Government travel insurance. Insurance Terms and Conditions Valid with effect from 1 November 2008

Transcription

1 INSURANCE TERMS AND CONDITIONS Valid with effect from 1 November 2008 Tapiola General Mutual Insurance Company Government travel insurance Insurance Terms and Conditions Valid with effect from 1 November 2008 Traveller s insurance Secondment insurance Luggage insurance Personal liability travel insurance

2 TABLE OF CONTENTS Traveller s insurance The insured and the recipient of compensation Validity of the insurance Nuclear damage, war and criminal activity Terminology related to travel insurance Indemnifiable insurance events and restrictions to compensability Compensation... 6 Terms and conditions of secondment insurance The insured and the recipient of compensation Validity of the insurance Nuclear damage, war and criminal activity Indemnifiable insurance events and restrictions to compensability Compensation Luggage and personal liability travel insurance The insured and the recipient of compensation Scope and term of validity of insurance Terminology related to travel insurance Luggage insurance Insured property Indemnifiable insurance events and restrictions to compensability Precautionary guidelines Compensation Personal liability travel insurance Indemnifiable insurance events and restrictions to compensability Settling of claims Compensation... 28

3 The content of the insurance contract shall be determined in accordance with the policy document, the traveller s insurance terms and conditions and the general terms and conditions of insurance. The insurance cover selected and any particulars relating thereto, such as the insured parties and the insurance coverage, shall be specified in the policy document. The objective of the insurance is to compensate for expenses and losses resulting from the insured event, to the extent of the agreed insurance cover and in accordance with these terms and conditions as well as the general terms and conditions of insurance. TRAVELLER S INSURANCE 1 The insured and the recipient of compensation 1.1 The insured The insured shall consist of the travelling staff that reside permanently in Finland, as well as those persons not covered by the Finnish social security system that the policyholder has dispatched abroad. Any children, grandchildren, siblings or half-siblings under 16 years of age travelling with the person endorsed in the policy document as the insured shall be covered by the travel insurance as well, even though they are not endorsed in the policy document. The insured shall include also any children other than those of the person endorsed in the policy document that reside in the same household as he/she and accompany him/her on the trip. An accompanying person under 16 years of age may be covered by only one travel insurance policy granted by Tapiola. 1.2 The recipient of compensation The insured or any other party entitled to compensation shall be the recipient of compensation. In the event of death, the beneficiary shall be the recipient of compensation. The beneficiaries shall be the next of kin, unless the policyholder has indicated otherwise (appointment of beneficiaries is described in clause 10 of the general terms and conditions). Next of kin shall refer to the spouse and heirs of the insured. The heirs shall consist primarily of the descendants of the insured, including his/her natural and adopted children. A spouse shall refer to the person to whom the insured was married or with whom he/she had a registered partnership at the time of his/her death. A common-law spouse shall not be considered a spouse in the meaning of the terms and conditions of insurance but must be appointed separately as a beneficiary. The Insurance Contracts Act provides a more detailed description of who is considered next of kin. The insured may appoint the beneficiary of the death benefit and the recipient of the daily allowance by notifying Tapiola in writing thereof prior to the insured event. 2

4 Validity of the insurance 1.3 Geographical limits and validity The traveller s insurance shall extend to travel and territories endorsed in the policy document. 1.4 Validity during sports Professional sports The insurance shall not apply to professional sports. A sport is considered professional when the athlete receives a salary or other remuneration for the sport, or when he/she must take out an insurance policy referred to in the Act on Accident and Pension Security of Athletes. Competitive sports The insurance shall not apply to competitions, matches or any other sports events for which the organiser requires the participants to take out a sports accident insurance or equivalent, or to sign a disclaimer. Nor shall the insurance cover training organised especially for the above mentioned sports or training typical of the sport. A separate insurance policy may be taken out to cover competitive sports. Risky sports The insurance shall not apply to the following sports or activities: power sports, such as weight-lifting, power-lifting and body-building martial arts or contact sports, such as boxing, wrestling, judo or karate motor sports, such as rally, go-karting or motocross bungee-jumping climbing sports, such as mountain-, cliff-, ice- or wall-climbing scuba diving or freediving speed skiing and downhill racing, freestyle skiing and downhill skiing outside marked slope areas aviation sports, such as skydiving, hang-gliding, gliding or flying with ultra-light or amateur-built aircraft crossing an ocean by boat hiking trips or expeditions to uninhabited areas abroad, such as hiking trips to deserts, wilderness areas, glaciers, jungle areas or mountains. A separate insurance policy may be taken out for risky sports, with the exception of aviation sports. 3

