repatriation assistance CHAPTER 1 : Our assistance services By using our assistance services, you accept that the decisions concerning the type, appropriateness and organization of required measures be taken solely by our assistance department. 11 Our medical assistance Decisions are taken solely in your medical interest. Our doctors contact the local medical facilities and, if need be, your usual doctor to collect information allowing us to take the decisions best suited to your health condition. You accept that your repatriation be decided and managed by medical personnel with officially acknowledged qualifications in the said personnel’s country of usual practice. Any refusal on your part to comply with the decisions taken by our medical department means you exempt us from any liability concerning the consequences of such an initiative and you then loose all your rights to our services and indemnities. In no case whatsoever can we replace local first-aid organizations or pay for the expenses thus incurred. 11.1 If your health condition requires repatriation : 11.1.1 We organize and pay for your repatriation to your domicile in Europe or for your transport to the nearest hospital around your domicile, and/or to the hospital best suited to your health condition. 11.1.2 At your request, as soon as your health condition makes this possible, we can then organize your return to your domicile in Europe. 11.1.3 We reimburse upon justificatory documents and up to FF 300 maximum per day your accomodation expenses from the day you are immobilized to the day you are repatriated to your domicile in Europe. 11.1.4 We pay for the additional transport expenses of your insured family members travelling with you, when they cannot use the means initially planned for their return to Europe due to this repatriation. 11.2 If you are admitted in a local hospital : If you are admitted in hospital for over 7 days, or 48 hours if you are under 18 or disabled, and if no member of your family travelling with you on the trip is of legal age, we pay a return ticket to a member of your family who had remained in Europe, so that he can visit you. 11.3 If you pay medical or hospital expenses prescribed by a doctor outside your country of residence and outside France : · We reimburse you, after initial reimbursements by social security, your mutual insurance company and/or any private supplementary insurance, the final portion of expenses to be borne by you within the limit of FF200.000 per personn and less the straight deductible of FF 200 per less. · We reimburse you, after initial reimbursement by Social Security, your mutual insurance company and/or any other private supplementary insurance, the final portion of emergency dental expenses to be borne by you, within the limit of FF 2.000 and less a straight deductible of FF 200 francs per loss. · If you are admitted in a hospital which has signed a payment agreement with us, we can advance the medical expenses by paying directly the hospital. You undertake that you will reimburse this advance within 1 month from the date on which you return from the trip. Should you fail to comply with this period, we will in addition be entitled to claim legal expenses and interests from you. We reserve the right to require in prior third party surety for reimbursement of the said medical expenses within 1 month from date of fund advance, by means of certified bank cheque or acknowledgement of debt in the same amount and deposited at our registered office. · Your right to be reimbursed by us expires on the day our medical department considers you can be repatriated. In any case, you undertake that you will send your reimbursement request to any relevant private supplementary insurance fund. 11.4 If you pay rescue and first-aid expenses We reimburse you the expenses incurred on this account, within the limit specified in the special terms. 11.5 If your health condition no longer allows you to drive back with your car to your domicile in Europe and no passenger can replace you : We provide a chauffeur for 3 days maximum who will drive back your vehicle to your domicile in Europe via the shortest route, petrol, toll and parking expenses to be borne by you. This cover is granted to you only if your vehicle is in perfect running condition, meets the regulations of the national and international Highway Code and meets the standards of the compulsory MOT. 12 Our assistance in case of death In case of death of an insuree, we organize and pay for : · body transportation from the location where the body is placed in the coffin to the place of burial in Europe. · funeral expenses, within the limit off FF 10.000. · additional transport expenses of his insured family members under this Contract and travelling with him, where they cannot use the means initially planned for their return to Europe, due to repatriation. 13 Our Return Before Due Date cover Where you cannot use the means initially planned for your return to Europe, we organize and pay for - your journey back home and, if need be, the journey back home of your insured family members travelling with you OR - a return ticket for one of the persons insured under this Contract. The choice you will make with our approval is irrevocable. This service applies in the following cases : a) serious illness or accident, of a life-threatening nature according to our medical department, or if you have to attend a burial due to the death of : your spouse by law or de facto spouse, one of your ascendants, descendants, your legal guardian, brother or sister, brother-in-law, sister-in-law, son-in-law, daughter-in-law and stepdaughter, father-in-law and stepfather, mother-in-law and stepmother not travelling with you on the trip and living in Europe or The pre-appointed person replacing you at work. · serious physical damage caused by burglary, fire, flood or a climatic event, making your presence on spot absolutely necessary to take urgency measures and carry out administrative steps, to more than 50% of your permanent home or country house. 