Benefits in detail

Travel health insurance benefits

The following benefits are reimbursable:

1. Medically necessary expenditures for

a) outpatient medical treatment (does not apply for treatment by an alternative practitioner), including X-ray diagnostics;

b) prescribed medicine, dressing material and remedies except for massages, therapeutic baths and poultices. The term “medicine” does not include nutriments and strengthening supplements, cosmetic products and the like, even if they are prescribed by the treating physician and include medicinal substances; certain medicine-like nutriments that are imperative in order to avoid serious health damage (e. g. in case of enzyme deficiency diseases, Crohn’s disease and cystic fibrosis), are, however, considered as medicine.

c) dental treatment for pain relief and simple fillings (amalgam fillings) as well as repair of existing dentures;

d) inpatient treatment including operations and ancillary costs of operations in hospitals which are under constant medical supervision and use methods scientifically recognized in Germany or the country of stay;

e) transport to the nearest appropriate hospital for the purpose of inpatient treatment;

f) medically necessary walking aids and rental of a wheelchair.

No claim for compensation can be made, as far as the policyholder or his/her insured person can claim compensation from an own or third-party insurance contract that was concluded prior to or after the conclusion of the present contract.

This applies in particular with regard to more general insurance products like health insurance or breakdown coverage. It also applies if such insurance includes a subsidiarity clause. With regard to such types of insurance, the present insurance policy is regarded as a more specific insurance according to this contract. If the other insurer denies his obligation to perform in writing, there shall, however, be an advance payment within this contract. The policyholder or his/her insured person shall do everything in his/her power to help that claims against other insurers can be pursued.

Medical treatment in Germany

The following benefits are reimbursable:

a) Expenses for outpatient medical and dental treatment up to 2.3 times the rate of either the Physician Fee Schedule (GOÄ) or Dentist Fee Schedule (GOZ) valid in Germany; or up to 1.8 times the rate in case of benefits pursuant to paragraphs A, E or O of the GOÄ; or up to 1.15 times the rate in case of benefits pursuant to paragraph M and number 437 of the GOÄ.

b) In case of inpatient treatment in a hospital: expenses for the general care level without optional services and for separately billable treatments by an attending physician equivalent to outpatient medical treatment within the framework established under item a).

2. Additional costs

a) for medically necessary or prescribed return transport of an ill insured person from abroad to his/her permanent residence in his/her home country, as far as medical care is not guaranteed abroad and return transport is necessary within the course of reimbursable medical treatment. Unless there are medical reasons to do otherwise, the insured shall choose the most cost-effective means of transport. Travel expenses saved by return transport shall be set off against the benefits.

b) up to 10,000 EUR for costs arising (in the event of death) through the repatriation of the insured person’s remains to his/her home country or through a funeral at the place of death.

The following applies to all benefits: scope of benefits and requirements of insurance coverage result from the General Insurance Conditions and the respective special conditions.

Private liability insurance benefits (if agreed)

The sum insured under the private liability insurance policy is a lump sum of 1,000,000 EUR for bodily injuries and property damage.

The insurance coverage only applies if the insured person is not sufficiently covered by other insurance policies.

The following applies to all benefits: scope of benefits and requirements of insurance coverage result from the General Liability Insurance Conditions in connection with the Special Conditions.

Accident insurance benefits (if agreed)

This insurance covers the following:

Payment in the event of death in the amount of 5,000 EUR
Payment in the event of 100% accidental disability in the amount of 30,000 EUR (disability benefit 30,000 EUR with no increase in the sum insured in proportion to the degree of disability)

The following applies to all benefits: scope of benefits and requirements of insurance coverage result from the General Accident Conditions in connection with the Special Conditions.

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