Globality YouGenio® for Germany EN

Résumé

General Conditions of Insurance for the Globality YouGenio® for Germany international private medical insurance plan of Foyer Global Health S.A. (Luxembourg), designed for expatriates who temporarily reside abroad for at least three months. The plan comprises three plan levels - Classic, Plus and Top - covering inpatient, outpatient, dental, medical assistance and additional assistance benefits, with 100 % reimbursement of eligible expenses according to the level chosen. Cover applies in geographical area I (worldwide including USA) or II (worldwide excluding USA), with the maximum sums doubled under area I. Existing medical conditions are excluded as a matter of principle unless included at application or through the moratorium clause, qualifying periods of 8 months apply to pregnancy, childbirth, psychotherapy and major dental performances, and cover for a person residing in Germany ends after a maximum period of 5 years.

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

Définitions

Terme	Définition	Page
Accident	An accident is defined as an external occurrence suddenly and unexpectedly acting on the body and causing damage to health.	p. 38
Acknowledged rate of fees	Basis on which medical and dental services are calculated. They may differ from one country to the next.	p. 38
Application	The application for insurance is filed for the policyholder and the other insured persons using an application form provided by the insurer.	p. 38
Assisteur	Our assisteur specialises in providing the insured persons with help and advice in emergencies or during hospital stays. They also provide additional services to make the stay of the insured person easier in the foreign country and handles the reimbursement of certain costs, such as the cost of return transport. The full range of services is set out in the enclosed Assistance Guidelines.	p. 38
Conditions precedent	Conditions precedent define standards of conduct which must be observed in order to qualify for the benefits claimed under the insurance contract.	p. 38
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. 38
Country of departure	The country of departure is the country in which the insured persons permanently lived prior to their stay abroad.	p. 38
Country of residence	The country of residence is the country in which the insured persons live after commencing their stay abroad.	p. 38
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 policy (see No. 4.2).	p. 38
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. The insured persons are free to choose any doctor meeting these criteria.	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 jeopardising 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 an insured person or for which the insured person is already receiving treatment. They can basically be included in the insurance contract by special agreement with you. Existing medical conditions that are not specified when filing the application are not insured.	p. 38
Follow-up rehabilitation	Follow-up rehabilitation is a medical treatment aiming at recovering the initial state of health after an illness/serious surgery, for example following bypass surgery, cardiac infarction, transplants and surgery involing large bones or joints, or after a serious accident.	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. 39
Globality Service Card	The insured persons receive a personal Globality Service Card with the address and main telephone numbers of their relevant Globality Health service centre. The Globality Service Card serves as personal proof of insurance for all service-providers.	p. 39
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. 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. 39
Home country	The home country is the country of which the insured person is a citizen or to which he or she is to be repatriated in the event of his or her death.	p. 39
Hospice	Institution with exclusive purpose being the care of patients with a limited remaining life expectancy for whom curative treatment is no longer available. It attemps at offering the best possible quality of life by using palliative 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. The following institutions do not qualify as hospitals: convalescent and nursing homes, health centers, health resorts and spas, as well as sanatoria.	p. 39
Insurance policy	The insurance cover agreed for the insured persons and the premium payable in each case are documented in an insurance policy.	p. 39
Outpatient surgery in lieu 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
Part-time hospital treatment	Part-time hospital treatment in a day or night clinic or hospital means that the patient only remains in the clinic during the day or night; full-time (i.e. 24-hour) inpatient treatment is not or no longer necessary.	p. 39
Policyholder/insured person	You are the policyholder, as you have concluded the insurance contract with us. The insured persons are all those for whom you have purchased insurance cover from us (e.g. you and your husband/wife or non-marital partner and children).	p. 39
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. 39
Substitute hospital cash plan benefits	If you do not claim any benefits from us for medically necessary inpatient treatment covered by the insurance for an insured person, we will instead pay a substitute hospital cash plan benefit per day actually spent in hospital for the medically recommended inpatient treatment, in accordance with the selected plan level.	p. 39
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 authorised to give treatment 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, masseurs and balneotherapists, and physiotherapists.	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
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. 41
AIDS	AIDS stands for Acquired Immune Deficiency Syndrome, a serious disorder of the immune system.	p. 41
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. 41
Chiropractic	Chiropractic is also known as manual therapy. Mutually displaced or dislodged vertebrae and other joints are "wrenched" into place again by certain manual actions.	p. 41
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. 41
Cures and sanatorium treatment	Cures and sanatorium treatment serve to strengthen a person's state of health.	p. 41
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. 41
Dressings	Dressings is the term used to describe the material for dressing wounds.	p. 41
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 recognised as drugs. Drugs must be prescribed by a doctor and must be obtained from a pharmacy. Medication, medicine and pharmaceuticals are synonymous terms.	p. 41
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. 41
Hydrotherapy	Hydrotherapy is defined as a specific external treatment using water.	p. 41
ICD Codes	ICD stands for the International Classification of Diseases and is an international system for encoding and classifying all known diagnoses.	p. 41
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. 41
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. 41
Oncology	Oncology is a subsection of internal medicine which deals with the occurrence, diagnosis and treatment of tumours and related illnesses.	p. 41
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. 41
Palliative medicine	Palliative medicine describes the comprehensive and acute 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. 42
Performances for conservation	These are defined as measures which are designed to preserve the teeth (e.g. fillings, treatment of the root canal).	p. 42
Performances 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. 42
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.	p. 42
Prophylactic measures	Prophylactic measures are preventive measures; they encompass individual and general measures to avert the threat of illness (e.g. vaccinations, passive immunisation, preventive medication when travelling to hazard areas, accident prevention etc.).	p. 42
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.	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; g) not for screening and preventive care purposes.	p. 30

Garanties

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

If inpatient treatment - including pre-hospital, posthospital and part-time inpatient treatment - is required, the insured person must attend to a recognised hospital in the country of treatment. Benefits will be paid without time limits for the duration of inpatient treatment. - Optionnelle : non - Condition : Insured in the Classic, Plus and Top plan levels. - Condition : The hospital must be operated under constant medical management, have suitable diagnostic and therapeutic facilities and keep complete medical records. - Condition : In the case of medically necessary treatment in hospitals that also provide health cures and in sanatoria or convalescent homes, but 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. - Condition : Inpatient treatment in tuberculosis clinics and sanatoria will also be reimbursed within the contractual scope for tuberculosis patients. - Condition : The relevant Globality Health service centre must be contacted before or upon admission to the hospital.

Medical treatment, including pathology, radiology, computed tomography, MRI, PET and palliative medicine (inpatient) - p. 9

Eligible claims include all expenses incurred for examination, diagnosis and therapy within the framework of medically necessary inpatient treatment. Eligible expenses also include those incurred for pathology, radiology, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET) and palliative medicine. - Optionnelle : non - Condition : Insured in the Classic, Plus and Top plan levels.

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

• Optionnelle : non
• Condition : Insured in the Classic, Plus and Top plan levels.

Additional costs for operating theatres, intensive care wards, laboratories - p. 9

These are defined as the additional costs incurred for the use of special facilities, such as operating theatres, intensive care wards and laboratories. - Optionnelle : non - Condition : Insured in the Classic, Plus and Top plan levels.

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

The expenses incurred for services required in this context will be reimbursed, 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 : Insured in the Classic, Plus and Top plan levels.

Drugs and dressings (inpatient) - p. 9

These must have been 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. - Optionnelle : non - Condition : Insured in the Classic, Plus and Top plan levels. - Condition : Nutriments, tonics, mineral water, cosmetics, hygiene and body care articles and bath additives are not recognised as drugs.

