General Terms and Conditions of Personal Health Insurance Magnolia

Transcription

1 General Terms and Conditions of Personal Health Insurance Magnolia TABLE OF CONTENTS TABLE OF CONTENTS... 1 I. GENERAL PROVISIONS... 1 II. DEFINITIONS... 2 III. THE SUBJECT MATTER AND SCOPE OF INSURANCE... 4 IV. CONCLUSION OF THE INSURANCE AGREEMENT... 4 V. INSURANCE PREMIUM... 5 VI. COMMENCEMENT AND EXPIRY OF THE INSURER S LIABILITY... 6 VII. LIMITATION OF INSURER S LIABILITY... 6 VIII. MAKING AN INSURANCE CLAIM:... 7 IX. RIGHTS AND OBLIGATIONS OF THE INSURING PARTY AND THE INSURED PERSON.. 8 X. INSURER S RIGHTS AND OBLIGATIONS... 8 XI. TERMINATION AND WITHDRAWAL FROM THE AGREEMENT... 8 XII. NOTIFICATIONS AND REPRESENTATIONS OF THE PARTIES... 9 XIII. COMPLAINTS... 9 XIV. JURISDICTION... 9 XV. ASSIGNMENT OF RIGHTS UNDER THE INSURANCE AGREEMENT... 9 XVI. FINAL PROVISIONS I. GENERAL PROVISIONS 1. On the basis of the General Terms and Conditions of Personal Health Insurance set forth herein (hereinafter referred to as GTI ), LMG Försäkrings AB Spółka Akcyjna, operating via its Branch in Poland with a registered office in Warsaw (hereinafter, the Insurer ), holding a licence to conduct insurance activity in the scope of Part II group I and II of the Appendix to the Act of 22 May 2003 on Insurance Activity (Journal of Laws , consolidated text, as amended.) (the Act ) issued by Finansinspektionen in Sweden, operating in Poland pursuant to Article 131 of the Act, concludes Insurance Agreements with natural persons. 2. The Insurer may, on the basis of separate agreements, commission the performance of activities resulting from agency in the conclusion of insurance contracts and managing them to insurance agents having operational tools (applications) which are appropriate with respect to the requirements of insurance agency and approved by the Insurer. GTI code: I/2/2013 1

2 3. The Insuring Party may also conclude an Insurance Agreement (hereinafter, the Agreement ) on somebody else s account, with it being understood that the name of the Insured Person who is a natural person shall be indicated in the Agreement. 4. Parties may introduce into the Agreement additional provisions or provisions other than those set forth in GTI. In such a case, the differences between the GTI and the Agreement shall be presented to the Insuring Party in writing or in an electronic form, bearing a safe electronic signature, with the use of the Agent s IT Application (this only concerns a situation where the Insuring Party is a user of the Agent s IT application), prior to the conclusion of the said Agreement. 5. In the case of discrepancies between the provisions set forth in the GTI and those set forth in the Agreement, the provisions set forth in the Agreement shall prevail. II. DEFINITIONS Terms used in these GTI, Insurance Application, Insurance Policy or other documents that constitute an integral part of the Agreement shall have the following meanings: 1. Agent an entrepreneur with whom the Insurer has entered into an agency agreement, providing insurance agency services for and on behalf of the Insurer by means of an IT application; 2. Agent s IT Application Insurance Platform which enables the Agent intermediation with respect to, conclusion, execution and administration of insurance contracts for and on behalf of the Insurer; 3. Customer Service Centre a LUX MED Insurance hotline through which the Insured Person may obtain information regarding insurance; 4. Illness abnormal physical or mental state of the body according to the generally recognized medical knowledge; 5. Normal pregnancy pregnancy progressing normally, which during its course does not require hospitalization that would be directly related to the pregnancy, in particular hospitalization in a ward of pregnancy pathology due to reasons related to both the mother and the foetus; 6. High-risk pregnancy pregnancy which involves a significant threat to the health or life of the mother or the foetus, related with the occurrence of risk factors which statistically increase the incidence of complications in pregnancy and childbirth, which may be medical (illness that occurred during or before pregnancy, addictions, obstetric and gynaecological history, disorders that occur in the family) or demographic and social (education, profession, occupation, mother s age, or socioeconomic status); 7. Insurance coverage start date date indicated in the Insurance Policy on which the liability of the Insurer towards the Insured Person begins, pursuant to and to the extent indicated in the List of Outpatient Services which constitutes Appendix No 1 to GTI; 8. Child the Insured Person s own or adopted child who on the day of taking up the insurance is at least 31 days old and