General Conditions of Insurance (GCI) for UVG supplementary insurance 2017 version

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1 General Conditions of Insurance (GCI) for UVG supplementary insurance 2017 version

2 Client information pursuant to the Swiss Federal Insurance Contracts Act (VVG), Article 3 The following information provides an overview of the insurer s identity and the general contents of the insurance contract. The individual rights and duties of the contractual parties are governed by the insurance quote and/or insurance contract, the contract terms and conditions and the applicable legislation, in particular the Swiss Federal Insurance Contracts Act (VVG). Upon acceptance of the quote, the policyholder will receive an insurance contract for signature. Who is the insurer? HDI Global SE Swiss branch Dufourstrasse Zurich hereinafter referred to as HDI. What risks are insured and what is the scope of the insurance cover? The insured risks and scope of the insurance cover can be found in the quote and/or, after concluding the policy, the insurance contract and conditions of insurance. How much is the premium? The level of the premium depends on the insured risks and desired cover and is agreed individually in each specific case. There may be an additional fee for instalment payments if applicable. All other information about the premium and any fees is contained in the quote and/or the insurance contract. When is there an entitlement to a premium refund? If the premium has been paid in advance for a specific term of insurance and the insurance contract is terminated prior to the end of this term, HDI will refund the premium applicable to the remaining insurance period. The premium is owed to HDI in full if: insurance benefits have been paid out due to the elimination of the risk; insurance benefits for a partial loss have been paid out and the policyholder terminates the insurance contract during the year following conclusion of the contract. What are the policyholder s duties? Changes in risk: If there is a change in a material fact during the term of the insurance which results in a significant increase in risk, the policyholder must notify HDI of this immediately in writing. Disclosure of information: The policyholder must cooperate with HDI in disclosing information pertaining to the insurance contract e.g. with regard to breaches of notification duties, increases in risk, claims assessments, etc. and provide HDI with all information and documents requested by it, obtain these from third parties on behalf of HDI and authorise third parties in writing to provide HDI with the information and documents etc. requested. HDI is also entitled to carry out its own investigations. Insured event: An insured event must be reported to HDI immediately. The policyholder must respond immediately to all of HDI s questions about the insured event and provide the documents requested by it, obtain these from third parties on behalf of HDI and authorise third parties in writing to provide HDI with the information and documents etc. requested. HDI is also entitled to carry out its own investigations. This list includes only the most common duties. Other duties arise from the conditions of insurance and the Swiss Federal Insurance Contracts Act (VVG). When does the insurance cover commence? The insurance cover commences on the date stipulated in the quote and/ or insurance contract. If a provisional cover note has been issued, HDI will grant insurance cover until the client receives the insurance contract on the terms stated in writing in the provisional cover note or in accordance with the law. When does the insurance contract end? The policyholder may end the insurance contract by termination: no less than three months before the end of the insurance contract or, if agreed, three months prior to the end of the insurance year. Notice of termination will have been duly given if it is received by HDI no later than the last day before commencement of the three-month notice period. If the insurance contract is not terminated, it will be automatically renewed for a further year. Fixed-term contracts without an extension clause end automatically on the date stipulated in the quote and/or insurance contract; following every insured event for which a benefit is owed, no later than 14 days from notice of payment by HDI; if HDI adjusts the premium. In this case, HDI must receive the termination by the last day of the insurance year; if HDI has breached its statutory duty of notification pursuant to Article 3 of the VVG. The right of termination lapses four weeks after the policyholder receives notification of the breach, but in all cases at the end of one year after the breach of duty. HDI may end the insurance contract by termination: no less than three months before the end of the insurance contract or, if agreed, three months prior to the end of the insurance year. Notice of termination will have been duly given if it is received by the policyholder no later than the last day before commencement of the three-month notice period. If the insurance contract is not terminated, it will be automatically renewed for a further year. Fixed-term contracts without an extension clause end automatically on the date stipulated in the quote and/or insurance contract; following every insured event for which a benefit is owed, provided the contract is terminated no later than the payment or last partial payment, if the benefit is paid in multiple parts; if material facts relevant to the risk have been concealed or incorrectly stated (breach of the duty of notification). 2

