Table of Benefits

Table of Benefits
Effective date: 01 July 2019

Group renewal date: 01 July 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
PWC Inbound German Expat Core Plan
Hospital accommodation - Semi-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
Emergency in-patient dental treatment Full Refund
Day-care treatment Full Refund 2
Kidney dialysis Full Refund 2
Policy number: P002599456 Page 1 of 9
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.
Out-patient surgery Full Refund 2
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)
Ambulance transport Full Refund
Emergency treatment outside area of cover (for trips of a 42 day limit

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
Repatriation of mortal remains or funeral expenses € 10,000 2
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
- Newborn care 2
- Other diagnostic tests (in-patient) 2
- Package 2
- Prescription drugs and materials 2
- Professional fees 2
- Semi-private room 2
- X-rays (in-patient) 2
Midwife visits (Cover is provided for 12 visits before the birth and Full Refund
10 visits after the birth)
- Mid-wife visits after the birth Max. 10

- Mid-wife visits before the birth Max. 12
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
- Professional fees 2
- Semi-private room 2
- Theatre charges 2
In-patient cash benefit (per night) (where treatment has been 25 day limit
received free of charge) € 150 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
PWC Inbound German Expat 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)
PWC Inbound German Expat Out-patient Plan
Prescribed drugs for children up to 12 years of age (must be Full Refund

prescribed by a physician, although a prescription is not legally
required for purchase)
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
Psychiatry and psychotherapy (visits) Max. 20
Prescribed medical aids Full Refund
Pre-natal classes € 300
Post-natal classes € 300
Prescribed home help (8 hours per day) 42 day limit
Prescription contraceptives (up to 21 years of age) Full Refund
PWC Inbound German Expat Dental Plan Maximum Plan Benefit € 2,050
Dental treatment 80% refund
Dental surgery 80% refund
Periodontics 80% refund
Orthodontic treatment and dental prostheses 50% refund
NOTES
.
Treatment Guarantee/Pre-authorisation
.
Treatment Guarantee/Pre-authorisation is a process whereby we guarantee cover for certain required treatment
and costs (where covered) as follows:
.
.
•All in-patient benefits¹ listed.
.
•Day-care treatment².
.
•Kidney dialysis².
.
•Out-patient surgery².
.
•MRI (Magnetic Resonance Imaging) scan. Treatment Guarantee is only required for this test if you would like
us to settle the bill directly with the medical provider.
.
•PET² (Positron Emission Tomography) and CT-PET² scans.
.
•Nursing at home or in a convalescent home².
.
•Routine maternity² and complications of pregnancy and childbirth² (in-patient treatment only).
.
•Oncology² (in-patient and day-care treatment only).
.
•Occupational therapy² (out-patient treatment only).
.
•Rehabilitation treatment².
.
•Medical evacuation² (or repatriation where covered).
.
•Travel costs of insured family members in the event of an evacuation/repatriation².
.
•Repatriation of mortal remains².
.
•Travel costs of insured family members in the event of the repatriation of mortal remains².
.
•Expenses for one person accompanying an evacuated/repatriated person²
.
•Palliative care².
.
•Long term care².
.
.
For the treatments listed above, please note that you and your physician should complete the relevant sections
of a Treatment Guarantee Form and send it to us for approval prior to the commencement of your treatment.
.
.
It is highly recommended that you take advantage of this facility as this will provide you with the benefit of
cashless access to hospitals for in-patient treatment, as well as the added advantage of having your treatment
overseen by our team of medical professionals.
.
.
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
.
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.
.
.
Amendment to standard policy terms and conditions
.
The following exclusions which appear in the Employee Benefit Guide are not applicable:
.
.
Care and/or treatment of drug addiction or alcoholism (including detoxification programmes and treatments
related to the cessation of smoking), instances of death, or the treatment of any condition that in our reasonable
opinion is related to, or a direct consequence of, alcoholism or addiction (e.g. organ failure or dementia).
.
.
Care and/or treatment of intentionally caused diseases or self-inflicted injuries, including a suicide attempt.
.
.
Consultations performed, as well as any drugs or treatments prescribed, by you, your spouse, parents
or children.
.
Developmental delay, unless a child has not attained developmental milestones expected for a child of that
age, in cognitive or physical development. We do not cover conditions in which a child is slightly or temporarily
lagging in development. The developmental delay must have been quantitatively measured by qualified
personnel and documented as a 12 month delay in cognitive and/or physical development.
.
.
Investigations into, and treatment of, obesity.
.
.
Investigations into, treatment of and complications arising from sterilisation, sexual dysfunction (unless
this condition is as a result of total prostatectomy following surgery for cancer) and contraception including
the insertion and removal of contraceptive devices and all other contraceptives, even if prescribed for medical
reasons. The only exception in relation to costs for contraception is where contraceptives are prescribed by a
dermatologist for the treatment of acne.
.
.
Speech therapy related to developmental delay, dyslexia, dyspraxia or expressive language disorder.
.
.
Stays in a cure-centre, bath centre, spa, health resort and recovery centre, even if the stay is medically
prescribed.
.
.
Treatment for any medical conditions arising directly or indirectly from chemical contamination, radioactivity
or any nuclear material whatsoever, including the combustion of nuclear fuel.
.
.
Treatment for conditions such as conduct disorder, attention deficit hyperactivity disorder, autism
spectrum disorder, oppositional defiant disorder, antisocial behaviour, obsessive-compulsive disorder,
phobic disorders, attachment disorders, adjustment disorders, eating disorders, personality disorders
or treatments that encourage positive social-emotional relationships, such as family therapy.
.
.
Treatment of sleep disorders, including insomnia obstructive sleep apnoea, narcolepsy, snoring, and bruxism.
.
.
Treatment required as a result of failure to seek or follow medical advice.
.
.
The following amended definitions shall apply:
.
Health and wellbeing checks including screening for the early 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 pap smear
.
- Mammogram (every two years for women aged 45+, or earlier where a family history exists)
.
- Prostate screening (yearly for men aged 45+, or earlier where a family history exists)
.
- Colon and rectal screening (yearly for members aged 50-54) or 40+ where a family history exists)
.
- Annual faecal occult blood test
.
- Skin cancer screening (every two years for members aged 35+, or earlier where a family history exists)
.
*Bone densitometry (every five years for women aged 50+)
.
*Well child test (for children up to the age of six years, up to a maximum of 15 visits per lifetime)
.
*Chlamydia screening (yearly for women up to the age of 25)
.
.
.
Dental treatment includes two check ups per year, simple fillings related to cavities or decay and root canal
treatment.
.
.
Orthodontics is the use of devices to correct malocclusion and restore the teeth to proper alignment and
function. We only cover orthodontic treatment where the standard metallic braces and/or standard removable
appliances are used. Cosmetic appliances such as lingual braces and invisible aligners are covered up to the
cost of metallic braces, subject to the “Orthodontic treatment and dental prostheses” benefit limit. The treatment
costs are only covered following the insured's 18th birthday, if the first orthodontic treatment, according to a
coherent treatment plan, has already started before the insured's 18th birthday.
.
.
The following additional definitions apply:
.
Pre-natal classes includes exercises for bodily relaxation, palliation of medical conditions caused by pregnancy
(e.g. pain in the back) and acquisition of specific breathing techniques (deep abdominal respiration, panting).
Yoga and Pilates classes for pregnant women are also covered within this benefit. Classes offered by hospitals,
family education centres, midwifes and registered physiotherapists are reimbursable.
.
.
Post-natal classes are active and passive training of the musculature of the pelvic floor after childbirth.
.
.
Members are entitled to home help prescribed by the treating physician if they cannot continue to run his/
her household due to, for example, in-patient or rehabilitation treatment or, in individual cases, being signed
off sick by a doctor. A further requirement is that there is a child living in the household up to the age 12 at
their next birthday or a disabled child that needs help. Cover is only provided if another person living in the
household cannot continue to run the household in the absence of the insured. In case a relative up to 2nd
grade is providing the home help, the costs are not reimbursable. Also costs for the home help to travel to and
from the household are not covered.
.
.
Prescribed drugs for children up to 12 years of age refers to products prescribed by a physician for the
treatment of a confirmed diagnosis or medical condition, or to compensate vital bodily substances including,
but not limited to, insulin, hypodermic needles or syringes. The prescribed drugs must be clinically proven to be
effective for the condition and recognised by the pharmaceutical regulator in a given country. Prescribed drugs
do not legally have to be prescribed by a physician in order to be purchased in the country where the member is
located; however, a prescription must be obtained for these costs to be considered eligible.
.
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.

