TRAVEL INSURANCE TERMS AND CONDITIONS
Old Mutual Life Assurance Company (Ghana) Ltd (Here in after called the Company) having received a Proposal and Declaration with date as stated in the Application form which together with the answers given by the Policyholder to any questions put forward shall form the basis of this contract the Company agrees with the Policyholder, subject to the payment of the premium specified in the Application form, to pay the benefit in accordance with the terms upon receipt of proof satisfactory as to:
1.MEDICAL EMERGENCY ASSISTANCE
i) Medical Expenses and hospitalization abroad
In the event of serious illness or injury of the insured occurring outside the Usual Country of Residence, The Insurer will pay the usual, customary, necessary and reasonable costs of hospitalization, surgery, medical fees and pharmaceutical products, prescribed by the attending doctor.
ii. Policy covers emergency hospital confinement and medical treatment by a legally qualified physician for the actual charges of hospitalization and medical expenses.
2. EMERGENCY MEDICAL EVACUATION
In the event of an accident or sudden illness, that is not pre-existing and which is acute, theCompany will take charge of transferring the Insured to a properly equipped health center or repatriating to his/her usual country of residence. The Assistance Company’s medical team will maintain the telephone contacts necessary with the doctors attending to the Insured and will decide which health center the Insured is transferred to or whether repatriation is necessary, depending on the situation or gravity of the state the latter is in. Policy holder will be arranged for evacuation, using the means it deems suitable, based on the medical evaluation of the seriousness of the Insured’s condition. These means may include air ambulance, surface ambulance, regular airplane, railroad or other appropriate means. Approval and arrangements shall be taken from the Assistance Company. In case any transportation or arrangement is made without obtaining prior approval from the Assistance Company, fees shall be paid by the Insured.
3. TRAVEL OF IMMEDIATE FAMILY MEMBER
In the event that the Insured should be admitted to hospital for more than five days as a result of an accident or serious illness covered in the policy, the insurer will take charge of the transfer of an immediate family member at the Insured’s choice, from the usual country of residence of the Insured, including meeting the cost of the outbound flight to the place of hospitalization, accommodation expenses and return journey, up to the limit provided.
4.REPATRIATION OF MINOR TRAVELLING WITH THE INSURED
Should the Insured be hospitalized due to sudden illness or accident for more than ten days or deceased, the Company will meet the cost of repatriating one minor accompanying the Insured at the moment of the event, to his usual place of residence, when the latter is placed in the same country of residence of the Insured, and provided this minor is unable to travel by his/her own means of transport or the means of transport used for the initial trip.
5. EMERGENCY DENTAL CARE If and when found necessary, the Company will provide the Insured party with the dental assistance required abroad. However, this coverage is restricted to the treatment of pain, infection and removal of the tooth/teeth affected and subject to the limits provided.
6.REPATRIATION OF MORTAL REMAINS
In the event of the death of the Insured, we will make the necessary arrangements for the return of the Insured’s remains to the Insured’s country of citizenship and the Company will meet the cost of the transfer expenses to the place of interment, cremation or funeral ceremony at his/her usual country of residence. Payment of expenses for interment, cremation or funeral ceremony is excluded from this guarantee.
7.PERSONAL ACCIDENT COVER
Accident by Means of Public Transport Insurance covers accidents the Insured may suffer at the means of transport used during the trip, including public means of transport (taxis, buses, microbuses, coaches) used by the Insured to get from his usual place of residence to the boarding point (airport, sea port, bus station) and from the point of arrival to the place of accommodation, as well as the return journey under the same conditions.
Accidental Death 1) Where an accident should lead to the death of the Insured, the Insurer shall pay the Beneficiary the sum assured determined for this eventuality.
2) If, prior to the death, the Insurer should have paid an indemnity for Disability, as a result of the same accident and this had occurred in less than one year, it shall indemnify the difference between the amount paid and the insured sum in the event of death. Should the indemnity already paid out be greater, the Insurer shall not lay claim to the difference
8.PERSONAL ASSISTANCE As soon as the Company is notified about a medical emergency resulting from the Insured’s accident or illness, the Assistance Company will contact the medical facility or location where the Insured isplaced and confer with the Physician at that location of the Insured to determine the best course of action to be taken. If possible and if deemed appropriate by the Company, the Insured’s Physician will be contacted in order to have a better knowledge of the medical conditions of the Insured, The Assistance Company will then analyze the situation and recommend the most appropriate way of providing the assistance benefits, as well as arranging hospital admission of the Insured where, in the discretion, of the Assistance Company is appropriate. The Assistance Company will serve as a central point for translation and communication for the Insured during emergencies. The Assistance Company agrees to provide to him advice on contacting and using services available from consulates, government agencies, translators and other service providers that can help with travel problems. Any cost associated with Assistance services not included in the list above shall be fully borne by the policyholder and NOT the Company.
