Inhalt

Appendix

Law excerpts

Data protection notice and list of service providers Hallesche

List of service providers

Customer Information
DEGIS-Kranken BD

Essential Parts of Tariff BD/Group

Out-patient medical treatment

100% reimbursement of out-patient medical treatment
100% reimbursement of way-charges and transports
100% reimbursement of X-raydiagnosis and therapy
100% reimbursement of medicaments and dressings
100% reimbursement of remedies as perthe tariff
100% reimbursement of medical aids as per the tariff
100% reimbursement of visual aids up to € 325
100% reimbursement of medical check-ups as perthe tariff
100% reimbursement of vaccinations
100% reimbursement of psychotherapy
reimbursement as per the tariff of out-patient deliveries and delivery at home plus and a lump-sum of € 750 as well as delivery
100% reimbursement of treatments by a non-medical practioner
100% reimbursement of specialised out-patient palliative care
100% reimbursement of domestic nursing

Hospital medical treatment

100% reimbursement of accommodationin a one, two or more bedded room (tariff rate BD.1) or in a two or more bedded room (tariff rate BD.2)
100% reimbursement of treatment by the senior consultant
100% reimbursement of transportation
100% reimbursement of a person accompanying
costs for child care abroad
100% reimbursement of in-patient care in hospices

Dental benefits

100% reimbursement of dental treatment
80% reimbursement of dentures and orthodontic measures up to a maximum of € 1,025 per person and calendar year

Transports to and from abroad

100% reimbursement of repatriations from abroad
100% reimbursement of repatriations in case of death to the home country orburial in the Federal Republic of Germany up to a maximum of €15,000
100% reimbursement of return transports of children up to € 5,000 per child
100% reimbursement of transports of stored blood units abroad

Digital health applications

Tariff BD/Group

Health Group Insurance for out-patient medical treatment, dental treatment and dentures, in-patient medical treatment and delivery
As per January 2022

This tariff is only valid in connection with the General Conditions of Insurance of the Group insurance for temporary stays in Germany.

I. Eligibility

Every person who fulfils the conditions of the group insurance contract and who is travelling with a temporary residence permit to Germany may be insured according to this tariff (main person insured). Accompanying spouses, homosexual partners as per § 1 of the German Lebenspartnerschaftsgesetz (Law of homo-sexual partnerships) and children of the main person insured may also be insured (co-insured persons), if they also have a temporary residence permit for Germany.

The period of insurance is limited to five years (§ 195 para. 3 Versicherungsvertragsgesetz -German Insurance Contract Law). Similar previous, temporary coverage, as well with another insurer will be deducted from the maximum insurance period, which is being abbreviated accordingly (§ 195 para. 3 sentence 2 Versicherungsvertragsgesetz -German Insurance Contract Law).

The coverage ends at the latest after the expiry of the maximum insurance period and ends as well in case the temporary residence permit for Germany has been omitted. The insured persons have the right to continue the insurance in an unlimited similar tariff within the group insurance contract, if the eligibility in the group insurance is still given. The reached entry age at the time of the tariff change is to consider. Continued insurance rights as per the valid General Conditions of Insurance remain unaffected.

II. Insurance Benefits

1. Out-patient or hospital medical treatment

In case of a medically necessary out-patient or hospital treatment the reimbursable costs are paid 100%, that is for

1.1 Medical treatment

Such as consultations, visits, examinations, special services as well as operations (however see point 3).

1.2 Services of a midwife

1.3 Way charges of the nearest physician

1.4 Transportation

Transports to and from the nearest suitable physician in case of

Inability to walk;
dialysis
deep X-ray therapy
chemotherapy.

In case of emergency transports to the nearest suitable doctor or to the hospital treatment in the nearest suitable hospital and back.

1.5 X-ray diagnosis and therapy

1.6 Medicaments and dressings

1.7 Remedies

The following remedies are covered:
physiotherapy/kinesitherapy, remedial exercises, massages, physiotherapy in palliative care, packs/hydrotherapy/baths, inhalations, crymotherapy and thermotherapy, electrical and physical medical treatment, electrotherapy, phototherapy, exposure, speech therapy, ergotherapy, chiropody, nutrition therapy. A lump-sum of € 50 will be paid for any prenatal classes as well as for regression therapy after pregnancy.

1.8 Visual aids

100% of the costs will be reimbursed up to a total of € 325. Only after 2 years of the last purchase of visual aids may the person insured make another claim. New visual aids can be claimed before the end of the 2 years period in case the visual acuity has changed by at least 0,5 dioptres.

