Assistance Service. The emergency assistance company contracted by us to provide assistance services to plan members at the time of your claim. The contact details for the Assistance Service can be found in the 'Contact details' section at the front of this agreement. The use of medical techniques, including, but not limited to, in- vitro fertilisation (IVF) with or without intra-cytoblastic sperm injection (ICSI), gamete intrafallopian transfer (GIFT), zygote intra-fallopian transfer (ZIFT), egg donation and intra-uterine insemination (IUI) with ovulation induction, received during the 3 month period prior to conception. All countries in the Caribbean region including the West Indies and all islands surrounded by or bordering the Caribbean Sea. The confirmation of your insurance cover issued by us. It confirms the plan type your employer has chosen, the NextCare network yo are entitled to use, the plan currency, your area of cover, period of cover, date of entry, renewal date, excess amount, special terms, your country of residence, your home country, and the schedule of insured persons. The schedule of insured persons lists the persons insured by us under your employer’s agreement with us. If there are any changes to the details on your certificate of insurance we will issue you with a new one confirming the changes. A disease, illness or injury that has one or more of the following characteristics: • it needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests • it needs ongoing or long-term control or relief of symptoms • you need to be rehabilitated or specially trained to cope with it • it continues indefinitely • it has no known cure • it comes back or is likely to come back A contribution that you must make towards the eligible costs of Whether hereditary or not, any abnormality, deformity, disease, illness or injury present at birth, whether diagnosed or not, or any deformity arising during the antenatal stages of pregnancy, or caused during childbirth. The country in which you are habitually resident as specified on your application form or subsequently advised to us in writing. The date on which cover for you, and each of your eligible dependants, first commenced. Your date of entry is as stated on your certificate of insurance. A patient admitted to a hospital or day-patient unit for a medical procedure which for medical reasons could not have been performed on an out-patient basis and which requires them to occupy a hospital bed for a period of medically supervised recovery, but it is not medically necessary for them to occupy a bed overnight. Dental procedures undertaken by your dental practitioner which are medically necessary for the maintenance and/or restoration of oral health, and are provided in accordance with accepted standards of dental practice. A qualified person legally carrying out this profession in the country in which he or she is located. Investigations, such as x-rays or blood tests to diagnose the cause of your symptoms. See Medical doctor.
Appears in 2 contracts
Samples: Corporate Global Health Foundation Plan Agreement, Corporate Global Health Foundation Plan Agreement
Assistance Service. The emergency assistance company contracted by us to provide assistance services to plan members at the time of your claim. The contact details for the Assistance Service can be found in the 'Contact details' section at the front beginning of this agreement. Assisted reproduction The use of medical techniques, including, but not limited to, in- vitro fertilisation (IVF) with or without intra-cytoblastic sperm injection (ICSI), gamete intrafallopian intra-fallopian transfer (GIFT), zygote intra-fallopian transfer (ZIFT), egg donation and intra-uterine insemination (IUI) with ovulation induction, received during the 3 month period prior to conception. Caribbean country and island All countries in the Caribbean region including the West Indies and all islands surrounded by or bordering the Caribbean Sea. Certificate of insurance The confirmation of your insurance cover issued by us. It confirms the plan type your employer has chosen, the NextCare network yo are entitled to use, the plan currencyyou have bought, your area of cover, period of cover, date of entry, renewal date, excess amount, special terms, your country of residence, your home countrycountry of nationality, and the schedule of insured persons. The schedule of insured persons lists the persons insured by us under your employer’s agreement with us. If there are any changes to the details on your certificate of insurance we will issue you with a new one confirming the changes. Chronic condition A disease, illness or injury that has one or more of the following characteristics: • it needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests • it needs ongoing or long-term control or relief of symptoms • you need to be rehabilitated or specially trained to cope with it • it continues indefinitely • it has no known cure • it comes back or is likely to come back Claim A course of treatment for a specific illness, injury, medical condition, dental condition or pregnancy, or the use of an expat benefit. Co-insurance A contribution that you must make towards the eligible costs of Complications of pregnancy Congenital condition Whether hereditary or not, any abnormality, deformity, disease, illness or injury present at birth, whether diagnosed or not, or any deformity arising during the antenatal stages of pregnancy, or caused during childbirth. Country of residence The country in which you are habitually resident as specified on your application form or subsequently advised to us in writing. Country of nationality Your country of origin, for which you hold a passport. If you hold more than one passport your country of nationality will be the country you have declared on your application form. Date of entry The date on which cover for you, and each of your eligible dependants, first commenced. Your date of entry is as stated on your certificate of insurance. Day-patient A patient admitted to a hospital or day-patient unit for a medical procedure which for medical reasons could not have been performed on an out-patient basis and which requires them to occupy a hospital bed for a period of medically supervised recovery, but it is not medically