Journey EN (2)

Résumé

Special Conditions of the Journey international private medical insurance product, applicable to the Plans Basic, Extensive, Advanced and Premium, designed for expatriates who stay abroad for at least three months. The document sets out the scope of cover, the geographical areas (I - worldwide including USA, II - worldwide excluding USA), the deductibles, co-payments and out-of-pocket maxima, the annual overall limits (from EUR 1,500,000 in the Basic Plan to Unlimited in the Advanced and Premium Plans) and the scope of inpatient, outpatient, mental health and wellbeing, maternity, vision and dental, medical assistance and additional assistance Benefits per Plan. It also lists the exclusions and a glossary. The document states that it prevails over the General Conditions of Insurance and is itself subordinate to the Particular Conditions.

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

Définitions

Terme	Définition	Page
Acupuncture	Acupuncture is a method in ancient Chinese traditional medicine that cures Diseases and Bodily Injuries or reduces pain with the help of fine needles placed into the body. Conventual medicine recognises this primarily as a method for pain relief.	p. 39
Annual Overall Limit	The maximum which will be paid for all Benefits in total for each Insured Person, for each Insurance Year.	p. 39
Cancer	The general term used for all malignant disorders caused by the uncontrolled multiplication of mutated cells (new growths or tumours). These cells can destroy the surrounding tissue and produce metastases (secondary growths).	p. 39
Chiropractic	A system of diagnosis and Treatment based on the idea that the nervous system coordinates all the body's functions, and that Disease results from a lack of normal nerve function. A chiropractor uses manipulation to change body structures, such as the spinal column, to relieve pressure on nerves coming from the spinal cord caused by a vertebra being displaced.	p. 39
Co-Payment	A Co-Payment is the portion of the cost of a covered medical service that the Insured Person is required to pay, as a percentage of the total eligible expense for every Claim up to the Out-of-Pocket Maximum - if applicable. The remaining balance is paid by the Insurer, subject to the Terms and Conditions of the policy.	p. 39
Computed Tomography (CT)	Computed Tomography (CT) is a diagnostic procedure that uses special x-ray equipment to get cross-sectional pictures of the body. The CT computer displays these pictures as detailed three-dimensional images of organs, bones, and other tissues. This procedure is also called CT scanning, computerized tomography, or computerized axial tomography (CAT).	p. 39
Congenital Conditions	Any Disease or illness, abnormality, birth defect, premature birth or malformation present at birth including any related condition, whether diagnosed or not.	p. 39
Conventional Medicine	The form of medicine based on accepted scientific methods which are taught at universities and so are generally acknowledged and used.	p. 39
Country of Departure	The last country in which the Insured Person had his habitual residence.	p. 39
Daycare	Daycare refers to the Treatment received in Hospital without involving an overnight stay. The length of stay in Hospital is between 8 (eight) and 24 (twenty-four) hours.	p. 39
Deductible	The effect of a Deductible is that the Insured Person bears a certain portion of the costs. The Deductible is the share to be borne by the Insured Persons, up to an agreed limit. If a Deductible has been agreed, this will be shown in the Insurance Policy.	p. 39
Dentist	A Doctor or Practitioner who focuses on Diseases of the teeth and mouth.	p. 39
Dialysis	Dialysis is primarily used to provide an artificial replacement for lost kidney function (renal replacement therapy) due to kidney failure. Dialysis may be used for sudden but temporary loss of kidney function (acute renal failure) or for persons who have permanently lost their kidney function (end-stage kidney Disease). Dialysis is done in Dialysis units which are part of Hospitals and clinics or at home.	p. 39
Eligible Expenses	The costs incurred for medically necessary healthcare services, Treatments, and procedures that are covered under the Terms and Conditions of this Insurance Policy. These expenses typically include charges for Hospitalisation, physician consultations, diagnostic tests, surgical procedures, prescribed Medications, and other approved medical interventions. To qualify as eligible, the services must be provided by licensed healthcare professionals or accredited medical facilities, and must align with the Insurance Policy's cover guidelines, exclusions, and any applicable Waiting Periods or pre-authorization requirements.	p. 39
(Inpatient) Follow-Up Rehabilitation	A medical Treatment aiming at recovering the initial state of health after an illness or serious surgery, for example following bypass surgery, cardiac infarction, transplants and surgery involving large bones or joints, or after a serious Accident.	p. 40
Geographical Area	The following Geographical Areas to which the insurance cover provided under the Insurance Policy may apply: Geographical Area I: Worldwide including USA. Geographical Area II: Worldwide excluding USA.	p. 40
Glossary	The Glossary of defined terms, which forms an integral part of the Special Conditions.	p. 40
Home Country	The country where the Insured Person is a citizen or national of or has habitual/permanent residence or where their mortal remains will be sent if they die.	p. 40
Homeopathy	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. 40
Hospice	An institution where the only purpose is to care for patients with limited life expectancy for whom curative Treatment is no longer available. It aims to offer the best possible quality of life by using palliative care.	p. 40
Hydrotherapy	Hydrotherapy is the targeted Treatment by external application of water.	p. 40
Implants	Dental Implants (metal or ceramic) which are embedded as a substitute for the root of a tooth or in the toothless jaw.	p. 40
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 tissues and organs.	p. 40
Maximum Outpatient Limit	The maximum amount the Insurer will reimburse for the total of all outpatient Benefits per Insured Person and per Insurance Year under a specific insurance Plan, as stated in the Scope of Benefits.	p. 40
Medical Condition	Any illness, Disease, injury or any physical, mental or psychological abnormality as well as pregnancies.	p. 40
Nutritional and/or Dietary Supplements	Products used to boost the nutritional content of the diet, including vitamins, minerals, herbs, meal supplements, sports nutrition products, natural food supplements.	p. 40
Osteopathy	The osteopathic approach to medicine includes comprehensive manual diagnostics and therapy of the malfunctioning of the body's musculoskeletal framework, internal organs and the nervous system. It is mainly used in chronic pain of the vertebral column and the peripheral joints.	p. 40
Out-of-Pocket Maximum	The Out-of-Pocket Maximum is the maximum cumulative amount that the Insured Person is required to pay in the form of Co-Payments for Eligible Expenses during an Insurance Year. Once this threshold is reached, the remaining balance is paid by the Insurer, subject to the Terms and Conditions of the policy.	p. 40
Outpatient Treatment	Any Treatment given by a qualified and licensed medical professional which does not need an overnight stay (also Hospital stays for less than 8 (eight) hours).	p. 40
Palliative Medicine	Palliative Medicine is the extensive and active Treatment of patients with a limited life expectancy for which curative therapy is no longer possible in their condition. This type of Treatment provides the best possible quality of life for the patient and its family.	p. 40
Policy Period	The Policy Period is the period in time during which the insurance cover is granted under the Insurance Policy, which the Policyholder has selected for the Insured Persons in the Application Form.	p. 40
Positron Emission Tomography (PET)	A non-invasive imagery process based on the detection and imagery of a substance with positron emitters spread inside the patient's body. The concentration of these "markers" in a tumour can then be quantified, the substance is injected intravenously, and the radiation is detected with external detectors. With the help of PET important biological processes can be visualised in tumours.	p. 41
Practitioner	A person who, besides Doctors, also has recognised and well-founded training in their area of Treatment and are authorised for Treatment in that speciality in the country in which the Treatment is to be provided. The following are understood to be Practitioners: naturopaths, speech Therapists and midwives as well as independent Practitioners practicing in state approved medical ancillary professions (for example massage Therapists and medical attendants, physiotherapists).	p. 41
Pre-Existing Conditions	Pre-Existing Conditions refer to any Medical Conditions, Diseases, Bodily Injuries, or their consequences that the Policyholder or any Insured Person was aware of, or received medical advice, diagnosis, or Treatment for, prior to signing the Application Form. This includes: any condition for which the Insured Person underwent diagnostic testing (including preventive screenings or routine health check-ups) that resulted in abnormal findings, regardless of whether a formal diagnosis was made; any signs or symptoms, whether diagnosed or not, as well as any physical or organic abnormalities, congenital anomalies, disabilities, or deformities; the presence of any medical devices such as Implants, stents, prostheses, or any other devices permanently or temporarily attached to the body. Additionally, any illness, injury, or Medical Condition that arises between the date of signing the Application Form and the date of signing the Particular Conditions will also be considered a Pre-Existing Condition.	p. 41
Professional Sports	Any sports the Insured Person is being paid for taking part in.	p. 41
Prophylactic Measures	Preventive measures which include individual and general measures to avoid the threat of illness (for example, vaccinations, passive immunisation, preventive Medication when travelling to dangerous areas, preventing Accidents and so on).	p. 41
Repatriation	If a Medical Necessary Treatment for which the Insured Person is covered is not available locally, the Insurer covers the return to the Home Country for Treatment, rather than to the nearest appropriate medical centre. This only applies when the Home Country is located within the Insured Persons Geographical Area of cover.	p. 41
Sanatorium Treatment	A cure or Treatment different from a Medical Treatment that serves to rehabilitate a person's state of health or Fitness.	p. 41
Second Opinion	The medical advice given by a second independent Doctor not involved in the Treatment. The Insured Person can also consult a second Doctor through the relevant Service Centre to get a Second Opinion if potentially fatal illnesses or serious permanent disabilities are involved.	p. 41
Start of Treatment	The date on which a Medical Treatment, prescribed and administered by a Medical Authority subsequent to a Disease or Bodily Injury, commences.	p. 41
Substitute Hospital Cash Plan Benefit	If the Insured Person does not claim any Benefits from the Insurer for Medically necessary inpatient Treatment covered by the insurance, the Insurer will instead pay a Substitute Hospital Cash Plan Benefit for every day actually spent in Hospital for the medically recommended inpatient Treatment. This is in line with the Plan level chosen.	p. 41
Therapist	A Doctor, but also anyone who has received in-depth training in their field and is licensed or authorised to give Treatment in the country in which Treatment is provided. This includes Practitioners of complementary medicine, speech Therapists and midwives and obstetric nurses, as well as members of state-approved assistant medical professions with their own practice, such as masseurs and physiotherapists.	p. 41
Usual, Customary and Reasonable	Usual, Customary and Reasonable charges refer to the average fee charged for a specific medical service by licensed medical Practitioners within a defined geographic region (e.g. city or country), based on publicly available fee schedules or databases maintained by recognized health authorities or insurance industry benchmarks.	p. 42
Insured event	An insured event is characterized by the Medically necessary Treatment required for an illness, an Accident, or other events specified in the Special Conditions. The commencement of the insured event is marked by the initiation of Treatment formalised by a prescription of a Doctor and concludes when medical findings indicate that further Treatment is not Medically necessary. In the event that the Insured Person requires Treatment unrelated to the original insured event, it will be treated as a distinct new insured event.	p. 6

Garanties

Annual Overall Limit - p. 7

The maximum which will be paid for all Benefits in total for each Insured Person, for each Insurance Year. - Optionnelle : non · Limite : Basic: EUR 1,500,000 / USD 1,950,000 / GBP 1,260,000 / CHF 1,395,000 - Extensive: EUR 3,000,000 / USD 3,900,000 / GBP 2,520,000 / CHF 2,790,000 - Advanced: Unlimited - Premium: Unlimited - Condition : This row carries the amounts only; no tick or cross symbol is printed in it.

Accommodation in a private or semi-private room - p. 8

The Insured Person has the flexibility to select the Hospital for receiving Medical Treatment. Medical Treatment in a Hospital encompasses any Treatment, during which the Insured Person is admitted to a Hospital in the country where they are undergoing Treatment, for a minimum duration of 24 (twenty-four) hours. Accommodation is restricted to standard private or semi-private rooms; a standard private room is defined as a basic single occupancy room with an adjoining private bath or shower room in a Hospital. The Insurance Policy covers the entire inpatient Treatment without a specific time limit. - Optionnelle : non - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans. - Condition : In cases where the Treatment is conducted in Hospitals offering Sanatorium Treatment, the Insurance Policy exclusively covers Treatments meeting the criteria for Conventional Medicine/Medically necessary Treatment, unless alternative Treatments have been explicitly approved in writing by the Insurer prior to the Start of Treatment. - Condition : It explicitly excludes rooms with upgraded amenities, including but not limited to deluxe rooms, executive rooms, or suites that may have additional facilities such as kitchens, dining areas, or sitting rooms. - Condition : It is imperative to contact and inform the Insurer or the Service Centre regarding the Hospital stay and Treatment before or within 3 (three) calendar days of admission to the Hospital. Failure to do so may result in the Insurer not fully covering the Claim.

