Head office:Siegfried-Wedells-Platz 1 • D-20354 Hamburg
Terms and conditions for travel health insurance
VB-KV 2021 (SFE19-D)
We are HanseMerkur Reiseversicherung AG and our headquarters are located in Hamburg. You are our contract partner, referred to as thepolicyholder, if you have taken out an insurance policy with us.
If you have insured yourself, you are also the insured person. You may also have (jointly) insured other persons. We also refer to any such
persons in these insurance terms and conditions as “you”.
For ease of readability, we use the masculine form as standard. This is always intended to include the feminine form.

Section I – Overview of benefits
The full description of the insured benefits and events is provided in the relevant clauses of Section III Description of benefits.
Insured benefits
The amount of the benefit depends on the plan that you selectDeductible per insured event
Out-patient medical treatments in accordance with the fee schedule set out
2.1.1
in section III 1.2
2.1.2

Dental treatment for pain relief in accordance with the fee schedule set out
in section III 1.2 per insured event

2.1.3

Medications and surgical dressings

Plan
EconomyEUR 25

Plan
Economy Plus
None

Plan
First Class
None

100%

100%

100%

EUR 250

EUR 500

100%

100%

100%

100%
100%

2.1.4

Radiation therapy, light therapy and other physical treatments

100%

100%

2.1.5

Massages, mud packs, inhalation therapies and physiotherapy

Not insured

Not insured

100%

100%

100%

100%

2.1.6

Therapeutic aids following an accident

2.1.7

Visual aids

Not insured

Not insured

EUR 200

2.1.8

X-ray tests

100%

100%

100%

2.1.9

Operations

100%

100%

100%

2.1.10In-patient medical treatment under general care insurance (multiple-bedroom) without optional services (treatment by private doctor)

100%

100%

100%

2.1.11

Rehabilitation measures

Not insured

100%

100%

2.1.12

Screening check-ups for early detection of cancers per insurance year

Not insured

Not insured

EUR 200

2.1.13Outpatient psychoanalytical and psychotherapeutic treatments (up to 5
sessions per policy year)

Not insured

EUR 500

EUR 1,000

2.2.1

Dentures following an accident per insurance year

Not insured

EUR 500

EUR 2,000

2.2.2

Up to 50% of the cost (where eligible) for dentures, per insurance year

Not insured

Not insured

EUR 2,000

2.3.1

Treatment for pregnancy and treatment during premature birth

Not insured

100%

100%

2.3.2

Pregnancy screenings per insurance year
Deliveries, including screening and treatment costs by midwives

Not insured

100%

100%

2.4.1

Ambulance services for treatment in a hospital

100%

100%

100%

2.4.2

Medically sanctioned repatriation

100%

100%

100%

2.4.3

An accompanying person during repatriation

Not insured

100%

100%

2.5

Repatriation of mortal remains to the home country or funeral in theFederal Republic of Germany

EUR 10,000

EUR 10,000

100%

2.6

Hospital visit where the stay in hospital exceeds 14 days

Not insured

EUR 500

EUR 1,000

2.7

Follow-up liability until ability to travel is regained

100%

100%

100%

Section II – General provisions
1. Policyholder, insurable persons and eligibility
1.1

