GLOBE PARTNER
Globe Partner Association
Travel Insurance
Summary of Benefits
As a member of the Globe Partner Association, you have selected the cover that the Association has taken out with:••

MGEN, 3-7 Square Max Hymans, 75648 Paris Cedex 15, registered under n° SIREN 775 685 399regulated by
the French Mutual Insurance Companies code, under the policy n° MGENIB1100437SAP for the Medical
expenses, Assistance and Non accidental death benefits. MGEN outsource the coverage of assistance benefits to
LLT Consulting, 18 quai Georges Simenon, 17 000 La Rochelle, France, simplified limited company registered
RCS La Rochelle under n° 828 002 188 and operating under the name VYV International Assistance.
MGEN Portugal - Companhia de Seguros, S.A, whose head office is located at Rua Duque de Palmela, 11, Piso
1, 1250-097 Lisboa, Portugal, with a share capital of €7,500,000.00 and registered under the uniqueregistration and legal entity identification number 517503131 for the Accidental death & disability, Legal liability
benefits and Luggage benefits . MGEN Portugal is regulated by the Autoridade de Supervisão de Seguros e
Fundos de Pensões in Portugal and is authorized by the Prudential Supervision and Resolution Authority (ACPR)
to operate in France under the Freedom to Provide Services regime.

The administration of these benefits is delegated to ACS, 153 rue de l’Université, 75007 Paris, France, simplified limited
company with a capital of €150,000, insurance brokerage firm registered RCS Paris under n° 317 218 188, ORIAS n°
07 000 350.
How the cover is applied and the details of the benefits to which you are entitled are set out in this leaflet.
In case of discrepancy between the English version of this leaflet and the French version of the contract, the French
version of the contract will prevail.

Contents
1/ General provisions ................................................................................................................. 2
2/ Definitions ............................................................................................................................. 3
3/ Medical expenses, accidental death and dismemberment benefits ............................................. 5
4/ Assistance benefits............................................................................................................... 10
5/ Legal liability........................................................................................................................ 13
6/ Luggage .............................................................................................................................. 14
7/ Excluded risks for all benefits ................................................................................................ 16
8/ Basis of the insurance contract ............................................................................................. 16
9/ Data Protection .................................................................................................................... 18
10/ Mediation .......................................................................................................................... 19
11/ Authority in charge of overseeing insurers and insurance brokers.......................................... 19
12/ Consumers’ right to object to telephone marketing ............................................................... 20
13/ Contact information ............................................................................................................ 20
14/ Schedule of cover............................................................................................................... 21
15/ Appendix : Medical claim form ............................................................................................ 22
Annex : Privacy notice ACS ....................................................................................................... 23

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1/ General provisions
Eligibility – Enrolment
Members of the Globe Partner Association, under 40 years of age and travelling in the zone(s) selected duringsubscription, worldwide, outside of their country of residence are eligible on an optional basis.
The renewal of the contract (by the subscription of a new one) will only be accepted if the next contract immediately
follows the previous one without any interruption.
Upon enrolment, the Member must fill in the enrolment documents which include a health declaration and on whichshall read the corresponding premium amount. The chosen option cannot be modified during the period of coverage.
The Member shall pay for the entire period of coverage on subscription.
Acceptance of coverage may be subject to further information the Insurer considers necessary.
Upon acceptance to the insurance, the Member and his dependants if any shall be referred to as “Insured”.
The guarantees of the present contract will not apply in the country of residence of the Insured.
Commencement of cover
In order to receive benefits without a waiting period, the applicant must purchase the initial policy prior to departure.
When the Applicant subscribes after his departure, a waiting period of 8 days is applied to all benefits
from the date of subscription.
In case of subscription of a new contract after termination of the previous one, in order to receive benefits without awaiting period, the new contract must be subscribed immediately following the previous one without any interruption.
Otherwise, a waiting period of 8 days is applied to all benefits from the date of subscription of the newcontract.
Coverage applies for each eligible person upon acceptance from the Insurer and after payment of the insurance
premium.
The travel insurance policy GLOBE PARTNER is concluded for a fixed term and not eligible for the right renunciation
provided for in Article L 112-2-1 of the French Insurance Code or L.221-18 of the French Mutual Insurance
Companies Code.
Termination of coverOnce admitted to insurance and subject to the clauses of the French Insurance Code or the French Mutual Insurance
Companies regarding false declaration, the Insured cannot be excluded from the coverage as long as he fulfils theconditions.
The contract can be subscribed for a period of twelve (12) months maximum and can be renewed twice, by taking
out a new contract, with authorisation of the Insurer.
Coverage shall end:
for each Insured:• On the date of final return if the policy term is not complete,• At the time of her/his repatriation to her/his usual country of residence,• On the last day of her/his membership period, when she/he stops being a Member of the Globe Partner
Association,
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•In the event of judicial liquidation of the Insurer or the Globe Partner Association.

for the totality of the Insured, at the time of effectiveness of the cancellation of the group policy n°
MGENIB1100437SAP between the Globe Partner Association, MGEN and MGEN Portugal.
Termination of benefits (or suspension) means the end of benefits for the Insured for all medical acts incurred after
the termination date of coverage even if they started or were prescribed before the termination date.
Modification or cancellation of the contract
Any modification of date or cancellation of the contract can only be accepted if it was notified before the effective
date of the contract.
It is possible to change dates once only and within the limits of the current civil year.
In case of cancellation, the contract can only be refunded on presentation of supporting documents and 20 € will be
retained from the premium.
The contract is issued for a fixed period and cannot be cancelled or refunded once started.
Sanctions in case of false declaration
Any information supplied by the Insured or one of their beneficiaries that is incorrect, falsified, exaggerated or any
fraudulent acts on their part shall be the direct responsibility of the Insured and shall give rise to:• the nullity of your contract in case of intentional misrepresentation (L 113-8 of French Insurance Code or
L.221-14 of the French Mutual Insurance Companies Code), premiums paid are kept by the Insurer, who isentitled, as a compensation, to the payment of all premiums due; in such a case, the Insured will have toreimburse all the claims paid by the Insurer under the contract;• if the intentional misrepresentation, discovered before any claim, is not established, premium increase or
termination of the contract (L 113-9 of the French Insurance Code or L.221-15 of the French Mutual Insurance
Companies Code)• if the intentional misrepresentation, discovered after the claim, is not established, decrease of claim according
to the ratio between the paid premium and the premium that should have been paid if the initial declaration
had been consistent with the reality (L 113-9 of the French Insurance Code or L.221-15 of the French Mutual
Insurance Companies Code).
The Covered Person is deprived of all rights to the benefits of a claim in the event the Covered Person
voluntarily makes a false declaration about that claim including the date, nature, causes,
circumstances and/or consequences and/or amount of the loss.
The forfeiture of this right also applies in the event the Covered Person knowingly uses inaccurate
documents as supporting documents for that claim.

