Allianz - Employee Benefit Guide

International Healthcare Plans
Employee Benefit Guide

Valid from 1st November 2008
Allianz Worldwide Care
2
Welcome to Allianz Worldwide Care.

This guide sets out the benefits and rules of your
Thanks to a package negotiated by your company, you and your family can now depend on Allianz the world.
Allianz Worldwide Care plan. For details of your insurance company.
Worldwide Care, as your health insurer, to give you access to the best care possible wherever you are in We specialise solely in international health insurance and are backed by the resources and expertise of
contract please refer to your
Allianz SE, one of the worlds leading insurance companies, providing you with a service that is fast, flexible and totally reliable. This brochure describes in detail how we offer you access to the care you need, when you need it most.
Allianz Worldwide Care Limited, part of the Allianz Group, is registered in Ireland and regulated by the Irish Financial Services Regulatory Authority. Registered Office: 18B Beckett Way, Park West Business Campus, Nangor Road, Dublin 12, Ireland. Registered no.: 310852
Table of contents.
Member services. Helpline Service 24/5. Emergency Assistance Service 24/7. MediLine Medical Advice Service 24/7. Membership Pack. Online Services. Medical Provider Finder. What you are covered for. Benefit limits. Medical necessity. Chronic conditions. Pre-existing conditions. Waiting period. Co-payments or deductibles. Where you are covered. Your Core Plan explained. Other benefits under your Core Plan. Your Out-patient Plan explained. Your Dental Plan explained. Your Repatriation Plan explained. What your healthcare cover does not pay for.
4
5-11 5 6 6 7 10 11 12-28 12 13 13 14 14 14 15 15 17 25 27 28 29-35
Paying premiums and general information. Paying premiums. Important events. General information. How to claim. In-patient claims. Out-patient or dental claims. Fraud. Treatment Guarantee. Treatment in the USA. Questions answered. Making a complaint. Definitions. Additional policy terms.
36-45 36 38 43 46-56 46 47 51 51 55 57 58 59-68 69
Member services.
Please note that calls to our Helpline will be recorded and may be monitored for training, quality purposes or to assist with the resolution of complaints. Please also note that in some instances the toll-free numbers are not accessible from a mobile phone. In this case, please dial our normal Helpline number.
Please find details of all our member services below.
Helpline Service 24/5.

professional, multilingual staff are available 24 hours a day, 5 days a week (Sunday 6.00pm to Friday 7.00pm GMT), to handle your policy enquiries. Wherever you are in the world, and Allianz Worldwide Cares in-house team of
Helpline English: German: French: Spanish: Italian: Fax:
+ 353 1 630 1301 + 353 1 630 1302 + 353 1 630 1303 + 353 1 630 1304 + 353 1 630 1305 + 353 1 630 1306
whatever time of the day, we are available over the phone or via email to deal with your enquiry. Our Helpline staff have instant access to your policy details and any historical communication with us require e.g. confirmation of cover or an update on the status of your claim or Treatment Guarantee
so that we can provide you with the assistance you request. You can contact us by phone, fax or email
as follows:
Email: [email protected]
Toll-free from Singapore: 800 353 1018 Toll-free from Hong Kong: 800 901 705 Toll-free from North China: 10 800 744 1259 Toll-free from South China: 10 800 441 0115 Toll-free from the USA: 1 866 266 2182 Toll-free from France, Belgium & Switzerland: 00 800 66 302 302 Toll-free from Italy: 800 088 736
5
Member services
In the event that you require emergency medical treatment in a hospital or clinic, you should, where possible, contact our Helpline as soon as possible (contact details on page 5). Our emergency assistance service is available 24 hours a day, 365 days a year, to provide you with a range of emergency assistance services such as arranging an emergency medical evacuation or providing a Treatment Guarantee to your hospital (see pages 51 to 55 for details on Treatment Guarantee). For emergency cases, Treatment Guarantee is not required in advance of in-patient treatment, however, we should be advised within 24 hours of the event. For emergency treatment, please note that we can take Treatment Guarantee Form details over the telephone if you call our Helpline. This will
6
Emergency Assistance Service 24/7.
Our medical advice service, MediLine, offers you immediate telephone access to an experienced, English speaking medical team that provides comprehensive medical advice and information, such as: Pre- and post-operative treatment advice Advice and information on a range of lifestyle issues e.g. nutrition and dietary information, sports injuries, advice on smoking and alcohol consumption
MediLine Medical Advice Service 24/7.
give us the opportunity to arrange the direct settlement of your hospital bills, where possible, and will ensure that your claim can be processed without any delays.
Travel health information pre- and post-travel e.g. vaccinations Patient drug information e.g. advice on medication usage and reaction
You can access this member service 24 hours a day, 365 days a year on Tel: + 44 (0) 208 403 9970 you should contact the Allianz Worldwide Care Helpline directly (contact details on page 5). Please be advised that for policy or claims queries
before beginning any new treatment or if you have any questions regarding a medical condition. You understand and agree that Allianz Worldwide Care is not responsible or liable for any claim, loss or damage directly or indirectly resulting from your use of this advice line or the information or the resources provided through this service. Calls to the MediLine will be recorded and may be monitored for training and quality purposes.
Membership Pack.
Once your company and Allianz Worldwide Care have signed an insurance contract guaranteeing health insurance cover for you and your will be provided. The Membership Pack, which could be either soft copy or paper based dependants (if relevant), a full Membership Pack
Please note that the MediLine and its health-related information and resources are not intended to be a substitute for professional medical advice or for the care that patients receive from their doctors. It is not intended to be used for medical diagnosis or treatment and information should not be relied upon for that purpose. Always seek the advice of your doctor
Member services
(depending on which option was selected by your company), contains the following items:
renewal date of your cover (and effective dates of when dependants were added). It is important that you check that the information is correct. Please let us know, as soon as possible, if any corrections are required.
Your personalised Membership Card
Allianz Worldwide Care supplies a personalised Membership Card to every member, which are only a phone call away from help. We contains our essential contact numbers and addresses. This means that you and your family times. If you lose the card, dont worry, simply new card to be sent to you. suggest that you keep this card with you at all
Your Employee Benefit Guide
Benefit Guide should be read in conjunction with to your company. For details of the insurance contract, please refer your Insurance Certificate and Table of Benefits.
Allianz Worldwide Care plan. The Employee
This guide sets out the benefits and rules of your
contact our Helpline and we will arrange for a
Your Insurance Certificate
dependants. It also states the start date and

8
your company has chosen for you and your
Your Insurance Certificate details the plan that
A Treatment Guarantee Form
It is important that the relevant sections of this and are submitted for approval prior to any form are completed by you and your physician
treatment which requires Treatment
Guarantee. Treatment Guarantee is required your Table of Benefits. Please note that the our website. this document and marked with a 1 or a 2 in
us) to advise you of when a claim has been received and when it has been processed. Please note that the Claim Form is also available on our website.
for all treatments listed on pages 52 and 53 of Treatment Guarantee Form is also available on
Your Table of Benefits
A Claim Form
This document details the benefits and limits Benefits will also detail what benefits require submission of a Treatment Guarantee Form prior to treatment.
available to you under your plan. The Table of
To ensure that your claim is paid quickly and without delay, it is important that you follow 56). Fully completed Claim Forms are the guidelines on: How to claim (pages 46 to processed and payment instructions issued to your bank within 48 hours. Where further information is required to complete your claim, you/your medical practitioner will be notified by email or mail within 24 hours of receipt of the Claim Form. Emails are automatically sent to you (where email addresses are provided to
Your Online Services username and password

If this option has been selected by your based Online Services. company, you will receive a username and password allowing you access to our web-
Member services
Online Services.
access our secure Online Services through our website www.allianzworldwidecare.com If your company has requested this facility, you can
Online Services allows you to: View and amend your personal details online Securely retrieve a lost or forgotten username and password Download your Insurance Certificate, Employee Benefit Guide and Membership eCard in PDF format View your Table of Benefits and check how much remains payable under each benefit limit Confirm the status of any claims submitted to us and view claims related correspondence
If we have been provided with your email address, your Policy number, Surname and Date of birth,
'register' button on the login screen. Please type in
you can access your online account by clicking the
we have on record for you.
login details will then be sent to the email address
documents. An automated email containing your
exactly as shown on your Membership Pack
If we have not been provided with your email Pack.

10
available if you are part of a group scheme which has subscribed to this service on your behalf. Helpline. For Online Services assistance, please contact our
Please note that access to Online Services is only
address, your login details will have been sent to
you in a letter included as part of your Membership
Medical Provider Finder.

www.allianzworldwidecare.com. This online Allianz Worldwide Care website Our Medical Provider directory is available on the
doctors and specialists on a country by country
directory allows you to search for hospitals, clinics,
Surgery, Neurosurgery or Traumatology etc.
Medicine, as well as on specialism e.g. General
under Medical Practitioner categories e.g. Internal
specific regions and cities. Users can also search
basis, with the ability to narrow down the search to
Treatment Guarantee, please complete and submit a Treatment Guarantee Form prior to undergoing medical expenses with your medical provider. the required treatment. We will, where possible, try to arrange the direct settlement of your in-patient
11
in this directory. For any treatment that requires
You are not restricted to using the providers listed
What you are covered for.

