INSURANCE POLICY
FOR THE FACULTY OF THE
HEBREW UNIVERSITY OF
JERUSALEM
Summary of Coverage
up to
1.
Expenses during hospitalization
in a semi-private 2-bed ward, including
intensive care, surgeon’s fees
2.
Out-patient expenses
3.
Worsening of an existing condition
during hospitalization, including
intensive care and surgeon’s fees (up
to 45 hospitalization days)
$200,000.-
4.
Medical fees for out-patient
treatment
$5,000.-
5.
Emergency dental care
6.
Cost of transportation to the hospital
7.
Pregnancy and childbirth
$5,000.-
8.
Emergency psychological treatment
overseas
$3,000.-
9.
Emergency nursing treatment
overseas
$5,000.-
65-03406
05/2004
10. Transfer of mortal remains
$500,000.-
$7,500.-
Deductible as specified in Policy
1
Coverage for Extra Payment
1.
Medical flight
Full coverage
2.
Death caused by accident
$15,000.-
3.
Luggage -
personal
$1,000.-
family
$3,000.-
4.
Emergency flight - personal
5.
Winter sports
6.
Third-party liability
family
Deductibles as specified in Policy.
2
$1,000.$2,000.-
$50,000.-
Part A: Basic Policy
1. Definitions in This Policy
1.1
1.2
1.3
1.4
1.5
1.6
1.7
1.8
1.9
The Insurer: Harel Insurance Co. Ltd.
The Insured: The Applicant and/or any one of
his/her family mentioned in the proposal, provided
their age does not exceed 75 years and who are
Israeli residents.
Overseas: Any country outside of Israel, including
a ship or airline on the way to or from Israel.
Trip: Exiting from and re-entering Israel within
the time period stated in the Policy.
Period: The Insurance Period as defined in the
proposal and on the condition that it does not
exceed the maximum period, with an additional
48 hours for transportation delays preventing the
Insured from returning to Israel on time.
1.5.1 Maximum Period: Up to 365 days only.
The insured will be able to extend the
Policy for another 365 days on express
condition that there is continuous insurance
coverage and on the condition that the
Insurer agrees to the extension in writing.
Hospital: An institution overseas and/or within
Israel recognized by the authorities as a hospital,
which serves only as a hospital, with the exception
of an institution also serving as a sanitarium
and/or institution of rehabilitation.
Hospital expenses: Payment for hospitalization
and medical services in a hospital, including
room, food, medical treatment, tests and
diagnoses, operating room, surgeon’s fees,
intensive care, anesthetist and medication, which
begins during the period of the Policy and the
cost of which corresponds to the accepted level
in the country in which treatment is provided and
does not exceed that specified in the Policy.
Medical expenses: Payment for a physician,
diagnostic tests, medication, relevant loaned
equipment supplied to the Insured overseas, in
connection with an accident on an out-patient
basis and not in a sanitarium, during the
Insurance Period, in accordance with prices
acceptable in the country in which treatment is
rendered and not exceeded that specified in the
Policy.
Event: An accident or illness suffered by the
3
1.10
1.11
1.12
1.13
1.14
4
insurance, not including an accident or an illness
for which the Insured was receiving treatment,
or medication only, or was under medical
observation only, at the time of his departure
overseas, or during the 6 months prior to his
departure.
Worsening: A sudden unexpected change for
the worse of an existing illness for which
emergency treatment was necessary overseas.
Underwriting for the Insured: It is hereby
declared and agreed that Insurees who are not
able to sign the statement of continuous health
for the purpose of the Policy because they are
now and/or were during the 6 months prior to
their departure overseas, suffering an existing
illness and/or are in the course of medical
treatment and/or are under medical observation
and/or medication, will be defined according to
this Policy as suffering from an existing illness.
The Insurer will not be responsible for expenses
of any kind due to treatment of this existing
illness, with the exception of the case of
Worsening of this illness, for which the rules set
forth in the terms of this Policy for worsening of
an existing illness shall apply.
Insurees who have had surgical operation/s
and/or have been hospitalized during the 6
months prior to their departure overseas and/or
who suffer heart disease and/or kidney failure
and/or a malignant disease, shall submit separate
requests for underwriting and individual
underwriting will be undertaken for them. In the
case that they are accepted for Insurance, a
special appendix will be issued for them defining
the responsibility of the Insurer and the terms of
the insurance.
Medical flight: Transportation of the Insured
back to Israel, either by regular scheduled flight
or by special aircraft, accompanied by appropriate
medical team (suited to the Insured’s medical
condition), on the condition that the Insurer’s
physician has determined that medical
intervention may be necessary during the flight
and on the additional condition that such a flight
has been deemed medically necessary and
permissible.
Dollar: US Dollar.
Proposal: Details and proposals described
herewith.
1.15 Extension: A new Policy issued by the Insurer,
at the request of the Insured, as a continuation
of this Policy.
1.16 Accident: Unexpected and sudden bodily harm
caused during the period by external, obvious
and violent means, being the sole, immediate
and direct cause of death or injury of the Insured,
with the exception of verbal violence.
Part B: Insurer’s Liability
1. Hospital Expenses Overseas
The Insurer will cover hospital fees incurred by an
event, as follows:
1.1 Expenses during hospitalization: Hospitalization,
tests, x-rays, medicine, physician, surgeon’s
fees, intensive care, catheterization, balloon,
pacemaker, complications during childbirth, will
be paid for to a level customary in said country,
in a semi-private, 2-bed room.
1.2 Worsening of existing condition: Up to 45 days
of hospitalization at the standard of hospitalization
defined in section 1.1 above.
1.3 Worsening of existing condition for suffers from
heart diseaes.