1.9 Medical aids (with the exception of visual aids)

The costs for aids (objective and technical devices as well as body replacements),

which directly palliate or balance handicaps, sequelae of diseases or accidents (e. g. wheelchairs, prostheses)
which are necessary for a therapy and diagnostics (e.g. blood pressure monitor),
which are decisive for the life support (life-preserving aids such as oxygen resuscitation apparatus).

Furthermore we reimburse the costs for the purchase and the training of a guide dog.

Furthermore the costs for the repair and reparation of aids, except the repair of soles and heels of orthopaedic made-tomeasure shoes are reimbursed.

Aids are not reimbursable

if the German Compulsory Nursing Care Insurance covers these,
if they are within the range of fitness, wellness and / or relaxing,
if they are articles of daily use and hygiene articles of daily
use (such as clinical thermometer, anti allergy bed linen).

Aids which are required for a limited period of time should be leased.

Generally, the insurer offers support for the choice and purchase or lease of suitable aids with an aids service provider. Therefore it is recommended to join the medical prescription of aids if the invoice amounts € 350 and more.

1.10 Medical check-ups

Among these are the medical check-ups for early screening of diseases as per the statutory programmes introduced in the Federal Republic of Germany.

1.11 Vaccinations

The costs for vaccinations against influenza, tetanus, diphtheria, rabies, poliomyelitis as wellas tick bites are reimbursable.

The costs for single or multiple vaccinations recommended by the German Permanent Committee (STIKO – Ständige Impfkommission) with the Robert Koch-Institut are reimbursable; not reimbursable are vaccinations which are recommended before a stay abroad and vaccinations as a result of professional activity which the employer has to offer on the basis of legal prescriptions.

1.12 Psychotherapy

1.13 Out-patient delivery, delivery at home as well as delivery

In case of an out-patient delivery or delivery at home a lumpsum for deliveries of € 750 is paid on top the reimbursement as per II.1.1 to 1.11 to pay other costs.

In case of a delivery in an institution which is lead by midwifes (such as a house for deliveries, a midwifes‘ house) 100% of the costs will be reimbursed instead of the delivery lump-sum of € 750, however only the costs which would have occurred for a delivery in a hospital. These costs are also reimbursable if while giving birth (start of labours or rupture of the membranes) the mother has to be admitted to a hospital.

1.14 Out-patient medical treatment by a non-medical practitioner in the sense of the German Law for Non-Medical Practitioners

Such as:
Every method of examination and treatment mentioned in the respective valid scale of charges for non-medical practitioners, remedies and way charges included up to the respective maximum amount as well as medicaments and dressings.

1.15 Specialised out-patient palliative care

The costs for a medically prescribed specialised out-patient palliative care are reimbursable, if this care aims to enable a care of the person insured in the familiar domestic surroundings or within the family, if

the person insured suffers from a disease which is not curable, which hasadvanced a little or a lot,
if only a limited life span of weeks or few months – for children some years – is tobe expected and
an extremely expensive care willbe necessary

Homes for the elderly, hospital nursing care institutions and hospices.

100% of the reimbursable costs for doctors and specialists of the out-patient palliative care will be reimbursed up to the amount which would be invoiced for a person insured in the statutory health insurance.

1.16 Domestic nursing

The costs for a medically prescribed domestic nursing (consisting of all possible features of care, that is: medical treatment – to mention examples: change of dressing, giving medicaments, to measure blood pressure etc. -, the basic daily care and the care of the household) outside of in-patient institutions such as nursing homes, hospices and homes for rehabilitation by suitable experts, if a person living in the same household of the ill is not able to nurse and to care for him or her properly and if

the domestic care is necessary to guarantee the aim of the medical treatment or (caseA)
a hospital treatment is recommended, but cannot be carried through or if a hospital treatment can be avoided or shortened with domestic nursing (case B),

will be reimbursed as follows:

a) In case A and B the costs for medical treatment (change of dressings, giving medicaments etc.) are reimbursed.

In case that a hospital stay can be avoided also the costs for the daily care (such as hygiene, dressing) and for the organisation of the household (such as shopping, cooking) will be paid for upto four weeksper event insured against occurring, if no need of care in the sense of the German Nursing Care exists. Above the period of four weeks the costs will only be reimbursed, if the insurer has given a written consent.

b) 100% of the costs mentioned in a) are reimbursed, if they are reasonable. The costs are reasonable up to the amount of the general customary rates

If for a period of 6 months at least an especially high need of medical care is given, which requires the permanent presence of a suitable nurse for the individual control and commitment, especially because the nursing measures are unexpectedly required during day time and the night, no matter which intensity and frequency or if a life-sustaining aid (such as an oxygen resuscitation apparatus) is required day and night (intensive medical nursing care) and If this intensive medical nursing care is possible in the domestic surroundings or in a suitable institution (nursing home) within a radius of 50 km, the respective least costs for this nursing care are regarded as reasonable.

