Incoming Conditions. Policy condition 703

Transcription

1 Incoming Conditions Policy condition 703 Valid from February 2018

2 Contents A. Who can take out the insurance and how is it taken out? 3 B. When and where is the insurance valid? 3 C. Deductible 3 D. Medical treatment 3 E. Definitions country of origin 4 F. General terms and conditions 5 G. When injury or damage occurs 7 H. How to contact gouda 7 Contact Gouda Rejseforsikring Service centre business@gouda-rf.se Claims centre businessclaims@gouda-rf.se Your questions can also be answered on our website Insurance terms and conditions 703 2

3 Incoming Conditions 703 Policy condition 703 A. Who can take out the insurance and how is it taken out? The insurance can be taken out by foreign citizens, under the age of 70 years, who are to temporarily visit Sweden or other country within the Nordic Region. The insurance has to be taken before the arrival to Sweden or the Nordic Region. The person insured is stated on the insurance policy. B. When and where is the insurance valid? The policy is effective from the moment you arrive in the Nordic Region and valid until you leave the Nordic Region. The policy is however also valid in other countries within the Schengen area if the person insured has a valid Schengen visa issued by a Swedish embassy or other Swedish authority abroad. Everything stated in these conditions regarding the Nordic Region is also applicable on the Schengen Area. The policy is only valid for the period specified in your insurance policy. The maximum period of coverage is 12 months. If you choose to stay at the destination after the policy period has ended, the policy is not automatically extended. If you would like to extend your policy the extension has to be taken out and paid for before the end of the present policy period. If you would like to extend your policy, please contact Gouda. C. Deductible The policy is valid with a deductible of 100 per each claim. D. Medical treatment The policy covers necessary and reasonable costs if you become ill, injured or involved in an accident during your stay in the Nordic Region. Maximum compensation per each claim is D.1 Medical costs and hospital treatment You will only be compensated for necessary and reasonable costs for acute medical treatment, hospital treatment and medicines and for treatment and means of assistance prescribed by the treating doctor to treat the illness or injury. You will only be compensated for healthcare and treatment costs in Sweden if the care or treatment is provided by public health service. With the exception of acute treatment, Gouda must approve both costs and treatment before treatment commences. Gouda reserve the right to decide whether treatment should continue in the country you are visiting or whether you should return to your country of origin for further treatment. D.1.1 Compensation period The policy will compensate medical costs for acute illness, injury or accident for a period of 60 days counting from your first visit to a doctor. If you suffer from a new acute case of illness with the same diagnose, you must have been free from symptoms, treatment and medicine during at least 30 days, to be entitled to a new compensation period. D.1.2 Restrictions The policy will not compensate costs for preventive care, acupuncture, vaccinations, annual medical examinations, pregnancy tests, delivery, plastic surgery or eyesight tests performed by opticians. Furthermore costs for check-ups and/or medication for previous illnesses will not be compensated. D.2 Dental treatment due to accident the policy will compensate dental treatment costs caused by an accident. Damage to permanent dentures will be compensated in accordance with the same regulations that apply to natural teeth. This also applies to removable dentures that were in the mouth when damaged. You must visit a dentist immediately when damaging your teeth or dentures. With the exception of acute treatment, Gouda must approve both costs and treatment before treatment commences. D.2.1 Compensation period The policy will compensate dental treatment costs, caused by an accident, for a period of 60 days counting from your first visit to the dentist. D.2.2 Restrictions The policy does not compensate costs for normal and routine dental care and orthodontics. You will furthermore not be compensated for dental treatment that is due to inadequate oral hygiene or due to you not having had regular dental treatment, and you must be able to provide evidence showing you have had regular dental treatment every months. The policy only covers dental treatment due to accidents. D.3 Travel expenses for care and treatment The policy will compensate necessary and reasonable costs for journeys to/from visit to doctor, nurse, hospital treatment, physiotherapy and dental treatment. Journeys made by private car will be compensated based on Swedish mileage compensation. 3