1.3.1 Heart disease to be defined below and
shall include all the following illnesses and
procedures:a. Ischemic heart disease in its various
forms:
1. Stable or unstable angina pectoris.
2. Obstruction of cardiac muscle –
M.I.
3. Positive result of diagnostic
catheterization.
4. C a t h e t e r i z a t i o n s u c h a s
angioplastic, stent, laser etc.
5. Bypass operation CABG and/or
any operation the aim of which is
to improve the blood supply to the
cardiac muscle.
b. All types of valvular heart disease that
cause at least intermediate damage
in the functioning of the valve and/or
cause a change in the structure of the
5
c.
d.
e.
f.
g.
1.4
6
valve, without any relation to the
severity of the hemodynamic
disturbance.
All types of congenital heart disease,
excluding a congenital disease that
has undergone an entire correcting
operation and does not need further
treatment after the operation.
Cardiomyopathy.
Disturbances in heart rate, excluding
early ventricular or atrial beats that
have no need for treatment or followup.
Conduction disturbances, excluding
first degree atrioconduction block and
block in the right conduction.
Pacemaker
1.3.2 It is hereby agreed that obtaining medicine
without diagnosis of heart disease shall
not be evidence of such a disease.
1.3.3 It is agreed that all the terms and conditions
set out in the policy and which relate to
the insurer’s liability with regard to the
worsening of a pre-existing condition as
defined in subparagraph 1.10 including
subparagraphs 1.1 and 2.2 in Part II shall
also apply to insured persons who suffer
from heart disease as mentioned above
if there occurs a worsening in their
condition. However, if during the worsening
of their condition the insured person
undergoes one or more of the following
operations:
a. catheterization.
b. Catheterization + angioplastic.
c. Angioplastic + stent.
d. Heart operation, e.g. bypasses and/or
valves, etc.
e. Installation of pacemaker
The insurer shall pay these costs as
set out in the policy with policy excess
of 35% deductible up to a maximum
sum of $10,000.
To prevent any misunderstanding, it is to be
noted that the insurer have no liability of any
kind, even in a case of worsening of the condition
of the insured person, and shall not pay any
costs arising from the terms and conditions of
this policy for current continuous treatment that
1.5
1.6
1.7
is given to the insured person for a pre-existing
illness including evaluation, examinations,
medication, etc.
It is agreed that in the case of the worsening of
a malignant disease the liability of the insurer
shall be limited to covering emergency medical
expenses only, as set out in the terms and
conditions of this policy.
a. Cost of further hospitalization in a public
hospital in Israel, following an accident or
disease that occurred overseas, for a period
of no more than 90 days, as long as the
Insured is not entitled to coverage of his
hospitalization expenses from any other
organization, or from the health fund of which
he/she is a member. The Insurer’s liability
according to this section shall be for a period
of 90 days from the day of the Insured’s arrival
in Israel, or from the date of termination of
the Insurance Period, the earlier of the two.
b. Medical flight: The Insurer will undertake the
expenses of a medical flight as defined in
section 1.12 of the Definitions, in the case of
an event covered according to this Policy (an
event for which the Insured would be entitled
to a refund of hospital expenses) and will
transport the Insured to Israel for continued
medical treatment. The mode of transportation
will be determined solely by the Insurer’s
physician, after receiving precise information
on the Insured’s medical condition and the
possibility of treating the Insured at the place
where he fell ill or was injured. The Insurer’s
liability according to this clause is conditional
upon preliminary authorization on the part of
the Insurer and on the flight being carried out
solely by the Insurer and/or someone on its
behalf (including AXA), and on the condition
that an additional premium has been paid for
medical flight, to cancel exclusion 4.5.
In order to eliminate any doubt, travel tickets
held by the Insured and/or a person escorting
him/her to Israel will be assigned in favor of the
Insurer, or their cost will be deducted from the
compensation that the Insurer owes the Insured.
If the Insurance Period according to this Policy
ends while the Insured is hospitalized overseas
and the attending physician overseas determines
that the Insured is unable to return to Israel, the
7
Insurance Period will be extended, for payment
of additional insurance fees, for a period of 14
days or until the date that the physician
determines that the Insured is able to return to
Israel, the earlier of the two.
This extension will be executed according to the
discretion of the Insurer alone, after it receives
the medical documents related to the
hospitalization, and solely according to its written
consent. In this case, a new Policy will be issued
to the Insured with the terms and limitations
determined by the Insurer.
2. Outpatient Expenses Overseas
2.1
2.2
2.3
2.4
2.5
2.6
2.7
8
The Insurer will refund the Insured for the
Insured’s medical expenses, including medical
care and diagnostic tests, within the framework
of the fees that are customary in the country
where the treatment is provided, and after
deduction of $15.- for every event.
The Insurer will refund the Insured for expenses
occurred not during hospitalization in the case
of worsening of an existing condition up to the
amount of $5,000 and with a deductible of $250.for every event.
Medication: Refund of medicines prescribed by
a doctor, with a deductible of $15.- per event.
Medicines for treating the worsening of an existing
disease will be covered. Medicines for regular
treatment of such a disease will not be covered.
The Insurer shall bear the above expenses solely
and exclusively against a doctor’s prescription
and appropriate original receipts, which are a
fundamental condition for compensation
according to the above sections.
The Insurer shall bear the transportation
expenses involved in moving the Insured by
ambulance from the location of the accident
and/or illness to the place of treatment. In the
case that such transportation is not possible, the
Insurer shall bear the cost of travel in another
form of land transportation, but this shall be
limited in scope to one trip only for each illness
or accident event and its consequences.
