INFORMATION ON CHARACTERISTICS OF FINANCIAL SERVICE AND ELEMENTS OF VOLUNTARY HEALTH INSURANCE CONTRACTS

Transcription

1 Generali Osiguranje Srbija a.d.o. Vladimira Popovića Beograd / Srbija T F kontakt@generali.rs generali.rs ZA (ZD PR 01) INFORMATION ON CHARACTERISTICS OF FINANCIAL SERVICE AND ELEMENTS OF VOLUNTARY HEALTH INSURANCE CONTRACTS I. Voluntary Health Insurance By concluding voluntary health insurance contracts, Insured can be provided with different types and/ or larger contents, scope and standard of rights in obtaining medical protection than rights guaranteed under mandatory insurance. Types of voluntary health insurance which could be conducted by GENERALI OSIGURANJE SRBIJA a.d.o. pursuant to Decision on Voluntary Health Insurance are as follows: Parallel Health Insurance Additional Health Insurance Private Health Insurance Combination of parallel, additional and/or private health insurance Capacity of insured within parallel and additional health insurance can be obtained by a person who has the capacity of insured within mandatory health insurance, and within private health insurance can be obtained by a person who does not have a capacity of insured within mandatory health insurance. Policy holder shall be obliged to pay insurance premium by concluding voluntary health insurance contract, and insurer shall be obliged, in case of occurrence, to indemnify treatment expenses or pay financial compensation amounting to sum contracted. Basic characteristics of Generali Osiguranje Srbija a.d.o. voluntary health insurance products 1. Total Medic individual health insurance provides complete health protection. Depending on whether the insured possess mandatory health insurance, GENERALI OSIGURANJE SRBIJA a.d.o. offers two options: individual combined parallel and additional health insurance for those who have mandatory health insurance Individual private health insurance for those who do not posses mandatory health insurance Basic individual health insurance package covers expenses such as: 1. In-patient care 2. Out- patient care 3. Medical protection of pregnant women and newborns Additional care also including compensation for prescription medicines expenses can also be contract with basic Total Medic package. 2. Health insurance of foreigners provides urgent medical assistance to insured foreign citizen for the period of their stay in the Republic of Serbia, meaning medical assistance provided within 12 hours from the moment of reception of insured person in order to avoid expected occurrence of urgent medical condition NOTE: This notice is issued by the Insurer in accordance with the porvisions of the Insurance Law, as well as in accordance with the provisions of regulations governing the protection of personal data, whereby the Insurer meets the requirements referring to notifying the clients in pre-contract stage.

2 3. Vita Sana provides preventive protection, sanitary examination, cover for treatment of urgent conditions as well as one-off financial compensation in case of sever illnesses. 4. Medica Plus voluntary health insurance including Out-patient and in-patient treatments with certain limitations, but satisfying all usual needs for medical services and providing users with privileged treatment and supreme medical assistance. If additionally contracted and paid, additional insurance premium also covers: Physical examination. 5. Medica Exelenta voluntary health insurance enabling complete medical protection. Depending on specific needs and possibilities, a variety of different combinations of basic and additional covers can be contracted with different combinations of sum insured and limits of additional covers. Basic package covers expenses of: Out-patient and in-patient treatments If additionally contracted and paid, additional insurance premium shall also cover: Medical protection of pregnant women and newborns, prescription medicines, physical examination, ophthalmological services, dental services. 6. Insurance in case of severe illness and surgeries this insurance provides special financial assets in case of occurrence of severe illness or performed surgery. It means financial assistance in case of the most severe illnesses and provides feeling of safety even in the most difficult times. 7. Calendar of My Health this insurance includes the general physical exam, medical specialist examinations and diagnostic procedures if during the general physical exam the doctor suspects a malignancy. Critical illness insurance, surgical procedures and daily hospital benefits can also be included. 8. Medica Perfecta with this insurance the insured are entitled to InterConsultation service, and if the diagnosis is confirmed, they are also entitled to Find Best Care service. InterConsultation second medical opinion from the world s most respected medical experts outside Serbia, based on comprehensive review of medical documents and supporting material containing diagnosis of the insured. Find Best Care finding medical care abroad, which implies scheduling an appointment at the medical service provider, arranging a treatment, hotel accommodation and transport and monitoring the patient in order to evaluate the adequacy of medical treatment. This insurance includes: 1) coverage of the following expenses of the insured s treatment abroad (up to the limit set in the insurance policy) related to covered illnesses and medical procedures: treatment, transportation, accommodation, repatriation, acquisition of medicines in Serbia 2) daily hospital benefits (up to the limit set in the insurance policy) during treatment abroad

