Terms & Conditions
Here are the full terms and conditions of the International Medical Insurance policies provided by MedicalForNomads.com. Please read through it in full so you know everything that the policies cover, and if you have any questions or need anything explained, just contact us through this website!Global ReachThe medical insurance cover provided via MedicalForNomads.com is fully global and totally portable, everywhere in the world EXCEPT the USA. This means that this insurance cover is not suitable for anyone living in the USA, and anyone who travels to the USA for a short period of time should get specific travel insurance to cover them whilst in the USA. If something happens to you whilst you are in the USA, you will still be covered by your policy, but will not be able to claim at any USA-based hospital and will not be able to use the Global Evacuation and Repatriation benefit to take you back out of the USA.
For claims, there are a number of dedicated claims lines based in various countries around the world, so wherever you are, whatever time zone you’re on, there are people waiting for your call at any moment in time, speaking a variety of languages.
The insurance cover provided via MedicalForNomads.com is relied on by hundreds of thousands of global nomads and expatriates, consistently has a customer satisfaction rating of over 98%, and more than 99% of claims are paid in full.
Inpatient Benefits
Being admitted into hospital for treatment of an injury or an illness can be a daunting time, not only for the patient but for their friends and family too – even if it’s in your hometown. Add in the complexities of doing this in a foreign country, far from home, where you might not speak the local language, and it can be even more daunting.
The range of cover levels available via MedicalForNomads.com all include inpatient benefits, to ensure that this unique environment is experienced with the full backing and support of one of the world’s premier insurance companies.
With a team of qualified and experienced professionals behind the scenes, you can be sure that if you or your family need to be admitted to hospital, the 24/7 assistance service will be on hand to help you, nomad-er where you are in the world, to help you through this daunting time.
Having medically trained staff on hand to help you over the phone is a huge (and often underrated) benefit, ready and able to help you through the full process of hospital treatment, including helping you select the most appropriate hospital for your needs, pre-authorising and directly paying hospital bills, and being on-hand to talk to hospital staff if needed – including acting as your translator if needed – all the way through treatment up until the point you are discharged and fully recovered.
Outpatient Benefits
From an everyday cold to cuts and bruises, visiting an outpatient clinic or general practitioner for treatment and medication is common for those within the international, globally mobile community.
Receiving this treatment quickly is essential, and the outpatient benefits included with your policy ensure that the cost of this does not become an additional burden for you.
In addition to this, the claims reimbursement process, for any treatment which required immediate attention and therefore was not able to be pre-authorised, has been simplified to allow you to receive a speedy payment for your covered expenses, and has been streamlined to fit in with your nomadic lifestyle – no more paper forms or original receipts to post to the other side of the world! Everything can be done by emails and photos from your phone, and therefore everything is quick and easy.
Wellbeing Benefits
The suite of wellbeing benefits available help you to stay healthy longer and maximise your quality of live by giving you access to a number of preventative healthcare measures that can identify health issues early.
By detecting problems prior to feeling the effects of their symptoms, you can receive appropriate treatment before illnesses worsen, and by picking up the early signs of any sickness, you and your doctors are given more time to plan the ideal course for overcoming illnesses.
From annual medical health check-ups and eye tests, to coverage for vaccinations, the wellbeing benefits available via MedicalForNomads.com are an essential element of a comprehensive health insurance plan and allows you to be confident that your overall health is being guarded. Don’t forget to use them!!
Dental Benefits
Good dental health not only protects the integrity of teeth, but also ensures your smile remains bright or years to come!
The range of dental benefits available have been designed to comprehensively cover a multitude of dental needs, so you can be secure in the knowledge that your teeth will get the right attention along with your overall healthcare needs.
Whilst many dental plans are limited in the scope of their benefits, the coverage provided via MedicalForNomads.com extends across a wide range of situations including coverage following accidents with Emergency Dental treatment to more complex work included with Major Dental treatment down to the more lifestyle-orientated requirements contained within Routine Dental.
Overall, the higher-level medical insurance plans available via MedicalForNomads.com are ideal for anyone who wants to apply the additional coverage of dental benefits without the need to purchase separate standalone dental insurance.
Global Security Benefits
In an ever-turbulent global security environment, the unique approach of our insurer allows us nomads to trust that whilst we travel and reside around the world, our international health and medical insurance coverage caters for many of the potential dangers which we face.
Whilst many medical – and travel – insurance plans specifically exclude claims relating to terrorism and security-based events, the insurance policies available via MedicalForNomads.com have been specifically developed with generous benefits that mean these concerns can be addressed.
