|Zone-1(Africa – excluding Ethiopia, Europe and Middle East)|
|Per Person||Amount per person||Service Charge||Tax|
|Zone-2(America, Asia and Oceania)|
|Per Person||Amount per person||Service Charge||Tax|
A. WHILE THE BENEFICIARY IS VISITING ETHIOPIA* FOR SHORT TIME
Medical expenses in case of illness or accident for a
maximum period of 90 consecutive days per trip
10000 Excess 50
326200 Excess 1631
B. IN CASE OF DEATH OF THE BENEFICIARY IN THE COUNTRY OF RESIDENCE
Repatriation of mortal remains of the beneficiary to Ethiopia
Transport of a relative to accompany the deceased
RETURN TICKET Economy Class
(*) Maximum 90 consecutive days per trip to ETHIOPIA.
“Insurer” or “The Company” means:
NYALA INSURANCE S.C. With their Head Office at; Protection House, Mickey Leland Street, P.O. Box 12753, Addis Ababa, Ethiopia., registered and authorized in the country in which this insurance policy is issued and subscribed.
“The Assistance Company” means:
The company provided by the Insurer for the purpose of supplying the covers of this policy, directly or by means of its network, on the Insurer’s behalf.
All physical persons with their residence established in Ethiopia, taking the policy on behalf of the beneficiary resident outside Ethiopia. The Policyholder can also be a foreigner with their residence established in Ethiopia, taking the policy for his own behalf and/or for other relatives living in the same country. Maximum insured age is 80 years old.
“Beneficiary” or “Insured Person” means:
All physical persons with their residence established inside or outside Ethiopia that have been designated by the Insured while purchasing the policy and fulfil the requirements as per the full definition of “beneficiary” set in the policy wording and that fulfil the following requirements:
The beneficiary status also extends to the spouse and to the first degree ascendants and descendants if they each fulfil the foregoing requirements and having their individual premium paid.
“Manual Labour” means: unskilled, semi-skilled, and/or skilled labour involving working with your hands and/or operation of mechanical and/or non-mechanical machinery
“Immediate Family Member” of the Insured, means:
Spouse, children, parents, grandparents and siblings.
“Close Relative” of the Insured, means:
Spouse, parents, children, grandparents, grandchildren, siblings, mother and father in law and brothers and sisters in law.
Persons from 3 months to 18 years old.
Person officially registered as wife or husband of the Insured.
“Usual Country of Residence” means:
The country where the beneficiary has established its permanent residence that must be in one of the following geographical areas defined as Zone I and Zone II:
ZONE I: Beneficiaries with their residence established in Africa – excluding Ethiopia, Europe and Middle East
ZONE II: Beneficiaries with their residence established in America, Asia and Oceania.
Any change in health diagnosed and confirmed by a legally recognised doctor during the life of the policy and which is not comprised or derived from either of the following two groups:
Congenital disease: the disease that exists at the moment of birth as a consequence of hereditary factors or complaints acquired during pregnancy.
Pre-existing disease: the disease that the Insured suffered prior to the date of taking out this Policy, even if it wasn’t diagnosed.
“Serious Illness” means:
Any illness that requires admission to hospital and which, in the opinion of the Assistance Company's medical team, prevents the Insured from continuing travel on the date planned, or which involves the risk of death.
A medical problem caused by a sudden and severe external cause or reason beyond the control of the Insured, within the validity period of this Policy.
“Serious Injury" means:
An injury which, in the opinion of the Assistance Company's medical team, prevents the Insured from continuing travel on the date planned or involves the risk of death.
“Emergency Dental Care” means:
Any natural dental treatment covered by the policy due to a condition suddenly started up at travel and that it does not occur by reason of any pre-existing situation has been documented by dentist’s report.
“Doctor” or “Physician” means:
An officially registered medical practitioner according to the law of the place where the claim happens.
“Osteosynthesis material” means:
Parts or pieces of metal or of any other kind used to join together the ends of a fractured bone, or to knit together the tips of joints, by surgical operation and which can be reused.
Orthopaedic material or orthesis means:
Anatomical parts or items of any kind used to prevent or correct temporary or permanent deformations of the body (walking sticks, cervical collar, wheelchair, etc.).
These are deemed to be any item of any kind that temporary or permanently replaces the lack of an organ, tissue, organic fluid, member or part of any of them. By way of an example, mechanical or biological items such as cardiac valve parts, joint replacements, synthetic skin, intraocular lenses, biological materials (cornea), fluids, gels and synthetic or semisynthetic liquids that replace organic humours or liquids, medicine reservoirs, mobile oxygen therapy systems, etc.
The amounts set forth in the Conditions of this Policy, Schedules of Covers and Economic Limits of each different Plan, and which represents the maximum benefit (financial, temporary or another kind) covered under each guarantee.
