NATO Benefit Guide Medical and Dental Cover

NATO
Benefit Guide
Medical and Dental Cover
Valid from 1st January 2012

If you have any queries, please do not hesitate to contact us:
Helpline Email: unityhelpline@allianzworldwidecare.com

Toll-free from Belgium, United Kingdom, Denmark, Fax: +32 2 2106506
France, Germany, Italy, Luxembourg,
the Netherlands, Portugal, Spain, Bulgaria, Allianz Worldwide Care
Czech Republic, Estonia, Poland, Norway, 35 rue de Laeken
USA and Canada: +800 1 514 8585 1000 Brussels
Belgium
Toll-free from Greece: 00 800 441 46364
Toll-free from Croatia: 0800 806164
Telephone (from anywhere in the world):

DOC-MedEBG-EN-1111
+32 2 2106600
The Underwriter of your insurance is Allianz Vie, Société anonyme with capital of €643.054.425, governed by the Code des assurances, with registered office at 87, rue de Richelieu - 75002 Paris, France - N°
340 234 962 RCS Paris and which is regulated in France by the Autorité de Contrôle Prudentiel to carry out classes 20, 22, 24-26 in life insurance and classes 1 and 2 in non-life insurance.The Administrator of
your insurance is Allianz Worldwide Care Limited - Belgium Branch having its branch trading address at rue de Laeken 35, 1000 Brussels, Belgium. Allianz Worldwide Care Limited - Belgium Branch is a
branch of Allianz Worldwide Care Limited, which is part of the Allianz Group and is registered in Ireland.
DOC-MedEBG-NATO-EN-1111(inside pages)-QX7_Allianz 23/11/2011 11:34 Page 3
Welcome to Allianz
This guide describes in detail Thanks to a package negotiated by NATO, you and your family can now depend on Allianz, to give you access
how we offer you access to the
care you need, when you need to the best care possible – wherever you are in the world. Your insurance is backed by the resources and
it most. It sets out the standard expertise of the Allianz Group, one of the leading integrated financial services providers worldwide, providing
benefits and rules of your
group insurance policy. you with a service that is fast, flexible and totally reliable.
Please read this Benefit Guide
in conjunction with your Table
of Benefits to ensure that you The Underwriter of your insurance is Allianz Vie, Société anonyme with capital of €643.054.425, governed by
fully understand your level of
cover. the Code des assurances, with the registered office at 87, rue de Richelieu - 75002 Paris, France - N° 340 234
962 RCS Paris and which is regulated in France by the Autorité de Contrôle Prudentiel to carry out classes 20,
This document is intended
simply as a guide; any 22, 24-26 in life insurance and classes 1 and 2 in non-life insurance.
document other than the text
of the Group Insurance
Contract is legally void. This The Administrator of your insurance is Allianz Worldwide Care Limited - Belgium Branch, having its branch
text is the subject of a contract
that can be terminated on a
trading address at 35 rue de Laeken, 1000 Brussels, Belgium. Allianz Worldwide Care Limited - Belgium
periodical basis and this Branch is a branch of Allianz Worldwide Care Limited, which is part of the Allianz Group and is registered in
contract is kept in the NATO
archives in Brussels. Ireland.
References to "Allianz" in this Benefit Guide are to be construed as references to Allianz Vie for underwriting
purposes and to Allianz Worldwide Care Limited - Belgium Branch for administration and claims handling
purposes.
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Table of contents
Member services 5-8 Maternity and Adoption Cash Benefit 18
Helpline Service 5 Cover for Newborn Children 19
Emergency Assistance Service 5 Infertility Treatment 19
Membership Pack 6 Funeral Expenses 20
Online Services 7 Additional Cover 20
What you are covered for 9-22 Benefit limits and co-payments 23
Overview of your Medical and
Where you are covered 24
Dental Cover 9
Out-patient Treatment 10 Medical necessity 25
Out-patient Surgery 11
How to claim 26-35
Orthopaedic Appliances and
In-patient claims 28
Special Equipment 11
Out-patient and Dental claims 29
Nursing Charges 12
Medical and Dental Cost Estimates 30
Screening Tests Required for
Prior Approval 32
Early Detection of Illness and Disease 12
Treatment in the USA 33
Dental Treatment 13
Orthodontic Treatment 13 Definitions 36-41
In-patient Benefits 14 What your Medical and Dental Cover
In-patient Dental Treatment 15 does not pay for 42-43
Day-care Treatment 15
Rehabilitation Centres, Convalescence General information 44-45
and Specialist Care Centres 16 Making a complaint 46
Transport Costs 16
Thermal Cures 17 Additional policy terms 47
Glasses and Contact Lenses 18
4
Member services
Please find details of all our member services below.
Calls to our Helpline may be

recorded and may be Helpline Service Telephone (from anywhere in the world):
monitored for training, quality +32 2 2106600
and regulatory purposes.
Please note that in some Our in-house team of professional, multilingual staff
instances the toll-free are available 24 hours a day, 7 days a week to handle If you are an American national or resident in the
numbers are not accessible
from a mobile phone, your policy enquiries. Our Helpline staff has instant United States, or if you require emergency medical
in which case please call
access to your policy details so that we can provide treatment whilst in the United States please call
+32 2 2106600.
you with the assistance you require e.g. confirmation +1 888 288 9947.
of cover or an update on the status of your claim.
You can contact us by email, phone or fax as follows: Emergency Assistance Service
Helpline If you require emergency medical treatment in a

Toll-free from Belgium, United Kingdom, Denmark, hospital or clinic, you should, where possible, contact
France, Germany, Italy, Luxembourg, our Helpline as soon as possible. Our emergency
the Netherlands, Portugal, Spain, Bulgaria, assistance service is available 24 hours a day,
Czech Republic, Estonia, Poland, Norway, USA and 365 days a year, to provide you with a range of
Canada: 00 800 1 514 8585 services e.g. organising direct billing with a hospital.
If you require emergency medical treatment whilst in
Toll-free from Greece: 00 800 441 46364 the United States please call +1 888 288 9947.
Toll-free from Croatia: 0800 806164
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Allianz | Member services
For emergency cases, we must be advised within via email or telephone and we will arrange for a
48 hours of the event and at that point our Helpline new card to be sent to you.
can take details of your admission over the
telephone. This will give us the opportunity to • Your Table of Benefits
arrange the direct settlement of your hospital bills, Your Table of Benefits will outline the cover
where possible, and will ensure that your claim can available to you. It is important that you read your
be processed without any delays. Table of Benefits in conjunction with this guide to
ensure that you fully understand your cover.
Membership Pack
• Your NATO Benefit Guide for Medical and
The Membership Pack contains the following items: Dental Cover (this document)
This guide sets out the benefits and rules of your
• Your Personalised Membership Card policy. The Benefit Guide should be read in
We supply a personalised Membership Card to conjunction with your Table of Benefits.
every member, which contains our essential
contact details. We suggest that you keep this • A Medical Cost Estimate Form
card with you at all times. If you lose the card or if This form should be completed and sent to us in
a correction is required (e.g. the spelling of a advance of any planned admission to hospital or
name), don’t worry, simply contact our Helpline if you require any high cost medical treatment.
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• A Dental Cost Estimate/Fees Form Online Services

