MAWISTA Student Comfort: die Bedingungen im Volltext

[Seite 1] Versicherungen für Auslandsaufenthalte Informationsblatt zu Versicherungsprodukten Produkt: MAWISTA Student Unternehmen: AWP P&C S.A., Niederlassung für Deutschland Comfort Dieses Informationsblatt gibt Ihnen einen kurzen Überblick über die wesentlichen Inhalte unseres Versicherungsproduktes. Vollständig dargestellt ist der Versicherungsschutz in Ihren Versicherungsunterlagen. Damit Sie umfassend informiert sind, lesen Sie bitte alle Unterlagen durch. Um welche Art von Versicherung handelt es sich? MAWISTA Student Comfort ist ein Versicherungs-Paket und beinhaltet folgende Leistungen: Krankenversicherung, Notruf-Versicherung, Unfallversicherung und Haftpflichtversicherung. Was ist versichert? Was ist nicht versichert? Kranken- und Notruf-Versicherung Kranken- und Notruf-Versicherung Welche Ereignisse sind versichert? x Heilbehandlungen und andere ärztlich angeordnete Maßnahmen, die ein Anlass für den ✓ Krankheit oder Unfall Aufenthalt sind oder deren Notwendigkeit Ihnen vor Antritt oder zur Zeit des Versiche- ✓ Schwangerschaft und Entbindung rungsabschlusses bekannt war oder mit denen Sie nach den Ihnen bekannten Umständen Was wird ersetzt? rechnen mussten ✓ Kosten für ambulante Behandlung durch einen Arzt x Behandlungen von Schwangerschaften, die bereits vor Versicherungsbeginn eingetreten ✓ Kosten ärztlich verordneter Arzneimittel und Heilbehandlungen sind ✓ Kosten für stationäre Behandlung im Krankenhaus x Psychoanalytische und psychotherapeutische Behandlung sowie Hypnose ✓ Kosten für schmerzstillende Zahnbehandlung x Vorsorgeuntersuchungen ✓ Kosten für den medizinisch sinnvollen und vertretbaren Rücktransport in das Ihrem Wohn- ort nächstgelegene, geeignete Krankenhaus sowie im Todesfall die Überführungskosten Unfallversicherung ✓ Kosten für Zahnersatz (nach einer Wartezeit von acht Monaten) x Unfälle durch Geistes- oder Bewusstseinsstörungen, Schlaganfälle, Krampfanfälle; dies gilt ✓ Kosten für unfallbedingte Sehhilfen auch, soweit der Zustand auf Alkohol- oder Drogeneinfluss zurückzuführen ist ✓ Kosten für Impfungen Haftpflichtversicherung Im Rahmen der Notruf-Versicherung: Hilfe bei persönlichen Notfällen (Krankheit, Unfall und x Haftpflichtansprüche von gemeinsam versicherten Personen untereinander Tod) und Organisation des Kranken-Rücktransports mit medizinisch adäquaten Mitteln, sobald x Schäden, verursacht durch Gebrauch von Kraft-, Luft- oder motorgetriebenen dies medizinisch sinnvoll und vertretbar ist Wasserfahrzeugen Unfallversicherung ✓ Leistet Entschädigung, wenn ein versicherter Unfall zu dauernder Invalidität oder zum Tod der versicherten Person führt.  ersicherungssummen: € 10.000,- bei Tod, bis € 40.000,- bei Invalidität, € 140.000,- bei V Vollinvalidität und bis € 5.000,- für Such-, Rettungs- und Bergungskosten nach einem Unfall Gibt es Deckungsbeschränkungen? Kranken- und Notruf-Versicherung Haftpflichtversicherung ! Schmerzstillende Zahnbehandlung: höchstens € 1.000,- ✓ Bietet Versicherungsschutz, wenn Dritte wegen eines Schadenereignisses, das Sie ! Heilmittel (z. B. Massage- und Fango-Behandlungen sowie Lymphdrainagen): verursacht haben, Schadenersatzansprüche geltend machen höchstens 8 Behandlungen ! Unfallbedingte Hilfsmittel: € 1.000,- Versicherungssummen: € 1.000.000,- je Person bei Personen- und Sachschäden, ! Zahnersatz: 60 % der Gesamtkosten, maximal € 1.000,- nach einer Wartezeit € 250.000,- für Mietsachschäden von acht Monaten ! Unfallbedingte Sehhilfen: € 100,- nach einer Wartezeit von drei Monaten ! Überführungskosten: maximal € 25.000,- ! Impfungen: maximal € 250,- in der gesamten Vertragslaufzeit Unfallversicherung ! Wenn Krankheiten oder Gebrechen zu mindestens 25 % bei der unfallbedingten Gesund- heitsschädigung mitgewirkt haben, kann die Leistung entsprechend gekürzt werden. -1- [Seite 2] Wo bin ich versichert? ✓ Für Personen mit Heimatland Deutschland gilt der Versicherungsschutz für den vorübergehenden Aufenthalt außerhalb Deutschlands. ✓ Für Personen mit Heimatland außerhalb Deutschlands gilt der Versicherungsschutz für den vorübergehenden Aufenthalt in Deutschland, der EU sowie der Schweiz, Liechtenstein, Norwegen, dem Vereinigten Königreich und Island. ✓ Es besteht außerdem Versicherungsschutz für Deutsche in Deutschland bei einer Unterbrechung des Aufenthalts bis zu 6 Wochen je Versicherungsjahr. ✓ Generell sind Reisen in Gebiete, für die zum Zeitpunkt der Einreise eine Reisewarnung des Auswärtigen Amtes der Bundesrepublik Deutschland besteht, vom Versicherungsschutz ausgenommen. Welche Verpflichtungen habe ich? - Sie sind verpflichtet, uns Schadenfälle unverzüglich anzuzeigen. Kranken- und Notruf-Versicherung - Bei schweren Verletzungen oder Krankheiten, insbesondere vor Klinikaufenthalten müssen Sie sich unverzüglich an uns wenden. Unfallversicherung - Sie sind verpflichtet, die behandelnden oder begutachtenden Ärzte von der Schweigepflicht zu entbinden. - Für die Zahlung der Versicherungsleistungen wegen dauernder Invalidität sind besondere Fristen für die Geltendmachung zu beachten. Haftpflichtversicherung - Wird ein Anspruch gegen Sie geltend gemacht, müssen Sie uns dies innerhalb einer Woche mitteilen. Kommt es zu einem Prozess über den Haftpflichtanspruch, ist AWP die Prozessführung zu überlassen und dem Anwalt Vollmacht zu geben. Wann und wie zahle ich? Die Prämie ist erstmalig mit Beginn des Versicherungsvertrages fällig und monatlich im Voraus zu zahlen. Die Prämienzahlung kann mittels eines der angebotenen Zahlungsmittel (z. B. SEPA- Lastschrift oder Kreditkarte) erfolgen. Bei Vertragslaufzeiten von mehr als einem Monat sind die Folgeprämien jeweils zum 1. des neuen Monats fällig. Wann beginnt und endet die Deckung? Der Versicherungsschutz beginnt mit dem im Versicherungsschein bezeichneten Zeitpunkt (Versicherungsbeginn), jedoch nicht vor Antragsstellung, nicht vor Grenzübertritt und nicht vor Ablauf evtl. Wartezeiten. Der Versicherungsschutz endet mit dem vereinbarten Zeitpunkt, spätestens mit der Beendigung des versicherten Aufenthalts. Der Versicherungsvertrag kann für jeweils volle Monate vereinbart werden, maximal für 48 Monate. Wie kann ich den Vertrag kündigen? Sie können den Versicherungsvertrag täglich zum Monatsende kündigen. 2020-1072 AVB 20 -2- [Seite 3] Insurance Cover for stays abroad Insurance Product Information Document Product: MAWISTA Student Company: AWP P&C S.A., Germany Branch Comfort 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 Student Comfort is a comprehensive Insurance and includes the following benefits: Health Insurance, Emergency Call Insurance, Accident 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 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 Psychoanalytical and psychotherapeutic treatment and hypnosis ✓ Costs for inpatient treatment in a hospital x Prophylactic examinations and check-ups ✓ Costs for Pain-killing dental treatment ✓ Costs of the medically advisable and appropriate return transportation to the nearest Accident Insurance suitable hospital to the place of residence and, in the event of death, the repatriation of x Accidents caused by mental disorders or impairments of consciousness, strokes, epileptic mortal remains fits or cramps; this also applies if the condition is due to the influence of alcohol or drugs ✓ Costs for dentures (after the expiry of a waiting period of eight months) ✓ Costs for visual aids required as a result of an accident Liability Insurance ✓ Costs for vaccinations x Liability claims among and between insured persons travelling together x Loss or damage caused by the use of a motor vehicle, aircraft or motor-driven watercraft As part of the Emergency Call Insurance: Assistance for personal emergencies (illness, accident, death) and organisation of repatriation with medically adequate means, as soon as this is medically advisable and reasonable. Accident Insurance Are there any restrictions on cover? ✓ Pays compensation if an insured accident occurring during the trip leads to permanent Health Insurance and Emergency Call Insurance invalidity or death of the insured person. ! Pain-killing dental treatment: up to € 1,000 ! Medically prescribed treatment (e.g. massages, fango or lymph drainage treatments): Sums insured: € 10,000 in the event of death, up to € 40,000 in the event of disability, up to eight (medical) applications up to € 140,000 in the event of total disability and up to € 5,000 for the costs of search, ! Aids required as a result of an accident: up to € 1,000 rescue and recovery measures after an accident ! Dental prostheses: up to 60 % of the total costs incurred, but no more than € 1,000 (after an eight-month waiting period from the start of insurance coverage) Liability Insurance ! Visual aids due to an accident: up to € 100 (after a three-month waiting period from ✓ Provides insurance cover if third parties assert claims for damages based on a damaging the start of insurance coverage) event that occurred during your travel. ! Repatriation costs: up to € 25,000 ! Vaccinations: up to € 250 throughout the entire term of the contract Sums insured: € 1,000,000 per person in case of personal injury and damage to property, € 250,000 for damage to rented property Accident Insurance ! If illness or ailments have contributed by at least 25 % to an impairment of health caused by the accident, the benefits payable will be reduced. -1- [Seite 4] Where am I covered? ✓ Insurance cover is valid for insured persons with Germany as home country for the temporary stay outside Germany. ✓ Insurance cover is valid for insured persons with home country outside Germany for the temporary stays within Germany and the rest of the EU, as well as in Switzerland, Liechtenstein, Norway, United Kingdom and Iceland. ✓ In case the insured stay abroad is interrupted, the tariff Comfort provides insurance cover for insured persons with Germany as home country also in Germany for a period of up to 6 weeks per insurance year. ✓ In general, no coverage exists in areas for which the Federal Foreign Office of Germany has issued a travel warning at the time of your entry into this area. 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. Accident Insurance - Release the physician giving treatment or carrying out examinations from their professional confidentiality obligation. - For asserting a claim for reimbursement due to permanent invalidity, specific periods of time apply. 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 48 months. How do I cancel the contract? You may cancel your policy at any time. It will then expire at the end of that month. 2020-1072 AVB 20 -2- [Seite 5] Dokumente zur Versicherungspolice Die Leistungen im Überblick Inhaltsverzeichnis MAWISTA Student - Tarif Comfort Datenschutzhinweise und Hinweise für den Schadenfall 2 • Krankenversicherung Versicherungsbedingungen 3  Kein Selbstbehalt Allgemeine Bestimmungen 3 • Notruf-Versicherung Krankenversicherung 3 • Unfallversicherung Notruf-Versicherung 4  Versicherungssummen: je Person bis zu € 140.000,- bei Invalidität, € 10.000,- Unfallversicherung 4 bei Tod Haftpflichtversicherung 5 • Haftpflichtversicherung MAWISTA Student – Versicherungsleistungen auf einen Blick / Tariftabelle 6  Versicherungssummen: € 1.000.000,- je Person bei Personen- und Sachschäden, € 250.000,- für Mietsachschäden Bitte beachten Sie folgende wichtige Hinweise Wir sind für Sie da Geltungsbereich: siehe §2 VB AB-COM 20 MST Hilfe im Notfall Maximale Versicherungsdauer: Die Versicherungen gelten für den vereinbarten Bei Notfällen ist die Assistance für Sie da. Unser 24-Stunden-Notfall-Service bietet Zeitraum, maximal sind 48 Monate möglich. Ihnen rund um die Uhr schnelle und fachkundige Hilfe weltweit! Versicherungsfähige Personen: siehe § 1 Nr. 1 VB AB-COM 20 MST Abschlusshinweise: Der Vertrag kann jederzeit zum 1. eines Monats abgeschlossen werden. Der Versicherungsschutz beginnt mit dem in der Versicherungspolice Telefon: +49.89.6 24 24-496 bezeichneten Datum, jedoch nicht vor Antragstellung, Grenzübertritt und nicht vor Ablauf evtl. Wartezeiten. Wichtig für Hilfe im Notfall: • Halten Sie die genaue Anschrift und Telefonnummer Ihres derzeitigen Aufenthalts- Versicherungsschutz besteht nur für die namentlich auf der Versicherungspolice orts bereit. aufgeführte Person. Die Prämie ist erstmalig mit Beginn des Versicherungsvertrages • Notieren Sie sich die Namen Ihrer Ansprechpartner wie z. B. Arzt, Krankenhaus, Polizei. fällig und monatlich im Voraus zu zahlen. Die Prämienzahlung kann mittels eines der • Schildern Sie möglichst genau den Sachverhalt und halten Sie alle notwendigen An- angebotenen Zahlungsmittel (z. B. SEPA-Lastschrift oder Kreditkarte) erfolgen. Falls gaben bereit. der Versicherer ermächtigt wurde, die Prämie dem gewählten Zahlungsmittel zu be- lasten, gilt die Zahlung als erfolgt, wenn zum Zeitpunkt des Prämieneinzugs Deckung Schadenmeldung auf dem vom Versicherungsnehmer genannten Zahlungsmittel besteht. Die Höhe Schnell, bequem und rund um die Uhr melden Sie uns Ihren Schaden unter: der Prämie richtet sich in der Regel nach dem ausgewählten Versicherungsschutz www.mawista.com/schaden-melden und der Laufzeit des Vertrages. alternativ auch per Post an die Schadenabteilung MAWISTA (Adresse siehe rechts) Tritt der Versicherungsfall ein, müssen wir nur leisten, wenn die Prämie bezahlt ist oder wenn Sie als Versicherungsnehmer kein Beschwerde, anwendbares Recht, Widerruf Verschulden daran trifft, dass die Prämie nicht gezahlt wurde. Dies müssen Sie uns nachweisen. Beschwerdehinweis: Unser Ziel ist es, erstklassige Leistungen zu bieten. Ebenso ist es uns wichtig, auf Ihre Anliegen einzuge- hen. Sollten Sie einmal mit unseren Produkten oder unserem Service nicht zufrieden sein, teilen Sie uns dies bitte direkt mit. Die vertraglich vereinbarten Versicherungsleistungen werden von AWP P&C S.A. (Allianz Partners) nach Maßgabe der nachstehenden Versicherungsbedingungen Sie können uns Ihre Beschwerden zu Vertrags- oder Schadenfragen auf jedem Kommunikationsweg geboten. Mündliche Vereinbarungen sind unwirksam. Die Versicherungssteuer ist zukommen lassen. Telefonisch erreichen Sie uns unter +49.89.6 24 24-460, schriftlich per E-Mail an in den Prämien enthalten. Gebühren werden nicht erhoben. Maßgebend für den beschwerde-reise@allianz.com bzw. per Post an AWP P&C S.A.,Beschwerdemanagement, Bahnhofstraße Versicherungsumfang sind die in der Versicherungspolice dokumentierten Prämien 16, D - 85609 Aschheim (bei München). Nähere Informationen zu unserem Beschwerdeprozess finden Sie unter www.allianz-reiseversicherung.de/beschwerde. An Streitbeilegungsverfahren vor einer Ver- und Leistungsbeschreibungen. braucherschlichtungsstelle nehmen wir nicht teil. AWP P&C S.A. Hauptbevollmächtigter: Jacob Fuest Für Beschwerden aus allen Versicherungssparten können Sie sich an die zuständige Aufsichtsbehör- Niederlassung für Deutschland Registergericht: München HRB 4605 de Bundesanstalt für Finanzdienstleistungsaufsicht (BaFin), Graurheindorfer Straße 108, D - 53117 Bonn, wenden (www.bafin.de). Bahnhofstraße 16 USt.-IdNr.: DE 129274528 D - 85609 Aschheim (bei München) Das Vertragsverhältnis unterliegt deutschem Recht, soweit internationales Recht nicht entgegensteht. Klagen aus dem Versicherungsvertrag können vom Versicherungsnehmer oder der versicherten Person AWP P&C S.A. bei dem Gericht des Geschäftssitzes oder der Niederlassung des Versicherers erhoben werden. Ist der Versicherungsnehmer oder die versicherte Person eine natürliche Person, so können Klagen auch vor Aktiengesellschaft französischen Rechts dem Gericht erhoben werden, in dessen Bezirk der Versicherungsnehmer oder die ver-sicherte Person Sitz der Gesellschaft: Saint-Ouen (Frankreich) zur Zeit der Klageerhebung seinen Wohnsitz oder, falls kein Wohnsitz besteht, seinen gewöhnlichen Handelsregister: R.C.S. Bobigny 519 490 080 Aufenthalt hat. Vorstandsvorsitzende: Sirma Boshnakova Widerrufsrecht für Verträge mit einer Laufzeit von einem Monat oder mehr: Widerrufsfolgen: Sie können Ihre Vertragserklärung innerhalb von 14 Tagen ohne Angabe von Gründen in Textform (z. B. Im Falle eines wirksamen Widerrufs endet der Versicherungsschutz und wir erstatten Ihnen den auf Brief, Fax, E-Mail) widerrufen. Die Frist beginnt, nachdem Sie den Versicherungsschein, die Vertragsbe- die Zeit nach Zugang des Widerrufs entfallenden Teil der Prämien, wenn Sie zugestimmt haben, dass stimmungen einschließlich der Allgemeinen Versicherungsbedingungen, die weiteren Informationen der Versicherungsschutz vor dem Ende der Widerrufsfrist beginnt. Den Teil der Prämie, der auf die Zeit nach § 7 Abs. 1 und 2 des Versicherungsvertragsgesetzes in Verbindung mit den §§ 1 bis 4 der VVG- bis zum Zugang des Widerrufs entfällt, dürfen wir in diesem Fall einbehalten. Dabei handelt es sich Informationspflichtenverordnung unddiese Belehrung jeweils in Textform erhalten haben. Bei Verträ- um den anteilig nach Tagen berechneten Betrag. Die Erstattung zurückzuzahlender Beträge erfolgt gen im elektronischen Geschäftsverkehr (§ 312i Abs. 1 Satz 1 des Bürgerlichen Gesetzbuchs) beginnt unverzüglich, spätestens 30 Tage nach Zugang des Widerrufs. Beginnt der Versicherungsschutz nicht die Frist jedoch nicht vor Erfüllung unserer Pflichten gemäß § 312i Abs. 1 Satz 1 des Bürgerlichen vor dem Ende der Widerrufsfrist, hat der wirksame Widerruf zur Folge, dass empfangene Leistungen Gesetzbuchs in Verbindung mit Artikel 246c des Einführungsgesetzes zum Bürgerlichen Gesetzbuch. zurückzugewähren und gezogene Nutzungen (z. B. Zinsen) herauszugeben sind. Zur Wahrung der Widerrufsfrist genügt die rechtzeitige Absendung des Widerrufs. Der Widerruf ist zu richten an: Besondere Hinweise: AWP P&C S.A., Bahnhofstraße 16, D - 85609 Aschheim (bei München), Telefax + 49.89.6 24 24-244, Ihr Widerrufsrecht erlischt, wenn der Vertrag auf Ihren ausdrücklichen Wunsch sowohl von Ihnen als E-Mail: service-reise@allianz.com auch von uns vollständig erfüllt ist, bevor Sie Ihr Widerrufsrecht ausgeübt haben. Ihre AWP P&C S.A., Niederlassung für Deutschland -1- [Seite 6] Datenschutzhinweise Entsprechend Art. 13 und 14 der Datenschutz-Grundverordnung Wir können Ihre Daten gemäß Art 6 Abs. 1 d) DSGVO auch verarbei- III An welche Empfänger leiten wir Ihre Daten weiter? (DSGVO) informieren wir Sie über die Verarbeitung Ihrer per- ten, um Ihre lebenswichtigen Interessen zu schützen oder wenn Sie Empfänger Ihrer personenbezogenen Daten können sein: sonenbezogenen Daten durch AWP P&C S.A., Niederlassung in die Verarbeitung einwilligen, Art. 6 Abs. 1 a) DSGVO. ausgewählte externe Dienstleister (z. B. Assistance-Dienstleister, für Deutschland und die Ihnen nach dem Datenschutzrecht zu- Leistungsbearbeiter, Transportleistungserbringer, technische stehenden Rechte. Bitte geben Sie diese Hinweise allen mitver- Sollten wir Ihre personenbezogenen Daten für einen oben nicht ge- Dienstleister usw.) sowie andere Versicherer (z. B. bei Vorliegen sicherten Personen (z. B. Ehepartner) zur Kenntnis. nannten Zweck verarbeiten wollen, werden wir Sie im Rahmen der einer Mehrfachversicherung). gesetzlichen Bestimmungen darüber zuvor informieren. I Wer ist für die Verarbeitung Ihrer personenbezogenen Daten Von uns übernommene Risiken versichern wir bei speziellen Ver- verantwortlich? 2) Was gilt für besondere Kategorien von personenbezogenen sicherungsunternehmen (Rückversicherer). Dafür kann es erforder- Für die Verarbeitung Ihrer personenbezogenen Daten Daten, insbesondere Gesundheitsdaten? lich sein, Ihre Vertrags- und ggf. Schadendaten an einen Rückver- verantwortlich ist Die Verarbeitung von besonderen Kategorien personenbezogener sicherer zu übermitteln, damit dieser sich ein eigenes Bild über das Daten, zu denen auch Gesundheitsdaten gehören, unterliegt be- Risiko oder den Versicherungsfall machen kann. AWP P&C S.A., Niederlassung für Deutschland sonderem Schutz. Die Verarbeitung ist in der Regel nur zulässig, Bahnhofstraße 16 wenn Sie gemäß Art. 9 Abs. 2 a) DSGVO in die Verarbeitung einwil- Treten Sie als versicherte Person einem Gruppenversicherungsvertrag D - 85609 Aschheim (bei München). ligen oder eine der übrigen gesetzlich vorgesehenen Möglichkeiten bei (z. B. im Rahmen eines Kreditkarten-Erwerbs), können wir Ihre vorliegt, Art. 9 Abs. 2 b) – j) DSGVO. personenbezogenen Daten an den Versicherungsnehmer (z. B. Kre- Der Datenschutzbeauftragte ist per Post zu erreichen unter der oben- ditinstitut) weiterleiten, wenn dieser ein berechtigtes Interesse hat. stehenden Anschrift mit dem Zusatz – Datenschutzbeauftragter – a) Verarbeitung Ihrer personenbezogenen Daten besonderer oder per E-Mail unter datenschutz-azpde@allianz.com. Kategorien Darüber hinaus können wir Ihre personenbezogenen Daten an In vielen Fällen benötigen wir zur Prüfung des Leistungs- weitere Empfänger übermitteln, wie etwa an Behörden zur Erfül- II Für welche Zwecke und auf welcher Rechtsgrundlage werden anspruchs personenbezogene Daten, die einer besonderen lung gesetzlicher Mitteilungspflichten (z. B. Finanzbehörden oder Ihre Daten verarbeitet? Kategorie angehören (sensible Daten). Dies sind z. B. Ge- Strafverfolgungsbehörden). 1.) Was gilt für alle Kategorien von personenbezogenen Daten? sundheitsdaten. Indem Sie uns anlässlich eines konkreten Wir verarbeiten Ihre personenbezogenen Daten unter Beachtung Versicherungsfalles solche Daten verbunden mit der Bitte Die Weiterleitung der Daten ist eine Form der Verarbeitung und der EU-Datenschutz-Grundverordnung (DSGVO), des Bundes- um Prüfung und Schadenbearbeitung mitteilen, willigen Sie erfolgt ebenfalls im Rahmen der in Art. 6 Abs. 1 und Art. 9 Abs. 2 datenschutzgesetzes (BDSG), der datenschutzrechtlich relevanten ausdrücklich ein, dass wir Ihre für die Bearbeitung des Ver- DSGVO genannten Grundlagen. Bestimmungen des Versicherungsvertragsgesetzes (VVG) sowie sicherungsfalles erforderlichen sensiblen Daten verarbeiten. aller weiteren maßgeblichen Gesetze. Hierauf weisen wir Sie nochmals und gesondert im Formular IV Wie lange speichern wir Ihre Daten? zur Schadenmeldung hin. Wir bewahren Ihre Daten für die Zeit auf, in der Ansprüche gegen Stellen Sie einen Antrag auf Versicherungsschutz, benötigen wir unser Unternehmen gemacht werden können (gesetzliche Ver- die von Ihnen hierbei gemachten Angaben für den Abschluss des Die Einwilligung kann jederzeit mit Wirkung für die Zukunft jährungsfrist von drei bis zu 30 Jahren). Zudem speichern wir Ihre Vertrages und zur Einschätzung des von uns zu übernehmenden widerrufen werden. Wir weisen jedoch ausdrücklich darauf Daten, soweit wir gesetzlich dazu verpflichtet sind, z. B. nach den Risikos. Kommt der Versicherungsvertrag zustande, verarbeiten hin, dass dann die Leistungspflicht aus dem Versicherungsfall Vorschriften des Handelsgesetzbuches, der Abgabenordnung oder wir diese Daten zur Durchführung des Vertragsverhältnisses, evtl. nicht geprüft werden kann. Ist die Prüfung des Scha- des Geldwäschegesetzes. Die Speicherfristen betragen danach bis z. B. zur Rechnungsstellung. Angaben zum Schaden benötigen wir denfalles bereits abgeschlossen, können z. B. gesetzliche zu zehn Jahre. etwa, um prüfen zu können, ob ein Versicherungsfall eingetreten Aufbewahrungspflichten dazu führen, dass die Daten nicht und wie hoch der Schaden ist. gelöscht werden. V Wo werden Ihre Daten verarbeitet? Sollten wir Daten an Dienstleister außerhalb des Europäischen Wirt- Der Abschluss und die Durchführung des Versicherungsvertrages Ihre sensiblen Daten dürfen wir auch dann verarbeiten, wenn schaftsraums (EWR) übermitteln, erfolgt die Übermittlung inner- sind ohne die Verarbeitung Ihrer personenbezogenen Daten dies zum Schutz Ihrer lebenswichtigen Interessen erforder- halb des Allianz-Konzerns auf Grundlage von verbindlichen Unter- nicht möglich. lich ist und Sie aus körperlichen oder rechtlichen Gründen au- nehmensvorschriften, der sogenannten „Binding Corporate Rules“, ßerstande sind, Ihre Einwilligung abzugeben, Art. 9 Abs. 2 c) die von den Datenschutzbehörden genehmigt wurden. Diese sind Rechtsgrundlage für diese Verarbeitungen personenbezogener DSGVO. Das kann zum Beispiel bei schweren Unfällen wäh- Teil des „Allianz Privacy Standard“. Diese Unternehmensvorschrif- Daten für vorvertragliche und vertragliche Zwecke ist Art. 6 Abs. 1 b) rend der Reise der Fall sein. ten sind für alle Unternehmen der Allianz Gruppe verbindlich und DSGVO. stellen einen angemessenen Schutz von persönlichen Daten sicher. Werden wir bei Vorliegen einer Mehrfachversicherung von Der „Allianz Privacy Standard“ sowie die Liste der Unternehmen der Daneben gibt es in Art. 6 Abs. 1 a) und c) – f) DSGVO weitere einem anderen Versicherer in Anspruch genommen oder Allianz Gruppe, die diesen einhalten, kann hier aufgerufen werden: gesetzlich vorgesehene Möglichkeiten, die uns zur Verarbeitung nehmen wir einen anderen Versicherer in Anspruch, dürfen https://www.allianz-partners.com/allianz-partners---binding- berechtigen. wir Ihre sensiblen Daten zur Geltendmachung und zur Vertei- corporate-rules-.html. digung des gesetzlichen Ausgleichsanspruches verarbeiten, Wir verarbeiten Ihre Daten zur Erfüllung einer rechtlichen Verpflich- Art. 9 Abs. 2 f) DSGVO. In den Fällen, in denen der „Allianz Privacy Standard“ nicht anwend- tung gemäß Art 6 Abs. 1 c) DSGVO, z. B. zur Prüfung von Ausgleich- bar ist, erfolgt die Übermittlung in Drittländer entsprechend der ansprüchen, wenn wir von einem anderen Versicherer aufgrund b) Abfrage von Gesundheitsdaten bei Dritten zur Prüfung der Art. 44 – 50 DSGVO. einer bestehenden Mehrfachversicherung in Anspruch genommen Leistungspflicht werden. Zur Prüfung der Leistungspflicht