Health and Hospitalisation Insurance
Policy Wording

Definitions

To help You understand Your Policy, the following words and phrases used anywhere within Your Policy which have specific meanings, are explained in this section.

Acute
A Medical Condition that can be cured by Treatment.

Advice
Any consultation from a Medical Practitioner or Specialist including the issue of any prescriptions or repeat prescriptions.

Appliances
Devices and equipment when used as an integral part of a surgical procedure administered by a Medical Practitioner or Specialist.

Chronic
A Medical Condition that cannot be cured by Treatment.

Commencement Date
The date shown on the Policy Schedule on which cover under this Policy commences. For the purpose of this Policy the time of the start of cover will be 00.olam on the date shown on the Policy Schedule.

Congenital Anomaly
Intrauterine development of an organ or structure that is abnormal with reference to form, structure or position.

Country of Nationality
For the purpose of this Policy this will be the country for which You hold a Passport.

Country of Residence
The country in which You have Your habitual residence at the time this Policy is first taken out or at each subsequent Renewal Date.

Day-Patient
Treatment in a Hospital where the Insured Person is admitted to a Hospital bed but does not stay overnight.

Dental Practitioner
A person who is licensed by the relevant licensing authority to practice dentistry in the country where the dental Treatment is given.

Date of Entry
The date shown on the Policy Schedule on which an Insured Person was included under this Policy.

Dependants
A spouse or adult partner and/or unmarried children under the age of 21 years, living with You or in full-time education. (The term partner shall mean husband, wife or the person permanently living with You (whether or not of the same sex) in a similar relationship.)

Drugs and Dressings
Drugs, medicines and dressings prescribed by a Medical Practitioner or Specialist.

Evacuation
Costs incurred in moving an Insured Person from the place of incident to the nearest appropriate medical facility, as determined by the attending Medical Practitioner or Specialist in conjunction with Our medical advisors. All airline tickets are limited to economy class.

Excess
The amount payable by an Insured Person in respect of expenses incurred before any Benefits are paid under the Policy.

Expatriate Status
Any persons living or working outside of the country for which they hold a Passport.

Geographic Area
Your Country/Area of Residence used for premium calculation purposes.

Hospital
An establishment which is legally licensed as a medical or surgical Hospital under the laws of the country in which it is situated.

In-Patient
An Insured Person who stays in a Hospital bed and is admitted for one or more nights.

Insured Person/You/Your
You and/or the Dependents named on the policy schedule.

Local National Status
Any persons living or working in the country for which they hold a Passport.

Medical Condition
Any injury, illness or disease, including psychiatric illness.

Medical Practitioner
A person who has attained primary degrees in medicine or surgery by attending a Medical School recognised by the World Health Organisation and who is licensed by the relevant authority to practice medicine in the country where the Treatment is given.

Out-Patient
An Insured Person who receives Treatment at a recognised medical facility, but is not admitted to a Hospital bed as an In-Patient or Day-Patient.

Palliative Treatment
Any Treatment given for the purpose of offering temporary relief of symptoms. Palliative Treatment is not given to cure the Medical Condition causing the symptoms.

Period of Cover
The Period of Cover set out in the Policy Schedule and any subsequent period for which the Policyholder pays a premium which We accept. This will be a 12 month period starting from the Commencement Date or Renewal Date.

Physiotherapist
A person who is registered as a Physiotherapist and licensed to practice in the country in which Treatment is being given.

Policy
Our contract of insurance with You providing cover as detailed in this Policy document. The Application Form and Policy Schedule form part of the contract and must be read together with this Policy document.

Policyholder
The person or company with whom We have contracted this Policy.

Policy Schedule
The Schedule giving details of the Policyholder and the Insured Persons, Policy details and endorsements (if applicable).

Qualified Nurse
A qualified resident or daily Nurse whose name is currently on any register or roll of Nurses, maintained by any Statutory Nursing Registration Body within the country in which they are resident.

Renewal Date
The annual anniversary of the Commencement Date.