3 II. Limitations and exclusions of insurer s liabilities All limitations and exclusions of insurer s liability have been provided for under insurance terms and conditions. III. Applicable insurance terms and conditions General Terms and Conditions of Voluntary Health Insurance Special terms and Conditions for Individual Private Health Insurance Special Terms and Conditions for Individual Combined Parallel and Additional Health Insurance Special Terms and Conditions for Voluntary Health Insurance of Foreigners due to Occurrence of Urgent Medical Event during Their Stay in the Republic of Serbia Special Terms and Condition for Collective Combined Parallel and Additional Personal Health Insurance in case of Severe Illnesses, Physical Examinations, Specialist Examinations and Urgent Medical Cases Special Terms and Conditions for Combined Parallel and Additional Health Insurance in case of Severe Illnesses and Surgeries for Employees Special Terms and Conditions for Collective Combined Parallel and Additional Health Insurance for Employees Special Terms and Conditions for Collective Combined Parallel and Additional Health Insurance Special Terms and Conditions for Collective Private Health Insurance Special Terms and Conditions for Collective Additional Personal Health Insurance in case of Surgeries and/or Interventions Special Terms and Conditions for Collective Additional Personal Health Insurance in case of Severe Illnesses Voluntary Health Insurance Special Terms and Conditions, according to selected combination of coverage options Special Terms and Conditions for Group Combined Additional and Private Health Insurance for Treatment Abroad Special Terms and Conditions for Individual Combined Additional and Private Health Insurance for Treatment Abroad IV. Period of Insurance Contract Period of insurance contract is determined under the proposal and/or insurance policy. Insurer s obligation commences at hours on such date which has been specified under the policy as insurance commencement, if contracted premium and/or first installment of premium has been fully paid until such date. In case of failing to pay contracted premium until the date specified under the policy as insurance commencement, insurer s obligation shall commence at hours on such date when contracted premium and/or first installment of insurance premium was fully paid. If waiting period has been contracted, insurer s obligation shall start at hours of such date after the expiry of the waiting period, on condition that premium and/or installment of premium was paid.

