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INSURANCE CONDITIONS
COMPLEX HEALTHCARE
FOREIGNERS INSURANCE
PLUS
KZPCP 1/22
with effect from 1 March 2022
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Content:
PAGE 1
SECTION A COMMON PROVISIONS
Article 1 - Introductory provisions
Article 2 - Definitions Article 3 Scope and place of insurance Article 4 Scope and maturity of insurance benefits
PAGE 2
Article 5 - Insurance interest
Article 6 - Group insurance Article 7 Conclusion of the insurance contract Article 8
- Origin and duration of insurance. Insurance period Article
9 - Amendments and termination of the insurance contract. Termination of
insurance Article 10 - Premiums
PAGE 3
Article 11 - Rights and obligations of the insurer
Article 12 - Obligations of the policyholder Article
13 - Obligations of the insured Article 14 - Other
rights and obligations of the policyholders
PAGE 4
Article 15 - Service of documents Article 16
- Form of legal proceedings Article 17 Rescue costs Article 18 - Transfer of rights
to insurers Article 19 - Final provisions
SECTION B HEALTH INSURANCE
Article 1 - Purpose and subject of insurance
PAGE 5
Article 2 - Insured event Article 3
- Scope and place of insurance Article 4 Scope of insurance indemnity
PAGE 6
Article 5 - Exclusions from insurance
Article 6 - Obligations of the insured
Article 7 - Assistance services
SECTION C SCHENGEN AREA INSURANCE
Article 1 - Purpose and subject of insurance
Article 2 - Insured Article 3 - Scope and
place of insurance Article 4 - Scope of
insurance
PAGE 7
Article 5 - Exclusions from insurance
Article 6 - Obligations of the insured
Article 7 - Assistance services Article 8 Duration of insurance
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SECTION A
24. An insurer is a legal entity that is authorized to conduct insurance business under a special law.
COMMON PROVISIONS
25. The insured (or also the insured person) is the person whose life or health is covered by the insurance.
Art. 1
Introductory provisions
1. Rights and obligations of participants in comprehensive health insurance for foreigners PLUS
(hereinafter also referred to as “insurance”) is governed by the laws of the Czech Republic, in particular Act
26. Postpartum care of the newborn is health care for the newborn immediately following the birth without
interrupting the continuity of hospitalization.
27. A professional athlete is a person who has a professional contract with a sports club or other entity in this
No. 89/2012 Coll., the Civil Code, as amended (hereinafter the “Code”), these insurance conditions, the
field and / or performs sports activities for a fee that is the main or predominant income, and / or performs
provisions set out in the insurance contract and its annexes and in other documents that are part of it.
sports activities of min. 20 hours per week (including weekends), including training.
28. Professional sporting activity is a sporting activity performed by a person who is a professional athlete as
2. Provisions in the insurance contract that deviate from the Code or these insurance conditions take precedence.
defined in this Article.
29. The Insured 's ID card is a written confirmation of the origin of health insurance, which the insurer always
3. The contracting parties are the policyholder on the one hand and the insurer on the other.
issues with a validity limited to the period for which the premium was paid, unless otherwise agreed in the
insurance contract. The card is used by the insured to exercise the right to indemnity.
Art. 2
Definitions
For insurance purposes, the following definitions apply:
30. A contractual provider of health services (contracted medical facility) is a provider of health services
with which the insurer has a contract for these purposes.
1. Acute health care is care aimed at averting a serious deterioration in health or reducing the risk of a serious
deterioration in health so that the facts necessary to determine or change an individual treatment procedure
31. A loss event is a fact from which a loss arose and which could be the reason for the right to indemnity.
are identified in time or the insured does not get into a condition in which he or she would be endangered.
yourself or your surroundings.
32. Damage insurance is insurance whose purpose is to compensate for damage incurred as a result of an
insured event. 33. The damage is a reasonable cost demonstrably incurred for the health services provided
2. Without undue delay , it is a very short period of a maximum of days, which means immediate, immediate,
to the insured at the place of insurance.
immediate or immediate action to fulfill an obligation or to perform a legal act or other expression of will, the
duration of which will depend on the circumstances of the particular case. .
34. The insurer is a participant in the insurance and the policyholder as a contracting party, as well as the insured
and any other person who has a right or obligation arising from private insurance.
3. The waiting period is the period during which the insurer is not obliged to provide indemnity from events that
35. For the purposes of this insurance, an accident means an unexpected and sudden action of external forces
would otherwise be insured events. The waiting period is calculated from the day of the agreed beginning
or one's own physical force, regardless of the Insured's will, which occurs during the insurance period and
of the insurance period.
which causes the Insured's health or death, including accidents at work. An accident is considered to be
4. The duration of the insurance is the actual period within the agreed insurance period for which the person's
insurance was in force.
5. Hospitalization is a condition of the insured caused by an insurance risk, when he is provided with the
necessary medical diagnostic and medical care associated with his stay in bed.
6. Chronic illness is a long-lasting and developing illness (including post-traumatic conditions) that existed before
the start of the person's insurance and was stabilized during the previous 6 months and did not require
hospitalization or worsening or changing treatments or medications.
the moment when there were external forces or influences that caused damage to the health or death of
the insured.
An injury is also considered to be damage to health that was caused to the insured:
a) local pus after the penetration of pathogens into an open wound caused by an accident,
b) tetanus or rabies infection in the event of an accident, diagnostic, therapeutic and preventive interventions
carried out for the purpose of treating the consequences of the accident,
c) unexpected and uninterrupted exposure to high or low external temperatures, gases, vapors, electric
current (incl. lightning), radiation, toxic substances and poisons (except microbial poisons and
7. One insured event is an insured event from the insurance of one person arising for the same cause, at the
same place and at the same time, which includes all facts and their consequences, between which there is
a causal, territorial, temporal or other direct connection.
immunotoxic substances),
d) drowning and drowning,
e) bites and bites, insect bites.
36. Multiple insurance arises when two or more private insurances cover the same risk insured for the same
8. A one-off premium is a premium determined for the entire insurance period.
period if the sum of the indemnity limits exceeds the actual amount of damage incurred.
9. Comprehensive health services means health services provided to the insured in the insurer's contractual
medical facilities without direct reimbursement of the costs of treatment in order to maintain his state of
37. The applicant is a person who is interested in concluding an insurance contract with the insurer.
health from the period before the conclusion of the insurance contract. Comprehensive health services
38. A health care provider (medical facility) is a registered facility providing outpatient or outpatient and
include outpatient and inpatient health services, including diagnostic, preventive and dispensary services,
inpatient, diagnostic and medical care, which may include the necessary preventive measures (hospitals,
as well as emergency and rescue services, the provision of medicines and the transport of patients, the
outpatient physicians). The health care provider can be a natural or legal person.
eventual repatriation of the insured or the transport of his remains. The insurance also includes health
services related to the pregnancy of the insured mother and the birth of her child.
Art. 3
10. The time stated in days always means the number of calendar days.
11. A contingency is a fact that is possible and for which it is not certain whether it will occur at all during the
term of the insurance or whether the time of its occurrence is not known.
12. A sudden illness is a sudden and unexpected health disorder that directly endangers the health or life of the
insured, regardless of his / her will, and requires acute and urgent medical care.
Scope and place of insurance
1. The scope of the agreed insurance is determined by the insurance conditions and optional parameters specified
in the insurance contract. These parameters are chosen by the policyholder when concluding the insurance
contract on the basis of knowledge of the insured interest of the insured persons.
2. The policyholder chooses which types of insurance for which persons will be agreed and, if applicable, their
type, chooses any additional insurance, the insurance period and the upper limit of the insurance indemnity.
