Globality CoGenio® EN

Résumé

Globality CoGenio® is a worldwide private health insurance underwritten under a group contract concluded by an organization (employer or association) with Foyer Global Health S.A. in Luxembourg, and designed for expatriates who temporarily reside in a foreign country for at least three months. Cover is granted for illnesses, accidents and other events specified in the General Conditions of Insurance and comprises inpatient, outpatient, dental and assistance modules across three plan levels - Classic, Plus and Top - whose benefit tables state, benefit by benefit, whether reimbursement is insured or excluded for each level. Two geographical areas can be agreed (I: worldwide including USA; II: worldwide excluding USA), there are no waiting periods, and deductibles of € 250/€ 500/€ 1,000 (with USD and GBP equivalents) apply exclusively to outpatient expenses. The document also sets out the general exclusions, the claims procedure, the duties of the insured, premium payment rules, and Luxembourg law and jurisdiction.

• Assureur : Foyer Global Health · Branche : Complémentaire santé · Type : Conditions générales

Définitions

Terme	Définition	Page
Insured event	An insured event is defined as the medically necessary treatment required by an insured person due to illness or the consequences of an accident. The insured event commences with the treatment and ends when medical findings indicate that treatment is no longer required. If the treatment has to be extended to an illness or to the consequences of an accident not causally related to that for which treatment was originally provided, this shall constitute a new insured event. Insofar as the agreed plan level also provides for corresponding reimbursements, the following are likewise defined as insured events: outpatient screenings for early detection of illnesses; check-ups and medically necessary treatment associated with pregnancy and childbirth; expenses incurred for periods spent in hospital by the healthy newborn baby after birth; death of an insured person.	p. 5
Insurance year	The insurance cover commences on the date specified in the group contract and runs for 12 months. The insurance year for the individuals who join the insurance policy commences on the date indicated on their insurance certificate (inception of insurance) and runs until the renewal date of the group contract.	p. 5
Medically necessary	Medically necessary are all appropriate medical measures, based on internationally approved medical standards at the respective time and location, which are used to diagnose, treat, heal or relieve the disease condition, illness or injury and are recognized as appropriate by the insurer. These measures must be: a) carried out in a health care facility authorized and licensed by the authorities in the country of treatment; b) the most appropriate considering both patient safety and cost effectiveness; c) consistent with the diagnosis, symptoms or treatment of the underlying condition; d) clinically appropriate, in terms of type, frequency, extent, site, and duration, and considered effective for the patient's illness, injury, or disease; e) not required purely for comfort or convenience of the patient, medical providers, therapists or doctors; f) not for clinical trial, experimental, investigational, or cosmetic purposes (see No 6); g) not for screening and preventive care purposes.	p. 30
Routine health checks	Routine health checks are tests or screenings that are carried out without any clinical symptoms being present.	p. 19
Outpatient childbirth	Outpatient childbirth is defined as either giving birth at home or leaving the hospital, maternity home or comparable institution within 24 hours of childbirth.	p. 17
Accident	An accident is defined as an external occurrence suddenly and unexpectedly acting on the body and causing damage to health.	p. 37
Acknowledged rate of fees	Basis on which medical and dental services are calculated. They may differ from one country to the next.	p. 37
Acupuncture	Acupuncture is an ancient method used in Traditional Chinese Medicine with which thin needles are pricked into the body to heal illnesses or alleviate pain. In conventional medicine, it is primarily approved of for treating pain.	p. 37
AIDS	AIDS stands for Acquired Immune Deficiency Syndrome, a serious disorder of the immune system.	p. 37
Assisteur	Our assisteur specializes in helping and advising the insured persons in emergencies or during hospital stays. He/she also provides additional services to make your stay and that of the insured persons easier in the foreign country and handles the reimbursement of certain costs, such as the cost of return transport.	p. 37
Cancer	Cancer is the general term used for all malignant disorders caused by the uncontrolled multiplication of mutated cells (new growths, tumours, carcinoma). Such cells can destroy the surrounding tissue and produce metastases (secondary growths).	p. 37
Children	Children include the insured person's natural offspring, as well as adopted, step and foster children, up to the age of 25.	p. 37
Chiropractic	Chiropractic is also known as manual therapy. Mutually displaced or dislodged vertebrae and other joints are “manipulated” into place again by certain manual actions.	p. 37
Conditions precedent	Conditions precedent define standards of conduct which must be observed in order to qualify for the benefits claimed under the insurance policy.	p. 37
Conservative treatment	Conservative treatment is designed to preserve the teeth (e.g. fillings, treatment of the root canal).	p. 37
Conventional medicine	Conventional medicine is defined as the form of medicine based on accepted scientific methods which are taught at universities and are therefore generally acknowledged and applied.	p. 37
Conversion	Conversion is the term used when an existing insurance cover with us is changed, e.g. by agreeing on a different deductible, while maintaining the rights which the insured persons have already acquired through the previous continuous insurance with our company.	p. 37
Country of departure	The country of departure is the country in which the insured persons permanently lived prior to their stay abroad.	p. 37
Country of residence	The country of residence is the country in which the insured persons live after commencing their stay abroad.	p. 37
Cures and sanatorium treatment	Cures and sanatorium treatment serve to strengthen a person's state of health.	p. 37
Day case hospital treatment	Day case hospital treatment in a clinic or hospital means that the patient only remains in the clinic for a period between 8 and 24 hours and that a stay of longer than 24 hours is not necessary.	p. 37
Deductible	The effect of a deductible is that the insured person bears a certain portion of the costs. The deductible is the own share to be borne by the insured persons. If a deductible has been agreed, this will be documented in the insurance certificate (see No. 4.2).	p. 37
Dentist	Therapist who primarily deals with disorders of the teeth and mouth.	p. 38
Doctor	A doctor is a medical professional (general practitioner or specialist) or holder of a medical diploma who has the statutory approbation and is licensed to practise medicine in the country in which treatment is provided (see treatment). You and the insured persons are free to choose any doctor meeting these criteria.	p. 38
Domestic help	Domestic help is part of the nursing care provided at home. It encompasses assistance with the usual, recurrent tasks of everyday life associated with the running of a home, such as shopping, cooking, cleaning the home, washing-up, changing and washing the laundry and clothes, as well as heating the home.	p. 38
Dressings	Dressings is the term used to describe the material for dressing wounds.	p. 38
Drugs	Drugs are active agents which are administered in isolation or in combination with other substances to diagnose or treat illnesses, disorders, disabilities or pathological conditions. Foods, cosmetics, and body care articles are not recognized as drugs. Drugs must be prescribed by a doctor and must be obtained from a pharmacy. Medication, medicine and pharmaceuticals are synonymous terms.	p. 38
Emergency	An emergency is defined as the sudden, acute occurrence of an illness or the acute deterioration of some aspect of health directly jeopardizing the insured person's general state of health.	p. 38
Existing medical conditions	Existing medical conditions are defined as those illnesses and their consequences which already exist upon inception of the insurance, as well as the consequences of accidents already known to you or the insured person or for which you or the insured person are/is already receiving treatment.	p. 38
Follow-up rehabilitation	Follow-up rehabilitation is a medical measure to restore the former physical condition following a serious illness/major surgery, such as bypass operations, cardiac infarction, organ transplants and surgery involving big bones or joints, as well as following serious accidents.	p. 38
Geographical area	Insurance cover is provided for the following geographical areas: Geographical area I: Worldwide including the USA; Geographical area II: Worldwide excluding the USA.	p. 38
Globality Service Card	You and the insured persons receive a personal Globality Service Card with the address and main telephone numbers of your relevant Globality Health service centre. The Globality Service Card is your personal proof of insurance for all medical providers.	p. 38
Globality Health service centre	The Globality Health service centres on the ground offer direct access to local specialists, seamless service and first-class support. You can claim help services in line with the plan level you have chosen whenever an insured event or emergency happens. Call the number indicated on the reverse of your Globality Service Card to contact your service centre - 24 hours a day, 7 days a week. Please always have the nine digit “Insurance No.” indicated on the front side of your service card at hand. Globality Health service centres are familiar with the healthcare system and the local structures of your new country of residence. They will recommend doctors and hospitals, make appointments or procure medication. Your service centre can give a guarantee for payment or will ensure for the quick and straightforward reimbursement of costs.	p. 38
Hearing aid	A hearing aid is an electronic device worn in or behind the ear for amplifying sound.	p. 38
Home country	The home country is the country of which you and the insured persons are citizens or to which you or they are to be repatriated in the event of death.	p. 38
Homeopathy	Homeopathy is based on three elements: the law of similars, the principle of minimum dose and the principle of potentiation. A homeopath proceeds on the assumption that an illness which produces certain symptoms can be healed with remedies which produce similar symptoms in healthy people.	p. 39
Hospice	Institution for the limited purpose of supporting patients with a life expectancy of few months and relieving symptoms of the fatal illness by palliative medical care.	p. 39
Hospital	Institution for inpatient and sometimes outpatient treatment which is approved and licensed in the country in which it operates. Benefits are only paid if the hospital is under constant medical management, has adequate diagnostic and therapeutic facilities and keeps medical records. In the case of medically necessary treatment in hospitals which also provide health cures or sanatorium treatment or accept convalescent patients, but which meet with the above conditions in all other respects, benefits under the plan will only be paid if these have been confirmed in writing before treatment commences. Inpatient treatment in tuberculosis clinics and sanatoria will also be indemnified within the contractual scope for tuberculosis patients. The following institutions do not qualify as hospitals: convalescent and nursing homes, health centres, health resorts and spas, as well as sanatoria.	p. 39
Hydrotherapy	Hydrotherapy is defined as a specific external treatment using water.	p. 39
ICD Codes	ICD stands for the International Classification of Diseases and is an international system for encoding and classifying all known diagnoses.	p. 39
Implants	Implants are defined as dental implants (metal or ceramic) which are embedded as a substitute for the root of a tooth or in the toothless jaw.	p. 39
Insurance certificate	The insurance cover agreed for the insured persons and the premium payable in each case are documented in an insurance certificate.	p. 39
Magnetic resonance imaging (MRI)	A diagnostic technique in which radio waves generated in a strong magnetic field are used to provide images of the body's internal tissues and organs.	p. 39
Oncology	Oncology is a subsection of internal medicine which deals with the occurrence, diagnosis and treatment of tumours and related illnesses.	p. 39
Osteopathy	Osteopathy encompasses the comprehensive manual diagnosis and therapy of malfunctions in the locomotor system, internal organs and nervous system. It is primarily used for treating chronic pain of the spinal chord and peripheral joints.	p. 39
Outpatient surgery instead of inpatient treatment	Outpatient surgery which can be performed either by a doctor or in a hospital, but which does not make it necessary to spend the night in hospital and need not be followed by a stay in hospital.	p. 39
Palliative medicine	Palliative medicine describes the comprehensive active treatment provided to patients whose life expectancy is limited, whose illness can no longer be cured and for whom the purpose of treatment is to achieve the best possible quality of life for the patient and his/her relatives.	p. 39
Policyholder/insured person	The policyholder is an organization with legal capacity, such as your employer or association, etc. which has concluded a group contract with us. The insured persons are the policyholder's employees or members who have joined the group contract of their own free will or have been registered for group insurance by the policyholder, as well as other persons for whom insurance cover is also granted, such as the insured person's marital or non-marital partner and children.	p. 39
Positron emission tomography (PET)	Positron emission tomography (PET) is an imaging process with which the distribution of a substance marked with a positron emitter in the patient's body can be represented non-invasively. The concentration of such a “marker” in a tumour can also be assayed quantitatively. The substance is injected intravenously and its radiation emission detected with the aid of external detectors. Important biological processes in tumours can be visualized with the aid of PET.	p. 40
Prophylactic measures	Prophylactic measures are preventive measures; they encompass individual and general measures to avert the threat of illness (e.g. vaccinations, passive immunization, preventive medication when travelling to hazard areas, accident prevention etc.).	p. 40
Second opinion	Second opinion refers to the medical advice given by an independent second doctor not involved in the treatment of potentially fatal illnesses and serious, permanent disabilities.	p. 40
Substitute hospital cash plan benefits	If you or an insured person do not claim any benefits from us for medically necessary inpatient treatment covered by the insurance, we will instead pay a substitute hospital cash plan benefit per day actually spent in hospital for the medically prescribed inpatient treatment, in accordance with the selected plan level (see No. 4.3).	p. 40
Therapist	A therapist may be a doctor, but also anyone who has received acknowledged, in-depth training in his/her field and is licensed or authorized to give treatment in their field in the country in which treatment is provided. Therapists include practitioners of complementary medicine, speech therapists and midwives/obstetric nurses, as well as members of state-approved assistant medical professions with their own practice (such as masseurs, physiotherapists). Insured persons are free to choose any therapist meeting these criteria.	p. 40
Treatment	Treatment describes the diagnostic and therapeutic measures to be undertaken by the doctor in order to identify, alleviate or heal a disorder, illness or injury. A course of treatment is deemed medically necessary if it could reasonably be considered medically necessary in the light of objective medical and scientific findings at the time of treatment.	p. 40
Treatment relating to analysis and therapy of dental function	Examination and treatment method used in dentistry to diagnose disorders and illnesses of the entire masticatory apparatus.	p. 40
Underage person/minor	Underage persons or minors are defined as persons who are under 18 years.	p. 40

Garanties

Accommodation in a private or semi-private room - p. 9

Accommodation in a private or semi-private room during inpatient treatment. The insured person must go to a generally recognized hospital within the selected geographical area, operated under constant medical management, with adequate diagnostic and therapeutic facilities and keeping medical records. Accommodation means standard private or semiprivate accommodation as shown in the table of benefits; deluxe rooms, executive rooms and suites are not covered. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses) - Condition : Your relevant Globality Health service centre must be contacted before or upon admission to the hospital. - Condition : Benefits will be paid without time limits for the duration of inpatient treatment.

Medical treatment (inpatient) - p. 9

All expenses incurred for examination, diagnosis and medical services within the framework of medically necessary inpatient treatment, unless specifically mentioned elsewhere in the insurance policy. Eligible expenses also include those incurred for pathology, radiology, computer tomography, magnetic resonance imaging, positron emission tomography and palliative medicine. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Nursing care by qualified nursing staff as directed by a doctor - p. 9

Nursing care by qualified nursing staff as directed by a doctor, within inpatient treatment. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Other ancillary costs (inpatient) - p. 9

The other costs incurred for the use of special facilities, such as operating theatres, intensive care wards and laboratories. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Surgery (including outpatient surgery instead of inpatient treatment) - p. 9

Expenses incurred for services required in this context, such as medical services, anaesthesia and the use of special facilities. Expenses for outpatient surgery in lieu of inpatient treatment are also reimbursable. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Drugs and dressings (inpatient) - p. 9

Drugs and dressings prescribed by a hospital doctor/dentist in conjunction with the inpatient treatment. Drugs must additionally be dispensed by a pharmacy or other officially approved dispensary. Nutriments, tonics, mineral water, cosmetics, hygiene and body care articles and bath additives will not be recognized as drugs. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Therapies/physiotherapy, including massages (inpatient) - p. 9

Physical-medical therapies (inhalation, physiotherapy and physical exercise, massage, packs, hydrotherapy, medical baths, cryo- and thermotherapy, occupational therapy, electrotherapy or light therapy) provided by a doctor or the holder of a state-approved diploma as medical assistant and prescribed by the doctor within the framework of inpatient treatment. Do not include other therapies such as thermal baths, saunas and similar baths. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses) - Condition : The prescription must have been issued before treatment commences and must specify the diagnosis, nature and number of sessions.

Therapeutic aids and appliances (inpatient) - p. 9

Expenses for therapeutic aids and appliances designed to serve as a lifesaving measure or which directly alleviate or compensate physical disabilities, such as cardiac pacemakers, artificial limbs/prostheses (but not dentures). They must be fitted during the stay in hospital and remain in or on the body. Expenses for reasonable maintenance and reparation are reimbursed within the scope of these provisions. - Optionnelle : non · Limite : Plus: up to € 2,000/ $ 2,600/ £ 1,680 for artificial limbs/prostheses; Classic and Top: no amount printed in the table - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses) - such as cardiac pacemakers, if needed as a life-saving measure; Plus = insured (reimbursement of 100 % of eligible expenses) - such as cardiac pacemakers, if needed as a life-saving measure; in addition, reimbursement for therapeutic aids and appliances, such as artificial limbs/prostheses up to € 2,000/ $ 2,600/ £ 1,680; Top = insured (reimbursement of 100 % of eligible expenses) - Condition : * The specified maximum sums, maximum periods and lump sums apply per insured person and per insurance year.

Medical treatment related to pregnancy and childbirth, services of a midwife or obstetric nurse in the hospital - p. 9

Eligible expenses for childbirth, pregnancy or pregnancy-related illness in a hospital, maternity home or similar institution, the expenses for nursing at home or domestic help resulting from pregnancy or pregnancy-related illness and midwife or obstetric nurse services. Screenings related to pregnancy are excluded from this table row. Midwife services during delivery are covered only in the case of midwife led birth; doctor fees are not covered in these cases unless medically required following a complication during birth. Medically prescribed nursing at home is covered following an inpatient delivery after discharge from the hospital within 24 hours, for up to 5 consecutive days following the delivery. Any non-medically necessary caesarean sections will be covered up to the cost of an eligible routine delivery in the same hospital, up to the maximum limit in accordance with the selected plan level. - Optionnelle : non · Limite : Plus: up to € 5,000/ $ 6,500/ £ 4,200 - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - up to € 5,000/ $ 6,500/ £ 4,200; Top = insured (reimbursement of 100 % of eligible expenses)

Complications of pregnancy and childbirth (inpatient) - p. 9

Eligible expenses for premature birth, miscarriage, an abortion which is medically necessary, stillbirth, ectopic pregnancy, hydatidiform mole, caesarean section, post-partum haemorrhage, retained placental membrane and complications following any of these conditions. - Optionnelle : non - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Newborn care - p. 9

Treatment of a routine or acute medical condition suffered by a newborn baby which manifests itself within 30 days following birth is covered under the newborn benefit of the child's policy and not under any other benefit on the policy. Complications of assisted conception or childbirth, including premature or multiple births, are excluded from this benefit. - Optionnelle : non - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Outpatient childbirth - p. 9

Outpatient childbirth is defined as either giving birth at home or leaving the hospital, maternity home or comparable institution within 24 hours of childbirth. The lump sum childbirth allowance is paid per newborn baby on presentation of the birth certificate. - Optionnelle : non · Limite : Plus: Lump sum of € 250/ $ 325/ £ 210 per newborn baby; Top: Lump sum of € 500/ $ 650/ £ 420 per newborn baby - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - Lump sum of € 250/ $ 325/ £ 210 per newborn baby without proof of costs on presentation of the birth certificate; Top = insured (reimbursement of 100 % of eligible expenses) - Lump sum of € 500/ $ 650/ £ 420 per newborn baby without proof of costs on presentation of the birth certificate

Chemotherapy, oncological drugs and treatment (inpatient, e.g. for cancer patients) - p. 9

Eligible expenses for medical treatment, diagnostic tests, radio therapy, chemotherapy, drugs and hospital costs in conjunction with inpatient treatment. - Optionnelle : non · Limite : Classic: up to € 50,000/ $ 65,000/ £ 42,000; Plus: up to € 100,000/ $ 130,000/ £ 84,000; Top: no amount printed in the table - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses) - up to € 50,000/ $ 65,000/ £ 42,000; Plus = insured (reimbursement of 100 % of eligible expenses) - up to € 100,000/ $ 130,000/ £ 84,000; Top = insured (reimbursement of 100 % of eligible expenses) - Condition : * The specified maximum sums, maximum periods and lump sums apply per insured person and per insurance year.

Transport to the nearest suitable hospital for initial treatment following an accident or an emergency - p. 9

Transport to the nearest suitable hospital for initial treatment following an accident or an emergency, by an approved emergency service with conveyances appropriate to the situation. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Bone marrow and organ transplants - p. 10

In the case of bone marrow or organ transplants (e.g. heart, kidney, liver, pancreas), reimbursement of the eligible expenses for both the person receiving the transplant and the donor. Eligible expenses are the costs incurred in conjunction with procuring the organ from the donor, the cost of transporting the organ to the patient and the expenses incurred for hospital accommodation of the donor if necessary, but not the cost of finding the organ to be transplanted or a suitable donor. - Optionnelle : non · Limite : Plus: up to a maximum of € 200,000/ $ 260,000/ £ 168,000 for the duration of the group contract - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - up to a maximum of € 200,000/ $ 260,000/ £ 168,000 for the duration of the group contract; Top = insured (reimbursement of 100 % of eligible expenses)

Psychiatric treatment (inpatient) - p. 10

Expenses incurred for inpatient psychiatric treatment, if and insofar as we have agreed in writing to reimburse these costs before treatment commences. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses) - provided that we have agreed in writing to pay benefits before treatment commences; Plus = insured (reimbursement of 100 % of eligible expenses) - provided that we have agreed in writing to pay benefits before treatment commences; Top = insured (reimbursement of 100 % of eligible expenses) - provided that we have agreed in writing to pay benefits before treatment commences - Condition : provided that we have agreed in writing to pay benefits before treatment commences

Inpatient psychotherapy - p. 10

The costs of inpatient psychotherapy will only be reimbursed if the treatment is provided by a psychiatrist, psychotherapist or other specialist with appropriate qualifications in the field of psychiatry, psychotherapy or psychoanalysis. Moreover, these costs will only be reimbursed if and insofar as we have agreed in writing to reimburse these costs before treatment commences. - Optionnelle : non - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - provided that we have agreed in writing to pay benefits before treatment commences; Top = insured (reimbursement of 100 % of eligible expenses) - provided that we have agreed in writing to pay benefits before treatment commences - Condition : provided that we have agreed in writing to pay benefits before treatment commences

Parent rooming-in during inpatient treatment of an underage child - p. 10

Reimbursement of the additional costs incurred for accommodation of a parent during inpatient treatment of an insured underage child. - Optionnelle : non - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Nursing care at home and domestic help - p. 10

Eligible expenses of medically prescribed nursing at home and domestic help by suitable, duly trained nursing staff instead of the medically recommended hospital stay or in order to shorten the time spent in hospital. Nursing at home is supplementary to the medical treatment and will be reimbursed in addition to the latter. - Optionnelle : non · Limite : Plus: up to a period of 7 days; Top: up to a period of 14 days - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - up to a period of 7 days; Top = insured (reimbursement of 100 % of eligible expenses) - up to a period of 14 days

Nursing care at home after childbirth, instead of a hospital stay - p. 10

Nursing care at home after childbirth, instead of a hospital stay. - Optionnelle : non · Limite : Plus and Top: up to a period of 5 days - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - up to a period of 5 days if pre-approved; Top = insured (reimbursement of 100 % of eligible expenses) - up to a period of 5 days if pre-approved - Condition : if pre-approved

Substitute cash plan benefit for inpatient treatment - p. 10

Substitute cash plan benefit for inpatient treatment actually received, but for which no benefits have been claimed from us: if no benefits are claimed for medically necessary inpatient treatment covered by the insurance, a substitute hospital cash plan benefit is paid per day actually spent in hospital for the medically prescribed inpatient treatment, in accordance with the selected plan level. - Optionnelle : non · Limite : Plus: € 50/ $ 65/ £ 42 per day; Top: € 100/ $ 130/ £ 84 per day - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - € 50/ $ 65/ £ 42 per day; Top = insured (reimbursement of 100 % of eligible expenses) - € 100/ $ 130/ £ 84 per day

Inpatient follow-up rehabilitation - p. 10

Expenses incurred for inpatient follow-up rehabilitation to continue the medically necessary inpatient hospital treatment (e.g. following bypass surgery, cardiac infarction, organ transplants and surgery involving large bones or joints), if and insofar as we have agreed to reimburse such expenses in writing beforehand. Follow-up rehabilitation must in all cases commence within two weeks of being discharged from hospital. Treatments and periods of residence in health resorts, spas, sanatoria or convalescent homes and nursing homes are not covered by the insurance. - Optionnelle : non · Limite : Plus: up to a period of 14 days; Top: up to a period of 21 days - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - up to a period of 14 days; Top = insured (reimbursement of 100 % of eligible expenses) - up to a period of 21 days - Condition : if and insofar as we have agreed to reimburse such expenses in writing beforehand - Condition : Follow-up rehabilitation must in all cases commence within two weeks of being discharged from hospital.