5 1.5 Termination of insurance The insurance of an individual insured shall terminate when he/she resigns from the employ of the policyholder or ceases to belong to the insured group as defined in the policy document. The insurance of an individual insured shall not continue beyond his/her 70 th birthday. Termination of the insurance contract is described in detail under clause 16 of the general terms and conditions. 2 Nuclear damage, war and criminal activity The traveller s insurance shall not include any losses arising from the effects of a nuclear weapon or device causing mass injury to humans;war / armed conflict or service in United Nations peacekeeping forces (with regard to travel insurance, where the insured should have commenced his/her trip abroad prior to the beginning of the armed conflict and not have participated in it personally, this section shall be applicable only after 14 days have elapsed from the commencement of such armed conflict), with this section to be adopted immediately in the event of a major war; and criminal activity on the part of the insured. The travel insurance may be extended to cover travel to war-risk areas or service in United Nations peacekeeping forces upon separate agreement. Tapiola shall maintain a list of war-risk areas, available on Tapiola s website. 3 Terminology related to travel insurance Trip The trip shall be deemed to commence at the home or place of work of the insured and finish in such a location. A foreign trip shall refer to a trip outside the borders of Finland. In Finland, the insured shall not be considered to be on a trip at a residence or holiday home owned by him/her or a member of his/her family living in the same household, at a residence or holiday home regularly occupied by him/her, at a place of study or work, when moving between any of the above locations or if the distance to the destination is less than 50 km from any of the above locations. Next of kin For the purposes of the travel insurance, next of kin shall refer to the following persons spouse or common-law spouse; children and grandchildren of the insured and those of his/her spouse or common-law spouse, any other children than those of the insured in so far as they reside in the same household with him/her, parents, parents-in-law, adoptive parents, grandparents, siblings or half-siblings; daughters- and sons-in-law; a single travel companion with whom the insured has reserved the trip; or a maximum of one (1) person registered for the trip. 4

6 Partners in a registered partnership shall be treated as spouses. A common-law spouse shall refer to a person who, according to the Population Register, is cohabiting permanently with the insured. 4 Compensable insured events and restrictions to compensability The traveller s insurance shall cover damage resulting from insured events that have occurred during the time of validity of the traveller s insurance contract. Compensable insured events shall include travel-time illness, travel accident, the trip s cancellation, interruption of the trip and a missed trip. Compensation shall be paid in accordance with the insured sums applicable at the time of the insured event. 4.1 Travel-time illness Travel-time illness shall refer to an unanticipated and sudden illness requiring medical attention that, on the basis of medical assessment, reasonably can be judged to have originated in the course of the trip. Travel-time illness may be compensated for only if the insured has sought medical attention during the trip or within 14 days of the trip. Should the sickness have been caused by an infectious disease with a longer incubation time, the 14-day rule shall not apply. Further, travel-time illness shall also include a sudden and unanticipated worsening during travel of an illness the insured had before the commencement of the trip. 4.2 Travel accident A travel accident shall refer to a sudden occurrence caused by external factors that results in bodily injury to the insured against his/her will. The traveller s insurance shall also cover involuntary drowning, injury arising from gas poisoning, heat stroke, sunstroke, frostbite and poisoning caused by a substance accidentally consumed by the insured. Traveller s insurance shall cover also injury caused by a significant variation in air pressure and any muscle or tendon strain injury resulting from a sudden movement or exertion whose principal reason was not related to the illness or physical defect of the insured. It is a condition for the payment of compensation that medical treatment is commenced not later than within 14 days following such injury. Compensation shall be paid for a maximum of six (6) weeks from the occurrence of the strain injury. 5

7 4.3 Exclusions from compensation Traveller s insurance shall not cover any illness, injury or death incurred on account of the suicide or attempted suicide of the insured; any illness or bodily defect of the insured, or any occurrence of the insured event resultant therefrom; surgery, a treatment procedure or other medical treatment undergone in order to treat an illness or bodily defect, except when such procedure was performed to treat an injury covered by this insurance. Traveller s insurance shall not cover any illness, injury, defect or musculoskeletal degeneration unrelated to the insured event, even if it had been latent before the accident; rupture of the Achilles tendon and hernia of the intervertebral disk, abdomen or inguinal region, unless the injury is the result of an accident wherein even healthy tissue would have been damaged; dental disease; the mental effects of the insured event; poisoning, illness or any treatable dependency resulting from the abuse of alcohol, narcotic substances or medication by the insured (poisoning caused by medication or any substance consumed as food shall be compensated for as travel-time illness); and indirect expenses, such as food and dining expenses, telephone calls, transport costs of a vehicle or animal, loss of earnings or travel expenses of a companion. 5 Compensation 5.1 Medical treatment expenses arising from travel-time illness or travel accident Application for compensation Medical treatment expenses shall be covered in so far as they are not covered under any act of law. Medical treatment expenses shall be compensated for on the basis of the Employment Accidents Act, Farmers Occupational Accident Insurance Act, Motor Liability Insurance Act, Basic Education Act, Health Insurance Act and Patient Injuries Act. Also other legislation contains provisions pertaining to primary liability for compensation. Should compensation for medical treatment expenses be provided for by law, compensation must first be applied for on the basis of the act in question. Compensation under the Health Insurance Act paid by the The Social Insurance Institution of Finland may be applied for directly from Tapiola. In such a case, a power of attorney must always be delivered to Tapiola for the collection of the compensation under the Health Insurance Act. If the right to compensation in accordance with the Health Insurance Act is forfeited, Tapiola shall deduct from the compensation the portion that would have been paid in accordance with the Health Insurance Act. Compensable medical expenses Medical expenses incurred due to a travel-time illness or to the sudden and unanticipated worsening during travel of an illness that started before the travel shall be covered up to a maximum of 90 days following the commencement of the treatment. Treatment costs for any travel accident shall be covered to a maximum of three (3) years from the occurrence of the accident. Expenses incurred on account of medical treatment relating to the compensable insured event shall be compensated for on the basis of original invoices or receipts. 6