Emergency dental treatment: The Insured shall
be entitled to receive emergency dental treatment
and first aid, as specified below, and these
services only:
2.8
Extensive tooth decay - temporary filling; open
cavity - temporary filling; exposed tooth/dentin
- substance to prevent sensitivity; severe infection
- nerve removal or application of protective
substance; abscess originating in dental problem
- draining of abscess and/or treatment of closure;
compression of food - gum treatment; sub-crown
infection - rinse and/or medication; pain following
extraction - pain killer; pressure sores under
existing denture- release of sores; any other
toothache - treatment will be given to relieve or
stop the pain; examination and x-ray of painful
teeth; appropriate prescription of pain killer in
the case that no treatment can be administered
at the time.
Emergency treatment and first aid will be
administered even if they result from an existing
condition.
Out-patient expenses in Israel due to an
accident that occurred overseas, up to $2,000,
on the condition that the Insured is not entitled
to coverage of these expenses from any other
body.
3. Special Expenses
3.1
3.2
3.3
3.4
3.5
Pregnancy and childbirth: The Insurer will pay
the Insured the actual costs covered by this
Policy related to pregnancy and childbirth, up to
$5,000, subject to the preconditions, limitations
and deductible, as follows:
3.1.1 During childbirth or worsening in the course
of childbirth, due to fertility treatment, the
Insured shall bear only 50% of the
hospitalization costs as set forth in section
1.1.
3.1.2 The Insured will pay a deductible of $1,000
in the case of pregnancy and childbirth.
Psychological treatment as emergency treatment
overseas, up to $3,000.
Nursing care as emergency treatment overseas,
up to $5,000.
Physiotherapy due to accident only, up to $3,000.
Transfer of mortal remains:
3.5.1 Should the Insured die as a result of an
occurrence covered under this insurance
Policy, the Insurer will bear the expense
of transporting the corpse from the place
in which the event took place to Israel, up
9
3.6
to a maximum amount of $7,500, under
the express condition that the corpse be
transported by the Insurer and/or AXA
Ltd., in coordination with the Insured.
3.5.2 Should the beneficiary/beneficiaries of the
Insured and/or his/her legal heirs wish to
bury the corpse in the country where the
event took place, the Insurer will indemnify
the beneficiary/beneficiaries and/or, in the
absence of beneficiary, the legal heirs of
the Insured for the actual cost of burial
overseas, up to a maximum amount of
$2,500.
Orthopedic device/s fitted overseas due to an
accident that took place during the Insurance
Period.
The total liability of the Insured according to
Chapter 1 and Chapter 2 shall not exceed a
maximum amount of $500,000.
The total liability of the Insured according to
Chapter 1 and Chapter 2 in the case of
worsening or the case of complication during
childbirth shall not exceed a maximum
amount of $200,000.
All payments by the Insured according to this
Policy shall be solely and exclusively within
the framework of the accepted rates in the
country where the treatment is provided and
received.
4. Exclusions to Chapters 1, 2 and 3
1.
2.
3.
4.
10
Hospital expenses overseas.
Out-patient expenses.
Special expenses.
The Insurer will not pay for a claim/s resulting
from or connected with:
4.1 a. A pre-existing medical condition for
which treatment was anticipated at the
time that the Insured signed the
proposal or at the time of departure
overseas.
b. A medical condition for which the
Insured was advised by the attending
physician not to travel overseas.
c. A medical for which the Insured was
4.2
4.3
on the waiting list for medical treatment
or for hospitalization or for surgery.
d. A medical condition because of which
the Insured, or a close relative of the
Insured, was receiving medical
treatment, including medication only
and/or medical observation, at the time
that the Insured departed to go
overseas, or within 6 months prior to
the departure, or for sudden,
unexpected deterioration and change
for the worse in an illness that existed
in the past before the Insured’s
departure overseas (including, and
without detracting from the generality
of the above said, a malignant disease).
e. A trip for the purpose of obtaining
medical treatment overseas.
Periodic check-ups, examinations and
treatment related to the KUR healing program,
alternative medical treatment, holistic
medicine, mental disorder or nervous
condition, or temporary mental condition
and/or mental illness and/or any other mental
syndrome with the exception of those set
forth in Chapter 2, section 3.2, suicide or
attempted suicide, venereal diseases, AIDS,
organ transplant with the exception of a
transplant following an event, plastic surgery,
chiropractic and prostheses, physiotherapy
(including hydrotherapy, mechanotherapy
and inhalations), with the exception of that
set forth in section 3.4.
Notwithstanding the above-said in section
4.1 (a) of the Exclusions, according to which
the Insurer is not responsible for any expense
due to an illness or physical defect from
which the Insured suffered prior to the
beginning of the Insurance Period, and
subject to the other exclusions of this Policy
in the case of worsening, as defined in
Definition 1.10, the coverage will be expanded
and will include compensation for
hospitalization and medical expenses
overseas (except for transplantation of
organs) subject to the following
preconditions:
4.3.1 The Insured provided the Insurer with
a declaration and information about
11
4.4
4.5
4.6
12
the existence of the disease or defect
at the time of submitting the insurance
proposal.
4.3.2 The Insured provided the Insurer, prior
to his departure overseas, with medical
approval including the opinion of a
physician on the Insured’s trip and stay
overseas.
4.3.3 To avoid any doubt, and as set forth in
section 1.11, Insurees who have
undergone surgery and/or
hospitalization in the last 6 months
prior to their departure overseas and/or
who are suffering or have suffered heart
disease and/or a malignant disease,
will not be covered, even according to
the section on worsening, unless they
submit a special request to the Insurer
for medical underwriting and the
Insured has provided written approval
of the insurance, its special terms, and
its scope.
