Правила страхования

1.      GENERAL PROVISIONS

1.1.        Under the terms of these Rules for voluntary insurance of medical and/or other expenses of persons travelling abroad from the Republic of Kazakhstan (МСТ PREMIUM) (hereinafter referred to as the ‘Rules’) Joint Stock Company Insurance Company ‘NOMAD Insurance’, hereinafter referred to as the “Insurer”, concludes voluntary insurance contracts for medical and/or other expenses of persons travelling abroad from the Republic of Kazakhstan (hereinafter referred to as the ‘Contract’).

1.2.        The following terms are used in these Rules:

1.2.1.  Assistance – a legal entity, which, on the basis of a cooperation agreement with the Insurer, undertakes on behalf of the Insurer to organise, coordinate and control the provision of the Insured Services specified in the Contract within the territory of insurance.

1.2.2.  Close relatives – parents (adoptive parents) of the Insured, spouse in a registered marriage with the Insured, his children, including adopted children, as well as siblings, grandparents, grandchildren;

1.2.3.  Sudden acute illness – an unforeseen change in the Insured's state of health (illness, injury), clinically manifested by damage to organs and/or systems, posing a threat to life and requiring urgent medical attention.

1.2.4.  Beneficiary - a person who, in accordance with the Contract, is the recipient of the insurance payment.

Upon conclusion of the Contract, the Insurant shall have the right to appoint any person to receive insurance payments under the Contract – the Beneficiary – and to replace him/her at his/her discretion before the occurrence of an insured event, by notifying the Insurer in writing.

          The appointment and replacement of the Beneficiary under the Contract is permitted only with the written consent of the Insured.

          The Beneficiary cannot be replaced by another person after he fulfilled any of his obligations under the Contract or submitted a claim for insurance payment to the Insurer. 

          If no beneficiary has been designated in the Contract, in the event of death of the Insured upon the occurrence of the Insured event, the Beneficiary shall be the person who is the heir of the Insured.

1.2.5.   The Insured – an individual entity in respect of whom the Insurant concludes the Insurance Contract. In terms of COVID-19 insurance, this is a person whose age on the date of conclusion of the insurance contract is between 0 and 101 years.

1.2.6.  Medical Institutions of Assistance – institutions that have entered into service agreements with Assistance and provide the Insured with the services specified in the Contract within the territory of insurance on behalf of the Insurer.

1.2.7.  Medical Institutions and/or physicians – medical institutions or employees operating within the territory of insurance coverage, whose services the Insured used independently without referral from Assistance staff.

1.2.8.  Emergency Medical care – urgent medical care provided with the aim of restoring and maintaining vital human bodily functions and preventing further irreversible pathological processes in the body. Emergency medical care includes the relief (removal) of acute pain syndrome.

1.2.9.  Accident – a sudden, short-term event (incident) that occurs against a person's will as a result of external mechanical, electrical, chemical or thermal impact on the body and results in sudden acute illness and/or death of the Insured.

          An accident refers to a sudden, momentary impact of various external factors, the nature, time and place of occurrence of which can be clearly determined: natural disasters, explosions, burns, frostbite, drowning, electric shock, lightning strike, unlawful actions of third parties, animal attacks, snake bites, stinging insects, falling objects or the Insured themselves, as well as injuries sustained while travelling/operating means of transport (aircraft, car, bus, trains, etc.), including boarding and disembarking from means of transport, when using machines and mechanisms.

1.2.10.  Acute exacerbation of a chronic disease - a chronic illness that has acutely manifested itself in the Insured during the period of insurance coverage under the Contract and threatens the life of the Insured, for which the Insured has received treatment in the past, but which, according to the doctor's conclusion, does not prevent the Insured from travelling.

1.2.11.  A trip - a business, tourist, private or other trip organised and undertaken by the Insured, either independently or with the help (through) of relevant travel agencies, travel companies, bureaus, tour operators, host parties (employers, educational institutions), regardless of the form of ownership and legal form of the latter.

1.2.12.  Carrier – an individual or legal person who owns a railway, sea, inland waterway, air or road vehicle, either by right of ownership or on other legal grounds, and who has the right to transport passengers and their property for a fee or hire in accordance with the legislation of the territory of insurance, and who holds a license.

1.2.13.  Assistance staff – medical workers of Assistance or medical institutions of Assistance, representatives of Assistance who carry out activities related to the provision, organisation, coordination and control of the provision of services to Insured as provided for in the Contract, within the territory of insurance on behalf of the Insurer.

1.2.14.  Repatriation - organisation by Assistance of the transportation of the body of the deceased Insured to the international airport in the Republic of Kazakhstan closest to the place of burial or to the country of which the Insured was a citizen during his or her lifetime.

1.2.15.  Country of temporary stay (country of stay) – any country specified in the Insurance Contract and included in the territory of insurance, except for the country of which the Insured is a citizen and/or permanently resides.

1.2.16.  Country of permanent residence - the country or countries that are the primary or secondary place of permanent residence of the Insured.

1.2.17.  The Insurant is the person who has entered into the Contract with the Insurer.

1.2.18.  The Insurer - a legal entity that has obtained a license to conduct insurance activities in the Republic of Kazakhstan in accordance with the procedure established by the legislation of the Republic of Kazakhstan and is obliged, upon the occurrence of an insured event, to make an insurance payment to the Insurant or another person in whose favour the Contract (the Beneficiary), under the terms and within the limits of a specified amount (the sum insured) established by the Contract.

1.2.19.  Insurance payment – the amount of money paid by the Insurer to the Beneficiary within the limits of the sum insured, established by the Contract upon the occurrence of an insured event.

1.2.20.  Insurance premium - the amount of money that the Insurant is obliged to pay to the Insurer for the latter's assumption of obligations to make an insurance payment to the Insurant (the Beneficiary) in the amount specified in the Contract.

1.2.21.  An Insured event – an event upon the occurrence of which the Contract provides for the payment of insurance benefits. An insured event in relation to coronavirus infection is the occurrence, during the term of the Contract and within the territory of insurance, of unforeseen expenses (losses) incurred by the Insured for hospitalisation in connection with COVID-19, caused by SARS-CoV-2 coronavirus infection, diagnosed for the first time during the term of insurance cover.

1.2.22.  Sum Insured – the amount of money for which the insured object is insured, representing the maximum amount of the Insurer's liability in the occurrence of an insured event.

1.2.23.  Insurance territory – the country of temporary stay or other specifically designated territory specified in the Contract.

1.2.24.  Increased risk – an increase in the probability of an insured event occurring due to circumstances that directly influence such an increase (change in the territory of insurance, change in the purpose of the trip, change in the dates of the trip, diagnosis of diseases/conditions in the Insured for which these Rules provide for refusal of insurance payment, etc.);

1.2.25.  Units of account – the currency unit in which the Sum Insured under the Insurance Contract is determined.

1.2.26.  Franchise – exemption of the Insurer from compensation for damage not exceeding a certain amount, as provided for by the terms of insurance. Franchise can be conditional (non-deductible) and unconditional (deductible).

With a conditional deductible, the Insurer is exempt from compensating for damage not exceeding the established amount of the deductible, but must compensate for the damage in full if its amount exceeds this amount.

With an unconditional deductible, damages are compensated in all cases minus the established amount.

The deductible is established as a percentage of the insured amount or as an absolute amount.

1.2.27.  Chronic diseases are diseases that have at least two of the following characteristics:

§  There are no known recognizable methods of treatment;

§  They can exist for an indefinite period of time;

§  There are relapses, or there is a possibility of relapses;

§  They are permanent in nature;

§  Requires palliative care;

§  Requires long-term monitoring, consultations, examinations, tests or analyses;

§  The person must undergo rehabilitation or special training in order to cope with the disease.

1.2.28.  Evacuation - organisation by Assistance of the Insured's departure from the territory of insurance to the Republic of Kazakhstan or the country of which the Insured is a citizen, if the Insured, on the basis of the instructions of qualified Assistance staff in connection with a sudden worsening of health condition, was forced to extend their stay in the territory of insurance or return early and was unable to use their return ticket.

1.2.29.  Evacuation of insured children under the age of 16 in the event of hospitalisation/death of the Insured– organisation by Assistance of the departure of children under the age of 16 to the Republic of Kazakhstan or to the country of permanent residence of the child, in the event of hospitalisation/death of the Insured in the territory of insurance during the period of insurance coverage under the Insurance Contract.

1.2.30.  Emergency medical transport - emergency transport of the Insured to a medical facility within the territory of insurance on the recommendation of Assistance staff, associated with a sudden worsening of the Insured’s health and the need for medical care in outpatient/inpatient settings.

1.2.31.  Emergency hospitalisation - hospitalisation in a medical facility within the territory of insurance due to a sudden deterioration in health that poses a threat to the life of the Insured and requires medical care in a hospital setting.

1.2.32.  Internet resource – an electronic information resource displayed in text, graphic, audiovisual or other form, hosted on a hardware and software complex with a unique network address and/or domain name and operating on the Internet. The Company's Internet resource is used to exchange electronic information resources between the Insurant (insured, beneficiary) and the Company.