8 It is a prerequisite for the compensation of medical treatment expenses that any examination, treatment or equipment has been ordered by a physician and, according to generally accepted medical practice, is considered necessary for the examination or treatment of the illness or injury incurred. Each individual treatment expense must be reasonable. If the expense exceeds clearly the general price level for the country, compensation will only be paid for the portion corresponding to the general price level in the country in question. Compensable medical expenses shall include charges paid to a physician or other health care professional for examinations and treatment provided; charges for cosmetic treatment approved in advance by Tapiola; travel expenses to locations in the country of destination where the compensable treatment and examinations described above are provided; medication dispensed by a pharmacist under licence granted by the authorities; expenses for patient transport and any necessary escort, as approved by Tapiola in advance; charges for a maximum of 10 physical therapy sessions to treat injuries resulting from the accident; the first pair of spectacles prescribed by a physician due to injury resulting from the accident, as well as orthopaedic bandages or supports; the cost of repairing spectacles that were used by the insured and damaged in an accident for which medical treatment is necessary, or the cost of buying equivalent spectacles (expenses shall be compensated for in full for the first year of use and the following calendar year, then in the following calendar year the compensation shall be 80%, and in the following years 60%, 40% and 20%; thus, the cost of repairing or purchasing spectacles damaged in an accident that takes place in the sixth (6 th ) calendar year following the first year of use shall not be compensated for); and the cost of repairing any hearing aids or dentures that were used by the insured and damaged in an accident, or the replacement cost of same. Non-compensable medical expenses shall include travel expenses in Finland following the trip; the cost of dentures, hearing aids, spectacles or contact lenses lost at the time of an accident; charges for physical therapy or similar, except for those specified as compensable treatment expenses; charges for rehabilitation or therapy; costs incurred on account of spending time at a rehabilitation centre, spa or naturopathy establishments; and charges for homeopathic or anthroposophic products or any pharmaceutical, vitamin, trace element, mineral or nutrient preparations. Treatment expenses for dental injuries or sudden toothache With regard to medical treatment expenses for a dental injury resulting from a travel accident, compensation shall be paid only for the necessary expenses of treatment or examination provided or prescribed by the dentist and related travel expenses. The maximum compensation for the expenses of treating an injury to the teeth or dentures due to biting and related travel expenses shall be EUR 120. The maximum compensation for the expenses of the necessary first aid for sudden toothache and related travel expenses shall total EUR 120. Compensation shall be paid only in the event that the toothache began and the treatment was provided during the trip. 7

9 5.2 Cancellation of trip Cancellation of a trip shall mean the prevention of commencement of a trip. Cancellation of a trip shall be compensated if it results from sudden and unexpected illness, accident or death of the insured; unexpected and significant material loss in relation to any property of the insured located in his/her home country; or any sudden and unexpected illness, accident or death of next of kin of the insured. Cancellation of the trip shall be compensated in the event that any of the above factors have prevented the commencement of the insured s trip for a peremptory reason. The peremptory nature shall be assessed on medical grounds. With regard to material damage, the peremptory nature of cancellation is established should the damage necessitate the presence of the insured at the location of the accident. If a trip is cancelled, the compensation paid shall consist of the portion of the price of the trip that was paid prior to the start of the trip and shall not be reimbursed to the insured by the travel agent under the terms of the Package Travel Act. If the trip is not subject to the Package Travel Act, the compensation paid shall consist of the portion of the price of the trip that was paid prior to the start of the trip and that shall not be reimbursed to the insured by the travel agent in accordance with the terms and conditions of the trip. The maximum compensation paid due to the cancellation of the trip shall total EUR 5,000 per trip and per insured. The insured must notify the tour operator or transport company without delay in the event of cancellation of the trip. Should the insured neglect his/her obligation to do so, Tapiola shall have the right to deduct from the compensation paid to the insured the refund not paid by the operator or the transport company due to the negligence of the insured to notify. The insurance shall not cover cancellation of the trip in the event that the insurance was taken out less than three (3) days prior to the commencement of the trip or that the reason for cancellation should occur prior to the commencement of the insurance contract or the travel reservation. 5.3 Missed trip A missed trip shall refer to the insured not arriving in time to the point of departure of his/her aeroplane, boat, train or coach trip, or to the point of departure of a connection purchased in advance. A missed trip shall be compensated for where the reason for delay should result from adverse weather conditions, a technical fault or an accident causing hindrance to public transport used by the insured or an accident involving a private motor vehicle used by the insured such that continuation of the trip is rendered impossible. Any essential additional travel expenses resulting from a missed trip and necessary to continue the trip by other corresponding means to the original destination shall be compensated. The maximum compensation paid due to the missed trip shall total EUR 5,000 per trip and per insured party. 8