To ensure that you have all the information and and a Table of Benefits have been included in your standard Core Plans, which might have been documents that you need, an Insurance Certificate Membership Pack. Both of these specify the plan(s) chosen in combination with one of our standard other hand, your plan may have been designed specifically for your company. selected by your company. This could be one of our
The following is an overview of your healthcare cover.

your Table of Benefits and Insurance Certificate. If you have any queries regarding the cover provided under your plan, simply contact us for confirmation of your entitlements. Our Helpline policy enquiries.
staff are available 24 hours a day between Sunday 6.00pm and Friday 7.00pm GMT to deal with your
Out-patient, Dental or Repatriation Plans. On the
Benefit limits.
This section provides an outline of the cover we
provide under each plan. Please be aware that this cover is subject to our policy definitions (detailed and limitations (detailed on pages 29 to 35). on pages 59 to 68), as well as our policy exclusions To fully understand your insurance cover with us,
Table of Benefits. The maximum plan benefit, which pay for all benefits in total, per member, per applies to certain plans, is the maximum we will benefits also have a specific benefit limit which is Insurance Year, under that particular plan. Some in a convalescent home'. Specific benefit limits may be provided on a "per Insurance Year" basis, a "per applied separately, for example 'Nursing at home or
There are two kinds of benefit limits shown in the
please read this guide carefully in conjunction with

12
lifetime" basis or on a "per event" basis, such as per trip, per visit or per pregnancy. In some instances Where the term "Full refund" appears next to we will pay a percentage of the costs for the specific benefit e.g. "65% refund, up to 3,650/5,000/$7,100". certain benefits, please note that this refund is
In addition, our team of claims experts will ensure their charges are reasonable and customary. By reasonable and customary we mean that the charges are in accordance with standard and that we only reimburse medical providers where
applies to your plan(s).
subject to the maximum plan benefit, if one
generally accepted medical procedures. If a claim is deemed by us to be inappropriate, we reserve the
Medical necessity.
right to reduce the amount payable by us.
control medical costs, where possible, in order to professionals ensure that planned medical
As an insurance company, our clients expect us to
Chronic conditions.
following characteristics:
A chronic condition is defined as a sickness, illness, disease or injury which has one or more of the
To do this, our team of highly experienced medical necessary. By medically necessary we mean interventions are appropriate and medically
maintain affordable health insurance premiums.
treatment that is the most appropriate type and condition, illness or injury. level of service required to treat a patient's
Is recurrent in nature Is without a known, generally recognised cure Is not generally deemed to respond well to treatment Requires palliative treatment
13
What you are covered for
Requires prolonged supervision or monitoring Leads to permanent disability
Pre-existing conditions are covered under the section of your Table of Benefits.
policy unless indicated otherwise in the Notes
your Table of Benefits chronic conditions are
Unless indicated otherwise in the Notes section of
Pre-existing conditions.
any related conditions for which symptom(s) have been shown at some point during the 5 years prior such condition or related condition about which you or your dependants know, knew or could be deemed to be pre-existing. any medical treatment or advice was sought. Any to commencement of cover, irrespective of whether Pre-existing conditions are medical conditions or
covered within the limits of your plan.
Waiting period.
A waiting period is a period of time commencing
on your policy start date (or effective date if you are cover for particular benefits. Your Table of Benefits periods. will indicate which benefits are subject to waiting a dependant), during which you are not entitled to
Co-payments or deductibles.
A deductible is an amount which is payable by you and which will be deducted by us from the eligible reimbursable sum. Whereas, a co-
reasonably have been assumed to have known, will
payment is a percentage of the eligible costs
14
that any co-payment in excess of the maximum terms and conditions of your policy.
insured person, per Insurance Year. This means
may include a maximum co-payment per
incurred, which is payable by you. Some plans
Your Core Plan explained.

In-patient benefits.
In the case of in-patient treatment, you will be
amount will be reimbursed by us, subject to the Please refer to your Table of Benefits to apply to benefits within your plan.
reimbursed within the limits of your cover for the such as medical practitioner fees, prescription drugs and materials, anaesthesia and theatre charges, therapist fees, surgical appliances,
determine where co-payments or deductibles
hospital accommodation, as well as other benefits
benefits included under your Core Plan. This covers
Where you are covered.

geographical area of cover. Please refer to your Insurance Certificate to confirm this. Your company will have specified your particular
prostheses, diagnostic tests and organ transplant. Treatment Guarantee is required for all in-patient
51 to 55).
of Treatment Guarantee, please refer to pages
benefits listed in your Table of Benefits (for details
15
In-patient psychiatry and psychotherapy.

If cover for psychiatry and psychotherapy is included in your plan, this is provided on an in-
agreed otherwise between your company and us. the level of cover available under your plan.
Please refer to your Table of Benefits to determine
patient basis only, unless otherwise specified in months applies, unless agreed otherwise between your company and us. your Table of Benefits. A waiting period of 10
Emergency in-patient dental treatment.

If cover for emergency in-patient dental treatment is included in your plan, this benefit provides you dental treatment due to a serious accident and your dependants with a refund for emergency
Accommodation costs for one parent staying in hospital with an insured child under 18.
hospitalisation, the cost of one parent's In the event of an insured child requiring
requiring hospitalisation, up to the amount up dental treatment, dental surgery, dental
cover under this benefit does not extend to follow-
indicated in your Table of Benefits. Please note that
accommodation staying with a child under 18
years of age will be covered for the duration of the
bed is available in the hospital we will cover the
admission to hospital. In the event that no suitable
provided for these benefits, it will be listed separately in your Table of Benefits.
prostheses, orthodontics or periodontics. If cover is
equivalent of a 3 star hotel daily room rate, unless

16
Other benefits under your Core Plan.
out-patient department. Please note that Treatment Guarantee is required.
Your company may have included some or all of benefit entitlement and to check if Treatment
the following benefits in your plan. To confirm your of Benefits. If you would like any further Guarantee is necessary, please refer to your Table
Nursing at home or in a convalescent home.

home or in a convalescent home, if the nursing is provided immediately after, or instead of, hospitalisation, unless agreed otherwise between your company and us. The maximum amount available under this benefit is indicated in the Table of Benefits. It should also be noted that that this benefit is not payable in respect of You are entitled to claim for nursing received at
Day-care treatment.
clarification, simply call our Helpline.
is required.
care facility. Please note that Treatment Guarantee
day-care treatment received in a hospital or day-
Cover is provided under our Core Plans for planned
Treatment Guarantee is required. Please also note palliative care or long term care, which, where provided, is covered under a separate benefit.
Out-patient surgery.
performed in a surgery, hospital, day-care facility or
Cover is also provided for surgical procedures
17
Palliative care and long term care.

If this benefit is included in your Core Plan, we will cover the costs of ongoing treatment aimed at alleviating the physical/psychological suffering associated with progressive, incurable illness and Benefits and that submission of a Treatment well as for palliative care. limited to the benefit limit stated in your Table of Guarantee Form is required for long term care as
provided is indicated in your Table of Benefits.
Please note that Treatment Guarantee is required.
Local ambulance.
Cover is provided for ambulance transport required the nearest available and appropriate hospital or licensed medical facility. for an emergency or due to medical necessity, to
maintaining quality of life. Please note that cover is
Emergency treatment outside area of cover.

you and your dependants will be covered for If this benefit has been selected by your company,
Rehabilitation treatment.
If cover is provided under your plan, this is for rehabilitation facility, immediately after the acute medical treatment ceases. The level of cover treatment which takes place in a licensed
cover (where relevant). Cover is provided up to a maximum benefit amount. You will not be covered maximum period of 6 weeks per trip within the
and holiday trips outside of your chosen area of
emergencies only, which occur during business
18
for any curative or follow-up non-emergency
treatment, even if deemed unable to travel to a
Medical evacuation.
aeroplane transportation to the nearest This benefit provides for ambulance, helicopter or
country within your geographical area of cover. If Group Scheme Administrator.
you are moving outside your area of cover for more than 6 weeks, you should contact your companys Not only are you covered in the event of an
be located in your home country), if the necessary treatment for which you are covered is not unavailable in the event of an emergency.
appropriate medical centre (which may or may not available locally, or if adequately screened blood is The medical evacuation will be carried out in the medical condition. Your physician should request Guarantee will be required. most economical way, having regard to your the medical evacuation. Please note that Treatment If medical necessity prevents the insured member following discharge from an in-patient episode of
accident, but you are also covered for the sudden results in a medical condition that presents an
beginning, or worsening, of a severe illness which immediate threat to your health. To be considered as emergency treatment, and thus covered under
this benefit, please remember that the medical treatment provided by a physician, medical 24 hours of the emergency event.
practitioner or specialist should commence within
from undertaking the evacuation or transportation
19
accommodation up to a maximum of 7 days, comprising of a private room with en-suite 5 star hotel accommodation or hotel
care, we will cover the reasonable cost of hotel
Where adequately screened blood is not available locally, we will, where appropriate, endeavour to transfusion equipment, where this is advised by locate and transport screened blood and sterile
facilities. We do not cover costs for hotel suites, 4 or accommodation for an accompanying person. the nearest appropriate medical centre for ongoing Where an insured member has been evacuated to
the event that such endeavours are unsuccessful or is used by the treating authority.
Worldwide Care and its agents accept no liability in
do this when our medical experts so advise. Allianz
the treating physician. We will also endeavour to
accommodation must be more economical than appropriate medical centre and the principal
room with en-suite facilities. The cost of such
hotel accommodation comprising of a private
treatment, we will also cover the reasonable cost of
in the event that contaminated blood or equipment
successive transportation costs to/from the nearest country of residence. Hotel accommodation for an that Treatment Guarantee is required. accompanying person is not covered. Please note
Expenses for one person accompanying an evacuated/repatriated person.