This form should be completed by your Dental
Practitioner and sent to us in advance of any high You can access our secure Online Services through
cost dental or orthodontic treatment. our website: https://my.allianzworldwidecare.com.
Simply use the login details sent to you in a letter
• A Claim Form included in your Membership Pack.
This form should be completed and sent to us Alternatively, if you have not already received your
along with any medical or dental invoices for login details, you can access your online account by
which you are requesting reimbursement. clicking the “register” link in the members’ area.
Please type in your policy number, surname and date
• Your Online Services Username and of birth, exactly as shown on your Membership Pack
Password documents. An automated email containing your
login details will then be sent to the email address we
have on record for you (if this has been provided to
us).
7
Allianz | Member services
Online Services allows you to:
• View and amend your personal details online,

such as mailing address, e-mail and phone
number
• Securely retrieve a lost or forgotten username
and password
• Download your Benefit Guide. A Membership
eCard can also be downloaded in PDF format
• View your Table of Benefits
• Confirm the status of any claims submitted to us
and view claims related correspondence
For Online Services assistance, please contact our

Helpline.
8
What you are covered for
Overview of your Medical and of all out-patient and dental costs unless treatment is
required due to a work related accident/illness or the
Dental Cover expenses are incurred in respect of a handicapped
Your Table of Benefits specifies the benefits selected child, in which case reimbursement is at 100%. In
by NATO. This section provides an outline of the addition, if you are diagnosed with a serious illness,
cover provided and should be read in conjunction benefits will be reimbursed at 100%, up to the benefit
with the Table of Benefits. Please be aware that this limits. In such cases we will let you know how long
cover is subject to our policy definitions, exclusions benefits will be paid at 100% in respect of the serious
and limitations. If you have any queries regarding the illness - this can be reviewed at any stage. Please note
cover provided under your plan, simply contact our that costs will be assessed in accordance with
Helpline for confirmation of your entitlements. reasonable and customary charges.
90% of out-patient medical expenses and dental Claims for reimbursement must be submitted to us
expenses are reimbursed up to the benefit limits within two years of the treatment date.
specified in the Table of Benefits and the limits
applied are based on the country where you receive
treatment. Members are responsible for paying 10%
9
Allianz | What you are covered for
Out-patient Treatment Scientific Cooperative on Phytotherapy)

This is not covered if you are a member of the
Your medical plan includes cover for the following CMC who retired prior to 2001
benefits up to the benefit limits detailed in your • Prescribed physiotherapy, speech therapy,
Table of Benefits: and occupational therapy
• Screening tests required for early detection of
• Medical Practitioner fees illness or disease (further details provided below)
• Specialist and Professor fees • Infertility treatment and vasectomy
• Home visits by a Medical Practitioner, (further details provided below)
Specialist or Professor • Psychiatry and psychotherapy
• Diagnostic tests and investigations • Pre- and post-natal check ups and pre-natal
• Prescription drugs, dressings, serums, vitamins, exercise classes
contraceptives (excluding condoms) and blood • Prescribed medical aids and special equipment
• Vaccinations such as incontinence material, support stockings,
• Chiropractic treatment, osteopathy, homeopathy, blood pressure monitors (subject to medical
chiropody, podiatry and acupuncture. necessity) and the repair of prescribed medical
• Phytotherapy, provided the plants used in the aids
composition are included in the list of • Prescribed glasses and contact lenses
monographs published by ESCOP (European
10
• Routine eye examination carried out by an Orthopaedic Appliances and Special

optician, optometrist or opthamologist Equipment
Please refer to your Table of Benefits to confirm the This benefit provide cover for prescribed orthopaedic
benefit limits applicable to the above as well as which appliances such as hearing aids, wheelchairs,
benefits require pre-approval. Prior approval is orthopaedic shoes, orthopaedic soles and braces.
required for a number of these benefits, including In addition, we will also reimburse the cost of certain
speech therapy, psychotherapy, chiropractic prescribed medical equipment such as material for
treatment and acupuncture as well as the repair and the management of diabetes, CPAP, incontinence
renewal of orthopaedic appliances. In addition, material and surgical stockings provided prior
you will also need to obtain prior approval for elective approval has been given by us.
treatment in the USA if you are not resident in the
USA or are not an American national. We will cover the cost of a blood pressure monitor in
certain circumstances, such as if you are receiving
Out-patient Surgery home dialysis or suffering from diabetes.
Prior approval is required before such costs will be
This benefit provides cover for surgical procedures
reimbursed.
performed in a surgery, hospital, day-care facility or
out-patient department up to the amount specified
in your Table of Benefits.
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Nursing Charges • Cardiovascular exam

• Biological tests such as urine analysis and blood
You are entitled to claim for nursing care provided by tests
a qualified nurse or midwife. There is no benefit limit • Neurological exam
applicable to treatment given by a qualified nurse or • Cancer screening:
midwife, with the exception of daily supervision. - Annual pap smear
A maximum benefit will be paid for medical - Mammogram
supervision required over the course of a day or - Prostate screening (for men aged 40+,
24 hour period up to an overall maximum of 8 days. or younger if a family history exists)
Please refer to your Table of Benefits for further - Other tests such as colonoscopy (for members
details. aged 50+, prior approval is required for a
colonoscopy before the age of 50)
Screening Tests Required for Early Detection • Genetic tests where there is a family history of
of Illness or Disease genetic disorders - such tests are subject to prior
Your plan provides cover for prescribed tests and approval and submission of medical reports
examinations, performed at an appropriate age
interval, for the early detection of illness or disease.
Tests and exams include:
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Dental Treatment If you require expensive dental treatment such as

