Employee Benefit Guide Notice of Information

Valid from 1st January 2017

Healthcare Plans for France, Benelux or Monaco

This Benefit Guide sets out the standard benefits and rules of your group health insurance policy. Please read this guide in conjunction with your Insurance Certificate and Table of Benefits.

Your Insurance Certificate details the plan(s) and geographical area of cover that your company has chosen for you and your dependants (if relevant) as well as the start date and renewal date of your cover. For underwritten policies, this document will also state any special terms that apply to your cover. Please note that we will send you a new Insurance Certificate if we need to record any changes requested by your company or which we are entitled to make, or if, with your company’s approval and our acceptance, you request a change such as adding a dependant.

Your Table of Benefits outlines the plan(s) selected by your company and the associated benefits available to you. In addition, it specifies any benefits/treatments which require submission of a Treatment Guarantee Form and confirms any benefits to which specific benefit limits, waiting periods, deductibles and/or co-payments apply. Your Table of Benefits will be issued using the currency agreed with your company (or with you, if you pay for the insurance premium).

For full details of your company’s insurance contract, please contact your company’s Group Scheme Manager. Please note that the terms and conditions of your membership may be changed from time to time by agreement between your company and Allianz Worldwide Care.

Your healthcare cover

AWP Health & Life SA is regulated by the French Prudential Supervisory Authority located at 61, rue Taitbout, 75436 Paris Cedex 09, France.

AWP Health & Life SA, acting through its Irish Branch, is a limited company governed by the French Insurance Code. Registered in France: No. 401 154 679 RCS Nanterre. Irish Branch registered in the Irish Companies Registration Office, registered No.: 907619, address: 15 Joyce Way, Park West Business Campus, Nangor Road, Dublin 12, Ireland. Allianz Worldwide Care is a registered business name of AWP Health & Life SA.

Table of contents

Your cover 2-3

Definitions 4-12

Exclusions 13-17

Additionalterms 18-20

Generalinformation 21-30

Quickstartguide Detachablesection• Gettingtreatment • Usefulservices • Contactdetails

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Your cover

Wewouldliketobringyourattentiontothefollowingimportantpoints:

Benefitlimits

TherearetwokindsofbenefitlimitsshownintheTableofBenefits.Themaximum plan benefit, whichappliestocertainplans,isthemaximumwewillpayforallbenefitsintotal,permember,perInsuranceYear,underthatparticularplan.Somebenefitsalsohaveaspecific benefit limit,whichmaybeprovidedona“perInsuranceYear”basis,a“perlifetime”basisorona“perevent”basis,suchaspertrip,pervisitorperpregnancy.Insomeinstanceswewillpayapercentageofthecostsforthespecificbenefite.g.“65%refund,upto£4,150/€5,000/US$6,750/CHF6,500”.Whereaspecificbenefitlimitappliesorwheretheterm“Fullrefund”appearsnexttocertainbenefits,therefundissubjecttothemaximumplanbenefit,ifoneappliestoyourplan(s).Alllimitsarepermember,perInsuranceYear,unlessotherwisestatedinyourTableofBenefits.

Benefitlimitsfor“Routinematernity”and“Complicationsofpregnancyandchildbirth”arepayableoneithera“perpregnancy”or“perInsuranceYear”basis(thiswillbeconfirmedinyourTableofBenefits).Ifyourbenefitispayableona“perpregnancy”basisandapregnancyspanstwoInsuranceYears,pleasenotethatifachangeisappliedtothebenefitlimitatpolicyrenewal,thefollowingwillapply:

• Alleligibleexpensesincurredinthefirstyearwillbesubjecttothebenefitlimitthatappliesinyearone.

Overview

YourTableofBenefitsspecifiestheplan(s)selectedbyyourcompanyandtheassociatedbenefitsavailabletoyou.ThiscouldbeoneofourstandardCorePlans,whichmighthavebeenchosenincombinationwithoneofourstandardOut-patient,DentalorRepatriationPlans,oryourplanmayhavebeendesignedspecificallyforyourcompany.Coverissubjecttoourpolicydefinitions,exclusionsandbenefitlimitsandforunderwrittengroups,coverisalsosubjecttoanyspecialconditionsindicatedontheInsuranceCertificate(andontheSpecialConditionsFormissuedpriortopolicyinception).

Youwillfindfurtherdetailsaboutourbenefits inthe“Definitions”sectionofthisguide,howeverifyouhaveanyqueriesregardingwhatyouarecoveredfor,pleasedonothesitatetocallus.

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• Alleligibleexpensesincurredinthesecondyearwillbesubjecttotheupdatedbenefitlimitthatappliesinyeartwo,lessthetotalbenefitamountreimbursedinyearone.

• Intheeventthatthebenefitlimitdecreasesinyeartwoandthisupdatedamounthasbeenreachedorexceededbyeligiblecostsincurredinyearone,noadditionalbenefitamountwillbepayable.

Formultiplebirthbabiesbornasaresultofmedicallyassistedreproduction,in-patienttreatment islimitedto£24,900/€30,000/US$40,500/CHF39,000perchildforthefirstthreemonthsfollowingbirth.Out-patienttreatmentispaidwithinthetermsoftheOut-patientPlan.

Medicalnecessityandcustomarycharges

Thispolicyprovidescoverformedicaltreatment,relatedcosts,servicesand/orsuppliesthatwedeterminetobemedicallynecessaryandappropriatetotreatapatient’scondition,illnessorinjury.Pluswewillonlyreimbursemedicalproviderswheretheirchargesarereasonableandcustomaryinaccordancewithstandardandgenerallyacceptedmedicalprocedures.Ifthecostsofaclaimaredeemedbyustobetoohigh,ortheclaimisnotdeemedtobemedicallynecessarywereservetherighttoreducetheamountpayablebyus.

Pre-existingconditions

Pre-existingconditionsaremedicalconditionsoranyrelatedconditionsforwhichoneormoresymptomshavebeendisplayedatsomepointduringyourlifetime, irrespectiveofwhetheranymedicaltreatmentoradvicewassought.Anysuchconditionorrelatedconditionaboutwhichyouoryourdependantscouldreasonablyhavebeenassumedtohaveknownbeforethestartdateofthepolicy,willbedeemedtobepre-existing.

Pre-existingconditions(includinganypre-existingchronicconditions)arecoveredwithinthelimitsofyourplan(s).

AlltreatmentsarecoveredinlinewiththosetreatmentscoveredbytheFrenchSocialSecuritySystem,forinsuredpersonswhoareaffiliatedtotheFrenchSocialSecuritySystem.

1.1 Accident isasuddenunexpectedeventwhichcauses injuryand isduetoacauseexternal to the insuredperson.Thecauseandsymptomsmustbemedicallyandobjectivelydefinable,allowforadiagnosisandrequiretherapy.

1.2 Accidental death benefitreferstoanamountshownintheTableofBenefitswhichshallbecomepayableifaninsuredperson(aged18to70)passesawayduringtheperiodofinsuranceasaresultofanaccident(includingindustrialinjury).

1.3 Accommodation costs for one parent staying in hospital with an insured child refer to thehospitalaccommodationcostsofoneparentforthedurationoftheinsuredchild’sadmissiontohospitalforeligibletreatment.Ifasuitablebedisnotavailableinthehospital,wewillcontributetheequivalentofathreestarhoteldailyroomratetowardsanyhotelcostsincurred.Wewillnot,however,coversundryexpensesincluding,butnotlimitedto,meals,telephonecallsornewspapers.PleasecheckyourTableofBenefitstoconfirmwhetheranagelimitapplieswithregardtoyourchild.

1.4 Acute referstosuddenonset.

1.5 Chronic conditionisdefinedasasickness,illness,diseaseorinjurywhichhasoneormoreofthefollowingcharacteristics:

• Isrecurrentinnature.• Iswithoutaknown,generallyrecognisedcure.• Isnotgenerallydeemedtorespondwelltotreatment.• Requirespalliativetreatment.• Requiresprolongedsupervisionormonitoring.• Leadstopermanentdisability.

1.6 CompanyisyouremployerwhosenameismentionedintheCompanyAgreement.

1.7 Company Agreementistheagreementwehavewithyouremployer,whichallowsyouandyourdependantstobeinsuredwithus.Thisagreementsetsoutwhocanbecovered,whencoverbegins,howitisrenewedandhowpremiumsarepaid.

1.8 Complementary treatment referstotherapeuticanddiagnostictreatmentthatexistsoutsidetheinstitutionswhere conventional Western medicine is taught. Such medicine only includes chiropractic treatment,osteopathy, Chinese herbalmedicine, homeopathy, acupuncture and podiatry as practiced by approvedtherapists.

1.9 Complications of childbirthreferonlytothefollowingconditionsthatariseduringchildbirthandthatrequirearecognisedobstetricprocedure:post-partumhaemorrhageandretainedplacentalmembrane.Wheretheinsured’splanalsoincludesaroutinematernitybenefit,complicationsofchildbirthshallalsorefertomedicallynecessarycaesareansections.

DefinitionsThe following definitions apply to the benefits included in our range of Healthcare Plans and to some other commonly used terms. The benefits you are covered for are listed in your Table of Benefits. If any unique benefits apply to your plan(s), the definition will appear in the “Notes” section at the end of your Table of Benefits. Wherever the following words/phrases appear in your policy documents, they will always be defined as follows:

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1.10 Complications of pregnancyrelatetothehealthofthemother.Onlythefollowingcomplicationsthatariseduringthepre-natalstagesofpregnancyarecovered:ectopicpregnancy,gestationaldiabetes,pre-eclampsia,miscarriage,threatenedmiscarriage,stillbirthandhydatidiformmole.

1.11 Co-paymentisthepercentageofthecostswhichtheinsuredpersonmustpay.Theseapplyperperson,perInsuranceYear,unless indicatedotherwise in theTableofBenefits. Someplansmay includeamaximum co-paymentperinsuredperson,perInsuranceYear,andifso,theamountwillbecappedattheamountstatedinyourTableofBenefits.Co-paymentsmayapplyindividuallytotheCore,Out-patient,Dental,MaternityorRepatriationPlans,ortoacombinationoftheseplans.

1.12 Day-care treatment isplannedtreatmentreceivedinahospitalorday-carefacilityduringtheday,includingahospitalroomandnursing,thatdoesnotmedicallyrequirethepatienttostayovernightandwhereadischargenoteisissued.

1.13 Deductible is thatpartofthecostwhichremainspayablebyyouandwhichhastobedeductedfromthereimbursablesum.Whereapplied,deductiblesarepayableperpersonperInsuranceYear,unlessindicatedotherwiseintheTableofBenefits.DeductiblesmayapplyindividuallytotheCore,Out-patient,Dental,MaternityorRepatriationPlans,ortoacombinationoftheseplans.

1.14 Dental prescription drugs are thoseprescribedbyadentist for the treatmentof adental inflammationorinfection.Theprescriptiondrugsmustbeproventobeeffectivefortheconditionandrecognisedbythepharmaceuticalregulatorinagivencountry.Thisdoesnotincludemouthwashes,fluorideproducts,antisepticgelsandtoothpastes.

1.15 Dental prosthesesincludecrowns,inlays,onlays,adhesivereconstructions/restorations,bridges,denturesandimplantsaswellasallnecessaryandancillarytreatmentrequired.

1.16 Dental surgery includesthesurgicalextractionofteeth,aswellasothertoothrelatedsurgicalproceduressuchasapicoectomyanddentalprescriptiondrugs.Allinvestigativeproceduresnecessarytoestablishtheneedfordentalsurgerysuchaslaboratorytests,X-rays,CTscansandMRI(s)areincludedunderthisbenefit.Dentalsurgerydoesnotcoveranysurgicaltreatmentthatisrelatedtodentalimplants

1.17 Dental treatment includesanannualcheckup,simplefillingsrelatedtocavitiesordecay,rootcanaltreatmentanddentalprescriptiondrugs.

1.18 Dependantisyourspouseorpartner(includingsamesexpartner)and/orunmarriedchildren(includinganystep, fosteroradoptedchildren)financiallydependanton thepolicyholderup to thedaybefore their18th birthday;oruptothedaybeforetheir24thbirthdayifinfulltimeeducation,andalsonamedinyourInsuranceCertificateasoneofyourdependants.