Specialist
A registered Medical Practitioner who: -

1. Has at any time held a substantive consultant appointment in that speciality in an NHS Hospital.
   
   
2. Has at any time held a substantive consultant appointment which We on professional advice accept as being of equivalent professional status, or
   
   
3. Is recognised as such by the statutory bodies of the relevant country.

Treatment
Surgical, medical or other procedures the sole purpose of which is the cure or relief of a Medical Condition.

We/Our/Us
Programme Managers on behalf of Underwriters as detailed in the Policy Schedule.

Cover

We will provide insurance within the terms of this Policy, in respect of Acute Medical Conditions arising from either accident or illness which occur during the Period of Cover. The following Benefits are covered under this Policy, subject to an annual maximum of US$ 1,700.000 per Insured Person. All benefits, including full refunds, are subject to reasonable and customary charges.

Benefits

1. Medical Practitioner and Specialist Fees:
   
   1. Medical Practitioner fees including consultations.
   2. Specialist fees as an In-Patient, Day-Patient or Out-Patient.
   3. Diagnostic and surgical procedures as an In-Patient, Day-Patient or Out-Patient.
   4. Physiotherapy on referral by a Specialist. Physiotherapy on referral by a Medical Practitioner is restricted to 10 sessions per Medical Condition, after which it must be reviewed by a Specialist. A medical report will be required for Out-Patient Physiotherapy after 10 sessions.
   5. Treatment administered by registered Chiropractors, Osteopaths, Homeopaths and Acupuncturists when given under the direct control of and following referral by a Specialist.
      
      
2. Hospital Charges:
   Accommodation charges whilst an In-Patient or Day-Patient in a Hospital, including charges for nursing by a Qualified Nurse. Theatre fees and other charges incurred for Treatment of the Medical Condition.
   
   
3. Home Nursing:
   Nursing immediately received following treatment as an In-Patient or Day-Patient and on the recommendation of a Specialist, when provided by a Qualified Nurse. Limited to 30 days per Medical Condition.
   
   
4. Prescribed Drugs and Dressings:
   Drugs, medicines, dressings and Appliances Prescribed by a Medical Practitioner or Specialist.
   
   
5. Reconstructive Surgery:
   Reconstructive surgery following an accident or following surgery for an eligible Medical Condition, provided such surgery is carried out at a medically suitable stage after the accident or surgery has occurred.
   
   
6. Psychiatric Illness:
   
   1. Out-Patient Treatment, including Specialist Consultations.
   2. In-Patient Treatment in a recognised psychiatric unit of a Hospital, limited to 28 days per Period of Cover.
   
   All Treatment under this Benefit is conditional upon pre-authorisation and must at all times be administered under the direct control of a Specialist.
   
   
7. AIDS:
   Medical expenses which arise from or are in any way related to Human Immuno-deficiency Virus (HIV) and /or HIV related illnesses, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC) and /or any mutant derivative or variations thereof.
   
   Expenses are limited to pre and post diagnosis consultations, routine check-ups for this condition, prescribed drugs (except experimental or those unproven), Hospital accommodation and nursing fees. Limited to US$ 42,500.- in the lifetime of the Insured Person and subject to Policy cover being maintained throughout such period.
   
   
8. Accidental Damage to Teeth:
   Treatment received in a dental surgery or in an emergency room in a Hospital immediately following accidental damage caused to sound, natural teeth when given by a Medical or Dental Practitioner.
   
   
9. Complications of Pregnancy:
   Treatment of a Medical Condition which arises during the antenatal stages of pregnancy, or a Medical Condition which arises during childbirth and requires a recognised obstetric procedure.
   
   
10. Parent Accommodation:
    Hospital accommodation in respect of Parent or Legal Guardian staying with an Insured Person who is under 12 years o f age and is admitted as an In-Patient in a Hospital.
    
    
11. New-born Accommodation:
    Hospital accommodation costs relating to a new-born baby to accompany its mother (being an Insured Person) whilst she is receiving Treatment as an In-Patient in a Hospital.
    