dentures or implants we recommend that you
Please note that your Dental Plan contains a submit a Dental Cost Estimate Form (completed by
maximum benefit applicable per person, per year. your practitioner) to our Medical Services team who
In certain circumstances and following prior approval, will then be able to confirm the amount you will be
the annual benefit maximum can be exceeded, entitled to claim.
provided a Dental Cost Estimate/Fees Form and full
dental plan is submitted to us. The overall benefit If you require minor surgery in respect of dental
limit for dental treatment does not apply if you are a implants, the benefit limit applicable to the dental
member of the CMC who retired before 2001, surgeon's fees and hospital costs is as per the
however please note that the limits per individual in-patient treatment and surgeons’ fees.
dental benefit (e.g. Prosthetic tooth) remain
applicable. These are confirmed in your Table of Orthodontic Treatment
Benefits.
Your plan also provides cover for orthodontic
Please refer to the Table of Benefits for the various treatment provided this commences before the age
benefit limits applicable to dental treatment. of 18 and does not continue for longer than 3 years.
Please note that these limits apply per tooth unless The benefit limit applicable will be that of the year
otherwise stated. treatment began. If treatment is required for longer
13
than 3 years, an extension can be requested, surgical fees, surgical appliances, oncology,
provided the proposed extension period immediately maternity, prostheses and diagnostic tests, in-patient
follows the initial 3 years’ treatment. A further psychiatry, psychotherapy and dental treatment.
12 months cover may be granted but the total Please refer to your Table of Benefits for details of the
treatment period for orthodontic treatment cannot in-patient benefits available to you. In order that we
exceed 5 consecutive years. The annual limit can ensure that the anticipated costs for hospital
applicable to any extended period will be equivalent admissions are reasonable and customary,
to one third of the 3 year orthodontic benefit limit. we recommend that you contact us in advance of
any planned in-patient treatment. We will then issue
If you require orthodontic treatment following your a Guarantee of Payment to the medical facility
18th birthday you will need to contact us for prior concerned for all covered costs.
approval before any treatment will be reimbursed.
We will then confirm whether any benefit will be Our medical team will assess what benefit limit will
paid. apply based on the complexity of the surgery
required, following consultation with your treating
In-patient Benefits physician. If you are admitted to hospital for more
than one surgery at the same time, the benefit limit
In-patient benefits include things like hospital
for the second surgery will be reduced by 50%.
accommodation, anaesthesia and theatre charges,
14
If you require admission to hospital in respect of a Hospital costs are reimbursed at 100% up to the
major surgical intervention or you require a benefit limits detailed in the Table of Benefits. If you
prolonged admission, any costs in excess of the are admitted to a public hospital which charges a
benefit limit may be reimbursed following prior fixed amount per day, the benefit limits will not be
approval. applied.
All members are covered for emergency medical In-patient Dental Treatment
treatment required whilst travelling in the USA. If you
This benefit provides you and your dependants with a
are an American national or you are resident in the
refund for dental surgery which requires admission
USA, you will also be covered for planned treatment
to hospital on an in-patient or day-patient basis.
received in the USA. If you are not an American
Costs are reimbursed in accordance with the benefit
national or resident of the USA you will need to
limits for minor surgery.
contact us prior to any planned treatment so that we
can confirm if you are covered. Any eligible
Day-care Treatment
treatment received without prior approval will be
reimbursed up to the benefit limits applicable to your This benefit provides cover for planned day-care
usual country of residence or country of duty station. treatment received in a hospital or day-care facility
up to the amount specified in your Table of Benefits.
Day-care costs will be reimbursed at 100%, up to the
15
benefit limits, if you are admitted to hospital for a This benefit does not cover any personal expenses
surgical procedure which requires anaesthesia. incurred during the admission. If you are a member
of the CMC who retired prior to 2001 the benefit limit
Rehabilitation Centres, Convalescence and for convalescent homes does not apply (this will be
Specialist Institutions 100% refund).
This benefit provides cover for treatment which takes

Transport Costs
place in a licensed rehabilitation facility, nursing
home, children’s health home or convalescent home Cover is provided for transport costs required if you
where the admission is medically necessary, are unable to drive a car following treatment received
in accordance with the benefit limits specified in your or due to a medical condition or in the event of an
Table of Benefits. Cover also extends to treatment emergency (further details are provided below).
given to the physically handicapped, deaf, blind, mute Please note that prior approval is required for this
or maladjusted children in a specialist care centre. benefit.
A Medical Cost Estimate Form and a full medical
report must be submitted to our Medical Services Private Ambulance
team before any such admission, giving the main Costs of a private ambulance are covered to transport
diagnosis and an indication of the level of you to the nearest available and appropriate hospital
dependency. Please note that increased dependency or licensed medical facility in the event of a medical
alone will not be considered a reason for admission. emergency or when required to take you from one
16
hospital to another. We will also pay the cost of a In addition, transportation costs to and from a
private ambulance from the hospital to the insured nursing home, convalescent home, specialist care
person’s home if the insured person needs to be centre or rehabilitation facility will be reimbursed if
transported under medical supervision or if transport prior approval has been received.
in a seated position is not allowed for medical
reasons. Thermal Cures
This benefit provides cover for doctors’ fees,

Other Transport Costs
prescribed medical treatment and accommodation
If you are receiving renal dialysis, chemotherapy or
in a thermal cure centre, up to the amount specified
radiotherapy we will pay for the costs of a taxi or
in your Table of Benefits. Prior approval must be
public transport or private car to and from a medical
issued by our Medical Services team before any such
facility for ongoing out-patient treatment following
admission. If you are a member of the CMC who
submission of a doctor’s prescription. Costs for the
retired prior to 2001 you are not required to stay in a
use of a private car will be reimbursed in accordance
cure centre, you can elect to stay in a hotel provided
with the kilometric allowance for NATO / SHAPE staff
prior approval has been received.
members on mission.
17
Glasses and Contact Lenses Frames

For active staff members and CMC members retiring
Your plan covers you for glasses, contact lenses and after 2001, frames will be reimbursed once every
contact lens solution up to the benefit limits detailed 2 calendar years. For members of the CMC retiring
in the Table of Benefits. Contact lenses are prior to 2001, frames will be reimbursed every year.
reimbursable without prescription when the dioptre However, in case of accidental breakage, costs will be
has not changed. Please ensure that the strength of reimbursed at 100% for children aged 15 or under, or
the lenses is detailed on the receipt submitted. up to 50% of the benefit limit for members aged 16
or over.
Contact Lenses and Glasses Lenses
When the dioptre has changed, there is no limit to Maternity and Adoption Cash Benefit
the frequency of reimbursements; however, if the
dioptre has not changed, reimbursements will be A fixed benefit will be paid to you following the birth
limited to one pair of glasses per calendar year. In the or adoption of a child. The benefit is payable per child
case of disposable contact lenses lasting less than and you must send us a copy of either the birth
one year we will reimburse the cost of one year’s certificate or adoption certificate before the benefit
supply per calendar year. If the strength of your can be paid.
contact lenses is equal to or more than 5, the benefit
limit will not be applied.
18
Cover for Newborn Children • Hormonal treatment to stimulate fertility

