MAWISTA Science: die Bedingungen im Volltext

[Seite 1] Insurance Cover for stays abroad Insurance Product Information Document Company: AWP P&C S.A., Germany Branch Product: MAWISTA Science This information sheet provides you with a brief overview of the essential contents of our insurance product. The insurance cover is exhaustively described in the General Policy Conditions. To be fully informed, please read all documents. What is this type of insurance? MAWISTA Science is a comprehensive Insurance and includes the following benefits: Health Insurance, Emergency Call Insurance and Liability Insurance. What is insured? What is not insured? Health Insurance and Emergency Call Insurance Health Insurance and Emergency Call Insurance Which events are insured? x Medical treatment and other measures ordered by a physician that the insured person ✓ Illness or accident knew were necessary prior to inception of insurance cover or at the time of taking out the ✓ Pregnancy and childbirth (after the expiry of a waiting period of eight months) insurance or which he or she could have expected in the circumstances of which he or she What will be reimbursed? was aware. ✓ Costs for outpatient treatment by a physician x Treatment of pregnancies which occurred before the commencement of insurance ✓ Costs for medical treatment and medication prescribed by a physician x Treatment of pregnancies within the first eight months after the commencement of ✓ Costs for inpatient treatment in a hospital insurance (waiting period) ✓ Costs for Pain-killing dental treatment x Psychoanalytical and psychotherapeutic treatment and hypnosis ✓ Costs of the medically advisable and appropriate return transportation to the nearest x Prophylactic examinations and check-ups suitable hospital to the place of residence and, in the event of death, the repatriation of x Dentures mortal remains x Visual aids required as a result of an accident As part of the Emergency Call Insurance: Assistance for personal emergencies (illness, Liability Insurance accident, death) and organisation of repatriation with medically adequate means, x Liability claims among and between insured persons travelling together as soon as this is medically advisable and reasonable. x Loss or damage caused by the use of a motor vehicle, aircraft or motor-driven watercraft Liability Insurance ✓ Provides insurance cover if third parties assert claims for damages based on a damaging event that occurred during your travel. Are there any restrictions on cover? Sums insured: € 1,000,000 per person in case of personal injury and damage to property, Health Insurance and Emergency Call Insurance € 250,000 for damage to rented property ! Pain-killing dental treatment: The costs are completely assumed up to € 500. For costs between € 500 and € 1,000, 75% of the costs are assumed. ! Medically prescribed treatment (e.g. massages, fango or lymph drainage treatments): up to eight (medical) applications ! Aids required as a result of an accident: up to € 250 ! Repatriation costs: up to € 25,000 Where am I covered? ✓ Insurance cover is valid for insured persons worldwide for their temporary stay abroad (stay outside their home country). In case the insured stay abroad is interrupted, insurance cover is also provided in their home country for a period of up to 6 weeks per insurance year. What are my obligations? - You are obliged to report the damage or loss to us promptly. Health Insurance and Emergency Call Insurance - In case of severe injuries or serious illnesses, particularly prior to hospitalisation, you have to contact us immediately. Liability Insurance - If a claim has been asserted against you, you must notify us thereof within one week. If the liability claim is taken to a court of law, you shall allow us to conduct the proceedings and grant the legal counsel full power of attorney. When and how do I pay? The premium is due for the first time on commencement of the insurance contract and is payable each month in advance. The payment of the premium can be made by using one of the available payment methods (e.g. SEPA direct debit or credit card). If a contract is valid for a term of longer than one month, the renewal premium is payable on the 1st day of the new month respectively. When does the cover start and end? Insurance cover begins at the time stated in the insurance policy (start of insurance), however not before applying for insurance, not before crossing the border and not before the expiry of any waiting periods. Waiting periods are calculated from the commencement of insurance. Insurance cover ends at the agreed time, at the latest at the end of the insured stay in the agreed area of validity. The insurance contract can be agreed for full months in each case and for a maximum term of 60 months. 2018-1165 AVB 18_IPID zu 2018-1165 How do I cancel the contract? You may cancel your policy at any time. It will then expire at the end of that month. -1- [Seite 2] Documents to Insurance Policy The insurance purchased is documented in the insurance policy! Overview of Benefits Table of contents MAWISTA Science Data Protection and Insurance Information 2 • Health Insurance Terms and Conditions 3 • Emergency Call Insurance General Provisions 3 Health Insurance 3 • Liability Insurance Sums insured: € 1,000,000 per person in case of personal injury and damage to Emergency Call Insurance 4 property, € 250,000 for damage to rented property Liability Insurance 4 MAWISTA Science – Insurance Benefits at a Glance / Tariff Table 5 We are there for you Assistance in an emergency Please note the following important information If you require help in an emergency the Assistance is there for you. Our 24-hour emergency service guarantees rapid and expert assistance all over the world! Scope of validity: worldwide for their temporary stay abroad (stay outside their home country). In case the insured stay abroad is interrupted, insurance cover is also provided in their home country for a period of up to 6 weeks per insurance year. Phone: +49.89.6 24 24-496 Maximum insured travel duration: The insurances are valid for the agreed term, maximum 60 months. Important for help in an emergency: Insurable persons: The insured person is the person named in the insurance policy • Please hold the exact address and phone number of your current whereabouts as a language pupil, student, scholarship holder, candidate for a doctor‘s degree, ready to hand. guest researcher