General Terms and Conditions - Part 1
§ 1 Subject, scope and validity of the cover
1. The insurer provides insurance cover for illnesses, accidents and other events named in the contract. He will reimburse the costs of medical treatment and other contractually agreed services on the unforeseen occurrence of an insured event in Europe during academic stays, as far as something else doesn’t arise from § 1, item 4.
2. An insured event is the medically necessary treatment of an insured person as a result of illness or the consequences of an accident. The insured event commences with the medical treatment and ends with the finding by a medical practitioner that no further treatment is needed. If the treatment has to be extended for an illness or an accident, which has nothing in common with the first treatment, this is considered to be a new insurance case. An insured event is also, if the tariff provides conditions for it, the examination and medically necessary treatment for pregnancy and delivery or for a medically indicated abortion, as well as death.
3. The scope of the insurance cover is as stated on the certificate of insurance, in later written agreements, in the general terms and conditions of insurance and as in the applicable laws.
4. The insurance cover extends to medical treatment in Europe. The reimbursement is based on the common German rates. It can be extended with an agreement for a period of max. 6 weeks outside Europe. The extension is requested in advance in written form.
§ 2 Commencement of insurance cover
1. The insurance cover shall commence on the day of entry stated on the application (commencement of insurance) but not before conclusion of the insurance contract, not before payment of the premium and not before the start of the stay by the insured person in Europe and not before the end of the waiting period. For insurance cases that occurred before the beginning of the insurance contract or the payment of the premium, there will be no reimbursements.
2. Newborn children will be covered immediately following birth, if the mother is insured by the Insurer at the date of birth and the newborn has been applied for insurance retroactively within one month after the birth.
§ 3 Insurable persons; conclusion and duration of the insurance contract
1. The insurance is available to scholars, having their permanent residence outside of Germany, who are temporarily outside their home country in Europe for scientific project work and who intend to return to their home country. The scholarship should be tax-free, but may not be subject to compulsory social security insurance. Economically dependant family members can be jointly insured in the contract together with the scholar.
2. The insurance can be applied for up to a maximum period of four years. The period of insurance shall correspond to the period of the scholarship including preliminary language courses. A scholarship confirmation may be required.
3. In case of an extension of the stay, within the maximum insurance period, the originally arranged insurance period may only be extended, if the extension is applied for in written form and prior to expiration of the original insurance contract and if the Insurer accepts the extension. The extension is dependant upon the premiums and conditions valid on the date of the extension.
4. The insurance contract will be concluded with the acceptance of the application (handing over the certificate of insurance or a written declaration of the acceptance of the application).
§ 4 Waiting period
The waiting period is calculated from the day of the beginning of the insurance contract. It amounts for delivery to 8 months and may be modified on a special agreement. The special agreement is fixed in the tariff conditions. The waiting period for dental prostheses amounts to 8 months.
§ 5 Scope of cover
1. Types and amounts of reimbursements are fixed in the general terms and conditions and in the tariff conditions.
2. The insured person has the free choice of established recognised doctors and dentists. Non-medical practitioners cannot be reimbursed.
3. Drugs and dressings must be prescribed by those persons treating which are mentioned in point 2. Drugs have to be received from a pharmacy.
4. Nutritional food, restoratives, mineral waters, cosmetics, products for personal hygiene as well as bathing supplements are not considered to be drugs.
5. For a medically necessary inpatient treatment the insured person has the free choice of the public hospitals, which are under permanent medical control, which possesses sufficient diagnostic and therapeutic facilities and maintain patient histories.
§ 6 Exclusions
1. The insurer will not pay for:
1.1. Pre-existing conditions: any known or unknown medical conditions which are a consequence of any health disturbance that has or would have had required hospitalization and / or medical treatment and / or medications, and / or has been diagnosed within the one year period immediately prior to the first day of this insurance. The above definition of pre-existing conditions applies also in particular to any kind of chronic illnesses as well as existing dental defects and defective vision.
1.2. Treatment relating to birth defects and congenital illnesses. Birth defects are deemed to include hereditary conditions.
1.3. Prostheses, spectacles, contact lenses, hearing aids, bandages and all aids.
1.4. All Organ Transplantation.
1.5. Tests and treatment relating to infertility and in vitro fertilisation.
1.6. Any contraceptives (pill, spiral, etc.) and all consequences thereof as well as abortions.
1.7. Electric and physical medical treatment:
1.8. Treatment of mental illness, psychiatric and psychological disorders and all diseases caused by and/or related to mental diseases.
1.9. Elective and / or cosmetic treatments (e.g. removal of warts etc.).
1.10. Tuberculosis, Acquired Immune Deficiency Syndrome (AIDS), AIDS-related Complex Syndrome (ARCS) and all diseases caused by and/or related to HIV.
