guest care - sanitas...– all details are filled out correctly and in full – the relevant premium...
TRANSCRIPT
Supplementaryinsurance
Guest CareComprehensivecoverforyourguests
ThreegoodreasonsforchoosingGuestCare
Professionalsupportinmedicalemergencies fromSanitasAssistance (24/7phoneservice)
Shareoftransport,rescueandsearchcostscovered
Fullcostsofoutpatientandinpatientemergencytreatmentcoveredintheeventofillnessor accident
sanitas.com
GuestCareisaflexiblehealthinsurancesolutionforpeoplevisitingfromabroad.WithnomonetarylimitsonthetreatmentcostscoveredinSwitzer- land,andthankstotheminimumcoverinSchengenstatessetbytheSwissFederalOfficeforMigration,yourguestshavecomprehensivecover againstthefinancialconsequencesofillnessandaccident.
Sanitas AssistanceEmergencyhelpbyphone (Tel.+41444464747) – Anetworkofspecialistsonhandtohelparoundtheclockinanemergency – Supportwithorganisingtransport,commit-mentstoprovidecover,andmorebesides – SanitasAssistancemustbenotifiedimmedi-atelyifastayinhospitalisnecessary
Choose the desired cover – Generalward:multi-bedroom,withtreat-mentbyahospital-baseddoctor – Semiprivate:two-bedroomandprivatedoctor(canonlybetakenoutforpeopleuptoage65) – Private:singleroomandprivatedoctor(canonlybetakenoutforpeopleuptoage65)
Pleasenotethatexistingconditions, conditionsresultingfromanaccidentandmaternity-relatedclaimsarenotcovered.
EasytotakeoutStraightforward,comprehensivecover: Takingoutinsuranceforyourguestscouldn’tbeeasier.Simplyusetheenclosedpaying-inslip.Oncestampedbythepostoffice,thestubofthepaying-inslipisvalidconfirmationofinsurance.Youcaninsureuptofourpeoplewitheachpaying-inslip.Covercommencesonthedatechosenbyyou,butattheearliestwhenyourguestsenterSwitzerlandortheSchengenArea,providedthefollowingcondi-tionsaremet: – Insuranceistakenoutbeforeyour guestsenterthecountry – Alldetailsarefilledoutcorrectlyandinfull – Therelevantpremiumhasbeen transferredtoSanitas
CostsataglanceMonthlypremiums:GuestCarecanbetakenoutforwholemonthsonly(foramaximumofsixmonths)–dependingonrequirements–foranyonewhoisnotpermanentlyresidentinSwitzerland.MonthlypremiumsarespecifiedinSwissfrancs(CHF),anddependontheageofthepersoninsuredandthedesiredcatego-ryofcover.
Age* General Semiprivate Private
0–18 CHF140 CHF240 CHF290
19–25 CHF190 CHF290 CHF370
26–30 CHF250 CHF350 CHF450
31–40 CHF270 CHF400 CHF520
41–50 CHF290 CHF450 CHF590
51–60 CHF320 CHF500 CHF670
61–65 CHF350 CHF550 CHF750
66+ CHF350 Notinsurable Notinsurable
*Theagereachedinthecalendaryearinwhichinsurancecommences
MakingaclaimIntheeventofaclaim,pleasesendoriginalinvoicesandreceipts,medicalcertificates andreportsto:Sanitas,GuestCare,Jägergasse3,Postfach,8021Zürich
Scopeofcoverage
1 Basisoftheinsurancecontract
1 Theinsurancecontractisbasedonthegeneraltermsofinsurance.2 Intheeventthatamatterisnotexplicitlycoveredinthesedocuments,the
provisionsoftheInsuranceContractAct(IPA)shallapply.3 Thistranslationisprovidedforthesakeofconvenience.Thewordingofthe
Germanoriginalshalltakeprecedence.4 Inthisdocumentthemasculineformreferstobothgenders.
