B D A E G R U P P E TerMS and CoNDiTioNS for imited HeaTH insurance and SiCkNeSS DaiY aowance Cover of THe expat-series for ong-term journeys part ii Tariff expat goba-p US 2000 1. insurance CoMpaNY: 2. poicy HoDer: 3. parties entited To insurance: 4. individuas insurabe: 5. CoNTraCTUa basis: 6. area of appication: 7. STarT of insurance Cover: 8. insurance Year: 9. DUraTioN of insurance reationship: 10. TerMiNaTioN of insurance reationship: 11. premium payments: 12. DaTa on insured person's STaTe of HeaTH: 13. benefits: 13.1 outpatient TreaTMeNT: 13.2 inpatient TreaTMeNT: 13.3 pharmaceuticas, bandages and MeDiCiNeS: AGA (Aianz Goba Assistance) Internationa S.A., Niederassung für Deutschand, Ludmiastraße 26, D-81543 München BDAE Diensteistungsgeseschaft mbh Natura persons. Ony one person per famiy may be nominated as party entited to insurance. Parties entited to insurance and their famiy members up to the age of 65 years, if they are insurabe according to the conditions of insurance, part I, A, 1. Famiy members are defined as partners and chidren who share the same househod. Terms and conditions for imited heath insurance and sickness daiy aowance cover of the EXPAT-series for ongterm journeys part I and part II (EXPAT GLOBAL-P US 2000). Insurance cover appies wordwide with consideration to conditions of insurance part I, A, 1, para. 4 and 5 and conditions of insurance part II number 15. Temporary home country stays are insured in the reevant home country for the duration of the ong term trave period, aways provided that the home country is incuded in the seection of the pertinent geographic premium coverage (conditions of insurance part II number 15). The home country is the country of which the insured person is a citizen. At the time specified in the insurance confirmation document with consideration of conditions of insurance part I, A, 4. From 1 Juy of each year respectivey to 30 June of the foowing year. 5 years. A one-off extension for further 5 years is possibe with the consent of the insurance company. 1. The poicyhoder is obigated to inform the party entited to insurance and the insured persons of notice of termination of the framework insurance agreement with two months notice before the termination takes effect. 2. The insurance reationship for individua insured persons may be terminated by the party entited to insurance or the person insured at any time. It wi then end with the expiry of the month foowing on notice of termination being given. The notice of termination has to be submitted in writing to the poicy hoder. 3. If the party entited to insurance and the insured person are not identica, a notice of termination ony becomes effective, if the insured person concerned by the termination has attained knowedge of the termination decaration. The poicyhoder proves this accordingy to the insurance company at deregistration from the framework insurance agreement. The insured person concerned is in this case entited to continue the insurance contract under designation of a future party entited to insurance. An appropriate decaration must be made with-in two months after receiving the notice of termination. The premium is an annua premium, which is made out in equa monthy instaments. It becomes due for payment in advance by the time of the end of each contractua year. None. Pease observe the excusion of benefits in the conditions of insurance. expat goba-p US 2000 100% of the amount invoiced for medicay necessitated outpatient treatment as a private patient, radioogica treatment, ight, and other physica treatments, if prescribed by a doctor. 100% for medicay necessitated inpatient treatment at a hospita and treatment necessitated accommodation as a private patient in a 2-bed room, as we as for medicay necessitated operations, X-rays, radioogica treatment and diagnostics. 100%, if prescribed by a doctor and medicay necessitated. 13.4 DeNTa TreaTMeNT: 100% of the invoiced amount for medicay necessitated outpatient denta treatment in simpe form. The insurance cover incudes an annua checkup for preventive purposes, once in the insurance year, but does not incude any prophyactic treatment. BDAE DIENSTLEISTUNGSGESELLSCHAFT MBH KÜHNEHÖFE 3 D-22761 HAMBURG FON +49-40-306874-0 FAX +49-40-306874-90 info@bdae.de www.bdae.com BANK: DEUTSCHE BANK PRIVAT- UND GESCHÄFTSKUNDEN AG BLZ: 200 700 24 KONTO: 390 024 800 IBAN: DE47200700240390024800 BIC: DEUTDEDBHAM SITZ DER GESELLSCHAFT: HAMBURG HRB 121738 AMTSGERICHT HAMBURG GESCHÄFTSFÜHRER: ANDREAS OPITZ 1
13.5 TooTH repacement / Notwithstanding the conditions of insurance part I, A, 6, para. 2q insurance cover continues after expiration of orthodontic TreaTMeNT: 13.6 preventive CHeCkUpS: 13.7 benefits for pregnancy and DeiverY: 13.8 MeDiCa aids: 13.9 other benefits: 14. waiting period: 15. MoNTHY premium: the waiting period of 8 months for - 80% of the amount invoiced for tooth repacement and - orthodontic treatment up to the age of 18, - to a maximum amount, however, of EUR 2,000 in toto in the first two years of the poicy, - up to EUR 3,000 in toto in the first three years of the poicy, - from the fourth year of the poicy, at most up to EUR 4,000 per year of the poicy. The amounts mentioned are cacuated on a pro-rata basis for registrations / deregistrations during the year. Preventive outpatient medica examinations for chidren, as we as for eary recognition of cancer in accordance with statutory programmes that have been introduced in Germany. Insurance cover exists for: a) medicay necessitated treatment incuding pregnancy examinations, pregnancy treatment, in as far the pregnancy had not yet commenced at the beginning of the insurance reationship of the insured persons as we as treatment for miscarriage; b) medicay necessitated pregnancy treatment due to acute compaints caused by and treatment due to miscarriage as we as medicay necessitated abortions and deiveries up to the end of the 36th week of pregnancy (premature birth), even if the pregnancy had aready commenced at the start of the insurance reationship of the insured person, if the necessity for treatment was not yet obvious at this time; c) deiveries after expiry of the waiting period according to the agreed tariff. Notwithstanding the conditions of insurance part I, A, 6, para. 2g insurance cover continues for the foowing aids, if medicay nessitated and prescribed by a doctor: a) Visua aids costing up to EUR 50 per person insured and year of the poicy, b) bandages, dressings, orthopaedic inserts and waking supports in simpe design. a) 100% of the transport costs to the nearest suitabe hospita for inpatient treatment and for first-aid after an accident to the nearest suitabe doctor and back. b) For medicay necessitated return transport or conveyance to the native country or permanent pace of residence of the insured person, the insurance company wi reimburse - up to EUR 5,000 within a continent, - up to EUR 10,000 between continents. If for the return journey an authorised ambuance aeropane shoud be caed for, the restriction to the benefit amount no onger appies. The most economica means of transport is to be seected for the return journey, so ong as this is possibe from the medica point of view. Medica necessity for a return journey is given, if sufficient medica care is not avaiabe in the country of residence. To prove the medica necessity of return transport, a certificate of the doctor treating abroad must be submitted. 