1.19 Diagnostic testsareinvestigationssuchasx-raysorbloodtests,undertakeninordertodeterminethecauseofthepresentedsymptoms.

1.20 Dietician fees relate tocharges fordietaryornutritionaladviceprovidedbyahealthprofessionalwho isregisteredandqualifiedtopracticeinthecountrywherethetreatmentisreceived.Ifincludedinyourplan,coverisonlyprovidedinrespectofdiagnosedmedicalconditions.

1.21 Direct family history existswhereaparent,grandparent,siblingorchildhasbeenpreviouslydiagnosedwiththemedicalconditioninquestion.

1.22 Emergencyconstitutestheonsetofasuddenandunforeseenmedicalconditionthatrequiresurgentmedicalassistance.Onlytreatmentcommencingwithin24hoursoftheemergencyeventwillbecovered.

1.23 Emergency in-patient dental treatmentreferstoacuteemergencydentaltreatmentduetoaseriousaccidentrequiringhospitalisation.Thetreatmentmustbereceivedwithin24hoursoftheaccident.Pleasenotethatcoverunderthisbenefitdoesnotextendtofollow-updentaltreatment,dentalsurgery,dentalprostheses,orthodonticsorperiodontics.Ifcoverisprovidedforthesebenefits,itwillbelistedseparatelyintheTableofBenefits.

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1.24 Emergency out-patient dental treatment istreatmentreceivedinadentalsurgery/hospitalemergencyroomfortheimmediatereliefofdentalpaincausedbyanaccidentoraninjurytoasoundnaturaltooth,includingpulpotomyorpulpectomyandthesubsequenttemporaryfillingslimitedtothreefillingsperInsuranceYear.Thetreatmentmustbereceivedwithin24hoursoftheaccident.Thisdoesnot includeanyformofdentalprostheses,permanentrestorationsorthecontinuationofrootcanaltreatment.IfyourcompanyalsoselectedaDentalPlanforyou,youwillbecoveredunderthetermsofthisplanfordentaltreatmentinexcessofthe(CorePlan)emergencyout-patientdentaltreatmentbenefitlimit.

1.25 Emergency out-patient treatment istreatmentreceivedinacasualtyward/emergencyroomwithin24hoursofanaccidentorsuddenillness,wheretheinsureddoesnot,outofmedicalnecessity,occupyahospitalbed. IfyourcompanyalsoselectedanOut-patientPlanforyou,youarecoveredunderthetermsofthisplanfor out-patienttreatmentinexcessofthe(CorePlan)emergencyout-patienttreatmentbenefitlimit.

1.26 Emergency treatment outside area of cover is treatment formedicalemergencieswhichoccurduringbusinessorholidaytripsoutsideyourareaofcover.Coverisprovideduptoamaximumperiodofsixweekspertripwithinthemaximumbenefitamountandincludestreatmentrequiredintheeventofanaccident,orthesuddenbeginningorworseningofasevereillnesswhichpresentsanimmediatethreattoyourhealth.Treatmentbyaphysician,medicalpractitionerorspecialistmustcommencewithin24hoursoftheemergencyevent.Coverisnotprovidedforanycurativeorfollow-upnon-emergencytreatment,evenifyouaredeemedunable to travel toacountrywithinyourgeographicalareaofcover,nordoes itcovercharges relating tomaternity,pregnancy, childbirthor any complicationsofpregnancyor childbirth.You shouldadvise yourcompany’sGroupSchemeManagerifyouaremovingoutsideyourareaofcoverformorethansixweeks.

1.27 Expenses for one person accompanying an evacuated/repatriated personrefertothecostofonepersontravellingwiththeevacuated/repatriatedperson.Ifthiscannottakeplaceinthesametransportationvehicle,transportateconomyrateswillbepaidfor.Followingcompletionoftreatment,wewillalsocoverthecostofthereturntrip,ateconomyrates,fortheaccompanyingpersontoreturntothecountryfromwheretheevacuation/repatriationoriginated.Coverdoesnotextendtohotelaccommodationorotherrelatedexpenses.

1.28 Family historyexistswhereaparent,grandparent,sibling,child,auntorunclehasbeenpreviouslydiagnosedwiththemedicalconditioninquestion.

1.29 Group Scheme Manageristhedesignatedrepresentativeofthecompanyactingasthekeypointofcontactbetweenthecompanyandusformattersrelatingtotheadministrationoftheplansuchasenrolment,premiumcollectionandrenewal.

1.30 Health and wellbeing checks including screening for the early detection of illness or diseasearehealthchecks,testsandexaminations,performedatanappropriateageinterval,thatareundertakenwithoutanyclinicalsymptomsbeingpresent.Checksarelimitedto:

• Physicalexamination.• Bloodtests(fullbloodcount,biochemistry, lipidprofile,thyroidfunctiontest, liverfunctiontest,kidney

functiontest).• Cardiovascularexamination(physicalexamination,electrocardiogram,bloodpressure).• Neurologicalexamination(physicalexamination).• Cancerscreening:

-Annualpapsmear.-Mammogram(everytwoyearsforwomenaged45+,orearlierwhereafamilyhistoryexists).-Prostatescreening(yearlyformenaged50+,orearlierwhereafamilyhistoryexists).-Colonoscopy(everyfiveyearsformembersaged50+,or40+whereafamilyhistoryexists).-Annualfaecaloccultbloodtest.-Bonedensitometry(everyfiveyearsforwomenaged50+).

• Wellchildtest(forchildrenuptotheageofsixyears,uptoamaximumof15visitsperlifetime).

1.31 Home countryisacountryforwhichtheinsuredpersonholdsacurrentpassportoristheirprincipalcountryofresidence.

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AllianzWorldwideCareDefinitions

1.32 Hospital isanyestablishmentwhichislicensedasamedicalorsurgicalhospitalinthecountrywhereitoperatesandwherethepatientispermanentlysupervisedbyamedicalpractitioner.Thefollowingestablishmentsarenotconsideredhospitals:restandnursinghomes,spas,cure-centresandhealthresorts.

1.33 Hospital accommodationreferstostandardprivateorsemi-privateaccommodationasindicatedintheTableofBenefits.Deluxe,executiveroomsandsuitesarenotcovered.Pleasenotethatthehospitalaccommodationbenefitonlyapplieswherenootherbenefitincludedinyourplancoverstherequiredin-patienttreatment.Inthiscase,hospitalaccommodationcostswillbecoveredunderthemorespecificin-patientbenefit,uptothebenefitlimitstated.Psychiatryandpsychotherapy,organtransplant,oncology,routinematernity,palliativecareandlongtermcareareexamplesofin-patientbenefitswhichincludecoverforhospitalaccommodationcosts,uptothebenefitlimitstated,whereincludedinyourplan.

1.34 Infertility treatmentreferstotreatmentfortheinsuredpersonincludingallinvasiveinvestigativeproceduresnecessary toestablish the cause for infertility suchashysterosalpingogram, laparoscopyorhysteroscopy. IfyourTableofBenefitsdoesnothaveaspecificbenefitforinfertilitytreatment,coverislimitedtonon-invasiveinvestigationsintothecauseofinfertility,withinthelimitsofyourOut-patientPlan(ifyourcompanyselectedone).Ifhowever,thereisaspecificbenefitforinfertilitytreatment,thecostforinfertilitytreatmentwillbecoveredfortheinsuredmemberwhoreceivesthetreatment,uptothelimitindicatedintheTableofBenefits.Anycostsexceedingthebenefitlimitcannotbeclaimedunderthecoverofthespouse/partner(ifincludedinthepolicy).InthecaseofInVitroFertilisation(IVF),coverislimitedtotheamountspecifiedintheTableofBenefits.Pleasenotethatformultiplebirthbabiesbornasaresultofmedicallyassistedreproduction,in-patienttreatmentislimitedto£24,900/€30,000/US$40,500/CHF39,000perchildforthefirstthreemonthsfollowingbirth.Out-patienttreatmentispaidwithinthetermsoftheOut-patientPlan.

1.35 In-patient cash benefit ispayablewhentreatmentandaccommodationforamedicalcondition,thatwouldotherwisebecoveredundertheinsured’splan,isprovidedinahospitalwherenochargesarebilled.CoverislimitedtotheamountandthemaximumnumberofnightsspecifiedintheTableofBenefitsandispayableupondischargefromhospital.

1.36 In-patient treatmentreferstotreatmentreceivedinahospitalwhereanovernightstayismedicallynecessary.

1.37 Insurance Certificateisadocumentoutliningthedetailsofyourcoverandisissuedbyus.Itconfirmsthataninsurancerelationshipexistsbetweenyourcompanyandus.

1.38 Insurance Yearappliesfromtheeffectivedateoftheinsurance,asindicatedontheInsuranceCertificateandendsattheexpirydateoftheCompanyAgreement.ThefollowingInsuranceYearcoincideswiththeyeardefinedintheCompanyAgreement.

1.39 Insured personisyouandyourdependantsasstatedonyourInsuranceCertificate.

1.40 Laser eye treatment refers to thesurgical improvementof the refractivequalityof thecorneausing lasertechnology,includingnecessarypre-operativeinvestigations.

1.41 Local ambulanceisambulancetransportrequiredforanemergencyoroutofmedicalnecessity,tothenearestavailableandappropriatehospitalorlicensedmedicalfacility.

1.42 Long term care referstocareoveranextendedperiodoftimeaftertheacutetreatmenthasbeencompleted,usuallyforachronicconditionordisabilityrequiringperiodic,intermittentorcontinuouscare.Longtermcarecanbeprovidedathome,inthecommunity,inahospitalorinanursinghome.

1.43 Medical evacuation applieswhere thenecessary treatment forwhich the insuredperson iscovered isnotavailablelocallyorifadequatelyscreenedbloodisunavailableintheeventofanemergency.Wewillevacuatetheinsuredpersontothenearestappropriatemedicalcentre(whichmayormaynotbelocatedintheinsuredperson’s home country) by ambulance, helicopter or aeroplane. Themedical evacuation,which should berequestedby yourphysician,will be carriedout in themost economicalwayhaving regard to themedicalcondition.Followingcompletionoftreatment,wewillalsocoverthecostofthereturntrip,ateconomyrates,fortheevacuatedmembertoreturntohis/herprincipalcountryofresidence.

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Ifmedicalnecessitypreventstheinsuredpersonfromundertakingtheevacuationortransportationfollowingdischargefroman in-patient episode of care,wewillcoverthereasonablecostofhotelaccommodationuptoamaximumofsevendays,comprisingofaprivateroomwithen-suitefacilities,uptotheamountsspecifiedintheTableofbenefits.Wedonotcovercostsforhotelsuites,fourorfivestarhotelaccommodationorhotelaccommodationforanaccompanyingperson.

Whereaninsuredpersonhasbeenevacuatedtothenearestappropriatemedicalcentreforongoing treatment, wewillagreetocoverthereasonablecostofhotelaccommodationcomprisingofaprivateroomwithen-suitefacilitiesuptotheamountsspecifiedintheTableofBenefits.Thecostofsuchaccommodationmustbemoreeconomicalthansuccessivetransportationcoststo/fromthenearestappropriatemedicalcentreandtheprincipalcountryofresidence.Hotelaccommodationforanaccompanyingpersonisnotcovered.

Whereadequatelyscreenedbloodisnotavailablelocally,wewill,whereappropriate,endeavourtolocateandtransportscreenedbloodandsteriletransfusionequipment,wherethisisadvisedbythetreatingphysician.Wewillalsoendeavourtodothiswhenourmedicalexpertssoadvise.AllianzWorldwideCareanditsagentsacceptnoliabilityintheeventthatsuchendeavoursareunsuccessfulorintheeventthatcontaminatedbloodorequipmentisusedbythetreatingauthority.

MembersmustcontactAllianzWorldwideCareatthefirstindicationthatanevacuationisrequired.FromthispointonwardsAllianzWorldwideCarewillorganiseandcoordinateallstagesoftheevacuationuntiltheinsuredpersonissafelyreceivedintocareattheirdestination.IntheeventthatevacuationservicesarenotorganisedbyAllianzWorldwideCare,wereservetherighttodeclineallcostsincurred.