2 Subjectofinsurance
1 SanitasPrivatversicherungenAG(hereinafter“Sanitas”)coversthefinancialconsequencesofacuteillnessoraccidentduringatemporarystayinSwitzerlandoraSchengenmemberstate.Theinsuredpersoncanchoosebetweenthefollowingcategoriesofcoverage:– General:outpatienttreatment,plusthecostsofinpatientcareina generalward
– Semiprivate:outpatienttreatment,plusthecostsofinpatientcare inasemiprivateroom
– Private:outpatienttreatment,plusthecostsofinpatientcare inaprivateroom
2 Semiprivateandprivatecoveragecanonlybetakenoutiftheinsuredpersonisaged65orunderatthetimewhencoveragecommences.
3 Thefinancialconsequencesofmaternityarecoveredthroughtheendofthe26thweekofpregnancyintheeventofunforeseencomplicationsduringpregnancy.
3 Insuredpersons
1 CoverageisavailabletopersonswhoarenotresidentinSwitzerlandandarenotobligatedtotakeoutmandatoryhealthinsuranceundertheHealthInsuranceAct(HIA).
2 Theinsurancecoversthepersonsspecifiedontheremittanceslip(insuredpersons).
4 Scopeofbenefits
1 Theinsurancepayscostsinexcessofthebenefitspaidunderanysocialsecurityschemeintheinsured’scountryofresidence.InSchengenmemberstates,entitlementtominimumcoverageislimitedinaccordancewiththeSwissFederalOfficeforMigration’sdirectiveonthegrantingofvisas.
2 Ifinflatedchargesarebilled,Sanitasmaydefinebenefitsinlinewithcustomarylocalrates.
3 Ifcostsarenotitemized,Sanitaswillbreakthemdownatitsowndiscretion.
5 Definitions
1 Illnessisdefinedastheimpairmentofone’sphysical,mental,orpsychologi-calhealththatisnottheconsequenceofanaccidentandwhichrequiresmedicalattentionorpreventstheinsuredpersonfromworking.
2 Anaccidentisdefinedasthesudden,unintentional,harmfulinfluenceofanexceptionalexternalforceonthehumanbody,resultingintheimpairmentofone’sphysical,mental,orpsychologicalhealth,ordeath.Occupationalillnessesandaccident-likephysicalinjuriesaredeemedtobeequivalenttoanaccident.TheprovisionsoftheAccidentInsuranceAct(UVG/LAA)apply.
3 Acutehospitalsaredefinedastreatmentfacilitiesandclinicsthataremanagedandmonitoredbyphysiciansandonlyadmitpersonssufferingfromacuteillnessesoraccidents.Forthepurposeshereof,acutehospitalsalsoincludematernity,psychiatricandrehabilitationfacilities.
4 Thecountryofresidenceisdefinedastheinsuredperson’susualplaceofresidence.
6 Geographicalscopeofcoverage
CoverageisvalidinSwitzerlandandinSchengenmemberstates(apartfromtheinsured’scountryofresidence).
Insuredbenefits
7 Outpatientcare
Theinsurancecoversthecostsofoutpatienttreatmentbydoctorsandmedicallyprescribedoutpatienttreatment.
8 Hospitalcare
Theinsurancecoversthecostsofaccommodation,nursingcareandtreatmentintheinsuredwardofanacutehospitalfacilityasdefinedinSection5(3)aboveprovidedthatacutehospitalisationisnecessaryfromamedicalpointofviewandrepatriationisnotpossibleorappropriateformedicalreasons.
9 Costsoftransport,searchandrescue
1 TheinsurancewillpayuptoatotalofCHF50,000foremergencytransporttothenearestdoctorortothenearestacutehospitalfacilitysuitablefortherequisitetreatment,andformedicallynecessarytransfers.
2 TheinsurancewillpayuptoatotalofCHF20,000forsearchandrescueoperationsintheeventofanacuteillnessoraccident.
10 Sanitas Assistance
1 SanitasAssistanceisaserviceofferedbytheglobalemergencyassistanceorganisationEuropAssistanceonbehalfofSanitas.Theserviceincludescare,adviceandtheorganisationoftransportandtreatment,andtheassumptionofcostsasspecifiedinSection10 (2)below.