The reasonable costs for intensive nursing care are also reimbursed for stays in in-patient institutions (such as nursing homes).

It is recommended to ask the insurer for a take over of charges to be in a position to judge the reasonableness of the costs.

1.17 Accommodation, boarding and care in hospital General hospital benefits

a) In hospitals which liquidate according to the Krankenhausentgeltgesetz -German Law of Costs for Hospital Benefits or according to the Bundespflegesatzverordnung – German regulation of hospital charges -costs for general hospital benefits are: the hospital and nursing charges, special costs, lump-sums, the separately charged services of a doctor who has extra beds in a hospital, the costs for a mid-wife as well as for a delivery nurse who both work for several hospitals.

b) In hospitals which do not liquidate according to the Krankenhausentgeltgesetz -German Law of Costs for Hospital Benefits or according to the Bundespflegesatzverordnung – German regulation of hospital charges – costs for general hospital benefits are: accommodation in a three or more bedded room (General Nursing Class) included the separately charged fees for a midwife and a delivery nurse without individual optional or additional benefits.

Services of choice

a) In hospitals which liquidate according to the Krankenhausentgeltgesetz -German Law of Costs for Hospital Benefits or according to the Bundespflegesatzverordnung – German regulation of hospital charges -costs for services of choice according to those regulations are the costs for separately calculable accommodation in a one or two bedded room (surcharge to the nursing costs) and the treatment by the senior consultant which has been separately agreed upon.

b) In hospitals which do not liquidate according to the Krankenhausentgeltgesetz -German Law of Costs for Hospital Benefits or according to the Bundespflegesatzverordnung – German regulation of hospital charges – costs for services of choice are the additional costs for a one or two bedded room and the treatment by the senior consultant which has been separately agreed upon.

If a hospital distinguishes classes of nursing, the following is agreed: the first class of nursing is a one bedded room, the second nursing class is a two bedded room and the third nursing class is a three or more bedded room.

Reimbursed are 100% of the reimbursable costs, in

tariff rate BD.1

a stay in a one, two or more bedded room

tariff rate BD.2

a stay in a two or more bedded room
a stay in a one bedded room limited to the treatment by the senior consultant as well as further reimbursable costs which would have occurred during a stay in a two bedded room. If these cannot be proved the respective costs in a comparable neighbouring hospital are billed.

(however see artificial insemination)

The main person insured gets a daily hospital indemnity for all claims not laid, which amounts to:

Tariff insured	accommodation	with treatment by the senior consultant	without treatment by the senior consultant
BD.1	one bedded room		€ 15
	two bedded room	€ 20	€ 35
	more bedded room	€ 30	€ 45
BD.2	one bedded room		€ 15
	two bedded room		€ 15
	more bedded room	€ 15	€ 30

In case of a semi in-patient medical treatment no daily hospital indemnity is paid.

1.18 In-patient care in hospices

The costsfor a medically prescribed necessary in-patient or semi in-patient care in a hospice in which the palliative medical treatment isgiven are reimbursable,

if the person insured suffers from a disease which is not curable, which has advanced a little or a lot,
if only a limited life span of weeks or few months – for children some years – is to be expected and
if out-patient care in the household or family of the person insured or if care in a nursing institution cannot be given reasonably.

The reimbursable costs will be paid up to the amount which is paid for the care of a person insured in the statutory health insurance less any other reimbursement claims, such as of the private nursing care insurance.

2. Cure treatment

In case of a cure in a spa or health resort, also in case of a stay in a sanatorium the reimbursable costs mentioned in II.1.1 to 1.16 (out-patient medical treatment) are reimbursed as per the percentages mentioned there.

3. Artificial insemination

50% of the reimbursable costs agreed upon in the treatment plan are reimbursed.

The costs for an artificial insemination (measures of the assisted reproduction medicine to support the wish for a child) are reimbursable after a prior written consent, if besides the medical necessity the following conditions are met:

The person insured suffers from an organic sterility which can only be treated with reproduction medicine.
At the time of the treatment the woman is younger than 40 years of age.
The treatment is carried through with spouses or couples living together similar as spouses and only the eggs and sperma of the couple is used (homologue insemination).
The treatment is taken out according to German law.
Before starting the treatment the insurer has to be handed out a tentative therapy and cost plan.

Reimbursed under the above-stated conditions up to

8 insemination cycles in the spontaneous cycle and
3 insemination cycles according to hormonal stimulation

as well as a maximum total of up to 3 attempts from the following measures:

in vitro fertilisation (IVF)
intracytoplasmic sperm injection (ICSI) (including the necessary IVF)
intra-tubal gamete transfer (GIFT), a max of 2 attempts hereof.

