Insurance Conditions (VB) VIVANTE Long-term Care Insurance for Individuals

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1 Insurance Conditions (VB) VIVANTE Long-term Care Insurance for Individuals KLG en List of Contents Introduction Insurance Cover 1 What is covered by VIVANTE? 2 How is the need for care assessed? 3 What are the various care levels? Benefits 4 When does the entitlement to benefits begin? 5 When is the entitlement to benefits altered and when does it end? Benefits Processing 6 Who assesses the need for care, and how is this done? 7 How and where are benefits provided? 8 In what cases are benefits not provided? 9 What are my particular obligations in the event of a claim? General Provisions Period of Insurance 10 When does the insurance cover take effect? 11 When does the insurance relationship end? 12 How can I terminate the insurance? 13 When is the insurer entitled to alter the insurance relationship, in particular the Insurance Conditions (VB)? Premium 14 How is the premium charged? 15 When and how is the premium altered? 16 What are the consequences of late premium payment? 17 When is there an entitlement to reimbursement of the premium? 18 Can premiums be offset with benefits, and can benefits be assigned or pledged? Benefit Exclusions 19 What is not insured? Data Protection 20 How is my data handled? 21 Which companies are members of the Helsana Group? 22 Which companies are partner companies of the Helsana Group? 23 Is personal data transmitted to third parties? 24 How long is personal data stored? Notices 25 How do I receive information? Obligations of the Insured Person 26 What are my obligations as an insured person? Partner von Helsana Place of Jurisdiction 27 Where is the place of jurisdiction? Special Right of Termination 28 When does a special right of termination exist? Glossary Questionnaire for Assessing the Need for Care Item Key Translation: Only the original German text approved by the Swiss Supervisory Authority is binding. Introduction Insurer Unless otherwise stated below, Helsana Supplementary Insurances Ltd (hereinafter referred to as the «insurer») will provide the insurance benefits as the counterparty to the insured party(-ies) in the insurance policy. You can find the main terms of your supplementary insurance in your insurance policy (this shows the details of the insurance cover you have chosen); in the Special Insurance Conditions (BVB) agreed with you. In this case, there would be a reference to them in your policy; in the Insurance Conditions before you (VB); in the Federal Act on Insurance Contracts (VVG). The health care insurer indicated in the header is entitled to receive announcements and notices for Helsana Supplementary Insurances Ltd and to communicate announcements and notices to policyholders and insured persons on behalf of Helsana Supplementary Insurances Ltd. Announcements and notices sent to the health care insurer indicated in the header are legally deemed to have been sent to Helsana Supplementary Insurances Ltd. Glossary The glossary in the appendix forms an integral part of these Insurance Conditions. Terms in italics are explained in the glossary.