Hospice - p. 10

If outpatient care at home or in the insured person's family is not possible, reimbursement of the expenses incurred for accommodation, nursing care and support in accordance with the patient's state of health for a maximum of 7 weeks, provided the hospice works together with nursing staff and doctors with experience in palliative medical care and is operated under the professional supervision of a nurse or other suitably qualified person. Benefits are only granted if the insured person suffers from an illness which is progressive and has already reached an advanced stage, is incurable so that inpatient palliative care has become necessary, and permits a remaining life expectancy of weeks or only a few months. Hospice benefits are paid for the following illnesses, among others: cancer in advanced stages; fully developed infectious AIDS; disorders of the nervous system, with unstoppable progressive paralysis; chronic kidney, liver, heart, digestive or pulmonary illness in a terminal stage. - Optionnelle : non · Limite : Top: up to 7 weeks - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = reimbursement excluded from the scope of benefits; Top = insured (reimbursement of 100 % of eligible expenses) - up to 7 weeks

Inpatient dental treatment - p. 10

Reimbursement of costs for complex oral surgical procedures with a greater than average incidence of life threatening complications, such as congenital jaw deformities (e.g. cleft jaw), fractures of the jaw and tumors. - Optionnelle : non - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Emergency dental treatment (inpatient) - p. 10

Emergency in-patient dental treatment refers to a serious accident requiring hospitalization (e.g. reconstruction of the jaw following accidental injury). The treatment must be received within 24 hours of the emergency event. Cover under this benefit does not extend to follow-up dental treatment, dental surgery, dental prostheses or implants, orthodontics or periodontics. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses) - Condition : The treatment must be received within 24 hours of the emergency event. - Condition : The treating doctor has to specifically confirm that the in-patient dental treatment is a consequence of a serious accident and the occurrence of the accident must be proved through a corresponding medical or police report.

Medical treatment (outpatient) - p. 11

All expenses incurred for examination, diagnosis and therapy within the framework of outpatient treatment, unless specifically mentioned elsewhere in the insurance policy. Expenses incurred for pathology, radiology, computer tomography, magnetic resonance imaging, positron emission tomography and palliative medicine will also be reimbursed. - Optionnelle : non · Franchise : Classic: € 250/$ 325/£ 210 per insurance year (outpatient) - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses) (Classic: with a deductible of € 250/$ 325/£ 210 per insurance year in each case); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Chemotherapy, oncological drugs and treatment (outpatient, e.g. for cancer patients) - p. 11

Chemotherapy, oncological drugs and treatment (e.g. for cancer patients) on an outpatient basis. - Optionnelle : non · Franchise : Classic: € 250/$ 325/£ 210 per insurance year (outpatient) - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses) (Classic: with a deductible of € 250/$ 325/£ 210 per insurance year in each case); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Health checks - p. 11

Routine health checks are tests or screenings that are carried out without any clinical symptoms being present. These tests include the following examinations performed, at an appropriate age, to detect illness or disease, for example: vital signs (blood pressure, pulse, respiration, temperature); lipid profile; cardiovascular exam; neurological exam; cancer screening; well-child test; diabetes test; HIV and AIDS test; gynaecological screening. - Optionnelle : non · Limite : Plus: up to € 500/ $ 650/ £ 420; Top: up to € 1,000/ $ 1,300/ £ 840 - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - up to € 500/ $ 650/ £ 420; Top = insured (reimbursement of 100 % of eligible expenses) - up to € 1,000/ $ 1,300/ £ 840

Vaccinations of every kind, including the vaccines and prophylactic measures - p. 11

Vaccinations of every kind, including the vaccines and prophylactic measures, insofar as these are recommended for the applicable country of residence. - Optionnelle : non · Limite : Plus: up to € 250/ $ 325/ £ 210; Top: no amount printed in the table - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - up to € 250/ $ 325/ £ 210; Top = insured (reimbursement of 100 % of eligible expenses)

Maternity care and childbirth, services of a midwife or obstetric nurse (outpatient) - p. 11

Eligible expenses resulting from pregnancy or pregnancy-related illness, including standard routine maternity scans, tests and all medically necessary diagnostic tests, including nuchal scan, amniocentesis and Chorionic Villus Sampling (CVS). NIPT and all other forms of genetic testing are excluded. Midwife services carried out by a licensed midwife are reimbursable; corresponding examination and treatment costs by midwives are only covered if the costs for the same services have not been charged by a doctor. In addition, 12 post-natal midwife home visits per pregnancy are covered. Doula services are not reimbursable. - Optionnelle : non · Limite : Plus: up to € 2,000/ $ 2,600/ £ 1,680 - Sous-limite : 12 post-natal midwife home visits per pregnancy - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - up to € 2,000/ $ 2,600/ £ 1,680; Top = insured (reimbursement of 100 % of eligible expenses)

Complications of pregnancy and childbirth (outpatient) - p. 11

Eligible expenses for premature birth, miscarriage, abortion which is medically necessary, stillbirth, ectopic pregnancy, hydatidiform mole, caesarean section, post-partum haemorrhage, retained placental membrane and complications following any of these conditions. - Optionnelle : non · Limite : Plus: up to € 10,000/ $ 13,000/ £ 8,400 - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - up to € 10,000/ $ 13,000/ £ 8,400; Top = insured (reimbursement of 100 % of eligible expenses)

Pre and post-natal classes - p. 11

Pre- and postnatal classes, depending on selected plan level. The classes must be performed by a qualified and licensed practitioner, such as midwife or physiotherapist. Yoga or Pilates classes are excluded from cover. - Optionnelle : non · Limite : Top: up to € 250/ $ 325/ £ 210 - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = reimbursement excluded from the scope of benefits; Top = insured (reimbursement of 100 % of eligible expenses) - up to € 250/ $ 325/ £ 210

Acupuncture (needle technique), homeopathy, osteopathy and chiropractic, including drugs and dressings - p. 11

A share of the eligible expenses is reimbursed only if the treatment is provided by doctors or other therapists who can prove that they have received the requisite training and are licensed or authorized to practise in the country in which treatment is provided. Drugs and dressings prescribed by such doctors or therapists during treatment will also be reimbursed. - Optionnelle : non · Limite : Plus: up to € 500/ $ 650/ £ 420; Top: up to € 1,000/ $ 1,300/ £ 840 - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - up to € 500/ $ 650/ £ 420; Top = insured (reimbursement of 100 % of eligible expenses) - up to € 1,000/ $ 1,300/ £ 840

Speech therapy - p. 11

Eligible expenses of medically prescribed exercises and therapy for treating voice and speech disorders, as long as the treatment is provided by a doctor or registered speech therapist. These costs are only refunded if approved in writing prior to starting treatment. - Optionnelle : non - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - provided that we have agreed in writing to pay benefits before treatment commences; Top = insured (reimbursement of 100 % of eligible expenses) - provided that we have agreed in writing to pay benefits before treatment commences - Condition : provided that we have agreed in writing to pay benefits before treatment commences

Psychiatric treatment (outpatient) - p. 11

Expenses incurred for outpatient psychiatric treatment, if and insofar as we have agreed in writing to reimburse these costs before treatment commences. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses) - provided that we have agreed in writing to pay benefits before treatment commences; Plus = insured (reimbursement of 100 % of eligible expenses) - provided that we have agreed in writing to pay benefits before treatment commences; Top = insured (reimbursement of 100 % of eligible expenses) - provided that we have agreed in writing to pay benefits before treatment commences - Condition : provided that we have agreed in writing to pay benefits before treatment commences

Outpatient psychotherapy - p. 11

The costs of outpatient psychotherapy will only be reimbursed if the treatment is provided by a psychiatrist, psychotherapist or other specialist with appropriate qualifications in the field of psychiatry, psychotherapy or psychoanalysis. Such treatment must be prescribed by a doctor before treatment commences and must specify the diagnosis, nature and number of sessions. Moreover, these costs will only be reimbursed if and insofar as we have agreed in writing to reimburse these costs before treatment commences. - Optionnelle : non · Limite : Plus and Top: up to 20 sessions - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - up to 20 sessions, provided that we have agreed in writing to pay benefits before treatment commences; Top = insured (reimbursement of 100 % of eligible expenses) - up to 20 sessions**, provided that we have agreed in writing to pay benefits before treatment commences - Condition : provided that we have agreed in writing to pay benefits before treatment commences

Drugs and dressings (outpatient) - p. 11

Drugs and dressings must have been prescribed by a doctor/dentist or other duly authorized therapist. Drugs must additionally be dispensed by a pharmacy or other officially approved dispensary. Nutriments, tonics, mineral water, cosmetics, hygiene and body care articles and bath additives will not be recognized as drugs. - Optionnelle : non · Franchise : Classic: € 250/$ 325/£ 210 per insurance year (outpatient) - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses) (Classic: with a deductible of € 250/$ 325/£ 210 per insurance year in each case); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Therapies/physiotherapy, including massages (outpatient) - p. 12

Physical-medical therapies (inhalation, physiotherapy and physical exercise, massage, packs, hydrotherapy, medical baths, cryo- and thermotherapy, occupational therapy, electrotherapy or light therapy), provided by a licensed doctor or by a licensed medical assistant (e.g. physiotherapist) and prescribed by a doctor. The prescription must have been issued before treatment commences and must specify the diagnosis, nature and number of sessions. Therapies/physiotherapy do not include other therapies, such as thermal baths, saunas and similar baths. The additional costs incurred for home treatment of the insured person are not reimbursable. - Optionnelle : non · Franchise : Classic: € 250/$ 325/£ 210 per insurance year (outpatient) - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses) (Classic: with a deductible of € 250/$ 325/£ 210 per insurance year in each case); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses) - Condition : If more than 20 sessions of physiotherapy are prescribed for a single diagnosis, prior approval will be required from us in writing.

Therapeutic aids and appliances (outpatient) - p. 12

Expenses incurred for artificial limbs and organs, as well as orthopaedic and other therapeutic aids and appliances designed to prevent, alleviate or compensate physical disabilities. They must be prescribed by a doctor and should not be daily commodities. They include: bandages, trusses, insole supports for shoes, walking aids, compression stockings, corrective splints, artificial limbs/prostheses (excluding dentures), plaster shells for lying and sitting, orthopaedic arm, leg and body braces, as well as speaking aids (electronic larynx). All other therapeutic aids and appliances are only eligible for reimbursement insofar as benefits have been approved in writing beforehand. Expenses for reasonable maintenance and reparation are reimbursed within the scope of these provisions. - Optionnelle : non · Limite : Plus: up to € 2,000/ $ 2,600/ £ 1,680 - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - up to € 2,000/ $ 2,600/ £ 1,680; Top = insured (reimbursement of 100 % of eligible expenses)

Wigs and prosthetic bras following cancer treatment - p. 12

Wigs and prosthetic bras for women following cancer treatment are reimbursed up to a maximum of € 300. - Optionnelle : non · Limite : up to € 300/ $ 390/ £ 252 in all three plan levels - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses) - up to € 300/ $ 390/ £ 252; Plus = insured (reimbursement of 100 % of eligible expenses) - up to € 300/ $ 390/ £ 252; Top = insured (reimbursement of 100 % of eligible expenses) - up to € 300/ $ 390/ £ 252

Nutritional consultations - p. 12

Eligible expenses for outpatient consultations with a nutritionist may be refunded upon diagnosis of a condition benefiting from nutritional advice enabling better manage the diagnosed condition. Such conditions include cancer, eating disorders, gastrointestinal disease, heart disease and food intolerances and allergies. These services must be prescribed by a doctor; the prescription must have been issued prior to the start of treatment and must specify the diagnosis, nature and number of sessions needed. - Optionnelle : non · Limite : Plus: up to € 125/ $ 162.50/ £ 105; Top: up to € 250/ $ 325/ £ 210 - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - up to € 125/ $ 162.50/ £ 105; Top = insured (reimbursement of 100 % of eligible expenses) - up to € 250/ $ 325/ £ 210

