Global Health Options

POLICY RULES
Terms, General Exclusions, andDefinitions relating to your plan

POLICY RULES
Please read the Policy Rules along with your Certificate of Insurance and your Customer Guide
as they all form part of your contract between you and us.

CONTENTS
Important Information

3

Section 1 - General Terms and Conditions

4

Section 2 - General Exclusions

16

Section 3 - Definitions

23

www.cignaglobal.com | 2

IMPORTANT
INFORMATION
The insurance will be provided by:
Cigna Life Insurance Company of Europe S.A.–N.V
52 Avenue de Cortenbergh1000 Brussels
Belgium

This policy is designed for expatriates.
It does not provide any cover for thecost of treatment in a country of which
a beneficiary is a national at the time oftreatment (for example, the cover does
not cover the costs of a German national
obtaining any treatment in Germany) except
where the beneficiary is on a visit to thatcountry, all such visits during the period ofcover last for a total of less than ninety (90)days, and the country is within the selectedarea of coverage. See clause 17 for fulldetails.

If you do not fully understand the terms andconditions of this policy, then you should
contact us within fourteen (14) days of thestart date shown on your Certificate ofInsurance.

If the policy does not meet your needs, or
has not been issued in accordance with yourintention, you may ask us to cancel it within
fourteen (14) days of the start date shownon your Certificate of Insurance. If no claims
have been made, and no guarantees of
payment or prior approvals have been put
in place, we will refund any premium which
has been paid.
Words and phrases in italics have themeanings given to them in section 3,‘Definitions’.

This policy does not replace any state
health insurance scheme. You may wish totake appropriate advice before stopping
contributions to any state health insurance
scheme of which you are a member.

www.cignaglobal.com | 3

SECTION 1: GENERALTERMS AND CONDITIONS
1. Scope of cover
Subject to the terms, conditions, limits andexclusions set out in this policy, Cigna shall
reimburse medical and related expenses
relating to treatment provided within theselected area of coverage for injury andsickness. The treatment must occur during
the period of cover and deductibles, costshares and limits of cover may apply.

2. Policy documents
These Policy Rules, your application, yourCertificate of Insurance and the Customer
Guide constitute the entire contract
between you and us. You should read these
documents carefully.

3. Policy eligibility
You must be eighteen (18) years old or overto purchase a policy.

4.3
Where there is a delay between yourapplication and the initial start date of yourpolicy and your state of health changes
during the period of delay, you must let us
know. We reserve the right to cancel thepolicy or apply additional premiums or
exclusions as a result of any change to yourstate of health notified to us. If you fail to
inform us of any change to your state ofhealth during the period of delay, we maytreat this as a misrepresentation, which
could affect coverage under your policy or
payment of claims.

5. When does the cover end?
5.1
This policy is an annual contract. Thismeans that, unless it is terminated earlier
or renewed, the cover will end one (1) year
after the start date. For example, if the startdate is 1 January, the final day of cover willbe 31 December.

5.2
Cover will automatically end for any
beneficiary if:

4. When does the cover begin?
4.1
The cover will begin on the start date shownon the first Certificate of Insurance which
we send to you. The renewal date will fall on
this date each year.

4.2
If you choose to buy cover for any
additional beneficiaries, their cover will
begin on the start date shown on the first
Certificate of Insurance on which they arelisted.

5.2.1
the beneficiary dies (although any
benefits which may be payable after
death, such as repatriation of mortal
remains, will still be paid); or
5.2.2
the policy is terminated. The
circumstances in which you or we canterminate the policy are explained inclause 14.

www.cignaglobal.com | 4

5.3
If you die, cover will end for all beneficiaries.
If this happens, we will try to contact
any other beneficiaries who are covered
under this policy, and offer them theopportunity to continue the cover until theend date, with one of them taking over aspolicyholder. If the beneficiary does wish tocontinue the cover, they must respond, in
writing, within thirty (30) days, to confirm
their acceptance. If they do not do so,
all cover will end, and we will not makeany payments in relation to treatment orservices which are received on or after thedate on which the cover ends.

5.4
If this policy ends before the normal end
date, any premium which has been paid in
relation to the period after cover has ended
will be refunded on a pro rata basis, solong as no claims have been made and noguarantees of payment or prior approvals
have been put in place during the period ofcover.

(12) months. If you do not want to renew
your cover, you must let us know at least
seven (7) days before your policy end
date. Renewal is subject to the definitions,benefits and terms and conditions of the
Policy Rules in force at the time of renewal.
If we are unable to renew your cover for thereasons detailed in clause 14.1, we will give
you notice as described in clause 14.5.

6.3
If you do not renew your cover, any
beneficiaries who have been covered under
the policy can apply for their own cover. We
will consider their applications individually,
and inform them whether, and on whatterms, we are willing to offer them suchcover.

7. Who is covered?
7.1

If the policy ends before the normal end
date and you have made claims under it,
you will be liable for the remainder of any
premiums in respect of the policy which areunpaid.

You may add certain persons (e.g. family
members) as beneficiaries to your policy.
This is at our absolute discretion. In orderto do so, you must include them in yourapplication. If we agree to cover them, we
will include their names on your Certificate
of Insurance. Additional premium may bepayable, and special exclusions may be
applied in relation to them.

6. How is the policy renewed?

7.2

6.1
We will write to you at least one (1) calendar
month before the end date and ask you
whether you want to renew the cover you
currently have. We will also inform you of
any changes to the premiums, definitions,benefits and terms and conditions which
will apply on renewal.

6.2
If you choose to renew, you do not needto do anything, and your cover will berenewed automatically for another twelve

You may, if we give permission, take out
cover for certain people (e.g. minor children
or other dependents) while not taking out
cover for yourself. In this situation, you willbe the policyholder, and will be responsible
for payment of premiums and all otherobligations under the policy, but will not
be covered. All applications will be subject
to medical underwriting and we will let thepolicyholder know the terms that will apply
to any beneficiary named on the Certificate
of Insurance.

www.cignaglobal.com | 5

8. Can I add or remove beneficiaries
part way through the period ofcover?
8.1
Unless there has been a relevant qualifying
life event, you may add or remove abeneficiary only when you are renewing
the cover at the end of an annual periodof cover. For example, if the start dateshown on your Certificate of Insurance is 1
January, you may only add or remove a new
beneficiary with effect from 1 January thefollowing year.

8.2
If there has been a relevant qualifying life
event, you may add or remove the otherperson involved in that qualifying life event
as a beneficiary part way through the periodof cover. If you would like to add a new
beneficiary on this basis, you must send us acompleted application for that person.
We will then tell you whether we will offer
cover to that person and, if so, any special
conditions or exclusions and any additional
premium which would apply. Cover for the
new beneficiary will begin from the date on
which you confirm your acceptance.
We will send you an updated Certificate
of Insurance to confirm that the new
beneficiary has been added.

