TERMS AND CONDITIONS (Policy Wording)

Allianz Care International Healthcare Plans for EgyptValid from 1st July 2020

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Member Services Allianz Worldwide Care

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1. INTRODUCTION 1. Introduction 3

2. Purpose of the POLICY 3

3. Definitions 4-14

4. GeneralConditions 16-23

5. ExtentofCover 24-26

6. GeographicalAreaofCover 27

7. Exclusions 28-33

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The POLICY wording is drafted in a way to facilitate the full understanding of its terms and conditions. We urge you to read it carefully, noting that the official language used for the content of the POLICY wording is Arabic language, therefore if there is any discrepancy or difference in the translation, the Arabic wording shall prevail.

TheCOMPANYshallpaythecostsofmedicallynecessarymedicaltreatmentoccurringduringtheperiodofcoverresultingfromanaccidentormedicalillnessfortheINSUREDPERSON(S)coveredunderthisPOLICY.CoverageissubjecttothePOLICYtermsandconditionssetoutintheIndividualBenefitGuide,thebenefitlimitssetoutintheTableofBenefitsandanyterms,includingspecialconditions,outlinedintheInsuranceCertificateandsubjecttopaymentoftheagreedpremium.

2. PURPOSE OF THE POLICY

1.1 ThePOLICYHOLDER‘shealthinsurancePOLICYisanannualinsurancecontract,“thePOLICY”,withAllianzInsuranceCompany–Egypt,hereinafterreferredtoasthe“COMPANY”,andthePOLICYHOLDERnamedontheInsuranceCertificate.

1.2 ThePOLICY,theIndividualBenefitGuide,theTableofBenefits,theInsuranceCertificateandtheinformationprovidedtotheCOMPANYby,oronbehalfof,thePOLICYHOLDERinthesignedApplicationForm,submittedOnlineApplicationForm,ConfirmationofHealthStatusFormorothers(hereafterreferredtocollectivelyasthe“relevantapplicationform”)orothersupportingmedicalinformationconstitutestheentire contract between the parties hereto.

1.3 ThisPOLICYwillnottakeeffectbeforealldocumentsandinformationrequiredbythe COMPANY have been received and accepted by the COMPANY and the Initial premium has been fully paid.

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3.1 Accidentisaninjurywhichistheresultofanunexpectedevent,independentofthewilloftheINSUREDPERSONandwhicharisesfromacauseoutsidetheindividual’scontrol.Thecauseandsymptomsmustbemedicallyandobjectivelydefinable,allowforadiagnosisandrequiretherapy.

3.2 Accidental death benefitreferstoanamountshownintheTableofBenefitsthatbecomespayableiftheINSUREDPERSON(aged18to70)passesawayduringtheperiodofinsuranceasaresultofanaccident(includingindustrialinjury).

3.3 Accommodation costs for one parent staying in hospital with an insured child refers to the hospital accommodationcostsofoneparentforthedurationoftheinsuredchild’sadmissiontohospitalforeligibletreatment.Ifasuitablebedisnotavailableinthehospital,theCOMPANYwillcontributetheequivalentofathreestarhoteldailyroomratetowardsanyhotelcostsincurred.TheCOMPANYwillnot,however,coversundryexpensesincluding,butnotlimitedto,meals,telephonecallsornewspapers.TheINSUREDPERSON(S)shouldchecktheTableofBenefitstoconfirmwhetheranagelimitapplieswithregardtotheirchild.

3.4 Acute refers to sudden onset.

3.5 Chronic conditionisdefinedasasickness,illness,diseaseorinjurywhichhasoneormoreofthefollowingcharacteristics:

• Is recurrent in nature.• Iswithoutaknown,generallyrecognizedcure.• Isnotgenerallydeemedtorespondwelltotreatment.• Requirespalliativetreatment.• Requiresprolongedsupervisionormonitoring.• Leads to permanent disability.

The“Notes”sectionoftheTableofBenefitswillconfirmwhetherchronicconditionsarecovered.

3.6 The COMPANYAllianzInsuranceCompany–Egypt,legalentityunderwritingtheriskunderthecontractual terms of the insurance.

3.7 Complementary treatmentreferstotherapeuticanddiagnostictreatmentthatexistsoutsidetheinstitutionswhereconventionalWesternmedicineistaught.Suchmedicineincludeschiropractictreatment,osteopathy,Chineseherbalmedicine,homeopathyandacupunctureaspracticedbyapproved therapists.

3.8 Complications of childbirthrefersonlytothefollowingconditionsthatariseduringchildbirthandthatrequirearecognizedobstetricprocedure:post-partumhemorrhageandretainedplacentalmembrane.ComplicationsofchildbirthareonlypayablewheretheINSUREDPERSON’scoveralsoincludesaroutinematernitybenefit.Wherecoverincludesaroutinematernitybenefit,complicationsofchildbirthshallalsorefer to medically necessary cesarean sections.

3.9 Complications of pregnancy relatestothehealthofthemother.Onlythefollowingcomplicationsthatariseduringthepre-natalstagesofpregnancyarecovered:ectopicpregnancy,gestationaldiabetes,pre-eclampsia,miscarriage,threatenedmiscarriage,stillbirthandhydatidiformmole.

3. DEFINITIONSThe following definitions apply to benefits included in the Allianz Care Range of Plans and to some other commonly used terms.

The benefits the INSURED PERSON(S) are covered for are listed in the Table of Benefits. If any unique benefits apply to the POLICYHOLDER’s chosen plan(s), the definition will appear in the “Notes” section at the end of the Table of Benefits. Wherever the following words/phrases appear in the POLICYHOLDER’s POLICY documents, they will always be defined as follows.

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3.22 Emergency out-patient dental treatment istreatmentreceivedinadentalsurgery/hospitalemergencyroomfortheimmediatereliefofdentalpain,includingtemporaryfillingslimitedtothreefillingsperInsuranceYear,and/ortherepairofdamagecausedinanaccident.Thetreatmentmustbereceivedwithin24hoursoftheemergencyevent.Thisdoesnotincludeanyformofdentalprosthesesorrootcanaltreatment.

3.23 Emergency out-patient treatment istreatmentreceivedinacasualtyward/emergencyroomfollowinganaccidentorsuddenillness,wheretheINSUREDPERSONdoesnot,outofmedicalnecessity,occupyahospitalbed.Thetreatmentmustbereceivedwithin24hoursoftheemergencyevent.

3.24 Emergency treatment outside area of coveristreatmentformedicalemergencieswhichoccurduringbusinessorholidaytripsoutsidetheINSUREDPERSON’sareaofcover.Coverisprovideduptoamaximumperiodofsixweekspertripwithinthemaximumbenefitamountandincludestreatmentrequiredintheeventofanaccident,orthesuddenbeginningorworseningofasevereillnesswhichpresentsanimmediatethreattotheINSUREDPERSON’shealth.Treatmentbyaphysician,medicalpractitionerorspecialistmustcommencewithin24hoursoftheemergencyevent.Coverisnotprovidedforanycurativeorfollow-upemergencytreatment,eveniftheINSUREDPERSONisdeemedunabletotraveltoacountrywithinhis/hergeographicalareaofcover,nordoesitcoverchargesrelatingtomaternity,pregnancy,childbirthoranycomplicationsofpregnancyorchildbirth.TheINSUREDPERSONshouldadvisetheCOMPANYifhe/sheismovingoutsidetheirareaofcoverformorethansixweeks.

3.25 Expenses for one person accompanying an evacuated/repatriated INSURED PERSON refer to the costofonepersontravellingwiththeevacuated/repatriatedperson.Ifthiscannottakeplaceinthesametransportationvehicle,transportateconomyrateswillbepaidfor.Followingcompletionoftreatment,theCOMPANYwillalsocoverthecostofthereturntrip,ateconomyrates,fortheaccompanyingpersontoreturntothecountryfromwheretheevacuation/repatriationoriginated.Coverdoesnotextendtohotelaccommodation or other related expenses.

3.26 Family historyexistswhereaparent,grandparent,sibling,child,auntorunclehasbeenpreviouslydiagnosedwiththemedicalconditioninquestion.

3.27 Health and wellbeing checks including screening for the early detection of illness or disease are healthchecks,testsandexaminations,performedatanappropriateageinterval,thatareundertakenwithoutanyclinicalsymptomsbeingpresent.Checksarelimitedto:

• Physical examination.• Bloodtests(fullbloodcount,biochemistry,lipidprofile,thyroidfunctiontest,liverfunctiontest,kidney

functiontest).• Cardiovascularexamination(physicalexamination,electrocardiogram,bloodpressure).• Neurologicalexamination(physicalexamination).• Cancerscreening:

-Annualpapsmear.-Mammogram(everytwoyearsforwomenaged45+,orearlierwhereafamilyhistoryexists).-Prostatescreening(yearlyformenaged50+,orearlierwhereafamilyhistoryexists).-Colonoscopy(everyfiveyearsforINSUREDPERSONSaged50+,or40+whereafamilyhistoryexists).

-Annualfecaloccultbloodtest.• Bonedensitometry(everyfiveyearsforwomenaged50+).• Wellchildtest(forchildrenuptotheageofsixyears,uptoamaximumof15visitsperlifetime).• BRCA1andBRCA2genetictest(whereadirectfamilyhistoryexistsandwhereincludedinyourTable

ofBenefits).