Consultations and diagnostic services, including pathology, radiology, Computed Tomography (CT), magnetic resonance imaging (MRI), Positron Emission Tomography (PET) and Palliative Medicine (inpatient) - p. 8

The Insurance Policy will encompass all costs related to Medically necessary inpatient Treatment, covering examinations, diagnostics, and therapy as well as expenses related to pathology, radiology, Computed Tomography (CT), Magnetic resonance imaging (MRI), Positron Emission Tomography (PET), and Palliative Medicine. - Optionnelle : non - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans.

Hospital charges, including operating theatres, anaesthesia, intensive care wards and laboratories - p. 8

This pertains to additional expenses associated with the utilisation of specialised facilities, including operating theatres, intensive care units, and laboratories. - Optionnelle : non - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans.

Surgery and anaesthetics - p. 8

The Insurer will reimburse costs incurred for Medically necessary services in this context, such as medical services, anaesthesia, and the utilisation of specialised facilities, if prescribed by a specialist Doctor. - Optionnelle : non - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans.

Outpatient surgery instead of inpatient Treatment - p. 8

This pertains to elective surgery typically conducted in a Doctor's office or Hospital setting, without the necessity for an overnight stay. - Optionnelle : non - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans. - Condition : It excludes grade 1 or minor surgeries (invasive procedures involving only the resection of skin, mucous membranes, and connective tissue) and invasive operative procedures for obtaining tissue samples or bodily fluids, such as biopsies and colonoscopies.

Drugs and Dressings (inpatient) - p. 8

These Medications must be prescribed by a Hospital Doctor or Dentist in conjunction with inpatient Treatment. Additionally, the Drugs must be dispensed by a pharmacy, Hospital pharmacy, or another dispensary officially approved by competent authorities. - Optionnelle : non - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans. - Condition : Nutritional food, tonics, mineral water, cosmetics, products for personal hygiene, as well as bath salts, are not deemed as Drugs eligible for insurance cover under the Insurance Policy as part of Medical Treatment.

Physiotherapy, including massages (inpatient) - p. 8

Physiotherapy and massages must be prescribed by a Hospital Doctor as integral components of inpatient Treatment and must be administered by a Doctor or a qualified, certified Therapist. - Optionnelle : non - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans. - Condition : The prescription should be provided prior to the Start of Treatment and should specify the diagnosis along with details about the type and number of required sessions.

Therapies, including occupational therapy, light therapy, Hydrotherapy, inhalation, packs, medical baths, cryotherapy, thermotherapy, electrotherapy (inpatient) - p. 8

Physical-medical therapies must be prescribed by a Hospital Doctor as a component of inpatient Treatment and must be administered by a Doctor or a qualified, certified Therapist. - Optionnelle : non - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans. - Condition : The prescription must be provided before the Start of Treatment and should include details such as the diagnosis and the specific type and number of required sessions.

Therapeutic aids and appliances (inpatient) - p. 8

The Insurance Policy covers expenses related to therapeutic aids and appliances designed as life-saving measures or those directly addressing or compensating for physical disabilities, such as cardiac pacemakers and artificial limbs/prostheses (excluding dentures). - Limite : Basic: only if needed as a life-saving measure, such as cardiac pacemakers - Extensive: only if needed as a life-saving measure, such as cardiac pacemakers - Advanced: if needed as a life-saving measure, such as cardiac pacemakers; in addition, reimbursement for non life-saving therapeutic aids and appliances, such as artificial limbs/prostheses up to EUR 2,000 / USD 2,600 / GBP 1,680 / CHF 1,860 - Premium: no limit stated in the scope of Benefits - Condition : In the scope of Benefits the Basic, Extensive and Advanced columns of this row carry the qualifying wording only, with no tick or cross symbol; the Premium column carries a tick. - Condition : These aids must be fitted or adjusted during the inpatient stay and should remain in or on the body of the Insured Person. - Condition : The Insurer will reimburse costs for repairing therapeutic aids and appliances within the specified conditions during the Policy Period.

Congenital Conditions - p. 8

The Insurer will reimburse expenses for Congenital Conditions. Additionally, the Insurer covers complications arising from assisted conception, including childbirth, premature or multiple births. - Optionnelle : non · Limite : Basic: Up to a maximum of EUR 100,000 / USD 130,000 / GBP 84,000 / CHF 93,000 per lifetime - Extensive: Up to a maximum of EUR 100,000 / USD 130,000 / GBP 84,000 / CHF 93,000 per lifetime - Advanced: Up to a maximum of EUR 150,000 / USD 195,000 / GBP 126,000 / CHF 139,500 per lifetime - Premium: Up to a maximum of EUR 200,000 / USD 260,000 / GBP 168,000 / CHF 186,000 per lifetime - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans.

Cancer Treatment, oncological Drugs and Treatment, including reconstructive surgery for breast Cancer (inpatient) - p. 8

Within the scope of inpatient Hospital care, the Insurance Policy includes insurance cover for Eligible Expenses related to Medical Treatment for Cancer and direct consequences, including diagnostic tests, radiation therapy, chemotherapy, Drugs, and Hospital costs associated with inpatient Treatment. Additionally, reconstructive surgery for breast Cancer is covered. - Optionnelle : non - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans.

Prophylactic mastectomy surgery - p. 9

A prophylactic mastectomy involves the surgical removal of one or both breasts to decrease the likelihood of developing breast Cancer. The Insurer will only reimburse the expenses associated with preventive surgery aimed at reducing the risk of breast Cancer. - Limite : Premium: 50% Up to EUR 10,000 / USD 13,000 / GBP 8,400 / CHF 9,300 - Condition : Insured in the Premium Plan only; reimbursement is excluded from the scope of Benefits in the Basic, Extensive and Advanced Plans. - Condition : Waiting period of 24 months.

Dialysis - p. 9

The Insurer will reimburse Eligible Expenses for Dialysis, encompassing essential Medication and all associated costs. These Eligible Expenses cover Treatment on an inpatient Treatment, Outpatient Treatment, and Daycare. - Limite : Extensive: Up to a maximum of EUR 1,000,000 / USD 1,300,000 / GBP 840,000 / CHF 930,000 per lifetime - Advanced: Up to a maximum of EUR 1,500,000 / USD 1,950,000 / GBP 1,260,000 / CHF 1,395,000 per lifetime - Premium: Up to a maximum of EUR 2,000,000 / USD 2,600,000 / GBP 1,680,000 / CHF 1,860,000 per lifetime - Condition : Insured in the Extensive, Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic Plan.

Bone marrow and organ transplants (costs for donor and receiver) - p. 9

In instances of bone marrow or organ transplantation (such as heart, kidney, liver, pancreas), the Insurance Policy provides cover for medical expenses incurred by an Insured Person, serving in the dual role of both recipient and donor. Eligible Expenses encompass the costs linked to organ procurement from a donor, expenses for transporting the organ to the recipient's location, and potential inpatient stay costs for the donor. - Optionnelle : non · Limite : Basic: Up to a maximum of EUR 150,000 / USD 195,000 / GBP 126,000 / CHF 139,500 per lifetime - Extensive: Up to a maximum of EUR 150,000 / USD 195,000 / GBP 126,000 / CHF 139,500 per lifetime - Advanced: Up to a maximum of EUR 250,000 / USD 325,000 / GBP 210,000 / CHF 232,500 per lifetime - Premium: no limit stated in the scope of Benefits - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans. - Condition : It does not include expenses associated with the search for an organ or a suitable donor.

Parent accommodation during inpatient Treatment of a minor child - p. 9

The Insurance Policy includes cover for the supplementary accommodation expenses for one parent staying with a child under the age of 18 (eight-teen) who is admitted for inpatient Treatment. - Optionnelle : non - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans.

Nursing care at home, instead of a Hospital stay - p. 9

The Insurance Policy includes cover for Medically necessary nursing care provided at home by qualified nursing staff. This option serves as an alternative to a Hospital stay as medically advised or aims to shorten the duration of Hospitalisation. - Limite : Extensive: Up to 30 days after written pre-approval - Advanced: Up to 60 days after written pre-approval - Premium: Up to 90 days after written pre-approval - Condition : Insured in the Extensive, Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic Plan. - Condition : Subject to prior written approval from the Insurer before the Start of Treatment.

Substitute Hospital Cash Plan Benefit - p. 9

In cases where the Policyholder refrains from seeking reimbursement from the Insurer for an Insured Person undergoing a covered inpatient Treatment, the Insurance Policy provides payment in the form of a daily Hospital allowance per prescribed day in the Hospital. - Optionnelle : non · Limite : Basic: EUR 50 / USD 65 / GBP 42 / CHF 46.50 per day - Extensive: EUR 75 / USD 97.50 / GBP 63 / CHF 69.75 per day - Advanced: EUR 150 / USD 195 / GBP 126 / CHF 139.50 per day - Premium: EUR 200 / USD 260 / GBP 168 / CHF 186 per day - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans.

Inpatient Follow-Up Rehabilitation - p. 9

The Insurer will reimburse the costs associated with Inpatient Follow-Up Rehabilitation, which is essential for continuing Medically necessary inpatient Treatment. This applies specifically to cases such as post-bypass surgery, cardiac infarction, transplants, and surgeries involving large bones or joints. - Optionnelle : non · Limite : Basic: Up to 14 days after written pre-approval - Extensive: Up to 21 days after written pre-approval - Advanced: Up to 28 days after written pre-approval - Premium: Up to 35 days after written pre-approval - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans. - Condition : Subject to prior written approval from the Insurer before the Start of Treatment. - Condition : Inpatient Follow-Up Rehabilitation must commence within 2 (two) weeks of Hospital discharge. - Condition : The Insurance Policy does not cover expenses related to Sanatorium Treatments, cures, stays in cure establishments, spas, convalescent homes, or nursing homes.

Hospice - p. 9

The Insurer will reimburse expenses related to accommodation, nursing care, and support if outpatient care at home or in a family member's residence is not feasible. - Limite : Extensive: Up to 5 weeks - Advanced: Up to 7 weeks - Premium: Up to 9 weeks - Condition : Insured in the Extensive, Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic Plan. - Condition : Contingent upon the Hospice meeting specific criteria, including collaboration with experienced nursing staff and Doctors specializing in Palliative Medicine, and operating under the professional supervision of a nurse or another adequately qualified individual. - Condition : The Insurer provides Benefits exclusively for full- or part-time inpatient Hospice care if the Insured Person is afflicted with an illness that is progressive, has reached an advanced stage, is incurable necessitating inpatient Palliative Medicine, and offers a life expectancy of weeks or a few months. - Condition : The Insurer extends Hospice Benefits for various illnesses, including but not limited to: Cancer in advanced stages; Fully developed infectious AIDS; Disorders of the nervous system leading to unstoppable progressive paralysis; Terminal stages of chronic kidney, liver, heart, digestive, or pulmonary illnesses.

Daycare - p. 9

The Insurance Policy covers Treatment received in a Hospital that does not require an overnight stay. It also covers partial inpatient Treatment involving a visit to a day or night clinic or Hospital where the patient is present during the day or night. In both scenarios, the duration of the Hospital stay ranges from 8 (eight) to 24 (twenty-four) hours and must not surpass the 24 (twenty-four)-hour limit. - Optionnelle : non - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans.

Transport to the nearest suitable Hospital for initial Treatment following an Accident or an Emergency - p. 9

The Insurer will cover the Usual, Customary and Reasonable expenses for transporting to the closest suitable Hospital or medical facility. - Optionnelle : non - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans. - Condition : Unless otherwise agreed, the provision of transportation services must be carried out by a duly licensed service provider.

Inpatient dental Treatment - p. 9

The Insurer will cover expenses for complex oral surgical procedures associated with a higher-than-average risk of life-threatening complications. Examples include congenital jaw deformities (e.g. cleft jaw), jaw fractures, and tumours. - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans.