The number of reimbursable attempts increases by the number of attempts in which a clinically proven pregnancy occurs, however, this is unsuccessful due to complications (e.g. due to abortion)

If the insured person or their partner has claim for benefits at a different service provider (e.g. statutory or private health insurance) for reproductive medical procedures, this claim for benefits shall override the obligation of the insurer to provide benefits. The insurer is only obligated to provide benefits for such expenses that remain after advance payment of the other service provider.

4. Cryopreservation

Expenses for a one-time cryopreservation of egg cells and/or sperm cells or germ cell tissue are reimbursable after prior written consent. We will therefore reimburse the costs for

the preparationand collection,
the processing,
the transport,
the freezing,
the storage and
the subsequent thawing of egg and/or sperm cells or germ cell tissue.

We will grant cover whenthe insured person

receives a medically necessary therapy which is likely to damage germ cells and
can claim benefits for artificial insemination according to II.3.

We will only reimburse the costs for storage as long as the insured person could claim benefits for artificial insemination in accordance with II.3.

100% of the eligible expenses will be reimbursed.

5. Reimbursement of costs for a person accompanying

If a person insured is in hospital treatment and is accompanied by a person who is in-patient as well, the costs for accommodation and boarding which are separately charged are reimbursed for that person as well if the accompanying person is medically necessary.

The period of accompanying and the expenses for boarding and accommodationof that person are to beproved by the hospital.

6. Reimbursement of costs for child care abroad

In case of a medically necessary in-patient stay of the parent insured caring for the child or any in-patient stay of the parent as an accompanying person (see II.5) a daily benefit of € 25 is paid, if at least one child up to the age of 12 is living in the same household abroad and does not accompany the hospital stay.

7. Dentaltreatment

Such as general, preventive, preservative and surgical benefits, X-rays, treatment of a stomatopathy and diseases of the jaw as well as periodontosis treatment.

100% of the reimbursable costs without maximum limitation are reimbursed.

8. Dentures and orthodontic measures

such as prosthetic dentures, crowns of all kind, bridges and pivot teeth, reparation of dentures, dental splints, occlusal overlays, orthodontic measures, analytic and therapeutic measures as well as inlays (necessary preparatory surgical measures to build up the jawbone included).

Orthodontic treatments which start after the age of 18 are not reimbursable. This does not apply to expenses which are occurring as a result of an accident.

80% of the reimbursable costs are reimbursed. The benefits are limitedto € 1,025 per person and calendar year.

9. Repatriation

100% of the necessary costs for a repatriation to the Federal Republic of Germany or to the country out of which he or she originally has left, if the ill or injured person who is not able to travel as a regular passenger in the own or public means of transport) and

no reasonable treatment is possible in the country of residence or
if according to the type and severity of the disease or accident sequelae a medically necessary hospital treatment would last more than two weeks.

The claim for a reimbursement is reduced by the costs which would have occurred for a normal return, if he or she has a claim for reimbursement of the costs for this normal return.

10. Repatriation in case of death to the home country or burial in the Federal Republic of Germany

100% of the necessary costs will be reimbursed up to the total of € 15,000.00.

11. Return transport of children

The necessary costs of a return transport of co-insured children under 16 years of age are reimbursable, if the main person insured and all co-insured adults are transported back or have deceased. The travel costs include the costs for a transport to and from the travel destination of an accompanying person as well as the costs for the travel back of children.

100% of the travel costs of the general class of transportation will be reimbursed for each child insured as well as the necessary costs for an overnight stay; however not more than the total of € 5,000.

12. Transport of stored blood units abroad

The costs for a transport of storedblood units abroad are reimbursable, if stored blood units are required for an operation outside Europe and if foreign available blood units may be infected.

100% of the costs are reimbursed.

13. Digital health applications

13.1 In the event of an insured case, expenses for digital health applications included in the list of digital health applications of the Federal Institute for Drugs and Medical Devices (compare with § 139e (1) SGB V, see Annex 2) are reimbursable at 100% up to the prices specified therein, if these applications

a) are according to the prescription of the attending physician or the attending psychotherapist, or

b) are claimed for after prior written consent of the insurer.

13.2 Other digital health applications are also reimbursable at 80% up to an invoice amount of € 2,000 per year in the event of an insured case, provided that the insurer has agreed to reimburse them in writing prior to their use.

13.3 The benefits are initially provided for a maximum of 12 months. Thereafter, a new prescription or prior written consent is required in each case.

13.4 Instead of providing reimbursement of expenses, the insurer can also provide the digital health applications itself. The limitation according to II.13.3 applies accordingly in thiscase.

13.5 The reimbursable expenses will exclusively include the costs for the acquisition of the rights of use to the digital health application. We will not reimburse any costs in connection with the use of the digital health applications, in particular for the acquisition and operation of mobile end devices or computers, including internet, electricity and battery costs.