under the age of 18, and in the case of children who attend school [within the meaning of Article 2, clause 2) of the Act on the Educational System of 7 September 1991 (Journal of Laws , as amended), or attend a higher education school within the meaning of the Act on the Higher Education Law of 27 July 2005 (Journal of Laws , as amended)], is under the age of 25; 9. Insured Person s Card confirmation made by the Insurer that the Insured Person has been covered by insurance coverage in the scope of the Outpatient Module; 10. Doctor/consultant a person with legal rights to practice medicine in accordance with the provisions of the Polish law and holding relevant professional qualifications; 11. Accident a sudden event resulting from exposure to external physical factors beyond the control of the Insured Person and not related to his/her health status, resulting in an injury or death. Illnesses that occur suddenly are not considered to be an Accident; 12. Insurance Term 12-month term of the Agreement; 13. Period of Insurance Cover 12-month period in which insurance cover is granted to the Insured Person. The Period of Insurance Cover always ends on the day of Agreement s termination or expiry; 14. Operator an entity which coordinates the delivery of Outpatient Services on behalf of the Insurer; GTI code: I/2/2013 2

3 15. Life Partner a person maintaining a household together with the Main Insured Person, who is not the Insured Person s spouse and who is not related to the Insured Person through kinship or a legal relationship such as adoption or affinity; 16. Medical Facility organizational company unit of a healthcare entity, authorized to provide outpatient medical services, operating within the territory and according to the laws of the Republic of Poland, as indicated by the Insurer; 17. Insurance Policy document confirming the conclusion of the Agreement; 18. Discount percentage/amount discounted from the fixed price of an Outpatient Service in a Medical Facility as indicated in the List of Outpatient Services ; 19. Anniversary the day in each year of the term of the Agreement corresponding to the date of the conclusion of the Agreement; 20. Premium the payment due to the Insurer from the Insuring Party under the Agreement, whose exact amount and due date are specified in the Insurance Policy; 21. High-risk sports all aviation sports, motor gliding, paragliding, gliding, and piloting of any engine aircraft, ballooning, all types of parachuting, bungee jumping, mountain biking, motor sports and motor boating, jet skiing, kite surfing, mountaineering, high-mountain climbing, rock climbing, wall climbing, caving, mountain cave climbing, ski jumping, snowboarding and skiing except for recreational skiing/snowboarding on designated routes, bobsleighing, rafting and other water sports undertaken on mountain rivers, diving with the use of specialist equipment, martial arts, hunting and horse riding; 22. Insurance Amount the amount specified in the Insurance Policy which constitutes the upper limit of the Insurer s liability towards the Insured Person; 23. Hospital a hospital operating within the territory of the Republic of Poland, within the meaning of the Act on Medical Activity of 15 April 2011 (Journal of Laws 2011/112/654, as amended); 24. Outpatient Service a consultation with a Doctor or a psychologist, home visit or nursing/diagnostic/therapeutic examinations or treatments ordered by the physician, justified in the light of the Illness or a need to prevent an Illness or an Accident, as well as healthcare services provided in relation to normal pregnancy, specified and carried out in accordance with the Attachment to the Agreement List of Outpatient Services within the Insurance Period; 25. Healthcare Provider a Medical Facility that cooperates with the Insurer or the Operator on the provision of Outpatient Services; 26. Insurance Option healthcare insurance is available in the following Options: Individual Option and Family Option; 27. Individual Option a type of insurance in which the insurance only covers the Main Insured Person; 28. Family Option a type of insurance in which the insurance covers the Main Insured Person and the Coinsured; 29. Insuring Party a natural person who concludes the Agreement and is obliged to pay the Premium in accordance with the schedule and conditions set forth in the Insurance Policy; 30. Main Insured Person a natural person residing in the Republic of Poland, who is at least 18 years old and below 64 years old on the day of signing the Agreement, and who also is the Insuring Party; 31. Insured Person the Main Insured Person or the Co-insured. If the term Insured Person is used in the GTI, it means that the details set forth in the GTI apply both