13. Protective treatment is a protective measure imposed on perpetrators of an otherwise criminal offense who
cannot be prosecuted for their insanity, mental disorder or substance abuse.
3. The insurance is effective only in the agreed place of insurance, which is specified for individual types of
insurance in other sections of these insurance conditions.
Art. 4
14. An illness is, for the purposes of this insurance, a medically documented onset of illness, and for the
purposes of this insurance, an illness is a condition that endangers the health or life of the insured and
requires the provision of medical care.
15. Urgent healthcare is care that aims to prevent or reduce emergencies that are immediately life-threatening
or could lead to sudden death or serious health hazards, or cause sudden or intense pain or sudden
changes in the behavior of a patient who is self-threatening or their surroundings.
Scope and maturity of insurance benefits
1. The amount and scope of the insurance indemnity is determined by the insurer in accordance with the insurance conditions.
2. The provision of insurance indemnity is conditioned by the occurrence of an insured event and the fulfillment
of all conditions and obligations arising from the insurance contract and its components, in particular the
payment of insurance premiums.
3. Unless otherwise agreed by the contracting parties, the insurance indemnity is payable in the currency of the
16. For the purposes of this insurance, a newborn is a child from birth to completion
3 months of age.
Czech Republic and in its territory and the insurer pays it to the entitled person by transfer to his bank
account or by postal order to his name and address.
17. The entitled person is the person who, as a result of the insured event, acquires the right to indemnity.
4. If the insured was entitled to accept an indemnity which he did not receive during his life, the unpaid indemnity
18. The insurance is a written confirmation of the conclusion of the insurance contract, which is issued by the insurer
5. In cases of foreign currency conversion, the insurer shall use the exchange rate of the Czech National Bank valid
shall become the subject of inheritance proceedings.
policyholder.
19. The insurance period is the period for which the person's insurance was agreed.
20. An insured event is a fortuitous fact caused by an insured risk, with which the insurer's obligation to provide
insurance indemnity is connected.
21. The insured risk is a possible cause of the insured event (hereinafter referred to as the “cause”).
22. Insurance risk is a measure of the probability of the occurrence of an insured event caused by a premium
danger.
23. The policyholder is a person who has concluded an insurance contract with the insurer.
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at the time of the occurrence of the insured event.
6. The insurance indemnity is payable within 15 days after the end of the investigation of the reported event with
which the claim for insurance indemnity is connected. The investigation is concluded by communicating its
results to the person who has exercised the right to indemnity.
7. If the investigation necessary to ascertain the insured event, the extent of the indemnity or the person entitled
to accept the indemnity cannot be completed within three months from the date of notification, the Insurer
shall inform the notifier why the investigation cannot be terminated; if the notifier so requests, the insurer
shall provide him with the reasons in writing. The insurer shall provide the person
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who exercises the right to indemnity, at its request a reasonable advance on the indemnity; this does not apply if
2. The insurance arises at 0:00 on the day agreed as the beginning of the insurance period, but not earlier than on the day
there is a reasonable reason to refuse to provide the deposit.
following the payment of the premium, unless otherwise agreed in the insurance contract.
8. The Insurer is entitled to reduce the insurance indemnity:
a) as a result of compensations already received by the entitled person in another way,
3. The insurance lasts from the inception to the actual termination of the insurance.
b) if a lower premium has been agreed as a result of a breach of the policyholder's or the insured's obligations during
4. The insurance is not interrupted due to non-payment of the premium.
the negotiation or amendment, the insurer has the right to reduce the indemnity by such a part as the ratio of
Art. 9
the premium received to the premium it should have received,
Changes and termination of the insurance contract. Termination of insurance.
c) if the breach of the obligation of the policyholder, the insured or another person entitled to the indemnity had a
1. All changes to the insurance contract shall be made in writing by mutual agreement of the parties.
significant effect on the occurrence of the insured event, its course, increase the extent of its consequences or
determine or determine the amount of indemnity, the insurer has the right to reduce premiums performance in
2. The insurance of a person expires at the end of the insurance period, at midnight on the day agreed as the end of the
proportion to the effect of the breach on the extent of the insurer's obligation to perform,
insurance period.
3. The insurance of a person expires upon the termination of the insurance interest, the date of death of the insured person,
d) in the event of the transfer of the right to the insurer pursuant to Article 18 of this Section,
the date of termination of the insured legal entity without a legal successor or the date of delivery of the insurer's
e) if he has paid the indemnity in the unreduced amount and he subsequently becomes entitled to a reduction of the
indemnity. The Insurer has the right to claim the difference between the paid and reduced indemnity against
notification of refusal of insurance indemnity.
4. The termination of the insurance interest terminates all insurance of the person in the following cases:
the person in whose favor the indemnity was paid,
a) rejection of the visa application by the Department of Asylum and Migration Policy of the Ministry of the Interior of
f) if the policyholder or the insured fails to supply the insurer with the required medical request
the Czech Republic,
documentation.
b) termination of the visa in the territory of the Czech Republic.
9. If the policyholder or the insured violates any of the obligations set out in these insurance conditions, the insurer may
5. The termination of the insurance by the termination of the insurance interest does not occur at the end of the stay of the
reduce the insurance indemnity with regard to the seriousness and nature of the breach of this obligation.
10. The Insurer may refuse the insurance indemnity if the cause of the insured event was the fact that
insured person in the Czech Republic, if this person still has a valid visa after the end of the stay.
6. All insurance of a person expires on the date of receipt of the policyholder's notification by the insurer about the transfer
a) of which he learned only after the occurrence of the insured event,
of the insured to the public health insurance of the Czech Republic, if it includes a copy of a valid public health
b) which, when arranging the insurance or its change, was unable to find out as a result of a culpable breach of the
insurance card of the Czech Republic. If the insured person has an insured interest, the insurer will offer the insured
obligation set out in paragraph 1 or 2 of Article 14 of this Section,
person insurance of a different scope and for a different premium.
(c) if, in the light of that fact, when concluding the contract
did not close or if it closed under other conditions.
7.
11. Indemnity is limited by indemnity limits. The limits of insurance indemnity are
The insurer or the policyholder may terminate the insurance in writing:
a) within 2 months from the date of concluding the insurance contract. An eight-day notice period begins to run on the
for individual types of insurance specified in the insurance contract.
day of delivery of the notice, after which the insurance expires, b) within 3 months from the date of delivery of
12. A more detailed scope and method of insurance indemnity for individual types of insurance is given
the notification of the occurrence of the insured event. On the day of delivery of the notice, the notice period of 1
in other sections of these insurance conditions.
month begins to run, after which the insurance expires.
Art. 5
8. The policyholder may terminate the insurance with eight days' notice:
Insurance interest
a) within two months from the day when he learned that the insurer used an aspect contrary to the principle of equal
1. An insured interest is a legitimate need for protection against the consequences of an insured event.
treatment in determining the amount of the premium or in calculating the insurance benefit,
2. The policyholder has an insurance interest in his own life and health. The policyholder is also considered to have an
insured interest in the life and health of another person if he proves an interest conditioned by that person's
b) within one month from the date on which he received the notification of the transfer of the insurance pool or its part
relationship, whether it arises from a family relationship or is conditioned by a benefit or advantage from continuing
or of the transformation of the insurer,
his life or maintaining his health.
(c) within one month from the date of publication of the notice that the insurer 's authorization to conduct insurance
3. If the insured has given his consent to the insurance, it is considered that the policyholder's insurance interest was
business has been withdrawn.
9.
proven.