9. POLICY ENDORSEMENTS
The insured can request for extensions on the existing policy whiles the policy is active provided period of cover, including the original term of contract, does not exceed 90 days.POLICY CONDITIONS i. This policy insures individuals within ages 0 – 70 years inclusive. ii. Policy holder should be resident in Ghana for a period of a least 6 months at the time of applyingfor insurance. iii. All lives are individually insured. iv. Change of travel dates, extension of travel cover is allowed before policy inception.
10. GEOGRAPHICAL SCOPE OF COVERAGE
Provides worldwide cover excluding country of residence and other countries which may be specifically excluded in the policy schedule.
11. POLICY EXLUSIONS
1. Loss, damage, illness and/or injury directly or indirectly caused by, arising out of, and/or during, and/or in consequence of the following are excluded from the cover granted under this Policy: i. The bad faith of the Insured, by the insureds participation in criminal acts, or as a result of the insureds fraudulent, seriously negligent or reckless actions including those actions of the Insured in a state of derangement or under psychiatric treatment costs for which are themselves excluded;
ii. Extraordinary natural phenomena such as floods, earthquakes, landslides, volcanic eruptions, a typical cyclonic storms, falling objects from space and aerolites, and in general any extraordinary atmospheric, meteorological, seismic or geological phenomenon any other type of natural disaster;
iii. Events arising from terrorism, mutiny or crowd disturbances;
iv. Events or actions of the Armed Forces or Security Forces in peacetime;
v. Wars, with or without prior declaration, and any conflicts or international interventions using force or duress or military operations of whatever type.
vi. Those caused by or resulting from radioactive materials and nuclear energy;
vii. Those caused when the Insured takes part in bets, challenges or brawls, save in the case of legitimate defence or necessity;
viii. Illness or injuries existing prior to the claim, unless expressly included in the Private or Special Conditions and subject to payment of the relevant surcharge premium;
ix. Those that occur as a result of the participation by the Insured in competitions, sports, and preparatory or training tests;
x. Engaging in the following sports: motor racing or motorcycle racing in any of its modes, big game hunting outside European territory, underwater diving using artificial lung, navigation in international waters in craft not intended for the public transport of passengers, horse riding, climbing, pot holing, boxing, wrestling in any of its modes, martial arts, parachuting, hot air ballooning, free falling, gliding and, in general, any sport or recreational activity that is known to be dangerous;
xi. Participation in competitions or tournaments organised by sporting federations or similar organisations.
xii. Hazardous winter and/or summer sports such as skiing and/or similar sports.
xiii. Permanent resident and students outside of resident country. The use, as a passenger or crew, of means of air avigation not authorised for the public transport of travellers, as well as helicopters;
xiv. The accidents deemed legally to be work or labour accidents, consequence of a risk inherent to the work performed by the Insured.
xv. Internationally and locally recognized epidemics.
xvi. Illnesses or injuries arising from chronic ailments or from those that existed prior to the inception date of the policy;
xvii. Death as a result of suicide and the injuries or after-effects brought about by suicide and/or attempted suicide or any self-inflicted injuries.
xviii. Illness, injuries or pathological states caused by the voluntary consumption of alcohol, drugs, toxic substances, narcotics or medicines acquired without medical prescription, as well as any kind of mental illness or mental imbalance;\
xix. Illness or injuries resulting from refusal and/or delay, on the part of the Insured or persons responsible for him/her, in the transfer proposed by the Company and agreed by its medical service;
xx. Illness or injuries caused by pregnancy and childbirth or any complication therefore or voluntary termination of pregnancy;
xxi. Mental Health diseases.
xxii.Venereal sexually transmitted diseases.
xxiii. All pre-existing, congenital and/or Chronic Medical Conditions.
xxiv. Any cardiac or cardio vascular or vascular or cerebral vascular illness or conditions or after-effects thereof or complications that, in the opinion of a medical practitioner appointed by the Company, can reasonably be related thereto, if the insured person has received medical advice or treatment (including medication) for hypertension 2 years prior to the commencement of the Protected Journey.
