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  • Service
  • Claims handling
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Claims handling

Being insured through one of the BDAE products you are paying insurance premiums for an incidence of which you most certainly hope it will never occur. You are part of a community that more often than not only helps few of its members when they are in need for support. But you do maintain your membership in this community, because there is a risk that one day you yourself might suffer an illness, for which the cost of treatment would be impossible to bear on your own. In such cases the community of insured members will step in and pay for these medical costs.

In order to reimburse your medical expenses as quickly as possible we kindly suggest you read this leaflet. If you help us streamline the procedure of handling your claims by providing us with all required documents and information we will be able to reimburse your costs even quicker.

Thank you for your cooperation!

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CLAIMS HANDLING PROCEDURES

As soon as your claims documents have been submitted we will send you an email notification.

  • Following this we will immediately check the medical circumstances of your claim.
  • Ideally, the reimbursement will be assessed immediately.
  • Reimbursable costs will then be transferred within 14 days of having dispatched the list of settled invoices.
  • In some cases we might have to revert back to you and/or your medical practitioner in order to obtain further details with regard to your medical history. We will then require a letter signed by you stating the release from confidentiality of your medical practitioner. As long as this letter has not been provided we will not be able to investigate further and settle your claim. Unfortunately, we are regularly facing delays from the providers in answering our questions.
  • Once we have obtained all necessary information we will assess your claim and inform you in writing.

Outpatient and Inpatient Treatment

Outpatient treatment: You get an invoice by your medical practitioner and pay it within the requested period. Afterwords you submitt the invoice to us for reimbursement. We will reimburse all costs or a part of it as it is defined in the terms and conditions of your insurance product.

Inpatient treatment: We will be informed by the hospital or by you about your inpatient stay and we will make a declaration about the assuption of costs with the hospital as far as the treatment corresponds to the scope of benefits of your insurance contract. Please note that this is a service provided by us with is dependent by the cooperation of your hospital.


PROCEDURES FOR DENTAL TREATMENT

Claims documents for dental treatments must include specific details about the tooth / teeth being treated and must contain a list of all medical costs / procedures involved. Our insurance products cover the cost for synthetic fillings.

Depending on the product, a dental checkup is insured, but no preventative dental treatment (e.g. scaling and polishing). In order to make sure that your dental treatment is covered we recommend obtaining a cost and treatment plan from your dentist. We will then assess it and confirm which costs are covered under your insurance policy. Please note that there are waiting periods with regard to tooth replacement. Further details are provided in the terms and conditions of your policy.

PRINCIPLES OF INTERNATIONAL PRIVATE HEALTH INSURANCE

The reimbursement of claims unfortunately frequently leads to misunderstandings and conflicts. At best, the insured member will receive what he or she deems obvious - the reimbursement of your costs. In principle, we have to follow two main criteria of the insurers we cooperate with:

  • The total amount of claims must be within certain limits to ensure the sustainability of the products from an economic perspective, but also in order to protect the overall community of Insured Members.

  • Medical costs submitted for reimbursement must be assessed properly, in order to protect the interests of all Insured Members. If insurance premiums need to be increased due to an inefficient assessment of claims all Insured Members would be affected. This is why investigations are necessary when the extent of a certain treatment or the amount of its costs appear to be unreasonable.

Of course we will reimburse costs for all benefits which are defined in your insurance contract.

EXCLUSION OF PRE-EXISTING CONDITIONS

Most of our insurance products exclude costs for medical conditions that existed prior to the insurance cover and require further treatment. Such pre-existing conditions are calculated risks, producing predetermined costs. If we suspect a medical claim to be related to a pre-existing condition we must therefore make sure that this is an unsubstantiated suspicion. So what does this mean exactly?

If you suffer from an illness or have a medical ailment before you obtain your insurance policy it is considered a pre-existing condition. All costs related the treatment of such illness or ailment will not be covered.

If you have an illness that existed prior to your insurance cover, but has not caused any symptoms and has only been diagnosed after you have been insured with us, this illness will not be considered a pre-existing condition and will be covered. However, illnesses that are known to be chronic diseases will require a detailed assessment from our side, as to when it has been diagnosed and / or first appeared.

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