kann es erforderlich sein, VI Welche Rechte haben Sie? dass wir Angaben über Ihre gesundheitlichen Verhältnisse Sie haben das Recht über die bei uns gespeicherten Daten Auskunft Ihre Daten verarbeiten wir auch, um berechtigte Interessen von uns prüfen müssen, die Sie zur Begründung von Ansprüchen zu erhalten sowie unrichtige Daten berichtigen zu lassen. Unter oder von Dritten zu wahren, Art. 6 Abs. 1 f) DSGVO. Dies kann insbe- gemacht haben oder die sich aus eingereichten Unterlagen bestimmten Voraussetzungen haben Sie außerdem das Recht auf sondere erforderlich sein: (z. B. Rechnungen, Verordnungen, Gutachten) oder Mit- Löschung, das Recht auf Widerspruch gegen die Verarbeitung, • zur Gewährleistung der IT-Sicherheit und des IT-Betriebs, teilungen z. B. eines Arztes oder sonstiger Angehöriger eines das Recht auf Einschränkung der Verarbeitung und das Recht auf • zur Werbung für unsere eigenen Versicherungsprodukte sowie Heilberufs ergeben. Datenübertragbarkeit. für Markt- und Meinungsumfragen, • zur Verhinderung und Aufklärung von Straftaten, insbesondere Hierfür benötigen wir Ihre Einwilligung einschließlich einer Widerspruchsrecht nutzen wir Datenanalysen zur Erkennung von Hinweisen, die auf Schweigepflichtentbindung für uns sowie für alle Stellen, die Sie können einer Verarbeitung Ihrer Daten zu Zwecken der Versicherungsmissbrauch hindeuten können. der Schweigepflicht unterliegen und Angaben zur Prüfung Direktwerbung widersprechen. Verarbeiten wir Ihre Daten zur Wir verarbeiten in der Regel nur Daten, die wir direkt von Ihnen der Leistungspflicht machen müssen. Wahrung berechtigter Interessen, können Sie dieser Verar- erhalten haben. In Einzelfällen (z. B. wenn uns ein anderer Versiche- beitung aus Gründen, die sich aus Ihrer besonderen Situation rer bei Vorliegen einer Mehrfachversicherung in Anspruch nimmt) Wir werden Sie in jedem Einzelfall informieren, von welchen er-geben, widersprechen. erhalten wir diese von Dritten. Personen oder Einrichtungen zu welchem Zweck eine Aus- kunft benötigt wird. Sie können dann jeweils entscheiden, ob Darüber hinaus verarbeiten wir Ihre personenbezogenen Daten Sie in die Erhebung und Verwendung Ihrer Gesundheitsdaten Wenn Sie sich über den Umgang mit Ihren Daten beschweren zur Erfüllung gesetzlicher Verpflichtungen, wie z. B. aufsichts- durch uns einwilligen, die genannten Personen oder Einrich- möchten, können Sie sich an den oben genannten Datenschutz- rechtlicher Vorgaben, handels- und steuerrechtlicher Aufbe- tungen sowie deren Mitarbeiter von ihrer Schweigepflicht beauftragten wenden. Für Sie besteht außerdem ein Beschwerde- wahrungspflichten. Als Rechtsgrundlage für die Verarbeitung entbinden und in die Übermittlung Ihrer Gesundheitsdaten recht bei einer Datenschutzaufsichtsbehörde. dienen in diesem Fall die jeweiligen gesetzlichen Regelungen an uns einwilligen oder die erforderlichen Unterlagen selbst in Verbindung mit Art. 6 Abs. 1 c) DSGVO. beibringen. Allgemeine Hinweise für den Schadenfall Was ist in jedem Schadenfall zu tun? Wichtig: Aus den Rechnungen müssen der Name der behandelten Der Versicherte hat den Schaden möglichst gering zu halten und Person, die Bezeichnung der Erkrankung, die Behandlungsdaten und nachzuweisen. Sichern Sie deshalb in jedem Fall bitte geeignete die einzelnen ärztlichen Leistungen mit den entsprechenden Kosten Nachweise zum Schadeneintritt (z. B. Schadenbestätigung, Attest) hervorgehen. Rezepte müssen Angaben über die verordneten Medi- und zum Umfang des Schadens (z. B. Rechnungen, Belege). kamente, die Preise und den Stempel der Apotheke enthalten. Wie verhalten Sie sich bei Krankheit, Verletzung oder anderen Not- Woran sollten Sie bei Ansprüchen aus der Unfallversicherung oder fällen während des Aufenthalts im vereinbarten Geltungsbereich? Haftpflichtversicherung denken? (Krankenversicherung, Notruf-Versicherung) Notieren Sie sich bitte Namen und Anschriften von Zeugen, die das Wenden Sie sich bei schweren Verletzungen oder Krankheiten, Schadenereignis beobachtet haben. Lassen Sie sich eine Kopie des insbesondere vor Klinikaufenthalten, bitte unverzüglich an die Assi- Polizeiprotokolls aushändigen, falls die Polizei zu Ermittlungen einge- stance, damit adäquate Behandlung sichergestellt und notfalls der schaltet wurde. Informieren Sie AWP und reichen Sie diese Unterla- Rücktransport veranlasst werden kann. Für die Erstattung Ihrer vor gen und Informationen mit Ihrer Schadenmeldung ein. Ort verauslagten Kosten reichen Sie bitte Originalrechnungen und / oder -rezepte ein. -2- [Seite 7] Bedingungen der AWP P&C S.A., Niederlassung für Deutschland Allgemeine Bestimmungen nachgeholt, entfällt die Wirkung der Kündigung und der Vertrag Versicherungsbedingungen VB AB-COM 20 MST tritt wieder in Kraft. Für Versicherungsfälle, die nach Ablauf der Zahlungsfrist eingetreten sind, besteht jedoch kein Versiche- zur Krankenversicherung VB K-COM 20 MST Die nachstehenden Regelungen unter §§ 1 bis 11 gelten für alle rungsschutz. MAWISTA Student Versicherungsprodukte. Die nachfolgend abge- § 1 Was ist versichert? druckten Versicherungsbedingungen gelten für die jeweilige Ver- § 5 In welchen Fällen besteht kein Versicherungsschutz? 1. Versichert sind die Kosten sicherung. Versicherungsschutz besteht, wenn Sie die betreffende Nicht versichert sind a) der Heilbehandlung Versicherung vertraglich vereinbart haben. 1. Schäden durch Streik, Kernenergie, Beschlagnahme und son- b) des Krankentransports stige Eingriffe von hoher Hand sowie Schäden in Gebieten, für c) der Überführung bei Tod § 1 Wer ist versicherungsfähig? welche das Auswärtige Amt eine Reisewarnung ausgesprochen bei im vereinbarten Geltungsbereich und versicherten Zeitraum 1. Versicherungsfähig sind hat. Befindet sich eine versicherte Person zum Zeitpunkt der akut eintretenden Krankheiten und Unfällen. a) Personen mit Wohnsitz in Deutschland für Reisen ins Aus- Bekanntgabe einer Reisewarnung vor Ort, endet der Versiche- 2. Für die Kosten der ärztlichen Behandlung der Schwangerschaft land als Sprachschüler, Studenten, Stipendiaten, Doktoran- rungsschutz 14 Tage nach Bekanntgabe der Reisewarnung; der und Entbindung besteht nur dann im vereinbarten Geltungsbe- den, Gastwissenschaftler, Praktikanten oder im Rahmen von Versicherungsschutz dauert trotz der Reisewarnung fort, wenn reich Versicherungsschutz, wenn die Schwangerschaft (Emp- „Work- & Holiday“-Programmen sowie deren begleitende sich die Beendigung der Reise aus Gründen verzögert, welche fängnis) nach Versicherungsbeginn eingetreten ist. Ungeachtet Familienangehörige. die versicherte Person nicht zu vertreten hat; des Zeitpunktes des Eintrittes der Schwangerschaft erstattet der b Personen, die aufgrund eines Aufenthaltstitels (Aufenthalts- 2. Schäden durch Krieg oder kriegsähnliche Ereignisse. Versiche- Versicherer die Kosten der ärztlichen Heilbehandlung bei akut erlaubnis) zu Ausbildungszwecken in Deutschland befinden, rungsschutz besteht jedoch, wenn der Schaden sich in den auftretenden Schwangerschaftskomplikationen einschließlich und deren begleitende Familienangehörige. ersten 14 Tagen nach Beginn der Ereignisse ereignet; der Ver- Fehl- und Frühgeburt. c) Personen mit einem sonstigen befristeten Aufenthaltstitel für sicherungsschutz dauert jedoch fort, wenn sich die Beendigung 3. Pauschaler Spesensatz bei stationärer Unterbringung Deutschland. der Reise aus Gründen verzögert, welche die versicherte Person Werden die Kosten bei medizinisch notwendiger vollstationärer Voraussetzung ist, dass die Personen bei Versicherungsbeginn nicht zu vertreten hat. Dies gilt nicht bei Aufenthalten in Staaten, Heilbehandlung im vereinbarten Geltungsbereich von einer drit- das 55. Lebensjahr noch nicht vollendet haben. auf deren Gebiet bereits Krieg oder Bürgerkrieg herrscht oder ten Stelle getragen, so zahlt der Versicherer einen pauschalen 2. Versichert ist die in der Police namentlich genannte Person für der Ausbruch vorhersehbar war. Schäden durch die aktive Teil- Spesensatz (Telefon, TV, zusätzliche Verpflegung auch der Besu- den vorübergehenden Aufenthalt im vereinbarten Geltungs- nahme an Krieg, an Bürgerkrieg oder an kriegsähnlichen Ereig- cher etc.) in Höhe von maximal € 30,- je Tag, höchstens bis zu 45 bereich. nissen sind nicht versichert. Tagen ab Beginn der stationären Behandlung. 3. Schäden, welche die versicherte Person vorsätzlich herbeiführt. § 2 Welchen Geltungsbereich hat die Versicherung? § 2 Welche Kosten werden bei Heilbehandlung erstattet? Der Versicherungsschutz gilt für versicherte Personen § 6 Was muss die versicherte Person im Schadenfall unbedingt 1. Der Versicherer ersetzt die Aufwendungen für im vereinbarten 1. mit Heimatland Deutschland für den vorübergehenden Aufent- unternehmen (Obliegenheiten)? Geltungsbereich notwendige ärztliche Heilbehandlung. Dazu halt außerhalb Deutschlands. Für den Aufenthalt in Deutschland Die versicherte Person ist verpflichtet, gehören die Kosten für besteht kein Versicherungsschutz. Im Rahmen des Tarifs Com- 1. den Schaden möglichst gering zu halten und unnötige Kosten zu a) ambulante Behandlung durch einen Arzt; fort besteht Versicherungsschutz bei einer Unterbrechung des vermeiden; b) Heilbehandlungen und Arzneimittel, die der versicherten Per- versicherten Auslandsaufenthalts auch in Deutschland bis zu 2. den Schaden unverzüglich dem Versicherer anzuzeigen; son ärztlich verordnet wurden; einer Dauer von sechs Wochen pro Versicherungsjahr; 3. dem Versicherer jede sachdienliche Auskunft wahrheitsgemäß c) stationäre Behandlung im Krankenhaus einschließlich unauf- 2. mit befristetem Aufenthaltstitel für Deutschland für den vorü- zu erteilen. Zum Nachweis hat die versicherte Person Original- schiebbarer Operationen. Bei einer Frühgeburt werden (in bergehenden Aufenthalt in Deutschland sowie urlaubs- und Rechnungen und -Belege einzureichen, gegebenenfalls die Abweichung von § 1 VB AB-COM 20 MST) auch die Kosten der ausbildungsbedingte Aufenthalte in der EU sowie der Schweiz, Ärzte – einschließlich der Ärzte der Assistance – von der Schwei- im vereinbarten Geltungsbereich notwendigen Heilbehand- Liechtenstein, Norwegen, dem Vereinigten Königreich und Is- gepflicht zu entbinden und es dem Versicherer zu gestatten, lungen des neugeborenen Kindes bis zu einem Betrag von land. Außerhalb der genannten Länder besteht kein Versiche- Ursache und Höhe des geltend gemachten Anspruchs in zumu- € 100.000,- übernommen. rungsschutz. tbarer Weise zu prüfen. Für stationäre Behandlungen und Entbindungen in Deutsch- land gilt: Es werden allgemeine Krankenhausleistungen § 3 Wann beginnt und wann endet die Versicherung? § 7 Wann zahlt der Versicherer die Entschädigung? (Mehrbettzimmer) gemäß der Bundespflegesatzverordnung Der Versicherungsschutz Hat der Versicherer die Leistungspflicht dem Grund und der Höhe bzw. dem Krankenhausentgeltgesetz erstattet; Aufwendun- 1. beginnt mit dem im Versicherungsschein bezeichneten Zeit- nach festgestellt, wird die Entschädigung innerhalb von zwei gen für Wahlleistungen (privatärztliche Behandlung) sind punkt (Versicherungsbeginn), jedoch nicht vor Antragsstellung, Wochen ausgezahlt. nicht Gegenstand des Versicherungsschutzes. nicht vor Grenzübertritt und nicht vor Ablauf evtl. Wartezeiten. d) den medizinisch notwendigen Krankentransport zur statio- Wartezeiten rechnen ab Versicherungsbeginn. § 8 Was gilt, wenn die versicherte Person Ersatzansprüche nären Behandlung in das nächst erreichbare und geeignete 2. endet mit dem vereinbarten Zeitpunkt, spätestens mit der Been- gegen Dritte hat? Krankenhaus im vereinbarten Geltungsbereich und zurück in digung des versicherten Aufenthalts im vereinbarten Geltungs- 1. Ersatzansprüche gegen Dritte gehen entsprechend der gesetz- die Unterkunft; bereich. lichen Regelung bis zur Höhe der geleisteten Zahlung auf den e)  schmerzstillende Zahnbehandlung und Reparaturen von 3. kann auf Antrag vor Ablauf der ursprünglichen Vertragslaufzeit Versicherer über, soweit der versicherten Person daraus kein Zahnprothesen und Provisorien bis € 1.000,- pro Versiche- bis zu insgesamt max. 48 Monaten (= tarifliche Höchstver- Nachteil entsteht. rungsjahr; sicherungsdauer) verlängert werden, sofern der vorüber- 2. Die versicherte Person ist verpflichtet, in diesem Rahmen den f) Zahnersatz (nach acht Monaten Wartezeit ab Versicherungs- gehende Aufenthalt andauert und der Versicherungsnehmer Rechtsübergang auf Wunsch des Versicherers schriftlich zu be- beginn) bis zu 60 % der angefallenen Gesamtkosten, max. bereit ist, die im Zeitpunkt der Verlängerung gültigen Prämien stätigen. jedoch € 1.000,- pro Versicherungsjahr; zu zahlen. Ist die tarifliche Höchstversicherungsdauer von 3. Leistungsverpflichtungen aus anderen Versicherungsverträgen g) die ärztliche Betreuung und Behandlung von Schwanger- 48 Monaten erreicht, kann unter Berücksichtigung der nachfol- sowie der Sozialversicherungsträger gehen der Eintrittspflicht schaften, die nach Versicherungsbeginn eingetreten sind; genden Ziffer 4 ein neuer Vertrag beantragt werden. des Versicherers vor. Der Versicherer tritt in Vorleistung, sofern h) unfallbedingte Hilfsmittel bis € 1.000,- pro Versicherungsjahr; 4. Für Personen mit befristetem Aufenthaltstitel in Deutschland er unter Vorlage von Original-Belegen zunächst in Anspruch ge- i) unfallbedingte Sehhilfen (nach drei Monaten Wartezeit ab darf unter Berücksichtigung von gleichartigen Versicherungs- nommen wird. Versicherungsbeginn) bis € 100,- pro Versicherungsjahr; verträgen mit anderen Versicherern eine maximale Laufzeit von j) Schutzimpfungen, die von der ständigen Impfkommission 60 Monaten (= gesetzliche 60-Monatsgrenze) nicht überschrit- § 9 Wann verliert die versicherte Person den Anspruch auf des Robert-Koch-Institutes empfohlen werden, bis insgesamt ten werden. Versicherungsleistung durch Obliegenheitsverletzung und maximal € 250,- für alle während der Vertragslaufzeit stattfin- Verjährung? denden Impfungen; § 4 Welche Laufzeit hat der Vertrag und wann ist die Prämie 1. Wird eine Obliegenheit vorsätzlich verletzt, ist der Versicherer k) ärztlich verordnete Heilmittel (z. B. Massagen- und Fango- zu zahlen? von der Verpflichtung zur Leistung frei; bei grob fahrlässiger Behandlungen oder Lymphdrainagen), bis zu acht Anwen- 1. Der Versicherungsvertrag kann für jeweils volle Monate verein- Verletzung ist er berechtigt, die Leistung in einem der Schwere dungen insgesamt je Versicherungsjahr; dies gilt auch dann, bart werden, maximal für 48 Monate. des Verschuldens der versicherten Person entsprechenden Ver- wenn mehrere Anwendungen innerhalb eines Behandlungs- 2. Der Versicherungsvertrag kann vom Versicherungsnehmer täg- hältnis zu kürzen. termins durchgeführt werden; lich zum Monatsende gekündigt werden. 2. Das Nichtvorliegen einer groben Fahrlässigkeit hat die versicher- l) medizinisch notwendige, ärztlich verordnete Rehabilitations- 3. Die Prämie ist erstmalig mit Beginn des Versicherungsvertrages te Person zu beweisen. Außer im Falle der Arglist ist der Ver- maßnahmen als Anschlussheilbehandlung. fällig und monatlich im Voraus zu zahlen. Die Prämienzahlung sicherer zur Leistung verpflichtet, soweit die versicherte Person m)Der Versicherer leistet dabei im vertraglichen Umfang für kann mittels eines der angebotenen Zahlungsmittel (z. B. SEPA- nachweist, dass die Verletzung der Obliegenheit weder für den Untersuchungs- oder Behandlungsmethoden und Arznei- Lastschrift oder Kreditkarte) erfolgen. Eintritt noch für die Feststellung oder den Umfang der Leistungs- mittel, die von der Schulmedizin überwiegend anerkannt Ist die erste Prämie bei Eintritt des Versicherungsfalles nicht pflicht des Versicherers ursächlich ist. sind. Der Versicherer leistet darüber hinaus für Metho- gezahlt, ist der Versicherer nicht zur Leistung verpflichtet, es sei 3. Der Anspruch auf Versicherungsleistung verjährt in drei Jahren, den und Arzneimittel, die sich in der Praxis als ebenso denn, der Versicherungsnehmer hat die Nichtzahlung nicht zu gerechnet ab Ende des Jahres, in welchem der Anspruch ent- erfolgsversprechend bewährt haben und die angewen- vertreten. standen ist und die versicherte Person von den Umständen zur det werden, weil keine schulmedizinischen Methoden Falls der Versicherer ermächtigt wurde, die Prämie dem ge- Geltendmachung des Anspruchs Kenntnis erlangt hat oder ohne oder Arzneimittel zur Verfügung stehen; der Versicherer wählten Zahlungsmittel zu belasten, gilt die Zahlung als erfolgt, grobe Fahrlässigkeit hätte Kenntnis erlangen müssen. kann jedoch die Leistung auf die Höhe herabsetzen, die wenn zum Zeitpunkt des Prämieneinzugs Deckung auf dem bei der Anwendung schulmedizinischer Methoden oder vom Versicherungsnehmer genannten Zahlungsmittel besteht. § 10 Welche Form gilt für die Abgabe von Willenserklärungen? Arzneimittel angefallen wäre. 4. Bei Vertragslaufzeiten von mehr als einem Monat sind die Folge- 1. Anzeigen und Willenserklärungen der versicherten Person und 2. Der Versicherer erstattet im bedingungsgemäßen Rahmen die prämien jeweils zum 1. des neuen Monats fällig. des Versicherers bedürfen der Textform (z. B. Brief, Fax, E-Mail). Kosten über die vereinbarte Laufzeit des Versicherungsvertrages Falls der Versicherer ermächtigt wurde, die Prämie dem ge- 2. Versicherungsvermittler sind mit der Entgegennahme und Wei- hinaus bis zu 8 Wochen, maximal bis zum Tag der Transportfä- wählten Zahlungsmittel zu belasten, gilt die Zahlung als erfolgt, terleitung von Erklärungen an den Versicherer beauftragt. higkeit, sofern ein Rücktransport während der Vertragslaufzeit wenn zum Zeitpunkt des Prämieneinzugs Deckung auf dem medizinisch nicht vertretbar war. vom Versicherungsnehmer genannten Zahlungsmittel besteht. § 11 Welches Gericht in Deutschland ist für die Geltendma- Ist die Folgeprämie zu diesem Termin nicht bezahlt, kann der chung der Ansprüche aus dem Versicherungsvertrag § 3 Welche Kosten erstattet der Versicherer bei Krankenrück- Versicherer in Textform eine Zahlungsfrist von mindestens zwei zuständig? Welches Recht findet Anwendung? transport und Überführung? Wochen setzen. Tritt nach Ablauf der Frist ein Schadenfall ein 1. Der Gerichtsstand ist nach Wahl der versicherten Person Mün- Der Versicherer erstattet und ist der Versicherungsnehmer mit der Zahlung der Folgeprä- chen oder der Ort in Deutschland, an welchem die versicherte 1. die Kosten für den medizinisch sinnvollen und vertretbaren mie noch in Verzug, ist der Versicherer von der Verpflichtung zur Person zur Zeit der Klageerhebung ihren ständigen Wohnsitz Rücktransport der versicherten Person in das dem Wohnort der Leistung frei. Der Versicherer kann den Vertrag fristlos kündigen, oder ihren ständigen Aufenthalt hat. versicherten Person im Heimatland nächstgelegene geeignete wenn der Versicherungsnehmer nach Ablauf der Frist noch mit 2. Es gilt deutsches Recht, soweit internationales Recht nicht ent- Krankenhaus. der Zahlung in Verzug ist. Wird die Zahlung innerhalb eines gegensteht. Darüber hinaus werden auf Wunsch der versicherten Person Monats nach der Kündigung oder dem Ablauf der Zahlungsfrist -3- [Seite 8] die Kosten des medizinisch sinnvollen und vertretbaren Rück- keine Anerkenntnis der Eintrittspflicht des Versicherers aus dem 3. Unfälle der versicherten Person als Luftfahrzeugführer (auch transports erstattet, wenn nach der Prognose des behandelnden Versicherungsvertrag gegenüber der versicherten Person. Luftsportgeräte) sowie als sonstiges Besatzungsmitglied eines Arztes die weitere Krankenhausbehandlung voraussichtlich 14 2. Der Versicherer hat die Assistance damit beauftragt, für die ver- Luftfahrzeugs; Tage übersteigt. sicherte Person die nachstehend genannten Dienstleistungen 4. Gesundheitsschädigungen durch Heilmaßnahmen und andere Unabhängig hiervon werden die Kosten des Rücktransportes ins im 24-Stunden-Service zu erbringen. im Einverständnis mit der versicherten Person vorgenommene Heimatland übernommen, wenn diese im Rahmen der voraus- 3. Die versicherte Person hat zur Inanspruchnahme der Dienstlei- Eingriffe in ihren Körper, Strahlen, Infektionen und Vergiftungen, sichtlichen Kosten der weiteren Heilbehandlung bleiben. stungen in Notfällen unverzüglich Kontakt zur Assistance aufzu- es sei denn, diese sind durch den Unfall bedingt; 2. die unmittelbaren Kosten bis zu € 25.000,- für die Überführung nehmen. 5. Blutungen aus inneren Organen und Gehirnblutungen, es sei des verstorbenen Versicherten zur Bestattung im Heimatland, 4. Soweit die versicherte Person weder vom Versicherer noch von denn, dass der Unfall während des versicherten Aufenthalts im wahlweise die unmittelbaren Kosten der Bestattung vor Ort bis einem anderen Kostenträger die Erstattung verauslagter Beträ- vereinbarten Geltungsbereich die überwiegende Ursache ist; maximal zur Höhe der Kosten der Überführung. ge beanspruchen kann, hat die versicherte Person die Beträge 6. Krankhafte Störungen infolge psychischer Reaktionen, gleich- innerhalb eines Monats nach Rechnungsstellung an den Ver- gültig, wodurch diese verursacht sind. § 4 Welche Einschränkungen des Versicherungsschutzes sind sicherer zurückzuzahlen. zu beachten? § 3  Welche Leistung erbringt der Versicherer bei Tod der Kein Versicherungsschutz besteht für § 2  Welche Hilfeleistung bietet die Assistance bei Krankheit versicherten Person? 1. Heilbehandlungen und andere ärztlich angeordnete Maßnah- und Unfall? Führt der Unfall innerhalb eines Jahres zum Tod der versicherten men, die ein Anlass für den Aufenthalt im vereinbarten Gel- 1. Ambulante Behandlung Person, zahlt der Versicherer € 10.000,- an die Erben. tungsbereich sind; Die Assistance informiert auf Anfrage über die Möglichkeiten 2. Heilbehandlungen und andere ärztlich angeordnete Maßnah- ärztlicher Versorgung und benennt, soweit möglich, einen § 4  Welche Leistung erbringt der Versicherer bei dauernder men, deren Notwendigkeit der versicherten Person vor dem Deutsch oder Englisch sprechenden Arzt. Die Assistance stellt Invalidität der versicherten Person? Aufenthalt im vereinbarten Geltungsbereich oder zur Zeit des jedoch nicht den Kontakt zum Arzt her. Führt der Unfall zu einer dauernden Beeinträchtigung der körper- Versicherungsabschlusses bekannt war oder mit denen sie nach 2. Stationäre Behandlung lichen oder geistigen Leistungsfähigkeit (Invalidität) der versicher- den ihr bekannten Umständen rechnen musste; Bei stationärer Behandlung der versicherten Person in einem ten Person, so entsteht ein Anspruch aus der für den Invaliditätsfall 3. Nähr- und Stärkungsmittel; Krankenhaus erbringt die Assistance folgende Leistungen: versicherten Summe (unter Berücksichtigung der Progression ge- 4. kieferorthopädische Behandlungen, Zahnbehandlungen, a) Betreuung mäß Nr. 2. e)) in Höhe von bis zu maximal € 140.000,-. die über schmerzstillende Behandlungen, Reparaturen von Die Assistance stellt bei Bedarf über ihren Vertragsarzt Kon- 1. Die Invalidität muss innerhalb eines Jahres nach dem Unfall ein- Zahnprothesen und Provisorien hinausgehen; es besteht in takt zum jeweiligen Hausarzt der versicherten Person und zu getreten sowie spätestens vor Ablauf einer Frist von weiteren Abweichung hierzu für Zahnersatz nach acht Monaten War- den behandelnden Krankenhausärzten her; sie sorgt für die drei Monaten ärztlich festgestellt und geltend gemacht sein. tezeit ab Versicherungsbeginn Versicherungsschutz in Höhe Übermittlung von Informationen zwischen den beteiligten 2. Die Höhe der Leistung richtet sich nach dem Grad der Invalidität. von bis zu 60 % der angefallenen Gesamtkosten, max. jedoch Ärzten. Auf Wunsch informiert die Assistance Angehörige der Als feste Invaliditätsgrade gelten – unter Ausschluss des Nach- € 1.000,- pro Versicherungsjahr; versicherten Person. weises einer höheren oder geringeren Invalidität – 5. Heilmittel (z. B. Massagen- und Fango-Behandlungen sowie b) Krankenbesuche a) bei Verlust oder Funktionsunfähigkeit Lymphdrainagen), die acht Behandlungen im Versicherungsjahr Bei stationärer Behandlung der versicherten Person orga- eines Arms 70 % übersteigen; nisiert die Assistance auf Wunsch die Reise für eine der ver- einer Hand 55 % 6. die Anschaffung von Prothesen und Hilfsmitteln; für unfallbe- sicherten Person nahestehende Person zum Ort des Kranken- eines Daumens 20 % dingte Hilfsmittel besteht in Abweichung hierzu Versicherungs- hausaufenthaltes und zurück zum Wohnort im Heimatland. eines Fingers 10 % schutz bis € 1.000,- pro Versicherungsjahr; für unfallbedingte Der Versicherer übernimmt die Kosten der Beförderung bei eines Beins 70 % Sehhilfen besteht in Abweichung hierzu nach drei Monaten lebensbedrohender Krankheit der versicherten Person oder eines Fußes 40 % Wartezeit ab Versicherungsbeginn Versicherungsschutz bis bei stationärer Behandlungsdauer von mehr als 14 Tagen. einer Zehe 05 % € 100,- pro Versicherungsjahr; c) Kostenübernahme-Erklärung eines Auges 50 % 7. Behandlung von Alkohol-, Drogen- und anderen Suchtkrankhei- Bei stationärer Krankenhausbehandlung gibt der Versicherer des Gehörs auf einem Ohr 30 % ten sowie deren Folgen; der versicherten Person eine Kostenübernahme-Erklärung bis des Geruchs- oder des Geschmackssinnes 10 % 8. Behandlungen von Schwangerschaften, die bereits vor Ver- zu € 15.000,-. Diese Erklärung beinhaltet keine Anerkennung b) Bei Teilverlust oder Funktionsbeeinträchtigung eines dieser sicherungsbeginn eingetreten sind; der Leistungspflicht. Der Versicherer übernimmt im Namen Körperteile oder Sinnesorgane wird der entsprechende Teil 9. durch Siechtum, Pflegebedürftigkeit oder Verwahrung bedingte der versicherten Person die Abrechnung mit dem zuständi- des Prozentsatzes nach a) bestimmt. Behandlung oder Unterbringung; gen Kostenträger. c) Werden durch den Unfall Körperteile oder Sinnesorgane be- 10. psychoanalytische und psychotherapeutische Behandlung so- 3. Krankenrücktransport troffen, deren Verlust oder Funktionsunfähigkeit nicht nach wie Hypnose; Sobald es medizinisch sinnvoll und vertretbar ist bzw. wenn a) oder b) geregelt sind, so ist für diese maßgebend, inwie- 11. für Honorare und Gebühren, die den in dem betreffenden Land nach der Prognose des behandelnden Arztes die voraussicht- weit die normale körperliche oder geistige Leistungsfähigkeit als allgemein üblich und angemessen betrachteten Umfang liche Dauer des Krankenaufenthalts 14 Tage übersteigt, organi- unter ausschließlicher Berücksichtigung medizinischer Ge- übersteigen sowie für Wahlleistungen wie z. B. Einbettzimmer siert die Assistance nach vorheriger Abstimmung des Vertrags- sichtspunkte beeinträchtigt ist. oder Chefarztbehandlung. Die Erstattung kann ggf. auf die lan- arztes mit den behandelnden Ärzten vor Ort den Rücktransport d) Sind durch den Unfall mehrere körperliche oder geistige desüblichen Sätze gekürzt werden; mit medizinisch adäquaten Transportmitteln (einschließlich Funktionen beeinträchtigt, so werden die Invaliditätsgrade, 12. Krankenrücktransport aus einem der unter Nr. 1, 2, 7 und 9 ge- Ambulanz-Flugzeugen) in das dem Wohnort der versicherten die sich nach Nr. 2 a) bis c) ergeben, zusammengerechnet, nannten Gründe. Person im Heimatland nächstgelegene geeignete Krankenhaus. höchstens bis zu einer Gesamtleistung von 100 %. 