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

These are physical-medical services (inhalation, physiotherapy and physical exercise, massage, poultices, hydrotherapy, medical baths, cryo- and thermotherapy, occupational therapy, electrotherapy or light therapy). - Optionnelle : non - Condition : Insured in the Classic, Plus and Top plan levels. - Condition : These physical-medical services must be provided by a doctor or the holder of a state-approved diploma as a medical-related professional (e.g. masseur, balneotherapist, physiotherapist) and must be prescribed by the doctor within the framework of inpatient treatment. - Condition : The prescription must have been issued before treatment commences and must specify the diagnosis, nature and number of sessions. - Condition : Remedies/physiotherapy do not include other performances, such as thermal baths, saunas and similar baths.

Therapeutic aids and appliances (inpatient) - p. 9

Eligible expenses include those incurred for therapeutic aids and appliances which are 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). - Optionnelle : non · Limite : Classic: such as cardiac pacemakers, if needed as a life-saving measure - Plus: 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: no limit stated in the scope of benefits - Condition : Insured in the Classic, Plus and Top plan levels. - Condition : They must be fitted during the stay in hospital and remain in or on the body. - Condition : Expenses for repairing therapeutic aids and appliances will be reimbursed within the scope of these provisions. - Condition : * The specified maximum sums, maximum periods and lump sums apply per insured person and per insurance year.

Medical treatment during pregnancy and childbirth, services of a midwife or obstetric nurse in the hospital, but excluding screenings during pregnancy - p. 9

We will reimburse the eligible expenses for childbirth in a hospital, maternity home or comparable institution. - Limite : Plus: up to € 5,000/ $ 6,500/ £ 4,200* - Top: no limit stated in the scope of benefits - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : A waiting period of 8 months applies. - Condition : 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. - Condition : Medically prescribed nursing at home is covered following an inpatient delivery and after discharge from the hospital within 24 hours; Globality Health reimburses such costs for up to 5 consecutive days following the delivery. - Condition : 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.

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

We will refund the 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. - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : A waiting period of 8 months applies.

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 upon presentation of the birth certificate. - Limite : Plus: Lump sum of € 250/$ 325/£ 210 per newborn baby - Top: Lump sum of € 500/$ 650/£ 420 per newborn baby - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : without proof of costs on presentation of the birth certificate

Chemotherapy, oncological drugs and treatment (inpatient) - p. 9

We will reimburse the eligible expenses for medical treatment, diagnostic tests, radiation therapy, chemotherapy, drugs and hospital costs in conjunction with inpatient treatment. - Limite : Plus: up to € 5,000/ $ 6,500/ £ 4,200* - Top: no limit stated in the scope of benefits - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level.

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

By an approved emergency service with conveyances appropriate to the situation. - Optionnelle : non - Condition : Insured in the Classic, Plus and Top plan levels.

Bone marrow and organ transplants - p. 10

In the case of bone marrow or organ transplants (e.g. heart, kidney, liver, pancreas), we will reimburse the eligible expenses for both the person receiving the transplant and the donor. Eligible expenses are defined as the costs incurred by the donor in conjunction with acquiring the organ, the cost of transporting the organ to the patient and the expenses incurred for hospital accommodation of the donor if necessary. - Limite : Plus: up to a maximum of € 200,000/ $ 260,000/ £ 168,000 for the duration of the contract - Top: no limit stated in the scope of benefits - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : Not covered: the cost of finding the organ to be transplanted or a suitable donor.

Psychiatric treatment (inpatient) - p. 10

We will reimburse the 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 : Insured in the Classic, Plus and Top plan levels. - 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. - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : provided that we have agreed in writing to pay benefits before treatment commences - Condition : A qualifying period of 8 months applies to psychotherapy (see No. 2.4).

Parent rooming-in during inpatient treatment of a child (under the age of 18) - p. 10

We will reimburse the additional costs incurred for accommodation for one parent for children under the age of 18 if ordered by a doctor. - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level.

Nursing care at home and domestic help - p. 10

We will reimburse the eligible expenses of medically necessary nursing at home and domestic help by 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. - Limite : Plus: up to a period of 7 days - Top: up to a period of 14 days - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level.

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

• Limite : Plus and Top: up to a period of 5 days if pre-approved
• Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level.

Substitute cash plan benefit for inpatient treatment actually received, but for which no benefits have been claimed from us - p. 10

If you do not claim any benefits from us for medically necessary inpatient treatment covered by the insurance for an insured person, we will instead pay a substitute hospital cash plan benefit per day actually spent in hospital for the medically recommended inpatient treatment, in accordance with the selected plan level. - Limite : Plus: € 50/$ 65/£ 42 per day - Top: € 100/$ 130/£ 84 per day - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level.

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, transplants and surgery involving large bones or joints). - Limite : Plus: up to 14 days - Top: up to 21 days - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : provided that we have agreed in writing to pay benefits before treatment commences - Condition : Follow-up rehabilitation must in all cases commence within two weeks of being discharged from hospital. - Condition : Treatments and periods of residence in health resorts, spas, sanatoria or convalescent and nursing homes are not covered by the insurance.

Hospice - p. 10

If outpatient care at home or in the insured person's family is not possible, we will reimburse the expenses incurred for accommodation, nursing care and support in accordance with the patient's state of health. - Limite : Top: up to 7 weeks - Condition : Insured in the Top plan level only; reimbursement is excluded from the scope of benefits in the Classic and Plus plan levels. - Condition : The hospice must work together with nursing staff and doctors with experience in palliative medical care, and be operated under the professional supervision of a nurse, or other suitably qualified person, with several years of experience in palliative medical care. - Condition : Benefits for full or part-time inpatient hospice care is only granted if the insured person is suffering 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. - Condition : Hospice benefits are paid for the following illnesses, among others: Cancer in advanced stages; Fully developed infectious AIDS; Disorders of the nervous system, with uncheckable progressive paralysis; Chronic kidney, liver, heart, digestive or pulmonary illness in a terminal stage.

Inpatient dental treatment - p. 10

We will reimburse 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. - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level.

Emergency dental treatment - p. 10

Emergency in-patient dental treatment refers to a serious accident requiring hospitalization (e.g. reconstruction of the jaw following accidental injury). - Optionnelle : non - Condition : Insured in the Classic, Plus and Top plan levels. - Condition : The treatment must be received within 24 hours of the emergency event. - Condition : Cover under this benefit does not extend to follow-up dental treatment, dental surgery, dental prostheses or implants, orthodontics or periodontics. - 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, including pathology, radiology, computed tomography, MRI, PET and palliative medicine (outpatient) - p. 11

Eligible expenses include all measures required for examination, diagnosis and therapy within the framework of outpatient medical treatment. Expenses incurred for pathology, radiology, computer tomography, magnetic resonance imaging, positron emission tomography, chemotherapy and other oncological performances, palliative medicine, as well as for vaccinations and prophylactic measures recommended by the WHO (World Health Organization) will also be reimbursed. - Optionnelle : non · Franchise : Classic plan level: with a deductible of € 250/$ 325/£ 210 per insured person and insurance year. - Condition : Insured in the Classic, Plus and Top plan levels.

Chemotherapy, oncological drugs and treatment (outpatient) - p. 11

• Optionnelle : non · Franchise : Classic plan level: with a deductible of € 250/$ 325/£ 210 per insured person and insurance year.
• Condition : Insured in the Classic, Plus and Top plan levels.

Health checks - p. 11

Routine health checks are tests or screenings that are carried out without any clinical symptoms being present: 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. - Limite : Plus: up to € 250/ $ 325/ £ 210 - Top: up to € 500/ $ 650/ £ 420 - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level.

Vaccinations of every kind, including the vaccines and prophylactic measures, insofar as these are recommended for the applicable country of residence - p. 11

• Limite : Plus: up to € 250/ $ 325/ £ 210** - Top: no limit stated in the scope of benefits
• Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level.