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3.10 Co-paymentisthepercentageofthecostswhichtheINSUREDPERSONmustpay.TheseapplyperINSUREDPERSON,perInsuranceYear,unlessindicatedotherwiseintheTableofBenefits.Someplansmayincludeamaximumco-paymentperINSUREDPERSON,perInsuranceYear,andifso,theamountwillbecappedattheamountstatedintheTableofBenefits.Co-paymentsmayapplyindividuallytotheCore,Out-patient,Maternity,DentalorRepatriationPlans,ortoacombinationoftheseplans.

3.11 Day-care treatmentisplannedtreatmentreceivedinahospitalorday-carefacilityduringtheday,includingahospitalroomandnursing,thatdoesnotmedicallyrequirethepatienttostayovernightandwhereadischargenoteisissued.

3.12 DeductibleisthatpartofthecostwhichremainspayablebytheINSUREDPERSONandwhichhastobedeductedfromthereimbursablesum.Whereapplied,deductiblesarepayableperINSUREDPERSONperInsuranceYear,unlessindicatedotherwiseintheTableofBenefits.DeductiblesmayapplyindividuallytotheCore,Out-patient,Maternity,DentalorRepatriationPlans,ortoacombinationoftheseplans.

3.13 Dental prosthesesincludecrowns,inlays,onlays,adhesivereconstructions/restorations,bridges,denturesandimplantsaswellasallnecessaryandancillarytreatmentrequired.

3.14 Dental surgeryincludestheextractionofteeth,apicoectomy,aswellasthetreatmentofotheroralproblemssuchascongenitaljawdeformities(e.g.cleftjaw),fracturesandtumours.Dentalsurgerydoesnotcoveranysurgicaltreatmentthatisrelatedtodentalimplants.

3.15 Dental treatmentincludesanannualcheckup,simplefillingsrelatedtocavitiesordecayandrootcanaltreatment.

3.16 DependentisthePOLICYHOLDER’sspouseand/orunmarriedchildrenfinanciallydependentonthePOLICYHOLDERuptothedaybeforetheir18thbirthday;oruptothedaybeforetheir24th birthday ifinfulltimeeducation,andalsonamedintheInsuranceCertificateasoneofthePOLICYHOLDER’sdependents.

3.17 Diagnostic testsareinvestigationssuchasx-raysorbloodtests,undertakeninordertodeterminethecause of the presented symptoms.

3.18 Dietician fees relatetochargesfordietaryornutritionaladviceprovidedbyahealthprofessionalwhoisregisteredandqualifiedtopracticeinthecountrywherethetreatmentisreceived.IfincludedintheINSUREDPERSON’splancoverisonlyprovidedinrespectofeligiblediagnosedmedicalconditions.

3.19 Direct family history existswhereaparent,grandparent,siblingorchildhasbeenpreviouslydiagnosedwiththemedicalconditioninquestion.

3.20 Emergencyconstitutestheonsetofasuddenandunforeseenmedicalconditionthatrequiresurgentmedicalassistance.Onlytreatmentcommencingwithin24hoursoftheemergencyeventwillbecovered.

3.21 Emergency in-patient dental treatmentreferstoacuteemergencydentaltreatmentduetoaseriousaccidentrequiringhospitalization.Thetreatmentmustbereceivedwithin24hoursoftheemergencyevent.Pleasenotethatcoverunderthisbenefitdoesnotextendtofollow-updentaltreatment,dentalsurgery,dentalprostheses,orthodonticsorperiodontics.Ifcoverisprovidedforthesebenefits,itwillbelistedseparatelyintheTableofBenefits.

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3.40 Medical evacuationapplieswherethenecessarytreatmentforwhichtheINSUREDPERSONiscovered isnotavailablelocallyorifadequatelyscreenedbloodisunavailableintheeventofanemergency. TheCOMPANYwillevacuatetheINSUREDPERSONtothenearestappropriatemedicalcenter(whichmayormaynotbelocatedintheINSUREDPERSON’shomecountry)byambulance,helicopterorairplane.Themedicalevacuationwhichshouldberequestedbythetreatingphysician,willbecarriedoutinthemosteconomicalwayhavingregardtothemedicalcondition.

Followingcompletionoftreatment,theCOMPANYwillalsocoverthecostofthereturntrip,ateconomyrates,fortheevacuatedINSUREDPERSONtoreturntohis/herprincipalcountryofresidence.

IfmedicalnecessitypreventstheINSUREDPERSONfromundertakingtheevacuationortransportationfollowingdischargefromanin-patientepisodeofcare,theCOMPANYwillcoverthereasonablecostofhotelaccommodationuptoamaximumofsevendays,comprisingofaprivateroomwithen-suitefacilities.TheCOMPANYdoesnotcovercostsforhotelsuites,fourorfivestarhotelaccommodationorhotelaccommodationforanaccompanyingperson.

WhereanINSUREDPERSONhasbeenevacuatedtothenearestappropriatemedicalcenterforongoingtreatment,theCOMPANYwillagreetocoverthereasonablecostofhotelaccommodationcomprisingofaprivateroomwithen-suitefacilities.Thecostofsuchaccommodationmustbemoreeconomicalthansuccessivetransportationcoststo/fromthenearestappropriatemedicalcenterandtheprincipalcountryofresidence.Hotelaccommodationforanaccompanyingpersonisnotcovered.

Whereadequatelyscreenedbloodisnotavailablelocally,theCOMPANYwill,whereappropriate,endeavourtolocateandtransportscreenedbloodandsteriletransfusionequipment,wherethisisadvisedbythetreatingphysician.TheCOMPANYwillalsoendeavourtodothiswhentheirmedicalexperts so advise.

AllianzInsuranceCompanyanditsagentsacceptnoliabilityintheeventthatsuchendeavoursareunsuccessfulorintheeventthatcontaminatedbloodorequipmentisusedbythetreatingauthority.

INSUREDPERSON(S)mustcontactAllianzInsuranceCompanyatthefirstindicationthatanevacuationisrequired.FromthispointonwardsAllianzInsuranceCompanywillorganizeandcoordinateallstagesoftheevacuationuntiltheINSUREDPERSONissafelyreceivedintocareattheirdestination.IntheeventthatevacuationservicesarenotorganizedbyAllianzInsuranceCompany,theCOMPANYreservestherighttodeclineallcostsincurred.

3.41 Medical necessity refers to those medical services or supplies that are determined to be medically necessary and appropriate. They must be:

• Essentialtoidentifyortreatapatient’scondition,illnessorinjury.• Consistentwiththepatient’ssymptoms,diagnosisortreatmentoftheunderlyingcondition.• Inaccordancewithgenerallyacceptedmedicalpracticeandprofessionalstandardsofmedicalcare

in the medical community at the time.• Requiredforreasonsotherthanthecomfortorconvenienceofthepatientorhis/herphysician.• Proven and demonstrated to have medical value.• Considered to be the most appropriate type and level of service or supply.• Providedatanappropriatefacility,inanappropriatesettingandatanappropriatelevelofcarefor

thetreatmentofapatient’smedicalcondition.• Provided only for an appropriate duration of time.

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3.28 Home countryisacountryforwhichtheINSUREDPERSONholdsacurrentpassportand/ortowhichtheINSUREDPERSONwouldwanttoberepatriated.

3.29 Hospital isanyestablishmentwhichislicensedasamedicalorsurgicalhospitalinthecountrywhereitoperatesandwherethepatientispermanentlysupervisedbyamedicalpractitioner.Thefollowingestablishmentsarenotconsideredhospitals:restandnursinghomes,spas,cure-centersandhealthresorts.

3.30 Hospital accommodationreferstostandardprivateorsemi-privateaccommodationasindicatedintheTableofBenefits.Deluxe,executiveroomsandsuitesarenotcovered.PleasenotethatthehospitalaccommodationbenefitonlyapplieswherenootherbenefitincludedintheINSUREDPERSON’splancoverstherequiredin-patienttreatment.Inthiscase,hospitalaccommodationcostswillbecoveredunderthemorespecificin-patientbenefit,uptothebenefitlimitstated.Psychiatryandpsychotherapy,organtransplant,oncology,routinematernity,palliativecareandlongtermcareareexamplesofin-patientbenefitswhichincludecoverforhospitalaccommodationcosts,uptothebenefitlimitstated,whereincludedintheINSUREDPERSON’splan.

3.31 Infertility treatmentreferstotreatmentforbothsexesincludingallinvasiveinvestigativeproceduresnecessarytoestablishthecauseforinfertilitysuchashysterosalpingogram,laparoscopyorhysteroscopy.InthecaseofInVitroFertilization(IVF),coverislimitedtotheamountspecifiedintheTableofBenefits. IftheTableofBenefitsdoesnothaveaspecificbenefitforinfertilitytreatment,coverislimitedto non-invasiveinvestigationsintothecauseofinfertility,withinthelimitsoftheINSUREDPERSON’s Out-patientPlan(ifselected).Pleasenotethatformultiplebirthbabiesbornasaresultofmedicallyassistedreproduction,in-patienttreatmentislimitedtoUS$40,500perchildforthefirstthreemonthsfollowingbirth.Out-patienttreatmentispaidwithinthetermsoftheOut-patientPlan.

3.32 In-patient cash benefitispayablewhentreatmentandaccommodationforamedicalcondition,thatwouldotherwisebecoveredundertheINSUREDPERSON’splan,isprovidedinahospitalwherenochargesarebilled.CoverislimitedtotheamountspecifiedintheTableofBenefitsandispayableupondischargefromhospital.

