Common use of Medical expenses abroad Clause in Contracts

Medical expenses abroad. The insurer will reimburse the insured, following intervention from the French Social Security system and any other insurance body, for the medical, pharmaceutical, surgical and/or hospitalisation expenses prescribed by a doctor, up to the amounts indicated in the summary of cover table. In all cases, the Insurer will compensate the insured minus the excess, the amount of which is specified in the summary of cover table. Advance on hospital costs abroad: If the insured is outside of their country of residence and unable to settle their medical expenses resulting from hospitalisation due to illness or accident occurring during the period of cover, the insurer may, at the request of the insured, make an advance payment to the insured under the following cumulative conditions: - the insurer’s doctors must judge, after collecting information from the local doctor, that it is impossible to repatriate the insured immediately to their country of residence, - the care to which the advance applies must be prescribed with agreement from the insurer’s doctors, - the insured person or any person authorised by the latter must formally commit, by signing a specific document provided by the insurer during the implementation of this service: - to initiating the process of assuming the costs with the insurance agencies (the French Social Security system, mutual insurance agencies) within 15 days from the date of the Insurer sending the documents necessary for this process, - to reimburse the Insurer for the sums received for this purpose by the insurance agencies within one week of receipt of such sums. The Insurer will only be responsible for costs not borne by the insurance agencies, up to the amount expected for the medical services expenses. The Insured must notify the Insurer of the confirmation of uncovered losses originating from these insurance agencies within one week of receipt. In the absence of having taken the necessary steps to deal with the insurance bodies within the time limit, or failing to present to the Insurer the confirmation of uncovered losses originating from these insurance agencies within the time limit, the insured can under no circumstances claim the ‘medical expenses’ benefit and must reimburse all hospitalisation costs advanced by the Insurer who will, if necessary, initiate any proceedings to recover such costs if deemed necessary, the costs of which will be borne by the beneficiary. This cover will cease on the date in which the Insurer is able to repatriate the insured, or the day of return of the insured to their country of origin.