MainINSURANCE RULES FOR TRAVELLERS

INSURANCE RULES FOR TRAVELLERS

INSURANCE RULES

The object of insurance is the property interests of the Insured, related to the costs incurred in connection with the provision of medical and other assistance in connection with acute illness, exacerbation of a chronic illness, accident or death of the Insured, or other unforeseen circumstances provided for by the terms of the Insurance Contract (Insurance Policy) arising during the validity period of the Insurance Contract (Insurance Policy) and falling within the scope of these Rules of the Insurance Company.

GENERAL DEFINITIONS 

• Insurance company - legal entity, Established in accordance with the law and licensed to carry out insurance activities.

• Insured - an individual whose property interests are the object of insurance.

• Insurance risk is a supposed event, in the event of occurrence of which Insurance is carried out. The event, considered as an insurance risk, Must have signs of the probability and chance of its occurrence.

• Insurance premium - insurance payment, which the Policyholder makes the insurer for the obligation assumed by him to reimburse the Insured / For Insurance / Beneficiary / other third party property damage, Caused by the occurrence of an insured event. The insurance premium is established in Rubles or in other foreign currency, or in conditional monetary units according to Currency of the Policy.

• The deductible is a part of the losses determined by the Insurance Contract, it is not subject for reimbursement by the Insurer in accordance with the terms of the Contract Insurance and is established in the form of a certain percentage of the sum insured or at a fixed amount for each insured event.

• Assistance company - an organization determined by the Insurer, which on behalf of the insurance company provides the organization of services to the Insured on the Insurance Territory.

• Territory of insurance - state and other state-territorial and the administrative-territorial entities covered by the Insurance Contract, the exception is limited to the radius 100 kilometers from the administrative border of the place of permanent residence of the Insured.

• Chronic disease - long-lasting persistent deviation from the norm and requiring constant (regular) observation and / or treatment and which has one of the following conditions:

• acquired, can exist for an indefinite period of time regardless of whether he knew about him or not, requires medication or surgical treatment to eliminate or reduce the negative Influence on the body;
• Congenital, due to intrauterine damages or exposure other damaging factors on the fetus during pregnancy, diagnosed at birth, in childhood or in later periods, incl. And for the first time, requiring medical or surgical treatment to eliminate symptoms or reduce the negative impact on the body;
• Hereditary and genetic - diseases, the emergence and development of which are connected with defects in the hereditary apparatus of cells transmitted by inheritance through gametes, are caused by disturbances in the processes of storage, transmission and implementation of genetic information;
• There is a possibility of relapse;
• has a permanent character or progresses;
• does not have known recognized methods of treatment;
• requires palliative treatment;
• requires long-term follow-up, consultations, periodic inspections.
• Medical transportation or evacuation is necessary, with medical point of view (documented by the attending physician and agreed upon with the Assistance Company and / or the Insurance Company), transportation iInsured by medical or non-medical transport accompanied by Medical personnel providing qualified care for transportation insured person in the immediate vicinity of the place of injury or illness the specialized medical institution, in which there are conditions for rendering necessary medical assistance, or return of the Insured to the territory countries of permanent residence.

• Conditional unit (cu) - the equivalent of a monetary amount, determined by conditions of the Insurance Contract.

• Medical expenses - expenses for examination and treatment of the Insured, conducted in a licensed treatment and prophylactic institution or licensed physician, according to the standards of medicine of the host country insured, confirmed by a correctly issued medical report, invoice, and recipes.

EXCLUSIONS FROM 

INSURANCE COVERAGE

Following positions are not recognized as insurance event and will not be covered by insurance:

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• costs associated with the treatment of chronic diseases;

• Expenses related to the treatment of exacerbations of chronic diseases, which are not specified by the Insured (Insured) in the insurance application, in the insurance contract, in the insurance policy, in the Insurer's written request;

• costs associated with the purchase of medicines without prescribing a doctor;

• costs associated with the purchase of medicines, if prescribed, the composition of which is concealed by the originator, as well as the costs associated with the acquisition of food, fortifying agents, slimming and laxatives, prescription, cosmetics, mineral water and water additives In the bath;

• Expenses related to the provision of medical services, if the journey was undertaken with the intention of receiving treatment;

• costs associated with the treatment of cancer;

• costs associated with the course of treatment initiated before and continuing during the validity of the insurance contract, or if the journey was undertaken, despite the existence of medical contra-indications of the attending physician;

• costs associated with the treatment of nervous, mental illness and attempted suicide;

• costs associated with the treatment of illnesses caused by the use of psychotropic, narcotic, toxic substances, alcoholic beverages, and the treatment of injuries received by the Insured person while under the influence of the above substances;

• expenses for the treatment of alcoholism, drug addiction, substance abuse;

• expenses related to pregnancy for more than 12 weeks and abortions (with the exception of involuntary termination of pregnancy, which was the result of an accident);

• costs associated with the treatment of injuries, diseases caused by direct or indirect exposure to radiation of any kind, including solar radiation;

• expenses related to the purchase of glasses, contact lenses, hearing aids, prostheses, as well as expenses for all types of prosthetics;

• expenses related to treatment in sanatoriums and dispensaries;

• costs associated with the treatment of sexually transmitted diseases and AIDS;

• costs associated with the provision of preventive vaccinations and medical examinations;

• costs associated with cosmetic or plastic surgery;

• expenses related to acupuncture, physiotherapy and other types of restorative treatment;

• costs associated with the treatment of diseases, the onset of which could be prevented by advance vaccination;

• expenses related to the treatment of injuries, illnesses caused by sports, except for the cases of paying an additional premium with mandatory notification to the Insurer;

• expenses related to the treatment of injuries, illnesses caused by air transport, parachute jumping, mountaineering, moto and motor racing, and other dangerous sports, except for the cases of paying an additional premium with mandatory notification to the Insurer;

• expenses related to the treatment of injuries, diseases caused by participation in officially held sports competitions, except for cases of payment of an additional premium with mandatory notification to the Insurer;

• costs associated with the treatment of diseases and injuries resulting from civil wars, popular unrest, military operations, riots, insurrections, state of emergency and other such events;

• costs associated with the examination and treatment of the disease by scientifically unrecognized methods, as well as the costs of purchasing non-certified medications;

• costs associated with surgery or treatment that may be delayed until the Insured returns to the country of permanent residence and which has not been approved by the Insurer or the Service Company;

• expenses related to the treatment of diseases and injuries caused by criminal or illegal actions of the Insured;

• expenses related to the treatment of injuries and diseases received in a motor vehicle accident, if the Insured manages the means of transport without having a driver's license or transferred control to a person who does not have a driver's license;

• Expenses incurred as a result of violation of the rules of conduct established in public places for the Insured. 

• did not provide all the necessary documents to make a decision on the insurance payment;
• did not inform the Insurer of all information relevant to the assessment of the degree of risk;

• if the insured event occurred during the performance by the Insured of any type of employment (unless otherwise stipulated by the insurance contract).

The insurer also has the right to refuse an insurance payment if during the validity of the insurance contract: 

• deliberate actions of the Insured, the Insured person, aimed at the occurrence of an insured event;

• the commission by the Insured, the Insured, of an intentional crime, which is in direct connection with the occurrence of the insured event;

• The Insured's communication to the Insurer of knowingly false information about his health (or about the health of the Insured) and / or the amount and cost of medical services rendered.