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

We will refund the eligible expenses resulting from pregnancy or pregnancy-related illness, including standard routine maternity scans and tests. Coverage will also be granted for all medically necessary diagnostic tests, including amniocentesis and Chorionic Villus Sampling (CVS). - Limite : Plus: up to € 2,000/ $ 2,600/ £ 1,680** - Top: no limit stated in the scope of benefits - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : A waiting period of 8 months applies. - Condition : NIPT and all other forms of genetic testing are excluded. - Condition : Midwife services carried out by a licensed midwife are reimbursable in countries where it is common that routine pre-natal care is performed by a midwife, only if the costs for the same services have not been charged by a doctor. - Condition : In addition, we will cover 12 post-natal midwife home visits per pregnancy. - Condition : Doula services as well as pre- and postnatal classes are not reimbursable.

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

We will refund the 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. - Limite : Plus: up to € 4,000/ $ 5,200/ £ 3,360** - Top: no limit stated in the scope of benefits - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : A waiting period of 8 months applies.

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

We will reimburse a share of the eligible expenses only if the treatment is provided by doctors or other therapists who can prove that they have received the required training and are authorised 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. - Limite : Plus: up to € 500/ $ 650/ £ 420 - Top: up to € 1,000/ $ 1,300/ £ 840 - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level.

Speech therapy - p. 11

We will reimburse the eligible expenses of medically prescribed exercises and therapy for treating voice and speech disorders, subject to the condition that such treatment is provided by a doctor or speech therapist. - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : provided that we have agreed in writing to pay benefits before treatment commences

Psychiatric treatment (outpatient) - p. 11

We will reimburse the expenses incurred for outpatient psychiatric treatment if and insofar as we have agreed in writing to reimburse these costs before treatment commences. - Optionnelle : non · Franchise : Classic plan level: with a deductible of € 250/$ 325/£ 210 per insured person and insurance year. - Condition : Insured in the Classic, Plus and Top plan levels. - Condition : provided that we have agreed in writing to pay benefits before treatment commences

Outpatient psychotherapy - p. 11

The cost 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. - Limite : Plus and Top: up to 20 sessions** - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : provided that we have agreed in writing to pay benefits before treatment commences - Condition : A qualifying period of 8 months applies to psychotherapy (see No. 2.4).

Drugs and dressings (outpatient) - p. 12

Drugs and dressings must have been prescribed by a doctor/dentist or duly authorised therapist. Drugs must additionally be dispensed by a pharmacy or other officially approved dispensary. - Optionnelle : non · Franchise : Classic plan level: with a deductible of € 250/$ 325/£ 210 per insured person and insurance year. - Condition : Insured in the Classic, Plus and Top plan levels. - Condition : Nutriments, tonics, mineral water, cosmetics, hygiene and body care articles and bath additives do not qualify as drugs.

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

These are physical-medical therapies (inhalation, physiotherapy and physical exercise, massage, packs, hydrotherapy, medical baths, cryo- and thermotherapy, occupational therapy, electrotherapy or light therapy). - Optionnelle : non · Franchise : Classic plan level: with a deductible of € 250/$ 325/£ 210 per insured person and insurance year. - Condition : Insured in the Classic, Plus and Top plan levels. - Condition : Such physical-medical therapies must be provided by a doctor with own practice or by the holder of a state-approved diploma as medical assistant (masseur, masseur and balneotherapist, physiotherapist) with own practice and must be prescribed by a doctor. - Condition : The referral must have been issued before treatment commences and must specify the diagnosis, nature and number of sessions. - Condition : Remedies/physiotherapy do not include other services, such as thermal baths, saunas and similar baths. The additional costs incurred for home treatment of the insured person is not reimbursable.

Therapeutic aids and appliances (outpatient) - p. 12

Eligible expenses include the 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: bandages, trusses, insole supports for shoes, walking aids, hearing aids, compression stockings, corrective splints, artificial limbs/prosthetics (excluding dentures), plaster shells for lying and sitting, orthopaedic arm, leg and body braces, as well as speaking aids (electronic larynx). - Limite : Plus: up to € 2,000/ $ 2,600/ £ 1,680** - Top: no limit stated in the scope of benefits - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : Therapeutic aids and appliances must be prescribed by a doctor and should not be daily commodities. - Condition : All other therapeutic aids and appliances are only eligible for reimbursement insofar as benefits have been approved in writing beforehand. - Condition : Expenses for reasonable maintenance (such as an annual service or replacing batteries) and reparation of therapeutic aids and appliances will be reimbursed within the scope of these provisions.

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 : Classic, Plus and Top: up to € 300/ $ 390/ £ 252** - Condition : Insured in the Classic, Plus and Top plan levels.

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 to better manage the diagnosed condition. Such conditions include cancer, eating disorders, gastrointestinal disease, heart disease and food intolerances and allergies. - Limite : Plus: up to € 125/ $ 162.50/ £ 105 - Top: up to € 250/ $ 325/ £ 210 - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : 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.

Podiatry - p. 12

We will reimburse eligible costs for medically necessary podiatry treatment. - Limite : Plus: up to € 100/ $ 130/ £ 84 - Top: up to € 200/ $ 260/ £ 168 - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : 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.

Vision aids - p. 12

Expenses incurred for spectacle frames and glasses, as well as for contact lenses will be reimbursed up to the maximum total limit. - Limite : Plus: up to € 100/ $ 130/ £ 84 - Top: up to € 200/ $ 260/ £ 168 - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level.

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

By an approved emergency service with conveyances appropriate to the situation. - Optionnelle : non - Condition : Insured in the Classic, Plus and Top plan levels.

Infertility treatment - p. 12

Diagnostics and treatments to increase fertility including 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). - Limite : Plus: 50 % up to a maximum of € 7,500/ $ 9,750/ £ 6,300 per insured couple for the duration of the contract - Top: 50 % up to a maximum of € 15,000/ $ 19,500/ £ 12,600 per insured couple for the duration of the contract - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : insofar as benefits have been approved in writing beforehand - Condition : the woman must be 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 must be 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 must be insured with us and eligible for treatment on their selected plan level

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

• Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level.
• Condition : Part of the Basic dental services section of the scope of benefits.

Dental treatment - p. 13

• Optionnelle : non · Limite : Classic: Pain relief dental treatment - Plus: Including inlays without caps - Top: Including inlays without caps
• Condition : Insured in the Classic, Plus and Top plan levels.
• Condition : Part of the Basic dental services section of the scope of benefits.

X-rays (dental) - p. 13

X-ray examination; intraoral local anesthesia in connection with minor dental services. - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : Part of the Basic dental services section of the scope of benefits.

Scale-and-polish cleaning - p. 13

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. - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : Part of the Basic dental services section of the scope of benefits.

Treating oral mucosa and paradontium - p. 13

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 has taken already place before. - Optionnelle : non · Limite : Classic: Pain relief only - Plus and Top: no limit stated in the scope of benefits - Condition : Insured in the Classic, Plus and Top plan levels.

Simple fillings related to cavity - p. 13

Conservative services: simple fillings related to cavity; root canal treatment in connection with a following simple filling. - Optionnelle : non · Limite : Classic: Pain relief only - Plus and Top: no limit stated in the scope of benefits - Condition : Insured in the Classic, Plus and Top plan levels.

Surgery, extractions, root-canal treatment - p. 13

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. - Optionnelle : non · Limite : Classic: Pain relief only - Plus and Top: no limit stated in the scope of benefits - Condition : Insured in the Classic, Plus and Top plan levels.

Inclusion of an occlusal splint - p. 13

Insertion of occlusal splints: 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. Also functional analysis and functional therapy. - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level.

