Ingosstrakh contract

REGULATIONS FOR INSURANCE OF EMERGENCY
MEDICAL AND TRANSPORT
EXPENSES DURING TRIP ABOUT RUSSIA

1. GENERAL CONDITIONS

2. OBJECT OF INSURANCE

3. INSURED EVENTS

4. EXPENSES COVERED BY INSURER

5. EXPENSES NOT COVERED BY INSURER

6. SUM INSURED. INSURANCE PREMIUM

7. VALIDITY OF CONTRACT

8. CONTRACT CONCLUSION

9. CLAIM PROCEDURE

10. REFUSALS IN INSURANCE INDEMNITY

11. CONTRACT TERMINATION

12. DISPUTE RESOLUTION



1.GENERAL CONDITIONS


1.1 The present Regulations for the insurance of medical and transport
emergency expenses during a trip about Russia (hereinafter referred to as
the Regulations) are based on Legislation Acts of the Russian
Federation. The Regulations are an integral part of the Insurance
Contract (hereinafter referred to as the Contract) covering medical and
transport emergency expenses during a trip about Russia. The Contract
can also contain other terms and conditions agreed upon by the Parties
thereto.

1.2 The INGOSSTRAKH Joint Stock Insurance Company is the
Insurer and it concludes Contracts on the insurance of medical and
transport emergency expenses during a trip about Russia.

1.3 According to the Contract the Insured shall be recognized as legal
entities and capable physical persons.

1.4 The Insured is entitled to conclude Contracts in favor of the
third parties (the Insured Persons). If the Contract is concluded by
the Insured in his/her own favor he/she gets the Insured Person’s
rights and obligations. In accordance with the present Regulations the
Insured Persons can be physical persons only.



2. OBJECT OF INSURANCE


The object of insurance shall be recognized as insurance risk related to
the expenses for medical emergency help, medical transportation, transport
services including repatriation, provided the above expenses result from
the Insured Event and are incurred during the trip about Russia.



3.INSURED EVENTS


3.1 The Insured Event shall be recognized as the Insured
Person’s or his her representative’s request to the 24-hour Assistance
Center in the event of sudden illness, accident or death of the Insured
person which cause expenses for medical help, medical transportation or
other services stipulated in the present Regulations, provided the
above events happened within the Contract term during the Insured
Person’s trip about Russia. The Assistance Center under the
Regulations shall be recognized as a specialized institution indicated
in the Contract (Insurance policy), which on behalf of the Insurer
provides the Insured Person with 24-hour services envisaged by the
present Regulations.

3.2 A sudden illness shall be recognized as
unexpected disease which requires urgent medical interference.

3.3 An accident shall be recognized as sudden short-term external event
which causes injury or other health breakdown or death of the Insured
Person.

3.4 The request due to sudden illness, accident or death of the Insured
Person shall not be recognized as the Insured Event if the above result
from:

3.4.1 the Insured Person’s alcohol, drug or toxic abuse;

3.4.2 the Insured Person’s suicide or attempt to commit suicide;

3.4.3 the Insured Person’s piloting or flying by any aircraft except
for flights as a passenger in a civil aviation plane run by a
professional pilot;

3.4.4 the Insured Persons flying by any motorless aircraft, motor
gliders, superlight aircraft as well as parachuting;

3.4.5 military operations and their consequences, civil commotion,
strikes, revolts, riots, terrorist acts and their consequences;

3.4.6 nuclear explosion, radiation, radioactive contamination or other
kinds thereof;

3.4.7 the Insured Persons going in for any sports related to training
or participation in sports competitions;

3.4.8 dangerous activities of the Insured Person (professional drivers,
miners, builders, electricians, etc);

3.4.9 the Insured Persons or the concerned third parties deliberate
actions provoking the occurrence of the Insured Event;

3.4.10 law violation by the Insured Person;

3.4.11 natural calamities and their consequences.

3.5 The requests resulting from the activities stipulated in para
3.4.7 and para 3.4.8 shall be recognized as the Insured Events if
agreed upon by the Parties.



4.EXPENSES COVERED BY INSURER


4.1 In case of the Insured Event the Insurer arranges for medical
emergency assistance, medical transportation, transport services
including repatriation and covers the following expenses ensuing
thereof: A. Medical emergency expenses:

4.1.1 expenses for emergency and ambulance
services;

4.1.2 expenses for out-patient treatment including those for
the doctor’s services, diagnosis, medicines prescribed by the doctor,
dressing materials and means of fixation (plaster cast, splint).