10 Should the insured be unable to continue his/her trip due to the compensable late arrival, compensation shall be paid for the missed travel days. From the compensation shall be deducted any reimbursement or compensation to which the insured may be entitled from the tour operator or travel agency. 5.4 Travel interruption Travel shall be deemed interrupted in the event that the insured should need to return home during the trip. An interrupted trip shall be compensated for where it has resulted from serious travel-time illness or travel accident of the insured, or a sudden and unanticipated worsening during travel of an illness that started before the commencement of the trip; unexpected and significant material loss in relation to any property of the insured located in his/her home country; or serious, sudden and unexpected illness, accident or death of next of kin of the insured. The event motivating the interruption must occur after the commencement of the trip. Travel interruption shall be compensated in the event that any of the above circumstances should require the insured to return home for a peremptory reason. The peremptory nature of the accident or illness shall be assessed on medical grounds. With regard to damage to property, the peremptory nature is established if the damage should necessitate the presence of the insured at the location of the accident. The compensation shall be the sum of any necessary additional travel and accommodation expenses incurred as a result of the return home of the insured; reasonable expenses for a new trip to the travel destination in the event that this should be necessary during the term of insurance in order to continue studies or employment; any travel days missed on account of the interruption of holiday; and expenses for unused services, excursions and trips paid for by the insured prior to the travel, to a maximum of EUR 1,000. Travel shall also be deemed interrupted in the event that the insured should be admitted to a hospital as a result of a travel-time illness or travel accident during the holiday. The compensation shall be the sum of compensation to the insured for any missed travel days for the period of hospitalisation, should the hospitalisation exceed 24 consecutive hours; expenses for unused services, excursions and trips paid for by the insured prior to the travel, to a maximum of EUR 1,000; direct return travel and accommodation expenses of one (1) next of kin of the insured approved in advance by Tapiola to visit the insured, or any additional travel and accommodation costs of one (1) fellow traveller in the event that the insured should be in a life-threatening situation and cannot be transported back to his/her home country; and 9

11 compensation to an accompanying traveller for any missed travel days, in the event that the person admitted for hospital treatment is under 16 years of age and the treatment of the illness or injury as prescribed by the physician requires assisted care in hospital. Such a period shall be compensated for only on the basis of one (1) traveller s insurance policy by Tapiola. Any necessary additional travel and accommodation expenses incurred as a result of the insured returning home shall be compensated for if a travel-time illness or travel accident has delayed the return home for a peremptory reason. The peremptory nature of such an accident or illness shall be assessed on medical grounds. From the compensation shall be deducted any reimbursement or compensation to which the insured may be entitled from the tour operator or travel agency. Determination of missed travel days Any missed travel days shall be compensated for to such an extent of the total direct travel expenses paid prior to the commencement of the trip as indicated by the ratio of the missed days to the total number of travel days. Travel days shall be calculated in terms of full 24-hour periods from the commencement of the trip. Any missed travel days shall be calculated in terms of full 24-hour periods from the commencement of the interruption until the end of hospitalisation or, at maximum, until the intended completion date of the trip. In the event that the last period calculated thus should be exceeded by 12 hours, the time in excess shall be construed as one (1) full day. In the event that the insured should lose three quarters (3/4) of his/her total travel days, he/she shall be deemed to have lost all the travel days. 5.5 Daily allowance for disability resulting from accident Complete disability that results from an accident during the insurance period to an insured aged 18 to 70 years shall be subject to an agreed daily allowance, and any partial disability to a proportionate allowance. Disability shall be construed as full in the event that the insured should be entirely unable to perform his/her normal work duties, and partial in the event that the insured should be partially unable to perform them. Daily allowance shall be paid from the commencement of medical treatment, at the earliest, and shall cease no later than one (1) year from the date of the accident. 5.6 Compensation for handicap resulting from accident Handicap benefit shall be paid for a handicap resulting from an accident. The cover shall be applicable to an accompanying child only where the insurance of the parents should include a handicap benefit. The insured sum shall total EUR 10,000 for each accompanying child. 10