or practical trainee or members of his or her family. Persons up to • Note down the name of your contacts, e.g. physician, hospital or police. the age of 55 at inception of insurance cover can be insured. • Describe as exactly as possible the facts of the case and have the necessary infor- Guidelines on taking out insurance: The policy can be purchased at any time, mation at hand. effective on the first day of any month. Insurance cover commences at the time specified in the insurance policy, but not before submitting the application and Notification of claim commencement of the temporary stay. When purchasing after commencing the The simplest and quickest way of notifying us of your claim is via temporary stay, waiting periods may apply. www.mawista.com/schaden-melden (or alternatively by post to our Claims Department). Insurance cover is provided only for the person named on the insurance policy. The premium is due for the first time at the beginning of the insurance contract AWP P&C S.A. and is payable monthly in advance.The payment of the premium can be made by Niederlassung für Deutschland using one of the available payment methods (e.g. SEPA direct debit or credit card). (Germany Branch) If the insurer has been authorized to debit the premium from the selected payment Schadenabteilung MAWISTA method, the payment shall be deemed to have been made, if there is sufficient cover Bahnhofstraße 16 on the stated payment method at the time of debiting. The amount of the premiums D - 85609 Aschheim (near Munich) is usually based on the selected insurance cover and the term of the contract. Telefon: +49.89.6 24 24-0 Telefax: +49.89.6 24 24-222 There is no insurance cover if the non-recurring or initial premium has not been paid, unless the insured party is not responsible for non-payment. General information in the event of claim What do you do in any case of damage? The contractually agreed insurance payments are offered by AWP P&C S.A. The insured person must minimise and document the damage as far as possible. For this reason, (Allianz Partners) in compliance with the Terms and Conditions of Insurance named please ensure that you have suitable proof of the occurrence of the damage (e.g. confirmation of below. This translation is for information purposes only. In the event of any conflict damage, medical certificate) and of the extent of damage (e.g. bills, receipts). or inconsistency between the German and the English versions, the German original shall prevail. Verbal agreements are invalid. Insurance tax is included in What should you do if you fall ill, injure yourself or any other emergency occurs during your stay in the agreed area of validity? (Health Insurance, Emergency Call Insurance) the premiums. No fees are charged. The premiums and service specifications Please immediately contact the Assistance in case of severe injuries or serious illnesses, documented in the insurance policy are relevant for the scope of insurance. particularly prior to hospitalisation, so that adequate treatment can be ensured or repatriation transport arranged. For the reimbursement of the costs you have paid at the location, please submit original bills and/or prescriptions. Important: The bills must show the name of the person receiving treatment, the name of the illness, the treatment data and the individual medical services provided and the costs of these. Prescriptions must provide information on the medications prescribed, the prices and bear the stamp of the pharmacy. Olaf Nink, Chief Executive Officer What do you have to consider if you have caused damage? (Liability Insurance) Please note down the names and addresses of witnesses who saw the damaging event. Ask for a copy of the police report if the police was called in to investigate the case. Notify the insurer and submit these Allianz Partners Chief Executive Officer: Olaf Nink documents and this information to it with your notice of damage. AWP P&C S.A. Registration Court: München HRB 4605 Niederlassung für Deutschland VAT ID no: DE 129274528 (Germany Branch) Insurance tax no.: 802/V90802001910 Bahnhofstraße 16 D - 85609 Aschheim (near Munich) AWP P&C S.A. Public limited company under French law Registered Office: Saint-Ouen (France) Commercial register: R.C.S. Bobigny 519 490 080 Board of Management: Rémi Grenier (Chairman), Dan Assouline, Fabio de Ferrari, Ulf Lange, Claudius Leibfritz, Lidia Luka-Lognoné, Mike Nelson, Sylvie Ouziel -1- [Seite 3] Data Protection In accordance with Art. 13 of the General Data Protection We also process your personal data in order to fulfil other statutory We will notify you in each specific case about what persons Regulation (GDPR), we are informing you about the processing of obligations, such as regulatory stipulations, as well as retention ob- or institutions require information for what purpose. You may your personal data by AWP P&C S.A., Niederlassung für Deutsch- ligations imposed by commercial and tax law regulations. The legal then decide in each case whether you consent to us collecting land (Germany Branch), and about your rights under the data basis of the data processing in this case, is provided by the relevant and using your medical information, and whether to release protection law. statutory regulations in conjunction with Art. 6 para. 1 c) GDPR. the named persons or institutions and their employees from their duty of non-disclosure, and if you agree to the commu- 1. Who is responsible for processing your personal data? If we intend to process your data for any purpose other than those nication of your medical data to us, or if you want to per- described above, we will notify you in advance within the framework sonally provide the necessary documentation. Responsibility for processing your personal data rests with of the statutory regulations. 