2 Intheeventofacuteillnessoraccidentsufferedbytheinsuredperson,SanitasAssistancewillprovidethefollowingbenefits:– Advancemoneytocoverthecostsofinpatienttreatment.–Organiseandpayfortherepatriationoftheinsuredpersonandanaccompanyingpersontotheircountryofresidence,providedthatrepatriationismedicallypossibleandappropriate.
–Organiseandpayforsomeonetoaccompanythechildren(underage16)oftheinsuredpersonincaseswhereaninsuredeventpreventstheinsuredpersonoranotheraccompanyingpersonfromlookingafterthem.
–Organiseandpayfortravelandhotelaccommodation(10nights’accommodationatamaximumofCHF200pernight)foravisitordesignatedbytheinsuredpersonorhisorherfamilyifitisnotpossible,formedicalreasons,torepatriatetheinsuredpersontohisorhercountryofresidencewithin10daysofthecommencementofinpatienttreatment.
–Organiseandpayfortherepatriationofthebodyofadeceasedinsuredperson(includingCHF800foracoffin)andrepatriationofaccompanyingfamilymembers,providedthesefamilymembersarealsocoveredbySanitasAssistance.
3 InsuredcostsasperSection10 (2)abovewillnotbepaidunlessthecorrespondingmeasureswereinitiatedorapprovedinadvancebySanitasAssistance.
4 NeitherSanitasnorEuropAssistancemaybeheldliableforanyconsequenti-aldamagesifitisnotpossibletoprovideinsuredbenefits,oriftherearedelaysinprovidinginsuredbenefits,astheresultofeventsoverwhichSanitasandEuropAssistancehavenocontrol(e.g.warorwarlikeactivities,politicalunrest,strikes,naturaldisastersorrestrictionsimposedbygovernmentauthorities).
11 CoverageinSchengenmemberstates
1 InSchengenmemberstates,thecoveragelaiddownin7to10ofthepresentprovisionsislimitedtotheminimumcoveragespecifiedintheSwissFederalOfficeforMigration’sdirectivesonthegrantingofvisas.
2 Ifconfirmationofinsuranceisrequiredtoapplyforavisa,itcanberequestedbyphoning+41844150150orsendinganemailto [email protected],specifyingtheinsured’slastandfirstnameanddateofbirth,andthepolicynumberprintedonthereceipt.
Generaltermsofinsurance
SupplementaryinsuranceplansaspertheInsuranceContractAct(IPA)
July2009edition(amended2012),insurancecarrier:SanitasPrivatversicherungenAG
9049
08.19 en
Restrictions to insurance coverage
12 Benefitexclusions
Nobenefitswillbepaidforthefollowing:– Contributionstocostsandbenefitreductionsunderotherinsurancepolicies
–Medicalconditionsandconsequencesofanaccidentexistingpriortotheeffectivedateofthecontract
– Treatmentsandmeasuresthatarenoteffective,expedientoreconomicalunderthetermsoftheHealthInsuranceAct(HIA),wherebyeffectivenessmustbescientificallyproven
–Dentaltreatment–Measuresimposedbyajudicialoradministrativeauthority– Theconsequencesoftheabuseofnarcoticsoraddictivesubstances(e.g.alcohol,drugsandmedications)
– Theconsequencesofracingandtrainingrunswithmotorvehiclesandmotorboatsonracingandtrainingcourses,andparticipationinralliesandsimilarracesinvolvingmotorvehicles
– Theconsequencesofconductwheretheinsuredpersonseriouslyprovokedothers
– Theconsequencesofunrest,terroristacts,crimesoroffensesofalltypes,whethercommittedorattempted,andthemeasurestakenagainstthem,unlesstheinsuredpersoncanprovethatheorshedidnotactivelyparticipateonthesideoftheperpetratorsorincitethem
13 Curtailmentorrefusalofbenefits
1 Benefitswillbecurtailed,andinparticularlyseriouscasesnotdisbursedatall,inthecaseofclaimsresultingfromriskyactivities.Riskyactivitiesaredefinedasactsthroughwhichtheinsuredpersonexposeshim-orherselftoexceptionaldangerwithouttakingorbeingabletotakeprecautionstoreducetherisktoareasonablelevel.However,actiontakentorescuepersonsisinsuredevenifthisactioncanbeviewedasariskyactivityinitself.
