Care Discover - Health insurance abroad for foreign visitors

Care Discover - Health insurance abroad for foreign visitors

Terms and conditions of insurance


GTI Health insurance
GTI Accident/Liability
Product information (IPID)
Consumer informations/ Important notes
Terms and Conditions of the Travel Insurance Care Discover of HanseMerkur Reiseversicherung AG VB-KV 2015 Care Discover (CKV CD-G)
Designelement 1 zur Versicherung für weltweite Reisende § 1 - Insured persons and insurability
Designelement 1 zur Versicherung für weltweite Reisende § 2 - Conclusion and Termination of the Insurance Policy, Membership in the Group Insurance Policy, Additional Insurance for Children
Designelement 1 zur Versicherung für weltweite Reisende § 3 - Termination
Designelement 1 zur Versicherung für weltweite Reisende § 4 - Premium/Fees
Designelement 1 zur Versicherung für weltweite Reisende § 5 - The Right to Premium Adjustments
Designelement 1 zur Versicherung für weltweite Reisende § 6 - Scope of Application, Commencement, Duration and End of Insurance Cover
Designelement 1 zur Versicherung für weltweite Reisende § 7 - Minimum and Maximum Term/Membership Term in the Group Insurance Policy
Designelement 1 zur Versicherung für weltweite Reisende § 8 - Object of the Insurance Cover and Scope of Benefits
Designelement 1 zur Versicherung für weltweite Reisende § 9 - Restrictions of the Obligations to provide Benefits
Designelement 1 zur Versicherung für weltweite Reisende § 10 - Obligations and the Consequences of their Breaches
Designelement 1 zur Versicherung für weltweite Reisende § 11 - Conditions for the Payment of Insurance Benefits
Designelement 1 zur Versicherung für weltweite Reisende § 12 - Due Date of the Insurance Benefits, Payment
Designelement 1 zur Versicherung für weltweite Reisende § 13 - Assignment/Liens
Designelement 1 zur Versicherung für weltweite Reisende § 14 - Limitation Period
Designelement 1 zur Versicherung für weltweite Reisende § 15 - Compensation from other Insurance Policies and Claims against Third Parties
Designelement 1 zur Versicherung für weltweite Reisende § 16 - Offsetting
Designelement 1 zur Versicherung für weltweite Reisende § 17 - Declarations of Intent and Notifications
Designelement 1 zur Versicherung für weltweite Reisende § 18 - Transfer Guarantee
Designelement 1 zur Versicherung für weltweite Reisende § 19 - Applicable Law, Contract Language, Applicability for Insured Persons
Designelement 1 zur Versicherung für weltweite Reisende § 20 - Profit Sharing
Designelement 1 zur Versicherung für weltweite Reisende Anlage 1: Nicht versicherbare berufliche Tätigkeiten gemäß § 12c der Versicherungsbedingungen
Designelement 1 zur Versicherung für weltweite Reisende Auszug aus dem Versicherungsvertragsgesetz
Designelement 1 zur Versicherung für weltweite Reisende Download GTI
§ 1 - Insured persons and insurability
Unless otherwise agreed, the following applies:
  1. Insured are the insurable individuals listed by name on a separately maintained list and for whom the agreed premium has been paid.
  2. Insurable persons are individuals,
    1. who reside in other countries across the world; in this respect, a country qualifies as not being abroad when it is a country of which the insured person is a citizen and/or in which the person has his or her permanent residence (home country);
    2. who have German or Austrian citizenship and have had their permanent residence abroad for more than 2 years, and have only stayed temporarily in the Federal Republic of Germany, Austria, the countries of the European Union, the member states of the Schengen Agreement or in Liechtenstein, or
    3. who have German or Austrian citizenship and have a permanent residence in the Federal Republic of Germany or Austria, or the citizenship of one of the member states of the European Union or of a member state of the Schengen Agreement and Liechtenstein, with a permanent residence in the Federal Republic of Germany or Austria and stay abroad only temporarily, or
    4. who have another citizenship and are located abroad only temporarily, provided that they have had their permanent residence in the Federal Republic of Germany or Austria for at least the previous two years.
  3. Not insurable and not insured despite payment of a premium are individuals, who
    1. at the beginning of the insurance cover or at the time an application to extend insurance cover is made (associated membership), have reached the age of 66. (had their 66th birthday);
    2. in the country of their residence they are subject to compulsory health and/or nursing insurance obligation;
    3. play competitive sports or who engage in physical activity during the course of their trip in one of the occupations listed in Appendix 1 or carry out a sports activity against payment. Appendix 1 is an integral part of these terms and conditions;
    4. have entered into or reside illegally in the country of residence;
    5. need permanent care. A person is considered to need permanent care when he or she is primarily dependent on help from others for activities of daily life
    6. who permanently reside abroad.