13. Vorsorgeuntersuchungen zur Früherkennung von Krankheiten, e) Die Invaliditätsleistung nach Nr. 2. a) wird wie folgt erweitert: Kinder- und Jugenduntersuchungen, Zahnvorsorgeuntersu- § 3  Beschafft die Assistance für die versicherte Person notwen- Bei einem Invaliditätsgrad von mehr als 25 % erhöht sich die chungen und -prophylaxe sowie für Honorare und Gebühren für dige Arzneimittel? Entschädigungszahlung gemäß nachfolgender Tabelle: Atteste, Befundberichte und (Arbeitsunfähigkeits-) Bescheini- Die Assistance übernimmt in Abstimmung mit dem Hausarzt der gungen, die nicht vom Versicherer angefordert wurden. versicherten Person die Beschaffung ärztlich verordneter Arzneimit- von auf von auf von auf von auf von auf tel und den Versand an die versicherte Person, soweit dies möglich % % % % % % % % % % § 5  Was muss die versicherte Person im Schadenfall unbedingt ist. Die Kosten der Präparate hat die versicherte Person innerhalb 26 28 41 73 56 130 71 205 86 280 unternehmen (Obliegenheiten)? eines Monats nach Reiseende an die Assistance zu erstatten. 27 31 42 76 57 135 72 210 87 285 Die versicherte Person ist verpflichtet, 28 34 43 79 58 140 73 215 88 290 1. im Falle stationärer Behandlung im Krankenhaus, vor Beginn § 4  Welche Dienste leistet die Assistance bei Tod der versicher- 29 37 44 82 59 145 74 220 89 295 umfänglicher ambulanter oder stationärer diagnostischer und ten Person? therapeutischer Maßnahmen sowie vor Abgabe von Zahlungs- Stirbt die versicherte Person während des Aufenthalts im vereinbar- 30 40 45 85 60 150 75 225 90 300 anerkenntnissen unverzüglich Kontakt zur Assistance aufzu- ten Geltungsbereich, organisiert die Assistance nach dem Wunsch 31 43 46 88 61 155 76 230 91 305 nehmen – die nachgewiesenen Kosten zur Kontaktaufnahme der Angehörigen die Bestattung im vereinbarten Geltungsbereich 32 46 47 91 62 160 77 235 92 310 erstattet der Versicherer bis zu € 25,-; oder die Überführung der verstorbenen Person zum Bestattungsort 33 49 48 94 63 165 78 240 93 315 2. ihrem Rücktransport oder der Rückführung in ihr Heimatland im Heimatland. 34 52 49 97 64 170 79 245 94 320 bei Bestehen der Transportfähigkeit und Vorliegen der Voraus- 35 55 50 100 65 175 80 250 95 325 setzungen nach § 3 Nr. 1 VB K-COM 20 MST zuzustimmen, wenn die Assistance den Rücktransport nach Art der Krankheit und de- Versicherungsbedingungen 36 58 51 105 66 180 81 255 96 330 37 61 52 110 67 185 82 260 97 335 ren Behandlungsbedürftigkeit genehmigt. zur Unfallversicherung 38 64 53 115 68 190 83 265 98 340 3. dem Versicherer die Rechnungsoriginale oder Zweitschriften VB U 20 MST 39 67 54 120 69 195 84 270 99 345 mit einem Originalerstattungsstempel eines anderen Versiche- 40 70 55 125 70 200 85 275 100 350 rungsträgers über die gewährten Leistungen vorzulegen; diese § 1 Was ist versichert? Was ist ein Unfall? werden Eigentum des Versicherers. 1. Der Versicherer erbringt Versicherungsleistungen aus der ver- 3. Wird durch den Unfall eine körperliche oder geistige Funktion einbarten Versicherungssumme, wenn ein Unfall während des betroffen, die schon vorher dauernd beeinträchtigt war, so wird § 6 Welchen Selbstbehalt trägt die versicherte Person? versicherten Aufenthalts im vereinbarten Geltungsbereich zum ein Abzug in Höhe dieser Vorinvalidität vorgenommen. Dies ist Der Selbstbehalt entfällt. Tod oder zu dauernder Invalidität der versicherten Person führt. nach Nr. 2 zu bemessen. 2. Ein Unfall liegt vor, 4. Tritt der Tod unfallbedingt innerhalb eines Jahres nach dem Un- a) wenn die versicherte Person durch ein plötzlich von außen Versicherungsbedingungen auf ihren Körper wirkendes Ereignis unfreiwillig eine Gesund- fall ein, so besteht kein Anspruch auf Invaliditätsleistung. 5. Stirbt die versicherte Person aus unfallfremder Ursache inner- zur Notruf-Versicherung heitsschädigung erleidet; halb eines Jahres nach dem Unfall oder später als ein Jahr nach VB N 20 MST b) wenn durch eine erhöhte Kraftanstrengung ein Gelenk ver- dem Unfall und war der Anspruch auf Invaliditätsleistung ent- renkt oder Muskeln, Sehnen, Bänder oder Kapseln gezerrt standen, so ist nach dem Invaliditätsgrad zu leisten, mit dem Hinweis: oder zerrissen werden. aufgrund der zuletzt erhobenen ärztlichen Befunde zu rechnen Die Assistance ist mit der Durchführung der Leistungen aus der gewesen wäre. Notruf-Versicherung beauftragt. § 2  Unter welchen Voraussetzungen besteht kein Versiche- rungsschutz? § 5 Welche Einschränkungen gibt es bei der Leistung? § 1 Welche Dienste bietet der Versicherer? Nicht unter den Versicherungsschutz fallen: Haben Krankheiten oder Gebrechen bei der durch den Unfall her- 1. Der Versicherer bietet der versicherten Person während des 1. Unfälle durch Geistes- oder Bewusstseinsstörungen, Schlagan- vorgerufenen Gesundheitsschädigung oder deren Folgen mitge- Aufenthalts im vereinbarten Geltungsbereich in nachstehend fälle, Krampfanfälle, die den ganzen Körper ergreifen, sowie wirkt, so wird die Leistung entsprechend dem Anteil der Krankheit genannten Notfällen Hilfe und Beistand und trägt die entstehen- durch krankhafte Störungen infolge psychischer Reaktionen; oder des Gebrechens gekürzt, wenn dieser Anteil mindestens 25 % den Kosten im jeweils bezeichneten Rahmen. Die Deckungs- dies gilt auch, soweit der Zustand auf Alkohol- oder Drogenein- beträgt. prüfung bleibt dem Versicherer vorbehalten; Dienstleistungen fluss zurückzuführen ist; und Kostenübernahme-Erklärungen der Assistance sowie die 2. Unfälle, die der versicherten Person bei vorsätzlicher Ausführung Beauftragung von Leistungsträgern beinhalten grundsätzlich einer Straftat zustoßen; -4- [Seite 9] § 6  Welche weiteren Leistungen erbringt der Versicherer nach 5. Die in den „Leistungen im Überblick“ genannten Versicherungs- einem Unfall? summen bilden die Höchstgrenze für den Umfang der Leistun- 1. Bergungskosten gen des Versicherers pro Versicherungsfall; sie stellen gleich- Der Versicherer leistet Ersatz bis zur vereinbarten Höhe von zeitig die Höchstersatzleistung für alle Versicherungsfälle eines € 5.000,- für Such-, Rettungs- und Bergungskosten, wenn die Versicherungsjahres dar. versicherte Person nach einem Unfall gerettet oder geborgen werden muss, oder wenn die versicherte Person vermisst wird § 3 Welche Risiken sind nicht versichert? und zu befürchten ist, dass ihr etwas zugestoßen ist. Der Versicherungsschutz bezieht sich nicht auf 2. Kurbeihilfe 1. Haftpflichtansprüche Der Versicherer leistet nach einem unfallbedingten Kranken- a) soweit sie aufgrund vertraglicher oder sonstiger Zusage über hausaufenthalt von mindestens 21 Tagen eine medizinisch den Umfang der gesetzlichen Haftpflicht der versicherten notwendige Kur- oder Rehabilitationsmaßnahme, die im Zu- Person hinausgehen; sammenhang mit dem Unfallereignis steht und durch ein fach- b) der versicherten Personen untereinander und der ihrer Ange- ärztliches Attest nachzuweisen ist. Die Kur- oder Rehabilitations- hörigen (einschließlich Lebenspartner); maßnahme muss innerhalb von sechs Monaten nach Abschluss c) wegen der Übertragung einer Krankheit durch die versicherte der Krankenbehandlung angetreten sein und eine Mindestdauer Person; von 21 Tagen, maximal eine Dauer von 28 Tagen haben. d) wegen Schäden aus beruflicher Tätigkeit. Versichert sind dabei die Kosten für ärztliche Behandlung, Arz- 2. Haftpflichtansprüche gegen die versicherte Person nei- und Heilmittel (z. B. Bäder, Massagen und Krankengym- a) aus der Ausübung der Jagd; nastik) sowie die Aufwendungen für Kurtaxe, Unterkunft und b) wegen Schäden an fremden Sachen, die die versicherte Per- Verpflegung bis zu einem Höchstbetrag von € 1.500,-. son gemietet oder geliehen, durch verbotene Eigenmacht Der Versicherer erstattet die ggf. nach Vorleistung eines gesetz- erlangt oder welche sie in Obhut genommen hat. Versichert lichen oder privaten Kosten- oder Leistungsträgers verbleibende ist jedoch die Haftpflicht aus der Beschädigung von Räumen Kosten in Höhe von € 1.500,- maximal je versicherte Person. Die in Gebäuden während des Aufenthalts im vereinbarten Kosten werden für jeden Unfall nur einmal erstattet. Geltungsbereich, insbesondere von gemieteten Ferien- wohnungen und Hotelzimmern oder der Unterkunft, nicht § 7  Was ist nach Eintritt eines Unfalls zu unternehmen (Oblie- jedoch des Mobiliars; kein Versicherungsschutz besteht für genheiten)? Haftpflichtansprüche wegen Verschleißes, Abnutzung oder Die versicherte Person ist verpflichtet, übermäßiger Beanspruchung; 1. sich von den vom Versicherer beauftragten Ärzten untersuchen c) als Eigentümer, Besitzer, Halter oder Führer eines Kraft-, Luft- zu lassen; die für die Untersuchung notwendigen Kosten ein- oder motorgetriebenen Wasserfahrzeugs wegen Schäden, schließlich eines dadurch entstandenen Verdienstausfalls trägt die durch den Gebrauch des Fahrzeugs verursacht werden. der Versicherer; d) als Halter und Hüter von Tieren 2. die behandelnden oder begutachtenden Ärzte, andere Versiche- e) für Gefahren, die mit der vorsätzlichen und widerrechtlichen rer und Behörden von der Schweigepflicht zu entbinden. Begehung einer Straftat im unmittelbaren Zusammenhang stehen. § 8  Wann zahlt der Versicherer die Versicherungsleistung wegen dauernder Invalidität? § 4  Was muss die versicherte Person nach Eintritt des Ver- 1. Sobald dem Versicherer die Unterlagen zugegangen sind, die sicherungsfalls unbedingt beachten? (Obliegenheiten) zum Nachweis des Unfallhergangs und der Unfallfolgen sowie Versicherungsfall ist das Schadenereignis, das Haftpflichtansprüche über den Abschluss des für die Bemessung der Invalidität not- gegen die versicherte Person zur Folge haben könnte. wendigen Heilverfahrens beizubringen sind, ist er verpflichtet, 1. Jeder Versicherungsfall ist dem Versicherer unverzüglich in Text- innerhalb von drei Monaten zu erklären, ob und in welcher Höhe form (z. B. Brief, Fax, E-Mail) anzuzeigen. er einen Anspruch anerkennt. 2. Die Einleitung eines Ermittlungsverfahrens oder der Erlass eines 2. Erkennt der Versicherer den Anspruch an, so erfolgt die Auszah- Strafbefehls oder eines Mahnbescheids ist dem Versicherer von lung der Versicherungsleistung innerhalb von zwei Wochen. der versicherten Person auch dann unverzüglich anzuzeigen, 3. Innerhalb eines Jahres nach dem Unfall kann Invaliditätsleistung wenn der Versicherungsfall dem Versicherer bereits bekannt ist. vor Abschluss des Heilverfahrens nur bis zur Höhe der Todesfall- 3. Wird der Anspruch auf Entschädigung gegen die versicherte summe beansprucht werden. Person geltend gemacht, hat sie dies dem Versicherer innerhalb 4. Die versicherte Person und der Versicherer sind berechtigt, den einer Woche nach der Erhebung des Anspruchs anzuzeigen. Grad der Invalidität jährlich, längstens bis zu drei Jahren nach 4. Die versicherte Person hat außerdem dem Versicherer anzuzei- Eintritt des Unfalls, erneut ärztlich bemessen zu lassen. Dieses gen, wenn ein Anspruch unter Einschaltung gerichtlicher oder Recht muss vom Versicherer mit Abgabe der Erklärung entspre- staatlicher Hilfe geltend gemacht wird. chend Nr. 1, von der versicherten Person innerhalb eines Monats 5. Die versicherte Person ist verpflichtet, unter Beachtung der ab Zugang dieser Erklärung ausgeübt werden. Ergibt die end- Weisung des Versicherers nach Möglichkeit für die Minderung gültige Bemessung eine höhere Invaliditätsleistung, als sie der des Schadens zu sorgen und alles zu tun, was der Aufklärung Versicherer bereits erbracht hat, so ist der Mehrbetrag mit 5 % des Schadenfalls dient. Sie hat ausführlichen und wahrheitsge- jährlich zu verzinsen. mäßen Schadenbericht zu erstatten und alle Umstände, die mit dem Schadenereignis in Zusammenhang stehen, mitzuteilen sowie die entsprechenden Schriftstücke einzureichen. Versicherungsbedingungen 6. Kommt es zum Prozess über den Haftpflichtanspruch, hat die zur Haftpflichtversicherung versicherte Person die Prozessführung dem Versicherer zu VB H 20 MST überlassen, dem vom Versicherer bestellten oder bezeichneten Anwalt Vollmacht und alle von diesem oder vom Versicherer für § 1 Welches Risiko übernimmt der Versicherer? nötig erachteten Aufklärungen zu geben. Gegen gerichtliche Der Versicherer bietet Versicherungsschutz gegen Haftpflicht- oder staatliche Verfügungen auf Schadenersatz hat die versi- risiken des täglichen Lebens, wenn die versicherte Person während cherte Person, ohne die Weisung des Versicherers abzuwarten, des Aufenthalts im vereinbarten Geltungsbereich wegen eines fristgemäß Widerspruch zu erheben oder die erforderlichen Schadenereignisses, das während des Aufenthalts im vereinbarten Rechtsbehelfe zu ergreifen. Geltungsbereich eingetreten ist, aufgrund gesetzlicher Haftpflicht- 7. Wenn die versicherte Person infolge veränderter Verhältnisse bestimmungen privatrechtlichen Inhalts von einem Dritten auf das Recht erlangt, die Aufhebung oder die Minderung einer zu Schadenersatz in Anspruch genommen wird. Schadenereignisse zahlenden Rente zu fordern, ist die versicherte Person verpflich- sind Tod, Verletzung oder Gesundheitsschädigung von Menschen tet, dieses Recht in ihrem Namen vom Versicherer ausüben zu (Personenschaden) oder Beschädigung oder Vernichtung von lassen. Die Bestimmungen unter Nr. 3 bis 5 finden entsprechend Sachen (Sachschaden). Anwendung. 8. Der Versicherer gilt als bevollmächtigt, alle zur Beilegung oder § 2  In welcher Weise schützt der Versicherer die versicherte Abwehr des Anspruchs ihm zweckmäßig erscheinenden Erklä- Person vor Haftpflichtansprüchen, und in welchem rungen im Namen der versicherten Person abzugeben. Umfang leistet er Entschädigung? 1. Der Versicherer prüft die Haftung, wehrt unberechtigte Ansprü- § 5 Welchen Selbstbehalt trägt die versicherte Person? che ab und ersetzt die Entschädigung, welche von der versicher- Der Selbstbehalt entfällt. ten Person geschuldet ist. Der Versicherer ersetzt die Entschädigung insoweit, als er die Entschädigungspflicht anerkennt oder das Anerkenntnis der ver- sicherten Person genehmigt. Der Versicherer zahlt ebenfalls die Entschädigung, wenn er einen Vergleich schließt oder geneh- migt oder wenn eine gerichtliche Entscheidung vorliegt. 2. Macht der Geschädigte oder dessen Rechtsnachfolger den Haft- pflichtanspruch gerichtlich geltend, führt der Versicherer den Rechtsstreit auf seine Kosten im Namen der versicherten Person. 3. Wünscht oder genehmigt der Versicherer die Bestellung eines Verteidigers in einem Strafverfahren gegen die versicherte Person, das aus Anlass eines versicherten Schadenereignisses geführt wird, trägt er die Kosten des Verteidigers. 4. Falls die vom Versicherer verlangte Erledigung eines Haft- pflichtanspruchs durch Anerkenntnis, Befriedigung oder Ver- gleich an dem Widerstand der versicherten Person scheitert, hat er für den daraus entstehenden Mehraufwand an Hauptsache, Zinsen und Kosten nicht aufzukommen. -5- [Seite 10] MAWISTA Student – Versicherungsleistungen auf einen Blick / Tarifvergleichstabelle Tariftabelle MAWISTA Student Classic ® MAWISTAStudent Classic ® plus MAWISTA Student Comfort ® Allgemeine Bestimmungen § 2 Nr. 1 Versicherungsschutz für Deutsche in Deutschland bei einer Unter- nicht versichert nicht versichert bis zu 6 Wochen je Versicherungsjahr brechung des Auslandsaufenthalts Krankenversicherung § 2 Nr. 1 Höhe der Kostenerstattung für … ambulante Behandlung unbegrenzt unbegrenzt unbegrenzt Heilbehandlungen und Arzneimittel unbegrenzt unbegrenzt unbegrenzt Stationäre Behandlung unbegrenzt unbegrenzt unbegrenzt Heilbehandlung eines Neugeborenen bei Frühgeburt max. € 100.000,- max. € 100.000,- max. € 100.000,- Medizinisch notwendigen Krankentransport ins Krankenhaus unbegrenzt unbegrenzt unbegrenzt Schmerzstillende Zahnbehandlung je Versicherungsjahr max. € 500,- max. € 500,- max. € 1.000,- Zahnersatz je Versicherungsjahr 60 % der Gesamtkosten, nicht versichert nicht versichert max. € 1.000,- Behandlung wegen Schwangerschaft nach Ablauf einer Wartezeit von 3 bzw. 8 nach Ablauf einer Wartezeit von 3 bzw. 8 unbegrenzt Monaten: unbegrenzt Monaten: unbegrenzt Unfallbedingte Hilfsmittel je Versicherungsjahr max. € 250,- max. € 250,- max. € 1.000,- Unfallbedingte Sehhilfen je Versicherungsjahr nicht versichert nicht versichert max. € 100,- Impfungen max. € 250,- für die nicht versichert nicht versichert gesamte Vertragslaufzeit Heilmittel (z. B. Massagen-, Fango-Behandlungen, Lymphdraina- max. 6 Behandlungen max. 8 Behandlungen max. 8 Behandlungen gen) je Versicherungsjahr Rehabilitationsmaßnahmen unbegrenzt unbegrenzt unbegrenzt § 2 Nr. 2 Nachleistung nach Ablauf des Versicherungsvertrages max. 6 Wochen max. 6 Wochen max. 8 Wochen bei Transportunfähigkeit § 3 Nr. 1 Kostenerstattung für den medizinisch sinnvollen und vertretbaren Krankenrücktransport in das nächstgelegene Krankenhaus im Heimat- Krankenrücktransport ins Heimatland land in unbegrenzter Höhe, außerdem auf Wunsch der versicherten Person bei Krankenhausbehandlungen länger als 14 Tage. § 3 Nr. 2 max. € 25.000,- max. € 25.000,- max. € 25.000,- Kostenerstattung für Überführung ins Heimatland § 3 Nr. 2 max. bis zur Höhe der Überführungskosten max. bis zur Höhe der Überführungskosten max. bis zur Höhe der Überführungskosten Kostenerstattung für Bestattung vor Ort §6 € 50,- pro Versicherungsfall bei ambulanter ohne Selbstbehalt ohne Selbstbehalt Selbstbehalt Behandlung und bei Zahnbehandlungen Notrufversicherung §1-§4 Bietet weltweite Soforthilfe bei Notfällen im vereinbarten Geltungsbereich § 2 Nr. 2 max. € 15.000,- max. € 15.000,- max. € 15.000,- Höhe der Kostenübernahmeerklärung bei stationärer Behandlung Unfallversicherung §3 nicht versichert € 10.000,- € 10.000,- Versicherungssumme für den Todesfall §4 nicht versichert max. € 140.000,- max. € 140.000,- Versicherungssumme für den Invaliditätsfall § 6 Nr. 1 nicht versichert max. € 5.000,- max. € 5.000,- Bergungskosten § 6 Nr. 2 nicht versichert max. € 1.500,- max. € 1.500,- Kurbeihilfe Haftpflichtversicherung §1 • max. € 1.000.000,- für Personen- und • max. € 1.000.000,- für Personen- und Versicherungssummen nicht versichert Sachschäden Sachschäden • max. € 250.000,- für Mietsachschäden • max. € 250.000,- für Mietsachschäden Monatsprämien bis 40 Jahre € 33,10 € 59,70 € 39,70 € 63,80 € 76,80 € 76,80 Versicherungsdauer in Monaten 1. bis 12. 13. bis 48. 1. bis 12. 13. bis 48. 1. bis 12. 13. bis 48. 41 bis 55 Jahre € 69,90 € 114,- € 74,90 € 119,- € 129,90 € 134,- Versicherungsdauer in Monaten 1. bis 12. 13. bis 48. 1. bis 12. 13. bis 48. 1. bis 12. 13. bis 48. 2020-1072 -6- [Seite 11] Documents to Insurance Policy Overview of Benefits Table of contents MAWISTA Student - Tariff Comfort Data Protection and General Information in the Event of Claim 2 • Health Insurance Terms and Conditions 3  No deductible General Provisions 3 • Emergency Call Insurance Health Insurance 3 • Accident Insurance Emergency Call Insurance 4  Sums insured: up to € 140,000 per person in the event of disability, € 10,000 in Accident Insurance 4 the event of death Liability Insurance 5 • Liability Insurance MAWISTA Student – Insurance Benefits at a Glance / Tariff Table 6  Sums insured: € 1,000,000 per person in case of personal injury and damage to property, € 250,000 for damage to rented property Please note the following important information We are there for you Area of validity: see §2 VB AB-COM 20 MST Maximum insured travel duration: The insurances are valid for the agreed term, maximum 48 months. Assistance in an emergency Insurable persons: see §1 No. 1 VB AB-COM 20 MST If you require help in an emergency the Assistance is there for you. Our 24-hour Guidelines on taking out insurance: The policy can be purchased at any time, emergency service guarantees rapid and expert assistance all over the world! effective on the first day of any month. Insurance cover commences at the time specified in the insurance policy, but not before applying for insurance, not Phone: +49.89.6 24 24-496 before crossing the border and not before the expiry of any waiting periods. Important for help in an emergency: Insurance cover is provided only for the person named on the insurance policy. • Please hold the exact address and phone number of your current whereabouts The premium is due for the first time at the beginning of the insurance contract ready to hand. and is payable monthly in advance. The payment of the premium can be made by • Note down the name of your contacts, e.g. physician, hospital or police. using one of the available payment methods (e.g. SEPA direct debit or credit card). • Describe as exactly as possible the facts of the case and have the necessary infor- If the insurer has been authorized to debit the premium from the selected payment mation at hand. method, the payment shall be deemed to have been made, if there is sufficient cover on the stated payment method at the time of debiting. The amount of the premiums is usually based on the selected insurance cover and the term of the contract. Notification of claim The simplest and quickest way of notifying us of your claim is via https://www.mawista.com/en/file-a-claim/ If the insured event occurs, we will only be obliged to provide indem- or alternatively by post to our MAWISTA Claims Department (see adress on the right). nity if the premium has been paid, or if you, as the policyholder, are not at fault for the non-payment of the premium. You are required to prove this to us. Complaints, Applicable Law and Withdrawal AWP P&C S.A. General Representative: Jacob Fuest Niederlassung für Deutschland Registration court: Munich HRB 4605 Complaint Notice: Our goal is to offer first-class services. It is equally important to us to respond to your concerns. If you are (Germany Branch) VAT ID No. DE 129274528 not satisfied with any of our products or our service, please notify us directly. Bahnhofstraße 16 D - 85609 Aschheim (near Munich) You can send us your complaints relating to contract or claim issues using any means of com- Germany munication. You can reach us by telephone at +49.89.6 24 24-460, in writing by e-mail to beschwerde-reise@allianz.com, or by regular mail to AWP P&C S.A., Beschwerdemanagement, Bahnhofstrasse 16, D - 85609 Aschheim (bei München), Germany. Additional information on our com- AWP P&C S.A. plaint process can be found at www.allianz-reiseversicherung.de/beschwerde. We will not participate in Public Limited Company incorporated under French law dispute settlement proceedings before a consumer arbitration board. Registered Office: Saint-Ouen (France) Commercial register: R.C.S. Bobigny 519 490 080 In the event of complaints relating to all types of insurance, please contact the responsible superviso- ry authority, Bundesanstalt für Finanzdienstleistungsaufsicht (BaFin - the German Federal Financial Chairman of the Board of Management: Sirma Boshnakova Supervisory Authority), Graurheindorfer Strasse 108, D - 53117 Bonn, Germany (www.bafin.de). The contract is governed by the laws of the Federal Republic of Germany, unless this conflicts with in- ternational 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 This translation is for information purposes only. In the event of any the insurer. If the policyholder or the insured person is a natural person, legal action can also be brought conflict or inconsistency between the German and the English versi- before the court in the district of which the policyholder or the insured person has his place of residence ons, the German original shall prevail. when the legal action is brought or, if he does not have a place of residence, his habitual place of abode. Right to revoke contracts valid for a term of one month or more: Consequences of revocation: You can revoke your contractual declaration within 14 days in writing (e.g., letter, fax, e-mail) without When revocation is effective, insurance cover ceases and we shall refund to you that portion of the stating reasons. The period begins after you have received the insurance certificate, the terms of the premium allocated to the period after receipt of the revocation if you consented to insurance cover contract including the Terms and Conditions of Insurance, the additional information pursuant to § 7 beginning prior to the end of the revocation period. We are entitled in this case to retain that portion (1) and (2) of the Insurance Contracts Act (VVG) in conjunction with §§ 1 through 4 of the VVG Decree of the premium that is allocated to the period until receipt of the revocation. This is a sum calculated on Information Duties - each of these notifications in written form. In case of contracts in electronic proportionally by days. Amounts to be refunded will be remitted without undue delay, no later than commerce (§ 312i (1)(1) of the German Civil Code (BGB), this period shall not commence prior to 30 days after receipt of the revocation. If insurance cover does not commence prior to the end of the our performance of our duties pursuant to § 312i (1)(1) of the German Civil Code in conjunction with revocation period, then effective revocation means that payments received must be refunded and uses Article 246c of the Introductory Law to the German Civil Code (EGBGB). made thereof (e.g., interest) must be disbursed. The deadline for revocation is deemed met if the revocation is dispatched in good time. It must be sent to: Special notes: AWP P&C S.A., Bahnhofstraße 16, D - 85609 Aschheim (bei München), Telefax + 49.89.6 24 24-244, Your right of revocation lapses when the contract is completely performed both by you and also by us E-Mail: service-reise@allianz.com. at your express request before you have exercised your right of revocation. Your AWP P&C S.A., Germany Branch -1- [Seite 12] Data Protection In accordance with Art. 13 and 14 of the General Data Protec- In these cases, the legal basis of the data processing is provided III To what recipients will we communicate your data? tion Regulation (GDPR), we are informing you about how your by the relevant statutory regulations in conjunction with Art 6 Recipients of your personal data may include: selected external ser- personal data is processed by AWP P&C S.A., Niederlassung für (1) c) GDPR. vice providers (e.g. assistance service providers, benefit processors, Deutschland (Germany Branch), and about the rights to which transport service providers, technical service providers, etc.), other you are entitled under data protection law. Please make all co- We may also process your data in accordance with Art 6 (1) d) insurers (e.g. in the case of multiple insurance coverage). insured individuals (e. g. your spouse) aware of this policy. GDPR in order to protect your vital interests, or if you have con- sented to the data processing, Art. 6 (1) a) GDPR. We also insure some of the risks that we cover with specialist in- I Who is responsible for processing your personal data? surance companies (re-insurers). To this end, it may be necessary Responsibility for processing your personal data rests with If we wish to process your data for any purpose other than those to send your contract and, where relevant, your claims information specified above, we will notify you in advance within the frame- to a re-insurer, to enable it to form its own opinion of the risk or the AWP P&C S.A., Niederlassung für Deutschland work of the statutory regulations. insured event. Bahnhofstraße 16 D - 85609 Aschheim (near Munich). 