Health insurance for foreigners in Germany

The Coverage

§ 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 Germany during academic stays.

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.

§ 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 Germany 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 first 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 within Europe, who are insured under the statutory social security system of their home country. They must be able to proof this with the European Health Insurance Card (EHIC). They should be in Germany only temporary for scientific project work and intend to return to their home country after completion of the project. 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 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.

§ 5 Exclusions

1. The insurer will not pay for:

1.1. Visual aids.

1.2. Tuberculosis, Acquired Immune Deficiency Syndrome (AIDS), AIDS-related Complex Syndrome (ARCS) and all diseases caused by and/or related to HIV.

1.3. All tropical diseases, including but not limited to malaria, yellow fever, cholera, dysentery, leprosy.

1.4. Costs resulting from self-inflicted injury, suicide, abuse of alcohol, drug addiction or abuse and treatment of sexually transmitted diseases.

1.5. Treatment by a family member and any auto therapy including prescription of drugs.

1.6. Treatment resulting from active participation in war, riot, civil commotion or any criminal act, including resultant imprisonment.

1.7. Claims and costs for treatment in respect of medical expenses incurred after the expiry date of the Certificate.

1.8. Any benefit, treatment and expenses not particularly covered and specified in the Plan.

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.

§ 6 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 additional payments and the insured person must be clearly identifiable from the submitted invoices and receipts.

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 assigned 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.

§ 7 End of insurance cover

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 Germany.

§ 8 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 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 insurance does not end on the end of a calendar month only the pro-rata amount of the monthly premium becomes due.

4. The premiums are to be paid to the place assigned by the insurer.

5. The delayed payment of a follow-up premium leads to the loss of the insurance coverage.

§ 9 Obligations

1. 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 submitted and signed treatment ticket.

2. 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.

3. Every marriage with a German citizen and/or the receipt of the German citizenship is to be reported to the insurer immediately.

§ 10 Consequences of infringement of obligations

The insurer shall be freed of the obligation to make payment when one of the obligations named in § 9 is infringed.

§ 11 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.

§ 12 Insurer

Insurer of the International Science HealthCare Plan - EHIC is

DKV Luxembourg S.A.
43, av. J. F. Kennedy
L - 1855 Luxembourg

§ 13 Communications and declarations of intent

Communications and declarations of intent must be made in writing. Entitled to accept such communications and declarations is: