Insurance Terms and Conditions
Tour Package Purchase
While purchasing any of the Tourist Packages, the customer takes out two kinds of insurance, accident and health, by default under the Act of Ukraine 'On Tourism'. This insurance is in force for the period of the purchased E-voucher. The collected insurance payment is non-fixed and subject to the chosen Tourist Package and the age of the customer.
If you already possess the aforementioned insurance having an effect within the territory of Ukraine, inform us about it as soon as possible for us to refund you the insurance payment.
Through the tourist and transportation services of our Company you will be insured by the Double Liability Company UNIVERSALNA INSURANCE COMPANY (hereinafter referred to as the Insurer), legal address: 48a, vul. Bogdana Khmalnitzkogo, Kyiv, Ukraine, tel +38 0 800 500 381, pursuant to the Voluntary Medical Payments Insurance Rules and Voluntary
In the event of any accident that could be recognized as the insured loss (acute disease, disastrous occurrence, or any other accident provisioned by the the terms and conditions of the Insurance Contract), the Insured/Insurant/or any other persons representing the Insurants should immediately inform about the aforementioned event at any time of date and night by phone:
+0 800 500 381 (24/7)
Provide us with the following data please:
• First and last names of the Insurant.
• Your current location.
• Reason for contact and expected aid.
• Your telephone number.
• The Insurance Contract number and duration, the insurance program type.
For possible reimbursement of expenditures proceeding the Insurant (Policy Holder) should contact the Insurer within 15 days since the date of incurring the expenditures of the kind to address: 15, vul. Metalistiv, Kyiv, Ukraine.
THE GENERAL CONTRACT OF THE MEDICAL EXPENSES AND ACCIDENT INSURANCE OF THE TRAVELERS ON UKRAINE
In case of of independent purchase of services (In case of the event that can be acknowledged as an insured one)
the Insured Person’s beneficiary shall submit the following documents, which are common for any insured event, to the Insurer:
- a written application drawn up as established by the Insurer;
- Insurance Agreement or its copy;
- a copy of a passport;
- a copy of identification code certificate.
(ADDITIONAL) CONDITIONS FOR VARIOUS KINDS OF INSURANCE
I. VOLUNTARY MEDICAL AND RELATED EXPENSE INSURANCE
1. INSURANCE CONDITIONS UNDER “TOURIST” PROGRAM
1.1. Option «A» the following list of services:
emergency aid and emergency obstetrical aid (provided the gestational age of the Insured Person as of the beginning of the Agreement term was less than 28 weeks) provided locally: primary diagnostic measures, provision of medical aid using the medicinal products to the extent required by the Insured Person’s condition, transportation and emergent admission to the healthcare facility. Emergency aid may be provided by any commercial healthcare facilities (except for Boris clinic).
Limit – 1 call per period of the Contract validity.
in-patient care*, i.e.: doctors consultancy; diagnostics, treatment, emergency surgery; drug supply; staying in standard wards; diet based on norms accepted by the specific healthcare facility
*The Insurer shall pay the value of treatment within the limits of its liability (insurance coverage) set forth in the Agreement, only until the moment when the Insured Person’s health stabilizes and allows for, based on the doctor’s decision, his/her transportation to his/her place of permanent residence.
In case of independent purchase at a pharmacy of drugs prescribed by a doctor and of independent payment for the emergency medical treatment, the Insurer shall reimburse for such expenses incurred by the Insurant (the Insured Person) only if such prescription and expenses were prior agreed with the assisting company.
payment for emergency dental care, in particular: caries and endodontitis (X-ray, anesthesia, temporary filling, tooth extraction); traumatic injury of teeth and jaws. Limit – 200,00 UAH per period of the Contract validity.
payment for the medical services and treatment in the ambulatory/outpatient settings: examination to diagnose a case; doctor’s consultancy; drugs provision for the emergency aid in the accordance with the doctor’s prescriptions. Limit – 800,00 UAH
payment for drugs for the emergency aid or the reimbursement of expenses in case of the independent purchase of drugs prescribed by a doctor. Limit – 500,00 UAH
2.REASONS OF REFUSAL TO PAY OR SUSPEND THE INSURANCE BENEFIT. The Insurer shall not indemnify for the treatment and services related to the following diseases and conditions:
2.1. Health resort treatment expenses.
2.2. Any expenses that exceed the necessary ones, when the Insured Person’s health improved to the extent (according to medical indications) that he/she can return to the place of his/her permanent residence with or without any assistance.
2.3. Any expenses while traumatic injuries stipulated by joints instability or repeated traumatic injuries (relapsing dislocation).
2.4. Treatment of chronic diseases, congenital abnormalities (birth defects), deformities and chromosomal disorders.
2.5. Neoplasms, endocrine system disorders.
2.6. Nervous diseases (beside neuritis), psychic diseases, and any traumatic injuries related thereto.
2.7. Venereal diseases, immunodeficiency, AIDS.
2.8. Blood and hematopoietic organs diseases.
2.9. Epidemic and pandemic diseases.
2.10. Acute and chronic radiation disease.
2.11. Pregnancy (except for extrauterine gestation), interruption of pregnancy due to medical indications.
2.12. Any health problems, complications or death in the result of non-compliance, adverse effect of drugs that were not prescribed by a doctor or due to adverse effect of dietary supplements.
2.13. Diseases or consequences (complications) of viral hepatites, tuberculosis.
2.14. Auditory diseases and disorders, except acute auditory disease.
2.15. Highly dangerous infectious diseases (as provided in the list approved by the Ministry of Health of Ukraine).
2.16. Fungus and dermatological diseases, allergic dermatitis, caused by ultraviolet irradiation, sunburns of the first and the second degrees.
2.17. Diseases that emerged before the period of insurance and/or within the Place of Permanent Residence, which led to medical or additional expenses during a travel, as well as the diseases that emerged after the Insured Person had returned to the Place of his/her Permanent Residence.
2.18. Further treatment of the Insured Person if he/she refuses from medical evacuation to the Place of his/her Permanent Residence.
2.19. Medical examination due to any reasons other than acute pain, a sudden disease and body injury, provision of services that are not reasonably required or emergent in the healthcare point of view, or are not included in the therapy prescribed by a doctor, as well as provision of such special services as an individual ward, a telephone, a TV etc.
2.20. Services and treatment which may be postponed till return from the travel, including any surgery what may be currently replaced with a conservative therapy etc.
2.21. Preventive vaccination, medical expert examination and laboratory assessments not connected with the insured event.
2.22. All kinds of plastic and cosmetic surgeries and procedures, all kinds of prosthetic care, organ transplantation.
2.23. Dental care, except for emergency dental care (acute pain control).
2.24. Physiotherapeutic treatment and unconventional treatment.
2.25. Purchase or repair of assistive devices (glasses, contact lens, hearing aids, inhalation devices, prosthetic appliances, crutches, wheel chairs, measurers etc); purchase of health-promotion medications, personal hygiene products, baby food.
2.26. Artificial insemination, infertility treatment, pregnancy preventive measures.
2.27. Medical evacuation, repatriation or burial abroad arranged without a written consent to be provided by the Insurer.
2.28. Any expenses when a travel was organized for medical purposes.
2.29. Any expenses for medical care and medical services provided by any private healthcare facilities, unless otherwise agreed with the Insurer under the “TOURIST” Program.
2.30. Any expenses for medical care and medical services not stipulated with the Insurance Program.
2.31. Any expenses for further treatment of the Insured Person after his/her return to the Place of his/her Permanent Residence, and also those costs shall not be reimbursed which are covered at the expense of social, medical or any other insurance.
2.32. Any expenses for treatment or expenses incurred in case of the Insured Person’s death in a road accident if a vehicle was driven by the Insured Person not having a driving license of the relevant category or being under the influence of alcohol, drug or toxic substances, and if such person was knowingly riding in a vehicle driven by a person not having a driving license of the relevant category or being under the influence of alcohol, drug or toxic substances.
2.33. Any expenses connected with services provided by a healthcare facility without a relevant license or by a person not entitled for healthcare business.
2.34. Any expenses incurred upon the insurance agreement expiration.
2.35. Any expenses connected with rehabilitation treatment and physiotherapy.
2.36. Any expenses for paid-for treatment at any healthcare facility, as well as any expenses when the Insured Person has a right for free-of-charge medical care.
2.37. Any expenses for treatment required in the result of radiation or radioactive pollution influence.
2.38. Any expenses connected with funeral services and burial of the Insured Person.
2.39. Any expenses connected with an event that occurred in the result of the Insurant’s (the Insured Person’s) flight with a flying machine, operation of such machine, except for cases of flying as a passenger on a civil airplane operated by a professional pilot.
2.40. Any expenses connected with an event that occurred in the result of the Insurant’s (the Insured Person’s) doing any sports, unless otherwise is stipulated by the conditions contained in Part 1 of the Agreement.
2.41. Any expenses connected with an event that occurred in the result of the Insurant’s (the Insured Person’s) performing any dangerous activities, or any works at dangerous sites (drivers, mineworkers, builders, wiremen), unless otherwise is stipulated by the conditions contained in Part 1 of the Agreement.
2.42. No expenses shall be reimbursed, if the same were covered by the Insurant (the Insured Person) without prior agreement with the Insurer.
2.43. The Insurance Agreement shall not be concluded with regard to any persons aged under 1 year and older than 65 years. Insurance of such persons may be possible subject to inclusion of the additional insurance conditions and increase of the insurance premium.
2.44. Other cases stipulated by the Insurance Rules and the applicable law of Ukraine.
3.Reasons for the Insurer to suspend the insurance benefit include:
3.1. Reasoned doubts of the Insurer about the property interest of a person claiming for the insurance benefit, in particular, if the successor of the deceased Insured Person cannot confirm his/her status, because he/she does not have an inheritance certificate.
3.2. The relevant authorities of internal affairs, in case of any unlawful actions made to life and health of the Insured Person stated in the Agreement, have initiated criminal proceedings against the natural person beneficiary of the insurance benefit, and the investigation is being carried out as for the circumstances that resulted in harm. The decision on the insurance benefit shall be made within 15 (fifteen) business days upon the mentioned investigation (its termination, drawing up of a bill of indictment, closing of a criminal case etc).
3.3. The Insurer has reasoned doubts about accuracy of the submitted documents or correspondence between the event circumstances and the signs of the insured event, or availability of other facts that may be a ground to refuse to pay the insurance benefit. In such case, the Insurer shall be entitled to suspend the insurance indemnity for a term required to ascertain the truth as for the actual circumstances of the event, but for not more than 6 (six) months.
4.LIST OF DOCUMENTS THAT WITNESS THE INSURED EVENT AND EXTENT OF LOSS
4.1. In case of individual payment by the Insurant (the Insured Person) for the medical services prior agreed with the Insurer, the Insurer (the Insured Person) shall get the following documents from the healthcare facility:
4.2. invoice statement issued by the healthcare facility (printed on a letter-headed paper or with a relevant seal affixed thereto) which specifies: the patient’s surname, precise diagnosis, date of referral for the medical care, duration of treatment, details of medical services provided, diagnostics, prescribed drugs with their quantity and value specified;
4.3. prescriptions given by the attending doctor to the Insured Person for purchase of drugs with name of each medicinal product clearly specified;
4.4. detailed invoices for other services broken down by date and value;
4.5. documents that witness the fact of payment for the medicinal products, any medical and other services provided (cash settlement documents, sales slips, income receipts, bank receipts, etc);
4.6. other documents demanded by the Insurer.
5.PROCEDURE AND CONDITIONS OF THE INSURANCE BENEFIT
5.1. The insurance benefit intended to reimburse for any medical or other services stipulated hereby and arranged by the Insurer for the Insured Person shall be paid by the Insurer without participation of the Insured Person based on invoices billed to the Insurer.
5.2. In case of individual payment by the Insurant (the Insured Person) prior agreed for any medical or additional services, the Insurer shall pay the insurance benefit to the Insurant based on a relevant application for the insurance benefit and the documents mentioned in the General Conditions of Extraction from the General Contract
5.3. If as of the day of this Agreement expiration, the Insured Person’s condition requires emergency medical care, but the medical conclusion does not allow for repatriation (evacuation) to the Place of his/her Permanent Residence, the Insurer shall indemnify for the costs for further emergency treatment of the Insured Person for a term of not more than five calendar days, provided that such expenses do not exceed the insurance coverage and the Insurer’s liability limits under the respective insurance programs.
5.4. In case of any injury, a road accident or a car breakdown by which the Insurant (the Insured Person) travelled, the Insurer shall be additionally provided with an official protocol drawn up in the country of temporary stay or a certificate on the event, which must mandatorily provide for the following information:
officials that confirm the fact of the event, their authorities for such activities;
addresses and/or telephone numbers of the persons that confirmed the fact of the event;
detailed description of the event circumstances and the Insurant’s (the Insured Person’s) role in it;
the Insured Person’s condition as for being intoxicated with alcohol, drug or toxic substances.
5.5. In case of the Insurant’s referral due to damages caused by a road accident or a car breakdown, the Insurant shall be additionally provided with an opinion of automotive merchandising expertise.
5.6. With due account for the circumstances of the occurred event, the Insurer shall be entitled to demand any additional documents which would witness the fact and the circumstances of the insured event, as well as the extent of the insurance benefit.
II. VOLUNTARY ACCIDENT INSURANCE
1.INSURED EVENTS. The insured event shall be the actual accident which happened to the Insured Person within the term of this Agreement and brought about the following consequences:
1.1. Permanent occupational disability of the Insured Person (designation of primary disablement of group I or II);
1.2. Death of the Insured Person.
In case of the Insured Person’s death, the beneficiary under this Agreement shall be a successor (successors) at law or under a will.
The insured events shall exclude, besides those that stipulated with the Rules of Insurance, any disease of the Insured Person (except for tetanus, rabies).
1. PROCEDURE AND CONDITIONS OF THE INSURANCE BENEFIT
2.1. The Insurer shall decide on the insurance benefit based on documents the General Conditions of Extraction from the General Contract, as well as other documents:
a document which identifies the person and confirms his/her right for the insurance benefit;
an official protocol or a certificate issued by any healthcare facility within the territory of Ukraine and which specifies the place, date and time of the accident, date and time of referral to the healthcare facility, a diagnosis, a kind of injury, the event which led to the accident, and opinion on the Insured Person’s being intoxicated with alcohol or drugs at the moment of such accident;
2.1.1. in case the Insured Person is acknowledged as having acquired primary disablement in the result of the accident:
an opinion of a medical consultative board or a medico-social expert board on primary disablement of the Insured Person in the result of the accident;
2.1.2. in case of the Insured Person’s death in the result of the accident:
a death certificate;
an inheritance certificate;
other documents demanded by the Insurer.
2.2. The Insurer shall pay the insurance benefit:
2.2.1. in case of primary disablement – to the Insurant (the Insured Person):
group І – 100% of the accident insurance coverage;
group ІІ – 75% of the accident insurance coverage;
2.2.2. in case of the Insured Person’s death – 100% of the accident insurance coverage – to the beneficiary. For the non-resident Insured Persons, the insurance benefit shall be received by the Insured Person’s successor pursuant to the established norms regulated by the Section Х of the Law of Ukraine “On the International Private Law”.
2.3. With due account for the circumstances of the occurred event, the Insurer shall be entitled to demand any additional documents which would witness the fact and the circumstances of the insured event, as well as the extent of the insurance benefit.