3.33 In-patient treatmentreferstotreatmentreceivedinahospitalwhereanovernightstayismedicallynecessary.

3.34 Insurance CertificateisadocumentoutliningthedetailsoftheINSUREDPERSON’scoverandisissuedbytheCOMPANY.ItconfirmsthataninsurancerelationshipexistsbetweentheINSUREDPERSONandthe COMPANY.

3.35 Insurance Yearappliesfromtheeffectivedateoftheinsurance,asindicatedontheInsuranceCertificateand ends exactly one year later.

3.36 INSURED PERSON(S) isthePOLICYHOLDERandhis/herdependentsasstatedontheInsuranceCertificate.

3.37 Laser eye treatment referstothesurgicalimprovementoftherefractivequalityofthecorneausinglasertechnology,includingnecessarypre-operativeinvestigations.

3.38 Local ambulanceisambulancetransportrequiredforanemergencyoroutofmedicalnecessity,tothenearest available and appropriate hospital or licensed medical facility.

3.39 Long term care refers to care over an extended period of time after the acute treatment has been completed,usuallyforachronicconditionordisabilityrequiringperiodic,intermittentorcontinuouscare.Longtermcarecanbeprovidedathome,inthecommunity,inahospitalorinanursinghome.

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3.48 Nursing at home or in a convalescent homereferstonursingreceivedimmediatelyafterorinsteadofeligiblein-patientorday-caretreatment.TheCOMPANYwillonlypaythebenefitlistedintheTableofBenefitswherethetreatingdoctordecides(andtheCOMPANY’sMedicalDirectoragrees)thatitismedicallynecessaryfortheINSUREDPERSONtostayinaconvalescenthomeorhaveanurseinattendanceathome.Coverisnotprovidedforspas,curecentersandhealthresortsorinrelationtopalliativecareorlongtermcare(seeDefinitions3.59and3.39).

3.49 ObesityisdiagnosedwhenapersonhasaBodyMassIndex(BMI)ofover30.

3.50 Occupational therapyreferstotreatmentthataddressestheindividual’sdevelopmentoffinemotorskills,sensoryintegration,coordination,balanceandotherskillssuchasdressing,eating,grooming,etc.inordertoaiddailylivingandimproveinteractionswiththephysicalandsocialworld.

3.51 Oculomotor therapyisaspecifictypeofoccupationaltherapythataimstosynchronizeeyemovementincases where there is a lack of coordination between the muscles of the eye.

3.52 Oncologyreferstospecialistfees,diagnostictests,radiotherapy,chemotherapyandhospitalchargesincurredinrelationtotheplanningandcarryingouttreatmentforcancer,fromthepointofdiagnosis.

3.53 Oral surgical procedures referstosurgicalprocedures,suchas,butnotlimitedto,theremovalofimpactedwisdomteeth,whencarriedoutinahospitalbyanoralormaxillofacialsurgeon.TheCOMPANY does not cover procedures that can be carried out by a dentist unless the appropriate dental benefitsformpartoftheINSUREDPERSON’scover,inwhichcase,coverwillbesubjecttothelimitsofthedentalbenefits.

3.54 Organ transplant isthesurgicalprocedureinperformingthefollowingorganand/ortissuetransplants:heart,heart/valve,heart/lung,liver,pancreas,pancreas/kidney,kidney,bonemarrow,parathyroid,muscular/skeletalandcorneatransplants.Expensesincurredintheacquisitionoforgansarenotreimbursable.

3.55 Orthodonticsistheuseofdevicestocorrectmalocclusionandrestoretheteethtoproperalignmentandfunction.

3.56 Orthomolecular treatment referstotreatmentwhichaimstorestoretheoptimumecologicalenvironmentforthebody’scellsbycorrectingdeficienciesonthemolecularlevelbasedonindividualbiochemistry.Itusesnaturalsubstancessuchasvitamins,minerals,enzymes,hormones,etc.

3.57 Out-patient surgery isasurgicalprocedureperformedinasurgery,hospital,day-carefacilityor out-patientdepartmentthatdoesnotrequirethepatienttostayovernightoutofmedicalnecessity.

3.58 Out-patient treatmentreferstotreatmentprovidedinthepracticeorsurgeryofamedicalpractitioner,therapistorspecialistthatdoesnotrequirethepatienttobeadmittedtohospital.

3.59 Palliative care referstoon-goingtreatmentaimedatalleviatingthephysical/psychologicalsufferingassociatedwithprogressive,incurableillnessandmaintainingqualityoflife.Itincludesin-patient,day-careorout-patienttreatmentfollowingthediagnosisthattheconditionisterminalandtreatmentcannolongerbeexpectedtocurethecondition.Includedwithinthebenefit,theCOMPANYwillpayforphysicalcare,psychologicalcareaswellashospitalorhospiceaccommodation,nursingcareandprescriptiondrugs.

3.60 Periodonticsreferstodentaltreatmentrelatedtogumdisease.

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Asusedinthisdefinition,theterm“appropriate”shallmeantakingpatientsafetyandcosteffectivenessintoconsideration.Whenspecificallyappliedtoin-patienttreatment,medicallynecessaryalsomeansthatdiagnosiscannotbemade,ortreatmentcannotbesafelyandeffectivelyprovidedonanout-patientbasis.

3.42 Medical practitioner is a physician who is licensed to practice medicine under the law of the country in whichtreatmentisgivenandwherehe/sheispractisingwithinthelimitsofhis/herlicence.

3.43 Medical practitioner fees refertonon-surgicaltreatmentperformedoradministeredbyamedicalpractitioner.

3.44 Medical repatriation is an optional level of cover and where provided will be shown in the Table of Benefits.ThisbenefitmeansthatifthenecessarytreatmentforwhichtheINSUREDPERSONiscoveredisnotavailablelocally,he/shecanchoosetobemedicallyevacuatedtohis/herhomecountryfortreatment,insteadoftothenearestappropriatemedicalcenter.Thisonlyapplieswhenhis/herhomecountryislocatedwithinhis/hergeographicalareaofcover.

Followingcompletionoftreatment,theCOMPANYwillalsocoverthecostofthereturntrip,ateconomyrates,totheINSUREDPERSON’sprincipalcountryofresidence.Thereturnjourneymustbemadewithinone month after treatment has been completed.

INSUREDPERSONSmustcontactAllianzInsuranceCompanyatthefirstindicationthatrepatriationisrequired.FromthispointonwardsAllianzInsuranceCompanywillorganizeandcoordinateallstagesoftherepatriationuntiltheINSUREDPERSONissafelyreceivedintocareattheirdestination.IntheeventthatrepatriationservicesarenotorganizedbyAllianzInsuranceCompany,theCOMPANYreservestherighttodeclineallcostsincurred.

3.45 Midwife feesreferstofeeschargedbyamidwifeorbirthassistant,who,accordingtothelawofthecountryinwhichtreatmentisgiven,hasfulfilledthenecessarytrainingandpassedthenecessarystateexaminations.

3.46 Newborn careincludescustomaryexaminationsrequiredtoassesstheintegrityandbasicfunctionofthechild’sorgansandskeletalstructures.Theseessentialexaminationsarecarriedoutimmediatelyfollowingbirth.Furtherpreventivediagnosticprocedures,suchasroutineswabs,bloodtypingandhearingtests,arenot covered.

Anymedicallynecessaryfollow-upinvestigationsandtreatmentarecoveredunderthenewborn’sownPOLICY.Pleasenotethatformultiplebirthbabiesbornasaresultofmedicallyassistedreproduction, in-patienttreatmentislimitedtoUS$40,500perchildforthefirstthreemonthsfollowingbirth.Out-patienttreatmentispaidwithinthetermsoftheOut-patientPlan.

3.47 Non-prescribed physiotherapyreferstotreatmentbyaregisteredphysiotherapistwherereferralbyamedicalpractitionerhasnotbeenobtainedpriortoundergoingtreatment.Wherethisbenefitapplies,coverislimitedtothenumberofsessionsindicatedintheTableofBenefits.Additionalsessionsrequiredoverandabovethislimitmustbeprescribedinorderforcovertocontinue;thesesessionswillbesubjecttotheprescribedphysiotherapybenefitlimit.Physiotherapy(eitherprescribed,oracombinationof non-prescribedandprescribedtreatment)isinitiallyrestrictedto12sessionspercondition,afterwhichthetreatmentmustbereviewedbythereferringmedicalpractitioner.Shouldfurthersessionsberequired,aprogressreportmustbesubmittedtotheCOMPANY,whichindicatesthemedicalnecessityforanyfurthertreatment.PhysiotherapydoesnotincludetherapiessuchasRolfing,Massage,Pilates,FangoandMilta therapy.

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3.72 Principal country of residenceisthecountrywherethePOLICYHOLDER(andhis/herdependents)livesfor more than six months of the year.

3.73 Psychiatry and psychotherapy is the treatment of a mental disorders carried out by a psychiatrist orclinicalpsychologist.Theconditionmustbeclinicallysignificantandnotrelatedtobereavement,relationshiporacademicproblems,acculturationdifficultiesorworkpressure.Allday-careorin-patientadmissionsmustincludeprescriptionmedicationrelatedtothecondition.Psychotherapytreatment(onanin-patientorout-patientbasis)isonlycoveredwheretheINSUREDPERSON(orhis/herdependents) isinitiallydiagnosedbyapsychiatristandreferredtoaclinicalpsychologistforfurthertreatment. Inaddition,out-patientpsychotherapytreatment(wherecovered)isinitiallyrestrictedto10sessionspercondition,afterwhichtreatmentmustbereviewedbythereferringpsychiatrist.Shouldfurthersessionsberequired,aprogressreportmustbesubmittedtotheCOMPANY,whichindicatesthemedicalnecessityforany further treatment.