xxv. The services arranged by the Insured on his/her own behalf, without prior communication or without the consent of The Assistance Company, except in the case of an extreme emergency/urgent necessity. In that event, the Insured shall furnish the Company with the vouchers and original copies of the invoices;
xxvi. Assistance or medical services, which are not medically necessary and all Elective and/or non-Emergency medical condition and its complications.
xxvii. Rehabilitation treatments;
xxviii. Prostheses, orthopaedic material or thesis and osteosynthesis material, as well as spectacles.
xxix. Assistance or compensation for events that occurred during a trip that had commenced, in any of the following circumstances:
1) Before this insurance comes into force; 2) With the intention of receiving medical treatment; 3) After the diagnosis of a terminal illness; 4) Without prior medical authorisation, after the Insured had been under treatment or medical supervision during the twelve months prior to the start of the trip;
xxx. Expenses that arise once the Insured is at his/her usual country of residence, those incurred beyond the scope of application of the guarantees of the insurance, and, in any case, after the dates of the travel object of the Agreement have elapsed or after 92 days has elapsed since the start thereof, notwithstanding what is provided for in the Additional Clauses or in the Private or Special Conditions.
xxxi. Any Health Services that are received as Out-of-Hospital benefits.
xxxii. All expenses relating to dental treatment, dental prostheses, and orthodontic treatments in excess of approved limits and coverage.
xxxiii. Personal comfort and convenience items (television, barber or beauty service, guest service and similar incidental services and supplies).
xxxiv. Medical Services that are not performed by Authorized Healthcare Service Providers, apart from medical Services rendered in a Medical Emergency.
xxxv. Prosthetic devices and consumed medical equipment.
xxxvi. Treatments and services arising as a result of hazardous activities, including but not limited to, any form of aerial flight, any kind of power-vehicle race, water sports, horse riding activities,mountaineering activities, violent sports such as judo, boxing, and wrestling, bungee jumping and any professional sports activities.
xxxvii. Costs associated with hearing tests, vision corrections, prosthetic devices or hearing and vision aids.
xxxviii. Patient treatment supplies (including elastic stockings, ace bandages, gauze, syringes, diabetic test strips, and like products, non-prescription drugs and treatments, excluding such supplies required as a result of Healthcare Services rendered during a Medical Emergency).
xxxix. Services rendered by any medical provider relative of a patient for example the Insured person and the Insured member’s family, including spouse, brother, sister, parent or child.
xl. All Healthcare Services & Treatments for In-Vitro Fertilization (IVF), embryo transport, ovum and male sperms transport.
xli. Treatments and services related to viral hepatitis and associated complications, except for treatment and services related to Hepatitis A.
xlii. Air or Terrestrial Medical evacuation except for Emergency cases or unauthorized transportation services.
xliii. Medical services and associated expenses for organ and tissue transplants, irrespective of whether the Insured Person is a donor or recipient.
xliv. Any test or treatment not prescribed by a doctor.
LIMITATIONS SPECIFIC TO PERSONAL ACCIDENT COVER
In addition to the General Exclusions to all the guarantees of this policy described at the end of these General Conditions, the Insurer does not cover the consequences originated or produced by the following:
I. Accidents suffered as a result of being inebriated or under the effect of drugs, toxics or narcotics. Inebriation shall be taken to mean when the blood alcohol level is greater than 0, 50 grams per 1.000 cubic centimeters, or the Insured is fined or convicted for this cause.
II. Injuries that are a consequence of surgical operations or medical treatments not brought about by an accident covered by the policy.
III. Illnesses of any kind, fainting fits, syncope, strokes, epilepsy or epileptiform and caused by any kind of loss of consciousness as a result of an accident as the latter is defined in the Definitions of these General Conditions.
IV. The consequences of accidents that occurred prior to the coming into force of this insurance are also excluded, despite the fact that they become apparent during its lifetime, as well as the consequences or after-effects of an accident covered which become apparent after the three hundred and sixty-five days subsequent to the date on which it occurred.
CHANGE OF TRAVEL DATE
The insured should inform Old Mutual of any changes to the insurance prior to the date of commencement of the policy.
TRAVEL INSURANCE REFUND
Refunds are not available except as follows:
I. If the insured cancels the trip prior to the commencement date of the policy, a refund less administrative charges of GHC30.00 will be made available.
II. A refund less administration fee (GHC 30.00) is available when the insured requests for a refund based on visa denial to his or her intended destination, provided no travel has taken place and the request is received before the commencement date of the policy.