Through a team of dedicated security and risk management personnel, these policies deliver benefits tailored for terrorism, hostage negotiation, hijacking and mugging, and the service delivery of these means that nomads insured via MedicalForNomads.com can live, work, and travel globally with the peace of mind that we will be both covered and supported in any terrorism-related incident.
Psychology Benefits
Living and travelling overseas gives us nomads the opportunity to enjoy new and exciting experiences, however, with these unfamiliar environments can come added stress and the need for additional healthcare support.
As part of an overall, comprehensive and holistic approach to supporting the entirety of the medical needs of global nomads, all policy levels include services under Psychology Benefits.
With global access to teams of highly trained psychology specialists, you can be just a phone call away from vital counselling and coaching that can strengthen your overall wellbeing and confidence as you make your way around the world and through life.
International Assistance Benefits
As one of the premier concierge-level international medical insurance providers, our insurers’ comprehensive balance of services ensure total support for you, nomad-er where you are in the world, and nomad-er what your individual personal circumstances are.
Having access to local knowledge and experience from a global health provider can prove vital in the event of an injury or illness, and through the International Assistance Benefits attached to policies from MedicalForNomads.com, you can be sure that you’re getting the right treatment, in the right place, at the right time, with full support every step of the way.
From general information and advice, to the placement of “Guarantee of Payment” to medical facilities, and arrangement of further treatment, the 24/7 global assistance benefits are the ultimate in customer care.
Evacuation & Repatriation Benefits
Recognising that not all medical facilities in all global locations meet the highest levels of medical care, and/or have the ability to cope with the more complex treatment needs, the Evacuation & Repatriation Benefits are an important element when deciding on the right, tailored healthcare plan.
In the event that emergency treatment is not readily available near the place of injury or illness, you will be transported to the nearest appropriate medical facility by local ambulance as standard, whichever policy level you choose.
You also have the highly-recommended option of purchasing full global evacuation and repatriation cover for a small additional fee which provides full international medical transportation to a medical facility which DOES provide the highest level of medical care – this is an extremely important add-on for nomads living in, or travelling to, some of the more exotic parts of the world which may not have the best medical facilities.
Policy Wording
Okay, so these “Policy Wording” sections are not the most exciting thing you’ll ever read. However, they are worth reading for three very good reasons:
1. This is all about your medical insurance coverage, and therefore very important
2. It counts as general education, which is always a good thing
3. Reading this will help you compare the cover available from different insurance providers, and therefore help you to make a better purchase decision
Ready? Here we go.
Policy Wording – Definitions
The following words and phrases have specific meanings, and are defined as follows:
Accident: An unexpected, unforeseen and involuntary external event resulting in injury to an insured person and occurring whilst this policy is in force.
Act of Terrorism: An act, including, but not limited to, the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone, on behalf of, or in conjunction with any organisation(s) or government(s), committed for political, religious, ideological or ethnic purposes or reasons, including the intention to influence any government and/or to put the public or any section of the public in fear.
Acute: A medical condition which is brief, has a definite end point, and which the insurance company, on advice or general advice, determine can be cured by treatment.
Advice: Any consultation from a medical practitioner or specialist, including the issue of any prescriptions or repeat prescriptions.
Alternative Therapies Treatment: Treatment of a medical condition by homeopathy, naturopathy, osteopathy, acupuncture and traditional Chinese medicine only.
Annual Medical Check-ups: Medical tests/screenings that are conducted by a medical practitioner without any clinical symptoms being present.
Appliances: Devices, implants and equipment when used as an integral part of a surgical procedure adminis¬tered by a medical practitioner or spe¬cialist.
Benefits: The insurance cover provided by this policy and any applicable endorsements shown in an insured person’s certificate of insurance.
Bodily Injury: An injury that is caused solely by an accident and results in the insured person’s dismemberment, disablement or other physical injury.
Certificate of Insurance: A schedule that provides insured persons with information regarding the plan and benefit options elected by the policyholder, and lists those members, including any dependants, covered by the plan.
Chronic: A disease, illness or injury that has at least one of the following characteristics:
It continues indefinitely and has no known cure
It comes back or is likely to come back
It is permanent
Insured persons need to be rehabilitated or specially trained to cope with it
It needs long-term monitoring, consultations, check-ups, examinations or tests.
Chronic Conditions Benefit: Routine drugs and dressings for the treatment of a chronic medical condition.
Coinsurance: The percentage of the total value of incurred expenses for which the insured person is responsible.