1.44 Medical necessity refers tomedical treatment, servicesor supplies that aredetermined tobemedicallynecessaryandappropriate.Theymustbe:

(a)Essentialtoidentifyortreatapatient’scondition,illnessorinjury.(b)Consistentwiththepatient’ssymptoms,diagnosisortreatmentoftheunderlyingcondition.(c)Inaccordancewithmedicaland/orscientificknowledgeatthetimeoftreatment.(d)Requiredforreasonsotherthanthecomfortorconvenienceofthepatientorhis/herphysician.(e)Provenanddemonstratedtohavemedicalvalue.(f)Consideredtobethemostappropriatetypeandlevelofserviceorsupply.(g)Providedatanappropriatefacility, inanappropriatesettingandatanappropriate levelofcareforthe

treatmentofapatient’smedicalcondition.(h)Providedonlyforanappropriatedurationoftime.

Inthisdefinition,theterm“appropriate”meanstakingpatientsafetyandcosteffectivenessintoconsideration.Whenspecificallyappliedtoin-patienttreatment,medicallynecessaryalsomeansthatdiagnosiscannotbemade,ortreatmentcannotbesafelyandeffectivelyprovidedonanout-patientbasis.

1.45 Medical practitionerisaphysicianwhoislicensedtopracticemedicineunderthelawofthecountryinwhichtreatmentisgivenandwherehe/sheispractisingwithinthelimitsofhis/herlicence.

1.46 Medical practitioner fees refer to non-surgical treatment performed or administered by a medicalpractitioner.

1.47 Medical repatriationisanoptionallevelofcoverandwhereprovidedwillbeshownintheTableofBenefits.Thisbenefitmeansthatifthenecessarytreatmentforwhichyouarecoveredisnotavailablelocallyyoucanchoosetobemedicallyevacuatedtoyourhomecountryfortreatment,insteadoftothenearestappropriatemedicalcentre.Thisonlyapplieswhenyourhomecountryislocatedwithinyourgeographicalareaofcover.Followingcompletionoftreatment,wewillalsocoverthecostofthereturntrip,ateconomyrates,toyourprincipalcountryofresidence.Thereturnjourneymustbemadewithinonemonthaftertreatmenthasbeencompleted.

MembersmustcontactAllianzWorldwideCareatthefirstindicationthatrepatriationisrequired.FromthispointonwardsAllianzWorldwideCarewillorganiseandcoordinateall stagesof the repatriationuntil theinsuredpersonissafelyreceivedintocareattheirdestination.IntheeventthatrepatriationservicesarenotorganisedbyAllianzWorldwideCare,wereservetherighttodeclineallcostsincurred.

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AllianzWorldwideCareDefinitions

1.48 Midwife feesrefertofeeschargedbyamidwifeorbirthassistant,who,accordingtothelawofthecountryinwhichtreatmentisgiven,hasfulfilledthenecessarytrainingandpassedthenecessarystateexaminations.

1.49 Newborn care includescustomaryexaminationsrequiredtoassesstheintegrityandbasicfunctionofthechild’sorgansandskeletalstructures.Theseessentialexaminationsarecarriedoutimmediatelyfollowingbirth.Unlessthechildisincludedonthepolicyasaneligibledependant,furtherpreventivediagnosticprocedures,suchasroutineswabs,bloodtypingandhearingtests,arenotcovered.Anymedicallynecessaryfollow-upinvestigationsandtreatmentarecoveredunderthenewborn’sownpolicy.Pleasenotethatformultiplebirthbabiesbornasaresultofmedicallyassistedreproduction,in-patienttreatmentislimitedto£24,900/€30,000/US$40,500/CHF39,000perchildforthefirstthreemonthsfollowingbirth.Out-patienttreatmentispaidwithinthetermsoftheOut-patientPlan.

1.50 Non-prescribed physiotherapyreferstotreatmentbyaregisteredphysiotherapistwherereferralbyamedicalpractitionerhasnotbeenobtainedpriortoundergoingtreatment.Wherethisbenefitapplies,coverislimitedtothenumberofsessionsindicatedinyourTableofBenefits.Additionalsessionsrequiredoverandabovethislimitmustbeprescribedinorderforcovertocontinue;thesesessionswillbesubjecttotheprescribedphysiotherapybenefitlimit.Physiotherapy(eitherprescribed,oracombinationofnon-prescribedandprescribedtreatment)isinitiallyrestrictedto12sessionspercondition,afterwhichthetreatmentmustbereviewedbythereferringmedicalpractitioner.Shouldfurthersessionsberequired,aprogressreportmustbesubmittedtous,whichindicatesthemedicalnecessityforanyfurthertreatment.PhysiotherapydoesnotincludetherapiessuchasRolfing,Massage,Pilates,FangoandMiltatherapy.

1.51 Nursing at home or in a convalescent home referstonursingreceivedimmediatelyafter,or insteadof,eligiblein-patientorday-caretreatment.WewillonlypaythebenefitlistedintheTableofBenefitswherethetreatingdoctordecides(andourMedicalDirectoragrees)thatitismedicallynecessaryfortheinsuredpersontostayinaconvalescenthomeorhaveanurseinattendanceathome.Coverisnotprovidedforspas,curecentresandhealthresortsorinrelationtopalliativecareorlongtermcare(seedefinitions1.63and1.42).

1.52 ObesityisdiagnosedwhenapersonhasaBodyMassIndex(BMI)ofover30(aBMIcalculatorcanbefoundonourwebsite:www.allianzworldwidecare.com).

1.53 Occupational therapyreferstotreatmentthataddressestheindividual’sdevelopmentoffineandgrossmotorskills,sensoryintegration,coordination,balanceandotherskillssuchasdressing,eatingandgrooming,etc.inordertoaiddailylivingandimproveinteractionswiththephysicalandsocialworld.Aprogressreport isrequiredafter20sessions.

1.54 Oculomotor therapyisaspecifictypeofoccupationaltherapythataimstosynchroniseeyemovementincaseswherethereisalackofcoordinationbetweenthemusclesoftheeye.

1.55 Oncologyreferstospecialistfees,diagnostictests,radiotherapy,chemotherapyandhospitalchargesincurredinrelationtotheplanningandcarryingoutoftreatmentforcancer,fromthepointofdiagnosis.Wewillalsocoverthecostofawigintheeventofhairlossasaresultofcancertreatment.

1.56 Oral and maxillofacial surgical proceduresrefertosurgicaltreatmentperformedbyanoralandmaxillofacialsurgeoninahospitalasatreatmentfor:oralpathology,temporomandibularjointdisorders,facialbonefractures,congenitaljawdeformities,salivaryglanddiseasesandtumours.Pleasenotethatsurgicalremovalofimpactedteeth, the surgical removal of cysts andorthognathic surgeries for the correctionofmalocclusion, even ifperformedbyanoralandmaxillofacialsurgeon,arenotcoveredunlessaDentalPlanhasalsobeenselected.

1.57 Organ transplantisthesurgicalprocedureinperformingthefollowingorganand/ortissuetransplants:heart,heart/valve,heart/lung,smallintestine,liver,pancreas,pancreas/kidney,kidney,bonemarrow,parathyroid,skin/muscular/skeletal and cornea transplants. Expenses incurred in the acquisition of organs are notreimbursable.

1.58 Orthodontics istheuseofdevicestocorrectmalocclusionandrestoretheteethtoproperalignmentandfunction.Weonlycoverorthodontictreatmentwherethestandardmetallicbracesand/orstandardremovableappliancesareused.Cosmeticappliancessuchaslingualbracesandinvisiblealignersarecovereduptothecostofmetallicbraces,subjecttothe“Orthodontictreatmentanddentalprostheses”benefitlimit.

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1.59 Orthomolecular treatment referstotreatmentwhichaimstorestoretheoptimumecologicalenvironmentforthebody’scellsbycorrectingdeficienciesonthemolecularlevelbasedonindividualbiochemistry.Itusesnaturalsubstancessuchasvitamins,minerals,enzymesandhormones.

1.60 Out-patient surgeryisasurgicalprocedureperformedinasurgery,hospital,day-carefacilityorout-patientdepartmentthatdoesnotrequirethepatienttostayovernightoutofmedicalnecessity.

1.61 Out-patient treatment refers to treatmentprovided in thepracticeor surgeryofamedicalpractitioner,therapistorspecialistthatdoesnotrequirethepatienttobeadmittedtohospital.

1.62 Over-the-counter drugsrefertomedicationwhichcanbepurchasedinapharmacywithoutaprescription.Thedrugsmustbeclinicallyproventobeeffectivefortheconditionandrecognisedbythepharmaceuticalregulatorinagivencountry.

1.63 Palliative care referstoongoingtreatmentaimedatalleviatingthephysical/psychologicalsufferingassociatedwithprogressive,incurableillnessandmaintainingqualityoflife.Itincludesin-patient,day-careorout-patienttreatmentfollowingthediagnosisthattheconditionisterminalandtreatmentcannolongerbeexpectedtocure thecondition.Wewill alsopay forphysicalcare,psychologicalcareaswellashospitalorhospiceaccommodation,nursingcareandprescriptiondrugs.

1.64 Periodonticsreferstodentaltreatmentrelatedtogumdisease.

1.65 Post-natal carereferstothepost-partummedicalcarereceivedbythemother,uptosixweeksafterdelivery.

1.66 Pre-existing conditionsaremedicalconditionsoranyrelatedconditionsforwhichoneormoresymptomshavebeendisplayedatsomepointduringyourlifetime,irrespectiveofwhetheranymedicaltreatmentoradvicewassought.Anysuchconditionorrelatedconditionaboutwhichyouoryourdependantscouldreasonablyhavebeenassumedtohaveknownbefore thestartdateof thepolicy,willbedeemedtobepre-existing.Conditionsarisingbetweencompletingtherelevantapplicationformandthestartdateofthepolicywillequallybedeemedtobepre-existing.Suchpre-existingconditionswillalsobesubjecttomedicalunderwritingandifnotdisclosed,theywillnotbecovered.

1.67 Pregnancyreferstotheperiodoftimefromconceptiontodelivery.

1.68 Pre-natal careincludescommonscreeningandfollowuptestsasrequiredduringapregnancy.Forwomenaged35andover,thisincludesTriple/Bart’s,QuadrupleandSpinaBifidatests,amniocentesisandDNA-analysis,ifdirectlylinkedtoaneligibleamniocentesis.

1.69 Prescribed ancillary nursing care referstoservicesmedicallyprescribedandcarriedoutbyaqualifiednurseathomeorinanappropriatemedicalcentreonanOut-patientbasis.Thisincludesbutisnotlimitedto,actssuchasdressingchangesorinsulininjections.Onlyactsthataredeemedtobemedicallynecessarywillbecovered.

1.70 Prescribed drugs refertoproductsprescribedbyaphysicianforthetreatmentofaconfirmeddiagnosisormedicalcondition,ortocompensatevitalbodilysubstancesincluding,butnotlimitedto,insulin,hypodermicneedlesor syringes. Theprescribeddrugsmustbe clinicallyproven tobeeffective for the conditionandrecognisedbythepharmaceuticalregulator inagivencountry.Prescribeddrugsdonot legallyhavetobeprescribedbyaphysicianinordertobepurchasedinthecountrywheretheinsuredpersonislocated;however,aprescriptionmustbeobtainedforthesecoststobeconsideredeligible.

1.71 Prescribed glasses and contact lenses including eye examinationrefertocoverforoneeyeexaminationperInsuranceYear,carriedoutbyanoptometristorophthalmologistandforlensesorglassestocorrectvision.

1.72 Prescribed medical aidsrefertoanydevicewhichisprescribedandmedicallynecessarytoenabletheinsuredpersontofunctiontoacapacityconsistentwitheverydaylivingwherereasonablypossible.Thisincludes:

• Biochemicalaidssuchasinsulinpumps,glucosemetersandperitonealdialysismachines.• Motionaidssuchascrutches,wheelchairs,orthopaedicsupports/braces,artificiallimbsandprostheses.

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AllianzWorldwideCareDefinitions

• Hearingandspeakingaidssuchasanelectroniclarynx.• Medicallygraduatedcompressionstockings.• Longtermwoundaidssuchasdressingsandstomasupplies.