8 months for tooth repacement and deivery. Empoyees or members of the party entited to insurance Famiy members EUR 305 EUR 495 (per person) 15.a DeDUCTibe: US $ 2,000 per person and insurance year. The deductibe for insurance cover which is required for ess than one year is cacuated proportionay. 16. other MaTTerS: No pension reserve fund wi be estabished. You are recommended to take out a deferred insurance poicy scheme. 2
B D A E G R U P P E MEDICA AssIstANCE for persons INsuRED BY BDAE AND MEMBERs of BDAE For fast and smooth processing of medica services anywhere in the word, the BDAE GROUP has integrated an Assistance Programme into its insurance concept. The BDAE makes its Assistance services i.e. the aid, emergency and service offer avaiabe to its insured and members in coaboration with the speciaist ALLIANZ GLOBAL ASSISTANCE Service Deutschand. The foowing services to insured and members are incuded: 24 H BDAE EMERGENCY VIA +49-40 - 30 68 74-74 Mutiingua 24-hour Emergency Hotine, More than 100.000 medica service providers wordwide, Information about (denta) medicine service providers (e.g. names, addresses and teephone numbers as we as consuting hours for doctors and dentists, hospitas and cinics within the region of the current pace of residence), Patient advice in routine cases and emergencies as we as during crises that may compromise safety in the country of residence, Hep and support to famiy members by means of provision of country specific heath care data and information, Assistance in arranging treatment appointments at hospitas and with doctors for outpatient treatment, Organisation of hospita admission in the event of iness, Support in the obtention and shipment of prescription medicines (insofar as statutoriy permitted), Organisation of interpreting and transation services, Access to wordwide medica information in German and in Engish, Advice and support in the event of oss of important documents and means of payment. In addition to the services isted above, BDAE assumes the costs for the services it covers, for which ALLIANZ GLOBAL ASSISTANCE Service Deutschand seeks authorisation directy from BDAE and its risk carriers. These services incude: Organisation of emergency evacuations as we as transfers to appropriate hospitas in cases of medica necessity, Organisation and impementation of repatriations to a vaue of up to 250,000 per insurance event, Impementation of and cost assumption for body repatriation in the event of death, for up to 10,000. These services are avaiabe to persons insured by BDAE and members of BDAE 365 days a year, 24 hours a day. Generay, a scope of services of this kind can ony be taken advantage by arge companies. Because of the strategic partnership of BDAE with ALLIANZ GLOBAL ASSISTANCE Service Deutschand, private individuas, too, can benefit from the Safety Package. To ensure smooth processing in your deaings with the Assistance company, pease aways have your BDAE poicy or membership number ready when you contact ALLIANZ GLOBAL ASSISTAN- CE Service Deutschand. Stand: 01.07.2011 BDAE HOLDING GMBH KÜHNEHÖFE 3 D-22761 HAMBURG FON +49-40-306874-0 FAX +49-40-306874-90 info@bdae.de www.bdae.com BANK: HAMBURGER SPARKASSE BLZ: 200 505 50 KONTO: 12 68-13 25 35 IBAN: DE 11 200 505 50 12 68 13 25 35 BIC: HASPDEHHXXX SITZ DER GESELLSCHAFT: HAMBURG HRB 79790 AMTSGERICHT HAMBURG GESCHÄFTSFÜHRER: SILVIA OPITZ 1
AIANZ GoBA AssIstANCE service DEutsCHAND ALLIANZ GLOBAL ASSISTANCE Service Deutschand is subsidiary of AGA Group, Paris. AGA Group is the words argest assistance service provider with 32 subsidiaries wordwide and a network of partners in 172 countries. Besides this AGA Group cooperates with 400,000 certified and contractuay bond medica service providers. The Group empoys 10,000 empoyees a over the word and generated a turnover of 1,75 Biion Euro in 2010. ALLIANZ GLOBAL ASSISTANCE Service Deutschand is ocated in Munich and empoys more than 850 empoyees. A specia department has been estabished to service BDAE members and customers - amongst others there are 14 medica speciaists in this team. Stand: 01.07.2011 2
B D A E G R U P P E PATIENT LEGAL EXPENSES INSURANCE FOR BDAE CLIENTS NEW: PATIENT LEGAL EXPENSES INSURANCE WORLDWIDE FOR THE FIRST TIME In addition to your heath insurance, BDAE has now arranged a patient ega expenses insurance for your stays abroad. This increase of benefits is provided on a compimentary-basis to your existing cover. Originay deveoped by the renowned ega insurer ARAG Group at the beginning of 2010, this product, foowing the cooperation between BDAE and ARAG, is now avaiabe on a wordwide basis. WHAT IS INSURED? The poicy responds to situations where the professiona negigence of doctors or other medica personne cause you serious harm. Athough the reationship between patient and doctor is based on a high eve of trust, even medica professionas are capabe of making mistakes. In such situations, it is difficut for patients to assert and protect their rights whie trying to resove a compicated confict about errors in treatment. Even more so when they are not abe to communicate directy with the doctor, but have to address his professiona indemnity insurers. The poicy covers subject to a deductibe of 500 Euro per caim ega cases up to One Miion Euro, wordwide. ARAG accepts a costs for ega and court expenses up to this imit. If required, ARAG wi aso recommend a awyer speciaised in heathcare aw. WHAT ARE TREATMENT ERRORS AND AN INCORRECT CONSULTATION? Treatment errors are not merey instances of a pair of scissors being forgotten in the abdomen during a surgery they can aso incude incorrect advice given about the dosage of a medicine. A treatment error can