Special conditions - Active care | Lev Ins

SPECIAL CONDITIONS

ACTIVE CARE INSURANCE SPECIAL TERMS AND CONDITIONS

1.1. ZK LEV INS AD, hereinafter referred to as the Insurer, shall, pursuant to the Special Terms and Conditions herewith, insure Bulgarian and foreign nationals, hereinafter referred to as the Insured.
1.2. Persons over the age of 65 and persons who wish to include sporting event coverage to the insurance protection regulated by these Special Terms and Conditions shall be insured at a higher risk factor.

2. INSURANCE COVERAGE AND INSURER’S LIABILITY

2.1. The Insurer shall be liable to cover travel costs and/or emergency medical help costs following the occurrence of any of the following events grouped into two different coverage packages:

2.1.1. Basic coverage: in case of adverse developments coming as the result of a traffic accident and in case of an accident of any nature, when the Insured is far from home.
2.1.2. Extended /Full coverage: : in case of an accident of any nature and/or acute disease as provided in Attachment 1.

2.2. Transport assistance shall be rendered using ground vehicles or aircraft.
2.2.1. Ground assistance shall consist of transporting the injured from the scene of the accident to a specialized healthcare facility. 2.2.2. Airborne assistance shall be provided only where the events that have occurred present an immediate threat to the Insured’s life. 2.2.3. Life-threatening events and acute diseases shall be qualified as such following doctor consults and where the medical experts appointed by the Insurer have recommend so at their sole discretion.

2.3. First aid shall be administered on the scene of the insurance event by paramedics (in the case of ground assistance) or by a medical team (in the case of airborne assistance).
2.4. Transporting the injured shall be organized and coordinated by a 24-hour Call Center operating the 080010200 toll-free hotline.

3. GEOGRAPHICAL COVERAGE

3.1. This insurance shall be valid only for events that have occurred within the territory of the Republic of Bulgaria.

4. CONCLUSION, FORM, TERM OF DURATION, EFFECT, AND TERMINATION OF INSURANCE AGREEMENTS

4.1. Insurance Agreements shall be concluded in writing in the form of an Insurance Policy and shall cover only the risks expressly itemized therein.
4.2. Insurance Agreements shall be concluded on personal basis. Where more than one person is being insured, group policy shall be used. Such policies shall be accompanied by a list containing the full name, PIN, mailing address, telephone number, and е-mail of every one of the insured persons.

4.3. Insurance may be placed by the very person whose health and physical integrity is being insured (the Insured) or on behalf and for the account of a third party (Insuring party).
4.4. The term of duration of Insurance Agreements shall be 1 (one) year unless provided for otherwise.
4.5. Insurance Agreements shall take effect at 00:00 hours on the day stated in the Policy as the effective date, provided the Insured has received full payment of the insurance premium or the first installment thereof in the case of deferred payment, and shall expire at 24:00 hours on the day stated as the expiration date for the Insurance Agreement. The effective date of the policy shall not be any earlier than a day after the date of issuance of the Policy.

4.6. Insurance Agreements can be amended after they have been concluded based on written requests by the Insured. Such amendments shall take effect upon the issuance of a rider.

4.7. If the Insured has knowingly misrepresented or withheld circumstances which, had they been known by the Insurer beforehand, would have prevented the Insurer from concluding the Agreement, the Insurer will be entitled to either terminate the Insurance Agreement or

amend it in accordance with the provisions of Article 190 of the Insurance Code.
4.8. Insurance Agreements shall be terminated upon the expiration of their term of duration, upon reaching the policy payout limit and in the instances provided for in the Insurance Code.

4.8.1. Each party shall be able to terminate the Agreement by sending the other a 15-day Notice of Termination effective as of the day of receipt. The Insured shall not have the right to terminate the Agreement if he has received insurance compensations or if he has pending claims under his current insurance.

4.8.2. Upon termination of the Insurance Agreement, the Insurer shall refund part of the Insurance Premium. The amount to be refunded shall be calculated on a pro-rata basis for the period of time during which the Insurer has actually been liable to pay insurance compensation. This figure shall be further decreased by any administrative and service fees charged by the Insurer pursuant to the terms of the Insurance Agreement.

4.8.3. Irrespective of the duration of the period of time between the effective date and the termination date of the Insurance Policy, the Insurer shall not be liable to refund any insurance premiums if during that same period events have occurred that would suggest that the Insured will file a claim.

5. INSURANCE LIMIT AND INSURANCE PREMIUM

5.1. Insurance Limit is the maximum amount for which the Insurer is liable as set in the Insurance Policy.
5.2. Insurance Limits shall be the same for the main and for the extended coverage.
5.3. Insurance Premiums are calculated based on the Insurer’s Tariff Schedule depending on the level of coverage chosen by the Insured.page1image45664

Premiums shall be paid either as lump sum or in installments. Failure on the part of the Insurer to make good on a premium installment for more than 15 (fifteen) will entitle the Insurer to terminate the Insurance pursuant to a written notice of non performance.

