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Part II
Medical Expenses Insurance
IDLA Tariff
This tariff (Part II of the General Terms and Conditions of Insurance) is only valid in connection with Part I – General Provisions for Medical Expenses Insurance and (Daily) Hospital Benefit Insurance.
1. Persons covered
All persons under the age of 65 can be covered.
2. Period of insurance
The period of insurance is a maximum of one year. At the end of the agreed period of insurance the policy holder may apply for a one-off continuation insurance on the insurance conditions currently applying, provided that the other conditions continue to be met. Thereafter, the police holder may twice apply for a one year continuation of the insurance, provided that the other conditions continue to be met. If the application for continuation insurance is submitted by the end of the originally agreed period of insurance, the continuation insurance is provided without another risk assessment, directly following on from the original insurance contract. Current insured events are then included in the new insurance cover.
If the return journey by the end of the agreed period is not possible without endanering the health of the insured person (i.e. they are unfit to travel), then the insurance cover shall be extended on a one-off basis by two months.
3. Benefits from the insurer
Reimbursable expenditure is refunded in accordance with the percentages stated below.
A. Out-patient curative treatment
The tariff benefits is 100% of the reimbursable expenditure for:
- Medical services
- Drugs and surgical materials
- Remedies
- Medical aids.
The cost of transportation required for medical reasons in the country of stay using a special ambulance to and from the nearest doctor or hospital deemed suitable according to medical criteria shall be reimbursed.
In the event of the death of the insured person abroad the expenditure for the funeral at the place of death or transfer to the deceased’s last permanent place of residence are refunded up to a total amount of EUR 10,000.
The services of a non-medical practitioner in the Federal Republic of Germany and drugs, surgical materials and remedies prescribed by him are refunded up to a limit of 80% (up to EUR 400) per year.
B. Dental treatment
The tariff benefits for:
| Dental treatment will be |
100 % |
Tooth replacement (dentist’s fees, material costs and lab fees)
including repairs, crowns and orthodontics, of the reimbursable expenditure
|
80 % |
|
For tooth replacement and dental crowns the following costs are reimbursable to a maximum of:
Fixed dentures
| Crowns |
546 EUR |
| Inlay, gold |
496 EUR |
| Simple post crown |
422 EUR |
| Richmond post crown |
744 EUR |
| Post crown tooth with synthetic structure |
744 EUR |
| Bridge unit, gold and synthetic material |
496 EUR |
| Bridge unit, gold and ceramic |
546 EUR |
| Special retainers |
546 EUR |
| Abutments |
199 EUR |
Implants (synthetic root and crown structure) including preparatory work and measures
|
744 EUR |
|
Removable dentures
C. In-patient curative treatment
The tariff benefits is 100% of the reimbursable expenditure for:
- Medical services,
- Accommodation in a single room (1st class)
- Diagnostic, therapeutic and other related services, invoiced separately by the hospital (for example, laboratory or X ray investigations, drugs, use of operating theatre),
- The cost of transportation required for medical reasons in the country of stay using a special ambulance to and from the nearest hospital deemed suitable according to medical criteria shall be reimbursed.
The additional costs of a return journey from abroad required for medical reasons and ordered by a medical practitioner shall be borne if adequate medical treatment cannot be assured in situ or at a reasonable distance and there is therefore a risk of endangement to health; moreover, the additional costs for one accompanying person shall be reimbursed if this is medically necessary and a medical practitioner has given instructions to that effect. Return transportation shall be to the nearest hospital at home deemed suitable according to medical critera (cf. Part I, Section 1 para. 5).
In the event of the death of the insured person abroad the expenditure for the funeral at the place of death or transfer to the deceased’s last permanent place of residence are refunded up to a total amount of EUR 10,000.
There is no payment obligation for implants (synthetic root and crown construction) including preparatory work and measures..
Payment of (Daily) Hospital Benefit
If no costs are drawn in full in-patient treatment, a daily hospital benefit of 25 EUR is payable. Under the same circumstances the daily hospital benefit for children (0-15 years) is EUR 12.50. Patients undergoing partial in-patient treatment (semi-admittance) have no entitlement to hospital benefit.
D. Assistance benefits
Accommodation of a parent in a child’s hospital room
If the child has to stay in hospital, Interlux will bear the costs for the accommodation of one parent staying in the child’s room overnight (children up to 12 years)..
4. Payments by the Policy Holder
Monthly premium installments in EUR Statutory insurance tax is not included in the premiums and will be levied separately.
Click here for the premiums of the IDLA tariff.
The General Terms and Conditions of Insurance in English are just a translation, and the German General Terms and Conditions represent the legal documents. |
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