aso be in the form of inappropriate or deayed treatment of a patient by a physician or surgeon. The faiure of a physician or a surgeon to advise a patient about the necessity or risks of a treatment is aso considered to be an act of professiona negigence and hence woud be covered under the poicy. This not ony appies to physicians but aso to hospita staff, psychotherapists, pharmacists and nursing service providers. They are equate to physicians in the patient ega expenses insurance. ABOUT ARAG The ARAG Group is an internationay renowned independent provider of ega services and is the argest famiyowned company in the insurance market. Apart from Germany, ARAG aso operates in 12 European countries and in the USA, where it has taken a eading position in the ega insurance market. ARAG is aso market eader with its ega insurance products in Spain and Itay. BDAE has been associated with ARAG since 2008 and the two companies have now deveoped the first ega expenses insurance for overseas stay and trave on a wordwide basis. Stand: 01.04.2010 BDAE HOLDING GMBH KÜHNEHÖFE 3 D-22761 HAMBURG FON +49-40-306874-0 FAX +49-40-306874-90 info@bdae.de www.bdae.com BANK: HAMBURGER SPARKASSE BLZ: 200 505 50 KONTO: 12 68-13 25 35 IBAN: DE 11 200 505 50 12 68 13 25 35 BIC: HASPDEHHXXX SITZ DER GESELLSCHAFT: HAMBURG HRB 79790 AMTSGERICHT HAMBURG GESCHÄFTSFÜHRER: SILVIA OPITZ 1
B D A E G R U P P E appicant / party entited to insurance: overseas HeatH insurance FoR of Up to 60 MontHS expat Goba-p US 2000 appication Surname: First name(s): Current occupation: No. of membership, if existing: Address: Phone: Fax: e-mai: payment DetaiS: Payment type*: oannuay oevery 6 months (+2%) oquartery (+3%) omonthy (+5%) Bank: Acc.-No.: Sort Code: Credit Card (+6%)*: omaster-/eurocard ovisa odiners Vaid unti: Card-No.: Account / card hoder, if not appicant (pease sign beow aso): information on additiona HeatH insurance: Do you have additiona heath insurance?* onon oyes, with: Insurance no.: the FooWinG persons are to be incuded in the insurance: (Pease consider appicant) Surname, Sex* Panned country USA / Canada* First name(s) Nationaity m f Date of birth of residence inc. w/o Monthy premium (EUR) Start of insurance Month / Year (*pease tick) I / we hereby appy for insurance cover as outined by the terms and conditions for imited heath insurance and sickness daiy aowance cover of the EXPAT-series for ong-term journeys part I and part II (EXPAT Goba-P US 2000 tariff) for the persons isted above by registering them with the insurer as insured persons. The insured persons or their ega guardians permit the insurer to request any information from third parties at any time which may be necessary to estabish the state of heath of the insured persons. For this purpose, the third parties are reeased from their obigation to secrecy. The tota premium must be paid in advance in accordance with the chosen payment period. I hereby give permission for the premiums to be debited from my account or credit card (see above). Note: the premium is due after confirmation of insurance cover has been received and no ater than the beginning of the insurance. I / we are aware that the poicy hoder wi not register the isted persons as insured persons with the insurer (or wi terminate their registration) if the premium or other charges have not been paid in fu due to the actions of the person eigibe to be insured. I / we am / are aso aware that we do not have insurance cover in this case. Pace, date: Signatures: (appicant or ega guardian of persons who are to be incuded in the insurance and a aduts to be insured and possiby different account hoder / card owner) Insurer: AGA (Aianz Goba Assistance) Internationa S.A., Niederassung für Deutschand Poicy hoder: BDAE Diensteistungsgeseschaft mbh BDAE DIENSTLEISTUNGSGESELLSCHAFT MBH KÜHNEHÖFE 3 D-22761 HAMBURG FON +49-40-306874-0 FAX +49-40-306874-90 info@bdae.de www.bdae.com BANK: DEUTSCHE BANK PRIVAT- UND GESCHÄFTSKUNDEN AG BLZ: 200 700 24 KONTO: 390 024 800 IBAN: DE47200700240390024800 BIC: DEUTDEDBHAM SITZ DER GESELLSCHAFT: HAMBURG HRB 121738 AMTSGERICHT HAMBURG GESCHÄFTSFÜHRER: ANDREAS OPITZ 1
CHECKLIST FOR APPLICATION WE KINDLY REQUEST THAT YOU ARE REMEMBER THE FOLLOWING POINTS SO AS TO ENSURE THAT YOUR APPLICATON IS PROCESSED QUICKLY AND PROMPTLY 1. 2. THE APPLICATION MUST FILLED IN COMPLETELY AND IN BLOCK CAPITALS. PAYMENT METHOD DATA: 2.a Bank transfer of the premium is ony possibe once a year or every six months. 2.b A direct debit is ony possibe from a German account on a monthy, quartery, six monthy or annua basis. As an aternative, you can aso pay the premium by credit card using the same payment method as for a direct debit. 3. 4. THE APPLICATION MUST BE SIGNED BY THE APPLICANT AND ALL INSURED PERSONS WHO ARE OF FULL AGE. IF THE ACCOUNT HOLDER IS DIFFERENT FROM THE APPLICANT, THE SIGNATURE OF THE ACCOUNT HOLDER IS ALSO REQUIRED 5. THE FOLLOWING MUST BE NOTED FOR THE RATES EXPAT GERMANY, EXPAT RETIRED, EXPAT 36/60 AND EXPAT 36/60 US 1000: 5.a EXPAT GERMANY: A heath certificate or evidence of a German previous insurance must be submitted if the insured person has been resident in Germany for onger than 31 days. The heath certificate must not have been issued more than 14 days previousy. 5.b EXPAT RETIRED: Information on the heath decaration as we as the additiona decaration must be submitted with the appication. A heath certificate which has not been issued more than 3 months previousy must be submitted for persons aged 60 and over. 5.c EXPAT 36/60 UND EXPAT 36/60 US 1000: Pease indicate the occupation you wi pursue abroad. 6. HEALTH CERTIFICATE EXPAT GERMANY AND EXPAT RETIRED: 6.a The heath certificates must be issued in German or Engish and be egibe. 6.b Each question must be answered. 6.c Questions answered with yes or questions that indicate an abnorma resut require an expanation. 6.d The expanation in the presence of the doctor must be signed by the appicant and the doctor. 6.e The ast page of the certificate must aso be signed by the doctor. 6.f If the R-Dent or G-Dent tariff is seected, a denta report is required. 6.g The first and ast name must be specified on each page of the findings. 6.h Aways specify your GP using their fu name and the exact address. 6.i If any inpatient treatment has taken pace, it woud speed up the inspection if corresponding discharge reports and reports on findings were submitted to us aong with the heath certificate. 6.j If there are any further inquiries, pease adhere to the deadines specified in the etter of request as acceptance is otherwise not possibe. WITH THESE REGULATIONS, WE CAN ENSURE THAT YOUR APPLICATION IS PROCESSED SMOOTHLY AND PROMPTLY. THANK YOU FOR YOUR UNDERSTANDING!