Emergency dental Treatment - p. 9

Emergency inpatient dental Treatment pertains to a severe Accident necessitating Hospitalisation, such as the reconstruction of the jaw following accidental injury. - Condition : Insured in the Extensive, Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic Plan. - Condition : This Treatment should be administered within 24 (twenty-four) hours of the Emergency incident. - Condition : This Benefit does not encompass subsequent dental Treatment, dental surgery, dental prostheses or Implants, orthodontics, or periodontics. - Condition : The attending physician must explicitly confirm that the inpatient dental Treatment results from a significant Accident, and the incident's occurrence must be substantiated by a corresponding medical or police report.

Maximum Outpatient Limit - p. 10

The Benefits for Outpatient Treatment shall not exceed the Maximum Outpatient Limit, unless otherwise specified in the scope of Benefits. - Limite : Basic: EUR 2,000 / USD 2,600 / GBP 1,680 / CHF 1,860 - Extensive: EUR 12,000 / USD 15,600 / GBP 10,080 / CHF 11,160 - Advanced: Unlimited - Premium: Unlimited - Condition : This row carries the amounts only; no tick or cross symbol is printed in it.

Consultations and diagnostic services, including pathology, radiology, CT, MRI, PET and Palliative Medicine (outpatient) - p. 10

The Insurance Policy includes cover for incurred expenses related to Outpatient Treatment, encompassing examinations, diagnostics, and therapy, including but not limited to pathology, radiology, Computed Tomography (CT), Magnetic resonance imaging (MRI), Positron Emission Tomography (PET), and Palliative Medicine. - Optionnelle : non · Limite : Basic: 80% - Extensive: Max. outpatient limit applies - Advanced and Premium: no limit stated in the scope of Benefits - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans. - Condition : Max. outpatient limit applies (footnote of the outpatient scope of Benefits).

Outpatient surgery - p. 10

The Insurance Policy covers surgery that may be conducted by a Doctor or within a Hospital setting, which does not require an overnight Hospital stay and does not require subsequent Hospitalisation. - Limite : Extensive: Max. outpatient limit applies - Advanced and Premium: no limit stated in the scope of Benefits - Condition : Insured in the Extensive, Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic Plan.

Chemotherapy, oncological Drugs and Treatment (e.g. for Cancer patients) - p. 10

The Insurance Policy covers eligible Medically necessary measures for examination, diagnosis, and therapy in the context of Outpatient Treatment for Cancer and direct consequences, including chemotherapy, and other oncological procedures. - Optionnelle : non - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans.

Acupuncture (needle technique), Homeopathy, Osteopathy, Traditional Chinese medicine and Chiropractic - p. 10

The Insurance Policy will cover these expenses only if these Treatments are administered by Doctors or other Practitioners who can demonstrate certified and appropriate training in the country where the Treatment takes place, and they are duly approved or authorised to provide such Treatment. Additionally, the Drugs and Dressings prescribed by the treating Doctors or Practitioners during the relevant Treatment are also included in the insurance cover. - Limite : Extensive: Up to EUR 750 / USD 975 / GBP 630 / CHF 697.50 - Advanced: Up to EUR 2,500 / USD 3,250 / GBP 2,100 / CHF 2,325 - Premium: Up to EUR 5,000 / USD 6,500 / GBP 4,200 / CHF 4,650 - Condition : Insured in the Extensive, Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic Plan.

Speech therapy - p. 10

For speech and voice disorders, the Insurer will reimburse Eligible Expenses for medically prescribed exercises and therapy aimed at treating these disorders, under the condition that such interventions are conducted by a Doctor or a speech Therapist. - Limite : Advanced: Up to 20 sessions, after written pre-approval - Premium: After written pre-approval - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans. - Condition : Subject to obtaining prior written approval from the Insurer before the Start of Treatment.

Drugs and Dressings (outpatient) - p. 10

Prescriptions for Drugs and Dressings must be issued by a Doctor, Practitioner, Dentist, or a person authorised to do so under their supervision. These Drugs and Dressings must be obtained from a pharmacy or an officially approved supplier. - Optionnelle : non · Limite : Basic: 80%* - Extensive: Max. outpatient limit applies - Advanced and Premium: no limit stated in the scope of Benefits - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans. - Condition : Items such as nutritional food, tonics, mineral water, cosmetics, products for personal hygiene, and bath salts are not categorized as Drugs.

Over-the-counter Drugs - p. 10

Non-prescription, over the counter (OTC) Drugs can be purchased without a prescription and are typically used to alleviate symptoms of common Diseases that may not require a Doctor's visit for the Insured Person. - Limite : Extensive: Up to EUR 50 / USD 65 / GBP 42 / CHF 46.50 - Advanced: Up to EUR 75 / USD 97.50 / GBP 63 / CHF 69.75 - Premium: Up to EUR 100 / USD 130 / GBP 84 / CHF 93 - Condition : Insured in the Extensive, Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic Plan.

Physiotherapy, including massages (outpatient) - p. 10

The Insurance Policy covers physio-medical services, including physiotherapy and exercise therapy, as well as massages, that are accessible through a prescription and that are administered by a Doctor or a qualified and certified Therapist. - Limite : Extensive: Up to 15 sessions (including 5 non-prescribed sessions)* - Advanced: Up to 20 sessions (including 5 non-prescribed sessions) - Premium: (including 5 non-prescribed sessions) - Condition : Insured in the Extensive, Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic Plan. - Condition : The prescription should be provided prior to the Start of Treatment and must specify the diagnosis, as well as the type and number of sessions required.

Therapies, including occupational therapy, light therapy, Hydrotherapy, inhalation, packs, medical baths, cryotherapy, thermotherapy, electrotherapy (outpatient) - p. 10

The Insurance Policy covers physio-medical services provided they are administered by a Doctor or a certified Therapist and have been prescribed by the Doctor as part of Outpatient Treatment. - Limite : Advanced: Up to 10 sessions - Premium: no limit stated in the scope of Benefits - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans. - Condition : The prescription must be issued prior to the Start of Treatment and should specify the diagnosis, along with the type and number of sessions required.

Therapeutic aids and appliances (outpatient) - p. 11

The Insurance Policy covers therapeutic aids and appliances provided they have been prescribed by a Doctor. Eligible Expenses encompass costs related to artificial limbs and organs, as well as orthopaedic and other therapeutic aids designed to prevent or alleviate physical disabilities: bandages, trusses, insole supports for shoes, walking aids, hearing aids, compression stockings, corrective splints, artificial limbs and prosthetics (excluding dentures), plaster shells for lying and sitting, and orthopaedic braces for arms, legs, and the entire body. - Limite : Extensive: Up to EUR 1,000 / USD 1,300 / GBP 840 / CHF 930 - Advanced: Up to EUR 2,000 / USD 2,600 / GBP 1,680 / CHF 1,860 - Premium: no limit stated in the scope of Benefits - Condition : Insured in the Extensive, Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic Plan. - Condition : All other therapeutic aids and appliances require prior written approval from the Insurer for eligibility. - Condition : Expenses for reasonable maintenance, such as an annual service or battery replacement, and repairs of therapeutic aids and appliances are reimbursable within the scope of these provisions. - Condition : Expenses for sanitary supplies, such as pads and massage devices, as well as their use and maintenance, are not covered under the Insurance Policy.

Wigs and prosthetic bras following Cancer Treatment - p. 11

Wigs and prosthetic bras for women undergoing Cancer Treatment qualify for reimbursement under the Insurance Policy, with the amount contingent on the Plan level. - Limite : Extensive: Up to EUR 300 / USD 390 / GBP 252 / CHF 279 - Advanced: Up to EUR 300 / USD 390 / GBP 252 / CHF 279 - Premium: Up to EUR 500 / USD 650 / GBP 420 / CHF 465 - Condition : Insured in the Extensive, Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic Plan.

Podiatry - p. 11

The Insurer will cover qualifying expenses for Medically necessary podiatry Treatment. - Limite : Advanced: Up to EUR 100 / USD 130 / GBP 84 / CHF 93 - Premium: Up to EUR 200 / USD 260 / GBP 168 / CHF 186 - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans. - Condition : These services must be prescribed by a Doctor, and the prescription must be issued before the Start of Treatment. It should clearly specify the diagnosis, nature of the condition, and the required number of sessions.

Transport to the nearest suitable Doctor or Hospital for initial Treatment following an Accident or an Emergency (outpatient) - p. 11

The Insurer will reimburse Usual, Customary and Reasonable expenses for Emergency transportation to the nearest appropriate Doctor, Hospital, or facility following an Accident or Emergency. - Optionnelle : non - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans. - Condition : Unless otherwise agreed, the provision of services must be carried out by a duly licensed service provider.

Infertility Treatment - p. 11

The Insurer will reimburse expenses related to various Usual, Customary and Reasonable fertility-enhancing diagnostics and Treatments, including measures to prevent future miscarriages, investigations into miscarriage, and assisted reproduction, along with associated complications: diagnostic investigations, consultations, tests, and invasive procedures such as hysterosalpingogram, laparoscopy, or hysteroscopy; laboratory work; prescribed drug Treatments (including ovulation stimulation); In vitro fertilization (IVF); Intracytoplasmic sperm injection (ICSI); Artificial insemination (AI). - Limite : Premium: 50% up to EUR 10,000 / USD 13,000 / GBP 8,400 / CHF 9,300 for each insured couple, after written pre-approval per lifetime - Condition : Insured in the Premium Plan only; reimbursement is excluded from the scope of Benefits in the Basic, Extensive and Advanced Plans. - Condition : Waiting period of 24 months. - Condition : The woman is aged under 40 (fourty) and the man under 50 (fifty) at the time of Treatment, specifically the first stimulation day in each Treatment cycle or the first cycle day in the case of insemination without hormone stimulation. - Condition : Medical assessment has ascertained a significant possibility of success of over 15% for the selected method. - Condition : The Insured Person's sterile condition is due to organic causes and can only be overcome with the aid of reproductive help. - Condition : Both the man and the woman benefiting from the Treatment are Insured Persons and are eligible for Treatment on their selected Plan level.

Psychiatric Treatment (inpatient) - p. 12

The Insurance Policy includes cover for psychiatric services within the scope of inpatient Medical Treatment, subject to the Insurer granting written approval before the Start of Treatment. - Limite : Extensive: Up to 30 days, after written pre-approval - Advanced: Up to 40 days, after written pre-approval - Premium: Up to 60 days, after written pre-approval - Condition : Insured in the Extensive, Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic Plan. - Condition : A Waiting Period of 10 (ten) months applies.

Inpatient psychotherapy - p. 12

The Insurance Policy encompasses the costs of psychotherapy as an element of inpatient Treatment, on the condition that the Treatment is administered by a psychiatrist, Psychotherapist, or a Doctor with specialised training in psychiatry, psychotherapy, or psychoanalysis. - Limite : Advanced: Up to 20 sessions, after written pre-approval - Premium: Up to 40 sessions, after written pre-approval - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans. - Condition : Prior written approval from the Insurer is required before the Start of Treatment. - Condition : A Waiting Period of 10 (ten) months applies.

Psychiatric Treatment (outpatient) - p. 12

The Insurer will reimburse Outpatient psychiatric Treatment expenses only if a prior written approval has been given to cover these costs before the Start of Treatment. Psychiatric Treatment is administered by psychiatrists, who are medical Doctors with specialised training and education in mental health. - Limite : Extensive: Up to EUR 1,000 / USD 1,300 / GBP 840 / CHF 930, after written pre-approval - Advanced: Up to EUR 5,000 / USD 6,500 / GBP 4,200 / CHF 4,650, after written pre-approval - Premium: Up to EUR 10,000 / USD 13,000 / GBP 8,400 / CHF 9,300, after written pre-approval - Condition : Insured in the Extensive, Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic Plan. - Condition : A Waiting Period of 10 (ten) months applies.