3. To what recipients will we communicate your data? AWP P&C S.A. b) What applies to special categories of personal data, especially Recipients of your personal data may include: selected external ser- Niederlassung für Deutschland health-related data? vice providers (e.g. assistance service providers, benefit processors, (Germany Branch) There are special safeguards on the processing of special categories transport service providers, technical service providers, etc.), other Bahnhofstraße 16 of personal data, of which health-related data is one. As a rule, pro- insurers or re-insurers. D-85609 Aschheim (bei München). cessing is possible only if you have consented, or if one of the legally defined situations exist (Art. 9 section 2 GDPR). In addition, we may also communicate your personal data to other The Data Protection Officer can be contacted by standard mail at the recipients, such as public authorities for the fulfilment of statutory aforementioned address, using the suffix “Data Protection Officer”, aa) Processing of your special categories of personal data duties of notification (e.g. finance authorities or criminal investiga- or by email at datenschutz-azpde@allianz.com. In many cases, in order to examine the benefit entitlement, tion agencies). we require personal data belonging to a special category. This 2. For what purpose is your data processed, and on what legal includes health-related data, for example. If, in connection 4. For how long will we store your data? basis does this take place? with a specific insurance claim, you provide us with such data We will store your data for the period during which claims may be together with a request to examine the case and process the made against our company (statutory retention period from 3 to 30 a) What applies to all categories of personal data? claim, you are explicitly permitting us to process your health- years). We will also store your data if we are under a legal obligation We process your personal data in compliance with the EU General related data as necessary in order to process the insurance to do so, e.g. according to the provisions of the German Commercial Data Protection Regulation (GDPR), the German Federal Data claim. We will remind you again separately of this fact by way Code, the German Fiscal Code or the German Money Laundering Protection Act (BDSG), the provisions of the German Insurance of the claims form. Act. The relevant retention periods amount to 10 full years in these Contract Act (VVG) relevant to data protection law, as well as all cases. other applicable laws. The consent may be withdrawn at any time, taking effect for the future. However, please be informed that it may no 5. What are your rights? When you submit an application for insurance cover, we will require longer be possible to examine our duty to indemnify as a You have the right to be informed about all of the information stored the information provided by you in this regard, in order to conclude result of the insured event. If the insurance claim has already by us, and to demand that incorrect data be corrected. Under cer- the contract and to estimate the risk assumed by us. If the insurance been processed, it may be the case that the data cannot be tain conditions, you also have the right to deletion of data, the right contract comes into existence, we will process this data for the im- deleted for statutory retention periods, for example. to object to processing, the right to restriction of processing and the plementation of the contractual relationship, such as for invoicing right to data portability. purposes. We require information about the damage/loss in order bb) Requesting health-related data from third parties in order to be able to assess if an insured event has occurred and determine to examine the duty to indemnify Right of objection the extent of this damage/loss. In order to examine our duty to indemnify, it may be ne- You may object to the processing of your data for direct cessary for us to check information concerning your state of marketing purposes. If we process your data in order to protect It is not possible to conclude and implement the insurance con- health, as provided by you in substantiating claims, or which is legitimate interests, you may object to this processing for reasons tract without processing your personal data. evident from documents submitted (e.g. invoices, prescrip- pertaining to your particular situation. tions, reports) or statements, e.g. from a doctor or other Art. 6 section 1 b) GDPR constitutes the legal basis for the processing member of a healthcare profession. of personal data for pre-contractual and contractual purposes. If you have any objections concerning the handling of your data, For this purpose, we will require your consent, including a you may contact the aforementioned Data Protection Officer in this We will also process your data for the purposes of the legitimate confidentiality waiver covering us and all agencies subject to regard. You are also entitled to raise objections with a data protec- interests pursued by us or by third parties (Art. 6 section 1 f) GDPR). a duty of confidentiality, and which are required to provide tion supervisory authority. This can particularly be the case: information to enable the duty to indemnify to be examined. • for ensuring IT security and IT operation, • for marketing our own insurance products, and for conducting marketing and opinion polls, • for the prevention and investigation of criminal activities; in particular we use data analyses for the detection of facts that could indicate insurance fraud. Insurance Information Complaint Notice: Right to revoke contracts valid for a term of one month or more: Consequences of revocation: Our goal is to offer first-class services. It is equally important to us You can revoke your contractual declaration within 14 days in When revocation is effective, insurance cover ceases and we shall to respond to your concerns. If you are not satisfied with any of our writing (e.g., letter, fax, e-mail) without stating reasons. The refund to you that portion of the premium allocated to the period products or our service, please notify us directly. period begins after you have received the insurance certificate, after receipt of the revocation if you consented to insurance co- the terms of the contract including the Terms and Conditions of ver beginning prior to the end of the revocation period. We are You can send us your complaints relating to contract or claim issues Insurance, the additional information pursuant to § 7 (1) and entitled in this case to retain that portion of the premium that using any means of communication. You can reach us by telephone (2) of the Insurance Contracts Act (VVG) in conjunction with is allocated to the period until receipt of the revocation. This is a at +49.89.6 24 24-460, in writing by e-mail to service@allianz- §§ 1 through 4 of the VVG Decree on Information Duties sum calculated proportionally by days. Amounts to be refunded assistance.de, or by regular