1.2

1.3
1.3.1
1.3.2

1.3.3
1.4

2.4.2

The policyholder is the natural or legal person who has takenout the policy with us. The insured persons are those referred
to by name in the insurance certificate for whom the premium
was paid. Newborn infants of insured persons shall be
included in the policy after birth, on the same plan as theirparents. This is subject to the following conditions:– that they are insured with us within 2 months of the dayof birth with retrospective effect, and– the insurance contract was concluded at least 3 months
earlier– was uninterrupted and– no other insurance cover exists.
The following persons are insurable if, at the time of
application, they are below the age of 75 and are foreign
nationals with permanent residence abroad and temporarily
visiting the Federal Republic of Germany or one of thecountries listed in Clause 3.1:
au pairs, pupils, language pupils, students, scholarship
holders, postgraduate students, guest scientists, trainees,
volunteer helpers, exchange students and participants in
Work & Holiday programmes , persons who aredemonstrably visiting to pursue further education, or tourists.
The following persons are not eligible and will not be insured,
even if payment of contributions is made:persons subject to mandatory health and/or care insurance
in the country of destination;
persons permanently in need of care as well as persons
whose participation in everyday life is permanently excluded.
The mental condition and objective living conditions inparticular of said persons shall be taken into account as
regards classification. Persons in need of care are those
persons who largely require external assistance to complete
everyday tasks;
persons practising a professional sport.
The insurance contract cannot be signed for persons who do
not fulfil the requirements of Clauses 1.1 and 1.2, even if thepremium is paid. If, however, the premium is paid for these
persons, a refund is available to the person paying thepremium.

2.4.3
2.4.4

2. Waiting times
If the insurance cover or benefits entail waiting times, these arecalculated from the start of insurance. Unless special waiting times
are specified below, the general waiting time is 31 days. The general
waiting time does not apply if the application is made within 31 daysof arrival. The date of arrival must be proved on our request. The
waiting time also does not apply to accidents or to medical
interventions to avert acute mortal danger. A comparable priorinsurance policy that existed following arrival without interruption up
to when this insurance commenced is counted against the general
waiting time. The limitations on the obligation to pay benefits under
section III 3 (Limitations to the insurance cover) and the special
waiting times continue without restriction.
3. Scope of the insurance cover
3.1

3.2

4.1 Premium amountThe premium for an insured person is shown by the premium
overview.
4.2 Payment of the first or one-off premium
4.2.1
4.2.2

2.1 Taking out insurance and commencement of the policy

2.1.2

2.1.3

The insurance cover applies during the temporary stay inGermany and for temporary trips in the countries of theEuropean Union, Great Britain and Northern Ireland, theSchengen countries, Andorra, Monaco, San Marino and the
Vatican City, but not in your home country. Home country as
per this condition is considered your permanent residence
before your temporary stay abroad.
For insurance contracts lasting 5 months, insurance coveralso applies during a temporary return to your home country,
notwithstanding clause 3.1. Insurance cover in your homecountry is limited to 6 weeks for all stays in the home country.

4. What requirements must be met when paying the premiums?

2. Taking out insurance, commencement, duration andtermination of the policy and insurance cover
2.1.1

with the death of the policyholder; the insured persons may
extend the insurance policy within 2 months of thepolicyholder’s death by nominating a future policyholder;if the eligibility criteria are no longer met;in the event of repatriation to the nearest suitable hospital inyour home country.

The application for an insurance contract may be made at
any time. It must be concluded for the total remaining periodof the stay.
The insurance contract is concluded when the correctlycompleted application form, which we have provided for thispurpose, has been received by us and we have sent you an
insurance confirmation. The application is only consideredcorrectly completed when it contains all the requested
information in an unambiguous and complete form.
If clauses 2.1.1 or 2.1.2 are not fulfilled, the insurance
contract is not valid even if the premium is paid. In this case,the person paying the premium is entitled to a refund.

4.2.3

The first or one-time premium is due at the start of thecontract.
If you fail to pay the first or one-off premium on time, youhave no initial insurance cover, unless the non-payment ordelayed payment is for reasons outside of your control. If thereason for the failure to make payment on time is within yourcontrol, however, insurance cover starts only after payment.
We shall also be entitled to withdraw from the contract for as
long as the premium remains unpaid. This does not apply if
the reason for non-payment is beyond your control.

4.3 Payment of subsequent premiums
4.3.1
4.3.2

2.2 Commencement of insurance cover
The insurance cover begins on the date indicated on the insurance
certificate (commencement of insurance), after the waiting periods
have elapsed. The prerequisite for this is that the policy is valid. No
benefits are provided for insurance cases that arose before the startof insurance cover or before the waiting period elapsed.

