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INSURANCE TERMS AND
CONDITIONS
BASIC FOREIGNERS‘
MEDICAL INSURANCE
ZZPC 1/22
effective as of 1 March 2022
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ZZPC_PP_1/22_ENG
Contents:
PAGE 1
Article 1 – Introductory Provisions
Article 2 – Definition of Terms
Article 3 – Purpose and Subject of the Insurance
Article 4 – Insured Event
Article 5 - Extent and Place of Insurance
PAGE 2
Article 6 – Extent and Due Payment of the Insurance Benefit
PAGE 3
Article 7 – Exclusions from the Insurance
Article 8 – Insurable Interest
Article 9 – Group Insurance
Article 10 – Conclusion of the Insurance Policy
Article 11 – Commencement and Duration of the Insurance – Term of Insurance
PAGE 4
Article 12 – Amendments to and Termination of the Insurance Policy. Expiry of the Insurance
Article 13 – Premium
Article 14 – Rights and Obligations of the Insurer
Article 15 – Obligations of the Policyholder
PAGE 5
Article 16 – Obligations of the Insured Person
Article 17 – Other Rights and Obligations of the Parties to the Insurance
Article 18 – Delivery of Documents
PAGE 6
Article 19 – Form of Legal Acts
Article 20 – Rescue Costs
Article 21 – Assignment of Rights to the Insurer
Article 22 – Assistance Services
Article 23 - Final Provisions
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ZZPC_PP_1/22_ENG
Art. 1 23. The Insured Person is a person in respect to whose life or health the insurance
Introductory provisions relates.
1. The rights and responsibilities of parties to this Basic Foreigners' Medical
Insurance (hereinafter the “Insurance”) is governed by the laws of the Czech 24. A professional athlete is a person who has concluded a professional contract
Republic, particularly by Act No. 89/2012 Coll., the Civil Code, as amended with a sports club or other entity in this field and/or engages in sporting activity for
(hereinafter the “Code”), these Insurance terms and conditions, the provisions remuneration, which is this person‘s main or predominant income, and/or engages
contained in the insurance policy and its annexes and in other documents which in sporting activity for a duration of at least 20 hours per week (including
make up an integral part thereof. weekend), including training.
2. Arrangements in the insurance policy that deviate from the Code or these
Insurance terms and conditions shall prevail. Divergent provisions in the following 25. A professional sporting activity is a sporting activity carried out by a person who
sections of these Insurance terms and conditions shall prevail over the provisions is a professional athlete as defined in this Article.
of this section.
3. The contracting parties are on the one hand the Policyholder and on the other the 26. The Insured Person's Card comprises written confirmation of the establishment
Insurer of the medical insurance, which the Insurer issues always with the duration
being limited to a period for which the premium was paid, unless agreed
Art. 2 otherwise in the insurance policy. The card serves the Insured Person for
Definition of Terms exercising the right to Insurance Benefit.
The following definitions of terms shall apply for the purposes of this insurance:
1. Acute Healthcare is care designed to prevent a serious deterioration in the state 27. A Loss Event is an event resulting in damage which may constitute grounds for
of health or to reduce the risk of a serious deterioration in the state of health so the establishment of a right to an Insurance Benefit.
that the facts necessary for determining or changing the individual treatment
process are ascertained in time or so that the Insured Person does not get into a 28. Loss Insurance s insurance the purpose of which is to provide compensation for
state that would endanger him or his surroundings. a loss arising from an Insured Event.
2. Without undue delay is a very short period, up to a maximum ranging in days,
which means urgent, immediate, imminent, or direct action leading to the fulfil of 29. Damage refers to reasonable costs demonstrably spent on healthcare services
an obligation or to the execution of a legal act or other manifestation of will, given provided to the Insured Person at the Place of Insurance.
that the period of its duration will depend on the circumstances of the individual
case. 30. Transit Countries are understood to mean only those countries which are
3. The Duration of the Insurance is the actual period of time within the agreed Term essential for the fastest and shortest transportation of the Insured Person from the
of Insurance for which the personal Insurance was in effect. country where the Insured Person lives and from which he/she is travelling, to the
4. Hospitalisation is understood to mean the state of the Insured Person caused by Place of Insurance, and back again.
an Insured Peril, when he/she is provided with the necessary hospital diagnosis
and curative care connected with his/her stay in bed. 31. Party to the Insurance is the Insurer and the Policyholder, as the contracting
5. Chronic Illness is a long-standing and developing illness (including post-traumatic parties, as well as the Insured Person and every other person to whom a right or
states) that existed prior to the commencement of the insurance and was in a obligation arose under the private insurance.
stable state during the previous 6 months and did not call for hospitalisation or a
deteriorate or a change in the treatment procedures or medicine. 32. An Accident is understood, for the purpose of this Insurance, to be the
6. One Insured Event is an Insured Event arising from the Insurance of one person unexpected and sudden action of external forces or one’s own strength
and from one and the same cause, at the same place and the same time, independent of the insured person’s will, which occurs during the Duration of the
comprising all the facts and their consequences, amongst which there is a causal, Insurance and results in damage to the insured person’s health or his/her death,
territorial, chronological or other direct connection. including work Accidents. An Accident is deemed to occur the moment that the
7. A Single Premium is a premium determined for the entire period for which the external forces or influences damaging the health or causing the death of the
Insurance has been agreed. insured person came to bear.
8. Period given in days is always understood to be the number of calendar days. Damage to the health of an Insured Person caused by:
9. A Random Event is an event that is possible and in respect of which it is a) localised festering following invasion of pathogens into an open wound
uncertain whether it will even occur within the Duration of the Insurance, or the caused by an Accident,
time of its occurrence is unknown. b) tetanus or rabies infection in the course of an Accident, diagnostic,
10. A Sudden Illness is such a sudden and unexpected health disorder that directly therapeutic and preventive interventions carried out to treat the
threatens the health or the life of the Insured Person, independent of his own will, consequences of an Accident,
and which requires acute and urgent healthcare. c) unexpected and uninterrupted exposure to high or low outdoor
11. Urgent Healthcare is care, the purpose of which is to prevent or reduce the temperatures, gases, vapours, electric current (including lightning),
occurrence of sudden conditions that are imminently life threatening or could lead radiation, toxic substances and poisons (with the exception of microbial
to sudden death or serious endangerment to health, or cause sudden or intensive poisons and immunotoxic substances),
pain or sudden changes in the patient's behaviour, who endangers himself or his d) drowning and death by drowning,
surroundings. e) bite, sting, or stabbing by an insect
12. Necessary Healthcare is understood to mean the examination, diagnosis and is also considered to be an Accident.
treatment of sudden (acute) states when the healthcare needs to be provided
immediately or within a very short period of time. 33. Multiple Insurance arises when two or more private insurance policies relate to
13. Protective treatment is a protective measure that is imposed on the perpetrators the same insurance peril covered for the same period, if the sum of the Insurance
of an otherwise criminal offense that cannot be prosecuted due to their insanity, Benefit limits exceeds the actual amount of the damage caused.
mental disorder or substance abuse.
