Oncology, Chemotherapy and Radiotherapy
includes hospital charges for tests and drugs
that are related specifically to the treatment of
malignant disease (cancer).
Organ Transplantation Surgery
is the costs
incurred in respect of kidney, heart, heart-lung
and liver transplants up to a maximum limit per
transplant as shown in the Certificate. No other
organ transplantation is covered. The cost of
acquisition of the organ and any costs incurred by
the donor are not covered.
Outpatient Consultations
includes consultations
provided by a Physician who is licensed as a
General Practitioner, Specialist or Consultant.
Outpatient Diagnostic Treatment
includes
laboratory testing, radiographic and nuclear
medicine procedures, magnetic resonance imaging
(MRI) and computerised tomography (CT) used
to diagnose and treat medical conditions, that
are provided by or ordered by a Physician who is
licensed as a General Practitioner, Specialist or
Consultant.
Overall Limits
are the total aggregate benefits that
may be claimed in any one Certificate period by an
Insured Person, and are shown on the Certificate.
Physician
is a legally licensed medical
practitioner/therapist recognised by the law of the
country where treatment is provided and who, in
rendering such treatment, is practising within the
scope of his/her licensing and training.
Physiotherapy
is treatment provided by a licensed
Physiotherapist that has been ordered by a
Physician.
Pre-Existing Conditions
are any known medical
conditions (or related conditions) that have been
diagnosed, needed medical treatment (including
drugs, special diets, injections or other procedures
or investigations) or for which medical advice has
been sought, or undiagnosed symptoms which
have NOT been disclosed in your Application
Form.
Prescription Drugs
include medications whose
sale and use are legally restricted to the order of a
Physician, and do not include items that may be
purchased without a Physician’s prescription.
Administration
Arbitration:
Any difference in respect of medical
opinion in connection with the results of an
accident or illness will be settled between two
medical experts appointed in writing by the two
parties to the dispute. Any difference of opinion
between the two medical experts shall be referred
to an umpire who shall have been appointed in
writing by the two medical experts at the outset.
Cancellation:
If any claim shall in any respect
be false or fraudulent or if fraudulent means or
devices are used by the Insured Person or anyone
acting on his behalf to obtain benefit hereunder
then the Certificate shall be cancelled immediately
and all benefit and premium forfeited. The Plan
shall be cancelled immediately if any relevant
facts were not disclosed or were misrepresented at
the time of inception of the Plan.
Commencement and renewal:
Insurance shall
commence from the date specified on the
Certificate. Premiums are payable on or before the
inception date of the Plan. At renewal, premiums
are payable prior to the Due Date to avoid
termination of cover.
The Plan is an annual contract which until
terminated shall be renewed each year on the
anniversary of the Due Date subject to the Rules
and premiums in force at the time of each renewal
and any variations as may be set out in writing by
the Insurers.
Renewal will be effected by the Insured Person
paying and the Insurer accepting the required
renewal premium prior to the Due Date.
Co-ordination of benefits
The Plan will
not provide compensation other than on a
proportionate basis if the Insured Person has any
other insurance in force or is entitled to indemnity
from any other source, including local National
Health Schemes/Services, in respect of the same
bodily injury, sickness, disease, death or expense.
The Insurer has full rights of subrogation.
Due Date
is the date of commencement or renewal
of cover as shown on the Certificate.
Eligibility:
There is no maximum age for
enrolment in the Plan. The plan is available
to persons of any nationality. The Plan is only
available to persons who are resident in Europe.
Dependants are also eligible to join. Newborn
children shall be eligible for insurance from birth.
The benefits available to newborn children are
as defined under Newborn Care and up to the
limits shown in the Certificate. Cover is subject
to completion of an Addition of Dependant form
within fourteen days of birth.
Examinations:
The Insurer shall have the right and
opportunity through their medical representative
to examine any Insured Person whenever and so
often as may be reasonably required within the
duration of any Claim. In addition the Insurer
shall have the right to require an autopsy in the
case of death, where this is not forbidden by law.
Legal proceedings:
No action at law or equity
shall be brought to recover under the Plan prior
to the expiration of 60 days after the proof of
claim has been furnished in accordance with the
requirements of the Rules. Nor shall any such
action be brought at all unless commenced within
six years from the date of the Claim.
The parties are free to choose the law applicable
to this contract of insurance. Unless specifically
agreed to the contrary, this contract of insurance
shall be governed by the law of England and
subject to the exclusive jurisdiction of the courts
of England and Wales. Unless otherwise agreed
the language of this contract of insurance shall be
English.
No Claims Deductible Reduction
If no claims are
made during a Certificate period by an Insured
Person and/or their dependants, on renewal of the
Plan the Insured Person shall be eligible for a 10%
reduction in the Plan Deductibles applicable at the
Due Date. If no claims are made in subsequent
Certificate periods, a further 10% reduction to
the Plan Deductibles shall be applied on renewal
at each subsequent Due Date, up to a maximum
reduction of 50%. Once a claim has been made
by the Insured Person and/or their dependants the
full Deductible will apply at the next Due Date.
Return to Home Country:
Cover can remain in
force when an Insured Person returns to his/
her Home Country, provided only that the Home
Country is in Europe.
Termination of Cover:
The Plan may be
terminated with effect from any Due Date by either
party. The Insurer, whilst acting as Insurer of
MediCare, will not invoke cancellation as a result
of an Insured Person’s health record whilst insured
under the Plan. However, renewal will be subject
to premiums and Rules offered by the Insurer.
If the Plan is terminated by the Insured Person at
a date other than the Due Date, a proportionate
refund of premium will be made by the Insurer,
less an administration charge of
€
50. No
proportionate refund of premium will be made if a
claim has been made by the Insured Person and/or
any dependant in the current Certificate period.
All premiums will be payable in advance of the
Due Date. If payment is not made on or before the
Due Date the agreement will be terminated with
effect from the Due Date.
Claims
Pre-Authorisation:
All inpatient costs and any
other claim likely to exceed
€
3,250 in any
one Certificate period must be authorised and
agreed by the 24 hour Assistance Company
before being incurred. In the case of an
emergency admission, the Assistance Company
must be notified within 72 hours.
Notice and proof of claim:
The Insured Person
must provide written notice of a claim, no later
than 90 days from the start of treatment, to the
Insurer or to the appointed claims administrator.
A separate claim form must be submitted for each
medical condition.
Such notice must be provided even where the
original supporting documentation is not yet
available. Written notice must be followed, when
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