4.1.3 expenses for hospital stay and in-patient treatment in a
standard-type ward including those for surgery and diagnosis, medicines
prescribed by the doctor, dressing materials and means of fixation
(plaster cast, splint); B. Expenses for medical transportation:

4.1.4 expenses for medical transportation by ambulance or other means
of conveyance from the place of illness (accident) to the nearest
suitable hospital or doctor and expenses for medical transfer to
another medical facility prescribed by the attending doctor and
confirmed by the Insurer or by the Assistance Centers consent;

4.1.5 expenses for urgent medical repatriation by an adequate means of
conveyance including those for the accompanying person if prescribed by
the doctor to the Insured Person’s place of permanent residence if the
medical treatment cannot be provided locally and this fact is confirmed by
the Insurer or by the Assistance Centers consent based on the appropriate
documents from the local attending doctor;

4.1.6 expenses for medical repatriation of the Insured Person to the
place of his/her permanent residence or to the hospital nearest to the
Insured Person’s place of permanent residence when the expenses for
hospital stay may exceed the liability limit stipulated in the
Contract. Medical repatriation is carried out if there are no medical
contra-indications. C. Transport expenses:

4.1.7 the Insured Persons return to his/her permanent place of
residence by economy class if the departure of the Insured Person is
not effected in time (i.e. on the date indicated in the Insured
Persons return ticket) due to the Insured Event which caused the
necessity for the Insured Person’s in-patient treatment. The Insured
Person should undertake to return the unused travel tickets and to
reimburse their cost to the Insurer. Should the Insured Person fail to
observe this condition the Insurer reserves the right to deduct the
cost of unused travel tickets from the amount to be reimbursed to the
Insured Person;

4.1.8 return of the Insured Person’s accompanying children to theirs place
of permanent residence by economy class if the children are left without
care due to the Insured Event. The necessity to accompany the children
shall be determined by the Insurer / by the Assistance Center. D.
Expenses for Repatriation of Remains:

4.1.9 repatriation of the remains authorized by the Assistance Company
to the decreased place of permanent residence if his/her death was
caused by the Insured Event. However the Insurer does not cover morgue
and funeral expenses.

4.2 Medical emergency help (para 4.1.A) is provided to the Insured Person
by the medical facility recommended by the Insurer / by the Assistance
Center. Means of transportation of the Insured Person (para 4.1.B para
4.1.C) are determined by the Insurer / by the Assistance Center in view of
medical indications. The Insurer bears no liability in case the carrier
does not observe the transportation time table.



5.EXPENSES NOT COVERED BY INSURER


5.1 The Insurer does not cover the following expenses:

5.1.1 for treatment of diseases known before the conclusion of the
Contract no matter whether the disease was treated or not, except for
the cases when medical help was provided for an acute pain or saving
the Insured Person’s life;

5.1.2 for treatment of nervous and psychic
diseases;

5.1.3 for treatment of oncology diseases;

5.1.4 for treatment of chronic diseases except the conditions which
constitute an immediate threat to the Insured Person’s life;

5.1.5 for medical services rendered to the Insured Person, which are
not connected with a sudden illness or accident, for preventive
measures and check-ups;

5.1.6 for treatment of AIDS as well as the diseases resulting
therefrom;

5.1.7 for consultations and examinations connected with pregnancy
taking its normal course, for consultations, examinations and treatment
of complications of pregnancy in spite of the period thereof, as well
as for assisting with childbirth and for the post-natal care of the
child except for the cases when medical assistance is required by vital
indications;

5.1.8 for carrying out abortions unless a pregnancy-interruption
operation is required by vital indications;

5.1.9 for treatment of diseases which are mostly sexually transmitted,
as well as diseases resulting therefrom;

5.1.10 for plastic and corrective surgery, as well as for any kind of
prostheses (including dentures and eye prostheses);

5.1.11 for dental treatment except the expenses for examination,
treatment and medicine in case of the acute inflammation of the tooth
and adjacent tissues and of tooth injuries resulting from an accident;

5.1.12 for services not required upon proven medical necessity or
connected with a treatment not prescribed by the doctor;

5.1.13 resulting from the Insured Person’s voluntary refusal to follow
the doctor’s advice given on the Insured Person’s request caused by the
Insured Event;

5.1.14 for treatment by non-traditional methods;

5.1.15 for services rendered to the Insured Person by his/her
relatives;

5.1.16 for services rendered by medical facilities having no
appropriate license or by a person having no right to practice
medicine;

5.1.17 for rehabilitation and physical therapy;

5.1.18 for stay and treatment in balneal and health resorts, sanatoria,
boarding houses, holiday centers and alike;

5.1.19 connected with the Insured Person’s trip arranged for the
purpose of getting treatment;

5.1.20 for disinfecting, vaccination, injections, medical expertise and
laboratory examinations not connected with an accident or sudden
illness;

5.1.21 for extra conveniences such as a luxurious single ward, a
TV-set, a telephone, an air-conditioner, an air-moistener, a hair
dresser’s, a masseur’s or beauty parlous services, an interpreter and
etc.;

5.1.22 occurring after the Insured Person’s
return to the place of his/her permanent residence;

5.1.23 exceeding
the Sums Insured specified in the Contract;



6. SUM INSURED. INSURANCE PREMIUM


6.1 The Sum Insured agreed upon by the Parties separately for each type
of expenses (medical, medical transportation, transport, repatriation
of the remains) is an amount of money within the limits of which the
Insurer pays or reimburses a particular type of expenses.

