General insurance conditions
§ 1 Subject, scope and validity of the cover
1. The insurer provides insurance cover for illnesses, accidents and other events named in the contract. He will reimburse the costs of medical treatment and other contractually agreed services on the unforeseen occurrence of an insured event in Germany.
2. An insured event is the medically necessary treatment of an insured person as a result of illness or the consequences of an accident. The insured event commences with the medical treatment and ends with the finding by a medical practitioner that no further treatment is needed. If the treatment has to be extended for an illness or an accident, which has nothing in common with the first treatment,this is considered to be a new insurance case.
3. The scope of the insurance cover is as stated on the certificate of insurance, in later written agreements, in the general terms and conditions of insurance and as in the applicable laws.
4. The insurance cover extends to medical treatment in Germany.
§ 2 Commencement of insurance cover
The insurance cover shall commence on the day of entry stated on the application (commencement of insurance) but not before conclusion of the insurance contract, not before payment of the premium and not before the start of the stay by the insured person in Germany. For insurance cases that occurred before the beginning of the insurance contract or the payment of the premium, there will be no reimbursements.
§ 3 Insurable persons; conclusion and duration of the insurance contract
1. The insurance is available to persons, having their permanent residence outside of Germany, who are temporarily in Germany and who intend to return to their home country.
2. The insurance can be applied for a maximum of three months. An extension is not possible.
3. The insurance contract will be concluded with the acceptance of the application (handing over the certificate of insurance or a written declaration of the acceptance of the application).
§ 4 Scope of cover
1. Types and amounts of reimbursements are fixed in the general terms and conditions and in the tariff conditions.
2. The insured person has the free choice of established recognised doctors and dentists. Non-medical practitioners cannot be reimbursed.
3. Drugs and dressings must be prescribed by those persons treating which are mentioned in point 2. Drugs have to be received from a pharmacy.
4. Nutritional food, restoratives, mineral waters, cosmetics, products for personal hygiene as well as bathing supplements are not considered to be drugs.
5. For a medically necessary inpatient treatment the insured person has the free choice of the public hospitals, which are under permanent medical control, which possesses sufficient diagnostic and therapeutic facilities and maintain patient histories.
§ 5 Exclusions
1.The insurer will not pay for:
1.1. Pre-existing conditions: any known or unknown medical conditions which are a consequence of any health disturbance that has or would have had required hospitalization and / or medical treatment and / or medications, and / or has been diagnosed within the one year period immediately prior to the first day of this insurance. The above definition of pre-existing conditions applies also in particular to any kind of chronic illnesses as well as existing dental defects and defective vision.
1.2. Maternity Care, abortions and childbirth.
1.3. All Emergency Medical Evacuation and Repatriation costs.
1.4. Routine medical examinations ( including vaccinations, the issue of medical certificates and attestations, and examinations as to suitability for employment or travel ).
1.5. Treatment relating to birth defects and congenital illnesses. Birth defects are deemed to include hereditary conditions.
1.6. Prostheses, spectacles, contact lenses, hearing aids, bandages and all medical appliances.
1.7. All dental treatment which is not Emergency Dental Treatment and Relief of pain as defined herein, including but not limited to: gnatological, parodontological, endodontical treatments, costs for inlays, crowns, bridges, new dentures and all consequences thereof.
1.8. All Organ Transplantation.
1.9. Tests and treatment relating to infertility and in vitro fertilisation.
1.10. Any contraceptives (pill, spiral, etc.) and all consequences thereof.
1.11. Electric and physical medical treatment: physiotherapy, therapeutic exercises, massages, hydro-therapy and packs, thermo-therapy, electro-therapy and photo-therapy.
1.12. Treatment of mental illness, psychiatric and psychological disorders and all diseases caused by and/or related to mental diseases.
1.13. Elective and / or cosmetic treatments (e.g. removal of warts etc.).
1.14. Tuberculosis, Acquired Immune Deficiency Syndrome ( AIDS ), AIDS-related Complex Syndrome ( ARCS ) and all diseases caused by and/or related to HIV.
1.15. All tropical diseases, including but not limited to malaria, yellow fever, cholera, dysentery, leprosy.
1.16. Costs resulting from self-inflicted injury, suicide, abuse of alcohol, drug addiction or abuse and treatment of sexually transmitted diseases.
1.17. Treatment by a family member and any auto therapy including prescription of drugs.
1.18. Treatment resulting from active participation in war, riot, civil commotion or any criminal act, including resultant imprisonment.
1.19. Claims and costs for treatment in respect of medical expenses incurred after the expiry date of the Certificate arising from accidental bodily injury, illness or pregnancy occurring during the Certificate period.
1.20. Any benefit, treatment and expenses not particularly covered and specified in the Plan.
2.0. If a medical or any other treatment, which services were agreed upon exceeds the medically necessary extent, the insurer may reduce his payment to an appropriate amount.
§ 6 Refund of costs
1. The insurer shall only be obliged to make payment when the evidence demanded has been provided. Receipts become the property of the insurer.
2. The original invoices (copies or duplicates cannot be accepted) are to be submitted together with the corresponding treatment ticket, completed and signed by the doctor. Prescriptions for drugs, prescribed by doctors have to be submitted together with the corresponding doctor´s invoice.
3. If an insured person has claims for damages against other insurers or existing claims for damages against third parties, the insurer is only responsible for those expenses, which remain necessary after the advance payment. Rights to claim for damages have to be assigned in writing to the insurer.
4. The insurer is entitled to make payment to the person submitting or sending the correct proof of treatment, unless he has reasonable doubts about the legitimacy of the person submitting or sending the documents.
5. The insurer may hand over the claims settlements to independent specialists for the handling of health insurance.
§ 7 End of insurance cover
The insurance cover shall end - including cover for insured events which are not yet complete - with the end of the insurance contract, at the latest with the end of the stay in Germany.
§ 8 Payment of premiums
1. The premium is a daily premium and will be calculated from the start of the insurance on. The total premium is due after the certificate of insurance has been handed over.
2. The premiums are to be paid to the place assigned by the insurer.
§ 9 Obligations
1. Any hospital treatment is to be reported in writing to the insurer immediately, at the latest within ten days of its commencement. Furthermore, planned outpatient operations have to be announced in writing immediately.
2. The insured person has to submit the original invoices as soon as possible but no later than thirty days after the receipt together with a completely filled in and signed treatment ticket.
3. The insured person shall, on demand by the insurer, provide any and all information necessary for determination of the insured event or the obligation by the insurer to make payment and the extent of such obligation.
4. The insured person shall be obliged on demand by the insurer to undergo an examination by a doctor appointed by the insurer.
5. The insured person shall, if possible, take care to minimize the claim and refrain from any actions, which hinder the recovery.
6. Every marriage with a German citizen and/or the receipt of the German citizenship is to be reported to the insurer immediately.
§ 10 Consequences of infringement of obligations
The insurer shall be freed of the obligation to make payment when one of the obligations named in § 9 is infringed.
§ 11 End of insurance contract
1. The insurance shall end on expiry of the agreed insurance period.
2. The insurance relationship ends with the day of marriage with a German citizen and/or if a insured person receive the German citizenship.
3. The contract ends with no delay in case of supplying false information or receiving or trying to receive reimbursements for a claim by fraud.