III. Further Insurance Coverage

In the event of a claim, if benefits can be claimed from other insurance contracts, these benefit commitments take precedence. This also applies if subordinate liability is stipulated in one of these insurance contracts, irrespective of when the other insurance contracts were concluded. The reimbursable costs are reduced by the amount reimbursed by the other insurer. If the other insurer does not reimburse within the contractual or statutorily extent, a maximum of 50% out of this tariff will be reimbursed. If the insurance benefits as per II. are not covered with the other insurer, these will be fully reimbursed.

If a claim for benefits exists towards service providers other than those specified in § 5 para. 3 of the General Conditions of the group insurance for temporary stays in Germany, the main person insured is at liberty to decide which party to report the claim to. If the claim is reported by the main person insured to Hallesche Krankenversicherung AG first, it will make an advance payment within the framework of its obligations. Additionally, § 12 of these Terms of Insurance applies.

Appendix

GERMAN LAW OF HOMOSEXUAL PARTNERSHIPS – LEBENSPARTNERSCHAFTSGESETZ

§ 1 Form and Conditions

(1) Two persons of the same sex set up a civil union if they personally and in each other‘s presence declare before a registrar that they wish to enter into a civil union (companion for life). The declarations may not be subject to a condition ora time limit.

(2) The registrar should ask each person in turn whether they wish to establish a civil union. If both persons respond in the affirmative, the registrar shall declare that the civil union is now established. The establishment of a civil union can take place in the presence of up to two witnesses.

(3) A civil union cannot become established in law if

1. a person is a minor or married or has already entered into a civil union with anotherperson;

2. the persons aredirectly related to each other;

3. the persons arebrothers and sisters or half-brothers and half-sisters;

4. the partners agree when entering into the civil union that they do not wish to accept any of the obligations set out in § 2.

(4) The promise to establish a civil union means that it is notpossible to bring an action against the establishment of such a union. § 1297 para. 2 and §§ 1298 to § 1302 of the German Bürgerliches Gesetzbuch – civil law – apply accordingly.

GERMAN INSURANCE CONTRACT LAW – VERSICHERUNGSVERTRAGSGESETZ [VVG]

§ 195 Insurance Period

(1) 1The health insurance coverage which may replace completely or partly the health ornursing care insurance coverage ofthe statutory social system (substitute health insurance) is timely unlimited subject to para. 2 and 3 and § 196 and § 199. 2If the non-substitute health insurance is practised as per the life assurance, sentence 1 is valid accordingly.

(2) It is possible to arrange contract periods in case of an apprenticeship, stays abroad,travel and additional coverage insurance.

(3) 1If a person has a temporary residence permit for Germany it may be agreed that the health insurance ends at the latest after five years. 2In case a shorter period has been arranged it is possible to conclude a similar new contract, if the expired period has been considered and the maximum period of five years has not been exceeded; the new contract may also be concluded with anotherinsurer.

SOCIAL SECURITY ACT, FIFTH BOOK [SOZIALGESETZBUCH, SGB]

§ 139e Directory for digital health applications; authorisation to prescribe

(1) The Federal Institute for Medication and Medical Devices will maintain a list of reimbursable digital health applications in accordance with § 33a. The directory will be structured according to groups of digital health applications which are comparable in their functions and areas of application. The Federal Institute for Medication and Medical Devices will publish the list and any amendments thereto in the Federal Gazette and on the Internet.

Law excerpts

GERMAN INSURANCE CONTRACT ACT (VVG)

§ 8 Policyholder’s right of revocation

(1) The policyholder may revoke his contractual agreement within 14 days. The policyholder shall declare his revocation to the insurer in writing, but need not state any reason; timely dispatch shall suffice for compliance with the time limit.

(2) The revocation period shall begin at such time as the policyholder receives the following documents in writing:

1. the insurance policy and the terms of contract, including the general terms and conditions of insurance, as well as the other information in accordance with section 7 (1) and (2), and

2. a clearly worded instruction regarding the right of revocation and the legal consequences of the revocation which makes clear to the policyholder his rights commensurate with the requirements of the means of communication employed, and the names of the person to whom the revocation is to be declared, with an address at which documents may be served, as well as a note making reference to the commencement of the revocation period and to the rules set out in subsection (1), second sentence.

(3) The right of revocation shall not apply

1. to contracts of insurance with a term of less than one month,

2. to contracts of insurance for provisional cover, unless they are distance contracts within the meaning of section 312b (1) and (2) of the German Civil Code,

[…]

§ 14 Due date of the payment

(1) Payments of the insurer are due after the end of the assessment required to determine the occurrence of an insured event and the amount of compensation payable by the insurer.