§ 2 Conclusion and Termination of the Insurance Policy, Membership in the Group Insurance Policy, Additional Insurance for Children
  1. The group insurance contract is concluded between the policyholder and HanseMerkur Reiseversicherung AG.
  2. The group insurance contract can be terminated by giving notice 3 months prior to the end of the year. Termination by the policyholder is only effective if the insured persons affected by the termination have been notified of the termination and the policyholder can prove that such notification has been given. The insured persons affected by the termination have the right to continue the insurance contract under the terms and conditions of a single policy by appointing a new policyholder. A statement to this effect must be made within 2 months of receipt of an offer to continue cover.
  3. Statutory provisions for termination for cause still apply.
  4. The request for accepting insured persons into the group policy must be made prior to the beginning of the trip abroad or within one year after entry into the country of destination. Proof of the date of entry must be provided upon request.
  5. Applications for group policy membership are contingent on the insured person having cover. for the entire length of residency abroad.
  6. An insured person is accepted into the group policy by the explicit confirmation by the relevant insurer as of the time the date requested, provided that
    1. the application to be included in the group policy has been submitted using the current standard form (registration list) provided by HanseMerkur and intended for this purpose or via the secure online tool intended for this purpose;
    2. the printed form or the online application is properly completed and received by HanseMerkur and the initial or single premium has been paid The printed form or online application is considered to have been properly completed if it contains clear and complete information about the starting date and the term of the group policy contract, as well as information about the persons to be insured.
  7. If the length of stay can be extended without exceeding the maximum term of cover, the cover can be extended for an additional period of residence that was initially not insured, by establishing an additional policy within the group policy, in the form of a legally independent associated membership (extended membership) under the following conditions:
    1. The application for extended membership must be submitted using the valid form provided by HanseMerkur for this purpose or the secure online tool provided for this purpose;
    2. The application for extended membership must be submitted to HanseMerkur before the expiration of the initial term of the policy;
    3. The maximum policy term intended is not exceeded by the extension;
    4. HanseMerkur must explicitly approve the application for extension. In the event a policy is not explicitly accepted for which a premium has already been paid, any amounts paid - less expenses the insurer has incurred - will be reimbursed.
  8. If the initial cover is extended through a legally independent associated membership within the maximum term, cover shall only be granted for claims, illness, discomfort and the consequences thereof that began subsequent to the submission of the extension application (the date and time of the postmark or the receipt of the application on the HanseMerkur or Care Concept AG server). §§ 6, no. 2 and 9, no. 1 a. and j. apply accordingly. In addition, the special waiting periods, as specified in § 8 II. no. 3 are to be observed.
  9. Unless otherwise agreed, the legal effects of an independent associated membership are the same as those of a primary membership.
  10. Additional Insurance for Children:
    The insurance cover for newborns begins without any risk premium or waiting periods on the day the child is born, as long as the child is registered for insurance with HanseMerkur, Care Concept AG, retroactively no later than within 2 months of the birth and such registration can be verified.
    1. The prerequisites for the Additional Insurance for children is that
      aa. that on the day of the baby’s birth, at least one of the parents had uninterrupted cover within the group policy for at least 3 months;
      bb. the requested cover is not greater or more comprehensive that of the insured parent;
      cc. no other insurance cover is in place.
    2. The same applies to adoptions, provided that the child is still a minor at the time of the adoption. If there is increased risk, a risk premium of up to 100% in addition to the tariff rate may be charged.
    3. If the registration for cover takes place more than 2 months after the date of birth, or if greater or more comprehensive cover is requested, cover for the child will be contingent on an independent risk assessment by HanseMerkur, which is represented by Care Concept AG. In this case, insurance cover will be in place once the insurance contract is accepted. The provisions of this section, §§ 1 to 9 apply accordingly.
    4. The insurer has no obligation to provide cover within the scope of this Additional Insurance for Children, insofar as alternative private or statutory health insurance cover is in place in the domestic or foreign country for the newborn or the adopted child.
  11. Group policy members are required to give 3 months notice in writing (e-mail, fax, post) if they wish to terminate their own participation or the participation of others who are insured with them in the group policy.

    Termination by the member of the group insurance policy will only be effective if the insured person affected by the termination has been informedof the termination and the policyholder can prove that such notification has been given.
§ 3 - Termination
  1. Ordinary Termination
    The group insurance contract can be terminated by the policyholder, by giving notice 3 months prior to the end of the year. Termination by the policyholder is only effective if the insured persons affected by the termination have been notified of the termination and the policyholder can prove that such notification has been given. The insured persons affected have the right to continue the insurance relationship by stating the name of a new policyholder. This right ends 2 months after the insured person has been informed of this right.

