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Information Notice Allianz Prevoyance TNS - Insurance for Self-Employed Workers

Discover the information notice on the insurance coverage for self-employed workers offered by Allianz Deuil Enghien. This document details the guarantees, options, and procedures to follow in case of a claim, useful for freelancers and self-employed workers.

Self-employed workers, freelancers, and professionals looking for insurance coverage solutions tailored to their needs.
July 29, 2026 · 968.1 KB · 94 page(s) ·
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Allianz Prévoyance

Self-Employed Worker

Visa DPP13-224

INFORMATION NOTICE


What is the purpose of insurance coverage?

Insurance coverage protects you and your family in case of work stoppage, disability, or death. It allows you, for example, to receive compensation in case of work stoppage following an accident or illness. It covers your loved ones in case of death. In this case, this insurance also provides you with legal protection (subject to conditions) and services you may need. These coverages are presented following this Information Notice in two documents:

  • Legal Protection;
  • Assistance Agreement.

1. What guarantees and options do we offer you?

Allianz Prévoyance Self-Employed Worker is a comprehensive offer that adapts to your needs. You thus have numerous combinations of guarantees and options. Find the summary on page 3.

2. What to do in case of a claim?

You will find in the chapter “What to do in case of a claim?”, paragraph I, the details of the documents to provide to benefit from the benefits provided in your membership in the contract. In case of work stoppage, you can use online procedures, as described in the following paragraph. Otherwise, you can always send your documents and supporting evidence to the following address: Allianz – Client Life Solutions Center – TSA 81003 – 67018 Strasbourg Cedex. If these documents contain medical information, please indicate on the envelope “To the attention of the medical advisor.”

3. What services does your client area offer?

You will find in your client area allianz.fr the details of the subscribed guarantees and options as well as the contact information of your representatives. You will be able, in particular, to declare your work stoppage and follow the progress of your file directly from this client area. With the e-mail service, we make certain documents available to you. As soon as a new document is available, you will be informed by email. For more information on this service, refer to the chapter “General Information,” paragraph II.

To remember

Good to know
To facilitate your reading, the following icon will help you identify useful information.


Summary

  • Summary table of guarantees and options ----------------------------------------------------- 3
  • Main definitions --------------------------------------------------------------------------------------------------- 4
  • Membership conditions -------------------------------------------------------------------------------------------- 5
    • I. The Allianz Prévoyance Self-Employed Worker Contract 5
    • II. The purpose of the Contract 6
    • III. The fiscal framework 6
    • IV. The admission conditions related to the member/insured 6
    • V. Membership in the Contract 7
    • VI. The consequences of a false declaration upon membership 9
  • The details of the guarantees and options available to you -------------------------------------- 11
    • I. General limitations and exclusions 11
    • II. Guarantees in case of death 14
    • III. Guarantees in case of incapacity 16
    • IV. Guarantees in case of disability 20
    • V. Other guarantees and options 23
  • What to do in case of a claim? --------------------------------------------------------------------------------------- 26
    • I. Supporting documents to provide us 26
    • II. About your claim declaration 27
    • III. Medical control 28
  • Who benefits from the benefits? ---------------------------------------------------------------------------------- 29
    • I. In case of death 29
    • II. In case of Total and Irreversible Loss of Autonomy (PTIA) 30
    • III. In case of incapacity, disability, occurrence of a feared illness, and hospitalization 30
  • Your contributions ----------------------------------------------------------------------------------------------------------------- 31
    • I. The calculation of your insurance contributions 31
    • II. The evolution of insurance contributions over time 31
    • III. The payment of insurance contributions 32
  • Changes to your membership ------------------------------------------------------------------------ 33
    • I. Changing guarantees 33
    • II. Changing your personal situation 33
  • General information------------------------------------------------------------------------------------------ 34
    • I. The right of withdrawal 34
    • II. The e-mail service 35
    • III. Your contact person if you need information 36
    • IV. The protection of your personal data 37
    • V. Your right to oppose telemarketing 39
    • VI. Customer relations and mediation 39
    • VII. The prescription conditions 39
    • VIII. Subrogation 41
    • IX. Participation in technical and financial benefits 41
    • X. The fight against money laundering 41
    • XI. The solvency and financial situation of the insurer 41
    • XII. The supervisory authority and the rules governing the Contract 41
    • XIII. International sanctions 41
    • XIV. The unique identifier (IDU) ADEME 42
  • Specific disability scale ----------------------------------------------------------------------------------- 43
  • Glossary -------------------------------------------------------------------------------------------------------------------------------- 45

SUMMARY TABLE OF GUARANTEES AND OPTIONS

Here is the summary of the guarantees and options you can choose at the time of your membership:

Guarantees and options(1) Minimum/Maximum Madelin Device Conditions/Links with other guarantees Page of the notice
Guarantees in case of death
Death from all causes (in case of accident or illness) €15,000 minimum Yes (if paid as a life annuity) No (if paid as a capital) Taxation of choice at membership (affects the payment method). Legal protection included.
Accidental death €15,000 minimum No page 14
Spouse's annuity Between €1,800 and €50,000/year Yes page 14
Education annuity Between €900 and €50,000/year/child Yes page 15
Total and irreversible loss of autonomy (PTIA) Yes (PTIA spouse's annuity, PTIA education annuity) No (PTIA death from all causes, PTIA accidental death) Included and associated with the above guarantees. page 15
Double family effect No Taken out with the guarantees Death from all causes or/and Accidental death. page 16
Guarantees in case of incapacity
Total temporary incapacity in case of accident or illness (with or without back option) €15/day minimum Yes page 18
Total temporary incapacity in case of accident €15/day minimum Yes page 19
Daily allowances for general expenses (with or without back and psychological option) €15/day minimum No page 19
Exemption from contributions in case of total temporary incapacity No Included and associated with the guarantees in case of incapacity above. page 20
Guarantees in case of disability
Disability annuity in case of accident or illness (with or without back and psychological option) €7,500/year minimum Yes Taken out with the guarantee Total temporary incapacity in case of illness or accident lasting 1095 days. page 21
Disability annuity in case of accident €7,500/year minimum Yes Taken out with the guarantee Total temporary incapacity in case of accident lasting 1095 days. page 22
Disability capital in case of accident or illness (with or without back and psychological option) €15,000 minimum No page 23
Disability capital in case of accident €15,000 minimum No page 23
Exemption from contributions in case of disability No Included and associated with the guarantees in case of disability above. page 23
Other guarantees and options
Back and psychological option According to the taxation of the guarantee to which it applies. Complements only the incapacity and disability guarantees in case of accident or illness. page 23
Capital for feared illnesses Between €7,500 and €125,000 No page 24
Hospitalization guarantee Between €15 and €100/day
Yes Cannot be taken out alone. page 25
Legal protection According to the taxation of the Death from all causes guarantee
Included in the Death from all causes guarantee. (2)
Assistance Included at membership. (2)

(1) The chapter “The details of the guarantees and options available to you” specifies in its paragraph I. the limitations and exclusions associated with these different guarantees and options, particularly the sports practices that we do not cover by default.
(2) These guarantees are presented respectively in the documents “Legal Protection” and “Assistance Agreement” placed following this Information Notice.