14. Illness, for the purpose of this Insurance, is the medically documented onset of 34. An Interested Party is a party interested in concluding an insurance policy with
the illness, the given that the is, for the purposes of this Insurance, a state which the Insurer.
threatens the health or the life of the Insured Person and requires the provision of
medical care. 35. A Healthcare Service Provider (healthcare facility) is a registered facility
15. A Beneficiary is a party with a right to an Insurance Benefit as a result of an providing outpatient, or outpatient and inpatient, diagnostic and medical care,
Insured Event. which may also include necessary preventive measures (hospitals, outpatient
16. An Insurance Certificate is a written confirmation that an insurance policy has doctors). A Healthcare Service Provider may be a natural person or a legal entity.
been concluded, which the insurer issues to the Policyholder.
17. The Term of Insurance is the period for which the personal Insurance was Art. 3
agreed. Purpose and Subject of the Insurance
18. An Insured Event is an accidental state of affairs brought about by the Insured 1. The Insurer shall, in the event of the occurrence of an Insured Event, provide the
Peril, associated with the establishment of an obligation on the part of the Insurer Beneficiary with an Insurance Benefit to the extent of the loss affecting the subject
to provide an Insurance Benefit. of the Insurance up to the agreed Insurance Benefit limit.
19. An Insured Peril is the possible cause of an Insured Event (the “cause”). 2. The Beneficiary is the Insured Person.
20. An Insurance Risk is a measure of the probability of the occurrence of the 3. The subject of the Insurance is the health of the Insured Person.
Insured Event caused by an Insured Peril. 4. The Insurance is concluded as Loss Insurance.
21. The Policyholder is the party which has concluded the insurance policy with the
Insurer. Art. 4
22. The Insurer is a legal entity entitled to carry on insurance activity according to Insured Event
special legislation. 1. With the exception of the agreed exclusions, an Insured Event is a change in the
state of health of the Insured Person caused by Sudden Illness or Injury, which
occurred within the Duration of the Insurance and at the Place of Insurance to the
extent and under the conditions stipulated in the provisions of these Insurance
terms and conditions.
2. In the event of the occurrence of the Insured Event, the Insurer shall provide an
Insurance Benefit within the scope of Article 6 of these Insurance terms and
conditions.
.
Art. 5
Extent and Place of Insurance
1. The extent of the agreed Insurance is determined by the Insurance terms and
conditions and electable parameters stipulated in the insurance policy. These
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parameters are elected by the Policyholder upon concluding the insurance policy ZZPC_PP_1/22_ENG
based on knowledge of the insurable interest of the Insured Persons.
2. The Policyholder shall choose which types of insurance cover shall be arranged a) of which it learned only after the occurrence of the Insured Event,
for which persons and, if applicable, their type, insurance period insured, and the b) which it was unable to ascertain during the conclusion of the policy or its
upper limit of the Insurance Benefit.
3. Insurance is effective only at the agreed Place of Insurance, which is stipulated in amendment as a consequence of the culpable breach of the obligation
these Insurance terms and conditions. stipulated in paragraph 1 or 2 of Article 17,
4. The Policyholder shall elect the type of Insurance: c) the awareness of which at the time of the conclusion of the insurance policy
“Standard” Insurance applies to events occurring as part of a tourist stay as well would result in it not concluding it or concluding it under different terms and
as to events occurring in connection with the performance of work activity or conditions.
employment of the Insured Person, whilst at the same time this type of Insurance 11. The Insurance Benefit is limited to insurance benefit limits which are stipulated in
also includes common recreational and leisure sports listed in the List of Activities the insurance policy. The Insurer renders Insurance Benefits up to the limits
and Sports (hereinafter the “List”), which is part of these Insurance terms and pursuant to paragraph 15 of this Article to the extent of:
conditions, such as sports Without the Need for Supplementary Insurance, a) acute and urgent healthcare including:
“Hazardous Sports” Insurance also covers, besides sports listed under the - the essential examination required in order to determine the diagnosis
“Standard“ Insurance type, the operation of sports contained in the List as
Hazardous Sports. and the medical procedure to be taken,
5. Territorial Validity is “Schengen and Transit Countries“ - the essential standard treatment,
The Insurance is effective solely at the agreed Place of Insurance. For this - the essential hospitalisation for the patient in a multi-bed hospital room
Insurance, the Place of Insurance is deemed the territory of the Schengen Area
states and, when travelling through Transit Countries, also their territory, with standard equipment,
with the exception of a state whose travel document the Insured Person owns or, - a necessary operation with associated necessary expenses,
where applicable, another state where the Insured Person is authorised to reside. - transportation necessary from a healthcare standpoint from the location
Art. 6 where the Insured Event took place to the nearest medical first aid
Extent and Due Payment of the Insurance Benefit facility or hospital and back,
1. The amount and extent of the Insurance Benefit is determined by the Insurer in b) repatriation of a sick Insured Person with the approval of the attending doctor,
accordance with the Insurance terms and conditions. should his/her state of health allow it, by a medical transportation service
2. The payment of an Insurance Benefit is conditional on the occurrence of an organisation approved by the Insurer or by the Insurer's assistance service
Insured Event and the meeting of all the conditions and obligations ensuing from provider, to the state whose passport the Insured Person holds or to another
the insurance policy and parts thereof, namely the payment of the premium. state in which the Insured Person has been permitted residence. The Insurer
3. Unless otherwise agreed by the contracting parties, the Insurance Benefit shall be may, upon prior approval, also cover the transportation costs of another
payable in the currency of the Czech Republic and its territory and the Insurer person required to accompany the Insured Person in justified cases.
