Download Generali Providencia Health Insurance Guide

Generali Providencia Health Insurance Guide
Coverage
The commencement date of the coverage is the date when the Insured completes and
signs the Statement of the Insured’. The insurance covers only those insurance events that
occur within the territory of Hungary.
Besides the services listed below the cover also includes the cost of any medical
treatments related to illnesses already existing at the commencement date of the coverage
provided these treatments are within the scope of the basic medical service of CEU; i.e.
can be performed by a specialist of the Medical Center at CEU.
The ‘Statement of the Insured’ is complete only if a fully filled in ‘Medical
Questionnaire’ is attached to it.
The proof of insurance coverage is the Health Insurance Card containing the data of the
Insured. This card must be shown to the medical service provider when any medical
treatment in undertaken.
The insurance coverage is valid only during the period during which the resident
foreigner is a student of, or is employed by, CEU. The validity of the insurance is shown
on the Health Insurance Card.
In case the Insured leaves Hungary either temporarily or permanently during the validity
of the insurance coverage, he/she has to return the Health Insurance Card to CEU, and the
card will be temporarily/permanently withdrawn.
Services provided by the Insurer
In case an insurance event occurs, the Insurer will fulfill payment according to the terms
of the ‘Statement of the Insured’. For this reason the Insured will not incur any payment
obligations provided that the medical treatment was received in a designated institution.
The Insurer’s obligation of coverage includes in-patient and out-patient treatment
provided only in Hungary.
As part of the out-patient treatment the following will be reimbursed:
 Costs of basic medical treatment
 Costs of specialized medical treatment
 Costs of the physician’s visit to the patient, provided that the patient was not able
to visit the physician
 Costs of special examinations (e.g., laboratory tests, X-ray examination,
ultrasound scan, etc.) provided these were necessary for setting up the diagnosis
or for the cure
As part of the in-patient treatment the following will be reimbursed:
 Costs of medical treatment prescribed by a physician including operations
 Costs of hospital accommodation—standard service, nursing/attending
 Costs of medically justified abortion
The insurer will reimburse the costs of medicines, bandages and temporary therapeutic
aids above the deductible.
The costs of transportation to a physician (by ambulance or taxi) will be reimbursed only
if it is medically justified and needed.
The costs of the Insured being transported from the physician/hospital will be reimbursed
only if the state of health of the Insured allows it and makes it necessary and is also
recommended by the physician of the Insurer.
Limits of coverage
The Insurer will cover the costs arising from medical treatments up to specific limits and
using a deductible.
In any insurance year the insurer will fulfill payments to the insured up to 1,000,000, one
million, Hungarian forints, of which sum 100,000 Hungarian forints can be paid for each
of medicines and therapeutical aids, respectively, within the following limitations:
- Only 50% of the costs of therapeutical aids will be reimbursed to the Insured.
- Regarding the costs of medicines a 1500 Hungarian forints deductible applies per illness
per month.
This means that the Insurer will cover the costs of medicines only above the monthly
deductible, i.e., 1500 Hungarian forints per illness, per month.
What is not covered
The following are not considered to be insurance events and therefore do not serve as a
basis for any reimbursement claims:
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Hospitalization due to pregnancy or abortion except for medically justified cases
Cosmetic treatment and/or surgery if not a result of accident
Glasses, contact lenses and hearing aids
Dental treatments, except for acute or emergency cases, or corrections of
accidents
Rehabilitation treatments
Any form of artificial insemination
Treatment of illnesses resulting from HIV infection
Upgraded services (e.g. single-bed room)
Treatments related to or resulting from illnesses or accidents already known at the
commencement of the coverage period, except for those which can be treated
within the scope of the basic medical service (i.e. by a specialist of the Medical
Center at CEU).
Treatments made necessary or related to the consumption of alcohol or
drugs/narcotics
Acupuncture treatment or psychotherapy
Immunizations
Moreover, the Insurer does not cover events resulting from or contributed to by mental
infirmity or disease, ionizing radiation, nuclear energy, acts of war or any crime against
the state.
The Insurer does not cover events resulting from or in connection with the following
sports activities of the Insured:
 Motoring: car racing, motorbike sports, rally, moto-cross, driving-skill
competitions, go-kart, auto-crash, motorboat sports
 Aerial sports: amateur flying, parachuting, gliding, motor-gliding, hang-gliding,
ultra-light gliding, para-gliding, hot-air ballooning
 Others: scuba diving with oxygen-tank below 40 meters, single-handed and opensea sailing, mountain and rock-climbing from degree V., high-mountain
expeditioning, caving, cave-expeditioning.
The Insurer is relieved of any liability if the Insurer proves that the event was caused by
the Insured against the law, intentionally or with gross negligence.
The Insured is seriously negligent especially if:
 When the accident took place the Insured was in an alcoholic state and this fact
had a causal relationship with the accident. If there is a blood test result, alcoholic
state is defined as a blood-alcohol concentration of over 1.5 1/1000, or over 0.8
1/1000 when driving.
 The Insured was driving a vehicle that did not have a valid vehicle-license, or the
Insured had no license to drive that vehicle and this fact had a causal relationship
with the accident.
What to do if medical service is needed
If medical service is needed, a specialist of the Medical Center at CEU must be visited
during consultation hours for examinations, prescriptions of medicines, etc.
If necessary, the specialist of the Medical Center at CEU will refer the Insured for further
special examinations or hospital care and doing so justifies the necessity of the treatment.
The Insured will receive medical service covered by the Insurer:
 at the Medical Center by presenting his/her valid Health Insurance Card
together with his/her passport to the specialist of the Medical Center at CEU,
 or at the designated institutions by presenting the referral of the specialist of the
Medical Center at CEU.
If emergency medical service is needed and the Insured is treated not at a designated
institution ‘Medicina Betegség Megelőző Kft.’ has to be notified of this within 24 hours
or as soon as possible, and ‘Medicina Betegség Megelőző Kft.’ will issue a written
statement of coverage for the institution providing medical treatment for the Insured.
Based on the Insurance contract in order to be reimbursed for the costs of medical
treatments the following has to be submitted to ‘Medicina Betegség Megelõzõ Kft’:
- The original bills as proofs of payment
- All medical documents in connection with the medical service
Provided there is a just claim, ‘Medicina Betegség Megelõzõ Kft.’ will reimburse the
Insured within 30 days from the submission of all medical documents in connection with
the insured medical service.
Designated Institutions
MEDICAL CENTER at CEU:
Address: 5th district, Nádor u. 11. (in the courtyard)
Phone: 36-1-327-3815
Phone/Fax: 36-1-328-3695
Dr. Monika Horváth, e-mail: [email protected]
Dr. Gábor Sándor, e-mail: [email protected]
Marta Verebes, e-mail: [email protected]
MEDICINA SURGERY - BUDAPEST
Downtown – Health Care Specialist Outpatient Clinic of Lipótváros
Address: 5th district, Hercegprímás u., 14-16.
Phone: (36-1)-428-8125,
Phone/Fax: (36-1) 428-8127
e-mail: [email protected]
Working Hours: Monday-Friday: 8:00 a.m.-2:00 p.m
In-patient treatment - HOSPITALS
SEMMELWEIS MEDICAL UNIVERSITY
CLINIC OF TRANSPLANTATION AND SURGERY
Address: 8th district, Baross u. 23-25.
Please keep this Product Guide for further reference. It will be useful for you when
using medical services.