• IVF in case of infertility, up to a maximum of
Newborn infants will be accepted for cover from 6 attempts per lifetime
birth. To have a newborn added to the policy, • ICSI in case of infertility, up to a maximum of
you should contact your HR representative. 6 attempts per lifetime
• Artificial insemination, MESA and TESE in case of
Infertility Treatment infertility, up to a maximum of 6 attempts per
Your plan will provide cover for non-invasive lifetime
investigations into the cause of infertility, within the
benefit limits of your plan. You are also covered for If a day-patient stay is required which does not
further investigation necessary to establish the cause necessitate anaesthesia, costs will be reimbursed at
for infertility, such as hysterosalpingogram, 90%, up to the benefit limits detailed in your Table of
laparoscopy or hysteroscopy. Benefits. If you require an overnight stay in hospital,
anaesthesia costs will be reimbursed at 100%.
If prior approval has been issued by our Medical
Services team you will also be covered for the
following treatments:
19
Funeral Expenses If you require treatment for a serious illness we will

reimburse the costs incurred in respect of the illness
In the event of death the plan provides a lump sum at 100%. We will let you know how long we will pay
benefit to cover the cost of funeral expenses. benefits at 100% for the serious illness. Please refer to
The amount payable is detailed in the Table of the definition of a serious illness for details of the
Benefits and co-payment does not apply. conditions covered. If surgery is required in respect of
one of the listed serious illnesses an additional benefit
Additional Cover limit amount will apply as detailed in the Table of
Part 1 - not applicable to members benefiting Benefits.
from Norwegian, French or Danish social
health cover Handicapped Children
Your plan provides additional cover for any
Serious Illness handicapped children covered by the plan.
Your plan may provide additional cover for expenses
related to conditions considered to be serious If you receive a handicapped child allowance, we will
illnesses. reimburse the full cost of medically necessary
treatment required by the handicapped child, subject
to the benefit limits detailed in the Table of Benefits.
20
Part 2.1 – applicable to all members of the Your plan provides additional cover for out-patient
NWS, except those members whose current specialist fees, optical expenses for frames, contact
or last duty station is or was Germany or the lenses and contact lens solutions. The benefit limits
Netherlands, including NETMA detailed in the Table of Benefits in respect of these
treatments will be increased by a maximum of 30%.
Your plan provides additional cover which increases In addition, we will reimburse in full any ambulance
the dental limit applicable to dental prosthesis (both costs incurred where the transport has been
fixed and mobile) by 25%, subject to the overall prescribed by a specialist or doctor.
dental maximum stated in the Table of Benefits.
Part 2.3 – applicable only to members whose
Part 2.2 – applicable to all members of the current or last duty station is or was Turkey
NWS whose current or last duty station is or
was Germany or the Netherlands, excluding We will reimburse the full cost of medically necessary
NETMA treatment, subject to the benefit limits applicable to
the relevant treatment country, as detailed in the
Specialist fees, optical expenses and ambulance Table of Benefits.
costs:
21
Part 2.4 – applicable only to members whose

current or last duty station is or was France
We will reimburse 100% of the costs incurred for the

fees of doctors, surgeons and dentists who are
affiliated to the French Social Security, subject to the
benefit limits applicable to the relevant treatment
country, as detailed in the Table of Benefits.
22
Benefit limits and co-payments
Benefit Limits Co-payments

As a general rule the benefit limits will always be in A co-payment is a percentage of the eligible costs
excess of the reimbursements and cover provided by incurred, which is payable by you. A 10% co-payment
the Belgian Social Security legislation relating to the applies to out-patient and dental benefits unless
reimbursement of medical expenses. otherwise stated or where costs are incurred in
relation to a work related illness, work related
Unless otherwise stated or where costs are incurred accident or a diagnosed serious illness.
in relation to a work related illness or work related
accident, any costs incurred will be reimbursed up to
a maximum of 90% of the actual costs incurred, and
up to the benefit limits detailed in the Table of
Benefits.
23
Where you are covered
You are covered for medical and dental costs

incurred worldwide; however certain rules apply to
treatment received in the USA. All members are
covered for emergency medical treatment required
whilst travelling in the USA. If you are an American
national or you are a permanent resident in the USA
you will also be covered for planned treatment
received in the USA. If you are not an American
national or resident of the USA you will need to
contact us prior to any planned treatment so that we
can confirm if you are covered. Any eligible
treatment received without prior approval will be
reimbursed up to the benefit limits applicable to your
usual country of residence or country of duty station.
24
Medical necessity
As an insurance company, our clients expect us to In addition, our team of claims experts will ensure
control medical costs, where possible, in order to that we only reimburse medical providers where their
maintain affordable health insurance premiums. To charges are reasonable and customary. By reasonable
do this, our team of highly experienced medical and customary we mean that the charges are in
professionals ensures that planned medical accordance with standard and generally accepted
interventions are appropriate and medically medical procedures. If a claim is deemed by us to be
necessary. By medically necessary we mean inappropriate, we reserve the right to reduce the
treatment that is the most appropriate type and level amount payable by us. the Table of Benefits.
of service required to treat a patient's condition,
illness or injury.
25
How to claim
If you or your dependants are eligible to claim Where further information is required to
benefits under a mutual, other insurance company complete the claim, you/your medical
or social security system, please submit your claim practitioner will automatically be notified by
to them for initial reimbursement before sending email or mail within 48 hours of receipt of the
your claim and proof of settlement to us. We will Claim Form.
then reimburse any remaining eligible amounts,
subject to the benefit limits specified in your Table 3. A separate Claim Form is required for each
of Benefits. person claiming.
Please note the following important points:

4. Please specify on the Claim Form the currency
in which you wish to be paid, otherwise the
benefit due to you will be paid in the currency
1. It is your responsibility to keep copies of all
of your country of assignment. On the rare
correspondence with us (in particular, copies
occasion that the international banking
of Claim Forms and medical receipts).
regulations do not allow us to make a
We cannot be held responsible for
payment in the currency you have asked for,
correspondence lost in the post.
the benefit due to you will be paid in the
currency of your invoice (where possible).
2. Fully completed Claim Forms are processed
If we have to make a conversion from one
and payment instructions issued to your bank
currency to another, we will use the exchange
within 48 hours of receipt by us.
26
rate that applies on the date on which the net of any co-payments mentioned in the
invoices were issued, or we will use the Table of Benefits.
exchange rate that applies on the date that
claims payment is made. 8. All claims should be submitted to us with
original supporting documentation, invoices
5. Please ensure that the payment details that and receipts no later than 2 years after the
you supply on the Claim Form are correct treatment date. Beyond this time we are not
to avoid delays to claims settlement. If you do obliged to settle the claim.
not provide a bank account on the Claim Form
we will transfer any reimbursement to the last 9. We have the right to access all medical
bank account we received for you. records and to have direct discussions with the
medical provider or the treating physician. We
6. Please note that some out-patient treatments may, at our own expense, request a medical
require prior approval to be arranged before examination by our medical representative
treatment takes place. when we deem this to be necessary.
All information will be treated in strictest
7. Please note that only costs for incurred confidence. We reserve the right to withhold
treatment will be reimbursed within the limits benefits if you or your dependants have not
of your policy, after taking into consideration honoured these obligations.
any required prior approval, and this will be
27
Allianz | How to claim
In-patient claims will need to complete the relevant sections of

the Medical Cost Estimate Form. This form is
If you have to go to a hospital, where possible and included in your Welcome Pack.
with sufficient notice, we will arrange for direct
settlement with the medical provider subject to any 2. Once fully completed, please send the Medical
co-payments and benefit limits, i.e. where possible, Cost Estimate Form to us at least five working
we will settle the bill for you by dealing directly with days prior to treatment so that we can ensure
the hospital. there will be no delays at the time of admission.
You can submit it via:
To arrange for direct settlement, we can assist you
more quickly and efficiently if the following steps • Scan and email to:
are taken: unitymedical@allianzworldwidecare.com
• Fax to: +32 2 2106597
For planned treatment: • Post to the address shown on the Medical
Cost Estimate Form
1. Please download a Medical Cost Estimate Form • If treatment is due to take place within 72
from Online Services: hours, our Helpline can take details over the
https://my.allianzworldwidecare.com or telephone if you have the required
contact our Helpline. You and your physician information to hand
28
For emergency treatment: Out-patient and Dental claims

While there are no forms to complete, either you, For out-patient or dental treatment, unless you have
your physician, one of your dependants or a been informed of a different settlement
colleague must inform us about the hospital arrangement, you will need to pay the medical
admission within 48 hours of the event. At that provider for these costs at the time of treatment
point, please note that we can take details over the and then seek reimbursement from us, subject to
phone if you call our Helpline. This gives us the the benefit limits of your plan.
opportunity to arrange for the direct settlement of
your hospital bills, where possible. When you visit a medical practitioner, dentist,
physician or specialist on an out-patient basis please
In many cases, we can obtain discounts from the follow the steps below:
hospitals if we are notified in advance of an
admission. This is particularly true of treatment in 1. You will need to get an invoice from the
the USA, therefore where possible please ensure doctor/medical provider which states the
that you contact us prior to any hospital admission. diagnosis or medical condition treated, the
nature of the treatment and the fees charged.
29
2. Please complete a Claim Form, available from you at your correspondence address to advise you
https://my.allianzworldwidecare.com. A Claim when your claim has been processed. You can also
Form is also included in your Membership Pack. track your claim through the Online Services section
on our website.
3. When submitting your Claim Form to us,
please attach all original supporting Medical and Dental Cost
documentation, invoices and receipts, e.g.
medical practitioner/physician invoices and
Estimates
pharmacy receipts with related prescriptions
A Medical Cost Estimate Form or Dental Cost
(if available).
Estimate/Fees Form should be submitted where
possible at least five working days in advance of
4. If you have received reimbursement of part of
certain treatments and costs stated below.
the bill from another insurer or social security
These forms are available from
system, please submit details of the amounts
https://my.allianzworldwidecare.com. We will
paid with your Claim Form.
respond within 24 hours of receipt of a fully
completed form. Following approval by us, cover for
An email will automatically be sent to you (where
these required treatments or costs can then be
email addresses have been provided to us) to advise
guaranteed.
you of when the claim has been processed. If we do
not hold an email address for you, we will write to
30
Please note that our Helpline can accept requests necessary and charges that are reasonable and
over the phone if treatment is due to take place customary. Therefore, it is highly recommended
within 72 hours. that you contact us prior to the aforementioned
treatments taking place so that we can confirm
Cost estimates are required for the following medical necessity and appropriateness of costs.
benefits:
In addition, Cost Estimates will help us to provide
• In-patient or day-patient hospital admissions you with a better service in the following ways:
• Oncology (in-patient and day-care treatment
only) • In the case of planned treatment, we will have
• High cost medical treatments time to communicate with the hospital to
• High cost dental treatments facilitate smooth admission and where possible,
• Orthodontic treatment arrange for direct settlement, offering you
• Rehabilitation treatment cashless access to hospitals for in-patient
treatment
Why are Cost Estimates required? • Your treatment can be overseen by our Medical
Team
As with all health insurance policies, your plan with • In case of dental treatment we can let you know
us will only cover treatment that is medically how much we will reimburse
31
Prior Approval • Repair and replacement of orthopaedic

equipment, purchase of certain special
Please refer to your Table of Benefits to check equipment
which treatments require prior approval. • Genetic tests
• Transportation costs except in case of
Prior approval is required in advance of the emergencies
following treatments: • Orthodontic treatment required after age 18 or
where an extension to the maximum length of
• Nursing at home or in a convalescent home cover is requested
• Infertility treatment • Planned treatment in the USA if you are not an
• Speech therapy, psychotherapy, acupuncture, American national or resident in the USA
chiropractic treatment, podiatry, out-patient
occupational therapy and neural therapy You simply need to call our Helpline to get prior
• Rehabilitation treatment, treatment in a approval, however please note that for rehabilitation
professional/special re-education facility, treatment you will need to submit a Medical Cost
children’s health homes or sanatoriums, Estimate Form and we may need to request further
convalescent homes, thermal and spa cures medical information before we can authorise
treatment.
32
Treatment in the USA In-patient and Out-patient Claims
If you are resident in the US or an American Simply present your UHC Membership Card when
national: you visit a network physician, clinic or hospital.
These providers should recognise the UHC
To provide you with a local and efficient service, Electronic Claim Payer ID/Logo on the card and they
we have selected UnitedHealthcare (UHC) to will contact UHC to confirm eligibility of cover and
administer your healthcare policy on our behalf arrange for direct billing.
within the USA. UHC will deal directly with medical
providers to co-ordinate the direct settlement of all As detailed above, certain treatments require prior
your eligible medical treatment. approval in advance of treatment. All network
providers are aware of these pre approval
To locate a physician in the USA, simply go to: requirements. If you need to undergo one of these
www.myuhc.com, select “Find Physician, treatments your provider will contact UHC directly
Laboratory or Facility” and follow the on-screen on +1 888 288 9947 to request the necessary
instructions. pre-approval.
If you receive treatment outside the UHC network,

