General Conditions
DEFINITIONS:
Abroad: Outside the geographical boarders of the country of permanent residence.
Benefit/Service/Cover: The Benefits/Services/Covers the Beneficiary or Covered person is entitled to receive as described in the General conditions, and usually summarized in the schedule of Benefits/Services/Covers.
General & Specific Policy Conditions: The terms and provisions of all aspects of the policy which state the rights and duties of the Beneficiary or Insurance Company. The policy conditions will usually be located in the policy schedule.
Beneficiary: means any of the covered persons whose name is stated on the certificate of coverage and having the right to receive the corresponding Benefits/Services/Covers or amount of compensation as outlined in the policy. In case of Accidental death, Beneficiary will be legal heirs of the Insured person.
Country of Permanent Residence means the country in which the Beneficiary normally resides, whether or not he/she holds its citizenship.
Covered Trip: An intended and planned trip undertaken by the Beneficiary outside his country of permanent Residence. The maximum duration of any one Covered Trip is 92 consecutive days
Deductible or Excess: means the first amount of the claim which is payable by the Beneficiary, where applicable.
Doctor or Physician: An officially registered medical practitioner according to the law of the place where the Claim happens.
Insurance Company: The insurer registered and authorized in the country in which this insurance policy is issued and subscribed.
The Assistance Company: International Assistance Network (IAN or any of its subsidiaries).
Fraudulent Claims: When the Beneficiary or someone acting on his behalf, uses any fraudulent means or devices in order to obtain any of the Benefits of this policy, consequently, any payment of any amount in respect of such Claim shall be cancelled.
Medical Supervision: The supervision, care, or management of a patient to combat, ameliorate, or prevent a disease, disorder, or injury wherein constant or regular observation is required.
Treatment: The action or manner of treating a patient medically or surgically particularly adapted to the special disease being treated by a professional that may deem the Beneficiary to be Not Fit for Travel.
Not Fit for Travel:
Beneficiaries who have conditions which may have serious consequences or require medical supervision prior to the trip such as the following cases:
- Infants less than 48 hours old (longer after premature births)
- Women after the 36th week of pregnancy (32nd week of multiple pregnancy)
- Those suffering from:
· An unstable medical condition.
· Angina or chest pain at rest.
· Any active infectious diseases.
· Increased intracranial pressure.
· Recent heart attack (past 1-8 weeks).
· Recent stroke (past 1-8 weeks).
· Recent surgery or injury where trapped air or gas may be present (e.g. abdominal trauma, gastrointestinal surgery, craniofacial and ocular injuries,
brain surgery or eye operations).
· Severe chronic respiratory diseases.
· Breathlessness at rest.
· Unresolved pneumothorax.
· Sickle cell anemia.
· Psychotic illness, except where fully controlled.
The Beneficiary may be considered fit for travel even if he/she suffers from any of the following medical conditions/illnesses provided his/her condition or injury is stable and he/she generally feel well:
- Paralysis.
- Motor neuron disease.
- Multiple Sclerosis.
- Parkinson.
- Allergies to certain food.
- High blood pressure or high cholesterol.
- Diabetes.
- Blood disorder such as anemia (Provide no oxygen is requires).
- Epilepsy (only if the Beneficiary has not had a seizure within 24 hours prior to the flight departure time).
- Arthritis.
- Insect bites.
- Minor injuries such as toe and finger injuries, twisted ankles, pulled muscles or small cuts.
- Sunburn.
- Hepatitis B or C.
- Dengue fever.
- Viral meningitis.
- Malaria.
- Cholera (as long as the symptoms have settled, the Beneficiary is well enough to travel and the public health authority in the destination country
allows travel).
- Hepatitis A (as long as the Beneficiary feels well enough to travel).
- Shingles (as long as the rash is not weeping or is covered).
- Yellow fever (as long as the Beneficiary feels well enough to travel and the public authority in the destination country allows travel).
- Flu (as long as the symptoms have settled).
- A heart attack or angioplasty.
- Deep vein thrombosis (DVT) or pulmonary Embolism (PE).
- Stroke (CVA) or head injury.
- Surgery on the heart, chest or abdomen.
- Joint replacement or amputation.
- The Beneficiary does not require oxygen during the trip due to an existing condition.
Orthopaedic material or orthosis: Anatomical parts or items of any kind used to prevent or correct temporary or permanent deformations of the body (walking sticks, cervical collar, wheelchair, etc.).
