1. Object of insurance
Life, health, working capacity of the Insured Person; Possible losses or expenses that may be incurred by the Insured (the Insured Person or another person determined by the Insurance Agreement or on the basis of the legislation of Ukraine) in the event of an insured event.
Insurance is carried out for risks within the following insurance classes:
2. Insurance Risks and Insurance Limitations
According to Class 18, the insurance risk is a health disorder and/or death of the Insured Person, which have signs of accident and probability of occurrence, which occurred with the Insured Person during the term of the Agreement (taking into account the duration of insurance coverage, i.e. the number of insured days) and on the territory of the Agreement, upon the occurrence of which the Insured Person has incurred or may incur expenses in connection with the provision of urgent qualified medical and/or other necessary assistance, medical services and other expenses, within the limits and to the extent provided for by the relevant ZUSP-Offer Program and related to:
- the Insured's application to a medical institution in connection with a sudden acute illness, injury, poisoning, or the result of an accident;
- application of the heirs of the Insured Person, in case of his/her death as a result of a sudden illness or accident due to the need to cover the costs associated with the burial and/or repatriation of the Insured Person.
- Inconvenience of using air transport, namely: loss, shortage, damage or damage of all or part of the insured baggage, which was transferred under the responsibility of the Carrier.
According to Class 1, the insured risk is the occurrence of an accident with the Insured Person during the validity of the Agreement.
Insurance Limitations:
1. Persons under the age of 1 year and over 80 years who at the time of conclusion of the Agreement were recognized as legally incapable, were disabled of the first group, suffered from severe nervous diseases (including tumors of the brain or spinal cord, damage to the nervous system, acute encephalitis), were registered in specialized dispensaries (including, but not limited to: oncological, anti-tuberculosis, dermatovenereological, narcological, psychoneurological; in accident insurance: narcological, psychoneurological), centers for the prevention and control of AIDS).
2. The following persons cannot be insured:
- citizens of Ukraine;
- persons who have been declared legally incapacitated in accordance with the established procedure;
- HIV-infected and AIDS patients;
- persons who have malignant neoplasms or are undergoing treatment for this;
- persons who are disabled of I and II groups;
- persons suffering from severe nervous or mental illnesses and/or are registered in narcological and psychoneurological specialized dispensaries, centers for the prevention and control of AIDS;
- persons who are under inpatient treatment (hospitalized) at the time of conclusion of the Insurance Agreement;
- persons suffering from alcoholism, drug addiction, substance abuse, cirrhosis of the liver, viral hepatitis, except for hepatitis A;
- persons who have systemic scleroderma, systemic lupus erythematosus.
- persons with multiple sclerosis, deminelinating diseases.
- persons with diabetes mellitus (severe forms with complications).
- persons suffering from hereditary diseases, congenital gross malformations of organs and systems.
- persons with severe injuries of the central nervous system (brain contusion, cerebral hemorrhage, open craniocerebral injury, spinal cord rupture, etc.).
- persons with chronic renal failure (with the need for hemodialysis).
- persons with tuberculosis.
- persons suffering from severe diseases of the central nervous system (encephalitis, meningitis, epilepsy, paralysis).
- persons over the age of 60, unless otherwise agreed by the Individual Part of the Agreement.
- Pregnant women with a gestation period of more than 7 months.
3. Minimum and maximum amounts of the sum insured (liability limit)
from UAH 5,000 to UAH 20,000
from 30,000 USD/EUR to 50,000 USD/EUR
5 000 UAH
4. Minimum and maximum amounts of insurance premium and/or insurance tariff
from 0,50 UAH/day to 80,00 UAH/day.
from 7,00 UAH/day to 2,300,00 UAH/day.
from UAH 60.00 to UAH 350.00 for the period of validity of the Agreement.
5. Type, minimum and maximum amounts of the franchise (if any)
is not provided
Monetary - from 50 USD/EUR to 150 USD/EUR
Time – 3 (three) calendar days from the date of conclusion of the Agreement, applies to a limited list of medical expenses:
- emergency outpatient care;
- emergency medical care, emergency outpatient or inpatient care in connection with SARS-CoV-2 (COVID-19) disease
- emergency dental care;
- help with PTSD;
Telemedicine consultations.
