Daily Sickness Benefits Insurance
Insurance Product Information Document
Company : Hallesche Krankenversicherung a. G., Germany
This information sheet provides an overview of your coverage daily sickness benefits insurance from the Grant-Health-Insurance. This information is not exhaustive. For details, please refer to the insurance conditions and the other documents for group daily sickness benefits insurance. These consist of the tariff conditions (TB/KT and EKT/group), the general insurance conditions for daily sickness benefits insurance for temporary stays, the customer information and the confirmation of insurance. To ensure that you are fully informed, please read all documents carefully.
What type of insurance is this?
We offer group daily sickness benefits insurance for long-term stays abroad, which provides benefits in the event of incapacity to work as a result of illness or accident.
What is insured?
- The insurer provides insurance cover against loss of earnings as a result of illness or accidents, insofar as this causes incapacity for work. In the event of an insured event, the insurer shall pay a daily sickness allowance to the contractual extent for the duration of the incapacity to work.
- The insured event is the medically necessary treatment of an insured person due to illness or the consequences of an accident, in the course of which incapacity for work is medically determined. The insured event begins with the medical treatment; it ends when, according to medical findings, there is no longer any incapacity to work and no longer any need for treatment.
- The amount of the daily sickness allowance to be paid is stated in the confirmation of insurance. The daily sickness benefit may only be insured up to the amount of the net income from the professional activity converted to the calendar day.
What is not insured?
No obligation to pay benefits exists, for example, for:
- due to illnesses and accidents caused intentionally, including their consequences, and due to withdrawal measures, including withdrawal cures, with the following exception: benefits will be paid for the first inpatient withdrawal measure if and insofar as the insurer has agreed to pay benefits in writing before the measure begins.
Are there any restrictions on cover?
- Insurance cover is provided for long-term stays abroad of more than 91 days.
- The obligation to pay benefits begins on the first day of incapacity for work plus the agreed waiting period.
- The waiting period applies anew for each incapacity for work.
- The obligation to pay benefits ends with the restoration of the ability to work or with the end of the insurance cover for this insured event.
- The obligation to pay benefits ends at the latest upon expiry of the benefit period of 26 weeks agreed in the tariff. If an illness or consequence of an accident due to incapacity to travel or to be transported requires a stay abroad beyond the maximum duration, insurance cover shall exist for this illness or consequence of an accident until the incapacity to travel or to be transported is restored.
Where am I covered?
- All persons insurable under a group insurance contract who are temporarily traveling abroad or persons who are temporarily staying in Germany can be included in this tariff.
What are my obligations?
- The Insurer must be notified of the occurrence of total incapacity for work no later than the date of the specified commencement of benefits. The medical certificate must also contain the name of the illness.
- At the request of the insurer, any information required to determine the insured event or the obligation to pay benefits and its scope must be provided. The requested information must also be provided to an agent of the insurer.
- Timely payment of the monthly premium.
When and how do I pay?
- The contribution will be debited from your account monthly in advance.
When does the cover start and end?
- Insurance coverage begins at the time specified in the insurance confirmation.
- The insurance coverage ends – also for pending insurance cases – with the termination of the insurance relationship.
How do I cancel the contract?
- The insurance relationship may be terminated at the end of each insurance year with three months‘ notice.