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Effective date: 01 July 2019

PWC Inbound German Expat Core Plan

Hospital accommodation - Semi-private room Full Refund 1

Intensive care Full Refund 1

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

Surgical fees, including anaesthesia and theatre charges Full Refund 1

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

Emergency in-patient dental treatment Full Refund

Day-care treatment Full Refund 2

Kidney dialysis Full Refund 2

Policy number: P002599456 Page 1 of 9

Out-patient surgery Full Refund 2

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

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

Ambulance transport Full Refund

Emergency treatment outside area of cover (for trips of a 42 day limit

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

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

Repatriation of mortal remains or funeral expenses € 10,000 2

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

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

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

Policy number: P002599456 Page 2 of 9

- Mid-wife visits after the birth Max. 10

Complications of pregnancy and childbirth: Full Refund

- Laboratory tests (in-patient) 2

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

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

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

PWC Inbound German Expat Out-patient Plan

Medical practitioner fees and prescription drugs (Prescription Full Refund

Policy number: P002599456 Page 3 of 9

Prescribed drugs for children up to 12 years of age (must be Full Refund

Specialist fees Full Refund

Diagnostic tests Full Refund

Vaccinations Full Refund

Chiropractic treatment, osteopathy, homeopathy, Chinese herbal Full Refund

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

Prescribed physiotherapy (initially limited to 12 sessions per Full Refund

- Non-prescribed physiotherapy (visits) Max. 5

Prescribed speech therapy, oculomotor therapy and Full Refund

Psychiatry and psychotherapy (visits) Max. 20

Prescribed medical aids Full Refund

Pre-natal classes € 300

Post-natal classes € 300

Prescribed home help (8 hours per day) 42 day limit

Prescription contraceptives (up to 21 years of age) Full Refund

Dental treatment 80% refund

Dental surgery 80% refund

Periodontics 80% refund

Orthodontic treatment and dental prostheses 50% refund

Policy number: P002599456 Page 4 of 9

Policy number: P002599456 Page 5 of 9

Policy number: P002599456 Page 7 of 9

Policy number: P002599456 Page 8 of 9

Policy number: P002599456 Page 9 of 9

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