6. Territory and term of the insurance contract [including information on the procedure for its entry into force and insurance period(s) (if any)]
Territory of validity - the territory of travel is defined in the Agreement by one country or several countries-zones, except for the territory of Ukraine, the country of citizenship or country of permanent residence of the Insured Person, the territory of the Russian Federation, the Republic of Belarus, war zones, disaster zones and those territories that are under UN sanction.
1) Zone EUROPE - countries of travel "EU": Europe, CIS and Baltic States, Cyprus. Additionally, if stipulated by the Agreement, the countries of travel "OC" may be covered: Turkey, Egypt, Tunisia, UAE. The Schengen countries are a separate territory covered by insurance coverage within the European area.
2) Zone World* means the entire world, including the "EUROPE" coverage area, with the exception of some countries in the Americas, Africa, Asia, Australia and Oceania.
3) Zone "World" means the whole world, including the "EUROPE" coverage area.
A DETAILED LIST OF COUNTRIES AND COVERAGE AREAS FOR SUCH COUNTRIES IS GIVEN IN APPENDIX NO. 1 TO THESE WUSPS. IF THE AGREEMENT CONCLUDED FOR THE PURPOSE OF STAY "STUDY (N)" AND IF THE INSURED PERSON'S PASSPORT CONTAINS A NATIONAL VISA OF ONE OR MORE COUNTRIES ISSUED FOR THE PURPOSE OF STUDY, THE INSURANCE COVERAGE APPLIES EXCLUSIVELY TO THE TERRITORY OF SUCH COUNTRY/COUNTRIES.
The term of insurance coverage is from 3 (three) days to 1 (one) year.
Provision of insurance coverage – for the specified number of days of the duration of insurance coverage, including multiple trips, if they are provided for in the Agreement (the number of trips ("MultiTrip"/ "MULT") is specified in the Agreement).
The Agreement shall enter into force from the moment the Insured Person crosses the border of Ukraine and/or the country of permanent residence, but not earlier than the date and time of commencement of the Agreement specified therein, subject to the receipt of the insurance payment to the Insurer's account within the terms and to the extent provided for by the Agreement.
The Insurer shall be liable under the Agreement from the moment the Insured Person passes the exit border control of Ukraine, but not earlier than the date specified in the Agreement as the beginning of the term of this Agreement. The insurance premium shall be paid no later than the date of commencement of the Agreement. If the Insurant fails to pay the insurance premium within the specified period, the Insurance Agreement shall not come into force.
This Agreement shall be terminated from the moment the Insured Person passes the entry border control of Ukraine, but not later than the date specified as the date of expiration of this Agreement.
In the case of multiple travel insurance ("MultiTrip"/ "MULT"), the Insurer shall be liable within the total number of days of the Insured Person's stay abroad during the term of the Agreement. The Insurer shall be liable within the number of days specified in the Agreement. At each trip abroad, the term of the Agreement remains unchanged, while the duration of the trip is automatically reduced by the number of days spent by the Insured Person in the territory of this Agreement.
If the Insured Person uses all the days of stay abroad, in accordance with the terms of the Agreement, the Agreement is considered to have expired due to the fulfillment by the Insurer of its obligations to the Insured Person in full. In this case, the contract terminates in 24 hours. 00 min. on the 90th day of the Insured Person's continuous stay abroad within the term of the Agreement (unless otherwise provided by the Agreement).
The Agreement cannot be terminated after the start of the trip (the beginning of the term of the Agreement), if the Agreement was concluded for a single trip ("One time trip"/ "ONE").
7. Exclusions from Insured Events and Grounds for Refusal to Make Insurance Payments
Persons under the age of 1 year and over 80 years who at the time of conclusion of the Agreement were recognized as legally incapable, were disabled of the first group, suffered from severe nervous diseases (including tumors of the brain or spinal cord, damage to the nervous system, acute encephalitis), were registered in specialized dispensaries (including, but not limited to: oncological, anti-tuberculosis, dermatovenereological, narcological, psychoneurological; in accident insurance: narcological, psychoneurological), centers for the prevention and control of AIDS).
