As used in this definition, the term “appropriate” shall mean taking patient safety and cost
effectiveness into consideration. When specifically applied to in-patient treatment, medically
necessary also means that diagnosis cannot be made, or treatment cannot be safely and effectively
provided on an out-patient basis.
1.42
Medical practitioner
is a physician who is licensed to practice medicine under the law of the country
in which treatment is given and where he/she is practising within the limits of his/her licence.
1.43
Medical practitioner fees
refer to non-surgical treatment performed or administered by a medical
practitioner.
1.44
Medical repatriation
is an optional level of cover and where provided will be shown in the Table of
Benefits. This benefit means that if the necessary treatment for which you are covered is not available
locally, you can choose to be medically evacuated to your home country for treatment, instead of to
the nearest appropriate medical centre. This only applies when your home country is located within
your geographical area of cover. Following completion of treatment, we will also cover the cost of the
return trip, at economy rates, to your principal country of residence. The return journey must be
made within one month after treatment has been completed.
Members must contact Allianz Worldwide Care at the first indication that repatriation is required.
From this point onwards Allianz Worldwide Care will organise and coordinate all stages of the
repatriation until the member is safely received into care at their destination. In the event that
repatriation services are not organised by Allianz Worldwide Care, we reserve the right to decline all
costs incurred.
1.45
Midwife fees
refer to fees charged by a midwife or birth assistant, who, according to the law of the
country in which treatment is given, has fulfilled the necessary training and passed the necessary
state examinations.
1.46
Newborn care
includes customary examinations required to assess the integrity and basic function
of the child's organs and skeletal structures. These essential examinations are carried out immediately
following birth. Further preventive diagnostic procedures, such as routine swabs, blood typing and
hearing tests, are not covered. Any medically necessary follow-up investigations and treatment are
covered under the newborn's own policy. Please note that for multiple birth babies born as a result of
medically assisted reproduction, in-patient treatment is limited to £24,900/€30,000/US$40,500/
CHF39,000 per child for the first three months following birth. Out-patient treatment is paid within
the terms of the Out-patient Plan.
1.47
Non-prescribed physiotherapy
refers to treatment by a registered physiotherapist where referral by
a medical practitioner has not been obtained prior to undergoing treatment. Where this benefit
applies, cover is limited to the number of sessions indicated in your Table of Benefits. Additional
sessions required over and above this limit must be prescribed in order for cover to continue; these
sessions will be subject to the prescribed physiotherapy benefit limit. Physiotherapy (either
prescribed, or a combination of non-prescribed and prescribed treatment) is initially restricted to 12
sessions per condition, after which the treatment must be reviewed by the referring medical
practitioner. Should further sessions be required, a progress report must be submitted to us, which
indicates the medical necessity for any further treatment. Physiotherapy does not include therapies
such as Rolfing, Massage, Pilates, Fango and Milta therapy.
1.48
Nursing at home or in a convalescent home
refers to nursing received immediately after or
instead of, eligible in-patient or day-care treatment. We will only pay the benefit listed in the Table of
Benefits where the treating doctor decides (and our Medical Director agrees) that it is medically
necessary for the member to stay in a convalescent home or have a nurse in attendance at home.
Cover is not provided for spas, cure-centres and health resorts or in relation to palliative care or long
term care (see definitions 1.59 and 1.38).
10
Allianz Worldwide Care
Definitions