Prosthesis: These are deemed to be any item of any kind that temporary or permanently replace the lack of an organ, tissue, organic fluid, member or part of any of them. By way of an example, mechanical or biological items such as cardiac valve parts, joint replacements, synthetic skin, intraocular lenses, biological materials (cornea), fluids, gels and synthetic or semi synthetic liquids that replace organic humors or liquids, medicine reservoirs, mobile oxygen therapy systems, etc.
Risk: Probability or threat of a damage, Injury, liability, loss, or other negative occurrence, caused by external or internal vulnerabilities, and which may be neutralized through pre-mediated action.
Injury: A medical problem caused by a sudden and severe external cause or reason beyond the control of the Beneficiary, within the validity period of this Policy.
Serious Illness: Any Illness that requires admission to hospital and which, in the opinion of The Assistance Company's medical team, prevents the Beneficiary from continuing travel on the date planned, or which involves the Risk of death.
Accident: The bodily Injury suffered during the validity of the policy, which derives from a violent, sudden, external cause and one that is not intended by the Beneficiary.
The following shall also be construed to be Accidents:
a. Asphyxia or Injuries as a consequence of gases or vapors, immersion or submersion, or from the consumption of liquid or solid matter other than foodstuffs.
b. Infections resulting from an Accident covered by the policy.
c. Injuries that are a consequence of surgical operations or medical treatments resulting from an Accident Covered by the policy.
Sudden Illness or Injury means a sudden, unexpected, unusual, specific, unforeseen, external event which occurs at a single identifiable time and place and independently of all other causes, resulting directly, immediately and solely in physical bodily injury or trauma and requiring immediate medical intervention treatment. An event which directly or indirectly exacerbates a previously existing pathology and/or a physical bodily injury shall not be considered an Accident.
Any sudden change in health diagnosed and confirmed by a legally recognized Doctor during the life of the policy and which is not comprised or derived from either of the following two groups:
- Congenital disease that exists at the moment of birth as a consequence of hereditary factors or complaints acquired during pregnancy. - Pre-existing medical conditions that the Beneficiary suffered prior to the date of taking out this Policy, even if it wasn’t diagnosed.
In the cases where a sudden illness is described as a Serious Sudden Illness it refers to any Illness that requires admission to hospital and which, in the opinion of the Assistance Company's medical team, prevents the Beneficiary from continuing travel on the date planned, or which involves the risk of death; or where treatment is medically necessary in order to maintain life and/or relieve immediate sudden pain or distress.
Pre-existing Medical Condition means a pre-existing physical defect, infirmity, injury, sickness, pathology, disease, affliction, anomaly that could be congenital or acquired, major risk factor, or any other medical condition, whether known or unknown to the Beneficiary, which he/she was suffering from prior to his/her date of travel from his/her country of permanent residence.
Medical Emergency means an unforeseen and non-recurrent sudden pathology which requires an emergency treatment to prevent or alleviate existing danger to life or health. An emergency no longer exists when medical evidence indicates that the Beneficiary is able to return to his/her Country of Permanent Residence to seek and/or continue treatment. A pathology related to a pre-existing medical condition does not fall under the definition of a sudden pathology. Each time the patient is able to visit the doctor’s office in person; such case shall not be considered an emergency.
Terrorism: An act, including but not limited to the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organization(s) or government(s), committed for political, religious, ideological or similar purposes including the intention to influence ay government and/or to put the public, or any section of the public, in fear.
Personal Accident: Physical Injury or mental anguish caused, by actions or negligence of another Party.
Unattended: When the Beneficiary is not in full view of and not in position to prevent unauthorized interference at the time of the damage, loss, or theft of their property or vehicle, or left in place where it can be taken without the Beneficiary's knowledge (including on the beach or beside the pool while the Beneficiary swims), or where the Beneficiary is unable to prevent it from being unlawfully taken.
Business Companion mentioned under the trip cancellation section refers to a fellow member of the same firm or business activity with whom the Beneficiary has planned to travel on the same flight and whose presence is mandatory in order for the trip to take place.
Immediate Family Member: Spouse (Person officially registered as wife or husband of the Beneficiary), children, parents, grandparents, grandchildren, siblings, mother and father-in-law and brothers and sisters in law.
Permanent total disability means a disability in which a Beneficiary is forever prevented from working because of Injury.