3 HDI may terminate the insurance contract by withdrawal: if the policyholder defaults on payment of the premium, does not respond to reminders and HDI ceases demanding payment of the premium within two months of the end of the statutory reminder period or subsequently refuses to accept the premium payment; if the policyholder does not comply with their duty to cooperate in the disclosure of information. HDI is entitled to withdraw from the insurance contract within two weeks of the end of a four-week grace period stipulated in writing; in the event of insurance fraud. This list includes only the most common general grounds for termination. Other grounds aside from the general termination options are set out in the contractual conditions and the Swiss Federal Insurance Contracts Act (VVG). How does HDI handle data? HDI processes data deriving from the contract documents or the contract arrangement process and uses this in particular for premium calculation, risk assessment, processing insured events, statistical analyses and marketing purposes. Data is stored physically and/or electronically. HDI may, insofar as is necessary, forward data for processing and storage to third parties involved in arranging the contract within Switzerland and abroad, in particular to co-insurers and reinsurers as well as Swiss and foreign companies and branches of HDI Global SE. If offences against property or document fraud are suspected, or in the event that HDI withdraws from the insurance contract due to a fraudulent insurance claim (Article 40 VVG), a report may be sent to the Swiss Insurance Association (Schweizerischer Versicherungsverband or SVV) for entry in the central information system (CIS). If a broker or agent is acting on behalf of the policyholder, HDI is entitled to disclose client data e.g. data relating to the arranging of the contract, premium payments and insured events to this person. Furthermore, HDI may obtain pertinent information, in particular about the client s claims history, from public authorities and other third parties. This applies irrespective of whether or not an insurance contract is agreed. By signing the insurance contract, the policyholder agrees that their data will be processed in accordance with the principles above. The policyholder is entitled to request the information stipulated by law about the processing of data relevant to it. The consent to processing of data may be revoked at any time. 3

4 General Conditions of Insurance (GCI) for UVG supplementary insurance 2017 version Table of contents Page Page Basis of the contract 5 1 General principles...5 Scope of the insurance 5 2 Nature of insurance cover Insured accidents and occupational illnesses Insured persons Geographical scope Term of insurance cover for insured individuals Beginning of insurance cover End of insurance cover Insured events still open when the contract expires Insurance during unpaid holiday Transfer to individual insurance Right to transfer Reinstatement Restrictions on the right of transfer Gross negligence, extraordinary risks and hazards Restrictions on insurance cover...6 Benefits 6 11 Treatment costs (care services and reimbursement of costs) Entitlement, amount and duration of benefits Third-party benefits Daily hospital allowance Entitlement Benefit period Daily allowance Entitlement Waiting period Benefit period Partial incapacity for work Third-party benefits Disability Lump-sum disability benefit Entitlement Benefit calculation Degree of disability Progression options Pension payment Payment of benefits Impairment compensation Disability pension Entitlement Adjustment of the pension for inflation Buyout of pensions Third-party benefits Death Lump-sum death benefit Entitlement Eligible beneficiaries Survivors pension Entitlement Partner s pension Third-party benefits Adjustment of the pension for inflation Buyout of pensions UVG difference coverage...9 Additional insurance benefits 9 17 Insurance of continued salary payments after death Insurance for the consequences of earlier accidents Entitlement Benefits Treatment costs Daily allowance Third-party benefits Determination of insured benefits based on insured earnings Calculation basis Allowable earnings Set-off against liability claims Aircraft hijackings and similar events...10 Premiums Premium calculation Advance premium and premium adjustment Flat-rate premium Payment in instalments Reimbursement Change in the premium tariff...11 Surplus share Surplus share...11 Claims Obligations Consequences of a breach of contract...11 Term of the contract and right of termination Term of the contract Increase or decrease in risk Right of termination in the event of a claim...12 Miscellaneous Non-negligent breach of contract Assignment of claims Notifying HDI Place of performance and jurisdiction

5 Basis of the contract 1 General principles The insurance contract shall be based on a) these General Conditions of Insurance, any special terms together with the provisions of the policy with any addenda; b) the Swiss Insurance Contracts Act (Bundesgesetz über den Versicherungsvertrag or VVG) dated 2 April 1908 for matters not governed by the provisions in a) above; c) all existing written contractual agreements between HDI and the policyholder or insured person. Scope of the insurance 2 Nature of insurance cover HDI grants insurance cover against the financial consequences of accidents and occupational illnesses on the basis of the benefits set out in the policy. 3 Insured accidents and occupational illnesses a) The insurance covers accidents, occupational illnesses and bodily injuries pursuant to Art. 6 para. 2 UVG that are recognised as insurable events by the UVG insurer of the insured company or for which the UVG insurer of the insured company refuses cover due to culpable causation or extraordinary risks or hazards; accidents occurring during Swiss military service or another activity covered by military insurance, provided the insured person had they not performed the stated activities would have been previously insured by the UVG insurer pursuant to a), first bullet point, against non-occupational accidents. The prerequisite for HDI s benefit obligation is that the occurrence of accidents pursuant to Art. 6 para. 2 UVG the last hazard that occurred prior to the onset of an occupational illness falls within the term of insurance cover of this insurance contract. In all cases, this is without prejudice to section 10. b) Disability and death benefits will be reduced accordingly if the damage to health or death is only partially attributable to an insured accident. 