simply present your UHC Membership Card to the
33
provider. They will need to contact UHC to verify Prescribed Medication Claims
treatment eligibility and to obtain prior approval for
certain treatments. Where possible, UHC will If you need to purchase medication, simply present
arrange direct settlement with the provider. your UHC Membership Card at a pharmacy within
However, if this is not possible, you will have to pay the MedCo network. For a list of pharmacies please
for the treatment and then submit a claim for log on to www.welcometouhc.com and select
reimbursement. In this situation, you will need to “Prescription Benefits” and follow the on-screen
submit your membership details (policy number, instructions. You will not be required to pay for
name and address) and the original invoice(s) to medicines purchased from pharmacies within this
UHC. network (subject to any co-payments, benefit limits
and the terms of your policy).
Should you have any queries please call the UHC
helpline on +1 888 288 9947. Please note that Please note that you will have to pay for
should you call any other UHC telephone line your prescriptions bought from a pharmacy outside the
cover may not be recognised and your claim could MedCo network. In this instance, you will need to
be declined. submit the original invoices with MedCo’s Pharmacy
Direct Claim Form to MedCo for reimbursement. If
you have any queries please contact the MedCo
Helpline on: +1800 842 2038.
34
Please note that planned treatment and

prescriptions purchased in the USA will only be
covered if you are a permanent resident of the USA,
an American national or where you have received
prior approval from us for the required treatment.
35
Definitions
Wherever the following words and phrases appear in your policy
documentation, they will always have the meanings as defined below.
1.1 Accident is an injury caused by a sudden and violent 1.7 Dependant is your spouse (including same sex
external force or event. marriages) and/or unmarried children (including any
step, foster or adopted child) as recognised by NATO.
1.2 Complementary Treatment refers to therapeutic and
diagnostic treatment that exists outside the institutions 1.8 Diagnostic Tests are investigations such as x-rays or
where conventional Western medicine is taught. blood tests, undertaken in order to determine the cause
Such medicine includes but is not limited to of the presented symptoms.
chiropractic treatment, osteopathy, homeopathy,
mesotherapy, biofeedback, lymphatic drainage and 1.9 Emergency constitutes the onset of a sudden and
acupuncture as practiced by approved therapists. unforeseen medical condition that requires urgent
medical assistance.
1.3 Co-payment is the percentage of the costs which the
insured person must pay. 1.10 Group Insurance Contract is the agreement Allianz
France has with NATO, which allows you and your
1.4 Dental Prostheses include crowns, inlays, onlays, dependants to be insured with us. This agreement sets
adhesive reconstructions/restorations, bridges, out who can be covered, when cover begins, how it is
dentures and implants as well as all necessary and renewed and how premiums are paid.
ancillary treatment required.
1.11 Hospital is any establishment which is licensed as a
1.5 Dental Surgery includes the extraction of teeth, medical or surgical hospital in the country where it
apicoectomy, as well as the treatment of other oral operates and where the patient is permanently
problems such as congenital jaw deformities supervised by a medical practitioner. The following
(e.g. cleft jaw), fractures and tumours. Dental surgery establishments are not considered hospitals: rest and
does not cover any surgical treatment that is related to nursing homes, spas, cure centres and health resorts.
dental implants.
1.12 Hospital Accommodation refers to standard public,
1.6 Dental Treatment includes an annual check up, private or semi-private accommodation as indicated in
simple fillings related to cavities or decay and root canal the Table of Benefits. Deluxe, executive rooms and
treatment. suites are not covered.
36
1.13 Infertility Treatment refers to treatment for both (b) Consistent with the patient's symptoms, diagnosis
sexes including all invasive investigative procedures or treatment of the underlying condition.
necessary to establish the cause for infertility such as (c) In accordance with generally accepted medical
hysterosalpingogram, laparoscopy or hysteroscopy. practice and professional standards of medical
care in the medical community at the time.
1.14 In-patient Treatment refers to treatment received in a (d) Required for reasons other than the comfort or
hospital where an overnight stay is medically necessary. convenience of the patient or his/her physician.
(e) Proven and demonstrated to have medical value.
1.15 Insured Person is you and your dependants. (f) Considered to be the most appropriate type and
level of service or supply.
1.16 Local Ambulance is ambulance transport required for (g) Provided at an appropriate facility, in an
an emergency or out of medical necessity, to the appropriate setting and at an appropriate level of
nearest available and appropriate hospital or licensed care for the treatment of a patient’s medical
medical facility. condition.
(h) Provided only for an appropriate duration of time.
1.17 Maternity refers to any medically necessary costs
incurred during pregnancy and childbirth, including As used in this definition, the term “appropriate” shall
hospital charges, specialist fees, the mother's pre-and mean taking patient safety and cost effectiveness into
post-natal care, midwife fees as well as newborn care. consideration. When specifically applied to in-patient
Costs related to complications of pregnancy and treatment, medically necessary also means that
childbirth are also included. diagnosis cannot be made, or treatment cannot be
safely and effectively provided on an out-patient basis.
1.18 Medical Necessity refers to those medical services or
supplies that are determined to be medically necessary 1.19 Medical Practitioner is a physician who is licensed to
and appropriate. They must be: practice medicine under the law of the country in which
treatment is given and where he/she is practising
(a) Essential to identify or treat a patient's condition, within the limits of his/her licence.
illness or injury.
37
Allianz | Definitions
1.20 Medical Practitioner Fees refer to non-surgical 1.25 Out-patient Surgery is a surgical procedure performed
treatment performed or administered by a medical in a surgery, hospital, day-care facility or out-patient
practitioner. department that does not require the patient to stay
overnight out of medical necessity.
1.21 Midwife Fees refers to fees charged by a midwife, who,
according to the law of the country in which treatment 1.26 Out-patient Treatment refers to treatment provided
is given, has fulfilled the necessary training and passed in the practice or surgery of a medical practitioner,
the necessary state examinations. therapist or specialist that does not require the patient
to be admitted to hospital.
1.22 NWS refers to the NATO Wide Supplementary health
insurance scheme which provides additional 1.27 Periodontics refers to dental treatment related to gum
reimbursements in case of hospitalisation for serious disease.
illness, handicapped children, hospitalisations and
increased benefit limits for certain treatments 1.28 Prescribed Glasses and Contact Lenses refers to
applicable to certain members depending on their cover for lenses, glasses and frames required to correct
current or last duty station. vision as well as contact lens solution required to
correct vision.
1.23 Occupational Therapy refers to treatment that
addresses the individual’s development of fine motor 1.29 Prescribed Medical Aids refers to any instrument,
skills, sensory integration, co-ordination, balance and apparatus or device which is medically prescribed as an
other skills such as dressing, eating, grooming, etc. in aid to the function or capacity of the insured person,
order to aid daily living and improve interactions with such as a hospital bed, material for diabetes
the physical and social world. Out-patient occupational (glucometer, insulin pump) in case of insulin
therapy requires prior approval. dependency, incontinence material, blood pressure
monitor (subject to medical necessity), CPAP,
1.24 Oncology refers to specialist fees, diagnostic tests, anti-decubitus mattress, hearing aids, speaking aids
radiotherapy, chemotherapy and hospital charges (electronic larynx), crutches, walking frames,
incurred in relation to the planning and carrying out of wheelchairs, adapted buggies, wigs in case of cancer,
treatment for cancer, from the point of diagnosis. special bra after breast amputation, orthopaedic
38
supports/braces, artificial limbs, stoma supplies, • Active tuberculosis

