bupa secure care premium rates - ASA International Insurance

BUPA SECURE CARE PREMIUM RATES, EFFECTIVE JANUARY 1, 2013ZONEsBUPA SECURE CAREPREMIUM RATESEFFECTIVE JANUARY 1, 2013(a)Deductible Plan 1 (US$0/US$1,000) is only available for renewals as of January 1, 2013.Country1

BUPA SECURE CARE PREMIUM RATES, EFFECTIVE JANUARY 1, 2013ZONEsAdministrative notes• Rates are in U.S. dollars and don’t include taxes.• An annual US$75 administration fee per policy applies.• One deductible applies per insured, per policy year up to amaximum of the out-of-country deductible. If the in-countrydeductible has already been met, and treatment is later receivedout of country, the difference between both deductibles willbe the insured’s responsibility. A maximum of two deductiblesper policy, per policy year applies, up to a maximum amountof two out-of-country deductibles.• Maximum age to apply: 74 years old.• Premium rates are based on the country of residence. Seeseparate premium rates for Puerto Rico and the U.S. VirginIslands.• Available payment modes: annually, semiannually andquarterly.• The insurer, USA Medical Services, and/or any of theirapplicable related subsidiaries and affiliates will not engagein any transactions with any parties or in any countrieswhere otherwise prohibited by the laws in the United Statesof America. Please contact USA Medical Services for moreinformation about this restriction.• Bupa reserves the right to correct any errors or omissions.(a)Deductible Plan 1 (US$0/US$1,000) is only available for renewals as of January 1, 2013.Country1

BUPA SECURE CARE PREMIUM RATES, EFFECTIVE JANUARY 1, 2013ZONE 3Deductibles Plan 1 (a) Plan 2 Plan 3 Plan 4 Plan 5 Plan 6In country ofresidenceOut of countryof residenceUS$0 US$1,000 US$2,000 US$5,000 US$10,000 US$20,000US$1,000 US$2,000 US$3,000 US$5,000 US$10,000 US$20,000Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual1 Child US$1,184.00 US$627.52 US$1,064.00 US$563.92 US$627.00 US$332.31 US$536.00 US$284.08 US$460.00 US$243.80 US$340.00 US$180.202 Children 1,943.00 1,029.79 1,796.00 951.88 935.00 495.55 843.00 446.79 726.00 384.78 542.00 287.263+ Children 2,841.00 1,505.73 2,638.00 1,398.14 1,344.00 712.32 1,225.00 649.25 1,055.00 559.15 783.00 414.9918-24 2,611.00 1,383.83 2,206.00 1,169.18 1,731.00 917.43 1,328.00 703.84 1,150.00 609.50 875.00 463.7525-29 2,898.00 1,535.94 2,431.00 1,288.43 1,949.00 1,032.97 1,481.00 784.93 1,284.00 680.52 971.00 514.6330-34 3,347.00 1,773.91 2,787.00 1,477.11 2,292.00 1,214.76 1,722.00 912.66 1,490.00 789.70 1,123.00 595.1935-39 3,705.00 1,963.65 3,074.00 1,629.22 2,567.00 1,360.51 1,916.00 1,015.48 1,653.00 876.09 1,246.00 660.3840-44 4,176.00 2,213.28 3,445.00 1,825.85 2,926.00 1,550.78 2,166.00 1,147.98 1,874.00 993.22 1,408.00 746.2445-49 4,841.00 2,565.73 3,969.00 2,103.57 3,430.00 1,817.90 2,521.00 1,336.13 2,176.00 1,153.28 1,635.00 866.5550-54 5,294.00 2,805.82 4,329.00 2,294.37 3,777.00 2,001.81 2,765.00 1,465.45 2,388.00 1,265.64 1,788.00 947.6455-59 6,252.00 3,313.56 5,088.00 2,696.64 4,513.00 2,391.89 3,277.00 1,736.81 2,829.00 1,499.37 2,117.00 1,122.0160 6,591.00 3,493.23 