Common carrier means any air, land, or water motorized conveyance operated in accordance with all locally applicable laws and regulations and under a valid license for the transportation of passengers for hire for which a ticket has been issued and in which the Beneficiary is travelling only as a fare-paying passenger, including taxis and hired motor vehicles but excluding minibuses, non-standard motor vehicles and non-pressurized single engine piston aircraft. Common Carrier will not mean cruise ships at sea or any conveyance that is hired or used for a sport, gamesmanship, contest and/or recreational activity, regardless it such conveyance us licensed, such as, but not limited to, race cars, bob sleds, hunting vehicles, sightseeing helicopters, fishing boats, parasailing/paragliding and boat cruises.
BENEFITS DETAILS & CONDITIONS
Whenever the Beneficiary is traveling out of his/her Country of Permanent Residence and up to a maximum of 92 consecutive days, the Assistance Company shall provide the following benefits:
a) Cover of Emergency Medical expenses and hospitalization abroad
The Insurance Company shall cover only reasonable medical emergency expenses for accidents and medical emergency as defined above under definitions section, as well as hospitalization costs resulting from it, up to a limit specified in the certificate of coverage according to the minimal and standard costs of hospitalization in the country where the Beneficiary is being treated.
This coverage is complementary and only takes place if no other medical or insurance coverage is available. Nevertheless, the Insurance Company upholds her right to recovery at any time it appears that the Beneficiary’s holds a valid medical insurance that covers medical expenses outside his/her country of permanent residence.
Therefore, the Beneficiary authorizes the Insurance Company to claim back any paid medical costs from his/her primary medical insurance that provides travel coverage abroad, and undertake to hand over all requested documents for such recovery.
In case of hospitalization for sudden illness, the Insurance Company shall take in charge hospital stay in a classic, standard, semi-private room type or equivalent. The Insurance Company shall not bear any additional costs for unjustified upgrading. Patient amenities costs such as Rental of TV/DV, Wi-Fi, alcoholic beverages, food deliveries, phone calls as well as companion stay expenses are not covered under this travel plan.
The coverage is only valid for sudden illness or injury, meaning that this sudden illness or injury has no relation with any pre-existing medical condition or existing major risk factor, whether known or unknown, prior to the departure date of the current travel.
The Beneficiary is obliged to call the Assistance Company within 48-hours from the occurrence of any claim.
b) Evacuation and/or repatriation
In the event of an accident or sudden illness, the Insurance Company will take charge of transferring or repatriating the Beneficiary to a properly equipped health centre or to his/her country of permanent residence.
The Insurance Company or the Assistance Company, through its medical team, will decide which health centre the Beneficiary is transferred to or whether repatriation is necessary, depending on the situation or gravity of the state the Beneficiary is in.
Afterwards, the Insurance Company or the Assistance Company's medical team will maintain the necessary contacts with the centre and with the attending doctor, and will decide whether to transfer or repatriate the Beneficiary, and on the most suitable means of transport to use.
For minor or less serious illnesses or accidents, which in the opinion of the Assistance Company’s medical team do not require repatriation, the transfer of the Beneficiary shall be performed in ambulance or another means of transport, to the place where adequate medical assistance can be provided.
c) Repatriation of mortal remains
In the event of an accidental or a sudden death of the Beneficiary as a result of a sudden non-pre-existing illness, the Insurance Company shall assist with the necessary procedures and shall cover only the expenses of transportation for repatriation of the mortal remains back to the last airport of the country of permanent residence, up to a limit specified in the certificate of coverage. The ground repatriation, the administration and the funeral expenses at the destination (including the purchase of the coffin) are not covered.
The request of Repatriation of Mortal Remains resulting from death because of a pre-existing medical condition (which is not covered as per the policy conditions) shall NOT be covered either.
d) Return of dependent children
In the event that dependent children are left unattended due to an accident or sudden illness of which the Beneficiary is the victim, the Insurance Company shall organize and covers the expenses of transportation (one-way economy class) of the dependent children to their country of permanent residence. A qualified attendant will be designated, if necessary, without additional charges.
e) Transportation to join member following hospitalization of +10days
In the event where the Beneficiary, while travelling outside his/her country of permanent residence, is hospitalized for a period exceeding 10 consecutive days, the Insurance Company shall meet the costs of the round trip of one immediate family member designated by the Beneficiary, from the country of permanent residence of the Beneficiary to the international or domestic airport terminal or train station closest to the location of the hospital.
