General Terms and Conditions for Insurance

Transcription

1 General Terms and Conditions for Insurance Abroad SP-TAS-14 SP-TAS-14 (T-191) I. Introduction 1. Health Insurance with Medical Assistance Abroad 1.1 Health insurance with medical assistance while travelling abroad (hereinafter: the Insurance for Travelling Abroad) is the insurance for covering the expenses of emergency medical services abroad, related services abroad and other services as defined in these General Terms and Conditions, including medical assistance, for the case you are ill or injured abroad. 1.2 You can add additional coverages for the event of accident abroad to insurance for travelling abroad. Additional coverage means: permanent disability above 40% as a result of accident abroad and daily compensation for extended stay in a hospital abroad due to accident abroad. You cannot take out additional coverage independently without insurance for travelling abroad. 2. What are these General Terms and Conditions 2.1 The General Terms and Conditions for Insurance Abroad SP-TAS-14 (hereinafter: General Terms and Conditions) a constituent part of this insurance contract that you have taken out as the policyholder (the Insured) with the insurance company for the contractually agreed insurance period, area and package. By concluding the insurance contract you also accept the provisions of these General Terms and Conditions. 2.2 In the event of additional coverage, the Table for determining the percentage of permanent disability due to accident (hereinafter: the Disability table) shall be a constituent part of these General Terms and Conditions. 2.3 The common provisions of these General Terms and Conditions also apply to additional coverage. 2.4 In these General Terms and Conditions»you«refers to the policyholder (the Insured), if not expressly specified otherwise. In these General Terms and Conditions»we«or the»insurance company«refers to Vzajemna zdravstvena zavarovalnica, d.v.z. II. Concluding the insurance contract 3. Who can you insure under these General Terms and Conditions? 3.1 The policyholder (the Insured) can be either you or another person (individual insurance) or persons travelling together (group insurance) or family (family insurance). A family means up to two adults and their children, adopted children and grandchildren until the age of 26 years, provided that they have the same address of permanent residence. 3.2 There is no age-limit for taking out insurance for travelling abroad; for persons over 75 years of age, you have to pay an extra premium according to the insurance company s price list. 3.3 You can insure persons up to age 75 for additional coverage. 3.4 A person fully lacking legal capacity or a person with a mental disorder cannot be the policyholder. 4. How can you conclude the insurance contract? 4.1 You can conclude the insurance contract in the following manners: in the case of MULTITRIP insurance on the basis of a signed offer on the insurance company s form. The written offer to the insurance company for concluding the insurance policy shall be binding on the offerer for eight days from being received by the insurance company, unless specified otherwise. If the Insurer does not reject the offer not deviating from the terms & conditions of insurance in the set period, the insurance contract shall be deemed concluded once the insurance company has received the offer; your signature and the signature of the Insured replaces the signature on the policy. by signing the policy; by paying the premium, which you can prove with the certificate of premium payment, if so stipulated for the event of concluding the insurance contract at a distance. 5. When is insurance contract concluded? 5.1 The insurance contract is deemed concluded when the contractors sign the bid or an insurance policy or a certificate of coverage or confirm, in another way, that they agree on the essential elements of the insurance contract, such as determination of the scope of coverage, package, premium, insurance coverage and insurance term. 5.2 You must conclude the insurance contract prior to the Insured s departure abroad or prior to their trip. If you conclude the insurance contract on the day of departure abroad, it shall only be deemed concluded if you pay the premium in full on the same day, i.e. prior to the Insured s departure. 5.3 The insurance shall not be validly concluded if: you take out the insurance contract after the departure of the Insured abroad or if at the time it is taken out the Insured is already abroad; you pay the premium on the next day or any other day after the Insured s departure abroad. 5.4 You can can exceptionally extend the insurance coverage under the existing contract for an Insured if the latter extends their stay abroad or is not present in Slovenia on the day of extension. As a rule you must submit the request to the insurance company in writing, five (5) days prior to the expiry of the existing insurance. The insurance contract can be extended in the manner and under conditions specified by the insurance company. III. Insurance term 6. Insurance for travelling abroad 6.1 Insurance for travelling abroad can be concluded for a single trip abroad with specific duration or several trips abroad within one (1) year (MULTITRIP insurance). 6.2 The number of trips within an insurance year in the scope of MULTITRIP insurance is not limited and the insurance coverage only applies for the first 90 consecutive calendar days of the Insured s individual departure from Slovenia or the country of permanent residence abroad. 7. Additional criteria 7.1 You can only take out additional coverage for the duration of insurance for travelling abroad. IV. Start and end date of insurance coverage 8. Start date of insurance coverage in the case of insurance for travelling abroad 8.1 Insurance coverage starts at hours on the day stated as the start date on the insurance contract, provided that you have paid the premium until that time. The full premium shall fall due upon taking out the insurance and prior to the beginning of travel, unless specified otherwise in the insurance contract. 8.2 If you have taken out the insurance at an underwriting outlet of the insurance company on the day of departure of the Insured abroad and have paid the total premium, the insurance coverage can begin on the day of the Insured s departure abroad. 8.3 Insurance coverage for the Businessman package only applies during business trips abroad. 