1. The insurer shall provide insurance cover for illnesses, accidents and other events specified in the policy. If agreed, it shall also provide additional services directly related to the above. In the event of the occurrence of an unforeseeable insured event abroad, the insurer shall assume the costs incurred abroad for medical treatment and shall also award other agreed benefits.
2. An insured event is defined as the medically necessary treatment of an insured person due to illness or accident. An insured event commences upon receipt of medical treatment; it shall terminate when, according to medical estimation, further treatment is no longer required. Death is also deemed to be an insured event.
3. The scope of the insurance cover is specified in the certificate of insurance, any subsequent written agreements, these terms and conditions of insurance and the statutory provisions of the Federal Republic of Germany.
4. The state in which the insured person has a permanent place of residence or permanently exercises his or her profession is not deemed to be a foreign country.
5. Persons travelling abroad on a temporary basis only are eligible for cover if the tariff does not stipulate otherwise. The eligibility of foreigners entering the Federal Republic of Germany is governed by special terms and conditions.
   

1. Insurance cover commences at the specified point in time (inception of insurance), but not before the conclusion of the insurance policy, not before payment of the premium and not before crossing the border into a foreign country. The granting of an executable direct debit transfer is deemed to be equal to payment of premium.
2. Trips abroad involving a departure from the Federal Republic of Germany before the insurance takes effect are excluded from cover.
3. No benefits shall be paid for events which occurred prior to the commencement of insurance cover.
   

1. The insurance policy is concluded when the insurer accepts the application for insurance. The application for insurance must be submitted on the designated form. The acceptance of the application for insurance is effected through the delivery of the certificate of insurance. If insurance is applied for on the payment form designated by the insurer, the policy is deemed to be effected on the date of payment of the premium (date stamp of post office, financial institute or accounting office is decisive), subject to the insurer receiving the duly completed application. The payment voucher handed over to the applicant by the post office, bank or the like is deemed to be the certificate of insurance.
2. Should the policyholder have entered a premium in the application for insurance which is incorrect according to the tariff, the insurance application shall be deemed to have been made with the correct premium according to the tariff if the premium is paid by direct debit (§ 8, paragraph (2)).
3. The policy term is regulated by the tariff. In the case of death of an insured person, the insurance policy shall end with regard to that person. In the event of the death of the policyholder, the contractual relationship with the additional insured persons shall remain unaffected.

1. Insured persons are free to select the registered medical practitioners and dentists they wish to consult.
2. Drugs and dressings are only covered by the insurance if prescribed by the practitioners specified under (1) above.
3. In the case of medically necessary in-patient treatment, the insured person shall be free to choose among public hospitals which are permanently managed by physicians, have sufficient diagnostic and therapeutic facilities and keep medical records.
4. The type and amount of the insurance benefits are regulated by the tariff. Where the refund of evacuation or repatriation costs is agreed, the following shall apply:
   
   1. The evacuation of a person who has been taken ill must be deemed medically necessary, ordered by a medical practitioner and generally be carried out to the place where the patient had a permanent residence upon inception of the insurance policy, or to the nearest suitable hospital to such place of residence.
   2. Repatriation costs are the direct costs of the repatriation of an insured person who has died during the trip away from home to the place of residence at the time of inception of the insurance policy. Funeral expenses incurred abroad may be reimbursed instead of repatriation costs up to the sum specified in the tariff for repatriation costs. Repatriation costs and funeral expenses shall not be indemnified if the costs of treating the illness or accident causing death were not or would not have been reimbursable under this insurance.
      