4 Insured persons a) The insured persons shall be designated in the policy. b) The insurance may cover persons who are eligible for insurance in the compulsory or voluntary insurance of the insured company or occupation pursuant to the Swiss Federal Law on Accident Insurance (Bundesgesetz über die Unfallversicherung or UVG) of 20 March The insurance cover will also be granted to persons who work for the policyholder for at least eight hours per week if the accident occurs at another company or occupation subject to the UVG (multiple employers). This also applies to non-occupational accidents for which the UVG insurer of the other company subject to UVG insurance is responsible. HDI will provide insurance benefits within the scope of and based on the salary insured and declared in this insurance contract. HDI s insurance cover shall be subsidiary to the existing insurance cover of the other company subject to the UVG. Individuals sent abroad by the policyholder are covered by this insurance contract for the duration of their stay abroad, but no longer than a term of six years (subject to section 6.2). Temporary staff hired by the policyholder from a third-party organisation are excluded from this UVG supplementary insurance policy. c) Only if this is expressly mentioned in the policy are the insured persons voluntarily insured under UVG insurance. 5 Geographical scope The insurance shall apply all over the world. 6 Term of insurance cover for insured individuals 6.1 Beginning of insurance cover The insurance cover for insured individuals begins on the day the employment relationship commences or wage entitlement first exists, but in any event at the time when the employee begins their journey to work. However, the insurance cover shall begin no earlier than the commencement date designated in the policy. The insurance cover automatically applies to individuals who are not named but who belong to a group of insured persons listed in the policy; this is without prejudice to section 6.1, first bullet point. The insurance shall only apply to persons identified by name upon confirmation by HDI. 6.2 End of insurance cover The insurance cover for an insured individual ends when the person leaves the insured company; The insurance cover remains in effect for as long as the insured person is covered by the compulsory UVG insurance of the insured company. If the insured person first begins a new job, the insurance cover ends when the insured person begins the new job. for interruptions of work during which the insured person does not receive a salary and, insofar as the premium is defined in tenths of a percent of the salary, pursuant to the provisions of the UVG; The insurance may be extended beyond the statutory period in individual cases by means of an extended cover policy. in case of unemployment according to the provisions of the UVG; upon cancellation of the contract. 6.3 Insured events still open when the contract expires HDI will pay benefits after this date if applicable. 7 Insurance during unpaid holiday If the insured person has taken out a UVG extended cover policy, cover is also provided in the UVG supplementary insurance. No daily benefits are paid during unpaid holidays. However, periods of unpaid holiday are included in the waiting period. Daily benefits will not be paid before the date on which the insured person would have had to return to work. 8 Transfer to individual insurance 8.1 Right to transfer If an insured person leaves the group of insured individuals or this contract is cancelled, an insured person resident in Switzerland has the right to transfer to individual insurance policy from HDI. The right of transfer must be exercised within 90 days. 8.2 Reinstatement HDI will reinstate the previous insured benefits subject to the terms and conditions and tariffs for individual insurance applicable at the time of transfer. The state of health and age of the insured person at the date of joining the UVG supplementary insurance are the determining factors for reinstatement of insurance. 5

6 8.3 Restrictions on the right of transfer The right of transfer does not apply in the following circumstances: job changes and transfer into the UVG supplementary insurance of a new employer; cancellation of this UVG supplementary insurance policy and continuation of the policy with another insurer for the same group of individuals; over the age of 70; if the insured person moves abroad. 9 Gross negligence, extraordinary risks and hazards HDI will not reduce benefits for accidents insured under this contract that result from gross negligence, extraordinary risks or hazards as defined by the UVG. This is without prejudice to section Restrictions on insurance cover Insurance cover shall not include the following: a) consequences of warlike events in Switzerland; abroad. However, should war break out unexpectedly and surprise the insured person in the country in which they are located, the insurance cover will remain in effect for 14 days following the outbreak of war; b) accidents resulting from a deliberate criminal act or offence; c) benefits for accidents that occur while carrying out an offence will be reduced or denied pursuant to the customary reduction under UVG. This also includes accidents resulting from alcohol or drug consumption, unless there is evidently no causal connection between the insobriety/intoxication and the accident; d) suicide, self-inflicted injury or an attempt to do so; Exception: However, cover will be granted if the insured individual was completely incapable, through no fault of their own, of acting reasonably at the time of the incident, or if the suicide, suicide attempt or self-inflicted injury evidently resulted from an insured accident. e) accidents caused by the operation of aircraft and parachute jumping, if the insured person wilfully fails to comply with official regulations or does not hold the required official identification documents and permits; f) the effects of ionising radiation; Exception: There shall be cover for damage to health resulting from radiation treatments ordered by a doctor due to an insured accident. Damage to health resulting from radiation exposure while performing a professional activity for the insured company or occupation shall also be covered under the UVG, provided this has been expressly agreed with HDI. g) damage to health resulting from interventions, therapeutic measures and examinations that are not caused by an insured accident; h) accidents occurring during foreign military service; i) participation in war and warlike operations; j) participation in acts of terror and gang crimes; k) participation in scuffles and brawls, unless the insured person is injured by the fighting parties as a bystander or while assisting a defenceless individual; l) participation in riots and civil commotion. Benefits 11 Treatment costs (care services and reimbursement of costs) 11.1 Entitlement, amount and duration of benefits If treatment costs are insured, HDI shall assume the portion of the necessary expenses not covered by the UVG insurer and/or military insurance for an unlimited amount and period subject to b), d), f), g) and h) below for the following measures: a) medically prescribed or administered therapies (including medications); HDI shall also assume the deduction from daily benefits that the UVG insurer and/or military insurance makes for running costs. hospital and convalescent stays as defined by section 12.1 b); hiring of medical equipment; first-time acquisition of aids that compensate for bodily injuries or functional deficiencies: prostheses, glasses, hearing aids and orthopaedic devices; repair or replacement (replacement value) of objects that replace a body part or body function. Insured persons are only entitled to the repair or replacement of glasses, hearing aids and dental prostheses if these have been damaged or destroyed in an insured accident that results in bodily injury requiring treatment; b) complementary medicine treatments such as acupuncture, anthroposophical medicine, traditional Chinese medicine (TCM) therapies, traditional medical homeopathy and phytotherapy prescribed by a doctor and administered by doctors with the corresponding training. The total costs shall be limited to CHF 1,000 per person per case; c) HDI will provide home care (i.e. care of the accident victim at home) and take care of household errands for the duration of the medical treatment if the insured person is not able to do so themselves for accident-related reasons; d) all travel and transport of the insured person to the treatment location resulting from the accident, however only by aircraft if this is unavoidable for medical or technical reasons. However, the insurance shall not cover travel expenses for individuals who can reasonably be expected to walk. Should the insured person have an accident abroad that requires a hospital stay of more than 14 days, they may request to be transferred to a Swiss hospital. The transport must be adapted to the specifics of the injury and the medical interventions taken. HDI shall credit any savings resulting from refunds of unused train, plane and boat tickets against its benefit obligations; e) rescue operations for the benefit of the insured person that are not caused by illness; f) rescue operations and repatriation (transport to the place of burial) of the body if an insured accident results in death. If the transport of the body is accompanied by a family member, HDI will assume the travel costs for one person (first-class train travel or economy-class flight); g) search operations conducted to rescue or recover the insured person, up to a maximum of CHF 20,000 per insured individual; h) property damage up to CHF 5,000 per case; the policy covers expenses for cleaning, repairing or replacing clothing or other personal items (vehicles with registration plates are excluded) of the insured person damaged in an insured accident at replacement value as well as the cleaning of vehicles or other items of private individuals who were involved in rescuing and transporting the injured person. 6

7 11.2 Third-party benefits If the insured person or beneficiaries are entitled to benefits from social insurance (e.g. the Swiss old age and survivors, disability, health, accident, unemployment or military insurance), under a (compulsory and non-compulsory) occupational pension, other indemnity insurers or a liable third party, HDI will supplement these third-party benefits up to the amount of the treatment costs incurred. HDI will pay no more than the costs set out in section The above provision is also applicable to corresponding insurance institutions based in the Principality of Liechtenstein or other foreign countries. Should multiple insurances from licensed companies cover the treatment costs, they will only be paid once in total. HDI s payment obligations in such cases will be governed by the statutory provisions. However, any existing compulsory accident insurance pursuant to the Federal Law on Accident Insurance (UVG) provided by a licensed company is excluded from this calculation. 12 Daily hospital allowance 12.1 Entitlement a) HDI will pay the agreed daily hospital allowance for the duration of a doctor-prescribed, medically necessary stay in a hospital or convalescent home. Instead of the daily hospital allowance, HDI will pay a maximum of half of the daily hospital allowance per day for home care (care of the accident victim at home) by trained care personnel. A requirement for this benefit is that a hospital stay would be necessary in a doctor s opinion, but that hospitalisation is not possible or a hospital stay has been verifiably shortened or avoided. b) Hospitals are defined as infirmaries and psychiatric clinics managed or overseen by physicians. Convalescent homes are defined as establishments for spa, climatic or rehabilitation treatments and convalescence holidays managed by physicians. The stay is medically necessary if it serves the purpose of medical treatment with a view to a recovery or preventing a deterioration in the health condition. In addition, stays at convalescent homes are only covered if the insured person was in a doctor s care before entering the home. Furthermore, spa treatments must be administered under a doctor s supervision. Convalescent stays are only covered if they are carried out at a physician-led convalescent home Benefit period HDI will pay the daily hospital allowance per accident for a maximum of 1,800 days for hospital and convalescent stays combined. For home care it will in addition assume the costs for a maximum of 200 care days per accident. 