8.4 The MULTITRIP insurance coverage only applies for the first 90 consecutive calendar days of the Insured s individual departure from Slovenia or the country of permanent residence abroad. 9. Start date of insurance coverage in the case of additional coverage 9.1 If you have taken out any additional coverage, i.e. for accidents abroad, its period of validity is linked to the validity of the underlying insurance for travelling abroad. 10. Expiry and end date of insurance coverage in the case of insurance for travelling abroad 10.1 Insurance and insurance coverage end at hours on the day stated as the insurance contract termination date on the insurance contract Insurance and insurance coverage also end with termination of insurance for travelling abroad (the Insured s death, cancellation or termination of insurance) Insurance coverage for an insured who has turned 26 and has previously been insured on the basis of family insurance for travelling abroad shall be terminated upon the expiry of insurance. 11. Expiry and end date of insurance coverage in the case of additional coverage 11.1 Additional coverage shall automatically expire with the termination of insurance for travelling abroad Additional coverage for each insured from the insurance contract shall be terminated upon the first payment of full (100%) insurance policy benefit for permanent disability above 40%, as a result of an accident abroad Insurance coverage of additional coverage shall be terminated once the Insured has reached the age of 75 years, upon the expiry of the insurance policy. 12. Geographic validity and amount of insurance cover 12.1 Insurance and insurance coverage only apply to the area specified in the insurance contract. You can only conclude the insurance contract for the area of Extended Europe (area 1), World (area 2) or Croatia (area 3) The area Extended Europe covers the area to the Ural mountain range and the southern border of the Russian Federation, the countries of the Mediterranean, Jordan, Syria, and the Canary Islands. The area World covers the entire world If you have taken out any additional coverage, i.e. for accidents abroad, its geographic validity is linked to the geographic validity of the underlying insurance for travelling abroad Insurance and insurance coverage does not apply to Slovenia and the area of the country in which the Insured has official permanent residence Insurance coverage included in your insurance contract and total sum insured under the policy and sums insured for individual types of costs are specified on the policy and relate to all costs of services for the Insured in the scope of insurance for travelling abroad, incurred during the insurance coverage, except for emergency dental services, where the sum insured on the policy is defined per insurance case The MULTITRIP insurance policy specifies sums insured for the insurance year and specific event insured against, except for urgent dental services, for which the sum insured is specified for each case individually on the policy. 1

2 General Terms and Conditions for Insurance Abroad SP-TAS In the case of family and group insurance for travelling abroad, the sums insured are defined per individual specified in the insurance contract Sums insured of the additional coverage are specified in the policy. V. Our obligations 13. When does an event insured against occur during the term of insurance coverage? 13.1 An event insured against occurs on the basis of the Insured s justified need for urgent medical and other services arising from unforeseen illness or injury of the Insured and ends in the moment when the insurance company s doctor issues an opinion that the Insured no longer requires medical treatment or upon repatriation of the Insured (i.e. to Slovenia or the country where the Insured s permanent residence is located, if so specified on the insurance contract) A new insured event shall occur when medical or other services are required due to unforeseen illness or injury that is not in causal relationship with the above. 14. Coverage under insurance for travelling abroad 14.1 Insurance for travelling abroad comprises: coverage of costs of emergency medical services and related services abroad; medical assistance; coverage of costs of other services. 15. What do the costs of emergency medical services comprise 15.1 The costs of emergency medical services constitute the costs arising from unforeseen illness or injury abroad and in addition to the legally specified costs of emergency medical services comprise also the following: the cost of acute conditions of chronic illnesses, except in the case of S and Business S packages; the costs of medication and bandages, if prescribed by a doctor; the costs of medical devices needed for the treatment, if prescribed by a doctor; the costs of emergency transportation to the nearest appropriate medical centre or hospital and back to the place of accommodation; the costs of dental and oral cavity treatment in the case of acute pain resulting from an illness or recent dental injury, tooth s nerve treatment, emergency tooth extraction or treatment of abscesses; and the costs of an emergency visit by a physician at the location of the Insured, if the Insured is unable to get to a doctor by themselves. 16. What does medical assistance cover 16.1 Medical assistance is the service that comprises organisation and provision of assistance to the Insured in the event of unforeseen acute illness or injury abroad Medical assistance is provided by our contractual partner Allianz Global Assistance and it comprises the following services: selection of the nearest appropriate medical centre or hospital abroad, depending on the diagnosis; organisation of emergency transportation of the Insured to the nearest appropriate medical centre or hospital; notice to the hospital on the conditions for the payment of hospital treatment; organisation of an emergency visit by a physician at the location of the Insured, if the Insured is unable to get to a doctor by themselves; provision of the relevant information to medical staff over the telephone, if the Insured has problems communicating in a foreign language; informing of the Insured s relatives or sending information at his/her business address at the Insured s request; change of hotel, air ticket or rent-a-car booking due to reasons that cannot be influenced by the Insured (delayed flight, hospitalisation of the Insured and similar). 17. Which other costs are covered by the insurance for travelling abroad? 