5,322.00 2,820.66 4,819.00 2,554.07 3,469.00 1,838.57 2,995.00 1,587.35 2,241.00 1,187.7361 7,420.00 3,932.60 5,993.00 3,176.29 5,425.00 2,875.25 3,905.00 2,069.65 3,372.00 1,787.16 2,524.00 1,337.7262 8,251.00 4,373.03 6,661.00 3,530.33 6,032.00 3,196.96 4,344.00 2,302.32 3,751.00 1,988.03 2,808.00 1,488.2463 9,075.00 4,809.75 7,331.00 3,885.43 6,638.00 3,518.14 4,782.00 2,534.46 4,129.00 2,188.37 3,088.00 1,636.6464 9,906.00 5,250.18 8,002.00 4,241.06 7,245.00 3,839.85 5,221.00 2,767.13 4,508.00 2,389.24 3,374.00 1,788.2265 9,945.00 5,270.85 8,008.00 4,244.24 7,312.00 3,875.36 5,249.00 2,781.97 4,530.00 2,400.90 3,388.00 1,795.6466 9,984.00 5,291.52 8,017.00 4,249.01 7,379.00 3,910.87 5,279.00 2,797.87 4,554.00 2,413.62 3,398.00 1,800.9467 11,096.00 5,880.88 8,912.00 4,723.36 8,204.00 4,348.12 5,871.00 3,111.63 5,064.00 2,683.92 3,780.00 2,003.4068 12,208.00 6,470.24 9,807.00 5,197.71 9,028.00 4,784.84 6,461.00 3,424.33 5,571.00 2,952.63 4,160.00 2,204.8069 12,766.00 6,765.98 10,252.00 5,433.56 9,438.00 5,002.14 6,754.00 3,579.62 5,828.00 3,088.84 4,350.00 2,305.5070 12,855.00 6,813.15 10,272.00 5,444.16 9,596.00 5,085.88 6,825.00 3,617.25 5,883.00 3,117.99 4,372.00 2,317.1671 14,466.00 7,666.98 11,560.00 6,126.80 10,796.00 5,721.88 7,682.00 4,071.46 6,623.00 3,510.19 4,922.00 2,608.6672 16,077.00 8,520.81 12,848.00 6,809.44 12,001.00 6,360.53 8,536.00 4,524.08 7,360.00 3,900.80 5,472.00 2,900.1673 17,687.00 9,374.11 14,135.00 7,491.55 13,204.00 6,998.12 9,394.00 4,978.82 8,100.00 4,293.00 6,023.00 3,192.1974 19,300.00 10,229.00 15,426.00 8,175.78 14,406.00 7,635.18 10,251.00 5,433.03 8,839.00 4,684.67 6,573.00 3,483.6975 and up 21,082.00 11,173.46 16,810.00 8,909.30 15,804.00 8,376.12 11,210.00 5,941.30 9,668.00 5,124.04 7,182.00 3,806.46Additional coverageMaternitycomplicationsUS$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25TransplantProcedures250.00 132.50 250.00 132.50 250.00 132.50 250.00 132.50 250.00 132.50 250.00 132.50(a)Deductible Plan 1 (US$0/US$1,000) is only available for renewals as of January 1, 2013.4Costa Rica, El Salvador

BUPA SECURE CARE PREMIUM RATES, EFFECTIVE JANUARY 1, 2013ZONE 4Deductibles Plan 1 (a) Plan 2 Plan 3 Plan 4 Plan 5 Plan 6In country ofresidenceOut of countryof residenceUS$0 US$1,000 US$2,000 US$5,000 US$10,000 US$20,000US$1,000 US$2,000 US$3,000 US$5,000 US$10,000 US$20,000Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual1 Child US$1,099.00 US$582.47 US$987.00 US$523.11 US$581.00 US$307.93 US$498.00 US$263.94 US$427.00 US$226.31 US$314.00 US$166.422 Children 1,800.00 954.00 1,664.00 881.92 869.00 460.57 782.00 414.46 675.00 357.75 500.00 265.003+ Children 2,635.00 1,396.55 2,444.00 1,295.32 1,247.00 660.91 1,136.00 602.08 978.00 518.34 724.00 383.7218-24 2,424.00 1,284.72 2,046.00 1,084.38 1,605.00 850.65 1,232.00 652.96 1,067.00 565.51 810.00 429.3025-29 2,688.00 1,424.64 2,258.00 1,196.74 1,810.00 959.30 1,374.00 728.22 1,189.00 630.17 901.00 477.5330-34 3,103.00 1,644.59 2,587.00 1,371.11 2,125.00 1,126.25 1,595.00 845.35 1,382.00 732.46 1,043.00 552.7935-39 3,433.00 1,819.49 2,849.00 1,509.97 2,376.00 1,259.28 1,776.00 941.28 