“Fraudulent Claims” means:
When the Insured, beneficiary or someone acting on their behalf, uses any fraudulent means or devices in order to obtain any of the benefits of this policy, consequently, any payment of any amount in respect of such claim shall be cancelled.
“Deductible” or “Excess” means:
The amount of expenses or the number of days which are not covered by the Insurer, and that are to be paid or supported by the Insured Person before the Policy benefits become payable.
“Mandatory Excess” means:
An excess period of 30 days is mandatory for all beneficiaries, except while renewing automatically their policy after the initial one is expired.
The price of the insurance that the Policyholder must pay the Insurer in consideration for the coverage of the risks provided for the Insured by the latter, the receipt for which will include, moreover, the surcharges and taxes legally applicable.
“Period of Insurance” or “Effective Date of Coverage” means:
The period that commences and ends on the dates stated on the Certificate of the Policy contracted. Such period of Insurance is in any case not renewable.
Geographic area where the travel object of the contract takes place, and in which the events that occur there have coverage.
The Company will immediately provide the Insured, the assistance specified under the “Coverage” clause of this Insurance Policy for mishaps that occur due to unforeseen incidents, provided that this occurrence does not take place outside the specified geographical boundaries and does not take place out of the prescribed validity dates of this Policy. Period of Cover granted under this Policy for journeys taken by the Insured to his/her Country of Origin (ETHIOPIA) shall not exceed 90 consecutive days each travel.
II. GUARANTEES COVERED
The Insurer, where appropriate, shall be responsible for the rendering of the services shown below.
A. Medical expenses in case of illness or accident for a maximum period of 90 consecutive days:
Medical expenses are covered in Ethiopia for a maximum of 90 consecutive days per trip, except for beneficiaries with their residence established in Ethiopia. For these beneficiaries living in Ethiopia, the medical expenses will be covered while visiting their country of origin (outside Ethiopia) for a maximum of 90 consecutive days. In the event of illness or injury of the insured occurring while the insured is visiting Ethiopia, The Company will meet the usual, customary, necessary and reasonable costs of hospitalization, surgery, medical fees and pharmaceutical products, prescribed by the attending doctor.
The Company's medical team will maintain the telephone contacts necessary with the centre and with the doctors attending to the Insured to supervise the provision of proper health care.
This cover is subject to a limit of 10000 EUROS. 50 EUROS excess is applicable per claim.
B. Repatriation of mortal remains of the beneficiary to Ethiopia:
In the event of death of the insured party, the Insurer shall organize and take charge of the transport or repatriation of the body from the place where death has occurred to the place of burial in its country of origin.
The repatriation of mortal remains is covered in case of death of the beneficiary within the usual country of residence located either in Zone I or Zone II.
Payment of expenses for interment, cremation or funeral ceremony is excluded from this guarantee.
C. Transport of a relative to accompany the deceased:
In the event of repatriation for death, the Insurer shall reimburse a close relative (spouse, first degree ascendant or descendent, brother or sister) the price of a return ticket – Economy Class - in the most suitable means of transport to accompany the mortal remains from the place where death has occurred to the place of burial.
III. THE COMPANY’S LIABILITY CONDITIONS
Previously approved expenses will have to include the claim number obtained from The Assistance Company prior to sending the official receipts and/or letter explaining the reason and circumstances of why the Travel Assistance Services for which expenses are claimed were not obtained from The Assistance Company directly
IV. VALIDITY OF THE CONTRACT
This insurance shall be valid as long as NYALA INSURANCE S.C. maintains the insurance policy which has been contracted for this purpose in force.
Coverage shall take effect as from 0 hours of the day following the day on which the requirements established for the INSURED to acquire BENEFICIARY status are met, in accordance with the provisions of this policy. Likewise, this coverage shall terminate at 0 hours of the first day of the month following that in which the INSURED party is no longer insured, in accordance with the aforementioned definition, or on the date of cancellation of the policy.
Despite this, this coverage shall be valid as long as NYALA INSURANCE S.C. maintains the insurance policy which has been contracted for this purpose in force.
In the event of any or all of the guarantees of the policy being annulled or limited, NYALA INSURANCE S.C. shall communicate said circumstance with sufficient notice.
V. GENERAL EXCLUSIONS
VI. HOW THE INSURED SHOULD APPLY FOR ASSISTANCE?
Since the appearance of an event that could be included in any of the guarantees described previously, the beneficiary or any person acting in his place will necessarily contact, in the shortest possible time, in every case, the Alarm Centre mentioned below, which will be available to help any person 24h/24 7d/7.
By dialling our Emergency number, he/she will be prompt to provide:
Assistance Email firstname.lastname@example.org
Refunds Email: email@example.com