17.1 In addition to the costs of emergency medical services, related services and medical assistance, the Insurance also covers the costs of: transportation of an ill, injured or deceased person to the home country; searching and rescuing the Insured; accommodation for the relatives of a hospitalised Insured and lawyer s services The costs of transportation of the Insured constitute the costs of repatriation organised by us and arising from unforeseen illness or injury and comprise the following: transportation of the Insured to the residence or hospital in Slovenia, if the medical condition of the Insured requires repatriation. If the insurance company s doctor believes that the Insured can be transported and the Insured, or another person on their behalf, rejects the transportation, our contractual obligation for this event insured against is terminated; a medical team of the insurance company accompanying the Insured during repatriation, if so required by the Insured s medical condition; transportation of a deceased insured from the place of death to the place of burial, if the latter is in Slovenia; repatriation of the Insured s family members, if the original means of transport to be used to return to Slovenia can no longer be used due to the accident which caused the occurrence of the event insured against; transportation of the Insured s child under 18, accompanied by an authorised person of the insurance company to the residence in Slovenia, while the Insured whom the child travelled with is hospitalised abroad or has died and there is no other relative older than 18 years on the same trip with them The costs of search and rescue of the Insured comprise the costs arising from the search or rescue of ill or injured insured due to unforeseen illness or injury in hardly accessible area (particularly mountains, seas, lakes, caves, etc.), if such search or rescue is requested by a relative of the missing insured or a person travelling with the Insured and organised by us. The costs of search and rescue comprise the following: the costs of search for an officially missing insured arising after the accident; the costs of rescue of the Insured arising after the accident and after the Insured s location has been determined. The costs of rescue include the costs of transportation of the Insured from the place of accident to the nearest medical centre or hospital abroad. Transportation of the Insured to a medical centre or hospital abroad shall be deemed rescuing and not transportation, regardless of the emergency The costs of accommodation of a relative and the Insured s children, younger than 18 years, travelling together with the hospitalised insured include the costs of no more than seven overnight stays after the planned departure from the place where the Insured is hospitalised.if a large group travels together, costs are only covered for one relative staying with the Insured while the others continue their trip. If it is a family trip, the cost of accommodation is also covered for children Insurance covers the costs of lawyer s services if we judge that it is not likely that the Insured would be sentenced for the charges made against them under the applicable legislation.the costs of lawyer s services for any charges relating to professional activity of the Insured, use or security of vehicles are not covered. 18. Exclusions and limitations under insurance for travelling abroad 18.1 The insurance company s obligations are excluded, if the costs are the result of: Treatment or medical care and the results of treatment that is not urgent, including all dental services except urgent treatment for elimination of acute toothache or fresh tooth injuries, including tooth extraction, up to the amount specified on the policy; acute conditions of chronic illnesses in the case of S and Business S packages; illnesses, medical conditions and injuries that existed prior to departure abroad or that appeared and have not been fully treated prior to departure abroad; spa treatment, physical therapy and heliotherapy; aesthetic treatment, fitting of artificial limbs, all medical and technical devices and equipment, which is/are not necessary for the Insured s life (such as for example knee supports, glasses, contact lenses, etc.); preventive vaccination; planned treatment and surgeries; above-standard services, such as the following services in a hospital: single room, telephone, TV; transportation due to minor medical problems which could be treated at the venue of the event insured against and would not prevent the Insured from continuing the vacation or trip; treatment or medical care provided by the Insured s relative; pregnancy, regular examinations during pregnancy, complications upon pregnancy, delivery, except in the case of saving the mother s or the child s life; artificial insemination, terminated pregnancy, treatment of infertility or contraception; sexually transmitted diseases, including AIDS; mental disorders and depressions; accidents suffered by the Insured while engaging in motor racing (competitions, training, preparations) and racing; accidents suffered by the Insured while engaging in sports such as: extreme sports, parachuting or similar activities (e.g. gliding, hang-gliding, sky-diving and similar), extreme mountaineering without trained mountain guides, all activities above 6,000 a.s.l. and all activities that are not part of organised hiking, sports activities in whitewater, diving without international diving licence for a certain depth; operating aircraft of any type and travelling in any aircraft, vessel or other vehicle without the prescribed valid licence for use, with the exception of passengers in public transportation; accidents suffered by the Insured while using arms, performing particularly dangerous tasks, such as handling explosives; expeditions to unknown and unexplored areas; accidents at work, unless so explicitly agreed and subject to extra premium; accidents occurring while the Insured is under the influence of alcohol, drugs or narcotics. In the event of a car accident it shall be deemed that it was caused because of driving under the influence of alcohol at the time of accident, if the level of alcohol in the Insured s blood exceeds the legally permitted level of alcohol in the blood of participants in traffic, according to the Slovenian legislation; suicide or attempted suicide; participating in the preparation, attempt or execution of a wilful offence as well as escape after such an offence and participation in a fight or physical violence, with the exception of proven self-defence; 2