Covered amount includes the cost of an economy class round-trip air transport or a regular class round trip train tickets plus an allowance of 80 USD per day for a maximum period of 10 days.
f) Emergency Dental Expenses
The Insurance Company shall cover the dental expenses incurred by the Beneficiary in emergency cases, arising as a result of a bodily injury or of an acute and sudden illness, with the exclusion of any kind of prosthesis and /or definitive filing. The coverage is restricted to the treatment of pain, infection and removal of tooth affected. Expenses are covered up to a limit of 200$ per claim
g) Contribution to Sea & Mountain Search and Rescue
In the event that the Beneficiary is reported missing during his journey abroad, the Company shall contribute to the expenses associated with sea & mountain search and rescue operated by the local official authorities up to a limit of 25 000$.
h) Cover of Outdoor winter sports( Ski)
In the event of an accident while the Beneficiary is skiing on regular ski slopes or on ice (outdoor activities only), The Company shall cover assistance and medical expenses up to a limit of 10,000 $ and it is subject to a deductible of USD 250 per person per claim.
The Company reserves the right to recover any claim declared by the Beneficiary, should any effective policy covering the same risk prove to exist.
Any accident that occurs outside the ski slopes is not covered under this policy.
i) Compensation in the event of total loss or disappearance of baggage
In the event of total loss or disappearance of baggage while in the custody of the transport company, the Insurance Company shall pay compensation equivalent to amount paid by the transport company according to the International Air Transport Association (IATA) rules and regulations and up to a limit of 800$.
The 48-hour exclusion does not apply to this benefit.
j) Trip cancellation
The Company shall indemnify the Beneficiary in respect of all irrecoverable deposit, advance payment and other charges or due to be paid for travel and/or accommodation. The policy indemnifies against cancellation of a trip, i.e., the Beneficiary being prevented from setting off on a trip necessary because of:
1. The death of the Beneficiary or any immediate relative or business companion with whom the Beneficiary had arranged to travel (See definition section)
2. The accidental bodily injury or acute unforeseen non-pre-existing illness (estimated severe and unfit for fly by the Company physician) or significantly incapacitating the intended course of travel of the Beneficiary or any immediate relative or business companion with whom the Beneficiary had arranged to travel, excluding the grandparents, brother-in-law or sister-in-law, daughter-in-law or son-in-law, stepmother or stepfather mentioned in the Immediate Relative definition.
3. The Beneficiary or any immediate relative or business companion with whom the Beneficiary had arranged to travel being:
a) Quarantined or called for witness or jury service.
b) Had a significant, unexpected financial loss concerning his property in his Country of Permanent Residence.
c) Required to be present at his home or place of business in the usual Country of Permanent Residence following burglary or major damage.
4. Major damage rendering uninhabitable the accommodation in which Beneficiary had previously booked to reside during a covered trip.
5. Theft of the travel documents or identity documents of the Beneficiary within 24 hours prior to the start of the trip as stated in the police report.
In the event of a trip cancellation, the policy covers costs up to a limit of 5,000$ or at maximum the price of the original trip, for which the Beneficiary is liable under the transport company’s travel conditions. The policy covers also unused services, excursions and travel at the destination for which the Beneficiary has paid in advance. The Beneficiary must present the original non-refundable documents or penalty and cancellation fees if applicable.
The aggregate limit of 7,000$ is the maximum amount that can be covered per family per incident, for example, as in the case of death of a family member.
Any remuneration or compensation that the Beneficiary is or would be entitled to from the transport company when the reason for the cancellation transpires is deducted from the indemnification. Travel arrangements shall be cancelled immediately to the transport company after it has become known that the trip cannot be undertaken.
The 48-hour exclusion does not apply to this benefit.
Exclusions applicable only to this section, the general exclusions of the policy being equally applicable:
The Company shall not be liable for claims resulting from:
- Any condition or set of circumstances known to a Beneficiary at the time the trip was booked, where such condition or set of circumstances
could reasonably have been expected to give rise to the cancellation of the Beneficiary’s covered trip.
- Lack of reasonable care taken over means of travel route or departure time.
- The coverage is only valid for sudden illness or injury, meaning that this sudden illness or injury has no relation with any pre-existing medical
condition or existing major risk factor, whether known or unknown, at the time of signature of this contract.
- Charter trips and charter excursions are not covered by the Trip Cancellation benefit.