2. What applies to special categories of personal data, especially If you join a group insurance contract as an insured person, (e.g. health data? when acquiring a credit card), we may disclose your personal data to The Data Protection Officer can be contacted by standard mail at the There are special safeguards on the processing of special the policyholder (a bank for example), if it has a legitimate interest aforementioned address, using the suffix “Data Protection Officer“, categories of personal data, of which health data is one. As a rule, in knowing this information. or by email at datenschutz-azpde@allianz.com. processing is permitted only if you have consented to the pro- cessing in accordance with Art. 9 2) a) GDPR, or if this is a case of In addition, we may also communicate your personal data to other II F or what purpose is your data processed, and on what legal one of the other situations defined by law, Art. 9 (2) b) – j) GDPR. recipients, such as public authorities for the fulfilment of statutory basis does this take place? duties of notification (e.g. finance authorities or criminal investiga- 1. What applies to all categories of personal data? a) Processing of your special categories of personal data tion agencies). We process your personal data in compliance with the EU In many cases, in order to review the benefit entitlement, we General Data Protection Regulation (GDPR), the German Fe- require personal data belonging to a special category (sensi- The forwarding of data is a form of data processing, and is likewise deral Data Protection Act (BDSG), the provisions of the German tive data). This includes health data, for example. If, in connec- performed within the framework of the principles set out in Art. 6 Insurance Contract Act (VVG) relevant to data protection law, as tion with a specific insured event, you provide us with such (1) and Art. 9 (2) GDPR. well as all other applicable laws. data together with a request to review and process the claim, you are explicitly permitting us to process your sensitive data IV How long will we retain your data? When you apply for insurance cover, we will require the informa- necessary in order to process the insured event. We will again We will retain your data for the period during which claims may be tion provided by you at this point in order to arrange the contract remind you specifically of this fact in the claim form. made against our company (statutory limitation period of 3 to 30 years). and to estimate the risk assumed by us. If the insurance contract We will also retain your data if we are under a legal obligation to do so, comes into being, we will process this data for the implementati- You may withdraw your consent at any time, with future e.g. according to the provisions of the German Commercial Code, the on of the contractual relationship, such as for invoicing purposes. effect. However, we explicitly inform you that it may in that German Fiscal Code or the German Money Laundering Act. The relevant We require information about loss or damage in order to be able case no longer be possible to review our indemnity obligati- retention periods range up to ten years. to assess whether an insured event has occurred and determine on in connection with the insured event. If the review of the the extent of this loss or damage. claim is already concluded, there may be statutory retention V Where will your data be processed? obligations that mean the data cannot be erased. If we should transfer your data to service providers located outside It is not possible to arrange and implement the insurance of the European Economic Area (EEA), the transfer within the Allianz contract without processing your personal data. We may also process your sensitive data if this is necessary to Group will be performed on the basis of “Binding Corporate Rules“, protect your vital interests, and if you are physically or legally which have been approved by the data protection authorities. These Art. 6 (1) b) GDPR constitutes the legal basis for the processing incapable of giving consent, Art. 9 (2) c) GDPR. This may be the form part of the “Allianz Privacy Standard“. These Corporate Rules of personal data for pre-contractual and contractual purposes. case if you suffer a serious accident while travelling, for example. are binding on all companies within the Allianz Group, and they ensure an appropriate level of protection for personal data. The Alongside that, Art. 6 (1) a) and c) – f) GDPR contain other legally In the case of multiple insurance policies, if another insurer “Allianz Privacy Standard“ and the list of Allianz Group companies defined situations in which we are entitled to process personal seeks recourse from us or if we seek recourse from another bound by this standard, can be viewed here: https://www.allianz- data. insurer, we may process your sensitive data in order to assert partners.com/allianz-partners---binding-corporate-rules-.html. and defend the statutory claim for settlement, Art. 9 (2) f) GDPR. We will process your data in order to fulfil a legal obligation in In those cases in which the “Allianz Privacy Standard“ does not apply, accordance with Art 6 (1) c) GDPR, such as to review claims for b) Requesting health data from third parties for review of the transfer of data to third countries will take place in accordance settlement, if another insurer seeks recourse from us due to the the indemnity obligation with Art. 44 – 50 GDPR. existence of multiple insurance policies. In order to review our indemnity obligation, it may be ne- cessary for us to review information about the state of your VI What are your rights? We will also process your data in order to uphold our legitimate health, as provided by you for the substantiation of claims, or You have the right to be informed about all of the information re- interests or the legitimate interests of others, Art. 6 (1) f) GDPR. which is contained in the documents submitted (e.g. invoices, tained by us, and to demand that incorrect data be rectified. Under This may be the case particularly: prescriptions, medical reports) or statements, such as from a certain conditions, you also have the right to the erasure of data, the • for ensuring IT security and IT operations doctor or other member of the healthcare profession. right to object to processing, the right to the restriction of proces- • for marketing our own insurance products, and for conducting sing and the right to data portability. marketing surveys and opinion polls For this purpose, we will require your consent, including a • for the prevention and investigation of criminal activities (in par- confidentiality waiver covering us and all agencies subject to Right of objection ticular, we employ data analyses to detect possible indications of a duty of confidentiality, and which are required to provide You may object to the processing of your data for direct insurance fraud). information for review of the indemnity obligation. marketing purposes. If we process your data in order to protect legitimate interests, you may object to this processing for reasons As a rule, we only process that data that we have received directly We will notify you in each specific case about what persons pertaining to your particular situation. from you. In certain cases we may also receive such data from or institutions require information for what purpose. You may other sources (such as if another insurer seeks recourse from us then decide in each case whether you consent to us collecting If you have any objections concerning the handling of your data, due to the existence of multiple insurance policies). and using your health information, and whether to release the you may contact the aforementioned Data Protection Officer in this named persons or institutions and their duty of non-disclo- connection. You are also entitled to lodge an objection with a data We also process your personal data in order to fulfil other sure, and if you agree to the communication of your health protection supervisory authority statutory obligations, such as regulatory requirements, as well as data to us, or if you want to personally provide the necessary data retention obligations imposed by commercial and tax law. documentation. General Information in the Event of Claim What do you do in any case of damage? What should you remember for claims under the Accident Insu- The insured person must minimise and document the damage as rance or Liability Insurance? far as possible. For this reason, please ensure that you have suita- Please note down the names and addresses of witnesses who saw ble proof of the occurrence of the damage (e.g. confirmation of the damaging event. Ask for a copy of the police report if the police damage, medical certificate) and of the extent of damage (e.g. bills, was called in to investigate the case. Notify AWP and submit these receipts). documents and this information to it with your notice of damage. What should you do if you fall ill, injure yourself or any other emergency occurs during your stay in the agreed area of validi- ty? (Health Insurance, Emergency Call Insurance) Please immediately contact the Assistance in case of severe injuries or serious illnesses, particularly prior to hospitalisation, so that adequa- te 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 in- dividual medical services provided and the costs of these. Prescrip- tions must provide information on the medications prescribed, the prices and bear the stamp of the pharmacy. -2- [Seite 13] Terms and Conditions of AWP P&C S.A., Germany Branch General Provisions set for payment, the effect of the termination ceases to apply Terms and Conditions of the VB AB-COM 20 MST and the contract enters into force again. However, no insurance cover is provided for insured events occurring after the expiry of Health Insurance VB K-COM 20 MST The regulations as stipulated under §§ 1 to 11 apply to all MAWISTA the period set for payment. Student insurance products. § 1 What is insured? The Terms and Conditions (VB) printed below apply to the respec- § 5 In which cases does insurance cover not apply? 1. The insurance covers the costs of: tive insurance. Insurance cover is provided if you have contractually No insurance cover is provided in the following cases: a) Medical treatment agreed the insurance concerned. 1. Damage or loss caused by strikes, nuclear energy, confiscation b) Patient repatriation transportation and other invention acts by public authority, as well as damage c) Repatriation of mortal remains in case of death § 1 Who is eligible for insurance cover? or loss in areas for which the German Federal Foreign Office has in the event of acute illnesses and accidental injuries occurring in 1. The following are eligible for insurance cover: issued a travel warning. If an insured person is at such a location the agreed area of validity within the insured period. a) Residents of Germany who are travelling abroad as language at the time when a travel warning is issued, insurance cover ends 2. Insurance cover is provided in the agreed area of validity for the pupils, students, scholarship holders, candidates for a 14 days after the issuance of the travel warning; insurance cover costs of the medical treatment during pregnancy and child- doctor‘s degree, guest researchers, practical trainees, or who continues in spite of the travel warning if the end of travel is birth only if the pregnancy (conception) occurred after the are participating in „work- & holiday“-programs as well as delayed for reasons for which the insured person is not commencement of insurance. Irrespective of the time when accompanying members of his or her family. responsible. pregnancy occurred, the insurer will reimburse the costs b) Persons residing in Germany who are in possession of a 2. Damage or loss due to war or events similar to war; however, of medical treatment in case of the occurrence of acute residence permit for educational purposes, and the insurance cover does exist if the damage or loss occurs in the complications in the pregnancy including miscarriage and accompanying members of their family. first 14 days after the beginning of the events; insurance cover premature birth. c)  Persons in possession of another type of temporary continues if the end of travel is delayed for reasons for which the 3. Flat-rate expense allowance in case of hospitalisation: residence permit for Germany. 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 The requirement is that the person has not yet reached their stays in countries in whose territory war or civil war is already necessary treatment as an inpatient in the agreed area of 55th birthday on the date on which the insurance policy begins. ongoing or where such an outbreak was foreseeable. Damage or validity, the insurer will pay a maximum flat-rate expense 2. Insurance cover applies to the person specifically named in the loss through active participation in war, civil war or events similar allowance of € 30 per day for a maximum period of 45 days from insurance policy documentation for their temporary period of to war are not covered by the insurance. the commencement of inpatient treatment (for telephone, TV, residence in accordance with the agreed area of validity. 3. Damage or losses intentionally caused by the insured person. additional meal allowance for visitors etc.). § 2 What area of validity does the insurance apply to? § 6 What are the duties and obligations of the insured person § 2 What costs are reimbursed for medical treatment? Insurance cover is valid for insured persons in the event of a claim? 1. The insurer reimburses expenditures for all necessary medical 1.  with Germany as home country for the temporary stay The insured person is obliged to: treatment in the agreed area of validity, including costs incurred outside Germany. There is no insurance coverage for stays in 1. Minimise the loss as far as possible and avoid unnecessary costs. for: Germany. In case the insured stay abroad is interrupted, the tariff 2. Report the loss to the insurer without delay. a) Outpatient treatment by a physician. Comfort provides insurance cover also in Germany for a period 3. Describe the damaging event and the extent of damage and b) Medical treatment and medication prescribed by a physician of up to 6 weeks per insurance year. truthfully provide the insurer with any and all pertinent infor- for the insured person. 2. with temporary resident status in Germany, for the temporary mation. The insured person must furnish proof in the form of c) Inpatient treatment in hospital, including operations that stay in Germany, in addition to periods that count as holiday or original bills and receipts, release physicians from their confiden- cannot be postponed. In case of premature birth, the costs for training purposes in the EU as well as in Switzerland, Liech- tiality obligation as necessary – including the physicians of the of treatment required for the newborn child in the agreed tenstein, Norway, United Kingdom and Iceland. There is no insu- Assistance – and allow the insurer to reasonably examine the area of validity will also be covered up to € 100,000 rance cover outside the above-stated countries. cause and amount of the asserted claim. (notwithstanding § 1 VB AB-COM 20 MST). The following applies for inpatient medical treatment and § 3 When does the insurance begin and end? § 7 When does AWP pay compensation? childbirth in Germany: General hospital costs (multi-bed Insurance cover As soon as the insurer has determined whether and to what extent room) are reimbursed and according to the Federal Nursing 1. begins at the time stated in the insurance policy (start of it has an duty to indemnify, compensation is paid within two weeks. Care Tariff Ordinance and the Hospital Remuneration Act; insurance), however not before applying for insurance, not expenses for optional services (private medical treatment) before crossing the border and not before the expiry of any § 8 What applies if the insured person has claims for damages are not covered by the insurance. waiting periods. Waiting periods are calculated from the against third parties? d) Patient transportation deemed medically necessary for commencement of insurance. 1. In accordance with statutory regulations, claims for damages inpatient treatment at the nearest and appropriate hospital in 2. ends at the agreed time, at the latest at the end of the insured against third parties pass to the insurer up to the level of payment the agreed area of validity and back to the insured person‘s stay in the agreed area of validity. effected, provided that the insured person suffers no accommodation. 3. can be extended for up to 48 months (= maximum tariff-based disadvantage thereby. e) Pain-killing dental treatment and repairs of dentures and term of insurance) upon application before the expiry of the 2. The insured person is obliged to confirm the assignment of provisional measures up to € 1,000,- per insurance year. original term of contract insofar as the temporary period of claims to this extent in writing upon request by the insurer. f) Dental prostheses (after an eight-month waiting period from residency continues and the insurance policyholder is willing 3. Any duties to indemnify arising under other insurance contracts the start of insurance coverage) up to 60% of the total costs and able to pay the premiums applicable at the time of the and other social insurance institutions will have precedence over incurred, but no more than € 1,000 per insurance year. extension of cover. If the maximum tariff-based term of those of the insurer. The insurer will be deemed to have made g) The medical care and treatment of pregnancies which insurance of 48 months has been completed, a new contract can advance payment, if the original bills are first presented to the occurred after the commencement of insurance. be applied for if the requirements stipulated in No. 4 below are insurer for payment. h) Aids required as a result of an accident up to € 1,000 per insu- met. rance year. 4. For persons with temporary resident status in Germany, a § 9 When does the insured person forfeit claims to insurance i) Visual aids due to an accident (after a three-month waiting maximum term of 60 months (= statutory limit of 60 months) benefits due to a breach of duties and the statute of period from the start of insurance coverage) up to € 100 per may not be exceeded, taking into account any similar insurance limitations? insurance year. policies with other insurers. 1. If a breach of duty is intentionally committed, the insurer is j) Vaccinations which have been recommended by the German released from its duty to indemnify; in case of grossly negligent Standing Vaccination Committee (STIKO) of the Robert-Koch- § 4 What term of validity does the contract have? When is the violation, AWP is entitled to reduce its payment in proportion to Institute, up to a maximum of € 250 for all vaccinations- premium payable? the degree of fault of the insured person. throughout the entire term of the contract. 1. The insurance contract can be agreed for full months in each 2. The insured person must furnish proof that no gross negligence k) Medically prescribed treatment (e.g. massages, fango or case and for a maximum term of 48 months. was involved. Except in case of fraudulent intent, the insurer is lymph drainage treatments) up to eight (medical) applica- 2. The insured person can give notice of termination of the obliged to indemnify if the insured person furnishes proof that tions in total per insurance year, even then if multiple (medi- insurance contract daily to the end of the month. the breach of duty is not the cause of either the occurrence cal) applications are carried out within one treatment. 3. The premium is due for the first time on commencement of or the determination or the scope of the insurer’s duty to l) Medically necessary rehabilitation measures as subsequent the insurance contract and is payable each month in advance. indemnify. medical treatment prescribed by a physician. The payment of the premium can be made by using one of 3.  The claim to an insurance benefit lapses in three years, m). In this context, the insurer shall pay for methods of examina- the available payment methods (e.g. SEPA direct debit or calculated from the end of the year in which the claim tion or treatment widely accepted by conventional medicine credit card). occurred and the insured person obtained knowledge of the to the extent stated in the contract. In addition, the insurer If the first premium has not been paid upon the occurrence of circumstances in order to assert the claim, or would have shall pay for methods and medication which have shown the insured event, the insurer shall not have a duty to indemnify, obtained knowledge without gross negligence. themselves to be just as promising in practice and which unless the insured person is not responsible for non-payment. are applied because no conventional medical methods or If the insurer has been authorized to debit the premium from § 10 What form must be followed for submitted declarations of medication is available. However, the insurer may reduce the the selected payment method, the payment shall be deemed to intent? payment to the amount which would have been incurred if have been made, if there is sufficient cover on the stated pay- 1. Notices and declarations of intent from the insured person and conventional medical methods or medicine had been applied. ment method at the time of debiting. the insurer are required to be in text form (e.g. letter, fax or e-mail). 2. The insurer reimburses the costs in accordance with the 4. If a contract is valid for a term of longer than one month, the 2. Insurance agents are authorised to accept such documents and conditions for a duration of up to eight weeks after the agreed renewal premium is payable on the 1st day of the new month forward them to the insurer. term of validity of the insurance contract until the date when respectively. the insured person can be transported at the latest, if patient If the insurer has been authorized to debit the premium from the § 11 Which court in Germany is responsible for dealing with the repatriation was not advised for medical reasons during the term selected payment method, the payment shall be deemed to have assertion of claims based on the insurance contract and of the contract. been made, if there is sufficient cover on the stated payment which law applies? method at the time of debiting. 