Outpatient psychotherapy - p. 12

The Insurer will reimburse outpatient psychotherapy expenses if the Treatment is administered by a psychiatrist, psychotherapist, or a Doctor with additional training in the specialised fields of psychiatry, psychotherapy, or psychoanalysis. - Limite : Advanced: Up to 10 sessions, after written pre-approval - Premium: Up to 20 sessions, after written pre-approval - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans. - Condition : Subject to obtaining prior written approval from the Insurer before the Start of Treatment. - Condition : A Waiting Period of 10 (ten) months applies.

Routine health checks or screening tests conducted in the absence of clinical symptoms - p. 12

These tests are conducted based on age to detect anomalies or Diseases and comprise the following examinations: vital signs (blood pressure, pulse, respiration, temperature); lipid profile; cardiovascular examination; neurological examination; Cancer screening; well-child test; diabetes test; HIV and AIDS test; gynaecological screening. - Limite : Extensive: Up to EUR 250 / 325 USD / GBP 210 / CHF 232.50 - Advanced: Up to EUR 500 / USD 650 / GBP 420 / CHF 465 - Premium: Up to EUR 1,000 / USD 1,300 / GBP 840 / CHF 930 - Condition : Insured in the Extensive, Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic Plan.

Vaccinations of every kind, including the vaccines and Prophylactic Measures - p. 12

The Insurer will reimburse the costs associated with vaccinations and recommended Prophylactic Measures for the Insured Person's Country of residence. This insurance cover includes both the consultation fees for administering the vaccine and the cost of the vaccine itself. - Limite : Advanced: Up to EUR 500 / USD 650 / GBP 420 / CHF 465 - Premium: no limit stated in the scope of Benefits - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans.

Nutritional consultation - p. 12

The Insurance Policy provides insurance cover for Eligible Expenses related to outpatient consultations with a nutritionist, subject to reimbursement upon the diagnosis of a condition that Benefits from nutritional advice. Such conditions encompass Cancer, eating disorders, gastrointestinal Diseases, heart Diseases, and food intolerances or allergies. - Limite : Premium: Up to EUR 400 / USD 520 / GBP 336 / CHF 372 - Condition : Insured in the Premium Plan only; reimbursement is excluded from the scope of Benefits in the Basic, Extensive and Advanced Plans. - Condition : These services must be prescribed by a Doctor, and the prescription must be issued before the Start of Treatment. The prescription should clearly specify the diagnosis, nature of the condition, and the required number of sessions.

Maternity care and childbirth, services of a midwife or obstetric nurse in a Hospital (inpatient) - p. 13

The Insurer will reimburse Eligible Expenses related to childbirth, pregnancy, or pregnancy-related illnesses incurred in a Hospital, maternity home, or similar institution. This includes expenses for nursing at home necessitated by pregnancy or related illnesses, as well as midwife or obstetric nurse services. - Limite : Advanced: Up to EUR 5,000 / USD 6,500 / GBP 4,200 / CHF 4,650 - Premium: Up to EUR 20,000 / USD 26,000 / GBP 16,800 / CHF 18,600 - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans. - Condition : A Waiting Period of 12 (twelve) months applies. - Condition : Insurance cover for midwife services during delivery is applicable only in cases of midwifeled births. Doctor fees are not covered, unless deemed Medically necessary due to complications during birth. - Condition : Medically prescribed nursing at home is covered post inpatient delivery, following discharge from the Hospital within 24 (twenty-four) hours; the Insurer reimburses such costs for up to 5 (five) consecutive days following the delivery. - Condition : For non-Medically necessary caesarean sections, insurance cover extends up to the cost of an eligible routine delivery in the same Hospital, within the maximum limit specified by the selected Plan level.

Complications of pregnancy and childbirth (inpatient) - p. 13

The Insurer will reimburse Eligible Expenses associated with premature birth, miscarriage, Medically necessary abortion, stillbirth, ectopic pregnancy, hydatidiform mole, caesarean section, post-partum haemorrhage, retained placental membrane, and complications arising from any of these conditions. - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans. - Condition : A Waiting Period of 12 (twelve) months applies.

Nursing care at home after childbirth, instead of a Hospital stay - p. 13

• Limite : Advanced and Premium: Up to 5 days, after written pre-approval
• Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans.

Newborn care - p. 13

The Insurance Policy for the newborn provides insurance cover for the Treatment of routine and acute Medical Conditions occurring within the first 30 (thirty) days following birth. These Treatments are covered exclusively under the "Newborn Benefit" and are not eligible for reimbursement under any other Benefit category within the policy. - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans. - Condition : Newborn babies must be incepted as Insured Person under the Insurance Policy to have access to the Benefit. - Condition : Medical Conditions that are congenital in nature, as well as complications resulting from assisted conception or childbirth, including but not limited to premature birth or multiple births, are covered under the "Congenital Conditions" Benefit of the newborn's Insurance Policy.

Maternity care and childbirth, services of a midwife or obstetric nurse (outpatient) - p. 13

The Insurer will reimburse Eligible Expenses related to pregnancy or pregnancy-related illnesses, encompassing standard routine maternity scans and tests. Insurance cover extends to all Medically necessary diagnostic tests, including amniocentesis and Chorionic Villus Sampling (CVS). - Limite : Advanced: Up to EUR 5,000 / USD 6,500 / GBP 4,200 / CHF 4,650 - Premium: Up to EUR 10,000 / USD 13,000 / GBP 8,400 / CHF 9,300 - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans. - Condition : A Waiting Period of 12 (twelve) months applies. - Condition : NIPT and other forms of genetic testing are excluded. - Condition : In countries where routine prenatal care is commonly provided by a licensed midwife, midwife services are reimbursable, only if no charges for the same services have been administered by a Doctor. - Condition : Additionally, the Insurer will cover 12 (twelve) post-natal midwife home visits per pregnancy. - Condition : Doula services, as well as pre-natal and post-natal classes, are not eligible for reimbursement.

Complications of pregnancy and childbirth (outpatient) - p. 13

The Insurer will reimburse Eligible Expenses incurred for premature birth, miscarriage, Medically necessary abortion, stillbirth, ectopic pregnancy, hydatidiform mole, caesarean section, post-partum haemorrhage, retained placental membrane, and complications arising from any of these conditions. - Limite : Advanced: Up to EUR 5,000 / USD 6,500 / GBP 4,200 / CHF 4,650 - Premium: no amount stated in the scope of Benefits - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans. - Condition : A Waiting Period of 12 (twelve) months applies.

Outpatient childbirth cash benefit - p. 13

Outpatient childbirth is characterized by delivering at home or departing from the Hospital, maternity home, or a similar institution within 24 (twenty-four) hours of giving birth. The Insurer will provide the lumpsum childbirth allowance per newborn upon receiving a birth certificate and, if applicable, a certificate from the medical provider confirming the duration of stay. - Limite : Advanced: Lump sum of EUR 250 / USD 325 / GBP 210 / CHF 232.50 per newborn baby - Premium: Lump sum of EUR 500 / USD 650 / GBP 420 / CHF 465 per newborn baby - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans. - Condition : without proof of costs on presentation of the birth certificate - Condition : A Waiting Period of 12 (twelve) months applies.

Vision aids, including an eye test - p. 14

The Insurer will cover the costs for eyeglass, frames and lenses, including contact lenses or sunglasses equipped with dioptre lenses, along with one refraction test per Insurance Year. In the event that the Insured Person's visual acuity changes by at least 0.5 diopters during the term of the Insurance Year, a renewed entitlement to Benefits shall arise in respect of such change. - Limite : Advanced: Up to EUR 300 / USD 390 / GBP 252 / CHF 279 every 2 years. - Premium: Up to EUR 750 / USD 975 / GBP 630 / CHF 697.50 every 2 years. - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans.

Maximum dental limit - p. 14

The Benefits for dental Treatments shall not exceed the Maximum dental limit, unless otherwise specified in the scope of Benefits. - Limite : Basic: n.a. - Extensive: EUR 250 / USD 325 / GBP 210 / 232.50 CHF - Advanced: n.a. - Premium: n.a. - Condition : This row carries the amounts only; no tick or cross symbol is printed in it.

Screenings for early detection of disorder of the teeth, mouth and jaw - p. 14

The Insurance Policy covers routine screenings for early detection of disorders of the teeth, mouth and jaw. - Limite : Extensive: Up to 2 screenings per year - Advanced: Up to 2 screenings per year - Premium: Up to 2 screenings per year - Condition : Insured in the Extensive, Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic Plan. - Condition : Part of the Minor dental services section of the scope of Benefits. - Condition : Max. dental limit applies (footnote of the dental scope of Benefits).

X-rays (dental) - p. 14

General dental services including X-ray examination and intraoral local anaesthesia in connection with minor dental services. - Limite : Extensive: Max. dental limit applies - Advanced and Premium: no limit stated in the scope of Benefits - Condition : Insured in the Extensive, Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic Plan. - Condition : Part of the Minor dental services section of the scope of Benefits. - Condition : In the Extensive column this row carries the wording 'Max. dental limit applies' only, with no tick or cross symbol.

Scale-and-polish cleaning - p. 14

Prophylactic services including 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. - Limite : Extensive: Max. dental limit applies - Advanced and Premium: no limit stated in the scope of Benefits - Condition : Insured in the Extensive, Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic Plan. - Condition : Part of the Minor dental services section of the scope of Benefits. - Condition : In the Extensive column this row carries the wording 'Max. dental limit applies' only, with no tick or cross symbol.

Treating oral mucosa and paradontium - p. 14

Services provided for Diseases of the oral mucosa and periodontium include: 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 (three) millimetres; flap surgery, open curettage including osteoplasty, the pocket depth must be more than 5 (five) millimetres and the closed procedure has taken already place before. - Limite : Extensive: Max. dental limit applies - Advanced and Premium: no limit stated in the scope of Benefits - Condition : Insured in the Extensive, Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic Plan. - Condition : In the Extensive column this row carries the wording 'Max. dental limit applies' only, with no tick or cross symbol.

Simple fillings related to cavity - p. 14

Conservative services including simple fillings related to cavity and root canal Treatment in connection with a following simple filling. - Limite : Extensive: Max. dental limit applies - Advanced and Premium: no limit stated in the scope of Benefits - Condition : Insured in the Extensive, Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic Plan. - Condition : In the Extensive column this row carries the wording 'Max. dental limit applies' only, with no tick or cross symbol.

Surgery, extractions, root-canal Treatment - p. 14

Surgical services including 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. - Limite : Extensive: Max. dental limit applies - Advanced and Premium: no limit stated in the scope of Benefits - Condition : Insured in the Extensive, Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic Plan. - Condition : In the Extensive column this row carries the wording 'Max. dental limit applies' only, with no tick or cross symbol.

Inclusion of an occlusal splint - p. 14

Insertion of occlusal splints including 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. - Limite : Extensive: Max. dental limit applies - Advanced and Premium: no limit stated in the scope of Benefits - Condition : Insured in the Extensive, Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic Plan. - Condition : In the Extensive column this row carries the wording 'Max. dental limit applies' only, with no tick or cross symbol.

Accidental dental Treatment - p. 14

Full Benefits will be provided up to the overall limit if the Insured Person requires dental Treatment due to accidental injury to the teeth resulting from direct external impact to the head, such as falls or other Accidents causing injury through external force. - Limite : Extensive: Max. dental limit applies - Advanced and Premium: no limit stated in the scope of Benefits - Condition : Insured in the Extensive, Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic Plan. - Condition : No Waiting Periods apply. - Condition : Injuries caused by eating, drinking, or any injury resulting from biting, chewing, clenching, or grinding of teeth are not covered under this Benefit type. - Condition : The Dentist's receipt must explicitly confirm that the Treatment is a consequence of an Accident. Additionally, proof of the Accident, supported by a medical or police report, is necessary. - Condition : In the Extensive column this row carries the wording 'Max. dental limit applies' only, with no tick or cross symbol.

Major dental services - p. 15

The Insurer will reimburse outpatient major dental Treatment expenses only if a prior written approval has been given to cover these costs before the Start of Treatment. - Limite : Advanced: Reimbursement for the following benefits up to EUR 2,000 / USD 2,600 / GBP 1,680 / CHF 1,860 - Premium: Reimbursement for the following benefits up to EUR 5,000 / USD 6,500 / GBP 4,200 / CHF 4,650 - Condition : 10 (ten)-month Waiting Period applies to major dental services. - Condition : This heading row carries the amounts only in the Advanced and Premium columns; no tick or cross symbol is printed in it and the Basic and Extensive columns are blank.

