2014 JUNIOR EXPAT HEALTH INSURANCE FOR PEOPLE UNDER 36 WORLDWIDE MSH INTERNATIONAL on behalf of ASFE HEALTH INSURANCE ALL OVER THE WORLD
ASFE s : why do you need coverage? HEALTH INSURANCE ALL OVER THE WORLD For twenty years, ASFE has designed and managed international healthcare insurance solutions for all mobile individuals: Expatriates living abroad alone or with their families, Students, interns and young people with «Working Holiday Visas», Self-employed persons or company employees, Seniors. Wherever you are going, we will be by your side day after day Insurance plan managed by: 2 2
An insurance solution adapted to your situation For your stay abroad, wherever you are in the world, the plan is a comprehensive insurance package including coverage for healthcare, hospitalization, medical assistance / repatriation, loss or theft of luggage, personal third-party liability and death & disability. You are aged under 36. You are going abroad for a duration of three to twelve months (renewable), whether you are traveling around the world, on assignment, internship/studying, on a Working Holiday Visa, or for any other reason. ASFE guarantees you the following: Why choose ASFE? triates worldwide; coverage by market-leading insurers and assistance companies: AXA and Europ Assistance; on-line services making your life easier: on-line enrollment and payment, submission of claims and reimbursement tracking system, etc.; healthcare costs reimbursed on the basis of charges incurred, without deductibles, and direct hospital contact with our teams, available 24/7, thanks to our four claims departments in Calgary, Paris, Dubai, and Shanghai. 3
ASFE s Your Healthcare, Death & Disability and Third-Party Liability benefits To give you peace of mind when leaving your country of origin and allow you to make the most of your stay abroad, provides you with a comprehensive plan for healthcare, death & disability, third-party liability and assistance (including luggage assistance) covering you in any of these situations. HEALTHCARE BENEFITS We cover up to 200,000 of your medical and hospital expenses during your stay. In case of unforeseen illness* or accident*, ASFE reimburses the following costs: - 100% of charge - Consultations (excluding dentist), prescription drugs, laboratory test and handling fees, x-rays, medical imaging (M.R.I.) and scans, tests and paramedical fees - Dental care in case of accident or dental emergency* not resulting from a previous bad state of teeth or gums 100% of charge 100% of charge, up to 305 DEATH & DISABILITY BENEFITS Because an accident or unforeseen illness can result in a lot more than just medical expenses, ASFE provides in the event of: - Death - In case of Accidental Permanent Disability upon your enrollment (with a disability rate of at least 33%) PERSONAL THIRD-PARTY LIABILITY BENEFIT - For all damage 1,524,490 - For material damage only 762,245 *DEFINITIONS - Accident: Any unintentional personal injury suffered by an insured member and arising exclusively from the sudden unexpected effects of an external cause (such as sprains, fractures, etc.) surgery or treatment are required and cannot be delayed until return or repatriation to the country of - Dental emergency: Any infectious involvement of roots that might cause complications if not treated within 48 hours. We reimburse expenses after studying the medical or dental report provided by the insured member 4
ASFE s as well as your Assistance benefits ASSISTANCE BENEFITS MEDICAL ASSISTANCE AND EMERGENCY REPATRIATION - Assistance and repatriation: arrangement and coverage of the insured member, transportation to a nearby healthcare facility or repatriation to the country of origin Charges incurred - Return of an accompanying insured member Return trip Round-trip ticket + 100 per night, limited to 1,000 - Return to the place of residence after repatriation in the country of origin One-way ticket Round-trip ticket ASSISTANCE IN THE EVENT OF DEATH - Repatriation of the body to the country of origin Charges incurred 2,000 - Early return in the event of death of a family member Round-trip ticket Round-trip ticket + 100 per night, limited to 200 TRAVEL ASSISTANCE - Advance of bail bonds 15,000 - Advance and coverage of legal fees 3,000 - Mountain and sea search expenses 15,000 - Access to the on-line lock-box service of Europ Assistance «123 classez» during your policy term Free subscription to the