6. EXCLUDED RISKS

Pursuant to the Special Terms and Conditions herewith, the Insurer shall not be liable for events caused or coming as a result of:
6.1. The willful actions of the Insured aimed to cause injuries or disabilities to themselves as well as gross negligence on the part of Insured leading to health deteriorations;

6.2. Suicide or attempted suicide;

6.3. Felony or attempted felony;

6.4. Use of opiates, stimulants, PEDs, or alcohol or any illnesses (addictions) caused by such use; alcohol poisoning and drug abuse; 6.5. Radioactive poisoning;

6.6. Abortion, childbirth, and any complications following such except those caused by an accident;

6.8. Actions by the authorities in response to civil disobedience, insurrection, rebellion, or military actions;

7. RECOGNIZING INSURANCE EVENTS AND INSURANCE COMPENSATION

7.1. Following the occurrence of an insurance event the Insured shall undertake to inform the Insurer of it using the toll-free hotline (0800 10 200) so as to allow the Insurer to implement the necessary emergency procedures to organize and perform the transportation assistance services.
7.2. Where the Insured has provided for his own transportation from the scene of the insurance event (as defined in these Special Terms and Conditions) to the respective healthcare facility, the Insurer shall reimburse the Insured for the transportation costs actually incurred.

To this end the Insured shall raise his claim by filing a written notification at one of the Insurer’s offices within 14 (fourteen) days of the occurrence of the insurance event accompanied with medical documents, documentary evidence of payments made (invoices, receipts, etc.), and the original counterpart or a certified true copy of the Insurance Policy.
In cases such as these the Insurance Compensations shall be paid to the Insured within fifteen days of having submitted any and all documentary evidence related to the costs eligible for reimbursement.

7.3. The insurance coverage under this policy shall be limited to one case of airborne assistance and three cases of ground assistance for the term of duration of the insurance provided the insurance limit stated in the Insurance Policy has not been exceeded. Upon reaching the insurance limit, the Insurer shall inform the insured person at the mailing address provided in the Insurance Policy.

8. RIGHTS AND OBLIGATIONS OF THE PARTIES TO THE INSURANCE AGREEMENT

8.1. Rights of the Insured:

8.1.1. The Insured shall be entitled to increase the insurance coverage level by paying an additional premium;
8.1.2. The Insured shall be entitled to reinstate his insurance, depending on his insurance coverage level, where the insurance limit available to him has been partially impaired;
8.1.3. The Insured shall be entitled to terminate the Insurance Agreement;

8.2. Obligations of the Insured:

8.2.1. The Insured shall be required to pay the Insurance Premium up to the amount and within the deadline stated in the Insurance Policy;
8.2.2. The Insured shall undertake to inform the Insurer of any new development that could change the circumstances under which the Insurance Policy has been issued;

8.2.3. The Insured shall follow the medical prescriptions and instructions issued by the paramedics;

8.3. Rights of the Insurer:

8.3.1. If the obligations under Article 8.2. have not been fulfilled, the Insurer shall be entitled to refuse to help.
8.3.2. Should the Insured fail to fulfill his obligations under Article 8.2.2, the Insurer shall be entitled to refuse or decrease the insurance compensation stated in Article 7.2. of these Special Terms and Conditions;

8.4. Obligations of the Insurer:
8.4.1. The Insurer shall be required to provide the Insured with accurate, competent, full, and true information regarding the terms and conditions of the insurance including the current insurance coverage limit.

9. STATUTE OF LIMITATION AND JURISDICTION

9.1. The rights under the Insurance Agreement shall lapse three years after the occurrence of the insurance event they relate to.
9.2. The affairs between the parties to the insurance shall be settled in accordance with the provisions of the applicable Bulgarian law. All disputes shall be resolved through negotiations and where such negotiations have failed to produce results – by a competent Bulgarian court of law

10. DEFINITIONS

10.1. Accident shall mean an unforeseen event of external nature that has occurred suddenly and against the will and intentions of the Insured.
10.2. Acute Disease shall mean a severe and sudden insurance event causing pain and suffering for the Insured which is a threat to his health and life and requires immediate medical help.

10.3. Assistance shall mean transporting and administering first aid to a person who has been rendered incapable of helping himself by the occurrence of an insurance event.
10.4. First Aid shall mean the implementation of life-saving measures that help stabilize and relieve the condition of the injured until a professional medical team can treat them.

10.5. The term Paramedic shall refer to any person performing the activities they have been trained for as part of the training courses offered at the Bulgarian Red Cross or other licensed organizations granting certificates (in accordance with the applicable law) for administering first aid and implementing life-saving measures for the benefit of injured persons and persons in critical condition on the scene of an accident. 10.6. Far from home – if the person is outside the place of permanent or temporary residence.

These Special Terms and Conditions were adopted by the Board of Directors of ZK LEV INS AD by virtue of the Minutes Protocol for the meeting of June 12, 2014.

LIST

Of medical conditions of acute nature and
And conditions requiring immediate medical attention

Myocardial infarction – newly developed;

Acute heart failure irrespective of the cause;

Stroke – newly developed;

Acute life-threatening intoxications;

Acute respiratory failure;

Foreign material in the respiratory tract;

Bronchial asthma attack;

Compound fracture;

Traumatic injuries of internal organs and the central nervous system;

Severe life-threatening hemorrhage;

Shock and coma by various causes;

Acute cholecystitis and nephrolithiasis;

Acute surgical abdomen.