B D A E G R U P P E Terms and conditions for imited heath insurance and sickness daiy aowance cover of The expat-series for ong-term journeys part i part a - genera provisions vaid for a The insurance poicies and The respectiv Tariffs isted in part B 3. The insurance year wi be defined in the conditions of insurance for heath insurance and sickness daiy aowance cover of the EXPAT-series for ong-term journeys conditions of insurance part II. 1 insurabe persons and insurabiity So far as has not been agreed to the contrary, the foowing sha appy: 1. The appication of insured persons in the framework insurance agreement can ony be submitted by the party entited to insurance. Parties entited to insurance are juridica and natura persons according to the respektive underying tariff conditions. 2. Natura persons may be insured. 3. Not insurabe and despite premium payment not insured are 4. The poicyhoder sha be obiged to give the party entited to insurance and the insured person written notice of an adjustment of the premium eve or of the eve of benefits paid within a term of two months to the end of the agreed tariff insurance year. 4 scope, start, duration, and end of insurance cover The insurance company sha offer insurance cover to insured persons, who are resident for a imited time in the context of a imited visit to the agreed tariff area in the context of these conditions of insurance. So far as has not been agreed to the contrary, the foowing sha appy: a) Persons who are in need of constant care. A person is in need of care if he/ she for the most parts needs externa hep in order to manage the tasks of daiy ife. 1. The insurance cover starts for the insured person after binding registration into the framework insurance agreement at the time (start of insurance) specified in the insurance confirmation document, b) Persons who are constanty excuded from participating in daiy ife. For this cassification, in particuar the menta state and the objectiv ife circumstances of the person must be considered. 4. No insurance cover is granted for insured persons, who have their main pace of residence in the Federa Repubic of Germany. 5. Natura persons with a imited residence permit for the Federa Repubic of Germany may not be insured, if at the time of appying for registration in the framework insurance agreement the entire insurance duration of a heath insurance agreements concuded during the visit exceed a period of 5 years. 2 concusion and duration of The insurance contract 1. The framework insurance contract wi be concuded between the insurance company and the poicy hoder for the duration of a year. The framework insurance contract wi be extended by one year if notice of termination is not given with a term of notice of three months to the expiry date. a) however not before start of the stay of the insured person in the agreed tariff area; b) not before effectiveness of the insurabiity of the insured person according to tariff; c) not before payment of the premium; d) not before expiration of waiting periods agreed according to tariff. 2. No insurance cover is granted for caims occasioned before or at start of insurance. 3. No benefits wi be paid for caims occasioned during the waiting period as agreed in the tariff. 4. The maximum duration of insurance cover for the insured person is defined in terms of the reevant tariff. 2. The ega reguations on the extraordinary right to give notice of termination remain unaffected. 5. Insurance cover for individua persons insured comes to an end, even in connection with pending caims, with 3. At termination of the framework insurance agreement, the insurance company wi offer the insured persons continuation of the insurance cover. 3 premium, BenefiT adjustment, insurance year 1. The poicyhoder is entited to deregister individua insured persons from the framework insurance agreement because of non-payment of the premium. 2. Insurance company sha be entited to make changes in the premium eve or the extent of the benefits at the beginning of a new insurance year, provided that it notifies the poicyhoder of this with a term of notice of three months to the end of the agreed tariff insurance year. a) end of the insurance reationship of the insured person, at the atest however upon expiration of the maximum duration of insurance of the seect ed tariff; b) deregistration from the group of persons insured by the party entited to insurance, taking into account the terms of notice and conditions defined in the tariff; c) death of the person insured; d) with the ending of the insurabiity of an insured person according to conditions of insurance part I, A, 1; BDAE DIENSTLEISTUNGSGESELLSCHAFT MBH KÜHNEHÖFE 3 D-22761 HAMBURG FON +49-40-306874-0 FAX +49-40-306874-90 info@bdae.de www.bdae.com BANK: DEUTSCHE BANK PRIVAT- UND GESCHÄFTSKUNDEN AG BLZ: 200 700 24 KONTO: 390 024 800 IBAN: DE47200700240390024800 BIC: DEUTDEDBHAM SITZ DER GESELLSCHAFT: HAMBURG HRB 121738 AMTSGERICHT HAMBURG GESCHÄFTSFÜHRER: ANDREAS OPITZ
e) at the end of the month foowing termination of the temporary visit of the insured person in the agreed tariff area or fina return of the insured person to their native country; f) as soon as the tariff terms on the insurabiity of an insured person are inappicabe; k) For treatment on account of such inesses, incuding their consequences, or consequences of such accidents as are occasioned through professiona participation in sporting competitions organised by sporting federations and associations or prenotory measures reated to these, or such as are recognised as war injuries and are not expicity incuded in the insurance cover. g) with termination of the framework insurance agreement between the insurance company and the poicy hoder. ) On account of withdrawa measures incuding courses of withdrawa treatment; 5 object of insurance cover and scope of insurance BenefiTs So far as has not been agreed to the contrary, the foowing sha appy: 1. The insurance company sha offer insurance cover for urgent and unexpected insured events occurring during the stay in the agreed tariff area. m) On account of such inesses, incuding their consequences, which arise as a resut of the person's having negected to obtain the protective inocuations recommended by the Word Heath Organisation or prescribed by statute, uness there shoud be medica reasons why protective inocuation cannot be carried out. In this case, the medica reasons are to be proved to the insurance company by the submission of a doctor's certificate. 