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.