4 MAIN DEFINITIONS

Find other definitions in the glossary on page 45.

Main definitions

You
The member, who is also the insured.

We
Allianz Vie, the insurer.

ANCRE
NATIONAL ASSOCIATION for RISK COVERAGE, RETIREMENT, and SAVINGS. Non-profit association governed by the law of July 1, 1901, representing its members in relations with the insurer Allianz Vie.

Beneficiary
Person who receives benefits in case of triggering a guarantee.

Spouse
The spouse of the insured is considered as such, in the absence of the partner linked to the insured by the Civil Solidarity Pact. This definition applies to the beneficiary clauses of the guarantees Death from all causes and Accidental death. The case of cohabitation is specified in the chapter “Who benefits from the benefits?”, paragraph I.

Mandatory scheme
Legal social insurance scheme to which you are mandatorily subject.


5 MEMBERSHIP CONDITIONS

Membership conditions

I. The Allianz Prévoyance Self-Employed Worker Contract

Allianz Prévoyance Self-Employed Worker is the name given to two group insurance contracts with optional membership established under numbers 010-2014-001 and 010-2014-002, governed by French law and the Insurance Code.
They are subscribed:

  • with Allianz Vie;
  • by the NATIONAL ASSOCIATION for RISK COVERAGE, RETIREMENT, and SAVINGS (ANCRE) for the benefit of its members.

The group insurance contract 010-2014-001 is subscribed within the framework exclusively reserved for non-agricultural self-employed workers (article L144-1 of the Insurance Code) hereinafter referred to as the “Madelin device.”
The group insurance contract 010-2014-002 is subscribed for non-agricultural self-employed workers wishing to have guarantees not eligible for this same device.
These two contracts are hereinafter referred to as “the Contract.”

  1. The subscriber
    ANCRE is the subscriber of the Contract. It is a non-profit association governed by the law of July 1, 1901, and controlled by the Prudential Control and Resolution Authority (ACPR). ANCRE is located at 27 Boulevard des Italiens, 75002 Paris. Its statutes are available upon simple request from ANCRE or on the website www.ancre-vie.com.
    ANCRE defends the interests of its members.
    ANCRE aims to:
    • stimulate and develop, among its members, the sense of savings and foresight, and more generally all forms of guarantees against life risks;
    • study the various possibilities for voluntarily establishing supplementary retirement, savings, and insurance schemes;
    • enable the implementation of these schemes, notably by subscribing to the intention of its members the capitalization contracts, the corresponding group life insurance contracts, or the group insurance contracts aimed at covering additional retirement commitments;
    • inform its members of the evolution of these various schemes;
    • represent its members within the framework of the group insurance contracts it has subscribed and defend their interests with any intervening organization and public authorities;
    • make available to its members services related to the social purpose;
    • participate in any action, association, foundation, having an object related to that of the association;
    • propose privileged offers that the association may have obtained from partners;
    • exercise any act of solidarity towards individuals in a situation of disability, illness, or great distress.

To join the Contract, you must be a member of the ANCRE association. Non-members become members upon payment of the first annual statutory contribution (also called “membership fee”).
The contribution to the ANCRE association for the Contract you have joined is due each year.
The annual statutory contribution is indicated in the membership offer (or the membership application, if applicable). It is subject to annual revision by the association.

  1. The insurer
    All guarantees and options of the Contract are insured by Allianz Vie (under branch 20 “life-death,” branch 1 “accident,” and branch 2 “illness”). The list of branches is found in article R321-1 of the Insurance Code.

  2. The member/insured
    The Contract is reserved for individuals only, members of ANCRE who are up to date with their annual statutory contribution to the association.
    The member is the person who signs the acceptance of the membership offer (or the membership application if applicable) and who accepts the clauses we propose.
    The insured is the person whose death, disability, incapacity, feared illness, or hospitalization following an illness or accident triggers the payment of the guaranteed benefits in effect at the time of the occurrence of this event.
    In the context of the Contract, the member and the insured are one and the same person: you.


6 MEMBERSHIP CONDITIONS

  1. Modification or termination of the group insurance contract
    The Contract took effect on June 30, 2014. It is then renewed annually, each January 1, by tacit renewal.
    The Contract can be terminated each year on December 31 by Allianz Vie or ANCRE with a notice period of 6 months.

    a. In case of modification of the group insurance contract
    If this modification concerns the rights and obligations of members, it will be communicated to members in writing by ANCRE, in the form of “information to members,” at least 3 months before the intended date of their entry into force (article L141-4 of the Insurance Code). Following these modifications, members who wish can terminate their membership.

    b. In case of termination of the group insurance contract
    In this case, members are informed with a notice period of 3 months. They continue to be members of ANCRE and insured by Allianz Vie. They therefore benefit from the subscribed guarantees and options until the end of their membership, provided they pay the insurance and association contributions.

    c. In case of dissolution of ANCRE
    Allianz Vie commits to offering membership in another group insurance contract, subscribed by an association and meeting the requirements of the device reserved for self-employed workers (Madelin device).

II. The purpose of the Contract

The purpose of the Contract is to guarantee you, according to your choice, in case of death, total and irreversible loss of autonomy, incapacity, disability, occurrence of a feared illness, and hospitalization, following an illness or accident.

III. The fiscal framework

You are a non-agricultural self-employed worker, notably: artisan, merchant, independent, liberal profession, majority manager, under certain conditions social representative or collaborating spouse.
You join, according to the guarantees you choose:

  • the group insurance contract no. 010-2014-001. It allows you to benefit from tax deductibility under the Madelin device (article L144-1 of the Insurance Code).

Membership Conditions

I. Introduction

In this context, you must be up to date with your contributions to the mandatory health and old-age insurance schemes.

II. Group insurance contract

  • Contract no. 010-2014-002: It allows you to benefit from guarantees not eligible for the Madelin device.

III. Loss of non-agricultural self-employed worker status during membership

In the event that, during membership, you change from the status of non-agricultural self-employed worker to that of an employee, you must inform us within thirty days of this change, by registered letter with acknowledgment of receipt.