2 Sanitaswaivesitsrighttocurtailinsurancebenefitsintheeventofgrossnegligence.However,insuredpersonsarenotentitledtocompensationforthecurtailmentofbenefitsfromotherinsurancecompanies.
14 Multipleinsurancecoverage
Iftheinsuredpersonisinsuredwithmorethanoneinsurancecompany,thetotalinsuredcostsareonlycompensatedonce.InsuchcasesSanitaspaysbenefitsonlyinproportiontoitsinsuredbenefit’sshareofthetotalcoverage.
15 Third-partybenefits
1 TheinsuredpersonmustinformSanitaswithoutdelayofanybenefitsprovidedbythirdpartiesaswellasofanyagreementsregardinglump-sumsettlementsifSanitasisliabletopaybenefitsforthesameinsuranceclaim.
2 IfSanitaspaysbenefitsonbehalfofathirdparty,theinsuredpersonmustassignhisorherclaimstoSanitasintheamountofthebenefitsSanitasisobligatedtopay.
3 AgreementsbetweentheinsuredpersonandthirdpartiesarenotbindinguponSanitas.
Obligationsandestablishmentofclaims
16 Generalobligations
Theinsuredpersonisobligatedtocomplywiththeinstructionsofdoctorsorotherserviceproviders.
17 Notificationofinpatienttreatment
SanitasAssistancemustbenotifiedofadmissiontoacutehospitalimmediately.Ifacommitmenttoprovidecoverageisrequired,Sanitasmustbenotifiedtwoweeksbeforeadmission.
18 Establishmentofclaims
1 Whenclaimsarefiledforbenefits,detailedoriginalinvoicesanddocuments,andanyotherrequesteddocumentation,mustbesubmittedtoSanitas.
2 Theentitlementtoclaimbenefitsexpirestwoyearsupontheoccurrenceoftheeventgivingrisetotheclaim.
3 Ifbenefitsaredisbursedbyanotherinsurer,copiesoftheinvoicesanddetailedstatementsfromtheseinsurersmustbesubmittedtoSanitas.
4 TheaccidentreportformmustbesubmittedtoSanitaswhenaccidentbenefitsareclaimed.
19 Violationofobligations
IftheinsuredpersonviolateshisobligationstowardSanitasintheeventofaclaim,benefitsmaybecurtailedorrefusedaltogether.
Commencementandendofinsurancecoverage
20 Taking out coverage
1 Insurancecoverageistakenoutthroughpaymentoftherelevantpremium.Ifthepremiumispaidatapostoffice,thedateofthepostofficestampshallapply.Ifthepremiumpaymentistransferredfromabankorpostalaccount,thedateonwhichtheamountisdebitedfromtheaccountofthepersonpayingthepremiumshallapply.
2 Premiumsarecalculatedonaslidingscaleaccordingtotheinsuredperson’sageinthecalendaryearinwhichcoveragecommences.
3 Ifthepremiumpaiddoesnotcorrespondtotheactualageoftheinsuredpersonorthetermofinsuranceappliedfor,theinsuredbenefitsmaybereducedinproportiontothedifferencebetweenthepremiumpaidandthepremiumowed.
21 Commencementofcoverage
CoveragecommencesatthemomenttheinsuredpersonentersSwitzerlandortheSchengenarea,butnoearlierthanthedateontheremittanceslip(commencementofinsurance),providedthat– InsurancewastakenoutbeforetheinsuredenteredSwitzerlandortheSchengenarea
– Alltheinformationgivenontheremittanceslipwascompleteandaccurate.