2 Insurance Conditions (VB) VIVANTE Long-term Care Insurance for Individuals 2 Insurance Cover 1 What is covered by VIVANTE? According to the insurance option selected, VIVANTE protects the insured person against the economic consequences of a need for long-term care that arises due to illness or accident. VIVANTE provides fixed-sum insurance cover: In the event of a proven need for care, it provides benefits in accordance with the insurance contract without the need to substantiate a claim. Persons in need of care are considered to be persons who, due to illness or accident, require a substantial level of third-party assistance to perform the 10 activities of daily living (ADLs) for an extended period of time, i.e. for at least six months in accordance with medical knowledge. The need for personal supervision does not in itself represent a need for care. 2 How is the need for care assessed? The need for care of the insured person is assessed using the questionnaire in the appendix to evaluate how restricted the person is in performing each of the 10 activities of daily living via a points system. For each question, 0 points indicates no restriction, 5 points indicates moderate restriction and 10 points indicates severe restriction. The points for all 10 activities of daily living are totalled, yielding a value between 0 and 100 points. 3 What are the various care levels? There are four care levels: 25% of the agreed daily allowance is paid out starting from a score of 25 points (care level 1) 50% of the agreed daily allowance is paid out starting from a score of 50 points (care level 2) 75% of the agreed daily allowance is paid out starting from a score of 75 points (care level 3) 100% of the agreed daily allowance is paid out with a score of 100 points (care level 4) The amount of the agreed daily allowance is specified in the insurance policy. Benefits 4 When does the entitlement to benefits begin? The entitlement to benefits begins no earlier than the day on which the need for care is proven to exist. Three requirements must be satisfied in this regard: A medical certificate must provide confirmation of an illness or an accident; a resulting need for care that is predicted to last at least six months; in addition, assessment using the questionnaire (in the appendix) must indicate a need for care with a score of at least 25 points. For illness, it must also be noted that, due to the waiting period, there is no entitlement during the first three years of insurance. There is no waiting period for benefits in the event of an accident. A waiting period of three years also applies for occupational illnesses. If an illness or occupational illness occurs during the waiting period and persists thereafter, an entitlement to benefits shall exist upon expiry of the waiting period. 5 When is the entitlement to benefits altered and when does it end? The entitlement to benefits is altered when reassessment of the need for care indicates that a different care level is applicable. The entitlement to benefits ends when reassessment of the need for care using the questionnaire indicates a total score of fewer than 25 points, or in any case upon termination of the contract or the death of the insured person. Benefits Processing 6 Who assesses the need for care, and how is this done? The insured person must notify the insurer of the claim within 14 days. The insurer then requests a medical report that must confirm the presence of an illness or accident, as well as a need for care (for at least six months). If the insured person is under the care of a specialist, the insurer shall then assign this specialist to assess the need for care. If the insured person is not under the care of a specialist, the insurer shall assign a specialist independent of the insurance to perform this assessment. The specialist shall assess the need for care by filling out the questionnaire and immediately sending it to the insurer for evaluation. The insurer is entitled to verify medical assessments and the need for care at any time. 7 How and where are benefits provided? Benefits are calculated on a daily basis and are paid out once per month. The payment is made in Swiss national currency to a bank account in Switzerland. Unless otherwise agreed with the insurer, the insured benefits shall only be paid for care performed in Switzerland. 8 In what cases are benefits not provided? In addition to the benefit exclusions specified in Section 19, no benefits are provided in the following cases: in the event of a need for care that cannot be attributed to illness or accident, in particular maternity, prenatal damage, congenital defects and the directly resulting consequences thereof; for hospital stays on the part of the insured person (e.g. due to a temporary deterioration of their condition); within the waiting period; for care provided abroad; in the event that the duties of notification and other obligations necessary to make a claim have been violated (with the exception of any such violation that occurs through no fault of the insured person).

3 Insurance Conditions (VB) VIVANTE Long-term Care Insurance for Individuals 3 9 What are my particular obligations in the event of a claim? Each instance of care that could be used to justify an entitlement to benefits must be communicated to the insurer in writing within 14 days. The same procedure must be followed for any alteration in the need for care and for every admittance to a hospital or release from a hospital. If the insured person fails to comply with this procedure, the insurer can reduce or suspend the benefits. If notification of the need for care is late, entitlement to the insured benefits will commence on receipt of the notification at the earliest. If so requested by the insurer, the insured person must undergo a medical examination by a doctor designated by the insurer. Similarly, the insurer can assign specialists to verify or reassess the need for care. General Provisions Period of Insurance 10 When does the insurance cover take effect? The insurance cover takes effect on the date specified in the policy. The minimum period of insurance is one year. The contract shall be tacitly renewed for a further year on reaching the expiry date. 11 When does the insurance relationship end? Unless otherwise agreed, the insurance shall expire: in the event of termination, effective as of the end of the year, subject to the agreed notice period; if the insured person takes up permanent residence abroad; on the death of the insured person. 12 How can I terminate the insurance? This insurance can be terminated in writing effective as of the end of a calendar year, subject to a threemonth notice period following an uninterrupted oneyear insurance period. The termination shall be deemed on time if it is received by the insurer at the latest on the last working day of the month before commencement of the three-month notice period. Following each claim for which the insurer provides benefits, the policyholder can terminate this insurance in writing within 14 days of receiving the compensation or the relevant acknowledgement. The insurance cover shall cease when the insurer receives the notice of termination. Policyholders who are not in agreement with an alteration to the insurance according to Sec tion 13 or a premium alteration according to Section 15 of these Insurance Conditions can terminate this insurance product as of the date of the alteration. If the insurer does not receive notice of termination within 30 days of informing the policyholder of the alteration, the policyholder is deemed to have given their agreement. Premium alterations due to change of residence do not give entitlement to the aforementioned extraordinary termination. The insurer shall waive its legally valid right of termination in the event of a claim or upon expiry of the contract. It retains the right to withdraw from the contract in the case of conduct contrary to the terms of the contract. 13 When is the insurer entitled to alter the insurance relationship, in particular the Insurance Conditions (VB)? The insurer is entitled to alter the Insurance Conditions for any of the following reasons: expansion in the number of service providers or establishment of new types of service provider; recent developments in medicine and health care; creation of new or more cost-intensive types of therapy or care; alterations to compulsory health care insurance bene fits or the introduction of compulsory nursing insurance. If these Insurance Conditions are altered for these reasons, the new conditions shall become valid for the policyholder and the insurer. The insurer shall inform the policyholder in writing of any such alterations. Premium 14 How is the premium charged? The premium for the entire calendar year is payable in advance. For insurance policies concluded during the calendar year, the premium is calculated for the remaining period. The months of commencement and termination of the insurance are counted as whole months for payment purposes. 15 When and how is the premium altered? The insurer can set new premium tariffs each year on the basis of cost trends, claims experience and adjustments to the scope of coverage. The insurer shall inform policyholders in writing of any such alterations. If a change of residence results in a pre mium adjustment, the premium shall be altered from that point in time. 16 What are the consequences of late premium payment? If the policyholder does not fulfil their obligation to pay, they will receive a written reminder to make payment within 14 days of the date the reminder is sent, regardless of any agreed instalment payments. If the reminder does not meet with the desired success, the obligation to provide benefits will be suspended on expiry of the reminder period. The insurer also reserves the right to withdraw from the insurance.