Dentures (e.g. prostheses, inlays, bridges and crowns) - p. 15

Prosthetic services including impression or partial impression of a jaw for a situation model; preparation of a written schedule of Treatment and charges for prosthetic Treatment; preparation of a destroyed tooth with plastic augmentation materials and pin to receive a crown; inlay/onlay; adhesive fasting; restoration of a tooth with a full or partial crown; insertion of a prefabricated crown in a child; provisional crowns/bridge; restoration of a partially edentulous arch with a bridge or prosthesis; telescopic crown and prosthesis; restoration of an edentulous jaw with a total prosthesis. - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans. - Condition : Part of the Major dental services limits and the 10 (ten)-month Waiting Period.

Implants - p. 15

Implantological services including implant-related analysis; use of an orientation splint/positioning splint; implant insertion (only 4 (four) Implants per jaw and supporting dentures); exposure of an Implant; insertion of augmentation material (bone and/or bone substitute material); sinus floor elevation. - Limite : Implant insertion; only 4 (four) Implants per jaw and supporting dentures - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans. - Condition : Part of the Major dental services limits and the 10 (ten)-month Waiting Period.

Orthodontic Treatment (up to age 18) - p. 15

The Insurance Policy covers orthodontic Treatment for a child, undertaken before its 18th (eighteenth) birthday, which covers the use of metal braces, retainers, and a prescribed Treatment Plan. The determination of whether this Treatment is Medically necessary relies on the evaluation of the Index of Orthodontic Treatment Needs (IOTN) by the Insurer, referencing the British Orthodontic Society's standards. - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans. - Condition : The Insurer does not cover any additional costs or services, including specialised braces like lingual brackets or clear aligners such as Invisalign. - Condition : Part of the Major dental services limits and the 10 (ten)-month Waiting Period.

Dental laboratory work and materials - p. 15

Insurance cover includes dental materials and laboratory work based on average prices in the country of Treatment. - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans. - Condition : Part of the Major dental services limits and the 10 (ten)-month Waiting Period.

Treatment plan - p. 15

Before initiating Treatment, the Doctor or Dentist must provide a Treatment plan and associated costs, especially if dentures, extensive rehabilitation measures, or orthodontic Treatment are intended. Subsequently, the Insured Person will be notified by the Insurer regarding the reimbursement extent for these costs. - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans. - Condition : Part of the Major dental services limits and the 10 (ten)-month Waiting Period.

24-hour phone and e-mail service with experienced counsellors, own Doctors and specialists - p. 16

Medical assistance is accessible every day of the year, around the clock, either through e-mail or by contacting the medical assistance hotline. - Optionnelle : non - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans.

Medical evacuation and Repatriation - p. 16

This service encompasses a medically justified and necessary ambulance service, either within the Country of residence or to a cross-border location if the inpatient medical care or hygiene standards in the local Hospital are deemed inadequate. The service also includes the costs of medically justified and necessary medical accompaniment during transport. The Insured Person will be transported (within the selected Geographical Area) to a more suitable location for their Treatment in another country, to the Insured Person's Country of residence if the insured event occurred outside this country, or to the Insured Person's Country of Departure or Home Country. - Optionnelle : non · Limite : Basic, Extensive, Advanced and Premium: After written pre-approval - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans. - Condition : Evacuation or Repatriation must be prescribed by the treating Doctor and deemed Medically necessary. - Condition : The Insurer or the Service Centre must grant prior approval. - Condition : The Insurer will only cover transport to a location deemed suitable for Treatment.

Information on medical infrastructure (local medical care and names and addresses of multilingual Doctors) - p. 16

In the event of an insured incident or Emergency, the Insurer or the Service Centre will inform the Insured Person about the locally available medical care. Information regarding the designation of Doctors, Hospital consultants, Hospitals, and specialised medical facilities in the vicinity of the Insured Person can be provided in English, German, French and Spanish. Additionally, guidance and assistance in choosing a Treatment location, in case of a Medically necessary transfer or change of care provider, can also be offered. - Optionnelle : non - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans.

Support and information by our medical service (Second Opinion, monitoring the course of an illness) - p. 16

The Insured Person can reach out to the Insurer or the Service Centre via phone whenever local medical assistance is needed. Upon request, the relatives can be informed about the occurrence of an insured event or Emergency. In cases involving potentially fatal illnesses or serious permanent disabilities, the Insured Person has the option to seek a Second Opinion. For cases requiring inpatient Treatment, the progress of the illness can be monitored by Doctors associated with the Insurer or the Service Centre. - Optionnelle : non - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans.

Guarantee of payment (GOP) (preparing for a stay in Hospital) - p. 16

The Insurer or the Service Centre handles the necessary formalities and ensures cost cover for Doctors or the Hospital, including conducting a medical review of invoices to verify their adherence to Usual, Customary and Reasonable standards, coordinating with the Hospital on invoice submission addresses and payment terms, and ensuring direct payment of invoices. - Optionnelle : non - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans. - Condition : In the event of an Emergency requiring inpatient Treatment, the Insured Person must promptly contact the Insurer or the Service Centre. - Condition : If there is a planned inpatient Treatment or surgery qualifying as Outpatient Treatment instead of inpatient Treatment, the Insured Person shall notify the Insurer or the Service Centre at least 7 (seven) days before the scheduled Hospital admission. - Condition : Failure to inform the Insurer or the Service Centre beforehand or immediately in case of an Emergency may result in the Insurer not paying the full Claim.

Return of mortal remains - p. 16

In the event of a death abroad, the Insurer or the Service Centre can provide assistance: securing the death certificate or Accident report; liaising with public authorities and consulates in the foreign country; determining which surviving relatives are authorised to make decisions regarding the Repatriation or cremation of the deceased; managing all formalities. The Insurer will reimburse the direct costs incurred for repatriating the deceased to the Country of Departure or Home Country, including all associated formalities, and the costs related to repatriating the urn if the deceased has been cremated in the Country of residence. This also covers a family member traveling with the mortal remains if they were accompanying the deceased member at the time of death. - Optionnelle : non · Limite : Basic: Up to EUR 2,500 / USD 3,250 / GBP 2,100 / CHF 2,325 - Extensive: Up to EUR 5,000 / USD 6,500 / GBP 4,200 / CHF 4,650 - Advanced: Up to EUR 10,000 / USD 13,000 / GBP 8,400 / CHF 9,300 - Premium: Up to EUR 25,000 / USD 32,500 / GBP 21,000 / CHF 23,250 - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans. - Condition : Funeral costs per se will not be eligible for reimbursement.

Additional appropriate medical support (information on the nature, possible causes and possible Treatment of an illness) - p. 16

Whether an insured event has occurred or not, the Insurer or the Service Centre will offer general information about the destination, local customs, and required formalities, plus medical information including advice on vaccinations and medical consultations by phone, and guidance on what to include in a personal first-aid kit. In the event of an insured event, general information about the nature, potential causes, and available Treatments for the illness is provided, with clarification of the medical terminology and details on Drugs, their potential side effects, and interactions. - Optionnelle : non - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans.

Online services - p. 16

The Insured Person is entitled to use the dedicated online service in the provided online member area. - Optionnelle : non - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans.

Compassionate family visit - p. 17

In the event that the Insured Person undergoes inpatient Treatment due to a medical Emergency, whether in the Country of residence or while traveling for leisure or business, the Insurer or the Service Centre will organise for a family member to visit if the Hospital stay exceeds seven days. If an Insured Person is compelled to return to their Home Country due to a severe illness, Accident, or the death of a family member, the Insurer or the Service Centre will provide reimbursement up to the specified maximum amounts. The cover includes the reimbursement of transportation expenses (such as a first-class train ticket and/or economy plane ticket). - Limite : Advanced: Up to EUR 1,500 / USD 1,950 / GBP 1,260 / CHF 1,395 - Premium: Up to EUR 3,000 / USD 3,900 / GBP 2,520 / CHF 2,790 - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans. - Condition : Severe illness and serious Accidents are defined as those posing a life-threatening risk to the family member. - Condition : For the purposes of this cover, relatives are considered to be the spouse or unmarried partner, as well as the parents and children of the Insured Person. - Condition : Reimbursement for return transport costs due to severe illness and serious Accidents is contingent on advance contact with the Insurer or the Service Centre. Additionally, transport costs due to death are only reimbursable upon submission of the death certificate.

Return to Country of Residence after Repatriation - p. 17

The Insurer will cover transportation costs (first-class railway travel, economy-class flight) up to the maximum amount specified in the scope of Benefits. - Limite : Advanced: Up to EUR 1,500 / USD 1,950 / GBP 1,260 / CHF 1,395 - Premium: Up to EUR 3,000 / USD 3,900 / GBP 2,520 / CHF 2,790 - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans. - Condition : Only if the Insured Person has contacted the Insurer or the Service Centre in advance.

Delayed return trip - p. 17

If an Insured Person's return from the Country of residence is postponed due to a medical Emergency, rendering them unfit to travel, the Insurer will cover the additional expenses incurred for modifying hotel accommodation and flight reservations. - Limite : Advanced: Up to EUR 1,000 / USD 1,300 / GBP 840 / CHF 930 - Premium: Up to EUR 2,000 / USD 2,600 / GBP 1,680 / CHF 1,860 - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans.

Getting hold of and shipping vital Medication - p. 17

If an Insured Person depends on essential Medications that are unavailable in their Country of residence, they can request the Insurer or the Service Centre to procure these legally approved Drugs and send them, as long as importing them in this manner is not prohibited by law. - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans.

Return transport or care for children - p. 17

In the case of a medical Emergency requiring both parents to undergo inpatient Treatment in the Country of residence, the Insurer will arrange for a child welfare service to care for the children throughout the duration of the inpatient Treatment. If both parents experience a medical Emergency while traveling on holiday (up to 6 (six) weeks) and require inpatient Treatment, the Insured Person is entitled to claim return transport for the child (under the age of 18 (eight-teen)) with a companion to the Country of residence. - Condition : Insured in the Premium Plan only; reimbursement is excluded from the scope of Benefits in the Basic, Extensive and Advanced Plans.

Organizing help if you have legal difficulties - p. 17

The Insurer or the Service Centre has the capability to connect the Insured Person with lawyers or experts globally who are proficient in English, German, French or Spanish. When required, the Service Centre can facilitate an advance payment for lawyers' fees, court costs, or bail. - Condition : Insured in the Premium Plan only; reimbursement is excluded from the scope of Benefits in the Basic, Extensive and Advanced Plans. - Condition : The advance payment is not directly provided by the Insurer or the Service Centre; instead, they coordinate with banks or relatives and assist in transferring the funds if necessary.

Help with psychological problems possibly caused by the stay abroad - p. 17

If the time spent abroad causes psychological conflicts for the Insured Person, the Insurer or the Service Centre will provide psychological assistance via phone and will also arrange for appropriate local support if deemed necessary. - Limite : Advanced: Psychological and therapeutic help by telephone; up to 3 calls - Premium: Psychological and therapeutic help by telephone; up to 5 calls - Condition : Insured in the Advanced and Premium Plans only; reimbursement is excluded from the scope of Benefits in the Basic and Extensive Plans.

Telemedicine - p. 17

The Insurer grants all Insured Persons access to telemedical services. In collaboration with a third-party provider, the Insurer offers a complimentary app, available on both iOS and Android platforms. The available services include telephone consultation, video consultation, and chat, all provided in English, German, and Spanish. These services are accessible around the clock, 7 (seven) days a week. - Optionnelle : non - Condition : Insured in the Basic, Extensive, Advanced and Premium Plans. - Condition : Access is open to all Insured Persons aged 18 (eight-teen) and above, actively covered under this Insurance Policy, and who have given consent for the processing of personal data.