Additional exclusions to section 3.1 on the
extension of coverage for pregnancy: The
Insurer will not bear payment for any of the
following events:
4.4.1 Treatment of any kind for the purpose
of correcting infertility, implantation,
or fertilization. This restriction does
not apply to:
4.4.1.1 Hospitalization expenses or
medical expenses incurred due
to deterioration of the
pregnancy condition as a result
of an event that is not related
to the pregnancy.
4.4.1.2 Hospitalization expenses or
medical expenses incurred in
order to terminate a pregnancy
if continuation of the pregnancy
jeopardizes the life of the
pregnant Insured.
A medical flight, unless an additional premium
of $15.- per person has been paid, in order
to cancel this exclusion, and has been
recorded on the Policy.
Medical and/or other apparatus purchased
in Israel and/or overseas and/or for damage
and/or loss overseas of spectacles, optical
4.7
spectacles, contact lenses, hearing aids, and
various kinds of prostheses. In order to
eliminate any doubt, the Insurer will pay for
an orthopedic device fitted overseas due to
accident.
Drug use.
5. Expansion of Chapters 1-2
5.1
5.2
5.3
a. An infant that is born overseas to an Insured
and his wife who is also an Insured will also
be insured according to this Policy, for payment
of additional regular premium, on the express
condition that one of the infant’s parents can
sign for him on a health declaration, in the
wording of the declaration for which the insured
signed. If the parents are unable to sign on
the health declaration as above because the
infant born has a defect or is ill with a disease
requiring medical treatment, the Insured will
cover the infant that is born according to the
conditions of the Policy for a period of up to
30 days only.
b. If the infant is born prematurely, the Insurer
will cover the premature infant born for a
period of up to 14 day of hospitalization and/or
treatment.
If the newborn is transferred for primary treatment
due to an emergency, to an institution of the type
excepted from the coverage as defined in section
1.6, the Insured will cover the cost of the primary
medical treatment in such an institution, as long
as the treatment administered is of the type that
is administered in a hospital as defined in the
beginning of section 1.6 above.
The total liability of the Insurer according to
section 5 and its subsections shall not exceed
a maximum amount of $100,000, including the
cost of medical flight of the infant and/or newborn
and/or premature infant.
6. Claims
6.1
The Insured will inform Harel Insurance Company,
Ltd., POB 1951, Ramat Gan 52118, by air mail,
by means of a registered letter and/or fax, of any
event that is liable to lead to hospitalization
according to this Policy, and will, at the earliest
possible opportunity, present all medical
13
6.2
6.3
6.4
6.5
documents and confirmations, invoices and
receipts, as well as all documents necessary in
the Insurer’s opinion in order to examine the
claim. All documents according to section 6.1
shall be original documents only.
If at the time of occurrence of the event covered
by this Policy the Insured has another insurance
that covers the same event, the Insurer will be
responsible at the rate of its relative part only in
the amount of the claim and related expenses.
The compensation according to Chapter 1 of this
Policy (Hospital Expenses) shall never exceed
the amount actually paid by the Insured. If the
amount was not paid by the Insured, the Insurer
will pay the hospital overseas directly, according
to the Insurer ’s existing procedures.
Any other compensation according to this Policy
or payments according to chapter 1 (Hospital
Expenses) that are not transferred directly to the
hospital overseas will be paid to the Insured in
Israel, in Israeli currency, according to the selling
rate of checks and transfers set in Israel on the
day of payment by the Insurer.
a. If the Insured claims payment from the Insurer
for an expense or damage that a third party
is liable to cover, by law or by an agreement,
including an insurance agreement, and the
said payment is paid by the Insurer, the Insurer
will be entitled to repayment of the money it
paid to the Insured.
b. If the Insured submits a claim against a third
party, by virtue of his/her right derived from
an event that caused damage covered by this
Policy, the Insured will include in the claim
the amount that he/she so paid out of the first
amounts that he/she receives on the basis of
his/her claim. In the case that the Insured
does not submit a claim as said, he/she will
be obligated to transfer to the Insurer all his/her
rights of claim and cooperate with the Insurer
so that the Insurer can submit the claim itself.
7. General Conditions
7.1
14
Extension of the Insurance Period
a.
The Insured is entitled to request extension
of the Insurance Period. The request will
be sent by registered mail or will by sent
to Harel by the Insured’s power of attorney.
7.2
7.3
7.4
7.5
The request must reach the Insurer no
less than 30 days prior to the end of the
Insurance Period.
b.
If the Insurer does not agree to extension
of the period, it will inform the Insured in
writing by registered mail of its refusal.
Such a letter will be sent to the Insured
within 10 days from the date of receipt of
the Insured’s request.
c.
If the Insurer does not sent the Insured
notification of its refusal to extend the
Insurance Period within the period set
form in section 7.1(b), this will be construed
as agreement to the extension, on the
express condition that no change has
occurred in the health condition of the
Insured since the day of his/her departure
from Israel and on the condition that he/she
would be able to sign the health declaration
of the Policy.
d.
Calculation of the insurance fees for the
additional period will be based on the
number of months extended according to
the rate of the Insurer’s insurance fees
that is valid at the time of the extension.
In the case of controversies between the Insurer
and the Insured on any issue deriving from this
Policy, each party will be allowed to refer to an
arbitration committee agreed upon in advance,
composed of a physician representing the
institution of higher education and a
representative of the insurance company.
The sole place of jurisdiction for all matters related
to and/or derived from this Policy shall be the
court in the State of Israel only.
The liability according to this Policy is conditional
upon careful maintenance and fulfillment of its
instructions by the Insured as well as on the
truthfulness of the declaration on the back of this
page and the correctness of all notifications
submitted by the Insured with regard to claims
according to this Policy.