necessary for them to occupy a bed overnight. Dental treatment Dental procedures undertaken by your dental practitioner which are medically clinically necessary for the maintenance and/or restoration of oral health, and are provided in accordance with accepted standards of dental practice. Dentist or dental practitioner A qualified person legally carrying out this profession in the country in which he or she is located. Diagnostic tests Investigations, such as x-rays or blood tests to diagnose the cause of your symptoms. Doctor See medical doctor. Eligible dependants Your spouse or partner, provided they are under age 70 at their date of entry, and your unmarried children (i.e. your son, daughter, step-son, step-daughter, adopted children and children subject to legal guardianship) provided the unmarried children are aged less than 18 years old, or less than 25 years old if in continuous full-time education. If a child is adopted or the subject of legal guardianship we may require proof. We may also require proof of a dependent child being in full time education. Emergency caesarean section A caesarean section which must take place immedicately and cannot be planned. Emergency treatment Essential treatment, covered by your plan, that is immediately required if you suffer an accident or a sudden and unforeseen illness you have never suffered from before, which is not a pre-existing medical condition, or a related condition, or a condition for which you have a personal medical exclusion. Excess The amount stated as the excess in your certificate of insurance, being the amount you must contribute to each claim. If your excess is per annum, the excess stated on your certificate of insurance is the amount you must contribute towards the cost of eligible treatment covered by your plan and received within the same period of cover. Hospital An establishment which is legally licensed as a medical or surgical Innocent bystander Someone who is not involved with, participating in or reporting on war, acts of foreign enemy hostilities (whether or not war is declared), civil war, rebellion, revolution, insurrection or military or usurped power, mutiny, riot, strike, martial law or state of siege, or attempted overthrow of government, or any acts of terrorism, or actively participating in operations countering any such activities. In-patient A patient who is admitted to hospital and who occupies a bed overnight or longer for medical reasons. Insured person You and any eligible dependants specified in your certificate of insurance as being included in the plan. Insurer The insurance company that provides the insurance cover for your plan. The insurer is Allianz (AWP Health & Life S.A.). Life-threatening condition A critical medical condition covered by your plan, which in the opinion of the Assistance Service constitutes a life-threatening situation which requires immediate in-patient treatment. London area Any address in the United Kingdom within the E, EC, N, NW, SE, SW, W or WC postcode areas. Medical doctor A person who is legally qualified in medical practice following attendance at a recognised medical school (as listed in the World Directory of Medical Schools as published from time to time by the World Health Organisation) to provide medical treatment and who is licensed to practise medicine in the country where the treatment is received. Medically necessary Treatment that is medically necessary and appropriate. The • essential to diagnose or treat a patient’s condition, illness or injury; • consistent with the patient’s symptoms, diagnosis or treatment of the underlying condition; • in accordance with generally accepted medical practice and professional standards of medical care at the time; • required for reasons other than the comfort or convenience of the patient or his or her physician • proven and been demonstrated to have medical value, with international medical and scientific evidence of the effectiveness and safety of the treatment; • considered to be the most appropriate type and level of treatment taking patient safety and cost effectiveness into consideration; • provided at an appropriate facility, in an appropriate setting, and at an appropriate level of care for the treatment of the patient’s medical condition; • provided only for an appropriate duration of time. Medical practitioner A person who has full registration under the Medical Acts of the country where they practice and who specialises in nursing, homeopathy, acupuncture, orthopaedic medicine, osteopathy, chiropractic, chiropody, podiatry or physiotherapy treatment, and to whom you have been referred by a medical doctor. Medical referral letter A letter from your medical doctor or specialist which refers you to another medical practitioner for treatment covered by your plan. We will only pay for treatment when the start date of your treatment is within 3 months of the date of your medical referral letter. Medical services provider(s) A hospital, out-patient clinic, medical practitioner, dental practitioner, optician or pharmacy. Medical underwriting The process of you providing and us assessing the health and medical information we ask for to decide the terms under which we will accept your application for cover, or for enhanced cover. Based on the information you give us, we may decide to place special terms on your cover, such as personal medical exclusions, or we may decide not to offer you cover. Out-patient A patient who attends a hospital consulting room, emergency room or out-patient clinic, when it is not medically necessary for them to be admitted as a day-patient or an in-patient. Out-patient surgical procedure An out-patient procedure where one or more of the following is • general or local anaesthesia or intravenous sedation • manipulation or relocation of a fractured bone or dislocated joint by a medical doctor • invasive surgical procedures • invasive diagnostic procedures involving venous cannulation • the use of endoscopic equipment Period of cover A period of 12 months from your date of entry or from any subsequent renewal date. Your period of cover is as shown on your certificate of insurance. Persistent vegetative state and neurological damage We will not pay for any treatment received after you have been in a vegetative state for a period