  • Within one month from the receipt of your letter, all your guarantees remain maintained.
  • However, you will no longer benefit from the tax device linked to the status of non-agricultural self-employed worker (Madelin device). Membership in contract no. 010-2014-001 is therefore terminated at the expiration of this one-month period.
  • Membership in contract no. 010-2014-002, however, is not modified.
  • We may offer you another contract adapted to your new situation.

IV. The admission conditions related to the member/insured

To join the Contract, you must meet the following conditions:

  • Have your tax residence as well as the place of your professional activity in metropolitan France or in the Overseas Departments and Regions(1).
  • Exercise a non-salaried, paid, and fiscally declared professional activity or be the non-salaried spouse, who provides effective collaboration to the non-salaried worker and is officially declared “collaborating spouse” by any official document such as Kbis or general assembly extract.
  • Be at least 18 years old and meet the age conditions indicated in the chapter “The details of the guarantees and options available to you” depending on the selected guarantees.

(1) Overseas Departments and Regions: Guadeloupe, French Guiana, Réunion, Martinique, Mayotte.

V. Membership in the Contract

At the time of membership, you commit to providing us with all important information in assessing your personal and professional situation on the documents provided to you for this purpose (health questionnaire or medical report, declarations of professional and sports activities, specific activity questionnaires).

1. Membership formalities

If you meet the admission conditions defined in this chapter, paragraph IV, you can proceed with the membership steps once you have chosen your guarantees and options.

a. Path through membership offer

You declare your personal and professional situation by completing and signing all the membership documents used to assess the risk we present to you.

  • You must comply with the medical formalities we set, complete and sign the health questionnaire corresponding to your situation. We may ask you for additional medical examinations or information depending on the medical elements you have declared.
  • Following our analysis of your situation, we may:
    • Refuse your membership;
    • Make you a membership offer without special conditions;
    • Make you a membership offer with special conditions of guarantees (restrictions on certain guarantees or exclusions) and/or rates (increased contributions).

If we make you a membership offer, you have the choice to accept or refuse it. To accept it, you simply need to return the signed acceptance of the membership offer.

When the membership offer includes special conditions of rates (increased contributions) and/or guarantees (restrictions on certain guarantees or exclusions), these conditions are then notified to you in writing. If you agree to them by returning them signed within a maximum of 60 days from their date of sending, you can then sign the acceptance of the membership offer. In the absence of receipt of your written agreement on these conditions within this period, the membership is deemed refused.

In all cases, if we do not receive your agreement within the period indicated in the membership offer, we consider that you refuse our membership offer.

At the moment you sign the acceptance of the offer, you must provide us with your bank details (RIB or RICE), a SEPA mandate, and a Kbis extract of less than 3 months.

Membership is concluded as soon as you sign the acceptance of the membership offer. We then provide you with a Membership Bulletin.

We cover the costs incurred by the contractual medical formalities we set. Those incurred by any requests for additional information from us are at your expense. If you join the Contract, these costs will be reimbursed to you upon request.

b. Path through membership request

If membership in the Contract is not eligible for the path through the membership offer mentioned in the above paragraph, in this case, you must provide us with:

  • The membership request, which you sign, accompanied by your bank details (RIB or RICE), a Kbis extract of less than 3 months, and a SEPA mandate;
  • The health questionnaires corresponding to your situation, completed and signed at the time of membership. We may ask you for additional medical examinations or information depending on the medical elements you declare;
  • And other documents from which the membership request is studied before we can accept or refuse the membership. These documents may include proof of income.

According to our analysis of your situation, we may:

  • Refuse your membership. In this case, this decision is notified to you;
  • Accept your membership without special conditions. We then send you a validating Membership Bulletin, thus concluding the membership;
  • Accept your membership under special conditions of rates (increased contributions) and/or guarantees (restrictions on certain guarantees or exclusions). These conditions are then notified to you in writing. If you agree to them by returning them signed within a maximum of 60 days from their date of sending, a Membership Bulletin is sent to you, thus validating that the membership is concluded. In the absence of receipt of your written agreement within this period, the membership is deemed refused.

Immediate guarantee in case of accidental death

In the context of this path through the membership request, if you have chosen at least one guarantee in case of death, you benefit from an immediate guarantee in case of accidental death for a maximum period of sixty days from the date of signing the membership request. This guarantee is set at the amount of the chosen death capital, up to €150,000.

If you die before the issuance of the Membership Bulletin, the capital is paid and the initial contribution received will be refunded.

No payment will be made under the immediate guarantee if the death is the result of:

  • An illness;
  • An accident occurring before the date of signing the membership request.

The immediate guarantee in case of accidental death ceases:

  • When you do not respond within 15 days from the date of sending our letter requesting additional information;
  • On the day of our refusal to grant the guarantee;
  • On the day of your refusal to accept the membership conditions;
  • On the date of conclusion of the membership.

Membership

Membership is materialized by the issuance of the Membership Bulletin, at the latest, 60 days after the signing of the membership request. This guarantee does not apply if the chosen death guarantees are deferred.

2. The start and end of your membership and your guarantees and options

a. Effect of your membership

Your membership takes effect on the date indicated in the Membership Bulletin. The main due date corresponds to the anniversary date of this effective date.

b. Effect of guarantees and options

The guarantees take effect on the effective date of the membership, provided you have paid the first contribution and the first annual statutory contribution to ANCRE. The effective date for all or part of your guarantees may, however, be deferred. When certain guarantees have a deferred effective date, this date is also specified on the Membership Bulletin.

For certain guarantees, there is also a waiting period for coverage. This begins from the effective date of the guarantee. The chapter “The details of the guarantees and options available to you” specifies the guarantees concerned by a waiting period as well as its possible modalities.

c. Duration of membership

Your membership has a duration of one year from its effective date. It automatically renews each year on its main due date (tacit renewal), unless terminated under the conditions provided in the following paragraph or at the end of all chosen guarantees.

d. Termination of membership

You have the option to terminate your membership according to the following modalities:

When and how to make your request? When is your membership terminated? Reference to the Insurance Code
At the due date (annual) By registered letter, simple letter, email, via your personal space, or any other durable support, 2 months before the due date of your membership. On its due date. Article L113-12
Loss of your status as a non-agricultural self-employed worker (chapter “Membership conditions,” paragraph III) By registered letter, simple letter, email, via your personal space, or any other durable support, as soon as you change status and within 30 days. One month after the receipt of your request. Only your membership in group insurance contract no. 010-2014-001 is terminated.
Modification of the Contract (chapter “Membership conditions,” paragraph I.4) By registered letter, simple letter, email, or any other durable support, upon receipt of the information sent by ANCRE. At the latest on the date of application of the modifications of the Contract. Article L141-4

Furthermore, we may terminate your membership under the following modalities:

When and how do we inform you? When is your membership terminated? Reference to the Insurance Code
At the due date (annual), during the first 2 years of membership By registered letter, 2 months before the due date of your membership. On its due date.
Non-payment of insurance contributions (chapter “Your contributions,” paragraph III.2) By sending a registered letter of formal notice, 10 days after the due date of your contributions. 40 days after the sending of the letter if you have not paid your contribution. Article L113-3
If you have committed fraud or attempted fraud in connection with a claim By registered letter. 10 days after the sending of the registered letter by our services.

