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 2011.
Premier Individual
Club Individual
Classic Individual
Essential Individual
Maximum plan benefit
€2,250,000
€1,500,000
€1,125,000
€500,000
In-patient benefits - please refer to note 2 for Treatment Guarantee
Hospital accommodation
Private room
Private room
Private room
Semi-private room
Prescription drugs and materials
(in-patient and day-care treatment only)
Full refund
Full refund
Full refund
Full refund
Surgical fees, including anaesthesia & theatre charges
Full refund
Full refund
Full refund
Full refund
Physician and therapist fees
(in-patient and day-care treatment only)
Full refund
Full refund
Full refund
Full refund
Surgical appliances and prostheses
Full refund
Full refund
Full refund
Full refund
Diagnostic tests
(in-patient and day-care treatment only)
Full refund
Full refund
Full refund
Full refund
Organ transplant
Full refund
Full refund
Full refund
€10,000
Psychiatry and psychotherapy
(in-patient and day-care treatment only)
(10 month waiting period applies)
Full refund
€6,000
€5,000
€5,000
Accommodation costs for one parent staying in hospital with an insured child under 18
Full refund
Full refund
Full refund
Full refund
Emergency in-patient dental treatment
Full refund
Full refund
Full refund
Full refund
Other benefits - please refer to note 2 for Treatment Guarantee
Day-care treatment
Full refund
Full refund
Full refund
Full refund
Out-patient surgery
Full refund
Full refund
Full refund
Full refund
Nursing at home or in a convalescent home
(immediately after or instead of hospitalisation)
€4,250
€2,830
€2,500
€2,500
Rehabilitation treatment
(in-patient, day-care and out-patient treatment, immediately after acute medical treatment ceases)
€4,420
€3,000
€2,500
€2,000
Local ambulance
Full refund
Full refund
Full refund
€500
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
Up to €10,000 max. 42 days
Medical evacuation
Where necessary treatment is not available locally, we will evacuate the insured person to the nearest appropriate medical centre
Full refund
Full refund
Full refund
Full refund
Where ongoing treatment is required, we will cover hotel accommodation costs
Full refund
Full refund
Full refund
Full refund
Evacuation in the event of unavailability of adequately screened blood
Full refund
Full refund
Full refund
Full refund
If medical necessity prevents an immediate return trip following discharge from an in-patient episode of care, we will cover hotel accommodation costs
Full refund, max. 7 days
Full refund, max. 7 days
Full refund, max. 7 days
Full refund, max. 7 days
Expenses for one person accompanying an evacuated person
€3,000
€3,000
€3,000
€3,000
NEW Travel costs of insured family members in the event of an evacuation
€2,000
€2,000
€2,000
€2,000
Repatriation of mortal remains
€10,000
€10,000
€10,000
€10,000
NEW Travel costs of insured family members in the event of the repatriation of mortal remains
€2,000
€2,000
€2,000
€2,000
CT scans
(in-patient and out-patient treatment)
Full refund
Full refund
Full refund
Full refund
MRI, PET and CT-PET scans
(in-patient and out-patient treatment)
Full refund
Full refund
Full refund
Full refund
Oncology
(in-patient, day-care and out-patient treatment)
Full refund
Full refund
Full refund
Full refund
Complications of pregnancy
(in-patient and out-patient treatment) (10 month waiting period applies)
Full refund
Full refund
Full refund
N/A
Laser eye treatment
(limited to one treatment per lifetime)
€1,000 per lifetime
€500 per lifetime
N/A
N/A
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
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
N/A
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
€500
N/A
N/A
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
Accidental death
(insured members aged 18 to 70)
€10,000
N/A
N/A
N/A
Notes
1. Area of cover
Allianz Worldwide Care offers a choice of three different geographical areas of cover:
Worldwide, which provides cover anywhere in the world
Worldwide excluding USA
Africa only
The chosen area of cover will be specified in the Insurance Certificate.
2. Treatment Guarantee
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:
All in-patient benefits as listed
Day-care treatment
Out-patient surgery
MRI (Magnetic Resonance Imaging) and PET (Positron Emission Tomography) and CT-PET scans
Nursing at home or in a convalescent home
Complications of pregnancy
Routine maternity and complications of childbirth (in-patient treatment only)
Oncology (in-patient and day-care treatment only)
Occupational therapy (out-patient treatment only)
Rehabilitation treatment
Medical evacuation (or repatriation where covered)
Travel costs of insured family members in the event of an evacuation/repatriation
Repatriation of mortal remains
Travel costs of insured family members in the event of the repatriation of mortal remains
Travel costs of insured members to be with a family member who is at peril of death or who has died
Expenses for one person accompanying an evacuated/repatriated person
Palliative care and long term care
For benefits marked with a 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 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, 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 £4,150/€5,000/$7,100/CHF7,500”. Where a specific benefit limit applies or where the term ”Full refund” appears next to certain benefits, the refund is subject to the maximum plan benefit, if one applies to your plan(s). All limits are per member, per insurance year, unless otherwise stated in your Table of Benefits.
5. Policy terms and conditions
Please note that cover 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 Individual Benefit Guide, which is issued to members upon policy inception. If you have any queries, please do not hesitate to contact us