1. Insurance object

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:

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

2)  The necessity for the Insured to obtain administrative and/or legal help within the territory of insurance, as provided for in these Rules.

2. Insurance event

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.

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.

3.       Covered expenses in case of an insured event:

3.1 Expenses for emergency medical care, namely:

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

- expenses for emergency hospitalization (not more than 10 days) in a standard ward, including consultations, examinations, in-hospital monitoring and care, surgical and/or medical treatment of the Insured;

- 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.

3.2 Expenses for emergency dental care in an amount not exceeding the limit of 500 (five hundred) u.a.* at the exchange rate of the National Bank of the Republic of Kazakhstan on the date of the insured event), as follows:

- expenses related to emergency care for purulent-inflammatory processes in the oral cavity, tooth pain syndrome and surrounding soft tissues, as well as expenses related to acute tooth pain syndrome and surrounding soft tissues resulting from an injury in an accident.

3.3  Expenses for transportation/evacuation:

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

•  From remote, hard-to-reach regions, evacuation/transportation 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’ and the above-mentioned risks have been covered by an additional insurance premium taking into account the adjustment coefficient).

- expenses for the medical transportation 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.

- expenses for the accompaniment of the Insured by medical personnel, but at a cost not exceeding 500 u.a.

3.3.1. Procedure and terms of evacuation coverage:

- provided that the Assistance staff are notified of the necessity to exchange/return tickets, and all required documentation is submitted to the Assistance staff;

- Assistance staff defines the urgency/necessity of the evacuation of the Insured and whether the condition of the Insured allows him/her to return as a regular passenger, or whether special equipment and means are required.

- The choice of the means of transportation and the conditions of transportation shall be determined by the Insurer on the basis of the recommendations and prescriptions of the medical institution staff.

3.4. 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.

3.5. 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 to the airport in the city closest to the settlement in which the child resides.

3.6. Expenses for obtaining legal and administrative assistance:

- 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 without the involvement of the Assistance and/or without the Insurer’s prior consent in written form, shall not be covered.

- expenses related to the issuance of duplicates of lost documents (passport, visa, ticket) and their delivery to the Insured within the territory of insurance.

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 specified in Section 2 of this Contract.

4. Obligations of the Parties.

4.1. The Insurer is obliged to:

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

2) in the event that the Insurant/Insured/Beneficiary fails to provide the documents stipulated in Insurance Rules, promptly, but no later than 5 (five) working days, provide written notice specifying the missing documents;

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

4.2 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) Promptly 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.

5. Actions of the insurant (insured) upon the occurrence of an insured event

5.1. 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) 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 the insurance event, and provide the requested information.

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 paragraph 4.2 of Section 4 of these Rules;

2) 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;

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

4) perform other actions provided for in these Rules.

5.2 After becoming aware or having become aware of the occurrence of an event covered by the risks specified in Section 2 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, provided that the expenses for such emergency medical care do not exceed 200 (two hundred) units of account for outpatient treatment or 500 (five hundred) units of account for inpatient treatment for the entire insurance period. In the event that the expenses for emergency medical care, independently paid by the Insurant (Insured), exceed 200 (two hundred) units of account for outpatient treatment or 500 (five hundred) units of account for inpatient treatment, the Insurer shall be entitled to refuse that part of the insurance payment which exceeds 200 (two hundred) units of account for outpatient treatment or 500 (five hundred) units of account for inpatient treatment.

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 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 5.2 of Section 5 of this Contract.

5.3 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.

6. The procedure and conditions for making insurance payments

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

1) to the Assistance specified in the Insurance Contract;

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

6.2. List of documents required to be provided the decision on insurance payment:

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

2) copies of the passport pages bearing the entry/exit stamps of the Insured to and from the territory of insurance and the Republic of Kazakhstan;

3) bank details of the Beneficiary's account;

4) the original medical report indicating the diagnosis/reason for seeking medical care;

5) the original invoice specifying each service/item and its cost;

6) the original receipts/payment slips for medical services;

7) other documents specified in the Insurance Rules.

6.3. 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 organization if this is provided for by the legislation of the territory of insurance.

6.4. 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.

6.5. The Insurer shall be entitled to shorten the above list of documents or to request additional documents if it considers that their absence makes it impossible to establish the occurrence of the insured event and to determine the amount of loss.