12 Handicap shall refer to general handicap assessed in medical terms that results to the insured from the accident. When assessing the handicap, only the nature of the injury resulting from the accident shall be taken into account and not any individual circumstances of the insured, such as his/her profession or hobbies. When assessing the handicap, any deficiencies or illnesses of the insured not resulting from the compensable accident shall not be considered. The extent of handicap shall be determined on the basis of the decision on classification of handicaps issued by the Ministry of Social Affairs and Health based on the terms of the Employment Accidents Act. In this decision, injuries are divided on the basis of their seriousness into handicap classes Class 1 shall correspond to a 5% handicap and the subsequent classes each to a further 5% handicap. Class 20 means full 100% handicap. Such allowance shall not be paid in the event of any handicap that should occur after three (3) years following the accident. Compensation for permanent handicap The compensation shall be paid where the handicap has become permanent. The compensation shall total the proportion of the agreed handicap benefit corresponding to the handicap class. In the event that the handicap class should be increased within three (3) years of payment of the lump sum benefit, a supplementary compensation shall be paid for the difference between the handicap classes. Subsequently, the amount of compensation shall not be adjusted in the event of variation in the handicap class. 5.7 Death benefit Death during travel Reasonable costs of transport home in the event of death of the insured while travelling, or burial costs overseas up to that amount, shall be compensated for on the basis of original invoices or receipts. The agreed death benefit shall be paid for accidental death or death caused by travel-time illness. The cover shall be applicable to an accompanying child only if the insurance cover of the parents includes insurance in the event of death. The insured sum shall total EUR 2,000 for each accompanying child. From the death benefit shall be deducted any lump-sum benefit for permanent handicap already paid for the same accident. The death benefit shall not be paid in the event of the death of the insured after more than three (3) years have elapsed from the compensable insured event. Compensation for death from an infectious disease In the event that the direct cause of death of the insured should be a generally dangerous infectious disease as defined in the Communicable Diseases Decree that was contracted during the trip, the agreed death benefit shall be paid. The cover shall be applicable to an accompanying child only if the insurance cover of the parents includes insurance in the event of death. The insured sum shall total EUR 2,000 for each accompanying child. The death benefit shall not be paid in the event of the death of the insured after more than one (1) year has elapsed from the diagnosis of the disease. 11

13 TERMS AND CONDITIONS OF SECONDMENT INSURANCE 6 The insured and the recipient of compensation 6.1 The insured The insured shall consist of those persons endorsed in the policy document who are Finnish nationals and dispatched from Finland, as well as persons not covered by the Finnish social security system that the policyholder has dispatched abroad. 6.2 The recipient of compensation The insured or any other party entitled to compensation shall be the recipient of compensation. In the event of death, the beneficiary shall be the recipient of compensation. The beneficiaries shall be the next of kin, unless the policyholder has indicated otherwise (appointment of beneficiaries is described in clause 10 of the general terms and conditions). Next of kin shall refer to the spouse and heirs of the insured. The heirs shall consist primarily of the descendants of the insured, including his/her natural and adopted children. A spouse shall refer to the person to whom the insured was married or with whom he/she had a registered partnership at the time of his/her death. A common-law spouse shall not be considered a spouse in the meaning of the terms and conditions of insurance but must be appointed separately as a beneficiary. The Insurance Contracts Act provides a more detailed description of who is considered next of kin. The insured may appoint the beneficiary of the death benefit and the recipient of the daily allowance by notifying Tapiola thereof in writing prior to the insured event. 7 Validity of the insurance 7.1 Geographical limits and validity The insurance shall be in force for the duration of the secondment in work in the territories endorsed in the policy document. The insurance shall extend to leisure travel only to the extent it has been specifically endorsed in the policy document. 7.2 Termination of insurance The insurance of an individual insured shall terminate when he/she resigns from the employ of the policyholder or ceases to belong to the insured group as defined in the policy document. The insurance of an individual insured shall not continue beyond his/her 65 th birthday. 12

14 7.3 Validity during sporting activities Professional sports The insurance shall not apply to professional sports. A sport is considered professional when the athlete receives a salary or other remuneration for the sport, or when he/she must take out an insurance policy as referred to in the Act on Accident and Pension Security of Athletes. Competitive sports The insurance shall not apply to competitions, matches or any other sports events for which the organiser requires the participants to take out a sports accident insurance or equivalent, or to sign a disclaimer. Nor shall the insurance cover training organised especially for the above mentioned sports or training typical of the sport. A separate insurance policy may be taken out to cover competitive sports. Risky sports The insurance shall not apply to the following sports or activities: power sports, such as weight-lifting, power-lifting and body-building martial arts or contact sports, such as boxing, wrestling, judo or karate motor sports, such as rally, go-karting or motocross bungee-jumping climbing sports, such as mountain-, cliff-, ice- or wall-climbing scuba diving or freediving speed skiing and downhill racing, freestyle skiing and downhill skiing outside marked slope areas aviation sports, such as skydiving, hang-gliding, gliding or flying with ultra-light or amateur-built aircraft crossing an ocean by boat hiking trips or expeditions to uninhabited areas abroad, such as hiking trips to deserts, wilderness areas, glaciers, jungle areas or mountains. A separate insurance policy may be taken out for risky sports, with the exception of aviation sports. 8 Nuclear damage, war and criminal activity The secondment insurance shall not include any losses arising from the effects of a nuclear weapon or device causing mass injury to humans; war / armed conflict or service in United Nations peacekeeping forces (where the insured should have commenced his/her trip prior to the commencement of an armed conflict and not have participated in it personally, this section shall be applicable only after 14 days have elapsed from the commencement of such armed conflict), with this section to be adopted immediately in the event of a major war; and criminal activity on the part of the insured. The insurance may be extended to cover travel to war-risk areas, or service in United Nations peacekeeping forces, upon separate agreement. Tapiola shall maintain a list of war-risk areas, available on Tapiola s website. 13