2/ Definitions
The terms and expressions used in this booklet shall have the following definition:
Accident: any unintentional bodily injury caused to the Insured, arising from abrupt, sudden and unexpected action
with an external cause, to the exclusion of an acute or chronic illness.
Acts of Terrorism / Terror Attack: any act of violence constituting a criminal or illegal attack against people and/or
property in the country in which you are staying, and whose purpose is to disturb public order seriously.
Such a “terror attack” should be identified as such by the French Foreign Ministry (Ministère des affaires étrangères
français).
Civil War: armed opposition between various parties belonging to the same country, and any armed rebellion,
revolution, revolt, insurrection, or coup d'état, and any application of martial law or border closure ordered by theauthorities of the country in question.
Claim / insured event: event that may result in the application of a guarantee under the policy.
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Consequential damage: any financial loss which is the consequence of the loss of use of a right, of the interruptionof a service provided by a person or personal or immovable property, or of the loss of a benefit, and which is the directconsequence of damage to the persons and property insured hereunder.
Country of residence: country in which is located your tax and legal residence.
Covered baggage/items: baggage and its contents, including personal effects and valuables, belonging to theMember, carried for the trip/travel and/or acquired during the trip/travel.
Damage to property: any harm done to, destruction of, change in, loss or disappearance of an, item, object or
substance, and also any physical harm done to an animal.
Deductible: the amount of the compensation payable by you.
Dental fees further to an accident: treatment must be performed within 15 days following the date of the accident
and consists of replacement of the sane and natural teeth which were lost or damaged.
Emergency: term used in case of accident or commencement of a serious covered illness requiring urgent medical
attention and treatment of the Insured. Only medical treatment given by a doctor, general practitioner or specialist anda hospitalisation intervention in the twenty four (24) hours following the direct cause of the emergency will beconsidered as conditions to be reimbursed.
Foreign War: declared or undeclared armed opposition between one state and another state, as well as any invasionor state of siege.
French Insurance Code / French Mutual Insurance Companies code: the compendium of the laws andregulations that govern the insurance policy.
Home address: by home address is meant your principal and usual residence in your country of residence.
Illness, Sickness or Disease: a degradation in health established by a medical authority, requiring medical
treatment.
Insurer:• MGEN, 3-7 Square Max Hymans, 75648 Paris Cedex 15, registered under n° SIREN 775 685 399regulated by•

the French Mutual Insurance Companies code, under the policy n° MGENIB1100437SAP for the Medical
expenses, Assistance and Non accidental death benefits. MGEN outsource the coverage of assistance benefits to
LLT Consulting, 18 quai Georges Simenon, 17 000, La Rochelle, simplified limited company registered RCS La
Rochelle under n° 828 002 188 and operating under the name VYV International Assistance.
MGEN Portugal - Companhia de Seguros, S.A, whose head office is located at Rua Duque de Palmela, 11, Piso
1, 1250-097 Lisboa, with a share capital of €7,500,000.00 and registered under the unique registration andlegal entity identification number 517503131 for the Accidental death & disability, Legal liability benefits andLuggage benefits. MGEN Portugal is regulated by the Autoridade de Supervisão de Seguros e Fundos dePensões in Portugal and is authorized by the Prudential Supervision and Resolution Authority (ACPR) to operate
in France under the Freedom to Provide Services regime.

Lapse: loss of the Cover right for the Damage in question.
Medical Expenses: Medically-prescribed pharmaceutical, surgery, consultation and hospitalisation expenses requiredfor diagnosing and treating an illness.
Members: the persons duly insured under this policy, also hereinafter referred to as "you". For the application of thelegal provisions relating to prescription, "Member" will be used whenever the articles of the French Insurance Coderefer to "the Insured".
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Members of the immediate family: the father, the mother, the children, brothers and sisters.
Natural Disasters: abnormal intensity of a natural element not arising from human intervention.
Obsolescence (dilapidation): Depreciation of the good's value caused by time, wear or its conditions of upkeep the
day of the damages. Unless the contract stipulates otherwise, the dilapidation applied to calculate the compensation
due is 1% per month up to a maximum of 80% of the initial purchase price.
Personal injury: any bodily harm suffered by an individual and the ensuing losses.
Pollution: degradation of the environment by substances that are not naturally present in the medium in question
being discharged into the air, the water, or the soil.
Hazard / random: event whose occurrence is uncertain and beyond the control of the insured
Strike: concerted collective action consisting in the employees of a firm, of an economic sector or of a professional
category ceasing to work in order to give weight to their claims.
Subrogation: legal situation whereby the rights of one person are transferred to another person (in particular: theInsurer taking the place of the contract holder for the purposes of proceedings against the opponent).
Third Party: any person other than the Insured Person who is responsible for the damage, injury or loss, to the
exception of a family member.
Insured Persons which are not members of the same family are considered to be third parties between themselves.
Transport company: any company duly approved by the public authorities for the transport of passengers.
Waiting period: the period between the subscription date and the date at which the Member becomes entitled tobenefits. During the waiting period, no benefit will come into effect and the insured cannot be compensated.

3/ Medical expenses, accidental death and dismemberment benefits
A/ Medical expenses benefits
Coverage consists of reimbursement of medical expenses resulting from an accident or illness which are recognizedby the World Health Organization (WHO), notwithstanding the further exclusions.
Reimbursement requests will be accepted only if the Insurer estimates that the amount of the bills and receipts thathave been sent is reasonable and habitual in the country where treatment is received. If not, the insurer is entitled
to reduce the amount of reimbursement.
The benefits for medical expenses end if our medical team deems that the Member can be repatriatedto his country of residence.
It is agreed and understood that whenever the insured person benefits or may benefit from the reimbursements ofany social organisation in the European Union, benefits shall be paid as a complement.
Maximum amount for medical expenses per beneficiary and per year is 300.000 €.
Limit to real expenses
In accordance with article 9 of law 89-1009 of December 31, 1989 and decree 90-769 of August 30, 1990,
reimbursement or indemnification of fees due to illness or accident cannot exceed the amount of fees due by the
Insured after reimbursements of any nature he is entitled to.
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Coverage of the same nature contracted to other insurance companies apply up to the limit of each benefit whatever
the date of subscription. Within this limit the beneficiary of the contract can obtain an additional indemnity joining
details of reimbursement provided by the other companies.
For application of the above mentioned clause, the limit of the amount of fees left to the Insured is indicated by the
Insurer for every covered medical expense.
In case of undue payments: the beneficiary of the benefit commits to repay to the Insurer, as soon as possible, theundue claims. As a consequence, the Insurer can make compensation between these amounts and any otherbenefits due by the Insurer to the Insured.
Excluded benefits from medical expenses
It is hereby stated that costs not recognised by the World Health Organisation, in accordance with the“International classification of Health interventions” (ICHI), as well as the benefits below are notcovered under this policy:
1. expenses incurred before or after period of coverage,
2. transportation fees of general practitioner which are usually not covered,
3. treatment and care non prescribed by a qualified physician,
4. medical fees for which the insured could have waited for the return to his country of residence,
5. medical fees incurred in the country of residence (except for students during stays of less than 30days for school holidays),
6. cosmetic treatment and surgery unless consecutive to an accident,
7. congenital disability, hereditary diseases, and chronic illnesses,
8. medical aids including hearing aids and dental prosthesis,
9. dental care (except in case of emergency and accident),
10. stomatology, dermatological treatment related to acne, and speech therapy,
11. optical care, orthoptics and contact lenses,
12. acupuncture, massages and physiotherapy (unless consequent to a covered accident which resulted
in a hospitalisation. Here, hospitalisation consists in staying several days in the hospital, at least 24
hours),
13. psychological care and psychotherapy including consultations,14. mental diseases including nervous breakdowns, treatment and care related to sleep disorder
15. HIV infection and its consequences, AIDS and its consequences,
16. sexual transmitted diseases (STD) and related tests,
17. thermal cures, and rehabilitation centres,
18. health check-ups,
19. vaccination fees,
20. medical expenses related to birth control, abortions, and sterility treatments,
21. medical expenses related to pregnancy, pathological pregnancy, maternity, vaginal and surgicalchildbirth / delivery, and sexual disorders,
22. expenses incurred for organ acquisition,
23. any operation or treatment related to a sex change,
24. non prescribed drugs, non medicinal products of current use such as medical alcohol, cotton, sunlotions, dental hygiene products, bandages, shampoos…,
25. subsidiary expenses such as telephone in case of hospitalisation or fees considered extravagant,unreasonable or unusual considering the country where they incurred.
Medical examination and arbitration
Doctors and authorised representative of the Insurer shall have access to the Insured in order to assess his state ofhealth. Upon request of the Insurer, the Insured shall provide any evidence and be performed any test or
examination.