If the Insurance Period according to this Policy
ends while the Insured is hospitalized overseas
and the attending physician overseas determines
that the Insured is unable to return to Israel, the
Insurance Period will be extended for a period
of 14 days or until the date that the physician
deems the beneficiary fit to return to Israel, the
15
7.6
earlier of the two. This extension shall be made
according to the discretion of the Insurer, after
being presented with medical documents
regarding the hospitalization, and it is only
according to the written approval of the Insurer
that the Insured will be issued a new Policy, in
return for additional insurance payment, under
the terms and limitations determined by the
Insurer.
It is stressed that the liability of the Insurer
according to this Policy will be solely and
exclusively in the framework of acceptable
prices in the country in which the treatment
is administered.
8. Cancellation of the Policy
8.1
8.2
8.3
16
If the Insured cancels the Policy prior to his/her
departure overseas, and there is and will be no
reason for claims according to it, the Insured will
be refunded the sum of the insurance premium,
with the exception of the premium for the first
day of insurance, according to the Insurer’s rate,
on the condition that the original Policy is returned
to the Insurer before the beginning of the
Insurance Period marked on it.
The Insurer is entitled to cancel the Policy prior
to the Insured’s leaving Israel. In such case, the
Insurer will inform the Insured of this and refund
the insurance premium in full.
Shortening of stay overseas, exceeding 9 days:
a.
After the Insured has left Israel, the Insured
will be entitled to a proportionate refund
of the daily insurance premium that is not
used, subject to the condition that no claim
has been submitted according to this
Policy.
b.
In the case of an Insured who goes
overseas for a period of over one year
and who holds a Policy for the entire
Insurance Period - the proportionate refund
of the insurance premium will be calculated
for each year separately. The premium
will not be refunded for a year for which
there was a claim.
Part C. Extensions:
Terms of the Policy
1. Definitions in addition to the basic Policy:
1.1
1.2
1.3
1.4
1.5
1.6
1.7
Basic Policy: The terms of the Insurance set
forth in Parts A and B of this plan.
Period: The Insurance Period as defined in the
proposal, with an additional 48 hours for
transportation delays, preventing the Insured
from returning to Israel on time. The Insurance
Period for baggage:
a.
From the day of the Insured’s departure
from his/her home in Israel on the shortest
route to the destination overseas.
b.
On the Insured’s way back to Israel and
throughout the period which shall not
exceed 30 days and which will end on the
date of the return of the Insured to Israel
or on the date of the end of the Insurance
Period, the earlier of the two, and on the
express condition that the definition “trip”
is upheld according to section 1.4 of the
Basic Policy, and there is an overlap
between the period of extension and the
period of the basic insurance.
Accident: Unexpected and sudden bodily harm
caused during the period by external, obvious
and violent means, being the sole, immediate
and direct cause of death or injury of the Insured,
with the exception of damage resulting from
verbal violence.
Permanent disability: Total loss, anatomical or
functional, of an organ or limb or part thereof,
due to accident and caused within 12 months of
the time of its occurrence.
Death: The death of the Insured due to an
accident, caused within 12 months of the time
of its occurrence.
Baggage: Personal belongings for personal use
accompanying the Insured or located in the hotel
or the apartment where he/she is staying, with
the exception of business/commercial baggage.
Travel ticket: A travel ticket purchased by the
Insured overseas in place of the ticket he/she
purchased upon departure from Israel in order
to return to Israel from a given destination at the
end of the trip.
17
1.8
Escort: Another person insured by the Insurer
with overseas travel insurance accompanying
the Insured on his/her departure from Israel, who
intends to return with him/her, as long as he/she
is a close relative.
1.9 Close relative: Wife, husband, father, mother,
son, daughter, brother, sister, father-in-law,
mother-in-law, grandmother, grandfather,
grandson or granddaughter.
1.10 Valuables: Precious metals, diamonds, jewelry,
precious stones, watch, fur, electrical appliances,
electronic or optical equipment, ski equipment,
diving equipment, surfboards and wind
surfboards, camera and other photographic
equipment, computer/s, musical instruments,
religious artifacts, included in the baggage.
Part D: The Insurer’s Liability
2. Accidents
The Insurer will pay the Insured regarding an event
that began during the Insurance Period and that is
covered according to this Policy as specified below:
2.1 If, during the Insurance Period, physical damage
is caused to the Insured due directly to an
accident, including passive war risks, insurance
payments will be made as follows:
a.
In the case of the Insured’s death,
compensation will be paid to the
beneficiary named in the proposal, or
where there is no beneficiary, to the legal
heirs of the Insured or to the executors of
his/her estate or will. The insurance
compensation will be: for an Insured
between the ages 18-65, $15,000. For an
Insured who has not yet reached the age
of 18 or has reached the age of 65, there
will be no coverage according to this
section.
b.
Permanent disability - The Insured will be
paid a percentage of the amount stated
in section 2.1(a) and an Insured up to 18
years old, percentage of the amount
$7,500.
18
Limb
One eye
30%
Both eyes
100%
One ear
20%
Both ears
50%
Leg
60%
(above the knee)
Thigh
70%
Foot
50%
Big toe
5%
One other toe 3%
Limb
Arm
Middle finger
Palm
Thumb
Forefinger
Right
75%
65%
60%
25%
15%
Left
65%
55%
50%
20%
12%
Middle finger 12%
10%
Fourth finger 10%
8%
Little finger
12%
10%
Knuckle One third of the above %
The percentages noted in the table above relate to 100%
permanent disability of the particular part; any other kind
of permanent disability will be calculated based on the
above table. Any previous disability will be taken into
consideration when calculating the percentage of disability.