to the Main Insured Person and the Co-insured; 32. Excess the amount or percentage contribution made by the Insured Person towards the cost of an insurance service, in accordance with the Agreement; 33. Insurance Agreement (Agreement) Insurance Agreement concluded by and between the Insurer and the Insuring Party on the basis of the GTI set forth herein; 34. Insurance option Individual Magnolia insurance with a standard premium and promotional premium under the loyalty program; 35. Insured Person s Age is calculated with respect to the proposed date of the beginning of the Insured Person s insurance coverage and corresponds to the number of the Insured Person s full years of age. 36. Insurance Application the Insuring Party s statement, filed with the Insurer or the Agent, expressing willingness to conclude an Agreement on the terms set out in the GTI. Insurance Application may also include other statements of will or knowledge. The Application may be filed in writing using the Agent s IT Application. 37. Adjustment Index annual index of an increase in prices of consumer goods and services published by the President of the Central Statistical Office; GTI code: I/2/2013 3

4 38. Co-insured a natural person (Life Partner, Spouse and/or Child) indicated by the Main Insured Person, as part of the Family Option, on whose account the Agreement has been concluded, residing in the Republic of Poland, and who on the day of filing the application was at least 18 years old and no more than 64 years old, and in the case of a Child below 25 years of age; 39. Competitive sports a competitive sport means: practising sports in sections or sports clubs consisting in regular participation in training sessions and sports competitions, as well as practising sports for profit or participation in trips or expeditions to places with extreme weather conditions or extreme natural conditions; 40. List of Outpatient Services a list of Outpatient Services covered by the Agreement, which constitutes an Attachment No 1 to GTI; 41. Insurance event a medically justified provision of an Outpatient Service in the Period of Insurance Coverage. III. THE SUBJECT MATTER AND SCOPE OF INSURANCE 1. The subject matter of the insurance is the Insured Person s health. 2. The scope of insurance in the Outpatient Module covers the cost of provision of Outpatient Services, specified in the List of Outpatient Services, provided within the Period of Insurance Coverage subject to provisions set out below. 3. Insurance is available as an Individual Option and Family Option. 4. Outpatient Services are provided only within the territory of the Republic of Poland in facilities indicated on the Insurer s website: 5. The scope of insurance does not include healthcare services provided to save life in accordance with the National Medical Rescue Act (Journal of Laws , as amended). 6. Information on the most up-to-date list of Medical Facilities is available on the website and at the Customer Service Centre. 7. The Insurer reserves the right to amend the list of Medical Facilities during the term of the Agreement for important reasons, and in particular: termination of an agreement with a Medical Facility; a Medical Facility being removed from the relevant register in whole or in part; announcement of liquidation/bankruptcy of a Medical Facility; economic reasons. 8. In the event of a change of a Medical Facility, the Insurer is obliged to ensure availability of Outpatient Services within 30km from the Medical Facility used previously, and if this should be impossible, the Insurer shall notify the Insured Person, who has the right to terminate the Agreement without observing the notice period within 30 days of receiving information about the change. IV. CONCLUSION OF THE INSURANCE AGREEMENT 1. The Agreement is concluded for 1 year (Insurance Term); 2. The Agreement is concluded based on the Insurance Application filed in writing or by means of the Agent s IT Application. 3. If the Insurance Application does not contain all the details required, the Insuring Party shall complete the Insurance Application within the scope and deadline specified by the Insurer. 4. Should the Insuring Party fail to complete the missing details within the deadline specified, the conclusion of the Agreement shall not take place. 5. The Insurer may make the providing coverage for particular persons, who are indicated in the Application as the Insured, dependent on obtaining information which has an impact on the risk assessment, of which the Insurer shall inform the Insuring Party. 6. The Insurer may refer the persons who are to be covered by the insurance coverage to undergo additional medical examinations/tests in order to carry out a risk assessment. The cost of such examinations/tests shall be borne by the Insurer. GTI code: I/2/2013 4