1,536.00 814.08 1,155.00 612.1540-44 3,874.00 2,053.22 3,194.00 1,692.82 2,711.00 1,436.83 2,006.00 1,063.18 1,736.00 920.08 1,306.00 692.1845-49 4,487.00 2,378.11 3,676.00 1,948.28 3,181.00 1,685.93 2,336.00 1,238.08 2,016.00 1,068.48 1,515.00 802.9550-54 4,910.00 2,602.30 4,012.00 2,126.36 3,501.00 1,855.53 2,561.00 1,357.33 2,213.00 1,172.89 1,658.00 878.7455-59 5,796.00 3,071.88 4,714.00 2,498.42 4,179.00 2,214.87 3,037.00 1,609.61 2,624.00 1,390.72 1,961.00 1,039.3360 6,111.00 3,238.83 4,935.00 2,615.55 4,468.00 2,368.04 3,215.00 1,703.95 2,776.00 1,471.28 2,077.00 1,100.8161 6,882.00 3,647.46 5,559.00 2,946.27 5,027.00 2,664.31 3,620.00 1,918.60 3,127.00 1,657.31 2,339.00 1,239.6762 7,649.00 4,053.97 6,178.00 3,274.34 5,589.00 2,962.17 4,028.00 2,134.84 3,475.00 1,841.75 2,602.00 1,379.0663 8,416.00 4,460.48 6,796.00 3,601.88 6,151.00 3,260.03 4,431.00 2,348.43 3,826.00 2,027.78 2,865.00 1,518.4564 9,184.00 4,867.52 7,420.00 3,932.60 6,712.00 3,557.36 4,837.00 2,563.61 4,176.00 2,213.28 3,128.00 1,657.8465 9,219.00 4,886.07 7,425.00 3,935.25 6,776.00 3,591.28 4,866.00 2,578.98 4,199.00 2,225.47 3,138.00 1,663.1466 9,255.00 4,905.15 7,433.00 3,939.49 6,840.00 3,625.20 4,892.00 2,592.76 4,220.00 2,236.60 3,148.00 1,668.4467 10,287.00 5,452.11 8,264.00 4,379.92 7,603.00 4,029.59 5,439.00 2,882.67 4,694.00 2,487.82 3,501.00 1,855.5368 11,317.00 5,998.01 9,091.00 4,818.23 8,362.00 4,431.86 5,986.00 3,172.58 5,166.00 2,737.98 3,856.00 2,043.6869 11,835.00 6,272.55 9,507.00 5,038.71 8,742.00 4,633.26 6,259.00 3,317.27 5,398.00 2,860.94 4,033.00 2,137.4970 11,918.00 6,316.54 9,522.00 5,046.66 8,891.00 4,712.23 6,322.00 3,350.66 5,452.00 2,889.56 4,052.00 2,147.5671 13,411.00 7,107.83 10,716.00 5,679.48 10,006.00 5,303.18 7,117.00 3,772.01 6,137.00 3,252.61 4,563.00 2,418.3972 14,905.00 7,899.65 11,911.00 6,312.83 11,122.00 5,894.66 7,912.00 4,193.36 6,821.00 3,615.13 5,072.00 2,688.1673 16,399.00 8,691.47 13,104.00 6,945.12 12,233.00 6,483.49 8,704.00 4,613.12 7,506.00 3,978.18 5,581.00 2,957.9374 17,893.00 9,483.29 14,298.00 7,577.94 13,349.00 7,074.97 9,499.00 5,034.47 8,191.00 4,341.23 6,091.00 3,228.2375 and up 19,544.00 10,358.32 15,583.00 8,258.99 14,642.00 7,760.26 10,386.00 5,504.58 8,959.00 4,748.27 6,657.00 3,528.21Additional coverageMaternitycomplicationsUS$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25TransplantProcedures250.00 132.50 250.00 132.50 250.00 132.50 250.00 132.50 250.00 132.50 250.00 132.50(a)Deductible Plan 1 (US$0/US$1,000) is only available for renewals as of January 1, 2013. • (b) Excluding Trinidad & TobagoBelize, Guatemala, Guyana, Nicaragua, Suriname, Uruguay, rest of the CARIBBEAN (b)5