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In the event of an accident, the Insured is required to send an official report detailing the circumstances of his
accident to the Insurer.
The insured shall be notified by registered mail of all the decisions taken by the Insurer further to the conclusions of
its medical adviser. The Insured may object the decision within 10 days by means of a detailed medical certificate
addressed to the Insurer by Registered mail.
In case of disagreement on the state of health of the Insured, an amicable cross-examination by a physician chosen
by the Insured and a physician appointed by the Insurer may be performed.
If both doctors cannot reach the same conclusions, they designate a medical arbitrator for final settlement. Fail amutual choice, designation shall be judiciary.
Each party shall support the fees of its physician and share the ones of the arbitrator.
B/ Accidental death and dismemberment benefits•

Lump sum for non-accidental death:

In case of death of the Member, a lump sum of €1,000 is paid to the following benificiary(ies): the spouse, and by
default the children born or yet to come into equal parts, the death Insured portion belonging to her/his own
children and by default to brothers and sisters, or parents in equal parts, the death Insured portion belonging to thesurvivor, by default to the heirs in equal parts.
•

Lump sum for accidental death:

A lump sum payment of 8 000 euros is paid to the Insured in case of accidental death (see definitions), provided
death occurs within one year of the accident.
The lump sum for Accidental Death is paid to the following beneficiary(ies): the spouse, and by default the children
born or yet to come into equal parts, the death Insured portion belonging to her/his own children and by default tobrothers and sisters, or parents in equal parts, the death Insured portion belonging to the survivor, by default to theheirs in equal parts.
•

Permanent disability benefit further to an accident:

A lump sum payment is paid to the Insured if he becomes disabled further to an accident, provided disability occurs
within one year of the accident and provided the accident occurs before his 40th birthday.
Disability is deemed TOTAL when according to the scale and the rules of evaluation it reaches 100%. In this casetotal amount shall be granted.
Otherwise disability is deemed PARTIAL and the percentage of the lump sum for the corresponding disability shall
only be granted.
The maximum amount shall be 30 000 euros in case of permanent disability further to an accident.
Excluded risks for accidental death and dismemberment benefits
1. accidents caused by blindness, paralysis, mental illnesses, and all pre-existing diseases andinfirmities at the time of entering into the contract,
2. accidents caused by the use of a motorcycle with a cylinder in excess of 125 cm3 either as driver orpassenger,
3. accidents resulting from your professional activity,
4. accidents caused by a transport company not authorized for the public transport of persons,
5. accidents resulting from exercises carried out under military authority.
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Death capital sum
Total permanent disability capital sum
Scale of disablement:
Complete loss:of the armof the forearm or handof the thumbof the index fingerof the middle fingerof the third fingerof the little finger

SCHEDULE OF COVER
8 000 €
30 000 €Right*
75 %
65 %
20 %
16 %
12 %
10 %
8%

of the thigh

Left*
60 %
55 %
18 %
14 %
10 %
8%
6%
60 %

of the leg

50 %of two limbs

100 %of the foot40 %of the big toe

5%of the other toes3%of both eyes

100 %of sight of an eye

30 %complete deafness, incurable and not treatable

40 %complete deafness, incurable and not treatable in an ear

15 %total or incurable insanity

100 %*if it has been medically established that you are left-handed, the disability rate allocated for the right arm applies to the left arm, and viceversa

Disability ratings that are not included in the scale are determined by comparing their severity to the cases listed
above without taking into account the victim's profession.
Loss means complete amputation or total paralysis of the limb in question, or definitive and permanent ankylosis in
all the joints of which it is composed.
The benefits paid by the Insurer are complementary to those of any other Social Security scheme or any
supplementary body from which he/she could benefit personally, in particular the benefits covered by the European
health card.
How to claim medical, accidental death and dismemberment expenses
Within the context of reviewing the claim, that the Insurer’s advising medical expert may request any othersupporting documentation necessary to process the claim. Insofar as the documentation listed herein to besubmitted is incomplete, gives rise to doubt, or the Insurer is unable to investigate thoroughly its obligation to pay
the claim, the Insurer’s advising medical expert is entitled to request data from the following organisations andpersons subject to the Article on date protection:
▪
▪
▪
▪
▪
▪
▪
▪
▪

Doctors,
Hospitals,
Other medical institutions,
Care homes,
Caregivers,
Other personal insurance providers,
Statutory health insurance bodies,
Occupational insurance organisations andOfficial bodies

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In the event the members of the category of covered persons, including dependents, where applicable,
as defined herein, explicitly reject concrete data collection in the context of claims processing or
revoke consent the benefit may not become due if the Insurer is unable to determine whether and towhat extent the Insurer is liable for payment of the claim.
The Insurer shall not otherwise be held liable by the Policyholder for the impossibility of performing
the services under the present contract.
Any information provided by the Insured or by one of his Dependants that turns out to be erroneous, falsified or
exaggerated or any fraudulent action of their own will involve the direct responsibility of the Insured and therecovery of the amounts of money paid by the Insurer without due cause on this incorrect basis.
In case of hospitalisation, surgery, radiography or medical treatment, a request for prior approval must be sent to
the Insurer. A request for prior approval should be composed of a medical report and a detailed cost estimate of thecare for which the request for prior approval was made.
In case of non-respect of this provision, we are entitled to deny coverage. In case of hospitalisation the Insured can
ask for a full acceptance of liability in order to prevent him to advance fees.
Requests for reimbursements of medical expenses:
For all requests for reimbursement you should send to:
ACS
CLAIMS DEPARTMENT (to the attention of the Medical Adviser)
153, rue de l’Université – 75007 Paris, France
Tel. 00 33 (0)1 40 47 91 00 - Fax. 00 33 (0)1 40 47 61 90
e-mail : servicemedical@acs-ami.com
the following documentary evidence:•
your certificate number, original paid invoices from doctors and medical establishments, prescriptions forcorresponding medicines and any medical document indicating the diagnosis;•
Claims not exceeding Euro 500, can be sent via our secure platform https://clems.acs-ami.com. Please
note that the Insurer may request the corresponding original documents during 2 years.
In case of impossibility for the Insured to provide original documents, at the request of the Insurer the Insured takes
the commitment to repay, as soon as possible, the amounts received on the basis of the scanned documents.
Therefore, the Insurer is entitled to compensate any amount due in this respect with other reimbursements of claims
due by the Insurer to the Insured.
For costs of hospitalisation of more than 24 hours, it is possible to obtain an undertaking to pay medical costs bycontacting our MEDICAL ASSISTANCE service beforehand, which is available 24 hours a day (Vyv International
Assistance : ops@vyv-ia.com / 00 33 (0)5.86.85.00.50).
The Insurer may require any further necessary document to process the claim.
In case of non-accidental death: the death will only give rights to the benefits if it is declared, except in case of force
majeure, within six months of the date of death and provided the following documents are supplied:•a medical certificate of natural death issued by the doctor who confirmed the death,•a complete copy of the birth certificate,•a photocopy of the family record book,•
a complete copy of the birth certificate of the beneficiary or beneficiaries,•
the latest tax notice.