Costsformedicalaidsthatformpartofpalliativecareorlongtermcare(seedefinitions1.63and1.42)arenotcovered.

1.73 Prescribed physiotherapyreferstotreatmentbyaregisteredphysiotherapistfollowingreferralbyamedicalpractitioner.Physiotherapyisinitiallyrestrictedto12sessionspercondition,afterwhichthetreatmentmustbereviewedbythereferringmedicalpractitioner.Shouldfurthersessionsberequired,anewprogressreportmustbesubmittedtousaftereverysetof12sessions,whichindicatesthemedicalnecessityforanyfurthertreatment.PhysiotherapydoesnotincludetherapiessuchasRolfing,Massage,Pilates,FangoandMiltatherapy.

1.74 Prescription drugs refertoproducts,including,butnotlimitedto,insulin,hypodermicneedlesorsyringes,whichrequireaprescriptionforthetreatmentofaconfirmeddiagnosisormedicalconditionortocompensatevitalbodilysubstances.Theprescriptiondrugsmustbeclinicallyproventobeeffectivefortheconditionandrecognisedbythepharmaceuticalregulatorinagivencountry.

1.75 Preventative treatment referstotreatmentthatisundertakenwithoutanyclinicalsymptomsbeingpresentatthetimeoftreatment.Anexampleofsuchtreatmentistheremovalofapre-cancerousgrowth.

1.76 Principal country of residenceisthecountrywhereyouandyourdependants(ifrelevant)liveformorethansixmonthsoftheyear.

1.77 Psychiatry and psychotherapyisthetreatmentofmentaldisorderscarriedoutbyapsychiatristorclinicalpsychologist. The conditionmustbe clinically significant andnot related tobereavement, relationshiporacademicproblems,acculturationdifficultiesorworkpressure.Allday-careor in-patientadmissionsmustinclude prescriptionmedication related to the condition. Psychotherapy treatment (on an in-patient or out-patientbasis)isonlycoveredwhereyouoryourdependantsareinitiallydiagnosedbyapsychiatristandreferred toa clinicalpsychologist for further treatment. Inaddition,out-patientpsychotherapy treatment(wherecovered)isinitiallyrestrictedto10sessionspercondition,afterwhichtreatmentmustbereviewedbythereferringpsychiatrist.Shouldfurthersessionsberequired,aprogressreportmustbesubmittedtous,whichindicatesthemedicalnecessityforanyfurthertreatment.

1.78 Rehabilitation is treatment in the formofacombinationof therapiessuchasphysical,occupationalandspeechtherapyandisaimedattherestorationofanormalformand/orfunctionafteranacuteillness,injuryorsurgery.Therehabilitationbenefitisonlypayablefortreatmentthatstartswithin14daysofdischargeaftertheacutemedicaland/orsurgicaltreatmentceasesandwhereittakesplaceinalicensedrehabilitationfacility.

1.79 Repatriation of mortal remainsisthetransportationoftheinsuredperson’smortalremainsfromtheprincipalcountryofresidencetothecountryofburial.Coveredexpensesinclude,butarenotlimitedto,expensesforembalming,acontainerlegallyappropriatefortransportation,shippingcostsandthenecessarygovernmentauthorisations.Cremationcostswillonlybecoveredintheeventthatthisisrequiredforlegalpurposes.CostsincurredbyanyaccompanyingpersonsarenotcoveredunlessthisislistedasaspecificbenefitinyourTableofBenefits.

1.80 Routine maternity referstoanymedicallynecessarycostsincurredduringpregnancyandchildbirth,includinghospitalcharges,specialistfees,themother’spre-andpost-natalcare,midwifefeesaswellasnewborncare.Costsrelatedtocomplicationsofpregnancyandcomplicationsofchildbirtharenotpayableunderroutinematernity. In addition, anynon-medically necessary caesarean sectionswill be coveredup to the cost ofaroutinedelivery inthesamehospital,subjecttoanybenefit limit inplace. If thehomedeliverybenefit isincludedinyourplan,alumpsumuptotheamountspecifiedintheTableofBenefitswillbepaidintheeventofahomedelivery.

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1.81 Specialistisaqualifiedandlicensedmedicalphysicianpossessingthenecessaryadditionalqualificationsandexpertisetopracticeasarecognisedspecialistofdiagnostictechniques,treatmentandpreventioninaparticularfieldofmedicine.Thisbenefitdoesnot includecoverforpsychiatristorpsychologist fees.Wherecovered, aseparatebenefitforpsychiatryandpsychotherapywillappearintheTableofBenefits.

1.82 Specialist fees refertonon-surgicaltreatmentperformedoradministeredbyaspecialist.Thisbenefitdoesnotincludecoverforpsychiatristorpsychologistfees.Wherecovered,aseparatebenefitforpsychiatryandpsychotherapywillappearintheTableofBenefits.

1.83 Speech therapy referstotreatmentcarriedoutbyaqualifiedspeechtherapisttotreatdiagnosedphysicalimpairments,including,butnotlimitedto,nasalobstruction,neurogenicimpairment(e.g.lingualparesis,braininjury)orarticulationdisordersinvolvingtheoralstructure(e.g.cleftpalate).

1.84 Surgical appliances and materials arethosewhicharerequiredforthesurgicalprocedure.Theseincludeartificialbodypartsordevicessuchasjointreplacementmaterials,bonescrewsandplates,valvereplacementappliances,endovascularstents,implantabledefibrillatorsandpacemakers.

1.85 Therapistisachiropractor,osteopath,Chineseherbalist,homeopath,acupuncturist,physiotherapist,speechtherapist,occupationaltherapistoroculomotortherapist,whoisqualifiedandlicensedunderthelawofthecountryinwhichtreatmentisbeinggiven.

1.86 Travel costs of insured family members in the event of an evacuation/repatriation refertothereasonabletransportationcostsofallinsuredfamilymembersoftheevacuatedorrepatriatedperson.Ifthiscannottakeplaceinthesametransportationvehicle,roundtriptransportateconomyrateswillbepaidfor.Intheeventofaninsuredperson’srepatriation,thereasonabletransportationcostsofinsuredfamilymemberswillonlybecoverediftherelevantRepatriationPlanbenefitformspartofyourcover.Coverdoesnotextendtohotelaccommodationorotherrelatedexpenses.

1.87 Travel costs of insured family members in the event of the repatriation of mortal remains refer to reasonable transportation costs of any insured familymemberswho had been residing abroadwith thedeceasedinsuredperson,toreturntothehomecountry/chosencountryofburialofthedeceased.Coverdoesnotextendtohotelaccommodationorotherrelatedexpenses.

1.88 Travel costs of insured members to be with a family member who is at peril of death or who has died refertothereasonabletransportationcosts(uptotheamountspecifiedinyourTableofBenefits)sothatinsuredfamilymemberscantraveltothelocationofafirstdegreerelativewhoisatperilofdeathorwhohasdied. Afirstdegreerelativeisaspouse,parent,brother,sisterorchild,includingadoptedchildren,fosteredchildrenorstepchildren.Claimsaretobeaccompaniedbyadeathcertificateordoctor’scertificatesupportingthereasonfortravelaswellascopiesoftheflighttickets,andcoverwillbelimitedtooneclaimperlifetimeofthepolicy.Coverdoesnotextendtohotelaccommodationorotherrelatedexpenses.

1.89 Treatment referstoamedicalprocedureneededtocureorrelieveillnessorinjury.

1.90 Vaccinations refertoallbasicimmunisationsandboosterinjectionsrequiredunderregulationofthecountryinwhich treatment is being given, anymedically necessary travel vaccinations andmalaria prophylaxis. Thecostofconsultationforadministeringthevaccine,aswellasthecostofthedrug,iscovered.

1.91 Waiting period is aperiodof timecommencingon yourpolicy startdate (or effectivedate if youare adependant),duringwhichyouarenotentitled tocover forparticularbenefits.YourTableofBenefitswillindicatewhichbenefitsaresubjecttowaitingperiods.

1.92 We/Our/Us isAllianzWorldwideCare.

1.93 You/YourreferstothepersonworkingfortheCompanyandstatedontheInsuranceCertificate.

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AllianzWorldwideCareDefinitions

13

ExclusionsAlthough we cover most medically necessary treatment, expenses incurred for the following treatments, medical conditions and procedures are not covered under the policy unless confirmed otherwise in the Table of Benefits or in any written policy endorsement.

AlltreatmentslistedbelowareexcludedunlessotherwisecoveredbytheFrenchSocialSecuritySystem,forinsuredpersonswhoareaffiliatedtotheFrenchSocialSecuritySystem.

1. Anyformoftreatment or drug therapywhichisexperimental or unproven,basedongenerallyacceptedmedicalpractice.

2. Anytreatment carried out by a plastic surgeon,whetherornot formedical/psychologicalpurposesandanycosmeticoraesthetictreatmenttoenhanceyourappearance,evenwhenmedicallyprescribed.Theonlyexceptionisreconstructivesurgerynecessarytorestorefunctionorappearanceafteradisfiguringaccident,orasaresultofsurgeryforcancer,iftheaccidentorsurgeryoccursduringyourmembershipofthescheme.

3. Careand/ortreatmentofdrug addiction or alcoholism(includingdetoxificationprogrammesandtreatmentsrelatedtothecessationofsmoking),instancesofdeath,orthetreatmentofanyconditionthatisrelatedto,oradirectconsequenceof,alcoholismoraddiction(e.g.organfailureordementia).

4. Careand/ortreatmentofintentionally caused diseases or self-inflicted injuries,includingasuicideattempt.

5. Complementary treatment,withtheexceptionofthosetreatmentsindicatedintheTableofBenefits.

6. Consultations performed, as well as any drugs or treatments prescribed, by you, your spouse, parents or children.

7. Costsinrespectofafamily therapist or counsellorforout-patientpsychotherapytreatment.

8. Dental veneersandrelatedprocedures.

9. Developmental delay,unlessachildhasnotattaineddevelopmentalmilestonesexpectedforachildofthatage,incognitiveorphysicaldevelopment.Wedonotcoverconditionsinwhichachildisslightlyortemporarilylaggingindevelopment.Thedevelopmentaldelaymusthavebeenquantitativelymeasuredbyqualifiedpersonnelanddocumentedasa12monthdelayincognitiveand/orphysicaldevelopment.

10. Expensesfortheacquisition of an organincluding,butnotlimitedto,donorsearch,typing,harvesting,transportandadministrationcosts.

11. Expensesincurredbecauseofcomplications directly caused by an illness, injury or treatment for which cover is excluded or limitedunderyourplan.

12. Genetic testing,except:a)wherespecificgenetictestsareincludedwithinyourplan;b)whereDNAtestsaredirectlylinkedtoaneligibleamniocentesisi.e.inthecaseofwomenaged35orover;c)testingforgeneticreceptoroftumoursiscovered.

13. Home visits,unlesstheyarenecessaryfollowingthesuddenonsetofanacuteillness,whichrenderstheinsuredincapableofvisitingtheirmedicalpractitioner,physicianortherapist.

14. Infertility treatment includingmedicallyassistedreproductionoranyadverseconsequencesthereof,unlessyouhaveaspecificbenefitforinfertilitytreatment,oranOut-patientPlanhasbeen selected (whereby you are covered fornon-invasive investigations into the causeofinfertilitywithinthelimitsofyourOut-patientPlan).

15. Investigationsinto,andtreatmentof, loss of hair andanyhair replacementunlessthelossofhairisduetocancertreatment.

16. Investigationsinto,andtreatmentof,obesity.

17. Investigationsinto,treatmentofandcomplicationsarisingfromsterilisation, sexual dysfunction (unless this condition isasa resultof totalprostatectomy followingsurgery forcancer)andcontraception including the insertion and removal of contraceptive devices and all othercontraceptives,evenifprescribedformedicalreasons.Theonlyexceptioninrelationtocostsforcontraceptioniswherecontraceptivesareprescribedbyadermatologistforthetreatmentofacne.