3 General Terms and Conditions for Insurance Abroad SP-TAS-14 all forms of radiation, including exposure to light, sun and other radiation, change in temperature, except when saving another person s life; epidemics, pandemics, pollution of the environment or natural disasters; accidents in the time of civil war or war with a foreign country, riots, demonstrations, terrorist acts, sabotages or attempted murders and other similar cases, if the risk is assessed as high by the insurance company Excluded from the insurance company s obligation is the difference in cost arising due to grave acute illness or severe injuries which it did not approve, as specified in item 21.1 of these General Terms and Conditions. If you as the Insured, or another person on your behalf, rejects the proposed emergency treatment in the nearest appropriate healthcare centre or hospital abroad, the obligation of the insurance company for this event insured against terminates and you as the Insured shall bear the consequences related to potential complications of your medical condition. 19. What does additional coverage comprise? 19.1 Insurance for travelling abroad can be upgraded by additional coverage that offers you or the Insured financial and social security for the case of accident while travelling abroad, within the limits of the agreed sum insured You cannot take out additional coverage without the underlying insurance for travelling abroad. As a rule, you can add additional coverage to all forms of insurance for travelling abroad, regardless of the selected area, package or duration of insurance for travelling abroad Additional coverage comprises: permanent disability above 40% as a consequence of an accident that occurred abroad; daily benefit for extended stay in a hospital abroad due to accident abroad, namely for each overnight stay in a hospital exceeding the time for which the insurance contract has been concluded, but not more than 30 overnight stays In the case of additional coverage for permanent disability above 40%, the Insured shall be paid out the total amount of insurance benefit for permanent disability if they became permanently disabled due to an accident abroad, with the established rate of disability above 40%. The disability table, which is a constituent part of these Terms and Conditions shall be used to assess the level of disability resulting from the accident. As a rule, the level of disability due to accident rate above 40% is established no sooner than three (3) months after the finished treatment, unless specified otherwise in the disability table, when the consequences of the injury have settled. If the treatment is not finished three (3) years after the day of accident abroad, the state at the date of expiry of this period shall be deemed as final. In any case, potential disability percentage resulting from any accidents prior to taking out additional coverage is deducted when determining the final percentage of disability In the event of extended stay abroad, when accommodation and hospital treatment due to accident abroad is required, the Insured shall be paid the daily benefit for each overnight stay in the hospital exceeding the time for which the insurance contract has been concluded. Following individual injury abroad, the Insured is entitled to the payment of up to 30 overnight stays If under the previous insurance contract an insurance benefit has already been paid out in relation to additional coverage (except in the case of the payment of daily fee for staying in the hospital abroad for an injury abroad), no additional coverage can be added when taking out a new insurance for travelling abroad According to these General Terms and Conditions, an accident is any sudden, unforeseen event that occurs during the term of insurance coverage, affecting the Insured s body from the outside, suddenly and against their will, and causing physical injury to the Insured The following are above all considered an accident: fall, slip, being hit by an object or hitting against an object, car accident, being hit by electricity or lightning, injury by arms or other objects or explosives, being stabbed, being hit or bitten by an animal, poisoning by mushrooms or other chemical substance. Burns, strangling as a result of accident, drowning, twisted joints and broken healthy bones, and loss or breaking of healthy teeth due to accident shall also be considered an accident The following events in particular shall not be considered consequences of accident under these General Terms and Conditions: all illnesses and their consequences; anaphylactic shock, infections and diseases arising from various forms of allergies, actinic illnesses, insect bites; infections caused by pathogenic bacteria, parasites and viruses; the consequences of psychical impact (anxiety and depressive states, stress disorders, etc.), regardless of the cause; intervertebral and other hernias, degenerative diseases related to the spine and joints, nerve roots irritation, lumbago, ischialgia, fibrositis, myofascitis, bursitis; ruptured aneurysm and spontaneous pneumothorax; consequences of medical, particularly surgical interventions performed due to treatment or prevention of diseases. 20. Exclusions under additional coverage 20.1 All liabilities of the insurance company for the cases specified under Item 18 and relating to the accident shall be excluded. 3 VI. Your rights and obligations 21. What do you have to do immediately after the occurrence of the event insured against? 21.1 If you as the Insured fall seriously ill or sustain a severe injury or need hospital treatment or repatriation, you have to immediately inform the assistance centre of the insurance company thereof. If you fail to inform the assistance centre and your use of insurance coverage results in costs higher than in case the assistance centre were informed, the insurance company may reject the payment of the difference If you as the Insured get a mild acute illness or minor injury, you need not call the assistance centre. In this case you shall pay the costs of emergency medical and other services and you may subsequently claim reimbursement directly from the insurance company when returning home. These costs shall not exceed EUR 100. Even if you call the assistance centre of the insurance company, you shall be obliged to pay the costs under EUR 100 and you may subsequently claim reimbursement directly from the insurance company when returning home If an event insured against under the package of additional coverage occurs, you must inform the insurance company thereof immediately or as soon as possible, considering your medical condition. 