4 Insurance Conditions (VB) VIVANTE Long-term Care Insurance for Individuals 4 There is no entitlement to claims for illnesses, accidents and their consequences occurring during the benefit suspension period, even upon retroactive payment of the premium. The policyholder must compensate the insurer with an amount of at least CHF 50 for the additional administrative expenses incurred due to the reminder process. If the insurer is obliged to instigate debt collection proceedings, the policyholder must compensate the insurer with at least CHF 150 for the insurer s resulting additional administrative costs, in addition to the debt collection costs. 17 When is there an entitlement to reimbursement of the premium? If the premium has been paid in advance for a set period of insurance and the contract is terminated for legal or contractual reasons before the end of this period, the insurer will reimburse the premium for the unused period. There is no entitlement to reimbursement if the contract was in effect for less than one year and the insured person caused the contract to be dissolved by terminating it. 18 Can premiums be offset with benefits, and can benefits be assigned or pledged? The insurer has an offset right vis-à-vis the insured person, but the insured person has no offset right vis- à- vis the insurer. Benefits can only be legally pledged or assigned to third parties with the insurer s written consent. Benefit Exclusions 19 What is not insured? In addition to the benefit exclusions specified in Section 8, no benefits are provided in the following cases: illnesses, accidents and their consequences which had already taken place when the insurance was concluded; which occur after the insurance has expired; which continue to exist following expiry of the insurance cover, even if benefits were already paid out during the period of insurance; which can be attributed to exceptionally dangerous activities or hazardous behaviour; due to the consumption of alcohol, medication, drugs or chemicals; due to warlike events in Switzerland or the Principality of Liechtenstein; due to warlike events abroad, unless the insured person becomes ill or has an accident within 14 days of such warlike events breaking out in the country in which they are staying and this outbreak took them by surprise; cosmetic treatment and surgery; health damage resulting from exposure to ionising radiation and damage caused by atomic radiation; self-mutilation and suicide attempts; damage that is deliberately caused. In the event of grossly negligent causation of damage, the insurer can reduce the benefits according to the degree of blame. Data Protection 20 How is my data handled? Helsana Supplementary Insurances Ltd and the other companies in the Helsana Group handle the personal information of insured persons for the purposes of contractual processing and in order to provide personalised patient advice and care, but also in order to continually improve the quality of products and services they offer their potential, existing and former policyholders. The insurer can also commission other parties to process such information. The data is evaluated using mathematical and statistical methods to form needs-oriented customer groups in order to optimally address the varying individual needs of insured persons, and to enable Helsana Supplementary Insurances Ltd, the companies in the Helsana Group and partner companies (specifically those listed on the insurer s website) to provide cost-effective products and services of interest to potential, existing and former policyholders. Helsana Supplementary Insurances Ltd and the other companies in the Helsana Group are therefore also expressly entitled to examine any existing health insurance files related to basic and/or supplementary insurance and to process this information for the aforementioned purposes in the area of supplementary insurance (only). 21 Which companies are members of the Helsana Group? In addition to Helsana Supplementary Insurances Ltd, the members of the Helsana Group are Helsana Insurance Company Ltd, Progrès Insurance Company Ltd, sansan Insurance Ltd, avanex Insurance Ltd, maxi.ch Insurance Ltd, aerosana Insurances Ltd, Helsana Accidents Ltd, Helsana Investment Ltd, Helsana and procare Providence Ltd. 22 Which companies are partner companies of the Helsana Group? The current partner companies of Helsana Supplementary Insurances Ltd and the Helsana Group are listed on the insurer s website. 23 Is personal data transmitted to third parties? Helsana Supplementary Insurances Ltd and the Helsana Group are subject to particularly strict data protection guidelines. Therefore, no personal data is transmitted to third parties outside of the Helsana Group. Exceptions only occur in cases where the disclosure of data is expressly stipulated or permitted by a legal provision. 24 How long is personal data stored? The personal data is only processed and stored in a database or in paper form for as long as required by legal and contractual provisions. Personal data is subsequently deleted.