Accidental dental treatment - p. 13

Benefits will be paid in full up to the overall limit if you need dental treatment 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. - Optionnelle : non - Condition : Insured in the Classic, Plus and Top plan levels. - Condition : No waiting periods apply. - Condition : We will not cover injury caused by eating/drinking or any injury caused by biting, chewing, clenching or grinding of teeth under this benefit type. - Condition : The dentist's receipt must specifically confirm that treatment is a consequence of an accident. Proof of the accident with a medical or police report is required.

Major dental services - p. 13

Heading covering prosthetic services, implantological services, orthodontic treatment, dental laboratory work and the treatment plan. - Limite : Classic: Reimbursement for the outlined below benefits only if needed as a result of an accident - Plus: Reimbursement for the following benefits up to € 2,000/ $ 2,600/ £ 1,680 - Top: Reimbursement for the following benefits up to € 5,000/ $ 6,500/ £ 4,200 - Condition : Plus and Top: Waiting period of 8 months. - Condition : In the Classic column this row carries the symbol for 'Reimbursement is excluded from the scope of benefits' and, at the same time, the note about reimbursement if needed as a result of an accident; both are printed side by side in the scope of benefits.

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

Prosthetic services: impression or partial impression of a jaw for a situation model including an assessment for diagnosis or scheduling; preparation of a written schedule of treatment and charges for prosthetic treatment; preparation of a destroyed tooth with plastic augmentation materials or and pin to receive a crown; onlay; adhesive fasting (plastic buildup, pin, crown, partial crown); 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. - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : Part of the Major dental services limits and waiting period. - Condition : A qualifying period of 8 months applies to dentures and dental crowns (see No. 2.4).

Implantological services - p. 13

Implant-related analysis; use of an orientation splint/positioning splint; implant insertion; exposure of an implant; insertion of augmentation material (bone and/or bone substitute material); sinus floor elevation. - Limite : Plus and Top: up to four implants per jaw and the dentures to be secured to these implants - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : Part of the Major dental services limits and waiting period. - Condition : A qualifying period of 8 months applies to implants (see No. 2.4).

Orthodontic treatment - 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. - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : We will not cover additional costs or services such as special braces e.g. lingual brackets as well as clear aligner e.g. Invisalign. - Condition : Part of the Major dental services limits and waiting period. - Condition : A qualifying period of 8 months applies to orthodontic performances (see No. 2.4).

Dental laboratory work and materials - p. 13

Dental materials and laboratory work will be indemnified on the basis of average prices in the country where the treatment is provided. - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : Part of the Major dental services limits and waiting period.

Treatment plan - p. 13

A plan of treatment and costs compiled by the doctor or dentist must be submitted before commencing treatment if dentures or rehabilitation measures of a larger extent and orthodontic treatment are planned. You will then be informed of the extent to which these costs will be reimbursed. - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : Part of the Major dental services limits and waiting period.

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. If an insured persons needs help from our multilingual team, assistance coordinators and doctors, simply call the number specified in the insurance documents at any time, day or night. - Optionnelle : non - Condition : Insured in the Classic, Plus and Top plan levels.

Medical evacuation and repatriation - p. 14

Insured persons are entitled to crossborder transport by ambulance if inpatient medical care in the country of residence is inadequate. In consultation with your relevant Globality Health service centre and the attending physician, the insured person 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. - Optionnelle : non - Condition : Insured in the Classic, Plus and Top plan levels. - 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. - Condition : If necessary for medical reasons, we will also organize for a doctor to accompany the insured person during transport. Only transport to a place suitable for treatment is covered.

Information on medical infrastructure (local medical care and names and addresses of multilingual doctors) - p. 14

Your relevant Globality Health service centre will inform the insured persons of the medical care available locally, and will also provide the 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 : Insured in the Classic, Plus and Top plan levels.

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

Insured persons can contact the medical branch of your relevant Globality Health service centre by telephone as soon as initial medical support is required locally. The service centre can inform the insured person's relatives that the insured event or emergency has occurred, arrange a second opinion, help when planning admission to and discharge from hospital, and monitor the course of an illness. - Optionnelle : non - Condition : Insured in the Classic, Plus and Top plan levels.

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

Your relevant Globality Health service centre settles 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 reaches agreement with the hospital on the invoicing address and the terms of payment. - Optionnelle : non - Condition : Insured in the Classic, Plus and Top plan levels. - 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 Globality Health 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.

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

Your relevant Globality Health service centre will obtain the death certificate or accident report insofar as this is permitted by law, make contact with public authorities and consulates in the foreign country, establish which surviving relatives are authorized to decide on repatriation or cremation of the deceased, and handle all the formalities. We will reimburse up to the maximum limit the costs directly incurred for repatriating the deceased to the country of departure or home country (including all formalities), and 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. - 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 : Insured in the Classic, Plus and Top plan levels. - Condition : Funeral costs as such will not be reimbursed.

Appropriate additional medical support (information on the nature, possible causes and possible treatment of an illness) - p. 14

Regardless of whether an insured event has occurred, your relevant Globality Health service centre will provide insured persons with general information (about the country, customs formalities), as well as medical information (vaccinations, medical information by telephone) in preparation for your journey and will also advise you on what to obtain for your personal First Aid kit. If an insured person becomes ill, the service centre will provide general information on the nature, possible causes and possible treatment of the illness, explain the medical terms used and provide information on drugs and identical/comparable drugs, their side effects and their interactions. - Optionnelle : non - Condition : Insured in the Classic, Plus and Top plan levels.

Online services - p. 14

Our website www.globality-health.com includes a secure area where you can directly access a lot of useful online services: an idea of all the main contact information for your relevant Globalite; a personalized claim form; a provider search engine (doctors and hospitals in the country of residence); and country information including advice to travellers, information on certain illnesses and vaccination recommendations, information about the political stability or safety in various regions as well as the latest news. - Optionnelle : non - Condition : Insured in the Classic, Plus and Top plan levels.

Additional support - p. 15

Collective row covering the organization of visits to the patient and the procurement and shipment of vital medication. - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level.

Organizing visits to patient - p. 15

If you or an insured person receives inpatient treatment because of a medical emergency (both in the country of residence and while travelling on holiday or on business), the relevant Globality Health service centre will arrange for a member of your family to visit, if the stay in hospital lasts for more than seven days. They will make arrangements for one family member to travel to the hospital and back home. 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, Globality Health will reimburse 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 hospitalisation of the family member in the country of origin, and to the place of burial in the country of origin in the case of death. - Limite : Plus: up to € 1,500/ $ 1,950/ £ 1,260 - Top: up to € 3,000/ $ 3,900/ £ 2,520 - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level. - Condition : Serious illness and serious accident are considered to be that which endangers the life of the family member. - Condition : 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. - Condition : Return transport costs due to serious illness and serious accident are only reimbursable on condition that the corresponding service centre is contacted in advance. Transport costs due to death are only reimbursable prior to submission of the death certificate.

Procurement and shipment of vital medication - p. 15

• Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level.

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, we will organise a child welfare service 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, you are entitled to claim return transport for the child (under the age of 18) with a companion to the momentary place of residence in the country of residence. - Condition : Insured in the Top plan level only; reimbursement is excluded from the scope of benefits in the Classic and Plus plan levels.

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

If the stay abroad gives rise to psychological conflicts for insured persons, the relevant Globality Health service centre will provide psychological therapy by telephone and will also arrange for suitable local assistance if necessary. - Limite : Plus: psychological and therapeutic help by telephone; up to 3 calls - Top: psychological and therapeutic help by telephone; up to 5 calls - Condition : Insured in the Plus and Top plan levels only; reimbursement is excluded from the scope of benefits in the Classic plan level.