22. Claiming insurance benefit 22.1 If you pay the costs of emergency medical and other services to the service provider, you claim insurance benefit from the insurance company. If not, the insurance benefit is paid by the insurance company directly to the provider of services rendered, in compliance with the conditions referred to in item You have to inform us of claiming insurance benefit no later than within three (3) months of repatriation. You have to submit an application for benefit reimbursement accompanied by all necessary documentation and all information about the event insured against. The documentation on the event insured against shall comprise: Original invoices for services provided; Medical documentation about the event insured against testifying to the treatment emergency; Additional documentation, if required by us The invoices for medical services provided must state the date of service provision, the data about the issuer and the Insured s name, description of illness and services rendered.the invoices for medication must indicate the prescribed medication, and the invoices for dental services must state the description of treated teeth and procedures performed When you report an accident that occurred abroad, you must submit to the insurance company all the necessary facts and data required for resolving the insurance event, particularly about the time and place of the occurrence of accident abroad, complete description of event, medical reports and other documentation on treatment progress, type and level of physical injury and possible consequences, as well as data on potential physical disabilities that the Insured might have had prior to the accident abroad. If hospitalisation is required due to an accident abroad, the insurance company must be submitted the original certificate of hospitalisation with the name, surname and address of the Insured, their birth date and date of admission to and discharge from the hospital, when claiming the right to daily benefit for the period of hospitalisation due to an accident abroad The complete documentation of the event insured against, i.e. medical and/ or hospital or pharmacy bills and medical record must be delivered in Latin alphabet, either in Slovene, German, English, Croatian, Serbian, Italian, Spanish or French; otherwise, the Insured shall be obliged to cover the cost of official translation We will reimburse the insurance benefit arising from insurance for travelling abroad in the amount of costs translated into EUR as at the date of payment, no later than in fourteen (14) days of receipt of the application accompanied by all the necessary documentation related to the respective event insured against.the deadline can be extended accordingly if more time is needed for establishing the existence and amount of our obligations We shall pay the insurance benefit arising from additional coverage to the Insured within fourteen (14) days of receiving the written request and unambiguous evidence on the existence of the insurance company s obligation The insurance company shall bear no damage liability in case it were unable to timely and duly discharge its obligations under the General Terms and Conditions due to unexpected problems, restrictions or circumstances (force majeure, strike, technical difficulties, etc.) As the policyholder or the Insured you hereby authorise the insurance company to request on your behalf the reimbursement of costs of a medical service abroad directly from the Health Insurance Institute of Slovenia, according to the regulations on compulsory health insurance. VII Other provisions 23. Insurance cancellation 23.1 Insurance shall be terminated on the day stated as the date of expiry on the policy.

4 General Terms and Conditions for Insurance Abroad SP-TAS It can be terminated in exceptional cases. If you cancel the insurance before the commencement of insurance coverage, we are entitled to keep 20% of the premium and return the rest to you. If you cancel the insurance contract after the commencement of insurance cover, we are entitled to premium for the entire insurance period If you have insured another person, the Insured must be informed of the termination of the insurance contract If you took out insurance at a distance (i.e. via the Internet, by post, etc.) and Insurance with insurance period of one month or more, you are according to the law on consumer protection entitled to cancel the insurance contract by submitting to the insurance company a written notice in fifteen (15) days of taking out the insurance contract. If insurance is concluded at a distance for a period of less than one month, it is not possible to terminate the insurance contract If you terminate your travelling early, we shall not reimburse the proportional premium for the remaining period. 24. Fraud 24.1 If the Insured or another person on their behalf attempts to take out insurance contract and/or obtain the services and benefits in the scope of such insurance contract through fraud, the insurance company shall have no liabilities whatsoever under this insurance contract. 25. Costs of services 25.1 As the policyholder you are obligated to pay for the services you request from us separately. The price of these services is stated in the Price List applicable at the time. 26. Personal information 26.1 By taking out the insurance contract, the policyholder and/or the Insured expressly allows that their personal data may be collected, stored, forwarded and otherwise processed according to the RS law regulating personal data protection, if required in order to exercise the rights and obligations arising from or related to insurance, including inspection of the relevant medical documentation by a doctor authorised by the insurance company, and with the aim of conducting financial and medical supervision.the policyholder and the Insured also authorise the insurance company to verify other data with institutions that dispose with personal data The insurance company may also use personal data from the previous point, including the data on the date of birth of the policyholder and the Insured for direct marketing and direct marketing via electronic communications, namely for the