shall pay it to the Beneficiary by transfer to this person's bank account or by postal c) transportation of the physical remains of the Insured Person to the state
order to his name and address. whose passport the Insured Person holds or to another state in which the
4. If the Insured Person was entitled to receive the Insurance Benefit, that he/she did Insured Person has been permitted residence, performed by a specialist
not receive whilst alive, this unpaid Insurance Benefit shall become the subject of organisation approved by the Insurer or the Insurer's assistance service
inheritance proceedings. provider. The Insurer may, upon prior approval, also cover other related costs
5. In cases of the conversion of a foreign currency, the Insurer shall use the in justified cases,
exchange rate of the Czech National Bank valid at the time the Insured Event d) urgent dental care of the Insured Person to alleviate sudden pain or the
occurred. consequences of the accident within the scope of public medical insurance
6. An Insurance Benefit is payable within 15 days from the end of investigations of (hereinafter referred to as the “Urgent Dental Care),
the notified event, with which the claim for the Insurance Benefit is connected. The e) medicines and medical devices prescribed by a doctor on an outpatient basis
investigations conclude upon there porting of its results to the person who in the name of the Insured Person pertaining to acute and urgent healthcare
exercised the claim to the Insurance Benefit. (hereinafter the ”Outpatient-Prescribed Medicines),
7. If it is not possible to conclude the investigations necessary to ascertain the f) assistance services to the extent of Article 22 of this section. The Insurer
Insured Event, the extent of the Insurance Benefit or to ascertain the person renders these services via its contractual provider without direct payment to
entitled to receive the Insurance Benefit within three months of the notification the provider by the Insured Person.
date, the Insurer shall inform the notifier why the investigations cannot be 12. The costs of the healthcare services detailed in paragraph 11 of this article shall
concluded; if requested by the notifier, the Insurer shall inform the notifier of the be paid by the Insurer directly or via the assistance service provider to the
reasons in writing. The Insurer shall provide the person who exercised the claim to healthcare provider or another party that has demonstrably incurred these costs
the Insurance Benefit with an appropriate advance on the Insurance Benefit on the upon the receipt of at least a copy of the required documents.
basis of this person's request; this shall not apply if there are reasonable grounds 13. Direct reimbursement of the costs of healthcare and other services:
to deny the provision of such an advance. a) If the Insured Person or another person made a direct payment of the costs of
8. The Insurer is entitled to reduce the Insurance Benefit: healthcare services pursuant to paragraph 11 of this Article, which represent
a) as a consequence of the compensation which the Beneficiary has already an Insured Event and were rendered to the Insured Person by a healthcare
received in another manner, services provider in a healthcare facility located in the Czech Republic, the
b) if a lower premium was agreed as a consequence of a breach of a duty of the Insurer shall subsequently reimburse the Insured Person or another person
Policyholder or the Insured Person when negotiating the conclusion of the who incurred these costs the reasonable healthcare costs demonstrably
policy or its amendment, the Insurer shall be entitled to reduce the Insurance incurred.
Benefit by an amount equal to the ratio of the premium it received to the b) The Insurer shall provide an Insurance Benefit for an Outpatient Medicine
premium it ought to have received, prescribed by a doctor or a voucher for medical devices if the amount of
c) if the breach of the duty of the Policyholder, Insured Person or another party these costs for each prescription or voucher exceeds CZK 100. An Insurance
entitled to the Insurance Benefit had a material effect on the occurrence of Benefit is understood to mean the amount specified in the Code List of VZP
the Insured Event, its course, on increasing the extent of its consequences or CR for mass-produced medicinal products, medical devices, and individually
on ascertaining or determining the amount of the Insurance Benefit, the prepared medicinal products marked as MAX and valid at the time of the
Insurer shall be entitled to reduce the Insurance Benefit proportionally to the Insured Event occurring.
effect that this breach had on the extent of the Insurer's duty to render 14. If an Insured Event occurred and the continuous hospitalisation of the Insured
benefits, Person exceeds the Duration of the Insurance, the Insurer shall decide on the
d) in the event of the thwarting of the passing of the right to the Insurer pursuant subsequent procedure as follows:
to Article 21 of this Section, a) If the state of health of the Insured Person does not allow for his/her
e) if it paid the Insurance Benefit in the unreduced amount and has repatriation, he/she shall be treated by a healthcare services provider of the
subsequently acquired a claim to reduce the Insurance Benefit. The Insurer is Insurer until such time as his/her state of health improves to such a degree as
entitled to exercise a claim to the difference between the paid-out and the to allow for his/her repatriation,
reduced Insured Benefit from the person in whose favour it was paid. b) If the state of health of the Insured Person allows for his/her repatriation,
f) if the Policyholder or the Insured Person fails to supply the insurer with the his/her repatriation may be carried out with the consent of the attending
required medical documentation. doctor.
9. If the Policyholder or the Insured Person breaches any of the obligations set forth 15. The upper limit for the Insurance Benefit is determined by the benefit limits
in these Insurance terms and conditions, the Insurer may reduce the Insurance specified in the insurance policy:
Benefit with respect to the seriousness and nature of the breach of this obligation. a) The benefit limit for costs under letters a) to c) of paragraph 11 of this Article
10. The Insurer may refuse to pay the Insurance Benefit if the Insured Event was (Healthcare services, including repatriation and transportation) applies to the
caused by a fact Insurance Benefit for every single Insured Event.
b) The benefit limit for costs under letter d) of paragraph 11 of this article
(Urgent Dental Care) limits the Insurance Benefit for all Insured Events
occurring in one year of the Duration of the Insurance or for the Insurance
Period, if the Duration of the Insurance is shorter than one year,
c) The benefit limit for costs under letter e) of paragraph 11 (Outpatient-
Prescribed Medicines) limits the Insurance Benefit for all Insured Events
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occurring in one year of the Duration of the Insurance or for the Insurance ZZPC_PP_1/22_ENG
Period, if the Duration of the Insurance is shorter than one year.