We may also terminate your membership in case of a false declaration on your part, under the conditions specified in this chapter, paragraph VI. In all cases, the statutory contributions to the ANCRE association will not be refunded to you.

For guarantees giving rise to daily allowances, it is specified that any cessation of insurance does not end the payment of benefits due for a claim that occurred prior to the date of cessation of insurance.

e. Cessation of membership

Your membership and all guarantees cease:

  • in case of triggering the guarantees in case of death or the guarantee Total and Irreversible Loss of Autonomy;
  • at the latest the day before your 76th birthday.

The cessation conditions specific to each guarantee or option are described in the chapter “The details of the guarantees and options available to you.”

3. Contractual documents of membership

Your membership consists of the following documents:

  • this Information Notice which defines the guarantees and their entry into force modalities as well as the formalities to be completed in case of a claim;
  • subsequent information to members modifying the Contract;
  • the Membership Bulletin which specifies the chosen guarantees and sets the specific rules;
  • any document you have signed if your situation requires the acceptance of medical exclusions and any documents you have signed to accept rate increases in the path through the membership request;
  • any subsequent amendments.

VI. The consequences of a false declaration upon membership

You must take the utmost care in the membership formalities, particularly by sincerely communicating all the information we request.

Warning: in case of a false declaration, your membership in the Contract may be canceled or your benefits reduced.

Any false declaration or omission of information allowing us to assess the risk at the time of membership leads to the application of the sanctions provided by the Insurance Code:

  • if the false declaration or omission is intentional (article L113-8 of the Insurance Code), we cancel your membership. In this case, we retain the contributions you have paid. Furthermore, we have the right, as compensation, to demand payment of all contributions due until the main due date of your membership. You must also reimburse us for the amounts paid in connection with the claims we have compensated;
  • if the inaccurate declaration or omission is not intentional (article L113-9 of the Insurance Code), you expose yourself to:
    • before the claim: either an increase in your contribution, or termination of your membership,
    • after the claim: a reduction of your benefits proportionally to the contribution you should have paid if your declarations had been accurate.

The annual statutory contributions to the ANCRE association will not be refunded to you.

11. The details of the guarantees and options available to you

The details of the guarantees and options available to you

We detail in this chapter the functioning of the guarantees and options, our coverage conditions, and the general exclusions and those specific to each guarantee. You only benefit from the guarantees and options indicated in your Membership Bulletin or your last valid amendment: these documents also specify the amount of the different guarantees. As indicated in the continuation of the document, some guarantees and options can only be chosen at the time of the membership formalities (for example, the back and psychological option): during membership, these guarantees and options can be removed but it is not possible to add them.

I. General limitations and exclusions

1. Territoriality of guarantees

a. Travel and short stays abroad

Under the guarantees in case of death, you are covered worldwide. If you die abroad, the death certificate issued by the French representation (consulate or embassy) of the concerned country must be provided to us (outside metropolitan France, Overseas, and the Principality of Monaco).

Guarantees in case of incapacity

You are covered worldwide according to the provisions provided by the Contract, provided that the incapacity leads to hospitalization abroad in a public or private healthcare facility under medical control. You must provide us with proof of your hospitalization using documents issued by the local medical authority, endorsed by the doctor attached to the local French consular representation and written in French. Without receipt of these elements, the coverage of the guarantee in case of total temporary incapacity will be suspended until your return to France.

Guarantees other than in case of death and incapacity

You are covered worldwide, provided that a finding is established using documents from the local medical authority, endorsed by the doctor attached to the local French consular representation, written in French, and subject to the possibility of control by us under the conditions provided in the chapter “What to do in case of a claim?”, paragraph III.

In the absence of specific documents justifying your state of health, your right to benefits is suspended until the day of your return to metropolitan France, in the Overseas, or in the Principality of Monaco, in a country of the European Union or a neighboring country of metropolitan France. These specific documents will not be required for all stays in European Union countries or neighboring countries of metropolitan France.

Stays abroad of more than 90 days

In this case, you should refer to the chapter “Changes to your membership,” paragraph II, as the provisions of the previous point may be amended by specific conditions, exclusions, or termination of membership.

Exclusions

Exclusions for all guarantees and options

We exclude:

  • the consequences of civil or foreign wars, military conflicts, terrorism, sabotage, attacks, attempted attacks, riots, civil disturbances, or popular movements in all countries, regardless of where any of these events take place, as long as you take an active part in them, whether or not you act in the context of your professional activity;
  • the consequences of your participation as an author, co-author, or accomplice in intentional offenses, in crimes;
  • the consequences of the insured's state of intoxication medically established by a blood alcohol level exceeding the legal limit in force on the day of the event;
  • the consequences of the use of narcotics consumed by the insured without any medical prescription or the chronic alcoholism of the insured;
  • the consequences, recurrences, relapses, or complications, including those following treatment, of diseases or accidents occurring prior to the effective dates of the guarantees unless they have been declared at the time of membership and have not led to restriction or exclusion of coverage.

Specific exclusions for guarantees in case of death

For these guarantees, we exclude:

  • your death in case of suicide during your first year of insurance: the beneficiaries will then receive only the part of the contribution already paid covering the period after the death;
  • your death in case of suicide during the year following an increase in your guarantees: the beneficiaries will receive the benefits provided prior to the increase in the guarantee as well as the part of the contribution already paid covering the period after the death and corresponding to the increase in guarantee.

Specific exclusions for the Total and Irreversible Loss of Autonomy guarantee

For this guarantee, we exclude the consequences:

  • of diseases or accidents that are your voluntary act;
  • of voluntary mutilations;
  • or of a suicide attempt.

Specific exclusions for the Accidental Death guarantee and guarantees in case of incapacity, disability, and hospitalization

For these guarantees, we exclude:

  • injuries or lesions resulting from bets or challenges;
  • the consequences of diseases or accidents that are your voluntary act;
  • the consequences of voluntary mutilations;
  • the consequences of a suicide attempt;
  • claims resulting directly or indirectly from the disintegration of the atomic nucleus.