8.3
If you or your spouse gives birth, you may
apply to add the newborn as a beneficiary
to your existing plan:
8.3.1
If at least one parent has been coveredby the policy for a continuous periodof twelve (12) months or more prior to
the newborn’s birth and the applicationis received by us within thirty (30)days of the newborn’s date of birth,the newborn will not be subject tomedical underwriting, we will not require

information regarding the newborn’s
health or a medical examination, andcover will begin when we confirm
receipt of the application. We will send
you an updated Certificate of Insurance
confirming that the new beneficiary has
been added.
8.3.2
If at least one parent has been coveredby the policy for a continuous periodof twelve (12) months or more prior to
the newborn’s birth and the applicationis received by us more than thirty(30) days after the newborn’s date ofbirth, the newborn will be subject tomedical underwriting. We will then tell
you whether we will offer cover to thenewborn and, if so, any special conditions
and exclusions which would apply. If
you accept the offered terms, cover will
begin when we confirm receipt of theapplication. We will send you an updated
Certificate of Insurance confirming thatthe new beneficiary has been added.
8.3.3
If neither parent has been covered by
the policy for a period of twelve (12)consecutive months or more prior to
the newborn’s birth, the newborn will
be subject to medical underwriting. We
will then tell you whether we will offer
cover to the newborn and, if so, any
special conditions and exclusions which
would apply. If you accept the offeredterms, cover will begin when we confirm
receipt of the application. We will send
you an updated Certificate of Insurance
confirming that the new beneficiary has
been added.

www.cignaglobal.com | 6

9. What is covered?
9.1
This policy covers certain costs of services
or supplies which are recommended bya medical practitioner, and which are
medically necessary for the care andtreatment of an injury or sickness, as
determined by us.

9.2
The costs which are covered are set out in
the Customer Guide. These costs are subject
to the limits and exclusions which are set
out in these Policy Rules, the Customer
Guide, and your Certificate of Insurance.

9.3
In addition to prior approval for treatment;
further approval may be required forany treatment incurred in relation to thematernity and childbirth benefit if at thetime of treatment:
9.3.1
the mother is intending to be outside hercountry of habitual residence; or
9.3.2
the mother is intending to be in her
country of nationality.

9.4
Special exclusions, imposed on an individual
basis, may apply. Details of these special
exclusions will be shown on your Certificate
of Insurance. In some circumstances wemay, at our absolute discretion, agree toremove an exclusion if you pay an additional
premium. This will be agreed at the time
you purchase your policy.

9.5
Any claim is subject to the applicabledeductible, cost share and limits of cover
set out in these Policy Rules, the Customer
Guide, and your Certificate of Insurance.

9.6
This policy will not cover any costs relating
to treatment received before the cover
starts, or after the cover ends (even if thattreatment was approved by us before thecover ends).

10. Coverage options
10.1
The International Medical Insurance planis provided to every beneficiary. The
benefits which are available (subject tothe applicable terms, conditions, limits andexclusions) are set out in ‘Your Benefits in
Detail’ in the Customer Guide.

10.2
You may (if you pay additional premium)
add to the cover provided under theInternational Medical Insurance plan bychoosing one or more from the following
extra coverage options. If you do, the extra
coverage will apply to all beneficiaries
under your policy.
10.2.1
International Outpatient;10.2.2
International Medical Evacuation;
10.2.3
International Health and Wellbeing; and10.2.4
International Vision and Dental.

10.3
Details of the extra coverage options are
set out in ‘Your Benefits in Detail’ in the
Customer Guide.

10.4
Coverage options cannot be changed atyour request during the period of cover.
If you want to add or remove coverage

www.cignaglobal.com | 7

options, you should let us know before theannual renewal date.

deductibles elected on your policy willcontinue to apply.

10.5

To be eligible for this benefit the medical
condition requiring emergency treatment
must not have existed prior to the travel
and the beneficiary must have beentreatment-, symptom- and advice free ofthe medical condition prior to initiating
the travel.

If you want to add new coverage options,
we may ask for a completed medical history
questionnaire, and we may apply new
special restrictions or exclusions on the newcoverage options.

10.6
You may (unless your country of habitualresidence is the USA) choose between two
options (Worldwide excluding USA andWorldwide including USA) to determine
where in the world beneficiaries will becovered.
10.6.1
The Worldwide excluding USA option
provides cover, subject to the terms of
the policy, for treatment anywhere in
the world except the USA. This option is
not available if your country of habitualresidence is the USA.
Beneficiaries will be covered for
emergency treatment on an inpatientor daypatient basis or provided on an
outpatient basis (if the International
Outpatient additional coverage option
has been purchased under your policy)
during temporary business or holiday
trips even if those trips are outside
your selected area of coverage. As
with all emergency treatment, if you
have not purchased the International
Outpatient additional coverage option,
your emergency treatment will only becovered if it results in an admission to
the hospital. This cover will be limited toa maximum period of three (3) weeks
per trip and a maximum of sixty (60)days per period of cover for all trips
combined.
Coverage continues to be subject tothe maximum benefit amounts stated inyour Customer Guide; any cost shares or

Receiving medical treatment must nothave been one of the objectives of
the trip. Emergency treatment is only
applicable if you do not already havestate-provided healthcare in that country.
Charges relating to maternity, pregnancy,
childbirth or any complications ofpregnancy or childbirth are excluded
from this benefit.
Proof of the date of entry into thecountry outside your selected area ofcoverage will also be required prior tobenefits being paid under this cover.
This cover will cease once the treatment
provided results in a stabilised condition.
10.6.2
The Worldwide including USA option
provides cover, subject to the terms of
the policy, for treatment anywhere in theworld (including the USA).

11. Premium and other charges
11.1
Your Certificate of Insurance sets out thepremium and any other charges (such as
taxes) which are payable, and states whenand how they must be paid.

11.2
Payments must be made in the currency
and in the manner detailed on yourCertificate of Insurance.

www.cignaglobal.com | 8

11.3
We may apply certain penalties if any
beneficiaries do not seek prior approval fortreatment or receive treatment in the USA
at a hospital, clinic or medical practitioner
which is not part of the Cigna network. A
list of Cigna network of hospitals, clinics
and medical practitioners is available inyour secure online Customer Area.

11.4
You are responsible for paying the premium
and any other charges as detailed onyour Certificate of Insurance, and are also
responsible for making sure these payments
are made on time.

12. Deductible
12.1
We will reduce the amount which wewill pay towards the cost of treatment
in respect of each claim which is madeunder the International Medical Insurance
or International Outpatient option (ifapplicable) by the amount of any deductible
until the deductible for the period of coveris reached.

12.2
The deductible applies separately to eachbeneficiary, each coverage option, and eachperiod of cover.

11.5

12.3

If you do not pay premium and othercharges when they are due, we will notify
you by email immediately and suspend yourpolicy i.e. cover for all beneficiaries will besuspended. If payment is made, the policy
will be reinstated. We will not approvetreatment while the policy is suspended.
We will not settle any claim while any
payment to us is outstanding until theoutstanding amount is paid.

You can choose to have a deductible on
the International Medical Insurance orInternational Outpatient option. If you
do so, your premium will be lower than itotherwise would be. If you would like toapply a deductible, you should tell us so in
your application.