website LUGGAGE INSURANCE (COVERAGE FOR LUGGAGE BELONGING TO YOU) - Theft, partial or total destruction and loss of luggage 2,000* - Indemnity in case of delay in delivery of your luggage at the airport (exceeding 24h) 300 - Recovery costs for identity papers 150 AND ALSO - Early return in the event of an attack or natural disaster - Assistance in the event of theft, loss or destruction of identity papers, with an advance of funds of 2,300 - Coverage of costs incurred in the event of an extended stay, up to 100 per night and limited to 1,000 - Delivery of medication that cannot be found locally or transmission of urgent messages *Deductible of 30 / suitcase limited to 50% for valuable objects 5
ASFE s Efficient on-line services Find out about all the services included in your Participants Pages. As soon as your enrollment is completed, you will receive a Welcome Package including all useful etc.). You can also access your dedicated members pages via our website www.asfe-expat.com to manage Your on-line Participants Pages allow you to: YOUR JUNIOR EXPAT PLAN - Print your insurance ID card - Update your personal details: E-mail address address, mailing address, bank details, etc. - Fill out and print your claim forms for your healthcare expenses - Check the progress of your claims and view your reimbursement notices from the last 24 months - Download and print your member s practical guide - Consult the Expat Health section of your Participants Pages to access our network of more than 750,000 healthcare providers worldwide (hospital facilities, healthcare practitioners, etc.) - Use the «Submit an inquiry» section to ask any question you may have, ensuring that you are contacting the dedicated person within our claims teams 6
ASFE s : our services ASFE s Assets of ASFE An international team available for you at any time. In order to make your healthcare plan administration formalities easy from abroad, we strive to provide you with the greatest responsiveness to process the reimbursement of your routine medical expenses as well as to deal with more complex situations. Our multicultural team is at your service to answer any question or concern you may have in a timely manner. Go abroad with peace of mind: our claims departments located across the globe on four continents case of emergency. - Available 24/7 - Teams representing more than 45 nationalities and speaking over 30 languages to provide our members with international administration services YOUR JUNIOR EXPAT PLAN Paris (France), Calgary (Canada), Dubai (United Arab Emirates), Shanghai (China) treatment exceeding 400 or $400 accepted or at a later date of your choice your request - Worldwide reimbursements in more than 150 currencies - Medical second opinions if you are unsure of the diagnosis you have been given A multicultural medical team including 20 consulting physicians
ASFE s : rates ASFE s 2014 Your premium for 2014 Useful tip You can only enroll to insurance on an individual basis. If you are leaving as a family (spouse + children), please contact our sales team (+33 (0)1 44 20 48 77) who will offer you a solution more adapted to your situation. The prices below are valid until December 31, 2014 for a maximum period of 12 months (that may be renewed for at least three months on condition that you are aged under 36). Price per person and per stay Worldwide excluding USA Worldwide including USA 3 months 4 months 5 months 6 months 7 months 8 months 9 months 10 months 11 months 12 months 120 160 200 232 273 313 347 374 400 426 168 225 280 333 390 446 496 535 575 613
ASFE s : how to get enrolled ASFE s How to get enrolled? Easy and fast enrollment by mail By mail You need to send us: the enrollment form completed and signed, the medical questionnaire completed and signed, along with the additional medical details (on an additional page that you will date and sign) if you answered yes to any questions in the medical questionnaire, a copy of your identity card or passport, a bank account slip for your reimbursements from ASFE, the payment of your premium (see below). Payment of your premiums the direct debit authorization form* (for French accounts only) completed and signed, or a check payable to ASFE, or the credit card debit authorization form completed and signed* for the amount corresponding to your premium for the chosen duration of stay. Send your request for coverage together with all required documents to: ASFE, Service Adhésions (Enrollment Department) 82 rue Villeneuve - 92587 Clichy Cedex - FRANCE If you wish to pay your premium on a quarterly basis, send your enrollment form along with the direct debit authorization form (for French accounts only) completed and signed*. * Forms available on pages 13 and 14. Completion of enrollment You will receive by e-mail a Welcome Package when you join the plan including: your general terms and conditions, a practical guide to help you through your healthcare procedures and to provide you with clear and useful answers to the questions you are likely to have. 9