mail to AWP P&C S.A., - each of these notifications in written form. In case of will be remitted without undue delay, no later than 30 days after Beschwerdemanagement, Bahnhofstrasse 16, D - 85609 Aschheim contracts in electronic commerce (§ 312i (1)(1) of the receipt of the revocation. If insurance cover does not commence (bei München), Germany. Additional information on our complaint German Civil Code (BGB), this period shall not commence prior prior to the end of the revocation period, then effective revocation process can be found at www.allianz-reiseversicherung.de/ to our performance of our duties pursuant to § 312i (1)(1) of means that payments received must be refunded and uses made beschwerde. We will not participate in dispute settlement the German Civil Code in conjunction with Article 246c of the thereof (e.g., interest) must be disbursed. proceedings before a consumer arbitration board. Introductory Law to the German Civil Code (EGBGB). The deadline for revocation is deemed met if the revocation is Special notes: In the event of complaints relating to all types of insurance, please dispatched in good time. It must be sent to: Your right of revocation lapses when the contract is completely contact the responsible supervisory authority, Bundesanstalt AWP P&C S.A., Bahnhofstraße 16, D - 85609 Aschheim (near performed both by you and also by us at your express request für Finanzdienstleistungsaufsicht (BaFin - the German Federal Munich), Fax + 49.89.6 24 24-244, E-mail: service@allianz- before you have exercised your right of revocation. Financial Supervisory Authority), Graurheindorfer Strasse 108, assistance.de D - 53117 Bonn, Germany (www.bafin.de). Your AWP P&C S.A., Germany Branch The contract is governed by the laws of the Federal Republic of Ger- many, unless this conflicts with international law. Legal action based on the insurance contract can be brought by the policyholder or the insured person before the court with jurisdiction over the principal place of business or the branch of the insurer. If the policyholder or the insured person is a natural person, legal action can also be brought before the court in the district of which the policyholder or the insured person has his place of residence when the legal action is brought or, if he does not have a place of residence, his habitual place of abode. -2- [Seite 4] Terms and Conditions of AWP P&C S.A., Germany Branch AWP is the abbreviation of Allianz Partners and will hereinafter be continues if the end of travel is delayed for reasons for which the 3. Flat-rate expense allowance in case of hospitalisation referred to as “the insurer”. insured person is not responsible. This does not apply in case of If the costs are paid by a third party in case of medically stays in countries in whose territory war or civil war is already necessary treatment as an inpatient in the agreed area of validity, ongoing or where such an outbreak was foreseeable. Damage or the insurer will pay a maximum flat-rate expense allowance of General Provisions loss through active participation in war, civil war or events similar € 30 per day for a maximum period of 45 days from the on the MAWISTA Science Insurance Cover to war are not covered by the insurance. commencement of inpatient treatment (for telephone, TV, (abbreviated: VB AB 18 MSC) 3. Damage or losses intentionally caused by the insured person. additional meal allowance for visitors etc.). The regulations as stipulated under §§ 1 to 11 apply to all MAWISTA §6 What are the duties and obligations of the insured person § 2 What costs are reimbursed for medical treatment? Science insurance products. in the event of a claim? 1. The insurer reimburses expenditures for all necessary medical The General Policy Conditions (VB) printed below apply to the The insured person is obliged to: treatment in the agreed area of validity, including costs incurred respective insurance. Insurance cover is provided if you have 1. Minimise the loss as far as possible and avoid unnecessary costs. for: contractually agreed the insurance concerned. 2. Report the loss to the insurer without delay. a) Outpatient treatment by a physician; 3. Describe the damaging event and the extent of damage and b) Medical treatment and medication prescribed by a physician § 1 Who is insured? truthfully provide the insurer with any and all pertinent infor- for the insured person. 1. The insured person is the person named in the insurance policy mation. The insured person must furnish proof in the form of c) Inpatient treatment in hospital, including operations that as a language pupil, student, scholarship holder, candidate for a original bills and receipts, release physicians from their confiden- cannot be postponed. In case of premature birth, the costs doctor‘s degree, guest researcher or practical trainee or mem- tiality obligation as necessary – including the physicians of the of treatment required for the newborn child in the agreed bers of his or her family. Assistance – and allow the insurer to reasonably examine the area of validity will also be covered up to € 100,000 (notwith- 2. Persons up to the age of 55 at inception of insurance cover can cause and amount of the asserted claim. standing § 1 VB AB 18 MSC). The following applies for be insured. inpatient medical treatment and childbirth in Germany: § 7 When does the insurer pay compensation? General hospital costs (multi-bed room) are reimbursed and § 2 What area of validity does the insurance apply to? As soon as AWP has determined whether and to what extent it has according to the Federal Nursing Care Tariff Ordinance and 1. Insurance cover is valid for insured persons worldwide for their an duty to indemnify, compensation is paid within two weeks. the Hospital Remuneration Act; expenses for optional services temporary stay abroad (stay outside their home country). In case (private medical treatment) are not covered by the insurance. the insured stay abroad is interrupted, insurance cover is also §8 What applies if the insured person has claims for damages d) Patient transportation deemed medically necessary for provided in their home country for a period of up to 6 weeks per against third parties? inpatient treatment at the nearest and appropriate hospital in insurance year. 1. In accordance with statutory regulations, claims for damages the agreed area of validity and back to the insured person‘s 2. Home country is the country in which the insured person had his against third parties pass to the insurer up to the level of payment accommodation. or her permanent principal residence prior to the application of effected, provided that the insured person suffers no disadvantage e) Pain-killing dental treatment and repairs of dentures and insurance cover. thereby. provisional measures: The costs are completely assumed up 2. The insured person is obliged to confirm the assignment of to € 500 per insurance year. For costs between € 500 and § 3 When does the insurance begin and end? claims to this extent in writing upon request by AWP. € 1,000 per insurance year, 75% of the costs are assumed. No Insurance cover 3. Any duties to indemnify arising under other insurance contracts insurance cover is provided for any costs in excess thereof. 