4. If the applicant did not have an insurance interest and the insurer knew or should have known about it when concluding
the contract, the contract is invalid.
If the policyholder or the insured has intentionally or negligently breached the obligation set out in paragraph 1 or 2 of
Article 14 of this section, the insurer has the right to withdraw from the contract if he proves that he would not conclude
the contract after answering the questions truthfully and completely.
5. If the policyholder knowingly insured the non-existent insurance interest, but the insurer did not know or could not have
The policyholder has the right to withdraw from the contract if the insurer has breached the obligation set out in
known about it, the contract is invalid; however, the insurer is entitled to a fee corresponding to the premium until the
paragraph 7 or 8 of Article 11 of this section. The right of withdrawal shall lapse if the party does not exercise it within
time when he learned of the invalidity.
two months of the date on which he finds or has had to find a breach of the obligation set out in paragraph 1 or 2 of
6. The insurance interest does not end with the absence of the insured at the place of insurance or with the acquisition of
Article 14 or in paragraph 7 or 8 of Article 11 of this Section.
similar private insurance or due to simple lack of interest.
7. The termination of the insurance interest must always be proved to the insurer.
10. If the insurance contract was concluded in the form of a distance transaction, the policyholder has the right to withdraw
from the contract without giving a reason within fourteen days from the date of its conclusion or from the date when
Art. 6
the insurance conditions were communicated to him. request after the conclusion of the contract.
Group insurance
1. Group insurance is insurance that covers a group of insured persons specified in the insurance contract, whose identity
may not be known at the time of concluding the contract.
11. Exceptionally, in justified cases (eg due to a pandemic), the insurance contract may be terminated by a written agreement
of the contracting parties under the agreed conditions.
12. The insurance contract can be assigned only with the consent of the insurer.
2. If the insurance covers members of a certain group, the insurance contract need not contain the names of the insured, if
the insured persons can be identified without a doubt at least at the time of the insured event.
13. If third-party insurance is insured, then the insured enters the policyholder's place on the day of the policyholder's death
or on the day of his termination without a legal successor; however, if he notifies the insurer in writing within thirty
days from the date of the policyholder's death or from the date of his termination that he is not interested in the
3. Breach of the obligation to answer the insurer's truths completely and completely only affects the insurance of those
persons to whom the breach of this obligation relates in the case of group insurance.
duration of the insurance, the insurance expires on the day of death or termination of the policyholder's. The effects
of the delay on the insured shall not occur before the expiration of fifteen days from the day on which the insured
learned of his entry into the insurance. However, if more than one insured is a participant in the insurance, the
insurance of all persons expires at the end of the period for which the premium was paid.
Art. 7
Concluding an insurance contract
1. The insurance contract is concluded by accepting the insurer's offer. The offer is accepted by the signature of the
contracting parties, unless otherwise expressly stated in the offer. If the policyholder has accepted the offer by paying
the premium in a timely manner, the written form of the contract is considered
as preserved.
14. If the insurer reminds the policyholder of the payment of the premium and instructs him in the reminder that the insurance
will expire, if the premium is not paid even in the additional period, the insurance will expire upon the expiration of this
period in vain.
15. Due to the termination of the insured's stay at the place of insurance, the insurance does not expire before the end of
2. The insurance contract is concluded for a definite period.
3. In addition to the insurance conditions, all agreements, amendments and annexes to the insurance contract, as well as all
the insurance period.
16. The insurance contract is terminated by the termination of all insurances of all persons.
documents defining the conditions of origin, duration, changes and termination of insurance (eg applications,
Art. 10
questionnaires, protocols, medical examinations and examinations, terminations, records on the course of insurance
negotiations, information of the insurer for those interested in concluding an insurance contract).
Premiums
1. The insurance premium is a payment for the provided insurance protection. The amount of the premium is determined by
the insurer for the insurance contract. Premiums are negotiated as a one-off.
2. The premium is payable on the day of concluding the insurance contract in the currency and amount stated in the premium
Art. 8
Origin and duration of insurance. Insurance period
1. The insurance is arranged for a certain insurance period from the date of the beginning of the insurance period to the date
of the end of the insurance period. The insurance period is agreed in the insurance contract.
contract.
3. The insurance premium is paid if it is demonstrably accepted in full by the insurer's intermediary or is credited to the
insurer's bank account.
4. The insurer is entitled to premiums for the duration of the insurance. This right of the insurer arises on the day of
concluding the insurance contract.
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5. If the insurance expires due to the refusal of a visa or the expiry of the visa, the insurer shall return to the policyholder,
3. If multiple insurance arises, the policyholder shall notify each insurer without undue delay and shall state in the
after finding out all costs of insurance benefits, but no later than 3 months from the date of termination, the part
notification the other insurers and the limits of indemnity agreed in the other contracts.
of the premium corresponding to unused premium at the date of termination. after deduction:
4. Notify the change of correspondence address to the insurer without delay.
(a) claims incurred; and
5. If the insurance expires before the expiry of the agreed insurance period, the policyholder is always obliged to return
b) the amounts corresponding to the proportional part of the Above Standard (Section B, Article 4, paragraph 6),
the insured's card to the insurer no later than 5 calendar days from the date of termination of the insurance.
by which the Insured overdrawn the deserved part of the Above Standard corresponding to the actual
6.
duration of the insurance.
If the policyholder is also an insured, all the obligations of the insured also apply to him.
6. If the insurance expires as a result of the policyholder's termination or as a result of his notification of the transfer of
Art. 13
the insured to the public health insurance of the Czech Republic, the insurer will return the policyholder after
finding out all insurance costs, but no later than 3 months from the date of termination. , the part of the premium
that corresponds to the unused premium on the date of termination of the insurance after deduction:
Obligations of the insured
The insured is obliged to:
1. to do everything possible to avert the occurrence of the insured event and to reduce the extent of its consequences,
2. to release the provider of health services from confidentiality in writing and to give the insurer a written authorization
(a) costs associated with the creation and administration of insurance; and
to obtain information which is subject to the obligatory confidentiality of health care workers and which is
(b) costs related to claims, and
necessary for the insurer's investigation in the event of damage
events,
c) amounts corresponding to a proportional part of the Premium (Section B, Article 4, paragraph 6),
by which the insured has overdrawn the deserved part of the Above Standard corresponding to the actual
3. always follow the instructions of the attending physician,
duration of the insurance.
4. observe security measures for the duration of the insurance,
7. If the insurance expires as a result of an insured event, the insurer is entitled to a one-off premium
5. use appropriate protective aids and equipment necessary for the maximum safe performance of all activities
whole.
performed,
8. If the insurance contract is terminated by agreement before the date of insurance, the insurer will return to the
6. have the relevant valid authorization to perform all activities operated at the place of insurance,
policyholder, after his return of the insured's card, the received premium, from which he will deduct the costs
associated with the creation and administration of insurance.
9. The insurer's costs associated with the creation and administration of the insurance amount to 20% of the unused
premium.
7. ensure appropriate supervision or escort, if it is usual for the performed activity,
8. not to stay in places marked by the organizer as the organizer as
inappropriate,
10. The insurer is entitled to the premium until the time when he learned of the termination of the premium
9. comply with the legal regulations in force at the place of insurance,
of interest.
11. If the policyholder withdraws from the contract, the insurer shall reimburse him within 30 days from the date on
which the withdrawal becomes effective, the premiums paid less what he has already paid from the insurance; if
10. seek medical treatment if necessary,
11. comply with the obligations set out for the agreed types of insurance in other sections.
the insurer withdraws from the contract, he also has the right to set off the costs associated with the creation and
Art. 14
administration of the insurance. If the insurer withdraws from the contract and if the policyholder, the insured or
another person has already received the insurance indemnity, he shall at the same time reimburse the insurer
what exceeds the paid premium from the paid indemnity.