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In case of accidental death or dismemberment further to an accident:
You must report the accident giving rise to a claim so that it reaches us within 5 working days unless there is anunforeseen event or a case of force majeure; if this deadline is not adhered to, and because of this we incur a loss,
then you will lose all rights to compensation
Your accident report must be accompanied by the following documents as a minimum:• the initial medical certificate recording the injuries• any statements made by witnesses of the accident,• the report or statement establishing the precise circumstances of the accident.
During your course of treatment, you must be checked by our medical consultant so that s/he may assess theconsequences of the accident. You agree to undergo medical examinations that the medical consultant may decideto effect and to provide us with all the elements necessary for the preparation of your case.
If you so wish, you may be accompanied by a doctor of your choosing.
If there is disagreement either in regard to the causes of death or the injuries, or the consequences of the accident
for which compensation may be payable, we will submit the differences of opinion to two experts, one chosen by
you or your legal successors, the other chosen by us, subject to our respective rights. If there is still disagreement, athird expert will be appointed, either by common agreement, or by the presiding judge of the Tribunal de Grande
Instance de Paris, giving an emergency ruling (statuant au référé).
Each of us is responsible for the payment of the fees and expenses of our experts. The fees of the third expert will
be shared equally by both parties.

4/ Assistance benefits
Repatriation assistanceIf you find yourself caught up in one of the situations referred to hereinafter, we will implement the services
described, following a simple telephone call (reversed charge or collect call accepted from abroad).
In all cases, the decision to provide assistance and the choice of appropriate methods is at the sole discretion of the
VYV International Assistance doctor, after contacting the attending physician on site, and, where appropriate, thebeneficiary’s family. Only the medical interest of the beneficiary and compliance with the health regulations in force
are taken into consideration when making a decision regarding transport, the choice of method of transport, and thepossible place of hospitalisation.
Under no circumstances is VYV International Assistance a substitute for the local emergency assistanceorganizations.
What do we cover?
Repatriation or medical transport
If you are ill or injured following a covered event and your state of health requires a transfer, we organize and pay
for repatriation to:either the closest competent hospitaleither the competent hospital closest to the Insured’s home in his country of residence
either the Insured’s home in his country of residence;
if the local medical infrastructure does not have the capacity to provide appropriate care.
According to the seriousness of the case, repatriation and transport are effected under medical supervision, if
necessary, by the most appropriate of the following methods:•
special air ambulance•
Regular airliner, train, sleeper, boat, ambulance.
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Only medical necessity is taken into consideration when deciding on the date of repatriation, the choice of means oftransport or the place of hospitalisation.
The decision to repatriate is taken by our medical advisor, after consulting the occasional attending physician and,perhaps, the family physician.
During your repatriation, and on the advice of our consulting physician, we organise and pay for the transport of aperson to accompany you.
Any refusal of the solution proposed by our medical team will result in cancellation of the personal
assistance guarantee.
Extension of stay for medical reasons
If you are hospitalized during a covered trip, and our doctors deem this hospitalisation to be necessary beyond youroriginal return date, we will cover your return ticket and the return ticket and accommodation costs (room andbreakfast) for your beneficiary family members or an accompanying insured person to stay with you, up to theamount and for the maximum period indicated in the Table of Benefits.
If your medically certified state of health does not justify your hospitalisation but prevents you from undertaking
your return on the date initially planned (in particular in the event of a quarantine), we will cover your additional
hotel stay costs as well as those of your beneficiary family members or of an accompanying insured person, up to
the amount and for the maximum period indicated in the Table of Benefits. As soon as the conditions allow it, weorganize and cover your additional transport costs, and eventually those of your insured family members or of an
accompanying insured person who stayed with you, if the original transport tickets for your return and theirs cannot
be used because of this event.
Only medical requirements are taken into consideration when granting this benefit.
In all cases, the cost of meals or other expenses remains the responsibility of that person.
This benefit cannot be combined with the "Visit from a relative" benefit.
Presence of relative/friend when hospitalised
If you are hospitalized and the state of your health does not allow you to be repatriated before seven days, weorganize and pay for the cost of transporting a member of your family or a designated person who has remained inyour country of residence so that they can come to your bedside in hospital.
We also refund the hotel costs for that person up to the amount indicated in the table of sums insured, and organize
his return upon your release from hospital.
This guarantee does not apply, if you are already accompanied by a member of your immediate family on site.
Transport of the body in the event of death
In case of death due to a covered event, we will organize and pay for the transport of the body from the place
where the body was placed in the coffin to the international airport nearest your home address.
We will also pay for related costs necessary for the transport, including the cost of the coffin, thus enabling thetransport, up to the amount given in the schedule of cover.
The costs of the ceremony, all extras, interment or cremation, remain payable by the family.
Early return
If you have to interrupt your travel early because of the death of a member of your immediate family (as this term isdefined in the chapter Definitions), we will pay for your additional transport costs and those of the insured membersof your immediate family in order to allow you to attend the funeral, if the travel tickets provided for your return
journey and for theirs cannot be used because of this event.
Payment of search costs
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We will pay for the costs of sea or mountain searches following an event which endangers your life, up to theamount given in the schedule of cover. Only the costs invoiced by a company duly authorized to carry on this kind ofactivity will be reimbursed.
Advance of funds abroad
Following a theft or loss of your means of payment (credit card, check book …) or of your initial travel ticket, we will
advance you a sum of money up to the amount given in the schedule of cover.
This advance is subject to the establishment of an acknowledgement of debt form.
You commit to reimburse to us this advance within a delay of 3 (three) months following its release.
After this delay, we will be entitled to request the amount of the advance granted, together with interest at legal
rate.
Dispatch of medicines abroad
We will pay the expenses of sending medicines essential to the continuation of an ongoing medical course oftreatment prescribed by a doctor, if you no longer have the medicine due to an unforeseen event, and it is
impossible for you to procure these medicines or their equivalent where you are.
The cost of this medicine remains payable by you in all circumstances.
Forwarding of messages
We are responsible for forwarding messages intended for you when you cannot be contacted directly, forexample, if you are in hospital.
Similarly, by calling us, a member of your immediate family, may be given any message that you have left for theirattention.
Legal assistance abroada) Payment of fees
We will pay the fees of legal representatives whom you call upon, up to the amount given in the schedule of cover,
if you are being prosecuted for unintentionally breaking the law of the foreign country in which you are traveling.
b) Advance of bailIf, due to unintentional violations of the legislation of the country in which you are traveling, the authorities require
you to put up bail, we will advance you a sum up to the amount given in the schedule of cover.
This advance must be reimbursed within one month following presentation of our request for reimbursement that wesend to you.
If the bail money is paid back before this deadline by the authorities of the country, it must be sent to us
immediately.
What are the limits of our cover in case of force majeure?
We cannot be held liable for failures in the execution of the Assistance services resulting from cases of force majeureor the following events:
Civil or foreign wars, acknowledged political instability, popular movements, riots, acts of terrorism, reprisals,
restrictions to the free circulation of people and goods, strikes, explosions, natural catastrophes, meltdown of atomic
cores, nor delays in the execution of services resulting from the same causes.
What are the exclusions of the Assistance cover?
We cannot intervene if your request for assistance is due to:- pollution, natural disasters,- travel undertaken for the purpose of diagnosis and / or treatment,- states of pregnancy unless unforeseen complications, and in all cases from the 32nd week ofpregnancy,- the consequences of:- exposure to infectious biological agents,- exposure to chemical agents such as poison gas,
- exposure to incapacitating agents,- exposure to radioactive agents,
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- exposure to nerve agents or agents with persistent neuro-toxic effects,
subject to quarantine or to preventive measures or to a specific surveillance or torecommendations from international sanitary authorities or from local sanitary authorities.
What are your obligations in the event of accident?
For all requests for assistance, you should contact us, 24/7 VYV International Assistance : ops@vyv-ia.com / 00
33 (0)5.86.85.00.50 in order to obtain our prior approval before taking any steps or incurring any
expenses.
When we have organized your transport or repatriation, you must hand over your initial travel tickets to us, as they
will have become the property of VYV International Assistance.