BUPA SECURE CARE PREMIUM RATES, EFFECTIVE JANUARY 1, 2013ZONE 5Deductibles Plan 1 (a) Plan 2 Plan 3 Plan 4 Plan 5 Plan 6In country ofresidenceOut of countryof residenceUS$0 US$1,000 US$2,000 US$5,000 US$10,000 US$20,000US$1,000 US$2,000 US$3,000 US$5,000 US$10,000 US$20,000Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual1 Child US$936.00 US$496.08 US$842.00 US$446.26 US$496.00 US$262.88 US$423.00 US$224.19 US$364.00 US$192.92 US$269.00 US$142.572 Children 1,536.00 814.08 1,419.00 752.07 738.00 391.14 666.00 352.98 577.00 305.81 426.00 225.783+ Children 2,246.00 1,190.38 2,085.00 1,105.05 1,061.00 562.33 969.00 513.57 836.00 443.08 617.00 327.0118-24 2,066.00 1,094.98 1,746.00 925.38 1,369.00 725.57 1,053.00 558.09 910.00 482.30 693.00 367.2925-29 2,292.00 1,214.76 1,923.00 1,019.19 1,541.00 816.73 1,172.00 621.16 1,014.00 537.42 767.00 406.5130-34 2,645.00 1,401.85 2,203.00 1,167.59 1,812.00 960.36 1,361.00 721.33 1,178.00 624.34 891.00 472.2335-39 2,929.00 1,552.37 2,429.00 1,287.37 2,027.00 1,074.31 1,513.00 801.89 1,309.00 693.77 987.00 523.1140-44 3,304.00 1,751.12 2,726.00 1,444.78 2,316.00 1,227.48 1,712.00 907.36 1,482.00 785.46 1,113.00 589.8945-49 3,826.00 2,027.78 3,138.00 1,663.14 2,711.00 1,436.83 1,992.00 1,055.76 1,720.00 911.60 1,295.00 686.3550-54 4,185.00 2,218.05 3,421.00 1,813.13 2,986.00 1,582.58 2,184.00 1,157.52 1,889.00 1,001.17 1,414.00 749.4255-59 4,943.00 2,619.79 4,023.00 2,132.19 3,565.00 1,889.45 2,590.00 1,372.70 2,236.00 1,185.08 1,675.00 887.7560 5,213.00 2,762.89 4,210.00 2,231.30 3,809.00 2,018.77 2,742.00 1,453.26 2,367.00 1,254.51 1,769.00 937.5761 5,868.00 3,110.04 4,739.00 2,511.67 4,287.00 2,272.11 3,087.00 1,636.11 2,667.00 1,413.51 1,994.00 1,056.8262 6,522.00 3,456.66 5,268.00 2,792.04 4,767.00 2,526.51 3,432.00 1,818.96 2,965.00 1,571.45 2,218.00 1,175.5463 7,177.00 3,803.81 5,796.00 3,071.88 5,243.00 2,778.79 3,778.00 2,002.34 3,262.00 1,728.86 2,442.00 1,294.2664 7,830.00 4,149.90 6,324.00 3,351.72 5,724.00 3,033.72 4,121.00 2,184.13 3,562.00 1,887.86 2,667.00 1,413.5165 7,862.00 4,166.86 6,332.00 3,355.96 5,779.00 3,062.87 4,148.00 2,198.44 3,582.00 1,898.46 2,678.00 1,419.3466 7,892.00 4,182.76 6,341.00 3,360.73 5,831.00 3,090.43 4,171.00 2,210.63 3,599.00 1,907.47 2,687.00 1,424.1167 8,772.00 4,649.16 7,045.00 3,733.85 6,482.00 3,435.46 4,639.00 2,458.67 4,000.00 2,120.00 2,986.00 1,582.5868 9,652.00 5,115.56 7,752.00 4,108.56 7,132.00 3,779.96 5,102.00 2,704.06 4,404.00 2,334.12 3,289.00 1,743.1769 10,090.00 5,347.70 8,106.00 4,296.18 7,455.00 3,951.15 5,337.00 2,828.61 4,603.00 2,439.59 3,439.00 1,822.6770 10,162.00 5,385.86 8,119.00 4,303.07 7,583.00 4,018.99 5,391.00 2,857.23 4,649.00 2,463.97 3,455.00 1,831.1571 11,435.00 6,060.55 9,139.00 4,843.67 8,532.00 4,521.96 6,069.00 3,216.57 5,233.00 2,773.49 3,890.00 2,061.7072 12,708.00 6,735.24 10,155.00 5,382.15 9,485.00 5,027.05 6,745.00 3,574.85 5,819.00 3,084.07 4,325.00 2,292.2573 13,982.00 7,410.46 11,175.00 5,922.75 10,434.00 5,530.02 7,421.00 3,933.13 6,400.00 3,392.00 4,761.00 2,523.3374 15,254.00 8,084.62 12,192.00 6,461.76 11,382.00 6,032.46 8,098.00 4,291.94 6,984.00 3,701.52 5,195.00 2,753.3575 and up 16,664.00 8,831.92 13,287.00 7,042.11 12,487.00 6,618.11 8,857.00 4,694.21 7,639.00 4,048.67 5,676.00 3,008.28Additional coverageMaternitycomplicationsUS$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25TransplantProcedures250.00 132.50 250.00 132.50 250.00 132.50 250.00 132.50 250.00 132.50 250.00 132.50(a)Deductible Plan 1 (US$0/US$1,000) is only available for renewals as of January 1, 2013.6Ecuador, Venezuela