Documents required for a refund: I. Travel Insurance card II. Passport or Visa refusal letter III. Receipt of premium paid
Insurance cover begins when you set off from an exit port in Ghana and ends at the port of entry back into Ghana. The scope of this Policy becomes void when the travel causing the acquisition of this Policy ends and/or the Insured arrives at his/her Usual Country of Residence, whichever takes place first. Period of Cover granted under this Policy shall not exceed 90 consecutive days each travel. Please note that the terms and conditions of this policy binds third parties who act on behalf of the Insured.
Declaration: In witness to the above, Old Mutual Life Assurance Company (Ghana) Limited has caused this policy to be executed as of the policy date.
The bodily injury suffered during the life of the contract, which derives from a violent, sudden, external cause and one that is not intended by the Insured. For the purposes of this policy, the following shall also be construed to be accidents: a. Asphyxia or injuries as a consequence of gases or vapors, immersion or submersion, or from the consumption of liquid or solid matter other than foodstuffs. b.Infections resulting from an accident covered by the policy. c.Injuries that are a consequence of surgical operations or medical treatments resulting from an accident covered by the policy.
Person or persons for whom the Insured recognises the right to receive the corresponding amount of compensation as outlined in this contract. Should no one have been specified, the compensation will form part of the Insured’s estate.
The Company will immediately provide the Insured, the assistance specified under the "Coverage" clause of this Insurance Policy for mishaps that occur due to unforeseen incidents during travels outside his/her Usual Country of Residence, provided that this occurrence does not take place outside the specified geographical boundaries and does not take place out of the prescribed travel duration between the validity dates of this Policy. Congenital disease: the disease that exists at the moment of birth as a consequence of hereditary factors or complaints acquired during pregnancy.
"Emergency Dental Care" means:
Any natural dental treatment covered by the policy due to a condition suddenly started up at travel and that it does not occur by reason of any pre-existing situation has been documented by dentist's report.
"Doctor" or "Physician" means:
An officially registered medical practitioner according to the law of the place where the claim happens.
“Fraudulent Claims” means:
When the Insured, beneficiary or someone acting on their behalf, uses any fraudulent means or devices in order to obtain any of the benefits of this policy, consequently, any payment of any amount in respect of such claim shall be cancelled.
"Immediate Family Member" of the Insured, means:
Spouse, children, parents, grandparents and siblings
Any change in health diagnosed and confirmed by a legally recognized doctor during the life of the policy and which is not comprised or derived from either of the following two groups:
-Congenital disease: the disease that exists at the moment of birth as a consequence of hereditary factors or complaints acquired during pregnancy.
- Pre-existing disease: the disease that the Insured suffered prior to the date of taking out this Policy, even if it wasn’t diagnosed.
A medical problem caused by a sudden and severe external cause or reason beyond the control of the Insured, within the validity period of this Policy.
The amounts set forth in the Conditions of this Policy, Schedules of Covers and which represents the maximum benefit (financial, temporary or another kind) covered under each guarantee.
“Period of Insurance” or “Effective Date of Coverage” means:
The period that commences and ends on the dates stated on the Certificate of the Policy contracted. Such period of Insurance is in any case not renewable. Pre-existing disease: the disease that the Insured suffered prior to the date of taking out this Policy, even if it wasn't diagnosed.
“Osteosynthesis material” means:
Parts or pieces of metal or of any other kind used to join together the ends of a fractured bone, or to knit together the tips of joints, by surgical operation and which can be reused.
Orthopaedic material or orthesis means:
Anatomical parts or items of any kind used to prevent or correct temporary or permanent deformations of the body (walking sticks, cervical collar, wheelchair, etc.)
This are deemed to be any item of any kind that temporary or permanently replaces the lack of an organ, tissue, organic fluid, member or part of any of them. By way of an example, mechanical or biological items such as cardiac valve parts, joint replacements, synthetic skin, intraocular lenses, biological materials (cornea), fluids, gels and synthetic or semisynthetic liquids that replace organic humours or liquids, medicine reservoirs, mobile oxygen therapy systems, etc.
“Serious Illness” means:
Any illness that requires admission to hospital and which, in the opinion of the Assistance Company's medical team, prevents the Insured from continuing travel on the date planned, or which involves the risk of death.
“The Assistance Company” means:
The Services Company appointed by the insurer for the purpose of providing assistance to travellers on this policy, directly or by means of its network.
"Usual Country of Residence" means:
The country where the Insured person is a citizen or permanent resident for at least 6 months and where the
Policy is issued by the Insurer.
APPENDIX 2 Disability Scale
The following defines the degree of disability or incapacity
PERMANENT DISABILITY SCALE