of eight weeks or received after you have sustained permanent neurological damage and remained in hospital for a period of eight weeks, apart from any treatment you are eligible for under the lifetime care benefit. Personal medical exclusions A restriction on your cover that is stated on your certificate of insurance and specifically excludes treatment of a certain medical condition or conditions and any related conditions. Plan or plan type The Essential Care plan or Essential Care Plus plan on which you and your eligible dependants are covered. Plan holder The person stated as the plan holder on the certificate of Planned caesarean section A caesarean section which has been scheduled to take place more than 24 hours in advance, whether this be for medical or elective reasons. Post-hospital treatment Medically necessary follow-up consultations, physiotherapy, diagnostic tests and/or treatment required on an out-patient basis following in-patient or day-patient treatment covered by your plan and received within the 90 day period following the date you are discharged from hospital. Pre-existing medical conditions Any disease, illness or injury, whether the condition has been diagnosed or not before your date of entry, for which: • you have received medication, advice or treatment; or • you have experienced symptoms Premium The amount(s) you are required to pay to us either annually, half- yearly, quarterly or monthly for your insurance plan. Premium due date The date on which your premium is due to be paid. Preventive health checks Health tests, screening and/ or clinical procedures specifically designed for disease prevention and early detection. Qualified nurse A nurse whose name is currently on any official register of nurses maintained by a statutory nursing registration body within the country where treatment is provided. Reasonable and customary The charge that would typically be made for your treatment by medical services providers in the country where you receive your treatment, and for the medically necessary length of stay required. If the cost of your treatment is not reasonable and customary, we will only pay up to the amount which is typically charged in that country. If the length of stay is not reasonable and customary, we will only pay for the medically necessary length of stay required. In the event of a dispute, we will identify the amount typically charged for your treatment by obtaining comparable quotations from three other medical services providers in the country where you receive your treatment, and taking a mean average of these three quotations. Rehabilitation Related condition Any disease, illness or injury that is caused by a pre-existing medical condition or results from the same underlying cause as a pre-existing medical condition. Renewal date The anniversary date of your plan as shown on your certificate of insurance, normally the anniversary of your original date of entry to the plan.
Appears in 1 contract
Samples: Essential Health Plan Agreement
Assistance Service. The emergency assistance company contracted by us to provide assistance services to plan members at the time of your claim. The contact details for the Assistance Service can be found in the 'Contact details' section at the front beginning of this agreement. The use of medical techniques, including, but not limited to, in- vitro fertilisation (IVF) with or without intra-cytoblastic sperm injection (ICSI), gamete intrafallopian intra fallopian transfer (GIFT), zygote intra-fallopian transfer (ZIFT), egg donation and intra-uterine insemination (IUI) with ovulation induction, received during the 3 3-month period prior to conception. All countries in the Caribbean region including the West Indies and all islands surrounded by or bordering the Caribbean Sea. The confirmation of your insurance cover issued by us. It confirms the plan type your employer has you have chosen, the NextCare network yo you are entitled to use, the plan currencycurrency you have selected, your area of cover, period of cover, date of entry, renewal date, excess amount, special terms, your country of residence, your home countrycountry of nationality, and the schedule of insured persons. The schedule of insured persons lists the persons insured by us under your employer’s agreement with us. If there are any changes to the details on your certificate of insurance we will issue you with a new one confirming the changes. A disease, illness or injury that has one or more of the following characteristics: • it needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests • it needs ongoing or long-term control or relief of symptoms • you need to be rehabilitated or specially trained to cope with it • it continues indefinitely • it has no known cure • it comes back or is likely to come back A contribution that you must make towards the eligible costs of Whether hereditary or not, any abnormality, deformity, disease, illness or injury present at birth, whether diagnosed or not, or any deformity arising during the antenatal stages of pregnancy, or caused during childbirth. Your country of origin, for which you hold a passport. If you hold more than one passport your country of nationality will be the country you have declared on your application form. The country in which you are habitually resident as specified on your application form or subsequently advised to us in writing. The date on which cover for you, and each of your eligible dependants, first commenced. Your date of entry is as stated on your certificate of insurance. A patient admitted to a hospital or day-patient unit for a medical procedure which for medical reasons could not have been performed on an out-patient basis and which requires them to occupy a hospital bed for a period of medically supervised recovery, but it is not medically necessary for them to occupy a bed overnight. Dental procedures undertaken by your dental practitioner which are medically necessary for the maintenance and/or restoration of oral health, and are provided in accordance with accepted standards of dental practice. A qualified person legally carrying out this profession in the country in which he or she is located. Investigations, such as x-rays or blood tests to diagnose the cause of your symptoms. See Medical doctorDoctor.