5 Insurance Conditions (VB) VIVANTE Long-term Care Insurance for Individuals 5 Notices 25 How do I receive information? Policyholders receive notices from the insurer at their most recent reported address in Switzerland. Further information is published in the customer magazine, the insurer s publication medium, and on the insurer s homepage. Obligations of the Insured Person 26 What are my obligations as an insured person? On the application form, you must provide all truthful and complete information pertinent to the assessment of risk and of which you have knowledge, or should have knowledge, upon concluding the insurance policy. If such information is falsely communicated or concealed, the insurer can terminate the contract via a written declaration within four weeks of having become aware of the violated duty of disclosure. If the insurance is dissolved through termination, the insurer s obligation to provide benefits shall cease for any claims events that have already occurred, and the occurrence or scope of which was affected by the pertinent risk-related information that was not communicated or was falsely communicated. If such benefits have already been provided, the insurer is entitled to reimbursement. The applicant and the insured person shall release service providers, health insurers and other responsible entities from their legal duty of confidentiality with regard to the insurer s requests for information, and shall authorise these entities to provide the requested information. Any changes of residence must be communicated to the insurer in writing within a one-month period. In the event of a claim, the insured person must do everything in their power to recover and to refrain from activities that would delay recovery. They are particularly required to comply with the instructions of doctors and medical personnel. In the event an insured person violates this duty to mitigate losses, the insurer can reduce the benefits according to the degree of blame. Place of Jurisdiction 27 Where is the place of Jurisdiction? Actions arising from the insurance contract must be dealt with either in a court of law with jurisdiction for the Swiss domicile of the insured person, or with jurisdiction for the headquarters of the insurer. Special Right of Termination 28 When does a special right of termination exist? For insurance covers that were in effect before , the policyholder has the right to terminate the entire contract in departure from Section 12 of these Insurance Conditions (VB). Glossary 10 activities of daily living 1 Eating 2 Washing 3 Bathing or showering 4 Dressing 5 Getting on and off the toilet 6 Transferring from bed to chair 7 Walking 8 Ascending and descending stairs 9 Controlling bowels 10 Controlling bladder This list is definitive. Accident Accident is the sudden, unintentional and damaging effect of an unusual external factor on the human body, resulting in impairment to physical, mental or psychological health, or death. Bodily injuries similar to those caused by accidents and occupational illnesses are also considered accidents. Bodily injury similar to accident The following conclusive list of bodily injuries are equated with accidents, even without unusual external influences, in as far as they cannot be clearly attributed to an illness or a degenerative process: broken bones; dislocation of joints; torn meniscus; torn muscles; pulled muscles; torn tendons; ligament lesions; damage to ear-drum. This list is definitive. Congenital defects Congenital defects are illnesses already in existence at birth. Exceptionally dangerous activities An insured person is said to be exposed to exceptional danger if they are involved in one of the following activities: participating in civil commotion, acts of terrorism, armed conflicts, or engaging in foreign military service; carrying out deliberate criminal acts; the attempt to carry out deliberate criminal acts; participating in brawls and fights, if the insured was not an innocent party or injured by the fighters in an attempt to help a defenceless person; seriously provoking other persons.