1.2.33.  COVID-19 – a potentially severe acute respiratory infection caused by the SARS-CoV-2 (2019-nCoV) coronavirus.

1.2.34.  Public transport - a public transport system that provides regular passenger transport services on fixed routes and schedules, accessible to the general public for a fee (buses, trams, underground, trolleybuses, as well as taxis, motorcycle taxis, rickshaws and ferries).

1.3.       The Insurants under the Contract may be legally capable individuals (regardless of citizenship) and legal entities (regardless of ownership form) who have an interest in reimbursement of expenses incurred as a result of sudden acute illness, accident and/or death of the Insured within the territory of insurance.

1.4.       Individuals aged from birth to 101 years old may be insured under the Contract. At the same time, at the end of the insurance period, the age of the Insured must not exceed 101 years.

1.5.       The Insurer shall have the right to refuse to conclude the Contract with the Insured or in relation to a person falling into one of the following categories at the time of conclusion of the Contract:

1)       individuals over 101 years of age;

2)       persons who, at the time of conclusion of the Contract, have been recognised as disabled, have had their degree of loss of working capacity (total or partial) (general or professional) determined and/or have been diagnosed with an occupational disease;

3)       persons who use/have used drugs; persons who use/have used toxic substances for the purpose of toxic intoxication; persons who suffer/have suffered from alcoholism;

4)       persons with persistent nervous and mental disorders who are/have been registered for this reason at a psychoneurological dispensary;

5)       persons who have suffered injuries or had/have illnesses or their consequences resulting from alcohol, narcotic or psychotropic intoxication (of any degree);

6)       persons who have deliberately caused bodily harm to themselves, including attempted suicide;

7)       persons who have suffered injuries or have had/have diseases or their consequences arising in connection with mental illnesses, epilepsy, degenerative-dystrophic and demyelinating diseases of the nervous system;

8)       persons travelling abroad from the Republic of Kazakhstan for the purpose of receiving any type of treatment, including preventive treatment in sanatoriums, clinics, health resort and other sanatorium-type organisations;

9)       persons who are in the intended territory of insurance at the time of conclusion of the contract.

1.6.       By signing the contract, the Insurant confirms that the Insured/Beneficiary has consented to the transfer of their personal data to the Insurer and Assistance for the performance of the insurance contract, and also gives their consent to the transfer of information about the Insured, Beneficiary relating to insurance secrecy in accordance with Article 830 of the Civil Code of the Republic of Kazakhstan to the Assistance Service for the performance of the Insurer's obligations under the insurance contract.

2.      INSURANCE OBJECT

2.1        The object of insurance shall be the property interests of the Insurant (the Insured), not contrary to the legislation of the Republic of Kazakhstan, related to additional unforeseen expenses (losses) incurred by the Insured as a result of:

2.1.1. a sudden acute illness or an accident of the Insured within the territory of insurance as provided for by these Rules.

3.      INSURANCE EVENT

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3.1 An Insurance event is the occurrence, during the term of the Contract and within the territory of insurance, of unforeseen expenses (losses) incurred by the Insured as a result of a sudden acute disease or accident.

3.2 An insured event in relation to coronavirus infection is a disease caused by COVID-19 coronavirus infection, diagnosed for the first time during the period of insurance coverage, which led to the hospitalisation of the Insured during the period of insurance coverage, if the COVID-19 risk is selected and additionally paid for in the contract.

4.      COVERED EXPENSES IN CASE OF AN INSURED EVENT:

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4.1 Expenses for emergency medical care, namely:

1)  expenses for visits and consultations with medical specialists, medical examinations necessary to establish and/or confirm a diagnosis;

2)  expenses for emergency hospitalization (no more than 10 days) in a standard ward, including consultations, examinations, in-hospital monitoring and care, surgical and/or medical treatment of the Insured;

3)  isolation of the Insured Person at the place of temporary residence in the insurance territory in case of acute infectious disease requiring isolation of the Insured Person by doctor’s instructions, not for more than 7 days, at a cost not exceeding 100 u.a. per day.

-  additionally, within the Schengen area: if the additional ‘COVID-19’ risk is paid for, expenses for up to 5 (five) days of hospitalisation for urgent/emergency medical care with the main diagnosis of ‘COVID-19’, but not more than 5,000 (five thousand) euros for the entire insurance period.

4.2 Expenses for emergency dental care in an amount not exceeding the limit of 500 u.a.[1] at the exchange rate of the National Bank of the Republic of Kazakhstan on the date of the insured event), as follows:

1)  expenses related to pain in the tooth and surrounding soft tissues: therapeutic treatment, anesthesia, removal;

2)  expenses related to the treatment of purulent-inflammatory processes in the oral cavity: anesthesia, incision, drainage, stopping bleeding;

3)  expenses related to acute pain in a tooth and surrounding soft tissues as a result of traumatic injury in an accident;

     The following are also excluded and not covered by the Insurer: orthodontics, cosmetology, prosthetics, dental implantation and preparation for it, neoplasms in the oral cavity of various origins.

4.3 Expenses for transportation/evacuation of the Insured organised by Assistance, in particular:

1)   expenses for emergency medical transportation of the Insured, as recommended by Assistance staff, from the place where the insured event occurred to the nearest medical facility or doctor within the territory of insurance and back to the place of temporary residence.

· From remote, hard-to-reach mountain regions, evacuation by helicopter is covered only in the event of an injury for which emergency medical assistance cannot be provided at the site of the incident (if the purpose of travel/category selected in the Contract is ‘Sport’).

2)  the cost of transporting the Insured from the hospital to the nearest international airport within the territory of insurance for further independent return to the Republic of Kazakhstan or to the country of which the Insured is a citizen. The need for transportation is determined by Assistance doctors.

3)  expenses for medical evacuation of the Insured (in accordance with the doctor's instructions) to the Republic of Kazakhstan or to the country of which the Insured is a citizen, to the nearest international airport in the Republic of Kazakhstan or in the country of which the Insured is a citizen:

4)  expenses for the accompaniment of the Insured by medical personnel at a cost not exceeding 500 u.a.

Insurer shall pay the travel expenses for the accompaniment of the Insured by non-medical or medical personnel, not exceeding the cost of economy class return air tickets, and the accompanying person's accommodation and meal expenses for a period not exceeding 3 (three) days, but not exceeding the amount in tenge equivalent to 500 (five hundred) US dollars/euros. All reimbursable expenses related to the insured event, including the expenses of the accompanying person, may not exceed the total sum insured for the Insured under the Contract.

5)      The Insurer shall cover evacuation expenses in the following cases:

·    if the Insured, on the basis of instructions from qualified Assistance staff, due to a sudden deterioration of health condition caused by an insured event, was forced either to extend the stay within the territory of insurance or to return earlier and was unable to use the return ticket;

·    provided that the Assistance staff of the 24-hour dispatching service indicated in the insurance contract are notified of the necessity to exchange/return tickets, and all required documentation is submitted to the Assistance staff for the exchange/return of tickets (passport, tickets, and other documents);

·    if the evacuation of the Insured is organized through the Assistance.

6) The choice of transport and the conditions of transport/evacuation shall be made by the Insurer based on the recommendations and instructions of medical professionals in the country of stay.

7) If Assistance's qualified staff decide that evacuation of the Insured is possible, but the Insured refuses (verbally or in writing) to return, the costs of further outpatient treatment/hospitalisation, as well as the costs associated with subsequent return to the country of which the Insured is a citizen, shall not be covered by the Insurer.

4.4 Expenses for repatriation of the Insured's body to the Republic of Kazakhstan or to the country of which the Insured was a citizen during his/her lifetime, namely:

1)       Expenses for a coffin/urn for cremation that meets international transport requirements;

2)       Expenses related to the organisation, storage, cremation and transportation of the Insured's remains to the international airport in the Republic of Kazakhstan closest to the place of burial or to the country of which the Insured was a citizen during his/her lifetime.

3)       Repatriation expenses are covered only if repatriation is organised through Assistance. Repatriation of the Insured's body organised independently by the Insured's relatives or any other persons without the involvement of Assistance and/or written agreement with the Insurer is not covered;

4)       Within the territory of the Kingdom of Thailand, repatriation of the Insured shall be carried out within the limit of USD 90,000, subject to the selection of additional risk in the INSY Travel / CRM system.

4.5 Evacuation of insured children under the age of 16 to the Republic of Kazakhstan or to their country of permanent residence/citizenship in the event of hospitalisation/death of the Insured (parent/guardian/authorised representative):

1)       Expenses for the evacuation of insured children under the age of 16 to the Republic of Kazakhstan or to their country of permanent residence/citizenship in the event of hospitalisation and/or death of the insured parent/guardian/authorised person in the territory of insurance, provided that the insured child is left alone in the territory of insurance without care. The insurer shall cover the cost of economy class airfare for each child from the airport at their location (the airport closest to their location) to the airport in the city of the Republic of Kazakhstan (or the country in which the child permanently resides/has citizenship) closest to the settlement in which the child resides.

2)       The insurer reserves the right to return the ticket to the carrier and receive compensation or exchange the ticket with the carrier for an earlier or later date for the purpose of evacuating the children.

3)       The expenses for the evacuation to the Republic of Kazakhstan of insured minor children located in the territory of insurance shall be covered by the Insurer only if the evacuation is organised through Assistance. The evacuation of children under the age of 16 organised independently by relatives of the Insured or any other persons without the participation of Assistance and written agreement with the Insurer shall not be paid for by the Insurer.