1. At the option of the insured person, the courts of Munich or § 3 What costs does the insurer reimburse in case of patient If the renewal premium is not paid, the insurer may set a period the place in Germany where the insured person has his or her repatriation transportation and repatriation of mortal for payment of at least two weeks in text form. If an insured event permanent residence or habitual abode at the time the legal remains? occurs after the expiry of the period and the insured person is still action is brought will have jurisdiction and venue. The insurer reimburses the following: in arrears with the payment of the renewal premium, the insurer is 2. The laws of the Federal Republic of Germany apply insofar as 1. The costs of the medically advisable and justifiable repatriation exempted from its duty to indemnify. The insurer may terminate they do not conflict with international law. of the insured person to a suitable hospital located closest to the contract instantly if the insured person is still in arrears with the place of residence of the insured person in his or her home payment after the expiry of the period. If payment is made with- country. in one month after termination or after the expiry of the period -3- [Seite 14] In addition, the costs of the medically advisable and justifiable 2. The insurer has entrusted the Assistance with the provision of his or her agreement, radiation, infections and poisoning, unless repatriation are reimbursed upon request by the insured person services named below for the insured person as a 24-hour ser- these were due to accidental causes. where continued hospital treatment is expected to exceed 14 vice. 5. Bleeding from inner organs and cerebral haemorrhage, unless days in the opinion of the physician giving treatment. 3. The insured person must contact the Assistance without delay to primarily due to an accident suffered during the insured stay in Irrespective of this, the costs of the patient‘s repatriation to his or claim the services in an emergency. the agreed area of validity. her home country are paid if these remain within the limits of the 4. Insofar as the insured person cannot claim the reimbursement 6. Pathological disorders as a result of psychological reactions expected costs of continued medical treatment. of amounts paid out from the insurer or from another payer, the irrespective of the cause. 2. The actual costs of up to € 25,000 for the repatriation of the insured person must repay the amounts to the insurer within deceased insured person for a funeral in his or her home country one month of invoicing. § 3 What benefits does the insurer pay in the event of the or, alternatively, the actual costs of a local funeral up to the costs death of the insured person? of repatriation at the maximum. § 2 What help does the Assistance provide in case of illness Should the accident lead to the death of the insured person within and accident? one year, the insurer will pay € 10,000 to the heirs. § 4 What limitations on insurance cover are to be noted? 1. Outpatient treatment No insurance cover is provided for the following: The Assistance provides information on the possibilities of § 4 What benefits does the insurer pay in the event of the 1. Medical treatment and other measures ordered by a physician, medical care and names a physician who speaks German or permanent disability of the insured person? where the purpose of the stay in the agreed area of validity was English as far as possible. However, the Assistance does not Should the accident result in the permanent impairment of the to seek such treatment. contact the physician. insured person‘s physical or mental abilities (disability), the insured 2. Medical treatment and other measures ordered by a physician 2. Inpatient treatment person is entitled to claim benefits from the sum insured for that the insured person knew were necessary prior to the stay In case of inpatient treatment of the insured person at a disability (taking into account the progression pursuant to No. 2 (e)) in the agreed area of validity or at the time of taking out the hospital, the Assistance provides the following services: to a maximum amount of € 140,000. insurance or which he or she could have expected in the a) Support 1. Disability must have occurred within one year after the accident circumstances of which he or she was aware. If required, the Assistance establishes contact through its and must be determined by a physician and the claim asserted 3. Nutriments and tonics. contract physician to the respective family physician of the within a further three months. 4. Orthodontic treatment, dental treatment other than pain-killing insured person and to the hospital physicians providing 2.  The disability benefits payable depend on the degree of treatment, repairs to dentures and provisional measures treatment. It ensures that information is passed between the disability. Notwithstanding any evidence substantiating a higher Notwithstanding this, coverage is provided for dental prostheses physicians involved. Upon request, the Assistance informs or lower degree of disability, the following fixed scales of of up to 60% of the total costs incurred but no more than € 1,000 relatives of the insured person. disability are applicable: per insurance year after an eight-month waiting period from the b) Patient visits a) Loss or incapacity of: start of insurance coverage. In case of the inpatient treatment of the insured person, the an arm 70 % 5. Medical treatment (e.g. massages, fango or lymph drainage Assistance organises the travel for one person close to the a hand 55 % treatments) which exceed eight treatments per insurance year. insured person to the hospital where the insured person is a thumb 20 % 6. The purchase of prostheses and other medical aids; staying and back to his or her place of residence in his or her a finger 10 % notwithstanding this, insurance cover is provided up to € 1,000 home country. The insurer pays the costs of transport in case a leg 70 % per year for aids required as a result of an accident. Notwithstan- of a life-threatening illness of the insured person or if inpati- a foot 40 % ding this, coverage is provided for visual aids due to accidents ent treatment lasts for longer than 14 days. a toe 0 5% (after a three-month waiting period from the start of insurance c) Declaration to meet costs an eye 50 % coverage) up to € 100 per insurance year. In case of inpatient hospital treatment, the insurer will give hearing in one ear 30 % 7. Treatment of alcoholism, drug addiction and other addictions as the insured person a declaration that it will meet the costs up sense of smell or taste 10 % well as the consequences thereof. to an amount of € 15,000. This declaration does not involve b) In case of partial loss or functional impairment of one of 8. Treatment of pregnancies which occurred before the any recognition that the insurer has a duty to indemnify. The these parts of the body or sensory organs, the appropriate commencement of insurance insurer assumes settlement with the payer responsible in the proportion will be determined on the basis of the respective 9. Treatment or accommodation caused by infirmity, need of name of the insured person. percentage as specified under a) above. nursing care or detention. 3. Patient repatriation transportation c)  Should the accident affect parts of the body or sensory organs, 10.  Psychoanalytical and psychotherapeutic treatment and As soon as medically advisable and appropriate, or if the the loss or functional incapacity of which is not specified hypnosis duration of the hospital stay is expected to exceed 14 days in the under a) or b) above, the degree of disability will be measured 11.  For fees and charges which exceed the extent considered opinion of the physician giving treatment, the Assistance will by the extent to which the insured person‘s normal physical generally customary and reasonable in the country concerned organise return transportation using medically adequate means or mental capacity is impaired from a purely medical and for optional benefits such as a single room or treatment by of transport (including air ambulances) to the closest suitable perspective. the head physician. The reimbursement may be reduced to the hospital to the insured person‘s place of residence after prior d) Should the accident result in the impairment of several customary rates in the country. consultation between the contract physician of the Assistance physical or mental functions, the degrees of disability 12. Patient repatriation transport caused by one of the reasons and the local physicians handling the case. specified under 2 a) to c) will be added together. Such mentioned under no. 1, 2, 7 and 9. addition will, however, not total more than 100% disability. 13. Prophylactic examinations and check-ups, check-ups of children § 3 Does the Assistance procure the necessary medications for e) The disability payment under No. 2 a) shall be expanded as and young people, dental check-ups and dental prophylaxis as the insured person? follows: well as any charges and fees for medical certificates, reports on In concert with the family physician of the insured person, the In case of a degree of disability in excess of 25%, the diagnostic findings and doctor’s certificates for inability to work, Assistance takes care of procuring medically prescribed medi- indemnity payment shall increase in accordance with the which were not requested by the insurer. cation and sending it to the insured person, if this is possible. The following table: insured person must reimburse the costs of the medication to the § 5 What are the duties and obligations of the insured person Assistance within one month. from to from to from to from to from to in case of damage or loss? % % % % % % % % % % The insured person is obliged to: § 4 What services does the Assistance provide in case of the 26 28 41 73 56 130 71 205 86 280 1. Contact the Assistance immediately in the event of inpatient death of the insured person? 27 31 42 76 57 135 72 210 87 285 treatment at a hospital, prior to the commencement of any If the insured person dies during his or her stay in the agreed area of 28 34 43 79 58 140 73 215 88 290 extensive diagnostic or therapeutic procedures as an inpatient or validity, the Assistance will organise a funeral in the agreed area of 29 37 44 82 59 145 74 220 89 295 outpatient, and prior to any submission of acknowledgements of validity or the repatriation the deceased person‘s mortal remains to payment. The insurer will reimburse the documented costs for the place of the funeral in his or her home country as requested by 30 40 45 85 60 150 75 225 90 300 making contact up to € 25. the deceased person‘s relatives. 31 43 46 88 61 155 76 230 91 305 2. Consent to return or repatriation to his or her home country, 32 46 47 91 62 160 77 235 92 310 assuming the insured person is fit to be transported and 33 49 48 94 63 165 78 240 93 315 provided that the requirements under § 3 No. 1 VB K 18 MS have Terms & Conditions of 34 52 49 97 64 170 79 245 94 320 been met, if the Assistance authorises the return journey in view the Accident Insurance 35 55 50 100 65 175 80 250 95 325 of the nature of the illness and the treatment required. VB U 20 MST 36 58 51 105 66 180 81 255 96 330 3. Submit to the insurer the original invoices or duplicates with an 37 61 52 110 67 185 82 260 97 335 original reimbursement stamp by another insurance company § 1 What is insured? What is an accident? 38 64 53 115 68 190 83 265 98 340 concerning the benefits granted; these will then become the 1. The insurer provides insurance benefits from the agreed sum 39 67 54 120 69 195 84 270 99 345 property of the insurer. insured if an accident during the insured stay in the agreed 40 70 55 125 70 200 85 275 100 350 area of validity leads to the death or permanent disability of the § 6 What deductible does the insured person pay? insured person. There is no deductible. 2. An accident is deemed to have occurred: 3. Should the accident affect a physical or mental function already a) If the insured person involuntarily suffers damage to his or her subject to lasting impairment before the accident, an health as a result of an occurrence which has a sudden and appropriate deduction will be made to the extent of such Terms and Conditions of external impact on his or her body. previous disability. Such disability will be measured in the Emergency Call Insurance b) If a joint is dislocated or muscles, tendons, ligaments or accordance with No. 2 above. VB N 20 MST capsules are pulled or torn due to excessive exertion. 4. If the insured person should die as a result of the accident within one year after its occurrence, there will be no claim to disability N.B.: § 2 Under which circumstances does insurance cover not benefits. The Assistance is entrusted with the provision of services under the apply? 5. If the insured person should die for reasons unrelated to the Emergency Call Insurance. The following is not included in the insurance cover: accident within one year of the accident or should he or she die 1. Accidents caused by mental disorders or impairments of more than one year after the accident and a claim for disability § 1 What services does the insurer provide? consciousness, strokes, epileptic fits or cramps seizing the whole benefits had already arisen, benefits will be paid to the extent 1. The insurer provides assistance and support to the insured body as well as pathological disorders resulting from psychic of the degree of disability that would have been reasonably person during his or her stay in the agreed area of validity in the reactions. This also applies if the condition is due to the influence expected based on the last medical examination conducted. emergencies named below and pays the costs incurred up to of alcohol or drugs. the limits specified in each case. The insurer reserves the right 2. Accidents suffered by the insured person whilst intentionally § 5 What limitations on benefits are to be noted? to check cover. Services provided by the Assistance and declara- committing a criminal offence. Should illness or ailments have contributed to an impairment of tions on its part to meet costs as well as any orders placed with 3. Accidents suffered by the insured person as the pilot (also using health or the consequences thereof caused by the accident, the service providers do not include any acknowledgement of the aerial sports equipment) or a crew member of an aircraft. benefits payable will be reduced in proportion to the contributing insurer‘s duty to indemnify under the insurance contract vis-à- 4. Impairments to health caused by curative measures and other factor of such illness or ailments, provided such factor is at least 25%. vis the insured person as a basic principle. interventions performed on the body of the insured person with -4- [Seite 15] § 6 What other benefits does the insurer provide after an costs of the defence counsel. accident? 4. If the insurer fails to settle a liability claim by admission, satisfaction 1. Rescue costs or settlement on account of the resistance of the insured person, The costs of search, rescue and recovery measures are covered the insurer shall not be required to pay any additional expenses up to € 5,000 if the insured person has to be rescued or incurred for the main issue, interest and the costs. recovered after an accident or if the insured person is missing 5. The sums insured as stipulated in the Overview of Benefits are and it is feared that something has happened to him or her. the maximum limit of benefits payable by the insurer per in- 2. Health spa allowance sured event; they also constitute the aggregate maximum in- After an accident-related hospital stay of at least 21 days, the demnity paid for all insured events in an insurance year. insurer pays for medically necessary health spa or rehabilitation measures, which are connected to the accident event and § 3 What risks are not insured? documented by a certificate from a specialist. The health spa Insurance cover does not include the following: or rehabilitation measure must be started within six months of 1. Liability claims completion of hospital treatment and last for no less than 21 a) insofar as these exceed the scope of the insured person‘s days and no more than 28 days. statutory liability as a result of contractual or other The insurance covers the costs of medical treatment, medicine commitments; and remedies (such as baths, massages, and physiotherapy) b) among and between insured persons and insured persons as well as expenditures for spa tax, accommodations, and meals and their relatives (including life partners); up to a maximum of € 1,500. c) due to transmission of illness by the insured person; The insurer reimburses any remaining costs after prior payment d) due to damage caused by occupational activities. by a statutory or private payor or service provider up to a maximum of € 1,500 per insured person. Costs are only 2. Liability claims against the insured person reimbursed once for each accident. a) in connection with hunting activities; b) due to damage caused to third-party property rented by or § 7 What action is to be taken after an accident has occurred on loan to the insured person or obtained through unlawful (obligations)? interference or in the insured person‘s custody. However, The insured person is obliged to do the following: liability arising from damage to rooms and buildings during 1. Undergo a medical examination by physicians appointed by the the stay in the agreed area of validity, in particular damage insurer. The necessary costs of such examination and any loss of to rented holiday apartments and hotel rooms or the income incurred thereby will be borne by the insurer. accommodation but not damage to furniture; insurance 2.  Release the physician giving treatment or carrying out cover is not provided for liability claims based on wear and examinations as well as other insurers and authorities from their tear or excessive use; professional confidentiality obligation. c) as the owner, possessor, keeper or driver of a motor vehicle, aircraft or motor-driven watercraft due to damage caused by § 8 When does the insurer pay permanent disability benefits? the use of such a vehicle. 1. As soon as the insurer has received the documents that are to be d) as the owner or keeper of animals; submitted by the insured person for the purpose of e)  for hazards directly related to the deliberate and illegal documenting the circumstances and consequences of the commission of a punishable offence. accident and documenting the completion of the curative treatment necessary for determining the degree of disability, the § 4 What are the duties and obligations of the insured person insurer is obliged to declare within three months whether and to after the occurrence of damage or loss? what extent it recognises a claim. An insured event is deemed to be a damaging event that could 2. If the insurer recognises a claim, benefits will be paid within a entail liability claims against the insured person. period of two weeks. 1. Each and every insured event must be reported in text form (e.g. 3. Within one year after the accident, disability benefits may be letter, fax, e-mail) to the insurer immediately. claimed before completion of curative treatment only up to the 2. The insured person must also immediately inform the insurer level of the sum payable in the event of death. of any initiation of a preliminary investigation or issuance of an 4. The insured person and the insurer are entitled to have the order of summary punishment or payment order, even if the degree of disability determined each year by a physician for a insurer already knows about the insured event. period not exceeding three years after the occurrence of the 3. If a claim for compensation has been asserted against the accident. To exercise this right, the insurer must state this insured person, he or she must notify the insurer thereof within when submitting the declaration in accordance with No. 1; the one week after the claim is filed. insured person must exercise his or her right within one month 4. The insured person must also notify the insurer when a claim has after receipt of such declaration. Should the final assessment of been asserted that involves judicial or state assistance. disability result in higher disability benefits than the insurer had 5. The insured person is obliged to take all possible steps to already paid, this extra amount will be subject to payment at 5% minimise the loss while complying with the insurer‘s instructions annual interest. and to take every action necessary or useful to clarify the case of loss. The insured person must provide a detailed and truthful loss report, supply information on all circumstances connected with Terms and Conditions of the damaging event and submit the corresponding documents. the Liability Insurance 6. If the liability claim is taken to court, the insured person shall VB H 20 MST allow the insurer to conduct the proceedings, grant the legal counsel appointed and nominated by the insurer full power of § 1 What risk does the insurer assume? attorney to act on his or her behalf and submit all declarations The insurer provides insurance cover against everyday liability deemed necessary by the legal counsel or the insurer. Without risks if a third party asserts claims for damages against the insured awaiting instructions from the insurer, the insured person must person during his or her stay in the area of validity due to a damaging raise objections within the specified period or seek the necessary event that occurred during travel on the grounds of statutory liability legal remedies against orders for payment of damages decreed provisions as defined under private law. Damaging events are by the courts or by the state. defined as death, injury or impairment to health (personal injury) or 7. If the insured person obtains the right to demand the cancella- damage to or destruction of property (damage to property). tion or reduction of a payable annuity as a consequence of altered circumstances, the insured person is obliged to allow the § 2 How does the insurer protect the insured person against insurer to exercise such right on his or her behalf. The provisions liability claims? To what extent does it pay indemnity? of Nos. 3 to 5 apply accordingly. 1. The insurer examines liability claims with regard to their validity, 8. The insurer is considered to have full authority to submit all wards off unjustified claims and reimburses the compensa- declarations on behalf of the insured person that it deems tion owed by the insured person. The insurer reimburses the suitable to settle or ward off a claim. compensation if it recognises its duty to indemnify or approves admission of liability on the part of the insured person. The § 5 What deductible does the insured person pay? insurer also pays compensation if it effects or approves a There is no deductible. settlement or where decreed by a court ruling. 2. If the injured party or his or her legal successor asserts a liability claim in court, the insurer will conduct the legal dispute at its own expense on behalf of the insured person. 3. If the insurer requests or approves the appointment of a defence counsel in criminal proceedings against the insured person arising from an insured damaging event, the insurer will pay the -5- [Seite 16] MAWISTA Student – Insurance Benefits at a Glance / Tariff Table MAWISTA Student Classic ® MAWISTAStudent Classic ® plus MAWISTA Student Comfort ® General Provisions § 2 No. 1 Insurance cover for Germans in Germany if the stay abroad is not insured not insured up to 6 weeks per insurance year interrupted. Health Insurance § 2 No. 1 Amount of costs reimbursed for … Outpatient treatment unrestricted unrestricted unrestricted Medical treatment and medication unrestricted unrestricted unrestricted Inpatient treatment unrestricted unrestricted unrestricted Medical treatment of a newborn baby if born prematurely max. € 100,000 max. € 100,000 max. € 100,000 Medically necessary patient transportation to a hospital unrestricted unrestricted unrestricted Pain-killing dental treatment per insurance year max. € 500 max. € 500 max. € 1,000 Dentures per insurance year 60 % of the total costs, not insured not insured max. € 1,000 Treatment of pregnancy unrestricted, after the expiry of a waiting unrestricted, after the expiry of a waiting unrestricted period of 3 or 8 months respectively period of 3 or 8 months respectively Aids required as a result of an accident per insurance year max. € 250 max. € 250 max. € 1,000 Visual aids required as a result of an accident per insurance year not insured not insured max. € 100 Vaccination max. € 250 throughout the entire term of not insured not insured the contract Treatment (e.g. massages, fango and lymph drainage treatment) max. 6 treatments max. 8 treatments max. 8 treatments per insurance year Rehabilitation measures unrestricted unrestricted unrestricted § 2 No. 2 Provision of the insurance benefit subsequently after the expiry of max. 6 weeks max. 6 weeks 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 max. € 25,000 max. € 25,000 country § 3 No. 2 up to the costs of the repatriation of mortal up to the costs of the repatriation of mortal up to the costs of the repatriation of mortal Reimbursement of costs for local funeral remains at the maximum remains at the maximum remains at the maximum §6 € 50 per claim for outpatient and dental no deductible no deductible Deductible treatments Emergency Call Insurance §1-§4 Offers immediate assistance worldwide in case of an emergency in the agreed area of validity § 2 No. 2 max. € 15,000 max. € 15,000 max. € 15,000 Declaration of amount of costs assumed for inpatient treatment Accident Insurance §3 not insured € 10,000 € 10,000 Sum insured in case of death §4 not insured max. € 140,000 max. € 140,000 Sum insured in case of disability § 6 No. 1 not insured max. € 5,000 max. € 5,000 Rescue costs § 6 No. 2 not insured max. € 1,500 max. € 1,500 Health spa allowance Liability Insurance §1 • max. € 1,000,000 for personal injury and • max. € 1,000,000 for personal injury and Sums insured property damage property damage not insured • max. € 250,000 for damage to rented • max. € 250,000 for damage to rented property property Monthly Premiums up to 40 years € 33.10 € 59.70 € 39.70 € 63.80 € 76.80 € 76.80 Duration of insurance in months 1st to 12th 13th to 48th 1st to 12th 13th to 48th 1st to 12th 13th to 48th 41 to 55 years € 69.90 € 114 € 74.90 € 119 € 129.90 € 134 Duration of insurance in months 1st to 12th 13th to 48th 1st to 12th 13th to 48th 1st to 12th 13th to 48th 2020-1072 -6-