6 Insurance Conditions (VB) VIVANTE Long-term Care Insurance for Individuals 6 Hazardous behaviour Hazardous behaviour consists of actions via which the insured person exposes themselves to particularly great danger, without taking or being able to take the necessary precautions to limit the risk to a reasonable degree. Rescue operations to assist other persons are insured even if they can be regarded as hazardous behaviour. The list drawn up by the Federal Council in the context of the Accident Insurance Act (Art. 39 UVG) is authoritative in this regard. Hospital A hospital is a publicly recognized institution or ward used for the inpatient treatment of acute illnesses and the onsite performance of medical rehabilitation measures. Accredited birthing centres are also considered as hospitals. Illness Illness is any impairment to physical, mental or psychological health, not caused by an accident, and which requires medical examination or treatment, or results in incapacity to work. Insured person(s) The person(s) specified in the policy. Occupational illnesses Occupational illnesses are illnesses caused by particularly harmful materials or certain types of work, as well as other illnesses caused exclusively or to a highly predominant extent by occupational activities. The list drawn up by the Federal Council in the context of the Accident Insurance Act (Art. 9 UVG) is authoritative in this regard. Specialist A specialist is considered to be any graduate health care professional who is recognised and registered as a service provider in accordance with the Federal Health Insurance Act (KVG). Commissioned/employed certified health care professionals are deemed to be equal by the insurer. Substantial assistance An entitlement to benefits is only considered to exist when the need for care reaches at least level 1. Third-party assistance Such assistance consists of taking over or facilitating performance of 10 activities of daily living. The assistance can be performed by specialists or laypersons. Maternity Maternity includes pregnancy and birth, and the subsequent recovery time required by the new mother. Need for care Persons in need of care are considered to be persons who, due to illness or accident, require a substantial level of third-party assistance to perform the 10 activities of daily living for an extended period of time, i.e. for at least six months in accordance with medical knowledge. The need for personal supervision does not in itself represent a need for care.

7 Insurance Conditions (VB) VIVANTE Long-term Care Insurance for Individuals 7 Questionnaire for assessing the need for care Can the client eat without help from others? eating? Can the client perform washing activities without help from others? Does the client require assistance in performing washing activities? Can the client bathe or shower without help from others? bathing or showering? Can the client get dressed without help from others? getting dressed? Can the client get on and off the toilet without help from others? getting on and off the toilet? Continued on the next page Note: Assessment is based on observation over the past four weeks. Points Yes, go to question 2 0 Yes, but only in preparation of the food 5 Yes, go to question 3 0 Yes, go to question 4 0 Yes, go to question 5 0 Yes, go to question 6 0 Score 1

8 Insurance Conditions (VB) VIVANTE Long-term Care Insurance for Individuals 8 Points Can the client transfer (from bed to chair) without help from others? transferring (from the bed to the chair)? Can the client walk without help from others? Does the client require assistance when walking? Can the client ascend and descend stairs without help from others? ascending and descending stairs? Is the client incapable of controlling their bowels? How often is the client incapable of controlling their bowels? Is the client incapable of controlling their bladder? How often is the client incapable of controlling their bladder? Scores Yes, go to question 7 0 Yes, but only to the extent that someone 5 is there to monitor the situation Yes, go to question 8 0 walk with the help of another person) Yes, walking is impossible, requires complete assistance 10 Yes, go to question 9 0 Yes, but only partially (the client can still ascend and 5 descend stairs with the help of another person) Yes, ascending and descending stairs is no 10 longer possible, requires complete assistance Yes, go to the next question No, go to question 10 0 Once a week or less 5 More than once a week 10 Yes, go to the next question No (questionnaire completed) 0 Once a day or less 5 More than once a day 10 Score 1 Score 2 Total score Scoring key I obtained the following score: Below points points points 100 points This indicates: No need for care Care level 1 Care level 2 Care level 3 Care level 4 The insurer will pay: No daily allowance 25% of the agreed daily allowance 50% of the agreed daily allowance 75% of the agreed daily allowance 100% of the agreed daily allowance

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