13 Daily allowance 13.1 Entitlement HDI will pay the agreed daily allowance for the duration of a medically certified incapacity to work, however not before the end of the waiting period stipulated in the policy, for the days taken into account by the UVG insurer and/or military insurance for calculating the daily allowance. Advance certification of incapacity will be recognised for no more than one month. Depending on the agreement, the amount of the daily allowance may be based on earnings or set as a fixed amount in CHF Waiting period The waiting period begins on the first day following the date of the accident Benefit period HDI will pay the daily allowance at a maximum until the date on which the UVG disability pension commences in accordance with the decision of the UVG insurer Partial incapacity for work In the case of partial incapacity, HDI will pay a daily allowance corresponding to the degree of incapacity. Days of partial incapacity are counted as full days for the purpose of determining the waiting period and benefit duration Third-party benefits If the insured person or beneficiaries are entitled to benefits from social insurance (e.g. the Swiss old age and survivors, disability, health, accident, unemployment or military insurance), under a (compulsory and non-compulsory) occupational pension, other indemnity insurers or a liable third party, HDI will supplement these third-party benefits up to the level of the insured person s actual loss of earnings. HDI will pay no more than the agreed daily allowance. The above provision is also applicable to corresponding insurance institutions based in the Principality of Liechtenstein or other foreign countries. Should HDI pay a daily allowance to cover a loss of earnings instead of another liable third party, it will subrogate the rights of the insured person or beneficiary in proportion to the benefits paid. Should multiple insurance policies from licensed companies be in place for a daily allowance to cover loss of earnings, the insured loss of earnings under this contract will only be covered in proportion to the benefits guaranteed by all the insurers combined. However, any existing compulsory accident insurance pursuant to the Federal Law on Accident Insurance (UVG) provided by a licensed insurance company is excluded from this calculation. The provisions in section 13.5 above do not apply if the daily allowance is stipulated in the policy as a fixed amount in CHF. 14 Disability 14.1 Lump-sum disability benefit Entitlement HDI will pay the agreed lump-sum disability capital if the insured person suffers a permanent impairment of their physical or mental integrity. Any incapacity for work caused by the event is not taken into account Benefit calculation The disability sum insured is based on the agreed insurance sum, the degree of disability and progression option. If the insured person was already disabled prior to the accident, HDI will pay the difference between the disability sums applying to the degree of disability before and after the accident pursuant to this contract Degree of disability The provisions of the UVG governing impairment compensation apply to the measurement of the degree of disability. In case of a partial loss or partial loss of use, the lower degree of disability will apply. Full loss of use of limbs or organs is deemed equivalent to their loss. Should multiple body parts or organs be affected by the accident, the percentages are totalled. However, the degree of disability will never exceed 100%. 7

8 Progression options The table below shows the benefits paid as a proportion of the agreed insurance sum for different degrees of disability Pension payment If the insured person has turned 70 at the time of the accident, HDI will pay a life annuity instead of the disability sum insured (see section ). It amounts to CHF 95 per CHF 1,000 of disability compensation and is paid quarterly in advance. The pension takes effect once the degree of disability can be determined and any daily allowance payments have ceased Payment of benefits The disability sum insured or pension is paid once the degree of permanent disability can be determined, however no later than five years after the date of the accident. Only the insured person is entitled to benefits Impairment compensation a) Benefit calculation The impairment compensation is determined by the provisions of the UVG and is paid if the insured person suffers a permanent impairment of their physical or mental integrity as a result of the accident. b) Benefits HDI will pay the multiple of the impairment compensation insured under the policy based on the provisions of the UVG; depending on the agreement, this is related to the UVG salary and/or the surplus salary (see section 19.2) Disability pension Entitlement HDI will pay the agreed disability pension if the insured person s gainful employment is expected to be impacted permanently or for an extended period of time. The conditions for entitlement are based on the provisions of the UVG. However, the provisions concerning a complementary pension shall not apply Adjustment of the pension for inflation Pensions will be adjusted for inflation in line with the provisions of the UVG. However, the adjustment will be no more than 10% per year and years with less than 10% inflation cannot be compensated for by years with more than 10% inflation Buyout of pensions The provisions of the UVG apply; HDI will always buy out disability pensions if the monthly amount is less than CHF Third-party benefits If the insured person or beneficiaries are entitled to third-party benefits, HDI will supplement these benefits up to the level of the insured person s actual loss of earnings. At most, HDI will pay the agreed pension. Third-party benefits include, for example, those of social and private insurers in Switzerland and abroad, pension funds of any kind and statutory benefits. Fixed-sum insurance benefits are excluded. Table of : Benefit in % of insurance sum DoD* = Degree of disability DoD* Option Option Option Option DoD* DoD* DoD* A B C D A B C D A B C D A B C D