If the subsequent premium is not paid on time, we will send
you a reminder and will set a time limit of 2 weeks.
If you have still not made the payment when this deadline
expires, we are entitled to terminate the contract, if we havedrawn your attention to this when the reminder was sent.
If we have terminated the policy and you pay the amountdemanded within one month of receiving the termination, thepolicy shall continue. However, no insurance cover isprovided for insurance events that have occurred between
the deadline and the payment.

4.4 Collection of premiums

2.3 Duration

If you have agreed to the premium being collected from your accountby direct debit, this will take place as soon as the mandate has been
set up. The payment is considered to have been made in a timely
manner if we can collect the premium on the due date, and you do
not dispute collection of the correct payment.
If we cannot collect the premium due for a reason beyond yourcontrol, the payment shall still be considered to be on time if payment
is made immediately upon receipt of the written reminder from us.

The insurance applies for the agreed duration. The maximum period
of insurance is 365 days. The maximum insurance period also
applies taking into account similar insurance contracts that were notpreviously held with us.
2.4 Termination
The statutory provisions concerning the right to termination for cause
remain unaffected by these agreements. The insurance cover ends
upon termination of the insurance contract. The insurance contract
also ends for insured events not yet concluded or pending
2.4.1 at the agreed time;2

5. What requirements must be met when the benefit payment ismade?

payment and will contact the other insurer directly regarding cost
sharing.

5.1 Due date of the payment

6. Which law applies and what is the limitation period for
claims?
To whom do the provisions apply?

Once the proof of insurance and premium payment are available andwe have confirmed the amount of benefit and our liability to pay it, we
will pay within 2 weeks at the latest.
If the liability to pay is confirmed, but the amount of benefit has notbeen established within one month of receipt of the claim form by us,a reasonable down-payment on the benefit can be demanded.
If official enquiries or a criminal prosecution have been initiatedagainst you in connection with the insured event, we can postpone
the settlement of the claim until the legal conclusion of this process.

The German Insurance Contract Act (VVG) and in principle the lawsof the Federal Republic of Germany apply in addition to theseprovisions, unless international law states otherwise. Any claims
arising from this insurance contract expire in 3 years. Expiry bylimitation is measured from the end of the year in which the claim canbe made. If a claim has been made by you, the expiry period issuspended until our decision is sent to you in writing.
All provisions of the insurance policy also apply mutatis mutandis tothe insured persons.

5.2 Costs incurred in foreign currencies
We convert the costs using the euro exchange rate valid on the day
the records are received. The official exchange rate applies unlessthe currency to pay the bills was acquired at a less favourable rate.
We are entitled to deduct additional costs that arise if we need tomake transfers abroad or if particular forms of payment are requested
by you.

7. Offsetting
Counter-claims may be offset against our claims only if the counterclaim is uncontested or legally established.

5.3 Benefits from other insurance policies

8. What should be considered when contacting us?

If, in the case of an insured event, a benefit can be claimed fromanother insurance policy, that other policy shall take precedence. If
the insured event is reported to us first, we shall make an advanceAll notifications and statements intended for us should be made inwriting and directed to the address stated in the insurance certificate.
The language of the policy is German.

Section III – Description of benefits
1. Scope of insurance
1.1

1.2

1.2.1

1.2.2

1.3

prescriptions following the specific therapeutic directions of
homeopathy, anthroposophic medicine and phytotherapy).
We can however reduce our payments to the amount thatwould have been incurred by the use of available
conventional methods or medications.