4 D.4 Additional expenses for journey to country of origin If treating doctor concludes, due to medical reasons, that you have to interrupt you stay and return to your country of origin, the policy will compensate additional travel expenses. The necessity to return to the country of origin as well as the means of travel must be prescribed by the treating doctor and all expenses must be preauthorized by Gouda. The policy will also compensate additional travel expenses for one travel companion on condition that he/she has a valid Gouda Incoming insurance. The policy will only compensate travel expense to the country of origin, not expenses for returning to the Nordic Region. D.5 Repatriation to country of origin in case of death If you suffer an illness, injury or accident with lethal outcome, the policy will compensate transportation costs of the deceased back to the country of origin. The policy will also compensate additional travel expenses for journey to the country of origin for one travel companion on condition that he/she has a valid Gouda Incoming insurance. Instead of transportation to the country of origin, Gouda can compensate costs for burial at the place of stay. Maximum compensation for burial is D.6 Limitations costs/events not covered by the policy Costs due to medical condition/chronic disease that existed before entering the policy period. This applies to all medical conditions if symptoms have occurred, diagnose has been made, treatment and medication been given, and similar, before entering the policy period, regardless if you have seen a doctor or not, if it is considered reasonable that you should have known about the condition Illness, injury or accident caused by you using doping substances, alcohol, narcotic- or similar substances, or illness, injury or accident caused by severe mental disorder Costs for private health care Costs due to injury occurred during adventurous/dangerous sporting activities. Adventurous/dangerous sporting activities are sports, activities, expeditions or similar that can not be considered normal exercise, work out or hobby Costs for check-ups during pregnancy and costs for delivery. However, the policy does cover necessary and reasonable costs if a medical complication occurs during pregnancy, but not if the cost arise after the 28th week of pregnancy If a baby is delivered during the policy period, the new born baby is not covered by the insurance Costs connected to abortion, sterilization, fertility treatment and fertility examinations Dental treatment costs for dental conditions that are not caused by an accident Cost for staying at a spa-, health- or rehabilitation centre and/ or travel expenses incurred thereof Costs for repatriation caused only by your fear or concern for infection or other risk Costs caused by a boat, airplane or other means of transportation having to change course due your illness, injury or accident Costs covered by other sources in compliance with law, statutes, conventions or other insurance policies Costs connected to suicide or suicide attempt Additional travel expenses to and from studies/work as a result of your illness, injury or accident E. Definitions country of origin Country of origin is your country of domicile, i.e. the country where you were registered and living in prior to traveling to the Nordic Region. Doctor Unless otherwise is specified in these conditions, a doctor is the treating medical practitioner, who must be certificated and unbiased. Nordic region The Nordic Region consist of Denmark, Finland, Iceland, Norway and Sweden. Schengen area The Schengen Area consist of Belgium, Denmark, Finland, France, Greece, Iceland, Italy, Luxemburg, Netherlands, Norway, Portugal, Spain, Sweden, Germany and Austria. The policy only cover countries included in the Schengen Area at the time the policy is taken out. Schengen-visa Travelers traveling from a country outside the Schengen Area are obliged to have a Schengen-VISA when traveling to a country outside the Nordic Area but within the Schengen Area. Necessary and reasonable costs Necessary and reasonable costs means costs that, considering the circumstances in every specific case, are normal and customary, both regarding the amount and type of cost. 4