14 Our legal assistance abroad 14.1 If you pay lawyer fees : When legal proceedings are initiated against you, provided the dispute does not relate to your professional activity and/or to the use or guardianship of a motor vehicle and provided you are not liable to criminal sanctions under such action according to the relevant country laws, we will reimburse you within the limit of FF 10.000 and upon justificatory documents the lawyer fees incurred by you in defending the said proceedings. 14.2 If you need cash advance on criminal bail When you are sent to jail or likely to be sent to jail, provided the ground for prosecution against you is not : - drugs dealing, - your involvement in political organizations, - any deliberate breach of the laws of the country, · we lend you, within the limit of FF 100.000, the amount of the legally payable criminal bail. · you must reimburse the said amount to us within a 1 month period from the date on which we advanced the funds ; should you fail to comply with this period, we will in addition be entitled to claim from you expenses and interests calculated at legal rate. · we reserve the right to require in prior third party surety for reimbursement of the said criminal bail amount within 1 month from date of fund advance, by means of certified bank cheque or acknowledgement of debt in the same amount and deposited at our registered office. CHAPTER 2 : Cover application terms · The cover must be taken out and registered with Elvia T.I. before the beginning of the stay for which insurance is requested. · The cover applies during the term of services organized by the tour operator, as described on your trip reservation form, and during the return journey from and to your domicile provided the said journey does not exceed 48 hours. · However, if the entire trip duration exceeds two months or if your date of return or end of stay is not scheduled, the cover will automatically expire two months after departure date or after the date of beginning of stay specified on the reservation form. CHAPTER 3 : Cover exclusions In addition to the exclusions common to all covers (see Chapter 3 of Administrative Provisions), the following events are also excluded : 31 Concerning all assistance covers : 31.1 all expenses incurred without prior approval of our assistance department, 31.2 any pre-existing illness diagnosed and/or treated and/or having led to admission in hospital during the 6 month period preceding the assistance request, save straightforward and unforeseeable complication, 31.3 minor conditions or lesions which can be treated on spot, 31.4 convalescence and disease under treatment and not stabilized. 31.5 pregnancy and its possible complications after the sixth month, termination of pregnancy, delivery, in vitro fertilization and its consequences, 31.6 trips with a diagnosis and/or treatment purpose, 31.7 food expenses, expenses not expressly mentioned as refundable, as well as any expenses for which you have no supporting document, 32 Concerning medical expenses : 32.1 spa treatment expenses, heliotherapy expenses, slimming course expenses, rejuvenation treatment expenses and any « non-medically justified treatment » or aesthetics treatment expenses, physiotherapist expenses, 32.2 implant, prosthesis, apparatus and optical expenses, 32.3 vaccination expenses, 32.4 preventive medicine expenses 32.5 expenses incurred in the country where you have your permanent legal residence or of which you are a citizen and in France, 32.6 all expenses relating to contraception, termination of pregnancy, delivery and their consequences, 32.7 expenses resulting from the consequences, after-effects, complications or worsening of an illness or accident established before the beginning of the insured trip, 32.8 care or treatment which does not result from a medical emergency, 32.9 expenses resulting from any medical event the diagnosis, symptoms or cause of which are mental, psychological or psychiatric, and which did not lead to over 3 day admission in hospital, 32.10 expenses incurred in view of artificial insemination or any treatment against sterility, 32.11 care or treatment of a therapeutic nature not acknowledged by french law, 32.12 treatment or care supplied by a family member, CHAPTER 4 : What you must do in case of loss 41 For any assistance request You must contact us, or arrange for a third party to contact us, as soon as your situation implies return before due date or expenses falling under our cover. You can contact our assistance department 24 hours a day, everyday. · by telephone at 01 42 99 02 02 or 33 1 42 99 02 02 if you are abroad · by fax at 01 42 99 03 00 or 33 1 42 99 03 00 if you are abroad You will immediately be given a file number, and : - you must specify your Contract number, - you must give us your address and telephone number, as well as the details of the persons who take care of you - you must grant our doctors access to all medical informations on you or on the person causing our intervention. 42 For any reimbursement request · When you request our assistance, you must inform us of the insured expenses incurred by you with the approval of our assistance department and for which you claim reimbursement. · You must send us all supporting documents required to check the grounds for your request. 43 Payment of transport expenses · When we organize and pay for transport under our cover, transport is made by train 1st Class, by plane Tourist Class or by taxi, depending on the decision of our assistance department. · In that case, we become the owner of the initial ticket(s) and you undertake that you will send the said ticket(s) back to us or reimburse us the amount recovered from the organization having issued the transport ticket(s). · If initially you had not purchased any ticket for your journey back, we reserve the right to claim from you the expenses that you would necessarily have incurred for the said journey. 44 Scope of our interventions · Our interventions are carried out under the national and international laws and regulations, · Our services are subject to the issuance of the required authorizations by the relevant authorities. We cannot be held liable for delays in, or prevention of, the agreed services resulting from a case of force majeure or from events such as strikes, riots, civil commotions, restrictions to free circulation, sabotage, terrorist attacks, civil or foreign war, any consequences of a source of radioactivity or of any other Act of God. 45 Specific nature of our assistance interventions Warning :