5/ Legal liability
What do we cover?
We cover the financial consequences of the legal liability you may incur during your private life, including during
traineeships/ interships with respect to, on the one hand, personal injury and/or damage to property and, on theother hand, the consequential losses therefrom, caused accidentally to any person other than a member of yourfamily, that is your fault or the fault of things or animals under your care, this being provided up to the amount, andwith the deduction of an excess, indicated in the table of sums insured.
The cover also applies to objects entrusted during a period of traineeship/ intership up to the amount given in theschedule of cover.
What do we exclude?
Besides the exclusions given under the heading “EXCLUDED RISKS FOR ALL BENEFITS”, we do notcover :
1. damage intentionally caused or provoked by you,
2. damage resulting from the use of land motor vehicles, sailing and motorboats, and air navigation
appliances,
3. damage resulting from any professional activity,
4. the consequences of any material damage and/or personal injury affecting you personally, andmembers of your family,
5. consequential damage except where it is the direct result of accidental damage to property and/or
personal injury that is covered,
6. objects entrusted to the insured (except in case of traineeships/ internships)
7. damage resulting from the practice of air sports or from hunting,
8. damage you caused due to a fire, explosion or flooding,
9. Traineeships/ internships in the medical and paramedical field, except for traineeships/ internships
exclusively on an observation basis.
What are the limits of our cover?
Settlement – acknowledgement of liability
You should not accept any acknowledgement of liability, nor any settlement, without our prior and writtenagreement.
However, simply acknowledging the materiality of certain facts is not considered to be an acknowledgement ofliability, nor is the fact of having procured emergency help for a victim when this is an act of assistance that anyone
would have a moral duty to provide.
You should advise us within 5 working days of any event likely to incur your civil liability, unless there is anunforeseen event or a case of force majeure; if this deadline is not adhered to and because of this we sustain a loss,
then your cover will lapse.

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Proceedings
If legal action is taken against you, we will ensure your defense and will supervise the proceedings for the facts anddamage which come within the scope of the contract herein. However, you may join in the lawsuit as long as you
can establish a separate interest that is not taken charge of pursuant to the contract herein.
The mere fact of entering an appeal in your defense as a precaution may under no circumstances be interpreted initself as an acknowledgement of cover, and in no way implies that we agree to be liable for the harmful
consequences of events which would not be explicitly covered by the contract herein.
Even if you fail in your obligations after an accident, we are bound to compensate the people to whom you areliable. Nevertheless, in these cases, we retain the right to take legal action against you for reimbursement of all thesums that we have paid or provided on your behalf.
RedressInsofar as the means of obtaining redress are concerned:• We are entitled to act without reference to yourself before the civil, commercial or administrative jurisdictions, in
relation to the cover provided under this contract,• Before the criminal jurisdictions, redress may only be sought with your agreement,• if the lawsuit pending before a criminal jurisdiction no longer relates to any interests but civil interests, refusal to
give your agreement to our exercising the anticipated means of obtaining redress entails a right for us to claim
compensation from you equivalent to the loss which resulted for us.
Costs of proceedings
We will be liable for the costs of the proceedings, discharges and other settlement costs.
However, if you are ordered to pay a sum in excess of that of the cover, each of us shall bear these costs inproportion to their respective share in the sentence.
What are your obligations if an insured event occurs?
For any request, you must contact us : ACS, Claims Department, 153 rue de l’Université, 75007, Paris, France /servicesinistres@acs-ami.com

6/ Luggage
We cover your luggage, objects and personal effects taken with you or bought during your journey, during theoutward and return travel only (initial departure and final return) up to the amount given in the schedule of cover, inthe event of✓ robbery,✓ total or partial destruction,✓ loss during transport by a transport company.
The amount given in the schedule of cover constitutes the maximum reimbursement for all accidents occurring
during the insured period.
What is excluded?
Besides the exclusions given under the heading «EXCLUDED RISKS FOR ALL BENEFITS», we cannot
cover :
1. the fragile objects such as porcelain, glass, ivory, ceramic, marble objects,
2. the items listed hereinafter: jewels, device reproducing sound or image and corresponding
accessories, documents recorded on tapes or films as well as professional material, laptop
computers, mobile phones, sport articles, musical instruments, food products, lighters, pens,
cigarettes, alcohol, works of art, beauty products and photographic films, any prosthesis, equipmentof any kind, share certificates, eyeglasses, contact lenses, keys of any kind,
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3. cash, and documents listed hereinafter: passport, identity card or residence card, car registration
book and driving license, credit cards, books, travel tickets.
How is your compensation calculated?
Compensation will be paid to you against documentary evidence and on the basis of like-for-like replacement value,less obsolescence.
Under no circumstances is the proportional rule of capital provided in article L.121-5 of the French
Insurance Code applied.
What are your obligations in the event of a claim ?
Our reimbursements being complimentary to those of the transport company, your claim report must be
accompanied by a copy of the transport company’s documents, attesting the reimbursement of your luggage.
You must report to ACS, Claims Department, 153 rue de l’Université, 75007, Paris, France / servicesinistres@acsami.com within 3 months from the date of reimbursement by the transport company, except in case of unforeseen
circumstances or force majeure; if this deadline is not respected and we suffer a loss as a result, you will lose allrights to compensation.
The following elements must be included with the claim form:✓ The receipt for filing of a complaint in the event of theft or a theft report lodged with a competent authority(police, gendarmerie, transport company, purser, ...) in case of theft during the stay or loss by a transportcompany;✓ The report of loss or destruction filed with the carrier (maritime, air, rail, road) when the luggage or objects
were lost, damaged or stolen during the period when they were in the legal custody of the transporter;✓ A copy of the list of objects declared damaged or stolen, given to the transport company;✓ The letter of reimbursement from the airline or transportation company stating the compensation paid to you;
✓ Original proof of purchase for damaged or stolen items.
Failure to submit these documents will result in forfeiture of your rights to compensation. The sums
insured cannot be considered as proof of the value of the property for which you are claiming
compensation, nor as proof of the existence of this property.
You are obliged, by any means in your power and by all documents in your possession, to provide
evidence of the existence and value of these goods at the time of the loss, and the extent of thedamage.
If you knowingly use inaccurate documents or fraudulent means as proof, or if you make inaccurate statements or
fail to disclose any relevant information, you will lose all rights to compensation, without prejudice to the prosecutionthat we will then have grounds to instigate against you.
What happens if you recover all or part of the luggage, items and personal effects?
You must advise us immediately, in a letter sent by recorded delivery, as soon as you have been informed:••

if we have not yet paid you your compensation, you must take back the luggage, items, or personal effects;
we are then only obliged to pay for any damages or missing items;
if we have already paid out compensation, you have the option, within a period of 15 days, to do one of thefollowing:
1/ either to abandon the said luggage, items or personal effects in our favor,
2/ or to take back the said luggage, items, or personal effects in return for restitution of the compensationthat you received, having, where appropriate, deducted, that part of the compensation which corresponds todamaged or missing items.

