中 国 太 平 保 险 ( 英 国 ) 有 限 公 司 CHINA TAIPING INSURANCE (UK) CO LTD

Transcription

1 Schengen Zone Medical Insurance Policy Introduction This document sets out the terms of Your Medical Insurance cover, please read it carefully. It tells You what is covered and what is not, what to do if You want to make a claim and who to call if You need help. You should familiarise Yourself with the cover provided by this policy and all the terms, conditions and exclusions that apply. You should read the policy in conjunction with Your schedule. Whereas You by a proposal and declaration which shall be the basis of this contract and is deemed to be incorporated herein have applied to the Company for the insurance hereinafter contained and has paid or agreed to pay the Premium as consideration for such insurance. Now this policy witnesses that if at any time during the period of insurance stated in this Policy hereto You sustain any bodily injury illness or disease caused directly and solely by accidental and visible means, then the Company will subject to the Terms and Conditions contained herein or endorsed hereon pay to You, or in the event of Your death to Your appointed Beneficiary, the benefits specified in the Schedule of Benefits. Purpose of Policy The purpose of the policy is to guarantee the Insured in accordance with the provisions of the Decision of the Council of the European Union of 22 December 2003 concerning insurance cover for: "Emergency Medical Costs" and "Repatriation" required obtaining the uniform Schengen visa. For and on behalf of China Taiping Insurance (UK) Co Ltd, Authorised Insurer Chief Executive

2 Complaints procedures 中 国 太 平 保 险 ( 英 国 ) 有 限 公 司 Although We are proud of our fair and efficient service, should You feel on any occasion that our service has fallen below the standard You would normally expect, then You should contact Your insurance adviser or alternatively write under Private and Confidential cover or telephone to: The Chief Executive China Taiping Insurance (UK) Co. Ltd 2 Finch Lane London, EC3V 3NA Telephone: 0044 (0) Facsimile: 0044 (0) Your complaint will be acknowledged and investigated immediately. We will do our best to resolve the problem within 5 working days. For complaints relating to claims, it may take us a little longer, especially if We need to consult with medical professionals. We will, however, acknowledge Your complaint and keep You regularly informed about the progress of Your complaint. If Your complaint cannot be resolved to Your satisfaction and We cannot agree a way to put things right, the department manager will issue a letter which will set out the basis of Your complaint and how We have tried to resolve it. This is called a final response letter. If it is necessary to issue a final response letter, then We must issue this within 8 weeks from the date You first made Your complaint. If We cannot issue it within this period, We must tell You why and when We will be able to respond. If You are not satisfied with our final response, You can ask the independent Financial Ombudsman Service (FOS) to review Your case, without affecting Your legal right to take action. Financial Ombudsman Service Exchange Tower London E14 9SR Telephone: It would greatly assist us if You could quote Your policy number in any communication.

3 Definitions Insurer/Company/We/Us China Taiping Insurance (UK) Co. Ltd Insured/You/Your Each individual aged under 80 years shown as Insured on the insurance Certificate and the holder of a currently valid visa Policy Together with the Certificate, the application and any endorsements, is evidence of the contract between the Insured and Us. We agree to provide the insurance cover described in this Policy provided the premium is paid when due and We agree to accept it Certificate The document showing details of the cover and which should be read with this Policy Accident A sudden, unexpected and specific event, external to the body, which occurs at an identifiable time and place Illness/Disease A deterioration of health recorded by a competent medical authority Medical Service In the sense of the present policy a medical service is taken to mean: Medical acts, Care services, Medicines, and Medical goods (optical equipment, dental and non-dental prostheses, etc) prescribed by a competent medical authority in any country of Schengen Area.

4 Excess The sum expressed in GB Pounds and being the first amount of any claim to which an Excess applies and for which the Insured is responsible Claim Any legal complaint made by the Insured Schengen Area The Schengen Area is determined by the borders of the following countries only: Austria, Belgium, Cyprus, Czech, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, Switzerland, and Ireland Period of Insurance The period during which the Insured benefits from the Policy and the dates of which are stated in the insurance Certificate United Kingdom England, Scotland, Wales, Northern Ireland, the Channel Islands and the Isle of Man China Mainland China, Hong Kong, Macau, and Taiwan Doctors Person who, in one of the State bound by the decision and where the policyholder has been authorized to enter or transit through, is authorized to practice the art of healing in accordance with the regulation of the country in which he primarily practices High Risk Activities Aerobics, Jazzercise, Dancing, Mountaineering, Rock Climbing, Rappelling, Scuba Diving, Snow Skiing Snow Boarding, Water Skiing, Power Boating Riding, All Terrain Vehicle Riding, Sailing, Sea Kayaking,

