Condiciones de la póliza de seguros
De Wiki Spanish Trainee
Contenido |
GUARANTEES AND LIMITS PER INSURED:
A) ASSISTANCE TO PERSONS:
- 1. Medical, surgical, pharmaceutical (prescribed by a
doctor), hospital and ambulance costs or fees originating from accident or illness.
- 1.1.a. Medical costs incurred in the United States or
Canada up to 300,000.00 U.S. or Canadian Dollars,
- 1.1.b. Medical costs incurred in any other country in the
rest of the world up to €120,000.00
- 1.1.c. Costs incurred during short stays of the Insured,
authorised by the General Research Directorate, in countries abroad other than that for which the grant was awarded, including to/from journeys and the days corresponding to the holiday period, up to a maximum limit of €120,000.00.
- 2. Costs arising from preventive medicine that may be
required for diseases, epidemics or pandemics in the countries of destination.
- 3. Continuance of medical, pharmaceutical (prescribed
by a doctor), surgical, hospital and ambulance costs or fees in Spain or in the country of origin of the Insured, following repatriation or inter-hospital transport up to a limit of €75,000.00
- 4. Dental and maxillary-facial surgery costs up to a limit of € 900.00.
- 5. Pregnancy and childbirth.
Pregnancy and childbirth shall be covered during the term of this policy, including periodic check-ups and scans. Once the grant has finalised, only pregnancies of over 24 weeks gestation will be covered, as long as no cover exists from the National Health Service or any other similar organisation abroad, and up to a limit of €3,250.00.
- 6. Chronic illnesses.
During the term of the grant and until the expiry of the insurance policy. If the Insured is not a Social Security beneficiary, the insurer will assume the costs for treatment of illnesses that produce repatriation until any one of the following circumstances occur: finalisation of the grant or expiry of the policy, with a limit of €35,000.00 per insured for costs incurred in Spain or, in any case, up to the maximum limit of €70,000.00.
- 7. Psychological or psychiatric treatment.
Cover shall include psychological or psychiatric treatment for anxiety, stress, post-traumatic stress or any other kind of similar disorder, during the term of the grant and up to a maximum limit of €3,000.00. In the event that repatriation is necessary due to psychiatric or mental health reasons, continuance of the medical expenses in Spain or in the country of origin of the Insured shall not be included, unless the Insured does not have any cover under the National Health Service or any other similar organisation abroad. In any case the limit is that indicated in the previous paragraph.
- 8. Rehabilitation or physical therapy up to a limit of
€1,000.00.
- 9. Prostheses and ortheses up to a limit of €6,500.00.
- 10. Repatriation or inter-hospital transport of injured
or ill patients.
- 11. Repatriation or transport of the deceased.
- 12. Travelling expenses of a companion in the case of
death or hospitalisation of the Insured.
- 13. Accommodation expenses for the travelling
companion up to €160.00 per day, with a maximum of €1,600.00.
- 14. Costs of prolonging the Insured's hotel stay on
doctor's orders with a limit of €160.00 per day, with a maximum of €1,600.00
- 15. Return to the place of work.
- 16. Return of the Insured due to fire or accident in
their home or the death or hospitalisation of a relative.
- 17. Forwarding of medicines not available in the place
where the Insured is located.
- 18. Telephonic medical consultation.
- 19. Search, localization and transport of luggage and
personal effects.
- 20. Formalities and forwarding of forgotten documents
up to an amount of €125.00.
- 21. Legal defence costs as a result of an accident up to
an amount of €1,150.00.
- 22. Travel information and assistance.
- 23. Message transmission service.
- 24. Advance payments of criminal bail abroad up to
€6,000.00.
- 25. Repatriation or transport of minors and/or disabled
persons.
- 26. Repatriation of other insured parties.
- 27. Substitution of the Insured due to repatriation.
- 28. Reimbursements for ambulance services up to the
limit of €250.00.
- 29. Interpreter service.
- 30. Card cancellation.
- 31. Medical reference service.
- 32. Legal reference service.
- 33. Processing expenses for loss of documents up to a
limit established at €200.00.
- 34. Loss of hotel keys up to the limit of €200.00.
- 33. Loss of keys of the permanent residence up to a limit
established at €200.00.
EXCLUSIONS FROM PERSONAL ASSISTANCE COVERAGE:
- a) Claims caused deliberately or fraudulently by the
Insured, the Policyholder, the Rights' Holder or persons travelling with the Insured; suicide or illness or injury resulting from attempted suicide or deliberately self-inflicted by the Insured; treatment or illnesses or pathologic states due to the intentional ingestion or administration of toxic substances (drugs), alcohol or narcotics, or the use of medicines without prescription, or the voluntary abandonment of any part of a prescribed treatment.
- b) Claims arising from war, demonstrations or popular
movements, acts of terrorism or sabotage, strikes, arrest by any authority for offences not caused by traffic accidents, free movement restrictions or any other case of force majeure, unless the Insured should prove that the claim bears no relation to such circumstances, as well as claims arising from radiation caused by nuclear transmutation, fission or radioactivity.
- c) Accidents or injuries occurring due to participation
in sporting competitions, private or official, or training, trials or bets, and during the practice of high-risk sports such as mountaineering, climbing, motocross, gliding, hang-gliding and similar sports, as well as skiing accidents.
- d) Rescue from sea, mountain or desert.
- e) Assistance cover is excluded for Spain or any
countries other than that in which the stay was awarded for the term of the grant, unless authorised by the General Research Directorate, as well as any injuries incurred during the course of professional activity other than that which corresponds to the participation in the grant programme.
- f) Mental disorders, except those included under
Medical costs, Psychological and psychiatric treatment;psychosomatic and behaviour alterations due to adaptation problems; all illnesses and disorders arising from alcoholism and drug addiction; childbirth and pregnancies that have not exceed 24 weeks gestation at the time of termination of the grant, without prejudice to that indicated in under Medical costs in relation pregnancies and childbirth.
- g) Any pharmaceutical cost without medical
prescription; alternative medicine treatments such as Acupuncture, Homeopathy, Naturism, Hydrotherapy, etc., and experimental surgery and treatments not recognised by medical science, as well as preventive treatments such as gynaecological check-ups, paediatrics, etc.This exclusion shall not apply to the costs derived from preventive medical treatment that may be required for diseases, epidemics, pandemics existing in the country of destination of the grant or research work.
B) PERSONAL CIVIL LIABILITY up to the limit of €12,000.00.
EXCLUSIONS FROM COVER FOR PERSONAL CIVIL LIABILITY:
This cover does include:
- a) Any liability corresponding to the Insured resulting from
driving motor vehicles, flying aircraft or sailing vessels, or from the use of firearms.
- b) Civil liability arising from any professional activity.
- c) Fines or penalties imposed by Courts or any other
Authority.
INSTRUCTIONS TO FOLLOW IN CASE OF CLAIM.
Assistance should be requested by reverse charge telephone call to 91 572 43 43, indicating:
- Name and surname(s).
- Policy number.
- Address and telephone number of current location.
- Description of the problem.
This INSURANCE CERTIFICATE is not a contractual document.
It is for information purposes only, certifying the existence of the insurance policy and the effectiveness of its cover, subject to the terms, conditions and limits described below. It does not replace the General and Particular Wordings of the insurance contract nor the limitations or exclusions of same, which shall take precedence in the case of any discrepancy.