BUPA SECURE CARE PREMIUM RATES, EFFECTIVE JANUARY 1, 2013ZONE 6Deductibles Plan 1 (a) Plan 2 Plan 3 Plan 4 Plan 5 Plan 6In country ofresidenceOut of countryof residenceUS$0 US$1,000 US$2,000 US$5,000 US$10,000 US$20,000US$1,000 US$2,000 US$3,000 US$5,000 US$10,000 US$20,000Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual1 Child US$963.00 US$510.39 US$865.00 US$458.45 US$509.00 US$269.77 US$434.00 US$230.02 US$374.00 US$198.22 US$275.00 US$145.752 Children 1,577.00 835.81 1,457.00 772.21 757.00 401.21 686.00 363.58 592.00 313.76 437.00 231.613+ Children 2,309.00 1,223.77 2,142.00 1,135.26 1,089.00 577.17 995.00 527.35 859.00 455.27 633.00 335.4918-24 2,120.00 1,123.60 1,792.00 949.76 1,406.00 745.18 1,079.00 571.87 934.00 495.02 710.00 376.3025-29 2,353.00 1,247.09 1,975.00 1,046.75 1,582.00 838.46 1,203.00 637.59 1,041.00 551.73 787.00 417.1130-34 2,716.00 1,439.48 2,262.00 1,198.86 1,862.00 986.86 1,396.00 739.88 1,209.00 640.77 914.00 484.4235-39 3,006.00 1,593.18 2,493.00 1,321.29 2,082.00 1,103.46 1,554.00 823.62 1,344.00 712.32 1,012.00 536.3640-44 3,392.00 1,797.76 2,797.00 1,482.41 2,378.00 1,260.34 1,758.00 931.74 1,521.00 806.13 1,143.00 605.7945-49 3,928.00 2,081.84 3,219.00 1,706.07 2,784.00 1,475.52 2,046.00 1,084.38 1,767.00 936.51 1,328.00 703.8450-54 4,297.00 2,277.41 3,512.00 1,861.36 3,067.00 1,625.51 2,243.00 1,188.79 1,940.00 1,028.20 1,453.00 770.0955-59 5,075.00 2,689.75 4,130.00 2,188.90 3,661.00 1,940.33 2,659.00 1,409.27 2,297.00 1,217.41 1,719.00 911.0760 5,351.00 2,836.03 4,320.00 2,289.60 3,912.00 2,073.36 2,816.00 1,492.48 2,430.00 1,287.90 1,818.00 963.5461 6,025.00 3,193.25 4,863.00 2,577.39 4,402.00 2,333.06 3,171.00 1,680.63 2,738.00 1,451.14 2,049.00 1,085.9762 6,697.00 3,549.41 5,409.00 2,866.77 4,897.00 2,595.41 3,527.00 1,869.31 3,043.00 1,612.79 2,278.00 1,207.3463 7,369.00 3,905.57 5,951.00 3,154.03 5,387.00 2,855.11 3,880.00 2,056.40 3,349.00 1,774.97 2,509.00 1,329.7764 8,041.00 4,261.73 6,493.00 3,441.29 5,881.00 3,116.93 4,236.00 2,245.08 3,658.00 1,938.74 2,738.00 1,451.1465 8,073.00 4,278.69 6,502.00 3,446.06 5,937.00 3,146.61 4,262.00 2,258.86 3,680.00 1,950.40 2,750.00 1,457.5066 8,103.00 4,294.59 6,510.00 3,450.30 5,991.00 3,175.23 4,285.00 2,271.05 3,696.00 1,958.88 2,759.00 1,462.2767 9,007.00 4,773.71 7,234.00 3,834.02 6,657.00 3,528.21 4,766.00 2,525.98 4,109.00 2,177.77 3,068.00 1,626.0468 9,911.00 5,252.83 7,960.00 4,218.80 7,328.00 3,883.84 5,242.00 2,778.26 4,523.00 2,397.19 3,378.00 1,790.3469 10,363.00 5,492.39 8,322.00 4,410.66 7,660.00 4,059.80 5,483.00 2,905.99 4,728.00 2,505.84 3,531.00 1,871.4370 10,435.00 5,530.55 8,338.00 4,419.14 7,790.00 4,128.70 5,540.00 2,936.20 4,775.00 2,530.75 3,549.00 1,880.9771 11,743.00 6,223.79 9,385.00 4,974.05 8,765.00 4,645.45 6,235.00 3,304.55 5,376.00 2,849.28 3,996.00 2,117.8872 13,050.00 6,916.50 10,428.00 5,526.84 9,743.00 5,163.79 6,930.00 3,672.90 5,978.00 3,168.34 4,443.00 2,354.7973 14,358.00 7,609.74 11,476.00 6,082.28 10,718.00 5,680.54 7,626.00 4,041.78 6,574.00 3,484.22 4,890.00 2,591.7074 15,665.00 8,302.45 12,520.00 6,635.60 11,694.00 6,197.82 8,321.00 4,410.13 7,174.00 