ASFE s : enrollment form ASFE s I1251 Enrollment form Please write in capital letters. Title: Mrs. Miss Mr. Last name: Date of birth: / / Nationality: Occupation (for working people): Country of expatriation (several countries may be indicated): First name: Telephone no.: E-mail address: Mailing address: Coverage period: 3 months 4 months 5 months 6 months 7 months 8 months 9 months 10 months 11 months 12 months Effective date of coverage requested: / / (Subject to the acceptance of your application) Payment* : By check By credit card debit authorization By quarterly direct debit (from French account only) *There will be no reimbursement in case of early return. children in equal shares among them, otherwise my father and mother in equal shares among them or the survivor of them, otherwise my other heirs in equal shares among them. or In: Date: / / Insured member s signature preceded by read and approved 10
ASFE s : medical questionnaire I1251 le contrat ASFE s de l asfe Medical questionnaire Please write in capital letters. Mrs. Miss Mr. Last name: First name: Date of birth: / / Nationality: If you answer yes to any of the questions below: Please provide all details deemed useful (dates, medical grounds, carry-over effects, therapy, duration, etc.) on an dentiality reasons, for the attention of the Consulting Physician. Over the past 10 years, have you been hospitalized or undergone surgery? Yes No Have you been, or are you currently under medical supervision (therapy, medical care, prescribed medication )? Yes No Have you ever suffered from an illness, condition or accident that required medical supervision for more than 30 consecutive days? Yes No Are you scheduled to undergo a medical procedure or surgery and/or a medical examination and/or a medical treatment of any kind (psychology, psychiatry, physiotherapy, radiotherapy, speech therapy, chemotherapy, dental treatment, drug treatment, etc.) in the next 12 months? Yes No Have you ever suffered from an illness, condition or accident that required medical supervision for more than 30 consecutive days? Yes No I hereby testify that the foregoing declarations are accurate, complete and fair. accordance with the provisions of Articles L. 113-8 and L. 113-9 of the French Insurance Code (Code des Assurances). In: Date: / / Insured member s signature preceded by read and approved 11
ASFE s : signature ASFE s Le contrat de l ASFE I1251 Signature agreement of the enrollment form I hereby request coverage with ASFE (Association de Services des Français de l Etranger Association of services to French people living abroad), an association governed by the French law of 1901 is located 18 rue de Courcelles 75008 PARIS, France and also request to be covered under the insurance agreements underwritten by ASFE with the following insurance companies: - AXA France Vie, for Healthcare coverage and death & disability coverage - EUROP ASSISTANCE, for the Medical Assistance & Repatriation coverage - AXA Courtage, for Third-Party Liability Coverage. I hereby acknowledge the following: - I understand the advice given by MSH INTERNATIONAL and agree to follow it. MSH INTERNATIONAL is a French brokerage company (registered with the ORIAS under no. 07 002 75) which designs and manages ASFE s entire range of insurance plans on its behalf, including the FIRST EXPAT plan. - I have read and agree to the provisions of the general terms & conditions of EXPAT 2014 that constitute an information guide, from which I have terms and conditions of this application my opting-out right. - I have been informed that my telephone conversations with the administration teams of MSH INTERNATIONAL may be recorded for internal management purposes and with a view to improving services. I may access these records by writing to MSH INTERNATIONAL - Gestion ASFE - 82 rue