1. begins at the time stated in the insurance policy (start of and other social insurance institutions will have precedence f) The medical care and treatment of pregnancies which insurance), however not before applying for insurance, not over those of AWP. AWP will be deemed to have made advance occurred after the commencement of insurance and after the before crossing the border and not before the expiry of any payment, if the original bills are first presented to AWP for expiry of a waiting period of eight months. waiting periods. Waiting periods are calculated from the payment. g) Aids required as a result of an accident up to € 250 per commencement of insurance; insurance year. 2. ends at the agreed time, at the latest at the end of the insured §9 When does the insured person forfeit claims to insurance h) Medically prescribed treatment (e.g. massages, fango or stay in the agreed area of validity or at the agreed time; benefits due to a breach of duties and the statute of lymph drainage treatments) up to eight (medical) applica- 3. can be extended for up to 60 months in total (taking into limitations? tions in total per insurance year, even then if multiple (medi- consideration any similar insurance contracts with other 1. If a breach of duty is intentionally committed, the insurer is released cal) applications are carried out within one treatment. insurers) upon application before the expiry of the original term from its duty to indemnify; in case of grossly negligent violation, i) Medically necessary rehabilitation measures as subsequent of contract. However, the premiums and Terms and Conditions AWP is entitled to reduce its payment in proportion to the medical treatment prescribed by a physician. of Insurance valid at the time of the application for extension degree of fault of the insured person. j) In this context, the insurer shall pay for methods of examina- apply. 2. The insured person must furnish proof that no gross negligence tion or treatment widely accepted by conventional medicine was involved. Except in case of fraudulent intent, AWP is to the extent stated in the contract. In addition, the insurer §4 What term of validity does the contract have? When is the obliged to indemnify if the insured person furnishes proof that shall pay for methods and medication which have shown premium payable? the breach of duty is not the cause of either the occurrence or themselves to be just as promising in practice and which 1. The insurance contract can be agreed for full months in each the determination or the scope of AWP’s duty to indemnify. are applied because no conventional medical methods or case and for a maximum term of 60 months. 3. The claim to an insurance benefit lapses in three years, calcu- medication is available. However, the insurer may reduce the 2. The insured person can give notice of termination of the lated from the end of the year in which the claim occurred and payment to the amount which would have been incurred if insurance contract daily to the end of the month. the insured person obtained knowledge of the circumstances conventional medical methods or medicine had been applied. 3. The premium is due for the first time on commencement of in order to assert the claim, or would have obtained knowledge 2. The insurer reimburses the costs in accordance with the the insurance contract and is payable each month in advance. without gross negligence. conditions for a duration of up to eight weeks after the agreed The payment of the premium can be made by using one of the term of validity of the insurance contract until the date when available payment mehtods (e.g. SEPA direct debit or credit § 10 What form must be followed for submitted declarations of the insured person can be transported at the latest, if patient card). If the premium has not been paid upon the occurrence of intent? repatriation was not advised for medical reasons during the term the insured event, the insurer shall not have a duty to indemnify, 1. Notices and declarations of intent from the insured person and of the contract. unless the insured person is not responsible for non-payment. the insurer are required to be in writing (e.g. letter, fax or e-mail). If the insurer has been authorized to debit the premium from 2. Insurance agents are authorised to accept such documents and §3 What costs does the insurer reimburse in case of patient the selected payment method, the payment shall be deemed forward them to AWP. repatriation transportation and repatriation of mortal to have been made, if there is sufficient cover on the stated remains? payment method at the time of debiting. § 11 Which court in Germany is responsible for dealing with the The insurer reimburses the following: 4. If a contract is valid for a term of longer than one month, the assertion of claims based on the insurance contract and 1. The costs of the medically advisable and justifiable repatriation renewal premium is payable on the 1st day of the new month which law applies? of the insured person to a suitable hospital located closest to respectively. If the insurer has been authorized to debit the 1. At the option of the insured person, the courts of Munich or the place of residence of the insured person in his or her home premium from the selected payment method, the payment shall the place in Germany where the insured person has his or her country. In addition, the costs of the medically advisable and be deemed to have been made, if there is sufficient cover on the permanent residence or habitual abode at the time the legal justifiable repatriation are reimbursed upon request by the stated payment