Information to read before entering into an insurance contract

• Information about the insurance intermediary
  • Information about the insurance intermediary
• Insurance terms and conditions from JSC ARX Insurance Company
  • Information document for the product "Protection like at home"

   

• What is the insurance object?

  Health and working capacity of the Insured or a third person (the Insured) designated by the Insured in the Insurance contract with his/her consent, as well as medical and additional expenses directly related to the Insured event during the trip (travel) by the Insured or the Insured person.

• What risks are covered and what are the insurance limits?

  The program covers the following risks:

  • Insurance of medical expenses related to providing assistance (assistance) to persons in a difficult situation during a trip (trip) in Ukraine or abroad.
  • The conditions specified in clause 14 of Part B of the Insurance Contract are insurance limitations.
• What insured events are provided for under the Agreement?

  Insured events include:

  Provision of medical concierge services and/or telemedicine consultative assistance in case of an acute illness (diagnosis and treatment of an acute condition) exacerbation of a chronic illness (diagnosis and treatment of an acute condition), if the doctor considers it possible to provide such assistance online.

  Services for chronic diseases are provided for one disease no more than twice a year. "Disease" here means a diagnosis and etiologically related conditions from one "nosological block" according to ICD-10 (International Classification of Diseases, 10th Revision).

• When is it appropriate to provide a telemedicine consultation?

  The possibility of a telemedicine consultation with a doctor is decided on a case-by-case basis, but such consultations are advisable in the following cases:

  1. The symptoms of an acute respiratory viral infection, namely sore throat, cough, runny nose, fever, headache, weakness, etc;
  2. Diarrhea, vomiting; allergic reactions and dermatology (except for swelling of the lips, throat, difficulty breathing, blisters);
  3. Assistance in deciphering and interpreting test results (laboratory and instrumental); Counselling patients with chronic diseases such as diabetes, heart disease, respiratory diseases, if 30 they complain of a deterioration in their health right now;
  4. Issuing prescriptions for regular medication for chronic diseases, such as blood pressure (in case of loss of the prescription, with the provision of a previous medical history).
• What is the insured amount under the contract?

  The insurance amount under the contract is constant and amounts to 100,000 UAH per insured person.

• What is the maximum and minimum insurance amount under the contract?

  The cost of the contract is 350 UAH  per month. The minimum insurance premium is 1,350 UAH for 3 months and the maximum insurance payment is 4,200 UAH for 1 year.

• Is there a franchise in insurance contracts?

  Franchise is not applied (0 UAH).

• What is the insurance contract validity period?

  The Agreement shall be concluded for three months to one year.

  The start and end dates of the Contract are specified in the Insurance Contract in Part A (in the clause ‘Contract Term’).

  The Agreement shall come into force from 00:00 hours of the commencement date of the Agreement specified in Part A and shall be valid until 24-00 hours of the day specified in the Agreement.

• What is the insurance contract's territory?

  Europe, including Ukraine, except for the territories of the Autonomous Republic of Crimea, the city of Sevastopol, settlements of Luhansk and Donetsk regions, where the state authorities temporarily do not exercise or do not exercise their powers in full, territories (settlements) located on the contact line, where military operations are being (were) conducted or which are surrounded (blocked), territories temporarily occupied by the Russian Federation, as well as areas where the threat of a natural disaster has been officially declared above the normal state a6o which are recognized as exclusion zones as a result of the Chornobyl accident.

• What are the doctor profiles available?

  General practitioners and family doctors.

• What is the online consultation schedule?

  Consultations are provided 7 days a week from 8:00 to 20:00.

• How long to wait for an online consultation?

  Consultation waiting time - up to 24 hours.

• Will a prescription issued by a Ukrainian doctor be valid in all countries of the world?

  No. The prescription will not be valid in the Scandinavian countries, Poland, the United Kingdom, the United States, Ireland, Spain, and Indonesia.

• What is chronic disease monitoring?