If this cover is available under your plan, one person will be entitled to travel with the evacuated
may be a maximum amount that can be claimed
transport at economy rates will be paid for. There
the same transportation vehicle, round trip
or repatriated person. If this cannot take place in
20
under this benefit, and if so, this will be indicated in the Table of Benefits. Please note that required. accommodation and other related expenses are not covered and that Treatment Guarantee is
persons are not covered. All covered expenses in must be pre-approved by us using a Treatment Guarantee Form.
connection with the repatriation of mortal remains
Repatriation of mortal remains.
CT, MRI and PET scans.

and us, CT, MRI and PET scans, as well as CT/PET basis, are fully covered within the limits of your Unless agreed otherwise between your company scans, carried out on an in-patient or out-patient required for MRI, PET and CT/PET scans. Core Plan. Please note that Treatment Guarantee is
provide a maximum benefit as indicated in the principal country of residence to the country of
Where covered, in the event of death we will
Table of Benefits, to cover the cost of transportation of the insured persons mortal remains from the burial. Covered expenses include, but are not
limited to, expenses for embalming, a container authorisations. Cremation costs will only be costs and the necessary government legally appropriate for transportation, shipping
Oncology.
If this benefit has been selected by your company, you will be covered for specialist fees, diagnostic tests, radiotherapy, chemotherapy and hospital
purposes. Costs incurred by any accompanying
covered in the event that this is required for legal
21
charges incurred in relation to the planning and in-patient and day-care treatment.
carrying out of treatment for cancer, from the point of diagnosis. Treatment Guarantee is required for
benefit limit may apply. Benefit limits for routine
maternity are payable on either a per pregnancy or per Insurance Year basis. Please refer to your Table of Benefits for details. Treatment Guarantee
Routine maternity.
maternity refers to medically necessary costs If this benefit is provided under your plan, routine
is required for in-patient treatment.
Complications of pregnancy and childbirth.

the mother. Only the following complications that Complications of pregnancy relates to the health of
incurred during pregnancy and childbirth, well as newborn care. Costs related to
including hospital charges, specialist fees, the
mother's pre- and post-natal care, midwife fees as
complications of pregnancy and childbirth are not payable under routine maternity. Please note that a waiting period of 10 months will
and hydatidiform mole.
covered: ectopic pregnancy, miscarriage, stillbirth
arise during the pre-natal stages of pregnancy are
following conditions that arise during childbirth
Complications of childbirth refers only to the
apply to this benefit, unless otherwise agreed
and that require a recognised obstetric procedure: post-partum haemorrhage and retained placental membrane. Where the insureds plan also includes
between your company and us. Please note that a

22
caesarean sections. Treatment Guarantee is required. A 10 month waiting period applies to Treatment Guarantee is required.
childbirth shall also refer to medically necessary
a routine maternity benefit, complications of
In-patient cash benefit.

If this benefit appears in your plan, a specified amount will be paid to you for each night you only payable where treatment is received number of nights per Insurance Year. The benefit is completely free of charge and in respect of indicated in your Table of Benefits. treatment that is covered within the terms of your plan. The amount payable per night will be spend in hospital, up to a specified maximum
otherwise agreed between your company and us.
complications of pregnancy and childbirth unless
Home delivery.
If the home delivery benefit has been selected by indicated in the Table of Benefits. your company, a lump sum will be paid as
Emergency out-patient treatment.

you are covered for treatment received in a casualty ward or emergency room, following an accident or sudden illness. To be considered emergency, the treatment must be received within 24 hours of the
23
If this benefit has been included in your Core Plan,
emergency event. You are covered up to the amount specified in your Table of Benefits. However, if your company selected out-patient
However, if your company selected dental cover for you, you will also be covered, under the terms of this plan, for dental treatment in excess of the emergency cover benefit limit.
excess of the emergency cover benefit limit.
terms of this plan, for out-patient treatment in
cover for you, you will also be covered, under the
Cover for newborn children.

and us, the following will apply: Unless otherwise agreed between your company
Emergency out-patient dental treatment.

treatment received in a dental surgery or hospital fillings per Insurance Year, and/or the repair of be received within 24 hours of the emergency If selected by your company, this cover includes
emergency room for the immediate relief of dental
be accepted for cover from birth, provided that we Notification of the birth after 4 weeks will result in the date of such notification. In-patient treatment to 22,000/30,000/US$42,500 per child for the first medically assisted reproduction will be covered up for multiple birth babies born as a result of newborn children being accepted for cover from are notified within 4 weeks of the date of birth.
For non-underwritten groups, newborn infants will
pain. Cover includes temporary fillings, limited to 3 damage caused in an accident. The treatment must
dental prostheses or root canal treatment.

24
event. Please note that cover does not extend to
paid within the terms of the Out-patient Plan. infants (with the exception of multiple birth babies) will be accepted for cover from birth
3 months following birth. Out-patient treatment is
For groups with full medical underwriting, newborn without medical underwriting, provided that we
Your Out-patient Plan explained.

Out-patient Plans, each offering different levels of reimbursements, deductibles and co-payments. If your company has included out-patient treatment in your cover, a plan different to our your exact cover, please refer to your Table of Benefits. Allianz Worldwide Care offers a range of
if the mother has been insured with us for
are notified within 4 weeks of the date of birth and 6 continuous months. Notification of the birth after underwritten and cover will only commence from the date of acceptance. In-patient treatment for 4 weeks will result in newborn children being
standard plans may have been selected. To confirm
be paid within the terms of the Out-patient Plan. subject to full medical underwriting. Please note that all multiple birth babies will be
months following birth. Out-patient treatment will
22,000/30,000/US$42,500 per child for the first 3
assisted reproduction will be covered up to
multiple birth babies born as a result of medically
Our standard Out-patient Plans include some or all of the following benefits: Prescription drugs Specialist fees Medical practitioner fees
25
Diagnostic tests Vaccinations acupuncture Chiropractic treatment, osteopathy, homeopathy, Chinese herbal medicine and oculomotor therapy and occupational therapy
conjunction with the Definitions section of this guide (pages 59 to 68).
Infertility treatment.
Unless agreed otherwise between your company and us, your plan will provide cover for non-invasive limits of your Out-patient Plan, if one has been selected. investigations into the cause of infertility, within the
Prescribed physiotherapy, speech therapy, Routine health checks Infertility treatment
Psychiatry and psychotherapy Prescribed medical aids Prescribed glasses and contact lenses
Should your Table of Benefits include a specific benefit for infertility treatment, you will also be covered for for infertility, such as hysterosalpingogram, otherwise between your company and us. laparoscopy or hysteroscopy. Please note that a further investigation necessary to establish the cause waiting period of 18 months will apply, unless agreed
Guarantee Form may be required for some of these period may also apply. These details are confirmed in your Table of Benefits, which should be read in benefits (please refer to pages 51 to 55). A waiting
Please note that submission of a Treatment
26
Out-patient Plan. For groups with full medical full medical underwriting.
Out-patient treatment is paid within the terms of the
$42,500 per child for the first 3 months following birth. underwriting, all multiple birth babies will be subject to
reproduction will be covered up to 22,000/30,000/
babies born as a result of medically assisted
Please note that in-patient treatment for multiple birth
Your Dental Plan explained.

please refer to your Table of Benefits.
If dental cover has been included in your plan, the our standard plans. To confirm your exact cover,
benefits your company has selected may differ from
Under our standard Dental Plans, you can benefit from benefit limits. The Dental Plans offer reimbursement the fees payable on a range of benefits, subject to dental cover that offers up to 100% reimbursement of
for e.g. the cost of X-rays, laboratory tests and treatment and dental prostheses.
materials, dental surgery, periodontics, orthodontic
us.
unless otherwise agreed between your company and
prostheses, a waiting period of 10 months will apply,
Please note that for orthodontic treatment and dental
27
Your Repatriation Plan explained.

indicated in your Table of Benefits. This is an optional plan and where covered will be If the necessary treatment for which you are for treatment rather than to the nearest
Plan will enable you to return to your home country
covered is not available locally, your Repatriation
your home country is located within your
appropriate medical centre. This only applies when
residence as long as the return journey is made within one month of completion of treatment. Please note that submission of a Treatment Guarantee Form is required.
trip, at economy rates, to your principal country of
treatment, we will also cover the cost of the return
geographical area of cover. Following completion of
28
What your healthcare cover does not pay for.

1.
cover unless for emergencies or authorised by us. Pre-existing conditions (including any preTreatment outside the geographical area of covered.
Although we cover most illnesses, expenses incurred for the following treatments, medical conditions and procedures are not covered under the policy unless confirmed otherwise in the Table of Benefits or in any written policy endorsement.
pre-existing, and if not declared will not be
2.
3.
existing chronic conditions) are covered under Special Conditions Form that issues with your Insurance Certificate, if relevant. Please note that if you are part of a group that this policy, unless indicated otherwise in a
(except during pregnancy or to treat
Products classified as vitamins or minerals deficiency syndromes), nutritional or dietary
diagnosed, clinically significant vitamin
but not limited to, special infant formula and cosmetic products, even if medically as having therapeutic effects. doctors prescription. recommended or prescribed or acknowledged Products that can be purchased without a Unless the Table of Benefits includes a
consultations and supplements, including,
required medical underwriting, any pre-existing conditions that were not declared by you on the policy. Conditions arising between signing the Worldwide Care will equally be deemed to be by the Underwriting Department of Allianz
Application Form will not be covered under the
4. 5.
Application Form and confirmation of acceptance
specific benefit for infertility treatment, cover