Other rights and obligations of insurance participants
1. If the insurer asks the person interested in the insurance in writing during the negotiations on the conclusion of the
12. If the policyholder withdraws from the contract pursuant to paragraph 10 of Article 9 of this section, the insurer shall
contract or the policyholder during the negotiations on the change of the contract about the facts relevant to the
return the premiums paid to him without undue delay, but no later than within 30 days from the date on which
insurer's decision on how to assess the insurance risk, whether he insures them and under what conditions or
the withdrawal becomes effective; at the same time he has the right to deduct what he has already fulfilled from
the policyholder questions these truthfully and completely.
the insurance. However, if the indemnity has been paid in excess of the amount of the premium paid, the
The obligation shall be deemed to have been duly fulfilled if nothing significant has been concealed in the reply.
policyholder, or the insured or the intended
the insurer the amount of the indemnity paid, which exceeds the premium paid.
2. What is stipulated in paragraph 1 of this Article about the obligations of the policyholder shall apply mutatis mutandis
13. The Insurer's claims on the premium will be offset by the Insurer in the order in which
originated and not in the order in which they were mentioned.
to the insured.
3. If an event occurs with which the person considered to be entitled is associated with a claim for indemnity, he shall
notify the insurer without undue delay, give him a true explanation of the cause, occurrence and extent of the
Art. 11
consequences of such an event, the rights of third parties and any multiple insurance; at the same time, it
Rights and obligations of the insurer
submits the necessary documents to the insurer (eg the medical documentation of the insured) and proceeds in
1. The Insurer is entitled to check the submitted documents, request expert opinions of experts, or consult complex
the manner agreed in the contract. If he is not a policyholder or an insured at the same time, the policyholder
claims with health care providers or other competent entities, including abroad.
2. After concluding the insurance contract and paying the premium, the insurer shall issue the policyholder and the
and the insured also have these obligations.
4. The same notification may be made by any person who is legally entitled to the insurance benefit
insured's ID card for each insured person. The Insured's ID card is always issued for the period for which the
insurance premium was paid.
interest.
5. The notification referred to in paragraphs 3 and 4 of this Article shall be deemed to have been received after the insurer:
3. If a valid policy is lost, damaged or destroyed, the insurer shall issue a duplicate to the policyholder at his request;
I.) the event was reported on the duly completed form of the insurer and delivered
this applies similarly to the issuance of a copy of the written insurance contract and the insured's ID card. The
insurers,
Insurer may make the issue of a duplicate conditional on the reimbursement of costs incurred.
II.) All necessary documents or documents requested by the insurer have been handed over.
The necessary documents are:
A) documents proving:
4. Before concluding the insurance contract, the insurer shall inform the person interested in concluding the insurance premium
information about the insurer and the agreed insurance.
a) the cause, time, place and circumstances of the occurrence of the insured event, its scope and
5. The Insurer is obliged to accept due premiums and other due receivables from the insurance also from the
direct connection of the insured event with the person of the insured, at least by stating the
policyholder's pledgee, from the entitled person or from the insured.
name, surname and date of birth of the insured,
6. During the term of the insurance contract, the insurer notifies the policyholder of the information to his address
b) detailed specification of the subject of reimbursement (eg medical reports with diagnosis,
specified in the insurance contract or notifies it via its website. If the address for written communication is different
description and date of performed procedures and prescribed drugs),
from the address of the registered office or residence, it is referred to as correspondence. The address can also
be a contact intended for electronic communication.
c) the subject of the requested payment (eg bills or invoices issued by a doctor or bills issued by a
pharmacy on the basis of a prescription from the attending physician) and proving the date
7. If the insurer must be aware of the discrepancies between the insurance offered and the applicant's requirements
and amount of payment (eg cash receipts, account statements),
when concluding the contract, he shall notify him thereof. In so doing, account shall be taken of the circumstances
and manner in which the contract is concluded, as well as whether the other party is assisted in concluding the
B) in the case of insurance benefits for outpatient medicines and medical devices, also copies of
contract by an intermediary independent of the insurer.
prescriptions issued in the name of the insured with the date of issue, quantity and description of
8. If the candidate or the policyholder inquires in writing about the conclusion of the contract or the policyholder inquires
medicines and medical devices, signature and stamp of the exhibitor,
in writing about the insurance, the insurer will answer these questions truthfully and completely.
(C) in the event of an insured investigation by the police, also a copy of the police report; or
9. If the policyholder requests in writing from the insurer the communication of data relevant for performance under the
accident investigation certificate,
contract, the insurer shall communicate it to him without undue delay in writing.
D) in the event of the death of the insured, also a copy of the official death certificate and medical certificate
certificate of cause of death.
6. Insurance participants submit copies of documents to the insurer, originals on request
Art. 12
insurers.
The documents must be in the name of the insured and must bear the date of issue and, if prescribed on the
Obligations of the policyholder
document, the signature or. and stamp imprint.
The policyholder is obliged to:
1. Pay insurance premiums to the insurer.
2. To acquaint all insured persons with the content of the insurance contract, including its components, in a timely
manner and to provide them with all materials and information received for them from the insurer.
7.
The Insurer shall, without undue delay upon receipt of the notification referred to in paragraph 5 of this Article,
initiate the investigation necessary to determine the existence and extent of its obligation to perform. The
investigation is concluded by communicating its results to the person who has exercised the right to indemnity;
at the request of this person, the insurer shall justify in writing the amount of the insurance indemnity, or the
reason for its refusal.
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8. If the notification contains knowingly false or grossly distorted material information concerning the scope of the
through the data box, if the insurer allows delivery to the data box. This applies in particular to the reporting of
reported event, or if it knowingly conceals information concerning this event, the insurer shall be entitled to
a loss claim, to the notification of the policyholder or the insured regarding a change of surname, residential
reimbursement of costs expediently incurred in investigating the facts of which the data communicated or
address, correspondence address and other contact details specified in the contract. Legal proceedings,
withheld. The insurer is considered to have incurred the costs in the proven amount efficiently.
notifications and requests under this paragraph made other than in writing must be additionally supplemented
in writing, if the insurer so requests.
9. If the policyholder, the insured or another person who asserts the right to indemnity incurs the costs of the
investigation or their increase by breach of duty, the insurer shall have the right to adequate compensation
against him.
6. In matters of insurance relationship, especially in connection with insurance administration and settlement of
insurance claims, the insurer is entitled to contact other participants in the insurance by electronic or other
technical means (eg telephone, SMS, e-mail, fax, data box), unless agreed otherwise. When choosing the
10. The policyholder and the insured are obliged to:
a) immediately notify the insurer in writing of the change of all data specified in the insurance contract for the
duration of the insurance contract,
form of communication, the Insurer takes into account the obligations set out in the relevant legal regulations
and the nature of the information communicated.
b) to enable the insurer to carry out an investigation into the causes of the loss event and the extent of its
consequences, while providing the insurer with its cooperation,
c) to provide the insurer with information on all insurance contracts valid at the time of the occurrence of the
7. Legal proceedings, notifications and requests shall be effective against the other Contracting Party as soon as it is received
They were delivered.
loss event, the subject of which is the insurance of the same insurance risk.
Art. 17
11. The participants in the insurance may not, without the consent of the insurer, submit a claim for insurance
indemnity.