    If a new policy holder is not named, the insured persons have the right to continue the insurance relationship with the same rights gained under the previous policy, but under the conditions of an individual policy. A statement to this effect must be made within 2 months of receipt of an offer to continue cover.
    The insurer waives his ordinary termination rights.

  2. Extraordinary Termination
    Statutory provisions for termination for cause still apply.
§ 4 - Premium/Fees
  1. The policy holder shall pay HanseMerkur the premium for this insurance policy.
    The group policy member is obliged to pay the corresponding premium for the group policy to the policyholder or to someone named by the policyholder (e.g. a collection agency).
    The failure to pay the premium for the group insurance policy leads to the loss of the insurance cover in accordance with statutory regulations.
  2. Details of the Payment of Premiums/Fees
    1. The payment for the initial or subsequent premium, or the initial or subsequent fee may be made via SEPA direct debit, bank transfer, credit card or PayPal.
    2. If the premium or membership fee for the group insurance contract is requested by SEPA direct debit from a bank or credit card account, the payment is deemed to have been made on time if the premium can be withdrawn on the day the debit takes place and neither the policyholder nor (in cases in which the policyholder is not the account holder) the policyholder and/or the account holder does/do not object to the payment request. If, by no fault of the policyholder, the premium or the membership fee for the group insurance contract could not be debited, the payment shall be considered to have been paid on time, if payment is made immediately after the insurer has issued a payment request in text form (e.g. by email, fax or post).
§ 5 - The Right to Premium Adjustments
  1. During the contractual period of cover, the benefits provided by the insurer may alter, f. ex. due to an increase in medical treatment costs or in the number of claims. Accordingly, the insurer compares the insurance benefits calculated using the required calculation bases with the insurance benefits calculated using the technical calculation bases. If the comparison establishes a variance of more than 5%, the insurer reserves the right to review and, as far as necessary, adjust the premiums consistently in the entire group policy. Under the same conditions, an agreed premium supplement can also be adjusted accordingly as well as the maximum amount of benefits and daily allowances envisaged according to the tariffs.
  2. The adjustments in accordance with § 1 become effective at the beginning of the 2nd month following notification of the policyholder.
  3. If the insurer increases the premium based on § 1, the policyholder has the right to terminate the insurance relationship regarding the affected insured person within one month after receipt of the change notification. Such termination shall take effect at the effective date of the change.
    Termination by the policyholder is only effective if the insured persons affected by the termination have been notified of the termination and the policyholder can prove that such notification has been given. The insured persons affected have the right to continue the insurance relationship by stating the name of a new policyholder. This right ends 2 months after the insured person has been informed of this right. If a new policy holder is not named, the insured persons have the right to continue the insurance relationship with the same rights gained under the previous policy, but under the conditions of an individual policy. A statement to this effect must be made within 2 months of receipt of an offer to continue cover.
§ 6 - Scope of Application, Commencement, Duration and End of Insurance Cover
  1. Scope of Application
    1. Within the scope of this contract, HanseMerkur offers insurance cover to persons whose stay abroad during a trip is only temporary.
      In the context of these terms and conditions, abroad refers to all countries and territories of which the insured person is not a citizen and/or in which the insured person does not have permanent residence.
    2. Insurance cover is not available if an insured event occurs in the home country of the insured person.
    3. Notwithstanding b., cover is also in place in the insured person´s home country under the following conditions:
      - With a insurance terms of at least one year, there is also cover if the insured person returns to his or home country temporarily. The cover in the home country is limited to a maximum of six weeks per insurance year for all stays in the home country. An insurance year is a 12 month period of time, beginning with the start date of the commencement of the insurance, including all extensions of the initial insurance cover through at least one legally independent associated membership.
  2. Commencement
    Insurance cover begins when the registration list or the online form is completed (technical commencement), however
    1. not before insurance confirmation has been received,
    2. not before the insured person has crossed the border to enter the foreign country;
    3. not before the premium/ he membership fee has been paid;
    4. not before any potential waiting periods have expired; depending on which of these events occurs last.
      Cover is not provided for insured events that have occurred prior to the commencement of cover.

      For persons who do not fulfil the prerequisites for insurability specified in § 1 of these terms and conditions, insurance cover will not commence even if the premium has been paid. In the event payment has still been made for a non –insurable person, any amounts paid – less expenses that the insurer has incurred – shall be reimbursed.