22 Termofcoverage
Coveragecanbetakenoutonamonthlybasis,foramaximumofsixmonths.Thismaximumtermcannotbeextended.
23 Endofcoverage
1 CoverageendsthemomenttheinsuredleavesSwitzerlandortheSchengenarea,butnolaterthanonthelastdayoftheagreedtermofcoverage.
2 If,owingtotheoccurrenceofaninsuredevent(illnessoraccident)duringthetermofcoverage,itisnotpossiblefortheinsuredpersontoreturntotheircountryofresidenceformedicalreasons,coveragewillbeextendedbyamaximumof30daysbeyondtheagreedterm.Thisalsoappliestoaccompanyingpersons,providedtheyarealsocoveredbySanitasAssistance.
Miscellaneousprovisions
24 Datacollection—obtaininginformation
InsuredpersonsauthoriseSanitastocapturealldataelectronicallyand,intheeventofaclaim,toobtainalltheinformationnecessarytosettletheclaim.
25 Paymentofbenefits
1 Sanitaswilltransferbenefitpaymentstotheinsuredperson’sbankorpostalaccount.Ifotherformsofpaymentarerequested,Sanitasmaychargeafeetocovertheaddedexpenseinvolved.Inordertoenablebenefitpaymentstobetransferred,thenecessarypaymentdetailsmustbesuppliedtoSanitaswhentheinsuredpersonfirstfilestheclaim.
2 Sanitasmaydeductmoniesowedbytheinsuredpersonfromthebenefitsdisbursed.
26 Placeofperformanceandvenue
1 TheplaceofperformanceforobligationsunderthiscontractisSwitzerland,performancetoberenderedinSwisscurrency.
2 ThiscontractualrelationshipshallbegovernedandinterpretedexclusivelyinaccordancewiththelawsofSwitzerland.ThecourtsofZurich,Switzerland,shallhaveexclusivejurisdictionwithregardtoanyandallactionsbroughtagainstSanitas.
Em
pfa
ng
ssch
ein
/ R
écép
issé
/ R
icev
uta
Ei
nza
hlu
ng
Gir
o
V
erse
men
t V
irem
ent
Ver
sam
ento
Gir
ata
Kon
to/C
ompt
e/C
onto
K
onto
/Com
pte
/Con
to
Fr.
c.
Fr.
c.
Einb
ezah
lt vo
n / V
ersé
par
/ Ve
rsat
o da
▼▼
•
▼▼
•
Giro
aus
Kon
toV
irem
ent
du c
ompt
eG
irata
dal
con
to
Einb
ezah
lt vo
n / V
ersé
par
/ Ve
rsat
o da
202
Die
Ann
ahm
este
lleL’
offic
e de
dép
ôtL’
uffic
io d
’acc
etta
zion
e
Sanitas
Kran
kenversicherun
gHau
ptsitz
8021
Zürich
80
-100
05-3
Sanitas
Kran
kenversicherun
gHau
ptsitz
8021
Zürich
80
-100
05-3
Ein
zahl
ung
für /
Ver
sem
ent p
our /
Ver
sam
ento
per
Ein
zahl
ung
für /
Ver
sem
ent p
our /
Ver
sam
ento
per
This
cer
tific
ate
of re
ceip
t — to
geth
er w
ith th
e po
stm
ark
or b
ank
conf
irmat
ion
of re
mitt
ance
—
con
stitu
tes
the
insu
ranc
e ce
rtifi
cate
.
Insuredpe
rson
sLastnam
e
Lastnam
e
Lastnam
e
Lastnam
e
Commen
cemen
tofinsurance
Yourpolicyno
. G
Firstn
ame
Firstn
ame
Firstn
ame
Firstn
ame
Term
ofinsuran
ce
coverage(m
onths)
Dateofbirth(D-M
-Y)
Brokerora
gent
Compa
ny
441.02
SWK10
.08
Policyno
. G
800100053>
800100053>
Coverage
G
SP
P