Commencement Date: The date shown on the certificate of insurance on which the policy came into effect.
Conflict/Civil Unrest: Any war, invasion, acts of foreign enemy hostilities (whether or not war is declared), civil war, rebellion, revolution, insurrection or military or usurped power, mutiny, riot, strike, martial law or state of siege or attempted overthrow of government or any act of terrorism.
Congenital Anomaly: Any genetic, physical or (bio)chemical defect, disease or malformation which existed at or before birth, and which may or may not be obvious at birth.
Country (or countries) of Nationality: The country (or countries) for which insured persons hold a valid passport(s).
Country of Residence: The country in which the insured person(s) habitually reside at the time this policy is first taken out or at each subsequent renewal date.
Cover: Benefits provided to the insured person’s policy as listed in the certificate of insurance.
Date of Entry: The date on which an insured person was included under this policy without any break in cover.
Day Patient: An insured person who is admitted to a hospital bed but does not stay overnight.
Death Benefit: Life Insurance payment to the next of kin or estate following the death of the insured person.
Deductible: An amount that may be deducted from the reimbursement to you when making a claim for treatment received outside the direct settlement network, and which is equivalent to any coinsurance that would normally be the responsibility of the insured person.
Dental Practitioner: A person who is licensed by the relevant licensing authority to practice dentistry in the country where dental treatment is given.
Dependants: One spouse or adult partner and/or unmarried children who are not more than 18 years old and residing with the Policyholder, or 26 years old if in full-time education, at the date of entry or any subsequent renewal date. The term partner shall mean husband, wife or the person permanently living with the Policyholder in a similar relationship. All dependants must be named in the certificate of insurance.
Direct Family Member: Spouse, child, parent or sibling.
Direct Settlement: When your bill is settled directly by the insurance company either because the provider is contracted to the direct settlement network or because the insurance company has received and agreed to make a onetime direct settlement. Please note that where insured persons receive treatment for a medical condition that is not covered within the terms of the policy, the insured person remains liable for the costs of such treatment, which must be settled in full upon request. Failure to act accordingly will result in the suspension or cancellation of your cover, without refund of premium.
Drugs and Dressings: Essential drugs, dressings and medicines prescribed by a medical practitioner or specialist and which are not available without prescription.
Elective: Planned treatment that is medically necessary, but which is not required in an emergency.
Emergency: A sudden, serious and unforeseen acute medical condition or injury requiring immediate medical care.
Emergency Assistance: Access to tele¬phone assistance provided by the insurance company for the administration of covered benefits in the event of an emergency.
Emergency Dental: Treatment on natural sound teeth following an accident and received in an emergency room for the immediate relief of pain only.
Emergency Room Treatment: Treatment received in an emergency room of a hospital immediately following a medical emergency.
Evacuation: Where treatment is not available at the place of the incident, the costs incurred in moving an insured person from the place of incident to the nearest country with appropriate medical facilities, as determined by the attending medical practitioner or specialist in conjunction with the insurance company’s medical advisors. All airline tickets are limited to economy class.
Excess: The amount payable by an insured person in respect of expenses incurred before any benefits are paid under the policy, as specified in their certificate of insurance.
Expatriate: Any persons living or working outside their country of citizenship, for a period exceeding six months per period of cover.
Eye Test: Examination of eyes to test visual acuity, pupil function and extra ocular muscle motility by an optometrist.
General Advice: Advice from the relevant professional body to establish medical practice and/or established medical opinion in relation to any medical condition or treatment.
General Nursing Care: Care given by the nursing staff of a hospital not including a private nurse.
GP Consultation Fees: General Practitioner Consultation and examination fees.
Hereditary: A disease or disorder that is inherited genetically.
Hijacking: Detainment on a means of public transport due to it being hijacked by persons using violence or threat of violence.
Hospice: A facility that provides palliative treatment and does not provide a cure.
Hospital: An establishment that is legally licensed as a medical or surgical hospital under the laws of the country in which it is situated.
Hospital Cash Benefit: Where treatment is received in a state or charitable hospital and no claim is submitted under this policy for re-imbursement providing that the medical condition is eligible under the policy.
Hostage Negotiations: Professional negoti¬ations with kidnappers in the event of an insured person being taken hostage but not including the payment of any ransoms or provision of any items or undertakings connected with the negotiations or outcome or potential outcome of the negotiations.
Imaging and lab tests: Diagnostic procedures performed by a medical practitioner to determine the cause of medical symptoms.