    
12. Hormone Replacement Therapy:
    Medical Practitioner or Specialist consultations and the cost of prescribed implants or patches (not tablets), when such Treatment is prescribed solely for the purpose of hormone imbalance.
    
    
13. Transportation:
    Transportation costs to and from Hospitals by the most appropriate transport method when considered medically necessary by a Medical Practitioner or Specialist.
    
    
14. Evacuation:
    Evacuation costs of an Insured Person in the event of Treatment not being readily available at the place of the incident, to the nearest appropriate medical facility, for the purpose of admission to Hospital as an In-Patient or Day-Patient. Evacuation is subject to written agreement from Us prior to travel and certified instructions from the attending Medical Practitioner or Specialist including confirmation that the required Treatment is unavailable in the place of incident.
    
    Extended to cover the costs for one other person to travel with the Insured Person, as escort.
    
    Our medical advisors will decide the most appropriate method of transportation for the Evacuation.
    
    
15. Additional Travel Expenses (following Evacuation):
    Reasonable travel costs:
    
    1. to and from medical appointments when Treatment is being received as a Day-Patient or Out Patient.
    2. for an accompanying person to travel to and from the Hospital to visit the Insured Person following admission as an In-Patient.
    3. up to US$ 140 per day, per person for non-Hospital accommodation for immediate pre and post Hospital admission periods provided that the Insured Person is under the care of a Specialist. Limited to US$ 4,250 per person, per Evacuation.
       
       
16. Mortal Remains:
    In the event of death from an eligible Medical Condition:
    
    1. Cost of transportation of body or ashes of an Insured Person to his/her Country of Nationality or Residence or
    2. Burial or cremation costs at the place of death in accordance with reasonable and customary practice.
    Limited to US$ 8,500 per person.

Exclusions

This Policy does not cover expenses arising from:

1. Any Medical Condition or related condition for which You have received medical Treatment, had symptoms of or sought Advice prior to Your Date of Entry. (Pre-Existing Medical Condition.)
   
   However, after 2 years' continuous membership, all pre-existing conditions will become eligible for Benefit provided You have not:
   
   a) consulted any Doctor for medical Treatment or Advice (including check-ups).
   or
   b) taken medication (including drugs, medicines, special diets or injections).
   
   for a continuous period of 2 years after Date of Entry. (Two Year Moratorium).
   
   
2. a) Treatment of a Medical Condition which we, on the advice of the medical profession, determine is Chronic or Palliative.
   
   b) However, We will pay for the stabilisation of Acute exacerbation of Chronic Conditions.
   
   This Exclusion does not apply to Benefit 7 AIDS.
   
   
3. Chronic supportive Treatment of renal failure, including dialysis. However, We will pay for the cost of renal dialysis incurred:
   
   
   1. immediately pre and post operatively.
   2. in connection with Acute secondary failure when dialysis is part of intensive care.
      
      
4. Experimental or unproven Treatment.
   
   
5. Birth Injuries or Congenital Anomalies.
   
   
6. Routine physical examination by a Medical Practitioner, including gynaecological investigations and tests, inoculations, vaccinations and other preventative medicines.
   
   
7. Rehabilitation unless it forms an integral part of Treatment received as an In-Patient and is under the control or supervision of a Specialist and is undertaken in a recognised rehabilitation unit.
   
   
8. Treatments received in health hydros, nature cure clinics, spas or similar establishments or private beds registered as a nursing home attached to such establishments or a Hospital where the Hospital has effectively become the Insured Person's home or permanent abode or where admission is arranged wholly or partly for domestic reasons.
   
   
9. Cosmetic Treatment whether or not for psychological purposes.
   
   
10. Alternative medicines, other than Chiropractors, Osteopaths, Homeopaths and Acupuncturists.
    
    
11. Costs of providing or fitting any external prostheses or appliance.
    
    
12. Costs incurred in connection with locating a replacement organ or any costs incurred for removal of the organ from the donor, transportation costs of same and all associated administration costs.
    