5 7. On the basis of the risk assessment carried out, the Insurer may refuse to enter into the Agreement or may enter into the Agreement provided that provisions other than those set forth in the GTI or additional provisions are included in the Agreement. 8. The date of conclusion of the Agreement shall be the date of acceptance of the Insurance Application. 9. The contents of the Agreement shall be the details contained in the Insurance Application, Insurance Policy and in any other document submitted to the Insurer by the Insuring Party or the Insured Person, or forwarded by the Agent, including in particular all the statements submitted by the Insured Persons. 10. If in response to the Application submitted by the Insuring Party, the Insurer provides the Insuring Party with an Insurance Policy containing provisions that differ from the contents of the Application submitted by the Insuring Party to his/her disadvantage, the Insurer shall be obliged to point this out to the Insuring Party in writing or in an electronic form bearing a safe electronic signature in the case of Insuring Parties using the services of an Agent when delivering the Insurance Policy, giving the Insuring Party at least 7 days to file his/her objection. In the case of a failure to fulfil this obligation, changes made to the Insuring Party s disadvantage shall not be effective, and the Agreement shall be concluded according to the terms of the Application. 11. In the case described in Paragraph 10 above, in the absence of an objection, the Agreement shall be effective in accordance with the terms set out in the Insurance Policy on the day following the expiry of the deadline for submission of objections. 12. If no later than 30 days before the Anniversary, none of the Parties submit to the other Party a written Declaration on the withdrawal from the renewal of the Agreement, the Agreement shall then be renewed automatically on the existing terms and conditions for the period of another Insurance Term, without the need for the Insuring Party to submit a new Insurance Application. V. INSURANCE PREMIUM 1. The insurance premium is calculated for the duration of the Insurer s liability. In the event that the insurance relationship expires before the lapse of the period for which a Premium has been paid, the Insuring Party is entitled to a reimbursement of the Premium for the period of unused insurance coverage. 2. The Premium may be paid: a) as a single payment of the full amount; b) in monthly, quarterly or semi-annual instalments. 3. The Premium shall be paid upfront in amounts and within deadlines specified in the Insurance Application and confirmed in the Insurance Policy. 4. The Premium shall be paid to the bank account specified in the Insurance Policy. 5. If the Agreement is concluded directly between the Insuring Parties and the Insurer, the date of payment of the Premium is deemed to be the date when the Insurer s bank account has been credited with the total amount of Premium due. 6. If the Agreement is concluded via an Agent, the date of payment of the Premium is deemed to be the date when the Agent s bank account has been credited with the total amount of Premium due. 7. If the amount paid is lower than the amount of Premium due, the Premium shall be deemed unpaid. 8. In the case of arrears in paying Premiums, subsequent payments shall first be transferred to cover the amount in arrears. 9. In the case of overpaid premiums, the amount of the overpayment will be credited against future instalments, unless the Insuring Party requests the return of the overpayment. 10. In the case of paying the Premium in instalments, if a subsequent instalment is not paid, the Insurer may request the Insuring Party to pay the Premium instalment within an additional deadline of 7 days from the date of receipt of the notification, under the pain of expiry of the Insurer s liability in the case of a failure to pay the Premium instalment in the extended deadline. In the notification, the Insurer shall inform the Insuring Party of the consequences of a failure to pay the Premium. The Insuring Party shall pay the Premium for the period in which the Insurer has provided insurance coverage. 11. In the case of an automatic renewal of the Agreement for another Insurance Term, the Insuring Party shall pay the Premium or the first Premium instalment from the day of the commencement of the next Insurance Term. GTI code: I/2/2013 5