Podiatry - p. 12

Eligible costs for medically necessary podiatry treatment. These services must be prescribed by a doctor; the prescription must have been issued prior to the start of treatment and must specify the diagnosis, nature and number of sessions needed. - Optionnelle : non · Limite : Plus: up to € 100/ $ 130/ £ 84; Top: up to € 200/ $ 260/ £ 168 - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - up to € 100/ $ 130/ £ 84; Top = insured (reimbursement of 100 % of eligible expenses) - up to € 200/ $ 260/ £ 168

Vision aids - p. 12

Expenses incurred for spectacle frames and glasses, as well as for contact lenses, reimbursed up to the maximum limit altogether. - Optionnelle : non · Limite : Plus: up to € 100/ $ 130/ £ 84; Top: up to € 200/ $ 260/ £ 168 - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - up to € 100/ $ 130/ £ 84; Top = insured (reimbursement of 100 % of eligible expenses) - up to € 200/ $ 260/ £ 168

Hearing aids - p. 12

Eligible expenses for a medically prescribed hearing aid within the agreed scope of benefits. Expenses incurred for replacement batteries for hearing aids will not be reimbursed. - Optionnelle : non · Limite : Plus: up to € 1,000/ $ 1,300/ £ 840; Top: up to € 2,000/ $ 2,600/ £ 1,680 - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - up to € 1,000/ $ 1,300/ £ 840; Top = insured (reimbursement of 100 % of eligible expenses) - up to € 2,000/ $ 2,600/ £ 1,680

Transport to the nearest suitable doctor or hospital for initial treatment following an accident or an emergency - p. 12

Transport to the nearest suitable doctor or hospital for initial treatment following an accident or an emergency, by an approved emergency service with conveyances appropriate to the situation. - Optionnelle : non · Franchise : Classic: € 250/$ 325/£ 210 per insurance year (outpatient) - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses) (Classic: with a deductible of € 250/$ 325/£ 210 per insurance year in each case); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Infertility treatment - p. 12

Within the framework of the agreed scope of benefits, and provided that benefits have been pledged in writing beforehand, refund of the costs for the following diagnostic tests and treatments to increase fertility, as well as treatments to prevent future miscarriages, investigation into miscarriage and assisted reproduction and related complications: diagnostic investigations, consultations and tests including invasive procedures such as hysterosalpingogram, laparoscopy or hysteroscopy; laboratory work; prescribed drug treatment including but not limited to ovulation stimulation; Invitro fertilisation (IVF); Intracytoplasmatic sperm injection (ICSI); Gamete intrafallopian transfer (GIFT); Zygote intrafallopian transfer (ZIFT); Artificial insemination (AI). - Optionnelle : non · Limite : Plus: 50 % up to a maximum of € 7,500/ $ 9,750/ £ 6,300 per insured couple per lifetime; Top: 50 % up to a maximum of € 15,000/ $ 19,500/ £ 12,600 per insured couple per lifetime - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - 50 % up to a maximum of € 7,500/ $ 9,750/ £ 6,300 per insured couple per lifetime; Top = insured (reimbursement of 100 % of eligible expenses) - 50 % up to a maximum of € 15,000/ $ 19,500/ £ 12,600 per insured couple per lifetime - Condition : the woman is aged under 40 and the man under 50 at the time of treatment (first stimulation day in each treatment cycle or first cycle day in the case of insemination without hormone stimulation) - Condition : the insured person's sterile condition is due to organic causes and can only be overcome with the aid of reproductive help - Condition : both the man and the woman benefiting from the treatment are insured with us and are eligible for treatment on their selected plan level - Condition : provided that benefits have been pledged in writing beforehand

Basic dental services (section) - p. 13

Section heading of the dental table grouping the basic dental benefits listed below. General dental services: screenings for early detection of disorders of the teeth mouth and jaw; X-ray examination; intraoral local anesthesia in connection with minor dental services. Prophylactic services: tartar removal and polishing; professional teeth cleaning; assessment of oral hygiene status; local fluoridation for underage person; sealing caries-free tooth fissures for underage person. Conservative services: simple fillings related to cavity; root canal treatment in connection with a following simple filling. Surgical services: extraction of teeth; removal of a deeply fractured or tooth with deep destruction; hemisection or partial extraction; removal of a retained, impacted or misaligned tooth in an osteotomy; reimplantation of a tooth including simple fixation; excision of the mucosa or granulation tissue; resection of a root tip/root amputation and cystectomy. Services provided for diseases of the oral mucosa and periodontium: preparation and documentation of the status of the periodontium; local treatment of diseases of the oral mucosa; periodontal surgery (especially removal of subgingival concrements and root smoothing) closed procedure, the pocket depth must be more than 3 millimeters; flap surgery, open curettage including oteoplasty, the pocket depth must be more than 5 millimeters and the closed procedure took already place before. Insertion of occlusal splints and functional analysis/functional therapy are also listed under the minor dental services. - Optionnelle : non - Condition : Table of benefits: Classic = no mark printed on this section row; Plus = no mark printed on this section row; Top = no mark printed on this section row

Screenings for early detection of disorders of the teeth, mouth and jaw - p. 13

Screenings for early detection of disorders of the teeth, mouth and jaw. - Optionnelle : non - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Dental treatment - p. 13

Dental treatment. In the Classic plan level the table prints 'Pain relief treatment'. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses) - Pain relief treatment; Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

X-rays (dental) - p. 13

X-ray examination in connection with dental treatment. - Optionnelle : non - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Scale-and-polish cleaning - p. 13

Scale-and-polish cleaning (tartar removal and polishing, professional teeth cleaning). - Optionnelle : non - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Treating oral mucosa and paradontium - p. 13

Treating oral mucosa and paradontium. In the Classic plan level the table prints 'Pain relief only'. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses) - Pain relief only; Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Simple fillings related to cavity - p. 13

Simple fillings related to cavity. In the Classic plan level the table prints 'Pain relief only'. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses) - Pain relief only; Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Surgery, extractions, root-canal treatment (dental) - p. 13

Surgery, extractions, root-canal treatment. In the Classic plan level the table prints 'Pain relief only'. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses) - Pain relief only; Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Inclusion of an occlusal splint - p. 13

Inclusion of an occlusal splint without adjusting the surface; inclusion of an occlusal splint with surface adjustment; inspection of an occlusal splint or surface adjustments, e.g. additive or subtractive measures. - Optionnelle : non - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Accidental dental treatment - p. 13

Dental treatment required as a result of accidental injury to teeth, caused by direct external impact to the head e.g. falls, or other accidents causing injury by external force. Injury caused by eating/drinking or any injury caused by biting, chewing, clenching or grinding of teeth is not covered under this benefit type. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses) - Condition : The dentist's receipt must specifically confirm that treatment is a consequence of an accident. - Condition : Proof of the accident with a medical or police report is required.

Major dental services (section) - p. 13

Section of the dental table covering the major dental benefits listed below (dentures, implantological services, orthodontic treatment, dental laboratory work and materials, compilation of a plan of treatment and costs). Prosthetic services include impression or partial impression of a jaw for a situation model, preparation of a written schedule of treatment and charges, preparation of a destroyed tooth with plastic augmentation materials and pin to receive a crown, inlay/onlay, adhesive fasting, restoration of a tooth with a full or partial crown, insertion of a prefabricated crown in a child, provisional crowns/bridge, restoration of a partially edentulous arch with a bridge or prosthesis, telescopic crown and prosthesis, restoration of an edentulous jaw with a total prosthesis. Implantological services include implant-related analysis, use of an orientation splint/positioning splint, implant insertion (only 4 implants per jaw and supporting dentures), exposure of an implant, insertion of augmentation material, sinus floor elevation. - Optionnelle : non · Limite : Classic: reimbursement of 50 % for the following benefits if needed as a result of an accident; Plus: up to € 2,000/ $ 2,600/ £ 1,680; Top: up to € 5,000/ $ 6,500/ £ 4,200 - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits - Reimbursement of 50 % for the following benefits if needed as a result of an accident; Plus = insured (reimbursement of 100 % of eligible expenses) - Reimbursement for the following benefits up to € 2,000/ $ 2,600/ £ 1,680; Top = insured (reimbursement of 100 % of eligible expenses) - Reimbursement for the following benefits up to € 5,000/ $ 6,500/ £ 4,200 - Condition : * The specified maximum sums, maximum periods and lump sums apply per insured person and per insurance year.

Dentures (for example, prostheses, bridges and crowns, inlays, onlays) - p. 13

Dentures, for example prostheses, bridges and crowns, inlays, onlays. Pre- and post-treatments, e.g. dental treatments in connection with dental prostheses, are reimbursed as the expenses in the context in which they are prescribed or provided. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses) - Condition : Within the Major dental services limits of the selected plan level

Implantological services - p. 13

Implantological services, up to four implants per jaw and the dentures to be secured to these implants. - Optionnelle : non · Limite : up to four implants per jaw and the dentures to be secured to these implants, in all three plan levels - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses) - up to four implants per jaw and the dentures to be secured to these implants; Plus = insured (reimbursement of 100 % of eligible expenses) - up to four implants per jaw and the dentures to be secured to these implants; Top = insured (reimbursement of 100 % of eligible expenses) - up to four implants per jaw and the dentures to be secured to these implants - Condition : Within the Major dental services limits of the selected plan level

Orthodontic treatment (up to age 18) - p. 13

Orthodontic treatment for a child received before the date of their 18th birthday, including metal braces and retainers and a treatment plan. Medical necessity of orthodontic treatment is evaluated by us based on the Index of Orthodontic Treatment Needs (IOTN) from the British orthodontic society. Additional costs or services such as special braces e.g. lingual brackets as well as clear aligner e.g. Invisalign are not covered. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses) - Condition : Within the Major dental services limits of the selected plan level

Dental laboratory work and materials - p. 13

Dental laboratory work and materials. Dental materials and laboratory work will be indemnified on the basis of average prices in the country of treatment concerned. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses) - Condition : Within the Major dental services limits of the selected plan level

Compilation of a plan of treatment and costs (dental) - p. 13

Compilation of a plan of treatment and costs. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses) - Condition : Within the Major dental services limits of the selected plan level

24-hour phone and e-mail service with experienced counsellors, own doctors and specialists - p. 14

The assistance services are available 24 hours a day, 7 days a week, 365 days a year, through a multilingual team, assistance coordinators and doctors reachable on the number specified in the insurance documents. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Medical evacuation and repatriation - p. 14

Cross-border transport by ambulance if inpatient medical care in the country where the incident occurs is inadequate. The patient will be transported to a place more suitable for subsequent treatment in another country (within the selected geographical area), to the insured person's country of residence if the insured event has occurred outside this country, or to the insured person's last permanent place of residence in the country of departure or home country. If necessary for medical reasons, a doctor will also be organized to accompany the patient during transport. Return transport will not be covered. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses) - Condition : Evacuation or repatriation must have been prescribed by the treating doctor and must be medically necessary - Condition : Reimbursement of the costs must have been agreed by your relevant Globality Health service centre in advance.

Information on medical infrastructure - p. 14

Information on the medical care available locally, names and addresses of English, German, French or Spanish speaking local doctors and hospital services, as well as the addresses of hospitals, special clinics and the possibilities for transfer. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Support and information by our medical service (second opinion, monitoring of the course of the illness) - p. 14

Telephone contact with the medical branch of the Globality Health service centre as soon as initial medical support is required locally; information of relatives on request where technically possible; consultation of a second doctor to obtain a second opinion if potentially fatal illnesses or serious permanent disabilities are involved; help when planning admission to and discharge from hospital; monitoring of the course of an illness by doctors and assistance coordinators. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Assumption of costs guarantee (preparation for a stay in hospital) - p. 14

Settlement of the formalities necessary for guaranteeing the assumption of costs to doctors and/or the hospital, including medical review of the invoices to ensure they are reasonable, and agreement with the hospital on the invoicing address and terms of payment so that invoices are paid directly. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses) - Condition : If an emergency requiring inpatient treatment occurs, your relevant Globality Health service centre must be contacted as soon as possible. - Condition : If inpatient treatment is planned, your relevant service centre must be contacted at least seven days before admission to the hospital; this also applies in the case of outpatient surgery in lieu of inpatient treatment. - Condition : A cost estimate and medical report including the diagnosis, anamnesis and nature of planned treatment are required.