If you have not made your choice within 15 days, we will deem that you are opting for abandonment.

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7/ Excluded risks for all benefits
Expenses are not reimbursed if consequent to the following events or situations:
1. expenses related to pre-existing conditions: consequent to accidents or illnesses which occurredprior to the effective date of the contract,
2. an illness or an accident based on the intentional act of the covered person, self-mutilation or
attempt of suicide,
3. criminal proceedings against the Insured,
4. accidents or diseases incurred during sport competitions organised by any sports federation, as
well as any sport activities within a professional context and the consequences of practice of thefollowing sports: mountaineering, rock-climbing, bobsleigh, skeleton, any air sport, jet ski,
martial arts, off-piste winter sports,
5. participation of the insured in duel, bet, crime and offence, fights (except self-defence), strikes,
6. consequences of the use of medicines, drugs or narcotics not medically prescribed,
7. consequences of an obvious state of alcoholism or drunkenness,
8. accidents caused by hurricane, earthquake, volcanic eruption or other disasters,
9. accidents or diseases due to the release of nuclear radiation, any irradiation from ionisingradiation as well as insured events due to the effects of radiation caused by the artificial
acceleration of particles,
10. terrorism, sabotage, war (whether civil or not), riots, demonstrations, according to article L1218 of the French Insurance Code,
11. the absence of random,
12. consequences of voluntary non-compliance with the regulations of the countries visited, or thepractice of activities prohibited by the local authorities.
In addition, the Insurer shall not be liable for providing insurance (or reinsurance) coverage or for
paying any claim or providing any benefit hereunder if such coverage, payment or benefit would
subject the Insurer to any sanction, prohibition or restriction under United Nations resolutions relating
to economic or trade sanctions, or under the laws and regulations of the European Union, the UnitedStates of America or any other jurisdiction.

8/ Basis of the insurance contract
This policy is governed by the French Mutual Insurance Companies Code for the Medical Expenses, Repatriation
Assistance and Non-accidental death Covers, and by the French Insurance Code for the Luggage loss, Accidental
death & disability and Legal liability Covers. The law applicable to the contract is French law, both for the benefits
insured by MGEN and for the benefits insured by MGEN Portugal under the Freedom to Provide Services regime inFrance.
The definition of the covers, the pricing and their rules of application take into account the legal and regulatory
provisions in force on the effective date of the insurance contract.
SUBROGATIONThe Insurer is subrogated to the rights and actions that the Insured may have against the Third Party responsible
for the loss, in the limit of the amount of compensation that the Insurer has paid. In case Subrogation could notoperate in favour of the Insurer because of the Insured, the latter will be relieved of the obligations regarding theInsured in respect of the Subrogation that would have been possible.
TIME LIMIT OF ACTIONS STEMMING FROM THE INSURANCE CONTRACT
The provisions relating to the time limit within which action stemming from the insurance contract may be taken are
set out by Articles L 114-1 to L 114-3 of the French Insurance Code and Articles L.221-11 to L.221-12-1of the French Mutual Insurance Companies Code, as reproduced below:

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Article L 114-1 of the French Insurance Code and L.221-11 of the French Mutual Insurance Companies
Code:
Any actions stemming from an insurance contract are time barred two years after the event from which the actions
stem.
However, this time limit only starts running:
1 In the event of reticence/concealment, omission, misrepresentation or inaccurate declaration of the risk
incurred, from the date when the Insurer learned of the said risk;
2 In the event of an insurance loss, from the date when the interested parties learned of it, if they prove they
were unaware of it prior to that date.
When the action by the Insured Person against the Insurer is caused by recourse by a third party, the time limit foraction only starts running from the date when the third party takes legal action against the Insured Person or hasreceived compensation from the Insured Person. The time limit for action is increased to 10 years in life insurance
contracts when the beneficiary is a person distinct from the Contract holder and, in insurance contracts for personal
accidents, when the beneficiaries are the assigns of the deceased Insured Person.
For life assurance contracts, and notwithstanding the provisions of point 2 above, the right to action by thebeneficiary lapses at the latest 30 years after the death of the Insured Person.
Article L 114-2 of the French Insurance Code and L.221-12 of the French Mutual Insurance Companies
Code:
The time limit for action may be interrupted by any of the ordinary causes for interruption thereof, and byappointment of appraisers after a loss. Interruption in the time limit for action may also result from a registeredletter with acknowledgement of receipt being sent by the Insurer to the Insured Person to obtain payment of thepremium, and by the Insured Person to the Insurer to obtain payment of compensation.
Article L 114-3 of the French Insurance Code and L.221-12-1 of the French Mutual Insurance
Companies Code:Notwithstanding Article 2254 of the Code Civil (French Civil Code), the parties to the insurance contract may not,even by mutual agreement, either change the length of the time limit for action, or add causes for suspension orinterruption thereof.
The time limit for action is interrupted by one of the ordinary causes for interruption of the time limit set out in
Articles 2240 to 2246 of the French Civil Code, and by the appointment of experts following the occurrence of a risk.
The ordinary causes for interruption of the time limit for action provided by the French Civil Code are:
- Recognition by the obligee of the right of the person against whom the obligee could claim inaction (article 2240
of the French Civil Code),- Instigating legal proceedings (articles 2241 to 2243 of the French Civil Code),- Protective measures being taken pursuant to the French Code of Civil Enforcement Procedures (Code desprocédures civiles d'exécution) or by an enforcement being ordered (article 2244 of the French Civil Code).
- One of the jointly and severally liable obligees being summoned or notified through legal proceedings or throughan enforcement order, or recognition by the obligee of the right of the person against whom the obligee could
claim inaction (article 2245 of the French Civil Code).
- Summons or notification made to the main obligee, or the main obligee recognising the right in question for thetime limit for taking action against the guarantor (article 2246 of the French Civil Code).
ANTI MONEY LAUNDERINGThe controls that we are legally required to carry out as part of anti-money laundering and to combat the financing
of terrorism, especially cross-border flows, may lead us at any time to ask you for explanations or supporting
documents, including concerning the acquisition of insured goods.
Pursuant to the French Data Protection Law of 6 January 1978 as amended by the French Law of 6 August 2004,
and pursuant to the French Monetary and Financial Code, you are entitled to access your personal data by sending a
letter to the French Data Protection Authority (CNIL).
COURTS OF COMPETENT JURISDICTION – GOVERNING LAW
The pre-contractual and contractual relations are governed by French law and primarily by the French Insurance
Code and the French Mutual Insurance Companies Code.
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Any legal action relating to this contract shall be brought before French courts which have exclusive jurisdiction.
However, if you are domiciled in the Principality of Monaco, the Monaco Courts shall have sole jurisdiction for
disputes you and us.
LANGUAGE USEDThe language used on the occasion of pre-contractual and contractual relations is French.
OPTION OF CANCELLATION
If you are already insured for the same risk:
You are prompted to verify that you are not already the beneficiary of insurance covering one of the risks covered by
the new contract. If such is the case, you have the right to renounce this contract during the 14 (calendar) days
following its conclusion, without any fees or penalties, if all of the following conditions are satisfied:-

you took out this contract for non-professional reasons;this contract was added to the purchase of a good or service sold by a supplier;
you can show that you are already covered for one of the risks covered by this new contract;the contract you want to renounce has not been fully performed; andyou have not filed any claim for damage covered by this contract.