3.74 Rehabilitation istreatmentintheformofacombinationoftherapiessuchasphysical,occupationalandspeechtherapyandisaimedattherestorationofanormalformand/orfunctionafteranacuteillnessorinjury.Therehabilitationbenefitisonlypayablefortreatmentthatstartswithin14daysofdischargeaftertheacutemedicaland/orsurgicaltreatmentceasesandwhereittakesplaceinalicensedrehabilitationfacility.

3.75 Repatriation of mortal remainsisthetransportationofthedeceasedINSUREDPERSON’smortalremainsfromtheprincipalcountryofresidencetothecountryofburial.Coveredexpensesinclude,butarenotlimitedto,expensesforembalming,acontainerlegallyappropriatefortransportation,shippingcostsandthenecessarygovernmentauthorizations.Cremationcostswillonlybecoveredintheeventthatthisisrequiredforlegalpurposes.Costsincurredbyanyaccompanyingpersonsarenotcovered,unlessthisislistedasaspecificbenefitintheTableofBenefits.Allcoveredexpensesinconnectionwiththerepatriationofmortalremainsmustbepre-approvedbytheCOMPANYbyusingpre-authorization.

3.76 Routine maternity referstoanymedicallynecessarycostsincurredduringpregnancyandchildbirth,includinghospitalcharges,specialistfees,themother’spre-andpost-natalcare,midwifefees(duringlaboronly)aswellasnewborncare.Costsrelatedtocomplicationsofpregnancyorcomplicationsofchildbirtharenotpayableunderroutinematernity.Inaddition,anynon-medicallynecessarycesareansectionswillbecovereduptothecostofaroutinedeliveryinthesamehospital,subjecttoanybenefitlimitinplace.IfthehomedeliverybenefitisincludedintheINSUREDPERSON’splan,alumpsumuptotheamountspecifiedintheTableofBenefitswillbepaidintheeventofahomedelivery.Pleasenotethatformultiplebirthbabiesbornasaresultofmedicallyassistedreproduction,in-patienttreatmentislimitedtoUS$40,500perchildforthefirstthreemonthsfollowingbirth.Out-patienttreatmentispaidwithinthetermsoftheOut-patientPlan.

3.77 Specialistisaqualifiedandlicensedmedicalphysicianpossessingthenecessaryadditionalqualificationsandexpertisetopracticeasarecognizedspecialistofdiagnostictechniques,treatmentandpreventioninaparticularfieldofmedicine.Thisbenefitdoesnotincludecoverforpsychiatristorpsychologistfees.Wherecovered,aseparatebenefitforpsychiatryandpsychotherapywillappearintheTableofBenefits.

3.78 Specialist feesrefertonon-surgicaltreatmentperformedoradministeredbyaspecialist.

3.79 Speech therapy referstotreatmentcarriedoutbyaqualifiedspeechtherapisttotreatdiagnosedphysicalimpairments,including,butnotlimitedto,nasalobstruction,neurogenicimpairment(e.g.lingualparesis,braininjury)orarticulationdisordersinvolvingtheoralstructure(e.g.cleftpalate).

3.80 Surgical appliances and prosthesesrefertoartificialbodypartsordevices,whichareanintegralpartofasurgicalprocedureorpartofanymedicallynecessarytreatmentfollowingsurgery.

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3.61 PolicyholderreferstotheprincipalINSUREDPERSONnamedontheinsurancecertificate.

3.62 Post-natal carereferstotheroutinepost-partummedicalcarereceivedbythemother,uptosixweeksafter delivery.

3.63 Pre-existing conditions are medical conditions or any related conditions for which one or more symptomshavebeendisplayedatsomepointduringtheINSUREDPERSON’slifetime,irrespectiveofwhetheranymedicaltreatmentoradvicewassought.Anysuchconditionorrelatedcondition,aboutwhichtheINSUREDPERSON(orhis/herdependents)couldreasonablyhavebeenassumedtohaveknown,willbedeemedtobepre-existing.ConditionsarisingbetweencompletingtherelevantapplicationformandthestartdateofthePOLICYwillequallybedeemedtobepre-existing.Suchpre-existingconditionswillalsobesubjecttomedicalunderwritingandifnotdisclosed,theywillnotbecovered.

3.64 Pregnancyreferstotheperiodoftime,fromthedateofthefirstdiagnosis,untildelivery.

3.65 Pre-natal careincludescommonscreeningandfollow-uptestsasrequiredduringapregnancy.Forwomenaged35andover,thisincludesTriple/Bart’s,QuadrupleorSpinaBifidatests,amniocentesisandDNA-analysis,ifdirectlylinkedtoaneligibleamniocentesis.

3.66 Prescribed drugs referstoproductsprescribedbyaphysicianforthetreatmentofaconfirmeddiagnosisormedicalcondition,ortocompensatevitalbodilysubstancesincluding,butnotlimitedto,insulin,hypodermicneedlesorsyringes.Theprescribeddrugsmustbeclinicallyproventobeeffectivefortheconditionandrecognizedbythepharmaceuticalregulatorinagivencountry.PrescribeddrugsdonotlegallyhavetobeprescribedbyaphysicianinordertobepurchasedinthecountrywheretheINSUREDPERSONislocated;however,aprescriptionmustbeobtainedforthesecoststobeconsideredeligible.

3.67 Prescribed glasses and contact lenses including eye examination refers to cover for an eye examinationcarriedoutbyanoptometristorophthalmologist(oneperInsuranceYear)andforlensesorglassestocorrectvision.

3.68 Prescribed medical aidsreferstoanyinstrument,apparatusordevicewhichismedicallyprescribedasanaidtothefunctionorcapacityoftheINSUREDPERSON,suchashearingaids,speakingaids(electroniclarynx),crutchesorwheelchairs,orthopedicsupports/braces,artificiallimbs,stomasupplies,graduatedcompressionstockingsaswellasorthopedicarch-supports.Costsformedicalaidsthatformpartofpalliativecareorlongtermcare(seeDefinitions3.59and3.39arenotcovered).

3.69 Prescribed physiotherapyreferstotreatmentbyaregisteredphysiotherapistfollowingreferralbyamedicalpractitioner.Physiotherapyisinitiallyrestrictedto12sessionspercondition,afterwhichthetreatmentmustbereviewedbythereferringmedicalpractitioner.Shouldfurthersessionsberequired,aprogressreportmustbesubmittedtotheCOMPANY,whichindicatesthemedicalnecessityforanyfurthertreatment.PhysiotherapydoesnotincludetherapiessuchasRolfing,Massage,Pilates,FangoandMiltatherapy.

3.70 Prescription drugs referstoproducts,including,butnotlimitedto,insulin,hypodermicneedlesorsyringes,whichrequireaprescriptionforthetreatmentofaconfirmeddiagnosisormedicalconditionortocompensatevitalbodilysubstances.Theprescriptiondrugsmustbeclinicallyproventobeeffectivefortheconditionandrecognizedbythepharmaceuticalregulatorinagivencountry.

3.71 Preventive treatment referstotreatmentthatisundertakenwithoutanyclinicalsymptomsbeingpresentatthetimeoftreatment.Anexampleofsuchtreatmentistheremovalofapre-cancerousgrowth(e.g.moleontheskin).

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3.81 Therapistisachiropractor,osteopath,Chineseherbalist,homeopath,acupuncturist,physiotherapist,speechtherapist,occupationaltherapistoroculomotortherapist,whoisqualifiedandlicensedunderthelawofthecountryinwhichtreatmentisbeinggiven.

3.82 Third Party Administrator (TPA) refers to a company appointed by the insurer for the provision of administrationservicestotheINSUREDPERSON(S).

3.83 Travel costs of INSURED family persons in the event of an evacuation/repatriation refer to the reasonabletransportationcostsofallINSUREDfamilypersonsoftheevacuatedorrepatriatedperson,including,butnotlimitedto,minorswhomightotherwisebeleftunattended.Ifthiscannottakeplaceinthesametransportationvehicle,roundtriptransportateconomyrateswillbepaidfor.IntheeventofanINSUREDPERSON’srepatriation,thereasonabletransportationcostsofinsuredfamilyPERSONSwillonlybecoverediftheoptionalRepatriationPlanformspartoftheINSUREDPERSON’scover.Coverdoesnot extend to hotel accommodation or other related expenses.

3.84 Travel costs of INSURED family persons in the event of the repatriation of mortal remains refer to the reasonabletransportationcostsofanyINSUREDfamilypersonswhohadbeenresidingabroadwiththedeceasedINSUREDPERSON,toreturntothehomecountry/chosencountryofburialofthedeceased.Cover does not extend to hotel accommodation or other related expenses.

3.85 Travel costs of INSURED PERSONS to be with a family member who is at peril of death or who has died refertothereasonabletransportationcosts(uptotheamountspecifiedintheTableofBenefits)sothatinsuredfamilyPERSONScantraveltothelocationofafirstdegreerelativewhoisatperilofdeathorwhohasdied.Afirstdegreerelativeisaspouse,parent,brother,sisterorchild,includinglegallysponsoredchildrenorstepchildren.Claimsaretobeaccompaniedbyadeathcertificateordoctor’scertificatesupportingthereasonfortravelaswellascopiesoftheflightticketsandcoverwillbelimitedtooneclaimper lifetime of the POLICY. Cover does not extend to hotel accommodation or other related expenses.

