Subject of the insurance
The Insurer, pursuant to an executed Contract for Medical Insurance and upon receipt of the insurance premium, provides financial compensation for certain healthcare services and goods, aimed at protecting, maintaining, and restoring health for a certain period, amount, and scope, as well as compensation for loss of income resulting from an accident or disease.
Covered risks:
1. Risks arising from a disease or accident, related to financial compensation for certain healthcare services and goods;
2. Financial compensation for healthcare services and goods, related to disease prevention of the Insured individual, pregnancy, childbirth, etc.;
3. Financial compensation for other goods and services, related to the healthcare provided to the Insured individual, including transportation, specialized care;
4. Risks related to loss of income resulting from an accident or disease.
The insurance does not cover: organ transplants, tissues and cells; planned neurosurgical, cardiac, and eye surgeries; treatment of AIDS; treatment of alcoholism and drug addiction; mandatory immunizations; plastic cosmetic surgery and other cosmetic medical services; failure to comply with a prescribed regimen and/or treatment, simulating a disease by the Insured, as well as intentional damage to his health; preparation and participation in sports competitions; fights, attempted suicide, or suicide, committing general crime or another activity prohibited by law; damage to health due to excessive or chronic alcohol use, narcotics, intoxicating substances, or drug dependence; participation in military activities or exercises, or caused by radioactive or chemical materials in an uprising, riot, strike, lockout, or other similar activities, including emergency and disaster situations; health services necessitated by past diseases; home care which is not under a doctor's supervision, as well as measures for geriatric and rehabilitation treatment and treatment pedagogy; the following dental services: tooth implants, as well as measures and consequences which are in a causal relationship with them, insofar as they are not used to remove the consequences of an accident; orthopedics (dentures) and preparation for orthopedic activities; bolt-pin and pinless build-up of teeth; replants and implants; orthodontic work; teeth whitening; termination of pregnancy on request or for premature birth or complications due to air travel undertaken by an Insured individual whose pregnancy is at a stage after the 28th week; birth by optional caesarean section and its consequences; complications due to planned birth at home; surgery for correcting nearsightedness or farsightedness, or other eye defects, unless they are due to an accident or disease which has occurred during the term of the insurance;
Insurance coverage
The insurance coverage becomes effective at 00:00 h on the date indicated in the insurance policy as the beginning of the insurance, but no earlier than 24:00 h on the date on which the full amount of the premium or its first installment is paid, in the case of payment by installments. For the coverages for which there are deferral periods specified, the insurance becomes effective at 24:00 h on the date on which the respective deferral period ends.
The Insured individual/Insuring party, upon signing the contract, selects a combination of coverages for Medical expenses and Additional coverages from the following three base levels:
1. Basic;
2. Optimum;
3. Full.
Insurance contracts
The insurance contracts can be: individual, family, and group ones.
–An individual insurance contract is one under which a single person can be insured, with an age of 0 to 64 years, but not older than 65 years as of the expiry date of the contract’s term. Under this insurance, the policyholder may be the Insured individual or another person or legal entity;
–A family insurance contract is one under which the members of a single family can be insured, with ages of 0 to 64 years, but not older than 65 years as of the expiry date of the contract’s term.
–A group insurance contract is one under which groups of a minimum of 5 persons, which were formed in advance for non-insurance purposes, can be insured, with individual ages of the persons eligible for inclusion in the group based on the total number of persons, divided into 3 groups:
1. up to 15 persons – up to 64 years;
2. up to 50 persons – up to 74 years;
3. over 50 persons – without age restriction.
