More about health insurance
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Be informed on the subjects below;
The declaration form should be filled comprehensively and accurately.
Moreover, in case of occurrence of a risk at the time of issue and/or during the term of the policy,
The occurrence should be notified to the insurer as soon as possible within the legal period.
Giving incomplete or wrong information should be avoided. Otherwise the payment of indemnity may delay,
The amount of indemnity may decrease, payment of indemnity may be rejected or the policy may be cancelled and/or additional
premium/deductible may be applied for the related diseases.
3. The present health insurance policy is valid for 1 year. Following the expiration date of the policy,
A new policy may be issued upon the request of the insured/policyholder within the conditions to be determined by the insurer.
4. Pursuant to article 8 of the General Conditions for Health Insurance, whole amount of the insurance premium or,
if the premium will be paid in installments, the first installment of the premium should be paid at the date defined
on the policy. In case of non-payment of the premium, the liability will not be undertaken by the insurer.
5. In order to prevent any future conflict, we kindly ask you to not forget to receive a receipt upon payment of the premium
(cash or in installments).
6. If the due date of the premium payment has been defined in the policy,
Turkish Commercial Code article 1434 will be apply in case of non-payment of the premium or the installment at the due date.
7. The policy of all the insured who are covered will be cancelled immediately in case of a deliberate attempt to benefit of any
insured covered by this policy against the general conditions and application principles of the policy.
8. Children under 18 years old can be insured alone by this product dedicated to foreigners, on condition that an additional premium
is applied and the policyholder is above 18 years old.
C- GENERAL INFORMATION 1. The policy/addendum covers diagnostic and treatment expenses of the insured(s) related
to a disease and/or an accident occurred between the inception and expiration date of the policy/addendum within the coverage
, limit, contribution rates and practices determined by the policy/addendum in accordance with the General and Special
Conditions of the Health Insurance for Foreigners. 2. After the assessment of the application form and the health risk analysis,
the insurer has the right to apply additional clause/ exception for these risks according to the medical condition of the insured,
to not cover them by applying a deductible, to request some contribution or additional premium, to set limits or to not
underwrite the insurance. 3. The present health insurance policy is valid for 1 year. Following the expiration date of the policy,
a new policy may be issued upon 2 the request of the insured/policyholder within the conditions to be determined by the insurer.
In case of no renewal of the policy after the expiration date, the insured will be considered as a new insured i.e. a proposal will be
given to the insured and the insured will be considered as a new one. If the insured requests to change the insurance plan during
the renewal period, the acquired rights will no longer be valid and the issued policy will be considered as new business.
The insurer will make a risk analysis in order to decide to renew the policy or not and may apply exceptions, guarantee limits,
additional premium and contribution rates according to diseases at the renewal period. During the decision process,
the insurer may request from the insured/policyholder by having its written consent, a health declaration form,
an evidence of private health insurance and additional examinations. The insurer may also obtain information from individuals
and institutions providing health care services for the insured. Those who own a health insurance product from Groupama Sigorta
accept beforehand the exchange of information and documents with official authorities within the scope of the health insurance policy.
The present policy gives no renewal guarantee. The policies of those who are 70 years old and above will not be renewed.
4. Expenses of diagnosis, outpatient treatments, minor interventions, surgeries and inpatient treatments related to the below
mentioned diseases and complications are not covered for 36 months following the first issue date of the policy provided by
Groupama Sigorta: Hearth diseases, cancer, chronic diseases (diabetes, hypertension, COPD, MS, Thyroid Gland
Diseases/Goiter, hepatisis, gastroesophageal reflux, peptic ulser etc.) benign tumor – mass- polyp- lypoma nevus- verruca - c
yst. Providing that, after evaluating the declaration/documents of the insured/ the policyholder, the insurer may extend the
waiting period for the abovementioned diseases or apply waiting period for other diseases on condition that it is written on
the addendum. All kind of physiotherapy and rehabilitation expenses as well as algology treatments are not covered
for 36 months following the first issue date of the policy. Hospital room – hospital attendant guarantee, Intensive care unit
guarantee and all inpatient treatment guarantees in total, the expenses are covered for maximum 180 days within the limits
of coverage. Coverage for the intensive care unit is limited with 90 days at most.
D- DETERMINATION OF THE PREMIUM The insurance premium is calculated based on the standard tariff determined
according to the age, the gender and the chosen insurance plan by taking into account the loss ratio and the current disease risks
of the insured as well as the list of the contracted healthcare institutions for foreigners. Changes in Turkish Medical Association
minimum fee tariff, increases in private hospitals current prices and medicine and consumables prices, additional costs of new
diagnostic and treatment methods, general expenses, commissions, changes in the repartition of risks by age, gender,
disease and treatment in the portfolio, payment periods, interest rates, inflation and exchange rates are taken into account
in the calculation of the standard tariff premiums. If necessary the criteria of the standard tariff premiums and the premium
calculation can be revised and changed. Premiums of the policy are calculated based on the standard tariff premiums and
the tariffication model effective at the issue date of the policy. E- ADJUSTMENT OF THE PREMIUM In the calculation
the renewal premium, Groupama Sigorta has the right to apply on the standard tariff arising from your claims.