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 your relevant Globality Health service centre in a sealed envelope with personal password. If the originals are lost the copies will be sent to the insured person by post, courier service or fax to help you obtain replacements. - Condition : Insured in the Top plan level only; reimbursement is excluded from the scope of benefits in the Classic and Plus plan levels. - Condition : The document depot is retained for five years unless updated by the insured person.

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

The relevant Globality Health service centre can refer the insured person to English, German, French or Spanish-speaking lawyers or experts throughout the world. If necessary, your relevant Globality Health service centre will arrange for an advance to pay the lawyers' fees, courts costs or bail. - Condition : Insured in the Top plan level only; reimbursement is excluded from the scope of benefits in the Classic and Plus plan levels. - Condition : The advance is not paid by the relevant Globality Health service centre; it merely makes contact with your bankers, for instance, or relatives and can help in transferring the money if applicable.

Procurement of intercultural training - p. 15

In preparation for the stay abroad, the relevant Globality Health service centre can refer the insured person to special institutions which provide specific training for the country and/or region concerned, taking into account aspects of living and working abroad. - Condition : Insured in the Top plan level only; reimbursement is excluded from the scope of benefits in the Classic and Plus plan levels.

Temporary cover for geographical area I - p. 7

The following special features apply 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. - Optionnelle : non · Portée : Geographical area I (Worldwide including USA), for absences of not more than six weeks - Condition : Journeys undertaken for the purpose of obtaining treatment in geographical area I are not insured. - Condition : Please contact us if you wish to change the geographical area as this will affect your premium and your insurance cover.

Doubling of maximum sums for geographical area I - p. 8

Insofar as insurance cover for geographical area I (worldwide including USA) has been agreed on for the insured persons, the maximum sums and lump sums specified in Nos. 4.3, 4.4 and 4.5 will be doubled. - Optionnelle : non · Portée : Geographical area I - Worldwide including USA - Condition : If a benefit is limited to a certain number of days, this limit will remain unchanged. If a deductible has been agreed, it will remain unchanged.

Inclusion of existing medical conditions (optional) - p. 4

Existing medical conditions are excluded from the insurance cover as a matter of principle; they are governed by the moratorium clause (see No. 1.3). However, the inclusion of existing medical conditions can be selected when applying for insurance. - Optionnelle : oui - Condition : In order to include existing medical conditions from the start date of the insurance, the health questions listed in the application must be answered completely, correctly and to the best of your knowledge. A health check will also be required in this case.

Moratorium (alternative to full medical underwriting) - p. 4

Instead of applying for full medical underwriting, if the insured person is 55 or younger and if we agree, you may choose a 'moratorium'. In that case any known pre-existing medical condition that an insured person has experienced during the last five years will be covered after a continuous two-year period free of medical treatment, symptoms, advice or medication relating to the known pre-existing medical condition. - Optionnelle : oui - Condition : If an insured person has any treatment, advice, symptoms or medication during the first two years of cover relating to a pre-existing medical condition, the two-year period (free of any treatment, advice or medication) may start again for that pre-existing medical condition. - Condition : We will cover any new and unrelated medical conditions immediately.

Insurance of new-born babies - p. 36

The new-born baby is insured as from the moment of birth, without qualifying periods, provided that at least one parent is insured under the Globality YouGenio® plan on the date of birth and we receive the application for insurance within two months. Adopting a child is equivalent to giving birth, provided that the child is still a minor at the time of adoption. - Optionnelle : non - Condition : 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; a premium loading of not more than 100 % may be charged for insurance medical reasons. - Condition : The insurance cover for the new-born child must not be greater or more comprehensive than that of one insured parent. - Condition : A premium loading of up to 100 % may be agreed in the case of a higher risk for an adopted child.

Outpatient screenings for early detection of illnesses, pregnancy and childbirth, hospital stay of the healthy newborn baby, death of an insured person - p. 5

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.

Exclusions

Exclusion	Description	S'applique à	Page
Acting or travelling against medical advice	We do not cover treatment required as a result of you failing to seek or follow medical advice, or as a result of you travelling against medical advice.	all	p. 26
Complications caused by excluded cover	We will not cover expenses caused by complications directly caused by an illness, injury or treatment for which we exclude or limit cover.	all	p. 26
Cosmetic and plastic surgery	Expenses incurred for cosmetic or plastic surgery and treatment will not be reimbursed.	all	p. 26
Detoxification programmes including therapies	We do not cover detoxification programmes including treatments for drug addiction and alcoholism. Without affecting this condition, we will pay the benefits for an initial detoxification if you cannot claim a refund from anywhere else. In the case of inpatient detoxification, we will only refund the expenses for basic hospital services, including medical treatment and drugs. We will not cover further treatment caused by or directly associated with harmful, hazardous or addictive use of any substance including alcohol and drugs.	all	p. 26
Developmental disorders	We will 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. 26
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. 26
Existing medical conditions	Existing medical conditions are initially excluded from the insurance cover (refer to the moratorium clause, No. 1.3). However, they can be included by answering the health questions on the application. Existing medical conditions that are not specified when filing the application are not insured.	all	p. 26
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 have a final license and clearly stated approval from at least one of EMA, FDA (phase III completed) or EUnetHTA, or is not clearly stated as such on NICE, AWMF or AHRQ National Guideline. Interim approval is not sufficient. 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. 26
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. 26
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. 26
Gender reassignment	We will not cover changing the biological sexual characteristics, by surgery and hormone treatment, to those of the opposite sex.	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. 27
Illnesses, accidents and their consequences caused deliberately (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. 27
Injuries caused within the military service	Illnesses and accidents and their consequences, which have been caused while exercising military duties are excluded from the insurance cover.	all	p. 27
Need for long-term care and custody	We will not reimburse any costs incurred for accommodation in conjunction with the need for long-term care and custody.	all	p. 27
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. 27
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. 27
Post-natal classes	We will not cover post-natal classes following birth to deal with the physical effects on the body of being pregnant and giving birth.	all	p. 27
Professional sports	We do not cover treatments or diagnostic procedures of injuries or illnesses arising from taking part in professional sports.	all	p. 27
Sleep disorder	We do not cover investigations into, or treatment of, sleep disorders, including insomnia. This includes CPAP (continuous positive airway pressure machine) and BIPAP (bilevel positive airway pressure machine).	all	p. 27
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. 27
Sterilisation, sexual dysfunction and contraception	We will not cover any procedure which is 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. 27
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. 27
Termination of pregnancy	Listed under Exclusions and worded as follows: 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. 27
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 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 that occur after you have been informed of the 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 that are incurred more than one month after notification.	all	p. 28
Treatment by wives, husbands, non-marital partners, parents or children	We will not refund the costs if you are treated by your wife, husband, non-marital partner, parents or children. However, we will refund the proven cost of materials needed for your treatment in line with the plan.	all	p. 28
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.	all	p. 28
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. 28
Other limits - treatment beyond what is medically necessary or charges outside 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 within the usual, customary and reasonable, we will be entitled to reduce its payment/reimbursement and the insured shall be responsible for all costs which are not within the 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 within the usual, customary and reasonable.	all	p. 28
Subsidiarity towards other providers of benefits	If you or the insured person can also claim benefits from a statutory health insurance fund or from any other provider of benefits or any other institution, we will only have to refund those expenses which are still necessary despite these benefits.	all	p. 28
International sanctions regulations	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
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 contract 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.	Temporary cover for geographical area I	p. 7
Cost of finding the organ to be transplanted or a suitable donor	Eligible expenses are defined as the costs incurred by the donor in conjunction with acquiring the organ, 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.	Bone marrow and organ transplants	p. 17
Treatments and periods of residence in health resorts, spas, sanatoria or convalescent and nursing homes	Treatments and periods of residence in health resorts, spas, sanatoria or convalescent and nursing homes are not covered by the insurance.	Inpatient follow-up rehabilitation	p. 17
Follow-up dental treatment, dental surgery, dental prostheses or implants, orthodontics or periodontics after emergency dental treatment	Please note that cover under this benefit does not extend to follow-up dental treatment, dental surgery, dental prostheses or implants, orthodontics or periodontics.	Emergency dental treatment	p. 18
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 are not recognised as drugs.	Drugs and dressings	p. 16
Thermal baths, saunas and similar baths	Remedies/physiotherapy do not include other performances, such as thermal baths, saunas and similar baths.	Therapies/physiotherapy	p. 16
Additional costs for home treatment	The additional costs incurred for home treatment of the insured person is not reimbursable.	Therapies/physiotherapy (outpatient)	p. 19
NIPT and all other forms of genetic testing in maternity care	NIPT and all other forms of genetic testing are excluded.	Maternity care and childbirth (outpatient)	p. 19
Doula services as well as pre- and postnatal classes	Doula services as well as pre- and postnatal classes are not reimbursable.	Maternity care and childbirth (outpatient)	p. 19
Special braces (e.g. lingual brackets) and clear aligners (e.g. Invisalign)	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	p. 22
Injury caused by eating/drinking, biting, chewing, clenching or grinding of teeth	We will not cover injury caused by eating/drinking or any injury caused by biting, chewing, clenching or grinding of teeth under this benefit type.	Accidental dental treatment	p. 22
Fluoridation of tooth surface and fissure sealing for adults	Dental exclusion.	Dental treatment	p. 22
Veneers including partial front teeth crowns	Dental exclusion.	Dental treatment	p. 22
Bleaching or any related cosmetic and aesthetic services	Dental exclusion.	Dental treatment	p. 22
Sedation/anaesthesia (dental)	Dental exclusion.	Dental treatment	p. 22
Pain and anxiety-relieving measures (dental)	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 Health 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
Funeral costs	Funeral costs as such will not be reimbursed.	Organizational support in case of bereavement	p. 24
Fraud	Entitlement to benefits does not exist if benefits are claimed incorrectly, fraudulently or if third parties have fraudulently sought to obtain benefits under the present contract without legal ground, but with an insured person's consent. All rights to benefits under this contract will be extinguished in such cases. Payments remitted prior to disclosure of the fraudulent actions must be repaid to our company in full.	all	p. 33