  3. End of Cover
    Insurance cover also ends for insured events that have not yet been closed
    1. at a mutually agreed point in time;
    2. at the latest, once the trip abroad has ended;
    3. if the conditions of a temporary stay abroad no longer exist;
    4. if the conditions for the insurability of the insured person no longer exist. The condition also no longer applies if the person in question has obtained the citizenship of the destination country or has transferred his or her permanent residence to the destination country;
    5. once the group insurance contract has ended;
    6. once the membership in the group insurance contract has ended.
  4. Follow-up Liability
    If illness requires medical attention beyond the end of the insurance cover because there is evidence that the insured person cannot embark on the return trip cover within the policy provisions still exists
    1. for membership terms of up to 6 months, including all extensions of the initial insurance cover by at least one legally independent associated membership, until the insured person can be transported, for a maximum of a further one month,
    2. for membership terms of more than 6 months, including all extensions of the initial insurance cover by at least one legally independent associated membership, until the insured person can be transported, for a maximum of a further 3 months.
§ 7 - Minimum and Maximum Term/Membership Term in the Group Insurance Policy
  1. The minimum term of the insurance/minimum term of the membership in the group insurance policy is 1 month.
  2. The maximum term of the policy/of the membership in the group insurance policy, including, where appropriate, all extensions of the insurance cover through independent follow up contracts, is 3 years.
§ 8 - Object of the Insurance Cover and Scope of Benefits
I. General Information
  1. Once the waiting period has expired, HanseMerkur provides compensation for the costs related to the treatment of acute, insured events that occur during a trip abroad. The provisions related to waiting times are specified in § 8, II.
  2. An insured event constitutes necessary medical treatment of an insured person due to illness or the consequences of an accident. The insured event starts with the treatment and ends once there is no longer medical evidence of the need for treatment. If medical treatment needs to be extended treat an illness or consequence of an accident not causally connected to the illness or consequence of an accident for which the previous treatment was provided, a new insured event occurs. An insured event also includes
    1. medical treatment due to pregnancy examinations and pregnancy treatment, provided that the pregnancy did not already exist when the insurance cover was requested or when an application for the extension of insurance cover extension through a legally independent associated membership (extension membership) at HanseMerkur or Care Concept AG was received;
    2. childbirth;
    3. death.
  3. The Scope of the insurance cover is defined in the group policy, the membership certificate, other separately written agreements, these general terms and conditions of insurance, the provisions of each agreed rates, as well as the statutory provisions of the Federal Republic of Germany.
  4. While abroad, the insured person is free to consult the established doctors or dentists or dentists of his or her choice. The policy scope provides for reimbursement of medical treatment costs for the services provided by the treating doctor/dentist, insofar as these charges are based on the current official, applicable fee schedule for doctors and dentists in the relevant country and that such servicescan be properly invoiced. In the event that at the time of the treatment there is no official, applicable fee schedule available, the treatment costs will be reimbursed based on the usual local rates in the country of residence at the time of the treatment..
  5. Medicines, dressings, therapeutic products and medical aids must be prescribed by the clinician described in section 4; in addition, medicines must be obtained from a chemist. Even if prescribed, medicines do not include nutriments, tonics, mineral water, disinfectants, cosmetic supplements, dietary supplements, baby food or similar items.
  6. In the event inpatient treatment is necessary, the insured person has the choice of any recognised public or private hospital in the country of residence, as long as the facility is under permanent medical supervision, has sufficient access to both diagnostic and therapeutic facilities, that maintains patient records and is not involved in providing curative or sanatorium treatment or take in convalescents. The insurance cover provides a general level of care (shared room) without optional services (private medical treatment). For medically necessary inpatient treatment at a hospital that also provides curative or sanatorium treatment or takes in convalescents, but that still meet the criteria in section 1, benefits will only be paid if no other hospitals named in section 1 are located within a reasonable distance or if HanseMerkur has agreed in writing to assume the costs prior to the commencement of the treatment.
  7. Within the scope of the contract, HanseMerkur provides cover for examination or treatment methods and for medicinal products that are largely accepted by conventional medicine. In addition, it pays for methods and medicines that have become established in practice as equally promising or that are used because traditional medical methods or medicines are not available. In such cases, HanseMerkur may, however, at any time reduce benefits to the amount that would have been incurred, had existing traditional methods or medicines been used,
  8. Within the scope of the contract, HanseMerkur pays benefits for the repatriation of mortal remains and funeral costs, provided that the death of an insured person is covered by an event that is part of the contractual obligations of this policy.
II. Waiting periods
  1. The general waiting period is 31 days. It begins with the time stamp on the registration list or online form (technical commencement of insurance), however
    1. not before the insurance/membership confirmation has been received;
    2. not before the insured person has crossed the border to enter the foreign country.