Persons recognized as legally incapable in accordance with the procedure established by the current legislation of Ukraine, as well as persons suffering from severe nervous diseases, acute encephalitis, mental illnesses, diseases of the cardiovascular system with severe circulatory disorders, severe diabetes, systemic lesions of the musculoskeletal system cannot be insured against an accident. The effect of insurance coverage in respect of a particular Insured Person shall expire as soon as such person has become such a person who cannot be insured for the reasons specified in this paragraph.
Insurance events do not include and insurance indemnity is not paid if the losses of the Insured Person are related to an event that is not specified as an insurance risk or event in these ZUSP-Offer, and/or took place not during the term of the Agreement or outside the territory of the Agreement.
The Insurer does not indemnify for consequential damages, including, but not limited to, non-pecuniary damage, damage caused to the reputation or image of a third party, fines, penalties or other financial sanctions, which are not a direct consequence of the damage caused to third parties.
The Insurer does not reimburse the costs associated with:
- exposure to ionizing radiation, radioactive contamination of any origin;
- the Insured Person's engagement in any kind of mass sports, sports of the highest achievements, including during competitions or training, or professional activities, unless otherwise provided by the terms of the Individual Part of the Agreement.
Insured events do not include:
― carrying out any planned surgical interventions;
― surgical interventions for the treatment of malignant and benign neoplasms;
― chemotherapy treatment of malignant neoplasms, including malignant neoplasms of lymphoid, hematopoietic and related tissues;
― radiation therapy or radiosurgical treatment;
― surgical interventions - joint prosthetics;
― surgical interventions in order to treat diseases or old injuries of the spine and joints;
― coronary angiography and planned surgical interventions on the heart and blood vessels, including stenting;
― surgical interventions for surgical correction of acquired and congenital defects;
― transplantation of organs and tissues for any diseases;
― treatment of slow viral infections of the central nervous system, chronic viral hepatitis (hepatitis "B", hepatitis "C", viral hepatitis not specified), AIDS, sexually transmitted infectious diseases and THORCH infections;
― treatment of mental and behavioral disorders due to the use of psychoactive substances (alcohol, drugs and toxic substances);
― treatment of chronic mental illness and panic attacks;
― Infertility treatment.
― cash, traveler's checks, bank cards, securities;
― personal and business documentation (including commercial or scientific materials),
― travel documents, passports and any kind of documents;
― air tickets, railway or other tickets,
― especially valuable things and items, namely: precious metals and products made of them, precious and semi-precious stones without settings, jewelry, fur products, philatelic, numismatic and other collections or items that are inherently precious, precious or
― rare, things and objects of artistic or historical value;
― fuel coupons;
― any type of dentures (including dentures) and contact lenses;
― audiovisual recordings, (portable) portable audio, photo, film, video, computing and software systems, printing devices, etc., and any accessories to them;
― objects of religious cult;
― animals, plants and seeds.
8. Limits of the insurer's liability for a separate object of insurance, insurance risk and/or insured event, group of insurance risks and/or insured events (if any), other components of the insurance product
In the event of a Class 18 insured event, the Insurer organizes services within the following limits:
Costs
|
Insurance program, liability limit within the sum insured |
|||
S (Standart) |
E (Elite) |
P (Premium) |
||
Medical expenses (Class 18.1) | ||||
1 | Calling an ambulance
|
up to 100%
|
up to 100%
|
up to 100%
|
2 | Emergency inpatient care
|
up to 100%
|
up to 100%
|
up to 100%
|
3 | Emergency outpatient care
|
up to 100%
|
up to 100%
|
up to 100%
|
4 | Emergency medical care, emergency outpatient or inpatient care in connection with SARS-CoV-2 disease (COVID-19)
|
up to 100%
|
up to 100%
|
up to 100%
|
5 | Emergency dental care
|
up to 150 USD
|
up to 200 USD
|
up to 200 USD
|
6 | Emergency gynecological and obstetric care up to the 30th week of pregnancy
|
up to 100%
|
up to 100%
|
up to 100%
|
7 | Help with PTSD
|
up to 100%
|
up to 100%
|
up to 100%
|
8 | Telemedicine consultations
|
up to 100%
|
up to 100%
|
up to 100%
|
9 | Transportation of the Insured Person to the nearest medical facility
