IAK Supplementary Health Care Insurances - IAK Verzekeringen

12
Charge for payment via paper payment slip
If the policyholder does not make use of the payment options for which no charge is made, the policyholder will be
sent a paper payment slip, in which case a charge of € 0.50 will apply per payment slip. The policyholder will also be
sent a paper payment slip if a direct debit cannot be executed. In such cases, a charge of € 0.50 per paper payment
slip will also apply.
3.2.2 Direct debit authorisation applies to the payment of premiums, excess, individual contributions and other expenses.
The direct debit of excess, individual contributions and other expenses due is subject to a maximum of € 250.00 per
month. A payment slip will be sent in respect of any amounts over and above € 250.00. There will be no charge to the
policyholder in cases where the health care insurer opts to send a payment slip.
3.3
3.4
3.5
3.5.1
3.5.2
3.5.3
3.5.4
3.5.5
3.5.6
Claim
The policyholder is not permitted to set off the amounts he/she owes against an amount to be received from the
health care insurer.
Death
Should the insured person die, the premium already paid will be refunded from the day after the date on which he or
she died.
Overdue premium payments, statutory contributions and costs
If the policyholder fails to meet the obligation to pay the premium, statutory contributions, excess and costs on time,
the healthcare insurer will send a reminder. If payment is not made within the period named in the reminder (which
period must be at least 14 days), the health care insurer may suspend coverage.
In the event of suspension, there shall be no entitlement to care or reimbursement of care costs, as described in these
policy conditions, from the last premium due date before the reminder or a later date (to be stipulated). The
policyholder will continue to owe the premium for the period of the suspension. Cover will resume from the day
following the date on which the full amount due plus the costs as referred to in clause 3.5.3 have been received by the
health care insurer.
In the event of termination of the insurance contract, a new application for insurance can be submitted following
payment of the amount due and any costs. The insurance will then come into effect on 1 January of the subsequent
calendar year.
The health care insurer can charge the policyholder administration costs, collection charges (both statutory and nonstatutory)
and statutory interest.
If the policyholder has already been sent a reminder regarding failure to pay the premium, statutory contributions,
excess, individual contributions or costs on time and the policyholder then fails to pay a subsequent invoice on time,
the health care insurer shall not be required to send the policyholder a second written reminder.
The health care insurer can set off overdue premium and costs as referred to in paragraph 3.5.3 against claims that
the insured person has submitted and/or any other amounts the health care insurer owes to the insured person.
If the insurance policy is terminated because of a failure to pay the premium on time, the health care insurer can
refuse to conclude a new insurance contract with the policyholder for a period of 5 years.
4 Other obligations
4.1
4.2
Obligations
The policyholder and the insured person are obliged:
• to ask the attending practitioner to disclose the reasons for hospitalization to the health care insurer’s medical
advisor;
• to cooperate with the health care insurer, its medical advisor or those responsible for inspection so that the
information can be acquired that is needed for the proper implementation of the insurance;
• to submit a referral from the attending general practitioner, company doctor or medical specialist, stating that the
care and/or transport being provided is medically necessary, in cases where authorisation is required under the
policy conditions;
• to inform the health care insurer about any facts that might mean that expenses may be recovered from liable (or
potentially liable) third parties, and to provide the health care insurer with the necessary information in this
regard. In this context, the insured person will not make any arrangements with any third parties without the prior
written approval of the health care insurer. The insured person will refrain from any actions that may prejudice the
interests of the health care insurer;
• to inform the health care insurer as soon as possible (but no later than two months after the change has taken
place) of all facts and circumstances that might be relevant to the proper implementation of the insurance. Such
changes include birth, adoption, death or a different bank or giro account number. The health care insurer bears
no risk whatsoever where the policyholder/insured person fails to inform it of the above changes.
If the obligations are not fulfilled, thereby harming the interests of the health care insurer, the health care insurer may
suspend entitlement to the reimbursement of health care costs.
Deadline for submitting declarations
When claiming reimbursement of the costs of care, the policyholder and the insured person must submit the original
invoices within three years of the invoice date. These invoices must be itemised in such a manner that it can be
deduced from them, without further enquiry, which reimbursement the health care insurer is required to make.