A left-side limb of a left-handed person will be considered
as a right limb in accordance with the table above.
2.2
Accompanying Personal Baggage Insurance
2.2.1 The value of baggage in the case of loss
or damage occurring as specified in section
1.1 above, for the Insured’s accompanying
baggage, up to a total of $1,000 but no
more than its real value (minus
amortization). An Insured under the age
of 18 years will be paid one-half of this
sum.
Total insurance payments for baggage will
be up to the amount of $1,000, including
valuables of up to $500.
Suitcase, or handbag or purse, up to a
total of $50.
Maximum coverage in the case of theft of
baggage from a vehicle (excluding a public
vehicle), including in the case of theft of
baggage during theft of the car itself and/or
theft from a left luggage locker, up to a
maximum of $200.
2.2.2 For a family, up to the amount of $3,000,
but no more than its real value (minus
amortization), including up to $1,500 for
valuables.
The above-said in this section will entail
a deductible of $40 for every claim for
each Insured.
19
3. Expenses in the Case of an Emergency Flight
The cost of airfare in the case that the Insured purchases
a travel ticket as defined in section 1.7 due to the
sudden death or critical illness of a close relative as
defined in Part C, section 1.9, in Israel, on the condition
that a medical certificate is presented that proves that
the cause of the event of death and/or critical illness
began after the beginning of the Insurance Period
according to this Policy, and up to $1,000 per single
Insured and up to $2,000 per family. In order to eliminate
any doubt, the travel tickets that were in the possession
of the Insured will be assigned in favor of the Insurer
or their cost will be deducted from the compensation
that the Insurer owes the Insured.
4. Third Party Liability
Up to a total of $50,000 for bodily harm or damage to
property for which the Insured has third-party liability,
including legal fees, according to Civil Wrongs
Ordinance.
5. Exceptions
To section 2.2 Accompanying Personal Baggage
Insurance
5.1 The Insurer will not cover any claims derived
from or involving: cash, checks of any sort,
stamps, photographic film, tickets of any sort
(flight/train/bus tickets, tickets for the theater
or other performances that cannot be
reconstructed, etc.), computer software,
diskettes, compact discs, cellular telephones,
weapons, loss or damage to work tools and/or
commercial goods, including business
samples, spectacles, contact lenses, medical
apparatus, including false teeth, hearing aids,
medications (as baggage), umbrellas,
parasols, damage to camera and/or
photographic accessories, objects d’art,
breakable objects. This applies whether the
damage and/or loss occurred to a separate
item or as part of the entire baggage.
Normal amortization, deterioration, gradual
wear and tear, breakage, mechanical or
electrical damage, damage due to moths,
worms, confiscation, expropriation of a
suitcase or travel bag, except in the case of
theft or fire.
20
5.2
5.3
5.4
Damage caused by carelessness of the
Insured or by failure to take reasonable
measures to prevent, reduce or return it.
Loss or damage caused to valuables as
defined in this Policy that were not kept on
the body of the Insured or in a handbag next
to him/her.
a. In the case that the damaged property was
new and the Insured holds a sales receipt
for the same property, the Insurer will
evaluate the damage (with no reduction
for amortization), although Value Added
Tax (as customary in the country in which
the object was purchased) will be deducted
from the compensation paid by the Insurer.
b. In the case that the Insured has no receipts
dated prior to the time of the damage, the
Insurer will evaluate the damage, although
in any case the maximum compensation
for any kind of loss and/or damage to
baggage of any type will be the value of
the object when new, minus no less than
35% amortization.
In the case that the baggage was in the
possession of an air or land transporter or
in the possession of a third party, the Insurer
will compensate the Insured only above the
amount of compensation paid by the
transporter and up to the limit of the Insurer’s
liability.
To eliminate any doubt, it is hereby clarified
that delay in arrival of baggage is not covered
according to this Policy and the Insurer shall
not be responsible for damage that results
from delay in arrival of baggage.
The Insurer will not be liable for consequential
damage, including and without detracting
from the generality of the above, expenses
derived from loss and waste of time for any
reason whatsoever, cancellation of a
transaction including suspension, delay,
bankruptcy, mental anguish, pain and
suffering, nursing care and the like.
To section 4 - Third Party Liability
5.5
The Insurer will not pay for a claim/s derived
from or involving: employer’s liability,
contractual liability or liability towards the
21
Insured’s close relative, liability resulting
from a deliberate act, an act of malice, or an
illegal act. Liability regarding an animal
belonging to the Insured or in the Insured’s
care or under his/her control. Liability due to
vocation, business or profession. Liability
resulting from the use of a vehicle, ship or
aircraft. Liability resulting from mountain
climbing, winter sports, diving, horse-back
riding and/or the use of weapons.
General Exceptions
The Insurer will not pay claim/s resulting from or
connected with:
5.6 An earthquake, unless an additional premium
has been paid to cancel this exception and
is recorded on the Policy, a volcanic eruption,
a nuclear reaction, nuclear or radioactive
fallout.
5.7 A flight where the Insured is not a passenger
on a regular scheduled flight authorized by
the authorities.
5.8 Participation of the Insured and/or a close
relative in acts of war, military acts, police
activity, subversive activity, a political coup,
revolt, disturbances, demonstrations,
sabotage, terror, strikes or illegal activity,
suicide or attempted suicide, use of a weapon.
5.9 Mountain climbing with ropes, rock climbing
or rappelling (snapling), diving, water skiing,
use of a jet ski, bungee, sports activity as
part of a sports society and/or competitive
sports activity, boxing, wrestling, and any
type of contact fighting, parachuting,
hovering/gliding using parachutes and/or any
other implement for hovering/gliding, rafting,
active participation in car racing, rafting.