Specific exclusions for guarantees in case of incapacity, disability, and hospitalization

For these guarantees, we exclude:

  • periods of maternity or paternity leave, as defined in articles L1225-17 and following and L1225-35 of the Labor Code, whether or not you are subject to them;
  • claims resulting from any surgical act for aesthetic purposes (excluding reconstructive surgery), as well as its possible consequences and complications.

Specific exclusions if the back and psychological option is not retained

For the only guarantees that can be associated with the back and psychological option, namely the guarantees Total temporary incapacity in case of accident or illness, Daily allowances for general expenses, Disability capital in case of accident or illness, Disability annuity in case of accident or illness, if you have not retained the back and psychological option, we exclude:

  • claims resulting from lumbago, low back pain, sciatica, cruralgia, cervical radiculopathy, thoracic outlet syndrome, disc protrusion, herniated disc, back pain, neck pain, coccydynia, unless this condition requires surgical intervention during incapacity;
  • claims resulting from depression, anxiety-depressive syndrome, anxiety disorders, generalized anxiety, panic disorder, obsessive-compulsive disorders, traumatic neurosis, hysterical neurosis, delirium, psychosis, schizophrenia, paranoia, bipolar disorder, borderline personality, eating disorders, hyperactivity, Tourette syndrome, dementia, spasmophilia, chronic fatigue syndrome, fibromyalgia, burnout or professional exhaustion, unless hospitalization of more than 15 continuous days related to these conditions was necessary during this incapacity (excluding day hospitalization) or if you have been placed under guardianship or curatorship by judgment.

Specific exclusions for the Hospitalization guarantee

Under this guarantee, we exclude stays made:

  • in non-hospital establishments;
  • in the following hospital establishments:
    • establishments, houses, centers, or long-stay units, health houses of any kind,
    • establishments, houses, centers, or units fighting against mental illnesses, alcoholism, and drug addiction,
    • psychiatric or neuropsychiatric services other than those of a public hospital or participating in the public hospital service,
    • health-oriented children's homes,
    • rehabilitation establishments including slimming cures, except for thermal cures,
    • rest homes, unless they are consecutive to a guaranteed event.

We also exclude events resulting from:

  • a treatment or surgical intervention for aesthetic purposes (excluding reconstructive surgery), as well as its possible consequences and complications;
  • an accident occurring during a test flight or a flight on an aerial prototype.

Risks practiced as an amateur or paid amateur

The risky sports listed below practiced as an amateur or paid amateur are excluded from the guarantees in case of death, incapacity, disability, as well as the guarantees for Total and Irreversible Loss of Autonomy and Hospitalization. These sports are as follows:

  • Trekking and hiking without a guide at over 3,500 meters or with a guide at over 5,000 meters, mountaineering, paragliding, expeditions in extreme environments, climbing in natural environments, climbing on artificial walls, via ferrata, caving;
  • Skiing/snowboarding/snow surfing/mono skiing (whether the practice is off-piste or extreme or solo), artistic or acrobatic skiing, speed skiing, ski jumping, skiathlon, ski touring, speed riding, ice hockey, bobsleigh. In addition, all snow or ice sports, as long as they are practiced in competition, are excluded;
  • Competitive cycling, competitive mountain biking, radical or extreme mountain biking, BMX;
  • Motor sports and/or sports requiring a land or floating motor vehicle;
  • Water sports such as kitesurfing, windsurfing, hydrospeed, diving from high or artistic heights, yachting more than 50 nautical miles from a shelter, regattas, offshore races, rafting, canoeing-kayaking, kayaking, canyoning, scuba diving from a depth of 20 meters, diving with a diving suit;
  • In competition: windsurfing, speed sailing, water skiing, barefoot skiing, surfing, paddleboarding, windsurfing, surfboarding, Hawaiian surfing;
  • Aerial activities such as paragliding, hang gliding, delta wing, parachuting, ascension parachuting, paramotoring, gliding, glider, ultralight, gyrocopter, hot air ballooning, airship, light aviation with airplane or helicopter, aerial acrobatics;
  • Equestrian sports such as show jumping, cross-country, complete competitions, horseball, hunting, jousting, polo, western riding, equestrian vaulting, equestrian marathon, fox hunting;
  • Small game hunting, big game hunting, safari hunting;
  • Any combat sport, self-defense, and/or martial arts, except for the following sports as long as they are practiced without competition: aero-kick, aikido/aikibudo, body combat, combat cane, capoeira, cardio-kickboxing, energy-full, judo/jiu-jitsu, karate, kung fu, Breton wrestling/Greco-Roman wrestling, taekwondo, tai chi chuan, wendo, yoseikan budo;
  • American football, pole vaulting, base jumping, bungee jumping, bullfighting;
  • In competition: skateboarding, skating, fencing, gymnastics, squash;
  • Record attempts, extreme sports, exploits, sports combining at least one of the sports from this entire list.

However, when you practice these sports occasionally, that is to say, in the context of a baptism, initiation, or training lasting a maximum of one week per year, the guarantees remain available to you if you establish that the practice of the activity was supervised by qualified personnel belonging to a structure authorized to practice the activity.


The details of the guarantees and options available to you

At your express request, all or part of these activities may be subject to a guarantee study. In this case, we will indicate to you:

  • If these exclusions can be lifted, subject to special pricing;
  • Or if we maintain these exclusions by refusing to cover the risk.

i. Sports practiced professionally

By default, the consequences of practicing sports professionally are excluded from all guarantees. You must therefore declare to us the sports you practice professionally during the preliminary formalities for membership so that we can study:

  • If these exclusions can be lifted, subject to special pricing;
  • Or if we maintain these exclusions by refusing to cover the risk.

II. The guarantees in case of death

1. Death from all causes guarantee

This guarantee can be chosen from 18 to 74 years old inclusive. It ceases, at the latest, the day before your 76th birthday. If you die during membership as a result of an illness or an accident, we pay your designated beneficiaries the guaranteed death benefit in the form of:

  • A life annuity (Madelin device);
  • Or capital (excluding Madelin device).

Legal protection is associated with the Death from all causes guarantee. It is described in the document “Legal Protection” placed following this Information Notice.

Waiting period

This guarantee has no waiting period: you are covered from the effective date of the guarantee.

2. Accidental death guarantee

This guarantee can be chosen from 18 to 74 years old inclusive. It ceases, at the latest, the day before your 76th birthday. If you die during membership as a result of an accident, we pay your designated beneficiaries the guaranteed death capital.

Waiting period

This guarantee has no waiting period: you are covered from the effective date of the guarantee.