      This does not apply
    1. if the insured person can prove that he or she has entered the insured country of residence within 31 days prior to the registration or if the registration or if the registration occurred prior to the commencement of the trip abroad. The decisive factor is the receipt of the registration list or the online registration with HanseMerkur or Care Concept AG;
    2. for accidents that occur after commencement of insurance.
  2. If a previous policy existed and there has been no interruption in cover between that policy and the beginning of the HanseMerkur policy, the existence of the previous policy can be used to reduce the general waiting period. The restrictions on benefits in accordance with § 9 continue to apply without restriction.
  3. The special waiting period for childbirth is eight months. The waiting period at the first application of insurance cover is calculated from the date of the application. If an extension of insurance cover is requested through a legally independent associated membership (extension membership), it is calculated from the date of application for the extension of the insurance cover. To the extent that the initial policy and the follow-up contract or several follow-up contracts are in direct succession to each other, the term from the corresponding previous policy or policies will be credited when calculating the waiting period for the new policy.
    The special waiting period for dentures is eight months. The waiting period at the first application of insurance cover is calculated from the date of the application. If a legally independent associated membership (extension membership) is requested, it is calculated from the date of application for the extension of the insurance cover.
    Insofar as the first membership and the associate membership or several legally independent associated memberships (extended memberships) directly follow each another, the time from the previous policy will be credited when calculating the waiting period for the new policy.
III. Treatment Costs
Unless otherwise agreed, the following applies:
  1. After having deducted the agreed excess - where appropriate - for each insured event, HanseMerkur will reimburse costs incurred for medically necessary treatment. Following § 8 I, section 2, the excess applies to every medically necessary treatment, every examination and every treatment that is required due to pregnancy, as well as for childbirth. The amount of the agreed excess - where appropriate - is determined by the rate chosen. Medical treatment within the meaning of the present terms and conditions means the following:
    1. medical treatment, including examinations during pregnancy, treatment during pregnancy and consequences, provided that the pregnancy did not yet exist when the application for insurance cover was received or the application for extension of the insurance cover was received through a legally independent associated membership (extension membership) at HanseMerkur or Care Concept AG;
    2. medical treatment, causedby acute symptoms, medically necessary treatment during pregnancy and treatment due to miscarriage as well as medically necessary abortions and deliveries up to the end ot the 36th week of pregnancy already existed when the application for membership in the group policy or the request for the extension of coverage in the form of a legally independent associated membership (extended membership) was received, provided that the need for treatment was not yet known at that point in time;
    3. medically prescribed medicines and dressings;
    4. medically prescribed radiation, light and other physical therapies;
    5. medically prescribed aids that are necessary due to an accident and that serve to assist with the direct treatment of the consequences of the accident;
    6. diagnostic radiology;
    7. urgent inpatient treatment with standard care (shared room) without optional services (private medical treatment);
    8. the cost of transporting patients for the treatment to the nearest appropriate hospital and, if first aid has been given after an accident, the costs of transporting patients to the nearest suitable doctor and back;
    9. urgent operations;
    10. childbirth,after the expiry of the waiting period;
    11. costs for rehabilition measures as medically necessary follow-up treatment.
  2. Costs of Dental Treatment
    After having deducted the agreed excess – where appropriate – for each insured event, HanseMerkur will reimburse costs incurred during the trip for:
    1. pain-relieving, preservative dental treatment, including care of the affected tooth with non-adhesive plastic fillings (including cavity linings);
    2. measures for the restoration of the function of dentures (repairs). Overall, HanseMerkur will reimburse the specified cost of dental treatment at membership terms of aa. up to six months, including all extensions of the overall term through at least one legally independent associated membership (extended membership), a total maximum amount of 300.00 EUR,
      bb. over six months, including all extensions of the total term through at least one legally independent associated membership (extended membership), a total maximum amount of 600.00 EUR per insurance year and insured person.

      The insurance year is a period of 12 months following the beginning of the initial registration. If the overall insurance term is extended through at least one legally independent associated membership (extended membership) beyond a term of 6 months, the higher benefits can only be paid for those insured events that occurred after the extensions were received.
IV. Return Transport, Funeral Transport Charges/Funeral Costs
With the exception of a stay in the home country, HanseMerkur shall reimburse
  1. in the event of an insured person’s death, the additional and necessary costs for the repatriation of the mortal remains of the deceased to the home country up to a maximum of 55,000.00 EUR;
  2. the costs of a funeral up to the amount that would have been incurred for a repatriation of mortal remains, up to a maximum of 55,000.00 EUR;
  3. the additional costs incurred because of a medically prescribed and reasonable repatriation to the home country of the insured person.