29
What your healthcare cover does not pay for
is limited to non-invasive investigations into Out-patient Plan.
the cause of infertility, within the limits of your
8.
In-patient treatment for multiple birth babies is limited to 22,000/30,000/US$42,500 per the Out-patient Plan.
born as a result of medically assisted reproduction child for the first 3 months following birth. Outpatient treatment is paid within the terms of
6.
investigations into, treatment and
Benefits, cover is not provided for
Unless stated otherwise in the Table of
complications arising from sterilisation, sexual dysfunction and contraception, including
9.
Cosmetic or plastic surgery, or any treatment arising from it, whether or not for medical/ re-constructive surgery necessary to restore the accident or surgery occurs during your membership of the scheme. psychological purposes. The only exception is
devices and all other contraceptives, even if prescribed for medical reasons. The only by a dermatologist. exception is the prescribing of contraceptives for the treatment of acne, where prescribed
insertion and removal of contraceptive
function or appearance after a disfiguring
accident, or as a result of surgery for cancer, if
7.
of danger to the life of the pregnant woman.
Termination of pregnancy except in the event
10. Stays in a cure centre, bath centre, spa, health

resort and recovery centre, even if the stay is medically prescribed.
30
11. Care and/or treatment of intentionally caused

diseases or self-inflicted injuries, including a suicide attempt. alcoholism.
quantitatively measured by qualified
developmental delay must have been personnel and documented as a 12 month delay in one of the above mentioned areas.
12. Care and/or treatment of drug addiction or 13. Illnesses, accidents and the consequences
the insured person.
15. We do not cover treatment for conditions

such as conduct disorder, attention deficit hyperactivity disorder, autism spectrum disorder, oppositional defiant disorder,
thereof, as well as instances of death, that are caused by the misuse of alcohol or drugs by
antisocial behaviour, obsessive-compulsive disorders, as well as all treatments that therapies, floor time and family therapy. relationships, such as communication encourage positive social-emotional
disorder, attachment disorders, adjustment
14. Developmental delay unless a child has not

following areas: cognitive, physical or
attained developmental milestones expected for a child of that age in one or more of the language development. We do not cover temporarily lagging in development. The conditions in which a child is slightly or
16. Speech therapy is only eligible for
reimbursement in the context of a diagnosed physical impairment such as, but not limited
31
(e.g. lingual paresis, brain injury) or
to, nasal obstruction, neurogenic impairment structure (e.g. cleft palate). We do not pay for articulation disorders involving the oral
progress report must be submitted to us, therapist or counsellor are not covered.
further treatment. Costs in respect of a family
which indicates the medical necessity for any
language disorder.
delay, dyslexia, dyspraxia or expressive
speech therapy related to developmental
19. Treatment for any illnesses, diseases or
17. Psychotherapy treatment, on an in-patient or

out-patient basis, is only covered where you clinical psychologist for further treatment. a clinical psychiatrist and referred to a or your dependants are initially diagnosed by
war, riots, civil disturbances, terrorism or acts been declared or not.
injuries resulting from active participation in against any foreign hostility, whether war has
20. Treatment for any medical conditions arising

directly or indirectly from chemical material whatsoever, including the combustion of nuclear fuel. contamination, radioactivity or any nuclear
18. Where covered, out-patient psychotherapy
treatment is initially restricted to 10 sessions
Should further sessions be required, a

32
reviewed by the referring clinical psychiatrist.
per condition, after which treatment must be
21. Investigations into or treatment of sleep

disorders, including insomnia.
22. Expenses for the acquisition of an organ
including, but not limited to, donor search,
27. Medical practitioner fees for the completion of 28. Home visits unless they are necessary
of visiting their medical practitioner,
typing, transport and administration costs. arising from an engagement in professional
a Claim Form or other administration charges. following the sudden onset of an acute physician or therapist.
23. Treatment or diagnostic procedures of injuries

sports.
illness, which renders the insured incapable
24. Any form of treatment or drug therapy which

medical practice. Definition 1.46). unproven based on generally accepted in our reasonable opinion is experimental or
29. Genetic testing except for DNA tests when

i.e. in the case of women aged 35 or over.
directly linked to an eligible amniocentesis
25. Orthomolecular treatment (please refer to 26. Consultations performed, as well as any drugs
parents or children.
30. Pre- and post-natal classes. 31. Triple/Barts, Quadruple or Spina Bifida tests,
except for women aged 35 and over.
or treatments prescribed, by you, your spouse,
32. Investigations into and treatment of obesity.

33
33. Investigations into and treatment of loss of

of hair is due to cancer treatment.
hair and any hair replacement unless the loss
39. Treatment in the USA is not covered, if we

treatment for a condition, when the
know or suspect that cover was purchased for the purpose of travelling to the USA to receive the member prior to the purchase of cover. symptoms of the condition were apparent to
34. Complementary treatment with the exception

Benefits. of those treatments indicated in the Table of
35. Treatment required as a result of failure to

seek or follow medical advice.
40. Travel costs to and from medical facilities

(including parking costs) for eligible and medical repatriation benefits. treatment, except any travel costs covered under local ambulance, medical evacuation
36. Treatment required as a result of medical error. 37. Treatment to change the refraction of one or
both eyes (laser eye correction).
41. Expenses incurred because of complications

for which cover is excluded or limited under your plan.
directly caused by an illness, injury or treatment
38. Sex change operations and related treatments.
34
42. The following treatments, medical conditions

or procedures or any adverse consequences or complications thereof, are not covered, Benefits: unless otherwise indicated in your Table of Dental treatment, dental surgery,
42.10 Routine health checks 42.11 In-patient psychiatry and
42.12 Out-patient psychiatry and 42.13 42.14 42.15 42.16

psychotherapy treatment Infertility treatment Rehabilitation treatment Medical repatriation Expenses for one person accompanying an evacuated/repatriated person
psychotherapy treatment
42.1
periodontics, orthodontics and dental
42.2 42.3 42.4 42.5 42.6 42.7 42.8 42.9
within the overall limit of your Core Plan Out-patient treatment Routine maternity Home delivery Vaccinations Emergency dental treatment Prescribed glasses and contact lenses Prescribed medical aids Preventive treatment
surgical procedures, which are covered
prostheses with the exception of oral
35
Paying premiums and general information.

Paying premiums.
If your company is responsible for paying your insurance premium.
payment of premiums to Allianz Worldwide Care dependants covered under the Company In most cases, your company is responsible for the
The following section provides you with general information on paying your premiums and details other important aspects of your membership.
If you are responsible for paying your insurance premium yourself.
required to pay the premium due to us in advance, your company and us. The amount your company each Insurance Year have been agreed between
premiums to Allianz Worldwide Care, you are
If you are responsible for the payment of your
for your membership and for the membership of
for the duration of your membership. Premiums for
that may be payable in respect of your or their membership.
payments due (such as Insurance Premium Tax)
Agreement, together with the amount of any other
have chosen, will be shown on your Insurance instalment is payable immediately after our acceptance of your application.
has agreed with us and the method of payment you
Certificate. The initial premium or the first premium
However, please note that you may be liable for company.

36
your company. For details, please check with your
payment of tax in respect of the premiums paid by
depending on the payment method you choose.
monthly, quarterly, half yearly or annual payments
chosen payment period. You may choose between
Subsequent premiums are due on the first day of the
the agreed quotation and your Payment Details through third parties. We are not responsible for payments made
Please note that if there is any difference between letter/Invoice, you should contact us immediately.
Paying other charges.

pay us the amount of any Insurance Premium Tax to your membership that may be imposed after you join and that we are required by law to pay or to on your Payment Details letter/Invoice. collect from you. The amount of any IPT or taxes, levies or charges that you have to pay us is shown You are required to pay to us any such IPT, taxes, unless otherwise required by law. In addition to paying premiums, you also have to
(IPT) and any new taxes, levies or charges relating
unable to pay your premium for any reason, please contact us on +353 1 630 1301. Changes in written instructions which must be received by us a payment terms can be made at policy renewal via
elected to pay when applying for cover. If you are
Your premium should be paid in the currency you
premium on time may result in loss of insurance cover.
Failure to pay an initial premium or subsequent
minimum of 30 days prior to the renewal date.
levies and charges when you pay your premiums,
Changes to premiums and other charges.

Each year on the renewal date, we may change how we calculate your premiums, how we determine
37
Paying premiums and general information
method of payment. Please be assured that if we do make changes they will only apply from your renewal date.
the premiums, what you have to pay and the
Within 30 days of the date on which the changes take effect, or Within 30 days of us telling you about the changes, whichever is later
We may change the amount you have to pay us in of IPT or any new such tax, levy or charge is charges at any time if there is a change in the rate respect of IPT or in respect of other taxes, levies or
Important events.
such tax, levy or charge.
introduced or there is a change in the rate of any
end your membership, or include other people as your dependants. This section explains exactly to continuously improve our service to our know the reason why.
important events such as when you start, renew or
Throughout this guide, you will see references to
If we do make any changes to your premiums or to you about the changes. If you do not accept any made, if you end your membership:
38
when, and how, these events take place. Our aim is
other taxes, levies or charges, we will write to tell and we will treat the changes as not having been
the amount you have to pay in respect of IPT or
members. In order to help us do this, if for any
reason you cancel your membership, please let us
changes we make, you can end your membership
Starting membership.
The insurance shall be valid as of the start date on the Insurance Certificate. The cover will continue until the group renewal date as detailed in your Insurance Certificate. Generally, this is one
dependant as agreed between your company and long as any child dependants remain under the defined age limit, if applicable).
you remain a member of a group scheme (and as
us. Their membership may continue for as long as
Insurance Year unless agreed otherwise between can renew the insurance on the basis of the time. You will be bound by those terms.
mid-year. At the end of this period, your company Employee Terms and Conditions applicable at that
your company and us or if you started your policy
Adding dependants.
You may apply to include any of your family
members under your membership as one of your us. Notification to add a dependant should be stated.
dependants, provided that you are allowed to do so under the agreement between your company and made through your company unless otherwise
When cover starts for dependants included in your membership.

your membership, their membership will start on If any other person is included as a dependant in
Certificate. This certificate will list them as a
the effective date as stated on your Insurance
be accepted for cover from birth, provided that we are notified within 4 weeks of the date of birth. Notification of the birth after 4 weeks will result in
39
For non-underwritten groups, newborn infants will
newborn children being accepted for cover from for multiple birth babies born as a result of
the date of such notification. In-patient treatment to 22,000/30,000/$42,500 per child for the first 3
assisted reproduction will be covered up to
22,000/30,000/$42,500 per child for the first 3
medically assisted reproduction will be covered up be paid within the terms of the Out-patient Plan. infants (with the exception of multiple birth babies) will be accepted for cover from birth months following birth. Out-patient treatment will
months following birth. Out-patient treatment will be paid within the terms of the Out-patient Plan.
subject to full medical underwriting.
Please note that all multiple birth babies will be
For groups with full medical underwriting, newborn
Renewing membership if your company is responsible for paying your insurance premium.
dependants, if applicable) is subject to your
without medical underwriting, provided that we if the mother has been insured with us for 6 weeks will result in newborn children being
are notified within 4 weeks of the date of birth and
The renewal of your membership (and that of your company renewing your membership under the Company Agreement. If your company renews the contract with Allianz
continuous months. Notification of the birth after 4 the date of acceptance. In-patient treatment for
underwritten and cover will only commence from multiple birth babies born as a result of medically
Certificate which will cover you (and your
Worldwide Care, you will receive a new Insurance
40
dependants, if applicable) until the next renewal date.
Ending your membership.