[Seite 1] Insurance Cover for stays abroad Insurance Product Information Document Product: MAWISTA Student Company: AWP P&C S.A., Germany Branch Comfort 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 Student Comfort is a comprehensive Insurance and includes the following benefits: Health Insurance, Emergency Call Insurance, Accident 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 ✓ Illness or accident person knew were necessary prior to inception of insurance cover or at the time of ✓ Pregnancy and childbirth taking out the insurance or which he or she could have expected in the circum- What will be reimbursed? stances of which he or she 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 Psychoanalytical and psychotherapeutic treatment and hypnosis ✓ Costs for inpatient treatment in a hospital x Prophylactic examinations and check-ups ✓ Costs for Pain-killing dental treatment ✓ Costs of the medically advisable and appropriate return transportation to the Accident Insurance nearest suitable hospital to the place of residence and, in the event of death, the x Accidents caused by mental disorders or impairments of consciousness, strokes, repatriation of mortal remains epileptic fits or cramps; this also applies if the condition is due to the influence of ✓ Costs for dentures (after the expiry of a waiting period of eight months) alcohol or drugs ✓ Costs for visual aids required as a result of an accident (after the expiry of a waiting period of three months) Liability Insurance ✓ Costs for vaccinations x Liability claims among and between insured persons travelling together x Loss or damage caused by the use of a motor vehicle, aircraft or motor-driven As part of the Emergency Call Insurance: Assistance for personal emergencies (illness, watercraft accident, death) and organisation of repatriation with medically adequate means, x Consequential damages as a result of the loss of keys (e.g. burglary) and liabilities as soon as this is medically advisable and reasonable. ensuing from the loss of keys to movable property (incl. safe keys, keys to items of furniture). Deductible: 10% per insured benefit for outpatient treatment and for dental treatment, max. € 250 per calendar year; for stays outside of Germany: 20% of the costs if a medi- cally justifiable patient return transport to Germany is refused Accident Insurance Are there any restrictions on cover? ✓ Pays compensation if an insured accident occurring during the trip leads to Health Insurance and Emergency Call Insurance permanent disability or death of the insured person: ! Pain-killing dental treatment: up to € 1,000 ! Medically prescribed treatment (e.g. massages, fango or lymph drainage treat- Sums insured: € 10,000 in the event of death, up to € 40,000 in the event of disability, ments): up to eight (medical) applications up to € 140,000 in the event of total disability and up to € 5,000 for the costs of search, ! Aids required as a result of an accident: up to € 1,000 rescue and recovery measures after an accident ! Dental prostheses: up to 60 % of the total costs incurred, but no more than € 1,000 (after an eight-month waiting period from the start of insurance coverage) Liability Insurance ! Visual aids due to an accident: up to € 100 (after a three-month waiting period from ✓ Provides insurance cover if third parties assert claims for damages based on a the start of insurance coverage) damaging event that occurred during your travel. ! Repatriation costs: up to € 25,000 ! Vaccinations: up to € 250 throughout the entire term of the contract Sums insured: € 1,000,000 per person in case of personal injury and damage to ! Reimbursement of medical / dental outpatient treatment within Germany up to the property, € 250,000 for damage to rented property € 2,000 for the loss of a third- 3.5 fold rate of the Scale of Fees and Charges for Physicians in Germany (GOÄ) or of party’s private residence keys the Scale of Fees and Charges for Dentists in Germany (GOZ) Deductible: for the loss of a third-party’s private residence keys € 100 per damage Accident Insurance event ! If illness or ailments have contributed by at least 25 % to an impairment of health caused by the accident, the benefits payable will be reduced. -1- [Seite 2] Where am I covered? ✓ Insurance cover is valid for insured persons with Germany as home country for the temporary stay outside Germany. ✓ Insurance cover is valid for insured persons with home country outside Germany for the temporary stays within Germany and the rest of the EU, as well as in Switzerland, Liechten- stein, Norway, United Kingdom and Iceland. ✓ In case the insured stay abroad is interrupted, the tariff Comfort provides insurance cover for insured persons with Germany as home country also in Germany for a period of up to 6 weeks per insurance year. ✓ In general, no coverage exists in areas for which the Federal Foreign Office of Germany has issued a travel warning at the time of your entry into this area. What are my obligations? - You are obliged to report the damage or loss to us promptly. - You are obliged to inform us immediately of any changes in your personal circumstances that are contractually relevant. Health Insurance and Emergency Call Insurance - In case of severe injuries or serious illnesses, particularly prior to hospitalisation, you have to contact us immediately. Accident Insurance - Release the physician giving treatment or carrying out examinations from their professional confidentiality obligation. - For asserting a claim for reimbursement due to permanent invalidity, specific periods of time apply. 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 ends automatically upon your 40th birthday, without any cancellation being required. The insurance contract can be agreed for full months in each case and for a maximum term of 60 months. How do I cancel the contract? You may cancel your policy at any time. It will then expire at the end of that month. 2021-1450 AVB 22 -2- [Seite 3] DOCUMENTS TO THE INSURANCE POLICY OVERVIEW OF BENEFITS TABLE OF CONTENTS MAWISTA Student – Tariff Comfort Complaints, Applicable Law, Contractual Language, and Withdrawal 2 Data Protection and Information on Contracts in Electronic Commerce 3 • Health Insurance Terms and Conditions 4 Deductible: 10% per insured benefit for outpatient treatment and dental treatment, General Provisions 4 maximum € 250 per calendar year Health Insurance 4 • Emergency Call Insurance Emergency Call Insurance 5 • Accident Insurance Accident Insurance 6 Sums insured: up to € 140,000 per person in the event of disability, € 10,000 in the Liability Insurance 6 event of death MAWISTA Student – Insurance Benefits at a Glance / Tariff Table 8 • Liability Insurance Sums insured: € 1,000,000 per person in case of personal injury and damage to pro- perty, € 250,000 for damage to rented property, € 2,000 for the loss of a third-party’s private residence keys DEFINITIONS AND NOTES Deductible: in the case of loss of residence keys € 100 per damage event Area of application: see § 2 VB AB-COM 22 MST Maximum insured travel duration: The insurances are valid for the agreed term, maxi- mum 60 months. Insurable persons: see § 1 No. 1 VB AB-COM 22 MST Guidelines on taking out insurance: The policy can be purchased at any time, effective HOW TO CONTACT US on the first day of any month. Insurance cover commences at the time specified in the insurance policy, but not before applying for insurance, not before crossing the border and not before the expiry of any waiting periods. Assistance in an emergency If you require help in an emergency the Assistance is there for you. Our 24-hour Insurer: We, AWP P&C S.A., Branch Office Germany are your insurer. Our main business emergency service guarantees rapid and expert assistance all over the world! activity is the insurance of goods and services, including travel insurance. Phone: +49.89.6 24 24 – 496 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 and is payable Important for help in an emergency: monthly in advance. The payment of the premium can be made by using one of the • Please hold the exact address and phone number of your current whereabouts ready available payment methods (e.g. SEPA direct debit or credit card).If the insurer has been to hand. authorized to debit the premium from the selected payment method, the payment shall • Note down the name of your contacts, e.g. physician, hospital or police. be deemed to have been made, if there is sufficient cover on the stated payment method • Describe as exactly as possible the facts of the case and have the necessary informati- at the time of debiting. The amount of the premiums is usually based on the selected on at hand. insurance cover and the term of the contract. Notification of claim The simplest and quickest way of notifying us of your claim is via If the insured event occurs, we will only be obliged to provide indemnity if https://www.mawista.com/en/service/file-a-claim/ the premium has been paid, or if you, as the policyholder, are not at fault alternatively by post to our MAWISTA Claims Department (see adress on the right) for the non-payment of the premium. You are required to prove this to us. The contractually agreed insurance services are offered by AWP P&C S.A. in accordance with the following Terms and Conditions of Insurance. Verbal agreements shall not be va- lid. Insurance tax is already included in the insurance premiums. No fees are charged. The scope of the insurance is conclusively defined in the insurance certificate or the insurance premiums and service descriptions documented in the travel / booking confirmation. GENERAL INFORMATION AWP P&C S.A. General Representative: Jacob Fuest IN THE EVENT OF CLAIM Niederlassung für Deutschland (Germany Branch) Registration court: Munich HRB 4605 VAT ID No. DE 129274528 Bahnhofstraße 16 What do you do in any case of damage? D – 85609 Aschheim (near Munich) The insured person must minimise and document the damage as far as possible. For this Germany reason, please ensure that you have suitable proof of the occurrence of the damage (e.g. confirmation of damage, medical certificate) and of the extent of damage (e.g. bills, re- AWP P&C S.A. ceipts). Public Limited Company incorporated under French law Registered Office: Saint-Ouen (France) What should you do if you fall ill, injure yourself or any other emergency occurs Commercial register: R.C.S. Bobigny 519 490 080 during your stay in the agreed area of validity? (Health Insurance, Emergency Call Chairman of the Board of Management: Sirma Boshnakova Insurance) Please immediately contact the Assistance in case of severe injuries or serious illnesses, particularly prior to hospitalisation, so that adequate treatment can be ensured or repa- triation transport arranged. For the reimbursement of the costs you have paid at the loca- tion, 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. What should you remember for claims under the Accident Insurance or Liability In- This translation is for information purposes only. In the event of any conflict surance? or inconsistency between the German and the English versions, the German Please note down the names and addresses of witnesses who saw the damaging event. original shall prevail. Ask for a copy of the police report if the police was called in to investigate the case. Notify AWP and submit these documents and this information to it with your notice of damage. -1- [Seite 4] COMPLAINTS, APPLICABLE LAW, CONTRACTUAL LANGUAGE, AND WITHDRAWAL How you can lodge a complaint INSTRUCTION REGARDING REVOCATION 2. Our address for service and any other address rele- It is our aim to offer you first-class services. Engaging with vant to the business relationship between us and you. your concerns is equally important to us. If, at any time, Part 1: Right of Revocation for Contracts With a In the case of legal persons, associations of persons you are not completely satisfied with our products or our Term of One Month Or More, Consequences or groups of persons, the name of a person autho- service, please do not hesitate to inform us. of Revocation and Special Notices rised to represent them must also be stated. If this communication is made by means of the transmissi- You can use any means of communication to inform us of Right of Revocation on of the contractual provisions, including the gene- your complaints concerning contractual or claims-related You may revoke this contractual agreement within 14 ral terms and conditions of insurance, the information issues: days in text form (e.g. letter, fax, email) without having must be in a prominent and clearly designed form. by telephone at +49 89 624 24-460, to state any reason. The revocation period shall begin 3. Our main business activity by email at beschwerde-reise@allianz.com or at such time as you receive the following documents in 4. The essential characteristics of the insurance benefit, by letter addressed to text form: in particular information on the type, scope and due AWP P&C S.A., Beschwerdemanagement, • the insurance policy, date of our benefit Bahnhofstraße 16, D – 85609 Aschheim (near Munich). • the terms of contract, including the general terms 5. The total price of the insurance, including taxes, and Further details about our complaints handling process is and conditions of insurance, these in turn including other price components. If the insurance relationship available at www.allianz-reiseversicherung.de/beschwerde. the tariff regulations, is to comprise several independent insurance con- We will not participate in dispute settlement proceedings • this Instruction Regarding Revocation, tracts, the insurance premiums must be quoted se- before a consumer arbitration board. • the Insurance Product Information Document, parately. If an exact price cannot be stated, we must • and the further information listed hereafter in part 2. provide information on the basis of the calculation of For complaints about any insurance line, you can also Timely dispatch of the revocation shall suffice for com- the premium to enable you to verify the price. contact the competent supervisory authority: pliance with the time limit. The revocation notice should 6. Details regarding payment and performance, in par- German Federal Financial Supervisory Authority (BaFin), be addressed to: ticular as to the payment of the insurance premium Graurheindorfer Strasse 108, D – 53117 Bonn, Germany AWP P&C S.A., Branch Office Germany 7. Details of how the contract will come into existence, (www.bafin.de). Bahnhofstraße 16 in particular the commencement date of the insu- D – 85609 Aschheim (near Munich) rance and the insurance cover, as well as the duration Please note that this does not affect your right to take Fax +49.89.6 24 24-244 of the period during which you, as the applicant, are legal action. Email: info@mawista.com to be bound by the application 8. The existence or non-existence of a right of revoca- Applicable law Legal consequences of revocation tion as well as the conditions, details of the exercise, The contractual relationship is governed by German law, If you have effectively exercised your right of revocation, in particular the name and address of the person to unless this is precluded by international law. Lawsuits the insurance cover shall end. In this case the following whom the revocation is to be declared, and the legal arising from the insurance agreement may be raised by applies: If you agreed that the insurance cover com- consequences of the revocation, including informati- the policyholder and the insured person before the court mences prior to the end of the revocation period, we on on the amount you may have to pay in the event which holds jurisdiction over the location in which the shall reimburse you for that part of the insurance premi- of revocation. If this communication is made by me- company or its branch office has its registered address. If ums attributable to the time after your revocation notice ans of the transmission of the contractual provisions, the policyholder or the insured person is a natural person, was received. We will be entitled to retain the portion of including the general terms and conditions of insu- lawsuits may also be raised before the court which holds the premium which corresponds to the period of time up rance, the information must be in a prominent and jurisdiction over the location in which the policyholder or to the receipt of the revocation notice. It will be calcula- clearly designed form. the insured person is domiciled at the time the action is ted on a pro rata basis per day, based on the amount of 9. Information on the duration of the contract filed or, if he / she has no domicile, over the location in the insurance premium shown in the insurance policy for 10. Information on the termination of the contract, in which he / she has his / her habitual residence. the entire insured period. The duty to reimburse shall be particular on the contractual termination conditions. fulfilled without undue delay, at the latest 30 days after If this communication is made by means of the trans- Contractual Language receipt of the revocation. If the insurance cover did not mission of the contractual provisions, including the We will conduct our correspondence with you in German. commence prior to the end of the revocation period, the general terms and conditions of insurance, the infor- As an offer, we provide some of our documents and web- effect of a revocation notice will be that any benefits re- mation must be in a prominent and clearly designed site information in English. However, these are for informa- ceived must be reimbursed and any advantage derived form. tion purposes only, the respective German version remains therefrom (e.g. interest) must be handed over. 11. The Member States of the European Union whose legally binding. law we use as a basis for establishing relations with Special Notices you prior to the conclusion of the insurance contract Your right of revocation shall cease to apply if the 12. The law applicable to the contract, a contractual contract has been wholly fulfilled by both sides at your clause on the law applicable to the contract or on the explicit request before you have exercised your right of court of competent jurisdiction revocation. 13. The languages in which the terms and conditions of the contract and the preliminary information listed in this Part 2 will be communicated and the languages Part 2: List of further information required for the in which, with your consent, we will communicate with commencement of the time limit. you during the term of this contract 14. A possible access for you to an out-of-court com- With regard to the „further information“ mentioned in plaint and redress procedure and, where applicable, part 1 sentence 2, the information obligations are listed the conditions for such access. It shall be expressly in detail below: stated that this does not affect the possibility for you We must provide you with the following information: to take legal action. 1. Our identity and that of the branch, if any, through 15. The name and address of the competent supervisory which the contract is to be concluded. Furthermore, authority and the possibility of lodging a complaint the commercial register with which the legal entity with this supervisory authority is registered and the corresponding register number have to be specified. End of Instruction Regarding Revocation -2- [Seite 5] DATA PROTECTION POLICY In accordance with Art. 13 and 14 of the General Data We may also process your data in accordance with Art 6 (1) III To what recipients will we communicate your data? Protection Regulation (GDPR), we are informing you about d) GDPR in order to protect your vital interests, or if you have Recipients of your personal data may include: selected exter- how your personal data is processed by AWP P&C S.A., consented to the data processing, Art. 6 (1) a) GDPR. nal service providers (e.g. assistance service providers, benefit Niederlassung für Deutschland (Germany Branch), and about processors, transport service providers, technical service provi- the rights to which you are entitled under data protection law. In accordance with Article 6 (1) f) GDPR, we may also use ders, etc.), other insurers (e.g. in the case of multiple insurance Please make all co-insured individuals (e. g. your spouse) aware available information from contractual relationships that have coverage). of this policy. been active in the last three years to decide on the acceptance of an application. We also insure some of the risks that we cover with specialist I Who is responsible for processing your personal data? insurance companies (re-insurers). To this end, it may be ne- Responsibility for processing your personal data rests with If we wish to process your data for any purpose other than cessary to send your contract and, where relevant, your claims those specified above, we will notify you in advance within the information to a re-insurer, to enable it to form its own opinion AWP P&C S.A., Niederlassung für Deutschland framework of the statutory regulations. of the risk or the insured event. Bahnhofstraße 16 D – 85609 Aschheim (near Munich). 