- Boat cruises of more than 12 hours are also excluded from this benefit.
- Limit in the aggregate, in case the incident affects more than one Beneficiary from the same family (Immediate relative) or business relationship
(business companion), will be fixed up to a total aggregate per case mentioned in the table of benefits (per plan).
- The beneficiary or the severely ill immediate relative or the business companion or their legal representatives shall liberate his/her treating doctor from medical secrecy for the Company to gather all related medical information to this claim.
k) CompensationforFlightCancellation(4-HoursExcess)
In the event that a flight is delayed for more than 4 hours AND THEN cancelled by the airline company outside the country of permanent residence, an indemnity of 150$ shall be paid to the Beneficiary, provided that proof of such delay and cancellation is submitted to the Company. In the case of connection flights for example, the case of a delay in the first flight leading to missing the second flight will not be covered by this benefit. This benefit aims to compensate only for basic expenses incurred by the beneficiary during the delay period.
The 48-hour exclusion does not apply to this benefit.
l) Travel information Service
The Beneficiary may, prior to his/her departure, call the appropriate Assistance Alarm Center on the assistance number mentioned on his policy, in order to obtain important administrative or medical advice regarding passport and visa processes, vaccination requirements, taxes, customs duties, currencies, and other various requirements.
m) Delivery of urgent messages
The Insurance Company will take charge of relaying any urgent messages of the Beneficiary relating to any of the events covered in this Agreement.
n) Long distance medical advice
Should the Beneficiary, during his/her journey abroad, need medical advice which is not available at their location, he/she may call the appropriate Alarm Centre and get medical advice from a qualified physician. A telephone conversation does not permit the establishment of a diagnosis and must therefore be considered as mere advice. The Assistance Company and the physician shall not hold any malpractice liability to his/her medical opinion.
o) Referral to Medical Correspondents Abroad
During his stay abroad, the Beneficiary can contact the Assistance Company to be directed to one of the doctors of his network. Most internationally accredited doctors speak English. The company shall not be held liable for any medical malpractice or inadequate or deficient treatment that might incur following that referral.
p) Dispatch of a Specialist Physician
In such cases where medical repatriation proves to be impossible due to the patient’s condition, the Company may, at its discretion, pay for the dispatch of a specialist physician to make on-site evaluation with the attending physician and arrange for the eventual medical repatriation of the Beneficiary.
OBLIGATION OF THE BENEFICIARY
In the event of a medical emergency or a sudden illness, the Beneficiary releases from professional secrecy all doctors and paramedical staff who might examine him/her both before and after the incident. The Beneficiary is required to communicate confidentially to the attention of the Assistance medical advisor, all facts and circumstances required under the guarantees of assistance abroad.
Any reluctance or omission in the communication of this data entitles the Assistance Company to suspend the assistance guarantees as soon as it becomes aware of the said facts or circumstances.
The Assistance platform cannot in any way replace the local emergency relief organizations. The Assistance platform is not responsible for the consequences of medical malpractice or inadequate treatment. In the case where any of the Beneficiaries has subscribed to another policy for the same risk (Insurance and / or Assistance), he is obliged to declare it to the Assistance Company.
Claims Conditions
IAN (International Assistance Network) part of the Eurocross Network, is the assigned assistance platform for this plan. It operates on a 24/7 basis, in agreement with the Beneficiary in order to respond to his/her needs. Any request for assistance must be made to the Assistance Company within 48 hours and prior to any expenditure commitment.
The Assistance Company shall not be involved in the expenses that the Beneficiary would have incurred on his/her own initiative. However, in order not to penalize the Beneficiary who have shown reasonable initiative, the Assistance Company could consider coverage upon presentation of supporting documents.
In order to receive the benefits under this travel plan, the Beneficiary must contact the Alarm Center within 48 hours of the occurrence of the event by phone or email:
In the Middle East: 00961-4-548648
Rest of the World: 00420-2346-22727
Email: claims@mideast-assistance.com
If the Beneficiary is not in a position to contact the appropriate Alarm Center, notification given by a close person, the police, the hospital, the fire brigade, or any person having intervened upon the occurrence of the damage will be considered of the same worth as a call from the Beneficiary him/herself.
The Insurance Company reserves the right to verify the truthfulness of the damage declared. Failure to submit such required documents within a period of two months from the occurrence of the accident/sudden illness gives the Insurance Company the right to deny any benefits and/or reimbursement in relation with the incurred costs. Furthermore, the Beneficiary must provide the requested original documents within twelve months:
a- The damage
- Official statement of accident issued by the police authorities.