Organizational support in case of bereavement, share of repatriation costs - p. 14

Help in the event of death abroad: obtaining the death certificate or accident report insofar as this is permitted by law, contact with public authorities and consulates in the foreign country, establishing which surviving relatives are authorized to decide on repatriation or cremation, and handling all the formalities for repatriation or cremation or a local funeral. Reimbursement of the costs directly incurred for repatriating the deceased to the country of departure or home country (including all formalities), and of the costs for repatriating the urn to the country of departure or home country if the deceased has been cremated in the country of residence. Funeral costs as such will not be reimbursed. - Optionnelle : non · Limite : Classic: up to € 2,500/ $ 3,250/ £ 2,100; Plus: up to € 5,000/ $ 6,500/ £ 4,200; Top: up to € 10,000/ $ 13,000/ £ 8,400 - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses) - up to € 2,500/ $ 3,250/ £ 2,100; Plus = insured (reimbursement of 100 % of eligible expenses) - up to € 5,000/ $ 6,500/ £ 4,200; Top = insured (reimbursement of 100 % of eligible expenses) - up to € 10,000/ $ 13,000/ £ 8,400

Appropriate additional medical support - p. 14

General information (about the country, customs formalities) and medical information (vaccinations, medical information by telephone) in preparation for the journey, advice on the personal First Aid kit, general information on the nature, possible causes and possible treatment of an illness and explanation of the medical terms used, information on drugs and identical/comparable drugs, their side effects and interactions, and coordination and monitoring of outpatient treatment. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Online services - p. 14

A secure area of the website www.globality-health.com giving direct access to online services; access information is provided together with the Globality Service Card. - Optionnelle : non - Condition : Table of benefits: Classic = insured (reimbursement of 100 % of eligible expenses); Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Additional support (family visits and vital medication) - p. 15

Section row of the additional assistance table grouping the two benefits below (organizing visits for a relative to the patient; procurement and shipment of vital medication). - Optionnelle : non - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Organizing visits for a relative to the patient - p. 15

If an insured person receives inpatient treatment on account of a medical emergency (both in the country of residence and while travelling on holiday or on business), the Globality Health service centre will arrange for a member of the family to visit. Arrangements are made for one family member to travel to the hospital and back home if the stay in hospital lasts for more than seven days. The cost of transport (first class railway travel, economy class flight) and hotel accommodation (for up to seven days) is paid up to the specified maximum limit. - Optionnelle : non · Limite : Plus: up to € 1,500/ $ 1,950/ £ 1,260; Top: up to € 3,000/ $ 3,900/ £ 2,520 - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - up to € 1,500/ $ 1,950/ £ 1,260; Top = insured (reimbursement of 100 % of eligible expenses) - up to € 3,000/ $ 3,900/ £ 2,520 - Condition : only if your relevant Globality Health service centre has been contacted beforehand - Condition : if the stay in hospital lasts for more than seven days

Procurement and shipment of vital medication - p. 15

If an insured person depends on a supply of vital drugs which are not available in the country of residence, the Globality Health service centre can be asked to procure these - legally approved - drugs and to send them, insofar as their import and procurement are not prohibited by law. - Optionnelle : non - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses); Top = insured (reimbursement of 100 % of eligible expenses)

Organizing return journey - p. 15

If the return from the country of residence is delayed on account of a medical emergency rendering the insured person unfit to travel, the Globality Health service centre will ensure that hotel accommodation and flight reservations are altered accordingly. - Optionnelle : non · Limite : Plus and Top: up to € 2,000/ $ 2,600/ £ 1,680 - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - up to € 2,000/ $ 2,600/ £ 1,680; Top = insured (reimbursement of 100 % of eligible expenses) - up to € 2,000/ $ 2,600/ £ 1,680*

Travel costs of insured members to be with a family member who is at peril of death or who has died - p. 15

If an insured person is forced to return to his/her home country due to a serious illness/accident or death of a family member, reimbursement of the transport expenses (return train ticket in first class and plane ticket in tourist class, respectively) to the place of residence or the place of hospitalization of the family member in the country of origin, in the case of serious illness or accident, and to the place of burial in the country of origin, in the case of death of the family member. Serious illness and serious accident are considered to be that which endangers the life of the family member. For the purposes of this coverage, relatives are considered to be the spouse or unmarried partner as well as the parents and children of the insured. - Optionnelle : non · Limite : Plus: up to € 1,500/ $ 1,950/ £ 1,260; Top: up to € 3,000/ $ 3,900/ £ 2,520 - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - up to € 1,500/ $ 1,950/ £ 1,260; Top = insured (reimbursement of 100 % of eligible expenses) - up to € 3,000/ $ 3,900/ £ 2,520 - Condition : Return transport costs due to serious illness and serious accident are only reimbursable on condition that the corresponding Globality Health service centre is contacted in advance. - Condition : Transport costs due to death are only reimbursable prior to submission of the death certificate.

Travel costs for an accompanying person, in the event of repatriation of an insured person - p. 15

In the event of a medically necessary repatriation of an insured person, for which reimbursement of the costs has been agreed in advance and in accordance with No. 5.1 of the GCI, reimbursement of the travel costs (first class rail travel and economy class air ticket) for the accompanying person, to the insured person's last permanent place of residence in his/her home country or country of departure, or to the place where the insured person will receive inpatient treatment following the repatriation. - Optionnelle : non · Limite : Top: up to € 1,500/ $ 1,950/ £ 1,260 - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = reimbursement excluded from the scope of benefits; Top = insured (reimbursement of 100 % of eligible expenses) - up to € 1,500/ $ 1,950/ £ 1,260

Organizing return transport or care for the children - p. 15

If a medical emergency should make it necessary for both parents to receive inpatient treatment in the country of residence, a child welfare service is organized to look after the children for as long as inpatient treatment is necessary. If both parents suffer a medical emergency while travelling on holiday (maximum six weeks) and require inpatient treatment, return transport for the underage child/children with a companion to the momentary place of residence in the country of residence can be claimed. - Optionnelle : non - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = reimbursement excluded from the scope of benefits; Top = insured (reimbursement of 100 % of eligible expenses)

Help with psychological problems possibly attributable to the stay abroad - p. 15

If the stay abroad gives rise to psychological conflicts, the Globality Health service centre will provide psychological therapy by telephone and will also arrange for suitable local assistance if necessary. - Optionnelle : non · Limite : Plus: up to 3 calls; Top: up to 5 calls - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = insured (reimbursement of 100 % of eligible expenses) - psychological and therapeutic help by telephone; up to 3 calls; Top = insured (reimbursement of 100 % of eligible expenses) - psychological and therapeutic help by telephone; up to 5 calls

Document depot (safe custody, help in obtaining replacements) - p. 15

Copies of personal documents (e.g. passport, ID card, visa, credit card, driving licence, vehicle registration certificates, proof of vaccinations, allergy pass, business documents comprising up to 20 size A4 sheets) may be deposited with the Globality Health service centre in a sealed envelope with personal password. If the originals are lost - regardless of whether or not an insured event has occurred - the copies will be sent by surface mail, courier service or fax to help obtain replacements. The document depot is retained for five years unless updated. - Optionnelle : non - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = reimbursement excluded from the scope of benefits; Top = insured (reimbursement of 100 % of eligible expenses)

Organizing help in the event of legal difficulties - p. 15

Referral to English, German, French or Spanish-speaking lawyers or experts throughout the world. If necessary, the service centre will arrange for an advance to pay the lawyers' fees, courts costs or bail; the advance is not paid by the Globality Health service centre, it merely makes contact with bankers or relatives and can help in transferring the money if applicable. - Optionnelle : non - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = reimbursement excluded from the scope of benefits; Top = insured (reimbursement of 100 % of eligible expenses)

Procurement of intercultural training - p. 15

Referral to special institutions which provide specific training for the country and/or region concerned, taking into account aspects of living and working abroad, in preparation for the stay abroad. - Optionnelle : non - Condition : Table of benefits: Classic = reimbursement excluded from the scope of benefits; Plus = reimbursement excluded from the scope of benefits; Top = insured (reimbursement of 100 % of eligible expenses)