3. Spouse's annuity guarantee

This guarantee can be chosen from 18 to 74 years old inclusive. It ceases, at the latest, the day before your 76th birthday. If you die during membership as a result of an illness or an accident, we pay a life annuity to your beneficiary, as specified in the chapter “Who benefits from the benefits?”, paragraph I.2.

a. Waiting period

This guarantee has no waiting period: you are covered from the effective date of the guarantee.

b. How is the annuity paid?

The amount of the annuity paid is indicated in the Membership Bulletin or in the last amendment related to this guarantee, in effect at the date of your death. We pay a monthly annuity in arrears, automatically life-long. However, your beneficiary may request the conversion of this life annuity into a temporary annuity before the first payment. The amount of the temporary annuity will then be recalculated based on the requested duration.

During the payment of the annuity, and in order for us to ensure that your beneficiary is still alive, they must send an annual civil status document (certificate of life) to our Client Solutions Center.

The payment of the annuity ceases definitively upon the death of your beneficiary. This annuity is non-reversible. If a change occurs in your family situation, notify us promptly. Indeed, this change (divorce or death of the beneficiary, for example) may have a consequence on the triggering of the guarantee or the amount of your contribution (see the chapter “Your contributions”). Contributions paid prior to the receipt of this information by our Client Solutions Center will not be refunded.

4. Education annuity guarantee

This guarantee can be chosen from 18 to 74 years old inclusive. It ceases, at the latest, the day before your 76th birthday. If you die during membership as a result of an illness or an accident, we pay a temporary annuity to each of the children you have designated as beneficiaries of this guarantee at the time of your membership. Only children financially dependent on you can be designated.

Under this Contract, a child is financially dependent on a person if:

  • They are attached to the tax household of that person;
  • Or if the person pays them a declared alimony for tax purposes.

a. Waiting period

This guarantee has no waiting period: you are covered from the effective date of the guarantee.

b. How is the annuity paid?

You choose the amount of the annuity for each of your beneficiary children. This annuity can be fixed or evolve over time. In the latter case, you choose amounts for different age brackets (we offer you three age brackets that you can adapt).

The amount of the annuity paid to each beneficiary child is indicated in the Membership Bulletin or in the last amendment in effect at the date of your death.

We pay a monthly annuity in arrears:

  • to the person who assumes the responsibility for your child, if the latter is under 18 years old;
  • to your child, if they are at least 18 years old.

The payment of the annuity ceases definitively:

  • if your child continues their studies, the month of their 26th birthday;
  • if your child does not continue their studies, the month of their 18th birthday;
  • if your child over 18 years old does not provide a certificate of study follow-up within 2 months following the start of each academic year;
  • upon the death of the beneficiary child. This annuity is non-reversible.

During the payment of the annuity, in order for us to ensure that your beneficiary is still alive, they must send an annual civil status document (certificate of life) to our Client Solutions Center. If they are over 18 years old, they must also provide us with a certificate of study follow-up.

The arrival of a new child

A free temporary guarantee is automatically established when a new child enters your family, provided that they are:

  • your child, by established filiation with you, until the eve of their 7th month;
  • a child you have adopted, until the eve of the 7th month from the adoption deed.

Beyond these 7 months, to have an Education annuity guarantee for this child, you must contact your usual contact person.

This temporary guarantee is identical to that already subscribed for the youngest of the other beneficiary children.

You must inform us as soon as possible of any event that may have consequences on the triggering of this guarantee (example: end of studies of a beneficiary child over 18 years old or death of a beneficiary child…). Contributions paid prior to the receipt of this information by our Client Solutions Center will not be refunded.

5. Total and Irreversible Loss of Autonomy (PTIA) guarantee

This guarantee is included and associated with the following death guarantees:

  • Death from all causes;
  • Accidental death;
  • Spouse's annuity;
  • Education annuity.

You are recognized as being in a state of PTIA when, following an illness or accident occurring after the effective date of the guarantees, you can no longer engage in any activity providing you with gain or profit and must rely on the assistance of a third party to perform ordinary acts of daily life (moving, dressing, eating, washing), on the day determined by the medical expert we designate.

If you are recognized as being in a state of PTIA, during membership and before your 76th birthday, we pay you in advance:

  • for the PTIA Death from all causes: the capital provided in case of death from all causes if the PTIA follows an illness or accident;
  • for the PTIA Accidental death: the capital provided in case of accidental death if the PTIA follows an accident;
  • for the PTIA Spouse's annuity and the PTIA Education annuity: the annuities provided in case of death if the PTIA follows an illness or accident.

The triggering of this guarantee ends your membership.

Waiting period

This guarantee has no waiting period: you are covered from the effective date of the guarantee.

6. Double family effect guarantee

This guarantee can be chosen from 18 to 74 years old inclusive. It can only be subscribed as a complement to a Death from all causes or Accidental death guarantee.

It ceases, at the latest, the day before your 76th birthday.

At the time of your death, an individual insurance contract for Death from all causes (without guarantee in case of Total and Irreversible Loss of Autonomy in this case) is established in the name of a new insured, without any contribution being required for this contract.

The insured of this new contract is the person who, following your death, will have the tax responsibility (in the sense of the Contract) for children under 26 years old (yours or theirs) or the only person who will have the tax responsibility for the youngest child if several people can assume the role of insured. They must send us a declaration on honor of the responsibility for this child.

The amount of the guaranteed capital is then:

  • the amount of the capital of the Death from all causes guarantee or the Accidental death guarantee if you have only subscribed one of these two guarantees;
  • or the amount of the capital of the Death from all causes guarantee if you have subscribed both the Death from all causes and Accidental death guarantees.

Upon the death of the insured of the new contract, we pay the guaranteed capital, in equal parts, to the children financially dependent on you or on this insured before your death and still under 26 years old at the time of the death of the insured of the new contract.

Each year, the insured of this new contract must justify to us that the various beneficiary children of this new contract under 26 years old remain financially dependent on them.

a. Waiting period

This guarantee has no waiting period: you are covered from the effective date of the guarantee.

b. Cessation conditions

The guarantee ceases definitively when the insured of this new contract:

  • does not provide the proof that the beneficiary children of the new contract remain financially dependent on them;
  • reaches their 76th birthday.

The guarantee also ceases if all the beneficiary children of the new contract are aged at least 26 years.

III. The guarantees in case of incapacity

1. Common rules for guarantees in case of incapacity (excluding Exemption guarantee)

These guarantees can be chosen from 18 to 62 years old inclusive.

Only individuals who justify the effective exercise of a paid and fiscally declared professional activity or individuals who are collaborating spouses (of artisans, merchants, or individuals exercising any other liberal profession) and who provide effective and regular collaboration to a non-salaried worker can subscribe to a Total temporary incapacity guarantee. It ceases upon the definitive cessation of any real and paid professional activity.