If at thirty (30) days the amount is still
outstanding, we will write to you informing
you that the policy is cancelled. The
cancellation date shall take effect on thedate when the first outstanding payment
was due.
If you settle the outstanding amountwithin thirty (30) days of when the first
outstanding payment was due, we will
reinstate your cover back to that date.

11.6
The premium and / or other charges mayvary from year to year. We will write to you
before the annual renewal date to tell you
about the premium and or other charges
which will apply during the next period ofcover.

12.4
No deductible applies to ‘Inpatient Cash
Benefits’ or ‘Newborn Care Benefits’.

12.5
You will be responsible for paying theamount of any deductible directly to thehospital, clinic or medical practitioner. We
will let you know what this amount is.

12.6
You can request a change to the deductible
with effect from your annual renewal dateeach year. If you wish to remove or reduce
your deductible, we may require a medical
history questionnaire, and we may apply
new special restrictions or exclusions.

www.cignaglobal.com | 9

13. Cost share
13.1
If a cost share is selected on theInternational Medical Insurance plan, we will
reduce the amount we pay towards the costof treatment by the cost share percentage.
The cost share percentage results in a
proportion of the costs of treatment not
being covered by us; these costs will becapped by the out of pocket maximum you
have chosen for any one period of cover.

apply a cost share, you should tell us so in
your application. Additionally, if you choose
to have a cost share, you also select acorresponding out of pocket maximum.

13.6
If you select both a deductible and a costshare, the amount you will need to pay
due to the deductible is calculated before
the amount you will need to pay due tothe cost share. Refer to clause 12 for more
information relating to deductibles.

13.2

13.7

If a cost share is selected on theInternational Outpatient option, we will
reduce the amount we pay towards the costof treatment by the cost share percentage.
The cost share percentage results in a
proportion of costs of treatment not being
covered by us; these costs will be cappedby the out of pocket maximum you havechosen for any one period of cover.

You will be responsible for paying theamount of any cost share directly to thehospital, clinic or medical practitioner. We
will let you know what this amount is.

13.3
Only amounts you pay related to thecost share on the International Medical
Insurance or International Outpatient plan
are subject to the capping effect of theout of pocket maximum. Any amounts you
pay due to a deductible; due to exceeding
limits of cover; for treatment not coveredby the International Medical Insurance
plan or International Outpatient option; ordue to penalties for not obtaining proper
pre-authorisation or using out of network
providers in the USA, are not subject to theout of pocket maximum.

13.8
You can request a change to the costshare and out of pocket maximum witheffect from your annual renewal date eachyear. If you wish to remove or reduce yourcost share or reduce your out of pocket
maximum, we may require a medical history
questionnaire and we may apply new
special restrictions or exclusions.

14. Termination of cover
14.1
Subject to any conflicting legal or
regulatory requirements we may terminate
this policy if:

13.5

14.1.1any premium or other charge (including
any relevant tax) is not paid in full within
thirty (30) days of the date on which it isdue. We will give you written notice if weare going to terminate the policy for thisreason; or

You can choose to have a cost share on
the International Medical Insurance planor International Outpatient option. If you
do so, your premium will be lower than itotherwise would be. If you would like to

14.1.2it becomes unlawful for us to provide anyof the cover available under this policy;or

13.4
The out of pocket maximum and the costshare apply separately to each beneficiaryand each period of cover.

www.cignaglobal.com | 10

14.1.3
any beneficiary is identified on any list
imposing financial sanctions on targetedindividuals or entities maintained by theUnited Nations Security Council, theEuropean Union, the United States Officeof Foreign Assets Control or any otherapplicable jurisdiction. Furthermore, wewill not pay claims for services received
in sanctioned countries if doing so would
violate the requirements of the United
Nations Security Council, the European
Union or the United States Departmentof Treasury’s Office of Foreign Assets
Control; or
14.1.4
we determine, on reasonable grounds,
that you have, in the course of applying
for the policy or when making any claim
under it, knowingly or recklessly provided
information which you know or believe
to be untrue or inaccurate or failed toprovide information which we have asked
for; or
14.1.5
we are no longer in the market to sell thepolicy or a suitable alternative in yourgeographical area.

14.2
If you want to terminate this policy and end
cover for all beneficiaries, you may do soat any time by giving us at least seven (7)days’ notice in writing.

If the policy ends before the normal end
date and you have made claims under it,
you will be liable for the remainder of any
premiums in respect of the policy which areunpaid.

14.4
If treatment has been authorised, Cigna will
not be held responsible for any treatment
costs if the policy ends or a beneficiaryleaves the policy before treatment has takenplace.

14.5
We will wherever possible, write to you atleast one (1) month before the end date togive you written notice that the policy will
not be renewed with effect from the end
date.

15. Your duty of reasonable care
You must take reasonable care to answer
all questions from us honestly, accurately
and in full. If you fail to do so, or if you
deliberately or recklessly provide us withinformation which you know or believe to
be untrue or inaccurate, this could resultin us cancelling your policy, reducing thevalue of any claims payment which you aredue, or in refusing to pay a claim or claims
altogether.

14.3
If this policy ends before the normal end
date, any premium which has been paid in
relation to the period after cover has ended
will be refunded on a pro rata basis, solong as no claims have been made and noguarantees of payment or prior approvals
have been put in place during the periodof cover. If your policy is terminated inaccordance with clause 14.1.4, however, we
may not refund any premiums you have
paid and payment of any claims you havemade under your policy may also not be
made.

16. Fraud
Any beneficiary who, knowingly and withintent to defraud any insurance company
or other person: (1) files an application for
insurance or statement of claim containing
any materially false information; or (2)conceals for the purpose of misleading,information which has been asked for,commits a fraudulent insurance act, which isa crime.

www.cignaglobal.com | 11

17. Expatriates and nationals
17.1
This policy does not cover any costsof treatment in a country of which thebeneficiary receiving treatment is a national,
except where the beneficiary is on a visit tothat country, all such visits during the periodof cover last for a total of less than ninety(90) days and the country is within theselected area of coverage.

17.2
If any beneficiary is not, or ceases to be, an
expatriate (whether as a result of a changeof nationality or a change of habitualresidence), then you may:
17.2.1leave the policy in force. Cover willremain unaffected for any beneficiary
who is an expatriate and for any
beneficiary who is not an expatriate but
obtains treatment outside their countryof nationality; or
17.2.2
terminate the policy in accordance withclause 14.2, in which case clauses 14.3
and 14.4 will apply.

17.3
In some instances, we may need to end thecover if a change of country of habitualresidence would make it unlawful for us
to provide you with cover or would resultin a breach of regulations governing theprovision of healthcare cover to local
nationals, residents or citizens.

increase. If the premium increases, we will
give you the right to cancel, in accordancewith clause 14.2, in which case clauses 14.3
and 14.4 will apply.

18. Change of address and nationality
18.1
We will send any communication andnotices in relation to this policy to thepostal address or email address you haveprovided. If you have chosen to receive yourpolicy documents electronically, we willplace them in your secure online Customer
Area.

18.2
You must tell us if any beneficiaries change
address, country of habitual residence, orcountry of nationality. We will then send
you an updated Certificate of Insurance by
the means which you have chosen (postal
address you have provided or placing inyour secure online Customer Area).