Appears in 1 contract
Samples: Health Insurance Agreement
Assistance Service. The emergency assistance company contracted by us to provide assistance services to plan members at the time of your claim. The contact details for the Assistance Service can be found in the 'Contact details' section at the front beginning of this agreement. Assisted reproduction The use of medical techniques, including, but not limited to, in- vitro fertilisation (IVF) with or without intra-cytoblastic sperm injection (ICSI), gamete intrafallopian intra-fallopian transfer (GIFT), zygote intra-fallopian transfer (ZIFT), egg donation and intra-uterine insemination (IUI) with ovulation induction, received during the 3 month period prior to conception. Caribbean country and island All countries in the Caribbean region including the West Indies and all islands surrounded by or bordering the Caribbean Sea. Certificate of Insurance The confirmation of your insurance cover issued by us. It confirms the plan type your employer has chosen, the NextCare network yo are entitled to use, the plan currencyyou have bought, your area of cover, period of cover, date of entry, renewal date, excess amount, special terms, your country of residence, your home countrycountry of nationality, and the schedule of insured persons. The schedule of insured persons lists the persons insured by us under your employer’s agreement with us. If there are any changes to the details on your certificate Certificate of insurance Insurance we will issue you with a new one confirming the changes. Chronic condition A disease, illness or injury that has one or more of the following characteristics: • it needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests • it needs ongoing or long-term control or relief of symptoms • you need to be rehabilitated or specially trained to cope with it • it continues indefinitely • it has no known cure • it comes back or is likely to come back Claim A course of treatment for a specific illness, injury, medical condition, dental condition or pregnancy, or the use of an expat benefit. Co-insurance A contribution that you must make towards the eligible costs of Complications of pregnancy Congenital condition Whether hereditary or not, any abnormality, deformity, disease, illness or injury present at birth, whether diagnosed or not, or any deformity arising during the antenatal stages of pregnancy, or caused during childbirth. Country of residence The country in which you are habitually resident as specified on your application form or subsequently advised to us in writing. Country of nationality Your country of origin, for which you hold a passport. If you hold more than one passport your country of nationality will be the country you have declared on your application form. Date of entry The date on which cover for you, and each of your eligible dependants, first commenced. Your date of entry is as stated on your certificate Certificate of insuranceInsurance. Day-patient A patient admitted to a hospital or day-patient unit for a medical procedure which for medical reasons could not have been performed on an out-patient basis and which requires them to occupy a hospital bed for a period of medically supervised recovery, but it is not medically necessary for them to occupy a bed overnight. Dental treatment Dental procedures undertaken by your dental practitioner which are medically clinically necessary for the maintenance and/or restoration of oral health, and are provided in accordance with accepted standards of dental practice. Dentist or dental practitioner A qualified person legally carrying out this profession in the country in which he or she is located. Diagnostic tests Investigations, such as x-rays or blood tests to diagnose the cause of your symptoms. Doctor See medical doctor. Eligible dependants Your spouse or partner, provided they are under age 70 at their date of entry, and your unmarried children (i.e. your son, daughter, step-son, step-daughter, adopted children and children subject to legal guardianship) provided the unmarried children are aged less than 18 years old, or less than 25 years old if in continuous full-time education. If a child is adopted or the subject of legal guardianship we may require proof. We may also require proof of a dependent child being in full time education. Emergency caesarean section A caesarean section which must take place immedicately and cannot be planned. Emergency treatment Essential treatment, covered by your plan, that is immediately required if you suffer an accident or a sudden and unforeseen illness you have never suffered from before, which is not a pre-existing medical condition, or a related condition, or a condition for which you have a personal medical exclusion. Excess The amount stated as the excess in your Certificate of Insurance, being the amount you must contribute to each claim. If your excess is per annum, the excess stated on your Certificate of Insurance is the amount you must contribute towards the cost of eligible treatment covered by your plan and received within the same period of cover. Hospital An establishment which is legally licensed as a medical or surgical Innocent bystander Someone who is not involved with, participating in or reporting on war, acts of foreign enemy hostilities (whether or not war is declared), civil war, rebellion, revolution, insurrection or military or usurped power, mutiny, riot, strike, martial law or state of siege, or attempted overthrow of government, or any acts of terrorism, or actively participating in operations countering any such activities. In-patient A patient who is admitted to hospital and who occupies a bed overnight or longer for medical reasons. Insured person You and any eligible dependants specified in your Certificate of Insurance as being included in the plan. Insurer The insurance company that provides the insurance cover for your plan. The insurer is Allianz (AWP Health & Life SA). Life-threatening condition A critical medical condition covered by your plan, which in the opinion of the Assistance Service constitutes a life-threatening situation which requires immediate in-patient treatment. London area Any address in the United Kingdom within the E, EC, N, NW, SE, SW, W or WC postcode areas. Master policy The contract of insurance issued by us to the Xxxxxxx Xxxxxxx Association for Health, Financial Protection and Well-Being, for