Inpatient: An insured person who stays in a hospital bed and is admitted for one or more nights solely to receive treatment.
Inpatient Cover: Treatment received by an insured person when admitted to a hospital bed for an overnight stay of one or more nights.
Insured Person / Member / You / Your: The policyholder and/or the dependants named on the policy schedule or certificate of insurance.
Intensive Care: Standard accommodation and food provided in an intensive care unit of a hospital including general nursing care.
Local National: Any persons living or working in their country of citizenship, for a period exceeding six months per period of cover.
Local Ambulance to hospital: Road vehicle used for transportation to hospital in the event of a medical emergency.
Major Dental: Treatment of teeth including fillings and extractions only.
Medical Condition: Any injury, illness or disease, including psychiatric illness.
Medical Practitioner: A person who has attained primary degrees in medicine or surgery by attending a medical school recognised by the World Health Organisation and who is licensed by the relevant authority to practice medicine in the country where the treatment is given.
Medically Necessary: A medical service or treatment, which in the opinion of a qualified medical practitioner is appropriate and consistent with the diagnosis and which in accordance with generally accepted medical standards could not have been omitted without adversely affecting the insured persons condition or the quality of medical care rendered.
Mugging: Where treatment is received in a hospital as a result of an act of attacking and robbing a member in a public place.
New Born: A baby who is within the first 16 weeks of its life following delivery.
Nomad: Any persons living or working outside their country of citizenship, for a period exceeding six months per period of cover.
Oncology Cover: Oncologist fees, radio-therapy and chemotherapy for the treatment of cancer including diagnosis.
Organ Transplant Cover: The replacement of vital organs (including bone marrow) as a consequence of an underlying medical condition.
Outpatient: An insured person who receives treatment at a recognised medical facility, but is not admitted to a hospital bed as an inpatient or day patient.
Outpatient Cover: Treatment received without admission to a hospital bed.
Outpatient Surgical: Minor surgical procedures carried out by a medical practitioner.
Overall Plan Limit per year: The most the insurance company will pay for each insured person in any period of cover.
Palliative Treatment: Any treatment given, on advice or general advice, for the purpose of offering temporary relief of symptoms. Palliative treatment is not given to treat the underlying medical condition causing the symptoms. For the purposes of this policy, palliative treatment will include renal dialysis.
Parental Accommodation: One added bed in the hospital room for a parent to stay with their child whilst admitted into hospital for an injury or an illness covered by this policy.
Period of Cover: The period of cover set out in the certificate of insurance. This will be a 12-month period starting from the date of entry or any subsequent renewal date, as applicable.
Personal Coaching: Telephone access to personal coaches provided by the insurance company.
Physiotherapy: Treatment received within 6 months of an injury or illness by a physiotherapist upon referral by a medical practitioner.
Plan Limit: The maximum amount payable for each insured person in any period of cover.
Policy: The medical insurance policy, the contract of insurance between the policyholder and the insurance company providing cover as detailed in the policy documentation.
Policy Documentation: The set of policy documents that form a contractual agreement between the insurance company and the policyholder. These documents include any application forms, the certificate of insurance, table of benefits and policy wording terms, conditions and exclusions, and any other supporting documentation.
Policyholder: The person named as policyholder in the policy schedule or certificate of insurance.
Post-hospitalisation: Treatment received within 6 months of an injury or illness that required admission into hospital as an inpatient.
Pre-hospitalisation: Treatment and diagnosis received within 6 months of an injury or illness that required admission into hospital as an inpatient.
Prescribed Medication: Drugs and medicines prescribed by a medical practitioner.
Private Room: Single occupancy accommodation in a hospital but not including VIP suites.
Provider: A provider who is legally licensed to supply treatment in the country in which it is provided.
Provider Network: A supplier of treatment participating in the direct settlement network.
Psychology Counselling: Telephone access to qualified psychologists provided by the insurance company.
Qualified Nurse: A qualified nurse whose name is currently on any register or roll of nurses, maintained by any Statutory Nursing Registration Body within the country in which he/she is resident.
Reasonable and Customary Charges: The average amount charged in respect of valid services or treatment costs, as determined by the insurance company’s experience in any particular country, area or region and substantiated by an independent third party, being a practicing surgeon/physician/specialist or government health department.
Rehabilitation Cover: Assisting an insured person who, following a medical condition, requiring physical therapy and assistance in independent living to restore them, as much as medically necessary or practically able, to the position in which they were in prior to such medical condition occurring.