Rescue costs
1. If the policyholder has expediently incurred the costs of averting an imminent insured event to mitigate the
Art. 15
Service of documents
consequences of an already occurring insured event, he shall be entitled to compensation from the insurer,
as well as to compensation for damage suffered in connection with this activity.
1. Documents delivered through the holder of a postal license (hereinafter referred to as "post")
will be sent to: a)
2. Reimbursement of rescue costs for saving lives or human health shall be limited
the insurer at the address of the registered office specified in the insurance contract, or another
the address communicated to the policyholder by the insurer;
b) by the insurer to the correspondence address of the relevant person (addressee) specified in the insurance
30% of the agreed sum insured or indemnity limit.
Reimbursement of other rescue costs is limited to CZK 100,000 for the duration of the insurance contract,
with the exception of costs incurred by the policyholder with the consent of the insurer.
contract or otherwise notified to the insurer. If the correspondence address is not specified in the
insurance contract or notified to the insurer, the documents will be sent to the address specified in the
3. Reimbursement of rescue costs is beyond the agreed limit of insurance indemnity.
contract or notified to the insurer as residence or permanent residence, or the registered office of such
4. If the rescue costs have been incurred by the insured or another person beyond the obligations stipulated by law,
person.
he has the same right to compensation against the insurer as the policyholder.
2. Unless otherwise agreed, documents may also be delivered electronically (for example via a data box, the
Art. 18
insurer's internet application, by electronic message) to the contact details provided for the purpose of
electronic communication.
Transfer of rights to insurers
A document sent by the Insurer electronically to the last address provided by the addressee shall be deemed
to have been delivered on the third working day after its dispatch, unless the date of its delivery can be
ascertained or unless otherwise stipulated in the relevant legal regulations.
1. If, in connection with an imminent or insured event, a person entitled to indemnity, an insured person or a person
who has incurred rescue costs has incurred a right to compensation or another similar right against another,
this claim, including accessories, security and other rights associated with it at the time of payment of benefits
from the insurance to the insurer, up to the amount of benefits paid by the insurer to the entitled person. This
3. Documents may also be delivered by an employee of the insurer or another person authorized by the insurer, in
particular to the addresses referred to in paragraph 1 (a). b), but also to any other place where the addressee
does not apply if such a person has acquired such a right against the person who lives with him in the same
household or is dependent on him for maintenance, unless he caused the insured event intentionally.
will be willing to take over the document. A document delivered in this way shall be deemed to have been
delivered on the day of its receipt.
4. The participants in the insurance are obliged to notify the insurer without undue delay of any change concerning
the facts relevant for delivery and to notify each other of their new postal address, electronic address or data
box or telephone number.
2. The person whose right has passed to the insurer shall issue the necessary documents to the insurer and provide
him with everything necessary to enforce the claim. If the transfer of the right to the insurer is thwarted, the
insurer has the right to reduce the insurance benefit by the amount it could otherwise have received. If the
insurer has already provided benefits, he is entitled to compensation up to this amount.
5. If it is not a delivery according to paragraphs 6 to 8, the document sent by the insurer by registered mail with
delivery is considered delivered on the day specified as the day of receipt of the document on the delivery
note and the document sent by the insurer by registered mail without delivery or sent by ordinary consignment,
the third working day after dispatch and in the case of delivery to an address in a country other than the Czech
3. The entitled person is obliged to take measures to prevent the right to compensation or expiration of the right to
compensation, which according to the law passes to the insurer.
4. The entitled person may not enter into such agreements with a third party by which he would waive the right to
compensation against the third party in the event that these claims pass to the insurer.
Republic, then the fifteenth working day after dispatch.
5. The entitled person is obliged to transfer the rights to the insurer at his request in writing
6. If the addressee fails to reach the document by refusing to accept it, it shall be deemed that it has been received properly
the date on which the addressee refused to accept the document.
7. If the addressee fails to receive the document by failing to accept the document sent by the insurer by registered
confirm.
6. If the Insurer incurs additional costs in connection with the assertion of the claim, the Insurer is entitled to claim
these costs from the Beneficiary.
mail or registered mail with delivery delivered to the post office within the storage period, it shall be deemed
Art. 19
to have been duly received on the day of deposit at the post office.
Final Provisions
8. If the addressee fails to deliver the document other than stated in the previous paragraphs (eg by not marking the
mailbox with his name and surname or title), it is valid that it was duly received on the day of its return to the
1. Declarations and notifications to the insurer shall be valid only if they are made in writing.
insurer.
9. A document sent by the insurer by registered letter or registered letter with delivery shall be deemed to have been
delivered even if it is taken over by another person (such as a family member) to whom the post office
delivered the item in accordance with postal law.
2. The language of communication is Czech.
3. Their guardian shall act on behalf of persons limited in their autonomy. Persons who have not acquired full
autonomy shall be deemed to act with or with the consent of the legal representative.
4. If a cash payment is made, the day of payment shall be the day on which the amount is paid in full to the
Art. 16
Form of legal proceedings
beneficiary. If a non-cash payment is made, the day of payment is the day on which the amount is credited in
full to the beneficiary's account.
1. The insurance contract must be concluded in writing, unless otherwise provided by the Civil Code
otherwise.
2. In the event that the acceptance of the offer by the policyholder is found invalid due to non-compliance with the
5. All disputes arising out of or in connection with the insurance will be resolved, unless otherwise agreed, or for outof-court settlement, at the competent court in the Czech Republic under Czech law.
written form or other reason, and the policyholder pays the first premium or its installment in the amount and
deadline specified in the offer (if no deadline is stated in the offer, within one month) from the delivery of the
offer), the offer is considered accepted by payment of this first premium or its installment.
SECTION B
HEALTH INSURANCE
3. Legal proceedings, notifications and applications require a written form if they affect: a) the duration
and termination of the insurance, b) changes in the premium, c) changes in the scope of insurance.
Health insurance (hereinafter referred to as “insurance”) is governed by the provisions of this section in addition to
the common provisions in section A.
4. Legal proceedings for which a written form is required are valid, in particular if they are signed by the person
Art. 1
acting or the signature is replaced by mechanical means, where this is customary, if done through a data box,
if it is provided with a guaranteed electronic by signature pursuant to a special law, or if it is made through the
insurer's protected internet client portal.
Purpose and subject of insurance
1. In the event of an insured event, the insurer shall provide the entitled person with indemnity to the extent of the
damage incurred on the subject of insurance up to the agreed limit of indemnity.
5. Legal proceedings, notifications and requests not referred to in paragraph 3 may be made in writing, by telephone,
by e-mail, via the insurer's internet application or
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2. The insured is the entitled person.
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3. The subject of insurance is the health of the insured. The health of the insured mother's newborn can also
be insured.
e) if the insurance of the “Professional Sports” type is effective at the time of the occurrence of
the insured event, the Insurer shall provide the insurance indemnity also in the case of conducting
professional sports activities and in preparation for it,
4. The insurance is arranged as a damage.
Art. 2
Insured event
1. The insured event is, with the exception of the agreed exclusions, a change in the insured person's state
of health or other acts related to the insured person's state of health due to illness or injury that occurred
during the insurance period and after
f) treatment of the insured's teeth in order to eliminate sudden pain or consequences of an accident
within the scope of public health insurance, preventive examinations
(hereinafter referred to as "Dental Treatment"),
g) medicines and medical devices prescribed by an outpatient doctor in the name of
the Insured (hereinafter referred to as “Outpatient Medicines”),
waiting period, at the place of insurance and to the extent and under the conditions of the provisions of this section.
2. In the event of an insured event, the insurer shall provide insurance indemnity within the scope of Article 4
of this section.