the benefit of its members. Medical doctor A person who is legally qualified in medical practice following attendance at a recognised medical school (as listed in the World Directory of Medical Schools as published from time to time by the World Health Organisation) to provide medical treatment and who is licensed to practise medicine in the country where the treatment is received. Medically necessary Treatment that is medically necessary and appropriate. The • essential to diagnose or treat a patient’s condition, illness or injury; • consistent with the patient’s symptoms, diagnosis or treatment of the underlying condition; • in accordance with generally accepted medical practice and professional standards of medical care at the time; • required for reasons other than the comfort or convenience of the patient or his or her physician • proven and been demonstrated to have medical value, with international medical and scientific evidence of the effectiveness and safety of the treatment; • considered to be the most appropriate type and level of treatment taking patient safety and cost effectiveness into consideration; • provided at an appropriate facility, in an appropriate setting, and at an appropriate level of care for the treatment of the patient’s medical condition; • provided only for an appropriate duration of time. Medical practitioner A person who has full registration under the Medical Acts of the country where they practice and who specialises in nursing, homeopathy, acupuncture, orthopaedic medicine, osteopathy, chiropractic, chiropody, podiatry or physiotherapy treatment, and to whom you have been referred by a medical doctor. Medical referral letter A letter from your medical doctor or specialist which refers you to another medical practitioner for treatment covered by your plan. We will only pay for treatment when the start date of your treatment is within 3 months of the date of your medical referral letter. Medical services provider(s) A hospital, out-patient clinic, medical practitioner, dental practitioner, optician or pharmacy. Medical underwriting The process of you providing and us assessing the health and medical information we ask for to decide the terms under which we will accept your application for cover, or for enhanced cover. Based on the information you give us, we may decide to place special terms on your cover, such as personal medical exclusions, or we may decide not to offer you cover. Out-patient A patient who attends a hospital consulting room, emergency room or out-patient clinic, when it is not medically necessary for them to be admitted as a day-patient or an in-patient. Out-patient surgical procedure An out-patient procedure where one or more of the following is • general or local anaesthesia or intravenous sedation • manipulation or relocation of a fractured bone or dislocated joint by a medical doctor • invasive surgical procedures • invasive diagnostic procedures involving venous cannulation • the use of endoscopic equipment Period of cover A period of 12 months from your date of entry or from any subsequent renewal date. Your period of cover is as shown on your Certificate of Insurance. Persistent vegetative state and neurological damage We will not pay for any treatment received after you have been in a vegetative state for a period of eight weeks or received after you have sustained permanent neurological damage and remained in hospital for a period of eight weeks, apart from any treatment you are eligible for under the lifetime care benefit. Personal medical exclusions A restriction on your cover that is stated on your Certificate of Insurance and specifically excludes treatment of a certain medical condition or conditions and any related conditions. Plan or plan type The Essential Care plan or Essential Care Plus plan on which you and your eligible dependants are covered. Plan holder The person stated as the plan holder on the Certificate of Insurance. Planned caesarean section A caesarean section which has been scheduled to take place more than 24 hours in advance, whether this be for medical or elective reasons. Post-hospital treatment Medically necessary follow-up consultations, physiotherapy, diagnostic tests and/or treatment required on an out-patient basis following in-patient or day-patient treatment covered by your plan and received within the 90 day period following the date you are discharged from hospital. Pre-existing medical conditions Any disease, illness or injury, whether the condition has been diagnosed or not before your date of entry, for which: • you have received medication, advice or treatment; or • you have experienced symptoms Premium The amount(s) you are required to pay to us either annually, half- yearly, quarterly or monthly for your insurance plan. Premium due date The date on which your premium is due to be paid. Preventive health checks Health tests, screening and/ or clinical procedures specifically designed for disease prevention and early detection. Qualified nurse A nurse whose name is currently on any official register of nurses maintained by a statutory nursing registration body within the country where treatment is provided. Reasonable and customary The charge that would typically be made for your treatment by medical services providers in the country where you receive your treatment, and for the medically necessary length of stay required. If the cost of your treatment is not reasonable and customary, we will only pay up to the amount which is typically charged in that country. If the length of stay is not reasonable and customary, we will only pay for the medically necessary length of stay required. In the event of a dispute, we will identify the amount typically charged for your treatment by obtaining comparable quotations from three other medical services providers in the country where you receive your treatment, and taking a mean average of these three quotations. Rehabilitation Related condition Any disease, illness or injury that is caused by a pre-existing medical condition or results from the same underlying cause as a pre-existing medical condition. Renewal date The anniversary date of your plan as shown on your Certificate of Insurance, normally the anniversary of your original date of entry to the plan. Session A single continuous consultation during which time you may receive advice, treatment and/or prescribed medication.