Temporary cover for Geographical Area I - p. 5

If the Insurer has agreed to provide insurance cover under the Insurance Policy for 'Geographical Area II - Worldwide excluding USA', and the Insured Person is temporarily residing in the USA, the Insurer will still provide insurance cover for medical emergencies, accidents, and death occurring within Geographical Area I: Worldwide including USA, for trips lasting up to 6 (six) weeks. Should an insured event occur within such 6 (six)-week period, and the Insured Person requires Emergency Treatment in the USA, there is no specific time limit on the Treatment itself. - Optionnelle : non · Portée : Geographical Area I (Worldwide including USA), for trips lasting up to 6 (six) weeks - Condition : If a medical Emergency arises, the Insurer may relocate the Insured Person to another country for Treatment if deemed medically appropriate and feasible. - Condition : The Insurance Cover provided under the Insurance Policy will not extend to journeys undertaken solely for the purpose of obtaining Treatment in Geographical Area I.

Double Benefits for Geographical Area I - p. 5

If the Insured Person is covered under Geographical Area I (worldwide including USA) the Insurer will double the maximum sums and lump sums shown in 3.5, 3.6, 3.7, 3.8, 3.9 and 3.10 (whether the Treatment takes place in the USA or not). - Optionnelle : non · Portée : Geographical Area I - Worldwide including USA - Condition : If a Benefit is limited to a certain number of days or sessions, this limit will not change. If the Insurer has agreed to a Deductible, and/or copayment, out of pocket maximum, it will not change.

Inclusion of Pre-Existing Conditions (optional) - p. 3

Pre-Existing Conditions are excluded from insurance cover, and their status is governed by the moratorium clause. However, in the Application Form, the Policyholder may opt for the inclusion of Pre-Existing Conditions on the basis of a health risk assessment and subject, as the case may be, to Waiting Periods. - Optionnelle : oui - Condition : The Insured Person must accurately complete a medical questionnaire to the best of its knowledge and, if necessary, share medical files with the Insurer. In some cases, an applicant may also undergo a medical evaluation. - Condition : Adjustments to the Insurance Policy may be required: modifying Terms and Conditions, introducing new ones, imposing an additional or increased premium, adding an exclusion, or declining to conclude the Insurance Policy for the respective Insured Person.

Moratorium clause (optional) - p. 4

Insured Persons aged 55 (fifty-five) or younger, who choose not to undergo the medical examination and comprehensive risk assessment outlined in Article 1.3, may, with the Insurer's agreement, opt for a "moratorium." Insurance cover for any Medical Condition that the Insured Person had in the 5 (five) years before the Policy started will only become eligible after a continuous 2 (two)-year Waiting Period from the Policy start date. - Optionnelle : oui - Condition : During this 2 (two)-year period, the Insured Person must not show any signs or symptoms, take Medication, have medical consultations, or receive Treatment for the Pre-Existing Condition. - Condition : If the Insured Person experience symptoms or receives Treatment during this period, a new 2 (two)-year Waiting Period will start from that date. - Condition : Also, the condition must be reversible to be covered. If it is not reversible, it will not be covered at all. - Condition : New and unrelated Medical Conditions will be covered immediately, subject to Terms and Conditions of the Insurance Policy.

Exclusions

Exclusion	Description	S'applique à	Page
Nursing Home	The Insurance Policy excludes insurance cover for expenses associated with staying at home or receiving non-medical care at home, in a convalescence home, psychiatric home, or similar facilities.	all	p. 34
Acting against medical advice	The Insurer does not cover Treatments resulting from the Insured Person's failure to seek or follow medical advice, or from traveling against medical recommendations.	all	p. 34
Complications caused by excluded cover	The Insurer will not provide cover for expenses resulting from complications directly arising from an illness, injury, or Treatment that are excluded or have limited cover.	all	p. 34
Cosmetic/plastic surgery	Expenses incurred for cosmetic or plastic surgery and Treatment will not be reimbursed.	all	p. 34
Detoxification programmes including therapies	Detoxification programs, including Treatments for drug addiction and alcoholism, are not covered by the Insurance Policy. However, Benefits for an initial detoxification will be paid if the Insured Person is unable to claim a refund elsewhere, and in the case of inpatient detoxification, the Insurer will only reimburse expenses related to basic Hospital services, including medical Treatment and Drugs. Any subsequent Treatment resulting from or directly associated with harmful, hazardous, or addictive use of any substance, including alcohol and Drugs, will not be covered.	all	p. 34
Developmental disorders	The Insurer does not provide cover for services, therapies, educational testing, or training associated with learning disabilities or disorders of psychological development. This includes conditions 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. 34
Epidemics, pandemics and Disease outbreaks	Expenses associated with Treatment, medical evacuations, and/or Repatriations, whether directly or indirectly resulting from epidemics, pandemics, or Disease outbreaks of comparable scale that have been brought under the control of local public health authorities, will not be reimbursed unless otherwise approved by the Insurer in writing.	all	p. 34
Experimental and investigational Treatments	The Insurer will not provide cover for any form of Treatment or drug therapy that it deems 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 clear 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 indicate the need for more research, be under a research environment, have limited evidence, insufficient evidence, or lack clinical utility.	all	p. 34
Extreme sport and high-risk activities	Extreme sport and high-risk activities are not covered under the Insurance Policy. Extreme sports and high-risk sporting activities encompass any form of sport or athletic pursuit characterized by a heightened level of inherent danger, including inter alia: abseiling, mountaineering (apart from indoor climbing and low mountain areas fully equipped for sports climbing) and racing of any kind; bobsleigh, luge, skeleton, off-piste skiing, and off-piste snowboarding; bungee and cliff jumping; combative sports; downhill mountain biking and cross-country cycling; extreme tourism (e,g, tours to Antarctica); horseback hunting, horse jumping, polo, steeplechasing, or any form of horse racing; motorcycle sports, including motorcycle riding and quad biking; microlight flying, wingsuit flying, ballooning, hang gliding, paragliding, parascending, and parachute jumping; solo caving (potholing) or cave diving, scuba diving beyond 10 meters, high diving, white water rafting, and canyoning; ultra marathons or activities similar in nature; any other hazardous activity similar in risk to the before mentioned ones, such as e.g. train surfing. Search and rescue services for extreme sport and high-risk activities, including but not limited to cave, sea and mountain rescue, are excluded from cover.	all	p. 35
Eyesight	The Insurer will not provide cover for any Treatment or surgery aimed at correcting an Insured Person's eyesight, including procedures such as laser Treatment, refractive keratotomy (RK), and photorefractive keratectomy (PRK). Cover does apply to the correction of the Insured Person's vision when this is Medically necessary (e.g., cataract or detached retina).	all	p. 35
Genetic testing	The Insurance policy does not cover the expenses related to genetic testing unless particular genetic tests are explicitly mentioned as part of the Insured Person's Plan, or the Insurer expressly gives prior written approval.	all	p. 35
Illnesses, Accidents and their consequences caused by intent or gross negligence	The Insurer will not provide insurance cover for illnesses, Accidents, and their ensuing consequences that are intentionally caused or caused by gross negligence. This includes, but it is not limited to: self-inflected injuries; attempted suicide; stays in an institution for drug withdrawal; and injuries caused in the context of criminal acts.	all	p. 35
Injuries caused by military service	The Insurer will not provide insurance cover for illnesses, Accidents, and their resulting consequences that occur while the Insured Person is engaged in military operations, military service, riot and civil commotion.	all	p. 35
Need for long-term care and custody	The Insurer will not reimburse any expenses related to accommodation necessitated by long-term care and custody.	all	p. 35
Non-medical Hospital expenses	The Insurance Policy does not cover expenses caused by any person accompanying the Insured Person, and does further not cover non-medical consumables, catering, and any media-related expenses (such as TV and radio).	all	p. 36
Nuclear, chemical and biological contamination	The Insurer does not provide cover for illnesses, Accidents, and their consequences caused by nuclear energy (including nuclear reactions, radiations, and contamination), as well as illnesses, Accidents, and their consequences resulting from chemical or biological weapons.	all	p. 36
Post-natal classes	The Insurer will not provide cover for post-natal classes aimed at addressing the physical effects on the body resulting from pregnancy and childbirth.	all	p. 36
Professional Sports	The Insurer does not provide cover for Treatments or diagnostic procedures related to injuries or illnesses resulting from participation in Professional Sports.	all	p. 36
Gender reassignment	The Insurer will not provide cover for the alteration of biological sexual characteristics through surgery and hormone Treatment to transition to the characteristics of the opposite sex.	all	p. 36
Sleep disorder	The Insurer does not provide cover for examinations or Treatment related to sleep disorders, including insomnia. This encompasses CPAP (continuous positive airway pressure machine) and BIPAP (bilevel positive airway pressure machine).	all	p. 36
Sterilisation, sexual dysfunction and contraception	The Insurer will not provide cover for procedures intended to render a person incapable of reproduction, any procedures, Treatments, or Medications aimed at preventing pregnancy, or any Treatment for sexual dysfunction (unless part of infertility Treatment).	all	p. 36
Spa and wellness massages	The Insurer will not provide cover for stays or Treatments in a cure centre sanatorium, spa, health resort, or recovery centre, even if medically prescribed. This restriction also includes thermal baths, saunas, and various wellness massages.	all	p. 36
Surrogacy	The Insurer will not reimburse expenses associated with Treatments directly related to surrogacy, regardless of whether the Insured Person is serving as a surrogate or are the intended parent. Children born to a surrogate mother are not covered under the Insurance Policy.	all	p. 36
Termination of pregnancy	Listed under Exclusions and worded as follows: The Insurer will provide insurance cover for the termination of pregnancy in the event of a life-threatening danger to the pregnant woman or if the foetus is non-viable, the prerequisite is, that the chosen plan includes reimbursements for maternity benefits. This cover is subject to prior written approval from the Insurer. The specified conditions must be substantiated with required medical investigation reports, along with a medical report from the Doctor outlining the reasons for the termination of the pregnancy.	all	p. 36
Treatment in sanatoriums, convalescent and nursing homes	The Insurer does not provide cover for therapies and Treatments in sanatoriums or convalescent and nursing homes. However, based on the selected Plan level, the Insurer may partially refund expenses for Follow-Up Rehabilitation.	all	p. 36
Transport costs	Transport costs, other than Emergency ambulance services, will not be refunded unless the Insurer expressly gives prior written approval.	all	p. 37
Treatment by certain Doctors, Dentists and other Therapists, as well as in certain Hospitals	The Insurance Policy does not cover Treatments administered by physicians, Dentists, and other Therapists, as well as Hospital services whose invoices the Insurer has declined to settle for substantial reasons. Nevertheless, this release from the obligation to provide Benefits is applicable solely to insured events occurring subsequent to the Insured Person's notification of Benefit exclusion. If an insured event has already occurred at the time of notification, the Insurer's exemption from Benefits will only pertain to expenses incurred more than 1 (one) month after receiving notice.	all	p. 37
Treatment by marital or non-marital partners, parents or children	The Insurer will not reimburse expenses if the Insured Person receives Treatment from its spouse, husband, non-marital partner, parents, or children. However, the documented cost of materials required for the Treatment, in accordance with the Plan, will be eligible for reimbursement.	all	p. 37
Unlawful Acts and Hazardous Behaviour	The Insurer will not cover any illnesses, accidents, or resulting consequences that arise from unlawful acts or hazardous behaviour. This includes, but it is not limited to: activities undertaken in violation of explicit warnings or prohibitions issued by medical professionals, public health authorities, or law enforcement agencies; consequences of drunkenness and/or intoxication; disturbances and measures taken to combat such disturbances, unless the Policyholder and/or Insured Person proves that the Insured Person did not actively participate in them; quarrels and/or heated arguments, except in case of legitimate self-defence (a report from the authorities will be used as proof); and betting and/or defiance.	all	p. 37
Vitamins and minerals	The Insurer will not reimburse expenses for items categorized as vitamins or minerals, with the exception of Medically necessary instances during pregnancy or for the Treatment of diagnosed, clinically significant vitamin-deficiency syndromes. This also applies to Dietary Supplements, including special infant formula and cosmetic products, even if they are medically recommended, prescribed, or acknowledged for therapeutic effects. Products such as nutriments, tonics, mineral water, cosmetics, hygiene and bodycare products, and bath additives are not considered Medically necessary, and costs incurred for them will not be refunded.	all	p. 37
War, civil unrest, acts of terrorism	The Insurance Policy 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 Insured Person 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 Policy will only cover Emergency, lifesaving Treatment and only for as long as the Insured Person is prevented from leaving the country or region concerned, but for not more than 28 (twenty-eight) days at most.	all	p. 37
Other limitations to pay Benefits - beyond Medically necessary or outside Usual, Customary and Reasonable	If the Treatment or other agreed-upon measure exceeds what is Medically necessity or the claimed amount falls outside the Usual, Customary and Reasonable range, the Insurer reserves the right to reduce the payment/reimbursement. The Insured Person will be responsible for any costs that do not align with the Usual, Customary and Reasonable standards. The Insurer retains the right to assess any cost or estimate with the input of medical professionals to determine its conformity with Usual, Customary and Reasonable standards.	all	p. 38
Subsidiarity towards other providers of Benefits	If the Insured Person can claim Benefits from a statutory health insurance fund or any other provider, the Insurer will only reimburse expenses that remain necessary despite those Benefits. Complications arising from excluded conditions are not covered.	all	p. 38
Pre-Existing Conditions	Pre-Existing Conditions are excluded from insurance cover, and their status is governed by the moratorium clause. However, in the Application Form, the Policyholder may opt for the inclusion of Pre-Existing Conditions on the basis of a health risk assessment and subject, as the case may be, to Waiting Periods. Any illness that arises between the signing of the Application Form and the signing of the Particular Conditions will be considered a Pre-Existing Condition.	all	p. 3
Treatment abroad that was the reason for travelling	Treatment abroad is excluded from Benefits if such Treatment was the sole reason or one of the reasons for travelling abroad.	all	p. 3
Journeys undertaken solely to obtain Treatment in Geographical Area I	The Insurance Cover provided under the Insurance Policy will not extend to journeys undertaken solely for the purpose of obtaining Treatment in Geographical Area I.	Temporary cover for Geographical Area I	p. 5
Deluxe rooms, executive rooms or suites	It explicitly excludes rooms with upgraded amenities, including but not limited to deluxe rooms, executive rooms, or suites that may have additional facilities such as kitchens, dining areas, or sitting rooms.	Accommodation in a private or semi-private room	p. 18
Grade 1 or minor surgeries and procedures for obtaining tissue samples or bodily fluids	It excludes grade 1 or minor surgeries (invasive procedures involving only the resection of skin, mucous membranes, and connective tissue) and invasive operative procedures for obtaining tissue samples or bodily fluids, such as biopsies and colonoscopies.	Outpatient surgery instead of inpatient Treatment	p. 18
Nutritional food, tonics, mineral water, cosmetics, personal hygiene products and bath salts	Nutritional food, tonics, mineral water, cosmetics, products for personal hygiene, as well as bath salts, are not deemed as Drugs eligible for insurance cover under the Insurance Policy as part of Medical Treatment.	Drugs and Dressings	p. 18
Search for an organ or a suitable donor	It does not include expenses associated with the search for an organ or a suitable donor.	Bone marrow and organ transplants	p. 19
Sanatorium Treatments, cures, stays in cure establishments, spas, convalescent homes or nursing homes after rehabilitation	The Insurance Policy does not cover expenses related to Sanatorium Treatments, cures, stays in cure establishments, spas, convalescent homes, or nursing homes.	Inpatient Follow-Up Rehabilitation	p. 20
Subsequent dental Treatment after Emergency dental Treatment	This Benefit does not encompass subsequent dental Treatment, dental surgery, dental prostheses or Implants, orthodontics, or periodontics.	Emergency dental Treatment	p. 21
Sanitary supplies such as pads and massage devices	Expenses for sanitary supplies, such as pads and massage devices, as well as their use and maintenance, are not covered under the Insurance Policy.	Therapeutic aids and appliances (outpatient)	p. 23
NIPT and other forms of genetic testing in maternity care	Insurance cover extends to all Medically necessary diagnostic tests, including amniocentesis and Chorionic Villus Sampling (CVS), while excluding NIPT and other forms of genetic testing.	Maternity care and childbirth (outpatient)	p. 25
Doula services and pre-natal and post-natal classes	However, doula services, as well as pre-natal and post-natal classes, are not eligible for reimbursement.	Maternity care and childbirth (outpatient)	p. 25
Specialised braces (lingual brackets) and clear aligners (Invisalign)	However, the Insurer does not cover any additional costs or services, including specialised braces like lingual brackets or clear aligners such as Invisalign.	Orthodontic Treatment	p. 28
Injuries caused by eating, drinking, biting, chewing, clenching or grinding of teeth	Injuries caused by eating, drinking, or any injury resulting from biting, chewing, clenching, or grinding of teeth are not covered under this Benefit type.	Accidental dental Treatment	p. 28
Fluoridation of the tooth surface and fissure sealing for adults	Dental exclusion listed under 'Dental exclusions'.	Dental Treatment	p. 28
Veneers, including partial front teeth crowns	Dental exclusion listed under 'Dental exclusions'.	Dental Treatment	p. 28
Bleaching or any related cosmetic and aesthetic services	Dental exclusion listed under 'Dental exclusions'.	Dental Treatment	p. 28
Sedation/anaesthesia (dental)	Dental exclusion listed under 'Dental exclusions'.	Dental Treatment	p. 28
Pain and anxiety-relieving measures (dental)	Such as Acupuncture, hypnosis, general anaesthesia, sedation with laughing gas, twilight sleep anaesthesia. For the avoidance of doubt, the following is covered: insurance cover for the costs of children up to the age of 12 (twelve) if diagnosed with an anxiety disorder by a qualified specialist; additionally, in the case of the failure of local anaesthesia; Treatment under local anaesthesia deemed impossible due to severe psychological and physical disability in a patient.	Dental Treatment	p. 28
Funeral costs	However, funeral costs per se will not be eligible for reimbursement.	Return of mortal remains	p. 30