4.6 Expenses for obtaining legal and administrative assistance:

1)  Expenses for obtaining legal assistance related to organising and paying for assistance to the Insured in initiating proceedings to protect their rights if the accident occurred through the fault of a third party:

Payment shall be made only if the assistance is organised through the Assistance. Assistance arranged independently, either by close relatives of the Insured or by any other persons, without the involvement of the Assistance and/or without the Insurer’s prior consent, shall not be covered.

2)  Expenses for obtaining administrative assistance related to the issuance of duplicates of lost documents (passport, visa, ticket) and their delivery to the Insured within the territory of insurance. Payment shall be made to the Assistance or to the Beneficiary under the Contract in accordance with Section 10 of these Rules;

3)  Expenses for the payment of 2 (two) telephone calls of the Insurant (the Insured) to the telephone numbers of the 24-hour dispatching service of the Assistance specified in the Insurance Contract and related to the insured event. Payment shall be made to the Beneficiary under the Contract in accordance with Section 10 of these Rules.

5.      SUM INSURED. FRANCHISE. INSURANCE PREMIUM.

5.1.         Sum insured – the maximum amount of money specified in the Contract within which the Insurer is liable for the performance of its obligations and on the basis of which the amount of the insurance premium and the maximum amount of the Insurer's obligations under the Contract are determined.

5.1.1. In addition to the total sum insured, sums insured are established for a separate risk (type of service) or group of risks (several types of services).

5.1.2.

5.1.2. .1.1. на рорудование и средстварачаIf the costs of the services provided for in the Insurance Contract exceed the established sum insured and/or the sum insured for a separate risk/group of risks, the Insurant (Insured) shall independently cover the portion of the costs exceeding the sum insured or the sum insured for a separate risk/group of risks.

5.2.         Franchise – exemption of the Insurer from compensation for damage not exceeding a certain amount.

5.2.1. The franchise is established and its amount is determined by agreement of the parties upon conclusion of the Contract. The amount of the franchise may be expressed as a percentage of the sum insured or as an absolute value. The franchise may be provided for both for the entire package of risks and separately for certain risks.

5.2.2. Unless otherwise specified in the Contract, for Insured over 65 (sixty-five) years of age, an unconditional deductible of 10% (ten) percent is automatically applied to any insured event from the amount of expenses claimed for reimbursement incurred by the Insurant/Insured under the terms of the insurance.

a) When receiving services through Assistance, Insureds over 65 (sixty-five) years of age shall independently pay 10% (ten) percent of the cost of the services provided for in this Contract.

b) In cases where the insurance payment is made by paying for services and expenses directly to the Assistance, which organises the provision of these services, part of the cost of the services provided, in an amount equal to the deductible established in the Insurance Contract, shall be paid by the Insured (the Insured) upon receipt (provision) of the services, or to the Insurer within 15 (fifteen) calendar days after the event is recognised as an insured event and receipt of notification of payment for the services provided.

5.3.         Insurance premium - the amount of money that the Insurant is obliged to pay to the Insurer for the latter's assumption of obligations to make an insurance payment to the Insurant (Beneficiary) in the amount specified in the Contract.

5.3.1.    The insurance premium shall be calculated by the Insurer for the entire term of insurance, based on the risks subject to insurance, the sum insured, the basic tariff rates and the corrective ratio thereto (increasing and decreasing) (Annex No. 1 to these Rules), taking into account the specific conditions of insurance: the age of the Insured, the number of persons insured under the Insurance Contract, the purpose of travel, the duration of travel, the Insured’s participation in various sports, and other factors materially affecting the determination of the degree of risk.

           The decision to apply increasing or decreasing coefficients to the base tariff rates is made by the Insurer independently and individually in each case.

5.3.2.    The insurance premium under the Insurance Contract shall be paid by the insurant in a lump sum, as a one-time payment for the entire term of insurance. The insurance premium shall be paid no later than the effective date of the Insurance Contract, unless otherwise specified in the terms and conditions of the Insurance Contract.

5.3.3.    In the event of failure to pay the insurance premium within the period specified in the terms and conditions of the Contract, the Insurance Contract shall be deemed not to have entered into force, and the Insurer shall be released from the obligation to make insurance payments.

5.3.4.    The date of payment of the insurance premium (insurance contribution) shall be deemed to be the date on which the funds are credited to the Insurer's bank account or cash desk.

6.      THE PROCEDURE FOR CONCLUDING A CONTRACT

6.                          

6.1.                             The basis for concluding the Contract is a verbal or written statement by the Insurant.

6.2.      When concluding the Contract, the insurant shall inform the Insurer of all circumstances known to the insurant (Insured) that are material to determining the probability of an insured event occurring and the amount of possible losses from its occurrence, if these circumstances are not known and should not be known to the Insurer.

6.3.      The contract is concluded without prior medical examination of the Insured. At the Insurer's request, the Insured must complete a questionnaire in the form (application form) provided by the Insurer.

6.4.      The information received by the Insurer as a result of the health check is strictly confidential. However, the Insurer has the right to transfer data about the Insured to the reinsurer or another insurer to the extent necessary to assess the degree of risk and to formalise a reinsurance contract. The transfer of data about the Insured to the Assistance is permitted only to the extent necessary for insurance purposes.

6.5.      The contract shall be concluded in writing by drawing up and signing by the parties an insurance contract or by the Insurant acceding to the standard insurance terms and conditions provided for by the legislative acts of the Republic of Kazakhstan, or the Insurance Rules developed by the Insurer unilaterally (accession contract), and by the Insurer issuing an insurance policy to the Insurant.

6.6.      In order to conclude the Contract, the Insurer may request additional documents characterising the degree of insurance risk.

6.7.      The Insurer has the right to refuse to conclude the Insurance Contract with the Insurant without providing any reasons.

6.8.      Persons over 60 years of age are not subject to insurance under the COVID-19 option, unless otherwise specified in the Insurance Contract. (If the purpose of travel/category “COVID” is selected in the Contract, and the above-mentioned risks are covered by an additional insurance premium with an adjustment coefficient applied, the age limit is 101 years.)

6.9.      When the insurance product is distributed through the Insurer’s online resource or that of its partner:

1)  The Insurant shall complete the data in the electronic application form;

2)  The Insurance Policy shall be concluded by the Insurant’s accession to these Rules. The issuance of the Insurance Policy shall be carried out in two ways:

a)   at the location of the person distributing this insurance product, by issuing the Insurance Policy to the Insurant; or

b) through the official online resource of the Insurer or its partners, by issuing an electronic Insurance Policy and sending it to the email address of the Insurant specified by him/her when entering the data on the Insurer’s or its partner’s online resource.

6.10. Prior to concluding the Insurance Policy, the Insurant must notify the Insurer in writing:

a)   if he (the Insurant) is a public official, his spouse and/or close relative.

b) if the beneficial owner is another person (not the Insurant).

7.      THE TERM AND PLACE OF VALIDALITY OF THE CONTRACT

7.            

7.1.            The Contract shall enter into force on the date specified therein.

7.2.      The Contract shall be concluded for a specific trip (journey, tour, excursion, business trip, etc.) on the basis of an oral or written application for insurance. If the application for insurance is submitted in writing, the standard application form established by the Insurer shall be used. The Contract may be concluded for the period of the Insurant’s (the Insured’s) stay within the territory of insurance, not exceeding one year, unless otherwise provided for in the Insurance Contract.

7.3.      In the case of insurance under the Multi Travel programme, which provides for multiple trips abroad from the Republic of Kazakhstan, the Contract shall be valid for the number of days specified in the Contract. Each time the Insured travels abroad from the Republic of Kazakhstan, the insurance period shall be automatically reduced by the number of days spent in the territory of insurance. The contract under the Multi Travel programme shall terminate upon exhaustion of the number of days of insurance specified in the contract.

7.4.      Insurance coverage:

a) starts when the Insured is registered by border and/or customs services upon arrival in the insurance territory (country of stay) specified in the Contract, but not earlier than the date the Contract comes into effect;

b) ends from the moment of registration of the Insured's departure by the border and/or customs services in the territory of insurance (country of stay) specified in the contract, but not later than the expiry of the contract.

7.5.      The following may not be included in the territory of insurance:

          a) the territory of the Republic of Kazakhstan;

          b) for foreign citizens, additionally, the territory of the country of which the Insured is a citizen/resident.

7.6.      The insurance coverage of the Contract does not extend to:

1)       the territory of states within which military operations are being conducted;

2)       the territory of states against which economic and/or military sanctions have been imposed by the United Nations (UN);

3)       within the territory of states in which epidemic outbreaks have been detected or officially declared and/or quarantine has been imposed;

4)       in respect of persons who have obtained citizenship/residence permit (except for those who have obtained a residence permit for the purpose of studying abroad) of the country of stay specified in the Insurance Contract after the Contract has entered into force;

5)       if the Insurance Contract was issued while the Insured was already present within the territory of insurance.