method at the time of debiting. If the renewal action is brought will have jurisdiction and venue. insured person where continued hospital treatment is expected premium is not paid, the insurer may set a period for payment 2. The laws of the Federal Republic of Germany apply insofar as to exceed 14 days in the opinion of the physician giving of at least two weeks in text form. If an insured event occurs they do not conflict with international law. treatment. after the expiry of the period and the insured person is still in Irrespective of this, the costs of the patient‘s repatriation to his or arrears with the payment of the renewal premium, the insurer is her home country are paid if these remain within the limits of the exempted from its duty to indemnify. The insurer may terminate Terms and Conditions of the expected costs of continued medical treatment. the contract instantly if the insured person is still in arrears with payment after the expiry of the period. If payment is made within Health Insurance 2. The actual costs of up to € 25,000 for the repatriation of the MAWISTA Science deceased insured person for a funeral in his or her home country one month after termination or after the expiry of the period set (abbreviated: VB K 18 MSC) or, alternatively, the actual costs of a local funeral up to the costs for payment, the effect of the termination ceases to apply and of repatriation at the maximum. the contract enters into force again. However, no insurance § 1 What is insured? cover is provided for insured events occurring after the expiry of 1. The insurance covers the costs of: § 4 What limitations on insurance cover are to be noted? the period set for payment. a) Medical treatment No insurance cover is provided for the following: b) Patient repatriation transportation 1. Medical treatment and other measures ordered by a physician, § 5 In which cases does insurance cover not apply? c) Repatriation of mortal remains in case of death in the event of where the purpose of the stay in the agreed area of validity was No insurance cover is provided in the following cases: acute illnesses and accidental injuries occurring in the agreed to seek such treatment. 1. Damage or loss caused by strikes, nuclear energy, confiscation area of validity within the insured period. 2. Medical treatment and other measures ordered by a physician and other invention acts by public authority, as well as damage 2. Insurance cover is provided in the agreed area of validity for the that the insured person knew were necessary prior to the stay or loss in areas for which the German Federal Foreign Office has costs of the medical treatment during pregnancy and childbirth in the agreed area of validity or at the time of taking out the issued a travel warning. If an insured person is at such a location only if the pregnancy (conception) occurred after the commen- insurance or which he or she could have expected in the at the time when a travel warning is issued, insurance cover cement of insurance and after the expiry of a waiting period of circumstances of which he or she was aware. ends 14 days after the issuance of the travel warning; insurance eight months. Irrespective of the time when pregnancy occurred 3. Nutriments and tonics. cover continues in spite of the travel warning if the end of travel is and the waiting period, the insurer will reimburse the costs 4. Orthodontic treatment, dental treatment other than pain-killing delayed for reasons for which the insured person is not of medical treatment in case of the occurrence of acute treatment, repairs to dentures and provisional measures. responsible. complications in the pregnancy including miscarriage and pre- 5. Medical treatment (e.g. massages, fango or lymph drainage 2. Damage or loss due to war or events similar to war; however, mature birth. treatments) which exceed eight treatments per insurance year. insurance cover does exist if the damage or loss occurs in the first 14 days after the beginning of the events; insurance cover -3- [Seite 5] 6. The purchase of prostheses and other medical aids; notwith- 2. Inpatient treatment 5. The sums insured as stipulated in § 1 are the maximum limit of standing this, insurance cover is provided up to € 250 per year In case of inpatient treatment of the insured person at a hospital, benefits payable by the insurer per insured event; they also con- for aids required as a result of an accident. the Assistance provides the following services: stitute the aggregate maximum indemnity paid for all insured 7. Treatment of alcoholism, drug addiction and other addictions as a) Support events in an insurance year. well as the consequences thereof. If required, the Assistance establishes contact through its 8. Treatment of pregnancies which occurred before the contract physician to the respective family physician of the § 3 What risks are not insured? commencement of insurance and for the treatment of pregnan- insured person and to the hospital physicians providing Insurance cover does not include the following: cies within the first eight months after the commencement of treatment. It ensures that information is passed between the 1. Liability claims insurance (waiting period). physicians involved. Upon request, the Assistance informs a) insofar as these exceed the scope of the insured person‘s 9. Treatment or accommodation caused by infirmity, need of relatives of the insured person. statutory liability as a result of contractual or other commit- nursing care or detention. b) Patient visits ments; 10. Psychoanalytical and psychotherapeutic treatment and In case of the inpatient treatment of the insured person, the b) among and between insured persons and insured persons hypnosis. Assistance organises the travel for one person close to the and their relatives (including life partners); 11. For fees and charges which exceed the extent considered insured person to the hospital where the insured person c) due to transmission of illness by the insured person; generally customary and reasonable in the country concerned is staying and back to his or her place of residence in his or d) due to damage caused by occupational activities. The and for optional benefits such as a single room or treatment by her home country. The insurer pays the costs of transport in insurance includes the recourse claim of the employer the head physician. The reimbursement may be reduced to the case of a life-threatening