(2) If such assessment is not finished after expiry of one month since the notification of the insured event, the policyholder can request payment by installments amounting to the minimum that the insurer can be expected to be required to pay. The period shall be suspended as long as the assessment cannot be finished due to a fault of the policyholder.

(3) Any agreement under which the insurer is exempt from his obligation to pay default interest shall be invalid.

§ 19 Duty of disclosure

(1) The policyholder shall disclose to the insurer before making his contractual acceptance the risk factors known to him which are relevant to the insurer’s decision to conclude the contract with the agreed content and which the insurer has requested in writing. If, after receiving the policyholder’s contractual acceptance and before accepting the contract, the insurer asks such questions as are referred to in the first sentence, the policyholder shall also be under the duty of disclosure as regards these questions.

(2) If the policyholder breaches his duty of disclosure under subsection (1), the insurer may withdraw from the contract.

[…]

§ 28 Breach of a contractual obligation

(1) In case of a breach of a contractual obligation towards the insurer that the policyholder needs to fulfill prior to the occurrence of the insured event, the insurer may cancel the contract without notice within one month from the time he becomes aware of the breach, unless the breach is not the result of intention or gross negligence.

(2) Where the contract stipulates that the insurer is exempt from its liability to pay in case of a breach of a contractual obligation that the policyholder needs to fulfill, the insurer is only exempt from its liability to pay if the policyholder has deliberately breached the obligation. In the event of a grossly negligent breach of the obligation, the insurer shall be entitled to reduce his benefits according to the severity of the fault of the policyholder; the burden of proof for the non-existence of a grossly negligent behavior lies with the policyholder.

(3) By way of derogation from paragraph 2, the insurer is obliged to pay if the breach of the obligation was neither the cause for the occurrence or determination of the insured event nor for the determination or scope of the insurer’s liability to pay. Sentence 1 shall not apply if the policyholder has fraudulently breached the obligation.

(4) Where an obligation to provide information is breached after the occurrence of the insured event, the insurer’s full or partial exemption from performance according to paragraph 2 requires that the insurer has informed the policyholder in writing by separate notification about this legal consequence.

(5) An agreement based on which the insurer is entitled to withdraw from the contract in the event of the non-observance of an incidental obligation shall be void.

§ 37 Delayed payment of first insurance premium

(1) If the single premium or the first premium is not paid in good time, the insurer shall be entitled to withdraw from the contract as long as the payment has not been made, unless the policyholder is not responsible for the non-payment.

(2) If the single premium or first premium has not been paid when the insured event occurs, the insurer shall not be obligated to effect payment, unless the policyholder is not responsible for the non-payment. The insurer shall only be released from liability if he had informed the policyholder of the legal consequence of non-payment of the premium in writing in a separate communication or by means of a conspicuous note in the insurance policy.

§ 38 Delayed payment of subsequent premium

(1) If a subsequent premium is not paid in good time, the insurer may set the policyholder a payment deadline of no less than two weeks at his expense and in writing. The setting of the deadline shall only be effective if it details the individual amounts of the premium which are in arrears, the interest and costs, as well as quoting the legal consequences associated in accordance with subsections (2) and (3)with expiry of the time limit; in the case of consolidated contracts, the amounts must be quoted separately.

(2) If the insured event occurs after the deadline expires, and if the policyholder is in arrears as regards the payment of the premium or of the interest or costs, the insurer shall not be obligated to effect payment.

(3) The insurer may, after the deadline expires, terminate the contract without prior notice insofar as the policyholder is in arrears as regards the payment of the due amounts. The termination can be linked to the setting of the payment deadline in such a way that it becomes effective once the deadline expires if the policyholder is in arrears as regards the payment at that point in time; the policyholder must be explicitly informed of this in the termination. The termination shall become void if the policyholder makes the payment within one month after the contract has been terminated or, if it has been linked to the setting of a deadline, within one month after the deadline expires; subsection (2) shall remain unaffected.

§ 86 Subrogation of claims for compensation

(1) Where the policyholder has a claim for compensation against a third party, the insurer is subrogated to this claim if he compensates the damage. This subrogation cannot be asserted to the policyholder’s disadvantage.

(2) The policyholder has to assert his / her claim for compensation or any right to secure this claim properly and in due time and assist the insurer, as far as necessary, in enforcing such claim for compensation. Where the policyholder breaches this obligation intentionally, the insurer is exempt from his liability to pay insofar as he can consequently not claim compensation from the third party. In case of a grossly negligent breach of obligations, the insurer is entitled to reduce his benefits according to the severity of the policyholder’s fault. The burden of proof for the non-existence of a grossly negligent behavior lies with the policyholder.