7.7.      An Insurance Policy purchased via the Insurer’s online resource shall take effect from the date specified therein. Payment of the insurance premium shall be made on the Insurer’s or its partner’s online resource, in accordance with paragraph 2 of Article 394 and paragraph 3 of Article 396 of the Civil Code of the Republic of Kazakhstan, after familiarization with the standard terms of insurance established by the legislative acts of the Republic of Kazakhstan, or with these Insurance Rules. Such payment shall be deemed full and unconditional consent (acceptance) to conclude the Insurance Policy, as well as acceptance of all provisions contained in these Rules, and shall entitle the Insurer to collect and process personal data in accordance with the Law of the Republic of Kazakhstan “On Personal Data and Their Protection.” Following such acceptance, the Insurant shall be issued an electronic version of the Insurance Policy/Insurance Certificate, which shall be sent to the email address indicated by the Insurant when completing the data on the Insurer’s or its partner’s online resource.

7.8.      If necessary, the Insurant undertakes to provide all documents requested by the Insurer in order to comply with the requirements of the legislation of the Republic of Kazakhstan on counteracting the legalization (laundering) of proceeds from crime and the financing of terrorism.

7.9.      By signing the Application Form, the Insurant confirms that the transaction carried out by him/her is not related to the legalization (laundering) of proceeds from crime and the financing of terrorist activities.

8.      RIGHTS AND OBLIGATIONS OF THE PARTIES

8.            

8.1.           The insurer has the right to:

1)       verify the information and documents provided by the Insurant, as well as the Insurant's compliance with the requirements and conditions of the contract;

2)       upon receipt of notification of circumstances entailing an increase in insurance risk, demand changes to the terms of the contract or payment of an additional insurance premium commensurate with the increase in risk;

3)       demand termination of the Contract if the Insurant fails to fulfil their obligation to inform the Insurer of any significant changes in circumstances that have become known to them, communicated to the Insurer upon conclusion of the contract, if these changes may significantly increase the insurance risk, or if the insurant objects to changes in the terms of the contract or to additional payment of the insurance premium commensurate with the increase in the degree of risk;

4)       require the Insured to undergo a medical examination for alcohol/narcotic substances in accordance with the legislation of the country of stay, if there is suspicion of alcohol/narcotic intoxication of the Insured at the time of the insured event. If alcohol/drug intoxication is established, or if the Insured refuses to undergo a medical examination, refuse to make an insurance payment.

5)       independently investigate the causes and circumstances of an event that appears to be an insured event, including requesting documents confirming the occurrence of the insured event and the amount of damage caused from the relevant state authorities, law enforcement agencies, medical institutions, travel agencies/operators, other enterprises, institutions and organisations that have information about the circumstances of the insured event, based on and in accordance with their competence;

6)       request from the Insurant/Insured/Beneficiary any information and/or documents necessary to establish the occurrence of an insured event and the circumstances thereof;

7)       refuse, in whole or in part, to make an insurance payment on the grounds provided for in these Rules.

8)       the Insurer shall have the right to transfer information concerning the Insured and/or the Beneficiary, relating to personal data and insurance secrecy in accordance with Article 830 of the Civil Code of the Republic of Kazakhstan, to the Assistance company for the purpose of fulfilling the Insurer’s obligations under the Contract;

9)       suspend the insurance payment for up to 30 (thirty) calendar days if signs of bad faith on the part of the Insurant are identified, in accordance with the Law of the Republic of Kazakhstan “On Insurance Activities,” by sending a notice of suspension of the insurance payment to the Insurant (Beneficiary), indicating that the relevant inspection will be carried out no later than the day following the date of suspension.

8.2.      The Insurer is obliged to:

1)       acquaint the Insurant with these Insurance Rules and, upon request, provide (send) a copy of the Rules;

2)       ensure the confidentiality of insurance information in accordance with Articles 828 and 830 of the Civil Code of the Republic of Kazakhstan;

3)       in the event that the Insurant/Insured/Beneficiary fails to provide the documents stipulated in Section 10 of these Insurance Rules, promptly, but no later than 5 (five) working days, provide written notice specifying the missing and/or improperly executed documents;

4)       make the insurance payment to the Insurant, the Insured, or the Beneficiary, or provide a written, substantiated refusal to make such payment in accordance with the provisions of these Rules;

5)       reimburse the Insurant, the Insured, or the Beneficiary for expenses incurred to mitigate losses arising from an insured event;

6)       perform other actions provided for by the Contract, these Rules, and the applicable legislation of the Republic of Kazakhstan.

8.3.      The Insurant has the right to:

1)  request from the Insurer clarification of the terms and conditions of insurance covering medical or other expenses of persons travelling outside the Republic of Kazakhstan, as well as clarification of his/her rights and obligations under the Contract;

2)  challenge, in accordance with the procedure established by the legislation of the Republic of Kazakhstan, the Insurer’s refusal to make an insurance payment or the reduction of its amount.

8.4.      The Insurant is obliged to:

1)       when concluding the Contract, provide the Insurer with all information requested that is necessary for the assessment of the degree of risk and the conclusion of the Contract;

2)       pay the insurance premium in the amount, manner, and within the time limits established by the Contract;

3)       at the time of conclusion of the Contract and during its validity, inform the Insurer of all existing and/or newly concluded insurance contracts covering;

4)       inform the Insurer of the condition of the insured risk;

5)       promptly, but no later than 3 (three) working days, notify the Insurer of any significant changes in the circumstances communicated to the Insurer at the time of conclusion of the Contract, if such changes may materially affect the increase of the insured risk;

6)       in the event of an increase in the degree of risk, amend the Contract and/or pay an additional insurance premium within 5 (five) working days from the date on which the Insurant receives notification of the amendment to the Contract and/or additional premium payment;

7)       immediately notify the Insurer or its representative of the occurrence of an insured event. If the Insurant is not the Insured, such obligation shall rest with the Insured.

8.5.      The Beneficiary has the right to:

1)       request from the Insurer clarification of the terms and conditions of insurance, as well as his/her rights and obligations under the Contract;

2)       submit a claim for an insurance payment to the Insurer;

3)       receive the insurance payment in the manner and on the terms provided for by these Rules;

4)       challenge, in accordance with the procedure established by the legislation of the Republic of Kazakhstan, the Insurer’s refusal to make an insurance payment or the reduction of its amount;

5)       notify the Insurer of the occurrence of an insured event in all circumstances, regardless of whether or not the Insurant or the Insured has done so;

6)       perform other actions not contrary to the Contract and the legislation of the Republic of Kazakhstan.

8.6.      The rights and obligations of the parties provided for in this section are not exhaustive. The parties have the rights and obligations provided for in other clauses or conditions of the contract and the legislation of the Republic of Kazakhstan.

8.7.      The list of rights and obligations of the parties may be amended (supplemented) by the Contract.

9.      ACTIONS OF THE INSURANT (INSURED) UPON THE OCCURRENCE OF AN INSURED EVENT

9.                     

9.1.                    Once the Insurant/Insured becomes aware or should have become aware of the occurrence of an event that may lead to an insured event, they are obliged to:

1)  take reasonable and affordable measures under the circumstances to prevent or mitigate possible losses;

2)  immediately, regardless of the time of day, notify the 24-hour Assistance dispatch service at the telephone number specified in the Contract of the occurrence of a sudden acute illness or an accident, and provide the following information:

- surname, first name, and patronymic (if applicable) of the Insured;

- the Contract number and its validity period;

- the name of the Insurer;

- the country and city of stay;

- the date, time, and place of the occurrence of the insured event;

- all available information on the circumstances of the sudden acute illness or accident, and the type of assistance required;

- the location of the Insured, together with the country code and telephone number at which he/she can be contacted in the country of stay;

3)  obtain medical care or other services provided for under the Insurance Contract strictly in accordance with the instructions of the Assistance dispatcher;

4)  present the Insurance Contract and an identity document when receiving medical services;

5)  if the Insured fails to call the Assistance dispatch service prior to consulting a doctor and/or receiving other services independently, the Insurer shall make the insurance payment in accordance with sub-paragraph 1) of paragraph 8.2 of Section 8 of these Rules.

Exception: this condition does not apply in emergency cases requiring immediate medical intervention (severe bleeding caused by injuries or illnesses, loss of consciousness, respiratory and circulatory arrest, seizures, anaphylactic shock, etc.), confirmed by official medical reports.

6)  in the event of emergency hospitalization, the Insured shall be obliged to immediately, but no later than 12 (twelve) hours from the occurrence of the insured event (i.e., from the moment of emergency hospitalization), notify the 24-hour Assistance dispatch service thereof. If, at the time of the event, the Insured is unconscious, notification of the occurrence of the event shall be made to the Assistance company within 24 (twenty-four) hours from the occurrence of the event by the Insured’s relatives or by other persons who could do so on his/her behalf. In the event of untimely notification or absence of notification of the Insured’s hospitalization, the Insurer shall make the insurance payment in accordance with sub-paragraph 1) of paragraph 9.2 of Section 9 of these Rules.

7)  allow the Insurer or persons acting on its behalf to review the complete medical documentation and obtain information from third parties (doctors, medical institutions, health services, etc.);

8)  follow all instructions from the Assistance and/or Insurer related to the insured event and comply with all prescriptions of the attending physician; in case of hospitalisation, comply with the rules established by the medical institution;

9)  undergo a medical examination for alcohol/narcotic substances in accordance with the legislation of the country of residence, in case of suspicion of alcohol/narcotic intoxication at the time of the insured event;

10)  for the purpose of evacuation by the Insurer/Assistance, to undertake, where possible, all actions necessary for the exchange of the ticket with a change of the departure date through the Assistance staff or in coordination with them, if the Insured is compelled to return earlier or to remain longer.