|
up to 500 USD
|
up to 500 USD
|
up to 500 USD
|
10 | Transportation of the Insured Person to the country of permanent residence (medical evacuation)
|
up to 500 USD
|
up to 500 USD
|
up to 500 USD
|
11 | Repatriation of the body of the Insured Person to the country of permanent residence (Ukraine)
|
up to 100%
|
up to 100%
|
up to 100%
|
12 | Burial of the Insured Person in the host country
|
-
|
up to 10%
|
up to 10%
|
13 | Organization of urgent message transmission
|
-
|
up to 20 USD
|
up to 20 USD
|
14 | Organization of support for non-insured events "Medical Concierge"
|
-
|
up to 100%
|
up to 100%
|
15 | Organization of an alternative consultation
|
-
|
up to 100%
|
up to 100%
|
16 | Travel (return) of children under 16 years of age to Ukraine
|
-
|
-
|
up to 500 USD
|
17 | Travel in economy class for a close relative
|
-
|
-
|
up to 500 USD
|
Expenses other than medical expenses (Class 18.2) | ||||
18 | Losses of the Insured Person from loss, shortage, damage or damage of all or part of the Insured Baggage
|
100%, when this Option is enabled in the Program
|
||
The currency of all liability limits corresponds to the currency of the sum insured
|
Calling an ambulance in case of conditions requiring such assistance at the pre-hospital stage (at the place of the case): in case of accidents, acute diseases and conditions that pose a threat to the life of the Insured Person. It is carried out by specialized ambulance teams using specialized equipped vehicles.
The Insurer reimburses the costs of: departure of the ambulance team, express diagnostics and emergency care at the place of the incident (call), provision of medicines and consumable medical materials, delivery by ambulance to a specialized medical institution for further treatment.
Emergency inpatient care in case of sudden illness or accident, including the cost of emergency operations, diagnostic laboratory tests, instrumental examinations, medication prescribed by a doctor and payment for the services of a certified doctor abroad.
Emergency outpatient care in case of sudden illness or accident, including the cost of emergency operations, diagnostic laboratory tests, instrumental examinations, medication prescribed by a doctor and payment for the services of a certified doctor abroad.
The coverage is valid from the 4th day from the date specified as the date of conclusion of the Agreement.
Emergency medical care, emergency outpatient or inpatient care in connection with SARS-CoV-2 (COVID-19) disease, including the cost of diagnostic laboratory tests, instrumental examinations, medications prescribed by a doctor and payment for the services of a certified doctor abroad within 50% of the sum insured.
This risk is covered by the payment of diagnostic tests only in the presence of symptoms of especially dangerous infections and symptoms of respiratory diseases (class X ICD 10), namely COVID-19.
The Coverage is valid from the 4th day from the date specified in Part 1 as the date of conclusion of the Agreement.
The following are not covered: preventive diagnostic tests (tests that must be done when crossing the border of the country of entry in order to obtain the right to enter, testing if necessary to determine the presence of infection when information appears that there was contact with an infected person in the absence of symptoms of the disease, testing at the request of the Insured Person without medical necessity, testing without a referral from the attending physician and without the consent of the Assistance and other preventive tests) self-isolation or observation, evacuation costs to Ukraine, payment for tickets to return to Ukraine, reimbursement of expenses for unused tickets.
Emergency dental care within the limit of liability determined by the Insurance Program.
The Coverage is valid from the 4th day from the date specified in Part 1 as the date of conclusion of the Agreement.
Emergency gynecological and obstetric care for medical reasons up to the 30th week of pregnancy.
Providing care for PTSD (post-traumatic stress disorder).
Psychological diagnostics and 1 psychotherapeutic session are covered.
Means of communication:
- application "DOBRODOC +"";
- telephone number 0800 330 036.
Telemedicine consultations are carried out from 8:00 a.m. to 8:00 p.m. daily.
The Coverage is valid from the 4th day from the date specified in Part 1 as the date of conclusion of the Agreement.
Telemedicine consultations
The option provides for the organization and payment of the consultation, which is provided by the doctor of the Assistance. If technically possible and necessary, the client may be offered an electronic prescription indicating the international nonproprietary name (INN) of the active ingredient of the medicinal product.
