IMPORTANT! FOR OPD CLAIMS ONLY!

During the first 15 days after the start date of the policy, the company will not send a Guarantee of Payment (GOP) to the hospital. The patient must pay out-of-pocket and then apply for reimbursement.

After the first 15 days, in the event of a claim, the company will send a GOP to the hospital in advance.

The insured can receive advance GOP as follows:

• 4 GOPs for a 120-day policy
• 3 GOPs for a 90-day policy
• 2 GOPs for a 60-day policy
• 1 GOP for a 30-day policy

Total OPD claims allowed per policy:

• 1 OPD claim for a 30-day policy
• 2 OPD claims for a 60-day policy
• 3 OPD claims for a 90-day policy
• 4 OPD claims for a 120-day policy

Advance GOP: An advance Guarantee of Payment that the company sends to the hospital upon the insured's request.

Treatment:

Mandatory medical expenses due to an accident or illness of the insured while abroad are covered. This includes treatment until the insured's health allows them to be discharged from the hospital or transported to their home country, where further treatment can continue.

Medicines and Drugs

Includes the cost of medicines, medications, and medical supplies prescribed by a doctor, which are necessary for the treatment of an acute medical condition.

Emergency Dental Services

Coverage includes emergency expenses for dental care required to relieve acute tooth pain or address new tooth damage, including tooth extraction. However, the cost of definitive treatment to fully resolve the dental issue is not included.

Acute Exacerbation of Chronic Diseases

Emergency medical care, transportation, medication, and all other expenses are covered for acute exacerbation of chronic diseases, up to the limit specified in the insurance coverage table. For the purposes of this policy, a chronic disease is defined by at least one of the following characteristics:

• Requires constant or long-term follow-up with consultations, examinations, doctor visits, and/or tests.
• Continuous or long-term monitoring or symptom management is necessary.
• Requires rehabilitation or the ability of the insured to manage the disease.
• The duration of the disease is undetermined.
• There is no known cure.
• The disease recurs or has the potential to recur.

Mental Health

Urgent medical treatment for an acute episode of a new or pre-existing mental health disorder (e.g., panic attack or anxiety attack) is covered up to the specific limit stated in the insurance coverage chart. No coverage is provided under any other section of the policy in relation to mental health.

Transport to and from the Nearest Hospital

The cost of transporting the insured to the nearest hospital or clinic and back to their original location abroad is included.

Transportation to Your Home Country

The cost of transporting a sick or injured insured person to their home country is covered if their health permits. This must be done with the prior consent of the care company and applies to insured individuals who are unable to return home as originally planned for medical reasons.

Transport and Accommodation for a Person Living with the Insured

The additional transportation and accommodation costs for a person accompanying the insured, as recommended or requested by the attending physician, are covered. This includes bringing a close relative from their home country to the location of the insured's hospitalization if no other companion is available. If the insured person is a minor, transportation and per diem expenses for the accompanying person are covered, regardless of whether the accompaniment was recommended by the attending physician.

Escort and Transportation of a Minor Child

The costs of transporting an insured child under the age of 18 to their permanent residence are covered, including the transportation costs of their companion in the event of the insured's hospitalization or death, if the child is not accompanied by an adult.

Transportation of a family member

The cost of a return ticket for public transport (economy class) for one family member is included if the insured person cannot return home for medical reasons and is hospitalized for more than 7 days for the reasons specified in these conditions.

Return home in case of death or serious family member's health

In the event of a death or serious health condition of a family member, the expenses for organizing an emergency return of the insured person to the house are covered. The cost of moving the ticket is covered.

Transportation of the remains to the home of the insured person

The costs of transporting the remains of the insured person from abroad to their homeland are covered.

Hospital A&E and Inpatient (IPD) Emergency Medical Care and Treatment

Urgent Medical Care or Treatment in a Hospital Accident & Emergency (A&E) department and/or hospital inpatient facilities, medically necessary for diagnosis and treatment of a serious bodily injury or an acute serious illness, first occurred during the period of insurance.

