| Core Plans |
Treatment Guarantee is required for all in-patient benefits ( ) and may be required for other benefits ( ) as indicated in the table below - please refer to note 2 for more information. These plans are valid from 1st November 2009. The following plan(s) are only available for corporate groups of three employees or more. |
| Premier | Executive | Club | Classic | Essential | ||
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Maximum plan benefit | €2,250,000 | €1,500,000 | €1,125,000 | €1,125,000 | €500,000 |
In-patient benefits - please refer to note 2 for Treatment Guarantee | ||||||
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Hospital accommodation | Private room | Private room | Semi-private room | Private room | Semi-private room |
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Prescription drugs and materials (in-patient and day-care treatment only) | Full refund | Full refund | Full refund | Full refund | Full refund |
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Surgical fees, including anaesthesia & theatre charges | Full refund | Full refund | Full refund | Full refund | Full refund |
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Physician and therapist fees (in-patient and day-care treatment only) | Full refund | Full refund | Full refund | Full refund | Full refund |
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Surgical appliances and prostheses | Full refund | Full refund | Full refund | Full refund | Full refund |
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Diagnostic tests (in-patient and day-care treatment only) | Full refund | Full refund | Full refund | Full refund | Full refund |
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Organ transplant | Full refund | Full refund | Full refund | Full refund | €10,000 |
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Psychiatry and psychotherapy (in-patient and day-care treatment only) (10 month waiting period applies) | Full refund | €17,680 | €10,600 | €8,850 | €5,000 |
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Accommodation costs for one parent staying in hospital with an insured child under 18 | Full refund | Full refund | Full refund | Full refund | Full refund |
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Emergency in-patient dental treatment | Full refund | Full refund | Full refund | Full refund | Full refund |
Other benefits - please refer to note 2 for Treatment Guarantee | ||||||
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Day-care treatment | Full refund | Full refund | Full refund | Full refund | Full refund |
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Out-patient surgery | Full refund | Full refund | Full refund | Full refund | Full refund |
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Nursing at home or in a convalescent home (immediately after or instead of hospitalisation) | €4,250 | €3,550 | €2,830 | €2,500 | €2,500 |
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Rehabilitation treatment (immediately after acute medical treatment ceases) | €4,420 | €3,500 | €3,000 | €2,500 | €2,000 |
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Local ambulance | Full refund | Full refund | Full refund | Full refund | €500 |
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Emergency treatment outside area of cover (for trips of a maximum period of six weeks) | Full Refund Max. 42 days | Full Refund Max. 42 days | Full Refund Max. 42 days | Full Refund Max. 42 days | Up to €10,000 Max. 42 days |
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Medical evacuation | Full refund | Full refund | Full refund | Full refund | Full refund |
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Expenses for one person accompanying an evacuated or repatriated person | €3,000 | €3,000 | €3,000 | €3,000 | €3,000 |
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Repatriation of mortal remains | €10,000 | €10,000 | €10,000 | €10,000 | €10,000 |
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CT scans (in-patient and out-patient treatment) | Full refund | Full refund | Full refund | Full refund | Full refund |
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MRI, PET and CT-PET scans (in-patient and out-patient treatment) | Full refund | Full refund | Full refund | Full refund | Full refund |
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Oncology (in-patient and out-patient treatment) | Full refund | Full refund | Full refund | Full refund | Full refund |
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Routine maternity (in-patient & out-patient treatment) (10 month waiting period applies) | Full refund | €6,000 per pregnancy | Full refund | N/A | N/A |
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Complications of pregnancy and childbirth (10 month waiting period applies) | Full refund | Full refund | Full refund | Full refund | N/A |
Home delivery | €1,000 | N/A | N/A | N/A | N/A | |
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In-patient cash benefit (per night) (where treatment has been received free of charge) | €150 Max. 25 nights | €150 Max. 25 nights | €150 Max. 25 nights | €150 Max. 25 nights | €150 Max. 25 nights |
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Emergency out-patient treatment (where these benefit amounts are reached, any additional costs may be reimbursed within the terms of any separate out-patient plan) | €750 | €750 | €750 | €750 | N/A |