- Copy of passport and visa (where applicable).
- Complete medical file established by the doctor or the hospital visited at the place of the accident, medical prescriptions.
- Medical and hospital bills.
b The delay or loss of baggage
- Copy of check reimbursed from the Airlines.
- Letter from the Airlines.
RESTRICTIVE CONDITIONS OF BENEFITS COVERAGE
1. Liability
The Assistance Company can only intervene within the limit of the approvals given by the local authorities, medical and/or administrative, and can under no circumstances replace local emergency organizations nor bear the incurred expenses if they pertain to the public authority.
2. ExceptionalCircumstances
The Assistance Company shall not be held liable in case of non-compliance with the obligations outlined herein, if such non-compliance leads to:
- Acaseofforcemajeuremakingitimpossibletocarryoutthecoverage. - Eventssuchascivilorforeignwar.
- Revolution, civil commotion, riot, strike, sequestration or constraint by the public authorities, official prohibition issued by the authorities, piracy, detonation of explosives, nuclear or radioactive effects, climatic obstructions.
3. LimitationofCoverage
- Coverageshallceaseautomaticallyupontheexpirationdateofthiscontract.
- Coverage under this plan is secondary, which means that the Insurance Company will not pay any cost which is recoverable from any other insurance, fund or institution, except eligible amounts that exceed the limits covered by that other insurance, fund or institution, subject to the General Conditions of this contract, and up to the limits herein set.
- The Insurance Company shall not be held liable for the consequences of medical malpractice or inadequate or deficient treatment.
- The Insurance Company shall not be held liable for any medical post-treatment or follow-up in curred by the generating events.
4. Exemption from providing benefits
The Insurance Company is released from any obligation to provide benefits in the following cases:
- Failure by the Beneficiary to notify the Company within 48 hours of the event
- Failure by the Beneficiary to submit to the Company all documents required for setting the case of the accident.
- All files or bills treated outside a guarantee of payment or a previously written authorization from The Company, if accepted, are subject to reimbursement according to the Company’s standard prices in the incident country.
- Committing by the Beneficiary of a crime or an offense, which was the cause of the accident.
- DenialofthecompulsorypriorapprovalbytheCompanyfortheorganizationandfinancingoftheassistance.Anydecisionstoundergo treatment, transfer to a different medical facility, or perform a necessary procedure, such as a surgery, or additional investigation, such as MRI or scanner, during an approved hospitalization must be subject to the Company’s prior approval. Failure to notify the Company of such decision will result in the denial of coverage.
- Failure by the Beneficiary to notify the Company of the existence of another insurance covering the same risks.
- Failure by the Beneficiary to take measures which reasonably ought to have been taken to avoid the accident.
- Failure by the Beneficiary to provide the Company with the information it needs, and to give it honest and complete answers.
- Refusal by the Beneficiary or the person who decides for him/her to receive those benefits provided by the Company and mutually agreed upon by the Company doctors and those present at the place of the damage. Such refusal will result in the cancellation of the contract, unless the Beneficiary changes his/her mind before the expiration of the contract.
- Any workmen’s compensation or any claim related to work or labor accidents, consequence of a risk inherent to the work or under the scope of employment performed by the Beneficiary.
GENERAL EXCLUS IONS
Expenses and damages resulting from the following events are not covered:
1- The practice of reckless undertakings or needless risk by the Beneficiary or not taking reasonable care, except in an attempt to save human life.
2- Brawl (punches during a violent dispute).
3- The practice of high-risk sports such as, but not limited to: parachuting, acrobatics, spelunking, races using mechanical appliances, high wire, ski jumping, sky flying & surfing, bungee jumping, Base jumping, hang gliding, open water swimming, scuba diving, jet skiing, kite & windsurfing, water surfing, wakeboarding, rafting & kayaking, shooting, indoor & outdoor climbing, alpinism, mountain biking, free falling, boxing, motor racing, rugby, aviation, ATV riding, mountain sickness related claims ,as well as all professional competition sports.
4- The Assistance Company shall study on case-by-case basis the circumstances related to the practiced sport.
5- War, declared or otherwise, revolution, sabotage actions, terrorism or vandalism strikes, street barricades erected at the time of public demonstrations, and generally troubles of all kinds and measures taken for restoring order.