3.86 Treatmentreferstoamedicalprocedureneededtocureorrelieveillnessorinjury.

3.87 Vaccinations refertoallbasicimmunizationsandboosterinjectionsrequiredunderregulationofthecountryinwhichtreatmentisbeinggiven,anymedicallynecessarytravelvaccinationsandmalariaprophylaxis.Thecostofconsultationforadministeringthevaccine,aswellasthecostofthedrug,iscovered.

3.88 Waiting periodisaperiodoftimecommencingonthePOLICYHOLDER’sPOLICYstartdate(oreffectivedateiftheINSUREDPERSONisadependent),duringwhichhe/sheisnotentitledtocoverforparticularbenefits.TheTableofBenefitswillindicatewhichbenefitsaresubjecttowaitingperiods.

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4.1 Eligibility CoverunderthisPOLICYisavailableonlytotheINSUREDPERSON(S)asreferredtoin

theInsuranceCertificateissuedbytheCOMPANY.

4.2 Application procedure AllpoliciesaresubjecttothecompletionoftheappropriateApplicationprocedures

includingbutnotlimitedtoanApplicationForm,otherformsthatTheCOMPANYdeemstobenecessaryandmedicalexaminationand/ormedicalunderwriting.

4.3 Endorsement Additions and deletions of INSURED PERSON(S) and premiums relating thereto:

Adding dependents ThePOLICYHOLDERmayapplytoincludeanyofhis/hereligiblefamilymembers

underhis/herPOLICYasoneofhis/herdependents,providingtheymeetthedefinitionof‘dependent’andthePOLICYHOLDERcompletestherelevantapplicationform.

Newborninfants(withtheexceptionofmultiplebirthbabiesandsponsoredbabies)willbeacceptedforcoverfrombirthwithoutmedicalunderwriting,providedthattheCOMPANYisnotifiedwithinfourweeksofthedateofbirthandthebirthparenthasbeeninsuredwiththeCOMPANYforaminimumofeightcontinuousmonths.TonotifytheCOMPANYofthePOLICYHOLDER’sintentiontohavehis/hernewbornchildincludedonhis/herPOLICY,arequestshouldbemadeinwritingandsentbyemailtotheCOMPANY’sUnderwritingTeam.

Notificationofthebirthafterfourweekswillresultinnewbornchildrenbeingunderwritten and cover will only commence from the date of acceptance. Please notethatallmultiplebirthbabiesandadoptedchildrenwillbesubjecttofullmedicalunderwritingandcoverwillonlycommencefromthedateofacceptance.In-patienttreatment for multiple birth babies born as a result of medically assisted reproduction willbecovereduptoUS$40,500perchildforthefirstthreemonthsfollowingbirth.Out-patienttreatmentwillbecoveredunderthelimitsoftheOut-patientPlan.

Theadditionalpremiumpertainingtosuchpersonsshallbecalculatedonapro-ratabasisfromtheireffectivedateofcoverandbecomesimmediatelypayabletotheCOMPANY.

4. GENERAL CONDITIONS

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4.4 Paying premiums ThePOLICYHOLDERisrequiredtopaythefullpremiumduetotheCOMPANYin

advanceforthedurationofhis/herPOLICY.TheamountthePOLICYHOLDERhasagreedtopaywillbeshownonthequotationorontheSpecialConditionsForm(whereanadditionalloadingisapplied),priortotheissueofthePOLICY.

ThefullpremiumshouldbepaidinadvancebythePOLICYHOLDER.TheCOMPANYisnotresponsibleforpaymentsmadethroughthirdparties.ThepremiumshouldbepaidinthecurrencythePOLICYHOLDERelectedtopaywhenapplyingforcover.

ChangesinpaymenttermscanbemadeatPOLICYrenewal,viawritteninstructions,whichmustbereceivedbytheCOMPANYaminimumof30dayspriortotherenewaldate.

Termination Clause IfthePOLICYHOLDERdoesnotpaythepremiumbytheduedate,TheINSURANCE

COMPANYreservestherighttosuspendcoveranddenyclaims.ThePOLICYshallbedeemednullandvoidifthefullpremiumhasnotbeenpaidtendaysfromthesendingofaregisteredletterbytheINSURANCECOMPANYtothePOLICYHOLDERtohis/heraddressdeclaredinthepolicyoratthelastaddressnotifiedtotheInsuranceCompany.IfthePOLICYHOLDERdoesnotpaythepremiumduringthe10daynoticeperiodtheINSURANCECOMPANYwillsendafurtherregisteredlettertothePOLICYHOLDERtonotifythePOLICYHOLDERofthecancellationofthePOLICY.

TheeffectsofterminationshallceaseifthePOLICYHOLDERmakesapaymentwithinonemonthaftertheduedateor,iftheterminationwascombinedwiththesettingofatimelimit,withinonemonthaftertheexpirationofthetimeforpayment,providedthatno claims have been incurredintheinterveningperiod.

The premiumwillbeadjustedonceayearattherenewaldate,atwhichtimewealsoreservetherighttoalterourPOLICYtermsandconditions.

Paying other charges Inadditiontopayingpremiums,thePOLICYHOLDERalsohastopaytheamountof

anyInsurancePremiumTax(IPT)andanynewtaxes,leviesorchargesrelatingtohis/herPOLICYthatmaybeimposedafterhe/shejoinsandthattheCOMPANYisrequiredbylawtopayortocollectfromthePOLICYHOLDER.TheamountofanyIPTortaxes,leviesorchargesthatthePOLICYHOLDERhastopaytheCOMPANYisshownonhis/herPaymentDetailsLetter/Invoice.

ThePOLICYHOLDERisrequiredtopaytotheCOMPANYanysuchIPT,taxes,leviesand

chargesaswellaspremiums,unlessotherwiserequiredbylaw.

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4.7 Participation in insurance Ifitisfoundthatthereisaninforceinsurancepolicyorpoliciesbelongingtothe

INSUREDPERSONoranyoneelsehadissueditinfavoroftheINSURED,coveringthesameinsuredriskscoveredunderthisPOLICYatthetimeofclaim,theCOMPANYwillnotabidetocompensatethefullinsuranceamount,buttoonlythepercentageoftheCOMPANY’ssharetothetotalinsuranceamountsunderallactivepoliciescoveringthat risk.

4.8 Insurance cancellation TheCOMPANYmaycanceltheinsuranceaftertheexpiryoftendaysfrominforming

thePOLICYHOLDERbysendingregisteredlettertothePOLICYHOLDERonthelastaddressknowntothem.InthiscasetheCOMPANYhastherighttokeepportionofthepremium relative to the elapsed time of the insurance cover.

ThePOLICYHOLDERmaycancelthisinsurance,subjecttothereturnofallmedicalcards(includingthedependent’scards),andsubjecttonoclaimshavingbeenmaderelatingtotheinsuranceyearofcancellation.InthiscasetheCOMPANYreservestherighttoretainportionofthepremiumrelativetotheelapsedtimeoftheinsurancecover in accordance with the short term rate schedule:

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Changes to premiums and other charges Eachyear,ontherenewaldate,theCOMPANYmaychangehowitcalculatesthe

POLICYHOLDER’spremiums,howitdeterminethepremiums,whatthePOLICYHOLDERhas to pay and the method of payment. Please be assured that if the COMPANY does makechanges,theywillonlyapplyfromthePOLICYHOLDER’srenewaldate.

TheCOMPANYmaychangetheamountthePOLICYHOLDERhastopaytheCOMPANYinrespectofIPTorinrespectofothertaxes,leviesorchargesatanytimeifthereisachangeintherateofIPToranynewsuchtax,levyorchargeisintroducedorthereisachangeintherateofanysuchtax,levyorcharge.

IftheCOMPANYdoesmakeanychangestothePOLICYHOLDER’spremiumsortotheamountthePOLICYHOLDERhastopayinrespectofIPTorothertaxes,leviesorcharges,theCOMPANYwillwritetoinformthePOLICYHOLDERaboutthechanges.IfthePOLICYHOLDERdoesnotacceptanychangestheCOMPANYmakes,he/shecanendhis/herPOLICYandtheCOMPANYwilltreatthechangesashavingnotbeenmade,ifhe/sheendshis/herPOLICYwithin30daysofthedateonwhichthechangestakeeffect,orwithin30daysoftheCOMPANYinforminghim/heraboutthechanges,whichever is later.

4.5 Pre-authorization Sometypesofmedicaltreatmentmayrequirepre-authorizationinaccordancewiththe

proceduresstipulatedintheTableofBenefits.

• Ifthetreatmentreceivedissubsequentlyproventobemedicallyunnecessary, theCOMPANYreservestherighttodeclinetheINSUREDPERSON’sclaim.

• ForthebenefitslistedintheTableofBenefitswitha1,theCOMPANYreservestherighttodeclinetheINSUREDPERSON’sclaim.Iftherespectivetreatmentissubsequentlyproventobemedicallynecessary,theCOMPANYwillpayonly80%oftheeligiblebenefit.

• ForthebenefitslistedintheTableofBenefitswitha2,theCOMPANYreservestherighttodeclinetheINSUREDPERSON’sclaim.Iftherespectivetreatmentissubsequentlyproventobemedicallynecessary,theCOMPANYwillpayonly50%oftheeligiblebenefit.