18. Medicalevacuation/repatriationfroma vessel at seatoamedicalfacilityonland.

19. Medical practitioner fees for the completion of a Claim Formorotheradministrationcharges.

20. Orthomolecular treatment (pleaserefertodefinition1.59).

21. Pre- and post-natal classes.

22. Productsclassifiedasvitamins or minerals (exceptduringpregnancyortotreatdiagnosed,clinicallysignificantvitamindeficiencysyndromes)andsupplements,suchasspecial infantformulaandcosmeticproducts,evenifmedicallyrecommended,prescribedoracknowledgedashavingtherapeuticeffects.Costsincurredasaresultofnutritionalordietaryconsultationsarenotcovered,unlessaspecificbenefitisincludedwithinyourTableofBenefits.

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AllianzWorldwideCareExclusions

23. Productsthatcanbepurchasedwithouta doctor’s prescription,exceptwhereaspecificbenefitcoveringthesecostsappearsintheTableofBenefits.

24. Speech therapy relatedtodevelopmentaldelay,dyslexia,dyspraxiaorexpressive languagedisorder.

25. Staysinacure centre, bath centre, spa, health resort and recovery centre,evenifthestayismedicallyprescribed.

26. Termination of pregnancy,exceptintheeventofdangertothelifeofthepregnantwoman.

27. Travel coststoandfrommedicalfacilities(includingparkingcosts)foreligibletreatment,exceptanytravelcostscoveredunderlocalambulance,medicalevacuationandmedicalrepatriationbenefits.

28. Treatmentdirectly related tosurrogacy,whetheryouareactingasa surrogate,orare theintendedparent.

29. Treatmentforanyillnesses,diseasesorinjuries,aswellasinstancesofdeathresultingfromactive participation in war, riots, civil disturbances, terrorism, criminal acts, illegal acts or acts against any foreign hostility,whetherwarhasbeendeclaredornot.

30. Treatmentforanymedicalconditionsarisingdirectlyorindirectlyfromchemical contamination, radioactivity or any nuclear materialwhatsoever,includingthecombustionofnuclearfuel.

31. Treatmentforconditionssuchasconduct disorder, attention deficit hyperactivity disorder, autism spectrum disorder, oppositional defiant disorder, antisocial behaviour, obsessive-compulsive disorder, phobic disorders, attachment disorders, adjustment disorders, eating disorders, personality disorders or treatments that encourage positive social-emotionalrelationships,suchasfamily therapy,unlessindicatedotherwiseintheTableofBenefits.

32. Treatment in the USAifweknowthatcoverwaspurchasedforthepurposeoftravellingtotheUSAtoreceivetreatmentforacondition,whenthesymptomsoftheconditionwereapparenttotheinsuredpersonpriortothepurchaseofcover.

33. Treatment of sleep disorders, including insomnia, obstructive sleep apnoea, narcolepsy,snoringandbruxism.

34. Treatmentordiagnosticproceduresforinjuries arising from an engagement in professional sports.

35. Treatmentoutside the geographical area of cover,unlessforemergenciesorauthorisedbyus.

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36. Treatmenttochangetherefraction of one or both eyes (laser eye correction).

37. Treatmentrequiredasaresultoffailure to follow medical advice.

38. Treatmentrequiredasaresult of medical error.

39. Triple/Bart’s, Quadruple or Spina Bifida tests,exceptforwomenaged35orover.

40. Tumour marker testing,unlessyouhavepreviouslybeendiagnosedwiththespecificcancerinquestion,inwhichcase,coverwillbeprovidedundertheOncologybenefit.

41. The following treatments, expenses, procedures or any adverse consequences or complicationsrelatingtothem,unlessotherwiseindicatedinyourTableofBenefits:

41.1 Dentaltreatment,dentalsurgery,periodontics,orthodonticsanddentalprostheseswiththeexceptionoforalandmaxillofacialsurgicalprocedures,whicharecoveredwithintheoveralllimitofyourCorePlan.

41.2 Dieticianfees.41.3 Emergencydentaltreatment.41.4 Expensesforonepersonaccompanyinganevacuated/repatriatedperson.41.5 Health andwellbeing checks including screening for theearlydetectionof illnessor

disease.41.6 Homedelivery.41.7 Infertilitytreatment.41.8 In-patientpsychiatryandpsychotherapytreatment.41.9 Medicalrepatriation.41.10Organtransplant.41.11Out-patientpsychiatryandpsychotherapytreatment.41.12Out-patienttreatment.41.13Prescribedglassesandcontactlensesincludingeyeexamination.41.14Prescribedmedicalaids.41.15Preventivetreatment.41.16Rehabilitationtreatment.41.17Routinematernity.41.18Travelcostsofinsuredfamilymembersintheeventofanevacuation/repatriation.41.19Travelcostsofinsuredfamilymembersintheeventoftherepatriationofmortalremains.41.20Travelcostsofinsuredmemberstobewithafamilymemberwhoisatperilofdeathor

whohasdied.41.21Vaccinations.

42. Theaccidental death benefit,incircumstanceswherethedeathofaninsuredpersonhasbeencausedeitherdirectlyorindirectlyby:

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AllianzWorldwideCareExclusions

42.1 Activeparticipationinwar,riots,civildisturbances,terrorism,criminalacts,illegalactsoractsagainstanyforeignhostility,whetherwarhasbeendeclaredornot.

42.2 Intentionallycauseddiseasesorself-inflictedinjuries,includingsuicide,withinoneyearoftheenrolmentdateofthepolicy.

42.3 Activeparticipationinunderground/underwateractivitysuchasundergroundminingordeepseadiving.

42.4 Abovewateractivity(suchasoilplatforms,oilrigs)andaerialactivity,unlessotherwisespecifiedintheCompanyAgreement.

42.5 Chemicalorbiologicalcontamination,radioactivityoranynuclearmaterialcontamination,includingthecombustionofnuclearfuel.

42.6 Passivewarrisk:- BeinginacountrywheretheFrenchorBritishgovernmenthasrecommendedtheircitizenstoleave(thiscriteriawillapplyregardlessoftheinsuredperson’snationality)andadvisedagainst‘alltravel’tothatlocation;or

- Travellingtoorstaying,foraperiodofmorethan28daysperstay,inacountryoranareawheretheFrenchorBritishgovernmentadvises“againstallbutessentialtravel”.

Thepassivewarriskexclusionappliesregardlessofwhethertheclaimarisesdirectlyorindirectlyasaconsequenceofwar,riots,civildisturbances,terrorism,criminalacts,illegalactsoractsagainstanyforeignhostility,whetherwarhasbeendeclaredornot.

42.7 Beingundertheinfluenceofdrugsoralcohol.42.8 Deaththattakesplacemorethan365daysaftertheoccurrenceoftheaccident.42.9 Deliberateexposuretodanger,exceptinanattempttosavehumanlife.42.10 Intentionalinhalationofgasorintentionalingestionofpoisonsorlegallyprohibiteddrugs.42.11 Flyinginanaircraft,includinghelicopters,unlesstheinsuredpersonisapassengerand

thepilotislegallylicensed,orisamilitarypilotandhasfiledascheduledflightplanwhenrequiredbylocalregulations.

42.12Activeparticipationinextremeorprofessionalsportsincluding,butnotlimitedto:- Mountainsportssuchasabseiling,mountaineeringandracingofanykind(otherthanonfoot).

- Snowsportssuchasbobsleigh,luge,mountaineering,skeleton,skiingoff-pisteandsnowboardingoff-piste.

- Equestriansportssuchashuntingonhorseback,horsejumping,polo,steeplechasingorhorse-racingofanykind.

- Watersportssuchaspotholing(solocaving)orcavediving,scubadivingtoadepthofmorethan10metres,highdiving,whitewaterraftingandcanyoning.

- Carandmotorcyclesportssuchasmotorcycleridingandquadbiking.- Combativesports.- Air sports such as flyingwith amicrolight, ballooning, hang gliding, paragliding,parascendingandparachutejumping.

- Variousothersportssuchasbungeejumping.

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1. Applicable law and dispute resolution: YourmembershipisgovernedbyFrenchlaw,unlessotherwiserequiredundermandatorylegalregulations.AnydisputethatcannototherwiseberesolvedwillbedealtwithbycourtsinFrance.

2. Data protection: AllianzWorldwideCare,amemberoftheAllianzGroup,isaFrenchauthorisedinsurancecompany.Weobtainandprocesspersonalinformationforthepurposesofpreparingquotations,underwritingpolicies,collectingpremium,payingclaimsandforanyotherpurposewhichisdirectlyrelatedtoadministeringpoliciesinaccordancewiththeinsurancecontract.Theconfidentialityofpatientandmemberinformationisofparamountconcerntous.Youhavearighttoaccessthepersonaldatathatisheldaboutyou.Youalsohavetherighttorequestthatweamendordeleteanyinformationwhichyoubelieveisinaccurateoroutofdate.Wewillnotretainyourdataforlongerthanisnecessaryforthepurposesforwhichitwasobtained.

3. Eligibility: Only those group members (and dependants) as described in the CompanyAgreement.

4. Fraud and non-disclosurea) For groups that require medical underwriting, any incorrect disclosure/non-disclosure or

any intentional false statement of any material facts, by you or your dependants, which changes the nature or affects our assessment of the risk may render your cover void from the start date. Thisincludes,butisnotlimitedtomaterialfactsdeclaredontherelevantapplicationformorinrelationtoanincreasedriskduringthetermofthepolicy.

Whereincorrectdisclosure/non-disclosureisestablished,butisnotintentional,theinsurerisentitledtoeitherincreasetheamountofyourpremium,orterminateyourpolicy10daysafterwehaveprovidedyouwithwrittennoticetothiseffect.Inthelattercase,wewillrefundtheportionofthepremiumpaidforthetimewhereyouarenolongeroncover.Ifavalidclaimhasbeensubmitted,weshallreducetheamountoftheclaimpaymentinproportiontotherateofthepremiumwhichwouldhavebeenpaidifthefactshadbeenfullyandaccuratelystated.

Conditionsarisingbetweencompletingtherelevantapplicationformandthestartdateofthepolicywillequallybedeemedtobepre-existing.Suchpre-existingconditionswillalsobesubjecttomedicalunderwritingandifnotdisclosed,theywillnotbecovered.Iftheapplicantisnotsurewhethersomethingisrelevant,theapplicantisobligedtoinformus.

b) If any claim is false, fraudulent, intentionally exaggerated or if fraudulent means or devices have been used by you or your dependants or anyone acting on your or their behalf to obtain benefit under this policy, we will not pay any benefits for that claim.

AdditionaltermsThe following are important additional terms that apply to your policy with us:

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Theamountofanyclaimsettlementmadetoyoubeforethefraudulentactoromissionwasdiscovered,willbecomeimmediatelydueandowingtous,andanypendingclaimssettlementswillbeforfeited.Wereservetherighttoinformthecompanyofanyfraudulentactivityonthepartofyouoryourdependants.

5. Force majeure: Weshallnotbeliableforanyfailureordelayintheperformanceofourobligationsunderthetermsofthispolicy,causedby,orresultingfrom,forcemajeurewhichshallinclude,butisnotlimitedto:eventswhichareunpredictable,unforeseeableorunavoidable,suchasextremelysevereweather,floods,landslides,earthquakes,storms,lightning,fire,subsidence,epidemics,actsofterrorism,outbreaksofmilitaryhostilities(whetherornotwarisdeclared),riots,explosions,strikesorotherlabourunrest,civildisturbances,sabotage,expropriationbygovernmentalauthoritiesandanyotheractoreventthatisoutsideofourreasonablecontrol.

6. Legal action: Alllegalactionsarisingfromaninsurancepolicyshallhaveatimelimitoftwoyearsfromthedateoftheeventthatgaverisetotheaction.

However,thelimitationperiodshallnotapplyinthefollowingcircumstances:

• intheeventofnon-disclosure,omission,fraudulentrepresentationormisrepresentationoftheriskincurred.Inthisinstancethetimeperiodshallbeginfromthedateonwhichwe become aware of the non-disclosure, omission, fraudulent representation ormisrepresentation.

• iftherelevantpartyprovesthattheywereunawareofsuchfactsthatgaverisetotheaction.Thelimitationperiodshallstartfromthedatethepartybecomesawareofsuchfactsthatledtotheaction.

Ifalegalactionisduetoathirdpartyclaim,thelimitationperiodshallonlyrunfromthedateonwhichthethirdpartyinitiatesalegalactionagainstaninsuredpersonorwascompensatedbytheinsuredperson.