15 9 Compensable insurance events and restrictions to compensability Secondment insurance shall cover illness and accidents during the secondment, as well as health care in the secondment destination, if the said cover has been included in the insurance and endorsed in the policy document. The insurance shall also cover cancellation and interruption of trips made during the secondment, as well as missed trips. Compensation shall be paid in accordance with the insured sums applicable at the time of the insured event. 9.1 Illness The insurance shall cover unanticipated and sudden illness requiring medical attention that, on the basis of medical assessment, reasonably can be judged to have originated in the course of the secondment. Illness may be compensated for only if the insured has sought medical attention during the secondment or within 14 days following the end of the secondment. Should the illness have been caused by an infectious disease with a longer incubation time, the 14-day rule shall not apply. Further, travel-time illness shall also include a sudden and unanticipated worsening during travel of an illness the insured had before the commencement of the trip. 9.2 Accident The insurance shall cover accidents during the secondment. An accident shall refer to a sudden occurrence caused by external factors that results in bodily injury to the insured against his/her will. The secondment insurance also shall cover involuntary drowning, injury arising from gas poisoning, heat stroke, sunstroke, frostbite and poisoning caused by a substance accidentally consumed by the insured. Also, the insurance shall cover any injury caused by a significant variation in air pressure and any muscle or tendon strain injury resulting from a sudden movement or exertion whose principal reason was not related to the illness or physical defect of the insured. It is a condition for the payment of compensation that medical treatment is commenced not later than within 14 days following such injury. Compensation shall be paid for a maximum of six (6) weeks from the occurrence of the strain injury. 9.3 Exclusions from compensation The insurance shall not cover any illness, injury or death having occurred on account of the suicide or attempted suicide of the insured; any illness or bodily defect of the insured, or any occurrence of the insured event resultant therefrom; surgery, a treatment procedure or other medical treatment undergone in order to treat an illness or bodily defect, except when such procedure was performed to treat an injury covered by this insurance. 14

16 The insurance shall not cover any illness, injury, defect or musculoskeletal degeneration unrelated to the insured event, even if it had been latent before the accident; rupture of the Achilles tendon, or hernia of the intervertebral disk, abdomen or inguinal region, unless the injury is the result of an accident where even healthy tissue would have been damaged; the mental effects of the insured event; poisoning, illness or any treatable dependency resulting from the abuse of alcohol, narcotic substances or medication by the insured (poisoning caused by medication or any substance consumed as food shall be compensated for as sickness); or indirect expenses, such as food and eating expenses, telephone calls, transport costs of a vehicle or animal, loss of earnings or travel expenses of a companion. 10 Compensation 10.1 Medical treatment expenses arising from illness or accident Application for compensation Medical treatment expenses shall be covered in so far as they are not covered under any act of law. Medical treatment expenses shall be compensated for on the basis of the terms of the Employment Accidents Act, Farmers Occupational Accident Insurance Act, Motor Liability Insurance Act, Basic Education Act, Health Insurance Act and Patient Injuries Act. Also other legislation contains provisions pertaining to primary liability for compensation. Should compensation for medical treatment expenses be provided for by law, compensation must first be applied for on the basis of the act in question. Compensation under the Health Insurance Act paid by The Social Insurance Institution of Finland may be applied for directly from Tapiola. In such a case, a power of attorney always must be delivered to Tapiola for the collecting of the compensation under the Health Insurance Act. If the right to compensation in accordance with the Health Insurance Act is forfeited, Tapiola shall deduct from the compensation the portion that would have been paid in accordance with the Health Insurance Act Compensable medical expenses Further, treatment expenses arising from illness or from a sudden and unanticipated worsening of an illness that started before the trip shall be covered during the secondment. Tapiola shall cover medical treatment expenses resulting from illness for up to a maximum of 90 days following the end of the secondment. Treatment costs for any accident shall be covered to a maximum of three (3) years from the occurrence of the accident. Expenses incurred on account of medical treatment relating to the compensable insured event shall be compensated for on the basis of original invoices or receipts. It is a prerequisite for the compensation of medical treatment expenses that any examination, treatment or equipment has been ordered by a physician and, according to generally accepted medical practice, is considered necessary for the examination or treatment of the illness or injury incurred. Each individual treatment expense must be reasonable. If the expense exceeds clearly the general price level for the 15