6.6. The amount of the insurance payment shall be determined on the basis of documents confirming the expenses incurred by the Insured.

6.7. The Insurer shall make a decision within 15 (fifteen) business days from the date of receipt of all required documents and make the insurance payment or provide the Beneficiary with a written reasoned refusal of the insurance payment.

6.8. 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.

6.9. In the absence of an indication of the payment currency in the documents confirming the payment, the Insurer shall automatically calculate the insurance indemnity 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.

7. Insurance limitations and exclusions from insured events.

7.1. 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 Insured 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 Insured 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.

7.2. 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) military action, acts of terrorism, counterterrorism operations; civil war, civil unrest, 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);

7.3. 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.

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

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

a) any type of professional and/or amateur sport;

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;

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 (unicycle,monowheel, hoverboard and etc.), trips and journeys on horseback or other animals, etc.).

d) The insured person has coronavirus SARS-CoV-2 (2019-nCoV) COVID-19, 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.

5) for expenses related to transportation/evacuation by air transport from remote/inaccessible regions in cases of acute illness.

Transportation by air transport shall be carried out only in the event of an injury where it is impossible to provide emergency medical care at the place of occurrence.

7.4.    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 for the relief of acute pain syndrome)

5) 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;

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

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:

- conducting consultative and diagnostic examinations and treatment of the Insured for the purpose of achieving and maintaining pregnancy, treatment of pregnancy complications,

- 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;

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

- diagnosis and/or treatment of any menstrual cycle disorders;

9) 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 SARS-CoV-2 (2019-nCoV) 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) any kind of sexually transmitted diseases, HIV and AIDS, alcoholism or drug addiction, tuberculosis, diabetes mellitus, and their consequences and complications;

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 materials for osteosynthesis/osteoplasty; selection, purchase, and repair of medical aids (lenses, glasses, hearing aids, glucometers, thermometers, wheelchairs, diapers, orthopedic shoes, compression stockings, etc.);

20) dental care, except for emergency care specified in Section 3 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;

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

1) 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;

2) 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;

3) the Insured, at the time of conclusion of the Contract, was already present in the territory of insurance or was undergoing inpatient treatment and/or required other medical assistance in the territory of insurance related to an illness/accident that occurred prior to the date of conclusion of the Contract;

4) 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.

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

1) the Insurant providing the Insurer with knowingly false information about the object of insurance, 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) failure to notify or untimely notification of the Insurer about the occurrence of 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;

7.7. 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 3.6, 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.

7.8. 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 of the country of stay specified in the Insurance Contract;

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

8. Terms and conditions for termination/cancellation/amendments of the contract

8.1. The Contract shall be terminated in case of expiration of the Contract or early termination of the Contract.

8.2. Amendments to the Contract may be made by mutual agreement of the Parties through the execution of a written agreement.

8.3. 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. The Insurant shall be obliged to submit to the Insurer a written application for termination not less than 1 (one) business day prior to the commencement date of the insurance coverage.

8.4. In addition to the general grounds for termination of obligations provided for by the Civil Code of the Republic of Kazakhstan (hereinafter – the Civil Code of the RK), the Contract shall be terminated early in the cases stipulated by Clause 1 of Article 841 of the Civil Code of the RK.

8.5. In the event of early termination of the Contract on the grounds stipulated in Clause 7.4 of the Contract, the Insurer shall be entitled to a portion of the insurance premium proportional to the period during which the insurance was in effect.

8.6. 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 related to the circumstances specified in clause 7.4., the Insurer shall refund part of the insurance premium calculated according to the following formula: ((IP:N) * (N – n)) - (IP – 15% * IP)) where: 

IP – insurance premium under the Contract

N – duration of the Contract in days

n – elapsed period of the Contract in days

In the event of the Insurant’s withdrawal from the Contract, if not related to the circumstances specified in Clause 7.4 of the Contract, the insurance premium or insurance contributions paid to the Insurer shall not be subject to refund.

8.7. For all other matters not regulated by the Contract, the Parties shall be guided by the Rules of voluntary insurance of medical and/or other expenses of persons travelling abroad from the Republic of Kazakhstan (TMI), developed by the Insurer.