In this situation, you can exercise your right to renounce this contract by letter or any other durable medium sent to
ACS, 153, rue de l’Université, 75007, Paris, FRANCE, accompanied by a document proving that you already havecover for one of the risks covered by the new contract. We are required to reimburse the premium paid, within 30
days from your renunciation.
"I the undersigned M.................. residing at ................ hereby renounce my contract No. ................
taken out with ............................ I hereby attest that I have no knowledge at the date of sending thisletter, of any damage covered by the contract."

9/ Data Protection
According to the Data Protection Act of January 6th 1978, as amended, and in the context of the management of
the insurance contract, the personal data of the Insured may be transferred to the Insurer, its administrators, its
service providers, its subcontractors or reinsurers. Insured persons are informed that treatments concerning them,as well as those of their potential beneficiaries, are implemented as part of the conclusion, management andexecution of this contract as well as for its commercial management. They may also be used in the context ofcontrol, prospecting, anti-fraud and money laundering and terrorist financing operations, the search for beneficiaries
of unregulated death contracts, the execution of legal and regulatory provisions.
The data collected is necessary for the implementation of these treatments and is intended for the relevant servicesof the Insurer and its Managing Delegate and, where appropriate, its subcontractors, service providers or partners.
The Insurer is required to ensure that this data is accurate, complete and, if necessary, updated. The data collected
will be kept for the duration of the contractual relationship increased legal requirements or in respect of the terms
provided by the Commission Nationale Informatique et Libertés (CNIL).
This personal data may be transferred to service providers or subcontractors established in countries outside theEuropean Union. These transfers concern only countries recognized by the European Commission as having anadequate level of protection of personal data, or recipients with appropriate guarantees.
The Insured members and/or their beneficiaries have the right of access, rectification or deletion, limitation of theprocessing of their data, or request the portability or opposition of the data transmitted, and have the right toprovide guidelines regarding the processing of their personal data after their death.

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Any request for the exercise of their rights may be addressed to the Data Protection Officer of the VYV Group: Tour
Montparnasse – 33, avenue du Maine – BP 245 – 75755 Paris Cedex 15 or dpo@groupe-vyv.fr or by contacting :ACS,
To the attention of the Data Protection Officer,
153, rue de l’Université,
75007 Paris,
Francedpo@acs-ami.com
During the exercise of their right, the production of an ID may be requested. In case of persisting disagreement,
they may appeal to the CNIL : www.cnil.fr or 3, place de Fontenoy – TSA 80715 – 75334 Paris cedex 7, France.

10/ Mediation
WHAT IS THE PROCEDURE FOR EXAMINING COMPLAINTS?
In the event of difficulties in the application of your contract, ACS is able to investigate all your requests andcomplaints. You can address your complaints to our dedicated complaints department, whose contact details are
given below:
ACS, Complaints Department,
153, rue de l’Université, 75007 Paris, France
recla@acs-ami.com
ACS undertakes, from the date of sending your written complaint, to acknowledge receipt of your complaint within
10 days and to provide you with a response within a maximum of 2 months.
In any event, after this two-month period, and regardless of response you receive or in the absence of a response,
you may:o

For the benefits insured by MGEN, appeal to the MGEN Mediator, whose contact details are as follows:
CNPM - MÉDIATION – CONSOMMATION
27 Avenue de la Libération 42400 SAINT-CHAMOND
www.cnpm-mediation-consommation.eu; oroFor the benefits insured by MGEN Portugal, appeal to the Insurance Mediator, whose contact details are as
follows:
Le Médiateur de l’Assurance (LMA)
TSA 50110
75441 PARIS CEDEX 09 France
www.mediation-assurance.org

11/ Authority in charge of overseeing insurers and insurance brokers
The supervisory authority for MGEN is the Autorité de Contrôle Prudentiel et de Résolution (ACPR)
located at 4 place de Budapest CS 92459 75436 Paris Cedex 09, France.
➢ The supervisory authority for MGEN Portugal is the Autoridade de Supervisão de Seguros e Fundos dePensões located at Av. da República 76, 1600-205 Lisbon, Portugal.

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12/ Consumers’ right to object to telephone marketing
If you do not wish to be contacted for the purposes of telephone marketing, you can have yourself added to atelephone marketing opt-out list, free of charge.
These provisions apply to any consumer, i.e. any natural person acting for purposes unrelated to their commercial,industrial, craft or self-employed activities.

13/ Contact information
9édiation
For any assistance request or payment of a hospitalisation, please contact 24/7:
VYV International Assistance,
00 33 (0)5.86.85.00.50
ops@vyv-ia.com

For any question regarding coverage or claims, please contact:
ACS
153 rue de l’Université – 75007 Paris - France
Tel. 00 33 (0) 1 40 47 91 00
contact@acs-ami.com

In case of difference between the French and English or other versions of this summary of benefits,
the French version shall prevail.

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14/ Schedule of cover
MEDICAL COSTS (1)Maximum 300,000 € / person year (2)Surgery and hospitalisation

100% of actual costs*

Consultations, pharmacy, x-ray analyses, paramedic care

100% of actual costs*

Emergency dental treatment

100% up to € 300 *Dental treatment following an accident

100% up to € 600 **For students : You maintain the same coverage for emergencies only in your country of residence when you return on holiday, up to a maximum of 15 000 €.
ACCIDENTAL DEATH AND DISMEMBERMENT BENEFITS
Lump sum non-accidental death€ 1 000

Lump sum accidental death€ 8 000

Permanent disability benefit further to an accident€ 30 000LEGAL LIABILITY
Damage that has been caused to someone else during the trip (travel incl.) is guaranteed
Deductible for the three guarantees€ 100 per file and per claim
Personal injury€ 4 500 000

Damage to property and consequential losses therefrom€ 450 000

Objects entrusted during a period of traineeship€ 11 500
ASSISTANCE BENEFITS

Medical transport

100% of actual costs

Repatriation

100% of actual costs

Presence of a relative if hospitalized for more than 7 days

Outward/return ticket + € 80 per night (max. 8 nights)

Early return following the death of a member of the immediate family

Return ticket – actual costs

Extension of stay for medical reasons

Inbound ticket + €80 per night (max 15 nights)

Dispatch of essential medicines which cannot be found on site

100% of actual costs

Forwarding of urgent messages

100% of actual costs

Search costs

100% up to € 3 000

Advance of funds in cases of theft

up to € 700

Legal assistance

up to € 3 000

Advance of bail money

up to € 7 000

Transport of body in cases of death

Actual costs (funeral costs limited to € 1 500 )LUGGAGE INSURANCE

During the outward / return journey€ 1 150(1) If the insured person benefits from the French Social Security or any other insurance organism, our reimbursements are complementary to thelatter.
(2) Maximum benefit for a 12-months guarantee through one or several contracts.