i) for events occurring during activities at locations not designated for such
Art. 7 activities (e.g. skiing and other activities outside designated pistes, ski-
Exclusions from the Insurance jumping and the like),
1. Unless it is otherwise agreed in writing by the contracting parties, the Insurer shall
not provide Insurance Benefits for the following cases: j) if a Loss Event occurs as a result of or in connection with:
a) all care provided in connection with pregnancy and birth and examinations - the effects of released nuclear energy, chemical or biological weapons,
associated with contraception, including reimbursement for contraception, - wartime events and civil war,
b) dental treatment and related services, including the preparation and repair of - acts of violence (including civil disturbances and terrorist activity), in
dental prostheses, fixed bridges and orthodontic aids, except in the case of which the Insured Person has participated,
the consequences of an Injury and urgent dental treatment to eliminate - the handling of a firearm or explosive by the Insured Person,
sudden pain,
c) psychological examinations, psychotherapy and protective treatment, k) if a Loss Event occurs as a result of or in connection with:
d) performances not provided by a healthcare services provider, a healthcare - disturbances or criminal activities committed or induced by the Insured
professional, or treatments and therapies which are not medically recognised, Person; this exclusion does not apply in the case of Injury,
e) preventive check-ups, vaccinations, medical examinations, - use by the Insured Person of alcohol, medicine, narcotics or other
f) treatment and medicine not directly associated with Sudden Illness or Injury, psychotropic or addictive substances or in connection with their effects;
g) cosmetic procedures, this exclusion does not apply in the case of Injury,
h) rehabilitation, physical treatments, spa cures or healthcare in specialist
treatment centres, chiropractic operations, training therapy or self-sufficiency l) for searches and transportation, if the health of the Insured Person was not at
training, the same time affected by an Insured Event,
i) acupuncture and homeopathy,
j) organ transplants, haemophilia treatment, insulin therapy, except for the m) in cases designated in the insurance policy.
provision of first aid, chronic haemodialysis and the administration of
medicine, which was commenced on the territory of the state whose passport Art. 8
the Insured Person holds or to another state in which the Insured Person has Insurable Interest
been permitted residence, 1. Insurable interest is a legitimate need for protection from the consequences of the
k) complications which may occur during the treatment of illnesses or Injuries to Insured Event.
which the Insurance does not apply, 2. The Policyholder has an insurable interest in his own life and health. It is
l) examination and treatment of hepatitis, venereal and sexually transmitted understood that the Policyholder also has an insurable interest in the life and
illnesses and AIDS, including testing for HIV, from the time their diagnosis is health of another person, if he/she demonstrates an interest conditional on his
established, relationship to this person, whether resulting from a family relationship or being
m) spectacles, contact lenses, hearing aids and orthopedic prostheses (i.e. their conditional on the benefit or advantage he/she gains from a continuation of this
preparation and repair), person's life or preservation of this person's health.
n) suicide committed or attempted by the Insured Person, 3. If the Insured Person consented to the Insurance it is understood that the
o) situations in which the Insured Person breached legal provisions in effect in Policyholder's insurable interest was demonstrated.
the state where he is staying, e.g. driving a motor vehicle without a valid 4. The insurance policy shall be invalid if the Interested Party did not have an
driving licence at the time the loss occurred, insurable interest and the Insurer knew or ought to have known this when
p) events occurring during preparations for and performance of Professional concluding the insurance policy.
Sporting Activity, 5. The insurance policy shall be invalid if the Policyholder has knowingly insured a
q) events which have occurred during test trials of Transport Means, non-existent insurable interest, but the Insurer did not or could not have known
r) events which have occurred during stunt activities, this; however, the Insurer shall be entitled to remuneration corresponding to the
s) events occurring during the preparation and performance of Extreme or premiums until the time it learned of the insurance policy being invalid.
Uninsurable sports stated in the Activities and Sports List, 6. The insurable interest does not terminate upon the absence of Insured Person at
t) events which have occurred during preparations for and performance of the Place of Insurance, the taking up of similar private insurance or for reason of
activities for which a corresponding type of cover was not taken out within the plain disinterest.
scope of paragraph 4 of the Article 5, 7. The termination of the insurable interest must always be proven to the Insurer.
u) payments for medicine not prescribed by a doctor, i.e. purchased over the
counter without a doctor's prescription, or the administration of which Art. 9
commenced before the commencement of the Insurance, Group Insurance
v) costs of regulatory fees and additional charges, 1. Group Insurance is Insurance pertaining to a group of Insured Persons, as further
w) costs connected with contacting the Insurer or the assistance service defined in the insurance policy, whose identity need not be known at the time of
(telephone call charges, etc.). the insurance policy being concluded.
2. The Insurer shall not provide Insurance Benefits: 2. If the Insurance applies to members of a certain group, the insurance policy need
a) for the treatment of illnesses and states of health where healthcare is not specify the names of the Insured Persons, on the condition that the Insured
appropriate, expedient and necessary, but can be delayed and provided after Persons can be identified beyond doubt at least at the time of the Insured Event.
the Insured Person returns to the state whose passport the Insured Person 3. In the case of group insurance, a breach of the duty to give truthful and complete
holds or to another state in which the Insured Person has been permitted answers to the Insurer's questions only impacts the Insurance of those persons to
residence, whom a breach of this duty applies.
b) for healthcare services that are not covered under public medical insurance in
the Czech Republic, Art. 10
c) for events occurring while the Insured Person on the territory of his State to Conclusion of the Insurance Policy
the state whose passport the Insured Person holds or to another state in 1. The insurance policy is concluded upon acceptance of the Insurer's Insurance
which the Insured Person has been permitted residence, with the exception of offer. The offer is accepted upon its signing by the contracting parties, unless
the Czech Republic, another manner of acceptance is expressly stated therein. If the Policyholder
d) in cases where travel is for the purposes of utilising healthcare, accepted the offer by the timely payment of the premium, it shall be deemed that
e) for events occurring as a result of the intentional conduct, fault or shared fault the written form of the insurance policy has been duly observed.
of the Insured Person; this exclusion does not apply in the event of an Injury, 2. The insurance policy is concluded for a definite time period.
f) for events cause to the Insured Person by a Beneficiary or another person at 3. An integral part of the insurance policy, apart from the Insurance terms and
the instigation of the Insured Person or a Beneficiary, conditions, are also all agreements, supplements and annexes to the insurance
g) in cases when healthcare is provided as a result of illness, accident or other policy and all documents defining the terms and conditions of the establishment,
conditions, for which the Insured Person was treated prior to the conclusion of duration, alteration and expiration of the Insurance (e.g. applications,
the Insurance, or questionnaires, reports, medical examinations and checks, notices, records of the
in cases when healthcare is provided in connection with the treatment of course of concluding the Insurance, the Insurer's information for the Interested
illness, accident or other conditions, the cause or symptoms of which Party on the conclusion of the insurance policy).
occurred prior to the conclusion of the Insurance or during the waiting period,
h) if the Insured Person refuses to undergo repatriation, treatment or the Art. 11
required medical examination by a doctor designated by the Insurer or the Commencement and Duration of the Insurance – Term of Insurance
Insurer's assistance service provider, 1. The Insurance is concluded for a fixed Term of Insurance from the
commencement of the Term of Insurance to the end of the Term of Insurance. The
Term of Insurance is agreed in the insurance policy.