4.6 Modification of plan The POLICYHOLDER may elect to change the plan of insurance selected on the

original application only as at the renewal date of the POLICY and subject to the acceptance of the COMPANY. TheCOMPANYmayasktheINSUREDPERSONtocompleteamedicalhistoryquestionnaireand/ortoagreetocertainexclusionsorrestrictions to any additional cover before the COMPANY accepts the application. Ifanincreaseincoverisaccepted,anadditionalpremiumamountwillbepayable andwaitingperiodsmayapply.

Period of insurance cover - number of days

Short term rate scheduleApproximate % of premium the

COMPANY reserves the right to retain

30 8%

60 16%

90 25%

120 33%

150 41%

180 49%

210 58%

240 66%

270 74%

300 82%

330 90%

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4.10 Insurance cards IfforanyreasoncoverfortheINSUREDPERSON(S)comestoanendinadvanceofthe

renewaldateofthePOLICY,itistheresponsibilityofthePOLICYHOLDERtoreturntherelevantindividualidentitycard(s),totheCOMPANYimmediatelyuponterminationofany individual cover.

Inaddition,intheeventthatthePOLICYHOLDERcancelshis/herPOLICYinaccordancewithClause4.8duringtheInsuranceYear,itistheresponsibilityofthePOLICYHOLDERtoreturntherelevantindividualidentitycard(s)(includingtheidentitycardsofhis/herdependents)inadvancetotheCOMPANYpriortothecancellationofthePOLICYtakingeffect.

The COMPANY shall have no liability to pay any claims for any Insurance Year where thePOLICYHOLDERcancelsthePOLICYunderthetermsofClause4.8.

4.11 Renewal ThisPOLICYisissuedfortheperiodfromtheContractEffectiveDatetotheExpiryDate

asstatedintheInsuranceCertificate,andmayberenewedbythePOLICYHOLDERatthePOLICYrenewaldateforanotherperiodofoneyear,subjecttothetermsinforceatthetimeofeachrenewaldateandtopaymentofpremium,unlessthereiswrittennoticegivenbythePOLICYHOLDERorTHECOMPANYatleastthirty(30)dayspriortotherenewaldatetocancelthePOLICY.THECOMPANYreservestherighttoreviewthePOLICY terms and conditions and to alter the Premium rates at renewal of the POLICY.

4.12 POLICY expiry UponexpiryofthePOLICY,therightoftheINSUREDPERSONtoreimbursementends.

AnyexpensescoveredundertheinsurancePOLICYandincurredduringtheperiodofcover shall be reimbursed up to six months after the expiry of the insurance POLICY. However,anyongoingorfurthertreatmentthatisrequiredaftertheexpirydateofthePOLICYwillnolongerbecovered.

4.13 Medical records TheINSUREDPERSON(S)agreestoassisttheCOMPANYinobtainingallnecessary

informationtoprocessaclaim.TheCOMPANYhastherighttoaccessallmedicalrecordsandtohavedirectdiscussionswiththemedicalproviderorthetreatingphysician.TheCOMPANYmay,atitsownexpense,requestamedicalexaminationbytheCOMPANY’smedicalrepresentativewhentheCOMPANYdeemsthistobenecessary.Allinformationwillbetreatedinstrictconfidence.TheCOMPANYreservestherighttowithholdbenefitsiftheINSUREDPERSONhasnothonoredtheseobligations.

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4.9 Forfeiture AlltheINSUREDPERSON’srightsarisingfromthisPolicywillforfeitureinthefollowing

cases:

A. IncorrectdisclosurebytheINSUREDorhis/herrepresentativeintheapplicationformorinthedeclarationsgiven,withthepurposeofurgingtheCOMPANYtoaccepttheinsuranceoranynon-disclosuretotheCOMPANYofanymaterialfactswhichhe/shehadtoinformtheCOMPANYwithbeforethePOLICYcommencement date.

B. ViolationbytheINSUREDorhis/herrepresentativesofthelawsorregulations,whichorganizestheperformanceofhis/her,ownactivity,ifinvolvingintentionalfelony or misdemeanour.

TheINSUREDorthebeneficiaries’rightstoclaimwillforfeitureiftheinsuredorhis/herrepresentativesubmitsmisleadingorfraudulentdataorsupporttheclaimformwithfraudulent data or if the indemnity has been fabricated.

Cancellation and fraudA. ThePOLICYHOLDERshallreimbursetheCOMPANYintheeventthattherelevant

insurance cards issued by the COMPANY or its appointed Third Party Administrator aremisusedbytheINSUREDPERSON(S).

B. ThePOLICYHOLDERshallreimbursetheCOMPANYinrespectofanyexpensespaid by the COMPANY or its appointed Third Party Administrator that exceed the agreedbenefitamountlimitsaspertheTableofBenefits.

C. Death UponthedeathofthePOLICYHOLDERoradependenttheCOMPANYshouldbe

notifiedinwritingwithin28days.Thecorrespondinginsurancewillbeterminatedand a pro rata repayment of the premium will be made if no claims have been filed.TheCOMPANYreservestherighttorequestadeathcertificatebeforearefund is issued.

UponthedeathofthePOLICYHOLDER,adependentonthePOLICYcanapplytobecomethenewPOLICYHOLDER,iftheywishtodoso,andiftheymeettheminimumagerequirementsandincludetheotherdependentsunderhis/herPOLICY.

Ifadependentdies,theywillbetakenoffthePOLICYandaproratarepaymentofthecurrentyear’spremiumforthatPERSONwillbemade,ifnoclaimshavebeenfiled(pleasenotethattheCOMPANYreservestherighttorequestadeathcertificatebeforearefundisissued).

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hostilities(whetherornotwarisdeclared),riots,explosions,strikesorotherlabourunrest,civildisturbances,sabotage,expropriationbygovernmentalauthoritiesandanyotheractoreventthatisoutsideoftheCOMPANY’sreasonablecontrol.

4.21 Changes, declarations TheCOMPANYmayalterboththeIndividualBenefitGuideand/ortheTable

ofBenefitsfromtimetotimebutnoalterationshalltakeeffectuntilthenextannualrenewalofthisAgreement.TheCOMPANYshallnotifysuchchangestothePOLICYHOLDERinwritingand–whereappropriate–shallissuereplacementdocumentstothePOLICYHOLDER.ThisPOLICYcanonlybevariedinwriting.NovariationwillbeadmittedunlessitisinwritingandsignedonbehalfoftheCOMPANYandthePOLICYHOLDER.

4.22 Designated courts AlldisputesarisingfromtheinterpretationorexecutionofthisPOLICYshallbesettled

bytherelevantEgyptiancourtsinwhosejurisdictionliestheofficeoftheCompanywhich issued the POLICY.

4.23 Data protection and release of medical records OurDataProtectionNoticeexplainshowwe,AllianzCare,theadministrators(data

processors)actingonbehalfofyourinsurer,protectyourprivacy.Thisisanimportantnotice which outlines how we will process your personal data and should be read by you before the submission of any personal data to us. To read our Data Protection Notice visit: www.allianzcare.com/en/privacy.Alternatively,youcancontactuson19154(whencallingfrominsideEgypt)andon+35316301301(whencallingfromoutsideEgypt)torequestapapercopyofourfullDataProtectionNotice.Ifyouhaveanyqueriesabouthowweuseyourpersonaldata,youcanalwayscontactusbye-mailat: AP.EU1DataPrivacyOfficer@allianz.com.

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4.14 Legal action TheINSUREDPERSONshallnotinstituteanylegalproceedingstorecoveranyamount

underthePOLICYuntilatleast60daysaftertheclaimhasbeensubmittedtotheCOMPANYandnotmorethantwoyearsfromthedateofthissubmission,unlessotherwiserequiredbymandatorylegalregulations.

4.15 Observance of terms ThedueobservanceandfulfilmentofthetermsandconditionsofthisPOLICYinso

farastheyrelatetoanythingtobedoneorcompliedwiththePOLICYHOLDERoranINSUREDPERSONshallbeaconditionprecedenttoanyliabilityoftheCOMPANY.

4.16 Subrogation AnyclaimantunderthisPOLICYshallattherequestandexpenseoftheCOMPANY

takeandpermittobetakenallnecessarystepsforenforcingrightsagainstanyother party in the name of the Insured before or after any payment is made by the COMPANY.

4.17 Time bar TheinsurancecoverageunderthisPOLICYwillbesubjecttoCivilCodeArticleNo.752.

4.18 Liability TheCOMPANY’sliabilitytotheINSUREDPERSON(S)islimitedtotheamounts

indicatedintheTableofBenefitsandanysubsequentPOLICYendorsements.Innoeventwilltheamountofreimbursement,whetherunderthisPOLICY,publicmedicalschemesandanyotherinsurance,exceedtheamountoftheinvoice.

4.19 Making contact with dependents InordertoadministerthePOLICYinaccordancewiththeinsurancecontract,theremay

becircumstanceswhentheCOMPANYwillneedtorequestfurtherinformation.IftheCOMPANYneedstomakecontactinrelationtoadependentonaPOLICY(e.g.whenweneedtocollectanemailaddressforanadultdependent),thePOLICYHOLDER,actingforandonbehalfofthedependent,maybecontactedbytheCOMPANYandbeaskedtoprovidetherelevantinformation,providedthatthesearenon-sensitivemedicalinformationrelatingtoadependent.Similarly,anynon-medicalinformationinrelationtoapersoncoveredbythePOLICY,forthepurposesofadministeringclaims,maybesentdirectlytothePOLICYHOLDER.