    
13. The first US$ 100.- of all admissible expenses of each new Medical Condition.
    
    
14. Any second or subsequent medical opinions from a Medical Practitioner or Specialist for the same condition unless it has been authorised by Us in writing.
    
    
15. Normal pregnancy and childbirth.
    
    
16. Pregnancy terminations on non-medical grounds.
    
    
17. Complications of pregnancy costs incurred within the first 12 months from Date of Entry.
    
    
18. Treatment directly or indirectly arising from or required in connection with male and female birth control, infertility, contraception, sterilisation (or its reversal) and any form of assisted reproduction.
    
    
19. Treatment of impotence or any consequence thereof.
    
    
20. Treatment directly or indirectly associated with a sex change.
    
    
21. Venereal disease or any other sexually transmitted diseases.
    
    
22. Normal eye tests, provision of visual aids, normal hearing tests, provision of hearing aids.
    
    
23. Corrective surgery for sight defects not incurred as a result of an accident.
    
    
24. Routine or restorative dental Treatment, whether or not performed by a Medical or Dental Practitioner or a Specialist or an Oral and Maxillofacial surgeon.
    
    
25. Orthodontic Treatment.
    
    
26. Removal of fat or other surplus tissue from any part of the body whether or not it is carried out for medical or psychological reasons.
    
    
27. Treatment for learning difficulties in children.
    
    
28. Treatment for alcoholism, drug or substance abuse or any addictive condition of any kind and any injury or illness arising directly or indirectly from such abuse or addiction.
    
    
29. Suicide or attempted suicide, wilfully self-inflicted bodily injury or illness or injury sustained as a result of a felony.
    
    
30. Travel and accommodation costs unless specifically agreed by Us in writing prior to travel. No travel and accommodation costs are payable where Treatment is obtained solely as an Out-Patient.
    
    
31. Reasonable travel costs in respect of Benefit 15 shall exclude the costs of a hire car.
    
    
32. Costs and expenses incurred where an Insured Person has travelled against medical advice.
    
    
33. Elective Treatment in the United States of America for persons resident in Areas 1 and 2. However, accident and emergency Treatment is covered unless such condition existed prior to the first date of travel and was likely to recur or require Treatment over the duration of the trip.
    
    
34. The fees of a religious practitioner in respect of Benefit 16.
    
    
35. Treatment directly or indirectly arising from or required as a consequence of:
    
    War, invasion, acts of foreign enemy hostilities (whether or not war is declared), civil war, rebellion, revolution, insurrection or military or usurped power, mutiny, riot, strike, martial law or state of siege or attempted overthrow of government or any acts of terrorism, unless the Insured Person sustains bodily injury whilst an innocent bystander.
    
    
36. Treatment directly or indirectly arising from or required as a result of chemical contamination or contamination by radioactivity from any nuclear material whatsoever or from the combustion of nuclear fuel, asbestosis or any related condition.

Optional Modules

The following Endorsements only apply if they are specifically noted on the Schedule of Insurance:

Endorsement Number 001 -CHRONIC CONDITIONS:

Cover under this Policy is extended to include routine management and Palliative medical expenses incurred in connection with a Chronic condition. Cover is restricted to new Medical Conditions, which have not been previously suffered from, whether or not diagnosed, occurring after the Purchase Date of this Benefit. (See Policy Schedule for Purchase Date.)

Medical Expenses are limited to:

Routine check-ups associated with the Chronic condition, drugs prescribed for management of the condition, Hospital accommodation, nursing, surgery and Palliative Treatment.

The Benefit payable in respect of this Endorsement is limited to a maximum of US$ 42,500.- per Period of Cover, per Insured Person for a period of 5 years from the date of confirmed diagnosis and is subject to the Policy being maintained throughout the period of the claim.

As a result of this Endorsement, the following amendments are applied to the standard Policy Wording:

Exclusion 2 a): Deleted.

Exclusion 3): Deleted.

Endorsement Number 002 - ROUTINE DENTAL TREATMENT:

Cover under this Policy is extended to include the fees of a Dental Practitioner carrying out routine dental Treatment in a dental surgery.