Medically necessary treatment of an insured person due toillness or accident is considered to be an insured event. The
insured event starts with your treatment. It ends once it is
medically established that no further treatment is needed. If
the treatment needs to be extended to an illness orconsequences of an accident that is not causally linked totreatment up to that point, a new insured event shall beconsidered to have occurred. Also considered as an insured
event is the death of the insured person, as well as
necessary treatments for complaints during pregnancy,premature birth up to the 36th week of pregnancy,
miscarriages, medically necessary terminations ofpregnancy if the necessity of treatment had not existed at thetime the policy commenced and out-patient check-ups.
During your stay, you have free choice of the doctors,
dentists and hospitals recognised and accredited in the
country of destination. Hospitals must be under permanent
medical management. They must have sufficient diagnostic
and therapeutic facilities and manage case histories. These
hospitals may not carry out any spa treatments or sanatorium
treatments, nor may they accept reconvalescents. We
reimburse the costs arising in accordance with clause 2(Insured benefits).
In Germany, we reimburse the costs for medically necessary
medical treatment up to the so-called threshold values of theGerman Scale of Medical Fees (GOÄ) and the German Scaleof Fees for Dentists (GOZ). The following are deemed to be
the so-called threshold levels for payments- according to the fee schedule for dentists (GOZ), 2.3
times the fee rate,- according to the fee schedule for doctors (GOÄ)
pursuant to no. 437 and Section M (laboratory services)of the fee schedule for doctors, 1.15 times the fee rate,- according to Sections A, E and O (technical services),
1.8 times the fee rate,- for all other services of the GOÄ, 2.3 times the fee rate.
If you have purchased the First Class plan, costs will becovered up to the highest rates in the German Regulations
on Scales of Fees for Medical Doctors (GOÄ) and for
Dentists (GOZ).
Outside Germany, we assume the costs arising frommedically necessary treatment, if the fees were based on therelevant official current fee schedule – if available – or basedon fees generally charged for similar medical care in the localarea.
We only pay for diagnostic and treatment methods andmedications that are universally or generally recognised byconventional medicine. In addition, we pay for methods andmedications which have proved equally promising inpractice, or which are used because no conventional
methods or treatment are available (e.g. treatment and2. Insured benefits
If an insured event occurs, we provide the following benefits, if they
are insured under the plan selected by you, the insured event
occurred after the start of insurance cover, and the waiting times
have elapsed. An overview of these can be found in Section I of theseinsurance terms and conditions.
If benefits for aids are foreseen in the plan selected, the following
objects are considered to be aids: Bandages, trusses, inlays,
crutches and compression stockings, hearing aids, corrective splints,
artificial limbs/prostheses, cradles and seat shells, lifts with disabled
access, breathing monitoring equipment, infusion pumps, inhalation
devices, oxygen monitors, baby monitors, orthopaedic back, arm andleg support apparatus and speech devices.
2.1 Treatment expenses
Medical treatment within the meaning of these terms and conditions
is defined as medically necessary
2.1.1 outpatient treatment by a doctor;
2.1.2 pain-relieving, preservative dental treatment, including
simple fillings as well as repairs of existing dental prostheses,
provided these are carried out or prescribed by a dentist, as
well as repairs to braces (retainers) that cannot be delayedor their adjustment if pain occurs;
2.1.3 medication and dressings prescribed by a doctor (medication
does not include nutritional products and tonics or cosmetic
preparations even if prescribed by a medical practitioner);
2.1.4 radiation therapy, light therapy and other physical treatments
prescribed by a doctor;
2.1.5 massages, medicinal packs, inhalations and physiotherapy
prescribed by a doctor;
2.1.6 basic aids prescribed by a doctor that are required for the firsttime solely as a result of an accident and used to directly treat
the consequences of the accident;
2.1.7 visual aids such as glasses and contact lenses, after a
waiting time of 6 months, if vision has changed by at least
0.5 dioptres;
2.1.8 X-ray tests;
2.1.9 surgery that cannot be postponed;
2.1.10 in-patient medical treatment that cannot be delayed undergeneral care insurance (multiple-bed room) without optional
services (treatment by private doctor);
2.1.11 medically necessary rehabilitation measures;
2.1.12 screening check-ups for the early diagnosis of cancers inaccordance with statutory programmes introduced inGermany, after a waiting time of 6 months has elapsed;32.1.13 out-patient
treatment.

psycho-analytical

or

3.2.3

psycho-therapeutic

2.2 Dental replacement benefits
Dental replacements in the terms of this plan include pivot teeth,
inlays, crowns, bridges, orthodontic treatment, functional analysis
and functional therapeutic measures and implant dental treatments.
2.2.1 We reimburse the costs of a denture that has become
necessary for the first time due to an accident during theinsured period.
2.2.2 We reimburse 50% of the eligible cost of a basic, medicallynecessary denture after a waiting time of 6 months.