(h) assistance services within the scope of Article 7 of this Section; the insurer provides these services
through the contractual provider without direct payment to the insured provider.
6. In addition to the indemnity within the scope of paragraph 5 of this Article, the Insurer shall reimburse the
Art. 3
costs of the Insured incurred for the above-mentioned above-standard health services (hereinafter
Scope and place of insurance
referred to as the “Above Standard”), up to the amount of the Above Standard limit specified in the
1. The insurance is effective only in the agreed place of insurance, which is the territory of the Czech Republic
insurance contract: a ) vaccination (vaccine including its application), which is not covered by this
standard (eg against tick-borne encephalitis),
of the Republic.
2. The waiting period shall apply to cases of health services due to:
3 months pregnancy ,
childbirth for 8 months.
The waiting period does not apply if the insurance type "Newborn" is agreed in the insurance contract.
(b) over - the - counter medicines and medical devices purchased in pharmacies (excluding
prescription) and in medical supply stores,
c) plastic fixings (lightweight plaster),
d) hormonal contraception,
3. If an event occurred which could have been or was an insured event from the medical expenses insurance
e) hearing aids, spectacles and contact lenses,
in the Schengen area agreed in accordance with Section C of these insurance conditions or from other
f) walkers and wheelchairs (including electric drive),
medical expenses insurance with the insurer (eg from travel insurance) and which requires medical
g) reimbursement of the costs of transporting the insured to the medical facility due to treatment or
care after returning to the Czech Republic, the condition of a change in the state of health of the insured
hospitalization; the condition for reimbursement of costs is, in addition to the submission of proof
in the Czech Republic does not apply in the event of this event.
of own transport costs, also the submission of a medical report confirming the occurrence of an
insured event within the scope of paragraph 5 of this Article; this performance is limited to CZK
4. The policyholder chooses the insurance period, the upper limit of the insurance indemnity (indemnity limits)
for health services, including repatriation and transportation, or for the agreed supplementary insurance,
and the type of insurance in the following scope:
500 per event,
h) preventive examinations, examinations and consultations to detect a specific disease (eg laboratory
tests of blood, prostate; examination for malignant melanoma of the skin), including the issuance
The "standard" of insurance includes comprehensive health services provided to the insured; the
of an extract from medical records, and other examinations not covered by public health insurance
insurance does not cover events for which the insurance indemnity is conditioned by an agreement of
(to confirm driver's license, for sports activities, etc.),
the type Newborn or Professional Sports insurance,
"Newborn" beyond the type of insurance "Standard" insurance also covers the events specified under
i) dental hygiene and above-standard dental material (white seals, etc.),
letter (d) paragraph 5 of Article 4 of this Section,
j) above-standard room or board in the hospital within the hospitalization of the insured.
"Professional sports" beyond the type of insurance "Standard" insurance also covers the events
The above-standard can be drawn during the insurance period even in partial amounts of at least CZK
100.
specified under letter (e) paragraph 5, Article 4 of this Section.
7. The costs of health services pursuant to paragraph 5 of this Article shall be reimbursed directly or through
Art. 4
Scope of insurance indemnity
1. The condition for exercising the right to indemnity in the form of drawing on health services provided by
the assistance service provider to the health service provider, the insured or another person who has
demonstrably incurred these costs.
8. The Insurer shall reimburse the costs of above-standard health and other services pursuant to paragraph
the insurer is the presentation of a valid card insured by the provider of these services always before
6 of this Article to the Insured or the person who demonstrably incurred these costs, upon presentation
the start of their use. Others may fulfill this obligation
person.
of proof of their reimbursement.
2. The Insurer shall provide insurance benefits for health services drawn in connection with pregnancy or
childbirth only after the expiry of the waiting period, if agreed.
9. Direct reimbursement of costs for health and other services:
a) If the Insured or another person has made direct reimbursement of costs for health services pursuant
to paragraph 5 of this Article, which are an insured event, and were provided to the Insured at a
3. The Insurer does not provide insurance indemnity for services drawn outside the duration of the insurance.
health service provider in the Czech Republic, the Insurer will subsequently reimburse reasonable
4. Indemnity is limited by indemnity limits.
insured costs for these health services or the person who incurred these costs.
5. Indemnity up to the limits of indemnity pursuant to paragraph 11 of this Article shall be provided by the
Insurer to the extent of:
a) health services in the scope of a similar list of health services reimbursed to the insured persons of
b) The Insurer shall provide insurance indemnity for the prescription for outpatient medicines or a
the public health insurance of the Czech Republic (hereinafter referred to as “health services”),
voucher for medical devices, if the amount of these costs
but with agreed exclusions from the insurance and with agreed limits of indemnity.
for each recipe or voucher exceeds the limit of CZK 100. Indemnity means the amount specified
in the VZP ÿR Nomenclature for mass-produced medicinal products, medical devices and
The insurer provides these health services to contractual health care providers
individually prepared medicinal products marked as MAX and valid at the time of the occurrence
services. Only in the event of a sudden deterioration in the health of the insured and there is a
of the insured event.
risk of serious damage to his health or endanger his life due to delay, the insurer will provide
10. If an insured event has occurred and the continuous hospitalization of the insured exceeds the duration
these health services even in non-contractual
of the insurance, the insurer shall decide on further action as follows:
providers of health services in the Czech Republic. Necessary and reasonable costs demonstrably
a) if the health condition of the Insured does not allow his repatriation, the Insured will be treated in a
incurred for health services will be reimbursed, and only until it has been possible to provide
medical facility designated by the Insurer until his health condition improves to such an extent
health services with the insurer's contractual health service provider.
that it will be possible to carry out his repatriation,
b) if the health condition of the insured allows for his repatriation, it may be agreed upon
b) repatriation of a sick insured person with the consent of the attending physician, if his / her health
condition allows, through an organization of medical transport service approved by the insurer or
the attending physician to carry out his repatriation.
11. The upper limit of indemnity is determined by the limits of indemnity specified in the insurance contract:
the insurer's assistance services provider, to the state whose travel document the insured owns
or to another state, in which the insured has a residence permit. After prior approval, the insurer
a) Performance limit for costs listed under letter a) to c) paragraph 5 of this Article, (Health services
may, in justified cases, also cover the transport costs of another person necessary to accompany
including repatriation and transportation) limits the insurance indemnity for each single insured
the insured; the insurer provides these services through the contractual provider without direct
event.
payment to the insured provider,
b) Performance limit for costs listed under letter d) paragraph 5 of this Article (Postpartum care of the
insured mother's newborn) limits the insurance indemnity for all insured events arising during the
insurance period.
c) the transport of the Insured's remains to the State whose travel document the Insured owned, or to
c) Performance limit for costs under letter f) paragraph 5 of this article (Dental treatment)
another State in which the Insured had a residence permit, carried out by a specialized
limits the indemnity for all insured events occurring in one year of the insurance period or for the
organization approved by the Insurer or the Insurer's assistance service provider. Upon prior
insurance period if the insurance period is shorter than one year.
approval, the Insurer may, in justified cases, cover other related costs; the insurer provides these
d) Limit of performance for costs under letter g) par .
services through the contractual provider without direct payment to the provider,
d) if the insurance of the “Newborn” type is effective at the time of the occurrence of the insured event,
the insurer will also provide insurance benefits in the case of postpartum care for the newborn
insured mothers born or born during the insurance period,
e) Limit of performance for costs according to letter a) to j) paragraph 6 of this Article (Above standard)
restricts benefits for all above-standard health and other services for the duration of the insurance.
The Insurer provides this above-standard performance beyond the limits specified in paragraph
5 of this Article.