9 15 Death 15.1 Lump-sum death benefit Entitlement HDI will pay the agreed lump-sum death benefit if the insured person dies. The lump-sum death benefit will be no more than CHF 20,000 for insured individuals who have not yet turned 16 or are over the age of 70 on the date of the accident. Should the insured person die within five years of an accident as a consequence of the accident, HDI will pay the sum insured in the event of death, less any disability compensation already paid for the same accident Eligible beneficiaries The insured person may deviate from the arrangements below and designate or exclude beneficiaries by notifying HDI in writing. Such a declaration may be revoked or amended at any time by written notification to HDI. If there is no such special designation, the following shall be the sole valid beneficiaries, in this order: a surviving spouse or registered partner; If the marriage or registration of the partnership took place after the accident, an entitlement shall exist if the marriage or partnership had lasted for at least two years at the date of death of the insured person. an unrelated partner (including same-sex partners) who had an uninterrupted common law marriage in the same household as the deceased in the last five years prior to their death; children in equal shares; This shall also include children whose long-term care and upbringing were being provided by the insured person at the time of the accident without payment. parents. The beneficiaries are listed in order of priority, with each category excluding the categories below. If none of the beneficiaries are available, only the funeral expenses not covered by the UVG insurer or military insurance will be reimbursed up to 10% of the lump-sum death benefit, subject to a maximum of CHF 20,000. Eligible beneficiaries of an insured person shall receive the benefits even if they refuse their inheritance. The benefits will not enter into the estate of the deceased Survivors pension Entitlement HDI will pay the agreed survivors pension if the insured person dies. The conditions for entitlement are based on the provisions of the UVG. However, a divorced spouse or former partner in a partnership that has been dissolved is not entitled to a survivors pension and the provisions governing a complementary pension shall not apply Partner s pension a) All of the following requirements must be met in order for a partner s pension to be paid: Partners of the opposite or same sex must have verifiably lived in a joint household on an uninterrupted basis for at least the last five years prior to the death of the insured person, or they verifiably lived in a joint household at the time of death of the insured person and the surviving partner is responsible for the maintenance of at least one joint child. Neither partner was married or in a registered or other partnership at the time of death of the insured person. The partners are not related to one another. The surviving partner does not receive any other spouse s, widow s, widower s or partner s pension from a previous marriage or registered or other partnership. b) Amount and duration of the partner s pension The amount and duration of the partner s pension shall be governed by the provisions on survivors pensions under the UVG. The date on which the joint household has existed for five years or the date of birth of the partners child living in the joint household shall apply instead of the date of marriage. c) Obligation The surviving partner must provide all documents necessary for proving a claim to the partner s pension Third-party benefits If the insured person or beneficiaries are entitled to third-party benefits, HDI will supplement these benefits up to the level of the insured person s actual loss of earnings. At most, HDI will pay the agreed pension. Third-party benefits include, for example, those of social and private insurers in Switzerland and abroad, pension funds of any kind and statutory benefits. Fixed-sum insurance benefits are excluded Adjustment of the pension for inflation Pensions will be adjusted for inflation in line with the provisions of the UVG. However, the adjustment will be no more than 10% per year and years with less than 10% inflation cannot be compensated for by years with more than 10% inflation Buyout of pensions The provisions of the UVG shall apply. HDI will always buy out survivors pensions if the monthly amount is less than CHF UVG difference coverage If UVG difference cover has been taken out, reductions or refusals of benefits by the UVG insurer or military insurance in the event of accidents that are due to gross negligence, extraordinary risks or hazards (with the exception of accidents that are caused deliberately) will be covered. This is without prejudice to section 10 of these General Conditions of Insurance. If the benefits are payable by a liable third party or their representative, these benefits will be deducted in full from the benefits payable by HDI. HDI is entitled (but not obliged) to buy out pension benefits it owes at their present value at any time, as a result of which all claims arising from the insured accident lapse. For pension benefits, there will in no case be any extra payment as an inflation adjustment. Additional insurance benefits 17 Insurance of continued salary payments after death HDI will assume the employer s statutory duty of continued salary payments for the policyholder as defined by Art. 338, para. 2 of the Swiss Code of Obligations (OR). This benefit will only be paid if this insurance contract also provides for a lump-sum death benefit, a survivors pension or a daily allowance. 9