3.2.4

2.3 Insurance benefits in the event of pregnancy and
birth
2.3.1

2.3.2

3.2.5

We reimburse the costs that arise from medically necessary
pregnancy treatment indicated by symptoms, childbirth up to
the end of the 36th week of pregnancy (premature birth),treatment relating to a miscarriage, and a medicallynecessary abortion. The prerequisite for this is that thenecessity for treatment was not yet determined when theinsurance contract started.
If the pregnancy had not yet started at the beginning of theinsurance contract, we reimburse the costs for pre-natal
screenings and childbirth. The costs for pregnancy are only
reimbursed after the end of a waiting period of 8 months. The
reimbursement of corresponding examination and treatment
costs by midwives is possible only if the costs are not also
charged concurrently by a doctor.

3.2.6
3.2.7

3.2.8

2.4 Transportation costs
2.4.1
2.4.2
2.4.3

We reimburse the costs for ambulance transport to in-patientor out-patient treatment in the nearest suitable hospital andback to the accommodation.
We reimburse the additional costs of repatriation to thenearest suitable hospital to your place of residence, provided
the return transport is medically appropriate and reasonable.
We also assume the costs for a companion as well as thepresence of a doctor if this is required, provided thispresence is medically necessary, required by the authorities
or required by the transport company involved.

3.2.9
3.2.103.2.11
3.2.12

2.5 Repatriation of mortal remains and funeral costs
We reimburse the necessary additional costs that arise in the eventof the death of an insured person through the transfer of thedeceased to the home country, or assumes the cost of burial in
Germany up to the level of costs that would have been incurred forrepatriation of mortal remains.

3.2.133.2.14

2.6 Hospital visit
3.2.153.2.16

If it is clear that the insured person will have to stay in a hospital for
longer than 14 days, we shall arrange, upon request, for a relative or
friend of the insured person to travel to the location of the hospitaland back to their place of residence, and we shall cover the transport
costs for the round trip. This is, however, provided that the in-patient
treatment has not been completed by the time the relative or friend
arrives.

for treatment and other measures ordered by a physician
which the insured person knew to be necessary before theirstay in the agreed scope of cover or at the time of taking out
the insurance or which the insured person had to expect in
the circumstances of which he or she was aware;
for such illnesses, including their consequences, orconsequences of accidents which were caused byforeseeable acts of war or active participation in civil unrest
and were not explicitly included in the insurance cover; actsof war or internal unrest are considered to be foreseeable if
the Foreign Office of the Federal Republic of Germany –before the start of the journey – issues a warning against
travel for the country in question;
for spa and sanatorium treatments, unless these treatments
result from an insured, entirely in-patient hospital treatment
due to a major stroke, major heart attack or serious skeletal
disease (disc surgery, hip replacement) and serve to shorten
the stay in an acute hospital, and services which were agreed
in writing by the insurer before the start of treatment;
for addiction treatment, including withdrawal treatments;
for out-patient treatment in a spa or health resort; therestriction does not apply if the treatment becomes
necessary due to an accident at the location; for illnesses itdoes not apply if you were visiting the spa or health resort
only briefly and were not staying for the purposes oftreatment;
for treatments by spouses, parents or children or by persons
with whom you are living in your own home or in a homebeing visited; documented material costs will be reimbursed
according to the plan selected;
for such illnesses, including their consequences orconsequences of accidents caused by nuclear energy, orother interventions by authority;
for treatment or accommodation caused by infirmity, a needfor care or custody;
for hypnosis, psycho-analytical and psycho-therapeutic
treatment, provided no other regulations exist in the plan
selected;for dental implants, pivot teeth, bridges, crowns, bridges,
orthodontic treatment, prophylactic treatment, dental splints
and tracks, treatments and implant dental treatments
involving functional analysis and functional therapeuticmeasures, provided no other regulations exist in the plan
selected;for immunisation measures;for treatments due to disorders and damage to thereproductive organs, including sterility, artificial insemination
and associated medical check-ups and follow-up treatment;
for suicide, suicide attempts and their consequences;
for organ donations and their consequences.