5 Canoeing, Horseback Riding, Surfing, Roller Skating, Roller Blading, Bungee Jumping, Paintball, Moped, Motorcycle Riding, Wave Runners, Jet Skiing, Snowmobiling, River Rafting, Hiking, Camping, Hunting, Handling of Guns/Firearms, Martial Arts, Wrestling, Hang Gliding, Parachuting, Parasailing, Ice Hockey, Diving Motor Driven Vehicle, Diving including 15 Feet Above Water Level, Riding in a Private Plane

6 Summary of Cover Granted 中 国 太 平 保 险 ( 英 国 ) 有 限 公 司 1. Repatriation 1.1 Medical Repatriation The Insurer will reimburse the cost of return of the Insured to the destination of repatriation if, following an illness or accident, their state of health does not enable them to continue their stay in the Schengen area and emergency repatriation is required. The decision to repatriate and the method of transportation will be made exclusively by the Insurer and their medical advisors. 1.2 Repatriation of the Body in the Event of Death The Insurer will cover the cost of the transport of the body of the Insured in the event of death of the Insured having occurred during the period of insurance in the Schengen area. 1.3 Means of Repatriation The means of repatriation are limited to: - Rail; - Ambulance; - Regular airline, economy class with special equipment if necessary; - Medically-equipped aircraft. 1.4 Destinations of repatriation The destinations of repatriation shall be limited to Schengen Area, United Kingdom, or China only. 1.5 Repatriation Benefits Repatriation is insured up to the costs actually incurred with maximum limitation of GBP60, per policy. 1.6 Excess for repatriation There is no excess for Medical Repatriation or Repatriation of the Body.

7 2. Emergency Medical Costs Cover 2.1 Following illness or accident the cost of medical services which, according to the opinion of the Our Emergency Assistance Doctors, must be provided to the Insured in order to prevent a major aggravation of their state of health likely to harm irreversibly, harm them physically, or likely to put their life in danger. The following are covered: Emergency medical costs in the event of hospitalization and Other approved emergency medical costs. 2.2 Sum of the emergency medical costs cover Emergency medical costs cover is guaranteed up to the limit of GBP30, per event and per trip for each Insured Person 2.3 Excess for Emergency Medical Costs Cover The Insured will remain liable for an Excess of GBP50.00 for each medical service (act, care service, medicine or medical good) Cover Period Cover takes effect for the period of insurance mentioned in the certificate on arrival of the Insured in the Schengen Area and ceases when the Insured leaves this same area. The maximum period of insurance under this Policy will not exceed a) 7 consecutive days for 7-day Single-Trip Policy or b) 14 consecutive days for 14-day Single-Trip Policy and 20 consecutive days or aggregate 90 days for Multi-Trip Policy. Cover is granted to the Insured for events that occur and medical services supplied only in the Schengen Area.

8 Exceptions Exceptions Applicable to All Cover The policy does not guarantee claims resulting from: a) an accident occurring in a country where a state of war exists (declared or not) if the accident is the direct consequence of the war; b) terrorism, which means any acts(s) of any person(s) or organization(s) involving: 1. the causing, occasioning or threatening of harm of whatever nature and by whatever means; 2. putting the public or any section of the public in fear c) the Insured engaging in flying of any kind other than as a passenger, who has paid the fare; d) the Insured taking a drug or drugs other than according to the manufacturer s instructions or as prescribed by a registered medical practitioner; e) the insured taking a drug or drugs for the treatment of drug addiction; f) the Insured being intentionally self-inflicted; g) the Insured committing or attempting to commit suicide; h) the Insured being directly or indirectly involved in an unlawful act; i) the Insured deliberately or recklessly exposing themselves to exceptional danger; j) fibromyalgia, myalgic encephalomyelitis, chronic fatigue syndrome, post-traumatic stress disorder or any mental or nervous disorder; k) an accident occurring whilst driving, or in charge of, a vehicle and the Insured s blood/urine alcohol level is above the legal limit stated in the laws of the country where the accident occurs; l) the Insured participating in High Risk Activities; m) the Insured engaging in or taking part in armed forces service or operations; n) pregnancy more than six months, childbirth, dystocia; o) the tour operator, airline or any other company, firm or person either becoming insolvent or being unable or unwilling to fulfill any part of their obligation; p) which have not been proven and the amount thereof substantiated.