An additional premium between 5% and 100% may be applied for each disease/sickness of the insured. Maximum additional
premium arising from claims that can be applied is 300%. Once the renewal premium is fixed, if there is an indemnity request
related to the previous policy and if this request changes the renewal premium, the insurer has the right to apply additional premium
or to cancel the policy. In the calculation of renewal premium, no discount will be applied according to loss ratio for policies to which
an additional premium was given according to the loss ratio of the previous year. No-claim bonus will not be given at the end of the
first year even if the loss ratio is 0 (zero). 3 F- INFORMATION ABOUT THE COVERAGE The health insurance policy contains
different guarantees given according to products. The scope of guarantees given according to our current products is mentioned below.
Please refer to your policy for cover limits given for different products. G- OCCURRENCE OF A RISK 1. Beneficiaries are obliged to
furnish the relevant documents to the insurer in order to be able to claim the rights arising from the policy. Even though documents
required for the payment of indemnities depend on the indemnity requests raised in line with guarantees of the policy, the documents
required in general are as follows: Indemnity request form, original invoices, medical prescription, medication barcode, medica
l examination request form ordered by the physician, copy of the test results. For inpatient treatment, in additional of the above
stated documents, hospital discharge report with anamnesis, detailed hospital invoice, copy of the observation file, surgery report,
and in the case of a traffic accident, accident report and intoxication report . 2. When the risk is realized, please contact the insurer
by phone or at the address mentioned on the front page within 8 days with required information and documents. 3. At the time of
claim notification please act in accordance with the instructions given by the insurer 4. When the risk is realized, the indemnity is
paid by the insurer. H- INDEMNITY 1. In addition to the article 2 of the General Conditions of the Health Insurance, expenses
regarding diseases and disabilities which exist before the issue date of the policy, examination and treatment following the first diagnose of congenital diseases and disabilities, diagnoses and treatments of hereditary diseases and disabilities as well as the expenses for any related disorder, and all articles under Exclusions on the article 5 of the Special Conditions of Health Insurance for Foreigners are not covered. I- PAYMENT OF INDEMNITY 1. If the insured receives healthcare services from a contracted healthcare institution, the insurer may pay the treatment expenses directly to the contracted healthcare institution (LIST OF CONTRACTED HEALTHCARE INSTITUTIONS FOR HEALTH INSURANCE FOR FOREIGNERS) after the assessment made in accordance with the general and special conditions of the policy and guarantee schedule mentioned in the addendum. For healthcare expenses in a contracted healthcare institution, the insured is obliged to give its client number and present the original passport to the representative of the institution at the time of application. Applications made without presenting the original passport will not be treated by the institution as direct payment. CONTRACTED Coverage Inpatient Treatment Hospital Room & Meals Intensive Care Outpatient Diagnosis & Treatment Auxiliary Medical Supplies Inland Emergency Assistance and Medical Consultancy Unlimited Charge for standard single room Charge for Intensive Care Unit 2,000 TRY * 1,000 TRY Unlimited 20,000 Charge for standard single room Charge for Intensive Care Unit 2.000 TRY * 1,000 TRY Unlimited Annual Daily Daily Annual Annual Annual None None None 40% 40% None 20% 20% 20% 40% 40% None Scope Limit of Coverage Limit of Coverage Contribution Contribution NON-CONTRACTED *The annual limit of outpatient treatment coverage is to 2,000 TRY for contracted and non-contracted healthcare institutions. 4 2. If the insured receives healthcare services from a non-contracted healthcare institution treatment expenses shall be paid first by the insured. After the payment of the treatment expenses, the insured should send to the Insurance Company as attachment of the invoice the indemnity request form fully completed and signed by the physician as well as the documents specified in the Special Conditions. Please find the indemnity request form at www.groupama.com.tr. 3. If the physician is not a staff member of a contracted healthcare institution or do not have a contract with Groupama Sigorta, the physician should issue a separate invoice for diagnose, treatment, surgery and medical follow-up charges. This invoice will not be considered as a direct payment and will be paid within the limits specified on the policy if the relevant documents are sent once the payment is made by the insured. 4. After the reception of the required information and documents in full by the insurer, the indemnification request will be assessed and paid within 5 business days and the limits and rates specified on the policy. 5. In order to make the payment, the details of a bank account in Turkey (name of bank, branch office code, branch office name, account number and IBAN number) should be provided to the insurer. J- TERMS AND CONDITIONS OF THE TERMINATION OF THE INSURANCE CONTRACT If the policyholder requests the cancelation of the health insurance policy before the expiration date, the following conditions will be fulfilled: • Evidence of a new private health insurance contract covering the period of the residence permit; • Termination of the residence permit ; • Evidence of registration to Public Health Insurance system in accordance with the Social Security and Public Health Insurance Law No. 5510. Moreover, the documents proving the date of exit from the country should be sent to the insurance company. In case of cancelation of the contract, the premium shall be charged in accordance with the insurance principles on pro rata basis on condition that it is not before the date of the last claim and cancelation of the contract shall be effected. K- COMPLAINTS AND INFORMATION REQUESTS Below mentioned address and telephone numbers may be used for information requests and complaints regarding the insurance.
The insurance company is obliged to reply the requests within 15 days after their reception.