Franchises

• Standard : Globality YouGenio® Classic: Fixed deductible of € 250/ $ 325/ £ 210.
• Variable : Globality YouGenio® Plus or Top: Variable deductible of € 250/ $ 325/ £ 210, € 500/ $ 650/ £ 420, € 1,000/ $ 1,300/ £ 840, or without deductible.
• Outpatient treatment : Deductibles apply per insurance year and per insured person, and only for expenses incurred in conjunction with outpatient treatment. If a deductible has been agreed, we will reimburse 100 % of the eligible expenses insofar as these exceed the deductible.

Délais d'attente

• Pregnancy, childbirth, psychotherapy, dentures, dental crowns, performances relating to analysis and therapy of dental function, implants and orthodontic performances : Qualifying periods only apply for pregnancy, childbirth, psychotherapy, dentures, dental crowns, performances relating to analysis and therapy of dental function, as well as implants and orthodontic performances. The qualifying period equals 8 months as from inception of the insurance in all these cases. If the contract is amended, the qualifying periods will apply to the new, additional part of the insurance cover, depending on the agreed plan level. (8 months as from inception of the insurance) p. 5
• Major dental services (Plus and Top) : The scope of benefits states 'Waiting period of 8 months' in the Plus and Top columns of the 'Major dental services' row. (Waiting period of 8 months) p. 13
• Accidental dental treatment : No waiting periods apply. (none) p. 22
• New-born babies : The new-born baby is insured as from the moment of birth, without qualifying periods, provided that at least one parent is insured under the Globality YouGenio® plan on the date of birth and we receive the application for insurance within two months. (none) p. 36
• Pre-existing medical conditions under the moratorium : Any known pre-existing medical condition that an insured person has experienced during the last five years will be covered after a continuous two-year period free of medical treatment, symptoms, advice or medication relating to the known pre-existing medical condition. (continuous two-year period free of medical treatment, symptoms, advice or medication) p. 4

Obligations de l'assuré

• All questions in the application form must be answered completely and correctly so that we can check the application. 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. (at application · The contract shall be null and void in case of willful violation of the duty to provide information that changes our assessment of the risk in such a way that, had we known of the undisclosed circumstance, we would not have concluded the insurance contract in the first place or only if it were subject to other terms. In such a case, all insured persons will be obliged to repay the insurance benefits received. Premiums paid will not be refunded.) p. 4
• 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 (duty 8 a) · 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. This only applies in cases of wilful intent or gross negligence.) p. 33
• 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, the insured person 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 request (duty 8 b) · See the sanction under No. 8.) p. 33
• We may request that the insured persons be examined by a doctor authorised 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 (duty 8 c) · See the sanction under No. 8.) p. 33
• The insured persons must make every effort to minimise the damage and desist from all actions detrimental to your or their convalescence. (when an insured event occurs (duty 8 d) · See the sanction under No. 8.) p. 33
• You and the insured person 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. (when an insured event occurs (duty 8 e) · See the sanction under No. 8.) p. 33
• If an insured person can claim non-insurance damages of any kind from a third party, the insured person is obliged to assign such claims to us in writing up to the limit that expenses are reimbursed under the insurance contract, notwithstanding the statutory subrogation. (when such a claim exists · If an insured person surrenders 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
• You must inform us immediately, meaning right after becoming aware of, latest however on the effective date of the change, about any new address, especially of any change in the country of residence, or any change of nationality or citizenship. We can ask you to provide proof of residence. (immediately, at the latest on the effective date of the change · If you fail to inform us, we cannot guarantee cover and we may have to terminate the insurance contract in line with paragraph 2.7 of our General Terms and Conditions.) p. 36
• When you return to your home country and thereby you are ending the period of expatriation abroad, you will have notify us of the exact date of relocation to the home country as soon as you become aware of it, latest however on the actual day of relocation. (as soon as you become aware, at the latest on the day of relocation · If you fail to inform us of the relocation, we cannot guarantee cover and we may have to terminate the insurance contract in line with paragraph 2.7.) p. 36
• You must inform us immediately about change of contact, or new name for you and any insured person. Let us know your new account number without delay so that we can remit our payments to the correct account. Please update your credit card data (expiry date, security number or bank) on our website. (immediately / without delay · If you fail to do so, we cannot guarantee cover and may have to terminate the insurance contract in line with paragraph 2.7.) p. 36
• Please contact us if you wish to change the geographical area as this will affect your premium and your insurance cover. (before the change) p. 7
• Such termination is only valid if you as policyholder can prove that the insured persons concerned have been informed of the termination. You need to send us proof that all insured persons have been informed about the termination of the policy. (on termination · The termination is not valid without this proof.) p. 6
• The premium stated in the insurance policy is a monthly premium and is always payable in advance. The first premium or premium installment is due immediately when we have accepted the insured person's application for insurance. (in advance · 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; if the premium has not been paid ten days after expiry of the additional time-limit, we will be entitled to terminate the insurance with immediate effect.) p. 34
• If your country of residence is outside the EU/EEA, the policyholder is responsible for the registration and payment of local taxes and other charges that may occur for the insurance. (throughout the contract) p. 34

