Product Information on STÚDIUM Fee-for Service Health Insurance

Transcription

1 Product Information on STÚDIUM Fee-for Service Health Insurance The Core Concept of STÚDIUM Insurance The STÚDIUM product of Generali-Providencia Biztosító Zrt. (Generali-Providencia Insurance Ltd.) provides a fee-for-service health insurance coverage within the territory of the Republic of Hungary primarily for foreign citizens and their relatives, provided that they have already reached 16 years of age but are not older than 65 years of age, are not insured under the state insurance scheme in Hungary, and are named as insured in an insurance contract for STÚDIUM insurance. The insurance covers the costs of surgeries, medical treatments and services, medications and medical aids, and in medical necessity, patient transport of the insured, if the named service or services are provided by the designated health care service provider or with the connivance thereof, or if the urgency of the matter as understood in accordance with the professional principals of medicine, requires the insured to use such health care services at a health care service provider or institution other than the designated one. You may read detailed information on this insurance product in STÚDIUM Fee-for-Service Health Insurance Terms and Conditions. You are advised to carefully read this product information as well as the insurance terms andconditions referred to above which are part of the insurance contract, so that you can clearly understand what events are covered under the insurance you wish to take out. Please be advised furthermore that as set forth in the insurance conditions there are cases which are not covered under this insurance, or where the benefit payment is limited, or where the Insurance Company may be exempt from benefit payment. What you need to know about this insurance: Parties to the insurance contract: policyholder: a party that enters into the insurance contract and undertakes to pay the insurance premium. insured: any natural person who is not less than 16 and not more than 65 years of age as at the date when the insurance contract is concluded and whose health is covered under the insurance contract with respect to specific insured events, and who is a student at the University of Debrecen (registered seat: H-4032 Debrecen, Egyetem tér 1.) during the term of the insurance but is not insured under the national social insurance scheme in Hungary may be insured by this insurance. Insured, furthermore may be any natural person with foreign citizenship who is a close relative to an insured as defined above, and has not reached the age of 65. Conclusion of the insurance contract: the insurance contract is concluded when the insured completes the consolidated version of the Proposal/Policy/Statements form with the required information, and signs it. Whenever insurance is taken out the standard form of the consolidated Proposal/Policy/Statement document referred to herein must be completed and signed. Effective from: 1st September /4 and the translated English version, the Hungarian version shall prevail.

2 Health insurance card: a numbered card with an embedded hologram issued by the insurance company containing the most important data related to the insurance, the insurance period for which the insurance premium has been paid and the reference number of the proposal/policy/statement, which is designed to be proof of the insured status before the Health care service provider. A Health insurance card shall be issued for any one insured only once, when the first insurance is concluded. If the insured takes out insurance once again after the first insurance period is over by completing and signing a new Proposal/policy/statement form, the health insurance card, which has been issued before, shall be validated with a hologram that contains the period of the particular insurance as well as the number of the signed Proposal/policy/statement. Insurance year: one (1) year starting on 1st September of the current year and ending on 31st August of the subsequent calendar year. Insurance period: the insurance year can be divided into two insurance periods: I. insurance period shall last from 1st September of the current year to 28th February of the year following the current year. II. insurance period shall last from 1st March of the current year to 31st August of the current year. In any one insurance period the insured can have only one valid STUDIUM insurance policy. Coverage under the insurance: effective from 0 hours of the day following the day when the consolidated version of the Proposal/Policy/Statements form is signed by the insured, provided that the insurance premium for the insurance period has been credited to the bank account of the insurance company in full. No waiting period. Insurance premium: the premium payable for the insurance cover, which is due in one sum at the time when the insurance is concluded for each insurance period (that is for each insurance policy). The insurance premium for the given insurance period is shown in the Proposal/policy/statements printed form. Irrespective of the date when the insurance is concluded in any given insurance period, the insurance premium shall be paid in a total amount for the insurance period. Geographical limit: The Republic of Hungary. Limit: HUF /insurance period The insurance company shall pay a maximum of three million Hungarian forint to cover the costs of medical services received by the insured in medical necessity in any one insurance period (of which maximum HUF shall be paid to cover the costs of medicinal products (medications) and medical aids). Deductibles: the insurance company shall pay 70% of the costs of medicinal products and medical aids purchased or received in medical necessity, so these costs shall be subject to 30% deductibles. Other deductibles shall not be applied. Premium of the insurance contract: Insurance premium shall be due in one sum at the time when the insurance is concluded. Designated health care service provider and medical center: Debreceni Egyetem Orvos- és Egészségtudományi Centrum [University of Debrecen - Medical and Health Sciences Centre] (Nemzetközi Oktatási Központ ) [Secretariat of the English Program] H-4012 Debrecen, PoBox 48. OR H-4032 Debrecen, Nagyerdei krt.98. Tel.: (52) , fax: (52) Effective from: 1st September /4 and the translated English version, the Hungarian version shall prevail.