Your company can end your membership or that of any of your dependants by notifying us in writing. We cannot backdate the cancellation of your membership. Your membership will automatically end: At the end of the Insurance Year, if the and your company is terminated agreement between Allianz Worldwide Care If your company decides to end the cover or does not renew your membership If your company does not pay premiums or any other payment due under the Company Agreement with Allianz Worldwide Care If you are an individual payer and you do not
Renewing membership if you are responsible for paying your insurance premium yourself.
If your company renews your membership (and Company Agreement, your policy will be that of your dependants, if applicable) under the automatically renewed for the next Insurance Year, provided that all premiums due to us have been we would need to have up-to-date credit card paid and the payment details we have for you are still valid on the policy renewal date. For example, details for credit card payers. Please note that when you receive a new credit card with a new expiry date, you will need to notify us of this change.
pay premiums or any other payment due under

41
the Company Agreement with Allianz Worldwide Care When you stop working for the company Upon the death of the policyholder
Applying for cover if group membership ends.

If your cover under the Company Agreement comes to an end, you can apply for cover under one of our Healthcare Plans for individuals. Your policy may decide on the acceptance of your application. month of leaving the group scheme. The be subject to underwriting. We reserve the right to The application must be submitted within one commencement date, if accepted for cover, will be the first day after leaving the group scheme.
Allianz Worldwide Care can end a persons
membership and that of all the other people listed on the Insurance Certificate if there is reasonable attempted to mislead us. By this, we mean giving false information or withholding pertinent evidence that the person concerned has misled, or information from us, or working with another party to give us false information, either intentionally or Whether you (or they) can join the scheme What premiums your company has to pay Whether we have to pay any claim carelessly, which may influence us when deciding:
42
General information.
Table of Benefits.
Your Table of Benefits will be issued using the be Euro, Sterling or US Dollar.
Amending your membership details.

either of the following occur: We will send you a new Insurance Certificate if If, with your companys approval, you are adding another dependant such as a newborn child to your membership entitled to make If we need to record any other changes
you pay the insurance premium yourself). This can
currency agreed with your company (or with you, if
Making changes to your cover.

The terms and conditions of your membership may be changed from time to time by agreement Care. between your company and Allianz Worldwide
requested by your company or which we are
earlier version you possess as from the start date shown on the new Insurance Certificate.
Your new Insurance Certificate will replace any
43
Other parties.
No other person is allowed to make or confirm any changes to your membership on our behalf, or to your membership will be valid unless it is Allianz Worldwide Care. decide not to enforce any of our rights. No change specifically agreed between your company and
If your treatment is needed as a result of somebody elses fault.

when somebody else is at fault, you must write and in which you are a victim. If so, you will need to treatment for an injury suffered in a road accident If you are claiming for treatment that is needed
tell us as soon as possible. For example, if you need
Policy expiry.
Please note that upon the expiry of your insurance expenses covered under the insurance policy and reimbursed up to 6 months after the expiry of the your insurance policy will no longer be covered.
44
take any reasonable steps we ask of you to obtain the treatment paid for by us.
the insurance details of the person at fault so that we can recover, from the other insurer, the cost of
cover, your right to reimbursement ends. Any
incurred during the period of cover shall be
for which we have paid, you must repay that Care.
If you are able to recover the cost of any treatment amount (and any interest) to Allianz Worldwide
insurance cover. However, any on-going or further treatment that is required after the expiry date of
If you are covered by another insurance scheme.

insurance cover for the cost of the treatment or the cost of the treatment. You must write to tell us if you have any other
Correspondence.
Letters between us must be sent by post and with documents to you. However, if you ask us at the of course return them to you. the postage paid. We do not usually return original time you send the original documents to us, we will
benefits you have claimed from us. If you do have
other insurance cover, we will only pay our share of
If you change your address/email address.

Any change in your home, business or email help us to keep in contact with you. Services as soon as possible. This information will address should be communicated to Client
Applicable law.
Your membership is governed by Irish law. Any dealt with by courts in Ireland. dispute that cannot otherwise be resolved will be
45
How to claim.
In-patient claims.
Before you make a claim, please check that your plan covers the treatment you are seeking. Please refer to your Table of Benefits and call our Helpline if you have any queries.
To arrange for direct settlement, we can assist you more quickly and efficiently if the following steps are taken: For planned treatment: 1. Please download a Treatment Guarantee Form from our website www.allianzworldwidecare.com. You/your physician will need to complete the relevant sections of the Treatment Guarantee Form. 2. Once fully completed, please send the Treatment Guarantee Form to us at least 5 of admission. You can submit it in the following ways:
possible and with sufficient notice, arrange for
If you have to go to a hospital, we will, where
direct settlement with the medical provider subject to any co-payments, deductibles and benefit limits
settle the bill for you by dealing directly with the hospital. All in-patient treatment requires submission of a Treatment Guarantee Form prior to pages 51 to 55. details on Treatment Guarantee can be found on commencement of treatment. Further important
i.e. where possible, Allianz Worldwide Care will
working days prior to treatment so that we
can ensure there will be no delays at the time
46
Scan and email to
Fax to +353 1 630 1306 or Post to the address shown on the Treatment Guarantee Form [email protected]
2. In the case of emergency treatment, to assist you in the claims process, please note that we can take Treatment Guarantee details settlement of your hospital bills, where be processed without any delays. over the phone if you call our Helpline. This
Guarantee Form details over the information to hand
hours, our Helpline can take Treatment
If treatment is due to take place within 72
gives us the opportunity to arrange the direct possible, and will ensure that your claim can
telephone if you have the required For emergency treatment: 1. While Treatment Guarantee is not required you, your physician, one of your dependants or a colleague needs to inform us about the hospital admission within 24 hours of the penalty is applied. event to ensure that no Treatment Guarantee in advance of emergency treatment, either
Out-patient or dental claims.

For out-patient or dental treatment, unless you have been informed of a different settlement arrangement, you will need to pay the medical be subject to the benefit limits of your plan. provider for these costs at the time of treatment
and then seek reimbursement from us, which will
When you visit a medical practitioner, dentist,
physician or specialist on an out-patient basis,
47
How to claim
www.allianzworldwidecare.com) and follow the steps below: 1. You will need to get an invoice from the nature of the treatment and the fees charged.
be downloaded from our website
please take a Claim Form with you (this form can
3. When submitting your Claim Form to us, please attach all original supporting pharmacy receipts with related documentation, invoices and receipts e.g. prescriptions (if available). It is your responsibility to keep copies of all copies of Claim Forms and medical correspondence lost in the post. correspondence with us (in particular, receipts). We cannot be held responsible for medical practitioner/physician invoices and
The Claim Form and Treatment Guarantee Form can be downloaded from our website: www.allianzworldwidecare.com
doctor/medical provider which states the
diagnosis or medical condition treated, the
2. Please complete sections 1-5 of the Claim be completed, dated and signed by your doctor if the invoice does not state the
Form. The other sections will only need to diagnosis and nature of the treatment (if
4. An email will automatically be sent to you to us) to advise you of when the claim has been received and when it has been processed. If we do not hold an email your claim has been processed.
(where email addresses have been provided
48
in sections 6 and 7 of the Claim Form).
doctor provides the information requested
you are responsible for ensuring that your
these details are not shown on the invoice,
address for you, we will write to you at your
correspondence address to advise you when
ADDRESS: Allianz Worldwide Care 18B Beckett Way Parkwest Business Campus Nangor Road Dublin 12 Ireland
Please note the following important points: 1. Fully completed Claim Forms are processed and payment instructions issued to your bank within 48 hours. Where further information is required to complete the
3. A separate Claim Form is required for each condition being claimed for. person claiming and for each medical
4. Please specify on the Claim Form the currency in which you wish to be paid, otherwise the benefit due to you will be paid in the currency of the invoice. On the rare occasion that the international banking regulations do not allow us to make a payment in the to you will be paid in the currency of your currency you have asked for, the benefit due invoice (where possible). If we have to make a conversion from one currency to another we will use the exchange rate that applies on the date on which the invoices were issued.
claim, you/your medical practitioner will
automatically be notified by email or mail 2. If the amount to be claimed is less than the not destroy or dispose of them. Keep
within 24 hours of receipt of the ClaimForm. deductible figure under your plan, remember to retain the Claim Form and receipts - do collecting all out-patient receipts and Claim Forms until you reach an amount in excess of your plan deductible. Then forward to us all completed Claim Forms together with original receipts/invoices.
49
How to claim
5. Please ensure that the payment details that avoid delays to claims settlement.
you supply on the Claim Form are correct, to
8. Upon expiry of your insurance cover, your right to reimbursement ends (for more expiry on page 44). details, please refer to the section on Policy
6. Please note that some out-patient treatments refer to the Table of Benefits to check which Form prior to treatment taking place. Please require submission of a Treatment Guarantee
9. All claims should be submitted to us with original supporting documentation, after the end of the Insurance Year, or if cover invoices and receipts no later than 6 months
benefits require Treatment Guarantee. 7. Please note that only costs for incurred limits of your policy, after taking into
treatment will be reimbursed within the Guarantee, and this will be net of any
consideration any required Treatment the Table of Benefits.
settle the claim.
cover. Beyond this time we are not obliged to
than 6 months after the end of the insurance
is cancelled within the Insurance Year, no later
deductibles or co-payments mentioned in
claim. We have the right to access all medical records and to have direct discussions with the medical provider or the treating physician. We may, at our own
obtaining all necessary information to process a
You and your dependants agree to assist us in
50
medical representative when we deem this to be
expense, request a medical examination by our
that claim. The amount of any claim settlement owing to us.
necessary. All information will be treated in strict
made to you before the fraudulent act or omission was discovered, will become immediately due and
confidence. We reserve the right to withhold benefits if you or your dependants have not honoured these
obligations.
You can track your claim through the Online Services section on our website if your company has selected this option. Please refer to page 10 to find out more about our Online Services.
Treatment Guarantee.
benefits available to you. whether Treatment Guarantee applies to any of the Please refer to your Table of Benefits to check
Fraud.
What is Treatment Guarantee?