3,802.22 5,336.00 2,828.0875 and up 17,113.00 9,069.89 13,645.00 7,231.85 12,828.00 6,798.84 9,101.00 4,823.53 7,846.00 4,158.38 5,831.00 3,090.43Additional coverageMaternitycomplicationsUS$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25TransplantProcedures250.00 132.50 250.00 132.50 250.00 132.50 250.00 132.50 250.00 132.50 250.00 132.50(a)Deductible Plan 1 (US$0/US$1,000) is only available for renewals as of January 1, 2013.Argentina, Colombia, Panama, Paraguay7

BUPA SECURE CARE PREMIUM RATES, EFFECTIVE JANUARY 1, 2013ZONE 7Deductibles Plan 1 (a) Plan 2 Plan 3 Plan 4 Plan 5 Plan 6In country ofresidenceOut of countryof residenceUS$0 US$1,000 US$2,000 US$5,000 US$10,000 US$20,000US$1,000 US$2,000 US$3,000 US$5,000 US$10,000 US$20,000Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual1 Child US$1,699.00 US$900.47 US$1,525.00 US$808.25 US$884.00 US$468.52 US$689.00 US$365.17 US$593.00 US$314.29 US$439.00 US$232.672 Children 2,789.00 1,478.17 2,576.00 1,365.28 1,312.00 695.36 1,088.00 576.64 936.00 496.08 696.00 368.883+ Children 4,078.00 2,161.34 3,781.00 2,003.93 1,889.00 1,001.17 1,578.00 836.34 1,360.00 720.80 1,011.00 535.8318-24 3,733.00 1,978.49 3,153.00 1,671.09 2,424.00 1,284.72 1,707.00 904.71 1,377.00 729.81 1,116.00 591.4825-29 4,147.00 2,197.91 3,477.00 1,842.81 2,731.00 1,447.43 1,903.00 1,008.59 1,548.00 820.44 1,245.00 659.8530-34 4,787.00 2,537.11 3,987.00 2,113.11 3,209.00 1,700.77 2,212.00 1,172.36 1,813.00 960.89 1,441.00 763.7335-39 5,299.00 2,808.47 4,390.00 2,326.70 3,592.00 1,903.76 2,456.00 1,301.68 2,027.00 1,074.31 1,599.00 847.4740-44 5,978.00 3,168.34 4,930.00 2,612.90 4,102.00 2,174.06 2,780.00 1,473.40 2,305.00 1,221.65 1,809.00 958.7745-49 6,929.00 3,672.37 5,676.00 3,008.28 4,811.00 2,549.83 3,240.00 1,717.20 2,700.00 1,431.00 2,102.00 1,114.0650-54 7,580.00 4,017.40 6,194.00 3,282.82 5,299.00 2,808.47 3,553.00 1,883.09 2,973.00 1,575.69 2,300.00 1,219.0055-59 8,955.00 4,746.15 7,284.00 3,860.52 6,329.00 3,354.37 4,217.00 2,235.01 3,540.00 1,876.20 2,719.00 1,441.0760 9,442.00 5,004.26 7,621.00 4,039.13 6,763.00 3,584.39 4,465.00 2,366.45 3,751.00 1,988.03 2,879.00 1,525.8761 10,631.00 5,634.43 8,582.00 4,548.46 7,614.00 4,035.42 5,029.00 2,665.37 4,239.00 2,246.67 3,244.00 1,719.3262 11,820.00 6,264.60 9,543.00 5,057.79 8,467.00 4,487.51 5,590.00 2,962.70 4,725.00 2,504.25 3,611.00 1,913.8363 13,005.00 6,892.65 10,503.00 5,566.59 9,321.00 4,940.13 6,156.00 3,262.68 5,215.00 2,763.95 3,973.00 2,105.6964 14,193.00 7,522.29 11,463.00 6,075.39 10,170.00 5,390.10 6,716.00 3,559.48 5,701.00 3,021.53 4,342.00 2,301.2665 14,249.00 7,551.97 11,477.00 6,082.81 10,267.00 5,441.51 6,756.00 3,580.68 5,732.00 3,037.96 4,355.00 2,308.1566 14,306.00 7,582.18 11,487.00 6,088.11 10,362.00 5,491.86 6,796.00 3,601.88 5,763.00 3,054.39 4,373.00 2,317.6967 15,901.00 8,427.53 12,769.00 6,767.57 11,519.00 6,105.07 7,556.00 4,004.68 6,417.00 3,401.01 4,863.00 2,577.3968 17,495.00 9,272.35 14,053.00 7,448.09 12,678.00 6,719.34 8,317.00 4,408.01 7,073.00 3,748.69 5,353.00 2,837.0969 18,299.00 9,698.47 14,691.00 7,786.23 13,255.00 7,025.15 8,695.00 4,608.35 7,400.00 