4 Insurer s obligation terminates at hours on such date specified under the policy as insurance expiry. Insurer s obligation shall also expiry on such date when death of insured person occurred and when insured person lost their status of mandatory insured person, in case of conclusion of parallel and additional health insurance and/or obtained the status of mandatory insured person, in case of conclusion of private health insurance. Termination of insurance contract and conditions for termination Insurance provider must not terminate voluntary health insurance contract before the expiry of period for which contract was concluded, except in case of failing to pay contracted premium. Exceptionally, insurance provider can terminate voluntary health insurance contract before the expiry of period for which contract was concluded for person who lost their status of mandatory insured person for parallel and additional voluntary health insurance during the period of contract If a policy holder has failed to pay due insurance premium before the contracted term nor it has been done by any other interested person, insurance contract shall terminate after the expiry of 30 days from the date when policy holder was delivered insurer s certified letter with notification of due premiums, providing that such period cannot expiry before 30 days elapsed from the date of premium maturity. Anyway, insurance contract terminates if premium has not been paid within a year from its maturity. The amount of premium, insurance premium payment method, amount of contributions, taxes and other expenses calculated in addition to insurance premium The amount and insurance payment method are provided for under insurance contract/and or insurance policy. Premium is calculated pursuant to insurance premium tariff and depending on contracted sum insured, types of contracted insurance cover, contracted limit for insurance cover, insured person s entry age, insured person s sex, medical condition, participation of insured person in claim (so called participation). Policy holder and/or insured shall be obliged to pay insurance premium duly, on time and withinterms provided for under insurance contract and/or policy. If contracted to pay annual premium in semiannual, quarterly or monthly installments, in case of termination of insurance contract within the period of insurance year, insurer shall be entitled to premium for entire period of insurance year. Insurer shall be obliged as well to accept paid premium from any person having legal interest in having premium paid. Insurer cannot increase period during the period for which contract was concluded. Exceptionally, for contracts concluded for more than one year, premium can be changed after expiry of period of 12 months from the date of conclusion of insurance contract and/or after each 12 months up to expiry of period for which insurance contract was concluded. Neither tax nor other expenses shall be calculated on the insurance premium at the moment of conclusion of insurance contract. Insurance premium shall be paid within contracted terms by cash payment at the post offices or banks, as well as at the Company s cash desks. Further information on detailed instructions for paying premium, account numbers for paying insurance premium can be obtained from Generali Osiguranje Srbija a.d.o. as per instructions given in closing part of this pre-contractual information.

5 V. Period within which proposal is obligatory for insurance company Written proposal made to insurer for conclusion of insurance contract shall be obligatory for offerer, within 8 days, if not provided for otherwise, as of the date of proposal delivery to insurer, and if medical examination is need, then within 30 days. If, within such period, insurer has not rejected proposal not deviating from terms and conditions under which proposed insurance is conducted, it shall be deemed that proposal was accepted and contract concluded. In such case, contract shall be deemed concluded when insurer received the proposal. VI. Method of protecting client's rights and interests All complaints arising from the violation of rights or interests in relation to the Insurer's actions and conduct or decision-making in relation to the insurance agreement or its execution, the client may file personally or through his/her representative, i.e. by proxy, in writing, in one of the following manners: by visiting one of the Insurer's facilities, by sending a complaint by mail to the following address: GENERALI OSIGURANJE SRBIJA a.d.o., Belgrade, Vladimira Popovica Street 8, by filing a complaint on the website by sending an electronic complaint to the address: prigovori@generali.rs, by sending a complaint by fax to the following number: It is necessary for the complaint to contain the following information and documentation: name, surname and address of the complainant (natural persons) or business name, registered office address and name and surname of the legal representative/authorized person (legal entities), the cause of complaint and complainant's request, evidence to support the allegations stated within the complaint, date of filing the complaint, complainant's signature, or the signature of complainant's representative or proxy, unless the complaint is filed in electronic form, the power of attorney for representation, if the complaint is filed by a proxy. The Insurer shall be obliged to respond to the complaint within 15 days, except under special circumstances, for reasons that cannot be attributed to the Insurer's will, when the relevant period may be extended for maximum 15 days, on which the complainant shall be notified accordingly. If the insured person is not satisfied with the response to the complaint, he/she shall be entitled to exercise his/her rights by filing a complaint to the National Bank of Serbia, registered office at the address: Kralja Petra Street 12, Belgrade and Nemanjina Street 17, Belgrade, in the capacity of the authority competent for the supervision over Insurer's business operations.