Procédure de sinistre

1. Claims for insurance benefits must be declared and the relevant invoices submitted without delay when the treatment has ended. We are only obliged to indemnify 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 has ended) p. 30
2. Unless otherwise agreed, the insured person should send the invoices directly to the relevant Globality Health service centre when an insured event occurs. To process of reimbursements all original documents should be submitted to the Insurer. They must meet the standard legal requirements for issuing invoices in the respective country. We will also accept the transmission of receipts for amounts paid by means of telecommunication such as email or fax as long as the quality of transmission is sufficient for processing the claim. If there is a legitimate interest, the insurer may request the original receipts. If another health insurer or institution has reimbursed part of the costs, it will be sufficient to send us duplicates of the invoices or documents with the other insurer's or institution's original confirmation of reimbursement. p. 30
3. Invoices must include: first name and surname, as well as the date of birth of the insured person; a precise identification 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. p. 31
4. All documents or invoices should preferably be issued in English, German, French, Dutch or Spanish and must use Arabic numerals and Latin characters (1, 2, 3 ... a, b, c ...) as well as the ICD Code 9 or 10 (International Classification of Diseases). Prescriptions must specify the first name and surname, as well as the date of birth of the insured person, the drugs which have been prescribed, their price and the receipt of payment. Prescriptions 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. p. 31
5. 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
6. 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. p. 31
7. Insured persons 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 his/her 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 you back immediately. (délai : any time, day or night) p. 31
8. If an emergency requiring inpatient treatment occurs, your relevant Globality Health service centre must be contacted as soon as possible. If inpatient treatment is planned, your relevant Globality Health 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. (délai : as soon as possible (emergency) / at least seven days before admission (planned)) p. 24
9. At request, fixed costs, such as the rate for nursing care or the costs for hospital accommodation or the fees for transport by ambulance, can be paid directly to the party issuing the invoice. In addition, the insured person may also assign the entitlement to reimbursement from us to the party providing the treatment or services by signing a 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
10. The insured person are the contractual partner of the doctor/therapist consulted. The insured person can present the invoice to the relevant Globality Health service centre so that the contractually agreed benefits can be paid out to you from there. p. 31
11. As a rule, benefits are paid according to the principle of reimbursement. As a special service at request, we can pay our reimbursement directly to the party issuing the invoice, provided that they agree to direct payment and this is not prevented by legal considerations. 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. p. 31

Durée & résiliation

• Durée : The insurance contract is initially concluded for a duration of one year. The insurance year commences on the date specified in the insurance policy (inception of insurance) and runs for 12 months. The insurance year for dependants who later join the insurance policy commences on the date indicated on their insurance certificate (start date of insurance) and runs until the renewal date of the main insured member. If you or an insured person resides in Germany, your insurance coverage will end after a maximum period of 5 years, including all policy extensions and/or previous health insurance coverage taken out with other insurance companies.
• Reconduction tacite : oui
• Préavis : The insurance contract is automatically renewed for further periods of 12 months upon expiry of each insurance year, unless you object to the renewal not less than three months before expiry of the insurance year.
• Modalité : Notice of termination must either be sent by registered mail or presented against confirmation of receipt. Unless specified otherwise, the termination shall only become effective after one month from the day following the delivery/receipt (in case of registered mail).
• Modalité : You may withdraw your insurance contract in writing within 14 days, without specifying any reasons; it is sufficient to send your notice of withdrawal by post, email or fax before the deadline expires.
• Droit spécial : Right of withdrawal: You may withdraw your insurance contract in writing within 14 days, without specifying any reasons. The time period for withdrawal begins to run on the day on which you receive the insurance policy and the General Conditions of Insurance.
• Droit spécial : You may terminate the insurance policy if we make a change to the general conditions of insurance (see 10.1) or if we increase the fees and premiums (see 9); notice of termination within three months of receiving notice of the change.
• Droit spécial : However, you cannot terminate the insurance policy if we amend the premium as a result of you or an insured person moving up to the next age band.
• Droit spécial : We may terminate the insurance policy if you fail to give us any information we ask for, within one month of becoming aware that you failed to give us this information.
• Droit spécial : Extraordinary right of termination in the event that a sanction, prohibition or restriction 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.
• Droit spécial : In order to safeguard compliance with applicable laws, we reserve the right to terminate the insurance policy or to exclude single persons from the insurance cover if the insurance policy is or becomes non-compliant with national laws or regulations applicable in the home country or in the country of residence.
• Droit spécial : The contract shall be null and void in case of willful violation of the duty to provide information (No. 2.8).
• Droit spécial : End of cover (No. 2.9): in the event of your death and/or the death of any other insured person (in the event of your death the other insured persons may continue the insurance relationship, to be declared within two months); when you and/or any other insured persons permanently cease to reside abroad before the maturity of the contract; when you object to renewal after the end of the insurance year; if the insurance contract is terminated or declared to be void; in the event of nullity of the insurance contract.
• Droit spécial : The insurance contract is deemed to have been terminated if premiums are not paid for a period of more than two years.

Prime

• Indexation : The agreed insurance premium is subject to change depending on: the actual claims costs no longer corresponding to the technical calculation basis on the insurance plan or if the observed cost trend in the health care system gives serious reason to assume that the actual costs will become disproportionate to the calculated costs in the following insurance year; the change of age band; changes to applicable legislation. We are furthermore entitled to pass on to you all increases in statutory charges, dues or taxes or similar payments. Once per year, these changes will be assessed and premiums may be adjusted; we will inform you in writing at least three months before the beginning of the next insurance year. The exchange rates for US dollar and pounds Sterling are reviewed by us every December and June and adjusted as required, which may result in higher or lower premiums.
• The premium stated in the insurance policy is a monthly premium and is always payable in advance. Any premium loading charged for insurance medical reasons must be specified separately.
• If the insurance does not commence on the first day of the calendar month and/or if it ends before the last day of the calendar month, only a prorated monthly premium will be payable for the first and/or last insurance month.
• If your country of residence is within the EU/EEA, we must invoice you for the statutory charges, dues or taxes associated with your insurance policy. Any local tax rates that apply will be shown in your insurance policy.
• The insurance premium for each insurance year depends on the personal state of health, the individual premium according to the current table of premiums as well as the insured persons age on the first day of the insurance year. The age bands are distributed according to the following structure: 0-19, 20-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79.
• Late payment: if the agreed premium is not paid within ten days of the due date, we may demand payment upon expiry of this time-limit by registered letter; 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.
• If the premium has not been paid ten days after expiry of the additional time-limit, we will be entitled to terminate the insurance with immediate effect.
• A premium loading of not more than 100 % may be charged for insurance medical reasons if the birth of a new-born baby is reported after expiry of the two-month period; a premium loading of up to 100 % may be agreed in the case of a higher risk for an adopted child.
• The contractual currency for the Globality YouGenio® plan is euro, US dollar or pound sterling, depending on the choice made in the application form.