3,922.00 5,600.00 2,968.0070 18,422.00 9,763.66 14,721.00 7,802.13 13,477.00 7,142.81 8,784.00 4,655.52 7,473.00 3,960.69 5,627.00 2,982.3171 20,735.00 10,989.55 16,566.00 8,779.98 15,169.00 8,039.57 9,887.00 5,240.11 8,423.00 4,464.19 6,335.00 3,357.5572 23,046.00 12,214.38 18,414.00 9,759.42 16,858.00 8,934.74 10,991.00 5,825.23 9,377.00 4,969.81 7,044.00 3,733.3273 25,355.00 13,438.15 20,262.00 10,738.86 18,553.00 9,833.09 12,096.00 6,410.88 10,329.00 5,474.37 7,753.00 4,109.0974 27,668.00 14,664.04 22,111.00 11,718.83 20,244.00 10,729.32 13,200.00 6,996.00 11,280.00 5,978.40 8,460.00 4,483.8075 and up 30,223.00 16,018.19 24,095.00 12,770.35 22,206.00 11,769.18 14,436.00 7,651.08 12,346.00 6,543.38 9,246.00 4,900.38Additional coverageMaternitycomplicationsUS$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25TransplantProcedures250.00 132.50 250.00 132.50 250.00 132.50 250.00 132.50 250.00 132.50 250.00 132.50(a)Deductible Plan 1 (US$0/US$1,000) is only available for renewals as of January 1, 2013.8

BUPA SECURE CARE PREMIUM RATES, EFFECTIVE JANUARY 1, 2013ZONE 8Deductibles Plan 1 (a) Plan 2 Plan 3 Plan 4 Plan 5 Plan 6In country ofresidenceOut of countryof residenceUS$0 US$1,000 US$2,000 US$5,000 US$10,000 US$20,000US$1,000 US$2,000 US$3,000 US$5,000 US$10,000 US$20,000Age Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual Annual Semiannual1 Child US$1,018.00 US$539.54 US$914.00 US$484.42 US$538.00 US$285.14 US$461.00 US$244.33 US$395.00 US$209.35 US$291.00 US$154.232 Children 1,667.00 883.51 1,541.00 816.73 805.00 426.65 724.00 383.72 625.00 331.25 463.00 245.393+ Children 2,440.00 1,293.20 2,263.00 1,199.39 1,155.00 612.15 1,052.00 557.56 906.00 480.18 670.00 355.1018-24 2,244.00 1,189.32 1,894.00 1,003.82 1,486.00 787.58 1,141.00 604.73 988.00 523.64 750.00 397.5025-29 2,489.00 1,319.17 2,091.00 1,108.23 1,676.00 888.28 1,272.00 674.16 1,101.00 583.53 834.00 442.0230-34 2,873.00 1,522.69 2,395.00 1,269.35 1,968.00 1,043.04 1,477.00 782.81 1,280.00 678.40 966.00 511.9835-39 3,179.00 1,684.87 2,638.00 1,398.14 2,200.00 1,166.00 1,644.00 871.32 1,422.00 753.66 1,069.00 566.5740-44 3,587.00 1,901.11 2,957.00 1,567.21 2,510.00 1,330.30 1,857.00 984.21 1,607.00 851.71 1,209.00 640.7745-49 4,155.00 2,202.15 3,404.00 1,804.12 2,945.00 1,560.85 2,163.00 1,146.39 1,867.00 989.51 1,403.00 743.5950-54 4,546.00 2,409.38 3,715.00 1,968.95 3,242.00 1,718.26 2,371.00 1,256.63 2,049.00 1,085.97 1,535.00 813.5555-59 5,367.00 2,844.51 4,365.00 2,313.45 3,869.00 2,050.57 2,812.00 1,490.36 2,430.00 1,287.90 1,816.00 962.4860 5,658.00 2,998.74 4,569.00 2,421.57 4,137.00 2,192.61 2,977.00 1,577.81 2,570.00 1,362.10 1,923.00 1,019.1961 6,372.00 3,377.16 5,147.00 2,727.91 4,655.00 2,467.15 3,352.00 1,776.56 2,895.00 1,534.35 2,166.00 1,147.9862 7,082.00 3,753.46 5,720.00 3,031.60 5,175.00 2,742.75 3,730.00 1,976.90 3,218.00 1,705.54 2,409.00 1,276.7763 7,793.00 4,130.29 6,293.00 3,335.29 5,695.00 3,018.35 4,103.00 2,174.59 3,543.00 1,877.79 2,653.00 1,406.0964 8,504.00 4,507.12 6,870.00 3,641.10 6,215.00 3,293.95 4,479.00 2,373.87 3,867.00 2,049.51 2,896.00 1,534.8865 8,536.00 4,524.08 