Annex III: Medical Coverage
The medical insurance scheme provides for reimbursement of medical, hospital and dental treatment up to a maximum of US$50,000 per fellowship holder or participant in any individual period of coverage, subject to the following limitations:
A. The Insurers undertake to reimburse 100% of the expenses involved in respect of medical treatment prescribed by doctors qualified to treat patients. At the rate of 100% are also reimbursed the costs of hospital services such as:
- bed and board (maximum rate: the rate of the hospital concerned for a room for two or more patients)
- general nursing service
- use of operating rooms and equipment
- use of recovery rooms and equipment
- laboratory examinations
- X-ray examinations
- drugs and medicine for use in the hospital
B. The following types of treatment alone are subject to certain limitations:
1. Dental treatment
The costs of dental care, of periodontic treatment, of false teeth crowns, bridges, other similar appliances, and of dentofacial orthopaedics is reimbursed only to a maximum sum of US$500 per individual period of coverage.
2. Special examinations and treatments
- The costs of psychiatric treatment including psychoanalysis are reimbursable only if the patient is treated by a psychiatrist. The costs of psychiatric treatment are reimbursable only at the rate of 50% and to a maximum reimbursement of US$500, for not more than 50 visits per insured person in any consecutive six-month period.
- The costs of radiological treatment are reimbursable only if the patient has been referred to the specialist by the doctor in attendance.
3. Expenses for or in connection with travel or transportation whether by ambulance or otherwise are covered if a professional ambulance service is used to transport the insured person between the place where he is injured by an accident or stricken by a disease and the first hospital where treatment is given. In case of emergency or major disability, special transport of insured person, including cost of accompanying person or attendant will be allowed, up to a maximum of US$7,500. In addition, preparation on repatriation to the home country will be covered up to a maximum of US$ 7,500.
1. Excluded costs:
- Hearing aids, spectacles, fees for examination of the eye for glasses and costs of spa-cures
- periodic, preventive health examinations
- rejuvenation cures and cosmetic treatment. Cosmetic surgery is covered, however, when it is necessary as a result of an accident occurred during the insurance period.
2. Excluded risks:
Following risks are not covered:
- the consequences of sicknesses or accidents resulting from voluntary and intentional action on the part of the insured person;
- the results of wounds or injuries resulting from motor vehicle racing and dangerous competitions in respect of which betting is allowed; normal sports competitions are covered;
- the consequences of insurrections or riots, if by taking part the insured person has broken the applicable laws; the consequences of brawls, except in cases of self-defense;
- the direct or indirect results of explosions, heat release or irradiation produced by transmutation of the atomic nucleus or by radioactivity or resulting from radiations produced by the artificial acceleration of nuclear particles;
- aircraft accidents are only covered if the insured person is a passenger on board of an aircraft with a valid certificate of air-worthiness, piloted by a person in possession of a valid license for the type of aircraft in question.
IMPORTANT REMARK: Medical expense of the first US$10 per individual period of coverage are not reimbursable