Certain treatments and costs require you to submit required treatments or costs can then be guaranteed. a Treatment Guarantee Form in advance. Following approval by Allianz Worldwide Care, cover for these
If any claim is false, fraudulent, intentionally
acting on your or their behalf to obtain benefit
been used by you or your dependants or anyone
exaggerated or if fraudulent means or devices have under this policy, we will not pay any benefits for
51
How to claim
In the Table of Benefits, benefits which require preapproval through submission of a Treatment When required, the relevant sections of a us for approval prior to treatment. Guarantee Form are indicated by either a 1 or a 2. Treatment Guarantee Form need to be completed by you and your physician, and then submitted to Please contact us at least 5 working days prior to respond within 24 hours of receipt of a fully completed form.
ready to give over the phone, including the contact details of your doctor.
When is Treatment Guarantee required?

Treatment Guarantee is required for the following plan: benefits, which may or may not be included in your All in-patient treatments scans
receiving treatment so that we can ensure that there will be no delays at the time of admission. We will
MRI (Magnetic Resonance Imaging), PET
(Positron Emission Tomography) and CT/PET Nursing at home or in a convalescent home only) only) Routine maternity including complications of Oncology (in-patient and day-care treatment
Please note that if you call our Helpline, we can accept Treatment Guarantee requests over the hours. Please have as many details as possible phone if treatment is due to take place within 72
pregnancy and childbirth (in-patient treatment
52
Out-patient surgery Day-care treatment only) Occupational therapy (out-patient treatment Rehabilitation treatment
necessary and charges that are usual and necessity and appropriateness of costs.
customary. Therefore, it is vital that you contact us prior to treatment so that we can confirm medical In addition, Treatment Guarantee will help us to ways:
Palliative care and long term care evacuated/repatriated person
Expenses for one person accompanying an
Medical evacuation (or repatriation)
provide you with a better service in the following In the case of planned treatment, we will have
Repatriation of mortal remains
Your Table of Benefits will indicate which benefits require submission of a Treatment Guarantee Form prior to treatment.
possible, arrange for direct settlement, offering you cashless access to hospitals for in-patient treatment Your treatment can be overseen by our doctor
facilitate smooth admission and where
time to communicate with the hospital to
Why is Treatment Guarantee required?

As with all health insurance policies, your plan with us will only cover treatment that is medically
53
How to claim
In the case of an evacuation/repatriation, we evacuation on your behalf. Please contact the will be able to organise and co-ordinate the Helpline Team for assistance with this process
respective treatment is subsequently proven to be eligible benefit. medically necessary, we will pay only 80% of the
What happens if Treatment Guarantee is not obtained?

Unless agreed otherwise between your company and us, the following will apply: If Treatment Guarantee approval is not obtained decline your claim.
If Treatment Guarantee is not obtained for the reserve the right to decline your claim. If the
benefits listed in the Table of Benefits with a 2, we
respective treatment is subsequently proven to be medically necessary, we will pay only 50% of the eligible benefit. While Treatment Guarantee is not required in
and the treatment received is subsequently proven
to be medically unnecessary, we reserve the right to If Treatment Guarantee is not obtained for the reserve the right to decline your claim. If the
54
to ensure that no Treatment Guarantee penalty is
informed within 24 hours of the emergency event
advance of emergency treatment, we should be
benefits listed in the Table of Benefits with a 1, we
give us the opportunity to arrange the direct
to complete a Treatment Guarantee Form. This will
take the details over the phone that will enable us
applied. In the case of emergency treatment we can
settlement of your hospital bills, where possible, without any delays.
and will ensure that your claim can be processed
symptoms of the condition were apparent to the member prior to the purchase of cover.
Treatment in the USA.

worldwide cover should instruct their medical verify eligibility of cover. We can then arrange For treatment in the USA, members with provider to contact our toll-free number (please see
InRoomMDTM.
InRoomMDTM in the USA to offer a number of Allianz Worldwide Care has partnered with
the reverse of your Membership Card) in order to
based in the USA or who are travelling there on available to members with Worldwide
additional benefits to members who are either
business or on holiday. InRoomMDTM services are geographical cover or to those who have the benefit for Emergency treatment outside area of cover. InRoomMDTM offers immediate access to a qualified
treatment.
direct settlement for in-patient and out-patient
covered, if we know or suspect that cover was
Please note that treatment in the USA is not
purchased for the purpose of travelling to the USA to receive treatment for a condition, when the
physician, at night, during weekends or when hospital Emergency Room (ER) as well as the
travelling, avoiding any unnecessary trips to a
possibility of long waiting times. Services include

55
How to claim
prescription refills and express ER triage and
physician visits, replacement of lost/forgotten
24hr a day telephone consultation, in-room
available in the USA, are supported in both English and Spanish. A telephonic translation service is available for incoming calls to the InRoomMDTM toll-free number, as and when required.
www.allianzworldwidecare.com/inroommd.php
hospital admittance. Full details can be found at To access InRoomMDTM, you can call the toll-free existing policy Membership Card/e-card). These your policy number ready (available on your
number 1800 649 0705. Youll simply need to have services are available on a cashless direct settlement basis.
InRoomMDTM medical services are offered in
conjunction with your Table of Benefits, subject to the limits of your cover, for medical care that is when travelling. These services, which are only required outside of normal working hours and/or
56
Questions answered.
For more details, please visit www.allianzworldwidecare.com
We have selected a few questions, which may be of interest to you. If you have further questions, please do not hesitate to contact us.
Q. In which countries can I receive treatment? A. Where the necessary medical treatment for which you are covered is not available locally, you can avail of treatment in any country within your geographical area of cover (your area of cover is confirmed in your Insurance Certificate). In order to seek reimbursement for medical treatment and travel expenses incurred, you will need to submit a Treatment Guarantee Form for approval prior to travel. Where the necessary medical treatment for which you are covered is available locally, but you choose to travel to another country within your geographical area of cover for treatment, we will reimburse all eligible costs incurred within the terms of your plan, however, we will not pay for travel expenses. Q. Which hospitals can I go to? A. You can use our online Medical Provider Finder to search for providers worldwide, however, you are not restricted to using providers from this directory. For any treatment that requires Treatment Guarantee, please contact our Helpline prior to undergoing the required treatment. We will, where possible, try to arrange the direct settlement of your in-patient medical expenses with your medical provider.
Q. What happens when I return to my home country? A. Unless otherwise agreed between your company and us, when you return to your home country to make it your principal country of residence, your policy can continue as long as your home country is within your geographical area of cover. Please note that cover in some countries is subject to legal restrictions, particularly for nationals of that country.
Q. Why do I need to complete a Treatment Guarantee Form? A. Treatment Guarantee is a process whereby Allianz Worldwide Care guarantees cover for certain treatments and costs following submission of a Treatment Guarantee Form. This will ensure that you have cashless access to hospitals as well as the fact that your treatment will be overseen by our in-house medical team.
57
Making a complaint.
We are always pleased to hear about aspects of appreciated, or that you have had problems with. If with as quickly and effectively as possible. procedure to ensure that your concerns are dealt something does go wrong, here is a simple your membership that you have particularly
Please find guidelines on our complaints process below.