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15/ Appendix : Medical claim form
Complete this form and join the original paid invoices, copies of the prescriptions and full medical report, copy of your passport(identification + arrival stamp). The medical documents must always mention the patient's full name, the date of the medical treatment,
the name, address and telephone number of the practitioner, the medical facility, the laboratory or the pharmacist. Simple receipts notproviding all this information won't be sufficient (a detailed bill is required). Please, group your claims in order to avoid low amounts ofreimbursements and make photocopies of all the documents before sending them to:
A.C.S. – Medical Service – To the attention of the Medical Advisor 153 Rue de l'Université 75007 Paris, France
Claims requests of less than € 500 can be sent via our secure platform https://clems.acs-ami.com
ATTENTION: The insurer reserves the right to request ORIGINALS at any time for a period of 2 years.
Certificate ID: G_______________________________ Date of birth:________________________________________________________
Family name: __________________________________________ Given name: ______________________________________________
Complete address: ________________________________________________________________________________________________
Telephone: _____________________________________ Personal E-mail: __________________________________________________The received treatment is related to:
Accident: Circumstances (date, place, details): __________________________________________________________________________________________________________________________________________________________________________________
Illness/ Diagnosis: Pathology and date: (Example: Otitis 12th Sept) _________________________________________________
Medical or surgical history in direct or indirect relation to the medical condition concerned: ____________________________________________________________________________________________________________________________________________
Date of the first symptoms/signs: ___________________________________________________________________________
Detail of the invoices related to medical expenses:
Date of treatment

Country

Currency andsettled amount

1. _______________________________________________________________________________________________________

2. _______________________________________________________________________________________________________

3. _______________________________________________________________________________________________________

4. _______________________________________________________________________________________________________

5. _______________________________________________________________________________________________________

Treatments

Comments: ______________________________________________________________________________________________________________________________________________________________________________________________________________________
In case of reimbursement, I would like to receive:
A wire transfer to a bank account in Euros (Indicate IBAN number and SWIFT or BIC code)
A wire transfer to a bank account in a foreign currency (please join an official document indicating the complete banking details andnotably the SWIFT Code) (Note: International transfers subject to variable bank charges and accepted for a minimum reimbursement of 50 Euros)

A wire transfer to a third-party account: also forward the account holder’s passport copy and a written authorization from theinsured stating that he/she agrees to receive the reimbursement on the third-party’s account.
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Annex : Privacy notice ACS
Protecting data and the privacy of insured members is a top priority. This privacy notice explains how and what type of
personal data will be collected, why it is collected and to whom it is shared or disclosed. Please read this noticecarefully.
Processing of personal data
The information collected by ACS, insurance broker, simplified joint-stock company registered under number 317
218 188 RCS Paris, and located at 153, rue de l’Université – 75007 Paris, France, either directly from you or via yourinsurance intermediary, is subject to data processing for the sole purpose of:
•

•
•
•

preparing, concluding, managing and executing your quote or contract (study of needs, underwriting,calculation and collect of premium, preparation of endorsements, claims management, treatment of complaints
if any…),
enforcing regulations related to anti-money laundering and terrorist financing prevention, fight against fraud,elaborating statistical and actuarial studies,
redistributing risks via reinsurance or coinsurance.

The processing of such data is carried out in compliance with the requirements applying to the collection, processing,recording, organization, purpose limitation and data minimization, storage, adaptation or alteration, retrieval,consultation, use, disclosure by transfer, dissemination, security of personal data.
The recipients of such data are, within the limits of their relevant assignments and according to applicable purposes, theinsurers, reinsurers, insurance intermediaries (your direct broker, if applicable), and eventually their subcontractors,
which intervene in the context of the execution or the management of your contract, third party administrators, themediator if a case is submitted to him/her, authorities legally authorized to manage your complaints, Tracfin for thefight against terrorism and anti-money laundering. Your data may also be transmitted to any person benefiting from thecontract (subscriber, insured, member, and beneficiary of the contract).
You expressly accept the collection and processing of data concerning your health. This information is necessary for the
execution and the management of your contract and your benefits, which is the sole purpose of the processing, andmade in accordance with the regulations of medical confidentiality. This information is exclusively intended for the
medical advisors of ACS, its departments in charge of managing your benefits, its third-party administrators andassistance providers if applicable, as well as for the insurers and reinsurers of your contract.
Transfer of personal data :In addition, we inform you that your personal data, or that of other parties concerned by or benefiting from thecontract, may be transferred outside the European Union if necessary for the performance of your contract.
The sole purpose of such transfers is to allow the performance of insurance and assistance claims, and only the datanecessary for the achievement of this purpose are transferred.
The recipients or categories of recipients authorized to receive the data are the accredited staff of the medical
administrators and assistance companies as well as of the insurers, where appropriate.
These transfers are made according to the regulations relating to the protection of personal data applicable in theEuropean Union.

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Your rights :In accordance with the French data protection law n° 78-17 of January 6 1978 as amended in 2004 and 2018 and to EU
regulation 2016/679 of April 27th 2016, you have the right to Access, Rectify, Erase, and to the Portability of, any data
concerning yourself, as well as the rights to the Restriction of and to Object to the processing of your personal data,
which you can pursue by writing to our Data Protection Officer: dpo@acs-ami.com or by postal mail to « ACS, To theattention of the DPO, 153, rue de l’Université, 75007 Paris, France » (together with a copy of an official ID).
You may send a complaint:••

On the CNIL website by filling out the online form.
By postal mail writing to CNIL - 3 Place de Fontenoy - TSA 80715 - 75334 PARIS CEDEX 07 FRANCE

Regarding your health data, these rights may also be exercised by writing to the ACS Medical Consultant (ACS, To theattention of the Medical Consultant, 153, rue de l’Université, 75007 Paris, France) together with of a copy of an official
ID.
Data retention Duration :Personal data will be retained in accordance with applicable laws and regulations, and specifically as follows :Documents
Proposal, quotations
Individual Enrollment Forms
Contributions and premiums
Healthcare claims (illness/ accident medical
expenses)Claims files in the event of Death, Total andIrreversible Loss of Autonomy, Incapacity,
Disability

Data Retention Duration
3 years•
5 years from the date of the termination of contract(if no claim)•
5 years from the date of the termination of the insurance coverage
5 years
3 years from the date the claim is closed•••

Permanent Partial Disability Due to Illness(PPDI)- Permanent Partial Disability Due to
Accident Disability (PPDA)GLOBE PARTNER••

if the benefit has been paid: 10 years from the last date of payment
if the benefit has not been paid in totality or partially to thebeneficiary(ies) in the event of death of the Insured: 30 years from thedate of the recognition of the death of the Insured by the company
if the benefit could not be paid in total or partial due to the disappearanceof absence of the Insured: 30 years from the date of recognition by thecompany of the determination of the disappearance or absence of the
Insuredif the benefit has been paid: 10 years from the last date of payment
if not paid: 30 years

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