      

1. The insurer shall not be liable to pay
   1. for illnesses and consequences of an accident the treatment of which was the purpose of the trip abroad, or for treatment which was known to be required in the course of the planned journey, unless the journey took place because of the death of the spouse or a first-degree relative;
   2. for illnesses /accidents caused by warlike events or participation in civil commotion during the journey, including the ensuing consequences or deaths;
   3. for illnesses and accidents caused deliberately, including their consequences, or for the treatment of addictions;
   4. for the treatment of mental and psychological disorders and illnesses or for hypnosis or psychotherapy;
   5. for examinations and treatment due to pregnancy, childbirth, miscarriage and abortion or any consequences thereof. Costs shall, however, be indemnified if medical attendance is necessary due to acute complications in pregnancy including miscarriage in the country where the insured person is staying;
   6. for dental prosthesis, including crowns and orthodontic surgery;
   7. for medical aids;
   8. for health resorts and sanatorium treatment as well as rehabilitation measures;
   9. for out-patient medical treatment at a spa or health resort. This limitation shall not apply if medical treatment becomes necessary during a temporary stay due to an illness or accident which is not connected to the purpose of the stay;
   10. for treatment administered by the spouse, parents or children. Material costs shall be reimbursed.
   11. for accommodation necessitated by nursing-care or safekeeping requirements;
   12. for sterility treatment and artificial insemination.
       
2. Should medical treatment or another measure for which benefits are agreed exceed the medically necessary degree, or if the fee charged is inappropriate, then the insurer may reduce the benefit payments to an appropriate amount.
3. Should the insured person be entitled to benefits from statutory health, accident or annuity insurance carriers or to statutory medical care or accident compensation, the insurer shall only be liable for those costs which remain necessary despite such benefits paid.

1. The insurer shall only be liable to pay when presented with original invoices and any required supporting evidence; such documents shall then become the property of the insurer. If the original documents have been presented to another insurer (e.g. as named under § 5, paragraph 3) for indemnification, then copies of the invoices shall suffice if the other insurer has noted the amount of its payment thereon.
2. All documents must contain the name of the attending physician, the first name, surname and date of birth of the person treated, and a description of the ailment(s) along with the treatment dates; prescriptions must clearly state the prescribed medication, the price and the annotation of receipt. In the case of dental treatment, the documents must contain a description of the teeth treated and the treatment performed in each case. Payments or their rejection by the insurer named in § 5, paragraph 3, must be substantiated.
3. A doctor’s certificate confirming medical necessity must be submitted as evidence of the medical necessity of an evacuation.
4. If claims are made for compensation of repatriation costs or funeral expenses, an official or medical certificate of the cause of death must be submitted.
5. The insurer shall be obliged to pay the insurance benefits to the insured person if the policyholder has named that person to the insurer in writing as the beneficiary of the insurance benefits. If this premise is not fulfilled, then only the policyholder can demand to receive the benefit.
6. Costs incurred in a foreign currency shall be converted into euro at the exchange rate valid on the date the insurer receives the receipts. The daily rate shall be the official EUR exchange rate at the European Central Bank. In the case of non-traded currencies for which no reference rates are set, the rate according to the most recent version of the "Exchange Rate Statistics" published by Deutsche Bundesbank in Frankfurt/Main shall apply, unless the insured person proves by means of a bank slip that the currency required to pay the invoices was purchased at a poorer rate of exchange.
7. The cost of transferring insurance benefits to a foreign account or of special types of remittance chosen upon the insured person’s instructions may be deducted from the benefits.
8. Rights to insurance benefits can be neither subrogated nor pledged.
9. For the rest, the conditions governing the insurer’s liability to pay are set down in § 14 VVG (German Insurance Contract Act; see Appendix).

1. The insurance cover shall terminate at the agreed point in time, but at the end of the trip at the latest, including cover for pending claims.
2. If the return journey is not possible by the agreed point in time for medical reasons, the insurer’s liability to pay indemnifiable claims shall continue beyond the agreed point in time until the insured person is able to be transported again.
   

If an insured person objects to any medically warranted and reasonable return transportation to his/her home country following reinstatement of his/her ability to be transported then the obligation to perform on the part of the insurer shall cease on the day the insured person objects to return transportation.

1. The premium is a single premium. It results from the tariff and is payable upon conclusion of the insurance policy at the latest.
2. The tariff may prescribe payment of the premium by direct debit order. In this case, the legally valid direct debit authorisation shall be deemed to be the premium payment if the insurer was subsequently able to debit the premium.
   