11)  assist the Insurer's representative in determining the causes and circumstances of the insured event, including providing the Insurer with all available information and documentation that allows it to assess the causes, course and consequences of the insured event, as well as the nature and extent of the damage caused;

12)  bear the burden of proving the occurrence of an insured event and the losses caused by it, including the cost of conducting an expert examination, sending experts to the scene of the incident, engaging and consulting specialists, collecting documents, translating them into Russian or Kazakh, and notarising the translation and all documents necessary for the insurance payment;

13)  at the Insurer's request, undergo additional examinations related to the insured event that are necessary for deciding on coverage

14)  perform other actions provided for in these Rules.

9.2.      After becoming aware or having become aware of the occurrence of an event covered by the risks specified in Section 3 of these Rules, which may lead to the occurrence of an insured event, the Insurant/Insured shall have the right to:

1)       not to contact the 24-hour Assistance dispatch service but to obtain and pay independently for emergency medical care at a medical institution and/or from a physician, provided that the expenses for such emergency medical care do not exceed 1000 (one thousand) units of account for outpatient treatment or 2000 (two thousand) units of account for inpatient treatment/hospitalization for the entire insurance period. In the event that the expenses for emergency medical care, independently paid by the Insurant (Insured), exceed 1000 (one thousand) units of account for outpatient treatment or 2000 (two thousand) units of account for inpatient treatment/hospitalization, the Insurer shall be entitled to refuse that part of the insurance payment which exceeds 1000 (one thousand) units of account for outpatient treatment or 2000 (two thousand) units of account for inpatient treatment/hospitalization.

2)       Contact the 24-hour Assistance call center and, if it is impossible for the Assistance to organize/provide medical services (and/or other services stipulated by this Contract), obtain a referral from the Assistance for independent consultation at a medical institution/with a doctor (consulate, etc.) and pay for the services received independently. Reimbursement of expenses in full shall be carried out by the Insurer after confirmation of the Insured’s contact with the Assistance on the day of the insured event prior to receiving assistance, and on the mandatory condition that the Insured seeks medical services from a medical institution/doctor recommended by the Assistance.

In the event that:

·         the Insured’s contact with the Assistance is not confirmed;

·         the Insured’s contact with the Assistance was recorded post factum, i.e. after medical services had already been received;

·         the Insured failed to seek medical services from a medical institution/doctor recommended by the Assistance and instead chose a medical institution/doctor at their own discretion;

The Insurer shall make the insurance payment in accordance with the terms of sub-clause 1) of clause 9.2 of Section 9 of this Contract;

9.3.      If the Insured pays for medical care or other services covered by these Insurance Rules independently, they must notify the Insurer in writing immediately, but in any case, no later than 10 (ten) working days from the date of arrival in the Republic of Kazakhstan.

10.  THE PROCEDURE AND CONDITIONS FOR MAKING INSURANCE PAYMENTS

10.       

10.1.      In the event of an insured occurrence, the Insurer shall make the insurance payment in accordance with the terms of these Rules.

10.2. The total amount of insurance payments under the Contract may not exceed the sum insured specified in the Contract in respect of each Insured.

10.3. If the total amount of expenses subject to reimbursement by the Insurer exceeds the sum insured specified in the Contract, expenses for emergency medical care shall be paid first. All other expenses shall be reimbursed from the remaining amount in the order set out in Section 4 of these Rules; after reimbursement of expenses in one category, reimbursement shall be made for expenses in another category of Section 4 of these Rules.

10.4. Insurance payments shall be made in the following order:

10.4.1. To the Assistance, specified in the Insurance Contract, on the basis of a cooperation agreement concluded between the Insurer and the Assistance, under which the Assistance, on behalf of the Insurer, provides the Insured Persons with round-the-clock organization and delivery of services stipulated by the terms of the Contract within the territory of insurance coverage.

10.4.2.  To the Insured/Beneficiary, if he/she has independently paid for the services stipulated by the terms of the Contract.

10.5.      In order to ensure the process of insurance payments, the Insurer shall immediately, upon notification of the occurrence of an insured event, provide the Insured/Beneficiary with:

- a comprehensive list of documents required for the insurance payment;

- information about the deadline for reviewing the documents and making the insurance payment after all the necessary documents have been submitted.

10.6. List of documents required to be provided by the Insurant (Insured, Beneficiary) for the decision on insurance payment:

1)  insurance claim form;

2)  copies of documents proving the identity of the Insured and the Beneficiary (passport, identity card, child's birth certificate);

3)  copies of passport pages with marks indicating crossing of the borders of the territory covered by the insurance contract (if the customs control of the country of stay does not provide for stamps in the passport, it is possible to provide the relevant boarding passes or electronic tickets); marks indicating crossing of the borders of the Republic of Kazakhstan;

4)  the original or a notarised copy of the conclusion of the relevant medical institution, indicating the full name of the Insured, the nature of the harm caused to the Insured, the diagnosis, and the date of treatment (hospitalisation);

5)   the original or a notarised copy of the conclusion of the medical institution that certified the death of the Insured, indicating the date and cause of death;

6)  a notarised copy of the death certificate;

7)  originals of invoices, fiscal receipts, sales receipts, payment receipts from medical institutions confirming the procedures performed, doctor's appointments, indicating the name of each procedure, appointment, their number, cost, date of payment and full name of the insured.

·                If the currency of payment is not specified in invoices, fiscal receipts, sales receipts, receipts and other documents confirming payment, the Insurer shall automatically calculate the insurance payment in tenge at the official exchange rate of the National Bank of the Republic of Kazakhstan for the currency of the country of stay on the date of the insured event;

8)  originals or notarised copies of detailed prescriptions from the attending physician for procedures and consultations, for which invoices have been issued, indicating the date of the consultation, the diagnosis that led to the prescription, and the full name of the insured;

9)  at the Insurer's request, notarised copies of outpatient records, medical history or extracts from the aforementioned documents, certified by an authorised person and stamped by the relevant medical institution; original X-ray images;

10)       if the insured event occurred as a result of a traffic accident, unlawful actions of third parties, fire, etc., additionally – originals or duly certified copies of the relevant documents issued by competent authorities (documents of law enforcement bodies, prosecutor’s office, investigation, inquiry authorities, judicial authorities, fire supervision authorities, etc.) confirming the occurrence of the insured event, the damage caused, and identifying the persons responsible for causing such damage.

11)       If necessary, health examination for alcohol and other types of intoxication;

12)       in the event that the Insured obtains duplicate documents – a receipt for payment of the consular fee for the restoration of a passport with a visa, a receipt for payment of photographs for the preparation of the relevant documents, a receipt for payment of the services of a transport company for the restoration of travel documents;

13)       in the event of evacuation/transportation: documents indicating the passenger's full name, date, destination and cost for each passenger;

14)       originals or notarised copies of documents confirming the costs of telephone calls made by the Insurant (Insured) to the 24-hour Assistance dispatch service numbers specified in the Contract. The bill for the call to the Assistance dispatch service must contain the following information: date of the call, telephone number, duration of the call and the paid amount;

15)       bank details of the Beneficiary's account; in the event of the death of the Insured, an additional notarised copy of the certificate of inheritance rights.

16)       documents confirming the identity and rights of the Beneficiary, if necessary (power of attorney, birth certificate, etc.).

10.7. Documents shall be provided to the Insurer in the original or in the form of a copy, notarised or certified with an original seal and signed by an authorised representative of the competent organisation.

10.8. All documents listed in this section must be provided at the Insurer's request in Russian or Kazakh, or translated into Russian or Kazakh, with the translation certified by a notary.

10.9. The insurer who has accepted the documents shall draw up two copies of a certificate indicating the full list of documents submitted by the applicant and the date of their acceptance. One copy of the certificate shall be issued to the applicant, and the second copy, marked by the applicant as received, shall remain with the insurer.

10.10. The Insurer reserves the right to verify all submitted documents and to conduct its own investigation, including, if necessary, having the Insured examined by medical specialists and independently determining the causes and circumstances of the insured event. In this case, the Insurant (Insured) shall be obliged to provide the Insurer with access to all documents indicating the health condition of the Insured before and after the insured event, necessary for the payment of insurance benefits, and, at the Insurer’s request, to undergo a medical examination at the Insurer’s expense in a medical institution designated by the Insurer and provide the results thereof.

10.11.  The amount of the insurance payment shall be determined by the Insurer on the basis of documents confirming the expenses incurred by the Insured. If the insurance contract provides for a deductible, the insurance payment shall be made minus the amount of the deductible.

10.12.  The deadline for the Insurer to decide on the payment of insurance benefits and to affect the payment to the Beneficiary shall be 15 (fifteen) working days from the date of receipt of all necessary documents. If a decision on the payment of insurance benefits cannot be made within the prescribed period due to the need for additional information or clarification regarding the submitted documents, the Insurer shall notify the Insurant (Insured, Beneficiary) explaining the reasons for the extension of the payment period.
At the same time, the Insurer shall ensure that the insurance payment is made within a period not exceeding 15 (fifteen) working days from the date of the expiry of the initial period for reviewing the documents for the insurance payment.