2. What applies to special categories of personal data, If you join a group insurance contract as an insured person, especially health data? (e.g. when acquiring a credit card), we may disclose your per- The Data Protection Officer can be contacted by standard mail There are special safeguards on the processing of special sonal data to the policyholder (a bank for example), if it has a at the aforementioned address, using the suffix “Data Protec- categories of personal data, of which health data is one. As legitimate interest in knowing this information. tion Officer“, or by email at datenschutz-azpde@allianz.com. a rule, processing is permitted only if you have consented to the processing in accordance with Art. 9 2) a) GDPR, or if In addition, we may also communicate your personal data to II For what purpose is your data processed, and on what this is a case of one of the other situations defined by law, other recipients, such as public authorities for the fulfilment of legal basis does this take place? Art. 9 (2) b) – j) GDPR. statutory duties of notification (e.g. finance authorities or crimi- 1. What applies to all categories of personal data? nal investigation agencies). We process your personal data in compliance with the EU a) Processing of your special categories of personal data General Data Protection Regulation (GDPR), the German In many cases, in order to review the benefit entitlement, we re- The forwarding of data is a form of data processing, and is like- Federal Data Protection Act (BDSG), the provisions of the quire personal data belonging to a special category (sensitive wise performed within the framework of the principles set out German Insurance Contract Act (VVG) relevant to data data). This includes health data, for example. If, in connection in Art. 6 (1) and Art. 9 (2) GDPR. protection law, as well as all other applicable laws. with a specific insured event, you provide us with such data together with a request to review and process the claim, you IV How long will we retain your data? When you apply for insurance cover, we will require the are explicitly permitting us to process your sensitive data We will retain your data for the period during which claims may information provided by you at this point in order to arrange necessary in order to process the insured event. We will again be made against our company (statutory limitation period of 3 the contract and to estimate the risk assumed by us. If the in- remind you specifically of this fact in the claim form. to 30 years). We will also retain your data if we are under a legal surance contract comes into being, we will process this data obligation to do so, e.g. according to the provisions of the Ger- for the implementation of the contractual relationship, such as You may withdraw your consent at any time, with future effect. man Commercial Code, the German Fiscal Code or the German for invoicing purposes. We require information about loss or However, we explicitly inform you that it may in that case no Money Laundering Act. The relevant retention periods range up damage in order to be able to assess whether an insured event longer be possible to review our indemnity obligation in con- to ten years. has occurred and determine the extent of this loss or damage. nection with the insured event. If the review of the claim is already concluded, there may be statutory retention obliga- V Where will your data be processed? It is not possible to arrange and implement the insurance con- tions that mean the data cannot be erased. If we should transfer your data to service providers located tract without processing your personal data. outside of the European Economic Area (EEA), the transfer We may also process your sensitive data if this is necessary to within the Allianz Group will be performed on the basis of Art. 6 (1) b) GDPR constitutes the legal basis for the processing protect your vital interests, and if you are physically or legally “Binding Corporate Rules“, which have been approved by the of personal data for pre-contractual and contractual purposes. incapable of giving consent, Art. 9 (2) c) GDPR. This may be the data protection authorities. These form part of the “Allianz case if you suffer a serious accident while travelling, for example. Privacy Standard“. These Corporate Rules are binding on Alongside that, Art. 6 (1) a) and c) – f) GDPR contain other all companies within the Allianz Group, and they ensure an legally defined situations in which we are entitled to process In the case of multiple insurance policies, if another insurer seeks appropriate level of protection for personal data. The “Allianz personal data. recourse from us or if we seek recourse from another insurer, we Privacy Standard“ and the list of Allianz Group companies may process your sensitive data in order to assert and defend the bound by this standard, can be viewed here: https://www. We will process your data in order to fulfil a legal obligation in statutory claim for settlement, Art. 9 (2) f) GDPR. allianz-partners.com/allianz-partners---binding-corporate- accordance with Art 6 (1) c) GDPR, such as to review claims for rules-.html. settlement, if another insurer seeks recourse from us due to the b) Requesting health data from third parties for review of the existence of multiple insurance policies. indemnity obligation In those cases in which the “Allianz Privacy Standard“ does not In order to review our indemnity obligation, it may be necessa- apply, the transfer of data to third countries will take place in We will also process your data in order to uphold our legiti- ry for us to review information about the state of your health, accordance with Art. 44 – 50 GDPR. mate interests or the legitimate interests of others, Art. 6 (1) f) as provided by you for the substantiation of claims, or which is GDPR. This may be the case particularly: contained in the documents submitted (e.g. invoices, prescrip- VI What are your rights? • for ensuring IT security and IT operations tions, medical reports) or statements, such as from a doctor or You have the right to be informed about all of the information • for marketing our own insurance products, and for conducting other member of the healthcare profession. retained by us, and to demand that incorrect data be rectified. marketing surveys and opinion polls Under certain conditions, you also have the right to the erasure • for the prevention and investigation of criminal activities (in For this purpose, we will require your consent, including a of data, the right to object to processing, the right to the restric- particular, we employ data analyses to detect possible indica- confidentiality waiver covering us and all agencies subject to tion of processing and the right to data portability. tions of insurance fraud). a duty of confidentiality, and which are required to provide information for review of the indemnity obligation. Right of objection As a rule, we only process that data that we have received You may object to the processing of your data for direct directly from you. In certain cases we may also receive such We will notify you in each specific case about what persons marketing purposes. If we process your data in order to data from other sources (such as if another insurer seeks or institutions require information for what purpose. You may protect legitimate interests, you may object to this processing recourse from us due to the existence of multiple insurance then decide in each case whether you consent to us collecting for reasons pertaining to your particular situation. policies). and using your health information, and whether to release the named persons or institutions and their duty of non-disclosure, If you have any objections concerning the handling of your We also process your personal data in order to fulfil other and if you agree to the communication of your health data to data, you may contact the aforementioned Data Protection statutory obligations, such as regulatory requirements, as well us, or if you want to personally provide the necessary docu- Officer in this connection. You are also entitled to lodge an as data retention obligations imposed by commercial and tax mentation. objection with a data protection supervisory authority. law. In these cases, the legal basis of the data processing is provided by the relevant statutory regulations in conjunction with Art 6 (1) c) GDPR. INFORMATION FOR CONTRACTS IN ELECTRONIC COMMERCE If you have arranged your insurance contract electroni- II Which technical step leads to the conclusion of the III Will your contract data and the text of the contract cally (e.g. via an online portal), the following information contract? be stored after the conclusion of the contract? applies: We will guide you step by step to the online conclusion. On The contract data you entered and the text of the contract will the page "Ihre Zahlungsdaten" you will see a summary of your be stored by us. You will receive the insurance certificate with I Can entries that have been made be changed before details in the right-hand column. Please check that all data is the essential elements of the contract by e-mail after the insu- the insurance is concluded? correct. The insurance policy itself is only arranged when you rance has been arranged. If you are unsure whether you have entered correct informa- click on the button "Jetzt beitragspflichtig abschließen" or tion everywhere, you can check and change your details at "Sie bezahlen XX,XX EUR". With this you conclude a binding IV Which languages are available? any time before concluding the insurance. You can also use the contract with us and the data is transmitted to us. This offer is only available in German. "Zurück" button to edit previous steps. -3- [Seite 6] TERMS AND CONDITIONS OF AWP P&C S.A., GERMANY BRANCH General Provisions If the first premium has not been paid upon the 4. Inform the insurer immediately of any changes in your VB AB-COM 22 MST occurrence of the insured event, the insurer shall personal circumstances that are relevant to the con- not have a duty to indemnify, unless the insured per- tract (e.g. end of studies, taking up employment, etc.). The regulations as stipulated under §§ 1 to 11 apply to all son is not responsible for non-payment. If the insurer MAWISTA Student insurance products. has been authorized to debit the premium from the §7 When does the insured person forfeit claims to The Terms and Conditions (VB) printed below apply to the selected payment method, the payment shall be insurance benefits due to a breach of duties and respective insurance. Insurance cover is provided if you deemed to have been made, if there is sufficient cover the statute of limitations? have contractually agreed the insurance concerned. on the stated payment method at the time of debiting. 1. If a breach of duty is intentionally committed, the in- 4. If a contract is valid for a term of longer than one surer is released from its duty to indemnify; in case of § 1 Who is eligible for insurance cover? month, the renewal premium is payable on the 1st day grossly negligent violation, AWP is entitled to reduce 1. Persons up to their 40th birthday are eligible for insu- of the new month respectively. its payment in proportion to the degree of fault of the rance, if they belong to one of the following groups: If the insurer has been authorized to debit the premi- insured person. a) Persons residing in Germany who are in possession um from the selected payment method, the payment 2. The insured person must furnish proof that no gross of a residence permit for educational purposes, and shall be deemed to have been made, if there is suffici- negligence was involved. Except in case of fraudulent the accompanying members of their family. ent cover on the stated payment method at the time intent, the insurer is obliged to indemnify if the insured b) Persons in possession of another type of temporary of debiting. person furnishes proof that the breach of duty is not the residence permit for Germany. If the renewal premium is not paid, the insurer may set cause of either the occurrence or the determination or c) Residents of Germany who are travelling abroad a period for payment of at least two weeks in text form. the scope of the insurer’s duty to indemnify. as language pupils, students, scholarship holders, If an insured event occurs after the expiry of the period 3. The claim to an insurance benefit lapses in three years, candidates for a doctor‘s degree, guest researchers, and the insured person is still in arrears with the pay- calculated from the end of the year in which the claim practical trainees, or who are participating in „work- ment of the renewal premium, the insurer is exempted occurred and the insured person obtained knowledge & travel“-programs as well as accompanying mem- from its duty to indemnify. The insurer may terminate of the circumstances in order to assert the claim, or bers of his or her family. the contract instantly if the insured person is still in would have obtained knowledge without gross negli- 2. Insurance cover applies to the person specifically arrears with payment after the expiry of the period. If gence. named in the insurance policy documentation for their payment is made with-in one month after termination temporary period of residence in accordance with the or after the expiry of the period set for payment, the § 8 When does the insurer pay compensation? agreed area of application. effect of the termination ceases to apply and the con- As soon as the insurer has determined whether and to tract enters into force again. However, no insurance what extent it has an duty to indemnify, compensation is § 2 What area of application does the insurance cover is provided for insured events occurring after the paid within two weeks. apply to? expiry of the period set for payment. Insurance cover is valid for insured persons 5. As soon as the insured person has turned 5 or 18 or 30 § 9 What applies if the insured person has claims for 1. with Germany as home country for the temporary stay years old, the premium for the next higher age group damages against third parties? outside Germany. There is no insurance coverage for must be paid from the month following the birthday 1. In accordance with statutory regulations, claims for stays in Germany. In case the insured stay abroad is in- month. damages against third parties pass to the insurer up terrupted, the tariff Comfort provides insurance cover to the level of payment effected, provided that the also in Germany for a period of up to 6 weeks per insu- § 5 In which cases does insurance cover not apply? insured person suffers no disadvantage thereby. rance year. No insurance cover is provided in the following cases: 2. The insured person is obliged to confirm the assign- 2. with temporary resident status in Germany, for the 1. Damage or loss caused by strikes, nuclear energy, con- ment of claims to this extent in writing upon request by temporary stay in Germany, in addition to periods that fiscation and other invention acts by public authority, as the insurer. count as holiday or for training purposes in the EU as well as damage or loss in areas for which the German 3. Any duties to indemnify arising under other insurance well as in Switzerland, Liechtenstein, Norway, United Federal Foreign Office has issued a travel warning. If contracts and other social insurance institutions will Kingdom and Iceland. There is no insurance cover out- an insured person is at such a location at the time when have precedence over those of the insurer. The insurer side the above-stated countries. a travel warning is issued, insurance cover ends 14 will be deemed to have made advance payment, if the days after the issuance of the travel warning; insurance original bills are first presented to the insurer for pay- § 3 When does the insurance begin and end? cover continues in spite of the travel warning if the end ment. 1. Insurance cover begins at the time stated in the insu- of travel is delayed for reasons for which the insured rance policy (start of insurance), however not before person is not responsible. § 10 What form must be followed for submitted decla- applying for insurance, not before crossing the border 2. Damage or loss due to war or events similar to war; rations of intent? and not before the expiry of any waiting periods. Wai- however, insurance cover does exist if the damage 1. Notices and declarations of intent from the insured per- ting periods are calculated from the commencement or loss occurs in the first 14 days after the beginning son and the insurer are required to be in text form (e.g. of insurance. The insurance year begins on the date of of the events; insurance cover continues if the end of letter, fax or e-mail). commencement of the insurance relationship specified travel is delayed for reasons for which the insured 2. Insurance agents are authorised to accept such docu- in the insurance policy. person is not responsible. This does not apply in case ments and forward them to the insurer. 2. Insurance cover ends at the agreed time, at the latest at of stays in countries in whose territory war or civil war is the end of the insured stay in the agreed area of appli- already ongoing or where such an outbreak was fore- § 11 Which court in Germany is responsible for dealing cation. seeable. Damage or loss through active participation with the assertion of claims based on the insu- 3. Insurance cover can be extended for up to 60 months in war, civil war or events similar to war are not covered rance contract and which law applies? (= maximum tariff-based term of insurance) upon by the insurance. 1. At the option of the insured person, the courts of application before the expiry of the original term of 3. Damage or losses intentionally caused by the insured Munich or the place in Germany where the insured contract insofar as the temporary period of residency person. person has his or her permanent residence or habitual continues and the insurance policyholder is willing and 4. No insurance cover exists if abode at the time the legal action is brought will have able to pay the premiums applicable at the time of the a) there are economic, trading or financial sanctions or jurisdiction and venue. extension of cover. If the maximum tariff-based term embar-goes declared by the European Union or the 2. The laws of the Federal Republic of Germany apply of insurance of 60 months has been completed, a new Federal Republic of Germany and insofar as they do not conflict with international law. contract can be applied for if the requirements stipula- b) these are directly applicable against you or us, or ted in No. 4 below are met. which prevent the provision of insurance cover. Terms and Conditions of the 4. For persons with temporary resident status in Germany, This also applies for economic, trading or financial a maximum term of 60 months (= statutory limit of 60 sanctions or embargoes imposed by the United States Health Insurance VB K-COM 22 MST months) may not be exceeded, taking into account any of America, insofar as these do not violate European or similar insurance policies with other insurers. German legal regulations. § 1 What is insured? 5. The insurance ends automatically upon the 40th birth- 1. The insurance covers the costs of: day without the need for cancellation. § 6 Duties and obligations in the event of a claim a) Medical treatment The insured person is obliged to: b) Patient repatriation transportation § 4 What term of validity does the contract have, 1. Minimise the loss as far as possible and avoid unneces- c) Repatriation of mortal remains in case of death when is the premium payable and what applies sary costs. in the event of acute illnesses and accidental injuries when you reach a certain age? 2. Report the loss to the insurer without delay. occurring in the agreed area of application within the 1. The insurance contract can be agreed for full months in 3. Describe the damaging event and the extent of dama- insured period. each case and for a maximum term of 60 months. ge and truthfully provide the insurer with any and all 2. Insurance cover is provided in the agreed area of 2. The insured person can give notice of termination of the pertinent information. The insured person must furnish application for the costs of the medical treatment insurance contract daily to the end of the month. proof in the form of original bills and receipts, release during pregnancy and childbirth only if the pregnancy 3. The premium is due for the first time on commence- physicians from their confidentiality obligation as (conception) occurred after the commencement of ment of the insurance contract and is payable each necessary – including the physicians of the Assistance – insurance. Irrespective of the time when pregnancy month in advance. The payment of the premium can be and allow the insurer to reasonably examine the cause made by using one of the available payment methods and amount of the asserted claim. (e.g. SEPA direct debit or credit card). -4- [Seite 7] occurred, the insurer will reimburse the costs of medi- 3. The insurer reimburses the costs in accordance with the § 5 What are the duties and obligations of the cal treatment in case of the occurrence of acute com- conditions for a duration of up to eight weeks after the insured person in case of damage or loss? plications in the pregnancy including miscarriage and agreed term of application of the insurance contract The insured person is obliged to: premature birth. until the date when the insured person can be trans- 1. Contact the Assistance immediately in the event of 3. Flat-rate expense allowance in case of hospitalisation: ported at the latest, if patient repatriation was not inpatient treatment at a hospital, prior to the com- If the costs are paid by a third party in case of medi- advised for medical reasons during the term of the mencement of any extensive diagnostic or therapeutic cally necessary treatment as an inpatient in the agreed contract. procedures as an inpatient or outpatient, and prior to area of application, the insurer will pay a maximum any submission of acknowledgements of payment. The flat-rate expense allowance of € 30 per day for a § 3 What costs does the insurer reimburse in case of insurer will reimburse the documented costs for making maximum period of 45 days from the commencement patient repatriation transportation and repatria- contact up to € 25. of inpatient treatment (for telephone, TV, additional tion of mortal remains? 2. Consent to return or repatriation to his or her home meal allowance for visitors etc.). The insurer reimburses the following: country, assuming the insured person is fit to be trans- 1. The costs of the medically advisable and justifiable re- ported and provided that the requirements under § 2 What costs are reimbursed for medical patriation of the insured person to a suitable hospital § 3 No. 1 VB K-COM 22 MST have been met, if the treatment? located closest to the place of residence of the insured Assistance authorises the return journey in view of the 1. The insurer reimburses expenditures for all medically person in his or her home country. nature of the illness and the treatment required. If, necessary medical treatment in the agreed area of In addition, the costs of the medically advisable and according to the prognosis of the attending physician, application, including costs incurred for: justifiable repatriation are reimbursed upon request by the need for treatment outside Germany is expected to a) Outpatient treatment by a physician. the insured person where continued hospital treatment last longer than 30 days, the insured person shall bear b) Medical treatment and medication prescribed by a is expected to exceed 14 days in the opinion of the a personal contribution of 20% of the costs incurred if a physician for the insured person. physician giving treatment. patient return transport is refused, although it is possi- c) Inpatient treatment in hospital, including operations Irrespective of this, the costs of the patient‘s repatriati- ble and medically reasonable and justifiable. § 6 does that cannot be postponed. In case of premature on to his or her home country are paid if these remain not apply in this case. birth, the costs of treatment required for the new- within the limits of the expected costs of continued 3. Submit to the insurer the original invoices or duplicates born child in the agreed area of application will medical treatment. with an original reimbursement stamp by another also be covered up to € 100,000 (notwithstanding 2. The actual costs of up to € 25,000 for the repatriation insurance company concerning the benefits granted; § 1 VB AB-COM 22 MST). of the deceased insured person for a funeral in his or these will then become the property of the insurer. The following applies for inpatient medical treat- her home country or, alternatively, the actual costs of ment and childbirth in Germany: General hospital a local funeral up to the costs of repatriation at the § 6 What deductible does the insured person pay? costs (multi-bed room) are reimbursed according to maximum. The insured person pays a deductible of 10% per insured the Federal Nursing Care Tariff Ordinance and the benefit for outpatient treatment and dental treatment. Hospital Remuneration Act; expenses for optional § 4 What limitations on insurance cover are to be The deductible is limited to a total of € 250 per calendar services (private medical treatment) are not covered noted? year. by the insurance. No insurance cover is provided for the following: d) Patient transportation deemed medically necessary 1. Medical treatment and other measures ordered by a Terms and Conditions of the for inpatient treatment at the nearest and appropri- physician, where the purpose of the stay in the agreed ate hospital in the agreed area of application and area of application was to seek such treatment. Emergency Call Insurance back to the insured person‘s accommodation. 2. Medical treatment and other measures ordered by a VB N 22 MST e) Pain-killing dental treatment and repairs of dentures physician that the insured person knew were necessary and provisional measures up to € 1,000 per insu- prior to the stay in the agreed area of application or at N.B.: The Assistance is entrusted with the provision of rance year. the time of taking out the insurance or which he or she services under the Emergency Call Insurance. f) Dental prostheses (after an eight-month waiting could have expected in the circumstances of which he period from the start of insurance coverage) up to or she was aware. § 1 What services does the insurer provide? 60% of the total costs incurred, but no more than 3. Nutriments and tonics. 1. The insurer provides assistance and support to the € 1,000 per insurance year. 4. Orthodontic treatment, dental treatment other than insured person during his or her stay in the agreed g) The medical care and treatment of pregnancies pain-killing treatment, repairs to dentures and pro- area of application in the emergencies named below which occurred after the commencement of insu- visional measures. Notwithstanding this, coverage is and pays the costs incurred up to the limits specified in rance. provided for dental prostheses of up to 60% of the total each case. The insurer reserves the right to check cover. h) Aids required as a result of an accident up to € 1,000 costs incurred but no more than € 1,000 per insurance Services provided by the Assistance and declarations per insurance year. year after an eight-month waiting period from the start on its part to meet costs as well as any orders placed i) Visual aids due to an accident (after a three-month of insurance coverage. with service providers do not include any acknow- waiting period from the start of insurance coverage) 5. Medical treatment (e.g. massages, fango or lymph ledgement of the insurer‘s duty to indemnify under the up to € 100 per insurance year. drainage treatments) which exceed eight treatments insurance contract vis-à-vis the insured person as a j) Vaccinations which have been recommended by the per insurance year. basic principle. German Standing Vaccination Committee (STIKO) 6. The purchase of prostheses and other medical aids; 2. The insurer has entrusted the Assistance with the provi- of the Robert-Koch-Institute, up to a maximum of notwithstanding this, insurance cover is provided up sion of services named below for the insured person as € 250 for all vaccinations throughout the entire term to € 1,000 per year for aids required as a result of an a 24-hour service. of the contract. accident. Notwithstanding this, coverage is provided 3. The insured person must contact the Assistance without k) Medically prescribed treatment (e.g. massages, for visual aids due to accidents (after a three-month delay to claim the services in an emergency. fango or lymph drainage treatments) up to eight waiting period from the start of insurance coverage) up 4. Insofar as the insured person cannot claim the reim- (medical) applications in total per insurance year, to € 100 per insurance year. bursement of amounts paid out from the insurer or even then if multiple (medical) applications are 7. Treatment of alcoholism, drug addiction and other from another payer, the insured person must repay the carried out within one treatment. addictions as well as the consequences thereof. amounts to the insurer within one month of invoicing. l) Medically necessary rehabilitation measures as 8. Treatment of pregnancies which occurred before the subsequent medical treatment prescribed by a commencement of insurance. § 2 What help does the Assistance provide in case of physician. 