Within the contractually agreed benefits, the benefits paid by the insurer may change, e.g. due to increasing medical treatment costs, more frequent use of medical services or rising life expectancies. Therefore, at least once a year the insurer shall compare the required insurance benefits with the benefits and mortalities calculated for each tariff where the insurer’s right of ordinary cancellation is ruled out contractually or by law.

The premiums shall be adjusted subject to the applicable legal requirements to the extent necessary according to the result of this review. The premium adjustments shall take effect at the beginning of the second month following notification of the policyholder.

In the event of an increase in premium, the policyholder may cancel the insurance policy within one month of receiving notification of the increase with effect from the date when the premium is due to increase. The policyholder may cancel the insurance policy up to the date when the adjustment takes effect, even if the deadline of one month has already expired at this point in time.

1. The General Terms and Conditions of Insurance may, if the insurer’s right of cancellation is ruled out contractually or by law, be amended with effect for existing insurance policies, for the remainder of the current insurance year as well (see tariff), on the basis of the applicable legal provisions if such amendment appears necessary in order to sufficiently safeguard the interests of the insured persons
   1. in the case of a not merely temporary change in the state of the public health system,
   2. in the event that terms and conditions are pronounced invalid in court, if the replacement thereof is necessary in order to uphold the policy,
   3. in the case of amendments to laws upon which the terms and conditions of the insurance policy are based,
   4. in the case of changes to supreme court rulings or to administrative practices of the Federal Supervisory Authority for Financial Services or of the cartel authorities which directly affect the insurance policy. With regard to the letters c und d, an amendment is only permissible where it relates to §§ 1, 2, 3, 4, 5, 7, 8, 9, 10, 13, 14 para. 2, AVB-R.
      
      
2. Amendments pursuant to paragraph 1 shall become effective at the beginning of the second month after the policyholder has received notification thereof.
3. In the event of an adjustment of terms and conditions, the policyholder may cancel the insurance policy within one month of receiving notice of the amendment, and such cancellation shall take effect on the date when the amendment is due to take effect. The policyholder may cancel the insurance policy up to the date when the adjustment takes effect, even if the deadline of one month has already expired at this point in time.
   
   

1. The policyholder or the insured person specified as the beneficiary (cf. § 6, para. 5) must submit all documents by the end of the third month after the end of the trip at the latest; any hospital treatment must be reported within 10 days of its commencement.
2. Upon the request of the insurer, the policyholder or the insured person specified as the beneficiary (cf. § 6, para. 5) shall be required to provide each and every kind of information necessary to determine an insured event or an obligation to perform on the part of the insurer and the scope thereof.
3. Upon the request of the insurer, the insured person shall be obliged to undergo a medical examination by a doctor appointed by the insurer.
   

1. If the policyholder or an insured person has claims for compensation against third parties, then, notwithstanding the statutory assignment of claims according to § 86 VVG (see Appendix), that person shall be obliged to subrogate such claims in writing to the insurer up to the amount to which compensation is paid under the insurance policy (reimbursement of costs, non-cash benefits and services).
2. The policyholder or the insured person must protect his/her claim to compensation or any right which serves to safeguard any such claim in compliance with the applicable formal and temporal requirements and contribute towards its enforcement by the insurer where necessary.
3. Should the policyholder or an insured person deliberately violate the obligations specified in paragraphs 1 and 2, then the insurer shall not be required to perform to the extent that it cannot obtain any compensation from the third party as a consequence. In the case of any breach of obligation due to gross negligence, the insurer is entitled to reduce the amount of compensation it awards in relation to the severity of the breach.
4. If the policyholder or an insured person is entitled to claim against a provider of services for the repayment of fees paid without legal grounds which the insurer has reimbursed on the basis of the insurance policy, then paragraphs 1 to 3 shall be applied accordingly.
   