19. Contacting you
If we need to contact you in relation to thispolicy, or if we need to give you notice that
we are going to amend or terminate thispolicy, we will write to you at the postal
address or email address you have given us.

17.4
We reserve the right to ask you for further
information about a change in your countryof habitual residence. A change to yourcountry of habitual residence may result in
an increase to your premium or additionaltax becoming payable, meaning you haveto make an additional payment of premiumor your monthly or quarterly payments may

www.cignaglobal.com | 12

20. Contacting us
In some circumstances, which are explainedin these rules, you may need to contact us
in writing. If so, you should write to us at:
Cigna Global Health Options
Customer Care Team
1 Knowe Road
Greenock
Scotland
PA15 4RJ
or email us at:
cignaglobal_customer.care@cigna.com

when we can review them at a future annual
renewal date, to consider whether we arewilling to remove the exclusion. If this is thecase, we will show the exclusions review
date on the Certificate of Insurance. At
such date, we will also review the additional
premium (if any) which we have applied tocover a condition.
You should contact us upon receipt of therenewal notification, and at least fourteen(14) days before the annual renewal date if
there is an exclusion which is due for review
at that date.

In other circumstances you can call our
Customer Care Team 24/7 on: +44 (0) 1475
788 182 or from inside the USA on 800 835
7677.

We will then advise you of changes (if any)
we have made and, where appropriate,issue an amended Certificate of Insurance.
Amendments will be effective from therelevant annual renewal date.

21. Changes to this policy

We do not guarantee that any special
exclusion(s) or additional premiums will be
removed on renewal.

21.1
No person other than an executive officer of
Cigna has authority to change this policy or
to waive any of its provisions on our behalf,
for example, sales representatives, brokers
and other intermediaries cannot vary or
extend the terms of the policy.

21.2
We reserve the right to change this policy
to comply with any changes to relevantlaws and regulations. If this happens, we will
write and tell you of the change.

21.3
We also reserve the right to make changes
to the terms of cover on renewal. We will
give you at least one (1) calendar month’s
notice of such changes and the changes willtake effect from the annual renewal date.

21.4
If special exclusion(s) have been applied
to any beneficiary there may be occasions

22. Who can enforce this policy?
Only we and you have legal rights inconnection with this insurance. This meansthat only we or you may enforce theagreement (although we will allow anyone
who is covered under this policy to use ourcomplaints process).

23. Our right to recovery from third
parties
If a beneficiary requires treatment as aresult of an accident or deliberate act for
which a third party is at fault, we (or any
person or company we nominate) will takeon that beneficiary’s right to recover thecost of that treatment from the third party
at fault (or their insurance company). If we
ask a beneficiary to do so, he or she mustwww.cignaglobal.com | 13

take all steps to include the amount ofbenefit claimed from us under this policy
in any claim against the person at fault (ortheir insurance company).
The beneficiary will need to sign and deliver
all documents or papers and takeany other steps we require to secure ourrights. The beneficiary must not take any
action which could damage or affect theserights. We can take over and defend or
settle any claim, or prosecute any claim, in abeneficiary’s name for our own benefit.
We will decide how to carry out any
proceedings and settlement.

24. Other insurance
If another insurer also provides cover, we
will negotiate with them as regards whopays what proportion of any claim.

25. Data protection

This data will be processed by us to carryout our obligations, and we may need toshare it, in certain circumstances, withthird parties (such as healthcare providers
or suppliers) who assist us in carrying out
our obligations to you) which may meanin certain instances we need to transfer
data outside the European Economic
Area (EEA). Where we do this, we takeappropriate steps to ensure your data issecure and protected.
If you would like a copy of the information
we hold about you, please write to us
quoting your policy number. Please notethat we may charge a reasonable fee toprovide this information.

25.3
To help us detect and prevent fraud, we
may need to share information with otherinsurers or organisations. If we need toshare information for this reason, we will
only share information which is required
to enable the prevention or detection of
fraud or attempted fraud, and will not share
information about any beneficiary which is
not necessary for these purposes.

25.1
Cigna needs to collect and process yourpersonal information relating to you, forexample your name, address, date ofbirth, telephone numbers and sensitive
information such as details of healthinformation relating to you, for the purposesof administering this policy and providing
the insurance. You consent to Cigna
collecting and processing all personal andsensitive information relating to you tothe extent reasonably necessary for these
purposes.

25.2
Telephone calls to and from Cigna may berecorded, for quality control.
Under the EU Data Protection Directive(Directive 95/46/EC) and the Data
Protection Act 1998, we act as the data
controller for the personal data we hold.

26. Language
You have asked for all of the policy
documents and all communications inrelation to this policy to be provided
in English. All such documents andcommunications will be provided in English
only.

27. Regulatory information
Cigna is regulated in Belgium by National
Bank of Belgium (La Banque Nationale deBelgique/De Nationale Bank van België)for prudential supervision and the Financial
Services and Markets Authority (L’Autoritédes services et marchés financiers/De
www.cignaglobal.com | 14

Autoriteit voor Financiële Diensten enMarkten) for the integrity of the financial
markets and fair treatment of financial
consumers.

28. Complaints
28.1
Any complaint should in the first instancebe sent to us at:

29. Applicable law and jurisdiction
29.1
This policy is governed by, and will beinterpreted in accordance with, English law.

29.2
Any disputes about this policy, including
disputes about its validity, formation andtermination, will be determined in the courtsof England and Wales.

Cigna Global Health Options
Customer Care Team
1 Knowe Road
Greenock
Scotland
PA15 4RJ

28.2
If the complaint is not resolved, you may
complain to one of the following complaints
bodies:Ombudsman des Assurances
Square de Meeûs 35, boîte 61000 Bruxelles
Ombudsman van de Verzekeringende Meeûssquare 35, bus 61000 Brussel
Telephone: +32 (2) 547 58 71
Fax: +32 (2) 547 59 75
Email: info@ombudsman.as
The Financial Ombudsman Service
Exchange Tower
LondonE14 9SR
Telephone: 0800 0 234 567 or outside of
the UK: +44 (0) 2079 640 500
Email: complaint.info@financialombudsman.org.uk

www.cignaglobal.com | 15

SECTION 2: GENERALEXCLUSIONS
These are your General Exclusions. Pleasealso refer to the list of benefits detailed in
the Customer Guide, including the notes
section for any further restrictions andexclusions that apply, in addition to theGeneral Exclusions. Please also refer toyour Certificate of Insurance for any special
exclusions that may apply.

1.5

1.

1.6

Cover under this policy is subject to thefollowing general exclusions:

1.1
We will not offer cover or pay claims when
it is illegal for us to do so under applicablelaws. Examples include but are not limited
to, exchange controls, local licensing
regulations or trade embargo.

1.2
We will not cover you or pay claims when
doing so would violate applicable trade
restrictions, including but not limited torestrictions imposed by the United States
Department of Treasury’s Office of Foreign
Assets Control, the European Union
Commission or the United Nations Security
Council Sanctions Committees.

