|I. General Information
II. Waiting periods
- The insurer shall indemnify for the treatment costs incurred after expiry of the waiting period for acute insured events occurring during the trip abroad. The regulations governing the waiting period are listed in § 8 II.
- An insured event is the medically necessary treatment of an insured person due to illness or the consequences of an accident. The insured event begins with the medical treatment; it ends when, according to medical findings, there is no longer a need for treatment. If the treatment has to be extended to an illness or the consequences of an accident which is not causally connected with the illness or the consequences of the accident previously treated, a new insured event arises. The following are also considered to be insured events:
- medical treatment including pregnancy examinations and pregnancy treatment, if the pregnancy did not yet exist at the time of receipt of the application for insurance coverage or at the time of receipt of the application for extension of insurance coverage by a legally independent follow-up membership (extension membership) with the insurer or Care Concept AG;
- the delivery;
- The scope of the insurance coverage is determined by the group contract, the membership certificate, any separate written agreements, these General Terms and Conditions of Insurance, the provisions of the agreed plan/plan rate and the statutory provisions of the Federal Republic of Germany.
- In the country of destination, the insured person is free to choose between locally-established, licensed doctors and dentists. Within the scope of the contract, the costs for treatment provided by the practitioner shall be covered insofar as this treatment can be billed in accordance with the current official rates for physicians and dentists valid in the country. If there is no official/legal fee schedule in the country of destinatio at the time of treatment, the costs of treatment will be reimbursed according to the fee customary in the country of destination at the time of treatment.
- Medications, bandages, remedies and aids must be prescribed by the practitioners mentioned in 4, and medicines must also be obtained from the pharmacy. Medicinal products, even if prescribed as such, shall not include nutritional and tonic products, mineral water, disinfectants and cosmetics, dietetic and infant foods and the like.
- In the case of medically necessary inpatient hospital treatment, the insured person has a free choice among the public and private hospitals which are generally recognised as hospitals in the country of stay, are under permanent medical supervision, have sufficient diagnostic and therapeutic facilities, keep medical records and do not carry out any cures or sanatorium treatments or admit convalescents. Insurance coverage exists for the standard care class (shared room) without optional benefits (private medical treatment). For medically necessary in-patient treatment in hospitals that also offer cures or sanatorium treatments or admit convalescents, but otherwise fulfill the requirements of sentence 1, the plan benefits shall only be granted if none of the other hospitals mentioned in sentence 1 is reasonably close, or if the insurer has agreed in writing to assume the costs before the start of treatment.
- The insurer shall pay to the contractual extent for examination or treatment methods and medications which are predominantly recognised by orthodox medicine. The insurer shall also pay for methods and medications which have proved equally promising in practice or which are used because no conventional methods or medications are available; however, the insurer may reduce its benefits to the amount which would have been incurred if existing methods or medications had been used.
- The insurer shall pay the contractual amount for transfer and funeral costs if the death of an insured person occurs as a result of an event that falls within the scope of this contract.
III. MedicalTreatment Costs
- The general waiting period is 31 days. It begins at the time indicated in the registration list or online form (official commencement of insurance), however
- not before receipt of the insurance/membership confirmation;
- b. not before crossing the border into a foreign country.
It doesn’t apply,
aa. if the insured person proves entry into the insured country of stay within 31 days before registration or if the registration took place before the start of the trip abroad. Receipt of the registration list or the online registration by the insurer or Care Concept AG is a decisive factor in this matter;
bb. in the event of accidents occurring after the commencement of the insurance coverage.
- Previous insurance coverage that has existed without gaps since departure to a foreign country up to the commencement of the insurance coverage can be credited against the general waiting period. The benefit restrictions pursuant to § 9 shall continue to apply without restriction.