You are recognized as being in a state of total temporary incapacity when, temporarily and continuously, you can no longer exercise your professional activity, even partially, either at your workplace or at home.

The amount of daily allowances is indicated in your Membership Bulletin or your last valid amendment at the start date of your state of total temporary incapacity. It is determined based on the income proofs you provide.

a. Deductible and duration of coverage

Our coverage begins at the expiration of the deductible period indicated in the Membership Bulletin, as long as the total temporary incapacity is medically justified and recognized by us. The duration of this coverage:

  • corresponds to the number of days of total temporary incapacity prescribed by your doctor minus the number of deductible days;
  • and is a maximum of 365 or 1095 consecutive days (irreversible choice at membership) for the same total temporary incapacity.
Waiver of deductible in case of hospitalization

If you are hospitalized for at least two consecutive nights and if the deductible of your guarantee is less than or equal to 30 days, we compensate you from the first day of your hospitalization (the deductible is waived).

b. Conditions to receive your daily allowances

From the beginning of your total temporary incapacity, you must:

  • be covered under this guarantee;
  • exercise...

Total Temporary Incapacity Guarantee

General Conditions

To benefit from the guarantee, you must:

  • Have a paid and fiscally declared professional activity or be a collaborating spouse of an artisan, merchant, or individual exercising any other liberal profession.
  • Provide effective and regular collaboration to a non-salaried worker within the framework of your professional activity.

Exclusions

If, on the first day of your work stoppage (the day of the claim), you are:

  • Unemployed
  • Retired (except in case of combined employment-retirement)
  • Ceasing professional activity

You will not be able to claim this guarantee and the contributions paid will be refunded for the non-covered period, up to a maximum of 60 days.

Case of Therapeutic Part-Time Resumption

If you have accumulated a period of 90 days of continuous total work stoppage, and you are recognized by our medical advisor as being in a state of partial temporary incapacity, you may resume your professional activity part-time for therapeutic reasons. In this case, we pay you half a daily allowance for a duration depending on the guarantee invoked.

The compensation for part-time resumption follows the same exclusions as compensation for total temporary incapacity.

Case of Relapses or Multiple Stoppages

In case of relapse within 60 days following the end of the compensated total temporary incapacity period, diagnosed medically as stemming from the same cause:

  • There is no new application of the deductible.
  • The number of days of allowances already paid is deducted from the maximum duration of possible coverage.

If the total temporary incapacity is due to a new cause or if the relapse occurs after a period of 60 days, this incapacity is considered a new stoppage with the usual coverage rules applying.

In case of relapse within 60 days following the end of a non-compensated total temporary incapacity period, we will not compensate you.

Cessation Conditions

The payment of daily allowances ceases on the date of the first occurrence of one of the following events:

  • The day of your total resumption of any professional activity.
  • The day of your non-compensated part-time resumption under the Contract.
  • At the latest on the date of consolidation provided for in the framework of disability guarantees.
  • At the latest within 365 or 1095 days after the start date of the work stoppage compensation, depending on the duration chosen at membership.
  • The day you liquidate your rights to retirement or pre-retirement, except in case of combined employment-retirement.
  • At the latest the day before your 67th birthday.

The guarantees in case of total temporary incapacity cease:

  • The day you liquidate your rights to retirement (except in case of combined employment-retirement).
  • On the day of taking charge under the disability annuity guarantee.
  • The day of cessation of membership.

You must inform us as soon as you resume your professional activity after a work stoppage, even partially.

Total Temporary Incapacity Guarantee in Case of Accident or Illness

If your health condition falls under total temporary incapacity, following an accident or illness, we pay you flat-rate daily allowances, independent of the benefits paid by your mandatory scheme.

Waiting Period

Only a total temporary incapacity starting after the waiting period can be compensated. The waiting period is as follows:

  • No waiting period in case of accident.
  • 6 months for certain illnesses (e.g., lumbago, low back pain, depression, etc.).
  • 3 months for other illnesses.

In case of an amendment with an increase in the amount of the daily allowance, the new waiting period applies to the differential guarantee.

Case of Therapeutic Part-Time Resumption

The maximum duration of the half-allowance during a part-time resumption is 90 days.

Back and Psychological Option

You can choose the back and psychological option to cancel the coverage limitations. Be careful, possible exclusions may be specified in the document you validated and signed.

Daily Allowance Bonus

The daily allowance bonus allows you to acquire additional daily allowances.

Acquisition of the Bonus

If you have not been subject to coverage during a full insurance year, you acquire one day of bonus, up to a maximum of 7 days.

Consumption of the Bonus

The acquired bonus can be invoked if you receive daily allowances. The use of bonus days decreases the acquired balance. Unused bonus days add to the next acquired days.

Total Temporary Incapacity Guarantee in Case of Accident

If your health condition falls under total temporary incapacity following an accident, we pay you flat-rate daily allowances, independent of the benefits paid by your mandatory scheme.

Waiting Period

This guarantee has no waiting period.

Case of Therapeutic Part-Time Resumption

The maximum duration of the half-allowance during a part-time resumption is 30 days.

Daily Allowances for General Expenses Guarantee

If your health condition falls...

Daily Allowances in Case of Total Temporary Incapacity

In case of total temporary incapacity, following an accident or illness, we pay you flat-rate daily allowances to compensate all or part of your general expenses.

General Expenses

By general expenses, we refer to the fixed and permanent costs you usually incur for the exercise of your profession and accepted as operating charges for tax purposes. They are limited to the following items:

  • rents for professional premises and associated charges;
  • the cost of renting professional equipment and furniture (including leasing);
  • maintenance and repair costs for professional premises;
  • expenses for water, gas, electricity, heating, telephone;
  • vehicle expenses and other travel expenses;
  • office supplies, documentation, correspondence, and telephone expenses;
  • salaries and social charges of staff (employer and employee shares);
  • the cost of replacing staff (temporary staff);
  • professional taxes and fees (excluding VAT);
  • professional insurance premiums (excluding borrower insurance);
  • union and professional contributions;
  • various management expenses (including fees for accountants).

Any supporting document regarding the amount of general expenses you wish to insure can only be retained for these specific items.

Duration of Coverage

Our maximum duration of coverage is 365 consecutive days for the same total temporary incapacity. These allowances are independent of the benefits paid by your mandatory scheme.

a. Waiting Period

Only a total temporary incapacity starting after the waiting period can be compensated. The waiting period is as follows:

  • no waiting period in case of accident;
  • 6 months in the case of the following illnesses: lumbago, low back pain, sciatica, cruralgia, cervical radiculopathy, thoracic outlet syndrome, disc protrusion, herniated disc, back pain, neck pain, coccydynia, depression, anxiety-depressive syndrome, anxiety disorders, generalized anxiety, panic disorder, obsessive-compulsive disorders, traumatic neurosis, hysterical neurosis, delirium, psychosis, schizophrenia, paranoia, bipolar disorder, borderline personality, eating disorders, hyperactivity, Tourette syndrome, dementia, spasmophilia, chronic fatigue syndrome, fibromyalgia, burnout, or professional exhaustion;
  • 3 months in the case of other illnesses.