5.10 Becoming intoxicated with alcohol.
5.11 The Insured and/or AXA Ltd. will not be
responsible for the existence of medical
services, provision of services, their quality,
quantity or the results of their provision, nor
will the Insured or AXA Ltd. be responsible
in any case in which the Insured refrains from
requesting and/or receiving medical
assistance.
5.12 An expense or damage that a third party is
responsible for covering.
22
5.13 The cost of taxi fare, permits, commission,
tax levies, telephone calls, faxes, legal costs
and professional fees, interest, bank
expenses, fines and the like.
6. Claims
6.1
6.2
The Insured will cooperate with the Insurer both
before and after making a claim and will undertake
to do everything necessary to enable the Insurer
to examine its liability with regard to compensation
according to the Policy and its scope.
The Insured will inform the Insurer immediately
of any event covered by the Insurance and will,
at the earliest possible opportunity, present all
the necessary documents (originals only) and
the following details:
a.
Hospitalization overseas: The
hospitalization form from the hospital
where the Insured was hospitalized. In
addition, the hospital must contact the
Insurer to obtain approval of payment for
the hospitalization.
b.
Out-patient medical expenses
overseas: A physician’s document
including diagnosis, reason for treatment,
and history of the illness. If treatment was
administered in stages, the details and
the reasons for each treatment should be
given separately. Confirmation of payment
by original receipts. Medication - a doctor’s
prescription of the need to purchase
medication, accompanied by original
receipts. In order to eliminate any doubt,
the Insured must pay all medical expenses
overseas that are not during hospitalization
as set forth above. The Insured must
present the Insurer with the claim for
insurance payments that are due to
him/her, if such are due according to the
terms of the Policy, in Israel.
c.
Loss or damage to baggage: A detailed
description of the event including details
of the property claims, stating dates and
place of purchase and the amount of the
claim per item, accompanied, as relevant,
by confirmation of notification of the police
at the location of the event overseas, the
airline or other office responsible for public
23
6.3
a.
b.
6.4
6.5
6.6
24
transportation, purchase documents and
any documents from the customs
authorities in Israel on the release of
baggage requiring customs.
d.
Travel ticket: The unused original ticket,
the newly purchased ticket and the doctor’s
certificate indicating in detail that a close
relative of the Insured died suddenly or
suffered a critical illness, as set forth in
section 3.
Insurance by other companies
The Insured must supply the Insurer with written
notice as soon as he/she becomes aware of any
other insurance that covers the risks covered in
this Policy.
This Policy will cover loss or damage or expenses
of any kind, if, at the time of the loss/damage
mentioned, the Insured was also covered by
another insurance(s), whether by the Insured or
whether by another, up to the limit of responsibility
defined in this Policy. However, the Insurer will
have the right of repayment by the other insurer/s
with regard to overlapping sums.
a. If the Insured has claimed payment from the
Insurer for an expense or damage for which
there was Third Part liability for coverage
according to law, including an insurance
agreement, and the appropriate payment has
been made by the Insurer, the Insurer will
have the right to repayment of the sums that
it paid to the Insured.
b. In the event that sums were paid out by the
Insurer as described in sub-clause (a), the
Insurer will receive all rights belonging or
having belonged to the Insured against a Third
Party, to the sum of the insurance payments
paid by it.
c. The Insured must cooperate fully with the
Insurer and do all in his/her power to permit
receipt of monies paid by the Insurer and
which were the responsibility of a Third Party.
d. The instructions of this condition shall not
apply to personal accident insurance.
All payments in Israeli currency according to this
Policy will be transacted according to the
representative exchange rate of the relevant
currency on the day that the Insured pays the
Insurer.
The Insured is not entitled, without the written
6.7
6.8
permission of the Insurer, to admit to liability or
undertake commitments that place liability on
the Insurer.
The Insurer will have the right to engage on
behalf of the Insured in any procedure pertaining
to liability according to this Policy or connected
with this claim.
The limitation period of any insurance claim shall
be 3 years from the date of the event.
7. Law and Jurisdiction
Any legal proceeding pertaining to or resulting from
this Policy shall be discussed according to the laws of
the State of Israel and the only and sole place of
jurisdiction of any such proceeding shall be in a court
in Israel.
25
AXA ASSISTANCE
Important
Dear Insured,
By purchasing this travel insurance policy from our company,
you are entitled to benefit from and use the service of the
AXA Assistance Company. AXA Assistance will be available
to you if you should need medical services to which you
are entitled under the conditions of our insurance in a
foreign country, and are unable to locate the appropriate
service providers required (hospitals, doctors, etc.).
In such a case, please call one of the AXA Assistance
Centers, which operate 24 hours a day, 7 days a week.
Upon contact, first tell them the phone number from which
you are calling, where they can reach you directly.
Then give them your personal details, policy number,
Insurance Period, and the nature of the event.
In the United States there is a separate center, as well as
toll-free service. See the list of centers on the next page.
You may call any of the following centers collect, if there
is such an arrangement in the country from which you are
calling. If you are unable to contact the center using this
method, give them your telephone number, including country
code and city code, and the center staff will call you back
immediately.
In any case, you may also call us directly in Israel, at the
numbers that appear below during work hours.
After work hours
Tel: xx-972-3-7547030
27
Tel:
972-3-7547030
Fax: 972-3-7547993
AXA ASSISTANCE
- International Headquarters Dial the code for making international calls in the
country where you are located (instead of the xx
below) and then dial the number:
00-420-2-72-10-10-31
IN AMERICA
North America
Chicago, Illinois
Tel:
1-312-935-3555
Toll free: 1-800-621-0295
Fax:
28
1-312-935-3575
Procedure for Submitting
Claims
It is not the purpose or the role of AXA to settle regular
claims. Therefore we strongly advise that you study the
procedures for submitting claims before leaving Israel:
1.