6,875.00 3,643.75 6,274.00 3,325.22 4,506.00 2,388.18 3,888.00 2,060.64 2,906.00 1,540.1866 8,569.00 4,541.57 6,882.00 3,647.46 6,333.00 3,356.49 4,530.00 2,400.90 3,907.00 2,070.71 2,915.00 1,544.9567 9,525.00 5,048.25 7,652.00 4,055.56 7,040.00 3,731.20 5,036.00 2,669.08 4,346.00 2,303.38 3,242.00 1,718.2668 10,479.00 5,553.87 8,418.00 4,461.54 7,743.00 4,103.79 5,543.00 2,937.79 4,783.00 2,534.99 3,570.00 1,892.1069 10,958.00 5,807.74 8,803.00 4,665.59 8,094.00 4,289.82 5,795.00 3,071.35 4,998.00 2,648.94 3,734.00 1,979.0270 11,035.00 5,848.55 8,817.00 4,673.01 8,232.00 4,362.96 5,854.00 3,102.62 5,048.00 2,675.44 3,752.00 1,988.5671 12,418.00 6,581.54 9,922.00 5,258.66 9,265.00 4,910.45 6,590.00 3,492.70 5,682.00 3,011.46 4,225.00 2,239.2572 13,801.00 7,314.53 11,029.00 5,845.37 10,298.00 5,457.94 7,326.00 3,882.78 6,316.00 3,347.48 4,696.00 2,488.8873 15,184.00 8,047.52 12,133.00 6,430.49 11,327.00 6,003.31 8,059.00 4,271.27 6,950.00 3,683.50 5,168.00 2,739.0474 16,568.00 8,781.04 13,239.00 7,016.67 12,360.00 6,550.80 8,795.00 4,661.35 7,584.00 4,019.52 5,640.00 2,989.2075 and up 18,096.00 9,590.88 14,429.00 7,647.37 13,557.00 7,185.21 9,617.00 5,097.01 8,295.00 4,396.35 6,164.00 3,266.92Additional coverageMaternitycomplicationsUS$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25 US$225.00 US$119.25TransplantProcedures250.00 132.50 250.00 132.50 250.00 132.50 250.00 132.50 250.00 132.50 250.00 132.50(a)Deductible Plan 1 (US$0/US$1,000) is only available for renewals as of January 1, 2013.TRINIDAD & TOBAGO9

BUPA SECURE CARE PREMIUM RATES, EFFECTIVE JANUARY 1, 2013ZONEsHOW IS THE PREMIUM PAID?Bupa must receive payment before the coverage can take effect.Please submit payment with your application. You can chooseamong the following payment options:Online payment by credit card through our websitewww.bupalatinamerica.comCredit card MasterCard, VISA, American Express, or Diners ClubPersonal check in U.S. dollars drawn on an American bank,cashier’s check, money order, traveler’s checkBank transfer:Procedure for ACH’sWells Fargo Bank200 South Biscayne Blvd, FL6011Miami, FL 33131Account # 2000037371881ABA # 067006432Account Name: Bupa Worldwide Premium TrustReference: Policyholder Name and Policy NumberProcedure for domestic wire transfersWells Fargo Bank200 South Biscayne Blvd, FL6011Miami, FL 33131Account # 2000037371881ABA # 121000248Account Name: Bupa Worldwide Premium TrustReference: Policyholder Name and Policy NumberProcedure for international wire transfersWells Fargo Bank200 South Biscayne Blvd, FL6011Miami, FL 33131Account # 2000037371881ABA # 121000248CHIPS # 0407SWIFT # WFBIUS6SAccount Name: Bupa Worldwide Premium TrustReference: Policyholder Name and Policy Number(a)Deductible Plan 1 (US$0/US$1,000) is only available for renewals as of January 1, 2013.10Country

BUPA SECURE CARE PREMIUM RATES, EFFECTIVE JANUARY 1, 2013ZONEs7001 S.W. 97th AvenueMiami, Florida 33173Tel. +1 (305) 398 7400Fax +1 (305) 275 8484www.bupalatinamerica.combupa@bupalatinamerica.com(a)Deductible Plan 1 (US$0/US$1,000) is only available for renewals as of January 1, 2013.CountryPR-SEC 2013 ENG11