10.13. The Insurer shall pay the insurance benefit to the Beneficiary in tenge at the official foreign currency exchange rate of the National Bank of the Republic of Kazakhstan on the date of the insured event.

10.14. The Insurer shall be liable for late payment of insurance benefits in accordance with Article 353 of the Civil Code of the Republic of Kazakhstan.

10.15. The procedure and conditions for making insurance payments may be changed (supplemented) by the Contract.

11.  REFUCAL OF INSURANCE PAYMENT

11.       

11.1.      The Insurer shall be entitled to fully or partially refuse payment of insurance benefits if the insured event occurred as a result of:

1)  intentional actions of the Insurant (Insured, Beneficiary) aimed at causing the insured event or contributing to its occurrence, except for actions performed in a state of necessary defense or extreme necessity;

2)  actions of the Insurant (Insured, Beneficiary) recognized in accordance with the procedure established by the applicable legislation as intentional criminal or administrative offenses that are causally related to the insured event.

11.2. The insurer shall be exempt from making insurance payments if the insured event occurred as a result of:

1)       risks not covered by the insurance contract;

2)       the effects of a nuclear explosion, radiation or radioactive contamination;

3)       any kind of military action or military operations/special operations and their consequences, damage or destruction by rockets, shells, bombs, other weapons, means of warfare and combat operations, piracy, as well as civil war, civil unrest, uprisings, mutiny, mass riots and strikes;

4)       military service of the Insured in the armed forces of any country;

5)       environmental pollution, global disasters, earthquakes, volcanic eruptions or the effects of fire, landslides, rockfalls, storms, whirlwinds, hurricanes, floods, hail or heavy rain and other natural disasters;

6)       suicide or attempted suicide;

7)       failure by the Insured to comply with the requirements of the legislation of the territory of insurance (country of stay);

8)       losses directly or indirectly related to any kind of infectious diseases (including coronavirus disease 2019 (COVID-19) and any of its mutations or variations);

9)       violations of any sanctions law or regulation, as a result of which the Insurer will be or may be subject to any penalty under sanctions laws and regulations or restrictions imposed by UN resolutions or trade or economic sanctions, laws or regulations of the European Union, the United Kingdom or the United States and other authorised international organisations;

10)  violation of information security, loss/leakage of personal data, confidential information and personal data stored on servers, the Internet cloud, portable devices, computers, Internet resources, including as a result of cyber-attacks, the influence of computer viruses, network hacking, etc.;

11)  exposure to asbestos, asbestos fibres or any products containing asbestos, as well as radioactive isotopes (when applying these Rules to the insurance product).

11.3. The Insurer shall not make an insurance payment:

1)       if the Insured, at the time of the event, was under the influence of alcohol, drugs, toxic substances, or any psychoactive substances;

2)       if the Insured was in the country of stay for work purposes.

Exception: if the purpose/category of the trip specified in the Contract is “Work” and the risk has been covered by an additional insurance premium with the applicable corrective ratio;

3)       if the Insured was in the country of stay for study purposes.

Exception: if the purpose/category of the trip specified in the Contract is “Study” and the risk has been covered by an additional insurance premium with the applicable corrective ratio.

4)       if the incident occurred as a result of the Insured's participation in:

a) any type of professional and/or amateur sport. Exception: if the purpose of the trip/category ‘Sport’ is selected in the Contract, and the above risks are covered by an additional insurance premium, considering the corrective ratio;

b) in any activities involving the use of motorised land, water or air vehicles, as well as participation in horse racing, car racing, flying aircraft, including parachutes, paragliders, motorised paragliders and hang gliders, or participation by the Insured in any kind of trials. Exception: if the purpose of the trip/category ‘Sports’ is selected in the Contract, and the above risks are covered by an additional insurance premium, taking into account the corrective ratio;

c) engaging/participating by the Insured in active recreation and physical activities with an increased risk of injury (including riding on bananas and other water attractions, active sports games; training in gyms; any underwater diving; any type of surfing; staying at alpine camps, tourist or sports bases, as well as in areas located above 1,000 meters above sea level; hiking, caving, volcano trips; off-road car trips and journeys; trips and journeys by bicycles, mopeds, scooters, kick scooters and etc.; trips and journeys on horseback or other animals, etc.). Exception: if the purpose/category of the trip specified in the Contract is “Active Leisure” and the above-mentioned risks have been covered by an additional insurance premium with the applicable corrective ratio.

5)       upon detection of COVID-19 in the insured within the territory of insurance, included in the list approved by Order of the Minister of Health and Social Development of the Republic of Kazakhstan No. 367 dated 21 May 2015 ‘On approval of the list of socially significant diseases and diseases posing a danger to others.’ Exception: if the purpose of the trip/category ‘COVID’ is selected in the Contract, and the above risks are covered by an additional insurance premium, considering the corrective ratio.

6)       for expenses related to the transportation/evacuation by air transport from remote or hard-to-reach regions in cases of acute illnesses. Transportation by air transport is carried out only in the event of an injury when it is impossible to provide emergency medical care at the place of the incident.

11.4. The Insurer shall not make insurance payments for the following expenses:

1)            diagnosis and/or treatment of any diseases that the Insured had prior to the effective date of the Contract;

2)            the Insured receiving medical care before the commencement date or after the expiry of the term of the Contract, as well as outside the territory of insurance specified in the Contract;

3)            the Insured receiving diagnostics and/or treatment exceeding the scope of emergency medical care (laboratory tests for viruses and bacteria, bacterial cultures of biomaterial, histological examinations, laboratory diagnostics for injuries, repeated dressing of injuries/wounds, follow-up examinations by doctors, etc.);

4)            diagnosis and/or treatment of illnesses that the Insured has suffered in the last 6 (six) months prior to the effective date of the Contract and which required follow-up treatment (the restriction does not apply if medical assistance was necessary to save a person's life, to prevent complete loss of working capacity or to relieve acute pain);

5)            self-medication, as well as the prescription and administration of treatment by family members, relatives or acquaintances of the Insurant (Insured);

6)            treatment and/or diagnosis of chronic diseases and their complications/exacerbations, except for cases of first aid to eliminate an immediate threat to the Insured's life;

7)            diagnosis and/or treatment of malignant and/or benign neoplasms, hyperplastic processes, as well as any complications caused by and associated with them;

8)            diagnosis and/or treatment of the reproductive system, namely:

a)            conducting consultative and diagnostic examinations and treatment of the Insured for the purpose of achieving and maintaining pregnancy;

normal or premature births, as well as caesarean sections and artificial termination of pregnancy (abortion, curettage of the uterine cavity) for medical reasons or at will of the Insured.

Exception: pregnancy complications due to severe bleeding posing a threat to the life of the fetus and the mother at a gestational age of no more than 12 weeks; emergency artificial termination of pregnancy at a gestational age not exceeding 12 weeks, the need for which arose as a result of an accident involving the Insured that may be recognized as an insured event;

b) artificial insemination, diagnosis and treatment of infertility/impotence, prostatitis; sterilization, as well as any methods of contraception, including insertion/removal of intrauterine devices (IUDs);

c) diagnosis and/or treatment of any menstrual cycle disorders.

9)            related to the care, treatment of a newborn child, being under medical supervision, and transportation (including evacuation and/or repatriation); expenses related to the care and treatment of a newborn child, medical supervision, and transportation (including evacuation and/or repatriation);

10)       diagnosis and/or treatment of any congenital, hereditary diseases and/or congenital/acquired anomalies/malformations of the body, including pathological bone fractures;

11)       diagnosis and/or treatment (including surgery) related to myopia/hyperopia, astigmatism, cataracts, glaucoma, retinal detachment;

12)       expenses for inpatient care lasting more than 10 (ten) days for the entire period of the Contract, including for COVID-19;

13)       diagnosis and/or treatment of liver cirrhosis, any types of hepatitis and their consequences;

Exception: acute hepatitis A (Botkin’s disease).

14)       diagnosis and/or treatment of mental disorders (schizophrenia, depression, panic attacks, delirium, hysterical disorders, sleep disorders, behavioral disorders, etc.);

15)       diagnosis and/or treatment of sexually transmitted diseases, HIV and AIDS, alcoholism or drug addiction, tuberculosis, diabetes mellitus, and their consequences;

16)       expenses for plastic surgery, cosmetic diagnosis/treatment, and any other types of diagnosis/treatment related to the elimination of physical defects or abnormalities, sex reassignment surgery, weight/body correction, diagnosis/treatment of obesity or dystrophy;

17)       diagnosis and treatment of psoriasis and its complications; congenital ichthyosis, eczema, alopecia, vitiligo, warts, acne, demodicosis;

18)       consultations and treatment related to obstruction of the ear canal by earwax plugs;

19)       expenses for selection, purchase, and repair of medical aids (lenses, glasses, hearing aids, glucometers, thermometers, bandages, crutches, wheelchairs, diapers, orthoses, orthopedic shoes, compression stockings, etc.);

20)       dental care, except for emergency care specified in Section 4 of these Rules and the Contract;

Expenses related to orthodontics, cosmetology, prosthetics, implantation, and preparation for these procedures are not covered; diagnosis and treatment of neoplasms of various origins in the oral cavity are also not covered.