The purpose of the assistance cover is not the payment of an indemnity. Indeed, the assistance cover is mainly an offer of services in kind. As a result, the insuree will be not entitled to any reimbursement or compensatory indemnity for services not requested during the trip or not organized by us. interrupted stay CHAPTER 1 : Our cover 11Purpose of cover We pay you an indemnity calculated proportionally to the number of trip days not used, if the insured stay is interrupted as a result of your medical repatriation organized by us. 12 Cover beneficiary The sick or injured person who needs repatriation is granted the interrupted stay indemnity, as well as any other insured person travelling with the said sick or injured person. CHAPTER 2 : Cover amount 21 The indemnity paid under this Contract can in no case whatsoever exceed the price of the insured trip, declared price serving as basis for the calculation of the premium of this Contract. 22 The indemnity is calculated from the day following the event justifying medical repatriation and proportionally to the number of trip days not used : for hotel stays : the indemnity is calculated on the basis of the total price per person of the insured stay ; for rentals : the indemnity is calculated on the basis of the total price of the insured rental, it being agreed that the rental premises must be fully vacated. For the calculation of your indemnity, the initial invoice issued by the rental organization or the hotel will be requested. Less the handling fee, the visa, insurance and tip expenses, as well as the reimbursements or compensation granted by the service-providers of your trip. CHAPTER 3 : How are you indemnified ? The said indemnity is reimbursed to you by bank cheque. CHAPTER 4 : Cover application terms 41 The cover must be taken out and registered with Elvia T.I. before the beginning of the stay for which insurance is requested. 42 The cover applies during the term of services organized by the tour operator, as described on your trip reservation form. However, if the entire trip duration exceeds two months or if your date of return or end of stay is not scheduled, the cover will automatically expire two months after departure date or after the date of beginning of stay specified on the reservation form. CHAPTER 5 : Cover exclusions In addition to the exclusions common to all covers (see Chapter 3 of Administrative Provisions) and to the exclusions applicable to the assistance cover, are also excluded : 51 interrupted stays which have not been in prior approved by Elvia T.I’s assistance department 52 natural disasters falling under the procedure provided for by law 82.600 dated 13 July 1982 and their consequences, CHAPTER 6 : What you must do in case of loss Once you have requested our assistance and obtained the approval of our departments concerning the interruption of your stay, you must make your request for the reimbursement of the services not used as a result of the said interruption. Call us at (tel) 01 42 99 02 02 Or 33 1 42 99 02 02 if you are abroad You will be given all required information on how to report your loss. You will then receive very shortly a loss report file. You must then fill-in and return the said file with a copy of your insurance Contract, and send to Elvia T.I. any document deemed necessary to check the grounds for your request and to assess your damage (trip reservation form, tour operator invoice ...). ski civil liability CHAPTER 1 : Our cover 11 We grant you cover against the financial consequences of the civil liability which may fall on you, pursuant to the laws or caselaw of the country where you are staying, as a result of accidental damage caused to third parties : - by you - by persons for whom you are answerable - by things or animals under your guardianship. Only damage resulting from a private life act committed by you during your trip is covered. 12 The cover applies outside France and only in the countries where you are not covered by a civil liability insurance taken out otherwise. CHAPTER 2 : Cover amount 21 Elvia T.I. grants you cover for bodily injuries within the limits of FF 30.000.000 per loss, physical damage and their resultant consequential losses, within the limits of FF 30.000 per loss. 22 The amount off FF 30.000.000 per loss is the maximum compensation amount per event, combined single limit, bodily injury, physical damage and resultant consequential losses. 23 In any case, a deductible of FF 500 per loss, specified in the special terms, will be borne by you. CHAPTER 3 : Cover application terms 31 The cover must be taken out and registered with Elvia T.I. before the beginning of the stay for which insurance is requested. 