1.39
Maternity/paternity cash benefit
applies to the Channel Islands Plan only and if provided under
your plan, an amount will be paid to each parent insured with Allianz Worldwide Care, following the
birth of a child dependant. This benefit is only payable where treatment is received free of charge and
the amount payable will be indicated in your Table of Benefits. To claim the maternity/paternity cash
benefit, please send us a copy of the baby’s birth certificate within three months of the birth. To be
eligible for this benefit, the mother/father must be covered under our Healthcare Plan for the
Channel Islands for a minimum of 10 continuous months before the baby is born.
1.40
Medical evacuation
applies where the necessary treatment for which the insured person is covered
is not available locally or if adequately screened blood is unavailable in the event of an emergency.
We will evacuate the insured person to the nearest appropriate medical centre (which may or may
not be located in the insured person’s home country) by ambulance, helicopter or aeroplane. The
medical evacuation, which should be requested by your physician, will be carried out in the most
economical way having regard to the medical condition. Following completion of treatment, we will
also cover the cost of the return trip, at economy rates, for the evacuated member to return to his/her
principal country of residence.
If medical necessity prevents the insured member from undertaking the evacuation or transportation
following discharge from an in-patient episode of care, we will cover the reasonable cost of hotel
accommodation up to a maximum of seven days, comprising of a private room with en-suite
facilities. We do not cover costs for hotel suites, four or five star hotel accommodation or hotel
accommodation for an accompanying person.
Where an insured member has been evacuated to the nearest appropriate medical centre for
ongoing treatment, we will agree to cover the reasonable cost of hotel accommodation comprising
of a private room with en-suite facilities. The cost of such accommodation must be more economical
than successive transportation costs to/from the nearest appropriate medical centre and the principal
country of residence. Hotel accommodation for an accompanying person is not covered.
Where adequately screened blood is not available locally, we will, where appropriate, endeavour to
locate and transport screened blood and sterile transfusion equipment, where this is advised by the
treating physician. We will also endeavour to do this when our medical experts so advise. Allianz
Worldwide Care and its agents accept no liability in the event that such endeavours are unsuccessful
or in the event that contaminated blood or equipment is used by the treating authority.
Members must contact Allianz Worldwide Care at the first indication that an evacuation is required.
From this point onwards Allianz Worldwide Care will organise and coordinate all stages of the
evacuation until the member is safely received into care at their destination. In the event that
evacuation services are not organised by Allianz Worldwide Care, we reserve the right to decline all
costs incurred.
1.41
Medical necessity
refers to medical treatment, services or supplies that are determined to be
medically necessary and appropriate. They must be:
(a) Essential to identify or treat a patient's condition, illness or injury.
(b) Consistent with the patient's symptoms, diagnosis or treatment of the underlying condition.
(c) In accordance with generally accepted medical practice and professional standards of medical
care in the medical community at the time.
(d) Required for reasons other than the comfort or convenience of the patient or his/her physician.
(e) Proven and demonstrated to have medical value.
(f) Considered to be the most appropriate type and level of service or supply.
(g) Provided at an appropriate facility, in an appropriate setting and at an appropriate level of care for
the treatment of a patient’s medical condition.
(h) Provided only for an appropriate duration of time.
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