1.3
We will not pay a claim which we havereasonable grounds to suppose has been
made fraudulently.

1.4
We cannot be held responsible for any loss,
damage, illness and/or injury that may occur
as a result of receiving medical treatment
at a hospital or from a medical practitioner,
even when we have approved the treatment
as being covered.

If a beneficiary does not have cover underthe International Outpatient, International
Medical Evacuation, International Healthand Wellbeing, or International Vision and
Dental options, we will not pay for any of
the treatments or other benefits which areavailable under those options.

The following exclusions apply to theInternational Medical Insurance plan and to
all of the extra coverage options.
Where, in the exclusions which are set out
below, we have stated that we will pay fortreatment in some circumstances, this issubject to the beneficiary having coverunder the appropriate coverage option or
options.

1.7
We will not pay for:
1.7.1
Life support treatment (such as mechanicalventilation) unless such treatment has areasonable prospect of resulting in thebeneficiary’s recovery, or restoring thebeneficiary to his or her previous state ofhealth.
1.7.2
Treatment for:a) a pre-existing condition; orb) any condition or symptoms which result

from, or are related to, a pre-existing
condition.

www.cignaglobal.com | 16

We will not pay for treatment for a preexisting condition of which thepolicyholder was (or should reasonably havebeen) aware at the date cover commenced,
and in respect of which we have notexpressly agreed to provide cover.
1.7.3
Treatment for a condition which is the
subject of a special exclusion. Special
exclusions are set out in your Certificate ofInsurance.
1.7.4
Non-medical admissions or stays in hospitalwhich include:> treatment that could take place on a
daypatient or outpatient basis;> convalescence;> admissions and stays for social ordomestic reasons e.g. washing, dressing
and bathing.
1.7.5
Costs of hospital accommodation for adeluxe, executive or VIP suite.
1.7.6
Donor organs:a) mechanical or animal organs, except

where a mechanical appliance is
temporarily used to maintain bodilyfunction whilst awaiting transplant;b) purchase of a donor organ from any

source; orc) harvesting and storage of stem cells,

when a preventative measure against
possible future disease.

through maternity and shall be subject
to the limits detailed in the ‘ComplicatedMaternity’ section of your policy, where
covered.
1.7.8
Footcare by a Chiropodist or Podiatrist.
1.7.9
Sleep disorders unless there are indications
that the beneficiary is suffering from severe
sleep apnoea. In these circumstances, wewill only pay for:> one sleep study;> the hire of equipment such as aContinuous Positive Airway Pressure(CPAP) machine (only if the beneficiaryhas cover under the International
Outpatient option).
If it is medically appropriate, we will pay forsurgery.
1.7.10Treatment which is provided by:a) a medical practitioner who is notrecognised by the relevant authorities
in the country where the treatment isreceived as having specialist knowledgeof, or expertise in, the treatment of thedisease, illness or injury being treated;b) a medical practitioner, therapist, hospital,

clinic, or facility to whom we havegiven written notice that we no longer
recognise them as a treatment provider.
Details of individuals, institutions andorganisations to whom we have givensuch notice may be obtained by calling
our Customer Care Team; orc) a medical practitioner, therapist, hospital,

1.7.7
Foetal surgery, i.e. treatment or surgery
undertaken in the womb before birth, unless
this is resulting from complications arisingclinic, or facility which, in our reasonable
opinion, is either not properly qualified or
authorised to provide treatment, or is notcompetent to provide treatment.
www.cignaglobal.com | 17

1.7.11
Treatment which is provided by anyone wholives at the same address as the beneficiary,or who is a member of the beneficiary’s
family.

1.7.15Treatment for or in connection with speechtherapy that is not restorative in nature, or ifsuch therapy is:a) used to improve speech skills that have

1.7.12Treatment for, or in connection with,smoking cessation.
1.7.13Treatment which is necessary as a result ofconflict or disaster including but not limited
to:

not fully developed;b) can be considered educational; orc) is intended to maintain speechcommunication.
1.7.16Developmental problems including:a) nuclear or chemical contamination;a) learning difficulties such as dyslexia;b) war, invasion, acts of terrorism, rebellion(whether or not war is declared), civil
war, commotion, military coup or otherusurpation of power, martial law, riot,or the act of any unlawfully constituted
authority;c) any other conflict or disaster events;

where the beneficiary has:
> put him or herself in danger by enteringa known area of conflict (as identified
by a Government in your Country ofnationality, for example the British
Foreign and Commonwealth Office);> actively participated in the conflict; or> displayed a blatant disregard for theirown safety.
1.7.14Treatment that arises from, or is in any way
connected with attempted suicide, or any
injury or illness that the beneficiary inflicts
upon him or herself.

b) autism or attention deficit disorder(ADHD);c) physical development problems such as

short height.
1.7.17
Disorders of the temporomandibular joint(TMJ).
1.7.18Treatment for obesity, or which is necessary
because of obesity. This includes, but is not
limited to, slimming classes, aids and drugs.
We will only pay for gastric banding or
gastric bypass surgery if a beneficiary:> has a body mass index (BMI) of 40 orover and has been diagnosed as being
morbidly obese;> can provide documented evidence ofother methods of weight loss which havebeen tried over the past 24 months;> has been through a psychologicalassessment which has confirmed that it
is appropriate for them to undergo theprocedure.

www.cignaglobal.com | 18

1.7.19
Treatment in nature cure clinics, health spas,
nursing homes, or other facilities which
are not hospitals or recognised medical
treatment providers.
1.7.20Charges for residential stays in hospitalwhich are arranged wholly or partly fordomestic reasons or where treatment is
not required or where the hospital has
effectively become the place of domicile orpermanent abode.
1.7.21Treatment for a related condition resulting
from addictive conditions and disorders.
1.7.22Treatment for a related condition resulting
from any kind of substance or alcohol use or
misuse.

a) in-vitro fertilisation (IVF);b) gamete intrafallopian transfer (GIFT);c) zygote intrafallopian transfer (ZIFT);d) artificial insemination (AI);e) prescribed drug treatment;f) embryo transportation (from one
physical location to another); org) ovum and/or semen donation and related
costs.
We will pay for investigations into the cause
of infertility if:a) the specialist wishes to rule out any

medical cause;b) the beneficiary has been covered under

1.7.23Treatment needed because of or relating tomale or female birth control, including but
not limited to:this policy for two (2) consecutive
years before the investigations havecommenced; andc) the beneficiary was unaware of thea) surgical contraception namely:> vasectomy, sterilisation or implants;b) non surgical contraception, namely:> pills or condoms;c) family planning namely:> meeting a doctor to discuss becoming
pregnant or contraception.
1.7.24Treatment relating to infertility (other thaninvestigation to the point of diagnosis),
fertility treatment of any sort, or treatmentof complications arising as a result of suchtreatment. This includes, but is not limited
to:existence of any infertility problem, andhad not suffered any symptoms, when
their cover under this policy commenced.
1.7.25Treatment by way of the intentionaltermination of pregnancy, unless the
pregnancy endangers a beneficiary’s life ormental stability.
1.7.26
Treatment directly related to surrogacy. We
will not pay maternity benefits:a) to a beneficiary who acts as a surrogate;orb) to anyone else acting as a surrogate for abeneficiary.

www.cignaglobal.com | 19

1.7.27‘Newborn Care Benefits’ for children born
as a result of fertility treatment, such as IVF,
or for children born to a surrogate, or who
have been adopted. These children can only
join once they are ninety (90) days old, andwill be subject to medical underwriting.
1.7.28Nursery care for a newborn in hospital,
unless the mother is required to remain
in hospital due to medical necessity fortreatment that is covered by this policy.
1.7.29Treatment for more than ninety (90)continuous days for a beneficiary who has
suffered permanent neurological damage
and/or is in a persistent vegetative state(PVS).
1.7.30Treatment for personality and/or character
disorders, including but not limited to:a) affective personality disorder;b) schizoid personality disorder; orc) histrionic personality disorder.