21)       expenses for routine vaccination; medical examinations or care not related to an acute illness; preventive check-ups, medical examinations, certificates for educational institutions and other organizations;

22)       surgical interventions or treatment that may be postponed until the Insured returns to the Republic of Kazakhstan and/or that was not approved by the Assistance;

23)       provision of a special separate ward in a medical institution (except in cases prescribed by the Assistance physician), as well as the provision of a television, telephone, air conditioner, humidifier, etc.;

24)       treatment and/or diagnosis by non-traditional methods (phytotherapy, hirudotherapy, homeopathy, mud therapy, light therapy, treatment in a pressure chamber, manual therapy, massage, bioresonance therapy, etc.), restorative (rehabilitation) treatment, as well as any methods of physiotherapeutic treatment;

25)       provision of services of a psychotherapist, dietitian, geneticist, speech therapist, cosmetologist, massage therapist, hairdresser, stylist, interpreter;

26)       treatment and/or diagnosis carried out by persons not authorized to practice medicine or by a medical institution lacking the appropriate license.

27)       expenses for assistance in the event of an accident resulting in injuries or illnesses of the Insured, occurring as a result of a motor vehicle accident, if:

a) the Insured was driving a vehicle without a valid driver’s license or was under the influence of alcohol, drugs, or toxic intoxication;

b) the Insured entrusted the driving of the vehicle to a person without a valid driver’s license;

c) the Insured was in a vehicle (as a passenger) driven by a person under the influence of alcohol, drugs, or toxic intoxication, except for public transport;

11.5. The Insurer shall be released from the obligation to make an insurance payment if:

1)       the Insurant failed to pay the insurance premium within the period stipulated by the terms of the Contract;

2)       Treatment/receipt of medical services was the purpose of the Insured’s trip, as well as in cases of treatment/receipt of medical services in sanatoriums, health resorts, recreation center, and other sanatorium-resort type organizations;

3)       at the time of conclusion of the Contract, the Insured had already been recognized as disabled and/or had a loss (total or partial) of working capacity (general or professional) and/or an occupational disease, and this was the direct cause of seeking medical care;

4)       at the time of conclusion of the Contract, the Insured was already on the territory of insurance coverage;

5)       the Insured failed to comply with the Insurer’s requirement to undergo a medical examination and/or medical test for alcohol/narcotic intoxication, and/or failed to provide the results of such examination/test at the Insurer’s request;

11.6. The grounds for the Insurer’s refusal to make an insurance payment shall also include the following:

1)       the Insurant (the Insured, the Beneficiary) providing the Insurer with knowingly false information about the object of insurance (including health condition), the insured risk, the insured event and its consequences;

2)       failure by the Insurant (the Insured) to notify the Insurer of a change in the Insured’s type of activity, occupation, or purpose of travel, if such change became the direct or indirect cause of the occurrence of an event possessing the characteristics of an insured event;

3)       intentional failure by the Insurant (the Insured) to take measures to reduce losses from the insured event;

4)       obstruction by the Insurant (the Insured) of the Insurer’s investigation of the circumstances of the insured event and determination of the amount of damage caused by it;

5)       diagnosis and/or treatment not confirmed by relevant documents in accordance with the terms of the Contract and/or where the information and documents submitted by the Insured to the Insurer for the purpose of obtaining an insurance payment or when concluding the insurance contract are insufficient, or contain incomplete, inaccurate, or knowingly false information about the causes and circumstances of the insured event, as well as the types and cost of services provided in connection with the insured event;

6)       failure to notify or untimely notification of the Insurer about the occurrence of the insured event.

11.7. The Insurer does not cover:

1)       moral damage, losses of the Insurant (the Insured), including fines, penalties, forfeits, legal expenses, loss of profit, etc.;

2)       expenses directly or indirectly caused by confiscation, nationalization, requisition, destruction, or damage to the Insured’s property by order of any government, state, or local authorities of the country of stay;

3)       expenses for the evacuation of the Insured at his/her own will/discretion or on the basis of prescriptions of medical personnel, but organized independently by the Insured, the Insured’s relatives, or any other persons without the participation of the Assistance and/or without the Insurer’s written approval;

4)       expenses for evacuation in cases of minor illnesses or injuries that are subject to local treatment and do not prevent the Insured from continuing the trip.

5)       expenses for the purchase/exchange of airline, railway, and/or other transport company tickets, carried out independently without the participation of the Assistance;

6)       expenses for the evacuation of the Insured’s minor children, organized independently by close relatives of the Insured or by any other persons without the participation of the Assistance and/or without the Insurer’s approval;

7)       expenses related to the transportation (including accommodation and meals) of the Insured’s minor children from the international airport closest to their place of residence to their actual place of residence;

8)       expenses for the transportation of the Insured’s remains from the international airport closest to the burial place to the Insured’s burial site;

9)       expenses for the repatriation of the Insured’s body, organized independently by the Insured’s relatives or by any other persons without the participation of the Assistance and/or without the Insurer’s written approval.

10)  any expenses for the funeral of the Insured in the Republic of Kazakhstan or in the country of which the Insured was a citizen during his/her lifetime;

11)  expenses for telephone calls of the Insurant (the Insured) not specified in clause 4.6, sub-clause 3) of these Rules;

12)  expenses incurred by the Insurant (the Insured) for translation into Russian or Kazakh and/or notarization of documents required by the Insurer to decide on the insurance payment;

13)  expenses related to the insured event if, after the entry into force of the Contract, the Insured obtained citizenship or a residence permit of the territory of insurance specified in the insurance contract.

11.8. The insurance coverage under the Contract does not apply:

1)     to the territories of states where military actions are taking place;

2)     to the territories of states that are subject to economic and/or military sanctions imposed by the UN (United Nations);

3)     to the territories of states where epidemic outbreaks have been identified or declared and/or quarantine has been imposed;

4)     to persons who have obtained citizenship or a residence permit of the country of stay specified in the insurance contract;

5)     if the insurance contract was issued while the Insured was already located within the territory of coverage.

11.9. In the event that an occurrence cannot be recognized as an insured event, including where the occurrence does not meet the characteristics of an insured event, the Insurer shall send the Insurant (the Insured, the Beneficiary) a written, reasoned refusal to make an insurance payment within 15 (fifteen) business days from the date of receipt of all necessary documents on the grounds provided for by the insurance contract and/or the legislation of the Republic of Kazakhstan.

11.10. In case of disagreement with the amount of the insurance payment or with the Insurer’s refusal to make the insurance payment, the Insurant/Beneficiary/Insured shall have the right to appeal such decision by applying to the insurance ombudsman, the authorized body and/or the court.

12.  AMENDMENT OF THE TERMS AND VALIDITY PERIOD OF THE CONTRACT. PROCEDURE FOR ISSUANCE OF A DUPLICATE CONTRACT

12.  

12.1. Amendments and additions to the Contract shall be made by mutual agreement of the Parties on the basis of a written application from one of the Parties. From the moment one Party receives such an application until a decision is made, the Contract shall remain in force under its original terms. All amendments and additions to the Contract shall be legally valid only if made in writing and signed by the authorized representatives of both Parties.

12.2. A Contract issued through the  «INSY Travel» / «CRM» system or similar third-party systems shall not be subject to re-issuance (it shall be terminated and a new one shall be concluded).

11.  

12.  

12.2.  

12.2.1. Re-issuance of a Contract that has not entered into force shall be carried out by the Insurer, provided that a written application is received from the Insurant before the commencement date of the Contract. When re-issuing the Contract for a new validity period, the Insurer shall offset the insurance premium under the initial Contract, less 0.1 MCI, against the insurance premium under the new Contract;

12.2.2. Re-issuance of a Contract that has entered into force shall be carried out by the Insurer for all risks provided for under these Rules, based on a written application from the Insurant received by the Insurer after the commencement date of the Contract. The Insurer shall withhold from the paid insurance premium the following expenses:

§ administrative expenses, which amount to 10% if the Contract has been in effect for up to 14 calendar days, and 15% of the total insurance premium if more than 14 calendar days have elapsed;

§ the portion of the insurance premium proportional to the expired period of the Contract;

§ the cost of the form in the amount of 0.1 MCI.

          After the above deductions have been made, the Insurer shall offset the remaining part of the insurance premium against the payment of the insurance premium under the new Contract.

In the case of re-issuance of the Contract, in case:

§ the new insurance period is shorter (in terms of number of days) than the period under the original Contract, the Insurer shall refund part of the insurance premium, considering the deductions specified in sub-clauses 12.2.1 and 12.2.2, within the time limits established by clause 13.6 of these Rules;

§ the new insurance period (in terms of number of days) remains unchanged, the Insurant shall pay the deductions specified in sub-clauses 12.2.1 and 12.2.2;

§ the new insurance period is longer (in terms of number of days) than under the original Contract, the Insurant shall pay the deductions specified in sub-clauses 12.2.1 and 12.2.2 and the difference in the insurance premium corresponding to the extended insurance period.

