Individual Health Supplement Insurance

Product Information Document

Company: Allianz IARD – Insurance company registered in France
Approval Number: 542110291
Product: Policy “Allianz Santé TNS”

What is covered?

The amounts of benefits are subject to ceilings that vary depending on the level of coverage chosen, and are listed in the benefits table. They cannot exceed the expenses incurred, and a sum may remain your responsibility.

The guarantees systematically provided:

• Total or partial reimbursement, depending on the case, of health expenses following an illness, an accident, or maternity, in addition to the benefits paid by the mandatory health insurance schemes where applicable:
  • 100% health baskets (optical and hearing equipment, dental care and prostheses, vehicles for persons with disabilities (VPH), and hair prostheses).
  • Hospitalization (for example: costs related to stays).
  • Medications.
  • Routine care (for example: consultations and medical auxiliaries, transport costs).
  • Optical (for example: frames, single or complex lenses).
  • Dental (for example: dental care, prostheses).
  • Hearing aids (for example: prostheses).
  • Alternative medicine (for example: dietitians, acupuncturists, osteopaths, chiropractors).
  • Prescribed pharmacies not reimbursed by Social Security.

Optional guarantees:

• The Hospital Package guarantee (payment of a flat allowance depending on the nature of a hospitalization).
• Reinforcements in hospitalization, optical/hearing aids, and/or dental care.

Associated services systematically provided:

• Care network (discount at Santéclair partners).
• Quote analysis service.
• Hospital information guide.
• Self-medication guide.
• Assistance:
  • Housekeeping assistance in case of hospitalization.
  • Medical repatriation in case of illness or accident abroad.

The guarantees and services preceded by a checkmark are systematically provided in the contract.

What is not covered?

• Care received before the effective date of membership.
• Exceeding fees beyond the limit set by regulation for doctors not adhering to a controlled pricing scheme.
• Care expenses from establishments or services for the elderly that provide assistance in daily life activities, care services, or social integration assistance.
• The daily flat fee charged by medico-social establishments, such as specialized reception houses (MAS), in medico-social services or by accommodation establishments for dependent persons (EHPAD).
• Cosmetic surgery not covered by Social Security.

Are there exclusions to the coverage?

Main exclusions:

• The flat participation of €2 and deductibles on medication boxes, paramedical acts, and transport.
• The increase in the co-payment and exceeding fees if health expenses are incurred outside the care pathway.

Main restrictions:

• Hospitalization: during the first 6 months from the date of membership, coverage of hospitalization for the Comfort ranges, with the Serenity reinforcement, and Premium limited to:

  • medical and surgical fees of DPTAM doctors: 220% of the Social Security base,
  • medical and surgical fees of non-DPTAM doctors: 200% of the Social Security base,
  • full daily flat fee,
  • stay costs: 200% of the Social Security base,
  • transport costs: 200% of the Social Security base,
  • private room: €80 (€40 if hospitalized in psychiatry or for follow-up and rehabilitation care).

• Optical: coverage limited to one piece of equipment per 2-year period, reduced to 1 year for an insured under 16 years old or in case of vision changes for those 16 years and older.

• Hearing: payment of a flat fee per ear every 4 years.

This information document presents a summary of the main guarantees and exclusions of the product. It does not take into account your specific needs and requests. You will find complete information on this product in the pre-contractual and contractual documentation. In particular, the levels of reimbursement will be detailed in the benefits table.

What type of insurance is this?

The Allianz Santé TNS product is designed to reimburse health expenses remaining the responsibility of the insured and any beneficiaries after intervention by the French Social Security. This contract may also offer assistance services or benefits. The product complies with the conditions of the specifications for responsible contracts.

The portion of the contribution related to your care guarantee and, optionally, to your Hospital Package guarantee, and that of your dependents, as defined in the contract, may entitle you to a tax deduction (Article 154bis of the General Tax Code).

Where am I covered?

The guarantees apply in metropolitan France, Martinique, Guadeloupe, Réunion, Guyana, and Mayotte.

Outside of these territories:

For care usually reimbursed by the French Social Security, it must continue to cover them during the stay. Benefits are settled based on the reimbursement rate indicated in the benefits table for “Medical expenses incurred abroad and reimbursed by the French Social Security.”

For routine care not usually covered by the French mandatory scheme (e.g., implants, alternative medicine...), they are reimbursed as if they had been provided in metropolitan France, Martinique, Guadeloupe, Réunion, Guyana, or Mayotte. Note: their coverage is within the limits of the corresponding packages mentioned in the reimbursement scale.

What are my obligations?

Under penalty of nullity of the insurance contract or non-coverage:

Upon signing the contract:

• answer the questions posed by the insurer accurately,
• provide all supporting documents requested by the insurer,
• pay the contribution (or portion of the contribution) indicated in the contract.