17 country, compensation will only be paid for the portion corresponding to the general price level in the country in question. Compensable medical expenses shall include charges paid to a physician or other health care professional for examinations and treatment provided; charges for cosmetic treatment approved in advance by Tapiola; travel expenses to locations in the secondment destination where the compensable treatment and examinations described above are provided; medication dispensed by a pharmacist under licence granted by the authorities; expenses for patient transport and any necessary escort, as approved by Tapiola in advance; charges for a maximum of 10 physical therapy sessions to treat injuries resulting from the accident; the first pair of spectacles prescribed by a physician due to injury resulting from the accident, as well as orthopaedic bandages or supports; the cost of repairing spectacles that were used by the insured and damaged in an accident for which medical treatment is necessary, or the cost of buying equivalent spectacles (expenses shall be compensated for in full for the first year of use and the following calendar year, then in the following calendar year the compensation shall be 80%, and in the following years 60%, 40% and 20%; thus, the cost of repairing or purchasing spectacles damaged in an accident that takes place in the sixth (6 th ) calendar year following the first year of use shall not be compensated for); and the cost of repairing any hearing aids or dentures that were used by the insured and damaged in an accident, or the replacement cost of same. Non-compensable medical expenses shall include travel and lodging expenses in Finland; the cost of dentures, hearing aids, spectacles or contact lenses lost at the time of an accident; charges for physical therapy or similar, except for those specified as compensable treatment expenses; charges for rehabilitation or therapy; costs incurred on account of spending time at a rehabilitation centre, spa or naturopathy establishment; and charges for homeopathic or anthroposophic products or any pharmaceutical, vitamin, trace element, mineral or nutrient preparations. Treatment expenses for dental injuries or sudden toothache (basic traveller s insurance F and G) With regard to medical treatment expenses for a dental injury resulting from an accident, compensation shall be paid only for the necessary expenses of treatment or examination provided or prescribed by the dentist and related travel expenses. The maximum compensation for the expenses of treating an injury to the teeth or dentures due to biting and related travel expenses shall be EUR 120. The maximum compensation for the expenses of the necessary first aid for sudden toothache and related travel expenses shall total EUR 120. Compensation shall be paid only in the event that the toothache began and the treatment was provided during the secondment. 16

18 10.3 Health care expenditure (extended traveller s insurance H) Compensation under secondment insurance shall only be paid for health care expenditure in the event that the said coverage has been included in the insurance and separately endorsed in the policy document. Costs compensated for as necessary and reasonable health care expenditure during the secondment shall consist of medical examinations by a physician, any corresponding medical procedures prescribed or performed by a physician dental treatment up to a maximum of EUR 3,000/calendar year monitoring of pregnancy and childbirth in the secondment destination, up to a maximum of EUR 12, Cancellation of trip Cancellation of a trip shall mean the prevention of commencement of a trip. Cancellation of a trip shall be compensated if it results from sudden and unexpected illness, accident or death of the insured; unexpected and significant material loss in relation to any property of the insured located in his/her home country; or any sudden and unexpected illness, accident or death of next of kin of the insured. Cancellation of the trip shall be compensated in the event that any of the above factors have prevented the commencement of the insured s trip for a peremptory reason. The peremptory nature shall be assessed on medical grounds. With regard to material damage, the peremptory nature of cancellation is established should the damage necessitate the presence of the insured at the location of the accident. If a trip is cancelled, the compensation paid shall consist of the portion of the price of the trip that was paid prior to the start of the trip and shall not be reimbursed to the insured by the travel agent under the terms of the Package Travel Act. If the trip is not subject to the Package Travel Act, the compensation paid shall consist of the portion of the price of the trip that was paid prior to the start of the trip and that shall not be reimbursed to the insured by the travel agent in accordance with the terms and conditions of the trip. The maximum compensation paid due to the cancellation of the trip shall total EUR 5,000 per trip and per insured party. The insured must notify the tour operator or transport company without delay in the event of cancellation of the trip. Should the insured neglect his/her obligation to do so, Tapiola shall have the right to deduct from the compensation payable to the insured the refund not paid by the operator or the transport company due to the negligence of the insured to notify. The insurance shall not cover cancellation of the trip in the event that the insurance was taken out less than three (3) days prior to the commencement of the trip or that the reason for cancellation should occur prior to the commencement of the insurance contract or the travel reservation. 17