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Art. 5
Exclusions from insurance
-
providing professional support in repatriation,
ensuring the transport of the insured's remains in the event of death.
1. Unless otherwise agreed in writing by the contracting parties, the insurer shall not provide, with the exception
of preventive, dispensary and health care related to the pregnancy of the insured mother and the birth of
SECTION C
her child, insurance benefits in cases of:
TREATMENT INSURANCE IN THE SCHENGEN AREA
A) costs of:
a) spa care, homeopathy and acupuncture,
b) regulatory fees and surcharges,
If the Insurance Contract for Medical Expenses in the Schengen Area (hereinafter referred to in this section as
c) protective treatment
“insurance”) is agreed in the insurance contract, the insurance is governed by the provisions of this section in
addition to the common provisions in Section A.
B) if the loss event occurred as a result of or in connection with active participation
insured:
Art. 1
a) at events of war and other armed conflicts, acts of violence or civil war,
Purpose and subject of insurance
b) when handling a weapon or explosive,
C) if the loss event occurred as a result of or in connection with:
1. In the event of an insured event, the insurer shall provide the entitled person with insurance indemnity to the
extent of the damage caused to the object up to the agreed limit of indemnity.
(a) riots or criminal activities caused or committed by the insured;
this exclusion does not apply in the event of an accident,
b) ingestion or in connection with the consequences of the insured's consumption of alcohol, drugs,
narcotics or other psychotropic or addictive substances; this exclusion does not apply in the
2. The insured is the entitled person.
3. The subject of insurance is the health of the insured.
4. The insurance is arranged as a damage.
event of an accident,
Art. 2
2. The insurer does not provide insurance benefits:
a) in cases where the medical care is provided as a result of an illness or accident or other conditions for
Insured event
which the insured was treated before the conclusion of the insurance,
or
sudden change in a long-term chronic illness) insured due to a sudden illness or injury that occurred during the
The insured event is, with the exception of the agreed exclusions, a change in the state of health (including a
in cases where medical care is provided in connection with the treatment of diseases or injuries or
insurance period and at the place of insurance and which requires subsequent provision of acute and urgent
other conditions, the cause or symptoms of which occurred before the conclusion of the insurance
medical care at the place of insurance.
contract or during the waiting period,
b) for health services that are not covered by public health insurance in the Czech Republic,
Art. 3
c) if the Insured refuses to undergo repatriation, treatment or necessary medical examinations or does
not follow the treatment regimen recommended by the doctor,
d) for examinations, examinations and other medical procedures in the personal interest or at the request
of the insured, including laboratory tests (concerning eg cosmetic procedures, abortion, infertility,
contraception, preparation of a medical certificate),
Scope and place of insurance
1. The insurance is effective only in the agreed place of insurance, which is the territory of the Schengen
states, with the exception of the territory of the Czech Republic. The territory of the States is
understood to include the exclusive economic zone (EEE).
2. The type of stay (trip) is not distinguished for insurance. The insurance is effective for both tourist and
business stays (trips).
e) for medicines and medical devices not prescribed by a doctor, ie. freely purchased without a
prescription or whose administration was started before the beginning of the insurance,
3. The insurance covers recreational trips and stays during the operation of ordinary recreational and leisure
sports, which are listed in the List of Activities and Sports (hereinafter the "List") as sports without the
need for additional insurance and sports listed in the List as sports. Dangerous sports. The sports listed
f) for optional vaccinations,
as Extreme and the sports Uninsurable are not covered by the insurance.
g) for complications that occur in connection with the provision of health care for diseases, conditions or
injuries that are not covered by the insurance,
h) for postpartum care of the newborn of the insured mother, if there is no damage at the time of the occurrence
Art. 4
"Newborn" type effective insurance events ; the agreed type of insurance is specified in the
Scope of insurance indemnity
insurance contract,
1. Unless it is further stated that the insurer carries out the insurance indemnity by providing services without
i) for events occurring during the operation of a professional sports activity and in preparation for it, if the
insurance of the “Professional Sports” type is not effective at the time of the occurrence of
the loss event; the agreed type of insurance is specified in the insurance contract.
The exclusions in this paragraph do not apply to payments under paragraph 6 of Article 4 of this section.
direct payment to the insured, the insurer shall reimburse the entitled person (the insured or the person
who actually incurred the costs) costs to the extent of the damage actually incurred.
2. The insurance indemnity up to the limits according to paragraph 5 of this article is provided by the insurer to the extent of:
a) acute and urgent medical care for the insured, including:
- the necessary examination to establish the diagnosis and treatment,
- necessary standard treatment,
Art. 6
Obligations of the insured
- the necessary hospitalization of the patient in a multiple room with
standard equipment,
In addition to the obligations set out in Section A., the Insured is obliged to:
- the necessary operation, including the related necessary expenses,
1. In the event of a loss event, always and without delay, if his health condition allows it, contact the
- necessary medicines and medical devices prescribed by a doctor in the amount required until the
insurer's assistance service provider and follow his instructions. This obligation may also be fulfilled
by another person.
return to the Czech Republic,
- the medically necessary transport from the place of occurrence of the insured event to the nearest
2. Provide health care providers with a valid ID card of the insured before drawing them . This obligation may
also be fulfilled by another person.
first aid facility or hospital and back,
b) repatriation of a sick insured person with the consent of the attending physician, if his / her health
3. Undergo treatment or necessary medical examinations by a doctor appointed by the insurer
or the insurer's assistance service provider.
condition allows it, through an organization of medical transport service approved by the insurer or
provider of assistance services of the insurer, to a medical facility in the Czech Republic designated
4. If the insured is required to pay direct damages, which is an insured event,
the insured is obliged to:
in the same way insured in the Czech Republic; the insurer provides these services through the
contractual provider without direct payment to the insured provider,
a) reimburse the eligible recipient (health service provider) for reasonable and demonstrable costs,
b) take over the originals of the necessary documents and keep them securely until they are handed over
insurers,
c) after prior approval, the insurer may reimburse in justified cases
as well as the costs of another person necessary to accompany the insured,
c) hand over the necessary documents to the insurer without undue delay.
5. If the health condition of the insured allows it, undergo repatriation at the proposal of the insurer or the
insurer's assistance service provider.
d) transport of the insured's remains to his / her place of residence in the Czech Republic by a specialized
organization approved by the insurer or the insurer's assistance service provider. Upon prior
approval, the Insurer may, in justified cases, cover other related costs; the insurer provides these
services through the contractual provider without direct payment to the provider,
Art. 7
Assisting services
1. Assistance services are services provided to the insured in connection with the agreed health insurance and
are provided by the insurer's contractual organization.
e) urgent treatment of the Insured's teeth in order to eliminate sudden pain, with the exception of the
manufacture and repair of dental prostheses, fixed dental prostheses and orthodontic appliances,
Assistance services are provided 24 hours a day, 7 days a week. Contact information for the assistance
service provider is indicated on the insured's ID card.
2. Assistance services are provided to the extent of:
(f) assistance services within the scope of Article 7 of this Section; the insurer provides these services
through the contractual provider without direct payment to the insured provider.
- the recommendation of the contracted health care provider,
- recommendation of an appropriate procedure in the event of a loss event,
- monitoring the development of health during hospitalization,
providing a liquidity guarantee to a contracted health care provider
-
3. Direct reimbursement of costs for health and other services:
If the Insured or another person has made direct reimbursement for medical services pursuant to
paragraph 2 of this Article, which are an insured event, and were provided to the Insured in a medical
in the case of a claim for insurance indemnity,
facility in the Schengen area, the Insurer shall subsequently reimburse reasonable demonstrable
ensuring the repatriation of the client in case of medical justification,
expenses for these medical services.