In case of an amendment with an increase in the amount of the daily allowance, the new waiting period applies to the differential guarantee.

b. Case of Therapeutic Part-Time Resumption

The maximum duration of the half-allowance during a part-time resumption is 90 days.

c. Back and Psychological Option

You can choose the back and psychological option, described in this chapter, paragraph V.1, to cancel the coverage limitations listed in this chapter, paragraph I.2.f. Be careful, possible exclusions may however be specified in the document we sent you following the membership formalities and that you validated and signed. These exclusions will apply even if you choose the back and psychological option.


Details of Guarantees and Options Available to You

5. Exemption from Contributions in Case of Total Temporary Incapacity

This guarantee is included as soon as a guarantee in case of incapacity is subscribed. If we pay you daily allowances under one of the guarantees in case of incapacity, we exempt you from paying all your future insurance contributions for all the guarantees provided under your membership, for the entire duration of our coverage under total temporary incapacity, after a waiting period of 60 days: it therefore always starts from the 61st day of stoppage, regardless of the deductibles of the guarantees in case of incapacity. This exemption takes the form of a reimbursement of the contributions you continue to pay us.

This exemption ceases at the end of our compensation for total temporary incapacity. In case of compensation for part-time therapeutic work resumption, the exemption from insurance contributions ceases.

IV. The Guarantees in Case of Disability

1. Common Rules for Guarantees in Case of Disability (Excluding Exemption Guarantee)

These guarantees can be chosen from 18 to 62 years old inclusive. The amount of the guarantees (annuity or capital) is indicated in your Membership Bulletin or your last valid amendment.

a. Waiting Period

The guarantees in case of disability have no waiting period.

b. Cessation Conditions

These guarantees cease:

  • the day you liquidate your rights to retirement or pre-retirement under your professional activity, except in case of combined employment-retirement;
  • at the end of the membership and at the latest the day before your 67th birthday.

c. Recognition, Evaluation of the State of Disability, and Consolidation

The guarantees in case of disability can be invoked from the date of consolidation of your health condition. Consolidation is the moment when the insured's health condition, after an accident or illness, stabilizes definitively such that treatment, given scientific and medical knowledge, is no longer necessary except to prevent deterioration. It must be established at the latest within 1095 days from the start date of your work stoppage. When your health condition is consolidated and leads to a total incapacity to exercise your professional activity, the doctor we designate determines a functional disability rate as well as a professional disability rate. This allows calculating the disability rate.

This assessment is independent of that retained by your mandatory health and maternity insurance scheme or any other organization.

The functional disability rate, ranging from 0 to 100%, is determined by the doctor we designate. This rate is set according to the scale you retained at the time of your membership:

  • either the “indicative scale for assessing disability rates in common law” also called the “Rousseau Scale,” published by the Medical Competition (most recent edition on the day of the expertise);
  • or the specific scale allowing a correlation between disability and profession exercised; this scale is found in the chapter “Specific Disability Scale.”

The scale you choose is valid for the different guarantees in case of disability. The professional disability rate, ranging from 0 to 100%, is determined by the doctor we designate and depends on the importance and nature of the professional unfitness compared to the professional activities you exercised before the accident or illness.

Disability Rate

The disability rate is obtained using a table crossing the functional disability rate from the Rousseau Scale or the specific scale and the professional disability rate:

Professional disability rate Functional disability rate
6
----------------------------------- -----
1 15.33
5 16.51
10 15.87
20 20.00
30 22.89
40 15.87
50 17.10
60 18.17
70 19.13
80 20.00
0 20.80 33.02 43.27 52.41 60.82 68.68 76.12 83.20 90.00 96.55
100 15.33 21.54 34.20 44.81 54.29 63.00 71.14 78.84 86.18 93.22

You are recognized as having a total permanent disability if your disability rate is greater than or equal to 66% on the date of consolidation.
The date of recognition of total permanent disability is set by the expert doctor we designate.

d. Consequence of invoking guarantees in case of disability

If a guarantee in case of disability is invoked, you remain covered for the guarantees in case of death as well as for the guarantees for Total and Irreversible Loss of Autonomy, Capital for feared illnesses, and Hospitalization, if you have subscribed them. The guarantees in case of incapacity subscribed only cease in case of total disability.

2. Disability annuity guarantee in case of accident or illness

This guarantee can only be retained if it is associated with the Total temporary incapacity guarantee in case of accident or illness with a chosen duration of compensation of 1095 days. The disability annuity cannot be paid if it follows a period of total temporary incapacity, following an accident or illness, that we have refused to compensate.
According to your choice made at the time of membership, we commit to paying a temporary flat-rate annuity when during membership, you are recognized as having a disability following an accident or illness.
The triggering disability rate is according to your choice of 15 or 33%.

a. Amount of the annuity paid

The annuity paid is determined based on the retained disability rate, the triggering disability rate, and the amount of your guarantee. It is calculated as follows:

Triggering Rate Disability Rate Amount of the annuity
15 % If disability rate < 15 % No annuity payment.
15 % If 15 % ≤ disability rate < 33 % The annuity paid is proportional to the retained disability rate.
15 % If 33 % ≤ disability rate < 66 % The annuity paid is proportional to the retained disability rate divided by 66 %.
15 % If disability rate ≥ 66 % Amount of annuity = total amount subscribed.
33 % If disability rate < 15 % No annuity payment.
33 % If 15 % ≤ disability rate < 33 % No annuity payment.
33 % If 33 % ≤ disability rate < 66 % The annuity paid is proportional to the retained disability rate divided by 66 %.
33 % If disability rate ≥ 66 % Amount of annuity = total amount subscribed.

Payment is made at the end of each quarter.
During the period of disability, you must inform us of any improvement or deterioration in your health condition. In this case, we appoint a doctor, at our expense, to determine a possible new disability rate.
We may also request on our own initiative and at our expense an examination to control the disability rate. The medical examination must be carried out on French territory.
If the membership is ongoing and if the final disability rate initially set is modified (upward or downward), the amount of the annuity will be adjusted to the amount.

Frequently Asked Questions

What are the guarantees of the insurance coverage for self-employed workers?
The answer to this question can be found in the document content above.
How to report a claim with Allianz?
The answer to this question can be found in the document content above.

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