Incaseofaccidentaldeath,thelimitationperiodisextendedtotenyearsforinsurancecontractscoveringpersonalaccidents,wherethepersonsentitledtobenefitarethebeneficiariesofthedeceasedinsuredperson.

Thelimitationperiodisinterruptedbyoneofthecommoncauses:

• Anylegalproceedings,includingsummaryproceedingsandcasesbroughtbeforeacourtthatdoesnothavejurisdiction;

• Anyenforcementaction,oranyprotectivemeasurebroughtundertheCivilEnforcementProceduresCode;

• Anyacknowledgementbyusofaninsuredperson’srighttoclaimunderthepolicy,oranyacknowledgementofdebtofaninsuredpersontowardsus.

Thelimitationperiodisalsointerruptedwhen:

• Anexpertisappointedfollowingaclaim; • Aregisteredletterinrelationtothepaymentofapremiumissentbytheinsurerand

receiptisacknowledgedbytheinsuredperson. • Aregisteredletterinrelationtothepaymentofapremiumissentbytheinsuredperson

andreceiptisacknowledgedbytheinsurer.

Inaccordancewitharticle L.114-3of theFrench InsuranceCode, theparties involved inaninsurancecontractshallnotmodifythedurationofthelimitationperiodoraddfurthercausesofsuspensionorinterruption,evenifmutuallyagreed.

7. Liability: Ourliabilitytothe insuredpersonis limitedtotheamounts indicatedintheTableofBenefitsandanysubsequentpolicyendorsement.Innoeventwilltheamountofreimbursement,whetherunderthispolicy,publicmedicalschemeoranyotherinsurance,exceedtheamountoftheinvoice.

8. Making contact with dependants: In order to administer your policy in accordancewiththe insurancecontract, theremaybecircumstanceswhenwewillneed to request furtherinformation. Ifweneedtomakecontact inrelationtoadependantonapolicy(e.g.wherefurtherinformationisrequiredtoprocessaclaim),thepolicyholder,actingforandonbehalfofthedependant,maybecontactedbyusandaskedtoprovidetherelevantinformation.Similarly,allinformationinrelationtoanypersoncoveredbytheinsurancepolicy,forthepurposesofadministeringclaims,maybesentdirectlytothepolicyholder.

9. Use of MediLine: PleasenotethattheMediLineanditshealth-relatedinformationandresourcesarenotintendedtobeasubstituteforprofessionalmedicaladviceorforthecarethatpatientsreceivefromtheirdoctors. It isnot intendedtobeusedformedicaldiagnosisortreatmentandinformationshouldnotberelieduponforthatpurpose.Alwaysseektheadviceofyourdoctorbeforebeginninganynewtreatmentorifyouhaveanyquestionsregardingamedicalcondition.YouunderstandandagreethatAllianzWorldwideCareisnotresponsibleorliableforanyclaim,lossordamagedirectlyorindirectlyresultingfromyouruseofthisadvicelineortheinformationortheresourcesprovidedthroughthisservice.CallstotheMediLinewillberecordedandmaybemonitoredfortraining,qualityandregulatorypurposes.

10. Third party liability: Ifyouoranyofyourdependantsareeligibletoclaimbenefitsunderapublicschemeoranyother insurancepolicywhichpertainstoaclaimsubmittedtous,wereservetherighttodeclinetopaybenefits.Theinsuredpersonmustinformusandprovideallnecessaryinformation,ifandwhenentitledtoclaimfromathirdparty.Theinsuredpersonandthethirdpartymaynotagreetoanyfinalsettlementorwaiveourrighttorecoveroutlayswithoutourpriorwrittenagreement.Otherwiseweareentitledtorecovertheamountspaidfromtheinsuredpersonandtocancelthepolicy.Wehavefullrightsofsubrogationandmayinstituteproceedingsinyourname,butatourexpense,torecover,forourbenefit,theamountofanypaymentmadeunderanotherpolicy.

Additionalterms AllianzWorldwideCare

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21

Adding dependants

Youmayapplytoincludeanyofyourfamilymembersasadependantprovidedthatyouareallowedtodosoundertheagreementbetweenyourcompanyandus.Notificationtoaddadependantshouldbemadethroughyourcompanyunlessotherwisestated.

Fornon-underwrittengroups,newborninfantswillbeacceptedforcoverfrombirth,providedthatwearenotifiedwithin fourweeksof thedateofbirth.Tohaveanewbornaddedto thepolicy,youmustaskyourcompanytosubmitarequest inwritingto itsusualAllianzWorldwideCarecontactpersonformembershipchanges.Ifwearenotifiedfourweeksormoreafterthedateofbirth,newbornchildrenwillbeacceptedforcoverfromthedateofthatnotification.

Forgroupswithfullmedicalunderwriting,newborninfants(exceptmultiplebirthbabies,adoptedandfosteredchildren)willbeacceptedforcoverfrombirthwithoutmedicalunderwriting,providedthatwearenotifiedwithinfourweeksofthedateofbirthandthebirthparentorintendedparenthasbeeninsuredwithusforaminimumofsixcontinuousmonths.Tohaveanewbornaddedtothepolicy,youmustaskyourcompanytosubmitarequestinwritingandsenditbyemailtoourUnderwritingTeamat:underwriting@allianzworldwidecare.com.Ifwearenotifiedfourweeksormoreafterthedateofbirth,newbornchildrenwillbeunderwrittenandcoverwillonlystartfromthedateofacceptance.Pleasenotethatallmultiplebirthbabies,adoptedandfosteredchildrenwillbesubjecttofullmedicalunderwritingandcoverwillonlycommencefromthedateofacceptance.

FollowingacceptancebyourUnderwritingteam,wewillissueanewInsuranceCertificatetoreflecttheadditionofadependant,andthiscertificatewillreplaceanyearlierversion(s)youmayhavefromthestartdateshownonthenewInsuranceCertificate.

Applying for cover if group membership ends

IfyourcoverundertheCompanyAgreementcomestoanend,youcanapplyforcoverunderoneofourHealthcarePlansforIndividuals.Yourpolicymaybesubjecttounderwriting.Wereservetherighttodecideontheacceptanceofyourapplication.Theapplicationmustbesubmittedwithinonemonthofleavingthegroupscheme.Thecommencementdate,ifacceptedforcover,willbethefirstdayafterleavingthegroupscheme.

Generalinformation

Changing country of residence

Itisimportantthatyouletusknowifyouchangeyourcountryofresidenceasitmayimpactthecoverorpremium,evenifyouremainwithinyourcurrentgeographicalregionofcover.Coverinsomecountries issubjectto localhealth insurancerestrictions,particularlyforresidentsofthatcountry.Itisyourresponsibilitytoensurethatyourhealthcarecoverislegallyappropriateandwewouldrecommendthatyouseekindependentlegaladviceinthisregard,aswemaynolongerbeabletoprovideyouwithcover.Notificationofchangeofresidenceshouldbemadethroughyourcompanyunlessotherwisestated.

Changing your address/email address

Allcorrespondencewillbesenttothedetailswehaveonrecordforyouunlessrequestedotherwise.Anychangeinyourhome,businessoremailaddressshouldbecommunicatedtousinwritingassoonaspossible.

Claims

Inrelationtomedicalclaims,pleasenotethat:

a) Allclaimsshouldbesubmittednolaterthantwoyearsafterthetreatmentdate.Beyondthistimewearenotobligedtosettletheclaim.

b) Ifyourcontractisatop-uptotheCFEorifyouareaffiliatedtotheFrenchsocialsecurity,werequirethecerfatreatmentform(“Feuilledesoins”,suppliedbyyourmedicalprovider)foralltreatmentsreceivedinFrance.

c) AseparateClaimFormisrequiredforeachpersonclaimingandforeachmedicalconditionbeingclaimedfor.Pleasenotethataswellasourhardandsoftcopyclaimforms,ifyourcompanyhasselectedourOnlineServicesfacility,memberscannowavailofourmobileMyHealthappforfastandeasyclaimssubmission.

d) Itisyourresponsibilitytoretainanyoriginalsupportingdocumentation(e.g.medicalreceipts)where copies are submitted to us, aswe reserve the right to request original supportingdocumentation/receiptsupto12months(orforuptotwoyearsforclaimsonCFEorFrenchsocialsecuritypolicies)afterclaimssettlement,forauditingpurposes.Wealsoreservetherighttorequestaproofofpaymentbyyou(e.g.bankorcreditcardstatement)inrespectofyourmedicalreceipts.Weadvisethatyoukeepcopiesofallcorrespondencewithusaswecannotbeheldresponsibleforcorrespondencethatdoesnotreachusforanyreasonthatisoutsideofourreasonablecontrol.

e) Iftheamounttobeclaimedislessthanthedeductiblefigureunderyourplan,keepcollectingallout-patient receiptsandClaimFormsuntil you reachanamount inexcessofyourplandeductible,thenforwardtousallcompletedClaimFormstogetherwithsupportingreceipts/invoices.

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f) PleasespecifyontheClaimFormthecurrencyinwhichyouwishtobepaid.Unfortunately,onrareoccasions,wemaynotbeabletomakeapaymentinthecurrencyyourequested,duetointernationalbankingregulations.Inthisinstancewewillrevieweachcaseindividuallytoidentifyasuitablealternativecurrencyoption.Ifwehavetomakeaconversionfromonecurrencytoanother,wewillusetheexchangeratethatappliesonthedateonwhichtheinvoiceswereissued,orwewillusetheexchangeratethatappliesonthedatethatclaimspaymentismade.Pleasenotethatwereservetherighttochoosewhichcurrencyexchangeratetoapply.

g) Onlycostsincurredasaresultofeligibletreatmentwillbereimbursedwithinthelimitsofyourpolicy,aftertakingintoconsiderationanyTreatmentGuaranteerequirements.Anydeductiblesorco-paymentsoutlinedintheTableofBenefitswillbetakenintoaccountwhencalculatingtheamounttobereimbursed.

h) Ifyouarerequiredtopayadepositinadvanceofanymedicaltreatment,thecostincurredwillonlybereimbursedaftertreatmenthastakenplace.

i) Youandyourdependantsagreetoassistusinobtainingallnecessaryinformationtoprocessaclaim,andagreetowaiveanyrightsthatyou/theyhavetomedicalsecrecy/confidentialityinrespectofanymedicalrecordspertainingtoyour/theirmedicalcondition.Youalsoauthorisemedicalpractitioners,doctors,dentists,healthcareprofessionals,hospitalemployeesandhealthservicestocommunicateanyrelevantinformationrelatingtoyourmedicalconditiontoourmedicaladviser(s)ortoanythirdpartyexpert(s)incaseofdisputes,subjecttoanylegalrestrictionswhichmayapply.Wemay,atourownexpense,requestamedicalexaminationbyourmedicalrepresentativewhenwedeemthistobenecessary.Allinformationwillbetreatedinstrictconfidence.Wereservetherighttowithholdbenefitsifyouoryourdependantshavenothonouredtheseobligations.

Reimbursement of eligible expenses under your policy incurred in respect of an illness, maternity or an accident, shall not exceed the costs that the insured person paid, following any additional reimbursement to which the insured person is entitled to receive. This includes payments made under article L.861-3 of the French Social Security Code. In addition, insurance cover of the same kind taken out with multiple insurers will only take effect within the limit of each insurance cover, regardless of the start date of each insurance policy.

Claims for accidental death

Ifthisbenefitisincludedonthehealthcareplanselected,pleasenotethatclaimsmustbereportedwithin90workingdaysfollowingthedateofdeathandthefollowingdocumentsmustbeprovided:

• AfullycompletedAccidentalDeathClaimForm.• Adeathcertificate.• Amedicalreportindicatingthecauseofdeath.• Awrittenstatementoutliningthedate,locationandcircumstancesoftheaccident.• Officialdocumentationprovingtheinsuredperson’sfamilystatus,andforthebeneficiaries,proof

ofidentityaswellasproofofrelationshiptotheinsuredperson.

Beneficiariesare,unlessotherwisespecifiedbytheinsured:

• Theinsuredperson’sspouse,ifnotlegallyseparated.• Failingthespouse,theinsuredperson’ssurvivingchildrenincludingstep-children,adoptedor

fosterchildrenandchildrenbornlessthan300daysfromthedateoftheinsuredperson’sdeath;inequalsharesamongthem.