Exclusions

Exclusion	Description	S'applique à	Page
Accommodation in nursing home	We will not reimburse any costs incurred for accommodation in a nursing home.	all	p. 27
Acting or traveling against medical advice/failing to seek advice	We do not cover treatment required as a result of failure to seek or follow medical advice, or as a result of travelling against medical advice.	all	p. 27
Complications caused by excluded cover	We will not cover expenses caused by complications directly caused by and linked to an illness, injury or treatment for which we exclude or limit cover.	all	p. 27
Cosmetic/plastic surgery	Expenses incurred for cosmetic or plastic surgery and treatment will not be reimbursed.	all	p. 27
Detoxification programmes including therapies	Detoxification programmes including therapies for drug addiction and alcoholism are not covered by the insurance. Without affecting this provision, the contractual benefits will be paid for an initial detoxification for which reimbursement of the costs or benefits in kind cannot be claimed elsewhere. In the case of inpatient detoxification, only the expenses incurred for general basic hospital services will be reimbursed. We will not cover any other treatment caused by or directly associated with harmful, hazardous or addictive use of any substance including alcohol and drugs.	all	p. 27
Developmental disorders	The insurance does not cover any services, therapies, education testing, or training related to learning disabilities or disorders of psychological development, such as developmental delays, scholastic skills, pervasive disorders, mental retardation, perceptual handicap, brain damage not caused by accidental injury or illness, minimal brain dysfunction, dyslexia or apraxia.	all	p. 27
Epidemics, pandemics and disease outbreaks	Costs related to treatment and/or medical evacuations and/or repatriations directly or indirectly arising from epidemics, pandemics or disease outbreaks of comparable dimension which have been put under the control of the local public health authorities will not be reimbursed, unless otherwise agreed by us in writing.	all	p. 27
Experimental and investigational treatments	We will not cover any form of treatment or drug therapy which we consider to be experimental or investigational. A service, technology, supply, procedure, treatment, drug, device, facility, equipment or biological product is considered experimental or investigational when it does not comply with all the following requirements: it must have a final license and clearly stated approval from at least one of EMA (European Medicines Agency), FDA (Food and Drug Administration - phase III completed), European network for Health Technology Assessment (EUnetHTA) - interim approval is not sufficient, the approval is only eligible for the corresponding medical indications and conditions, and in case of procedures and approved clinical pathway guidance it must be clearly stated as such on one of the following guidelines: NICE, AWMF, AHRQ National Guideline; and all approvals and guidance must be conclusive and must not state the need for more research, or under research environment, or limited evidence, or insufficient evidence or lack of clinical utility.	all	p. 27
Eyesight	We will not cover any treatment or surgery to correct an insured person's eyesight, such as laser treatment, refractive keratotomy (RK) and photorefractive keratectomy (PRK).	all	p. 27
Force Majeure	Costs related to treatment and/or medical evacuations and/or repatriations directly or indirectly arising from force majeure and where we are prevented from providing assistance, or where the situation is taken out of our control by local authorities will not be reimbursed, unless otherwise agreed by us in writing. Force majeure may include, but is not limited to, events which are unpredictable, unforeseeable or unavoidable, such as earthquakes, extremely severe weather, fire, floods, landslides, subsidence, and any other act or event that is outside of our reasonable control.	all	p. 27
Genetic testing	We shall not be liable for costs of genetic testing, except where specifically named genetic tests are included within your plan, or where we specifically agree otherwise in writing.	all	p. 28
Illnesses, accidents and their consequences caused by intent (self-inflicted injuries including attempted suicide)	Illnesses and accidents, as well as their consequences, which have been caused by intent are excluded from the insurance cover. An illness or accident is considered to have been caused by intent if the person concerned had at least some idea of the consequences of his/her actions and accepted the fact of the damage caused.	all	p. 28
Injuries caused by military service	We will not cover illnesses and accidents and their consequences caused while the insured person is carrying out their military duties.	all	p. 28
Need for long-term care and custody	We will not refund any costs incurred for accommodation in conjunction with the need for long-term care and custody.	all	p. 28
Non-medical hospital expenses	Accompanying partner, all non-medical consumables and catering and all media related expenses (such as TV and radio) are not covered.	all	p. 28
Nuclear, chemical and biological contamination	We do not cover illnesses and accidents, as well as their consequences, which have been caused by nuclear energy (nuclear reactions, radiations, and contamination), as well as illnesses and accidents and their consequences caused by chemical or biological weapons.	all	p. 28
Sex change	We will not cover changing the biological sexual characteristics, by surgery and hormone treatment, to those of the opposite sex.	all	p. 28
Sterilisation, sexual dysfunction and contraception	We will not cover any procedure aimed at making a person unable to reproduce, any procedure, treatment or medication to prevent a pregnancy or any treatment of sexual dysfunction (unless part of IVF treatment).	all	p. 28
Spa and wellness massages	We will not cover stays or treatments in a cure centre, a bath centre, a spa, a health resort or a recovery centre, even if they are medically prescribed. This also includes thermal baths, saunas and any kind of wellness massages.	all	p. 28
Surrogacy	We will not refund the cost of treatments directly relating to surrogacy, whether you are acting as a surrogate or are the intended parent. Children born to a surrogate mother are excluded from cover.	all	p. 28
Termination of pregnancy	We will cover termination of pregnancy in case of physical life threatening danger to the pregnant woman or if the foetus has become non-viable, and only if agreed by us in writing prior to the treatment. The above conditions must be proven by necessary medical investigation reports and a medical report from the doctor, providing the reasons for termination of the pregnancy.	all	p. 28
Therapies and treatment in sanatoriums, convalescent and nursing homes as well as specific rehabilitation measures	We will not cover therapies and treatments in sanatoriums or convalescent and nursing homes. However, depending on the plan level you have chosen, we will refund a share of the expenses for follow-up rehabilitation.	all	p. 28
Transport costs	Unless we have provided you with a prior approval in writing, we will not refund your transport costs other than emergency ambulance services.	all	p. 28
Treatment by certain doctors, dentists and other therapists, as well as in certain hospitals	This includes treatment by doctors, dentists, other therapists and in hospitals whose invoices have been excluded from reimbursement by us for an important reason. However, this exemption from the obligation to pay benefits only applies to those insured events which occur after you and the insured persons have been informed of this exclusion of benefits. If an insured event has already occurred at the time of notification, our exemption from benefits will only apply for those expenses which are incurred more than three months after notification.	all	p. 28
Treatment by marital or non-marital partners, parents or children	Costs for treatment by marital or non-marital partners, parents or children will not be reimbursed. The proven cost of materials necessary for the treatment will, however, be reimbursed in accordance with the plan.	all	p. 29
Vitamins and minerals	We will not refund the costs of products classified as vitamins or minerals (except where medically necessary during pregnancy or to treat diagnosed, clinically significant vitamin-deficiency syndromes), dietary supplements, including, but not limited to, special infant formula and cosmetic products, even if medically recommended, prescribed or acknowledged as having therapeutic effects. We do not recognise nutriments, tonics, mineral water, cosmetics, hygiene and body-care products and bath additives as medically necessary. Because of this we will not refund the costs of them.	all	p. 29
War, civil unrest, acts of terrorism	The insurance does not cover illnesses or accidents and their consequences, as well as death attributable to acts of war, civil unrest or acts of terrorism, unless the insured person is injured as an uninvolved third party who has not wilfully or negligently disregarded the danger and the insured person has not deliberately entered the area of conflict. Insurance cover shall not be granted under any circumstances if the uninvolved third party enters an area of direct warfare or renders services for one of the warring parties. The exclusion of benefits shall apply regardless of whether or not war has been declared. If the insured person acquires knowledge of the war, civil unrest or terrorist acts while in the country, the insurance will only cover emergency, life-saving treatment and only for as long as the insured party is prevented from leaving the country or region concerned, but for not more than 28 days at most.	all	p. 29
Treatment beyond what is medically necessary / not usual, customary and reasonable	If the treatment or other measure for which benefits have been agreed is more than is medically necessary or if the amount claimed for is not usual, customary and reasonable, we will be entitled to reduce its payment/reimbursement and the insured person shall be responsible for all costs, which are not usual, customary and reasonable, as we do not cover any amount, which is not usual, customary and reasonable. We reserve the right to have any cost or cost estimate evaluated by doctors in order to establish if a cost can be considered usual, customary and reasonable.	all	p. 29
International sanctions	In the interest of all involved parties, we will follow the international sanctions regulations in force. We shall not be deemed to provide cover and shall not be liable to pay any claim or provide any benefit under this insurance policy to the extent that the provision of such cover, payment of such claim or provision of such benefit would expose us to any sanction, prohibition or restriction under united Nations resolutions, to the trade or economic sanctions, laws or regulations of the European union or the united Kingdom, or to sanctions of the united States of America.	all	p. 29
Fluoridation of tooth surface and fissure sealing for adults	Listed under the exclusions of the dental chapter (No. 4.8).	Dental treatment	p. 22
Veneers including partial front teeth crowns	Listed under the exclusions of the dental chapter (No. 4.8).	Dental treatment	p. 22
Bleaching or any related cosmetic and aesthetic services	Listed under the exclusions of the dental chapter (No. 4.8).	Dental treatment	p. 22
Sedation/anaesthesia (dental)	Listed under the exclusions of the dental chapter (No. 4.8).	Dental treatment	p. 22
Pain and anxiety-relieving measures (dental)	Pain and anxiety-relieving measures, such as acupuncture, hypnosis, general anaesthesia, sedation with laughing gas, twilight sleep anaesthesia. Exceptions to this rule are: if an anxiety disorder has been diagnosed by a qualified specialist, Globality will cover the costs for children up to the age of 12; in addition in case of failure of local anesthesia; treatment under local anesthesia to be considered impossible due to severe psychologically and physically disabled patient.	Dental treatment	p. 22
Insured events occurring before inception of the insurance	Insured events occurring before inception of the insurance will not be indemnified. Insured events occurring after conclusion of the insurance policy are only excluded from indemnification insofar as they occur before inception of the insurance.	all	p. 5
Journeys undertaken for the purpose of obtaining treatment in geographical area I	Journeys undertaken for the purpose of obtaining treatment in geographical area I are not insured (where geographical area II - worldwide excluding USA - has been agreed).	Temporary exit from geographical area II	p. 7
Deluxe rooms, executive rooms and suites	Accommodation means standard private or semiprivate accommodation as shown in the table of benefits. We will not cover any sort of deluxe rooms, executive rooms and suites.	Accommodation in a private or semi-private room	p. 16
Nutriments, tonics, mineral water, cosmetics, hygiene and body care articles and bath additives	Nutriments, tonics, mineral water, cosmetics, hygiene and body care articles and bath additives will not be recognized as drugs.	Drugs and dressings (inpatient)	p. 17
Thermal baths, saunas and similar baths	Therapies/physiotherapy do not include other therapies, such as thermal baths, saunas and similar baths.	Therapies/physiotherapy, including massages (inpatient)	p. 17
Home treatment additional costs (outpatient physiotherapy)	The additional costs incurred for home treatment of the insured person are not reimbursable.	Therapies/physiotherapy, including massages (outpatient)	p. 20
Screenings related to pregnancy (inpatient maternity row)	The inpatient benefit row covers medical treatment related to pregnancy and childbirth and services of a midwife or obstetric nurse in the hospital, but excluding screenings related to pregnancy.	Medical treatment related to pregnancy and childbirth, services of a midwife or obstetric nurse in the hospital	p. 9
Doctor fees for midwife led birth	Midwife services during delivery are covered only in the case of midwife led birth. Doctor fees are not covered in these cases unless medically required following a complication during birth.	Medical treatment related to pregnancy and childbirth, services of a midwife or obstetric nurse in the hospital	p. 17
Complications of assisted conception or childbirth under the newborn benefit	Complications of assisted conception or childbirth, including premature or multiple births, are excluded from the newborn care benefit.	Newborn care	p. 17
Treatments and periods of residence in health resorts, spas, sanatoria or convalescent homes and nursing homes	Treatments and periods of residence in health resorts, spas, sanatoria or convalescent homes and nursing homes are not covered by the insurance (follow-up rehabilitation section).	Inpatient follow-up rehabilitation	p. 18
Follow-up treatment after emergency dental treatment	Cover under the emergency dental treatment benefit does not extend to follow-up dental treatment, dental surgery, dental prostheses or implants, orthodontics or periodontics.	Emergency dental treatment (inpatient)	p. 19
NIPT and all other forms of genetic testing (maternity)	NIPT and all other forms of genetic testing are excluded from the outpatient maternity care benefit.	Maternity care and childbirth, services of a midwife or obstetric nurse (outpatient)	p. 19
Doula services	Doula services are not reimbursable.	Maternity care and childbirth, services of a midwife or obstetric nurse (outpatient)	p. 19
Yoga or Pilates classes	Yoga or Pilates classes are excluded from cover under the pre and post-natal classes benefit.	Pre and post-natal classes	p. 19
Replacement batteries for hearing aids	Expenses incurred for replacement batteries for hearing aids will not be reimbursed.	Hearing aids	p. 21
Special braces and clear aligners	We will not cover additional costs or services such as special braces e.g. lingual brackets as well as clear aligner e.g. Invisalign.	Orthodontic treatment (up to age 18)	p. 22
Dental injury caused by eating/drinking, biting, chewing, clenching or grinding	We will not cover injury caused by eating/drinking or any injury caused by biting, chewing, clenching or grinding of teeth under the accidental dental treatment benefit type.	Accidental dental treatment	p. 22
Return transport after medical evacuation/repatriation	Return transport will not be covered (medical evacuation and repatriation).	Medical evacuation and repatriation	p. 23
Funeral costs	Funeral costs as such will not be reimbursed.	Organizational support in case of bereavement, share of repatriation costs	p. 24
Fraud	Entitlement to benefits does not exist if benefits are claimed incorrectly or fraudulently, or if third parties have fraudulently sought to obtain benefits under the present contract without legal foundation, but with your consent. All rights to benefits under this insurance policy will be extinguished in such cases. Payments remitted prior to disclosure of the fraudulent actions must be repaid to our company in the full amount.	all	p. 33

Franchises

• Standard : Plan level Classic: fixed deductible of € 250/$ 325/£ 210
• Variable : Plan levels Plus and Top: with or without optional deductible of € 250/$ 325/£ 210, € 500/$ 650/£ 420 or € 1,000/$ 1,300/£ 840
• Outpatient expenses : The deductibles apply exclusively for outpatient expenses. Deductibles apply per insurance year and per insured person. If a deductible has been agreed, we will reimburse 100 % of the eligible expenses insofar as these exceed the deductible. Expenses are ascribed to the insurance year in which the doctor/therapist was consulted and in which the drugs, dressings and therapeutic aids and appliances were obtained.