10 18 Insurance for the consequences of earlier accidents 18.1 Entitlement If the insured person suffers a relapse as the result of an earlier accident or if the delayed effects of an earlier accident worsen, HDI will provide insurance benefits if the following requirements have been met: The insured person must have been employed by the policyholder for at least three months at the time of the relapse or deterioration in the delayed effects of an earlier accident. The treatment costs and/or daily allowance must also be insured under this contract Benefits HDI will pay the following expenses from the date of the first benefit claimed, however for no longer than two years: Treatment costs outpatient medical treatment; treatment in the general ward of a hospital; medically prescribed after-treatment; the tools, objects and aids necessary for recuperation; the necessary travel and transports. These benefits will be calculated based on the provisions of the UVG. The maximum benefit is CHF 100, Daily allowance If the insured person is unable to work during medical treatment, from the third day of incapacity and for a maximum of two years, HDI will reimburse a daily allowance of 80% of the insured UVG salary that the insured person earned immediately prior to the interruption of work at the policyholder s company. Section 13.4 applies analogously in case of partial incapacity Third-party benefits The benefits pursuant to section 18.2 will not be provided: if the treatment costs are payable by the UVG insurance, military insurance, a compulsory health insurance, the Swiss federal disability insurance, a liable third party or a foreign insurer; if the insured loss of salary pursuant to section suffered by the insured person is reimbursed at a rate of 80% or more by the UVG insurer and/or military insurance, a foreign insurer or the Swiss federal disability insurance. If all of these benefits combined amount to less than 80% of the loss of salary suffered by the insured person during their incapacity, HDI will reimburse the difference. 19 Determination of insured benefits based on insured earnings 19.1 Calculation basis The hospital daily allowance and daily allowance are calculated based on the insured daily earnings. Lump-sum disability and death benefits are calculated based on the insured annual earnings. The insured earnings are determined based on the provisions of the UVG, consisting of both the UVG salary and the surplus salary Allowable earnings Depending on the agreement, earnings consist of the following: the UVG salary, i.e. the earnings insured pursuant to the UVG; the surplus salary, i.e. the portion of total earnings subject to the AHV (including earnings in kind) in excess of the UVG salary; the total salary, i.e. the UVG and surplus salary combined. Provided there is no agreement to the contrary, the allowable earnings shall be limited to CHF 300,000 per insured person per year. For one and the same insured person, this limit applies to both salary components together in the case of combined UVG/surplus salary insurance, and to the surplus salary alone if only the surplus of salary is insured. For persons insured voluntarily under the UVG insurance of the insured company, the insured earnings shall comprise the earnings stated in the policy and agreed in advance as the insured earnings; in case of combined UVG/surplus salary insurance, the maximum UVG salary shall always be considered the UVG salary. This rule shall also apply to other persons designated by name for whom insured earnings have been agreed in the policy in advance. 20 Set-off against liability claims The benefits paid under this accident insurance will be set off against the liability claims of the insured person or their survivors against the policyholder or other employees. 21 Aircraft hijackings and similar events a) Should insurance cover for an insured person end during an imprisonment following the hijacking of an aircraft on which the insured person was travelling; during an involuntary stay following a parachute jump to save the person s life or following an emergency landing or during the direct return trip home or onward travel to the original destination following imprisonment or an involuntary stay, it will remain valid beyond the expiry date for a period of no more than one year from the date of the hijacking, parachute jump or emergency landing. b) The exclusions pursuant to section 10 with regard to warlike events and riots do not apply to accidents suffered by the insured person aboard an aircraft, provided the accident is caused by persons who were also on board or by dangerous materials smuggled onto the aircraft; during imprisonment following the hijacking of an aircraft, during an involuntary stay following a parachute jump to save the person s life or an emergency landing or on the subsequent direct return trip home or onward travel to the original destination. The time limit pursuant to a) above shall also apply. c) However, should a war break out, the insurance cover pursuant to b) will end 48 hours after the outbreak of hostilities in the country in which the aircraft is located at the time. However, if the imprisonment, parachute jump or emergency landing has already occurred, the second bullet point under b) above will only expire at the end of one year. d) The extension of cover pursuant to a) and b) above shall apply provided that the insured person was not actively or through incitement involved in the relevant events. Premiums 22 Premium calculation The premium is calculated based on the insured person s salary as determined by AHV rules and the provisions of the UVG; the number of insured persons and/or the number of days of employment. 10