• Failingthechildren,theinsuredperson’sfatherandmother,inequalsharesbetweenthem,ortothesurvivorofthem.

• Failingthem,theinsuredperson’sestate.

Ifyouwishtonominateabeneficiaryotherthanthoselistedabove,pleasecontactourHelpline.

Pleasenotethatinthespecificcaseofthedeathoftheinsuredpersonandoneorallofthebeneficiariesinthesameoccurrence,theinsuredpersonshallbeconsideredthelastdeceased.

Continuation of cover

Weshallcontinuetoprovidecoverforyourmedicalcostsexpenses(and,whereapplicable,yourdependants)incertaincircumstances,asoutlinedinthefollowingsectionsbelow.

Whererequired,continuationofcoverforyourmedicalexpenseswillbeprovidedbyusunderanewpolicy.ThiscontinuationofcovermustbecompliantwiththeEvinAct(“LoiEvin”),theapplicableprovisionsoftheFrenchInsuranceCode,theSocialSecurityCode,thetermsandconditionsofthenewpolicyissuedbyus(includingpremiumpaymentterms)andtheconditionsasoutlinedinthesections:

Section A – Temporary cover

AccordingtoarticleL.911-8oftheFrenchSocialSecurityCode, intheeventthatyourcontractofemployment terminates,youandanydependantscoveredunderyourpolicyshallbeentitled tocontinuedcoverageundertheFrenchunemploymentinsurancesystem,providedtheterminationwasnotasaresultofyourgrossnegligence.

Thisonlyapplies:• Fromthedateyouremploymentisterminated.Coverwillbeprovidedforthedurationofyour

Frenchunemploymentbenefitperiod,limitedtothedurationofyourlastemploymentcontract(orlastcontracts,incasesofconsecutivecontractswiththesameemployer),subjecttoamaximumperiodof12months.Theperiodisassessedinmonths,roundedupifrequired.

• ifyouhaveinitiatedyourrightstoadditionalreimbursementwithyourlastemployer;• ifthecontinuedcoverageisthesameasthatinforcewithinthecompany;• ifthecontinuedcoveragedoesnotgiveyoutherighttocollectindemnitypaymentsofanamount

greaterthanthatoftheunemploymentbenefitthatyouwouldreceiveforthesameperiod;• ifyouprovetousyourentitlementtosuchcontinuedcoverunderthissection;• iftheemployerspecifiesthiscontinuedcoverageinthe“WorkCertificate”andinformsusofthe

terminationofthecontractofemploymentreferredtointhefirstbulletpoint.

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Section B – Permanent continuation of cover if you are affiliated to the French Social Security and your employment contract is terminated.

InaccordancewithArticle4oftheLoiEvin,weshallcontinuetoprovidecoverageformedicalexpensestoyouandyourdependantsshouldyouremploymentend.Thisonlyapplieswhen:

• youwereinreceiptofcoverasamemberundertheCompanyAgreementatthedateofterminationofyouremploymentcontract;and

• youare inreceiptofdisability, incapacitybenefits,retirementpensionor ifyouarenotemployed,inreceiptof“revenuederemplacement”(incomesubstitutionbenefit);and

• youcontinuetobeaffiliatedtotheFrenchSocialSecuritySystem.

Youmustrequestcontinuationofcoverfromuswithinsixmonthsfollowingtheterminationofyouremploymentcontract,or ifapplicable,withinsixmonthsfollowingtheexpiryoftheperiodwhen you benefitted from a temporary continuation of cover, in accordancewithsectionA.

Section C – Permanent continuation of cover upon the request from dependants of a deceased employee who was affiliated to the French Social Security

In the event of your death whilst you are amember under the Company Agreement, anydependant(s)coveredunderyourpolicy(asatthedateofyourdeath)willbeentitledtocontinuedcoverageformedicalexpensesonthesametermsasbefore.Thisonlyappliesif:

• thedependant(s)requestcontinuationofcoverfromuswithinsixmonthsfollowingthedateofyourdeath;and

• youwereaffiliatedtotheFrenchSocialSecuritySystematthedateofyourdeath.

In the event that such a request ismade, the dependant(s) will be entitled to continuedcoverageforamaximumof12monthsfollowingyourdeath.

Section D – Permanent continuation of cover upon your request if you are affiliated to the French Social Security and if the Company Agreement is terminated

IfyourcovercomestoanendduetotheterminationoftheCompanyAgreement,youwillbeentitled tocontinuedcoverageunderoneofourHealthcarePlans for Individuals.Thisonlyappliesif:

• you request continued coverage within one month of your cover ending under theCompanyAgreement,and

• youcontinuetobeaffiliatedtotheFrenchSocialSecuritySystem.

Inallcasesoutlinedpreviouslywemayrequire,atourdiscretion,anypersonwhorequestscontinuedcoveragetoprovetheirentitlementtosuchcontinuedcover. Ifyouareinreceiptofcontinuedcoverageyoushall immediatelynotifyusintheeventthatyourcircumstanceschange, includingwhereyou loseyourentitlement to thebenefitsoutlinedabove.Also forsectionsBtoD,thepremiumratechargedbyusforthefirstInsuranceYearofthecontinuedcoverageshallnotbemorethan50%abovetheaveragerateappliedtomembersundertheCompanyAgreementforequivalentcoveratthetimethenewinsurancepolicyforcontinuedcoveragecommences.

Section E – In all other cases, if the insurance cover terminates

IfyouarenotaffiliatedtotheFrenchSocialSecuritySystemandyourcoverundertheCompanyAgreementcomestoanend,youcanapplyforcoverunderoneofourHealthcarePlansforIndividuals.Yourpolicymaybesubjecttounderwritingandwereservetherighttodecideontheacceptanceofyourapplication.Theapplicationmustbesubmittedwithinonemonthofleavingthegroupscheme.Ifyouareacceptedforcover,thecommencementdatewillbethefirstdayafterleavingthegroupscheme.

Correspondence

Writtencorrespondencebetweenusmustbesentbyemailorpost(withthepostagepaid).Wedonotusuallyreturnoriginaldocumentstoyou,unlessyouspecificallyrequestustodosoatthetimeofsubmission.

Countries where you can receive treatment

If thenecessarymedical treatment forwhich youare covered isnot available locally, youcanavailof treatment inanycountrywithinyourgeographicalareaofcover(yourareaofcoverisconfirmedinyourInsuranceCertificate).Inordertoseekreimbursementformedicaltreatmentandtravelexpensesincurred,TreatmentGuaranteeisrequiredpriortotravel.

If thenecessarymedical treatment forwhich youare covered is available locally, but youchoosetotraveltoanothercountrywithinyourgeographicalareaofcoverfortreatment,wewillreimbursealleligiblemedicalcostsincurredwithinthetermsofyourpolicy;however,wewillnotpayfortravelexpenses.

Pleasenotethatasanexpatriatelivingabroad,youarecoveredforeligiblecostsincurredinyourhomecountry,providedthatyourhomecountryiswithinyourareaofcover.

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Ending your membership

Yourcompanycanendyourmembershiporthatofanyofyourdependantsbynotifyingusinwriting.Yourmembershipwillautomaticallyend:

• AttheendoftheInsuranceYear,iftheagreementbetweenAllianzWorldwideCareandyourcompanyisterminated.

• Ifyourcompanydecidestoendthecoverordoesnotrenewyourmembership.• IfyourcompanydoesnotpaypremiumsoranyotherpaymentduetoAllianzWorldwideCarein

accordancewiththeCompanyAgreement.• Ifyouareanindividualpayerandyoudonotpaypremiumsoranyotherpaymentdueunder

theCompanyAgreementwithAllianzWorldwideCare.Shouldthishappen,yourcompanymayexcludeyoufromthegroupschemeafterprovidingyouwith40dayswrittennotice.Thisnoticeshallonlybesent10daysafterthepremiumpaymentduedate.

• Whenyoustopworkingforthecompany.• Uponthedeathofthepolicyholder.

AllianzWorldwideCarecanendaperson’smembershipand thatof theirdependants if there isreasonableevidencethatthepersonconcernedhasmisledorattemptedtomisleadusi.e.givingfalseinformation,withholdingpertinentinformationfromus,orworkingwithanotherpartytogiveusfalseinformation,eitherintentionallyorcarelessly,whichmayinfluenceuswhendeciding:

• Whetheryou(orthey)canjointhescheme.• Whatpremiumsyourcompanyhastopay.• Whetherwehavetopayanyclaim.

Making a complaint

TheAllianzWorldwideCareHelpline(+353 1 630 1301)isalwaysthefirstnumbertocallifyouhaveanycommentsorcomplaints.Ifwehavenotbeenabletoresolvetheproblemonthetelephone,pleaseemailorwritetousat:

client.services@allianzworldwidecare.com

CustomerAdvocacyTeam,AllianzWorldwideCare, 15 JoyceWay, ParkWestBusinessCampus, NangorRoad,Dublin12,Ireland.

Wewillhandleyourcomplaintaccordingtoourinternalcomplaintmanagementproceduredetailedat:www.allianzworldwidecare.com/complaints-procedure. You can also contact ourHelpline toobtainacopyofthisprocedure.

Other parties

Nootherperson(exceptanappointedrepresentativeortheGroupSchemeManager)isallowedtomakeorconfirmanychangestoyourmembershiponyourbehalf,ordecidenottoenforceanyofourrights.NochangetoyourmembershipwillbevalidunlessitisspecificallyagreedbetweenyourcompanyandAllianzWorldwideCare.

Paying premiums

Inmostcases,yourcompanyisresponsibleforthepaymentofpremiumstoAllianzWorldwideCareforyourmembershipandforthemembershipofanydependantsalsocoveredundertheCompanyAgreement,togetherwithanyamountthatmaybedueandpayableinrespectofmembership(suchasspecialtaxoninsurancecontract(TaxedeSolidaritéAdditionnelle(TSA))).Pleasebeawarethatyoumaybeliableforpaymentoftaxinrespectofthepremiumspaidbyyourcompany.Fordetails,pleasecheckwithyourcompany.

If you are responsible for paying your insurance premium

Ifyouareresponsibleforpayingyourinsurancepremium,youarerequiredtopaythepremiumduetousinadvance,forthedurationofyourmembership.Theamountyourcompanyhasagreedwithusandthepaymentfrequencyyouhavechosen,willbeshownonyourInsuranceCertificate.Theinitial premiumorthefirstpremiuminstalmentispayableimmediatelyafterouracceptanceofyourapplication.Pleasenotethatifthereisanydifferencebetweentheagreedquotationandyourinvoice,youshouldcontactusimmediately.Wearenotresponsibleforpaymentsmadethroughthirdparties.Subsequent premiums aredueonthefirstdayofthechosenpaymentperiod.

Pleasenotethatyoualsohavetopayustheamountofanyspecialtaxoninsurancecontract,othertaxes,leviesorchargesrelatingtoyourmembershipthatwearerequiredbylawtopayortocollectfromyou.Thesemayalreadybeineffectwhenyoujoinbuttheycouldalsobeintroduced(orchangeinthefuture)afteryoujoin.Anysuchchargeswillbeshownonyourinvoice.

Ifanychangesareappliedtoyourpremiums,TSA,othertaxes,leviesorcharges,wewillwritetoinformyou.

Eachyearontherenewaldate,wemaychangehowwecalculateordetermineyourpremiums,theamountyouhavetopayand/orthemethodofpayment.Ifso,youwillbeinformedofthesechangesbyyourcompanyatleastthreemonthsbeforetheytakeeffect,andtheywillonlyapplyfromyourrenewaldate.Changesinpaymenttermscanbemadebyyouatpolicyrenewal.Pleasewritetoustorequestthisatleast30daysbeforetherenewaldate.

Ifyouareunabletopayyourpremiumforanyreason,pleasecontactussothatwecandiscussthiswithyou.

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Policy expiry

Pleasenote thatupon theexpiryof yourpolicy, your right to reimbursement ends.Anyeligibleexpensesincurredduringtheperiodofcovershallbereimburseduptotwoyearsafterthetreatmentdate.However,anyongoingorfurthertreatmentthatisrequiredaftertheexpirydateofyourpolicywillnolongerbecovered.