9 Exceptions Applicable to the "Emergency Medical Costs" Cover The policy does not cover: Non-random events contrary to the principle of the insurance such as development of a pre-existing state of health known to the Insured; Benign conditions which do not prevent the Insured from continuing their journey or their stay in the Schengen area; The consequences of a state of pregnancy after the sixth month; All medical treatment, care or services not satisfying the criteria of an emergency including but not limited to preventive medicine, thermal cures, health assessments, etc. The pre-existing medical condition is:- Any heart condition, breathing condition (including asthma), circulatory condition (including strokes and high blood pressure), gastrointestinal (digestive tract) conditions, bone or joint conditions, or any type of cancer, regardless of how long ago these were suffered; and Any medical condition or ailment that an insured person is suffering from or has suffered from in the last 12 months. This includes:- The Insured has had or are waiting for any investigation, tests, advice or results; Treatment is or has been given; Surgery is needed or has been given; Prescribed medication has been advised.

10 Cooling-Off Period and the Insured s Cancellation Rights The Insured can cancel this Policy at any time. If the Insured cancels within 14 days of receiving the Policy, the Insured will be entitled to a refund of premium, providing the Insured has not made, or intend to make, a claim during that period. If the Insured cancels the Policy after 14 days, no refund of premiums will be made. Administration fee may be applied to any cancellation. Emergency and Medical Service Contact the Emergency Assistance Service on Telephone: +44 (0) Fax: +44 (0) ctuktravel@healix.co.uk Ref: China Taiping Schengen In the event of Your Bodily Injury or Illness which may lead to in-patient hospital treatment or before any arrangements are made for repatriation or in the event of Curtailment necessitating Your early return to Your Home Area You must contact the Emergency Assistance Service. The service is available to You and operates 24 hours a day, 365 days a year for advice, assistance, making arrangements for hospital admission, repatriation and authorisation of medical expenses. If this is not possible because the condition requires immediate emergency treatment You must contact the Emergency Assistance Service as soon as possible. Private medical treatment is not covered unless authorised specifically by the Emergency Assistance Service. Medical assistance abroad The Emergency Assistance Service has the medical expertise, contacts and facilities to help should You be injured in an accident or fall ill. The Emergency Assistance Service will also arrange transport to Your Home Area when this is considered to be medically necessary.

11 Payment for medical treatment abroad If You are admitted to a hospital/clinic while abroad, the Emergency Assistance Service will arrange for medical expenses covered by the policy to be paid direct to the hospital/clinic. To take advantage of this benefit someone must contact the Emergency Assistance Service for You as soon as possible. Outpatient treatment If You need outpatient medical treatment, please provide a copy of Your validation certificate to the doctor and Your treatment will be paid for by HealthWatch S.A in line with Your policy. You will need to pay any Excess at the time of treatment. Note: Some clinics may not wish to settle their bill directly with Us and You may be asked to pay for Your treatment and claim this back upon Your return. Instructions to Outpatient Clinics Please send details of the treatment provided, costs after the Excess deduction and a copy of the patients validation certificate to: HealthWatch S.A. newcase@healthwatch.gr Out Patient Department Fax: or Out Patient Department Tel: You must include your bank account details, IBAN no s and / or Swift code for payment to be processed electronically. Alternatively you can contact the Company during the office hours: By telephone: +44 (0) By fax: +44 (0) By claim@uk.cntaiping.com

12 Declaration Period The Insured must declare any claim within five working days following the date on which the claim is known, except in the event of an accidental case. The coverage will not apply if the Insurer establishes that this delay has prejudiced a claim. Doctors and/or Experts of the Insurer Doctors and/or experts of the Insurer may request an inspection of the state of health of the Insured. Any unjustified refusal to comply with this inspection, after notice by registered letter with advice of receipt, shall lead to forfeiture of the Insured Legal and Statutory Provisions This insurance shall be governed by and construed in accordance with the Law of England and Wales unless the Insured person s habitual residence (in the case of an individual) or central administration and/or place of establishment is located in Scotland or Northern Ireland in which case the law of Scotland shall apply. Subrogation We are entitled to take over any rights in the defence or settlement of any claim and to take proceedings in Your name for Our benefit against any other party. False Declarations Independently of the ordinary causes of invalidity and of the causes of reduction of the services, the insurance policy is void in the event of a reticence or an intentional false declaration by the Insured, when this reticence or this false declaration changes the object of the risk or reduces its opinion for the Insurer, even when the risk omitted or misrepresented by the Insured has had no influence on the claim. The premiums paid shall then remain acquired by the Insurer, which is entitled to be paid all premiums fallen due as damages.

13 Arbitration Since the present policy is drawn up and signed in good faith, the contracting parties undertake, in the event of a disagreement, to go to law only after having attempted conciliation. To this end, they shall each designate an arbitrator. If the two arbitrators were unable reach an agreement concerning the decision to be taken, they would choose by joint agreement a third arbitrator to settle the matter, and all three would operate on the basis of a majority of votes. Each party pays the costs and fees of their arbitrator and, if applicable, half the fees of the third arbitrator.