entire term of the insurance contract and for a maximum period of ten (10) years after the termination of the insurance contract. The policyholder and the Insured may at any time, in writing, via telephone or personally demand that the Insurance company stop using their personal data for the purpose of direct marketing. The insurance company shall appropriately prevent the use of their personal data for the purpose of direct marketing within fifteen (15) days, of which they shall be informed in writing within five (5) days. The insurance company shall cover all costs of all actions related to your claim The policyholder and the Insured have been informed that they have the right to examine, copy, supplement, correct, block and delete their personal data in accordance with the RS law regulating personal data protection The insurance company shall protect personal information referred to hereunder in accordance with the provisions of the RS law regulating personal data protection As the policyholder and/or the Insured you are obliged to inform us in writing of any change of personal data and other circumstances relevant for insurance, namely within eight (8) days of change. 27. Out-of-court settlement of disputes 27.1 Disputes related to the insurance contract may be resolved out of court by filing an appeal. You may file the appeal orally or in writing at our branch, via website or at reklamacije@vzajemna.si The appeal shall be dealt with by our competent body according to the rules on internal appeal procedure. The internal appeal procedure is organised at two levels. The decision of the Appeal Committee at the second level is final If the decision of the Appeal Committee is disagreed with, you may continue the procedure for out-of-court settlement of the dispute with the Mediation Centre of the Slovenian Insurance Association or the Ombudsman of good practices in insurance. 28. Final provisions 28.1 Any relationships between the insurance company, the policyholder, the Insured, the beneficiary and other persons not regulated herein shall be subject to the legal provisions regulating obligations in the Republic of Slovenia If a dispute is being resolved through court, the court of jurisdiction shall be the court in the Republic of Slovenia and the court of venue shall be the Court of Ljubljana Supervision over the insurance company falls within the competence of the Insurance Supervision Agency, Trg republike 3, Ljubljana These General Terms and Conditions shall apply as of 01/04/

5 Additional Terms and Conditions for Insurance Abroad DP-TAS-EX-14 I. Introduction 1. General provision 1.1 Additional Terms and Conditions for Insurance Abroad DP-TAS-EX-14 (hereinafter: Additional Terms and Conditions) apply in the case of taking out health insurance with medical assistance for extended coverage while living abroad (hereinafter: insurance for extended coverage). 1.2 Together with the General Terms and Conditions for Insurance Abroad SP- TAS-14 (hereinafter: General Terms and Conditions), the Additional Terms and Conditions are a constituent part of this insurance contract that you have taken out as the Insured (policyholder) with Vzajemna zdravstvena zavarovalnica, d.v.z. (hereinafter: the insurance company) for the contractually agreed insurance period, area and package. By concluding the insurance contract you also accept the provisions of the Additional and General Terms and Conditions. 1.3 In the event of additional coverage, the Table for determining the percentage of permanent disability due to accident (hereinafter: the disability table) shall be a constituent part of the insurance contract. 2. What are these Additional Terms and Conditions 2.1 Additional Terms and Conditions regulate health insurance with medical assistance abroad with extended coverage. Since by concluding the insurance contract with extended coverage, the Insured can be entitled to a larger scope of rights, as defined in these Additional Terms and Conditions, not merely to essential medical and related services, a doctor can provide medical services to such Insured in the scope required for clinical assessment of illness, treatment or care for a certain condition, due to which the Insured need not return home early. 2.2 You can add additional coverages for the event of accident abroad to insurance with extended coverage. You cannot take out additional coverage independently without insurance with extended coverage. II. Concluding the insurance contract 3. Who and how can be insured under these Additional Terms and Conditions? 3.1 You can insure yourself or another person (individual insurance) or several persons (group insurance). 3.2 You can insure persons up to age 65. This limitation also applies to additional coverages. III. Insurance term 4. Insurance with extended coverage 4.1 You can conclude insurance with extended coverage for a single trip abroad with specific duration, namely from one (1) month to including one (1) year. IV. Geographic validity of insurance with extended coverage 5. Geographic validity of insurance coverage with extended coverage 5.1 You may conclude the insurance contract for the area of Extended Europe (area 1) or World (area 2). V. Our obligations 6. When does an event insured against occur in the case of insurance with extended coverage? 6.1 The insurance case in the event of insurance with extended coverage shall occur in the case of justified need of the Insured for urgent or required, subject to a doctor's assessment, medical and preventive and other services in line with these Additional Terms and Conditions. 6.2 A new insurance case occurs when urgent or required, subject to a doctor's assessment, medical and preventive and other services need to be provided, not in causal relationship with the previous. 7. What does insurance with extended coverage comprise? 7.1 Under these Additional Terms and Conditions, the insurance with extended coverage shall comprise the following coverage in addition to the coverage under the General Terms and Conditions up to the sum insured, indicated on the policy: coverage of costs of medical and related services that need to be provided according to a doctor's opinion, including an examination and urgent medical treatment during pregnancy and delivery; coverage of costs needed for dental services (toothache treatment, including simple fillings and repairs of denture, if prescribed by a dentist); coverage of costs of preventive outpatient examinations of children and adults, and preventive examination for early detection of cancer according to the programme foreseen by the public healthcare system in Slovenia; coverage of costs of prescribed physiotherapy, health resort (rehabilitation following injury or illness): preventive vaccination as foreseen by the public healthcare system in Slovenia; coverage of costs of prescribed medical devices and corrective lenses in line with the provisions applicable in the public healthcare system in Slovenia What do the costs of necessary medical services comprise? 