2. The insurance cover resuts from the insurance confirmation, these conditions of insurance, the seected tariffs, statutory reguations of the Federa Repubic of Germany. n) For treatment of a dependency syndrome and its consequences; o) For attempted suicides and their consequences; 6 genera imitations of The obigation To pay BenefiT So far as has not been agreed to the contrary, the foowing sha appy: 1. Insurance cover is not granted for damage occasioned by active participation in strikes, war, war-ike events, civi disturbance, damages by nucear energy, as we as for such events, resuting from intentiona activities of the poicyhoder, the party entited to insurance or the insured person. p) For organ donations and their consequences; q) For tooth repacement (such as e.g. pivot teeth, insert fiings, crowns, impants) and orthodontic treatment, occusive overay aids and gnathoogic measures. Note: Pease aso regarded the Specia Obigations on excusions in the conditions of insurance, part I, B. 2. There is no obigation to pay benefit: a) On account of inesses and compaints incuding their consequences existing and known at start of the insurance cover. Furthermore, there is no insurance cover for the consequences of such inesses and accidents, which have been treated in the ast six months before start of insurance. 7 obigations and consequences of faiure To observe To obigations 1. Poicyhoder, parties entited to insurance and insured person are obigated, after occurrence of the insured event a) To avoid everything that coud ead to an unnecessitated increase in costs; b) For spa and sanatorium treatments as we as rehabiitation measures organised by party egay responsibe for rehabiitation; b) To immediatey notify the insurance company or its agent of a damages that coud presumaby exceed a sum of EUR 1,000.00, c) For treatments during a stay in a spa or a heath resort, even if this invoves a stay in hospita. This imitation sha no onger appy if the person insured has his/her constant pace of residence there or if he/she becomes unabe to work as a resut of a sickness independent of the purpose of his/her visit or as a resut of an accident that has occurred there, so ong as this resuts, on medica testimony, in his/her being unabe to journey home. This imitation aso sha no onger appy if and to the extent that the insurance company has given written consent to benefit being paid before the start of residence abroad. d) In consequence of an accommodation occasioned by the need of ingering iness, care or custody; c) To permit the insurance company or its agent to make a reasonabe examinations regarding the cause and amount of its duty to pay benefits, provide a reevant information in this connection, to submit origina documents, and submit a death certificate in the case of death. 2. If required by the insurance company, the insured person is obigated to be examined by a doctor assigned by the insurance company. 3. Start and end, as we as an interruption of a stay in the area according to tariff, as we as the presence of the tariff terms concerning insurabiity must be proved by the insured person on request of the insured company in the case of benefit. e) For the treatment of menta or emotiona disturbances, or for hypnosis, psychoanaysis or psychotherapy; f) For immunisation measures; g) For medica aids; h) For treatment of steriity, incuding in vitro fertiisation we as pertinent preiminary examinations and subsequent treatments; i) For preventive medica examinations; 4. If the poicy hoder, the party entited to insurance or the person insured wifuy infringes one of the contractuay agreed obigations, the insurance company sha be reeased from its obigation to pay benefits. In the case of a grossy negigent infringement of the obigation, the insurance company is entited to reduce the benefits by an amount commensurate with the seriousness of the faut of the poicyhoder, the party entited to insurance or the person insured. The onus of proving that there has been no gross negigence rests with the poicyhoder, the party entited to insurance or the person insured. 5. The party entited to insurance and the person insured are obigated to immediatey communicate changes of address to the poicyhoder. j) For treatments by spouses, parents, chidren or persons iving together in the immediate domestic circe or persons iving together with the insured person within his/her own or guest famiy. Costs of materias wi be reimbursed in keeping with the given tariff. 2 8 payment of insurance BenefiTs So far as has not been agreed to the contrary, the foowing sha appy: 1. The insurance company sha be obiged to pay out benefits ony if the foow-
ing documentary proof is suppied, which then become the property of the insurance company: a) Paid origina receipts, which must carry the first name, surname and date of birth of the person treated, name and address of the doctor treating the patient, the description of the iness, nature of the services provided by the treating doctor according to type, pace and treatment period. If compensation may be caimed under another insurance contract in connection with an insured event and if the caim has first been asserted for the other contract, then dupicates of the invoices wi be considered sufficient, provided that the other insurance company has made a note on the document of the benefit paid. b) Prescriptions must be presented together with the doctor's bi, the bi for pharmaceuticas and medica aids together with the prescription. as far as the insurance company has reimbursed the damage. If necessary, the poicyhoder, the party entited to insurance or the insured person is obigated to provide a statement of assignment to the insurance company. The insurance company s obigation to provide benefits is suspended unti the statement of assignment has been submitted. 3. Caims of the poicyhoder, the party entited to insurance or the insured person against a medica practitioners due to excessive fees pass to the insurance company to the statutory extent, if the insurance company has reimbursed the appropriate bis. If necessary, the poicyhoder, the party entited to insurance or the insured person are obigated to assist during assertion of caims. Furthermore, the poicyhoder, the party entited to insurance or the insured person are obigated, if necessary, to provide a decaration of assignment to the insurance company. The insurance company s obigation to provide benefits is suspended unti the decaration of assignment has been submitted. c) Proof of the amount of costs, which woud have ensued in the case of a reguar return journey, if benefits are asserted for a medicay necessitated return transport. Furthermore, a doctor's certificate, which shoud ceary demonstrate the medica necessity of return transport, must be submitted. 