9. Treatment or accommodation caused by infirmity, need illness and accident? m) In this context, the insurer shall pay for methods of of nursing care or detention. 1. Outpatient treatment examination or treatment widely accepted by con- 10. Psychoanalytical and psychotherapeutic treatment The Assistance provides information on the possibilities ventional medicine to the extent stated in the con- and hypnosis of medical care and names a physician who speaks tract. In addition, the insurer shall pay for methods 11. For fees and charges which exceed the extent con- German or English as far as possible. However, the and medication which have shown themselves to be sidered generally customary and reasonable in the Assistance does not contact the physician. just as promising in practice and which are applied country concerned and for optional benefits such as a 2. Inpatient treatment because no conventional medical methods or medi- single room or treatment by the head physician. The In case of inpatient treatment of the insured person at a cation is available. However, the insurer may reduce reimbursement may be reduced to the customary hospital, the Assistance provides the following services: the payment to the amount which would have been rates in the country. a) Support incurred if conventional medical methods or medici- 12. Patient repatriation transport caused by one of the If required, the Assistance establishes contact ne had been applied. reasons mentioned under no. 1, 2, 7 and 9. through its contract physician to the respective 2. Costs of medically necessary treatment up to the so- 13. Prophylactic examinations and check-ups, check-ups family physician of the insured person and to the called threshold values of the valid German Scale of of children and young people, dental check-ups and hospital physicians providing treatment. It ensures Fees and Charges for Physicians (GOÄ) and Scale of dental prophylaxis as well as any charges and fees for that information is passed between the physicians Fees and Charges for Dentists (GOZ), up to a maximum medical certificates, reports on diagnostic findings and involved. Upon request, the Assistance informs of 3.5 times the rate. doctor’s certificates for inability to work, which were relatives of the insured person. not requested by the insurer. -5- [Seite 8] b) Patient visits § 3 What benefits does the insurer pay in the event of § 5 What limitations on benefits are to be noted? In case of the inpatient treatment of the insured the death of the insured person? Should illness or ailments have contributed to an impair- person, the Assistance organises the travel for one Should the accident lead to the death of the insured per- ment of health or the consequences thereof caused by the person close to the insured person to the hospital son within one year, the insurer will pay € 10,000 to the accident, the benefits payable will be reduced in propor- where the insured person is staying and back to his heirs. tion to the contributing factor of such illness or ailments, or her place of residence in his or her home country. provided such factor is at least 25%. The insurer pays the costs of transport in case of a § 4 What benefits does the insurer pay in the event of life-threatening illness of the insured person or if the permanent disability of the insured person? § 6 What other benefits does the insurer provide inpatient treatment lasts for longer than 14 days. Should the accident result in the permanent impairment after an accident? c) Declaration to meet costs of the insured person‘s physical or mental abilities (disa- 1. Rescue costs In case of inpatient hospital treatment, the insurer bility), the insured person is entitled to claim benefits from The costs of search, rescue and recovery measures are will give the insured person a declaration that it will the sum insured for disability (taking into account the pro- covered up to € 5,000 if the insured person has to be meet the costs up to an amount of € 15,000. This gression pursuant to No. 2 e)) to a maximum amount of rescued or recovered after an accident or if the insured declaration does not involve any recognition that the € 140,000. person is missing and it is feared that something has insurer has a duty to indemnify. The insurer assumes 1. Disability must have occurred within one year after the happened to him or her. settlement with the payer responsible in the name of accident and must be determined by a physician and 2. Health spa allowance the insured person. the claim asserted within a further three months. After an accident-related hospital stay of at least 21 3. Patient repatriation transportation 2. The disability benefits payable depend on the degree days, the insurer pays for medically necessary health As soon as medically advisable and appropriate, or if of disability. Notwithstanding any evidence substantia- spa or rehabilitation measures, which are connected the duration of the hospital stay is expected to exceed ting a higher or lower degree of disability, the following to the accident event and documented by a certifi- 14 days in the opinion of the physician giving treatment, fixed scales of disability are applicable: cate from a specialist. The health spa or rehabilitation the Assistance will organise return transportation using a) Loss or incapacity of: measure must be started within six months of comple- medically adequate means of transport (including air an arm 70 % tion of hospital treatment and last for no less than 21 ambulances) to the closest suitable hospital to the in- a hand 55 % days and no more than 28 days. sured person‘s place of residence after prior consulta- a thumb 20 % The insurance covers the costs of medical treatment, tion between the contract physician of the Assistance a finger 10 % medicine and remedies (such as baths, massages, and the local physicians handling the case. a leg 70 % and physiotherapy) as well as expenditures for spa a foot 40 % tax, accommodations, and meals up to a maximum of § 3 Does the Assistance procure the necessary medi- a toe 0 5% € 1,500. cations for the insured person? an eye 50 % The insurer reimburses any remaining costs after prior In concert with the family physician of the insured person, hearing in one ear 30 % payment by a statutory or private payor or service pro- the Assistance takes care of procuring medically prescri- sense of smell or taste 10 % vider up to a maximum of € 1,500 per insured person. bed medication and sending it to the insured person, if this b) In case of partial loss or functional impairment of Costs are only reimbursed once for each accident. is possible. The insured person must reimburse the costs of one of these parts of the body or sensory organs, the medication to the Assistance within one month. the appropriate proportion will be determined on § 7 What action is to be taken after an accident has the basis of the respective percentage as specified occurred (obligations)? § 4 What services does the Assistance provide in case under a) above. The insured person is obliged to do the following: of the death of the insured person? c) Should the accident affect parts of the body or sen- 1. Undergo a medical examination by physicians appoin- If the insured person dies during his or her stay in the sory organs, the loss or functional incapacity of which ted by the insurer. The necessary costs of such exami- agreed area of application, the Assistance will organise a is not specified under a) or b) above, the degree of nation and any loss of income incurred thereby will be funeral in the agreed area of application or the repatria- disability will be measured by the extent to which the borne by the insurer. tion the deceased person‘s mortal remains to the place of insured person‘s normal physical or mental capacity 2. Release the physician giving treatment or carrying out the funeral in his or her home country as requested by the is impaired from a purely medical perspective. examinations as well as other insurers and authorities deceased person‘s relatives. d) Should the accident result in the impairment of from their professional confidentiality obligation. several physical or mental functions, the degrees of Terms & Conditions of the disability specified under 2 a) to c) will be added to- § 8 When does the insurer pay permanent disability gether. Such addition will, however, not total more benefits? Accident Insurance than 100% disability. 1. As soon as the insurer has received the documents VB U 22 MST e) The disability payment under No. 2 a) shall be that are to be submitted by the insured person for expanded as follows: the purpose of documenting the circumstances and § 1 What is insured? What is an accident? In case of a degree of disability in excess of 25%, the consequences of the accident and documenting the 1. The insurer provides insurance benefits from the agreed indemnity payment shall increase in accordance completion of the curative treatment necessary for sum insured if an accident during the insured stay in the with the following table: determining the degree of disability, the insurer is agreed area of application leads to the death or per- obliged to declare within three months whether and to from to from to from to from to from to manent disability of the insured person. what extent it recognises a claim. % % % % % % % % % % 2. An accident is deemed to have occurred: 2. If the insurer recognises a claim, benefits will be paid 26 28 41 73 56 130 71 205 86 280 a) If the insured person involuntarily suffers damage to 27 31 42 76 57 135 72 210 87 285 within a period of two weeks. his or her health as a result of an occurrence which 28 34 43 79 58 140 73 215 88 290 3. Within one year after the accident, disability benefits has a sudden and external impact on his or her body. 29 37 44 82 59 145 74 220 89 295 may be claimed before completion of curative treat- b) If a joint is dislocated or muscles, tendons, ligaments 30 40 45 85 60 150 75 225 90 300 ment only up to the level of the sum payable in the or capsules are pulled or torn due to excessive 31 43 46 88 61 155 76 230 91 305 event of death. exertion. 32 46 47 91 62 160 77 235 92 310 4. The insured person and the insurer are entitled to have 33 49 48 94 63 165 78 240 93 315 the degree of disability determined each year by a phy- § 2 Under which circumstances does insurance cover 34 52 49 97 64 170 79 245 94 320 sician for a period not exceeding three years after the not apply? 35 55 50 100 65 175 80 250 95 325 occurrence of the accident. To exercise this right, the The following is not included in the insurance cover: 36 58 51 105 66 180 81 255 96 330 insurer must state this when submitting the declaration 1. Accidents caused by mental disorders or impairments 37 61 52 110 67 185 82 260 97 335 in accordance with No. 1; the insured person must ex- of consciousness, strokes, epileptic fits or cramps 38 64 53 115 68 190 83 265 98 340 39 67 54 120 69 195 84 270 99 345 ercise his or her right within one month after receipt of seizing the whole body as well as pathological dis- such declaration. Should the final assessment of disa- orders resulting from psychic reactions. This also ap- 40 70 55 125 70 200 85 275 100 350 bility result in higher disability benefits than the insurer plies if the condition is due to the influence of alcohol 3. Should the accident affect a physical or mental func- had already paid, this extra amount will be subject to or drugs. tion already subject to lasting impairment before the payment at 5% annual interest. 2. Accidents suffered by the insured person whilst intenti- accident, an appropriate deduction will be made to the onally committing a criminal offence. extent of such previous disability. Such disability will be 3. Accidents suffered by the insured person as the pilot Terms and Conditions of the measured in accordance with No. 2 above. (also using aerial sports equipment) or a crew member 4. If the insured person should die as a result of the acci- Liability Insurance of an aircraft. dent within one year after its occurrence, there will be VB H-COM 22 MST 4. Impairments to health caused by curative measures no claim to disability benefits. and other interventions performed on the body of the 5. If the insured person should die for reasons unrela- § 1 What risk does the insurer assume? insured person with his or her agreement, radiation, ted to the accident within one year of the accident 1. The insurer insurer provides insurance cover against infections and poisoning, unless these were due to acci- or should he or she die more than one year after the everyday liability risks if a third party asserts claims dental causes. accident and a claim for disability benefits had already for damages against the insured person during his or 5. Bleeding from inner organs and cerebral haemorrha- arisen, benefits will be paid to the extent of the degree her stay in the area of application due to a damaging ge, unless primarily due to an accident suffered during of disability that would have been reasonably expected event that occurred during travel on the grounds of the insured stay in the agreed area of application. based on the last medical examination conducted. statutory liability provisions as defined under private 6. Pathological disorders as a result of psychological law. Damaging events are defined as death, injury or reactions irrespective of the cause. impairment to health (personal injury) or damage to or destruction of property (damage to property). -6- [Seite 9] 2. The following applies in the event of loss of third-party • The insurance also covers the loss of third-party private residence keys (lost keys risk): The cover inclu- private residence keys (lost keys risk) in accor- des statutory liability of the insured person for the loss dance with § 1 no. 2. However, consequential of private residence keys belonging to a third party damages that occur as a result of the loss of keys which were lawfully in the safekeeping of the insured (e.g. burglary) and liabilities ensuing from the loss person. The insurance cover includes costs incurred for of keys to movable property (including safe keys, any necessary replacement of locks and locking sys- keys to items of furniture) are not insured. tems as well as any necessary interim security measures c) as the owner, possessor, keeper or driver of a motor (emergency lock). The sums insured contained in the in- vehicle, aircraft or motor-driven watercraft due to surance policy or in the overview of benefits constitute damage caused by the use of such a vehicle. the maximum level of benefits provided d) as the owner or keeper of animals; e) for hazards directly related to the deliberate and § 2 How does the insurer protect the insured person illegal commission of a punishable offence. against liability claims? To what extent does it pay indemnity? § 4 What are the duties and obligations of the 1. The insurer examines liability claims with regard to their insured person after the occurrence of damage validity, wards off unjustified claims and reimburses the or loss? compensation owed by the insured person. The insurer An insured event is deemed to be a damaging event that reimburses the compensation if it recognises its duty to could entail liability claims against the insured person. indemnify or approves admission of liability on the part 1. Each and every insured event must be reported in text of the insured person. The insurer also pays compen- form (e.g. letter, fax, e-mail) to the insurer immediately. sation if it effects or approves a settlement or where 2. The insured person must also immediately inform the decreed by a court ruling. insurer of any initiation of a preliminary investigation or 2. If the injured party or his or her legal successor asserts issuance of an order of summary punishment or pay- a liability claim in court, the insurer will conduct the ment order, even if the insurer already knows about the legal dispute at its own expense on behalf of the in- insured event. sured person. 3. If a claim for compensation has been asserted against 3. If the insurer requests or approves the appointment the insured person, he or she must notify the insurer of a defence counsel in criminal proceedings against thereof within one week after the claim is filed. the insured person arising from an insured damaging 4. The insured person must also notify the insurer when a event, the insurer will pay the costs of the defence claim has been asserted that involves judicial or state counsel. assistance. 4. If the insurer fails to settle a liability claim by admission, 5. The insured person is obliged to take all possible steps satisfaction or settlement on account of the resistance to minimise the loss while complying with the insurer‘s of the insured person, the insurer shall not be required instructions and to take every action necessary or use- to pay any additional expenses incurred for the main ful to clarify the case of loss. The insured person must issue, interest and the costs. provide a detailed and truthful loss report, supply infor- 5. The sums insured as stipulated in the Overview of mation on all circumstances connected with the dama- Benefits are the maximum limit of benefits payable by ging event and submit the corresponding documents. the insurer per insured event; they also constitute the 6. If the liability claim is taken to court, the insured per- aggregate maximum indemnity paid for all insured son shall allow the insurer to conduct the proceedings, events in an insurance year. grant the legal counsel appointed and nominated by the insurer full power of attorney to act on his or her § 3 What risks are not insured? behalf and submit all declarations deemed necessary Insurance cover does not include the following: by the legal counsel or the insurer. Without awaiting 1. Liability claims instructions from the insurer, the insured person must a) insofar as these exceed the scope of the insured raise objections within the specified period or seek the person‘s statutory liability as a result of contractual necessary legal remedies against orders for payment or other commitments; of damages decreed by the courts or by the state. b) among and between insured persons and insured 7. If the insured person obtains the right to demand the persons and their relatives (including life partners); cancellation or reduction of a payable annuity as a c) due to transmission of illness by the insured person; consequence of altered circumstances, the insured per- d) due to damage caused by occupational activities. son is obliged to allow the insurer to exercise such right 2. Liability claims against the insured person on his or her behalf. The provisions of Nos. 3 to 5 apply a) in connection with hunting activities; accordingly. b) due to damage caused to third-party property 8. The insurer is considered to have full authority to submit rented by or on loan to the insured person or all declarations on behalf of the insured person that it obtained through unlawful interference or in the deems suitable to settle or ward off a claim. insured person‘s custody. • However, liability arising from damage to § 5 What deductible does the insured person pay? rooms and buildings during the stay in the In the case of loss of residence keys the insured person agreed area of application, in particular pays a deductible of € 100 per damage event. damage to rented holiday apartments and hotel rooms or the accommodation but not damage to furniture; insurance cover is not provided for liabili- ty claims based on wear and tear or excessive use. -7- [Seite 10] MAWISTA STUDENT – INSURANCE BENEFITS AT A GLANCE / TARIFF TABLE Tariff Table MAWISTA Student Classic ® MAWISTA Student Classic ® Plus MAWISTA Student Comfort ® General Provisions § 2 No. 1 Insurance cover for Germans in Germany if the not insured not insured up to 6 weeks per insurance year stay abroad is interrupted. Health Insurance § 2 No. 1 Amount of costs reimbursed for … • Outpatient treatment unrestricted* unrestricted* unrestricted* • Medical treatment and medication unrestricted* unrestricted* unrestricted* • Inpatient treatment unrestricted unrestricted unrestricted • Medical treatment of a newborn baby if born prema- max. € 100,000 max. € 100,000 max. € 100,000 turely • Medically necessary patient transportation to a hospital unrestricted unrestricted unrestricted • Pain-killing dental treatment per insurance year max. € 500 max. € 500 max. € 1,000 • Dentures per insurance year not insured not insured 60% of the total costs, max. € 1,000 • Treatment of pregnancy unrestricted, after the expiry of a wai- unrestricted, after the expiry of a wai- unrestricted ting period of 3 or 8 months respectively ting period of 3 or 8 months respectively • Aids required as a result of an accident per insurance year max. € 250 max. € 250 max. € 1,000 • Visual aids required as a result of an accident per not insured not insured max. € 100 insurance year • Vaccination max. € 250 throughout the entire not insured not insured term of the contract • Treatment (e.g. massages, fango and lymph drainage max. 6 treatments max. 8 treatments max. 8 treatments treatment) per insurance year • Rehabilitation measures unrestricted unrestricted unrestricted Important note: Reimbursement for outpatient medical and dental services is made within the framework of the respective valid German Scale of Fees and Charges for Physicians and for Dentists (GOÄ and GOZ) Reimbursement of treatment costs according to GOÄ /GOZ up to max. 1.8-times the rate up to max. 2.3-times the rate up to max. 3.5-times the rate § 2 No. 2 Provision of the insurance benefit subsequently after the expiry of the insurance contract if the insured max. 6 weeks max. 6 weeks max. 8 weeks person is unfit to travel § 3 No. 1 Patient repatriation transportation to the home The costs of the medically advisable and justifiable patient repatriation transportation to the nearest hospital in the country insured person‘s home country at an unlimited amount, also if hospital treatment lasts longer than 14 days § 3 No. 2 Reimbursement of costs for repatriation of max. € 25,000 max. € 25,000 max. € 25,000 mortal remains to home country § 3 No. 2 Reimbursement of costs for local funeral up to the costs of the repatriation of up to the costs of the repatriation of up to the costs of the repatriation of mortal remains at the maximum mortal remains at the maximum mortal remains at the maximum § 6 Deductible per insured benefit for outpatient treat- 20%, max. € 250 per calendar year 15%, max. € 250 per calendar year 10%, max. € 250 per calendar year ment and dental treatment Important note for stays outside Germany: If treatment is expected to be necessary for longer than 30 days, there is a personal contribution of 20% of the treatment costs if return transport to Germany is refused, although it is possible and medically reasonable and justifiable. Emergency Call Insurance §1-§4 Offers immediate assistance worldwide in case of an emergency in the agreed area of validity § 2 No. 2 Declaration of amount of costs assumed for max. € 15,000 max. € 15,000 max. € 15,000 inpatient treatment Accident Insurance § 3 Sum insured in case of death not insured € 10,000 € 10,000 § 4 Sum insured in case of permanent disability not insured max. € 140,000 max. € 140,000 § 6 No. 1 Rescue costs not insured max. € 5,000 max. € 5,000 § 6 No. 2 Health spa allowance not insured max. € 1,500 max. € 1,500 Liability Insurance § 1 Sums insured • max. € 1,000,000 for personal injury • max. € 1,000,000 for personal injury and property damage and property damage not insured • max. € 250,000 for damage to • max. € 250,000 for damage to rented property rented property • max. € 2,000 for lost keys Monthly Premiums up to the 5th birthday € 49 € 66 € 117 from 5 years on up to the 18th birthday € 35 € 47 € 83 from 18 years on up to the 30th birthday € 25 € 34 € 60 from 30 years on up to the 40th birthday € 38 € 50 € 89 2021-1450 * Taking into account the reimbursable fee rates according to GOÄ and GOZ, as well as the respective tariff deductible. -8-