3 Costs of medical services provided by the designated health care service provider or by referral thereof, do not need to be prefinanced by the insured, as the insurance company covers the cost of medical treatments by direct payment to the designated health care institute. Documents related to the insurance: to take out the insurance, you need to complete a threepart carbonless form of the consolidated version of the Proposal/policy/statements document. The proposal/policy/statements document is drawn up in English and in Hungarian. The health insurance card is issued in a bilingual format (English and Hungarian). The data required for the identification of the insured and for the conclusion of the contract shall be given correctly and in full on the proposal/policy/statements document and on the card; these documents shall also contain the key data of the insurance (validity, premium, policy number, etc.) It is important that both the card and the insured s statement shall be signed by the policyholder or the insured where indicated so that the documents be legally valid and the insurance can take effect. The first (upper) and second copy of the insured s statement must be submitted to the insurance company, the third copy shall remain with the insured; the health insurance card shall also remain with the insured. Please note that the health insurance card is only valid together with a passport, thus it is important that the insured should carry both the health insurance card and his/her password at all times. Procedure of taking out insurance: Before taking out the insurance please carefully read all documents relating to the product (see hereunder). If you wish to take out this insurance, you need to complete the forms mentioned above (the insured s statement, the card) with accurate and complete information if you need help turn to the insurance intermediary or the administrator, sign them at all the places indicated (see as described above), and present a copy of the proof of payment (bank account statement or post office giro) of the full amount of the insurance premium to the insurance intermediary or the administrator. You will then receive the card (please make sure you always carry it, together with your passport) and the second copy of the insured s statement. Other documents with information on your insurance you may wish to read: this product information (in English), the general terms and conditions of the insurance (in English), the Customer Information of the Insurer (with key data of the insurer, in English). Should the insured be treated by a health care service provided other than the designated one, the designated health care provider shall be notified or informed (by the insured or by the health care institution providing the medical treatment to the insured) if practicable then before the medical treatment is started but no later than on the weekday following the day of such treatment of the name of the institution where the insured receives/received treatment and of the medical condition that is/was treated, to facilitate that the designated health care service provider may contact the treating physician, facility or health care service provider. If the condition of the insured only allows him/her to warn the treating health care service provider of the above obligation to supply information, then the insured shall not delay to do so, as it may help the insured to receive earlier and better treatment. The reverse of the health insurance card contains information which may be useful for the institution providing medical care. Effective from: 1st September /4 and the translated English version, the Hungarian version shall prevail

4 The itemized invoice for the health care services received shall be issued to the name of the designated institution (Debreceni Egyetem Orvos- és Egészségtudományi Centrum [University of Debrecen Medical and Health Sciences Center], 4032 Debrecen, Nagyerdei krt.98.), with the insured s name also shown on the invoice. The original invoice together with all medical documentation in connection with the medical service (hospital discharge report, outpatient record) shall be submitted in person or by mail to the address of the designated health care service provider specified above (in the first case to the cash desk of the health center specified herein during the office hours given above). If the insured purchases medications or medical aids in a medical necessity and in a medically reasonable manner, (from or by prescription of the designated health care service provider, or in a medical urgency by prescription from the treating physician), the insured must request an invoice issued to the name and address of the designated health care service provider (Debreceni Egyetem Orvos- és Egészségtudományi Centrum [University of Debrecen Medical and Health Sciences Center], 4032 Debrecen, Nagyerdei krt.98.) with the insured s name also shown on the invoice. The invoice, accompanied by a separate document with your bank account number, needs to be submitted in the manner described above to the designated health care service provider, so that the costs of the medications or medical aids, net of the 30% deductible, may be reimbursed by the insurance company as soon as practicable. If you do not provide a bank account number, the insurance company cannot reimburse payments. Effective from: 1st September /4 and the translated English version, the Hungarian version shall prevail

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