18B Beckett Way Nangor Road Ireland Dublin 12 Allianz Worldwide Care
Park West Business Campus
and Friday 7.00 pm GMT).
(available 5 days a week between Sunday 6.00 pm
complaints. Please call us on +353 1 630 1301
first number to call if you have any comments or
The Allianz Worldwide Care Helpline is always the
Fax: +353 1 630 1399
Email: [email protected] If we have not been able to resolve the problem to
In cases where we are not able to solve the problem on the phone, please email, fax or write to us at:
Manager at the address above.
complaint further, please write to the General
your satisfaction and you wish to take your
58
Definitions.
These definitions apply to the benefits included in our range of Healthcare Plans and may or may not form part of your specific plan. Please refer to your Table of Benefits to clarify which benefits apply to your cover with us. Wherever the following words and phrases appear in your policy documentation, they will always have the meanings as defined below.
1.1 Accident is an injury which is the result of an unexpected event, independent of the will of the insured and which arises from a cause outside the individuals control. The cause and symptoms must be medically and objectively definable, allow for a diagnosis and require therapy.
1.2
1.3
Accommodation costs for one parent staying in hospital with an insured child under 18 refers to the hospital accommodation costs of one parent for the duration of the insured childs admission to hospital for eligible treatment. If a suitable bed is not available in the hospital, we will contribute the equivalent of a 3 star hotel daily room rate towards any hotel costs incurred. We will not, however, cover sundry expenses including, but not limited to, meals, telephone calls or newspapers. Chronic condition is defined as a sickness, illness, disease or injury which has one or more of the following characteristics:
1.4 1.5
Requires palliative treatment Requires prolonged supervision or monitoring Leads to permanent disability
Company is your employer and whose name is mentioned in the Company Agreement.
Is not generally deemed to respond well to

treatment
1.6
Company Agreement is the agreement we have with your employer, which allows you and your dependants to be insured with us. This agreement sets out who can be covered, when cover begins, how it is renewed and how premiums are paid. Complementary treatment refers to therapeutic and diagnostic treatment that exists outside the institutions where conventional medicine is taught. Such medicine includes chiropractic treatment, osteopathy, Chinese herbal medicine, homeopathy and acupuncture as practiced by approved therapists.
Is recurrent in nature Is without a known, generally recognised cure
59
Definitions
1.7
1.8
Complications of childbirth refers only to the following conditions that arise during childbirth and that require a recognised obstetric procedure: postpartum haemorrhage and retained placental membrane. Where the insureds plan also includes a routine maternity benefit, complications of childbirth shall also refer to medically necessary caesarean sections.
1.12 Dental prostheses include crowns, inlays, onlays, adhesive reconstructions/restorations, bridges, dentures and implants as well as all necessary and ancillary treatment required. 1.13 Dental surgery includes the extraction of teeth, apicoectomy, as well as the treatment of other oral problems such as congenital jaw deformities (e.g. cleft jaw), fractures and tumours. Dental surgery does not cover any surgical treatment that is related to dental implants.
1.9
Complications of pregnancy relates to the health of the mother. Only the following complications that arise during the pre-natal stages of pregnancy are covered: ectopic pregnancy, miscarriage, stillbirth and hydatidiform mole. Co-payment is the percentage of the costs which the insured person must pay.
1.14 Dental treatment includes an annual check up, simple fillings related to cavities or decay and root canal treatment.
1.10 Day-care treatment is planned treatment received in a hospital or day-care facility during the day, including a hospital room and nursing, that does not medically require the patient to stay overnight and where a discharge note is issued. 1.11 Deductible is that part of the cost which remains payable by you and which has to be deducted from the reimbursable sum.
1.15 Dependant is your spouse or partner (including same sex partner) and/or unmarried children (including any step, foster or adopted child) financially dependant on the policyholder and not more than 18 years old; or not more than 24 years old if in full time education and also named on your Insurance Certificate as one of your dependants.
1.16 Emergency constitutes the onset of a sudden and unforeseen medical condition that requires urgent medical assistance. Only treatment commencing within 24 hours of the emergency event will be covered.
60
1.17 Emergency in-patient dental treatment refers to acute emergency dental treatment due to a serious accident requiring hospitalisation. The treatment must be received within 24 hours of the emergency event. Please note that cover under this benefit does not extend to follow-up dental treatment, dental surgery, dental prostheses, orthodontics or periodontics. If cover is provided for these benefits, it will be listed separately in the Table of Benefits.
1.18 Emergency out-patient dental treatment is treatment received in a dental surgery/hospital emergency room for the immediate relief of dental pain, including temporary fillings limited to 3 fillings per Insurance Year, and/or the repair of damage caused in an accident. The treatment must be received within 24 hours of the emergency event. This does not include any form of dental prostheses or root canal treatment. 1.19 Emergency out-patient treatment is treatment received in a casualty ward/emergency room following an accident or sudden illness, where the insured does not, out of medical necessity, occupy a hospital bed. The treatment must be received within 24 hours of the emergency event.
1.20 Expenses for one person accompanying an evacuated/repatriated person refers to the cost of one person travelling with the evacuated/repatriated person. If this cannot take place in the same transportation vehicle, transport at economy rates will be paid for. Following completion of treatment, we will also cover the cost of the return trip, at economy rates, for the accompanying person to return to the country from where the evacuation/repatriation originated. Cover does not extend to hotel accommodation or other related expenses. 1.21 Home country is a country for which the insured person holds a current passport and to which the insured person would want to be repatriated.
1.23 Hospital accommodation refers to standard private or semi-private accommodation as indicated in the Table of Benefits. Deluxe, executive rooms and suites are not covered.
61
1.22 Hospital is any establishment which is licensed as a medical or surgical hospital in the country where it operates and where the patient is permanently supervised by a medical practitioner. The following establishments are not considered hospitals: rest and nursing homes, spas, cure-centres and health resorts.
Definitions
1.24 Infertility treatment refers to treatment for both sexes including all invasive investigative procedures necessary to establish the cause for infertility such as hysterosalpingogram, laparoscopy or hysteroscopy. In the case of InVitro Fertilisation (IVF), cover is limited to the amount specified in the Table of Benefits. 1.25 In-patient cash benefit is payable when treatment and accommodation for a medical condition, that would otherwise be covered under the insureds plan, is provided in a hospital where no charges are billed. Cover is limited to the amount specified in the Table of Benefits and is payable upon discharge from hospital. 1.26 In-patient treatment refers to treatment received in a hospital where an overnight stay is medically necessary.
1.29 Insured person is you and your dependants as stated on your Insurance Certificate.
1.31 Long term care refers to care over an extended period of time after the acute treatment has been completed, usually for a chronic condition or disability requiring periodic, intermittent or continuous care. Long term care can be provided at home, in the community, in a hospital or in a nursing home. 1.32 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 persons home country). The medical evacuation 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.
1.30 Local ambulance is ambulance transport required for an emergency or out of medical necessity, to the nearest available and appropriate hospital or licensed medical facility.
1.28 Insurance Year applies from the effective date of the insurance, as indicated on the Insurance Certificate and ends at the expiry date of the Company Agreement. The following Insurance Year coincides with the year defined in the Company Agreement.
62
1.27 Insurance Certificate is a document outlining the details of your cover and is issued by us. It confirms that an insurance relationship exists between your company and us.
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 7 days, comprising of a private room with en-suite facilities. We do not cover costs for hotel suites, 4 or 5 star hotel accommodation or hotel accommodation for an accompanying person.
1.33 Medical necessity refers to those medical 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
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.
(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 patients medical condition (h) Provided only for an appropriate duration of time
1.34 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.
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.
63
Definitions
1.36 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. 1.37 Midwife fees refers to fees incurred 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.
1.35 Medical practitioner fees refer to non-surgical treatment performed or administered by a medical practitioner.
1.39 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 1.31 and 1.49). 1.40 Obesity is diagnosed when a person has a BMI (Body Mass Index) of over 30 (a BMI calculator can be found on our website www.allianzworldwidecare.com).
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.
1.38 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
64
1.41 Occupational therapy refers to treatment that addresses the individuals development of fine motor skills, sensory integration, co-ordination, balance and other skills such as dressing, eating, grooming etc. in order to aid daily living and improve interactions with the physical and social world. Out-patient occupational therapy requires Treatment Guarantee.
1.42 Oncology refers to specialist fees, diagnostic tests, radiotherapy, chemotherapy and hospital charges incurred in relation to the planning and carrying out of treatment for cancer, from the point of diagnosis.
1.43 Oral surgical procedures are surgical procedures, such as, but not limited to, the removal of impacted wisdom teeth, when carried out in a hospital by an oral or maxillofacial surgeon. 1.44 Organ transplant is the surgical procedure in performing the following organ and/or tissue transplants: heart, heart/valve, heart/lung, liver, pancreas, pancreas/kidney, kidney, bone marrow, parathyroid, muscular/skeletal and cornea transplants. Expenses incurred in the acquisition of organs are not reimbursable.
1.48 Out-patient treatment refers to treatment provided in the practice or surgery of a medical practitioner, therapist or specialist that does not require the patient to be admitted to hospital. 1.49 Palliative care refers to in-patient, day-care or outpatient treatment following the diagnosis that the condition is terminal and treatment can no longer be expected to cure the condition. Included within the benefit we will pay for physical care, psychological care as well as hospital or hospice accommodation, nursing care and prescription drugs.
1.47 Out-patient surgery is a surgical procedure performed in a surgery, hospital, day-care facility or out-patient department that does not require the patient to stay overnight out of medical necessity.
1.45 Orthodontics is the use of devices to correct malocclusion and restore the teeth to proper alignment and function. 1.46 Orthomolecular treatment refers to treatment which aims to restore the optimum ecological environment for the body's cells by correcting deficiencies on the molecular level based on individual biochemistry. It uses natural substances such as vitamins, minerals, enzymes, hormones, etc.
1.50 Periodontics refers to dental treatment related to gum disease. 1.51 Post-natal care refers to the routine post-partum medical care received by the mother up to six weeks after delivery.
1.52 Pre-existing conditions are medical conditions or any related conditions for which symptom(s) have been shown at some point during the 5 years prior to
65
Definitions
1.53 Pregnancy refers to the period of time, from the date of the first diagnosis, until delivery.
commencement of cover, irrespective of whether any medical treatment or advice was sought. Any such condition or related condition about which you or your dependants know, knew or could reasonably have been assumed to have known, will be deemed to be preexisting. Conditions arising between completing the Application Form and confirmation of acceptance by the Underwriting Department of Allianz Worldwide Care will equally be deemed to be pre-existing.
1.54 Pre-natal care includes common screening and follow up tests as required during a pregnancy. For women aged 35 and over, this includes Triple/Barts, Quadruple and Spina Bifida tests, amniocentesis and DNA-analysis, if directly linked to an eligible amniocentesis.
1.57 Prescribed physiotherapy refers to treatment by a registered physiotherapist following referral by a medical practitioner. Physiotherapy 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. 1.58 Prescription drugs refers to products, including, but not limited to, insulin, hypodermic needles or syringes, which require a prescription for the treatment of a confirmed diagnosis or medical condition or to compensate vital bodily substances. The prescription drugs must be clinically proven to be effective and recognised by the pharmaceutical regulator in a given country.
crutches or wheelchairs, orthopaedic supports/braces, artificial limbs, stoma supplies, graduated compression stockings as well as orthopaedic arch-supports. Costs for medical aids that form part of palliative care or long term care (see Definitions 1.31 and 1.49) are not covered.
1.55 Prescribed glasses and contact lenses refers to cover for an eye examination carried out by an optometrist or ophthalmologist (one per Insurance Year) and for lenses or glasses to correct vision. 1.56 Prescribed medical aids refers to any instrument, apparatus or device which is medically prescribed as an aid to the function or capacity of the insured person, such as hearing aids, speaking aids (electronic larynx),
66
1.59 Preventive treatment refers to treatment that is undertaken without any clinical symptoms being present at the time of treatment. An example of such treatment is the removal of a pre-cancerous growth (e.g. mole on the skin).
1.61 Psychiatry and psychotherapy refers to treatment of a mental, nervous or eating disorder carried out by a clinical psychiatrist or clinical psychologist. The disorder must be associated with present distress, or substantial impairment of the individual's ability to function in a major life activity (e.g. employment). The aforementioned condition must be clinically significant and not merely an expected response to a particular event such as bereavement, relationship or academic problems and acculturation. The disorder must meet the criteria for classification under an international classification system such as the Diagnostic and Statistical Manual (DSM-IV) or the International Classification of Diseases (ICD-10). 1.62 Rehabilitation is treatment aimed at the restoration of a normal form and/or function after an acute illness or injury. The rehabilitation benefit is payable only for treatment that starts immediately after the acute medical treatment ceases.
1.60 Principal country of residence is the country where you and your dependants live for more than 6 months of the year.
1.63 Repatriation of mortal remains is the transportation of the deceaseds mortal remains from the principal country of residence to the country of burial. Covered expenses include, but are not limited to, expenses for embalming, a container legally appropriate for transportation, shipping costs and the necessary government authorisations. Cremation costs will only be covered in the event that this is required for legal purposes. Costs incurred by any accompanying persons are not covered. All covered expenses in connection with the repatriation of mortal remains must be preapproved by us using a Treatment Guarantee Form 1.64 Routine health checks are tests/screenings that are undertaken without any clinical symptoms being present. Such tests include the following examinations performed, at an appropriate age interval, for the early detection of illness or disease:
Vital signs (blood pressure, cholesterol, pulse,
respiration, temperature etc.) Cardiovascular exam Neurological exam Cancer screening Well child test (for children up to the age of 6 years, up to a maximum of 15 visits per lifetime)
67
Definitions
1.66 Specialist is a qualified and licensed medical physician possessing the necessary additional qualifications and expertise to practice as a recognised specialist of diagnostic techniques, treatment and prevention in a particular field of medicine. This benefit does not include cover for psychiatrist or psychologist fees. Where covered, a separate benefit for psychiatry and psychotherapy will appear in the Table of Benefits. 1.67 Specialist fees refer to non-surgical treatment performed or administered by a specialist.
1.65 Routine maternity refers to any medically necessary costs incurred during pregnancy and childbirth, including hospital charges, specialist fees, the mother's pre- and post-natal care, midwife fees as well as newborn care. Costs related to complications of pregnancy and childbirth are not payable under routine maternity.
1.71 Vaccinations refer to all basic immunisations and booster injections required under regulation of the country in which treatment is being given, any medically necessary travel vaccinations and malaria prophylaxis. The cost of consultation for administering the vaccine as well as the cost of the drug is covered.
1.70 Treatment refers to a medical procedure needed to cure or relieve illness or injury.
therapist, who is qualified and licensed under the law of the country in which treatment is being given.
1.72 Waiting period is a period of time commencing on your policy start date (or effective date if you are a dependant), during which you are not entitled to cover for particular benefits. Your Table of Benefits will indicate which benefits are subject to waiting periods. 1.74 You/Your refers to the eligible employee stated on the Insurance Certificate. 1.73 We/Our/Us is Allianz Worldwide Care.
1.68 Surgical appliances and prostheses refer to artificial body parts or devices, which are an integral part of a surgical procedure or part of any medically necessary treatment following surgery.
1.69 Therapist is a chiropractor, osteopath, Chinese herbalist, homeopath, acupuncturist, physiotherapist, speech therapist, occupational therapist or oculomotor
68
Additional policy terms.