Franchises

• Standard : Deductibles: Basic: Not applicable. Extensive: EUR 0, EUR 250, EUR 500 and EUR 1,000 / USD 0, USD 325, USD 650, USD 1,300 / GBP 0, GBP 210, GBP 420, GBP 840 / CHF 0, CHF 232.50, CHF 465, CHF 930. Advanced and Premium: EUR 0, EUR 250, EUR 500, EUR 1,000, EUR 3,000, EUR 5,000 and EUR 7,000 / USD 0, USD 325, USD 650, USD 1,300, USD 3,900, USD 6,500 and USD 9,100 / GBP 0, GBP 210, GBP 420, GBP 840, GBP 2,520, GBP 4,200 and GBP 5,880 / CHF 0, CHF 232.50, CHF 465, CHF 930, CHF 2,790, CHF 4,650 and CHF 6,510.
• Variable : Co-Payments: Basic: Fixed 20%. Extensive: 0%, 10% or 20% with an Out-of-Pocket Maximum of EUR 1,500 / USD 1,950 USD / GBP 1,260 / CHF 1,395. Advanced and Premium: 0%, 10% or 20% with an Out-of-Pocket Maximum of EUR 2,500 / USD 3,250 USD / GBP 2,100 / CHF 2,325.
• All Outpatient Treatment : Deductibles and Co-Payments apply on the basis of the Insurance Year for each Insured Person, specifically for expenses related to all Outpatient Treatment, including outpatient benefits, Outpatient Treatments for mental health and well-being, and Outpatient Treatments for maternity.

Délais d'attente

• General rule : The Waiting Periods shall commence from the Effective Date, as set out in the Special Conditions. Waiting periods apply to maternity care and childbirth, including complications related to maternity care and childbirth, psychiatric Treatment, psychotherapy, prophylactic mastectomy surgery, infertility Treatment and major dental services. (from the Effective Date) p. 4
• Psychiatric Treatment, psychotherapy, and major dental services : A 10 (ten)-month Waiting Period applies to psychiatric Treatment, psychotherapy, and major dental services. (10 (ten) months) p. 4
• Maternity care and childbirth, including complications : A 12 (twelve)-month Waiting Period applies to maternity care and childbirth, including complications related to maternity care and childbirth, regardless of the number of Insured Persons. (12 (twelve) months) p. 4
• Prophylactic mastectomy surgery : A 24 (twenty-four)-month Waiting Period applies to prophylactic mastectomy surgery. (24 (twenty-four) months) p. 4
• Infertility Treatment : A 24 (twenty-four)-month Waiting Period applies to infertility Treatment for both spouses or partners. (24 (twenty-four) months) p. 4
• Pre-Existing Conditions under the moratorium : Insurance cover for any Medical Condition that the Insured Person had in the 5 (five) years before the Policy started will only become eligible after a continuous 2 (two)-year Waiting Period from the Policy start date. If the Insured Person experience symptoms or receives Treatment during this period, a new 2 (two)-year Waiting Period will start from that date. (continuous 2 (two)-year Waiting Period from the Policy start date) p. 4
• Accidental dental Treatment : No Waiting Periods apply. (none) p. 28

Obligations de l'assuré

• To facilitate the Insurer in deciding whether to incorporate Pre-Existing Conditions from the commencement of the Insurance Policy, it is crucial to provide truthful and thorough answers to the questions in the Application Form. The Insured Person must accurately complete a medical questionnaire to the best of its knowledge and, if necessary, share medical files with the Insurer. (at application · Adjustments to the Insurance Policy may be required, including modifying Terms and Conditions, introducing new ones, imposing an additional or increased premium, adding an exclusion, or, in certain instances, declining to conclude the Insurance Policy for the respective Insured Person.) p. 3
• The Policyholder is responsible for ensuring compliance with local social security laws and regulations for all Insured Persons covered by the Insurance Policy. (throughout the Policy Period · The Insurer reserves the right to terminate the entire Insurance Policy or the insurance cover for specific Insured Persons in the event of legal changes in a country that would result in a violation of laws or regulations.) p. 3
• If any Insured Person relocates to a Geographical Area different for the one agreed to be covered under the Insurance Policy for any duration, such relocation must be immediately notified to the Insurer, and this change will impact the premium due and any Benefits to be granted under the Insurance Policy. (immediately) p. 5
• It is imperative to contact and inform the Insurer or the Service Centre regarding the Hospital stay and Treatment before or within 3 (three) calendar days of admission to the Hospital. (before or within 3 (three) calendar days of admission · Failure to do so may result in the Insurer not fully covering the Claim.) p. 18
• In the event of an Emergency requiring inpatient Treatment, the Insured Person must promptly contact the Insurer or the Service Centre. If there is a planned inpatient Treatment or surgery qualifying as Outpatient Treatment instead of inpatient Treatment, the Insured Person shall notify the Insurer or the Service Centre at least 7 (seven) days before the scheduled Hospital admission. (promptly (Emergency) / at least 7 (seven) days before admission (planned) · Failure to inform the Insurer or the Service Centre beforehand or immediately in case of an Emergency may result in the Insurer not paying the full Claim.) p. 30
• A number of Benefits are payable only after written pre-approval by the Insurer before the Start of Treatment: nursing care at home, Inpatient Follow-Up Rehabilitation, speech therapy, psychiatric Treatment and psychotherapy (inpatient and outpatient), infertility Treatment, major dental services, therapeutic aids and appliances other than those listed, medical evacuation and Repatriation, and transport costs other than Emergency ambulance services. (before the Start of Treatment · Without the prior written approval the expenses are not reimbursed.) p. 20

Procédure de sinistre

1. It is imperative to contact and inform the Insurer or the Service Centre regarding the Hospital stay and Treatment before or within 3 (three) calendar days of admission to the Hospital. Failure to do so may result in the Insurer not fully covering the Claim. (délai : before or within 3 (three) calendar days of admission) p. 18
2. In the event of an Emergency requiring inpatient Treatment, the Insured Person must promptly contact the Insurer or the Service Centre. For planned inpatient Treatment or surgery qualifying as Outpatient Treatment instead of inpatient Treatment, notify at least 7 (seven) days before the scheduled Hospital admission. This enables the Insurer or the Service Centre to handle the necessary formalities and ensure cost cover for Doctors or the Hospital, including a medical review of invoices and coordination with the Hospital on invoice submission addresses and payment terms. (délai : promptly (Emergency) / at least 7 (seven) days before admission (planned)) p. 30
3. These services are available 24 (twenty-four) hours a day, 7 (seven) days a week, 365 days a year. If the Insured Person needs help from them, it simply calls the number shown in the insurance documents at any time, day or night. (délai : any time, day or night) p. 29
4. The Insurer will reimburse expenses solely for Medically necessary medical or dental Treatments within the scope of medical or dental practice. Reimbursement for such Treatments and services from other Therapists is subject to reasonable fees aligned with Usual, Customary and Reasonable rates. Additionally, the Insurer may reimburse expenses that surpass the maximum fees based on Usual, Customary and Reasonable rates if they are incurred due to difficulties arising from the illness or medical findings, provided the expenses are reasonably determined. p. 7

Durée & résiliation

• Durée : The Policy Period is the period in time during which the insurance cover is granted under the Insurance Policy, which the Policyholder has selected for the Insured Persons in the Application Form. (Glossary, p. 40)
• Droit spécial : The Insurer reserves the right to terminate the entire Insurance Policy or the insurance cover for specific Insured Persons in the event of legal changes in a country that would result in a violation of laws or regulations (1.2).
• Droit spécial : For changes of residence, the Insurer will assess each case individually, determining whether to issue, modify, or terminate the insurance cover (1.2).