(3) If the policyholder’s claim for compensation is against a person with whom he / she lived in cohabitation when the damage occurred, the subrogation in accordance with paragraph 1 cannot be asserted unless this person has intentionally caused the damage.

§ 193 Insured person; obligatory insurance

(1) The health insurance may be taken out for the policyholder or for another person. The insured person shall be that person for whom the insurance is taken out.

(2) Where the knowledge and the conduct of the policyholder are of legal significance under this Act, in the case of insurance for another person, account shall also be taken of the knowledge and conduct of that person.

(3) Each person with a place of residence in Germany shall be obligated to conclude and maintain with an insurance company licensed to operate in Germany for himself and for the persons legally represented by him, insofar as they are not themselves able to conclude contracts, a cost-of-illness insurance which comprises at least a cost refund for outpatient and inpatient treatment and in which the absolute and percentage excesses for outpatient and inpatient treatment which have been agreed for services covered by the respective tariff for each person to be insured are limited to an amount of Euro 5,000 per calendar year; for persons entitled to medical expenses assistance, the possible excesses emerge through the analogous application of the percentage not covered by the rate of medical expenses assistance to the maximum amount of Euro 5,000. The obligation in accordance with the first sentence shall not apply to persons who

1.  are insured or subject to obligatory insurance in statutory health insurance, or

2.  have a right to free treatment, to medical expenses assistance or to comparable rights to the extent of the respective entitlement, or

3.  have a right to benefits in accordance with the Asylum-Seekers Benefits Act, or

4.  are recipients of recurrent benefits in accordance with the Third, Fourth and Seventh Chapters of Social Code Book XII, and recipients of benefits in accordance with Part 2 of Social Code Book IX, for the duration of the receipt of such benefits and during periods of an interruption of the receipt of benefits of less than one month if the receipt of benefits commenced prior to 1 January 2009.

A cost-of-illness insurance contract agreed prior to 1 April 2007 shall be deemed to meet the requirements of the first sentence.

§ 194 Applicable provisions

(1) Insofar as the insurance cover is granted in accordance with the principles of indemnity insurance, sections 74 to 80 and sections 82 to 87 shall apply. Sections 23 to 27 and section 29 shall not apply to health insurance. Section 19 (4) shall not apply to health insurance if the policyholder is not responsible for the breach of the duty of disclosure. Notwithstanding section 21 (3), first sentence, the time limit for asserting the insurer’s rights shall be three years.

(2) If the policyholder or an insured person is entitled to the repayment of remuneration paid without legal basis to the provider of services for which the insurer has paid compensation on the basis of the contract of insurance, section 86 (1) and (2) shall apply mutatis mutandis.

(3) Sections 43 to 48 shall apply to health insurance with the proviso that only the insured person may demand payment of the insurance benefit if the policyholder has designated him in writing to the insurer as the beneficiary of the insurance benefit; such designation may be revocable or irrevocable. Where this condition is not met, only the policyholder may demand payment of the insurance benefit. The insurance policy need not be presented.

§ 195 Period of insurance

(1) Health insurance which may wholly or partially substitute for health and long-term nursing care insurance cover provided for in the statutory social insurance system (substitutive health insurance) shall be for an indefinite period, unless subsections (2) and (3) and sections 196 to 199 provide otherwise. Where the non-substitutive health insurance cover is provided in the manner of life insurance, the first sentence shall apply mutatis mutandis.

(2) In the case of vocational training, overseas, travel and residual debt health insurance, a period of contract may be agreed.

(3) In the case of health insurance for a person with a temporary residence permit for Germany, agreement may be reached to the effect that the insurance will expire after five years at the latest. If a shorter term has been agreed, a similar new contract may only be concluded with a maximum term that does not exceed five years when added to the term of the expired contract; this shall also apply if the new contract is concluded with another insurer.

§ 205 Termination of the contract by the policyholder

(3) If the contract of insurance provides that when the policyholder reaches a certain age or when other preconditions referred to therein are met the premium for another age or another age group applies or the premium is calculated taking old age reserves into account, the policyholder may terminate the insurance agreement with regard to the affected insured person within two months after the change with effect from the time it became effective if the premium increases as a result.

(4) If the insurer increases the insurance premium or reduces a benefit on account of an adjustment clause, the policyholder may terminate the insurance policy with regard to the affected insured person within two months after receipt of the communication of the change with effect from such time as the increase in the premium or the reduction of the benefits is to take effect.

§ 213 Collection of personal health data from third parties

(1) The insurer is only allowed to collect personal health data from the following third parties: physicians, any kind of hospitals, nursing homes and staff, other personal insurance providers and providers of compulsory health insurance as well as employers’ liability insurance associations and authorities; such collection of data is only allowed if knowledge of said data is necessary to assess the insured risk or the liability to pay and if the affected party has given his / her declaration of consent.