Villeneuve, 92587 Clichy Cedex, France and atta- my request. Each record is kept for a 90-day period. - I hereby acknowledge that enrollment to ASFE does not exempt me from any premium payable under any mandatory scheme to which I may be eligible. - I have been informed that no payment will be made, whether directly or indirectly, to countries subject to sanctions, as provided, for example, by the United Control (OFAC) of the US Department of the Treasury or the European Union. - I understand that the information col- purposes to allow me secure access to a website, or to collect information so MSH INTERNATIONAL can offer me customized solutions and answers. This information is exclusively intended for MSH INTERNATIONAL and is subject to automated processing used for compliance with legal requirements and for the purposes of signing, promoting, contracts. As provided by the French law of January 6, 1978 on Data Protection (loi informatique et libertés), amended in 2004, I acknowledge the right to request, access, rectify and delete any personal information held pertaining to myself. This right may be exercised by writing to: MSH INTERNATIONAL Direction juridique 18 rue de Courcelles 75384 Paris Cedex 08, France, together with a copy of a signed document of iden- I hereby authorize MSH INTERNATIO- NAL to receive on my behalf reimbursement statements for hospitalization expenses paid for me by direct payment agreement. I hereby testify that the foregoing declarations are accurate, complete and fair. I have been informed and I accept that information or proven false declaration that might mislead MSH INTERNATIO- NAL may result in the cancellation of the insurance cover and to the reduction of sions of Articles L.113-8 and L.113-9 of the French Insurance Code (Code des Assurances). In: Date: / / Insured member s signature preceded by read and approved 12
ASFE s : direct debit authorization DIRECT DEBIT AUTHORIZATION FORM (from French account only) all premiums due to the creditor named hereafter. In case of any dispute about a direct debit, I will be entitled to cancel its execution upon request to the institution in charge of my account. I will settle this dispute directly with the creditor. This authorization is to remain in force and effect until the creditor receives written notice from me of its termination in due course. N national d émetteur: 460359 FULL NAME AND ADDRESS OF THE ACCOUNT HOLDER ACCOUNT TO BE CHARGED Institution Sort code Account no. Check digits NAME AND ADDRESS OF THE CREDITOR MSH INTERNATIONAL 18, rue de Courcelles - 75384 Paris Cedex 08 NAME AND POSTAL ADDRESS OF THE INSTITUTION RESPONSIBLE FOR THE ACCOUNT TO BE CHARGED DATE MANDATORY SIGNATURE
ASFE s : information note ASFE s I1251 Information note Please be advised of the following important information: Our analysis and sales offers have been made on the basis of the information, needs and requirements that you communicated and expressed during our meetings and correspondence. Please note that the quality and accuracy It is very important that you carefully read the general terms & conditions of your insurance policy, in particular the measures in case of misrepresentation or non-disclosure. send a complaint in writing to our Service Réclamation, 82 rue de Villeneuve 92587 CLICHY Cedex, France or to the Complaint Department of your nearest regional headquarter (all contact details are available on our website). If the problem is still not resolved, you may also contact the Mediator of the Chambre Syndicale des Courtiers d Assurance [Industrial Union for Insurance Brokers in France], responsible for claims from individuals: 91 rue Saint Lazare, 75009 Paris, France, or the Autorité de Contrôle Prudentiel [French Regulatory Authority for Prudential Supervision], located 61 rue Taitbout 75009 Paris, France. The information collected may be subject to automated processing used for the purposes of administering and As provided by the French law of January 6, 1978 on Data Protection (loi informatique et libertés), amended in ASFE - MSH INTERNATIONAL - Direction juridique 18 rue de Courcelles 75384 Paris Cedex 08 Please do not hesitate to contact us should you have any questions or concerns. CREDIT CARD DEBIT AUTHORIZATION FORM I hereby authorize MSH INTERNATIONAL / ASFE to debit my credit card for the amount of my insurance premium, i.e.: Cardholder s details: Type of credit card: Visa Mastercard Amex Card number: / / / Expiration Date: / Card Validation Code: (last three digits on the back of your card, excluding Amex) In: Date: / / Insured member s signature preceded by read and approved