4.20 Force majeure The COMPANY shall not be liable for any failure or delay in the performance of its

obligationsunderthetermsofthisPOLICY,causedby,orresultingfrom,forcemajeurewhichshallinclude,butisnotlimitedto:eventswhichareunpredictable,unforeseeableorunavoidable,suchasextremelysevereweather,floods,landslides,earthquakes,storms,lightning,fire,subsidence,epidemics,actsofterrorism,outbreaksofmilitary

• Alleligibleexpensesincurredinthefirstyearwillbesubjecttothebenefitlimitthatapplies in year one.

• Alleligibleexpensesincurredinthesecondyearwillbesubjecttotheupdatedbenefitlimitthatappliesinyeartwo,lessthetotalbenefitamountreimbursedinyearone.

• Intheeventthatthebenefitlimitdecreasesinyeartwoandthisupdatedamounthasbeenreachedorexceededbyeligiblecostsincurredinyearone,noadditionalbenefitamount will be payable.

In-patienttreatmentformultiplebirthbabiesbornasaresultofmedicallyassistedreproductionwillbecovereduptoUS$40,500perchildforthefirstthreemonthsfollowingbirth.Out-patienttreatmentwillbecoveredunderthelimitsoftheOut-patientPlan.

ThisPOLICYdoesnotprovideanycoverorbenefitforanybusinessoractivitytotheextentthateitherthecoverorbenefitortheunderlyingbusinessoractivitywouldviolateanyapplicablesanctionlaworregulationsoftheUnitedNations,theEuropeanUnionoranyotherapplicableeconomicortradesanctionlaworregulations.

Changing country of residence

ItisimportantthatthePOLICYHOLDERadvisestheCOMPANYwhentheyortheircovereddependentschangecountryofresidence,asitmayimpacttheircoverorpremium,eveniftheyaremovingtoacountrywithintheirgeographicalareaofcover.IfanINSUREDPERSONmovestoacountryoutsideoftheirgeographicalareaofcover,theirexistingcoverwill not be valid there.

Pleasenotethatcoverinsomecountriesissubjecttolocalhealthinsurancerestrictions,particularlyforresidentsofthatcountry.ItisthePOLICYHOLDER’sresponsibilitytoensurethattheirhealthcarecoverandthecoveroftheircovereddependentsislegallyappropriate.Iftheyareinanydoubt,theyshouldseekindependentlegaladviceastheCOMPANYmaynolongerbeabletoprovidehim/herorhis/hercovereddependentswithcover.Thecoverprovided by the COMPANY is not a substitute for local compulsory health insurance.

Medical necessity and customary charges

ThisPOLICYprovidescoverformedicaltreatment,relatedcosts,servicesand/orsuppliesthat the COMPANY determines to be medically necessary and appropriate to treat a patient’scondition,illnessorinjury.Plus,theCOMPANYwillonlypayformedicalcostswhicharefairandreasonableandatthelevelcustomarilychargedinthespecificcountryandforthetreatmentprovided,inaccordancewithstandardandgenerallyacceptedmedicalprocedures.IfaclaimisdeemedbytheCOMPANYtobeinappropriate,theCOMPANYreservetherighttoreducetheamountpayablebythem.

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Overview

ThePOLICYHOLDER’sTableofBenefitsspecifiestheplan(s)selectedandtheassociatedbenefitsavailabletohim/herandhis/hercovereddependents.FurtherdetailsabouttheINSUREDPERSON(S)benefitsareprovidedinthe“Definitions”sectionofthisdocument.Notallofthebenefitslistedinthe“Definitions”sectionarenecessarilycoveredunderthePOLICYHOLDER’sPOLICY,whichiswhyitisimportantthattheINSUREDPERSON(S)checkwhichonesarelistedintheTableofBenefits.CoverissubjecttotheCOMPANY’sPOLICYdefinitions,exclusions,benefitlimitsandanyspecialconditionsindicatedontheInsuranceCertificate.

TheCOMPANYwouldliketospecificallyhighlightthefollowingimportantpoints:

Benefits Limits

TherearetwokindsofbenefitlimitsshownintheTableofBenefits.Themaximumplanbenefit,whichappliestocertainplans,isthemaximumtheCOMPANYwillpayforallbenefitsintotal,perINSUREDPERSON,perInsuranceYear,underthatparticularplan.

Somebenefitsalsohaveaspecificbenefitlimitwhichmaybeprovidedona“perInsuranceYear”basis,a“perlifetime“basisorona“perevent“basis,suchaspertrip,pervisitorperpregnancy.

InsomeinstancestheCOMPANYwillpayapercentageofthecostsforthespecificbenefit,e.g.:65%refund,upto$6,750”.Whereaspecificbenefitlimitappliesorwheretheterm“Fullrefund”appearsnexttocertainbenefits,therefundissubjecttothemaximumplanbenefit,ifoneappliestotheINSUREDPERSON’splan(s).

AlllimitsareperINSUREDPERSON,perInsuranceYear,unlessotherwisestatedintheTableofBenefits.

IftheINSUREDPERSONiscoveredformaternitybenefits,thesewillbestatedintheTableofBenefitsalongwithanybenefitlimitand/orwaitingperiodwhichapplies.Benefitlimitsfor“Routinematernity”and“Complicationsofchildbirth”arepayableoneithera“perpregnancy”or“perInsuranceYear”basis(thiswillalsobeconfirmedintheTableofBenefits).Ifthebenefitispayableona“perpregnancy”basisandapregnancyspanstwoInsuranceYears,pleasenotethatifachangeisappliedtothebenefitlimitatPOLICYrenewal,thefollowingwillapply:

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5. EXTENT OF COVER

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6. GEOGRAPHICAL AREA OF COVER

ThegeographicalareawhereMEDICAL TREATMENTmaybeobtainedasspecifiedintheInsuranceCertificate.

IfthenecessarymedicaltreatmentforwhichtheINSUREDPERSONiscoveredisnotavailablelocally,theINSUREDPERSONcanavailoftreatmentinanycountrywithinhis/hergeographicalareaofcover.Inordertoseekreimbursementformedicaltreatmentandtravelexpensesincurred,pre-authorizationisrequiredpriortotravel.

IfthenecessarymedicaltreatmentforwhichtheINSUREDPERSONiscoveredisavailablelocally,buthe/shechoosestotraveltoanothercountrywithinhis/hergeographicalareaofcoverfortreatment,theCOMPANYwillreimbursealleligiblemedicalcostsincurredwithinthetermsofthePOLICY;however,theCOMPANYwillnotpayfortravelexpenses.

PleasenotethattheINSUREDPERSONiscoveredforeligiblecostsincurredinhis/herhomecountry,providedthatthehomecountryiswithintheINSUREDPERSON’sareaofcover.

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Pre-existing conditions

Pre-existingconditionsaremedicalconditionsoranyrelatedconditionsforwhichoneormoresymptomshavebeendisplayedatsomepointduringtheINSUREDPERSON’slifetime,irrespectiveofwhetheranymedicaltreatmentoradvicewassought.Anysuchconditionorrelatedcondition,aboutwhichanINSUREDPERSONcouldreasonablyhavebeenassumedtohaveknown,willbedeemedtobepre-existing.

The“Notes”sectionoftheTableofBenefitswillconfirmifpre-existingconditionsarecovered.Pre-existingconditionswhichhavenotbeendeclaredontherelevantapplicationformarenotcovered.Plus,conditionsarisingbetweencompletingtherelevantapplicationformandthestartdateofthePOLICYwillequallybedeemedtobepre-existing.Suchpre-existingconditionswillalsobesubjecttomedicalunderwritingand,ifnotdisclosed,theywillnot be covered.

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7.1 Any form of treatment or drug therapy whichintheCOMPANY’sreasonableopinionisexperimental or unproven,basedongenerallyacceptedmedicalpractice.

7.2 Anytreatmentcarriedoutbyaplastic surgeon,whetherornotformedical/psychologicalpurposesandanycosmeticoraesthetictreatmenttoenhancetheINSUREDPERSON’sappearance,evenwhenmedicallyprescribed.Theonlyexceptionisreconstructivesurgerynecessarytorestorefunctionorappearanceafteradisfiguringaccidentorasaresultofsurgeryforcancer,iftheaccidentorsurgeryoccursduringtheINSUREDPERSON’smembershipofthescheme.

7.3 Care and/or treatment of drug addiction or alcoholism(includingdetoxificationprogrammesandtreatmentsrelatedtothecessationofsmoking),instancesofdeath,orthetreatmentofanyconditionthatintheCOMPANY’sreasonableopinionisrelatedto,oradirectconsequenceof,alcoholismoraddiction(e.g.organfailureordementia).

7.4 Careand/ortreatmentofintentionally caused diseases or self-inflicted injuriesincludinga suicide attempt.

7.5 Complementary treatment,withtheexceptionofthosetreatmentsindicatedintheTableofBenefits.

7.6 Consultations performed,aswellasanydrugsortreatmentprescribed,bytheINSUREDPERSON’sspouse,parentsorchildren.

7.7 Developmental delay,unlessachildhasnotattaineddevelopmentalmilestonesexpectedforachildofthatage,incognitiveorphysicaldevelopment.TheCOMPANYdoesnotcoverconditionsinwhichachildisslightlyortemporarilylaggingindevelopment.Thedevelopmentaldelaymusthavebeenquantitativelymeasuredbyqualifiedpersonnelanddocumentedasa12monthdelayincognitiveand/orphysicaldevelopment.