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Emergency out-patient dental treatment (where these benefit amounts are reached, any additional costs may be reimbursed within the terms of any separate dental plan) | €750 | €750 | N/A | N/A | N/A |
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Palliative care and long term care | Full refund, Max. 30 days per lifetime | Full refund, Max. 30 days per lifetime | Full refund, Max. 30 days per lifetime | Full refund, Max. 30 days per lifetime | Full refund, Max. 30 days per lifetime |
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NEW Death Benefit (in the event of death by accident or sickness) (for insured members aged 18 to 70) (12 month waiting period applies regarding death due to sickness) | €10,000 | N/A | N/A | N/A | N/A |
Notes |
1. Area of cover |
Allianz Worldwide Care offers a range of options in relation to geographical cover. The chosen area of cover will be specified in the Insurance Certificate. |
Certain treatments and costs require submission of a Treatment Guarantee Form in advance. Following approval by Allianz Worldwide Care, cover for these required treatments or costs can then be guaranteed. In the Table of Benefits, benefits which require pre-approval through submission of a Treatment Guarantee Form are indicated by either a or a . These benefits are listed below, along with further important details:
or a in the Table of Benefits, the member and their physician will need to complete the relevant sections of a Treatment Guarantee Form and send it to us for approval prior to commencement of treatment. We should be contacted at least 5 working days before receiving treatment, so that we can ensure that there will be no delays at the time of admission.
In the case of an emergency, we should be informed within 24 hours of the event to ensure that no Treatment Guarantee penalty will apply to the claim. If Treatment Guarantee is not obtained for the benefits listed with a , we reserve the right to decline a claim. If the respective treatment is subsequently proven to be medically necessary, we will pay only 80% of the eligible benefits.
If Treatment Guarantee is not obtained for the benefits listed with a , we reserve the right to decline a claim. If the respective treatment is subsequently proven to be medically necessary, we will pay only 50% ofthe eligible benefits.We should be contacted at least five working days before receiving treatment, so that we can ensure that there will be no delays at the time of admission. This will ensure that members have cashless access to hospitals for in-patient treatment, where possible, as well as providing the advantage of treatment being overseen by our medical professionals. In the case of an emergency, we should be informed within 48 hours of the event to ensure that no Treatment Guarantee penalty will apply to the claim. |
3. Claims process and turnaround |
Allianz Worldwide Care has a simple claiming process in place to ensure that members can seek reimbursement for medical expenses.
Fully completed Claim Forms are processed and payment instructions issued to the member’s bank within 48 hours. Where further information is required to complete the claim, the member/medical practitioner will automatically be notified by email or mail within 24 hours of receipt of the Claim Form. An email is sent automatically to the member (where email addresses are provided to us) to advise them when the claim is received and when it is processed. This swift claims processing policy ensures that our members receive their claims payment in the most effective and efficient manner. Both the Claim Form and Treatment Guarantee Form are available to download here. |
4. Benefit limits |
There are two kinds of benefit limits shown in the Table of Benefits. The maximum plan benefit, which applies to certain plans, is the maximum we will pay for all benefits in total, per member, per Insurance Year, under that particular plan. Some benefits also have a specific benefit limit which is applied separately, for example “Nursing at home or in a convalescent home”. Specific benefit limits may be provided on a 'per Insurance Year' basis, a 'per lifetime' basis or on a 'per event' basis, such as per trip, per visit or per pregnancy. In some instances we will pay a percentage of the costs for the specific benefit e.g. “65% refund, up to £3,650/€5,000/$7,100/CHF 7,500”. Where the term “Full refund” appears next to certain benefits, please note that this refund is subject to the maximum plan benefit, if one applies to your plan(s). |
5. Policy terms and conditions |
Please note that cover for smaller groups is subject to underwriting i.e. cover may be excluded for pre-existing conditions, or a higher premium rate may apply to reflect the higher risk due to pre-existing medical conditions or additional risk factors. Cover is conditional upon acceptance of your application, which is only confirmed when an Insurance Certificate is provided. This Table of Benefits provides an outline of the cover we provide under each plan. Cover is subject to our policy terms and conditions, as detailed in our Employee Benefit Guide, which is issued to members upon policy inception. If you have any queries, please do not hesitate to contact us |