Délais d'attente

• all : No. 2.4 “No waiting periods”: There are no waiting periods. p. 5
• Insurance of newborn babies : The newborn baby is insured as from the moment of birth, without qualifying periods, provided that at least one parent is insured under this plan on the day on which the child is born and we receive the application for insurance within two months of the date of birth. p. 35

Obligations de l'assuré

• Any questions in the membership form concerning your current state of health and existing medical conditions must be answered completely and correctly. If insurance cover is required for another person, he or she will also be responsible - together with you - for ensuring that the questions are answered completely and correctly. We will grant insurance cover in good faith, assuming that you have correctly and completely answered all the relevant questions raised before conclusion of the contract (precontractual duty to disclose information). (Before conclusion of the contract / when joining the group contract · Inadvertent violation: we may terminate insurance under the group contract within one month of being informed of the violation, provided that we can prove that we would not have insured the risk in any case (No. 2.6). Wilful violation which changes our assessment of the risk: insurance cover under the group contract is null and void, the insurance benefits received must be repaid and premiums paid will not be refunded (No. 2.7).) p. 4
• It is the obligation of the policyholder to ensure compliance with local social security provisions and regulations for all insured persons under the insurance policy. (During the contract · We reserve the right to terminate the group contract or to exclude single persons from the insurance cover if the insurance cover is or becomes non-compliant with national laws or regulations applicable in the home country or in the country of residence.) p. 4
• You must report a long-term change of geographical area for any insured person without delay as such a change will affect the amount of premium payable. (Without delay) p. 7
• All invoices need to be retained. We recommend that invoices only be submitted when the amount of the agreed deductible has been exceeded. (During the insurance year) p. 8
• Your relevant Globality Health service centre must be contacted before or upon admission to the hospital. If inpatient treatment is planned, your relevant service centre must be contacted at least seven days before admission to the hospital; this also applies in the case of outpatient surgery in lieu of inpatient treatment. (Before or upon admission; at least seven days before a planned admission) p. 16
• Hospital treatment must be reported to us without delay. It is sufficient to inform your relevant Globality Health service centre of such treatment. (Without delay · Any neglect of the conditions precedent specified in Nos. 8 a) to e) will relieve us from our obligation to pay benefits, or entitle us to limit our benefits, subject to the restriction specified in the legal regulations. However, this only applies in cases of wilful intent or gross negligence.) p. 33
• You and the insured persons are obliged to provide all the information requested by us or the relevant Globality Health service centre in order to establish the occurrence of an insured event or to establish our obligation to pay benefits and the amount of benefit due. In addition, you must allow us or our assisteur to obtain all further information required in this context (above all by releasing medical professionals from their duty of confidentiality). (On claim · Any neglect of the conditions precedent specified in Nos. 8 a) to e) will relieve us from our obligation to pay benefits, or entitle us to limit our benefits. However, this only applies in cases of wilful intent or gross negligence.) p. 33
• We may request that you or the insured persons be examined by a doctor authorized by our company. We will reimburse the cost of such examinations and any travel expenses incurred in this context upon submission of documentary proof. (On request · Any neglect of the conditions precedent specified in Nos. 8 a) to e) will relieve us from our obligation to pay benefits, or entitle us to limit our benefits. However, this only applies in cases of wilful intent or gross negligence.) p. 33
• You and the insured persons must make every effort to minimize the damage and desist from all actions detrimental to your or their convalescence. (On claim · Any neglect of the conditions precedent specified in Nos. 8 a) to e) will relieve us from our obligation to pay benefits, or entitle us to limit our benefits. However, this only applies in cases of wilful intent or gross negligence.) p. 33
• You and the co-insured persons must behave cost-consciously when an insured event occurs and limit expenses for treatment to the extent necessary, which may include opting for generic medication instead of branded medication. (On claim · Any neglect of the conditions precedent specified in Nos. 8 a) to e) will relieve us from our obligation to pay benefits, or entitle us to limit our benefits. However, this only applies in cases of wilful intent or gross negligence.) p. 33
• If you or an insured person can claim non-insurance damages of any kind from a third party, you or the insured person are obliged to assign such claims to us in writing up to the amount to which expenses are reimbursed under the insurance policy, notwithstanding the statutory subrogation. (When a third-party claim exists · If you or an insured person surrender such a claim or a right serving to secure the claim without our consent, we shall be relieved from our obligation to pay benefits insofar as we could have obtained compensation from the claim or right.) p. 33
• If benefits can also be claimed from a statutory health insurance fund, statutory or private personal accident insurance, statutory pension insurance fund or any other provider of benefits or institution, the insured person is obliged to assign all such rights to us. (When such rights exist) p. 29
• Declarations of intent, conversions and notices concerning the insurance policy must always be addressed to us in writing. Please inform us of your new address or new name without delay, otherwise important information from us may not reach you on time or not at all. Let us know your new bank account number without delay so that we can remit our payments to the correct account. Please let us know if you have new credit card data and we will send you a new SaferPay link to update your details. (Without delay) p. 35
• The newborn baby is insured as from the moment of birth, without qualifying periods, provided that at least one parent is insured under this plan on the day on which the child is born and we receive the application for insurance within two months of the date of birth. (Within two months of the date of birth · If the application for insurance is received more than two months after the date of birth, insurance cover will commence - at the earliest - on the day on which we receive the notification. If the birth is reported after expiry of the two-month period, a premium loading of not more than 100 % may be charged in addition to the plan premium following an assessment of the risk.) p. 35

Procédure de sinistre

1. Claims for insurance benefits must be asserted and the relevant invoices submitted without delay when the treatment is ended. We are only obliged to indemnify you when we have received all the invoices and documents requested by us; these invoices and documents become our property and we reserve the right to archive them. (délai : Without delay when the treatment is ended) p. 30
2. Unless agreed otherwise with you, please send the invoices directly to your relevant Globality Health service centre when an insured event occurs. Always hand in original documents in conformity with the respective legal regulations for invoices typical of the country concerned. Documents and invoices sent by fax or e-mail are also accepted, provided that the transmission quality permits subsequent processing; in justified cases original documents may be requested. If another health insurer or other institution has reimbursed part of the costs, duplicates of the invoices or documents with the other insurer's or institution's original confirmation of reimbursement are sufficient. p. 30
3. Invoices must specify: first name and surname, as well as the date of birth of the insured person; a precise designation of the illness (diagnosis) or otherwise a description of the symptoms by the doctor; the individual medical services and treatment data with unit price; where dental treatment is concerned, which teeth have been treated or replaced and which services have been rendered in each instance. All documents or invoices should preferably be issued in English, German, French, Dutch or Spanish and must use Arabic numerals and Latin characters as well as the ICD Code 9 or 10. Prescriptions must specify the first name and surname, date of birth of the insured person, the drugs prescribed, their price and the receipt of payment, and must be submitted together with the corresponding doctor's invoice; invoices for therapies and therapeutic aids and appliances must be submitted with the corresponding prescription. If substitute hospital cash plan benefits are claimed instead of reimbursement of costs, a certificate confirming the inpatient treatment must be submitted with the first name, surname and date of birth of the person receiving treatment, the diagnosis, the date of admission and discharge, as well as the duration of leave if applicable. p. 31
4. Wherever possible, please use our “Health Insurance Claim Form” in order to apply for reimbursements; this form can be downloaded from our website or obtained from your relevant Globality Health service centre and must be signed by your doctor. p. 31
5. You can contact us at any time, day or night. Addresses, telephone numbers and e-mail address are stated in all our documents. If an insured person contacts the relevant Globality Health service centre following the occurrence of a major insured event, particularly following an accident, emergency or in the case of inpatient treatment, we will offer to call back immediately. p. 31
6. At your request, fixed costs, such as the rate for nursing care or the surcharge for hospital accommodation or the fee for transport by ambulance, can be paid directly to the party issuing the invoice. In addition, you may also assign your entitlement to reimbursement from us to the party providing the treatment or services, for instance by signing a so-called declaration of assignment for the hospital. However, we can only pay the costs directly if the hospital agrees to this procedure and if this is in keeping with the customs typical of the country concerned. p. 31
7. You or the insured person are the contractual partner of the doctor/therapist consulted. When treatment commences, the doctor/therapist will conclude a contract for treatment with the insured person as the basis on which he/she can subsequently draw up an invoice. You can then present this invoice to your relevant Globality Health service centre so that the contractually agreed benefits can be paid out to you from there. p. 31
8. As a rule, benefits are paid according to the principle of reimbursement: we will reimburse the eligible costs incurred within the framework of medical treatment. As a special service at your request, we can pay our reimbursement directly to the party issuing the invoice, provided that they agree to such direct payment and this is not prevented by legal considerations. p. 31
9. The euro (€) is the basic currency for all our plans; US dollar ($) or pounds Sterling (£) can also be selected as the contractual currency. Invoices are reimbursed in the currency agreed with you. Foreign-currency costs are converted at the actual rate applicable on the day that the invoice was issued, unless you can submit bank vouchers proving that you purchased the necessary currency at a less advantageous rate in order to pay the invoices. p. 32

Durée & résiliation

• Durée : The insurance cover commences on the date specified in the group contract and runs for 12 months. The insurance year for the individuals who join the insurance policy commences on the date indicated on their insurance certificate (inception of insurance) and runs until the renewal date of the group contract. Insurance cover for you and the insured persons commences on the date specified in the insurance certificate (inception of insurance).
• Préavis : Notice of termination of insurance under the group contract must be given in writing. Unless specified otherwise, the termination shall only become effective upon expiry of a period of at least one month as from the day following delivery or the date on which receipt is confirmed or from the date of delivery in the case of registered mail.
• Modalité : Notice of termination of insurance under the group contract must be given in writing.
• Modalité : If you have joined the group contract by submitting an application for membership, cancellation is done by sending notice of cancellation to the insurer; the cancellation is only valid if you can prove that the insured persons concerned have been informed of the cancellation.
• Droit spécial : Amendment of the General Conditions of Insurance (see No. 10.1) or imposition of higher fees, deductibles and premiums, insofar as premiums must be paid by you as insured person (see No. 9): you may give notice of termination within three months of receiving notice of the change, with effect as per the date on which the change comes into force.
• Droit spécial : Inadvertent violation of the duty to disclose information: we shall be entitled to terminate insurance under the group contract within one month of being informed of the violation of duty, provided that we can prove that we would not have insured the risk in any case.
• Droit spécial : Sanctions/prohibitions under United Nations resolutions, EU or UK trade or economic sanctions or US sanctions hindering us from providing cover: extraordinary right of termination of the group contract, or exclusion of the affected persons from the insurance cover.
• Droit spécial : Wilful violation of the duty to provide information changing our assessment of the risk: insurance cover under the group contract shall be null and void; you will be obliged to repay the insurance benefits received and premiums paid will not be refunded (No. 2.7).
• Droit spécial : Ending of insurance cover (No. 2.8): a) when the group contract is ended by the policyholder or by us; b) when you or the insured persons are no longer eligible for insurance (see No. 1.1), for instance if you change your employer or upon completion of your delegation abroad as ordered by your employer; c) when you or the insured persons die(s); d) when you cancel your participation in the group contract or that of an insured person; e) if the insurance is null and void (see No. 2.7).
• Droit spécial : Insurance cover always ends - also for pending, i.e. ongoing insured events - when the group contract or insurance relationship ends.
• Droit spécial : If the premium has still not been paid ten days after expiry of the additional time-limit, we will be entitled to terminate the insurance with immediate effect. The insurance policy is deemed to have been terminated if premiums are not paid for a period of more than two years.

Prime

• Indexation : The euro (€) is the basic currency for all our plans. However, US dollar ($) or pounds Sterling (£) can also be selected as the contractual currency. The exchange rates for these currencies are reviewed by the insurer every January and July and adjusted as required. This may result in higher or lower premiums if the contractual currency has to be brought into line with the rate of exchange of the euro. (No. 7.8, page 32)
• The amount of premium, due date and terms of payment are governed by the agreements reached in the group contract. If the premium is stated in the insurance certificate, any additional premium loading will be stated separately.
• If the insurance does not commence on the first day of a calendar month and/or does not end on the last day of a calendar month, only a prorated monthly premium will be payable for the first and/or last insurance month.
• Belated payment (where premiums are to be paid by you as insured person): if the agreed premium is not paid within ten days of the due date, we may demand payment upon expiry of this time-limit. If the premium has still not been paid within 30 days of receiving the demand for payment, we will be relieved of our obligation to indemnify for all insured events occurring after expiry of the time-limit, as permitted by Article 21 of the Luxembourg Act of 1997 concerning insurance contracts. You remain obliged to pay premiums in the future.
• If the insurance policy is not terminated, our obligation to indemnify will be reinstated for all new insured events occurring if you have paid the sums and proven default costs due up to this point in time; insurance cover will then resume at midnight of the day on which we or our duly authorized person receive all outstanding sums.
• A long-term change of geographical area for any insured person must be reported without delay as such a change will affect the amount of premium payable (No. 3.2, page 7).
• Existing medical conditions: where the group contract stipulates health questions and a health check, we may charge a higher premium and/or exclude certain benefits insofar as a higher risk exists (No. 1.2, page 4).
• Newborn babies: if the birth is reported after expiry of the two-month period, a premium loading of not more than 100 % may be charged in addition to the plan premium following an assessment of the risk (No. 10.3, page 35).