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costs to the insured or the person who incurred these costs, after receiving at least copies of the
29. events arising during activities in places not designated for that purpose,
necessary documents.
30. events occurring in an area which the state administration body has designated as a war zone or an
4. If an insured event has occurred and the continuous hospitalization of the insured exceeds the duration of
otherwise dangerous zone for life and health or has not recommended traveling or staying in this area, if
the insurance, the insurer shall decide on further action as follows:
the trip or stay was started or the insurance contract was concluded after this announcement,
a) if the health condition of the Insured does not allow his repatriation, the Insured will be treated in a
medical facility designated by the Insurer until his health condition improves to such an extent that
31. events that occurred as a result of or in connection with:
it will be possible to carry out his repatriation,
a) the effects of released nuclear energy, chemical or biological weapons,
b) if the health condition of the Insured allows for his repatriation, with the consent of the attending
b) events of war and civil war,
physician it is possible to carry out his repatriation and, if necessary, additional treatment in a
c) acts of violence (including civil unrest and terrorist activities) in which the insured actively participated,
medical facility in the Czech Republic designated by the Insurer.
5. The upper limit of indemnity is determined by the following limits of indemnity:
a) Limit of performance for costs according to letter a) to d) paragraph 2 of this Article (Health care,
including repatriation and transportation) is stated in the insurance contract and limits the indemnity
d) handling of the insured's firearm or explosives,
32. events, incurred and health services provided on the territory of the Czech Republic,
33. events arising during the preparation and operation of extreme and uninsurable sports listed in the List of
for all insured events of the insured for the duration of the insurance.
b) A partial limit from the limit specified under letter a) of this paragraph is the limit of performance for
Activities and Sports,
34. events arising in the preparation and conduct of professional sports activities; the exclusion does not apply
costs according to letter e) paragraph 2 of this Article (Urgent treatment of teeth) is specified in the
if, at the time of the occurrence of the loss event, the "Professional Sports" type insurance for Health
insurance contract and limits the insurance indemnity for all insured events of the Insured arising in
Insurance according to Section B of these insurance conditions is effective; the agreed type of insurance
one year of the insurance period.
is specified in the insurance contract.
Art. 5
Art. 6
Obligations of the insured
Exclusions from insurance
Apart from the exclusions listed in Section A., the following are not considered to be insured:
In addition to the obligations set out in Section A., the Insured is obliged to:
1. events when medical care is provided as a result of an illness or accident or other conditions for which the
1. In the event of a loss event, always and without delay, if his health condition allows it, contact the
insured was treated before the conclusion of the insurance, or
insurer's assistance service provider and follow his instructions. This obligation may also be fulfilled
events when medical care is provided in connection with the treatment of diseases or injuries or other
by another person.
conditions, the cause or symptoms of which occurred before the conclusion of the insurance contract or
2. Provide health care providers with a valid ID card of the insured before drawing them . This obligation may
during the waiting period,
2. childbirth, including preterm and puerperium, abortion, artificial insemination, examination and treatment of
also be fulfilled by another person.
3. Undergo treatment or necessary medical examinations by a doctor appointed by the insurer
infertility or examination (including laboratory and ultrasound) to detect and monitor pregnancy,
examination in connection with contraception, including payment for contraception,
or the insurer's assistance service provider.
4. If the insured exceptionally requires direct compensation for the damage that is the insurance policy
events, the insured is obliged to:
3. cases of travel for the purpose of receiving health services,
a) reimburse the eligible recipient (health service provider) for reasonable and demonstrable costs,
4. treatment of teeth and related services, with the exception of treatment of the consequences of an injury and
the necessary simple treatment of teeth in order to eliminate sudden pain,
b) take over the originals of the necessary documents and keep them securely until they are handed over
insurers,
5. preventive examinations, vaccinations, control medical examinations,
6. treatment not related to sudden illness or injury,
c) hand over the necessary documents to the insurer without undue delay.
5. If the health condition of the insured allows it, undergo repatriation at the proposal of the insurer or the
7. rehabilitation, physical therapy, chiropractic services, training therapies, training
insurer's assistance service provider.
self-sufficiency,
Art. 7
8. organ transplantation, hemophilia treatment, interferon treatment, insulin therapy outside
first aid, chronic hemodialysis,
9. replacements for spectacles, contact lenses, hearing aids and for the manufacture and repair of orthopedic
Assisting services
1.
prostheses,
insurance and are provided by the insurer's contractual organization.
10. costs of contacting the insurer or assistance service (costs
for telephone calls, etc.),
11. examination and treatment of mental disorders not related to another sudden illness
Assistance services are provided to the insured in connection with the agreed medical expenses
Contact information for the assistance service provider is indicated on the insured's ID card.
2.
Assistance services are provided 24 hours a day, 7 days a week, in the range of:
providing a liquidity guarantee to the health service provider in the event of a claim for insurance
or injury, psychological examination and psychotherapy,
12. procedures and diagnostic methods that are not medically recognized or performed by a qualified healthcare
professional, including hospitalization provided in such facilities,
benefits,
-
13. cosmetic procedures,
14. spa and health treatment and stay, treatment in specialized medical institutions (including long-term care
hospitals, sanatoriums and hospice care) and in follow-up inpatient care facilities,
15. acupuncture and homeopathy,
16. complications that may occur in the treatment of diseases, conditions or injuries,
which are not covered by the insurance,
17. examination and treatment of sexually transmitted diseases and sexually transmitted diseases and AIDS
since diagnosis,
18. reimbursement of medicines and medical devices not prescribed by a doctor, ie. freely purchased without
a prescription or whose administration was started before the beginning of the insurance,
-
medical assistance in case of outpatient health care,
medical assistance in case of hospitalization,
ensuring the repatriation of the client in case of medical justification,
providing professional support in repatriation,
ensuring the transport of the insured's remains in the event of death,
- accompanied by a family member.
Art. 8
Duration of insurance
If during the insurance period a situation arises where the insured person cannot return to the Czech Republic
independently of his / her will before the end of the insurance period agreed in the insurance contract, the
insurance period is automatically extended without increasing the premium for the time strictly necessary until
the following reasons cease to exist, however, by a maximum of 7 days immediately following the original
insurance period. The reasons for the extension are objective facts, which may be natural elements (eg
earthquakes, volcanic eruptions, floods, storms), carrier strike, technical defect of the vehicle or terrorist acts
19. treatment of such diseases and conditions when the use of health services is appropriate, expedient and
preventing the return of the insured to the Czech Republic.
necessary, but they are delayed and can be provided only after returning to the Czech Republic,
20. events if the Insured refuses to undergo repatriation, treatment or necessary medical examinations by a
doctor appointed by the Insurer or the Insurer's assistance service provider,
21. transport, search, search and rescue operations, if at the same time there was no insured event for the
health of the insured,
22. events which the policyholder or the insured or beneficiary could have foreseen or
they were aware of them at the time of concluding the insurance contract,
23. events caused by the Insured intentionally (including suicide or attempted suicide) or caused by intentional
conduct of the Policyholder or the Beneficiary,
24. events caused to the insured by another person at the initiative of the insured, the policyholder or the
entitled person,
25. events arising in connection with a riot caused by the Insured or in connection with a criminal activity
committed by the Insured or in an attempt to do so,
26. events that occurred as a result of or in connection with the consumption or consequences of the insured's
consumption of alcohol, drugs, narcotics or other psychotropic or addictive substances,
27. events occurring during the test testing of vehicles,
28. events, occurring during the performance of stunt activities, taming of beasts,
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