During the contract:

Inform the insurer of any new circumstances that may worsen the risks or create new ones, including:

• changes in your situation: change of address, modification of family composition (birth, marriage, death), change in status regarding the French mandatory health and maternity insurance schemes,
• change of profession. In this case, the insured must provide the insurer with the necessary supporting documents to modify their contract. This change may, in some cases, lead to a modification of the contract and the contribution,
• requests for benefits following an accident involving the responsibility of a third party,
• benefit from a guarantee of the same nature as that covered by this contract, taken out individually or in a collective framework.

The declarations of the insured must reach the insurer, by registered letter, within fifteen days following their knowledge of one of these events.

In case of a claim:

The reimbursement request must reach the insurer within a maximum period of 2 years following the date of reimbursement of the care by Social Security.

When and how to make payments?

Contributions are payable in advance annually, on the date indicated in the contract, to the insurer or their representative within ten days from the due date.

However, a staggered payment may be granted at your choice (monthly, quarterly, or semi-annually). Payments can be made by direct debit.

When does coverage start and when does it end?

The contract takes effect on the date indicated on the Membership Certificate. It is concluded for a duration of one year and is automatically renewed from year to year on its main due date unless terminated by the insured or the insurer in the cases and conditions set forth in the contract. When the insured leaves metropolitan France, Martinique, Guadeloupe, Réunion, Guyana, or Mayotte for a period exceeding one year, the contract ends as soon as they no longer benefit from French Social Security.

How can I terminate the contract?

The insured may terminate their contract:

• on the main due date of the contract, by sending a registered letter, a simple letter, or an email to the insurer or their representative at least two months before this date,
• at any time by registered letter, simple letter, email, after a period of 1 year from the first membership. The termination takes effect 1 month after the insurer has received notification.
• in case of a change in their personal or professional situation,
• in case of a modification of the contract following a regulatory change,
• in case of a price increase initiated by the insurer following a worsening of the risk, independent of their state of health.

Allianz IARD
Company governed by the Insurance Code
Public limited company with a capital of €991,967,200
1 cours Michelet - CS 30051 - 92076 Paris La Défense Cedex
542 110 291 RCS Nanterre
www.allianz.fr

Coverage Level Tables

PREMIUM COMFORT

Other Benefits

• Medical expenses incurred abroad and reimbursed by the French Social Security: 100% (all levels)

Preventive Measures and Services

• Preventive acts covered by Social Security: Included (all levels)
• Santéclair: Included (all levels)
• Allianz assistance: Included (all levels)

Serenity Reinforcement (Hospitalization)

• Daily hospital flat fee: Actual costs
• Emergency patient flat fee: Actual costs
• Fees
  • Flat participation: Actual costs
  • Medical and surgical fees
    • DPTAM doctors: 400%
    • Non-DPTAM doctors: 200%
• Stays in medicine, surgery, psychiatry, home hospitalization, maternity, follow-up care, rehabilitation, and similar (contracted and non-contracted establishments)
  • Stay costs: 400%
  • Private room (excluding psychiatry, follow-up care, and rehabilitation) including outpatient: €125/day
  • Private room in psychiatry, follow-up care, and rehabilitation (per day and within the limit of 45 days per insurance year) including outpatient: €65/day
  • Transport costs: 400%
  • Surgical acts in medical office
    • DPTAM doctors: 400%
    • Non-DPTAM doctors: 200%
  • Accompanying costs (per day) within the limit of 20 days per hospitalization: €40
  • Ancillary costs (per day) (TV/Telephone/Wifi) within the limit of 20 days per hospitalization: €5

Optical & Hearing Aids Reinforcement

Optical

• Maximum reimbursement within the limit of one equipment per 2-year period (except for insured under 16 years and in case of vision changes for those 16 years and older) with a reimbursement ceiling for the frame at €100

Hearing Aids

• Maximum reimbursement within the limit of one equipment per ear per 4-year period

Dental Reinforcement

100% health care and prostheses

Comfort Ranges

The chosen level (1, 2, 3, or 4) covers all areas (Hospitalization, Routine Care, Optical, Hearing Aids, and Dental).

Possible optional reinforcements:

• Serenity: concerns Hospitalization and is possible for all 4 levels
• Optical/Hearing Aids Comfort: possible for levels 1, 2, and 3
• Dental Comfort: possible for levels 1, 2, and 3

The guarantees of the reinforcements replace those indicated at levels 1, 2, and 3. The Serenity reinforcement also replaces the guarantees of level 4.

Premium Ranges

The chosen level (5, 6, or 7) covers all areas (Hospitalization, Routine Care, Optical, Hearing Aids, and Dental).

Possible optional reinforcements:

• Optical/Hearing Aids Plus: possible for level 5
• Dental Plus: possible for level 5

The guarantees of the reinforcements replace those indicated at level 5.