1.7.31Preventative treatment, including but
not limited to health screening, routine
health checks and vaccinations (unlessthat treatment is available under one ofthe options under which a beneficiary has
cover).
We will pay for preventative surgery when abeneficiary:b) has undergone genetic testing which has

established the presence of a hereditarycancer syndrome. (Please note that wewill not pay for the genetic testing).
Under the International Medical Insurance
plan, the limits of cover for preventative
surgery in respect of congenital conditions
will apply, other than for cancer.
1.7.32Treatment for sexual dysfunction disorders(such as impotence) or other sexual
problems regardless of the underlying
cause.
1.7.33Treatment in the USA, unless the beneficiaryhas purchased Worldwide including USA
cover under this policy, or the treatment
can be covered under the Out of Area
Emergency cover conditions.
1.7.34Treatment in the USA (where theWorldwide including USA cover waspurchased) if we know or reasonably
suspect that the cover was purchased andthe beneficiary travelled to the USA for the
purpose of receiving treatment.
1.7.35Treatment which is intended to change therefraction of one or both eyes, including
but not limited to laser treatment,
refractive keratotomy and photorefractive
keratectomy.
We will pay for treatment to correct orrestore eyesight if it is needed as a result of
a disease, illness or injury (such as cataracts
or a detached retina).

a) has a significant family history of adisease which is part of a hereditarycancer syndrome (such as ovariancancer); andwww.cignaglobal.com | 20

1.7.36
Any treatment outside your selected areaof coverage, unless the treatment can becovered under the Out of Area Emergency
cover conditions.

c) scuba-diving at a depth of more than

1.7.37
Travel costs for treatment including
any fares such as taxis or buses, unlessotherwise specified, and expenses such as
petrol or parking fees.

1.7.43Treatment which (in our reasonable opinion)
is experimental, is not orthodox, or has notbeen proven to be effective. This includes
but is not limited to:

1.7.38Any expenses for international emergency
services which were not approved inadvance by the medical assistance service,where applicable.

a) treatment which is provided as part of a

1.7.39International services expenses for
emergency evacuation, medical repatriationand transportation costs for third parties
where the treatment needed is not covered
under this policy.
1.7.40Any expenses for ship-to-shore evacuations.
1.7.41
Sex change operations or any treatment
needed to prepare for or recover from these
operations (for example, psychologicalcounselling) including complications arisingout of such treatment.

thirty (30) metres unless the beneficiaryis appropriately qualified (namely PADI
or equivalent) to scuba-dive at that
depth.

clinical trial;b) treatment which has not been approvedby the relevant public health authority inthe country in which it is received; orc) any drug or medicine which is prescribedfor a purpose for which it has not been
licensed or approved in the country inwhich it is prescribed.
1.7.44Any form of plastic, cosmetic orreconstructive treatment, the purpose ofwhich is to alter or improve appearance
even for psychological reasons, unlessthat treatment is medically necessary andis a direct result of an illness or an injury
suffered by the beneficiary, or as a result ofsurgery. This includes but is not limited to:a) facelifts (rhytidectomy);

1.7.42Treatment which is necessary because of,or is any way connected with, any injury or
sickness suffered by a beneficiary as a resultof:a) taking part in a sporting activity on ab) nose reshaping (rhinoplasty);c) liposuction and other procedures whichremove fat tissue;d) hair transplants; andprofessional basis;e) surgery to change the shape of, enhanceb) solo scuba-diving; oror reduce breasts (other than breastreconstruction following treatment forcancer).

www.cignaglobal.com | 21

We will only pay for plastic, cosmetic orreconstructive treatment if the illness,injury or surgery as a result of which thetreatment is required took place during thebeneficiary’s current continuous period ofcover and is itself covered under the policy.
1.7.45
Appliances, including but not limited tohearing aids and spectacles (unless theInternational Vision & Dental option is
selected) which do not fall within our
definition of surgical appliances and/or
medical appliances.
1.7.46
Incidental costs including newspapers, taxi
fares, telephone calls, guests’ meals andhotel accommodation.
1.7.47
Costs or fees for filling in a claim form orother administration charges.
1.7.48
Costs that have been or can be paid byanother insurance company, person,organisation or public programme. If abeneficiary is covered by other insurance,
we may only pay part of the cost oftreatment. If another person, organisation or
public programme is responsible for paying
the costs of treatment, we may claim backany of the costs we have paid.
1.7.49Treatment that is in any way caused by, or
necessary because of, a beneficiary carryingout an illegal act.

www.cignaglobal.com | 22

SECTION 3: DEFINITIONS
The words and phrases set out below havethe meanings specified. Where those words
and phrases are used with those meanings,
they will appear in italics in these Policy
Rules, and in the Customer Guide, including
the list of benefits.
Unless otherwise provided, the singularincludes the plural and the masculine
includes the feminine and vice versa.

A‘Active treatment’ - treatment which isintended to shrink a cancer, stabilise it orslow down the spread of the disease. This
excludes treatment given solely to relieve
symptoms.

‘Acute’ - a disease, illness or injury that is
likely to respond quickly to treatment whichaims to return the beneficiary to the state ofhealth he or she was in immediately before
suffering the disease, illness or injury, or
which leads to his or her full recovery.

‘Annual renewal date’ - the anniversaryof the start date.

‘Application’ - the policyholder’sapplication (whether they have sent
in a form directly to us or through a
broker or applied online or through ourtelemarketers), and any declarations thatthey made during their enrolment forthem and any beneficiaries included in theapplication.

‘Appropriate age intervals’ - birth, two(2) months, four (4) months, six (6) months,
nine (9) months, twelve (12) months, fifteen(15) months, eighteen (18) months, two (2)years, three (3) years, four (4) years, five (5)years and six (6) years.

B‘Beneficiaries ’, ‘beneficiary’ - anybody
named on your Certificate of Insurance as
being covered under this policy, including
newborn children.

‘Benefit(s)’ - any benefit(s) shown in thelist of benefits.

C‘Cancer’ - a malignant tumour, tissues
or cells, characterised by the uncontrolled
growth and spread of malignant cells andinvasion of tissue.