§ 9 - Restrictions of the Obligations to provide Benefits
  1. There is no obligation to provide benefits in the following cases:
    1. for pre-existing and illnesses and symptoms and their consequences that were known at the commencement of the insurance cover or at the time of receipt, by HanseMerkur or Care Concept AG, of the application for a legally independent associated membership (extension membership) as well as the consequences of such illnesses and accidents that where treated within the six months previous to the commencement of the insurance or prior to the receipt of the application for extension by HanseMerkur or Care Concept AG. Notwithstanding the aforementioned, there is an obligation to provide benefits for the treatment or for the elimination of life threatening conditions that arose acutely during the trip abroad.
      Life threatening conditions are deemed health conditions which, based on general life experience (e.g. a heart attack) or due to the determination from a third party who is not directly treating the condition (e.g. the insurer’s independent medical examiner) could directly lead to the untimely death of the sick person;
    2. For those illnesses, including their consequences, as well as for the consequences of accidents and deaths caused by nuclear energy, acts of war or the active participation in riots and which are not expressly included in the insurance cover;
    3. For curative or sanatorium treatment and rehabilitation measures (for a follow-up treatment § 8 I (6) applies;
    4. For withdrawal measures including withdrawal treatment;
    5. For outpatient treatment at a spa or health resort. This restriction does not apply if medical treatment becomes necessary due to an accident occurring in such facilities. This restriction does not apply to medical conditions in circumstances where the insured party stays at a spa town or health resort only temporarily and is not staying for curative purposes;
    6. For treatment provided by a spouse, parents, or children. The policy does provide for reimbursement of material expenses in according to the standard rates where evidence can be provided;
    7. For treatment provided by the policyholder or persons with whom the insured person lives within his or her own family or within a host family. The policy does provide for reimbursement of material expenses in according to the standard
    8. fTreatment or accommodation required due to infirmity the need for care or custody;
    9. For psychoanalytical and psychotherapeutic treatment;
    10. For an existing pregnancies and medical consequences of pregnancies that existed when cover was requested or when the cover extension through a legally independent associated membership (extended membership) was received by HanseMerkur or Care Concept AG. An obligation to provide a benefit does, however, for unforeseeable complications during the contractual term, provided that, at the time of the receipt of the application for insurance cover or at the time of receipt of an extension of the insurance cover, by HanseMerkur or Care Concept AG, through a legally independent associated membership (extended membership), the mother-to-be had not yet completed the 36th week of pregnancy;
    11. For immunisation measures;
    12. For health aids that are initially required due to an accident during the period of the insurance cover;
    13. For treatment due to sterility, including in vitro fertilisation, the associated preliminary examinations and follow-up treatments, as well as disorders and/or damage to reproductive organs;
    14. For treatment related to HIV infections and their consequences;
    15. For checks-ups;
    16. For dentures, pivot teeth, inlay fillings, crowns and orthodontic treatment,implants, occlusal appliances and gnathological measures;
    17. For suicide, suicide attempts and the consequences of such actions;
    18. For organ donations and the consequences of such donations.
  2. HanseMerkur is released from the obligation to provide benefits when:
    1. The policyholder or the insured person intentionally caused the insured event;
    2. The policyholder or the insured person acts in bad faith by attempting to wilfully deceive HanseMerkur about issues relevant to the circumstances, the reason or the amount.
  3. In the event the treatment exceeds that which is medically necessary, HanseMerkur has the right to reduce the benefits paid to a reasonable amount.
  4. If there is entitlement to a benefit from the statutory accident or pension insurance, or from statutory health insurance or accident care, HanseMerkur has the right to deduct the statutory benefits from the insurance benefits.
§ 10 - Obligations and the Consequences of their Breaches
  1. Policy holders and insured persons have the following obligations:
    1. The policyholder is required to register the beginning and the end of each trip to his or her home country during the term of the policy prior to the commencement of each trip and in the event of a claim, to present evidence of the same, if requested to do so by HanseMerkur;
    2. to immediately inform HanseMerkur in text form if they become citizens of a destination country, of the issue of an unlimited residence permit or of the refusal of a residence permit for the destination country, as well as of the permanent residence in the destination country.
  2. If an insured event occurs, the policyholder and the insured person are required to
    1. keep the loss as low as possible and to avoid anything that may lead to an unnecessary increase in costs;
    2. report the loss to HanseMerkur immediately – no later than after the end of the trip, while submitting all relevant documentation;
    3. allow HanseMerkur all reasonable investigations on the cause and the amounts of any benefits to be granted, to give them helpful information, to submit original receipts, and in cases of death, to submit the death certificate;
    4. in the case of inpatient treatment at a hospital and before the start of extensive diagnostic and therapeutic measures, to contact HanseMerkur;
    5. accept the patient transport to the home address or the nearest appropriate hospital, if the patient is transportable and HanseMerkur has approved the transportation, based on the type of illness and the need for treatment;
    6. Additional obligations are regulated in connection with §15, paragraph 2. For further details, we request referring to those provisions;
    7. Insofar as deemed necessary by HanseMerkur, the insured person is required to submit to an examination by a physician commissioned by HanseMerkur;
    8. Knowledge and culpability of the insured person are treated the same as cknowledge and culpability of the policyholder.