(2) The declaration of consent in accordance with paragraph 1 can be given prior to issuing the contract statement. The affected person must be informed about data collection as stipulated in paragraph 1 and may object to the collection.

(3) The affected person can request at any time that a collection of data is only carried out if he / she gave his / her consent for each individual data collection.

(4) The affected person must be informed about his / her rights, in particular about the right of objection in accordance with paragraph 2 when being informed about data collection.

GERMAN INSURANCE SUPERVISION ACT (VAG)

§ 153 Hardship tariff

(1) Non-payers within the meaning of section 193 (7) of the German Insurance Contract Act form a tariff within the meaning of section 155 (3) sentence 1. The hardship tariff provides for the reimbursement of expenses solely in connection with benefits necessary for the treatment of serious illness and pain and those associated with pregnancy and maternity. By way of derogation from the above provision, expenses for insured children and young persons, in particular expenses for preventive medical examinations aimed at the early discovery of illnesses under statutory programmes and for immunisation recommended by the German Standing Committee on Vaccination (Ständige Impfkommission – STIKO) at the Robert Koch Institute under section 20 (2) of the German Protection against Infection Act (Infektionsschutzgesetz – IfSG) must be reimbursed.

(2) A standard premium must be calculated for all insured persons under the hardship tariff; section 146 (1) nos. 1 and 2 applies in all other respects. In the case of insured persons whose insurance contract only provides for the reimbursement of a percentage of the expenses incurred, the hardship tariff provides benefits equivalent to 20, 30 or 50 per cent of the insured treatment costs. Section 152 (3) applies, with the necessary modifications. The calculated premiums under the hardship tariff must not exceed the amount required to cover the claims expenditures under the tariff. Additional expenses that arise in connection with guaranteeing the limitations specified in sentence 3 must be allocated equally to all the insurer’s policyholders with an insurance contract that satisfies an obligation under section 193 (3) sentence 1 of the German Insurance Contract Act. The provision for increasing age must be offset against the premium to be paid under the hardship tariff such that up to 25 per cent of the monthly premium is covered by a withdrawal from the provision for increasing age.

GERMAN CRIMINAL CODE (STGB)

§ 218a Exemption from punishment for abortion

(2) A termination which is performed by a physician with the consent of the pregnant woman is not unlawful if, considering the pregnant woman’s present and future circumstances, the termination is medically necessary to avert a danger to the life of or the danger of grave impairment to the pregnant woman’s physical or mental health and if the danger cannot be averted in another manner which is reasonable for her to accept.

(3) The conditions of subsection (2) are also deemed fulfilled with regard to a termination performed by a physician with the consent of the pregnant woman if, according to medical opinion, an unlawful act under sections 176 to 178 has been committed against the pregnant woman, there are cogent reasons to support the assumption that the pregnancy was caused by the act and no more than 12 weeks have elapsed since conception.

GERMAN CIVIL CODE (BGB)

§ 195 Regular limitation period

The regular limitation period is three years.

Data protection notice and list of service providers Hallesche

The data protection information and the list of service providers of Hallesche Krankenversicherung AG are only available in the German version.

List of service providers

Service providers commissioned by DR-WALTER GmbH

In accordance with „Verhaltensregeln für den Umgang mit personenbezogenen Daten durch die deutsche Versicherungswirtschaft“
(Code of Conduct Data Protection)

German insurers have issued a Code of Conduct for the protection of your personal data and your privacy. We, DR-WALTER, comply with this Code of Conduct and would like to provide you with a list of service providers (companies and private individuals) with whom we work together during order processing when it comes to data processing and assignment of functions. The list also includes service providers with whom we cooperate in the use of health data and other data protected under § 203 German Criminal Code (StGB). We also work together with service providers who collect, process and use health data and other data protected under § 203 StGB.

Insurers and reinsurers

Assigned functions:

Collection, processing or use of personal data to establish, carry out or end an insurance contract (e. g. application processing, risk assessment, policy management, determination of the liability to pay)

Involved bodies / organizations:
insurers mentioned in the insurance certificate

Generali Deutschland Krankenversicherung AG,
Dialog Versicherung AG,
Würzburger Versicherungs-AG,
HanseMerkur Reiseversicherung AG,
ERGO Reiseversicherung AG,
ERGO Versicherung AG,
Allianz Partners – AWP Health & Life SA,
Inter Krankenversicherung AG,
Hiscox SA,
Barmenia Krankenversicherung AG,
Barmenia Allgemeine Versicherungs-AG,
Techniker Krankenkasse,
BDAE Holding GmbH,
Foyer Santé S.A.,
Globality S.A.,
BD24 Berlin Direkt Versicherung AG,
Hallesche Krankenversicherung a. G.