12.3. By agreement of the Parties, the Contract may be extended for the next term subject to mandatory compliance with the following conditions:

§ absence of reported and/or paid insured events under the Contract;

§ written notice to the Insurer not less than 5 (five) calendar days prior to the Contract’s expiry date.

12.4. Issuance of a duplicate Contract shall be carried out by the Insurer on the basis of a written application from the Insurant. The Insurer shall issue the duplicate Contract within 1 (one) business day from the date of receipt of the application from the Insurant. When issuing a duplicate Contract, the Insurer shall withhold the cost of the form in the amount of 0.1 MCI for the current year.

12.5. The Insurer shall have the right to refuse issuance of a duplicate Contract if the application is submitted after the expiration of the Contract.

13.  TERMS AND CONDITIONS FOR TERMINATION/CANCELLATION OF THE CONTRACT

11.    

12.    

13.    

13.1.   The Contract shall be terminated in the following cases:

1)       non-payment by the Insurant of the insurance premium in the amount and within the time limits established by the Contract;

2)       from the moment of registration of the Insured’s departure by the border and/or customs authorities in the territory of insurance (the country of stay) specified in the Contract, but no later than the expiry date of the Contract;

3)       upon expiration of the Contract;

4)       in the event of early termination of the Contract.

13.  

13.2.  

13.2.1.  

13.2.2.  

13.  

13.1.  

13.1.1. The Insurant shall have the right to withdraw from the Contract at any time, unless otherwise provided by the Law of the Republic of Kazakhstan and the insurance Contract.

12.1.    

13.2.   In addition to the general grounds for termination of obligations, as well as the grounds for early termination of the Contract provided for in paragraph 1 of Article 841 of the Civil Code of the Republic of Kazakhstan, the Contract shall be terminated early in the following cases:

1)       payment by the Insurer of the insurance indemnity in the amount of the sum insured specified in the Contract;

2)       failure of the Insurant to fulfill the obligation to notify the Insurer of significant changes in the circumstances reported to the Insurer upon conclusion of the Contract, if such changes may materially affect the increase of the insurance risk, or if the Insurant objects to the amendment of the Contract terms or to the additional payment of the insurance premium proportionate to the increase of the degree of risk;

3)       termination of the Contract at the request of the Insurant or the Insurer, as well as by mutual agreement of the Parties.

13.3.   Procedure and consequences of early termination of the Contract on the grounds specified in sub-clause 1) of clause 13.2 of these Rules:

13.2.  

13.3.  

13.3.1. In such cases, the Contract shall be deemed terminated from the moment of occurrence of the circumstance specified as the ground for termination of the Contract, and no notice of termination of the Contract shall be required.

13.3.2. Upon termination of the Contract on the above grounds, the insurance premium paid to the Insurer shall not be subject to refund.

13.4.   Procedure and consequences of early termination of the Contract on the grounds specified in sub-clause 2) of clause 13.2 of these Rules:

13.4.  

13.4.1. In such cases, the Contract shall be deemed terminated from the moment of occurrence of the circumstances entailing an increase in the degree of risk.

13.4.2. In this event, the Insurer shall be obliged to notify the Insurant of the termination of the Contract within 3 (three) business days from the date:

1)  when the Insurer became aware of the Insurant’s failure to notify of the increase in the degree of risk;

2)  of receipt of the Insurant’s refusal to amend the Contract or to pay an additional insurance premium;

3)  of the expiry of the period established by the Contract for acceptance of the Insurer’s requirement to amend the Contract and/or to pay an additional insurance premium.

13.4.3. Upon termination of the Contract on the above grounds, the insurance premium paid to the Insurer shall not be subject to refund.

13.5.   Procedure and consequences of early termination of the Contract on the grounds specified in sub-clause 3) of clause 13.2 of these Rules:

13.5.  

13.5.1. The Contract shall be deemed terminated on the day following the receipt by the Insurer (or the Insurant) of the Insurant’s (or the Insurer’s) written notice of termination, or on the date on which the relevant court decision enters into legal force (if the dispute is resolved in court) and the initiating Party shall notify the other Party of its intention to terminate the Contract at least 1 (one) business day prior to the date of termination of the Contract.

13.5.2. In the event of early termination of the Insurance Contract at the request of the Insurant, the Insurer shall refund 100% of the insurance premium paid to the Insurant before the start of the Contract term.

13.5.3. In the event of early termination of the Contract at the request of the Insurant, submitted after the commencement date of the Contract, if it is not related to the circumstances specified in clause 13.2, the Insurer shall refund part of the insurance premium calculated according to the following formula: ((IP : N) * (N – n)) – (IP – (up to 14 calendar days – 10%, after 14 calendar days – 15% * IP)) where: 

IP – insurance premium under the Contract;

N – duration of the Contract in days;

n – elapsed period of the Contract in days.

13.5.4. In cases where early termination of the Contract is caused by non-performance or improper performance of its terms due to the fault of the Insurer, the latter shall be obliged to refund to the Insurant the insurance premium or contributions paid in full.

13.5.5. In cases where early termination of the Contract is caused by non-performance or improper performance of its terms due to the fault of the Insurant, the insurance premium or contributions paid to the Insurer shall not be subject to refund.

13.5.6. In the event of withdrawal by the Insurant–individual from the insurance Contract within 14 (fourteen) calendar days from the date of its conclusion, the Insurer shall refund to the Insurant–individual the received insurance premium(s) less the portion of the insurance premium(s) proportional to the period during which the insurance was in effect, and the expenses related to the termination of the insurance Contract, which amount to 10% of the received insurance premium(s).

13.6.   The portion of the insurance premium subject to refund in accordance with the above provisions of this Article shall be paid by the Insurer in a lump sum within 15 (fifteen) business days from the date of receipt by the Insurer of the application for termination of the Contract.

14.  DISPUTE RESOLUTION PROCEDURE

14.1. Any disputes and/or disagreements arising out of or in connection with the Contract shall be resolved through negotiations.

14.2. If no agreement is reached by the Parties, disputes and/or disagreements shall be settled in accordance with the applicable legislation of the Republic of Kazakhstan, in the court at the location of the Insurer.

14.3. The Contract may provide for another procedure for dispute resolution, provided that it does not contradict the legislation of the Republic of Kazakhstan.

15.  CONCLUDING PROVISIONS

15.       

15.1.       By agreement of the parties, special conditions (insurance clauses, definitions, exclusions, etc.) that do not contradict the legislation of the Republic of Kazakhstan may be included in the Contract concluded in accordance with these Rules.

15.2. Double insurance:

1) Double insurance means insuring the same object with several insurers or with one insurer under separate insurance contracts with each of them.

2) In the case of double insurance, the Insurer shall bear property liability to the Beneficiary within the limits of the insurance Contract concluded with the Insurant; however, the total amount of insurance payments received by the Beneficiary from all insurers, or from multiple insurance products of one insurer, shall not exceed the actual loss.

3) In the case of double insurance, after the occurrence of an insured event, the Insurant /Insured shall be obliged to provide the Insurer with all information regarding the settlement of the insurance payment with other insurance companies, including information on the amounts of insurance payments received from other insurers.

4) In the case of double insurance, the Insurer shall have the right to investigate the causes and circumstances of the event having the characteristics of an insured event jointly with other insurance companies, or to make a payment only under one insurance product.

15.3. By signing this Contract, the Insurant confirms his/her consent, as well as the consent of the Insured (Beneficiary), to the collection, processing, storage, and transfer of personal data of the Insurant and the Insured (Beneficiary) by the Insurer or a third party in accordance with the Law of the Republic of Kazakhstan No. 94-V “On Personal Data and Their Protection,” including consent to:

1)       the Insurer’s receipt of data from the Joint Stock Company “State Credit Bureau” (hereinafter – the Bureau);

2)       the provision by the owners of state databases to the Bureau of information about the Insurant (the Insured, the Beneficiary), either directly or through third parties;

3)       the provision by a legal entity, designated by the Government of the Republic of Kazakhstan to provide public services in accordance with the legislation of the Republic of Kazakhstan, of existing and future information about the Insurant, the Insured (the Beneficiary) to the Bureau and to the Insurer through the Bureau;

4)       the cross-border transfer of personal data and the transfer of personal data to third parties;

5)       the disclosure by the Insurer of insurance secrecy, in accordance with clause 4 of Article 830 of the Civil Code of the Republic of Kazakhstan, to the following entities: “Life Insurance Company ‘Nomad Life’” JSC and “Nomad Digital Financial Services” LLP for the purpose of carrying out the Insurer’s overall business activities.

15.4. The retention period of personal data shall be determined by the Insurer until the need for further storage of personal data no longer exists. The use of personal data shall be carried out for the purpose of fulfilling the terms of the Contract and/or the legislation of the Republic of Kazakhstan by the Insurer or a third party, as well as for the implementation of the Insurer’s overall business activities.

15.5. The Insurant shall be obliged to obtain from the Insured (Beneficiary) written consent for the collection and processing of the Insured’s (Beneficiary’s) personal data by the Insurer or a third party, including the consent specified in sub-clauses 1)–5) of clause 15.3.

15.6. The Insurant shall be liable for the absence of the Insured’s (Beneficiary’s) consent to the collection and processing of the Insured’s (Beneficiary’s) personal data by the Insurer or a third party, including the consent specified in sub-clauses 1)–5) of clause 15.3.