‘Certificate of Insurance’ - thecertificate issued to the policyholder. Thisshows the policy number, start date, thedeductible amount (if selected), the costshare amount (if selected), the out of
pocket maximum (if applicable), detailsof who is covered, any special exclusions
or exclusions that have been removed at
an additional premium and benefits which
apply.

www.cignaglobal.com | 23

‘Cigna’, ‘we’, ‘us’, ‘our’, ‘the insurer’ -‘Customer Guide’ - contains the list of

See ‘Important Information’ section on page
3 of these Policy Rules for details of the
Cigna insurer providing your policy.

benefits and claiming information and forms
part of the policy.

‘Clinic(s)’ - a health care facility whichis registered or licensed in the country inwhich it is located, primarily to provide
care for outpatients and where care orsupervision is by a medical practitioner.

‘Complementary therapist’ - anacupuncturist, homeopath or practitionerof Chinese medicine who is appropriately
qualified and entitled to practise in the
country where treatment is given.

‘Congenital condition’ - any
abnormality, deformity, disease, illness or
injury present at birth, whether diagnosed
or not.

‘Cost share after deductible’, ‘cost
share(s)’ - is the percentage of each claim
which a beneficiary must pay themselves
after any deductible has been paid. A
separate cost share may apply to theInternational Medical Insurance plan andInternational Outpatient option. These will
be shown in the Certificate of Insurance if
selected.

D‘Daypatient treatment’ - care involving
admission to hospital and using a bed but
not staying overnight. In respect of USA
based admissions, this also includes surgicalprocedures carried out in the doctor’ssurgery.

‘Daypatient’ - a patient who is admitted
to a hospital or daypatient unit or othermedical facility for treatment or because
they need a period of medically supervised
recovery, but who does not occupy a bed
overnight.

‘Deductible(s)’ - is the amount of
any claim which a beneficiary must pay
themselves. This will be shown in theCertificate of Insurance if selected.

‘Dental emergency’ - where either‘Country of habitual residence’ - thesevere pain which is not amenable torelief by painkillers or facial swelling or
uncontrollable bleeding after an extraction
is being suffered and it is either outside
the business hours of a beneficiary’s usual
dentist or the beneficiary is staying at
a place which is away from the dental
practice he or she usually visits. The
treatment covered in such an instance isto purely stabilise the problem and relieve
severe pain.

country where a beneficiary habituallyresides, as stated on your application.

‘Dental injury’ - injury to a sound‘Cosmetic’ - services, procedures or items
that are supplied primarily for aesthetic
purposes and which are not necessary inorder to maintain an acceptable standard ofhealth.

‘Country of nationality’ - any country ofwhich a beneficiary is a citizen, national or
subject, as stated on your application.

natural tooth caused by extra-oral impact.
Treatment for dental implants, crowns ordentures is not covered unless you havepurchased the International Vision and
Dental option and subject to the conditions
outlined in the policy.

www.cignaglobal.com | 24

‘Dental treatment’ - any dental
procedure or service which:> is needed for continued oral health; and> is carried out or personally controlled bya dentist, including procedures provided
by a hygienist; andE‘Eligible female’ - a female policyholder
or beneficiary.

‘Emergency treatment’ - treatment> is included in the list of benefits,or, though not included in the listof benefits, is accepted by us as aprocedure or service meeting common
dental standards as upheld by arespectable, responsible and substantial
body of dental opinion, experienced in
the particular field of dentistry.

which is medically necessary to preventthe immediate and significant effects ofillnesses, injuries or conditions which, if
left untreated, could result in a significant
deterioration in health. Only medical
treatment through a physician, medical
practitioner and hospitalisation thatcommences within twenty four (24) hoursof the emergency event will be covered.

‘Dentist’ - a dentist, dental surgeon or‘End date’ - the date on which coverdental practitioner who is registered or
licensed as such under the laws of thecountry, state or other regulated area inwhich the treatment is provided.

under this policy ends, as shown in theCertificate of Insurance.

‘Detoxification’ - treatment forwithdrawal symptoms after a beneficiaryhas been abusing drugs, alcohol or both.
It includes the rest, medication, fluids andchanges in diet needed to stabilise thebody.

‘Diagnostic tests’ - investigations
such as x-rays or blood tests to find or tohelp to find the cause of the beneficiary’s
symptoms.

‘Doctor’ - a medical professional who
holds an appropriate doctoral degree, isregistered and licensed under the lawsof the country, state or regulated area topractice medicine in the country in which
the treatment is provided.

‘Evidence-based treatment’ treatment which has been researched,reviewed and recognised by:> the National Institute for Health andClinical Excellence; or> the Cigna Medical Team; or> another source recognised by the Cigna
Medical Team.

G‘Guarantee of payment’ - a guarantee
to pay agreed costs associated withparticular treatment which we may give toa beneficiary or a hospital, clinic or medical
practitioner.

www.cignaglobal.com | 25

H
‘Home nursing’ - visits from a qualified
nurse to the beneficiary’s home to giveexpert nursing services for up to 30 days:‘Intensive care’ - a specialised
department in a hospital that provides
intensive care treatment, for example
an intensive care unit, critical care unit,
intensive therapy unit, or intensive
treatment unit.

‘International services’ - services> immediately after hospital treatment as
required by medical necessity; and> visits for treatment which would normallybe provided in a hospital.
Home nursing is only covered when thespecialist who treated the beneficiary has
recommended such services.

‘Hospital’ - any organisation or institution
which is registered or licensed as a medicalor surgical hospital in the country in which
it is located and where the beneficiary isunder the daily care or supervision of a
medical practitioner or qualified nurse.

I‘Initial start date’ - the first day thebeneficiary’s cover commenced on theInternational Medical Insurance plan.

‘Injury’ - a physical injury.
‘Inpatient’ - a patient who is admitted tohospital and who occupies a bed overnightor longer, for medical reasons.

‘Insurance’ - the coverage which isprovided by us to the beneficiaries
subject to the terms, conditions, limits andexclusions set out in these Policy Rules, theCustomer Guide, and your Certificate ofInsurance.

arranged by the medical assistance service.

L‘List of benefits’ - the list of benefits
detailed in your Customer Guide, including
any notes.

M‘Maternity benefit’ - benefits available
in relation to all aspects of pregnancy orchildbirth under the Internatonal Medical
Insurance and International Outpatient
option, including any complications, for any
eligible female covered under this policy,
but excluding:> treatment by way of the intentionaltermination of pregnancy unless the
pregnancy endangers the life or mental
stability of the mother; and> nursery care for a newborn in hospital,
unless the mother is required to remain
in hospital due to medical necessity fortreatment that is covered by this policy.

‘Medical assistance service’ - a service
which provides medical advice, evacuation,
assistance and repatriation. This service canbe multi-lingual and assistance is available
twenty four (24) hours per day.

www.cignaglobal.com | 26

‘Medically necessary/ medical
necessity’ - medically necessary covered
services and supplies are those determinedby the medical team to be:

O‘Operation(s)’ - any procedure described> required to diagnose or treat an illness,injury, disease or its symptoms;> orthodox, and in accordance withgenerally accepted standards of medical
practice;> clinically appropriate in terms of type,
frequency, extent, site and duration;> not primarily for the convenience of thebeneficiary, physician or other hospital,
clinic or medical practitioner; andas an operation in the schedule of surgicalprocedures.
‘Oral health’ - for a patient, a reasonable
standard of oral health of the teeth, theirsupporting structures and other tissuesof the mouth, and of dental efficiency,
according to a standard acceptable to adentist of ordinary competence and skill in
the patient’s country of habitual residence
which will safeguard his or her general
health.