10 offset Poicyhoder, the party entited to insurance or the insured person is ony entited to a set-off against caims of the insurance company in the case of undisputed or finay asserted countercaims. d) For the assertion of caims in connection with conveyance of the body or funera costs an officia death certificate and medica certificate giving the cause of death must additionay be submitted. 2. Costs that have been incurred in a foreign currency wi be converted into the currency vaid in Germany at the exchange rate of the day on which the receipts are received by the insurance company, uness the foreign currency required for payment of the invoice was acquired at a ess favourabe rate and that this was caused by a change in the currency vauation. 11 decarations of intention and notifications Decarations of intention and notifications to the insurance company require the written form (Letter, fax, e-mai, eectronic data medium, etc.). The person insured has an intrinsic right to assert caims based on the contract against the insurance company. 12 appicabe aw / anguage of The contract German aw sha appy uness internationa aw takes precedence. The anguage of the agreement is German. 3. Costs incurred for the payment of insurance benefit by banker's draft to a foreign country, or for specia forms of fund transfer which have been agreed on, wi be deducted from the benefit paid. 4. Caims to insurance benefit can neither be assigned nor given in pedge. 5. In connection with examining the benefits to be provided, it may be necessitated for the insurance company to obtain persona-reated heath data within the egay permitted scope. If the party entited to insurance or insured person fai to consent to this and if the insurance company as a resut, is unabe finay to determine the amount and scope of its obigation to provide benefits, the due date of payment sha be suspended. The same appies if the institutions or persons who are requested to provide information are not reeased from their duty of secrecy vis-à-vis the insurance company. 6. One month after notification of a caim, the minimum amount which is payabe as matters then stand may be caimed as a payment on account. The said period stops running as ong as the insurance company s examination of the caim is hindered by faut on the part of the poicyhoder, the party entited to insurance, the insured person. 7. Caims under this framework insurance agreement sha become time-barred after three years. The imitation period begins at the end of the year in which the benefit may be demanded. 9 compensation from other insurance contracts and caims against Third parties 1. If compensation may be caimed under another insurance contract in an insured case, the other contract sha take precedence over this contract. This appies ikewise, even if a subordinate iabiity has aso been agreed upon in one of these insurance contracts, irrespective of when the other insurance contract was concuded. If the insured event was first communicated to the insurance company via this framework insurance agreement, the insurance company wi pay in advance and wi contact the other insurance company directy concerning distribution of costs. 2. Caims of the poicyhoder, the party entited to insurance or the insured person against third parties pass to the insurance company to the statutory extent, 13 surpus sharing The insurance specified here is not entited to surpus. 14 supervisory authority and ombudsman If you shoud not be satisfied with a benefit or a decision of the insurance company, pease contact the respective insurance company directy. The responsibe supervisory authority for compaints is the Bundesaufsichtsamt für Finanzdiensteistungen, Graurheindorfer Straße 108, 53117 Bonn. The Würzburger Versicherungs-AG is member of the Versicherungsombudsmann e.v. (registered association of the insurance ombudsman). This entites persons insured in tariffs covered by the Würzburger Versicherungs-AG to address the independent and neutra Ombudsman, if they do not agree with a decision made. The procedure is free of charge. Versicherungsombudsmann e.v. Postfach 080632 10006 Berin Te.: +49-30-20 60 58-99 Fax: +49-30-20 60 58-98 e-mai: beschwerde@versicherungsombudsmann.de www.versicherungsombudsmann.de part B specia provisions for individua insurances The reevant section appies in dependence on The insurance cover and Tariff seected section i heath insurance for ong-term journeys (ony vaid, if contained in The seected Tariff) 1 object of insurance So far as has not been agreed to the contrary, the foowing sha appy: 1. Grounds of a caim sha be the medicay necessitated treatment of a person insured on account of iness or in consequence of an accident. The caim sha be considered to begin with the treatment, and sha end when medica findings 3
indicate that there is no further need of treatment. If the medica treatment must be extended to an iness or consequence of an accident, with no causa connection to the previousy treated condition, then this is considered a new caim. 2. In so far as the tariff defines the reevant benefits, further grounds for a caim sha aso be: a) Medicay necessitated treatment incuding pregnancy examinations, pregnancy treatments, in as far the pregnancy had not yet commenced at the beginning of the insurance reationship of the insured personas we as treatment for miscarriage; b) Medicay necessitated pregnancy treatment due to acute compaints caused by and treatment due to miscarriage as we as medicay necessitated abortions and deiveries up to the end of the 36th week of pregnancy (premature birth), even if the pregnancy had aready commenced at the start of the insurance reationship of the insured person, if the necessity for treatment was not yet obvious at this time; c) Deiveries after expiry of the waiting period according to the agreed tariff; d) Outpatient examinations for eary diagnosis of inesses according to programmes and introduced to the Federa Repubic of Germany and prescribed by statute (purposefu preventive medica checkups); e) Death. 