Appears in 1 contract
Samples: Essential Health Plan Agreement
Assistance Service. The emergency assistance company contracted by us to provide assistance services to plan members at the time of your claim. The contact details for the Assistance Service can be found in the 'Contact details' section at the front beginning of this agreement. The use of medical techniques, including, but not limited to, in- vitro fertilisation (IVF) with or without intra-cytoblastic intracytoplasmic sperm injection (ICSI), gamete intrafallopian intra-fallopian transfer (GIFT), zygote intra-fallopian transfer (ZIFT), egg donation and intra-uterine insemination (IUI) with ovulation induction, received during the 3 3-month period prior to conception. All countries in the Caribbean region including the West Indies and all islands surrounded by or bordering the Caribbean Sea. The confirmation of your insurance cover issued by us. It confirms the plan type your employer has chosen, the NextCare network yo you are entitled to use, the your plan currency, your area of cover, period of cover, date of entry, renewal date, excess amount, special terms, your country of residence, your home countrycountry of nationality, and the schedule of insured persons. The schedule of insured persons lists the persons insured by us under your employer’s 's agreement with us. If there are any changes to the details on your certificate Certificate of insurance Insurance we will issue you with a new one confirming the changes. A disease, illness or injury that has one or more of the following characteristics: • it needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests • it needs ongoing or long-term control or relief of symptoms - • you need to be rehabilitated or specially trained to cope with it • it continues indefinitely • it has no known cure • it comes back A course of treatment for a specific illness, injury, medical condition, dental condition or is likely to come back pregnancy, or the use of a benefit in the Expat benefits section of the table of benefits. A contribution that you must make towards the eligible costs of Whether hereditary or not, any abnormality, deformity, disease, illness or injury present at birth, whether diagnosed or not, or any deformity arising during the antenatal stages of pregnancy, or caused during childbirth. Your country of origin, for which you hold a passport. If you hold more than one passport your country of nationality will be the country you have declared on your application form. The country in which you are habitually resident resident, as specified on your application form or subsequently advised to us in writing. The date on which cover for you, and each of your eligible dependants, first commenced. Your date of entry is as stated on your certificate Certificate of insuranceInsurance. A patient admitted to a hospital or day-patient unit for a medical procedure which for medical reasons could not have been performed on an out-patient basis and which requires them to occupy a hospital bed for a period of medically supervised recovery, but it is not medically necessary for them to occupy a bed overnight. Dental procedures undertaken by your dental practitioner which are medically clinically necessary for the maintenance and/or restoration of oral health, and are provided in accordance with accepted standards of dental practice. A qualified person legally carrying out this profession in the country in which he or she is located. Acronym for the Dubai Health Authority. Investigations, such as x-rays or blood tests to diagnose the cause of your symptoms. See Medical medical doctor. Your spouse and your unmarried children (ie your son, daughter, step-son, step-daughter, adopted children and children subject to legal guardianship) provided the unmarried children are aged less than 18 years old, or less than 25 years old if in continuous full-time education. If a child is adopted or the subject of legal guardianship we may require proof. We may also require proof of a dependent child being in full time education. A caesarean section, which must take place immediately and cannot be planned. Essential treatment that is immediately required as a result of medical emergency that presents a serious threat to the health of the insured person, or to the health of an unborn foetus of a mother insured on your plan, or (within the first 90 days of life) to the health of a newborn child of a mother insured on your plan.
Appears in 1 contract
Samples: Business Health Plan Agreement
Assistance Service. The emergency assistance company contracted by us to provide assistance services to plan members at the time of your claim. The contact details for the Assistance Service can be found in the 'Contact details' section at the front of this agreement. The use of medical techniques, including, but not limited to, in- vitro fertilisation (IVF) with or without intra-cytoblastic sperm injection (ICSI), gamete intrafallopian transfer (GIFT), zygote intra-fallopian transfer (ZIFT), egg donation and intra-uterine insemination (IUI) with ovulation induction, received during the 3 month period prior to conception. All countries in the Caribbean region including the West Indies and all islands surrounded by or bordering the Caribbean Sea. The confirmation of your insurance cover issued by us. It confirms the plan type your employer has chosen, the NextCare Neuron network yo are entitled to use, the plan currency, your area of cover, period of cover, date of entry, renewal date, excess amount, special terms, your country of residence, your home country, and the schedule of insured persons. The schedule of insured persons lists the persons insured by us under your employer’s agreement with us. If there are any changes to the details on your certificate of insurance we will issue you with a new one confirming the changes. A disease, illness or injury that has one or more of the following characteristics: • it needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests • it needs ongoing or long-term control or relief of symptoms • you need to be rehabilitated or specially trained to cope with it • it continues indefinitely • it has no known cure • it comes back or is likely to come back A contribution that you must make towards the eligible costs of Whether hereditary or not, any abnormality, deformity, disease, illness or injury present at birth, whether diagnosed or not, or any deformity arising during the antenatal stages of pregnancy, or caused during childbirth. The country in which you are habitually resident as specified on your application form or subsequently advised to us in writing. The date on which cover for you, and each of your eligible dependants, first commenced. Your date of entry is as stated on your certificate of insurance. A patient admitted to a hospital or day-patient unit for a medical procedure which for medical reasons could not have been performed on an out-patient basis and which requires them to occupy a hospital bed for a period of medically supervised recovery, but it is not medically necessary for them to occupy a bed overnight. Dental procedures undertaken by your dental practitioner which are medically necessary for the maintenance and/or restoration of oral health, and are provided in accordance with accepted standards of dental practice. A qualified person legally carrying out this profession in the country in which he or she is located. Investigations, such as x-rays or blood tests to diagnose the cause of your symptoms. See Medical doctor.