  The ability to consult with a doctor about a chronic disease/exacerbation and, if necessary, receive an electronic prescription for medicines.

• What is a "second medical opinion"?

  The ability to see another doctor to confirm the diagnosis or treatment plan with test results and a doctor's opinion.

• How do I get a consultation report and an electronic prescription?

  The conclusion and the electronic prescription will be sent to me by e-mail or through another communication channel convenient for me.

• What is medical assistance?

  Assistance from a local doctor in finding a medical facility, making an appointment with a doctor, getting tested, finding a pharmacy, medicines, etc.) The customer pays for the cost of a doctor's appointment, examination, and purchase of medicines.

• Who is FUIB's partner?

  PJSC Insurance Company "ARKS".

• Reasons for denial of insurance payment?

  The reason for the denial of insurance indemnity is:

  • Intentional actions of the Policyholder or the Insured aimed at the occurrence of the Insured Event and resulting in the Insured Event;
  • Failure of the Insured or the Insured person to notify the Insurer of the occurrence of the insured event on time without good reason or creation of obstacles to the Insurer in determining the circumstances of the insured event;
  • If the Insured (the Insured person) has provided false information when entering into the Insurance contract;
  • Other cases stipulated by the legislation of Ukraine.
• Are there any consequences for the consumer in case of failure to fulfil the obligations set out in the insurance contract?

  If the Insured fails to pay the Insurance Payments in the amount and within the time limits specified in Part A, the Contract is deemed not to have entered into force.

• Can the product be purchased separately, without related and/or additional services?

  The Agreement is not in addition to other goods, works or services that are not insurance. In connection with the conclusion of this Agreement, there is no need to obtain additional or related services of the Insurer and/or third parties related to obtaining a financial service under this Agreement.

• Are there any discounts or promotional offers for the health insurance policy?

  Discounts are not available for health insurance policies.

• A list of information that is material to the assessment of insurance risk and/or information on other circumstances that are taken into account when determining the amount of the insurance payment?

  Upon entering into the Insurance Contract and during its validity, the Insured shall provide the Insurer with reliable information that is essential for determining the risk level.

• What are the cases when the Insurer is not responsible under the Insurance Contract?

  The Insurer is not liable under the Insurance Contract if the event has occurred:

  • During a state of emergency, special or martial law declared by the authorities in the country of residence of the Insured and/or during civil unrest, revolution, uprising, strike or terrorist act, as a result of illegal actions (inaction) of state authorities in the country of residence of the Insured, as well as if entry to this country is not recommended by the Ministry of Foreign Affairs of Ukraine;
  • As a result of exposure to nuclear energy;
• Insurance does not reimburse expenses:
  • that arose as a result of illegal actions of the Insured, intentional harm to his/her health, suicide attempt;
  • for treatment of diseases that arose before the conclusion of Insurance contract, including diseases at the stage of treatment, except for cases when such treatment is included in a complex product and agreed upon with the Insurer;
  • arose as a result of diseases and injuries sustained by the Insured person and associated with unjustified risk and danger of harm to life and health, as well as the Insured person's professional sports, participation of the Insured person in any competitions arising as a result of altitude, decompression (caisson) disease;
  • arising from driving motorised two- or three-wheeled vehicles in the absence of a driver's licence or a licence of the corresponding category issued in the country of residence;
  • medical services, goods and medicines in connection with chronic diseases, including epilepsy, bronchial asthma, systemic connective tissue diseases, benign and malignant oncological diseases, tuberculosis, haematological, autoimmune and demyelinating diseases, chronic renal failure, viral hepatitis, except for hepatitis A, liver cirrhosis; complications of peptic ulcer disease (multiple duodenal and/or gastric ulcers, ulcer penetration, stenosis of the gatekeeper);
  • for medical services, goods and medicines related to age-related degenerative and dystrophic processes, congenital anomalies and developmental defects, hereditary, professional mental illnesses, diseases of a psychogenic nature, violation of the language of emergency care;
  • medical services, goods and medicines aimed at health improvement and prevention of vaccination;
  • vitamins, sanatorium and resort treatment, preventive examinations, etc. Vaccination is covered only in case of emergency and life-threatening conditions.
    Insect bites are not covered if they are not life-threatening;
  • for medical services, goods and medicines for conditions (diseases, injuries, burns and poisoning) resulting from alcohol, narcotic and toxic substances;
    for the Insured to receive services and/or goods that are not medically necessary for diagnosis, treatment of emergency conditions or expenses that have not been previously agreed with the Assistance or the Insurer;
  • for obtaining medical certificates for state and other institutions, etc;
  • for experimental treatment, receiving by the Insured person services provided by a medical institution or a person who does not have a relevant licence, treatment by methods of alternative medicine (iridodiagnosis, correction, etc.), hypnosis, psychotherapy, reflexology, biological supplements, physiotherapy, manual therapy, massage;
    for cosmetic and plastic surgeries, transplantation of organs and tissues, prosthetics, medical equipment, purchase of prostheses and medical devices that replace or correct the functions of the affected organs, operations with the use of a heart-lung machine (LIMA), drugs for replacement therapy for infertility, impotence, sexual dysfunctions, contraception;
  • for medical services, goods and medicines that are not properly certified in the country of residence of the Insured Person and are documented by a doctor of a medical institution in the country of residence of the Insured Person as appropriate and necessary for the treatment of an emergency;
  • for medical services, goods and medicines for any dermatological diseases, including allergic dermatitis and allergic reactions to solar radiation, and sunburn;
    medical services, goods and medicines related to particularly dangerous infections;
  • for medical services, goods and medicines related to classical venereal diseases and infections transmitted mainly through sexual contact, according to the classification of the World Health Organisation;
  • for medical services, goods and medicines related to AIDS (HIV);
  • related to changes in body weight or treatment of obesity, body modification to improve psychological, mental and emotional state, including surgical sex reassignment;
  • related to pregnancy and childbirth, except for ectopic pregnancy and the need to terminate pregnancy for medical reasons, unless otherwise provided for in the terms and conditions of the insurance program;
  • for surgeries for vascular aneurysms, except for emergency surgeries for complicated cerebral vascular aneurysms when there is a threat to the Insured person's life;
    for any dental services;
  • for treatment with lipid-lowering drugs.
• It is not an insured event either:
  • moral damages, indirect damages, damages caused by a doctor's professional error;
  • losses for search and rescue of the Insured person, losses and expenses that could have been postponed until the Insured person returns to the country of permanent residence;
  • losses and expense incurred in Ukraine (country of permanent residence), even if they are.
• What are the procedure for calculating, terms and conditions of insurance payments?
  • The Insurer paid the insurance payment within the insurance amount and limits of liability specified in the insurance program in Part A. The insurance payment for the Assistance insurance class may not exceed the direct losses amount incurred by the Insured.
  • The insured amount for a particular class of insurance is reduced by the insurance amount payment made by the Insurer.
• What actions of the Insured Person in case of an insured event?

  In the event of an insured event and the need to receive emergency medical care abroad, the Insured personally or through other persons shall provide the Assistance Company with the Contract number, the Insured person's surname and name, location, and reason for contacting the contacts:

  • Number for calls from abroad: +380445001414
  • e-mail: [email protected],
  • VIBER bot: Ensuria 
  • TELEGRAM bot: Ensuria
  • Facebook Messenger: Ensuriacom

  The contact center operator registers the request and records the information provided by the Insured (his/her representative) by phone.

• Where can I find the disclaimer on the information required before concluding a policy?

  Before entering into the Insurance Agreement, the Insured shall read the information on exclusions from insured events and reasons for refusal to make insurance payments, limits of liability of the Insurer for a particular insured object, insured risk and/or insured event, as well as the procedure for calculating and making insurance payments.

  This information is available in the Information to be read before entering into an insurance contract.