2. The Insurance commences at 0:00 hours on the day agreed as the
commencement of the Term of Insurance, but no earlier than on the day following
the day on which Insurance premium is paid, unless agreed otherwise in the
insurance policy.
3. The Insurance lasts from its commencement until the actual expiration of the
Insurance.
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4. The Insurance cannot be suspended for reason of the non-payment of the ZZPC_PP_1/22_ENG
premium.
part of the premium corresponding to the unearned premium as at the expiry of the
Art. 12 Insurance, after deducting:
Amendments to and Termination of the Insurance Policy. Expiry of the Insurance a) the costs associated with taking out and administering the Insurance and
1. All amendments to the insurance policy are made in writing upon the mutual b) the costs associated with the Insurance Benefits.
6. If the Insurance is terminated as a consequence of an Insured Event, the Insurer
agreement of the contracting parties. shall be entitled to the whole Single Premium.
2. The personal Insurance expires upon the lapsing of the Term of Insurance, i.e. at 7. If the insurance policy is terminated by agreement before the date of the
commencement of the Insurance, the Insurer shall return all received premiums to
24:00 hours on the day agreed as the date of the termination of the Term of the Policyholder minus the costs associated with taking out and administering the
Insurance. Insurance, upon the return of the Insured Person's Card.
3. The personal Insurance expires upon the termination of the insurable interest, on 8. The Insurer is entitled to the premium until the time it learned of the expiry of the
the date when the Insured Person dies, on the date that the legal entity is wound insurable interest.
up without a legal successor or on the date when the Insurer's notification of the 9. If the Policyholder withdraws from the insurance policy, the Insurer shall return to
refusal to pay the Insurance Benefit is received. the Policyholder the received premiums within 30 days of the date of the
4. The Insurer or the Policyholder may terminate the Insurance in writing: withdrawal taking effect less any Insurance Benefits it may have paid under the
a) within two months of the conclusion of the insurance policy. An eight day Insurance; if the Insurer withdraws from the insurance policy, it shall be entitled to
also set off the costs associated with taking out and administering the Insurance. If
notice period shall commence running upon the serving of the termination, the Insurer withdraws from the Insurance, the Policyholder, Insured Person or
with the Insurance terminating upon the expiry of this period, another party who had already received an Insurance Benefit shall reimburse the
b) within three months of the serving of the notification of the Insured Event. A Insurer within this same time period the amount of the Insurance Benefit received
one month notice period shall commence running upon the serving of the that is surplus to the received premiums.
termination, with the Insurance terminating upon the expiry of this period. 10. If the Policyholder withdraws from the insurance policy according to paragraph 7 of
5. The Policyholder may terminate the Insurance subject to an eight day notice Article 12, the Insurer shall return to the Policyholder the received premiums
period: without undue delay, but not later than 30 days from the date of the withdrawal
a) within two months of learning that the Insurer applied a viewpoint contrary to taking effect; in so doing, the Insurer shall be entitled to deduct any Insurance
the principle of equal treatment in determining the amount of the premium or Benefit it had already paid under the Insurance. However, if the amount of
for calculating the Insurance Benefit, Insurance Benefit paid exceeds the amount of premiums received, the
b) within one month of receiving notification of the transfer of the insurance Policyholder, or the Insured Person or the beneficiary in the event of the Insured
portfolio or part thereof or the transformation of the Insurer, Person's death, as the case may be, shall be obliged to pay the Insurer the
c) within one month of the publishing of the notification that the licence enabling amount of the Insurance Benefit paid that is surplus to the premiums received.
the Insurer to carry on its insurance business has been withdrawn. 11. The Insurer will set off its outstanding premiums in the order in which they were
6. If the Policyholder or the Insured Person breaches the duty stipulated in paragraph created rather than in the order in which reminder letters were sent.
1 or 2 of Article 17, either intentionally or through negligence, the Insurer shall be
entitled to withdraw from the insurance policy if it can prove that it would not have Art. 14
concluded the insurance policy had the questions been answered truthfully and Rights and Obligations of the Insurer
completely. The Policyholder shall be entitled to withdraw from the insurance 1. The Insurer is entitled to verify the submitted documents, to demand the
policy if the Insurer breached the duty stipulated in paragraph 7 or 8 of Article 14. submission of expert reports and/or to consult complicated Loss Events with
The right to withdraw from the insurance policy shall expire if not exercised by a healthcare providers or other competent entities, even abroad.
party within two months of the day that it learned or ought to have learned of a 2. The Insurer shall issue the Insurance Certificate and the Insured Person's Card for
breach of the duty stipulated in paragraph 1 or 2 of Article 17 or in paragraph 7 or every Insured Person to the Policyholder after the conclusion of the insurance
8 of Article 14. policy and payment of the premium. The validity of every Insured Person's Card
7. If the insurance policy was taken out for a period in excess of one month and shall always be for the period for which the premium was paid.
concluded by means of a remote transaction, the Policyholder shall be entitled to 3. If the event of the loss, damage or destruction of a valid Insurance Certificate, the
withdraw from the policy, without giving any reason, within 14 days of its Insurer shall issue a duplicate thereof to the Policyholder at the Policyholder's
conclusion or of the date on which the terms and conditions were communicated request; the same applies to the issue of a copy of the insurance policy concluded
to him, if such communication first occurs only upon his request after the in writing and the Insured Person's Card. The Insurer may make the issue of such
conclusion of the policy. a duplicate conditional on the payment of the costs it has incurred to do so.
8. The insurance policy may, in exceptional cases, be terminated by a written 4. The Insurer shall notify the Interested Party information about the Insurer and the
agreement of the contracting parties under the agreed conditions. Insurance taken out prior to the conclusion of the insurance policy.