6 Court in Belgrade shall have jurisdiction for court disputes in connection with conclusion of insurance contract. Insured within voluntary health insurance who has been deprived of the right to medical protection and/ or who is not satisfied with provision of medical services included in voluntary health insurance at the medical institution, private practice and/or at other medical services provider s can lodge a complaint to a medical worker managing work process or to a person employed at medical institution protecting patients rights, pursuant to the law governing medical protection and/or to a founder of private practice and/or competent person with other medical service provider s. VII. Competent authority for supervision over the insurance company s operations Supervision over the insurer s operations is performed by The National Bank of Serbia 12 Kralja Petra Street, Beograd 17 Nemanjina Street, Beograd VIII Personal Information Processing and Keeping Insurer shall, for the purpose of insurance contracts conclusions as well as meeting obligations under the insurance contracts, and pursuant to law regulation personal information protection, collect and process information on policy holder and/or insured before the conclusion of contracts. Without personal information collecting and processing, insurer is not able to maintain the insurance contract in force. Insurer shall process and forward information on insured/policy holder to its employees, medical institutions which it has service contract concluded with, such can be delivered to reinsurer or co-insurer which risk distribution contracts would be concluded with, in order to meet obligations under the insurance contracts and/or to public authorities and other institutions which, pursuant to law and by the nature of their operations have insight in or process personal information (the National Bank of Serbia, representatives of ministries and other government authorities, external auditors etc.). A list of medical institutions which the Company has service contracts concluded with and can exchange information on policy holders and insured in order to fulfill insurance contracts (inclusive of information on medical conditions as particularly sensitive information) is published on web site The insurer is allowed to process the policyholder/insured s data (name and surname, and telephone number), with prior consent, for the purpose of customer satisfaction survey throughout the duration of the insurance contract, and share them with Medallia, Ltd. 90 High Holborn, London, WC1V 6XX (hereinafter: Medallia), with which it has entered into a Data Processing Agreement, in order to implement the Project of analysis of clients satisfaction. Medallia processes personal data in the name and on behalf of the insurer. The survey process is arranged so that the customers are sent a Customer Satisfaction Questionnaire via . Upon receiving the Questionnaire with answers, Meadllia processes the information and sends the survey results to the insurer. Upon receiving the survey results, an employee of GENERALI OSIGURANJE SRBIJA a.d.o. may in some cases contact the customer in order to resolve some issues which the customer listed in the Questionnaire as problematic.

7 Data Processing Agreement signed with Medallia details the technical and organizational measures of data protection, as well as the measures for prevention of unauthorized and illegal processing, unintentional loss, destruction or damage. All information process for the purpose of insurance risk assessment and contracting insurance as well as for the purpose of meeting insurance contract and/or if agreed to by policy holder/insured, for other purposes as well, insurer shall keep both in electronic format and physically. GENERALI OSIGURANJE SRBIJA a.d.o. applies general acts on personal data protection and trade secret; it also holds the ISO certificate which strictly regulates the protection of data the Company uses and receives in its business operations. Information protection measured shall mean in particular as follows: 1. Use of computer, as well as of application within IT system is provided for under a set of internal procedures and instructions. 2. Users shall be obliged to lock computers when they leave rooms. 3. Rooms are secured by physical security of a building, as well. 4. All users computers in the Company are part of the internal network and all of them have internet access through centralized proxy server. 5. All computers are protected by corporate anti-virus solutions. 6. Keeping hard-copy information in the cabinet with lock during off-business hours and at the time when there are no employees in the office All databases kept and processed by insurer are registered with Central Data Collections Registry. Policy holder and insured shall be entitled to all legal rights in case of unauthorized information processing and/ or processing contrary to the purpose of meeting insurance contract and contrary to consent provided in insurance policy, and shall also be entitled to be notified, have insights in information and copy of it. If a policy holder/insurer has provided their consent to information processing for other purposes apart from the purpose of concluding and meeting insurance contract, such consent can be revoked, pursuant to the Law on personal information protection, providing that insurer shall be entitled to compensation for damage which insurer might suffer from such revoking. At the request of prosperous policy holder, insurer shall forward all documents necessary for conclusion of insurance contract as well as information o medical institutions, private practice, and/or other medical services provider where voluntary health insurance rights can be exercised. For further information, please contact the insurer GENERALI OSIGURANJE SRBIJA a.d.o. Beograd, at 8 Vladimira Popovića Street, Belgrade, phone number 011/ or by kontakt@generali.rs.