Related Condition: Any injuries, illnesses or diseases are related conditions if the insurance company, on general advice, determines that one is a result of the other or if each is a result of the same injury, illness or disease.
Renewal Date: The anniversary of the commencement date of the policy.
Room and Board: Hospital accommodation and food provided by a hospital as standard.
Routine Dental: Routine examinations of teeth including check-ups, x-rays, cleaning and polishing.
Semi-Private Room: Dual occupancy ac¬commodation in a private hospital.
Sound Natural Teeth: Teeth that were stable, functional, free from decay and advanced periodontal disease, and in good repair at the time of the accident.
Specialist: A registered medical practitioner who currently holds a substantive consultant appointment in that specialty, which is recognised as such by the statutory bodies of the relevant country.
Specialist Consultation Fees: Consultation with a specialist upon referral by a medical practitioner.
Table of Benefits: The schedule of benefits included within each level of cover and corresponding with the cover level as stated on the certificate of insurance.
Terrorism: Treatment received for physical injury as a result of violence and intimidation in the pursuit of political aims.
Treatment: Surgical, medical or other procedures, the sole purpose of which is the cure or relief of a medical condition.
Underwriters: The carrier of risk and payer of benefits as indicated in the policy documentation and certificate of insurance.
Vaccinations: Vaccinations and immunisations that are directly related to overseas travel requirements.
Waiting Period: A period of time from the commencement date where coverage will not apply.
Policy Wording – Conditions
Finished with the definitions? Great! Here are the policy conditions, which use those words above. This is also very important, for the same reasons as listed in the last section, so please make sure to read them carefully. This section, along with the table of benefits and the “Exclusions” section below, is what you can use to compare different insurances to see which one is best.
The following conditions apply to all sections of this insurance:
Policy: This insurance contract consists of the application form and the policy documentation, including the certificate of insurance, table of benefits and policy wording. The rights of the policyholder; or any beneficiary will not be affected by any provision other than the one described above.
Language: This policy is written in English. This policy may only be completed and interpreted in English and all other information and communications relating to this policy will also be in English.
Tax: The insurance company reserves the right to reflect any changes in insurance premium tax or other government levies as may be imposed upon them.
Eligibility for Cover: New applicants will be eligible for cover up until the age of 70.
Termination of Cover: Cover may end if the policyholder exhausts the maximum annual aggregate benefit under the plan, or if the policyholder fails to reimburse the insurance company within 14 days of receipt of notice that the insurance company has made a payment for treatment of a medical condition not covered within the terms and conditions of the policy.
Cover: The insurance company will pay the insurance benefits (specific benefits will not exceed the corresponding payment limit and the total amount of benefits will not exceed the mutually agreed maximum insured amount of the policy) as follows: *All costs incurred must be medically necessary and subject to reasonable and customary charges*. The insurance contract will provide cover for treatment given during the current period of cover.
Period of Cover: Your plan is in force for the period of cover noted in your certificate of insurance.
Certificate of Insurance: The insurance company will provide a certificate of insurance for each insured person and any eligible dependants benefitting from cover under this policy.
Contribution: If you or any dependant named on your policy, are entitled to claim from any other insurance policy for any of the costs, charges or fees for which you are insured under this contract, you must disclose the same to the insurance company providing cover under this policy and they shall not be liable to pay or contribute more than their rateable proportion.
Change of Risk: The policyholder or insured person must inform the insurance company as soon as reasonably possible of any material changes that affects information given in connection with the application for cover under this policy. The insurance company reserves the right to alter the policy terms or cancel cover for an insured person following a change of risk.
Declaration of Material Facts: All material facts (e.g., a pre-existing health condition or involvement in a hazardous activity) that may affect the insurance company’s assessment and consideration of an application should be declared. Failure to do so may invalidate your cover. If you are in doubt whether a fact is material, then it should be disclosed.
Break in Cover: Where there is a break in cover, for whatever reason, the insurance company reserves the right to reapply the relevant exclusion clause in respect of pre-existing medical conditions.
Claim Adjudication: All claims must be notified as soon as is reasonably practical after the event which causes the claim. Failure to do so may result in rejection of the claim if it is made so long after the event that the insurance company is unable to investigate it fully, or may result in you not receiving the full amount claimed for if the amount claimed is increased as a result of any delay. If the insurance company thinks that the evidence of the claim submission and the information provided is incomplete, then you will be informed promptly of the required supplementary information. The insurance company will not pay any interest on any amount payable under this policy. If any claim is in any respect fraudulent or unfounded, all benefits paid and/or payable in relation to that claim shall be forfeited and (if appropriate) recoverable. In addition, all cover in respect of the insured persons shall be cancelled void from the date of entry.
