Table of Benefits

Effective date: 24 February 2020

Group renewal date: 01 May 2020

Treatment Guarantee (pre-authorisation) may be required for some benefits as indicated by a '1' or a '2' in the
table(s) below. Please refer to the "Notes" section for further details.

All benefit and deductible amounts are per person, per year of cover, unless otherwise indicated.

Benefit limit

Everis Core Plan Maximum Plan Benefit € 2,250,000

Hospital accommodation - Private room Full Refund 1

Intensive care Full Refund 1

Prescription drugs and materials (in-patient and day-care Full Refund 1

treatment only) (Prescription drugs are those which legally can
only be purchased when you have a doctor’s prescription)

Surgical fees, including anaesthesia and theatre charges Full Refund 1

Physician and therapist fees (in-patient and day-care treatment Full Refund 1
only)

Surgical appliances and materials Full Refund 1

Diagnostic tests (in-patient and day-care treatment only) Full Refund 1

Organ transplant Full Refund 1

Psychiatry and psychotherapy (in-patient and day-care Full Refund 1

treatment only)

Accommodation costs for one parent staying in hospital with an Full Refund 1
insured child under 18

Day-care treatment Full Refund 2

Kidney dialysis Full Refund 2

Out-patient surgery Full Refund 2

Policy number: P002726125 Page 1 of 6

AWP Health & Life SA, acting through its Irish Branch, is a limited company governed by the French Insurance Code. Registered in France: No. 401 154 679 RCS Bobigny. Irish Branch
registered in the Irish Companies Registration Office, registered No.: 907619, address: 15 Joyce Way, Park West Business Campus, Nangor Road, Dublin 12, Ireland. Allianz Care and
Allianz Partners are registered business names of AWP Health & Life SA.
 Everis Core Plan Maximum Plan Benefit € 2,250,000

Nursing at home or in a convalescent home (immediately after € 2,500 2

or instead of hospitalisation)

Rehabilitation treatment (in-patient, day-care and out-patient € 2,500 2

treatment; must commence within 14 days of discharge after the
acute medical and/or surgical treatment ceases)

Local ambulance Full Refund

Emergency treatment outside area of cover (for trips of a Full Refund

maximum period of six weeks)

Medical evacuation: * Where necessary treatment is not Full Refund 2

available locally, we will evacuate the insured person to the
nearest appropriate medical centre, * Where ongoing treatment
is required, we will cover hotel accommodation costs, *
Evacuation in the event of unavailability of adequately screened
blood

- If medical necessity prevents an immediate return trip following 7 day limit

discharge from an in-patient episode of care, we will cover hotel
accommodation costs

Expenses for one person accompanying an evacuated person € 3,000 2

Travel costs of insured family members in the event of an € 2,000 2

evacuation (per event)

Repatriation of mortal remains € 10,000 2

Travel costs of insured family members in the event of the € 2,000 2

repatriation of mortal remains (per event)

CT and MRI scans (in-patient and out-patient treatment) Full Refund

PET and CT-PET scans (in-patient and out-patient treatment) Full Refund 2

Oncology (in-patient, day-care and out-patient treatment): Full Refund

- Chemotherapy (in-patient/daycare) 2
- Hospital accommodation 2
- Oncology diagnostic tests (in-patient) 2
- Oncology professional fees (in-patient) 2
- Purchase of a wig, prosthetic bra or other external prosthetic device for € 200 per member lifetime
cosmetic purposes
- Radiotherapy (in-patient/day case) 2

Routine maternity (in-patient and out-patient treatment): Full Refund

- Laboratory tests (in-patient) 2

- Mid-wife fees (in-patient) 2
- Newborn care 2

Policy number: P002726125 Page 2 of 6

AWP Health & Life SA, acting through its Irish Branch, is a limited company governed by the French Insurance Code. Registered in France: No. 401 154 679 RCS Bobigny. Irish Branch
registered in the Irish Companies Registration Office, registered No.: 907619, address: 15 Joyce Way, Park West Business Campus, Nangor Road, Dublin 12, Ireland. Allianz Care and
Allianz Partners are registered business names of AWP Health & Life SA.
 Everis Core Plan Maximum Plan Benefit € 2,250,000

- Other diagnostic tests (in-patient) 2

- Package 2
- Prescription drugs and materials 2
- Private room 2
- Professional fees 2
- Theatre charges 2
- X-rays (in-patient) 2