- The particular waiting period for deliveries is eight months. When applying for insurance coverage for the first time, the waiting period is counted from the time the application for coverage is submitted. When applying for an extension of the insurance coverage through a legally independent follow-up membership (membership extension), the waiting period is counted from the time of application for an extension of the insurance coverage. If the initial contract and the follow-up contract or several follow-up contracts follow each other consecutively, the waiting period resulting from the respective preliminary contract or contracts shall be credited. The particular waiting period for dental prostheses is eight months. When applying for insurance coverage for the first time, the waiting period is counted from the time the application is submitted. When applying for a legally independent follow-up membership (membership extension), the waiting period is counted from the time of the application for extension of the insurance coverage. Insofar as initial membership and follow-up membership or several legally independent follow-up memberships (memberships extensions) follow each other consecutively, the waiting period resulting from the respective preliminary contract shall be credited.
Unless otherwise agreed, the following shall apply:
IV. Return transport, transportation/burial costs
- The insurer will reimburse - less any deductible agreed per insured event - the costs incurred for medically necessary treatment. In accordance with § 8, I, 2, the deductible for each medically necessary treatment, each examination and each medically necessary treatment due to pregnancy as well as for births, shall be due. The amount of any agreed deductible is determined by the plan/plan rate selected. Treatment within the meaning of these terms and conditions shall be deemed:
- medical treatment including pregnancy examinations, pregnancy treatment and consequences, if the pregnancy did not yet exist at the time of receipt of the application for insurance coverage or at the time of receipt of the application for extension of insurance coverage with the insurer or Care Concept AG, in the form of a legally independent follow-up membership (membership extension),
- medical treatment caused by acute symptoms, medically necessary pregnancy treatment and treatment due to miscarriage as well as medically necessary abortions and deliveries until the end of the
36th week of pregnancy (premature birth), even if the pregnancy already existed at the time of receipt of application for inclusion in the group insurance contract or at the time of receipt of application for extension of insurance coverage in the form of a legally independent follow-up membership (membership extension), provided that the need for treatment was not determined at that time,
- medically prescribed medications and dressings,
- medically prescribed radiation, light and other physical treatments,
- medically prescribed massages, medical packs and inhalations,
- medically prescribed aids, which become necessary for the first time solely as the result of an accident and which serve the direct treatment of the consequences of the accident,
- diagnostic radiology,
- urgent in-patient treatment in the standard care class (multi-bed rooms) without optional benefits (private medical treatment),
- ambulance transport to the nearest suitable hospital for in-patient treatment and, in the case of first aid following an accident, to the nearest suitable physician and back,
- urgent operations,
- births, after the waiting period,
- costs for rehabilitation measures as medically necessary follow-up treatment.
- Dental Treatment cost
Costs for the following measures incurred during the trip will be reimbursed, less any deductible agreed per insured event:
- pain-relieving conservative dental treatment including restoration of the affected tooth with non-dentin-adhesive plastic filling material (including underfilling);
- measures for restoring the function of dental prostheses (repairs). In total, the insurer will reimburse for the aforementioned dental treatment costs for membership durations,
aa. of up to six months – including all extensions of the total duration of coverage by at least one legally independent follow-up membership (membership extension) – a maximum amount of EUR 300,
bb. of more than six months—including all extensions of the total duration of coverage by at least one legally independent follow-up membership (membership extension) — a maximum amount of EUR 600 per policy year and insured person.
The policy year is a period of twelve months calculated from the beginning of the first registration. If the total duration of coverage is extended by at least one legally independent follow-up membership (membership extension) for a period exceeding 6 months, the larger benefits can only be paid for insured events that occur after receipt of the extension.
The insurer will reimburse – except in the case of a stay in the home country –
- up to EUR 55,000 in the event of the death of an insured person, the necessary additional costs incurred by the transfer of the deceased person to the home country
- up to a maximum of EUR 55,000 the costs of a burial up to the amount of the expenses which would have arisen in the event of a transfer,
- the additional costs of a medically prescribed and medically appropriate return transport to the home country.