32 The cover applies during the term of services organized by the tour operator, as described on your trip reservation form, and during the return journey from and to your domicile provided the said journey does not exceed 48 hours. However, if the entire trip duration exceeds two months or if your date of return or end of stay is not scheduled, the cover will automatically expire two months after departure date or after the date of beginning of stay specified on the reservation form. CHAPTER 4 : Cover exclusions In addition to the exclusions common to all covers (see Chapter 3 of Administrative Provisions), are also excluded : 4.1 the consequences of your contractual liability, 4.2 damage caused to your family members, your employees while carrying out their duties or to any other person deemed an insuree under this Contract 4.3 damage caused to animals or objects which belong to you or which are rented, lent or entrusted to you, 4.4 damage caused by : - any motor vehicle meeting the definition provided for by article L211.1 of the Code of Insurance Law, - any vehicle designed and manufactured to be towed by a motor vehicle, - any aircraft, any sea or river vessel, 4.5 damage resulting from hunting, 4.6 fines, as well as any punitive damages. 4.7 damage caused to third parties and resulting from the organization, preparation or involvement in any competition organized under the aegis of a sports federation, requiring administrative authorization or insurance pursuant to the law, 4.8 damage caused in the course of your professional activity or during your involvement in an activity organized by a non-profit making association, an institution or a group, 4.9 the consequences of the liability which you may incur as a result of fire, explosion and flood (for instance : neighbours’ right of recovery, tenants’ right of recovery). CHAPTER 5 : What you must do in case of loss . You must not admit any liability nor accept any settlement without our consent. However, the acknowledgement of a material fact or the performance of a mere assistance obligation is not considered admission of liability. . You must inform us in writing within 5 working days from the date on which you become aware of the loss, save Act of God or Force Majeure. Should you fail to do so, if Elvia T.I. suffers damage due to late notification, you will loose all your rights to compensation. . Should proceedings be initiated against you, you give us full power of attorney to conduct the trial or to seek any remedy at law in the civil courts, or to unite with your defence and to seek any remedies at law concerning the damages awarded to an individual who instituted and won a civil action in the criminal courts. . Upon receipt, you must send us any convocation, writ of summons, extrajudicial acts and procedure documents which may be sent to you or served on you. Should you delay the sending of the above-mentioned documents, we reserve our right to claim from you an indemnity proportional to the resultant damage (article L 133.11 of the Code of Insurance Law). . If you fail to meet your obligations after the loss, we however indemnify the injured third parties or their beneficiaries, but reserve the right to take legal action against you to recover the sums thus paid. CHAPTER 6 : Applicable provisions where an annuity is granted to a victim as a result of a judiciary decision 5.1 If an acquisition of titles is ordered to secure payment of the annuity, we create this security up to the amount of our cover. 5.2 If no security is ordered, the capitalized value of the annuity is calculated in accordance with the applicable rules concerning the calculation of the life fund of this annuity. If the said value is inferior to the amount of our cover, the annuity is fully borne by us. If the said value exceeds the amount of our cover, only the portion of the annuity which meets in capital the amount of our cover is borne by us. SEARCH AND RESCUE EXPENSES If you have to pay search and/or rescue expenses as a result of a bodily injury in the mountains, as well as ambulance transportation expenses : ELVIA reimburses these expenses up to FF 50.000 maximum. This cover is an extension of the ASSISTANCE – REPATRIATION cover defined in Schedule B1 article 11.4 . As a result, the Insuree Obligations and Exclusions applicable to this SEARCH AND RESCUE EXPENSES cover are those provided for under the ASSISTANCE –REPATRIATION cover. SKI PASS REIMBURSEMENT The cover takes effect on the first day of the scheduled period of use of the ski pass and ends on the last day of the said period. However, if the overall trip exceeds two months or if there is no scheduled date for your return or for the end of your trip, the cover automatically expires two months after departure date or after the date on which the trip begins as mentioned on your reservation form. 1 – OUR COVER Concerning cover b, c and d, you are granted cover only if you inform ELVIA T.I before you return. 2 – COVER LIMIT 3 – HOW ARE YOU REIMBURSED ? You are reimbursed by cheque to your name. 4 – EXCLUSIONS : FOR ANY REIMBURSEMENT REQUEST SKI LESSONS REIMBURSEMENT However, if the overall trip exceeds two months or if there is no scheduled date for your return or for the end of your trip, the cover automatically expires two months after departure date or after the date on which the trip begins as mentioned on your reservation form. 1 – OUR COVER 2 – COVER LIMIT You are reimbursed by cheque to your name. 4 – EXCLUSIONS 5 – WHAT YOU MUST DO IN CASE OF ACCIDENT You must grant any ELVIA T.I doctor access to all medical informations. Inform ELVIA T.I of the loss within 5 days from the date on which you become aware of that loss , save Act of God or Force Majeure. Should you fail to comply with the loss report period, if Elvia T.I. suffers a prejudice due to your late notification you will loose all your rights to compensation. SKI BREAKAGE However, if the trip exceeds two months or if there is no scheduled date for your return or for the end of your trip, the cover automatically expires two months after departure date or after the date on which your trip begins as mentioned on your reservation form. 1 – OUR COVER 2 – COVER LIMIT 3 – EXCLUSIONS 4 – HOW ARE YOU REIMBURSED ? 5 – FOR ANY REIMBURSEMENT REQUEST MEDICAL ADVICE If you need medical advice before your departure : Feel free to call the Elvia T.I medical team to know whether you need to take any specific precautions before you travel abroad (vaccination, etc…) What you must do in case of medical advice : Call us at (tel) 01 42 99 02 02 |