Complications of pregnancy and childbirth: Full Refund

- Laboratory tests (in-patient) 2

- Other diagnostic tests (in-patient) 2
- Package 2
- Prescription drugs and materials 2
- Private room 2
- Professional fees 2
- Theatre charges 2
- X-rays (in-patient) 2

Home delivery € 1,000

In-patient cash benefit (per night) (where treatment has been 25 day limit
received free of charge) € 125 per day

Emergency out-patient treatment (where these benefit amounts € 750

are reached, any additional costs may be reimbursed within the
terms of any separate Out-patient Plan)

Emergency out-patient dental treatment (where these benefit € 750

amounts are reached, any additional costs may be reimbursed
within the terms of any separate Dental Plan)

Palliative care Full Refund 2

Long term care 30 day limit per member lifetime 2

Employee Assistance Programme offers access to a range Full Refund

of 24/7 multilingual support services as follows: Confidential
professional counselling (in-person, phone, video, on-line chat
and email); Legal and financial support services; Critical incident
support; Wellness website access

Travel Security Services offers 24/7 access to personal security Full Refund
information and advice for all your travel safety queries. This
includes: Emergency Security Assistance Hotline; Country
intelligence and security advice; Daily security news and travel
safety alerts

Policy number: P002726125 Page 3 of 6

AWP Health & Life SA, acting through its Irish Branch, is a limited company governed by the French Insurance Code. Registered in France: No. 401 154 679 RCS Bobigny. Irish Branch
registered in the Irish Companies Registration Office, registered No.: 907619, address: 15 Joyce Way, Park West Business Campus, Nangor Road, Dublin 12, Ireland. Allianz Care and
Allianz Partners are registered business names of AWP Health & Life SA.
 Everis Out-patient Plan

Medical practitioner fees and prescription drugs (Prescription Full Refund

drugs are those which legally can only be purchased when you
have a doctor’s prescription)

Specialist fees Full Refund

Diagnostic tests Full Refund

Vaccinations Full Refund

Chiropractic treatment, osteopathy, homeopathy, Chinese herbal Full Refund

medicine, acupuncture and podiatry (max. 12 sessions per
condition for chiropractic treatment and max. 12 sessions per
condition for osteopathic treatment, subject to the benefit limit)

- Chiropractic treatment Max. 12 per claim (diagnosis) per year

- Osteopathy Max. 12 per claim (diagnosis) per year

Prescribed physiotherapy (initially limited to 12 sessions per Full Refund

condition; limit also applies to prescribed and non-prescribed
physiotherapy sessions, where combined)

- Non-prescribed physiotherapy (visits) Max. 5

Prescribed speech therapy, oculomotor therapy and Full Refund

occupational therapy:

- Occupational therapy 2

Health and wellbeing checks including screening for the early € 1,500
detection of illness or disease. Checks are limited to: * Physical
examination * Blood tests (full blood count, biochemistry, lipid
profile, thyroid function test, liver function test, kidney function
test) * Cardiovascular examination (physical examination,
electrocardiogram, blood pressure) * Neurological examination
(physical examination) * Cancer screening

- Annual faecal occult blood test Max. 1

- Annual pap smear Max. 1
- Bone densitometry (every five years for women aged 50+) Max. 1 for a period of 5 years
- Colonoscopy (every five years for members aged 50+, or 40+ where a Max. 1 for a period of 5 years
family history exists)
- Mammogram (every two years for women aged 45+, or younger where Max. 1 for a period of 2 years
a family history exists)
- Prostate screening (yearly for men aged 50+, or younger where a Max. 1
family history exists)
- Well child test (for children up to the age of six years, up to a maximum Max. 15 per member lifetime
of 15 visits per lifetime)

Psychiatry and psychotherapy (visits) Max. 20

Prescribed medical aids € 2,500

Policy number: P002726125 Page 4 of 6

AWP Health & Life SA, acting through its Irish Branch, is a limited company governed by the French Insurance Code. Registered in France: No. 401 154 679 RCS Bobigny. Irish Branch
registered in the Irish Companies Registration Office, registered No.: 907619, address: 15 Joyce Way, Park West Business Campus, Nangor Road, Dublin 12, Ireland. Allianz Care and
Allianz Partners are registered business names of AWP Health & Life SA.
 Everis Out-patient Plan