Renewing membership

If your company pays for your premium, the renewalof yourmembership (and thatof yourdependants, if applicable) is subject to your company renewing yourmembership under theCompanyAgreement.

If you pay for your premium and your company renews yourmembership (and that of yourdependants,ifapplicable)undertheCompanyAgreement,yourpolicywillbeautomaticallyrenewedfor thenext InsuranceYear, provided thatwe can continue toprovide cover in your countryofresidence,allpremiumsduetoushavebeenpaidandthepaymentdetailswehaveforyouarestillvalidonthepolicyrenewaldate.Pleaseupdateusifyougetanew/replacementcreditcardorifyourbankaccountdetailshavechanged.

Treatment Guarantee

YourTableofBenefitswillconfirmwhichbenefitsavailabletoyourequirepre-authorisationthroughsubmissionofaTreatmentGuaranteeForm.Pleasenotethatunlessagreedotherwisebetweenyourcompanyandus,ifaTreatmentGuaranteeFormisnotsubmittedtous,thefollowingwillapply:

• Ifthetreatmentreceivedissubsequentlyproventobemedicallyunnecessary,we reserve the right to decline your claim.

• ForthebenefitslistedintheTableofBenefitswitha1, we reserve the right to decline your claim.Iftherespectivetreatmentissubsequentlyproventobemedicallynecessary,wewillpayonly80% oftheeligiblebenefit.

• ForthebenefitslistedintheTableofBenefitswitha2, we reserve the right to decline your claim.Iftherespectivetreatmentissubsequentlyproventobemedicallynecessary,wewillpayonly50% oftheeligiblebenefit.

Treatment in the USA

If youhave “Worldwide” cover andwish to locate amedical provider in theUSA, simply go to:www.allianzworldwidecare.com/olympus.Ifyouhaveaqueryaboutamedicalprovider,orifyouhaveselectedaproviderandwishtoarrangeanappointment,pleasecall(toll-freefromtheUSA) (+1) 800 541 1983.Yourcompanymayhaveopted toprovideyouwithaCaremarkpharmacycard.Ifthereisanyamounttobepaidbyyou,thepharmacywillconfirmthis.Pleaseensurethatthe

prescriptionsyoupresenthavethedateofbirthofthepersonthattheprescriptionisfor.Youcan also apply for a discount pharmacy cardwhich can be used any time your prescription is not coveredbyyourhealthcarepolicy.Toregisterandobtainyourdiscountpharmacycard,simplygoto:http://members.omhc.com/awc/prescriptions.htmlandclickon“PrintDiscountCard”.

PleasenotethattreatmentintheUSAisnotcovered,ifweknowthatcoverwaspurchasedforthepurposeoftravellingtotheUSAtoreceivetreatmentforacondition,whenthesymptomsoftheconditionwereapparenttotheinsuredpersonpriortothepurchaseofcover.Ifanyclaimshavebeenpaidbyusinrelationtothetreatmentdescribedabove,wereservetherighttoseekreimbursementfromtheinsuredpersonofanyamountswhichhavealreadybeenpaidinclaims.

Treatment needed as a result of somebody else’s fault

Ifyouareclaimingfortreatmentthatisneededwhensomebodyelseisatfault,youmustwriteandtellusassoonaspossible;e.g.ifyouneedtreatmentforaninjurysufferedinaroadaccidentinwhichyouareavictim.Pleasetakeanyreasonablestepsweaskofyoutoobtaintheinsurancedetailsofthepersonatfaultsothatwecanrecover,fromtheotherinsurer,thecostofthetreatmentpaidforbyus.Ifyouareabletorecoverthecostofanytreatmentforwhichwehavepaid,youmustrepaythatamount(andanyinterest)tous.

When cover starts for you and your dependants

YourinsuranceisvalidfromthestartdateontheInsuranceCertificateandwillcontinueuntilthegrouprenewaldate(alsostatedontheInsuranceCertificate).Generally,thisisoneInsuranceYear,unlessagreedotherwisebetweenyourcompanyandusorifyoustartedyourpolicymid-year.Attheendofthisperiod,yourcompanycanrenewtheinsuranceonthebasisofthepolicytermsandconditionsapplicableatthattime.Youwillbeboundbythoseterms.

Coverfordependants(ifrelevant)willstartontheeffectivedateshownonyourmostrecentInsuranceCertificatewhichliststhemasadependant.Theirmembershipmaycontinueforaslongasyouremainamemberofthegroupschemeandaslongasanychilddependantsremainunderthedefinedagelimit.Childdependantscanbecoveredunderyourpolicyupuntilthedaybeforetheir18thbirthday;orupuntilthedaybeforetheir24thbirthdayiftheyareinfulltimeeducation.Atthattime,theymayapplyforcoverintheirownrightunderoneofourHealthcarePlansforIndividuals,shouldtheywishtodoso.

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Quick start guideYou can detach this part of the Employee Benefit Guide, if you just wish to have the most commonly referenced information to hand. Your cover remains subject to our policy definitions, exclusions and benefit limits, as detailed in the full Employee Benefit Guide.

Remember, some treatments require pre-authorisation

The following treatments/benefits require pre-authorisation through submission of a Treatment Guarantee Form:

Use of the Treatment Guarantee Form helps us to assess each case and facilitate direct settlement with the hospital. Please note that we may decline your claim if a Treatment Guarantee is not obtained. You can find full details on page 29 of this guide.

Evacuations and repatriationsAt the first indication that a medical evacuation/repatriation is required, please call our 24 hour Helpline (details on the back cover of this guide) and we will take care of everything. Given the urgency of an evacuation/repatriation, we would advise that you call us, however, you can also contact us by email at: medical.services@allianzworldwidecare.com. When emailing, please include “Urgent – Evacuation/Repatriation” in the subject line. Please contact us before talking to any alternative providers, even if approached by them, to avoid potentially inflated charges or unnecessary delays in the evacuation process. In the event that evacuation/repatriation services are not organised by Allianz Worldwide Care, we reserve the right to decline all costs incurred.

Getting treatment First, please check that your plan covers the treatment you are seeking. Your Table of Benefits will confirm which benefits are available to you, however, you can always call our Helpline if you have any queries.

• All in-patient benefits listed (where you need to stay overnight in a hospital).

• Day-care treatment.• Expenses for one person accompanying an

evacuated/repatriated person.• Kidney dialysis.• Long term care.• Medical evacuation (or repatriation, where

covered).• MRI (Magnetic Resonance Imaging) scan.

Treatment Guarantee is not needed for MRI scans unless you wish to have direct settlement.

• Nursing at home or in a convalescent home.• Occupational therapy (only out-patient

treatment requires pre-authorisation).

• Oncology (only in-patient or day-care treatment requires pre-authorisation).

• Out-patient surgery.• Palliative care.• PET (Positron Emission Tomography) and

CT-PET scans.• Rehabilitation treatment.• Repatriation of mortal remains.• Routine maternity, complications of pregnancy

and childbirth (only in-patient treatment requires pre-authorisation).

• Travel costs of insured family members in the event of an evacuation (or repatriation, where covered).

• Travel costs of insured family members in the event of the repatriation of mortal remains.

Getting in-patient treatment

1. Download a Treatment Guarantee Form from our website: www.allianzworldwidecare.com/members

2. Send the completed form to us at least five working days before treatment, by:

• Scan and email to: medical.services@allianzworldwidecare.com

• Fax to: + 353 1 653 1780 or post to the address shown on the form.

• Our Helpline can take Treatment Guarantee Form details over the phone if treatment is taking place within 72 hours.

If it’s an emergency:1. Get the emergency treatment you

need and call us if you need any advice or support.

2. Either you, your physician, one of your dependants or a colleague needs to call our Helpline (within 48 hours of the emergency) to inform us of the hospitalisation. Treatment Guarantee Form details can be taken over the phone when you call us.

Getting out-patient or dental treatment

When you visit a doctor, dentist, physician or specialist on an out-patient basis, please settle the bill with them and claim back the eligible expenses from us. If your company has selected our Online Services facility, claims can be submitted quickly and easily through our MyHealth app: simply provide a few key details, take a photo of your invoice(s) and press ‘submit’. www.allianzworldwidecare.com/myhealth

Alternatively, simply download a Claim Form from our website: www.allianzworldwidecare.com/members and follow the steps below:

1. Get an invoice from the doctor/dentist which states your name, treatment date(s), the diagnosis/ medical condition that you received treatment for, the date of onset of symptoms, the nature of the treatment and the fees charged.

2. Complete sections 1-4 and 7 of the Claim Form. Sections 5 and 6 only need to be completed by the doctor/dentist if their invoice does not state the diagnosis and nature of treatment.

3. Send the Claim Form and all supporting documentation, invoices and receipts to us via:

• Scan and email to: claims@allianzworldwidecare.com or

• Fax to: + 353 1 645 4033 or post to the address shown on the form

Without the diagnosis, we cannot process your claim promptly, as we will need to request these details from you or your doctor.

We can process a claim and issue payment instructions to your bank within 48 hours, when all required information has been submitted. We will email or write to you to advise you of when the claim has been processed.

If you are French and the contract is a top up to the CFE, fully completed Claim Forms will be processed and payment instructions will be issued to your bank within five working days.

Please refer to the “Claims” section on pages 22-23 of this guide for additional important information about our claims process. You can find information about getting treatment in the USA on pages 29-30.

Please find details below of some useful services available to you:

• You can access our web-based member services at: www.allianzworldwidecare.com/members. Here you can search for medical providers, download forms and access a range of health and wellbeing resources. Please be aware that you are not restricted to using the medical providers listed on our website.

• If your company has requested this facility, you will receive a username and password in your Membership Pack giving you access to our Online Services at: my.allianzworldwidecare.com. Alternatively, on the same page, select “Register” and provide the information requested (available on your Insurance Certificate). Via Online Services you can download key policy documents, check remaining benefit limits and the status of claims. If you are responsible for paying your own premium, you can pay your premiums by credit card and update your credit card details. Plus you can also make use of the great range of services available on our MyHealth app. www.allianzworldwidecare.com/myhealth

• The 24/7 MediLine Medical Advice Service can be accessed on: +44 (0) 208 416 3929. This service, provided by an experienced English speaking medical team, offers information and advice on a wide range of topics including, but not limited to, blood pressure and weight management, infectious diseases, first aid, dental care, vaccinations, oncology, disability, speech, fertility, paediatrics, mental health and general health. For policy or cover related queries (e.g. benefit limits or the status of a claim), please contact our Helpline.

Useful services

If you have any queries, please do not hesitate to contact us:

24/7 Helpline for general enquiries and emergency assistance

Email: client.services@allianzworldwidecare.comFax: + 353 1 630 1306

Telephone:French: + 353 1 630 1303

English: + 353 1 630 1301German: + 353 1 630 1302Spanish: + 353 1 630 1304Italian: + 353 1 630 1305Portuguese: + 353 1 645 4040

Calls to our Helpline will be recorded and may be monitored for training, quality and regulatory purposes. Please note that only the policyholder (or an appointed representative) or the Group Scheme Manager can make changes to the policy. Security questions will be asked of all callers to verify their identity.

Toll-free numbers: www.allianzworldwidecare.com/toll-free-numbersPlease note that in some instances the toll-free numbers are not accessible from a mobile phone. In this case, please dial one of the Helpline numbers listed above.

Address: Allianz Worldwide Care, 15 Joyce Way, Park West Business Campus, Nangor Road, Dublin 12, Ireland. www.allianzworldwidecare.com

Contact details

AWP Health & Life SA is regulated by the French Prudential Supervisory Authority located at 61, rue Taitbout, 75436 Paris Cedex 09, France.

AWP Health & Life SA, acting through its Irish Branch, is a limited company governed by the French Insurance Code. Registered in France: No. 401 154 679 RCS Nanterre. Irish Branch registered in the Irish Companies Registration Office, registered No.: 907619, address: 15 Joyce Way, Park West Business Campus, Nangor Road, Dublin 12, Ireland. Allianz Worldwide Care is a registered business name of AWP Health & Life SA.

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Rating effective from 17th December 2015. For the latest rating, please visit

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