5 Accident Accident shall be deemed to mean physical injuries suffered as a result of sudden external force. Claim form Specific form to report a claim. The claim form is available on www. gouda-rf.se or can be ordere by telephone Gouda alarm Gouda Alarm, A.C Meyers Vænge 9, 2450 København SV, Danmark. Telephon: , Fax: , alarm@gouda-rf.se F. General terms and conditions F.1 Period of validity and payment of premium The period of validity is the period for which you have taken out the insurance. The policy period starts when you arrive in the Nordic Region, at the earliest the first day of coverage specified in the insurance policy. The policy premium must be paid in full before the first day of coverage and the policy is not valid until the insurance premium has been paid in full. If you take out the insurance on the same day you arrive in the Nordic Region, the policy is not valid until full payment has reached Gouda. Gouda is only liable to events that occur during the period of validity. F.2 Mentally abnormal persons and children If due care and attention, or other directive, is set aside or neglected by somebody in a mental state as stated in chapter 30, section 6 of the Criminal Code, or by somebody under the age of 12 years, the coverage will not be reduced or denied. If someone in a normal state of mind and over the age of 12 years has approved or taken part in the activity, compensation may be reduced or denied for this person. F.3 The personal data act (1998:204) (pul) The personal information we obtain about you when taking out this insurance and when handling claims, are necessary for us to be able to manage the insurance and fulfill our contractual obligations and meet your needs. The information can also be used to evaluate and develop policy conditions and marketing analyses. Personal information can, for these purposes, be shared with Goudas partners. Personal information can also be used to send you information about other services provided by Gouda and our partners. Gouda also have a responsibility towards authorities, which means that we must provide authorities with personal information if required. You are entitled, by written request, to demand information from us about what information we have about you and how it is used. You can also make a written request to us if you do not want your personal details used for marketing purposes. Our address is: Gouda, Personuppgiftsombudet, Box Stockholm, Sweden. If you want your personal information to be corrected, you can also send a request regarding correction to this address. F.4 Your responsibility and actions in case of damage F.4.1 Limitation of damages You are obliged to limit damage that has already occurred and to avoid damage that could immediately occur. If you intentionally or by gross negligence do not limit or avoid damage, and if Gouda as a result of this suffers any damage, your compensation will be reduced or denied. F.4.2 Fraudulent information If you give fraudulent information, conceal or withhold anything of significance from Gouda in the claims handling process, compensation will be denied. F.4.3 Provocation of insurance claim If you intentionally provoke an insurance claim, or aggravate the consequences of an insurance claim, compensation will be denied. Negligent behavior may cause reduction of compensation. Actions by family member or other person acting on your approval, will be equivalent to your actions. F.4.4 Negligence of security regulation If you neglect a security regulation, stated in policy conditions or by constitution, compensation will be reduced or denied due to what is reasonable considering the circumstances. F.5 Vaccinations and medicines you are obliged to assure that you have taken all vaccinations required before arriving in the Nordic Region. Should you suffer from a condition that requires the use of medication, you are obliged to bring as much medications as needed during your whole stay in the Nordic Region. If you do not fulfill these obligations, compensation will be denied for costs that arise due to this negligence. F.6 Payment of compensation Gouda is obliged to pay your compensation within a month from you have fulfilled your obligations to us in reporting the claim. If a 5

6 claim can not be completely settled at once, but it is obvious that partial compensation can be paid, Gouda is obliged to pay the partial compensation to you without delay. Regarding compensation for repaired or recovered property, compensation will be paid within a month after repair or recovery. F.7 Interest If, for some reason, payment of compensation is delayed with regards to what is stated above, you are entitled to interest for the period of delay in accordance with the Swedish Law on Interest (1975:635). If the delay is due to police investigation, you are only entitled to the official discount rate of the Swedish Central Bank. F.8 Force majeure The insurance does not cover loss that could occur if the handling of claims, repair or payment of compensation is delayed due to war, warlike events, civil war, revolution or uprising or due to actions of authorities, strikes, lockouts, blockades or similar events. F.9 Double insurance coverage If the same interests are covered against the same risk by several insurance companies, each company is liable as if they had granted cover by themselves. In case of double insurance coverage you are never entitled to higher compensation than the joint amount that corresponds to the claim. If the liability amount exceeds the claim, liability is divided between the companies in relation to the amounts of liability. F.10 Recovery To the same extent that Gouda has paid compensation for damages, Gouda reserves the right to demand compensation from those responsible for the damage. If it is a private person, Gouda will only demand compensation if he/she intentionally or by gross negligence caused damage or if the damage is related to his/her gainful employment. F.11 Legal provisions This insurance policy is subject to the provisions of the Swedish Insurance Contracts Act (2005:104) (FAL) and Swedish law in general. Disputes arising from the insurance agreement or from these policy conditions will be settled under Swedish law at a Swedish Court, unless otherwise agreed or specified in the insurance policy. F.12 Prescription of claim Injury or damage must be reported as soon as possible, but at the latest within three years from when you realized you could claim for compensation. Assessments of prescriptions are in accordance with chapter 7, 4, of the Swedish Insurance Contracts Act (2005:104) (FAL). You forfeit your right to insurance compensation if a claim is not raised within three years from the date you realized a claim could be raised, and in any case within ten years from when the claim could be made. If, however, you have notified Gouda within the timescale indicated here, you always have six months to take legal proceedings against Gouda, from the day on which Gouda advised you of our final decision in the matter of compensation. F.13 Reimbursement of premium Insurance premium can be reimbursed if: same premium has been paid twice (only one out of two premiums will be reimbursed). You will be reimbursed without administrative fee. you choose not to commence your journey. Premium will be reimbursed after an administrative fee of SEK 100. you terminate your journey and depart from the Nordic Region before the end of the policy period. You will be reimbursed with amount equivalent to the period remaining of the original journey and policy period when leaving the Nordic Region. Remaining premium will be reimbursed after an administrative fee of SEK 100. If you wish to apply for premium reimbursement you need to fill out an application form and send the form to Gouda. The form is available on or you can order the form by telephone If you apply for reimbursement due to terminated journey, you need to verify when you left the Nordic Region and we ask you to sent us a boarding card, baggage tag or similar. F.14 Handling of claims Information provided for claims handling will be registered and managed using information technology. F.15 Compensation from other insurance If you are entitled to compensation from elsewhere due to law, statute or another policy, compensation will not be paid from this insurance. F.16 Complaints and appeal If you have questions regarding Goudas claims handling, or if you are not satisfied with our decision regarding a claim, we ask you to contact us as soon as possible. We want to make sure that a mistake has not been made and that our decision is based on correct grounds. We ask you to gather all your questions and remarks and send a written request for reconsideration of our decision and a new claims handler will review your claim. 6