The Coverage is valid from the 4th day from the date specified in Part 1 as the date of conclusion of the Agreement.
Transportation of the Insured Person to the nearest medical institution, within the limit of liability determined by the Insurance Program, in case of sudden (acute) illness or accident, if his/her independent movement is impossible due to a serious condition.
Transportation of the Insured Person to the country of permanent residence (medical evacuation), within the limit of liability determined by the Insurance Program, in case of sudden illness or accident.
Medical evacuation/repatriation (economy class travel) from abroad, the need for which arose as a result of an accident or sudden illness, which is confirmed by relevant documents and is medically appropriate, is carried out to the hospital closest to the international airport (in the case of air transportation) or closest to the place of permanent residence. The costs of the accompanying person are also reimbursed if there is a medical certificate confirming the need for escort from abroad to the place of evacuation of the Insured Person. Evacuation/repatriation is also carried out in cases where the costs of hospital stay may exceed the costs of evacuation or the limit of the sum insured established by the Insurance Agreement and medical evacuation is not contraindicated from a medical point of view. The decision on medical evacuation/repatriation is made by the Insurer.
Medical evacuation/repatriation is carried out within 15 days after the end of the insurance period, if it is necessary for medical reasons or the Insurer has decided on such transportation. If the Insured Person or his/her relatives refused such medical evacuation/repatriation, then in the future they organize such return on their own and at their own expense. In this case, he/she may be compensated for the cost of economy class tickets to the territory of Ukraine: The Insured Person must purchase a ticket and apply for reimbursement within 30 days from the date of return to Ukraine. Tickets will be refunded up to the limit of 300 EUR/USD at the official exchange rate of the National Bank of Ukraine on the date of purchase of tickets.
Repatriation of the body of the Insured Person to the country of permanent residence (Ukraine), within the limits of liability determined by the Insurance Program, in case of death of the Insured Person as a result of an accident or sudden illness.
Repatriation of the body or remains to an international airport (in the case of air transportation) or to the place of destination with the consent of relatives. For this purpose, the relatives of the deceased are obliged to provide the Insurer with duly executed documents confirming family ties with the Insured Person as soon as possible. The type of transport and the terms of repatriation are determined by the Insurer.With the consent of relatives, the repatriation of the remains can be replaced by cremation and transportation of the urn with ashes.
Burial of the Insured Person in the host country, if they do not exceed the costs of repatriation to the country of permanent residence (in agreement with the Insurer and close relatives of the Insured Person).
Organization of the transmission of urgent messages related to the insured event, within the limit of liability determined by the Insurance Program.
Organization of support for non-insured events "Medical Concierge"
The option provides advice and medical care that is not covered by the insurance policy or is an exclusion from coverage (non-insured event). Includes:
a) advice on what to do in a particular case if the event is not insured (depending on the country, condition and type of assistance required);
b) assistance in finding analogues of drugs according to INN (international nonproprietary name) abroad in case of chronic diseases, the treatment of which is not included in the coverage. At the same time, the cost of medicines is not included in the option and must be paid independently by the Insured Person;
c) organization of Telemedicine Doctor's Consultation / Online Doctor's Consultation, which does not apply to insured events;
d) organization of the search for the necessary doctor and appointment with the doctor (if possible). At the same time, the cost of a doctor's consultation is not included in the option and must be paid independently by the Insured Person:
- the option applies to all non-insured events;
- The insured person has the status of Temporary Protection, but does not want to wait for the date of the appointment, for which he/she is scheduled to visit for free assistance;
- Outpatient care is required during the period of the 3-day time deductible.
Organization of an alternative consultation "Second Opinion". Providing an advisory opinion based on the collection and detailed study of the patient's medical data by the doctor.
If the Insured Person wishes to receive this service at his/her own discretion, the Assistance will organize a consultation, and the Insured Person shall pay the cost of the service provided.
Travel (return) of children under 16 years of age to Ukraine in economy class to Ukraine in case of long-term illness of the Insured Person (stay in a medical institution for more than 10 days), with whom they were abroad, within the limit of liability determined by the Insurance Program.
Travel in economy class of a close relative to visit the Insured Person in case of his/her stay in the intensive care unit for more than 10 days.
Losses incurred by the Insured Person due to loss, shortage, damage or damage of all or part of the Insured Baggage due to the action of any events during its transportation by professional carriers, within the limits of liability determined by the Insurance Program.
Insurance coverage applies only to baggage that:
9. Procedure for Calculation and Conditions of Insurance Payments
Upon occurrence of an event that can be recognized as an insured event, the Insurer makes a decision on payment or refusal to pay insurance compensation within 10 (ten) working days from the date of receipt of all necessary documents, by drawing up an insurance act or an act of refusal to pay insurance compensation, respectively.
The decision period is extended by the Insurer for the period of medical examination, waiting for documentation and information about the case from the Assistance, responses of competent authorities, medical or other institutions at the request of the Insurer and in accordance with the terms of this Agreement.
The Insurer shall pay the insurance indemnity within 7 (seven) working days from the date of approval of the insurance act.
In case of refusal to pay the insurance indemnity, the Insurer is obliged to inform the Insurant/Insured Person in writing of the justified reasons for the refusal within 7 (seven) working days from the date of drawing up the act of refusal to pay the insurance indemnity.
The amount of insurance indemnity is determined by the Insurer on the basis of the received documents certifying the fact of occurrence of the insured event.
The insurance indemnity is paid by the Insurer on the basis of the insurance act within the limits of the sum insured for one Insured Person and liability limits, in the amount of actual and documented expenses minus the deductible, the amount of which is established in this Agreement.
Insurance indemnity on the territory of Ukraine is made in the currency of Ukraine. If the limit of the Insurer's liability is set in foreign currency, then the payment (including the calculation of the deductible) is carried out at the rate of the National Bank of Ukraine on the date of the insured event with the deduction of all taxes and fees provided for by the current legislation of Ukraine. If the Agreement extends to a foreign territory in accordance with agreements concluded with foreign partners, then the procedure for currency settlements is regulated in accordance with the current legislation of Ukraine.
The sum insured per one Insured Person shall be reduced during the term of the Agreement by the amount of insurance payments made.
The Insurer does not reimburse the deductible specified in the Insurance Agreement.
Documents on the insured event must be provided to the Insurer within 30 (thirty) calendar days from the date of return to Ukraine after the Insured Person personally incurs such expenses. If there were substantial reasons why the documents were not submitted on time, they shall be submitted as soon as possible, with documentary justification of the reasons for the delay.
If there are grounds for doubts as to the validity (legality) of the insurance indemnity, the Insurer may postpone the decision to make the insurance indemnity until the circumstances and consequences of the event that has the signs of an insured event are clarified. The term of such deferral shall not exceed 90 (ninety) calendar days;
10. Possible consequences for the consumer in case of non-fulfillment of obligations determined by the insurance contract, including untimely notification of the occurrence of an insured event without valid reasons and late payment of the insurance premiu
In the case of self-payment for medical services, upon the occurrence of an event that has signs of an insured event (unforeseen medical expenses for the provision of emergency medical care) in the host country without the involvement and agreement with the Assistance or the Insurer, the latter reimburses these costs in the amount of no more than 150 USD. At the same time, the Insured Person (Insurant) is obliged to notify the Insurer immediately, as soon as possible, but not later than 48 hours from the moment of occurrence of the insured event, in any way that allows to record the fact of such notification. Within 2 (two) working days after returning to the territory of Ukraine, provide the Insurer with a written application for payment of insurance compensation. If, for valid reasons, the Insured Person (Insurant) was unable to submit an application for payment of insurance indemnity within the specified period, this period may be extended with the consent of the Insurer.
If the Insurant fails to pay the insurance premium within the specified period, the Insurance Agreement shall not come into force.
11. Information on the possibility of purchasing an insurance product separately, if such a product is offered together with an accompanying and/or additional product, work or service that is not insurance, as part of one package or contract
An insurance product is not a supplement to other goods, works or services that are not insurable. In connection with the conclusion of the agreement, there is no need to obtain additional or related services of the insurer and/or third parties related to the receipt of financial services under the agreement.
12. Conditions for obtaining a discount on the insurance product and promotional offers of the insurer (if any), including the terms of their validity
No discounts on the product.
No promotional offers.