graduated compression stockings, orthopaedic • Chronic arteriopathy with clinical ischemic
arch-supports as well as the repair of medical aids. manifestations
• Chronic severe nephropathy and nephrotic
1.30 Prescribed Physiotherapy refers to treatment by a syndrome
registered physiotherapist following referral by a • Chronic respiratory insufficiency
medical practitioner. • Complicated bilharziasis
• Complications of organ transplant
1.31 Prescription Drugs refers to products, including, • Cystic fibrosis
but not limited to insulin, hypodermic needles or • Decompensated cirrhosis of the liver
syringes, which require a prescription for the treatment • Disabling cerebrovascular accident
of a confirmed diagnosis or medical condition or to • Disabling multiple sclerosis
compensate vital bodily substances. The prescription • Haemophilia
drugs must be clinically proven to be effective and • Hereditary metabolic diseases requiring prolonged
recognised by the pharmaceutical regulator in a given treatment
country. • Homozygous hemoglobinopathy
• Insulin dependent or non-insulin dependent
1.32 Rehabilitation is treatment aimed at the restoration of diabetes that cannot be managed by diet alone
a normal form and/or function after an acute illness or • Leprosy
injury. The rehabilitation benefit is payable only for • Malignant tumour, malignant disorder of the
treatment that starts immediately after the acute lymphatic or hematopoietic tissue
medical treatment ceases. • Medullary Asplasia
• Myocardial infarction (within the last 6 months)
1.33 Serious Illness refers to any of the following medical • Paraplegia
conditions diagnosed by a registered medical • Parkinson’s Disease
practitioner: • Polyarteritis nodosa, disseminated lupus
erythematosus, progressive systemic scleroderma
39
Allianz | Definitions
• Progressive structural scoliosis (of which the angle 1.36 Speech Therapy refers to treatment carried out by a
exceeds 25 degrees up to rachitic maturation) qualified speech therapist to treat diagnosed physical
• Psychosis, severe personality disorder, mental impairments, including, but not limited to nasal
retardation obstruction, neurogenic impairment (e.g. lingual
• Severe immuno-deficiency requiring paresis, brain injury) or articulation disorders involving
prolonged treatment and AIDS (acquired the oral structure (e.g. cleft palate). Out-patient speech
immuno-deficiency syndrome) therapy requires prior approval.
• Severe ankylosing spondylitis
• Severe arterial hypertension 1.37 Therapist is a chiropractor, osteopath, homeopath,
• Severe cardiac insufficiency, valvulopathy and acupuncturist, physiotherapist, speech therapist, neural
congenital cardiopathy therapist, pedicurist or oculomotor therapist, who is
• Severe neuro-muscular disorder such as myopathy qualified and licensed under the law of the country in
• Severe rheumatoid arthritis which treatment is being given. Out-patient therapy
• Ulcerative colitis and Crohn’s Disease requires prior approval.
The above list is not exhaustive and medical conditions 1.38 Thermal Cures is treatment geared towards improving
of comparable seriousness will be considered for cover. a chronic medical condition or an additional form of
rehabilitation after an acute illness, accident or surgery
1.34 Specialist / Professor is a qualified and licensed by physical measures such as but not limited to thermal
medical physician possessing the necessary additional baths, physiotherapy, ultrasound, diets, inhalation
qualifications and expertise to practice as a recognised therapy, etc. It must be prescribed and delivered in a
specialist of diagnostic techniques, treatment and medical cure centre, where therapy is planned and
prevention in a particular field of medicine. overseen by physicians. Thermal cure requires prior
approval.
1.35 Specialist / Professor Fees refer to non-surgical
treatment performed or administered by a Specialist or 1.39 Treatment refers to a medical procedure needed to
Professor. cure or relieve illness or injury.
40
1.40 Vaccinations refer to all basic immunisations and

booster injections required under regulation of the
country in which treatment is being given, any
medically necessary travel vaccinations and malaria
prophylaxis. The cost of consultation for administering
the vaccine as well as the cost of the drug is covered.
1.41 We/Our/Us is Allianz.
1.42 Work Related Accident is an injury which is the result

of an unexpected event, independent of the will of the
insured and which arises from a cause outside the
individual’s control while an Insured Person is carrying
out their occupational duties. The cause and symptoms
must be medically and objectively definable, allow for a
diagnosis and require treatment.
1.43 Work Related Illness is an illness which arises from a

cause outside the individual’s control while an Insured
Person is carrying out their occupational duties. The
cause and symptoms must be medically and objectively
definable, allow for a diagnosis and require treatment.
1.44 You/Your refers to the eligible insured person.
41
What your Medical and Dental Cover

does not pay for
Although we cover most illnesses, 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 in any written policy endorsement.
1. Products that can be purchased without a 5. Treatment or diagnostic procedures of injuries

doctor’s prescription. arising from an engagement in races,
matches or bets, except in the case of normal
2. Cosmetic surgery except reconstructive sporting competitions. Treatment required in
surgery necessary to restore function or respect of injuries sustained whilst taking part
appearance after a disfiguring accident, in aerial acrobatics, record attempts or
or as a result of surgery for cancer. try-outs.
3. The consequences of illness or accidents 6. Any form of treatment or drug therapy which
caused voluntarily or intentionally by the in our reasonable opinion is experimental or
beneficiary or by the insured. unproven, based on generally accepted
medical practice.
4. Prescribed physiotherapy carried out during
pregnancy. 7. Complementary or alternative treatment
other than that included in definition 1.2.
42
8. Treatment that is not considered medically

necessary.
9. Expenses incurred in respect of domestic care,

personal or home trainers, adaptations to the
home, sundry items such as mattresses,
clothes, blankets, sheets except for
orthopaedic appliances.
10. Hazards of war :