7 If you, after an internal review of your claim, are still not satisfied with Goudas decision, you can get advice and appeal your claim outside of Gouda: Konsumenternas försäkringsbyrå: An insurance bureau for consumers. You can get advice, free of charge, in questions regarding consumer policies. The bureau represents the insurance companies, Finansinspektionen and the National Board For Consumer Policies. Address: Konsumenternas Försäkringsbyrå, box 24215, Stockholm. Telephone: The Swedish National Board for Consumer Complaimts (ARN): ARN has a special department for insurance issues for consumers. If you want ARN to look into your claim you shall contact ARN at: Allmänna Reklamationsnämnden, Box 174, Stockholm, telephone The services are free of charge. The board does not handle negligence issues or injury due to traffic accidents or medical disability assessments. Court: As in all disputes, you can always have your case examined by a court. Contact your nearest Swedish court for more information. G. When injury or damage occurs All claims must be reported in writing using Goudas claim form. The claim form is available on rf.se or you can order the form by telephone Claims shall be reported to Gouda as soon as possible, but no later than within three years from when you realize you could claim for compensation. You must specify your claim and provide all information an documentation we demand in order to settle the claim, for example original receipts, medical certificates etc. Your responsibility Below you will find guidelines on how to act in case of damage/ injury. Observe that these are only guidelines and that you must read them together with what is stated in each session in the policy conditions. Damage/injury Medical treatment Hospitalization Death Repatriation How to act: Contact Gouda Alarm, if possible before your visit to the doctor, since we then can pre-authorize coverage check the possibilities to make a guaranty of payment to the doctor. If you have already visited the doctor without contacting Gouda, you can ask the doctor to bill us directly or pay yourself and thereafter send us a claim form together with original receipts and medical certificate. Immediately contact Gouda Alarm if hospitalization is required. In case of death, establish contact with Gouda Alarm who will make necessary arrangements together with local authorities. If you, due to medical necessity, need to be repatriated to your country of origin, Gouda Alarm should be contacted and they will, together with treating doctor authorize and arrange transportation. H. How to contact gouda Gouda Alarm A.C Meyers Vænge København SV Denmark Phone: Fax: alarm@gouda-rf.se accepted by the doctor) etc. When contacting Gouda Alarm, we recommend that you have all relevant information gathered (policy number, telephone number to your doctor, medical certificate etc). Insurer Gouda Reseförsäkring Box 3031, Stockholm, Sweden Telephone: Gouda Alarm provides a 24-hour emergency service wherever the policyholder is. For acute treatment, Gouda Alarm will handle contact with doctors, provide payment guarantees to doctors and hospitals (if For questions regarding taking out the insurance etc., info@ gouda-rf.sefor questions regarding claims etc., claims@ gouda-rf.se Part of Gjensidige-gruppen. Gjensidige Forsikring ASA, Norge. Org. number:

8 703 ENG S Incomming feb Gouda Reseförsäkring P.O. Box Stockholm, Sweden Phone: (+46) Org.nr: info@gouda-rf.se Part of Gjensidige-gruppen Gjensidige Forsikring ASA, Norge Org. number: