Allianz Care – Premier

Core Plan	Premier
Maximum plan benefit EUR (€)	€7,500,000
In-patient benefits¹ – please refer to notes for more information on Treatment Guarantee
Hospital accommodation¹	Private room
Intensive care¹	Full refund
Prescription drugs and materials¹ (in-patient and day-care treatment only) (Prescription drugs are those which legally can only be purchased when you have a doctor’s prescription)	Full refund
Surgical fees, including anaesthesia and theatre charges¹	Full refund
Physician and therapist fees¹ (in-patient and day-care treatment only)	Full refund
Surgical appliances and materials¹	Full refund
Diagnostic tests¹ (in-patient and day-care treatment only)	Full refund
Organ transplant¹	Full refund
Psychiatry and psychotherapy¹ (in-patient and day-care treatment only) (10 month waiting period applies)	Full refund
Accommodation costs for one parent staying in hospital with an insured child under 18¹	Full refund
Emergency in-patient dental treatment	Full refund
Other benefits – please refer to notes for more information on Treatment Guarantee
Day-care treatment²	Full refund
Kidney dialysis²	Full refund
Out-patient surgery²	Full refund
Nursing at home or in a convalescent home² (immediately after or instead of hospitalisation)	€4,250
Rehabilitation treatment² (in-patient, day-care and out-patient treatment; must commence within 14 days of discharge after the acute medical and/or surgical treatment ceases)	€4,420
Local ambulance	Full refund
Emergency treatment outside area of cover (for trips of a maximum period of six weeks)	Full refund, max. 42 days
Medical evacuation² · Where necessary treatment is not available locally, we will evacuate the insured person to the nearest appropriate medical centre² · Where ongoing treatment is required, we will cover hotel accommodation costs² · Evacuation in the event of unavailability of adequately screened blood² · If medical necessity prevents an immediate return trip following discharge from an in-patient episode of care, we will cover hotel accommodation costs²	Full refund max. 7 days
Expenses for one person accompanying an evacuated person²	€3,000
Travel costs of insured family members in the event of an evacuation²	€2,000 per event
Repatriation of mortal remains²	€10,000
Travel costs of insured family members in the event of the repatriation of mortal remains²	€2,000 per event
CT and MRI scans (in-patient and out-patient treatment)	Full refund
PET² and CT-PET² scans (in-patient and out-patient treatment)	Full refund
Oncology² (in-patient, day-care and out-patient treatment) • Purchase of a wig, prosthetic bra or other external prosthetic device for cosmetic purposes	Full refund €200 per lifetime
Routine maternity² (in-patient and out-patient treatment) (10 month waiting period applies)	Full refund
Complications of pregnancy and childbirth² (10 month waiting period applies)	Full refund
Home delivery	€1,000
In-patient cash benefit (per night) (where treatment has been received free of charge)	€150, max. 25 nights
Emergency out-patient treatment (where these benefit amounts are reached, any additional costs may be reimbursed within the terms of any separate Out-patient Plan)	€750
Emergency out-patient dental treatment (where these benefit amounts are reached, any additional costs may be reimbursed within the terms of any separate Dental Plan)	€750
Palliative care²	Full refund
Long term care²	Full refund, max. 90 days per lifetime
Accidental death (insured members aged 18 to 70)	€10,000
Additional Core Plan Benefits
Employee Assistance Programme (provided by Morneau Shepell) offers access to a range of 24/7 multilingual support services as follows:	Covered
· Confidential professional counselling (in-person, phone, video, on-line chat and email) · Legal and financial support services · Critical incident support · Wellness website access
Travel Security Services (provided by red24) offers 24/7 access to personal security information and advice for all your travel safety queries. This includes: · Emergency Security Assistance Hotline · Country intelligence and security advice · Daily security news and travel safety alerts	Covered

Out-patient Plan	Gold
Maximum plan benefit	No limit
Out-patient benefits
Medical practitioner fees and prescription drugs (Prescription drugs are those which legally can only be purchased when you have a doctor’s prescription)	Full refund
Specialist fees	Full refund
Diagnostic tests	Full refund
Vaccinations	Full refund
Chiropractic treatment, osteopathy, homeopathy, Chinese herbal medicine, acupuncture and podiatry (max. 12 sessions per condition for chiropractic treatment and max. 12 sessions per condition for osteopathic treatment, subject to the benefit limit)	Full refund
Prescribed physiotherapy (initially limited to 12 sessions per condition; limit also applies to prescribed and non prescribed physiotherapy sessions, where combined) – Non-prescribed physiotherapy	Full refund 5 visits
Prescribed speech therapy, oculomotor therapy and occupational therapy²	Full refund
Health and wellbeing checks including screening for the early detection of illness or disease. Checks are limited to: · Physical examination · Blood tests (full blood count, biochemistry, lipid profile, thyroid function test, liver function test, kidney function test) · Cardiovascular examination (physical examination, electrocardiogram, blood pressure) · Neurological examination (physical examination) · Cancer screening – Annual pap smear – Mammogram (every two years for women aged 45+, or earlier where a family history exists) – Prostate screening (yearly for men aged 50+, or earlier where a family history exists) – Colonoscopy (every five years for members aged 50+, or 40+ where a family history exists) – Annual faecal occult blood test · Bone densitometry (every five years for women aged 50+) · Well child test (for children up to the age of six years, up to a maximum of 15 visits per lifetime) · BRCA1 and BRCA2 genetic test (where a direct family history exists)	€1,200
Infertility treatment (18 month waiting period applies)	€12,000 per lifetime
Psychiatry and psychotherapy (18 month waiting period applies)	30 visits
Prescribed medical aids	Full refund
Prescribed glasses and contact lenses including eye examination	€200
Dietician fees	4 visits
Prescribed drugs (must be prescribed by a physician, although a prescription is not legally required for purchase)	€50

Dental Plan	Dental 1
Maximum plan benefit	No limit
Dental benefits
Dental treatment	100% refund
Dental surgery	100% refund
Periodontics	80% refund
Orthodontic treatment and dental prostheses (10 month waiting period applies)	65% refund, up to €5,000

Repatriation Plan
Medical repatriation² · Where the necessary treatment is not available locally, you can choose to be medically repatriated to your home country instead of to the nearest appropriate medical centre² · Where ongoing treatment is required, we will cover hotel accommodation costs² · Repatriation in the event of unavailability of adequately screened blood² · If medical necessity prevents an immediate return trip following discharge from an in-patient episode of care, we will cover hotel accommodation costs²	Full refund max. 7 days
Expenses for one person accompanying a repatriated person²	€3,000
Travel costs of insured family members in the event of a repatriation²	€2,000 per event
Travel costs of insured members to be with a family member who is at peril of death or who has died	€1,500 per lifetime

NOTES

Treatment Guarantee/Pre-authorisation

Treatment Guarantee/Pre-authorisation is a process whereby we guarantee cover for certain treatment and costs, as indicated in the Table of Benefits with a 1 or a 2. If Treatment Guarantee is not obtained for the benefits indicated, we reserve the right to decline your claim. If the respective treatment is subsequently proven to be medically necessary, we will only pay 80% of the eligible benefit for benefits listed with a 1, and for those listed with a 2, we will only pay 50% of the eligible benefit. For further details please refer to our Benefit Guide, or simply contact our Helpline.

Chronic conditions

Chronic conditions that arise after the policy commencement date are covered within the limits of your policy. Please refer to the ‘Definitions’ section of our Benefit Guide for further information or simply contact our Helpline.

Pre-existing conditions

Pre-existing conditions (including any pre-existing chronic conditions) are covered under the terms of your policy, unless indicated otherwise on a Special Conditions Form enclosed. Please note that any pre-existing conditions that were not declared by you on the relevant application form will not be covered.

In addition, conditions arising between completing the application form and the start date of the policy will equally be deemed to be pre-existing. Such pre-existing conditions will also be subject to medical underwriting and if not disclosed they will not be covered.

For further details, please refer to the ‘Definitions’ section of our Benefit Guide or simply contact our Helpline.

Benefit limits

There are two kinds of benefit limits shown in the Table of Benefits. The maximum plan benefit, which applies to certain plans, is the maximum we will pay for all benefits in total, per member, per Insurance Year, under that particular plan. Some benefits also have a specific benefit limit, which may be provided on a ‘per Insurance Year’ basis, a ‘per lifetime’ basis or on a ‘per event’ basis, such as per trip, per visit or per pregnancy. In some instances we will pay a percentage of the costs for the specific benefit e.g. ‘65% refund, up to €5,000’. Where a specific benefit limit applies or where the term ‘Full refund’ appears next to certain benefits, the refund is subject to the maximum plan benefit, if one applies to your plan(s). All limits are per member, per Insurance Year, unless otherwise stated in your Table of Benefits.

Policy Terms and Conditions

The Table of Benefits outlines the cover we offer under your policy. Please note that cover is subject to our standard policy definitions, limitations and exclusions. These are detailed in our Benefit Guide, which is issued to you upon policy inception. Our current Benefit Guide can also be downloaded from our website www.allianzworldwidecare.com

Policy Endorsement(s)

If there are any policy terms and conditions unique to your policy they will be listed below. Please read carefully in conjunction with our Benefit Guide.

The Employee Assistance Programme Services are made available through AWP Health & Life Services Limited (‘AWP’) and provided by Morneau Shepell Limited, subject to your acceptance of AWP’s terms and conditions.

The Travel Security Services are made available through AWP Health & Life Services Limited (‘AWP’) and provided by red24 Operations Limited, subject to your acceptance of AWP’s terms and conditions.