  3. Consequences of Breaches of Obligations
    If the policyholder or the insured person intentionally breaches any of the contractual obligations, HanseMerkur does not have an obligation to provide benefits. In the event there is a breach of an obligation caused by gross negligence, HanseMerkur is authorised to reduce the benefits based on the gravity of the issue caused by the policy owner/insured person. The burden of proof to show that gross negligence was not involved rests with the policyholder.
§ 11 - Conditions for the Payment of Insurance Benefits
  1. Original receipts are to be sent to
    Care Concept AG
    Postfach 30 02 62
    53182 Bonn
  2. HanseMerkur is only obliged to pay benefits if the following forms of proof are submitted, each of which will then become the property of HanseMerkur.
    1. Original receipts in the official currency of the country of residence, which must contain the name of person treated, the name of the illness and information about the services provided by the attending doctor, featuring the type of location and the period of the treatment. If there is alternative insurance cover for treatment costs and this is utilised first, the duplicates of the receipts with reimbursement notes are sufficient evidence;
    2. Prescriptions, laboratory and radiological invoices are to be submitted with doctor´s bill, invoice for curative measures or aids, including the medical prescription for the physician´s orders for the latter;
    3. An official death certificate and a doctor´s certificate stating the cause of death, if payment is to be made for transport or funeral costs;
    4. If requested by HanseMerkur, evidence about the beginning and the end of the trip abroad or of each stay in the Federal Republic of Germany, Austria, the member states of the European Union, the member states of the Schengen Agreement or Liechtenstein;
    5. If requested by HanseMerkur, proof of the beginning and the end of each stay in the home country;
    6. If requested or, at the latest, when an insured event occurs, proof of having fulfilled the conditions for insurability in accordance with § 1 no. 2, as well asa valid residence permit for the stay in the destination country;
    7. If requested by HanseMerkur, proof of all health insurances that include insurance cover for the destination country during the stay in that country.
§ 12 - Due Date of the Insurance Benefits, Payment
  1. As soon as the documentation related to the payment of the insurance premium/the membership fee and all of the information/documents that the policyholder or the insured person is required to submit are available, and the obligation to pay, as well as the amount of the benefit have been determined, payment will be made no later than within two weeks. If an obligation to pay has been determined within one month of the receipt of the claim, a reasonable cash advance for the benefit can be requested.
    In the event that official investigations or criminal proceedings have been initiated against the policyholder the insured person in relation to this insurance event, the settlement of the claim may be delayed until a final ruling from a court has been issued on the case.
  2. During the course of the review of benefits, it may become necessary for HanseMerkur to obtain personal, health related data within the statutory limits. In the event the policyholder or the insured person culpably refuses permission for such data to be collected and HanseMerkur, therefore, cannot make a final assessment about the amount or the extent of the benefits owed, such refusal will delay the maturity of payments. The same applies if the institutions or individuals requested to supply information are intentionally not released from their confidentiality obligation towards HanseMerkur.
  3. Costs incurred in foreign currency will be converted into the currency of the Federal Republic of Germany at the daily exchange rate on the day the receipts are received by Care Concept AG. The daily rate for traded currencies is the official exchange rate quoted in Frankfurt/Main, for untraded currencies it is the rate in accordance with the “Currencies of the World”, publications by the German Central Bank, Frankfurt/Main, based on the most up-to-date rate, unless it can be verified that the currency required to pay the invoices were purchased at a more unfavourable rate.
  4. Additional costs which arise because HanseMerkur arranges international bank transfers or, upon request of the policyholder, selects specific forms of transfer, can be deducted from the insurance payments.
  5. Policyholders or insured persons have an obligation to immediately endeavour to make arrangements for the relevant compulsory insurance, in the event that health and/or nursing care insurance is mandatory in the country of residence, and to provide evidence of such endeavours upon request. Payments due will be delayed until the documentation requested has been submitted.
§ 13 - Assignment/Liens
Entitlements to insurance benefits may not be assigned nor pledged for liens.
§ 14 Limitation Period
  1. Any claims arising from this insurance contract lapse after three years. The limitation period begins at the end of the year in which any entitlement to benefits can be requested.
  2. If a policyholder has registered a claim with HanseMerkur, the limitation period regarding this claim is delayed until the decision from HanseMerkur has been received in text form.
