اﻟﺴﻬﻠﺔ واﻟﺒﺴﻴﻄﺔ‬www.bupa.com.sa ³‫ادﺧﻞ ان إ‬
registration process.
.‫ رﻋﺎﻳﺔ ﻃﺒﻴﺔ‬³‫ ﻋﻨﺪﻣﺎ ﲢﺘﺎج إ‬ã‫ﻧﻬﺎ ﺳﺘﻠﺰﻣﻚ داﺋﻤ‬É ،‫ﻔﻈﺘﻚ‬Ú – ‫اﺣﻤﻞ ﺑﻄﺎﻗﺘﻚ داﺋﻤﺎ ﻣﻌﻚ‬
Always carry your bupa membership card with you
ãääã åååæãã ³‫ك – رﺳﺎﺋﻞ ﺑﻮﺑﺎ اﻟﻌﺮﺑﻴﺔ ﻣﻦ ﺧﻼل إرﺳﺎل رﻗﻢ ﻋﻀﻮﻳﺘﻚ إ‬Ç‫اﺷ‬
Register with msg.bupa by sending your membership number to
0550 222 700

That’s It. ‫ﻫﺬا ﻛﻞ ﻣﺎﲢﺘﺎج إﻟﻴﻪ‬

Your card is activated to provide you not only medical cover but a host of ‫ ﺑﻞ اﻟﻌﺪﻳﺪ ﻣﻦ اﳋﺪﻣﺎت اﻟﺘﻲ ﰎ‬،ã‫ ﻃﺒﻴ‬Ü‫وأﺻﺒﺤﺖ ﺑﻄﺎﻗﺘﻚ ان ﻓﻌﺎﻟﺔ ﻟﺘﻘﺪم ﻟﻚ ﻟﻴﺲ ﻓﻘﻂ ﻏﻄﺎء‬
services designed to give you worry-free convenience when you need it most. .‫ﻳﺤﻚ ﻣﻦ اﻟﻘﻠﻖ وﺗﻀﻤﻦ ﻟﻚ اﻟﺮاﺣﺔ ﻋﻨﺪﻣﺎ ﲢﺘﺎج ﻟﻬﺎ‬Ç‫ ﻟﻚ ﻟ‬ã‫ﺗﺼﻤﻴﻤﻬﺎ ﺧﺼﻴﺼ‬

We wish you and your family the best of health. .‫ﻧﺘﻤﻨﻰ ﻟﻚ و ﻟﻌﺎﺋﻠﺘﻚ دوام اﻟﺼﺤﺔ‬

Bupa, with you for better health ‫ﻣﻌﻚ ﻟﺼﺤﺔ أﻓﻀﻞ‬... ‫ﺑﻮﺑﺎ‬
For feedback on service, call CCHI hotline: 920001177
٩٢٠٠٠١١٧٧ ‫ﻠﺲ اﻟﻀﻤﺎن اﻟﺼﺤﻲ اﻟﺘﻌﺎو¾ ﻋﻠﻰ‬ç ‫ ﺑﺮﺟﺎء اﻟﺘﻮاﺻﻞ ﻣﻊ‬،‫ﳌﻼﺣﻈﺎﺗﻜﻢ وﺗﻌﻠﻴﻘﺎﺗﻜﻢ ﻋﻠﻰ اﳋﺪﻣﺎت اﳌﻘﺪﻣﺔ‬
Bupa Arabia for Cooperative Insurance ¾‫ﺷﺮﻛﺔ ﺑﻮﺑﺎ اﻟﻌﺮﺑﻴﺔ ﻟﻠﺘﺄﻣﲔ اﻟﺘﻌﺎو‬
3538 Al-Khalidiyah-Nour Al Ehsan, Unit 1 ١ ‫ وﺣﺪه رﻗﻢ‬،‫ ﻧﻮر ا·ﺣﺴﺎن‬، ‫ اﳋﺎﻟﺪﻳﻪ‬٣٥٣٨
Jeddah 7505-23423, Kingdom of Saudi Arabia
‫ اﳌﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬،٢٣٤٢٣-٧٥٠٥ ‫ﺟﺪة‬
Toll free: 800 244 0307 ٨٠٠ ٢٤٤ ٠٣٠٧ :¾‫ﺎ‬ç ‫ﻫﺎﺗﻒ‬
Fax: 920 000 724 ٩ ٢٠ ٠٠٠ ٧٢٤ :‫ﻓﺎﻛﺲ‬

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

To download our app, please visit: bupa.com.sa/ar/app bupa.com.sa/ar/app :‫ أرﺟﻮ زﻳﺎرة‬،‫ﻟﺘﺤﻤﻴﻞ ﺗﻄﺒﻴﻖ ﺑﻮﺑﺎ اﻟﻌﺮﺑﻴﺔ‬

Follow us on our social media channels to get updates on our latest products, ‫ﺗﺎﺑﻌﻮﻧﺎ ﻋﻠﻰ ﻗﻨﻮات ﺑﻮﺑﺎ اﻟﻌﺮﺑﻴﺔ ﻟﻠﺘﻮاﺻﻞ اﻻﺟﺘﻤﺎﻋﻲ ﻟﻠﺤﺼﻮل ﻋﻠﻰ أﺣﺪث أﺧﺒﺎر ﻣﻨﺘﺠﺎﺗﻨﺎ وﺧﺪﻣﺎت اﻟﺮﻋﺎﻳﺔ اﻟﺼﺤﻴﺔ‬
healthcare services and health tips. :‫واﻟﻨﺼﺎﺋﺢ اﻟﺼﺤﻴﺔ‬
@BupaArabia @BupaArabia
/BupaArabia /BupaArabia @BupaArabia /Company/BupaArabia /Company/BupaArabia @BupaArabia /BupaArabia /BupaArabia
@BupaArabiaCare @BupaArabiaCare

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