Hospitalization in a hospital abroad:
Present the insurance policy to the hospital where
the Insured is hospitalized. It is the duty of the hospital
to contact Harel Insurance Company Ltd. in order to
obtain approval of payment. In addition, in an
emergency, you may contact any AXA center in order
to receive assistance (the list of centers appears in
the insurance policy).
2.
Medical expenses abroad not during
hospitalization
*
Make sure that the doctor prepares a document
including diagnosis, reason for treatment, and
history of the illness.
If prolonged treatment is administered, the details
and purpose of each treatment should be provided
separately.
3.
*
Confirmation of payment in the form of original
receipts.
*
Medications - A doctor’s prescription for the purpose
of purchasing medication, accompanied by original
receipts.
Claim for baggage
*
Accurately record the circumstances of the event,
the details of the property for which the claim is
made, the dates of purchase, place of purchase,
and sum of the claim for each item.
*
Enclose the confirmation of the police at the
location of the event abroad, which is an essential
condition for processing a claim for baggage (in
each and every case).
*
Confirmation of purchase of the items claimed.
29
*
Confirmation by the airline if the damage occurred
during flight or transportation.
*
All documents submitted to the Insurer must be
originals.
4.
In any claim that you submit, please record and
declare whether you do or do not have an additional
policy and or other insurance coverage (in another
insurance company and/or by means of an international
credit card). Please note the name of the company
and/or credit card.
5.
For any claim, contact:
Harel Insurance Company Ltd.
Ramat-Gan, 3 Abba-Hillel St., P.O.B. 1951, 52118
Tel: 972-3-7547030
Fax: 972-3-7547993
We wish you a pleasant and healthy trip.
30
31
to
policy for the period
is holdong a valid insurance
THANK YOU
P.O.B 1951 RAMAT GAN 52118 ISRAEL
HAREL INSURANCE CO. LTD.
If you have any doubt or questions as to our obligation to pay, please contact our claim department directly
Tel: 972-3-7547930 or by Fax. 972-3-7547993.
1. up to US$500,000 if illness has not been under medical care, supervision, or medication for 6 months prior to departure.
2. up to 45 days and not to exceed US$200,000 impatient hospitalization, as defined above for a pre-existing illness. In order to
assist us to effect direct payment by check to you (Which has been sanctioned by the Israeli authorities), please complete this
form as fully as possible and return it to us at your earliest conveniance. Please send us also your delaited invoice, so that we
may effect payment as above.
Our insurance policy covers hospitalization expenses as an inpatient up to 150 days including: SEMI-PRIVATE room rate,
ancillary charges, examinations, X-rays, medications, physicians’ fees, surgeons’ fees, intensive care. These expenses will be paid
according to the usual customary, and reasonable price rates prevalent in the area in which the services were rendered.
Dear Sir,
Passport No.
This is to certify that Mr/s
TO THE HOSPITAL’S ADMITTING OFFICE
ßÒÓ†‰ÒÈÏÂÙ
˙ȇÂÙ¯†˙ÂÈ„ÂÒÓ†¯Â¯Á˘†·˙Î
˙ȇÂÙ¯‰† ˙ÂÈ„ÂÒ‰† ˙·ÂÁÓ† ÂÈ„·ÂÚ† ȇÂÙ¯† „ÒÂÓ† ÏΆ ‡Ù¯† ÏΆ ‰Ê·† ¯¯Á˘Ó† ¨Ï¢ÂÁφ ÌÈÚÒÂ† ÁÂËȷφ ‰ÒÈÏÂÙ·† ÁË·Ӊ† ¨‰ËÓ† ÌÂ˙Á‰† È‡
ÂÈ˙‡ˆÂ˙†¨ÈφÔ˙È˘†ÏÂÙÈˉ†¨È‡ÂÙ¯‰†È·ˆÓ†¨È˙ÏÁÓ†˙„‡†Ì„ȆÏÚ†˘¯„Ȇ¯˘‡†ÍÓÒÓ†ÏΆ‰ÁÂΆ‡·Ï†Ӣڷ†ÁÂËȷφ‰¯·Á†Ï‡¯‰Ï†¯ÂÒÓφ¨‰Ê·†¨˘˜·ÓÂ
ÆȇÂÙ¯‰†È·ˆÓφڂÂ‰†¯Á‡†Ú„ÈÓ†ÏΆ‡ØÂ
∫˙·Â˙Ά†††††††††††††††††††††††††††††††ÆÊÆ˙†††††††††††††††††††††††††††††††‰ÁÙ˘Ó†ÈË¯Ù†Ì˘
∫˙·Â˙Ά††††††††††††††††∫ÏÙËÓ‰†‡Ù¯‰†Ì˘††††††††††††††††∫¯·Á†Ò˜Ù†ßÒÓ†††††††††††††††∫ÌÈÏÂÁ†˙Ù˜†¯·Á
Date:††††††††††††††††††††††††††††††††††††††††††††††††††∫Íȯ‡˙†††††††††† Signature:†††††††††††††††††††††††††††††††††††††††††††††∫‰ÓÈ˙Á
WAIVER OF MEDICAL SECRECY
I the undersigned,insured under traveller’s, Policy, hereby release any Doctor, Medical Institute and their staff from their
obligation of medical secrecy, and hereby request that any document requested by Harel Insurance Co. Ltd. or their
representative, regarding my disease/illness, medical state, rteatment received results thereof and/or any other information
regarding my medical condition, be given to them upon their a/m request.
33
Notes