Applicable Law: The law applicable to this policy shall be construed according to the laws of Nevis.
Subrogation: The policy shall be subrogated to all rights of recovery that insured persons have against any other party with respect to any payment made by that party to insured persons due to any injury, illness or medical condition insured persons sustain to the full extent of the benefits provided or to be provided by the policy. If insured persons receive any payment from any other party or from any other insurance cover as a result of an injury, illness or medical condition, the insurance company has the right to recover from, and be reimbursed by them, for all amounts the insurance company have paid and will pay as a result of that injury, illness or medical condition, from such payment, up to and including the full amount received. The insurance company shall be entitled to full reimbursement from any other party’s payments, even if such payment will result in a recovery that is insufficient to fully compensate the insured person in part or in whole for the damages sustained. Insured persons are required to fully cooperate with the insurance company in their efforts to recover any payments made including any legal proceedings that they may conduct and proceed with on your behalf at their sole discretion. Insured persons are required to notify the insurance company within 30 days of the date when any notice is given to any party, including another insurance company or lawyer, of the insured person’s intention to pursue or investigate a claim to recover damages or obtain compensation due to injury, illness or medical condition sustained by the insured person. Other than with the insurance company’s written consent, insured persons have no entitlement to admit liability for any eventuality or give promise of any undertaking that is binding upon them. In the event that any claim or dispute is made in respect of this subrogation or any part thereof, including, but not limited to, any right of recovery provision which is ambiguous or questions arise concerning the meaning or intent of any of its terms, the insurance company shall for the avoidance of doubt have the sole authority and discretion to resolve all disputes regarding the interpretation of this provision.
Membership Applications: The insurance company maintains the right to ask you to provide proof of age and/or a declaration of health of any person included in his/her application. The insurance company reserves the right to apply additional options, exclusions or premium increases to reflect any circumstances the insured person advises in their application form or declares to us as a material fact. You must tell the insurance company if you know about anything which may affect their decision to accept your insurance.
Medical Evaluation: The insurance company reserves the right to request further tests and/or evaluation where they have decided that a condition being claimed for may be directly or indirectly related to an excluded condition. You must give the insurance company all the documents needed to deal with any claim as determined by the insurance company and you will be responsible for the costs involved in doing so. All required documents, including, but not limited to medical reports, claim submissions, receipts and any other documents needed to deal with any claim must be written in English. You will be responsible for any costs involved in translating any documents. You must give the insurance company permission to obtain any medical reports or records needed from any medical practitioner who has treated any insured person. The insurance company may ask you to attend one or more medical examinations. If they do, they will pay the cost of the examination(s) and for any medical reports and records. If an insured person dies, the insurance company has the right to ask for a post-mortem examination.
Waiver: Any deviation from specific terms of the policy documentation hereunder at any time shall not constitute a waiver of the insurance company’s right to implement or insist upon compliance with that provision at any other time or times. This includes, but is not limited to, the payment of premiums or benefits. This applies whether or not the circumstances are the same.
Right of Cancellation: In the event of any non-payment of premium by the policyholder, the insurance company shall be entitled to cancel the policy and any related cover/plan. They may, at their discretion, reinstate cover if the full premium is subsequently paid, though terms of cover may be subject to variation. The insurance company may at any time terminate the cover of an insured persons if he/she or the policyholder has at any time:
a) Misled the insurance company by misstatement
b) Knowingly claimed benefits for any purpose other than as are provided for under this policy
c) Agreed to any attempt by a third party to obtain an unreasonable pecuniary advantage to the detriment of the insurance company
d) Otherwise failed to observe the terms and conditions of this policy or failed to act with good faith
Liability: The liability of the insurance company shall cease immediately upon termination of the policy for whatever reason, including without limitation non-renewal and non-payment of premium.
Minimising Loss: You must take all reasonable steps to avoid or reduce any loss which may mean you have to make a claim under this insurance.
Alterations or Adjustments: The insurance company reserves the right to alter or discontinue the benefits, terms, conditions or premiums of this policy at each renewal date. They shall notify you of such changes at least 15 days prior to the renewal date. If you fail to receive such notice for whatever reason this shall not invalidate the change.
Parties to the Contract: The only parties to the contract of insurance are the policyholder and the insurance company.