Transportation to the nearest hospital or clinic and back

The cost of transporting the insured to the nearest hospital or clinic and back to their original location abroad is included.

Serious acute deterioration of chronic condition

Urgent Medical Care or Treatment in a Hospital Accident & Emergency (A&E) department and/or hospital facilities, medically necessary for diagnosis and treatment of an unexpected acute serious, life-threatening deterioration of a previously declared stable chronic condition, requiring hospitalization as an inpatient, and up to up to the specific limit.

For the purposes of this policy, a chronic disease has at least one of the following characteristics:

• requires constant or long-term follow-up with consultations, examinations, visits to the doctor and / or examinations;
• continuous or long-term monitoring or relief of symptoms is necessary;
• requires rehabilitation or the ability of the insured to manage the disease;
• the duration of the disease is not determined;
• does not have a known treatment;
• it repeats or may happen again.

Outpatient Medical treatment and doctor’s visit (OPD)

Reasonable and customary professional fees for outpatient medical visits. This does not include diagnosis tests if it was not prescribed by the doctor officially. limits are per policy per person.

Emergency dental treatment

Included costs of urgent dental treatment which is necessary for suppressing acute pain due to illness or fresh injury of teeth, including tooth extraction are covered.

Transportation to Your Home Country

The cost of transporting a sick or injured insured person to their home country is covered if their health permits. This must be done with the prior consent of the care company and applies to insured individuals who are unable to return home as originally planned for medical reasons.

Mental Health

Urgent Medical Care or Treatment in a Hospital Accident & Emergency (A&E) department and/or hospital facilities, medically necessary for diagnosis and treatment of mental health disorders requiring immediate psychiatric treatment and hospitalization as an inpatient, and up to the specified limit.

Medical cover for children under 1 year old

Emergency/Urgent Medical Care or Treatment in a Hospital Accident & Emergency (A&E) department and/or hospital inpatient facilities, for diagnosis and treatment of a serious bodily injury or an acute serious illness for children under 1 year old is offered for members under Plan Insurance +. Claims related to congenital conditions are not included.

Maternity

Maternity: miscarriage, premature birth, and medical costs in cases of saving mother’s or child’s life before 37th week of pregnancy.

Repatriation of mortal remains

Costs of transporting the Insured’s mortal remains to his/her Homeland are covered.

Return in case of death of a family member

Return in case of a Severe Health Condition or death of a family member: the cost of arranging the return to the Homeland is covered in case of a family member’s Severe Health Condition or death. The cost of changing the scheduled flight or a return regular flight (economy class) is covered, provided that the rescheduling is not possible.

Terrorism cover

Terrorism cover: If, while staying abroad the Insured is injured due to a terrorist attack the Insurance Company will pay for any Urgent Medical Care or Treatment required up to the sum insured included in the insurance Benefit Table.

No cover is provided if the Insured is traveling to a specific country or an area where, prior to the trip commencing, an official government body has advised against travel. No cover is provided under this section in the following countries: Afghanistan, DR of Congo, Iraq, Iran, Israel (west bank and Gaza), Libya, Nigeria, Somalia, Sudan, Syria and Yemen.

Bone fracture bonus

We will pay for this in addition to medical expenses. The indemnity amount for bone fractures is €100 for fingers, toes and nose bones and € 500 for any other bone fracture, per person, per policy. It means if the Insured person has a bone fracture, the company covers the cost of treatment and pays an additional bonus to the Insured.

Cancer

Cancer following a period of 3 months after Policy inception date

Accidental total permanent disability

Accidental TPD - total permanent disability: when fulfilling all criteria specified in the definition, cover will be considered once medical specialist evidence and documentation from the home location has confirmed total permanent disability without any expectation of recovery, dated at least 12 months from the Accident

Accidental death

Accidental death: If, while staying abroad, the Insured dies due to an Accident, the Insurance Company will pay the benefit to the Insured’s heir/heiress. The insurance coverage for accidental death of the Insured shall not apply if the Insured is less than 14 years old when the insured event occurs, thereby excluding from insurance all obligations attaching to the Insurance Company in relation thereof