Prescribed glasses and contact lenses including eye € 200

examination

Everis Dental Plan Maximum Plan Benefit € 2,000

Dental treatment Full Refund

Dental surgery Full Refund

Dental prostheses 50% refund

NOTES
.
Treatment Guarantee/Pre-authorisation
.
Treatment Guarantee/Pre-authorisation is a process whereby we guarantee cover for certain treatment and
costs, as indicated in the Table of Benefits with a 1 or a 2. If Treatment Guarantee is not obtained for the
benefits indicated, we reserve the right to decline your claim. If the respective treatment is subsequently proven
to be medically necessary, we will only pay 80% of the eligible benefit for benefits listed with a 1, and for those
listed with a 2, we will only pay 50% of the eligible benefit. For further details please refer to our Benefit Guide,
or simply contact our Helpline.
.
.
Chronic conditions
.
Chronic conditions are covered within the terms of your policy. Please refer to the “Definitions” section of our
Benefit Guide for further information or simply contact our Helpline.
.
.
Pre-existing conditions
.
Pre-existing conditions are covered within the terms of your policy. For further details please refer to the
“Definitions” section of our Benefit Guide or simply contact our Helpline.
.
.
Benefit limits
.
There are two kinds of benefit limits shown in the Table of Benefits. The maximum plan benefit, which applies
to certain plans, is the maximum we will pay for all benefits in total, per member, per Insurance Year, under that
particular plan. Some benefits also have a specific benefit limit, which may be provided on a "per Insurance
Year" basis, a "per lifetime" basis or on a "per event" basis, such as per trip, per visit or per pregnancy. In some
instances we will pay a percentage of the costs for the specific benefit e.g. "65% refund, up to €5,000". Where
a specific benefit limit applies or where the term "Full refund" appears next to certain benefits, the refund is
subject to the maximum plan benefit, if one applies to your plan(s). All limits are per member, per Insurance
Year, unless otherwise stated in your Table of Benefits.
.
.
Policy Terms and Conditions

Policy number: P002726125 Page 5 of 6

AWP Health & Life SA, acting through its Irish Branch, is a limited company governed by the French Insurance Code. Registered in France: No. 401 154 679 RCS Bobigny. Irish Branch
registered in the Irish Companies Registration Office, registered No.: 907619, address: 15 Joyce Way, Park West Business Campus, Nangor Road, Dublin 12, Ireland. Allianz Care and
Allianz Partners are registered business names of AWP Health & Life SA.
.
The Table of Benefits outlines the cover we offer under your policy. Please note that cover is subject to our
standard policy definitions, limitations and exclusions. These are detailed in our Benefit Guide, which is
issued to you upon policy inception. Our current Benefit Guide can also be downloaded from our website
www.allianzworldwidecare.com
.
Policy Endorsement(s)
.
If there are any policy terms and conditions unique to your policy they will be listed below. Please read carefully
in conjunction with our Benefit Guide.

The Employee Assistance Programme Services are made available by Morneau Shepell Limited, subject
to your acceptance of our terms and conditions. You understand and agree that AWP Health & Life SA – Irish
Branch and/or AWP Health & Life Services Limited are not responsible or liable for any claim, loss or damage
directly or indirectly resulting from your use of the Employee Assistance Programme Services.
.
.
The Travel Security Services are made available by WorldAware LTD, subject to your acceptance of our terms
and conditions. You understand and agree that AWP Health & Life SA – Irish Branch and/or AWP Health & Life
Services Limited are not responsible or liable for any claim, loss or damage directly or indirectly resulting from
your use of the Travel Security Services.

Contact details

If you have any questions or need any help, please email us at: client.services@allianzworldwidecare.com. Or
you can call our Helpline 24 hours a day, 7 days a week on: + 353 1 630 1301.

Policy number: P002726125 Page 6 of 6

AWP Health & Life SA, acting through its Irish Branch, is a limited company governed by the French Insurance Code. Registered in France: No. 401 154 679 RCS Bobigny. Irish Branch
registered in the Irish Companies Registration Office, registered No.: 907619, address: 15 Joyce Way, Park West Business Campus, Nangor Road, Dublin 12, Ireland. Allianz Care and
Allianz Partners are registered business names of AWP Health & Life SA.