- In the case of active participation in the
war or,
- When the insured person wears a military
uniform or is armed.
11. Nutritional supplements, special food or food

for babies. Food supplements are only covered
if you are receiving chemotherapy or
radiotherapy.
43
General information
If your treatment is needed as a result of If you are covered by another insurance

somebody else’s fault scheme
If you are claiming for treatment that is needed when You must inform us in writing and provide all
somebody else is at fault, you must write and tell us necessary information, if and when you are entitled
as soon as possible; for example, if you need to claim from a third party. If you do have other
treatment for an injury suffered in a road accident in insurance cover, we will only pay our share of the
which you are a victim. In this case, you would need cost of the treatment.
to take any reasonable steps we ask of you to obtain
the insurance details of the person at fault so that we You and the third party may not agree to any final
can recover, from the other insurer, the cost of the settlement or waive our right to recover outlays
treatment paid for by us. without our prior written agreement. Otherwise we
are entitled to recover the amounts paid from you
If you are able to recover the cost of any treatment and to cancel the policy.
for which we have paid, you must repay that amount
(and any interest) to Allianz. We have full rights of subrogation and may institute
proceedings in your name, but at our expense, to
recover, for our benefit, the amount of any payment
made under another policy.
44
If you change your address/email address Fraud
Any change in your home, business or email address If any claim is false, fraudulent, intentionally
should be communicated to us as soon as possible. exaggerated or if fraudulent means or devices have
been used by you or your dependants or anyone
Original Documents acting on your or their behalf to obtain benefit under
this policy, we will not pay any benefits for that claim.
We do not usually return original documents.
The amount of any claim settlement made to you
However, if you ask us at the time of sending the
before the fraudulent act or omission was discovered,
original documents to us, we will of course return
will become immediately due and owing to us.
them to you.
Applicable Law
Your membership is governed by French law. Any

dispute that cannot otherwise be resolved will be
dealt with by courts in France.
45
Making a complaint
Please find guidelines on our complaints process below.
We are always pleased to hear about aspects of If we have not been able to resolve the problem to
your membership that you have particularly your satisfaction and you wish to take your
appreciated, or that you have had problems with. complaint further, please write to the General
If something does go wrong, there is a simple Manager at the aforementioned address.
procedure to ensure that your concerns are dealt
with as quickly and effectively as possible.
The Allianz Helpline is always the first number to

call if you have any comments or complaints. In
cases where we are not able to solve the problem
on the phone, please email, fax or write to us at:
Email: unityhelpline@allianzworldwidecare.com
Fax: +32 2 210 6506
Allianz Worldwide Care

35 rue de Laeken
1000 Brussels
Belgium
46
Additional policy terms

The following are important additional terms that apply to your policy with us.
1. Liability: Our liability to the insured person is limited 3. Making contact with dependants: In order to
to the amounts indicated in the Tables of Benefits and administer your policy in accordance with
any subsequent policy endorsement. In no event will the insurance contract, there may be circumstances
the amount of reimbursement, whether under this when we will need to request further information.
policy, public medical scheme or any other insurance, If we need to make contact in relation to a dependant
exceed the amount of the invoice. on a policy (e.g. where further information is required
to process a claim), the principal member, acting for
and on behalf of the dependant, will be contacted by
2. Data protection: Allianz obtains and processes us and asked to provide the relevant information.
personal information for the purposes of Similarly, all information in relation to any person
administration of the insurance contract and/or covered by the insurance policy, for the purposes of
settlement of the insurance claim and for any other administering claims, will be sent directly to the
purpose which is directly related to administering principal member.
policies in accordance with the insurance contract.
The confidentiality of patient and member information
is of paramount concern to us. We comply fully with
European Data Protection Legislation. You have a right
to access the personal data that is held about you. You
also have the right to request that we amend or delete
any information which you believe is inaccurate or out
of date. Should you wish to exercise this right, you
should send the request in writing and address it to the
Data Protection Officer, Allianz Worldwide Care –
Belgium Branch, 35 rue de Laeken, 1000 Brussels,
Belgium or by email to:
unityhelpline@allianzworldwidecare.com.
47
Notes
48
49
Allianz | Notes
50

NATO Benefit Guide Medical and Dental Cover

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NATO Benefit Guide Medical and Dental Cover

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NATO

Valid from 1st January 2012

Helpline Email: unityhelpline@allianzworldwidecare.com

Telephone (from anywhere in the world):

Calls to our Helpline may be

Helpline If you require emergency medical treatment in a

Allianz | Member services

• A Dental Cost Estimate/Fees Form Online Services

Allianz | Member services

Online Services allows you to:

• View and amend your personal details online,

For Online Services assistance, please contact our

What you are covered for

Allianz | What you are covered for

Out-patient Treatment Scientific Cooperative on Phytotherapy)

• Routine eye examination carried out by an Orthopaedic Appliances and Special

Allianz | What you are covered for

Nursing Charges • Cardiovascular exam

Dental Treatment If you require expensive dental treatment such as

Allianz | What you are covered for

Allianz | What you are covered for

This benefit provides cover for treatment which takes

This benefit provides cover for doctors’ fees,

Allianz | What you are covered for

Glasses and Contact Lenses Frames

Cover for Newborn Children • Hormonal treatment to stimulate fertility

Allianz | What you are covered for

Funeral Expenses If you require treatment for a serious illness we will

Allianz | What you are covered for

Part 2.4 – applicable only to members whose

We will reimburse 100% of the costs incurred for the

Benefit limits and co-payments

Benefit Limits Co-payments

Where you are covered

You are covered for medical and dental costs

Please note the following important points:

Allianz | How to claim

In-patient claims will need to complete the relevant sections of

For emergency treatment: Out-patient and Dental claims

Allianz | How to claim

Allianz | How to claim

Prior Approval • Repair and replacement of orthopaedic

Treatment in the USA In-patient and Out-patient Claims

If you receive treatment outside the UHC network,

Allianz | How to claim

Please note that planned treatment and

supports/braces, artificial limbs, stoma supplies, • Active tuberculosis

1.40 Vaccinations refer to all basic immunisations and

1.41 We/Our/Us is Allianz.

1.42 Work Related Accident is an injury which is the result

1.43 Work Related Illness is an illness which arises from a

1.44 You/Your refers to the eligible insured person.

What your Medical and Dental Cover

1. Products that can be purchased without a 5. Treatment or diagnostic procedures of injuries

8. Treatment that is not considered medically

9. Expenses incurred in respect of domestic care,

10. Hazards of war :

11. Nutritional supplements, special food or food

If your treatment is needed as a result of If you are covered by another insurance

If you change your address/email address Fraud

Your membership is governed by French law. Any

The Allianz Helpline is always the first number to