8.1 Medical services needed on the basis of a doctor's opinion, as stipulated by law, are services that are needed because of medical reasons, considering the nature of services and the expected length of the Insured's stay abroad. Scope and type of the necessary medical services shall be defined by the doctor who receives the Insured for treatment, considering, as a key factor, their medical condition and the length of the Insured's stay abroad. 8.2 Under these Additional Terms and Conditions, the following shall be covered in the event of pregnancy and delivery: examinations and treatment during pregnancy, treatment after spontaneous abortion, provided that the person was not pregnant when the insurance was taken out, examinations and urgent treatment during pregnancy, including examinations due to acute problems during pregnancy, treatment as a result of a spontaneous abortion and delivery by the end of the 36th week of pregnancy (early delivery), if such examinations and treatment are required and the need for them did not exist upon taking out insurance, in spite of pregnancy; Delivery after the expiry of the agreed waiting period, i.e. 6 months from the date of insurance commencement. 9. What do costs of preventive outpatient medical examinations and preventive programmes for early detection of cancer include? 9.1 Under these Additional Terms and Conditions, the Insured shall be entitled to preventive outpatient examinations, as foreseen in the system of public health insurance in Slovenia and preventive detection of cancer, namely: systematic and other preventive examinations of children, women and other adults in accordance with the programme of compulsory health insurance in Slovenia; and preventive services for the prevention, transplantation and early detection of illnesses, in accordance with the programme in Slovenia, such as: cervical cancer, breast cancer and colon cancer; mandatory vaccination, immunoprophylaxis in accordance with the programme in Slovenia. 9.2 Sums insured are specified on the policy. 10. What do the costs of physiotherapy and health resort comprise? 10.1 If, based on medical indication, a doctor should order physiotherapy or health resort as rehabilitation following illness or injury, the Insured shall be entitled to compensation of costs arising from such physiotherapy or health resort up to the amount of the sum insured as specified on the policy. 11. What does preventive vaccination comprise? 11.1 The cost of preventive vaccination, namely those defined according to the regular programme in Slovenia, is also covered under these Additional Terms and Conditions. The cost of preventive vaccination can be covered up to the amount of the sum insured as set out in the policy. 12. What do costs of medical devices and corrective lenses comprise? 12.1 These Additional Terms and Conditions cover the costs of standard medical devices, eye-treatment devices and corrective lenses prescribed by the doctor, namely up to the amount of the sum insured specified on the policy and in accordance with the rights stipulated in the framework of the system of public health insurance in Slovenia. 13. Exclusions 13.1 Under these Additional Terms and Conditions, all obligations of the insurance company as specified in the General Terms and Conditions are excluded, except for those that are the subject hereof. VI. Your rights and obligations 14. What do you have to do after the occurrence of the event insured against? 14.1 Upon the occurrence of the event insured against, you are obliged to act in accordance with the General Terms and Conditions. VII. Other provisions 15. Additional Terms and Conditions apply in addition to the General Terms and Conditions. If the contents of the Additional Terms and Conditions differs from General Terms and Conditions, the provisions of the Additional Terms and Conditions shall prevail. 16. These Additional Terms and Conditions shall apply as of 01/04/

6 Additional Terms and Conditions for Insurance for Foreigners in Slovenia DP-TAS-IN-14 I. Introduction 1. General provision 1.1 Additional Terms and Conditions for Insurance for Foreigners in Slovenia DP- TAS-IN-14 (hereinafter: Additional Terms and Conditions) apply in the case of taking out health insurance for foreigners in Slovenia (hereinafter: insurance for foreigners). 1.2 Together with the General Terms and Conditions for Insurance Abroad SP- TAS-14 (hereinafter: General Terms and Conditions), the Additional Terms and Conditions are a constituent part of this insurance contract that you have taken out as the Insured (policyholder) with Vzajemna zdravstvena zavarovalnica, d.v.z. (hereinafter: the insurance company) for the contractually agreed insurance period, area and programme. By concluding the insurance contract you also accept the provisions of the Additional and General Terms and Conditions. 2. What are these Additional Terms and Conditions? 2.1 These Additional Terms and Conditions regulate health insurance for foreigners who come to Slovenia. By concluding this insurance, the Insured is entitled to a larger scope of coverage in addition to urgent medical and related services. 2.2 Under these Additional Terms and Conditions, the Insured is also entitled to coverage for tourist or business travelling to other European countries. II. Concluding the insurance contract 3. Who and how can be insured under these Additional Terms and Conditions? 3.1 You can insure yourself or another person (individual insurance) or several persons (group insurance). 3.2 You can insure persons up to age 65. III. Insurance term 4. Insurance for foreigners 4.1 You can conclude insurance for foreigners for a specific duration, namely from one (1) month to including one (1) year. IV. Geographic validity of insurance for foreigners 5. Geographic validity of insurance for foreigners 5.1 You can conclude the insurance contract for the area of Slovenia and expanded Europe. 