Conditions particulières

• The insurance policy is designed for expatriates. All persons who temporarily reside abroad for a period of at least three months are eligible for insurance. p. 4
• Insurance cover can be requested by an application form which is obtained either from your insurance intermediary, directly from us or through our website. If you would like existing medical conditions to be included, this will apply above all to the questions concerning the present state of health, past or present illnesses, disorders and symptoms, as well as treatment. The application can be sent to us by post, email or fax. p. 4
• The contractual currency for the Globality YouGenio® plan is euro, US dollar or pound sterling, depending on the choice made in the application form. It is the currency used for management of the insurance contracts, as well as for calculation and payment of the premiums. p. 4
• Insurance cover commences on the date specified in the insurance policy (inception of insurance), but not before payment of the first premium and not before expiry of the qualifying periods. p. 5
• If you or an insured person resides in Germany, your insurance coverage will end after a maximum period of 5 years, including all policy extensions and/or previous health insurance coverage taken out with other insurance companies. p. 5
• The Globality YouGenio® plan comprises three plan levels: Classic, Plus and Top. The individual plan levels differ in regards to the type and amount of benefits agreed. Depending on the selected plan level, we will reimburse 100 % of the eligible expenses as listed in the scope of benefits. p. 8
• Insurance cover applies in the following geographical areas: Geographical area I: Worldwide including USA. Geographical area II: Worldwide excluding USA. p. 7
• The insured persons are 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. Fees will be reimbursed for medical and dental treatment, as well as for the services of other therapists if they are reasonably calculated according to an acknowledged rate of fees typical for the country in question. Expenses exceeding the maximum fees may also be reimbursed if they are caused by difficulties resulting from the illness or the medical findings and have been reasonably calculated. p. 30
• Within the scope of the contract, we will reimburse the expenses incurred for examination and treatment methods, as well as drugs, which are generally accepted by conventional medicine. In addition, we will also reimburse the costs incurred for methods and drugs which have been proven 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. 30
• Dental materials and laboratory work will be indemnified on the basis of average prices in the country where the treatment is provided. Dentures, implants and orthodontic treatment are deemed to be treatments performed by a dentist even when carried out by a doctor. They are not included in inpatient or outpatient treatment. p. 30
• Claims for insurance benefits may be neither assigned nor pledged. p. 31
• Our claims may only be set off against if the counterclaim is undisputed or has been established without appeal being granted. p. 33
• We may amend or change the general conditions of insurance. We will inform you in writing at least three months before 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. p. 36
• 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. p. 36
• Do not hesitate to contact us by post, telephone, fax or email if you have a suggestion or are dissatisfied with us: Foyer Global Health S.A., 12, rue Léon Laval, L-3372 Leudelange, Luxembourg. You can 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. 37
• All disputes arising from this insurance 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 you reside. If your 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. 37
• The insurance contract will be governed by the provisions of the law of the Grand Duchy of Luxembourg insofar as another applicable law according to national regulations does not contain provisions incompatible with the provisions of the law of the Grand Duchy of Luxembourg. p. 37
• The supervisory authority for Foyer Global Health S.A. can be contacted at the following address: Commissariat aux Assurances, 11, rue Robert Stumper, L-2557 Luxembourg. Commercial Register (R.C.S. Luxembourg): B 134.471 p. 2
• Terms which are printed in italics are explained in the definitions at the end of this document. p. 2
• For this reason, we provide an extensive range of assistance/services in addition to, and as part of, the health insurance cover as active support for you and the insured person during your time abroad. The assistance services are available 24 hours a day, 7 days a week, 365 days a year. When the insurance according to the Globality YouGenio® cover ends, the entitlement to our assistance services will also end simultaneously. p. 23

Lacunes d'extraction

• Risk carrier: the document does not use a phrase of the type "underwritten by". Foyer Global Health S.A., 12, rue Léon Laval, L-3372 Leudelange, Luxembourg, R.C.S. Luxembourg B 134.471, is named on p. 2 as the entity for which "the supervisory authority ... can be contacted" at the Commissariat aux Assurances, is the sender of the document, is the party addressed as "we/us" throughout ("Insurance cover is granted ... If an insured event occurs, we will reimburse the expenses", No. 2.1), and is named again as the operator of the website through which contractual information is served (No. 10.2). On that basis it is recorded as the carrier. "Globality Health", "Globality YouGenio®" and "Globality Health service centre" are brand and service names, not a second carrier. The separately defined "assisteur" (p. 38), through which additional services and the reimbursement of e.g. return transport costs are provided, is not named anywhere in the document.
• edition_date left null: the document prints no element labelled as an edition or version date. The only date-like token is the footer code "YG GER GCI 13.02/5" on p. 43, recorded as reference; the document nowhere states that "13.02" is an edition date. The source file name contains "0224", a string that is not printed anywhere inside the document and was therefore not used.
• Scope of benefits tables (Nos. 4.3 to 4.7, pp. 9-15): plan-level membership is NOT in the text layer. The marks are vector drawings - a 12.9 x 12.9 pt circle with a 7.2 x 5.6 pt tick in dark green for "Insured, i.e. we will reimburse 100 % of the eligible expenses" and a 9.3 x 9.3 pt grey cross for "Reimbursement is excluded from the scope of benefits" (legend, p. 2). Each mark was assigned to a column by its x-centre against the header centres (Classic 318.9 / Plus 415.3 / Top 511.7 pt, column width 96.4 pt) and to a row by the row rules (width 233.9 pt). The arithmetic closes on every page: p. 9 13 rows x 3 = 39 cells = 35 ticks + 4 crosses; p. 10 11 x 3 = 33 = 23 + 10; p. 11 10 x 3 = 30 = 23 + 7; p. 12 9 x 3 = 27 = 22 + 5; p. 13 15 benefit rows x 3 = 45 = 35 + 10 (the 16th band is the unmarked heading "Basic dental services"); p. 14 8 x 3 = 24 = 24 + 0; p. 15 8 x 3 = 24 = 12 + 12. These facts are recorded in the structured fields only; being drawings and not text they cannot be supported by a verbatim quote.
• Column-order check performed on every table page rather than assumed: cell texts were assigned by the x-centre of each text line, and no line crosses a column boundary. The reading is confirmed by the internal logic of the amounts (Classic <= Plus <= Top) and by the printed footnote markers.
• is_optional: the plan is sold in three plan levels rather than with optional add-ons. is_optional is false where a benefit carries a tick in Classic, Plus AND Top, and null where at least one plan level carries the cross, because a boolean cannot express "insured in Plus and Top only"; the exact plan-level membership is the first entry of each coverage's conditions. The genuinely optional elements are the deductible (No. 4.2) and the inclusion of existing medical conditions at application / the moratorium (Nos. 1.2 and 1.3), flagged is_optional true.
• Row "Major dental services" (p. 13): the Classic column carries the cross ("Reimbursement is excluded from the scope of benefits") and, at the same time, the note "Reimbursement for the outlined below benefits only if needed as a result of an accident". Both are printed side by side and are reproduced as they stand.
• prescription_period is null: this document contains no clause setting a time limit for bringing claims. (Section 7 covers what must be done when an insured event occurs, but states no limitation period.)
• No language clause: this document contains no section stating which language version prevails - its General information chapter ends at 10.7 Applicable law. Nothing has been imported from any other language or sibling document to fill that gap.
• Typographical oddities preserved as printed: "Accomodation in a private or semi-private room" (heading, p. 16), "Clearinhouse" (exclusion on experimental treatments), "To process of reimbursements all original documents should be submitted" (7.3 b), "you will have notify us" (10.4 b), "Optaining intercultural training" (heading, p. 25), "your relevant Globalite" (Online services, p. 24), "It attemps at offering" (definition of Hospice), "surgery involing large bones" (definition of Follow-up rehabilitation), "spinal chord" (definition of Osteopathy), "The insured person are the contractual partner" (7.6 b). These are the insurer's own text and have not been corrected.
• Page numbers in every block are PDF page numbers; on this document the printed folio matches the PDF page number (checked against pages 9-15 and 38-42).
• The document has two separate glossaries - No. 11 "Definitions" (pp. 38-40) and No. 12 "Medical definitions" (pp. 41-42). Both are transcribed into definitions[], each entry carrying the page on which it is printed.

Documents liés

• Globality YouGenio® for Germany (for Germany (Tarifstufen Classic, Plus und Top)) - DE - Conditions générales
• Globality YouGenio® World - EN - Conditions générales

Source & fidélité

• Source : https://globalhealth.insurance/wp-content/uploads/2026/01/Globality_YouGenio_Germany_GCI_EN_0224.pdf - téléchargé le 2026-08-04 - 43 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.