Policy Wording – Exclusions
Finished with the conditions? Great! Here are the policy exclusions, which clearly identify what isn’t covered. This is also very important, for the same reasons as listed in the other two “Policy Wording” sections, so please make sure to read them carefully. This section, along with the table of benefits and the “Conditions” section above, is what you can use to compare different insurances to see which one is best.
General exclusions apply to all sections of this insurance. The insurance company will not cover the following:
1. Any claim relating directly or indirectly to any medical condition or related condition for which you have received treatment, had symptoms of, had knowledge existed or should have known existed, or you sought advice for prior to your date of entry (pre-existing medical condition).
2. Any claim relating directly or indirectly to an incident, injury or illness which you were aware of at the time you purchased this insurance and which could reasonably be expected to lead to a claim.
3. Chronic supportive treatment of renal failure, including dialysis unless the Chronic Conditions benefit is part of your plan.
4. Any costs relating to a chronic medical condition unless the Chronic Conditions benefit is part of your plan.
5. Treatment, which the insurance company determines on general advice, is either experimental, unproven, unlicensed or not medically necessary.
6. Treatment received on an inpatient basis where it is available on an outpatient basis or customary to be received as an outpatient.
7. Treatment for a terminal illness or any costs incurred from a hospice.
8. Costs incurred or treatment received at an institution such as a convalescent or nursing home.
9. Any claim relating directly or indirectly to a congenital anomaly or conditions, birth injuries, birth defects or any hereditary medical conditions of any kind.
10. Preventive medicines, and routine tests and physical examinations by a medical practitioner, including gynaecological investigations unless they appear on your benefits schedule. Normal hearing tests are excluded.
11. Non-medical / natural degenerative eye defects, including, but not limited to, myopia, presbyopia and astigmatism and any corrective surgery for non-medical/natural degenerative sight defects. Normal eye tests are excluded unless they appear on your benefits schedule.
12. Costs of spectacles, lenses, contact lenses or any corrective eye devices.
13. Rehabilitation unless they appear on your benefits schedule.
14. Treatment received in health hydros, nature cure clinics, spas, or similar establishments. Services such as massages, hydrotherapy, Reiki, or other non-medical treatments.
15. Cost incurred while in or relating to a private room of a medical facility unless they appear on your benefits schedule.
16. Treatment given at establishments or a hospital where that facility has become the member’s home or permanent abode or where admission is arranged wholly or partly for domestic reasons.
17. Costs relating to cosmetic treatment or corrective treatment or any consequence thereof.
18. Treatment for weight loss or weight problems including, but not limited to bariatric procedures, obesity surgery or treatment, diet pills or supplements, health club memberships, diet programs and treatment in a residential treatment facility for eating disorders. Any complications arising from weight loss or other excluded procedures are not covered.
19. Alternative therapies unless they appear on your benefits schedule.
20. Costs incurred in connection with locating a replacement organ or any costs incurred for removal of the organ from the donor, transportation costs of same and all associated administration costs.
21. Any claim relating directly or indirectly to pregnancy, pregnancy terminations, pregnancy complications antenatal classes or midwifery costs, delivery costs, postnatal costs or any medical conditions relating to pregnancy or childbirth.
22. New born neo-natal care.
23. Treatment directly or indirectly arising from (or required in connection with) male and female birth control, sterilization (or its reversal). Infertility treatment (assisted conception) is excluded. Any complications of pregnancy and routine pregnancy costs resulting from infertility treatment (assisted conception) are excluded.
24. Treatment of impotence or any related condition or consequence thereof.
25. Treatment associated with a sex change and any consequence thereof.
26. Venereal disease or any other sexually transmitted diseases or any related condition.
27. Treatment for Human Immunodeficiency Virus (HIV) or HIV related illness, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS related complex (ARC) or any similar infections, illnesses, injuries or medical conditions relating directly or indirectly to these conditions.
28. Costs in respect of a psychotherapist or psychologist unless they appear on your benefits schedule.
29. Treatment for learning difficulties, hyper-activity, attention deficit disorder, speech therapy and developmental, social or behavioural problems.
30. Any claim relating to alcohol, alcoholism, drug or substance abuse or any addictive condition of any kind and any injury or illness arising directly or indirectly from such abuse, addiction or use.
31. Any claim relating to suicide or attempted suicide, bodily injury or illness, which is wilfully self-inflicted or due to negligent or reckless behaviour.
32. Any injury sustained directly or indirectly as a result of the member acting illegally or committing or helping to commit a criminal offence.