Appears in 1 contract
Assistance Service. The emergency assistance company contracted by us to provide assistance services to plan members at the time of your claim. The contact details for the Assistance Service can be found in the 'Contact details' section at the front beginning of this agreement. The use of medical techniques, including, but not limited to, in- vitro fertilisation (IVF) with or without intra-cytoblastic sperm injection (ICSI), gamete intrafallopian intra-fallopian transfer (GIFT), zygote intra-fallopian transfer (ZIFT), egg donation and intra-uterine insemination (IUI) with ovulation induction, received during the 3 3-month period prior to conception. All countries in the Caribbean region including the West Indies and all islands surrounded by or bordering the Caribbean Sea. The confirmation of your insurance cover issued by us. It confirms the plan type your employer has chosenyou have bought, the NextCare network yo are entitled to use, the plan currencycurrency you selected, your area of cover, period of cover, date of entry, renewal date, excess amount, special terms, your country of residence, your home countrycountry of nationality, and the schedule of insured persons. The schedule of insured persons lists the persons insured by us under your employer’s agreement with us. If there are any changes to the details on your certificate of insurance we will issue you with a new one confirming the changes. A disease, illness or injury that has one or more of the following characteristics: • it needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests • it needs ongoing or long-term control or relief of symptoms • you need to be rehabilitated or specially trained to cope with it • it continues indefinitely • it has no known cure • it comes back or is likely to come back A course of treatment for a specific illness, injury, medical condition, dental condition or pregnancy, or the use of an expat benefit. A contribution that you must make towards the eligible costs of Whether hereditary or not, any abnormality, deformity, disease, illness or injury present at birth, whether diagnosed or not, or any deformity arising during the antenatal stages of pregnancy, or caused during childbirth. Your country of origin, for which you hold a passport. If you hold more than one passport your country of nationality will be the country you have declared on your application form. The country in which you are habitually resident as specified on your application form or subsequently advised to us in writing. The date on which cover for you, and each of your eligible dependants, first commenced. Your date of entry is as stated on your certificate of insurance. A patient admitted to a hospital or day-patient unit for a medical procedure which for medical reasons could not have been performed on an out-patient basis and which requires them to occupy a hospital bed for a period of medically supervised recovery, but it is not medically necessary for them to occupy a bed overnight. Dental procedures undertaken by your dental practitioner which are medically clinically necessary for the maintenance and/or restoration of oral health, and are provided in accordance with accepted standards of dental practice. A qualified person legally carrying out this profession in the country in which he or she is located. Investigations, such as x-rays or blood tests to diagnose the cause of your symptomsA hospital, out-patient clinic or medical doctor with whom we hold a current direct billing agreement. See Medical medical doctor. Your spouse or partner, provided they are under age 70 at their date of entry, and your unmarried children (i.e. your son, daughter, step-son, step-daughter, adopted children and children subject to legal guardianship) provided the unmarried children are aged less than 18 years old, or less than 25 years old if in continuous full-time education. If a child is adopted or the subject of legal guardianship we may require proof. We may also require proof of a dependent child being in full time education. A caesarean section which must take place immediately and cannot be planned. Essential treatment, covered by your plan, that is immediately required if you suffer an accident or a sudden and unforeseen illness you have never suffered from before, which is not a pre- existing medical condition, or a related condition, or a condition for which you have a personal medical exclusion.
Appears in 1 contract
Samples: Plan Agreement
Assistance Service. The emergency assistance company contracted by us to provide assistance services to plan members at the time of your claim. The contact details for the Assistance Service can be found in the 'Contact details' section at the front beginning of this agreement. Assisted Reproduction The use of medical techniques, including, but not limited to, in- vitro fertilisation (IVF) with or without intra-cytoblastic sperm injection (ICSI), gamete intrafallopian transfer (GIFT), zygote intra-fallopian transfer (ZIFT), egg donation and intra-uterine insemination (IUI) with ovulation induction, received during the 3 month period prior to conception. Caribbean country and island All countries in the Caribbean region including the West Indies and all islands surrounded by or bordering the Caribbean Sea. Certificate of insurance The confirmation of your insurance cover issued by us. It confirms the plan type your employer has chosen, the NextCare network yo are entitled to use, the plan currency, your area of cover, period of cover, date of entry, renewal date, excess amount, special terms, your country of residence, your home countrycountry of nationality , and the schedule of insured persons. The schedule of insured persons lists the persons insured by us under your employer’s agreement with us. If there are any changes to the details on your certificate of insurance we will issue you with a new one confirming the changes. Chronic condition A disease, illness or injury that has one or more of the following characteristics: • it needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests • it needs ongoing or long-term control or relief of symptoms • you need to be rehabilitated or specially trained to cope with it • it continues indefinitely • it has no known cure • it comes back or is likely to come back Claim A course of treatment for a specific illness, injury, medical condition, dental condition or pregnancy, or the use of an expat benefit. Co-insurance A contribution that you must make towards the eligible costs of Complications of pregnancy Congenital condition Whether hereditary or not, any abnormality, deformity, disease, illness or injury present at birth, whether diagnosed or not, or any deformity arising during the antenatal stages of pregnancy, or caused during childbirth. Country of nationality Your country of origin, for which you hold a passport. If you hold more than one passport your country of nationality will be the country you have declared on your application form. Country of residence The country in which you are habitually resident as specified on your application form or