9. The insurance policy may be assigned only with the Insurer's consent. 5. The Insurer is also obliged to accept the payment of outstanding premiums and
10. If Insurance of another party's insurable risk is concluded, then the Insured Person other outstanding receivables under the Insurance from the Policyholder's
shall take the place of the Policyholder on the date of the Policyholder's death or pledgee, from a Beneficiary or from the Insured Person.
the date of it being wound up without a legal successor; however, if the Insured 6. Within the Duration of the Insurance, the Insurer shall provide information to the
Person gives written notice to the Insurer within thirty days of the Policyholder's Policyholder at his address stipulated in the insurance policy or via the Insurer's
death or winding up that he/she is not interested in the Insurance, the Insurance web site. If the correspondence address is different from the address of the
shall expire on the date of the Policyholder's death or winding up. The effects of a registered office or residential address, then it is designated as the
delay shall not impact the Insured Person before the expiration of 15 days from the correspondence address. The address may also be an address designated for
date that the Insured Person learned of his entry into the Insurance. electronic communication.
However, if there is more than one Insured Person, the Insurance of all such 7. If the Insurer ought to be aware of the inconsistencies between the Insurance
parties shall terminate upon the expiry of the period in respect of which a premium being offered and the Interested Party's requirements when concluding the
was paid. insurance policy, it shall alert the Interested Party of them. In so doing, the
11. If the Insurer issues the Policyholder with a notice reminding it to pay the premium circumstances and the manner in which the insurance policy is concluded, as well
and, as part of this reminder notice, and instructs the Policyholder that the as whether the other contracting party is being assisted in the conclusion of the
Insurance shall expire if the premium is not paid during the additional period, the policy by an agent independent of the insurer shall be taken into account.
Insurance shall expire upon the futile passing of this period. 8. If the Insurer asks the Interested Party or the Policyholder in writing whilst
12. The Insurance does not expire due to the termination of the Insured Person's negotiating the conclusion of the insurance policy about facts pertaining to the
residence at the Place of Insurance prior to the expiry of the Term of Insurance. Insurance, the Insurer shall answer these questions truthfully and completely.
13. The insurance policy terminates upon the expiry of all Insurances of all persons. 9. If the Policyholder asks the Insurer in writing to provide him with information that is
material for rendering benefits under the policy, the Insurer shall provide such
Art. 13 information in writing without undue delay.
Premium
1. The Premium is the consideration for the Insurance cover provided. The amount of Art. 15
the premium is determined by the Insurer for the insurance policy. The premium is Obligations of the Policyholder
arranged as a Single Premium. The Policyholder has the following obligations:
2. The Premium is payable on the date of the conclusion of the insurance policy in 1. To pay the Insurance premium to the Insurer.
the currency and the amount stated in the insurance policy. 2. To inform all Insured Persons, in a timely manner, of the contents of the insurance
3. The premium shall be considered as duly paid if demonstrably received by the policy, including all annexes and parts thereof, and provide them with all materials
Insurer's agent or credited to the Insurer's bank account. and information which it has received on their behalf from the Insurer.
4. The Insurer is entitled to the premium for the entire Duration of the Insurance. The 3. To inform every Insurer without undue delay in the event of Multiple Insurance
Insurer acquires this right on the date on which the insurance policy is concluded. occurring, providing details of the other insurers and the Insurance Benefit limits
5. If the Insurance is terminated as a consequence of the Policyholder's termination, agreed in the other insurance policies.
the Insurer shall return to the Policyholder, after calculating the total Insurance 4. To inform the Insurer without undue delay of a change in correspondence address.
Benefit paid, but not later than 3 months from the date of the Insurance expiring,
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5. Always return the Insured Person's Card to the Insurer within five calendar days of ZZPC_PP_1/22_ENG
the expiration of the Insurance, if the Insurance expires before the end of the
agreed Insurance Period. b) a detailed specification of the subject of compensation (e.g. a medical
report with the diagnosis, description and date of the procedures
6. If the Policyholder is also the Insured Person, all the obligations of the Insured performed and the medicine administered,
Person shall apply to the Policyholder as well.
c) the subject of the requested payment (e.g. bills or invoices issued by a
Art. 16 doctor or bills issued by a pharmacy on the basis of a prescription issued
Obligations of the Insured Person by the attending doctor) and detailing the date and amount of the
The Insured Person has the following obligations: payment (e.g. receipts on a cash payment, account statements),
1. to turn to the Insurer's assistance service provider in a Loss Event, always and
without delay, if his/her state of health permits, and follow its instructions. This B) in the case of Insurance Benefits for Outpatient Medicine prescribed by a
obligation may also be fulfilled by another person. doctor, also copies of the prescriptions made out in the name of the
2. to always identify himself by showing a valid Insured Person's Card to the Insured Person, specifying the date of issue, the quantity and description of
healthcare provider. This obligation may also be fulfilled by another person. the medicine and healthcare aids, and the signature and/or stamp of the
3. do everything to avert the occurrence of an Insured Event and to reduce the extent issuer,
of their consequences,
4. release the healthcare provider in writing, at the request of the Insurer, from its C) for an Insured Event investigated by the police, also a police report or
obligation to maintain confidentiality and provide the Insurer with written confirmation of the investigation of an accident,
authorisation to obtain information from healthcare staff which is subject to the
obligation to maintain confidentiality and which is required for the Insurer's D) in the case of the death of the Insured Person, also a copy of an official
investigations if any Loss Event has occurred, death certificate and medical certification of the cause of death.
5. To undergo treatment or necessary medical examinations by a doctor designated
by the Insurer or by the do everything to avert the occurrence of an Insured Event 6. The parties to the Insurance submit copies of documents to the Insurer, or
and to reduce the extent of their consequences, originals upon the Insurer’s request.
6. always follow the instructions of the attending doctor, All documents must be made out in the name of the Insured Person and must
7. to abide by the safety measures for the Duration of the Insurance, contain the date of issue and also the signature and stamp of the issuer, if
8. to use suitable protective aids and equipment required for the maximum safe prescribed on the document.
performance of all activities performed,
9. to have the appropriate valid licences for the performance of all activities carried 7. The Insurer shall commence investigations necessary to ascertain the existence and
out at the Place of Insurance, extent of its duty to perform without undue delay of the receipt of the notification
10. to arrange for proper supervision or escort, should this be usual for the performed under paragraph 5 of this article. The investigations shall be deemed as duly
activity, concluded upon the reporting of their outcome to the person who exercised the
11. to refrain from standing in places designated as inappropriate by the organiser, claim to the Insurance Benefit; at the request of this person, the Insurer shall
12. to comply with the legislation in force at the Place of insurance, justify the amount of the Insurance Benefit in writing, or the reason for this claim
13. to seek out medical treatment, should the need arise, being refused, as the case may be.