5.2 Insurance cover under these Additional Terms and Conditions, except for Slovenia, shall not apply in the area of the country in which the Insured has permanent residence. V. Our obligations 6. When does an event insured against occur in the case of insurance for foreigners? 6.1 The insurance case in the event of insurance for foreigners shall occur in the case of justified need of the Insured for urgent or required, subject to a doctor's assessment, medical and preventive and other services in line with these Additional Terms and Conditions. 6.2 A new insurance case occurs when urgent or required, subject to a doctor's assessment, medical and preventive and other services need to be provided, not in causal relationship with the previous. 7. What does insurance for foreigners comprise? 7.1 Under these Additional Terms and Conditions, the insurance for foreigners shall comprise the following coverage in addition to the coverage under the General Terms and Conditions: coverage of costs of medical and related services that need to be provided according to a doctor's opinion, including an examination and urgent medical treatment during pregnancy and delivery; coverage of costs needed for dental services (toothache treatment, including simple fillings and repairs of denture, if prescribed by a dentist); coverage of costs of preventive outpatient examinations of children and adults, and preventive examination for early detection of cancer according to the programme foreseen by the public healthcare system in Slovenia; coverage of costs of prescribed physiotherapy, health resort (rehabilitation following injury or illness): preventive vaccination as foreseen by the public healthcare system in Slovenia; coverage of costs of prescribed medical devices and corrective lenses in line with the provisions applicable in the public healthcare system in Slovenia. 8. What do the costs of necessary medical services comprise? 8.1 Medical services needed on the basis of a doctor's opinion, as stipulated by law, are services that are needed because of medical reasons and cannot be postponed to a later time, considering the nature of services and the expected length of the Insured's stay abroad. Scope and type of the necessary medical services shall be defined by the doctor who receives the Insured for treatment, considering, as a key factor, their medical condition and the length of the Insured's stay abroad. 8.2 Under these Additional Terms and Conditions, the following shall be covered in the event of pregnancy and delivery: examinations and treatment during pregnancy, treatment after spontaneous abortion, provided that the person was not pregnant when the insurance was taken out, examinations and urgent treatment during pregnancy, including examinations due to acute problems during pregnancy, treatment as a result of a spontaneous abortion and delivery by the end of the 36th week of pregnancy (early delivery), if such examinations and treatment are required and the need for them did not exist upon taking out insurance, in spite of pregnancy. Delivery after the expiry of the agreed waiting period, i.e. 6 months from the date of insurance commencement. 9. What do costs of preventive outpatient medical examinations and preventive programmes for early detection of cancer include? 9.1 Under these Additional Terms and Conditions, the Insured shall be entitled to preventive outpatient examinations, as foreseen in the system of public health insurance in Slovenia and preventive detection of cancer, namely: systematic and other preventive examinations of children, women and other adults in accordance with the programme of compulsory health insurance in Slovenia; preventive services for the prevention, transplantation and early detection of illnesses, in accordance with the programme in Slovenia, such as: cervical cancer, breast cancer and colon cancer; mandatory vaccination, immunoprophylaxis in accordance with the programme in Slovenia. 9.2 Sums insured are specified on the policy. 10. What do the costs of physiotherapy and health resort comprise? 10.1 If, based on medical indication, a doctor should order physiotherapy or health resort as rehabilitation following illness or injury, the Insured shall be entitled to compensation of costs arising from such physiotherapy or health resort up to the amount of the sum insured as specified on the policy. 11. What does preventive vaccination comprise? 11.1 The cost of preventive vaccination, namely those defined according to the regular programme in Slovenia, is also covered under these Additional Terms and Conditions. The cost of preventive vaccination can be covered up to the amount of the sum insured as set out in the policy. 12. What do costs of medical devices and corrective lenses comprise? 12.1 These Additional Terms and Conditions cover the costs of standard medical devices, eye-treatment devices and corrective lenses prescribed by the doctor, in accordance with the rights stipulated in the framework of the system of public health insurance in Slovenia and up to the amount of the sum insured specified on the policy. 13. Preliminary approval 13.1 A preliminary approval from the insurance company shall be required for the coverage of cost arising from the necessary medical services, acute conditions of chronic illnesses and physiotherapy or health resort in the case of rehabilitation, above the amount specified by the insurance company. 14. Exclusions 14.1 Under these Additional Terms and Conditions, all obligations of the insurance company as specified in the General Terms and Conditions are excluded, except for those that are the subject hereof The insurance company may refuse compensation of any costs of medical services for which no preliminary approval was obtained under these Additional Terms and Conditions from the insurance company. VI. Your rights and obligations 15. What you have to do after the occurrence of the event insured against? 15.1 Upon the occurrence of the event insured against, you are as a rule obliged to pay the cost of medical and other services to the service provider and then claim compensation from the insurance company under the General Terms and Conditions. VII. Other provisions 16. Additional Terms and Conditions apply in addition to the General Terms and Conditions. If the contents of the Additional Terms and Conditions differs from General Terms and Conditions, the provisions of the Additional Terms and Conditions shall prevail. 17. These Additional Terms and Conditions shall apply as of 01/04/