10.The insurance company carries additiona costs to the extent defined in the tariff for a medicay necessitated return transport prescribed by a doctor to the nearest suitabe hospita in the native country or to the permanent pace of residence of the insured person. Medica necessity for a return journey is given, if it is proven that in the agreed tariff area sufficient medica treatment is not ensured and the return journey is recommended by the doctor of the insurance company. The costs of an aso insured accompanying person are assumed, in as far the accompaniment is medicay necessitated, officiay ordered or required by the accompishing transport company. 2 specia excusions 1. So far as has not been agreed to the contrary, there is no obigation to provide benefits for treatments by doctors, dentists, icensed genera practitioner speciaised on aternative medicine, hospitas or midwives whose invoices the insurance company has excuded from reimbursement on good grounds. Precondition for this is that the insurance company has notified the party entited to insurance and the insured person before occurrence of the insured event and of the practitioner who wi not be reimbursed. In so far as at the time of notification a caim shoud be pending, no obigation to pay benefit for the practitioner concerned sha exist for expenses incurred after the expiry of three months from the time of notification being given. 2. If the medica treatment or other measure for which benefit has been agreed upon shoud exceed the medicay necessitated imits, or if the remuneration caimed is out of proportion, the insurance company may reduce benefit to an acceptabe eve. 3. The nature and amount of the insurance benefits sha be derived from these conditions of insurance of the respectivey seected tariff. 4. In the area of cover the insured person may choose from those medica doctors, dentists, icensed genera practitioners speciaised on aternative medicine and midwives who are practising on a egay approved basis in the insured s country of residence and who invoice on a ocay customary basis or - if appicabe - according to the officia scae of charges for their profession. 3 specia obigations after occurrence of The insured event 1. The insurance company is to be notified of any hospita treatment within ten days from its starting. 2. The person insured must submit the reevant documentary evidence to the insurance company within three months from the time of each individua course of treatment. 5. Pharmaceuticas, bandages, medicines and medica aids must be prescribed by the quaified practitioners mentioned in conditions of insurance section I, B, I, 1, para. 4. Pharmaceuticas may aso be obtained from a pharmacy. Nutriments, tonics, minera water, disinfectants and cosmetics, minera water, dietary, and baby food and the ike are not considered pharmaceuticas even if they have been prescribed. 3. If a person insured has concuded a contract for the insurance of medica expenses with another insurance company, if such exists or a person insured avais himsef/hersef of the entitement to insurance in connection with statutory heath insurance cover, the party entited to insurance or the person insured sha be obiged to notify the insurance company without deay of the other insurance cover arranged. 6. In case of medicay necessitated hospita treatment, the person insured has free choice from among those pubic and private hospitas that are under constant medica supervision, possess sufficient diagnostic and therapeutic equipment and conduct case histories and do not provide heath resort respectivey sanatorium treatments or accept convaescent patients. Insurance protection is granted for the genera cass (mutipe bedrooms) without coverage options (private treatment by doctor). 7. In case of medicay necessitated hospita treatment in icensed hospitas, which aso carry out heath resort or sanatorium or convaescent treatments but which in other respects conform to the conditions of section I, B, I, 1, para. 6, benefits at the agreed rate wi ony be paid if the insurance company has given written consent to this before the start of the treatment. In case of a TB condition, benefit wi be paid to the extent defined by the contract for hospita treatment in TB treatment centres and sanatoria as we. 4. The insurance company is to be informed of a case of pregnancy within four weeks after the existence of a pregnancy has been estabished, uness defined otherwise in terms of the reevant tariff. 5. The insurance company is to be informed of medicay necessitated return transports before being carried out. 6. The ega consequences of a breach of one of these obigations are set out in conditions of insurance part I, A 7, para. 4. section ii sickness daiy aowance insurance cover (ony vaid, if contained in The seected Tariff) 1 object of The insurance So far as has not been agreed to the contrary, the foowing sha appy: 8. The insurance company wi pay benefit to the extent defined by the contract for examination and treatment methods and pharmaceuticas that are generay recognised by schoo medicine. It wi in addition pay benefit for methods and pharmaceuticas, which have proved themseves in practice to be equay ikey to achieve success; the insurance company may however reduce the eve of benefit to the amount that woud have been paid if existing schoo medicine methods or pharmaceuticas had been used. 9. The insurance company wi pay to the extent defined in the tariff the conveyance and funera costs, if the death of an insured person is the consequence of an insured event. 1. The insurance company offers insurance cover against oss of income in consequence of iness or accidents either within Germany or abroad. In case of a caim arising based on inabiity to work, it wi provide a daiy sickness benefit aowance. 2. A caim sha exist in case of a proven inabiity to work in the course of medicay necessitated treatment by a doctor. The caim sha be considered to begin with the treatment, and sha end when medica findings indicate that the patient is no onger incapabe of working. 3. It sha be seen as a case of inabiity to work in the sense of these conditions if 4