Routine dental Treatment is defined as:

Examinations, tooth cleaning, normal compound fillings, porcelain crowns, extractions.

Benefit is limited to US$ 700 per Period of Cover, per Insured Person.

As a result of this Endorsement, the following amendments are applied to the standard Policy Wording:

Exclusion 1): Deleted.

Exclusion 13): Deleted in respect of this Benefit only.

Exclusion 24): Deleted and amended to read:
"Restorative Dental Treatment, whether or not performed by a Medical or Dental Practitioner or a Specialist or an Oral and Maxillofacial Surgeon."

Where Endorsement Number 003 is also operative, Exclusion 24 is deleted in its entirety.

Endorsement Number 003 - MAJOR RESTORATIVE DENTAL WORK:

Cover under this Policy is extended to include the fees of a Dental Practitioner and associated costs for the following specified procedures:

• Removal of impacted, buried or unerupted teeth
• Removal of roots
• Removal of solid odontomes
• Apicectomy
• New or repair of Bridge Work
• New or repair of Crowns
• New or repair of Upper and Lower Dentures

Benefit is limited to US$ 3,500.- per Period of Cover, per Insured Person.

As a result of this Endorsement, the following amendments are applied to the standard Policy Wording:

Exclusion 1): Deleted

Exclusion 13): Deleted in respect of this Benefit only.

Exclusion 24): Deleted and amended to read:
"Routine Dental Treatment, whether or not performed by a Medical or Dental Practitioner or a Specialist or an Oral and Maxillofacial Surgeon."

Where Endorsement Number 002 is also operative, Exclusion 24 is deleted in its entirety.

Endorsement Number 004 -NORMAL PREGNANCY AND CHILDBIRTH:

Cover under this Policy is extended to include the costs associated with normal pregnancy and childbirth and any related condition and incurred after the first 12 months from the Purchase Date of this Benefit (See Policy Schedule for Purchase Date).

Expenses are limited to:

• Childbirth, pre and post natal check-ups and delivery costs.

Maximum Benefit shall be limited to US$ 8,500.- per pregnancy.

As a result of this Endorsement, the following amendments are applied to the standard Policy Wording:

Exclusion 13): Deleted in respect of this Benefit only.

Exclusion 15): Deleted.

Endorsement Number 005 -EVACUATION/ REPATRIATION:

Benefit 14.) is deleted and replaced with:
"Evacuation costs of an Insured Person in the event of Treatment not being readily available at the Place of Incident to the nearest appropriate Medical Facility, Country of Residence or Country of Nationality or Country of Your Choice, for the purpose of admission to Hospital as an In-Patient or Day-Patient."

Endorsement Number 006 - POLICY EXCESS:

Exclusion 13) is deleted and replaced with the amount shown on the Policy Schedule which shall be applicable in respect of all admissible expenses of each new Medical Condition.

Endorsement Number007- IN-PATI ENT ONLY COVER:

Cover under this Policy is restricted to operate in respect of costs incurred for Treatment received as an In-Patient or Day-Patient. This restriction does not apply to Endorsement Numbers 001, 002, 003 and 004 if also operative.

However, Out-Patient Treatment provided immediately following discharge from a Hospital and under the supervision of a Specialist will be covered up to a maximum Benefit of US$ 1,700.- per Medical Condition.

Endorsement Number 008 - USA ELECTIVE TREATMENT:

Cover under this Policy is extended to provide elective Treatment in the United States of America.

As a result of this Endorsement, the following amendments are applied to the standard Policy Wording:

Exclusion 33): Deleted.

Endorsement Number 009 -MEDICAL HISTORIES DISREGARDED:

Cover under this Policy is extended to include Treatment of an eligible Medical Condition, or related condition for which You have received medical Treatment, had symptoms or sought Advice prior to Your Date of Entry. This Policy will compensate for Treatment costs incurred after Your Date of Entry.

As a result of this Endorsement, the following amendments are applied to the standard Policy Wording:

Exclusion 1): Deleted.

