7/22/2011

Generali Providencia Health Insurance Guide

Generali Providencia Health Insurance Guide

Generali Providencia Health Insurance Guide

Coverage

The commencement date of the coverage is the date when the Insured completes and signs the Statement of the Insured’. The insurance covers only those insurance events that occur within the territory of Hungary.

Besides the services listed below the cover also includes the cost of any medical treatments related to illnesses already existing at the commencement date of the coverage provided these treatments are within the scope of the basic medical service of CEU; i.e. can be performed by a specialist of the Medical Center at CEU.

The ‘Statement of the Insured’ is complete only if a fully filled in ‘Medical Questionnaire is attached to it.

The proof of insurance coverage is the Health Insurance Card containing the data of the Insured. This card must be shown to the medical service provider when any medical treatment in undertaken.

The insurance coverage is valid only during the period during which the resident foreigner is a student of, or is employed by, CEU. The validity of the insurance is shown on the Health Insurance Card.

In case the Insured leaves Hungary either temporarily or permanently during the validity of the insurance coverage, he/she has to return the Health Insurance Card to CEU, and the card will be temporarily/permanently withdrawn.

Services provided by the Insurer

In case an insurance event occurs, the Insurer will fulfill payment according to the terms of the ‘Statement of the Insured’. For this reason the Insured will not incur any payment obligations provided that the medical treatment was received in a designated institution.

The Insurer’s obligation of coverage includes in-patient and out-patient treatment provided only in Hungary.

As part of the out-patient treatment the following will be reimbursed:

· Costs of basic medical treatment

· Costs of specialized medical treatment

· Costs of the physician’s visit to the patient, provided that the patient was not able to visit the physician

· Costs of special examinations (e.g., laboratory tests, X-ray examination, ultrasound scan, etc.) provided these were necessary for setting up the diagnosis or for the cure

As part of the in-patient treatment the following will be reimbursed:

· Costs of medical treatment prescribed by a physician including operations

· Costs of hospital accommodation—standard service, nursing/attending

· Costs of medically justified abortion

The insurer will reimburse the costs of medicines, bandages and temporary therapeutic aids above the deductible.

The costs of transportation to a physician (by ambulance or taxi) will be reimbursed only if it is medically justified and needed.

The costs of the Insured being transported from the physician/hospital will be reimbursed only if the state of health of the Insured allows it and makes it necessary and is also recommended by the physician of the Insurer.

Limits of coverage

The Insurer will cover the costs arising from medical treatments up to specific limits and using a deductible.

In any insurance year the insurer will fulfill payments to the insured up to 1,000,000, one million, Hungarian forints, of which sum 100,000 Hungarian forints can be paid for each of medicines and therapeutical aids, respectively, within the following limitations:

- Only 50% of the costs of therapeutical aids will be reimbursed to the Insured.

- Regarding the costs of medicines a 1500 Hungarian forints deductible applies per illness

per month.

This means that the Insurer will cover the costs of medicines only above the monthly deductible, i.e., 1500 Hungarian forints per illness, per month.

What is not covered

The following are not considered to be insurance events and therefore do not serve as a basis for any reimbursement claims:

· Hospitalization due to pregnancy or abortion except for medically justified cases

· Cosmetic treatment and/or surgery if not a result of accident

· Glasses, contact lenses and hearing aids

· Dental treatments, except for acute or emergency cases, or corrections of accidents

· Rehabilitation treatments

· Any form of artificial insemination

· Treatment of illnesses resulting from HIV infection

· Upgraded services (e.g. single-bed room)

· Treatments related to or resulting from illnesses or accidents already known at the commencement of the coverage period, except for those which can be treated within the scope of the basic medical service (i.e. by a specialist of the Medical Center at CEU).

· Treatments made necessary or related to the consumption of alcohol or drugs/narcotics

· Acupuncture treatment or psychotherapy

· Immunizations

Moreover, the Insurer does not cover events resulting from or contributed to by mental infirmity or disease, ionizing radiation, nuclear energy, acts of war or any crime against the state.

The Insurer does not cover events resulting from or in connection with the following sports activities of the Insured:

· Motoring: car racing, motorbike sports, rally, moto-cross, driving-skill competitions, go-kart, auto-crash, motorboat sports

· Aerial sports: amateur flying, parachuting, gliding, motor-gliding, hang-gliding, ultra-light gliding, para-gliding, hot-air ballooning

· Others: scuba diving with oxygen-tank below 40 meters, single-handed and open-sea sailing, mountain and rock-climbing from degree V., high-mountain expeditioning, caving, cave-expeditioning.

The Insurer is relieved of any liability if the Insurer proves that the event was caused by the Insured against the law, intentionally or with gross negligence.

The Insured is seriously negligent especially if:

· When the accident took place the Insured was in an alcoholic state and this fact had a causal relationship with the accident. If there is a blood test result, alcoholic state is defined as a blood-alcohol concentration of over 1.5 1/1000, or over 0.8 1/1000 when driving.

· The Insured was driving a vehicle that did not have a valid vehicle-license, or the Insured had no license to drive that vehicle and this fact had a causal relationship with the accident.

What to do if medical service is needed

If medical service is needed, a specialist of the Medical Center at CEU must be visited during consultation hours for examinations, prescriptions of medicines, etc.

If necessary, the specialist of the Medical Center at CEU will refer the Insured for further special examinations or hospital care and doing so justifies the necessity of the treatment.

The Insured will receive medical service covered by the Insurer:

· at the Medical Center by presenting his/her valid Health Insurance Card together with his/her passport to the specialist of the Medical Center at CEU,

· or at the designated institutions by presenting the referral of the specialist of the Medical Center at CEU.

If emergency medical service is needed and the Insured is treated not at a designated institution ‘Medicina Betegség Megelőző Kft.’ has to be notified of this within 24 hours or as soon as possible, and ‘Medicina Betegség Megelőző Kft.’ will issue a written statement of coverage for the institution providing medical treatment for the Insured.

Based on the Insurance contract in order to be reimbursed for the costs of medical treatments the following has to be submitted to ‘Medicina Betegség Megelõzõ Kft’:

- The original bills as proofs of payment

- All medical documents in connection with the medical service

Provided there is a just claim, ‘Medicina Betegség Megelõzõ Kft.’ will reimburse the Insured within 30 days from the submission of all medical documents in connection with the insured medical service.

Designated Institutions

MEDICAL CENTER at CEU:

Address: 5th district, Nádor u. 11. (in the courtyard)

Phone: 36-1-327-3815

Phone/Fax: 36-1-328-3695

Dr. Monika Horváth, e-mail:

Dr. Gábor Sándor, e-mail:

Marta Verebes, e-mail:

MEDICINA SURGERY - BUDAPEST

Downtown – Health Care Specialist Outpatient Clinic of Lipótváros

Address: 5th district, Hercegprímás u., 14-16.

Phone: (36-1)-428-8125,

Phone/Fax: (36-1) 428-8127

e-mail: blaskotimea@medicinabm.hu

Working Hours: Monday-Friday: 8:00 a.m.-2:00 p.m

In-patient treatment - HOSPITALS

SEMMELWEIS MEDICAL UNIVERSITY

CLINIC OF TRANSPLANTATION AND SURGERY

Address: 8th district, Baross u. 23-25.

Please keep this Product Guide for further reference. It will be useful for you when using medical services.

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