6 12. The Insurer reserves the right to change the Premium amount for a subsequent Insurance Term by the Adjustment Index published no later than 3 months before the Anniversary. 13. In the case of carrying out Premium indexation, the Insurer shall inform the Insuring Party of the Premium amount for the subsequent Insurance Term no later than 2 months before the Anniversary. VI. COMMENCEMENT AND EXPIRY OF THE INSURER S LIABILITY 1. The date of commencement of the Insurance Coverage is specified in the Insurance Application and confirmed in the Insurance Policy, subject to the provisions of Paragraph 2 below. 2. Insurance coverage begins no earlier than three business days following the payment of the full premium or the first full instalment of the premium by the Insuring Party, and if the Agreement was concluded using the IT Application following the Agent s or Insurer s receipt of statements signed by the Main Insured Person and the Co-insured, contained in the Insurance Application form, necessary for the provision of services by the Insurer. 3. The Insurer s liability ends: a) in the case of all the Insured Persons: on the last day of Insurance Term, if one of the parties to the Agreement has filed a statement on the lack of willingness to renew the Agreement for another Insurance Term; on the date of withdrawal from the Agreement by the Insuring Party; on the last day of termination notice period resulting from the termination of the Agreement by the Insuring Party; on the day of expiry of the 7-day period for the payment of a subsequent Premium instalment, provided that the Insurer had previously requested the Insuring Party to pay the Premium instalment, calculated from the day of delivery of the notification to the Insuring Party; b) in the case of a given Insured Person: on the day of his/her death; on the last day of the period for which the Premium has been paid; on the last day of the Insurance Term during which the Insured Person has had his/her 65th birthday, and if the Co-insured is a Child 18th or 26th birthday, respectively. VII. LIMITATION OF INSURER S LIABILITY The Insurer s liability shall not cover Insurance Events that are a direct or indirect consequence of or in respect of the following: 1. acts of war, military operations, martial law, civil war, revolution, state of emergency, civil coup d état, acts of terrorism, military service, participation in military missions or stabilization missions, active participation of the Insured Party in riots, unrest or strikes; 2. use of scientifically unrecognized methods of treatment or alternative, traditional and oriental medicine, use of drugs that have not been authorized for use in Poland and their consequences, as well as the Insured Person s participation in medical experiments and their consequences; 3. transplantation of organs or tissues, cells, cell cultures (cultivated naturally or artificially), including those involving an autograft or inserting implants and devices (unless the scope of the insurance specifies otherwise); 4. practising competitive or high-risk sports; 5. epidemics, natural calamities and natural disasters announced and confirmed by the relevant government authorities; GTI code: I/2/2013 6

7 6. the impact of nuclear energy, radioactive radiation, electromagnetic field and biological and chemical agents harmful to a human; 7. the Insured Person driving a vehicle without a permit or driving a vehicle without a valid MOT certificate, according to the laws currently in force, or driving a vehicle under the influence of voluntarily consumed alcohol, drugs or other intoxicants, psychotropic drugs or substitute drugs within the meaning of the provisions on counteracting drug addiction; 8. the Insured Person attempting to commit suicide, self-harm, deliberately cause a health disturbance, or committing or attempting to commit a crime or an offence; 9. wilful misconduct or gross negligence of the Insured Person; 10. being under the influence of, abuse of or an intoxication with voluntarily consumed alcohol, drugs, other intoxicants or psychotropic drugs, tobacco, or drugs used contrary to the Doctor s recommendations; 11. detoxification, detox procedures and treatment; 12. treatment of mental health illnesses, disorders and other forms of mental disturbances, including the Alzheimer s disease, and their consequences; 13. diagnosis and treatment of infertility and procedures related to sex change; 14. prosthetic, orthodontic, periodontal and implant diagnoses and treatment; 15. diagnosis and treatment as well as procedures and surgeries in aesthetic medicine, plastic surgery and cosmetology; 16. sanatorium and health resort treatment and rehabilitation stays in a nursing home or other facility providing care and treatment or treatment and nursing care, in which the Insured Person is staying due to medical, family or social reasons; 17. abortions or a high-risk pregnancy; 18. treatment of infection with HIV (AIDS) or hepatitis (with the exception of hepatitis A) and diseases resulting from those infections; 19. highly specialized treatment of cancer, in particular treatment involving chemotherapy or radiotherapy; 20. receiving healthcare services not prescribed and/or not delivered in medical facilities indicated by the Insurer, as well as healthcare services received without medical indications, including those carried out at the patient s request and examinations related to planned procedures carried out under the National Health Fund (NFZ); 21. resulting from the Insured Person s participation in a flight in the capacity of a pilot, crew member or a passenger of a military or private aircraft of an unlicensed airline; 22. if the healthcare services provided to the Insured Person exceed the scope necessary from the medical perspective, the Insurer may reduce the services accordingly; 23. The Insurer shall not be held responsible for insurance events that result from: medical errors; errors resulting from medical dossier not being maintained properly by the Medical Facility. VIII. MAKING AN INSURANCE CLAIM: 1. Outpatient Services are provided by Medical Facilities in accordance with their opening hours and the scope of operation of a given facility. 2. In order to receive an Outpatient Service, the Insured Person must: a) contact the Operator s hotline or the Medical Facility in person, by phone or via other channels made available by the Operator; b) agree on the date and place of the provision of an Outpatient Service; c) at the Medical Facility, present a document confirming the identity of the Insured Person together with a photograph and the Insured Person s Card; d) comply with regulations, instructions and directions applicable at the Medical Facility, received from an employee of the Medical Facility; e) provide the Medical Facility with all the information regarding the grounds for the provision of an Outpatient Service (i.e. Illness, Accident). 3. Outpatient Services are delivered by Medical Facilities in accordance with the laws currently in force and standards of service applicable at the given Medical Facility. GTI code: I/2/2013 7

8 4. If Outpatient Services are provided to persons below the age of 18, the Medical Facility may require documents specified in the standards of service for an under-age patient applicable at the given facility prior to the provision of an Outpatient Service. 5. The Insurer shall not be held responsible for the provision by a Medical Facility of Outpatient Services not covered by the scope of the insurance and services ordered or delivered by a Medical Facility other than those indicated by the Insurer, unless the Agreement provides otherwise. 6. The Insurer ensures that the provision of Outpatient Services by a Medical Facility shall take place as soon as possible, without undue delay. IX. RIGHTS AND OBLIGATIONS OF THE INSURING PARTY AND THE INSURED PERSON 1. The Insuring Party and the Insured Person are obliged to provide the Insurer with any information known to them, which the Insurer requested in the Insurance Application or prior to the conclusion of the Agreement. If the Insurer entered into the Agreement despite not having received the Insuring Party s/insured Person s responses to particular queries, the omitted information shall be considered irrelevant. 2. The Insuring Party is obliged to: a) pay full Premium in the amount and within deadlines specified in the Agreement; b) notify the Insurer immediately and no later than within 14 days of any change of correspondence address; c) inform the Insurer about any changes in personal details of the Insured Persons; d) notify the Insurer of the death of an Insured Person. 3. The Insured Person is obliged to: a) strictly adhere to doctor s recommendations; b) comply with the rules of organization of work in Medical Facilities in the part related to patients; c) inform the Insurer about any changes to personal data or address; if the Co-insured is below the age of 18, this is the responsibility of the Main Insured Person or the Insuring Party; d) observe deadlines for the provision of medical services agreed with the Healthcare Provider; e) arrive at the Medical Facility at an agreed time or inform the Operator about the resignation from an Outpatient Service no later than 12 hours before the agreed time of service provision; f) not to make the Insured Person s Card available to third parties; g) refrain from any actions that might make the provision of a medical service by the Healthcare Provider difficult or impossible. X. INSURER S RIGHTS AND OBLIGATIONS The Insurer is obliged to: a) issue an Insurance Policy and deliver it to the Insuring Party; b) carry out obligations resulting from the Agreement in a proper and timely manner; c) inform the Insuring Party of a change of registered office or change of correspondence address; d) inform the Insuring Party of a change of the Customer Service Centre s telephone number or of the Operator s telephone number. XI. TERMINATION AND WITHDRAWAL FROM THE AGREEMENT 1. The Insuring Party may withdraw from the Agreement within 30 days from the day of the conclusion of the Agreement or the delivery of the Insurance Policy together with GTI, whichever of these dates comes later. GTI code: I/2/2013 8

