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IHI International Health and Hospital Plan (2007) ( Castellano )
Policy Conditions (valid from 1 January 2007)
Art. 6 What is covered by the insurance?
6.1 The insurance shall cover the medical expenses incurred by the insured in accordance with cover chosen and the applicable reimbursement rates. The valid reimbursement rates are stated in the List of Reimbursements.
6.2 Reimbursement shall be paid following the Company's approval of the expenses as being covered by the insurance after the original, receipted and itemised bills, provided with the policy number, have been received by the Company.
6.3 Once the covered expenses have met the annual deductible, the reimbursable amount will be paid. The deductible shall be reduced by amounts not exceeding the maximum rates specified in the valid List of Reimbursements. The deductible shall apply per person per policy year.
6.3.1 In the case of accident where 3 (three) or more family members insured with the Company are involved, only 1 (one) deductible, the highest, is applied
6.4 Physicians, specialists, dentists, etc performing the treatment must have authorisation in the country of practice. Furthermore, the method must be approved by the public health authorities in the country, where the treatment takes place. Methods of treatment not yet approved by the public health authorities, but under scientific research will only be covered if approved by the Company's medical consultants.
6.5 In no event shall the amount of reimbursement exceed the amount shown on the bill. If the insured receives reimbursement from the Company in excess of the amount to which he / she is entitled, the insured shall be under the obligation to repay the Company the excess amount immediately, otherwise the Company will set off the excess amount in any other account between the insured and the Company.
6.6 Reimbursements shall be limited to the usual, customary and reasonable charges in the area or country in which the treatment is provided.
6.7 Any discount which has been negotiated directly between the Company and providers will be specifically used by the Company for the overall benefit of the insured persons within the insurance product as a whole.
6.8 Any ex-gratia payments are at the Company's discretion. If the Company makes a payment to which the insured is not entitled under the insurance, this will still count toward the annual maximum cover per person per policy year.
| Para pedir una cotización o una aclaración / For a quote or details: | |
| saniprof@mail.ddnet.es / dmh@e-consultas.com | |
| Fax: | (+ 34) 91 8032484 |
| Teléfono / 'phone: | (+ 34) 609 522 300 |
This glossary with definitions is part of the Policy Conditions
INDEX
In accordance with the Danish Insurance Contracts Act.
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