33. Costs incurred while an inmate of a prison, jail or any correctional facility or while in any mental institution.
34. Costs and expenses incurred where a member has travelled against medical advice.
35. Evacuation expenses unless they appear on your benefits schedule. Air rescue, sea rescue or mountain rescue costs.
36. Travel and accommodation costs unless specifically agreed by us in writing prior to travel. No travel and accommodation costs are payable where treatment is obtained solely as an outpatient, including the costs of a hired car. Transportation costs from a ship, oil-rig platform or similar oil-shore location are not covered.
37. Treatment for sleep related disorders, including snoring, fatigue, jet lag or work-related stress or any related condition.
38. Dietary supplements or nutritional supplements and related substances that can be purchased without prescription, including, but not limited to, vitamins, minerals, organic substances, and infant formula given orally.
39. Home visits by a medical practitioner, specialist or qualified nurse unless specifically agreed by us in writing prior to consultation.
40. External prostheses, including their maintenance or fitting, any hearing aids or other equipment, medical or otherwise.
41. The following hazardous activities are excluded: playing professional sports and/ or taking part in motor sports of any kind; mountaineering, including potholing, spelunking or caving; high-altitude trekking over 2,500 metres; skiing off-piste or any other winter sports activity carried out off-piste; and Arctic or Antarctic expeditions.
42. Any claim arising as a result of your use of a two-wheeled motor vehicle unless:
a) As a passenger you wear a crash helmet and it is reasonable for you to believe that the driver holds a license to drive the two-wheeled motor vehicle under the laws of the country in which the accident occurs (if such a license is required under the laws of the country in which the accident occurs); or
b) As a driver you wear a crash helmet and you hold a license which permits you to drive the two-wheeled motor vehicle under the laws of the country in which the accident occurs and you have arranged adequate motor vehicle insurance coverage (if such a license and or insurance is required under the laws of the country in which the accident occurs).
43. Any claim arising as a result of you participating in motor racing, rally or vehicle racing of any kind.
44. Any claim involving you taking part in manual labour.
45. Any claim arising as a result of you failing to get the inoculations and vaccinations that you are reasonably required to receive.
46. Any claim arising from you acting in a way which goes against the advice of a medical practitioner.
47. Any costs for telephone calls, taxi fares, or food and drink (unless these form part of your hospital costs if you are kept as an inpatient)
48. Self-treatment, or treatment provided by a direct family member. This includes, but is not limited to, prescribed medication, diagnostic tests and surgical procedures.
49. All benefits are excluded unless they appear on your benefits schedule.
50. Any claim relating directly or indirectly to conflict/civil unrest or act of terrorism unless they appear on your benefits schedule.
51. Services which have not been recommended and prescribed by your attending physician or specialist.
52. Any consequential loss.
53. Costs incurred as a result of ionizing radiation, radioactive contamination, chemical contamination or nuclear contamination of any kind.
54. Costs incurred outside your geographical area of cover as stated on your certificate of insurance (USA).
55. Costs incurred outside the period of cover or in any period in which the appropriate premium has not been paid.
56. Any excess, deductible or co-insurance for each benefit per condition per year.
57. Any second or subsequent medical opinions from a medical practitioner or specialist for the same medical condition unless agreed in writing by us.
58. Expenses which are recoverable from a third party.
59. Costs for genetic testing.
60. Treatment for, or arising from, deafness caused by ageing.
61. Costs relating to loss of hair and or any hair replacement.
62. Any costs relating to ear or body piercing or tattooing.
63. Costs incurred for the completion of any claim forms or the provision of any documents or reports needed to adjudicate a claim.
64. Costs relating to cryopreservation, implantation or reimplantation of living cells or living tissue.
65. Vaccinations or inoculations unless they appear on your benefits schedule.
66. Costs incurred due to complications caused by an illness, disease, injury or treatment for which cover is excluded or limited within this policy.
67. Space travel, including but not limited to space tourism, interstellar voyages, and time travel (forwards or backwards).
Summary
If you’ve just read through all that, well done. It’s a lot, we know. But it is important, and it’s worth reading (so if you’ve skipped to the end, maybe consider going back and reading it!).
In particular, if you are comparing different insurances – whether that’s a like-for-like comparison (i.e. comparing this insurance to another international medical insurance policy), or a comparison of different types of cover (i.e. comparing this insurance to a travel insurance policy, which is a completely different type of insurance despite some overlaps) – it’s the details contained in the terms and conditions which will impact your coverage, so don’t just rely on headlines created by a marketing department!
Stay safe, dear nomads, and may the force be with you!