9 2. A withdrawal from the Agreement does not exempt the Insuring Party from the obligation to pay the full Premium for the period in which the Insurer provided the Insurance Coverage. 3. The Insuring Party may terminate the Agreement at any time with 3-months notice period in writing or by means of the Agent s IT Application. 4. The Insurer may terminate the Agreement by giving three months' notice, if the Insuring Party fails to pay, within 14 days of the conclusion of the Agreement, the first instalment of the Premium in the full amount, or if it fails to submit the required statements, where the Agreement was concluded using the IT Application. 5. In the case of paying the Premium in instalments, failure to pay a subsequent instalment on time may lead to the Insurer ceasing to bear liability in the case when the Insurer, following the expiry of the deadline, has requested the Insuring Party to pay the amount due, with a caution that failure to pay the amount due within 7 day will result in the cessation of liability. XII. NOTIFICATIONS AND REPRESENTATIONS OF THE PARTIES 1. All the notifications and representations submitted by the Parties in relation to the Agreement shall be made in writing or in other form agreed by the Parties. 2. If the Insuring Party and the Insurer communicate via the Agent, any changes and statements made by the Parties in connection with the Agreement may be executed using the IT Application. 3. The Parties agree to inform each other immediately of any change of the registered office (address). XIII. COMPLAINTS 1. Complaints related to the conclusion or the performance of the Agreement may be filed with the Insurer by the Insuring Party, the Insured Person or the entitled person, in writing, via an , a complaint form available on the Insurer s website and by phone by calling the number of the Customer Service Centre. A complaint may be filed in person at the Insurer s registered office or by post/courier. A complaint may also be made via the Agent using the IT Application. 2. The complaint should be addressed to the Director of the Branch. 3. A complaint is responded to without undue delay and no later than 30 days from the date of receiving the complaint in the form of the corresponding complaint. 4. If within the period specified above the examination of all the circumstances necessary to address the complaint proved impossible, the response shall be made within 14 days calculated from the day on which, with the observance of due diligence, the examination of these circumstances was possible, but no later than within 90 days from the date of receipt of the complaint. 5. A complaint may also be filed by an attorney. XIV. JURISDICTION Any action for claims under Agreements entered into on the basis of GTI may be brought under the provisions concerning general jurisdiction or before the court having jurisdiction over the place of residence or the registered office of the Insuring Party, the Insured Person, or the Entitled person. XV. ASSIGNMENT OF RIGHTS UNDER THE INSURANCE AGREEMENT GTI code: I/2/2013 9

10 Claims for healthcare services resulting from the Agreement may not be assigned within the meaning of Article 509 of the Polish Civil Code and may not be the subject of a pledge within the meaning of Article 327 of the Polish Civil Code. XVI. FINAL PROVISIONS 1. In matters not regulated by these GTI, the provisions of the Polish law currently in force shall apply, and in particular the provisions of the Polish Civil Code and the provisions of the Act on Insurance Activity, and the Act on the Protection of Certain Consumer Rights and on the Liability for Damage Caused by a Dangerous Product. 2. Services performed under the Agreements concluded on the basis of these GTI are not covered by the guarantee of the Insurance Guarantee Fund. 3. The language used in dealings with the Insuring Parties and the Insured Persons shall be the Polish language. These GTI have been approved by the Director General of LMG Försäkrings AB Spółka Akcyjna Branch in Poland on 22 April They shall supersede GTI in force from 1 December 2012 and apply to Agreements concluded on and after 1 June Anna Rulkiewicz Director General of the Branch GTI code: I/2/