11 23 Advance premium and premium adjustment a) At the beginning of every insurance year, the policyholder is required to pay the provisional premium (advance premium), which corresponds as closely as possible to the assumed final premium. The payment deadline is 30 days from the due date. b) The premium is adjusted at the end of each insurance year or when the contract ends. To this end, HDI will send the policyholder a form on which to report the particulars required for preparing the premium adjustment. Any premium supplement resulting from this adjustment is payable within 30 days of HDI s request for payment. Any premium rebate will be paid out to the policyholder by HDI within the same period after establishing the final premium. The premium supplement or premium rebate will be waived by the contractual parties for amounts of less than CHF 20. HDI is entitled to verify the information provided by the policyholder. The policyholder shall allow HDI to inspect all applicable documents (payslips, receipts, etc.) for this purpose. c) HDI may adjust the advance premium from the beginning of an insurance year to reflect a change in circumstances. 24 Flat-rate premium The premium is only considered to be a flat-rate premium if it was expressly agreed as such. The payment deadline is 30 days from the due date. 25 Payment in instalments If payment in instalments has been agreed, instalments that fall due during the insurance year are deemed only to have been deferred, subject to section Reimbursement If the contract is cancelled before the end of an insurance year, HDI will reimburse the share of the premium paid for the remaining insurance period and will not collect future instalments. The provisions concerning final adjustment of the premium pursuant to section 23 remain unaffected. However, the premium for the current insurance period is due in full if in the event of a partial loss the policyholder cancels the contract within one year of the start of the contract. 27 Change in the premium tariff Should there be a change in the material scope or level of the premium tariff for UVG supplementary insurance and/or the insurance benefits prescribed under the UVG, HDI may demand an amendment of the contract with effect from the following insurance year. To this end, HDI will notify the policyholder of the new contractual provisions no later than three months before the end of the insurance year. The policyholder is entitled to terminate the portion of the contract affected by the amendment or the entire contract as at the end of the current insurance year. HDI must receive the termination no later than the last day of the insurance year in order for it to be valid. Should the policyholder fail to terminate the contract, this shall be deemed to be an approval of the contractual amendment. Surplus share 28 Surplus share Should the policy include surplus sharing, the policyholder will receive the contractual share of any surplus at the end of the agreed adjustment period. The surplus is determined by deducting the insurance benefits paid for claims arising during the adjustment period from the premium applicable to the adjustment period. In the process, pension benefits are included at their present value. The length of the adjustment period, applicable premium and surplus share will be stipulated in the policy. The adjustment is made once the premiums due in the adjustment period have been paid and any claims have been settled. Any loss is not carried forward to the new adjustment period. If, after the adjustment has been completed, benefit claims are subsequently made or payments are issued which fall within the adjustment period that has ended, a new surplus sharing statement will be issued. HDI may reclaim surplus shares that have already been paid out. The entitlement to surplus sharing lapses if the contract is cancelled before the end of the adjustment period. Claims 29 Obligations Should an accident be likely to result in a claim for insurance benefits, a licensed doctor or dentist must be involved as soon as possible to ensure professional care. The insured person must follow the instructions of the treating physician or dentist or the medical support staff commissioned by them. The insured person is obliged to undergo an examination by the doctors commissioned by HDI; the policyholder or beneficiary must notify HDI in writing within 30 days. Furthermore, the beneficiary must do everything they can to help clear up the insured event and its consequences; HDI is entitled to demand additional documents and information, in particular medical certificates. The beneficiary grants HDI the right to request such documents and information directly and at its own expense. The beneficiary hereby releases the doctors who have treated the insured person from maintaining patient confidentiality with respect to HDI. In the event of death, HDI must be notified early enough so that it can request an autopsy at its own expense if the death may have been the result of something other than the accident. The autopsy may not be conducted if the insured person s spouse or registered partner or, if there is no spouse or registered partner, the parents or children of full age object, or if the insured person has issued a corresponding declaration of intent. 30 Consequences of a breach of contract If the duties pursuant to section 29 are culpably breached and the extent or assessment of the consequences of the accident are adversely affected as a result, HDI may reduce its benefits accordingly, unless the policyholder, insured person or beneficiary can prove that the breach of contract did not influence the consequences and assessment of the accident. Term of the contract and right of termination 31 Term of the contract a) At the end of the agreed term, the contract will be automatically renewed by one year, unless it is terminated at least three months prior to its expiry. b) Notice of termination will have been duly given if it is received by HDI or the policyholder no later than the last day before commencement of the three-month notice period. c) If the term of the contract is less than one year, the contract will automatically lapse on the defined expiry date. 11

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