Conditions particulières

• The insurance policy is designed for expatriates. All employees/members of the policyholder who temporarily reside in a foreign country for at least three months by order of the policyholder or for business purposes are eligible for insurance. The marital or non-marital partner and children accompanying the insured person may also be insured. Whilst we will endeavour to take all appropriate measures to ensure compliance of the insurance cover abroad, we have no control over adherence to other possible requirements. p. 4
• Unless specified otherwise in the group contract, existing medical conditions are always included in the insurance. Depending on the agreement reached with the policyholder in the group contract, however, the group contract may stipulate that the health questions contained in the membership form must be answered completely and correctly and that each insured person must undergo a health check (see No. 1.3). In such cases, we may charge a higher premium and/or exclude certain benefits insofar as a higher risk exists. p. 4
• To join the group contract, you will either be registered by the policyholder or you must complete a membership form with which you can also purchase insurance for your marital or non-marital partner and children. The registration procedure is defined in the group contract. We have the right to request further data should it be necessary for legal or compliance reasons or underwriting purposes. The membership form can be sent to us by surface mail, e-mail or fax. p. 4
• The plan comprises three plan levels - Classic, Plus and Top - with outpatient, inpatient, dental and assistance modules in each case. The individual plan levels differ with regard to the type and amount of benefits agreed. Which plan level can be insured and which combination of modules can be agreed for the insurance in question is governed by the group contract. In accordance with the agreed plan level/combination of modules, we will reimburse 100 % of the eligible expenses as specified in the tables setting out the scope of benefits, unless stipulated otherwise in these tables, the general provisions of the General Conditions of Insurance, the group contract or the definitions. p. 8
• Insurance cover applies in the following geographical areas: Geographical area I: Worldwide including USA; Geographical area II: Worldwide excluding USA. p. 7
• If insurance cover “Geographical area II - Worldwide excluding USA” has been agreed: during periods of temporary absence from the country of residence (i.e. for not more than six weeks), we will grant insurance cover for medical emergencies, as well as for the consequences of an accident or death, even in geographical area I. If an eligible medical emergency occurs, we may transfer you to another country for treatment, if medically appropriate and if the situation allows. Journeys undertaken for the purpose of obtaining treatment in geographical area I are not insured. p. 7
• The insured person is free to choose from all the doctors and dentists who are licensed to provide medical or dental treatment in the country in which treatment is provided. Other therapists must have completed an approved and soundly based course of training in their field of therapy. Fees will be reimbursed for medical and dental treatments if they are reasonably calculated according to an acknowledged rate of fees typical for the country in question (e.g. official schedule of doctors' fees). Services by other therapists, such as midwives, for whom a separate acknowledged rate of fees may not exist in the country of treatment, will be based on the comparable fees for doctors or customary prices in the country of treatment. p. 16
• Within the scope of the insurance policy, we will reimburse the expenses incurred for examination and treatment methods, as well as drugs, which are generally accepted by conventional medicine in the country of residence. In addition, we will also reimburse the costs incurred for methods and drugs which have proved promising in practice or which are employed because conventional methods or drugs are not available; however, our benefits may be limited to the sums which would have been payable had conventional methods and drugs been available. p. 16
• The newborn baby is insured as from the moment of birth, without qualifying periods, provided that at least one parent is insured under this plan on the day on which the child is born and we receive the application for insurance within two months of the date of birth. The insurance cover for the newborn child must not be greater or more comprehensive than that of one insured parent. Adopting a child is equivalent to giving birth, provided that the child is still a minor at the time of adoption. A premium loading of up to 100 % may be agreed in the case of a higher risk. p. 35
• We may amend or change the general conditions of insurance. We will inform you in writing about the amended or changed general conditions of insurance at least three months before the beginning of the next insurance year. The amendment or change will then apply from the beginning of the next insurance year. If you do not agree, you may terminate the insurance policy within three months of receiving our notice; the policy will end on the date on which the change would otherwise become effective. p. 35
• You agree that any information owed by us in application to the insurance policy or pursuant to any applicable law be validly supplied on paper or electronically, through the website of Foyer Global Health S.A., by e-mail or by any other mean of communication agreed between you and us. If you do not react within a period of sixty days from the date of the information, you will be deemed to have accepted it and agree to be bound by it on your own as well as on behalf of the insured persons and any other person whom you represent by law. p. 35
• Do not hesitate to contact us by surface mail, telephone, fax or e-mail if you have a suggestion or are dissatisfied with us: Foyer Global Health S.A., 12, rue Léon Laval, L-3372 Leudelange, Luxembourg, feedback@globality-health.com. You can naturally also contact the ombudsman for insurances (A.C.A. - Association des Compagnies d'Assurance - 12, rue Erasme, L-1468 Luxembourg, in cooperation with the U.L.C. - Union Luxembourgeoise des Consommateurs - 55, rue des Bruyères, L-1274 Howald) or the supervisory authority responsible for all private health insurers in Luxembourg: Commissariat aux Assurances, 11, rue Robert Stumper, L-2557 Luxembourg. p. 36
• All disputes arising from the group contract will be brought before a court of law in the Grand Duchy of Luxembourg or before a court of law in the town in which the policyholder has its registered office or in which the insured persons reside. If the policyholder's registered office or the insured person's place of residence is not in one of the member states of the European Union, jurisdiction will rest exclusively with the courts of law in the Grand Duchy of Luxembourg. p. 36
• Unless national regulations stipulate the application of a different national law or a different national law has been contractually agreed, the group contract and the insurance relationship will be governed by the law of the Grand Duchy of Luxembourg. p. 36
• The contractual language is English. Unless we agree otherwise with you, all correspondence between you and us will be in English. In any case, the English version of the General Conditions of Insurance (GCI) will prevail over any other language or translation. p. 36
• You or the insured persons may only set off against our claims if the counterclaim is undisputed or has been established without appeal being granted. p. 33
• Please note that it is standard practice in certain areas that your provider will ask for credit card details as a guarantee of payment. If deductibles apply, or if costs exceed your specific insurance limits, then your credit card might be charged with these expenses. p. 24
• In the event that a sanction, prohibition under United Nations resolutions, trade or economic sanctions, laws or regulations of the European Union or the United Kingdom, or sanctions of the United States of America are imposed which hinder us, directly or indirectly, from providing insurance cover under this group contract, we shall have an extraordinary right of termination of this group contract or may exclude affected persons from the insurance cover. p. 5

Lacunes d'extraction

• Risk carrier: the document names only one insurance undertaking, “Foyer Global Health S.A., 12, rue Léon Laval, L-3372 Leudelange, Luxembourg”, states that “The supervisory authority for Foyer Global Health S.A. can be contacted at the following address: Commissariat aux Assurances” and prints “R.C.S. Luxembourg B 134.471” (pages 2 and 41). The text never uses an explicit carrier verb (“insured by” / “underwritten by”); it refers to the carrier throughout as “we”/“the insurer” and to “Globality Health” and “Globality Health service centre” as the service brand/network, and to a distinct, unnamed “assisteur” (defined on page 37). The identification of Foyer Global Health S.A. as the carrier therefore rests on the supervisory-authority sentence, the R.C.S. number and the fact that it is the only insurance undertaking named; no other entity is named as risk carrier. This matches the task metadata (insurer_slug foyer-global-health).
• Plan-level membership (Classic / Plus / Top) is NOT in the text layer: the benefit tables of Nos. 4.3 to 4.7 (pages 9 to 15) carry it as vector drawings. The legend on page 2 defines both marks: a dark-teal circled check (circle 12.9 x 12.9 pt + check 7.2 x 5.6 pt, RGB 0/0.301/0.262) = “Insured, i.e. we will reimburse 100 % of the eligible expenses…”, and a grey cross (two strokes of 9.3 x 9.3 pt, RGB 0.655/0.664/0.674) = “Reimbursement is excluded from the scope of benefits.” Membership was rebuilt by taking each mark's x-centre against the Classic/Plus/Top header x-positions and its y against the table's own row separator lines, and confirmed on a high-resolution render of page 2 (legend) and page 15 (table). The arithmetic closes on every page: page 9, 14 rows x 3 = 42 cells = 38 ticks + 4 crosses; page 10, 11 x 3 = 33 = 23 + 10; page 11, 12 x 3 = 36 = 27 + 9; page 12, 9 x 3 = 27 = 21 + 6; page 13, 16 x 3 = 48 = 40 ticks + 5 crosses + 3 blanks (the “Basic dental services” section row, which carries no mark in any column); page 14, 8 x 3 = 24 = 24 ticks + 0 crosses; page 15, 11 x 3 = 33 = 17 + 16. These facts are not text and therefore cannot appear in key_quotes; they are recorded in each coverage's conditions as “Table of benefits: Classic = …; Plus = …; Top = …”.
• is_optional is set to false on every coverage: the document presents three plan levels (Classic, Plus, Top) and four modules (outpatient, inpatient, dental, assistance), not optional riders - “Which plan level can be insured and which combination of modules can be agreed for the insurance in question is governed by the group contract” (No. 4.1, page 8). A benefit marked with the grey cross in a plan level is not an optional extra in that level, it is explicitly excluded from it; a benefit marked with the tick is included. The only genuinely optional element described is the outpatient deductible of the Plus and Top levels (No. 4.2), recorded under deductibles.
• Edition date: the document prints no edition or version date. The only version-like marking is the footer code “CG GCI 09.17/2” on page 41, which has been recorded in reference; it has NOT been converted into an edition_date because the document nowhere states that 09.17 is an edition month/year. The file name in source_url contains “V18_0224”, but the document itself does not print it, so nothing was inferred from it.
• Prescription period: the document contains no prescription/limitation clause (no time bar for asserting claims is stated); prescription_period is therefore null. It only requires that claims be asserted and invoices submitted “without delay when the treatment is ended” (No. 7.3, page 30).
• Tacit renewal: the document states the 12-month insurance year and the renewal date of the group contract but never describes a tacit renewal mechanism, so tacit_renewal is left null.
• Amounts in the benefit tables are printed in three currencies (€ / $ / £) and reproduced verbatim, including the asterisks. Their meaning is printed under each table: “ The specified maximum sums, maximum periods and lump sums apply per insured person and per insurance year” (pages 9, 10, 13, 15), and on pages 11 and 12 “ With a deductible of € 250/$ 325/£ 210 per insurance year in each case” applies to the Classic column while “**” carries the per person/per insurance year meaning.
• Where a benefit is ticked for a plan level but no amount is printed in that cell, no limit has been invented: the cell means the benefit is insured with reimbursement of 100 % of the eligible expenses unless specified otherwise, per the page 2 legend. This is stated in the coverage's conditions rather than as a fabricated limit.
• Chapter 4.8 (pages 16 to 22) and chapters 5.1/5.2 (pages 23 to 26) are descriptive texts attached to the benefits of the tables; their substance has been merged into the description and conditions of the corresponding coverages, whose page cites the table row (Nos. 4.3 to 4.7) where the benefit and its limits are printed. The exclusions listed inside those descriptive chapters have been recorded separately in exclusions with their own page.
• The text layer of this PDF is clean: no zero-width spaces, no soft hyphens, no NBSP/U+2008/U+202F inside amounts, no Private-Use-Area glyphs, no NFD combining accents, and the € glyph is present (51 occurrences). It does, however, hyphenate words at line breaks 236 times (e.g. “infor- \nmation”); key_quotes were sliced programmatically so as never to cross such a break.
• Verification: the page text pasted in the prompt was compared page by page against an independent re-extraction of the source PDF (data/lu/pdfs/foyer-global-health/sante/cogenio-c2565902.pdf) with the same per-page text call; all 41 pages are byte-identical and the document text was not truncated.
• The benefit rows “Basic dental services” and “Major dental services” (page 13) are section rows of the dental table. “Basic dental services” carries no mark in any column; “Major dental services” carries the marks and the reimbursement rule applying to the dentures/implants/orthodontics rows that follow it. Both are recorded as coverages so that the section-level limits are not lost.
• “Complications of pregnancy and childbirth” appears twice in chapter 4.8 (pages 17 and 19) with the same wording, once under inpatient and once under outpatient treatment; it is a repetition in the source, not two different benefits, and is recorded once per module as the tables do.

Documents liés

• Globality CoGenio® - DE - Conditions générales
• Globality CoGenio® - ES - Conditions générales
• Globality CoGenio® - Conditions générales
• Globality CoGenio® - Conditions générales

Source & fidélité

• Source : https://globalhealth.insurance/wp-content/uploads/2025/12/Globality_CoGenio_GCI_EN_V18_0224.pdf - téléchargé le 2026-08-04 - 41 pages
• Extraction : claude-code-subagent:scale · prompt v1.1
• ⚠️ Ceci n'est pas le document officiel de l'assureur et peut contenir des erreurs d'extraction. Information, non un conseil - vérifiez toujours par rapport au document source.