1. Legal action taken against the policyholder arising from the insurance policy is subject to the jurisdiction of the court in the town of the policyholder’s permanent place of residence or, failing this, his habitual place of residence.
2. Legal proceedings against the insurer may be brought before the court in the town of the policyholder’s permanent or habitual residence or before the court in the town where the insurer has its head office.
3. If, after the conclusion of the policy, the policyholder relocates his permanent or habitual place of residence to a state which is not a member state of the European Union or a contracting state of the Treaty on the European Economic Area, or if his permanent or habitual place of residence is in one of the above states at the time of conclusion of the policy or if his permanent place of residence or habitual place of residence is not known at the time the proceedings are brought, the court at the location of the head office of the insurer has jurisdiction.

1. The insurer shall be liable to pay a cash benefit when enquiries necessary to establish the occurrence of the insured event and the extent of the insurer's liability have been concluded.
2. If these enquiries have not been concluded one month after notification has been given of the occurrence of the insured event, the policyholder may demand part payment in the amount which the insurer will at least be expected to pay. The time limit shall be suspended for as long as the enquiries cannot be concluded on account of the fault of the policyholder.
3. An agreement on account of which the insurer is released from the obligation to pay interest on arrears shall be void.
   

2. Where the contract provides that the insurer is not obligated to effect payment in the event of the non-observance of an incidental obligation on the part of the policyholder, he shall be released from the liability if the policyholder intentionally breached the obligation. In the case of grossly negligent non-observance of the obligation, the insurer shall be entitled to reduce any benefits payable commensurate with the severity of the policyholder's fault; the burden of proof that there was no gross negligence is on the policyholder.
3. Notwithstanding subsection (2), the insurer shall be liable insofar as the non-observance of the obligation neither caused the occurrence or the establishment of the insured event nor the establishment or the extent of the insurer's obligation to effect payment. The first sentence shall not apply if the policyholder fraudulently breached the obligation.
4. The condition on which the insurer's entire or partial release from liability in accordance with subsection (2) is based shall, in the event of a violation of an existing duty to provide information or duty of disclosure after the occurrence of an insured event, be the fact that the insurer instructed the policyholder in separate correspondence and in writing of this legal consequence.
   

1. The policyholder must, upon the occurrence of the insured event, ensure that the loss is avoided or minimised wherever possible.
2. The policyholder must follow the instructions of the insurer, where reasonable, and obtain instructions, circumstances permitting. If several insurers involved in the contract of insurance issue different instructions, the policyholder must act at his own proper discretion.
3. In the event of the breach of an incidental obligation under subsections (1) and (2), the insurer shall not be obligated to effect payment if the policyholder intentionally breached the incidental obligation. In the event of a grossly negligent breach, the insurer shall be entitled to reduce his benefits payable commensurate with the severity of the policyholder's fault; the burden of proof that there was no gross negligence is on the policyholder.
4. Notwithstanding subsection (3), the insurer shall be liable insofar as the breach of the incidental obligation is the cause neither of the establishment of the occurrence of the insured event, nor of the establishment of the extent of the liability. The first sentence shall not apply if the policyholder fraudulently breached the obligation.
   

1. If the policyholder is entitled to claim damages from a third party, this claim shall be assigned to the insurer insofar as the insurer compensates for the loss. The claim may not be assigned to the detriment of the policyholder.
2. The policyholder shall safeguard his claim for damages or a right serving to safeguard this claim in accordance with the applicable form and time requirements, and shall assist the insurer wherever necessary in asserting them. If the policyholder intentionally breaches this obligation, the insurer shall not be obligated to effect payment insofar as he cannot as a result claim compensation for it from a third party. In the case of grossly negligent non-observance of the obligation, the insurer shall be entitled to reduce any benefits payable commensurate with the severity of the policyholder's fault; the burden of proof that there was no gross negligence is on the policyholder.
3. If the policyholder claims compensation from a person with whom he is sharing a common household when the loss occurs, assignment in accordance with subsection (1) cannot be asserted, unless that person intentionally caused the loss.