General Conditions

1. Acceptance Clause:
   We are entitled to refuse to accept an application from any person without giving a reason. We maintain the right to ask You to provide proof of age and/or state of health of any person included in Your application.
   
   
2. Compliance with Policy Terms:
   We shall not be liable under this Policy in the event of any failure by an Insured Person to comply with its terms and conditions, except where the circumstances of any claim are unconnected with such failure and no fraud is involved.
   
   
3. Change of Risk:
   The Policyholder must inform Us as soon as reasonably possible of any material changes relating to any Insured Person which affect information given in connection with the application for cover under this Policy. We reserve the right to alter the Policy terms or cancel cover for an Insured Person following a change of risk to the extent permissible by the laws of Your Country of Residence.
   
   
4. Policy Duration and Premiums:
   
   1. The Policy is for one year and is renewable for successive one-year periods, subject to the terms in force at the time of each Renewal Date and to payment of the premium.
   2. The premium payable may be changed by Us from time to time. However, this Policy will not be subject to any alteration in premium rates generally introduced until the next Renewal Date.
   3. All premiums are payable in advance of any cover under this Policy being provided.
   4. Your Policy is an annual contract and You are responsible for the whole year's premium even if We have agreed that You may pay by instalments.
   
   
5. Government Taxes:
   To reflect any change in Insurance Premium Tax or other Government levies, We may alter the terms and conditions of this Policy at any Renewal Date. A copy of the current Policy terms will be sent to You at such time.
   
   
6. Break in Cover:
   Where there is a break in cover, We reserve the right to reapply Exclusion 1 in respect of Pre-Existing Medical Conditions.
   
   
7. Children:
   Children will be accepted for cover from birth, provided that their birth is notified to Us within 90 days from the date of birth. Notification received after this period will result in children being accepted for cover from the date of such notification.
   
   
8. Alterations:
   
   1. We may alter the terms and conditions of this Policy at any Renewal Date. A copy of the current Policy terms will be sent to You at such time. You may cancel Your Policy within 30 days following any Renewal Date and provided You have not made a claim We will refund Your premium. We will give You reasonable notice of such alterations. We will send details of such alterations to the address We have for You. However, the alterations will take effect even if You do not receive them for any reason.
   2. No alteration or amendment to the Policy terms will be valid unless it is in writing from Us.
   
   
9. Waiver:
   Waiver by Us in any instance of any term or condition of this Policy will not prevent Us from relying on such term or condition in other instances.
   
   
10. Cancellation:
    In the event of any non-payment of premium, We shall be entitled to cancel this Policy following the procedures (if any) provided by the laws of Your Country of Residence. Where no such procedures apply, cancellation will be automatic. We may at Our discretion reinstate the cover if the premium is subsequently paid.
    
    Whilst We shall not cancel this Policy because of eligible claims made by any Insured Person, We may at any time terminate an Insured Persons cover if he/she or the Policyholder has at any time
    
    
    1. misled Us by misstatements
    2. knowingly claimed benefits for any purpose other than as are provided for under this Policy.
    3. agreed to any attempt by a third party to obtain an unreasonable pecuniary advantage to Our detriment.
    4. otherwise failed to observe the terms and conditions of this Policy or failed to act with utmost good faith.
       
       
    If the Policy is cancelled by the Policyholder at any time other than following the Renewal Date there will be no return of premium.
    
    
11. Applicable Law:
    You are free to choose the law applicable to this Insurance Contract. Unless specifically agreed to the contrary, this insurance Policy shall be subject to English Law.
    
    The law applicable to this Policy shall be that specified in the Policy Schedule. The choice of applicable law shall not affect any statutory rights You may have under the laws of Your Country of Residence.
    
    
12. Several Liability:
    The various Underwriters of this Policy to which they subscribe are several and not joint and are limited solely to the extent of their individual subscriptions. The Underwriters are not responsible for the subscription of any co-subscribing Underwriter who for any reason does not satisfy all or part of its obligations.
    