4. General obligations and consequences of breaches ofobligations
4.1 Obligation to minimise costs
You have a duty to keep the claim as low as possible and to avoid
anything that could lead to an unnecessary increase in costs. If you
are fit to be transported, you must agree to return transport to yourplace of residence or to the nearest suitable hospital to your place ofresidence, if we approve the return transport according to the type of
illness and the necessity of treatment.

2.7 Follow-up liability
If an illness contracted during a stay abroad requires further
treatment which extends beyond the end of the insurance coverage
because the insured person is demonstrably unable to return home,
we are required under these terms and conditions to continue toprovide coverage until such time as the person is able to travel again.

4.2 Obligation to provide information
You must truthfully and promptly complete and return to us the claim
form that we sent to you. If we consider it necessary, you have a duty
to allow an examination by a doctor appointed by us to take place.

3 Restrictions to insurance cover
3.1 Deductible and restrictions of cover
3.1.1 For the Economy tariff, the agreed deductible amounts to
EUR 25 per insured event.
3.1.2 If a medical treatment exceeds the medically necessary levelor if the expenses for medical treatment exceed thosegenerally charged for similar medical care in the local area,
Advigon can reduce the benefits to a reasonable level.

4.3 Obligation to provide proof
You must submit the following proof, which thereby becomes ourproperty:
4.3.1 Original receipts containing the name of the person treated,the designation of the illness and the information from thedoctor in attendance on the treatment provided showing type,location and period of treatment. If other insurance cover fortreatment costs is available and if this is used first, thencopies of invoices noting the refund are sufficient asevidence.
4.3.2 Prescriptions together with the doctor’s invoice and invoices
for medicines and aids together with the prescription.
4.3.3 Proof of the amount of the costs that would have been
incurred had the return journey gone as planned, if payments
for return transport are claimed. In addition, a medical

3.2 Exclusions of cover
We do not provide cover:3.2.1 if you have wilfully brought about the insured event or attempt
to make fraudulent representations to us as to thecircumstances which are material to the grounds forproviding cover and the amount of insurance benefits;
3.2.2 for treatment that was the sole reason or one of the reasonsfor commencing the trip;

44.3.44.3.5

certificate from the doctor treating the patient abroad is to besubmitted with a detailed substantiation for medically
expedient and reasonable return transport.
An official death certificate and a doctor’s certificate which
details cause of death, if costs of repatriation of mortal
remains or burial are to be paid.
Further proof and receipts that we request in order to check
our obligation to pay, if the procurement of such proof andreceipts can reasonably be expected of you (e.g. proof of thedate of arrival).

4.4 Obligation toagainst third parties
4.4.1

4.4.2

secureclaimsforcompensation

If you have a basis to claim compensation from a third party,
this right shall be assigned to us, provided that we will pay
the damages. You must protect your claim for compensationor your right to secure this claim, taking into account theapplicable formal requirements and deadlines, and assist in
pursuing the claim if necessary. If your claim forcompensation is against a person with whom you were living
at the time of the event, the assigned claim cannot be
pursued unless this person caused the damage deliberately.
Your claims towards treating personnel who have charged
an excessively high fee will be transferred to us if we havereimbursed the costs. If necessary, you have a duty to assistin pursuing the claims.

4.5 Consequences of non-compliance with obligations
If you deliberately fail to comply with the above-mentioned
obligations, we shall be released from our obligation to provide
benefits. In the event that you fail to meet your obligations as a resultof gross negligence, we are entitled to reduce the benefit inproportion to the extent of culpability. If you demonstrate that you did
not fail to meet an obligation as a result of gross negligence, theinsurance cover remains unchanged.

5