14. if the state of health of the Insured Person permits, undergo repatriation at the
proposal of the Insurer or the Insurer's assistance service provider. 8. If the notification contains knowingly false or grossly distorted material information
15. In the event that he/she is required, on rare occasions, to participate directly in the pertaining to the extent of the notified event, or if information pertaining to this
settlement of the loss that is the Insured Event: event has been knowingly concealed therein, the Insurer shall be entitled to
a) pay reasonable and demonstrable costs to the authorised recipient (the compensation for the costs it purposefully incurred in investigating the facts in
healthcare provider), regards to which this information was given to or concealed from him. It is
b) collect the originals of the required documents and to store them safely until understood that the demonstrable costs of the Insurer were incurred purposefully.
their submission to the Insurer,
c) submit the required documents to the Insurer without undue delay. 9. If the Policyholder, the Insured Person or another party exercising a claim to the
Insurance Benefit causes investigation costs or an increase therein by breaching a
Art. 17 duty, the Insurer shall be entitled to claim reasonable compensation from such a
Other Rights and Obligations of the Parties person.
to the Insurance 10. The Policyholder and the Insured Person are obliged:
1. If the Insurer asks the Interested Party in writing whilst negotiating the conclusion a) to notify the Insurer in writing without undue delay at any time within the
Duration of the Insurance of a change of any and all particulars made in the
of the insurance policy or asks the Policyholder in writing whilst negotiating the insurance policy,
amendment of the insurance policy about facts that are relevant to the Insurer's b) to enable the Insurer to conduct investigations into the causes of the Loss
decision on evaluating the insurance risk, whether it will insure them and under Event and the extent of their consequences and to co-operate with the Insurer
what conditions, the Interested Party or the Policyholder shall answer these as required,
questions truthfully and completely. The duty shall be deemed to have been duly c) to notify the Insurer the details of all insurance policies valid at the time of the
met if nothing material had been concealed as part of the answer. Loss Event occurring, the subject of which is insurance of the same Insured
2. The provisions contained in paragraph 1 of this article regarding to the duty of the Peril.
Policyholder shall also apply to the Insured Person.
3. Should an event occur with which the person who considers him/herself to be a 11. The parties to the Insurance must not assign a claim for Insurance Benefit under
Beneficiary links his/her claim to an Insurance Benefit, he/she shall notify this fact the Insurance without the Insurer‘s consent.
to the Insurer without undue delay, give the Insurer a truthful explanation of the
cause, the origin and the extent of the consequences of such an event, the rights Art. 18
of third parties and any Multiple Insurance; at the same time, he/she shall also Delivery of Documents
submit to the Insurer the required documents (e.g. the Insured Person’s medical 1. Correspondence delivered via the holder of a postal licence (hereinafter the "post
documentation) and proceed in the manner agreed in the insurance policy. If this office") shall be sent:
person is not simultaneously the Policyholder or the Insured Person, the a) to the Insurer at the address of the registered office stated in the insurance
Policyholder and the Insured Person shall also have these duties. policy, or another address that is communicated to the Policyholder by the
4. The same notification may be made by any person with a legal interest in the Insurer;
Insurance Benefit. b) by the Insurer to the correspondence address of the relevant person
5. The notification under paragraph 3 and 4 of this article shall be deemed as having (addressee) stated in the insurance policy or otherwise notified to the Insurer.
been received after the Insurer: If the correspondence address is not stated in the insurance policy or
I.) was notified of the event via the Insurer's form, which has been duly subsequently notified to the Insurer, the correspondence will be sent to the
address stated in the policy or notified to the Insurer as the residence or
completed and delivered to the Insurer, permanent residence, or the registered office of such a person.
II.) was handed all the required documents or documents requested by the 2. Unless agreed otherwise, correspondence may also be delivered electronically (for
example, via a data box, the Insurer's internet app, by e-mail) to the contact
Insurer. information provided for the purpose of electronic communication.
The required documents are: Correspondence sent by the Insurer electronically to the last contact address
A) documents demonstrating: provided by the addressee shall be deemed as delivered on the third business day
after its sending, if the date of its delivery cannot be ascertained or if the relevant
a) the cause, time, place and circumstances of the occurrence of the legal regulations do not stipulate otherwise.
Insured Event, its extent and the direct connection of the Insured Event 3. Correspondence may also be delivered by an employee of the Insurer or another
with the Insured Person, at least detailing the first name, surname and person authorised by the Insurer, especially to the addresses pursuant to
date of birth of the Insured Person, paragraph 1 b), but also to any other place where the addressee will be willing to
accept the correspondence. The correspondence thus delivered shall be deemed
as delivered on the day of its receipt.
4. The parties to the Insurance are obliged to notify the Insurer without undue delay
of any change in the facts relevant to the delivery and to notify each other of their
new postal address, e-mail address or data box or telephone number.
5. If not a case of the delivery pursuant to paragraphs 6 to 8, correspondence sent by
the Insurer by registered post with an advice of delivery shall be deemed as
delivered on the day specified as the day of receipt of the correspondence on the
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advice of delivery, with correspondence sent by the Insurer by registered post ZZPC_PP_1/22_ENG
without an advice of delivery, or sent by regular mail, being deemed as delivered
on the third business day after dispatch, and in the case of delivery to an address Art. 21
in a country other than the Czech Republic, on the 15th business day after Assignment of Rights to the Insurer
dispatch. 1. If a person entitled to the Insurance Benefit, the Insured or a person incurring
6. If the addressee deliberately thwarts the delivery of correspondence, it shall be rescue costs, became entitled to compensation from another party for a loss or
deemed to have been duly delivered on the day that its receipt was thwarted by another similar right in connection with an Insured Event which is imminent or has
the addressee. already occurred, this claim, including appurtenances, security and other rights
7. If the addressee thwarts the delivery of correspondence by failing to take delivery connected therewith, shall pass to the Insurer upon the payment of the Insurance
of the correspondence. Benefit, up to the amount of the benefits rendered by the Insurer to the
8. If the addressee thwarts the receipt of correspondence in another manner, e.g. by Beneficiary. The above shall not apply if this person became entitled to this right
failing to take delivery of this correspondence or by failing to mark his/her/its letter against someone with whom he/she lives in a joint household or is dependent on
box by his/her first name and surname or company name, it shall be deemed to him/her, unless he/she caused the Insured Event intentionally.