    
13. Other Insurance:
    If there is any other insurance covering any of the same Benefits, You must disclose or ensure that the relevant Insured Person discloses the same to Us and We shall not be liable to pay or contribute more than Our rateable proportion.
    
    
14. Fraudulent/Unfounded Claims:
    If any claim under this Policy is in any respect fraudulent or unfounded, all benefits paid and/or payable in relation to that claim shall be forfeited and (if appropriate) recoverable in addition all cover in respect of the Insured Person shall be cancelled void ab initio, without refund of premiums.
    
    
15. Electronic Date Recognition Exclusion (EDRE):
    This Policy does not cover any loss, damage, cost, claim or expense, whether preventative, remedial or otherwise, directly or indirectly arising out of or relating to
    
    
    1. the calculation, comparison, differentiation, sequencing or processing of data involving the date change to the year 2000, or any other data change, including leap year calculations, by any computer system, hardware, programme or software and/or any microchip, integrated circuit or similar device in computer equipment or non-computer equipment, whether the property of the Insured or not; or
    2. any change, alteration, or modification involving the date change to the year 2000, or to any other date change, including leap year calculations, to any such computer system, hardware, programme or software and/or any microchip, integrated circuit or similar device in computer equipment or non-computer equipment, whether the property of the Insured or not.

Claims Procedure

Our Medical Help-line is available 24 hours a day, 365 days a year and is staffed by multi-lingual operators, who can arrange admission to Hospital, ambulance transfers and air Evacuation where necessary. To obtain medical assistance, use the Medical Help-line number shown on Your membership card. You will need to provide Your name, Policy number, telephone and/or fax number, location and medical problem. In any given situation, if You are unsure what to do, contact the Medical Help-line.

All Insured Persons under this Policy shall at all times take reasonable precautions to prevent accidents or illness and shall comply with recommended vaccination schedules and/or take appropriate Malaria and other drug prophylaxis. All expenditure for which Benefit is claimed must be reasonable and customary and be necessarily incurred and be wholly and exclusively for the purpose of Treatment.

Claims paid in a local currency will be converted at the rate of exchange quoted weekly in the Financial Times Guide to World Currencies, at the time We assess the claim.

To safeguard You against the possibility of being faced with expenses which are not covered under Your Policy, We have developed the following procedures:

Planned In-patient & Day-patient Treatment

In the event of a planned admission on an In-Patient or Day-Patient basis to a Hospital, the following steps should be taken. If You do not utilise this facility, remember that the Policy only pays costs which are considered reasonable and customary based on the information available to Us. Payment of all expenses incurred by You cannot be guaranteed unless You follow these procedures:

1. Contact Our Medical Help-line at least five days prior to admission, giving full details of the condition, proposed Treatment (including dates and name of procedure if known) together with the name of the Specialist and Hospital details. The telephone number is provided on the back of Your membership card.
   
   
2. The Medical Help-line will advise You if they have sufficient information to confirm Your cover. If not, they will advise You what further information is required.
   
   
3. The Medical Help-line will verbally confirm Your cover and will despatch written confirmation to You.
   
   
4. The Medical Help-line will make arrangements with the Hospital for all eligible bills to be settled directly (direct billing). Where this has been arranged, You should send the original claim form and the unpaid invoices (if given to You by the Hospital) to the Programme Managers’ Claims Department.

If direct billing has not been arranged, You should pay all of the bills and send the originals together with the claim form to the Programme Managers’ Claims Department who will reimburse You accordingly.

Emergency Admissions

In the event of emergency admissions, You should contact the Medical Help-line as soon as possible after admission and follow the steps described above for In-Patient Treatment. Please do not delay obtaining emergency Treatment.

Complaints Procedure

Our aim is at all times to provide a first class standard of service. However, there may be occasions when You feel that this objective has not been achieved. Should You have any complaint regarding this insurance Policy, please contact in writing:

Health and Hospitalisation Insurance
Frequently Asked Questions
Premium Rates
Benefit Schedule
Application Form
Claim Form
Sample Policy Wording

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