‘Orthodox’ - when used in relation to

Where applicable, the medical team
may compare the cost effectiveness ofalternative services, settings or supplies
when determining what the least intensive
setting is.

a procedure or treatment, ‘orthodox’
means that the procedure or treatment
in question is medically accepted in the
country where it takes place at the time of
the commencement of the procedure ortreatment, that complies with a respectable,
responsible and substantial body of medical
opinion, held and expressed by medical
practitioners experienced in the particularfield of medicine in question.

‘Medical practitioner’ - a doctor or‘Out of pocket maximum’ - is the

specialist who is registered or licensed topractice medicine under the laws of thecountry, state or other regulated area inwhich the treatment is provided, and who
is not covered under this policy, or a family
member of someone covered under thispolicy.

maximum amount of cost share underthe International Medical Insurance planor International Outpatient option any
beneficiary must pay per period of cover.
This will be shown in the Certificate ofInsurance if applicable. This applies only
to amounts paid relating to cost share on
the International Medical Insurance plan orInternational Outpatient option.

> rendered in the least intensive settingthat is appropriate for the delivery of theservices and supplies.

‘Medical team’ - means our clinical teamand / or the medical assistance service.

Any amounts paid due to a deductible;
due to exceeding limits of cover; fortreatment not covered by your plan; ordue to penalties for not obtaining proper
pre-authorisation or using out of network
providers in the USA, are not subject to theout of pocket maximum.

www.cignaglobal.com | 27

‘Outpatient’ - a patient who attends a‘Policyholder’ - a person who has

hospital, consulting room, or outpatient
clinic for treatment and is not admitted as a
daypatient or an inpatient.

made an application to us which has been
accepted in writing by us, and who pays thepremium under the policy.

P‘Palliative care’ - treatment that does not
cure or substantially improve a condition
but is given in order to alleviate symptoms.

‘Period of cover’ - the twelve (12)month continuous period during which thebeneficiaries are covered under this policy,
being the period from the start date to
the end date as noted on the Certificate
of Insurance or earlier if terminated inaccordance with the Policy Rules.

‘Persistent vegetative state’ - abeneficiary who is in a vegetative state
for at least ninety (90) consecutive days.
A persistent vegetative state meansa condition caused by injury, diseaseor illness in which the beneficiary has
suffered a loss of consciousness, withno behavioural evidence of awarenessof self or surroundings, other than reflex
activity of muscles and nerves for low level
conditioned response, and from which to areasonable degree of medical probability,
there can be no recovery.

‘Policy’ - the policy comprising these
Policy Rules, the Customer Guide (whichcontains the list of benefits and claiming
information), and your Certificate ofInsurance.

‘Policy documents’ - the documentation
relating to the policy, comprising of these
Policy Rules, the Customer Guide, yourCertificate of Insurance, the Cigna claim
form, and your Cigna ID Card.

‘Policy Rules’ - the terms and conditions
governing the policy, detailing ‘General
Exclusions’ and ‘Definitions’.

‘Pre-existing condition’ - any disease,illness or injury, or symptoms linked to suchdisease, illness or injury for which:> medical advice or treatment has beensought or received; or> the beneficiary knew about and did notseek medical advice or treatment;
before the initial start date.

Q‘Qualified nurse’ - a nurse who isregistered or licensed as such under thelaws of the country, state or other regulatedarea in which the treatment is provided.

‘Qualifying life event’ means:> marriage or civil partnership;> commencing cohabitation with a partner;> divorce or separation;> birth of a child;> legal adoption of a child; or> death of a spouse, partner or child.
We may require evidence of the above
event.

www.cignaglobal.com | 28

R
‘Rehabilitation’ - physical, speech andoccupational therapy for the purpose oftreatment aimed at restoring the beneficiaryto their previous state of health after anacute event.

S‘Schedule of surgical procedures’ the current schedule of surgical procedures
approved by our chief medical officer.

‘Selected area of coverage’ - means
either:> Worldwide, including USA; or> Worldwide, excluding USA.

‘Short-term’ - means a period oftime consistent with the recuperation
time required for the treatment andas prescribed by the treating medical
practitioner with the approval of our
medical director.

‘Sickness’ - a physical or mental illness,
including illness resulting from or relating topregnancy.

‘Sound natural tooth/teeth’ - a tooththat functions normally for chewing andspeech purposes and that is not a dental
implant. Such natural tooth/teeth should
not have experienced any of the following:> decay or filling;> gum disease associated with bone loss;‘Specialist’ - a doctor who is recognised,registered or licensed as such under thelaws of the country, state or other regulatedarea in which the treatment is provided
and only for the treatment which is being
recommended.

‘Spouse’ - a beneficiary’s legal husband orwife, or unmarried or civil partner who wehave accepted for cover under this policy.

‘Start date’ - the date on which coverage
under this policy starts, as shown in theCertificate of Insurance.

‘Surgery’ - the branch of medicine thattreats diseases, injuries, and deformities
by operative methods which involves anincision into the body.

‘Surgical appliance(s)’, ‘Medical
appliance(s)’ - means either:> an artificial limb, prosthesis or device
which is required for the purpose of or inconnection with surgery; or> an artificial device or prosthesis which
is a necessary part of the treatment
immediately following surgery for as longas required by medical necessity; or> a prosthesis or appliance which is
medically necessary and is part of therecuperation process on a short-termbasis.

T‘Therapist’ - a speech therapist, dietician
or orthoptist who is suitably qualified andholds the appropriate license to practice inthe country where treatment is received.

> root canal treatment.

www.cignaglobal.com | 29‘Treatment’ - any surgical or medical
treatment controlled by a medical
practitioner that is medically necessary
to diagnose, cure or substantially relievedisease, illness or injury.

U‘USA’ - the United States of America.

W‘Worldwide including USA’ - every
country throughout the world and at sea,
excluding any country with whom, at thedate of commencement of treatment,
the Federal Government of the USA
has prohibited trade to the extent thatpayments are illegal under applicable law.

‘Worldwide excluding USA’ worldwide, with the exception of the USA.

Y
‘You, your’ - the policyholder.

www.cignaglobal.com | 30

NOTESwww.cignaglobal.com | 31

“Cigna” and the “Tree of Life” logo are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporationand its operating subsidiaries. All products and services are provided by or through such operating subsidiaries, and not by Cigna
Corporation. Such operating subsidiaries include Cigna Global Insurance Company Limited, Cigna Life Insurance Company of Europe
S.A.–N.V, Cigna Europe Insurance Company S.A.-N.V. and Cigna Worldwide Life Insurance Company Limited. © 2015 Cigna
Policy Rules CLICE 10/2015