have been duly delivered on the date on which it was returned to the insurer. 2. The person whose right passed to the Insurer shall release the required
9. Correspondence sent by the Insurer by registered post or registered post with an documents to the Insurer and disclose it all that is necessary in order to exercise
advice of delivery shall be deemed duly delivered even in the case that they are the claim. Should this person thwart the passing of this right to the Insurer, the
received by another person in place of the addressee (e.g. a family member), to Insurer shall be entitled to reduce the benefits under the Insurance by the amount
whom the post office delivered the correspondence in accordance with the legal it could otherwise have received. If the Insurer has already rendered benefits, it
regulations pertaining to postal services. shall be entitled to compensation up to this amount.
3. The Beneficiary is obliged to take measures to ensure that the right to
Art. 19 compensation which pass to the Insurer under the law do not expire or become
Form of Legal Acts stature-barred.
1. The insurance policy must be concluded in writing, unless the Civil Code provides 4. The Beneficiary must not enter into an agreement with a third party to relinquish a
otherwise. claim for compensation against this third party if such claims pass to the Insurer.
2. In the event that the Policyholder‘s acceptance of the offer is found to be invalid 5. The Beneficiary is obliged to confirm the assignment of rights to the Insurer in
due to a failure to accept the offer in writing or for any other reason, and the writing upon the Insurer's request.
Policyholder pays the first premium or an instalment thereof in the amount and 6. If, in connection with the exercise of the claim, the Insurer incurs additional costs
within the time period specified in the offer (if no time period is stated in the offer, due to the fault of the Beneficiary, then the Insurer is entitled to require the
then within one month of the delivery of the offer), the offer shall be deemed to Beneficiary to pay such costs
have been received by virtue of the payment of this first premium or an instalment
thereof. Art. 22
3. Legal acts, notices, and requests must be made in writing if they have an affect Assistance Services
on: 1. The assistance services are services provided to the Insured Person in connection
a) the duration and termination of the insurance, with the Medical Insurance taken out and are arranged for by the Insurer's
b) changes in the premium, contractual organisation. Assistance services are provided 24 hours a day 7 days
c) changes in the scope of the insurance. a week. Contact details for the provider of the assistance services are contained in
4. A legal act, for which a written form is required, shall be valid, in particular, where the Insured Person's Card.
it is personally signed by the acting person, or where the signature is replaced by 2. The assistance services are provided to the following extent:
a mechanical means, where this is usual, if made by means of a data box, if - recommendation of a contractual healthcare provider,
provided with a guaranteed electronic signature pursuant to a special law, or if it is - arranging admission at a contractual healthcare provider for treatment during
made via the Insurer‘s protected internet client portal. office hours,
5. Legal acts, notices, and requests, not mentioned in paragraph 3. may be made in - arranging for the admittance of the Insured Person into the care of the
writing, over the telephone, by e-mail, via the Insurer‘s internet application or via a Insurer's contractual paediatrician or general practitioner,
data box, if the Insurer permits delivery to a data box. This applies namely to the - recommendation of an appropriate procedure in the case of a Loss Event,
reporting of an Insured Event, notification by the Policyholder or the Insured - monitoring developments in the state of health during the course of
Person pertaining to a change in the surname, residential address, hospitalisation,
correspondence address, and other contact details, as specified in the policy. - provision of a liquidity guarantee to the contractual healthcare provider in the
Legal acts, notices, and requests pursuant to this paragraph, made other than in event of a claim for an Insurance Benefit,
writing must be subsequently supplemented in written form, if the Insurer so - arranging for the repatriation of a client in a medically justified event,
requests. - arranging for a professional companion as part of the repatriation,
6. The insurer is entitled, as regards matters relating to the insurance relationship, - arranging for the transportation of the physical remains in the event of death.
namely in connection with the administration of the Insurance and the settlement
of Insured Events, to contact other parties to the Insurance by electronic or other Art. 23
technical means (e.g. via telephone, SMS, e-mail, fax, data box), unless agreed Final Provisions
otherwise. In electing the form of communication, the Insurer shall take into 1. Representations and notifications with respect to the Insurer are only valid if
account the obligations stipulated by the relevant legal regulations and the nature submitted in writing.
of the information communicated. 2. The language of communication is Czech.
7. Legal acts, notices, and requests shall be effective against the other contracting 3. Persons with restricted legal capacity shall be represented by their guardian. It is
party as soon as they have been received by this party. understood that persons who have yet to attain full legal capacity act with the
consent of their statutory representative or that this statutory representative acts
Art. 20 on their behalf.
Rescue Costs 4. If payment is made in cash, the date of payment is the date the sum is deposited
1. If the Policyholder purposefully incurs costs in averting the immediate threat of an in favour of the recipient. If the payment is not made in cash, the date of payment
Insured Event or to mitigate the consequences of an Insured Event that has is the date the sum is credited to the account of the recipient.
already occurred, it shall be entitled to compensation for these costs from the 5. The Insurer's costs associated with taking out and administering the insurance
Insurer, as well as compensation for the loss suffered by the Policyholder in policy come to 20% of the unearned premium.
connection with this activity. 6. All disputes arising out of or in connection with this Insurance which are not
2. Compensation for rescue costs incurred in order to save lives or the health of resolved by agreement or out-of-court settlement shall be dealt with by any court
persons is limited to 30% of the agreed insured amount or Insurance Benefit limit. having jurisdiction in the Czech Republic in compliance with Czech law.
The amount of compensation for other rescue costs for the Period of Validity of the
insurance policy is limited to CZK 100,000, with the exception of costs incurred by
the Policyholder with the Insurer's consent.
3. Compensation for rescue costs is in excess of the framework of the agreed
Insurance Benefit limit.
4. If the Insured Person or another person incurred rescue costs in excess of the
framework of duties stipulated by law, they shall have the same right to
compensation against the Insurer as the Policyholder.
.
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