6.2 The Insurance Premium is the amount of money the Insured should pay
to the Insurer (to the latter’s broker or agent) for the insurance in
accordance with the Contract.

6.3 The amount of the Insurance Premium is determined by the Insurer in
accordance with the latter’s tariffs. The amount of the Insurance
Premium is specified in the Contract. If the Insurer decides to insure
individuals practicing the activities specified in Paras 3.4.7 and
3.4.8 of the Regulations or the persons over the age of 70, the
Insurance Premium to be paid by them is determined in accordance with
the Insurer’s increasing ratio.

6.4 The
Insurance Premium is paid by the Insured lump sum for the entire period
of insurance. The Insurance Premium payment is effected in cash or by
non-cash transaction.



7. VALIDITY OF CONTRACT


7.1 The Contract is concluded for a period of up to one year, if not
otherwise specified in the Contract.

7.1.1 The insurance comes in force at the commencement of the trip but
not earlier than 0.00 o’clock of the insurance starting date specified
in the insurance policy (and in the identity card) provided the
Insurance Premium has been paid.
The commencement of the trip shall be recognized as the
following: for non-residents of Russia- the arrival at the territory
of the Russian Federation (with the frontier crossing confirmed by an
appropriate stamp in the passport); for Russian residents – the
Insured Person’s going over 100 km off the administrative borders of
his/her permanent place of residence. The permanent place of residence
shall be recognized as the place where the Insured Person permanently
or mainly resides.

7.1.2 If the annual Contract provides for multiple trips of the Insured
Person, the insurance shall cover the first 90 days of each trip.

7.1.3 If the Insured Person’s return from a trip is impossible by the
expiry date of the Contract due to the Insured Event supported by an
appropriate medical report, the Insurer bears responsibilities
specified in Para. 4 of the present Regulations and related to this
Insured Event within the period of 4 (four) weeks from the expiry date
specified in the Insurance Policy.

7.2 The Contract is not valid off
the borders of the Russian Federation.



8. CONTRACT CONCLUSION


8.1 To conclude the Contract, the Insured should submit to the Insurer
(the latter’s agent or broker) a written application form confirming
the intention to conclude the Contract or should inform the Insurer by
letter, telefax or telex providing the Insurer with the following
information:

8.1.1 the Insured Person’s family name, first name, patronymic, sex,
birth date, address and telephone number;

8.1.2 the Insured name, legal address, telephone number and banking
details if the Insured is a legal entity; in this case a list of
persons to be insured shall be attached to the application form;

8.1.3 anticipated date of commencement and expiry;

8.1.4 purpose of the trip;

8.1.5 profession and occupation if the Insured Person is going to work;

8.1.6 type of sport or sports competitions in which the Insured Person
is going to participate;

8.1.7 the Sum Insured.

8.2 When concluding the Contract, the Insured should inform the Insurer
about all the circumstances in his knowledge relevant to the estimation
of the insurance risk.

8.3 The Insured should inform the Insurer about all in his knowledge
insurance risk alterations happening within the effective period of the
Contract.

8.4 The Contract is concluded without medical examination of the
Insured Person. At the Insurer’s request the Insured Person should fill
in the questionnaire.

8.5 Conclusion of the Contract is confirmed by the Insurance Policy
issued by the Insurer and given to the Insured together with the
present Regulations. An identity card is also issued, if necessary.

8.6 When concluding the Contract
the Insured Person releases the doctors from confidentiality as regards
the Insurer as far as the Insured Event is concerned.



9. CLAIM PROCEDURE


9.1 When the Insured Event occurs the Insured Person should immediately
contact the Insurer’s Assistance Center by telephone number given in the
Insurance Policy or in the identity card (if the latter was issued),
inform the medical coordinator about the fact of the Insured Event and
the Insurance Policy details. Expenses for telephone calls to the
Assistance Company are reimbursed by the Insurer if confirming documents
are presented.

9.2 Upon receiving the information the Assistance Center provides the
Insured Person with the services stipulated in the Contract.