1. 2.
The following are important additional terms that apply to your policy with us.
Eligibility: Only those employees and dependants as described in the Company Agreement. recover, for our benefit, the amount of any payment made under another policy.
3.
Liability: Our liability to the insured person is limited to the amounts indicated in the Table of Benefits and any subsequent policy endorsement. In no event will the amount of reimbursement, whether under this policy, public medical scheme or any other insurance, exceed the amount of the invoice. Third party liability: If you or any of your dependants are eligible to claim benefits under a public scheme or any other insurance policy which pertains to a claim submitted to us, we reserve the right to decline to pay benefits. The insured person must inform us and provide all necessary information, if and when entitled to claim from a third party. The insured person and the third party may not agree to any final settlement or waive our right to recover outlays without our prior written agreement. Otherwise we are entitled to recover the amounts paid from the insured person and to cancel the policy. We have full rights of subrogation and may institute proceedings in your name, but at our expense, to
4.
Data protection: The confidentiality of patient and member information is of paramount concern to Allianz Worldwide Care. Allianz Worldwide Care complies fully with European Data Protection Legislation and International Medical Confidentiality Guidelines. You have a right to access the personal data that is held about you. You also have the right to request that we amend or delete any information, which you believe is inaccurate or out of date.
69
Notes.
70
Allianz Worldwide Care 18B Beckett Way Park West Business Campus Nangor Road Dublin 12 Ireland
If you have any queries, please do not hesitate to contact us: Helpline English: German: French: Spanish: Italian: Fax: +353 1 630 1301 +353 1 630 1302 +353 1 630 1303 +353 1 630 1304 +353 1 630 1305 +353 1 630 1306
[email protected] www.allianzworldwidecare.com
Allianz Worldwide Care Limited, part of the Allianz Group, is registered in Ireland and regulated by the Irish Financial Services Regulatory Authority. Registered Office: 18B Beckett Way, Park West Business Campus, Nangor Road, Dublin 12, Ireland. Registered no.: 310852
DOC-EBG-EN-1108
1
Toll-free from Singapore: 800 353 1018 Toll-free from Hong Kong: 800 901 705 Toll-free from North China: 10 800 744 1259 Toll-free from South China: 10 800 441 0115 Toll-free from the USA: 1 866 266 2182 Toll-free from France, Belgium & Switzerland: 00 800 66 302 302 Toll-free from Italy: 800 088 736

Allianz - Employee Benefit Guide

Uploaded by

Copyright:

Available Formats

Allianz - Employee Benefit Guide

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Allianz - Employee Benefit Guide

Uploaded by

Copyright:

Available Formats

International Healthcare Plans

Employee Benefit Guide

Welcome to Allianz Worldwide Care.

Allianz Worldwide Care plan. For details of your insurance company.

contract please refer to your

5-11 5 6 6 7 10 11 12-28 12 13 13 14 14 14 15 15 17 25 27 28 29-35

36-45 36 38 43 46-56 46 47 51 51 55 57 58 59-68 69

Please find details of all our member services below.

Helpline Service 24/5.

Helpline English: German: French: Spanish: Italian: Fax:

Allianz Worldwide Care

Emergency Assistance Service 24/7.

MediLine Medical Advice Service 24/7.

Allianz Worldwide Care

Your personalised Membership Card

Your Employee Benefit Guide

Allianz Worldwide Care plan. The Employee

This guide sets out the benefits and rules of your

contact our Helpline and we will arrange for a

Your Insurance Certificate

dependants. It also states the start date and

your company has chosen for you and your

Your Insurance Certificate details the plan that

A Treatment Guarantee Form

treatment which requires Treatment

Your Table of Benefits

available to you under your plan. The Table of

Your Online Services username and password

Allianz Worldwide Care

'register' button on the login screen. Please type in

you can access your online account by clicking the

we have on record for you.

login details will then be sent to the email address

documents. An automated email containing your

exactly as shown on your Membership Pack

If we have not been provided with your email Pack.

Please note that access to Online Services is only

address, your login details will have been sent to

you in a letter included as part of your Membership

Medical Provider Finder.

doctors and specialists on a country by country

directory allows you to search for hospitals, clinics,

Surgery, Neurosurgery or Traumatology etc.

Medicine, as well as on specialism e.g. General

under Medical Practitioner categories e.g. Internal

specific regions and cities. Users can also search

basis, with the ability to narrow down the search to

in this directory. For any treatment that requires

You are not restricted to using the providers listed

What you are covered for.

The following is an overview of your healthcare cover.

Out-patient, Dental or Repatriation Plans. On the

This section provides an outline of the cover we

There are two kinds of benefit limits shown in the

please read this guide carefully in conjunction with

applies to your plan(s).

subject to the maximum plan benefit, if one

generally accepted medical procedures. If a claim is deemed by us to be inappropriate, we reserve the