6- Telluric movements, floods, volcanic eruptions, or other kinds of natural phenomenon considered as natural calamity.
7- Any expenses related to abuse of consumption of alcohol, narcotics, and/or other hallucinogenic substances.
8- All damage to health brought about by ionizing rays (nuclear radiation).
9- Any loss arising from biological and/or chemical material(s), substance(s), compound(s) or the like used directly or indirectly for the purpose to harm.
10- Expensesrelated to mental health disorders and any Psychiatric disorder or any of its manifestations or complications.
11- Suicide or attempted suicide.
12- Ablation and transplantation of organs, tissues, or cells.
13- All events and accidents associated with or resulting from pregnancy and/or breastfeeding, including diagnosis, follow-uptreatments, abortion, or delivery.
14- All Healthcare Services & Treatments for In-Vitro Fertilization (IVF), embryo transport, ovum and male sperms transport.
a) Any internalorexternaldevice/materialusedontemporaryorpermanentbasissuchasbutnotlimitedtoorthopaedic,cardiac,vascular,urological, digestive devices/materials, etc., as well as anatomical prosthesis, any walking aids and splints.
b) All operations related to previous prosthesis or device as described in 13 -a)
16- Physiotherapy including all forms of physicalre-education.
17- Elective stay at a convalescent home or a revalidation center.
18- All treatments related to congenital or acquired malformations.
19- Endemic,epidemic and pandemic diseases.
20- Venereal and SexuallyTransmitted Infections.
21- Any Health Services that are received as Out-of-Hospital Benefits as well as outpatient doctor visits.
22- Spontaneous consultations of doctors and specialists, and all kinds of check-ups or medical investigations.
23- Treatment, hospitalization or any medical costs related to a pre-existing medical condition as describes under Definition ssection. This exclusion extends to any medical situation whether known or unknown, diagnosed or not, treated or not before the Beneficiary current travel dates and possible complications thereto. Pre-existing medical conditions, and any related treatment to it; repatriation, evacuation or Emergency Room expenses, are not covered under this plan.
24- Any subsequent admission to the hospital, related to the first one, unless considered as an emergency treatment by the Assistance Company physicians.
25- Gallstones and Cholelithiasis and any complication resulting from that.
26- Nephrolithiasis as well as ureterolithiasis and their complications.
27- Any vascular, cardiovascular, cerebrovascular illness and their related complications are excluded from the coverage of this policy 28- Any medical condition for which the Beneficiary didn’t take the recommended treatment or prescribed medications as directed by his medical practitioner in his Country of Permanent Residence.
29- Medicines purchased outside hospitals or Emergency room.
30- Unconventional trips.
31- In case of approval of a non-urgent hospital admission: prior any admission, authorization by the Assistance Company doctors concerning the choice of the hospital is mandatory; otherwise, the hospitalization fees are not covered by this certificate of coverage. 32- Allergic and auto-immune disorder and their complications.
33- In case of a non-typical or uncommon pathological disorder, failure to present to the Assistance Company doctors a clear and definite medical and etiological diagnosis within 3 (three) days of the hospital admission.
34- Every hospitalization undertaken initially in a diagnostic search purpose.
35- Investigations, treatment, or surgery which in opinion of the medical practitioner in attendance and/or the Company doctor can wait until return of the Beneficiary to country of permanent residence
36- Diagnostic investigations and procedures undertaken in search for pre-existing diseases and medical conditions excluded in the scope of the present coverage as described in Exclusion (23) and the definition section.
37- No coverage shall be rendered in case the Beneficiary has another valid medical or insurance coverage outside his/her Country of Permanent Residence.
38- In addition, the Beneficiary is not covered when a trip is undertaken:
39- Against medical advice.
40- Following acknowledgement of a diagnosis establishing an illness interminal phase.
41- With the intention to receive medical treatment, medical investigation or follow-up treatment for a pre-existing medical condition.
42- During a period of illness, major treatment, or in capacity to work.
43- When a doctor has ordered an operation, which has not yet been performed.
44- Industries, Seepage, Contamination and any kind of pollution or environmental liability.
45- Absolute Fungi Liability in accordance with the Absolute Fungi Liability Exclusion.
46- Asbestos risks.
47- Treatments and Services related to viral hepatitis and associated complications, except for treatment and Services related to Hepatitis A.
48- Terrorism unless an extra Premium is paid by the Beneficiary.