the person insured, on the strength of medica evidence, cannot in any way exercise his or her profession, does not practise it and has no other means of gainfu empoyment. If the medica treatment must be extended to an iness or the consequences of an accident which is unconnected, in terms of origin, with the condition treated hitherto, to that extent it sha be considered to be a new caim. 4. Insurance cover extends to a case of inabiity to work in the country of residence defined by the insurance agreement. 3 specia excusions So far as it has not been agreed to the contrary, no benefit wi be paid: 1. in a case of inabiity to work resuting excusivey from pregnancy, aso from termination of pregnancy, miscarriage or chidbirth. As an exception to this, benefit wi be paid to individuas in a position of empoyment who are insured for the payment of sickness daiy aowance with a waiting period (period without benefit) of at east 42 days, outside the statutory prohibitions on working in accordance with conditions of insurance part I, B, II, 3, para. 2. 2 scope of insurance BenefiTs So far as has not been agreed to the contrary, the foowing sha appy: 1. The insurance company's obigation to pay benefit sha begin with the first day of inabiity to work, with the addition of any days without benefit that form part of the terms of the agreement (period of restriction). The obigation to pay benefit ends when the person insured is abe to resume work or with the end of the insurance cover according to conditions of insurance part I, A, 4, para. 5 conditions of insurance part I, B, II, 4, but at atest with the end of the duration of benefit as defined in the given tariff. 2. The insurance company hereby undertakes to adjust the insurance cover with effect from the first of the foowing month after appication has been made by the party entited to insurance and the person insured, if and to the extent that, a) through a change in the reguar net income derived from professiona activity an increase in the sickness daiy aowance agreed upon is necessary, so as to maintain the previous percentage ratio between sickness daiy aowance and net income. This obigation is aso incumbent on the insurance company in case of a reduction in the eve of a sickness benefit caim on a statutory benefit provider. b) through a change in the duration of continued payment of saary, in case of inabiity to work, a switch to a different tariff eve with a different waiting period shoud be caed for. This adjustment must be appied for within two months from the occurrence of the reasons for the change. The reasons for the change must be presented in a convincing way, and shoud be supported by documentary evidence at the request of the insurance company. In the case of current caims, the increased eve of cover sha be aowed from the time when the change becomes effective. 3. If it shoud come to the knowedge of the insurance company that the net income of insured person has sunk beow the eve of the income on which the insurance agreement is based, it sha be entited, without distinction as to whether an insurance caim has aready occurred or not, to reduce the sickness daiy aowance and the premium correspondingy, with retrospective effect from the onset of the reduction, or ca for the reimbursement of benefit paid in excess. 4. The payment of sickness daiy aowance is based on the assumption that the person insured wi be treated by a doctor or in hospita for the duration of the period that he/she is unabe to work. 5. In case of medicay necessitated hospita treatment, the person insured has free choice from among those pubic and private hospitas that are under constant medica supervision, possess sufficient diagnostic equipment and conduct case histories. 6. In case of medicay necessitated hospita treatment in icensed hospitas which aso carry out heath resort or sanatorium or convaescent treatments but which in other respects conform to the conditions of insurance part I, B, II, 2, para. 5, benefits in terms of the given tariff wi ony be paid if the insurance company has given written consent to this before the start of the treatment. In case of a TB condition, benefit wi be paid to the extent defined by the contract for hospita treatment in TB treatment centres and sanatoria as we. 5 2. in case of inabiity to work during a period of statutory prohibition on working for expecting mothers in a position of empoyment and women in chidbirth (maternity protection). 4 additiona stipuations on The end of insurance cover 1. The insurance cover comes to an end, in addition to the circumstances mentioned in conditions of insurance part I, A, 4, para. 5 with the person insured's giving up gainfu empoyment, with the onset of occupationa disabiity or earning incapacity or a partia reduction of earning abiity or when the person insured starts to draw an od age pension or pension for occupationa disabiity or earning incapacity or for reduced earning capacity. 2. The insurance company wi decide on the question whether, to what degree and starting from what time occupationa disabiity or earning incapacity or reduced earning capacity has set in, on the basis of the documentary evidence submitted to or obtained by the company, and wi communicate its decision on the matter in writing. 5 specia obigations 1. The insurance company shoud be notified immediatey of a medicay attested inabiity to work, through presentation of the appropriate documents. The doctor's certificate may be sent in advance by fax. The originas must be sent by post without deay. Certification by spouses or ife partners, parents or chidren are not sufficient as a proof of inabiity to work. If notification is received ate, the sickness daiy aowance wi be paid ony from the day of receipt, not however before expiry of the period of restriction. Documentary proof of continuing inabiity to work shoud be reguary suppied to the insurance company, in so far as the insurance company does not request it on a different basis, at two-weeky intervas at most. 2. If a sickness daiy aowance poicy is concuded for a person insured with another insurance company, or if a person insured has recourse to the insurance entitement incuded in statutory heath insurance, the party entited to insurance and the person insured sha be obiged to inform the insurance company forthwith of the other insurance poicy. 3. The insurance company is to be notified without deay of any change of career by the person insured. 4. The party entited to insurance and the insured person must immediatey notify the insurance company of the termination of the empoyment contract between the party entited to insurance and the insured person. 5. A new insurance poicy with a third party insurer that incudes a caim to sickness daiy aowance may be taken out, or an existing one increased, ony with the consent of the insurance company. 6. Persons insured are obiged to notify the insurance company immediatey of a reduction in their net income derived from professiona activity, if this is not just a temporary condition, or of a change in the duration of continued saary payment by their empoyer.