subsequently advised to us in writing. Date of entry The date on which cover for you, and each of your eligible dependants, first commenced. Your date of entry is as stated on your certificate of insurance. Day-patient A patient admitted to a hospital or day-patient unit for a medical procedure which for medical reasons could not have been performed on an out-patient basis and which requires them to occupy a hospital bed for a period of medically supervised recovery, but it is not medically necessary for them to occupy a bed overnight. Dental treatment Dental procedures undertaken by your dental practitioner which are medically clinically necessary for the maintenance and/or restoration of oral health, and are provided in accordance with accepted standards of dental practice. Dentist or dental practitioner A qualified person legally carrying out this profession in the country in which he or she is located. Diagnostic tests Investigations, such as x-rays or blood tests to diagnose the cause of your symptoms. Doctor See Medical medical doctor.. Eligible dependants Your spouse or partner, provided they are under age 70 at their date of entry, and your unmarried children (i.e. your son, daughter, step-son, step-daughter, adopted children and children subject to legal guardianship) provided the unmarried children are aged less than 18 years old, or less than 25 years old if in continuous full-time education. If a child is adopted or the subject of legal guardianship we may require proof. We may also require proof of a dependent child being in full time education. Emergency caesarean section A caesarean section which must take place immediately and cannot be planned. Emergency treatment Essential treatment, covered by your plan, that is immediately required if you suffer an accident or a sudden and unforeseen illness you have never suffered from before, which is not a pre-existing medical condition, or a related condition, or a condition for which you have a personal medical exclusion. Employee You, the member of the health plan provided by your employer. Employer The plan holder specified as your company/employer on your
Appears in 1 contract
Samples: Essential Health Plan Agreement
Assistance Service. The emergency assistance company contracted by us to provide assistance services to plan members at the time of your claim. The contact details for the Assistance Service can be found in the 'Contact details' section at the front beginning of this agreement. Assisted Reproduction The use of medical techniques, including, but not limited to, in- vitro fertilisation (IVF) with or without intra-cytoblastic sperm injection (ICSI), gamete intrafallopian transfer (GIFT), zygote intra-fallopian transfer (ZIFT), egg donation and intra-uterine insemination (IUI) with ovulation induction, received during the 3 month period prior to conception. Caribbean country and island All countries in the Caribbean region including the West Indies and all islands surrounded by or bordering the Caribbean Sea. Certificate of Insurance The confirmation of your insurance cover issued by us. It confirms the plan type your employer has chosen, the NextCare network yo are entitled to use, the plan currency, your area of cover, period of cover, date of entry, renewal date, excess amount, special terms, your country of residence, your home countrycountry of nationality , and the schedule of insured persons. The schedule of insured persons lists the persons insured by us under your employer’s agreement with us. If there are any changes to the details on your certificate Certificate of insurance Insurance we will issue you with a new one confirming the changes. Chronic condition A disease, illness or injury that has one or more of the following characteristics: • it needs ongoing or long-term monitoring through consultations, examinations, check-ups and/or tests • it needs ongoing or long-term control or relief of symptoms • you need to be rehabilitated or specially trained to cope with it • it continues indefinitely • it has no known cure • it comes back or is likely to come back Claim A course of treatment for a specific illness, injury, medical condition, dental condition or pregnancy, or the use of an expat benefit. Co-insurance A contribution that you must make towards the eligible costs of Complications of pregnancy Congenital condition Whether hereditary or not, any abnormality, deformity, disease, illness or injury present at birth, whether diagnosed or not, or any deformity arising during the antenatal stages of pregnancy, or caused during childbirth. Country of nationality Your country of origin, for which you hold a passport. If you hold more than one passport your country of nationality will be the country you have declared on your application form. Country of residence The country in which you are habitually resident as specified on your application form or subsequently advised to us in writing. Date of entry The date on which cover for you, and each of your eligible dependants, first commenced. Your date of entry is as stated on your certificate Certificate of insuranceInsurance. Day-patient A patient admitted to a hospital or day-patient unit for a medical procedure which for medical reasons could not have been performed on an out-patient basis and which requires them to occupy a hospital bed for a period of medically supervised recovery, but it is not medically necessary for them to occupy a bed overnight. Dental treatment Dental procedures undertaken by your dental practitioner which are medically clinically necessary for the maintenance and/or restoration of oral health, and are provided in accordance with accepted standards of dental practice. Dentist or dental practitioner A qualified person legally carrying out this profession in the country in which he or she is located. Diagnostic tests Investigations, such as x-rays or blood tests to diagnose the cause of your symptoms. Doctor See Medical medical doctor.. Eligible dependants Your spouse or partner, provided they are under age 70 at their date of entry, and your unmarried children (i.e. your son, daughter, step-son, step-daughter, adopted children and children subject to legal guardianship) provided the unmarried children are aged less than 18 years old, or less than 25 years old if in continuous full-time education. If a child is adopted or the subject of legal guardianship we may require proof. We may also require proof of a dependent child being in full time education. Emergency caesarean section A caesarean section which must take place immediately and cannot be planned. Emergency treatment Essential treatment, covered by your plan, that is immediately required if you suffer an accident or a sudden and unforeseen illness you have never suffered from before, which is not a pre-existing medical condition, or a related condition, or a condition for which you have a personal medical exclusion. Employee You, the member of the health plan provided by your employer. Employer The plan holder specified as your company/employer on your
Appears in 1 contract
Samples: Essential Health Plan Agreement