Prime

• The premium will be determined following the completion of the Application Form, taking into account factors such as the Country of Residence.
• Change from Geographical Area II to Geographical Area I: if the Country of Residence changes during the term of the Policy that initially covered Geographical Area II, resulting in a transition to Geographical Area I, the premiums applicable to Geographical Area I - including those for U.S. insurance cover - shall apply immediately.
• Change from Geographical Area I to Geographical Area II: if the Country of Residence changes during the term of the Policy that initially covered Geographical Area I, resulting in a transition to Geographical Area II, the premiums applicable to Geographical Area II shall apply as of the next Insurance Year. Premiums for U.S. insurance cover shall remain payable until that time.
• Should the Insured Person transition to a different age category after a birthday, the premium will be adjusted to reflect the new age category upon next renewal.
• These adjustments will be carried out in accordance with the provisions outlined in the Terms and Conditions of Insurance and the applicable legal regulations.
• The specific premium amount applicable to the Insurance Policy is detailed on the invoice or the Particular Conditions (where applicable).
• A relocation to a different Geographical Area must be immediately notified to the Insurer, and this change will impact the premium due and any Benefits to be granted under the Insurance Policy.

Conditions particulières

• In the event of discrepancy between the General Conditions of Insurance, the Special Conditions and the Particular Conditions, the Particular Conditions shall prevail over the Special Conditions and the General Conditions of Insurance, and the Special Conditions shall prevail over the General Conditions of Insurance. The English version of all relevant literature and documentation shall prevail over any other language or translation. p. 3
• Terms capitalized in this document, unless explicitly defined otherwise, will bear the meanings specified in the Glossaries outlined in the Special and the General Conditions of Insurance. p. 3
• The Insurer offers insurance cover for Diseases, Bodily Injuries, and other occurrences leading to insured events as outlined in the Insurance Policy. Upon the occurrence of an insured event, the Insurer reimburses the expenses related to Medically necessary Treatment and other agreed Benefits, contingent upon the conditions set forth in the Insurance Policy and statutory regulations. Under the current Special Conditions and within specified limits, the Insurer covers the medical expenses for each of the Insured Persons identified in the Insurance Policy. p. 3
• The Insurance Policy is designed for expatriates. Anyone who stays abroad for at least 3 (three) months is eligible for insurance cover unless the Insurer agrees otherwise. Should the Insured Person decide to return to their Home Country and establish it as their Country of residence, the continuity of their policy can be maintained with the Insurer's approval. p. 3
• The Plan level, as selected by the Policyholder in the Application Form, is defined by the nature and extent of Benefits set out in the Special Conditions. Based on the selected Plan, the Insurer will reimburse Eligible Expenses up to 100% of the Annual Overall Limit specified in the scope of Benefits, unless expressly stated otherwise in the Terms and Conditions of Insurance. p. 6
• Insurance cover applies to insured events occurring in the following areas, as selected by the Policyholder in the Application Form: Geographical Area I: Worldwide including USA. Geographical Area II: Worldwide excluding USA. p. 5
• Insured Persons have the flexibility to select any licensed Doctors, Dentists, or Therapists within the country where they need medical or dental Treatment, and this choice extends to other healthcare Practitioners. p. 7
• These rates refer to expenses associated with approved and covered medical services or supplies, not exceeding the standard fees charged by other providers of similar standing in the same Geographical Area, offering comparable Treatment for a similar illness and/or injury. For services by other Therapists, such as masseurs, midwives, or Practitioners of complementary medicine, reimbursement will be based on comparable fees for Doctors and customary prices in the country where the Treatment occurs. p. 7
• Insurance cover includes dental materials and laboratory work based on average prices in the country of Treatment. Dental procedures like dentures, Implants, dental surgery, and orthodontic Treatment, even when performed by a Doctor in a Hospital, are not considered part of inpatient or Outpatient Treatment. p. 7
• Under the Insurance Policy, the Insurer will reimburse expenses for examinations, Treatment methods, and Drugs widely accepted in Conventional Medicine. Additionally, costs for methods and Drugs proven in practice or used due to the unavailability of Conventional Medicine are eligible for reimbursement. However, Benefits may be limited to amounts equivalent to what would have been paid if Conventional Medicine had been accessible. p. 7
• The Insurers service and assistance network of competent and experienced partners on the ground offers the Insured Persons individual support worldwide as well as comprehensive, competent consultation for any situation. This network is represented in more than 180 countries. When the insurance cover provided for under the Insurance Policy ends, the Insured Person will no longer be entitled to these services. p. 29
• Foyer Global Health S.A., Registered Office L-3372 Leudelange, 12, rue Léon Laval, Luxembourg. Telephone: +352 270 444 3500. E-mail: policy@globalhealth.insurance. Internet: https://www.globalhealth.insurance. Commercial Register (R.C.S. Luxembourg): B 134.471. VAT: LU22284578 p. 43

Lacunes d'extraction

• Risk carrier: this document never names the carrier in words. It refers throughout to "the Insurer" and its Glossary (section 6) does NOT define that term - clause 1.1 states that capitalized terms not defined here "will bear the meanings specified in the Glossaries outlined in the Special and the General Conditions of Insurance", and the General Conditions of Insurance are a separate document that is not part of this file. The only company named anywhere in the document is Foyer Global Health S.A. (Registered Office, 12, rue Léon Laval, L-3372 Leudelange, Luxembourg, R.C.S. Luxembourg B 134.471, VAT LU22284578) in the publisher's imprint on p. 43. The task metadata gives the same insurer, and no divergence was found; but the identification rests on the imprint, not on a clause of the document. A "Service Centre" is repeatedly mentioned alongside the Insurer and is likewise never named.
• Document type: the metadata supplied with this task is conditions_generales and has been copied through, but the document calls itself "Journey - Special Conditions (Plans Basic, Extensive, Advanced and Premium)" on its cover and in the running head of every page, and clause 1.1 places it expressly BETWEEN the Particular Conditions (which prevail over it) and the General Conditions of Insurance (over which it prevails). It is therefore one contractual layer of the Journey product and not the general conditions themselves; several matters normally found in general conditions - the definition of "Insurer", the policy duration, renewal and termination rules, the claims-submission procedure, applicable law, jurisdiction and any prescription period - are absent from this file and were not imported from anywhere else.
• 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 "GH_JOY_LT_SC_25.11" on p. 43, recorded as reference; the document nowhere states that "25.11" is an edition date.
• Scope of Benefits tables (3.5 to 3.12, pp. 7-17): Plan membership is NOT in the text layer. The marks are vector drawings - an 11.3 x 11.3 pt tick glyph for "Insured, i.e. the Insurer will reimburse 100 % of the Eligible Expenses" and a 10.1 x 10.0 pt cross for "Reimbursement is excluded from the scope of Benefits" (legend on p. 4), both filled in the same dark brown. Each mark was assigned to a column by its x-centre against the header centres (Basic 241.1 / Extensive 326.2 / Advanced 411.2 / Premium 496.2 pt, column width 85.0 pt) and to a row by the row rules (width 141.9 pt). Every mark on every page was placed inside a column and a row: p. 8 41 marks, p. 9 48, p. 10 36, p. 11 20, p. 12 28, p. 13 28, p. 14 29, p. 15 20, p. 16 32, p. 17 32. These facts are recorded in the structured fields only; being drawings and not text, they cannot be supported by a verbatim quote.
• Some rows carry an amount or a qualifying phrase INSTEAD of a mark, and this is recorded rather than smoothed over: Annual Overall Limit (p. 7) and Maximum Outpatient Limit (p. 10) carry only amounts in all four columns; Maximum dental limit (p. 14) carries "n.a." or an amount; Major dental services (p. 15) carries an amount in the Advanced and Premium columns and nothing in Basic and Extensive; Therapeutic aids and appliances (p. 8) carries the qualifying wording with no mark in Basic, Extensive and Advanced and a tick in Premium; and seven dental rows on p. 14 carry "Max. dental limit applies" with no mark in the Extensive column. Each such case is stated in the coverage's conditions.
• is_optional: the product is sold in four Plan levels rather than with optional add-ons. is_optional is false where a Benefit carries a tick in Basic, Extensive, Advanced AND Premium, and null where at least one Plan carries the cross or no mark, because a boolean cannot express "insured in the Advanced and Premium Plans only"; the exact Plan membership is the first entry of each coverage's conditions. The genuinely optional elements are the Deductible and Co-Payment (3.3), the inclusion of Pre-Existing Conditions at application (1.3) and the moratorium (1.4), flagged is_optional true.
• The asterisks in the outpatient and dental tables are explained by the tables' own footnotes: "Max. outpatient limit applies" (p. 11) and "Max. dental limit applies" (p. 15). Amounts are reproduced verbatim including the inconsistent currency-order printing (for example "Up to EUR 250 / 325 USD / GBP 210 / CHF 232.50" on p. 12 and "EUR 250 / USD 325 / GBP 210 / 232.50 CHF" on p. 14) and the Out-of-Pocket wording "EUR 1,500 / USD 1,950 USD / GBP 1,260 / CHF 1,395" on p. 6, where "USD" is printed twice.
• The text layer contains 4 soft hyphens (U+00AD) inside words broken at a line end - "prosthe-ses" (p. 8) and "non-pre-scribed" (p. 10, three occurrences) - and about fifty non-breaking spaces. Quotations were sliced programmatically from the text layer and deliberately routed around these breaks; the structured fields spell the words normally.
• Typographical oddities preserved as printed: "self-inflected injuries" (exclusion on intent/gross negligence), "extreme tourism (e,g, tours to Antarctica)", "the woman is aged under 40 (fourty)", "under the age of 18 (eight-teen)", "midwifeled births", "exceeds what is Medically necessity", "Conventual medicine" (Glossary, Acupuncture), "a Geographical Area different for the one agreed". These are the insurer's own text and have not been corrected.
• prescription_period, applicable law, place of jurisdiction, complaint handling, policy duration, renewal and termination: none of these are set out in this document, which regulates the scope of Benefits only. duration_and_cancellation carries the two termination rights that the document does state (clause 1.2) plus the glossary definition of Policy Period; the remaining fields are left null rather than filled from another document.
• Page numbers in every block are PDF page numbers. The folio printed in the running head ("Page N of 43") matches the PDF page number on every page checked (2 to 42).

Documents liés

• Journey - Conditions générales
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• Journey (Tarife Basic, Extensive, Advanced und Premium) - DE - Conditions générales
• Journey (Plans Basic, Extensive, Advanced and Premium) - EN - Conditions générales
• Journey (Modalidades Basic, Extensive, Advanced y Premium) - ES - Conditions générales
• Journey (Modalidad Short) - ES - Conditions générales
• Journey (Plan Short) - Conditions générales
• Journey (Plan Short) - EN - Conditions générales
• Journey - EN - Conditions générales
• Journey - DE - Conditions générales

Source & fidélité

• Source : https://globalhealth.insurance/wp-content/uploads/2025/12/SCI_Journey_T1-T4_En.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.