ASFE s : questions ASFE s Questions you may have in mind: Is the plan a comprehensive or complementary coverage? The plan provides comprehensive coverage and reimburses 100% of charges incurred as from the 1 st without deductibles. Is it necessary to make cash advances? In the event of hospitalization or medical expenses over 400, we pay the hospital or healthcare facility on a direct basis, avoiding you to pay upfront for your medical costs. For outpatient care (consultations, Can I get a refund for my plan if my Visa application is denied? Absolutely. You just need to send us the Visa denial letter so that we can reimburse you the cost of the premium if it has been collected. How far in advance should I purchase coverage and is coverage effective immediately? No waiting period is applicable and your policy may be effective as early as the next day following your online enrollment or upon receipt of your request sent by mail, or at a later date of your choice, selected upon your enrollment (but no later than two months as your medical questionnaire is only valid for two months). However, in order to go overseas with total peace of mind, we recommend you enroll at least 10 to 15 days before your departure, in order to be sure you get your Welcome Package before leaving. Will I receive documents after my enrollment is completed? Of course, upon acceptance of your duly documented request for coverage, we will send you a Welcome and the guide to insured members detailing all the general procedures applicable to your plan. Is it possible to enroll from abroad? Absolutely, you can directly enroll via our website www.asfe-expat.com from any country in the world, excluding the USA (please contact us in that case); you can also log in to your Participants Pages to request extension or renewal of your coverage. What would you recommend before going overseas? We recommend you have a medical check-up (in particular, vaccination booster shots and a comprehensive aid kit including basic pharmaceutical products of everyday life, as well as your prescriptions if needed. It is also important that you communicate your insurance policy number and our contact details to a friend and/or your family, as well as your address and telephone number on site. For further answers, go to our website www.asfe-expat.com, under What to know before you go Q&A. 15
ASFE, THE EXPATRIATE HEALTHCARE INSURANCE SPECIALIST ASFE, the Association de Services des Français de l Etranger (Association of services to French people living abroad) was created in 1992 and is governed by the French law of 1901 on associations. Our purpose is to provide expatriates all over the world with solutions in / repatriation and third-party liability. Our comprehensive offers provide solutions suited to all according to the level of coverage desired, age, family situation and country of expatriation. from a satisfaction survey conducted in December 2012). MSH INTERNATIONAL MANAGES ASFE S INSURANCE PLANS ON ITS BEHALF MSH INTERNATIONAL is a world leader in the design and management of international healthcare solutions. Part of the SIACI SAINT HONORE group, MSH INTERNATIONAL has over 300,000 insured members across 194 countries and more than 2,000 corporate clients worldwide. The teams of MSH INTERNATIONAL represent over 45 different nationalities speaking 30 languages. MSH INTERNATIONAL is the healthcare partner for internationally mobile individuals: employees of multinationals, employees of international organizations, small and medium enterprises, individual expatriates, students and cross-border commuters. Our four regional headquarters in Calgary, Paris, Dubai and Shanghai share the same keen sense of premium customer service. Available 24/7, wherever you are living in the world, our teams continuously strive to be ASFE - SALES CONTACT 18 rue de Courcelles - 75384 Paris Cedex 8 - France Tel +33 (0)1 44 20 Email: 48 77 - Fax bm@world-expat.com +33 (0)1 44 71 48 80 1, rue des Quatre Chapeaux - 69002 Lyon - France Ph: 954-418-8885 contact@asfe-expat.com Cell: 561-706-9177 MSH INTERNATIONAL on behalf of ASFE HEALTH INSURANCE ALL OVER THE WORLD Plateougazeuse - Pictures: Capital Pictures / Fotolia / Fotosearch / GettyImages / istockphoto