7.8 Expensesfortheacquisition of an organincluding,butnotlimitedto,donorsearch,typing,harvesting,transportandadministrationcosts.

7.9 Expensesincurredbecauseofcomplications directly caused by an illness, injury or treatment for which cover is excluded or limitedundertheINSUREDPERSON’sselectedplan.

7.10 Genetic testing,exceptwherespecificgenetictestsareincludedwithintheINSUREDPERSON’Splan,orwhereDNAtestsaredirectlylinkedtoaneligibleamniocentesisi.e.inthecaseofwomenaged35orover.

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7. EXCLUSIONSAlthough the COMPANY covers most medically necessary treatment, expenses incurred for the following treatments, medical conditions and procedures are not covered under the POLICY unless confirmed otherwise in the Table of Benefits or any written POLICY endorsement.

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7.21 ProductsclassifiedasVitamins or minerals(exceptduringpregnancyortotreatdiagnosed,clinicallysignificantvitamindeficiencysyndromes)including,butnotlimitedto,specialinfantformulaandcosmeticproducts,evenifmedicallyrecommendedorprescribedoracknowledgedashavingtherapeuticeffects.Costsincurredasaresultofnutritionalordietaryconsultationsarenotcovered,unlessaspecificbenefitisincludedwithintheINSUREDPERSON’sTableofBenefits.

7.22 Productsthatcanbepurchasedwithouta doctor’s prescriptionexceptwhereaspecificbenefitcoveringthesecostsappearsintheTableofBenefits.

7.23 Sex change operations and related treatments.

7.24 Speech therapyrelatedtodevelopmentaldelay,dyslexia,dyspraxiaorexpressivelanguagedisorder.

7.25 Staysinacurecenter,bathcenter,spa, heath resort and recovery center,evenifthestayis medically prescribed.

7.26 Termination of pregnancy,exceptintheeventofdangertothelifeofthepregnantwoman.

7.27 TreatmentdirectlyrelatedtosurrogacywhethertheINSUREDPERSONisactingassurrogate,oristheintendedparent.

7.28 Treatmentforanyillness,diseasesorinjuriesaswellasinstancesofdeathresultingfromactive participation in war, riots, civil disturbances terrorism, criminal acts, illegal acts or acts against any foreign hostility,whetherwarhasbeendeclaredornot.

7.29 Treatmentforanymedicalconditionsarisingdirectlyorindirectlyfromchemical contamination, radioactivity or any nuclear materialwhatsoever,includingthecombustion of nuclear fuel.

7.30 TheCOMPANYdoesnotcovertreatmentforconditionssuchasconduct disorder, attention deficit hyperactivity disorder, autism spectrum disorder, oppositional defiant disorder, antisocial behavior, obsessive-compulsive disorder, phobic disorders, attachment disorder, adjustment disorders, eating disorders, personality disorders or treatmentsthatencouragepositivesocial-emotionalrelationship,suchasfamily therapy.

7.31 Travel coststoandfrommedicalfacilities(includingparkingcosts)foreligibletreatment,exceptanytravelcostscoveredunderlocalambulance,medicalevacuationandmedicalrepatriationbenefits.

ExclusionsMember Services Allianz Worldwide Care

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7.11 Home Visits,unlesstheyarenecessaryfollowingthesuddenonsetofanacuteillness,whichrenderstheinsuredincapableofvisitingtheirmedicalpractitioner,physicianortherapist.

7.12 Infertility treatment includingmedicallyassistedreproductionoranyadverseconsequencesthereof,unlesstheINSUREDPERSONhasaspecificbenefitforinfertilitytreatment,orhaveselectedanOut-patientPlan(wherebytheINSUREDPERSONiscoveredfornon-invasiveinvestigationsintothecauseofinfertilitywithinthelimitsofhis/herOut-patientPlan).

7.13 Investigationsinto,andtreatmentof,loss of hair and any hair replacement unless the loss of hair is due to cancer treatment.

7.14 Investigationsinto,andtreatmentof,obesity.

7.15 UnlessstatedotherwiseintheTableofBenefits,coverisnotprovidedforinvestigationsinto,treatmentandcomplicationsarisingfrom sterilization, sexual dysfunction(unlessthisconditionisaresultoftotalprostatectomyfollowingsurgeryforcancer)andcontraception,includingtheinsertionandremovalofcontraceptivedevicesandallothercontraceptives,evenifprescribedformedicalreasons,unlessstatedotherwiseintheINSUREDPERSON’sTableofBenefits.Theonlyexceptioninrelationtocostsforcontraceptioniswherecontraceptivesareprescribedbyadermatologistforthetreatment of acne.

7.16 Medicalevacuation/repatriationfromavessel at sea to a medical facility on land.

7.17 Medical practitioner fees for the completion of a Claim Form or other administration charges.

7.18 Orthomolecular treatment(treatmentwhichaimstorestoretheoptimumecologicalenvironmentforthebody’scellsbycorrectingdeficienciesonthemolecularlevelbasedonIndividualbiochemistry).

7.19 Pre- and post-natal classes.

7.20 Pre-existing conditions(includinganypre-existingchronicconditions)whichareindicatedonaSpecialConditionsFormthatisissuedpriortoPOLICYinception(ifrelevant)andconditionswhichhavenotbeendeclaredontherelevantapplicationform.Inaddition,conditionsarisingbetweencompletingtherelevantApplicationFormandthestartdateofthePOLICYwillequallybedeemedtobepre-existing.Suchpre-existingconditionswillalsobesubjecttomedicalunderwritingandifnotdisclosedtheywillnotbe covered.

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12. Organtransplant.13. Out-patienttreatment.14. Out-patientpsychiatryandpsychotherapytreatment.15. Prescribedglassesandcontactlensesincludingeyeexamination.16. Prescribedmedicalaids.17. Preventivetreatment.18. Rehabilitationtreatment.19. Routinematernityandcomplicationsofchildbirth.20. TravelcostsofINSUREDfamilypersonsintheeventofanevacuation/repatriation.21. TravelcostsofINSUREDfamilypersonsintheeventoftherepatriationofmortal

remains. 22. TravelcostsofINSUREDPERSONStobewithafamilymemberwhoisatperilof

death or who has died.23. Vaccinations.

7.41 The COMPANY will not pay the Accidental death benefit* lump sum payment in circumstanceswherethedeathofanINSUREDPERSONhasbeencausedeitherdirectlyor indirectly by:

1. AccidentswhichhappenwhiletheINSUREDPERSONisengagedinaviationactivitiesofanydescription,includingenteringandalightingfromaircraft,otherthanasafarepayingpassengerinastandardmulti-engineaircraftoperatedbyarecognizedairlineorairchartercompany.

2. Mountaineeringincludingcavingandpotholingwhichrequirestheuseofropesorguides.

3. Takingpartinmotorsportsofanykind,includingboating,inanyboatdesignedtotravelataspeedinexcessof30knots.

4. Takingpartinspeedordurationtestsorracesofanykind.5. Whitewaterraftingandcanoeing,scubadivingandyachtingorboatingoutside

coastalwaters(12milesormorefromthecoast).

*TheCOMPANY’ssetofstandardconditions;exclusionsandlimitationalsoapplytoaccidentaldeathbenefitcover.

Arbitration Clause

Anydisputearisingbetweenbothpartiesofthispolicy,shallbereferredtowordingoflawNo.27for1994-ArbitrationLawincivilandcommercialcodeupontheiragreement.

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7.32 Treatment in the USA is not covered if the COMPANY knows or suspects that cover was purchasedforthepurposeoftravelingtotheUSAtoreceivetreatmentforacondition,whenthesymptomsoftheconditionwereapparenttotheINSUREDPERSONpriortothepurchase of cover.

7.33 Treatmentofsleep disordersincludinginsomnia.

7.34 Treatmentordiagnosticproceduresforinjuries arising from an engagement in professional sports.

7.35 Treatmentoutsidethegeographical area of coverunlessforemergenciesorauthorized

by the COMPANY.

7.36 Treatmentrequiredasaresultoffailure to seek or follow medical advice. 7.37 Treatmentrequiredasaresult of medical error.

7.38 Triple/Bart’s, Quadruple or Spina Bifidatests,exceptforwomenaged35orover. 7.39 Tumour marker testingunlesstheINSUREDPERSONhaspreviouslybeendiagnosed

withthespecificcancerinquestion,inwhichcase,coverwillbeprovidedundertheOncologybenefit.

7.40 Thefollowingtreatments,medicalconditionsorproceduresoranyadverseconsequencesorcomplicationsthereof,arenot covered,unlessotherwiseindicatedintheTableofBenefits:

1. Complicationsofpregnancy.2. DentalTreatment,dentalsurgery,periodontics,orthodontics,anddentalprostheses

withtheexceptionoforalsurgicalprocedures,whicharecoveredwithintheoveralllimitoftheINSUREDPERSON’Scoreplan.

3. Dietician fees. 4. Emergencydentaltreatment.5. Expensesforonepersonaccompanyinganevacuated/repatriatedINSURED

PERSON.6. Healthandwellbeingchecksincludingcancerscreening.7. Homedelivery.8. Infertilitytreatment.9. In-patientpsychiatryandpsychotherapytreatment.10. Lasereyetreatment.11. Medical repatriation.

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