19 10.5 Missed trip A missed trip shall refer to the insured not arriving in time to the point of departure of his/her aeroplane, boat, train or coach or to the point of departure of a connection purchased in advance. A missed trip shall be compensated for where the reason for delay should result from adverse weather conditions, a technical fault or an accident causing hindrance to public transport used by the insured or an accident involving a private motor vehicle used by the insured such that continuation of the trip is rendered impossible. Any essential additional travel expenses resulting from a missed trip and necessary for the trip to continue by other corresponding means to the original destination shall be compensated. The maximum compensation paid due to the missed trip shall total EUR 5,000 per trip and per insured party. From the compensation shall be deducted any reimbursement or compensation to which the insured may be entitled from the tour operator or travel agency Travel interruption Travel shall be deemed interrupted in the event that the insured should need to return to the secondment destination or his/her home country during the trip. An interrupted trip shall be compensated for where it has resulted from the insured s serious travel-time illness or travel accident, or a sudden and unanticipated worsening during travel of an illness that started before the commencement of the trip; unexpected and significant material loss in relation to any property of the insured located in his/her home country; or serious, sudden and unexpected illness, accident or death of next of kin of the insured. The event motivating the interruption must occur after the commencement of the trip. Cancellation of the trip shall be compensated for in the event that any of the above circumstances should require the insured to return to the secondment destination or to his/her home country. The mandatory nature of this effect of accident or illness shall be subject to assessment on medical grounds. With regard to damage to property, the mandatory nature of cancellation is established should the damage necessitate the presence of the insured at the location of the accident. The allowance paid shall be the sum of any necessary additional travel and accommodation expenses incurred as a result of the return to the secondment destination or home country of the insured and reasonable expenses for a new trip from the insured s home country to the secondment destination in the event that this should be necessary during the insurance term in order to continue employment. The cost of the new trip to the secondment destination is compensated only if the trip has commenced on the 30 th day from the date of interruption, at the latest. 18

20 10.7 Daily allowance for disability resulting from accident Complete disability that results from an accident during the insurance period to an insured aged 18 to 65 years shall be subject to an agreed daily allowance, and any partial disability to a proportionate allowance Disability shall be construed as full in the event that the insured should be entirely unable to perform his/her normal work duties, and partial in the event that the insured should be partially unable to perform them. Daily allowance shall be pa from the commencement of medical treatment, at the earliest, and shall cease no later than one (1) year from the date of the accident Compensation for handicap resulting from accident Handicap benefit shall be paid for a handicap resulting from an accident. Handicap shall refer to general handicap assessed in medical terms that results to the insured from the accident. When assessing the handicap, only the nature of the injury resulting from the accident shall be taken into account and not any individual circumstances of the insured, such as his/her profession or hobbies. When assessing the handicap, any deficiencies or illnesses of the insured not resulting from the compensable accident shall not be considered. The extent of handicap shall be determined on the basis of the handicap classification decision issued by the Ministry of Social Affairs and Health, based on the terms of the Employment Accidents Act. In the handicap classification decision, injuries are divided, on the basis of their seriousness, into handicap categories Category 1 shall correspond to a 5% medical handicap and the subsequent categories each to a further 5% handicap. Class 20 means full 100% handicap. Such allowance shall not be paid in the event of any handicap that should occur after three (3) years following the accident. The compensation shall be paid where the handicap has become permanent. The compensation shall total the proportion of the agreed handicap benefit corresponding to the handicap class. In the event that the handicap class should be increased within three (3) years of payment of the lump sum benefit, a supplementary compensation shall be paid for the difference between the handicap classes. Subsequently, in the event of variation in the level of handicap, the amount of compensation shall not be adjusted Death benefit Death during secondment Reasonable costs of transport home in the event of death of the insured while on a secondment, or burial costs overseas up to that amount, shall be compensated for on the basis of original invoices or receipts. 19

21 The agreed death benefit shall be paid for accidental death or death caused by travel-time illness. From the death benefit shall be deducted any lump-sum benefit for permanent handicap already paid for the same accident. The death benefit shall not be paid in the event of the death of the insured after more than three (3) years have elapsed from the compensable insured event. Compensation for death from an infectious disease In the event that the direct cause of death of the insured should be a generally dangerous infectious disease as defined in the Communicable Diseases Decree that was contracted during the trip, the agreed death benefit shall be paid. The death benefit shall not be paid in the event of the death of the insured after more than one (1) year has elapsed from the diagnosis of the disease. LUGGAGE AND PERSONAL LIABILITY TRAVEL INSURANCE 11 The insured and the recipient of compensation 11.1 The insured The insured shall consist of persons endorsed in the policy document or persons within a specified group endorsed in the policy document. Any next of kin of the insured who reside permanently in the same household with the insured and accompany him/her on the trip shall be subject to the luggage and personal liability travel insurance. Next of kin have been defined in the section Terminology related to travel insurance The recipient of compensation The insured or any other party entitled to compensation shall be the recipient of compensation. 12 Geographical limits and validity of insurance The luggage and personal liability travel insurance shall extend to such territories and period of insurance as endorsed in the policy document. 13 Terminology related to travel insurance Trip The trip shall be deemed to commence at the home or place of work of the insured and finish in such a location. A foreign trip shall refer to a trip outside the borders of Finland. 20