illness of the insured person or if against the insured person based on personal injury or customary rates in the country. inpatient treatment lasts for longer than 14 days. property damage as a result of negligence. Damage caused 12. Patient repatriation transport caused by one of the reasons c) Declaration to meet costs by intent is excluded. The maximum indemnity paid per mentioned under No. 1, 2, 7 and 9. In case of inpatient hospital treatment, the insurer will give the damaging event is € 10,000 for all claims in an insurance year. 13. Prophylactic examinations and check-ups, check-ups of children insured person a declaration that it will meet the costs up The deductible amounts to 10% of the reimbursable damage and young people, dental check-ups and dental prophylaxis as to an amount of € 15,000. This declaration does not involve for each claim, however € 150 at the maximum. well as any charges and fees for medical certificates, reports on any recognition that the insurer has a duty to indemnify. The 2. Liability claims against the insured person diagnostic findings and doctor’s certificates for inability to work, insurer assumes settlement with the payer responsible in the a) in connection with hunting activities; which were not requested by the insurer. name of the insured person. b) due to damage caused to third-party property rented by or 3. Patient repatriation transportation on loan to the insured person or obtained through unlawful §5 What are the duties and obligations of the insured person As soon as medically advisable and appropriate, or if the interference or in the insured person‘s custody. However, in case of damage or loss? duration of the hospital stay is expected to exceed 14 days in the liability arising from damage to rooms and buildings during The insured person is obliged to: opinion of the physician giving treatment, the Assistance will the stay in the agreed area of validity, in particular damage 1. Contact the Assistance immediately in the event of inpatient organise return transportation using medically adequate means to rented holiday apartments and hotel rooms or the accom- treatment at a hospital, prior to the commencement of any of transport (including air ambulances) to the closest suitable modation but not damage to furniture.; insurance cover is extensive diagnostic or therapeutic procedures as an inpatient or hospital to the insured person‘s place of residence after prior not provided for liability claims based on wear and tear or outpatient, and prior to any submission of acknowledgements of consultation between the contract physician of the Assistance excessive use; payment. The insurer will reimburse the documented costs for and the local physicians handling the case. c) as the owner, possessor, keeper or driver of a motor vehicle, making contact up to € 25. aircraft or motor-driven watercraft due to damage caused by 2. Consent to return or repatriation to his or her home country, §3 Does the Assistance procure the necessary medications for the use of such a vehicle. assuming the insured person is fit to be transported and provided the insured person? d) as the owner or keeper of animals; that the requirements under §§ 3 No. 1 VB K 18 MSC have been In concert with the family physician of the insured person, the e) for hazards directly related to the deliberate and illegal met, if the Assistance authorises the return journey in view of the Assistance takes care of procuring medically prescribed medication commission of a punishable offence. nature of the illness and the treatment required. and sending it to the insured person, if this is possible. The 3. Submit to the insurer the original invoices or duplicates with an insured person must reimburse the costs of the medication to the §4 What are the duties and obligations of the insured person original reimbursement stamp by another insurance company Assistance within one month. after the occurrence of damage or loss? concerning the benefits granted; these will then become the An insured event is deemed to be a damaging event that could property of the insurer. §4 What services does the Assistance provide in case of the entail liability claims against the insured person. death of the insured person? 1. Each and every insured event must be reported in text form (e.g. § 6 What deductible does the insured person pay? If the insured person dies during his or her stay in the agreed area of letter, fax, e-mail) the insurer immediately. There is no deductible. validity, the Assistance will organise a funeral in the agreed area of 2. The insured person must also immediately inform the insurer validity or the repatriation the deceased person‘s mortal remains to of any initiation of a preliminary investigation or issuance of an the place of the funeral in his or her home country as requested by order of summary punishment or payment order, even if the Terms and Conditions of the deceased person‘s relatives. insurer already knows about the insured event. the Emergency Call Insurance 3. If a claim for compensation has been asserted against the MAWISTA Science insured person, he or she must notify the insurer thereof within (abbreviated: VB N 18 MSC) Terms and Conditions of one week after the claim is filed. the Liability Insurance 4. The insured person must also notify the insurer when a claim has N.B.: MAWISTA Science been asserted that involves judicial or state assistance. The Assistance is entrusted with the provision of services under the (abbreviated: VB H 18 MSC) 5. The insured person is obliged to take all possible steps to mini- Emergency Call Insurance. mise the loss while complying with the insurer‘s instructions and § 1 What risk does the insurer assume? to take every action necessary or useful to clarify the case of loss. § 1 What services does the insurer provide? The insurer provides insurance cover against everyday liability risks if The insured person must provide a detailed and truthful loss 1. The insurer provides assistance and support to the insured person a third party asserts claims for damages against the insured person report, supply information on all circumstances connected with during his or her stay in the agreed area of validity in the emer- during his or her stay in the area of validity due to a damaging event the damaging event and submit the corresponding documents. gencies named below and pays the costs incurred up to the limits that occurred