1.11. All tropical diseases, including but not limited to malaria, yellow fever, cholera, dysentery, leprosy.
1.12. Costs resulting from self-inflicted injury, suicide, abuse of alcohol, drug addiction or abuse and treatment of sexually transmitted diseases.
1.13. Treatment by a family member and any auto therapy including prescription of drugs.
1.14. Treatment resulting from active participation in war, riot, civil commotion or any criminal act, including resultant imprisonment.
1.15. Claims and costs for treatment in respect of medical expenses incurred after the expiry date of the Certificate arising from accidental bodily injury, illness or pregnancy occurring during the Certificate period.
1.16. Any benefit, treatment and expenses not particularly covered and specified in the Plan.
1.17. Any missed vaccinations in accordance with our vaccinating calendar and missed U3-U10.
2. If a medical or any other treatment, which services were agreed upon exceeds the medically necessary extent, the insurer may reduce his payment to an appropriate amount.
§ 7 Refund of costs
1. The insurer shall only be obliged to make payment when the evidence demanded has been provided. Receipts become the property of the insurer.
2. The original invoices (copies or duplicates cannot be accepted) are to be submitted together with the corresponding treatment ticket, completed and signed by the doctor. Prescriptions for drugs, prescribed by doctors have to be submitted together with the corresponding doctor´s invoice.
3. If an insured person has claims for damages against other insurers or existing claims for damages against third parties, the insurer is only responsible for those expenses, which remain necessary after the advance payment. Rights to claim for damages have to be as- signed in writing to the insurer.
4. The insurer is entitled to make payment to the person submitting or sending the correct proof of treatment, unless he has reasonable doubts about the legitimacy of the person submitting or sending the documents.
5. The insurer may hand over the claims settlements to independent specialists for the handling of health insurance.
§ 8 End of insurance cover
1. The insurance cover shall end - including cover for insured events which are not yet complete - with the end of the insurance contract, at the latest with the end of the stay in Europe, unless there is a special agreement for countries outside Europe.
2. If an illness requires treatment beyond the end of the insurance cover, due to the fact that the return journey is impossible because of proven transportation inability, then the Insurance Cover within this tariff will continue until the transportability is restored for a maximum of 8 weeks.
§ 9 Payment of premiums
1. The premium is a monthly premium and will be calculated from the start of the insurance on. The premiums are due on the first of every calendar month.
2. If the insurance does not commence on the first day of a calendar month only the pro-rata amount of the first monthly premium rate becomes due.
3. If the insurance does not end on the end of a calendar month only the pro-rata amount of the monthly premium becomes due.
4. Insured children will have to pay the premium of an insured spouse as from the end of that month in which they attained the age of 18 years.
5. The premiums are to be paid to the place assigned by the insurer.
6. The delayed payment of a follow-up premium leads to the loss of the insurance coverage.
§ 10 Obligations
1. Any hospital treatment is to be reported in writing to the insurer immediately, at the latest within ten days of its commencement. Furthermore, planned outpatient operations have to be announced in writing immediately.
2. The insured person has to submit the original invoices as soon as possible but no later than thirty days after the receipt together with a completely filled in and signed treatment ticket.
3. The insured person shall, on demand by the insurer, provide any and all information necessary for determination of the insured event or the obligation by the insurer to make payment and the extent of such obligation.
4. The insured person shall be obliged on demand by the insurer to undergo an examination by a doctor appointed by the insurer.
5. The insured person shall, if possible, take care to minimize the claim and refrain from any actions, which hinder the recovery.
6. Every marriage with a German citizen and/or the receipt of the German citizenship is to be reported to the insurer immediately.
§ 11 Consequences of infringement of obligations
The insurer shall be freed of the obligation to make payment when one of the obligations named in § 10 is infringed.
§ 12 End of insurance contract
1. The insurance shall end on expiry of the agreed insurance period, the end of the scholarship or an untimely end, which has been confirmed in writing, whatever event occurs first.
2. The contract ends with no delay in case of supplying false information or receiving or trying to receive reimbursements for a claim by fraud.
3. With the end of the insurance of the scholarship holder ends also the insurance for the family members.
4. The insurance relationship ends with the day of marriage with a German citizen and/or if an insured person receives the German citizenship.
§ 13 Insurer
Insurer of the International Science HealthCare Plan is
DKV Luxembourg S.A.
§ 14 Communications and declarations of intent
Communications and declarations of intent must be made in writing. Entitled to accept such communications and declarations is:
§ 15 Legal domicile and law
1. The legal domicile is Luxembourg.
2. The insurance is subject to the law of Luxembourg.