9.3 In case of inability to call the Assistance Center prior to any
consultations with the doctor or transfer to the hospital, the Insured
Person should contact the Assistance Center afterwards as soon as
possible. In case of any request to the doctor or for hospitalization,
the Insured Person should submit the Insurance Policy or the identity
card (if the latter was issued) to the medical staff.

9.4 If the Insured Person incurred the expenses related to the Insured
Event, on return he/she should inform the Insurer in writing about what
happened for the Insurer to recognize the occurrence as the Insured
Event; the Insured Person should also present the following
documents:

9.4.1 claim form for the reimbursement of expenses related to the
Insured Event and explanation of his/her failure to contact the
Assistance Center for the arrangement of the required medical help;

9.4.2 the Insurance Policy or its copy;

9.4.3 original invoice of the medical facility (on its standard form or
bearing an appropriate stamp) with the patient’s name, diagnosis, date
of the patient’s request for medical help, duration of the treatment,
detailed list of services with dates and costs and the total amount to
be paid;

9.4.4 original prescriptions issued by the doctor for the illness;

9.4.5 original invoices for laboratory tests with dates, names and
costs of the rendered services;

9.4.6 original checks printed by cash register
confirming payment for the treatment, medicines and other services (in
case of the absence of checks – other documents confirming payment of
the invoices which are submitted for reimbursement).

9.5 To reimburse the out-patient expenses the Insurer accepts the invoices
only together with the documents confirming payment for the medical
services. Provided the Insured Person submits unpaid invoices, he she
should provide written explanations.

9.6 The claim form and documents specified in Para. 9.4 shall be submitted
to the Insurer within 30 (thirty) calendar days after the Insured Person’s
return from the trip during which the Insured Event happened.

9.7 Insurance indemnity by
means of reimbursing the expenses which the Insured Person incurred is
effected by the Insurer within 15 (fifteen) working days after all the
documents specified in Para.9.4 have been received. The Insurer
reserves the right to check all the submitted documents, to make
inquiries at the institutions bearing the information about the
circumstances of the Insured Event, as well as to have the Insured
person examined by the Insurer’s doctor. If any additional information
on the Insured Event is necessary the indemnity shall be paid within 15
days after all the requested documents have been received by the
Insurer.



10. REFUSALS IN INSURANCE INDEMNITY


10.1 The Insurer has the right to turn down, entirely or partially, the
indemnity under the Contract if the following events happened during the
effective period of insurance:

10.1.1 breaking the Para. 8.2, 8.3, 9.1, 9.3, 9.6 of the present
Regulations;

10.1.2 submitting to the Insurer the documents with deliberately false
information on the health condition of the Insured Person or about the
medical and other services rendered to the latter;

10.1.3 deliberate or careless augmentation of losses or failure to
undertake reasonable measures to reduce them.

10.2 The reasons for turning down the indemnity or reimbursement shall be
submitted to the Insured or Insured Person in writing.



11. CONTRACT TERMINATION


11.1 The Contract is terminated in the following cases:

11.1.1 Contract expiry (at 24.00 o’clock of the insurance expiry date
indicated in the Insurance Policy (and in the identity card);

11.1.2 departure from the territory of the Russian Federation;

11.1.3 after the Insured Person’s return from the trip but not later than
24.00 o’clock of the insurance expiry date indicated in the Insurance
Policy (and in the identity card);

11.1.4 complete fulfillment of the Insurer’s contractual obligations;

11.1.5 in other cases envisaged by the legislation of the Russian
Federation.

11.2 The Contract can be canceled by either of the parties at any time by
a written notice (for reasons of violating the contractual obligations by
the other party inclusive) in conformity with the in-force legislation of
the Russian Federation. In this case the Insurance Premium refund is
effected as the following:

11.2.1 If the Contract is canceled before the expiry date by the
Insurer’s request the latter refunds the Insured the paid insurance
premium for the non-expired period of the Contract less the Insurer’s
expenses. If the Insurer’s request is caused by the fact of the Insured
the Insurance Premium refund shall not be effected.

11.2.2 If the Contract is canceled before the expiry date by the
Insured’s request the Insurer refunds the paid insurance premium for the
non-expired period of the Contract less the Insurer’s expenses. If the
Insured’s request is caused by the fact of the Insurer violating the
Contract the latter refunds the Insurance Premium to the Insured in full
amount.

11.3 No refund of the insurance premium shall be effected if the Insured
Person informs the Insurer about the trip cancellation after the expiry
date of the insurance specified in the insurance Contract.

11.4 If the Contract is canceled before the expiry date the Insurance
Premium refund is effected within 5 (five) banking days after the written
notice of termination is received by the Insurer.



12. DISPUTE RESOLUTION


Any dispute arising under the Contract shall be settled by
negotiations.
Should the negotiations fail the dispute shall be submitted to the court
in conformity with the active Law of the Russian Federation.