§ 15 Compensation from other Insurance Policies and Claims against Third Parties
  1. If compensation from another insurance policy can be requested after an insured event has occurred, the other insurance policy shall take precedence. This also applies if one of the other insurance policies also contains a subordinate liability clause, regardless of when the other insurance contract was concluded. If an insured event is first reported to HanseMerkur, and HanseMerkur has already provided benefits in advance, it will contact the other insurance company directly, with the view to sharing the costs.
  2. If the policyholder has a claim for compensation against a third party, such a claim shall be transferred to the insurer, insofar as the insurer has already provided compensation for the loss. Such a transfer cannot be made to the detriment of the policyholder. The policyholder has to safeguard his claim for compensation or a right which serves to secure such a claim, while considering the current provisions on formality and deadlines, and to participate in the assertion of such claim by the insurer, insofar as this is necessary, and to provide evidence of such participation upon request. The consequences of the breach of this obligation are determined by §10, paragraph 3.
  3. The claims by the policyholder or the insured person towards the treating doctors due to excessive fees transfer to HanseMerkur within the scope of the law, provided that HanseMerkur has provided payment for the corresponding invoices. If necessary, the assistance of the policyholder or the insured person may be required to enforce the claims. Additionally, the policyholder or the insured person have an obligation to submit a declaration of assignment to HanseMerkur, if this is required.
§ 16 Offsetting
The policyholder is only able to offset amounts owed to HanseMerkur, if the counterclaim is undisputed or has been legally established.
§ 17 Declarations of Intent and Notifications
  1. All declarations of intent and notifications made to HanseMerkur and Care Concept AG must be made in text form.
  2. If the policyholder/the insured person changes his/her address and does not inform the insurer, in relation to a declaration of intent to be given to the policyholder/the insured person, it is sufficient to provide evidence of the note by the post office that letters to the policyholder’s/the insured person’s address last known to the insurer were not deliverable. This declaration is considered to have been received three days after it was sent. Clauses 1 and 2 are to be applied in the same way in the event of a name change by the policyholder/the insured person.
  3. Paragraph 2 applies to electronic data transfer (email) and in the case of a change of the email address, correspondingly for the sending of the email and the technical delivery fault message by the system..
§ 18 Transfer Guarantee
  1. In the event that the group insurance policy is terminated, HanseMerkur guarantees the acceptance of the insured person into the insurance cover or the continuation of the insurance cover for the insured persons by the product Care Economy by Care Concept AG. If the Care Economy product is replaced by another equivalent product while the insurance cover is in place, the guarantee in accordance with clause 1 shall also apply correspondingly to this product.
  2. The scope of the product Care Economy by Care Concept AG or of the equivalent product replacing this product, shall not be extended by the transfer guarantee.
  3. The transfer guarantee in accordance with paragraph 1 is cancelled, if HanseMerkur has a right to an extraordinary termination or amendment of the initial insurance relationship for reasons caused exclusively by the policyholder and / or the insured person(s) (f. ex. in case of a contestation by the insurer providing the insurance cover). In this case, the transfer guarantee is cancelled in accordance with §15, paragraph 2, clause 1, irrespective of whether the original insurance relationship with Hanse Merkur has or has not been terminated.
§ 19 Applicable Law, Contract Language, Applicability for Insured Persons
German law applies, to the extent that it does not conflict with international law. The contract language is German. All agreed provisions shall apply correspondingly to the other insured persons.
§ 20 Profit Sharing
The insurance(s) listed here do(es) not give the right to participate in profit sharing.
Anlage 1: Nicht versicherbare berufliche Tätigkeiten gemäß § 1 Ziff. 3 c. der Versicherungsbedingungen
Professions Determination of the activities Limitations on the exclusion
Artists All activities
Construction workers Selected activities Only the following activities are excluded:
Concrete workers
Roofers
Scaffolders
Workers in high-rise construction
Bricklayers
Steel fixers
Plasterers
Workers in underground construction
Carpenters
Miners All activities
Professional soldiers All activities
Professional divers All activities
Dompteure Animal trainers Only insofar as animals originating in the wild (large cats, elephants, etc.) are trained
Skydivers All activities
Firefighters All activities
Sea fishermen All activities
Butchers All activities
Offshore workers Selected activities Only those directly involved in the oil industry
Pyrotechnicians All activities
Security forces Selected activities Only the following activities are excluded
Body guards
Security staff
Demolitions experts All activities
Stunt personnel All activities
surf teachers All activities
Diving teachers All activities
Workers in the processing industry Selected activities Activities in meat processing
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Please note that the English translation is for convenience only. The legally binding version is the German one.


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