during travel on the grounds of statutory liability pro- 6. If the liability claim is taken to court, the insured person shall specified in each case. The insurer reserves the right to check visions as defined under private law. Damaging events are defined allow the insurer to conduct the proceedings, grant the legal cover. Services provided by the Assistance and declarations on as death, injury or impairment to health (personal injury) or damage counsel appointed and nominated by the insurer full power of its part to meet costs as well as any orders placed with service to or destruction of property (damage to property). attorney to act on his or her behalf and submit all declarations providers do not include any acknowledgement of the insurer‘s deemed necessary by the legal counsel or the insurer. Without duty to indemnify under the insurance contract vis-à-vis the §2 How does the insurer protect the insured person against awaiting instructions from the insurer, the insured person must insured person as a basic principle. liability claims? To what extent does it pay indemnity? raise objections within the specified period or seek the necessary 2. The insurer has entrusted the Assistance with the provision 1. The insurer examines liability claims with regard to their vali- legal remedies against orders for payment of damages decreed of services named below for the insured person as a 24-hour dity, wards off unjustified claims and reimburses the compen- by the courts or by the state. service. sation owed by the insured person. The insurer reimburses the 7. If the insured person obtains the right to demand the cancella- 3. The insured person must contact the Assistance without delay to compensation if it recognises its duty to indemnify or approves tion or reduction of a payable annuity as a consequence of claim the services in an emergency. admission of liability on the part of the insured person. The altered circumstances, the insured person is obliged to allow the 4. Insofar as the insured person cannot claim the reimbursement insurer also pays compensation if it effects or approves a settle- insurer to exercise such right on his or her behalf. The provisions of amounts paid out from the insurer or from another payer, the ment or where decreed by a court ruling. of Nos. 3 to 5 apply accordingly. insured person must repay the amounts to the insurer within 2. If the injured party or his or her legal successor asserts a liability 8. The insurer is considered to have full authority to submit all one month of invoicing. claim in court, the insurer will conduct the legal dispute at its declarations on behalf of the insured person that it deems own expense on behalf of the insured person. suitable to settle or ward off a claim. §2 What help does the Assistance provide in case of illness 3. If the insurer requests or approves the appointment of a defence and accident? counsel in criminal proceedings against the insured person § 5 What deductible does the insured person pay? 1. Outpatient treatment arising from an insured damaging event, the insurer will pay the There is no deductible. However, for damage caused by occupatio- The Assistance provides information on the possibilities of costs of the defence counsel. nal activities, the deductible is 10% of the reimbursable damage for medical care and names a physician who speaks German or 4. If the insurer fails to settle a liability claim by admission, each insured event, € 150 at the maximum. English as far as possible. However, the Assistance does not satisfaction or settlement on account of the resistance of the contact the physician. insured person, the insurer shall not be required to pay any additional expenses incurred for the main issue, interest and the costs. -4- [Seite 6] MAWISTA Science – Insurance Benefits at a Glance / Tariff Table MAWISTA Science General Provisions § 2, No. 1 Insurance cover in the insured person‘s home country if the stay up to 6 weeks per insurance year abroad is interrupted. Health Insurance § 2, No. 1 Amount of costs reimbursed for … a) Outpatient treatment unrestricted b) Medical treatment and medication unrestricted c) Inpatient treatment unrestricted c) Medical treatment of a newborn baby if born prematurely max. € 100,000 d) Medically necessary patient transportation to a hospital unrestricted e) Pain-killing dental treatment per insurance year 100% for bills up to € 500, 75% for bills above € 500 up to max. € 1,000 f) Dentures per insurance year not insured g) Treatment of pregnancy after the expiry of a waiting period of unrestricted 8 months h) Aids required as a result of an accident per insurance year max. € 250 i) Visual aids required as a result of an accident per insurance year not insured j) Treatment (e.g. massages, fango and lymph drainage treatment) max. 8 treatments per insurance year k) Rehabilitation measures unrestricted § 2, No. 2 Provision of the insurance benefit subsequently after the expiry of max. 8 weeks the insurance contract if the insured person is unfit to travel. § 3, No. 1 The costs of the medically advisable and justifiable patient repatriation transportation to the nearest hospital in the insured person's home Patient repatriation transportation to the home country country at an unlimited amount, also if hospital treatment lasts longer than 14 days on request by the insured person. § 3, No. 2 Reimbursement of costs for repatriation of mortal remains to home max. € 25,000 country § 3, No. 2 up to the costs of the repatriation of mortal remains at the maximum Reimbursement of costs for local funeral §6 no deductible Deductible Emergency Call Insurance §1-§4 Offers immediate assistance worldwide in case of an emergency in the agreed area of validity § 2, No. 2 c) max. € 15,000 Declaration of amount of costs assumed for inpatient treatment Liability Insurance §1 • max. € 1,000,000 for personal injury and property damage Sums insured • max. € 250,000 for damage to rented property § 3, No. 1d) Sum insured for damage caused by occupational activities due to max. € 10,000 recourse claims of the employer in case of negligence §5 10% of the reimbursable damage, max. € 150 per insured event Deductible in case of damage caused by occupational activities Monthly Premiums up to 40 years € 44.80 € 72.10 Duration of insurance in months 1st to 12th 13th to 60th 41 to 55 years € 88.50 € 143.10 Duration of insurance in months 1st to 12th 13th to 60th 2018-1355 -5-