Saman Travel Insurance General Conditions
Part 1: Definitions
A) 1. Insured: The policyholder.
2. Immediate family member: the spouse or fiancé, children (aged 18 years or less) or parents or company of the insured person permanently residing with the insured person.
3. (SIC): BIMEH SAMAN (Saman Insurance Company), 123 Khaled Eslamboli Ave., Tehran 1513813119, Iran.
4. Assistance provider: Mideast assistance international S.A.L.
5. Usual country of residence: the home of residence of an insured in the usual country of residence. In the case, it is Iran.
6. Medical team: medical structure appropriate to every claim and defined by the assistance provider chief medical officer and treating physician.
7. Illness: wherever used therein means sudden and unforeseen sickness or disease contracted, commencing o originating after the beginning of the journey abroad undertaken by the insured during which such sickness or disease gives rise to a request for assistance by the insured or his/her representative.
8. Serious illness: a change in health that requires admission to hospital and which, in the opinion of the assistance provider medical team, prevents the insured from continuing travel on the date planned, or which involves risk of death.
9.bodily injury: wherever used therein means bodily injury caused solely and directly by violent, accidental, external and visible means, excluding illness or disease, and occurring after the beginning of the journey abroad undertaken by the insured during which such injury gives rise to a request for assistance bye the insured or his/her representative.
10. Serious injury: an injury which, in the opinion of the assistance provider medical team, prevents the insured continuing travel on the date planned, or which involves risk of death.
11. Assistance event (Claim): any event that gives rise to the assistance provider intervention and that is generated by the occurrence of once or several risks related to the benefits to travel assistance services.
12. EUR: shall mean the lawful currency of the European Union.
13. Deductible: part of the expenses borne directly by the insured.
14. Cover: The ASSISTANCE PROVIDER will immediately provide the insured, the assistance specified under the "part 2"clause of this insurance policy for mishaps to occur due to unforeseen incident during travels outside his/her usual country of residence, provided that this occurrence does not take place outside the specified geographical boundaries and does not take place out of the prescribed travel duration between the validity dates of the policy. The scope of this policy becomes void when travel causing the acquisition of this policy ends and/or the insured arrives at his/her usual country of residence-whichever takes place first.
B) Territoriality: the benefits mentioned in travel assistance service apply worldwide outside the geographical territory of Iran, except in the countries at either civil or foreign war, whether declared or not.
C) Period of Cover: TRAVEL ASSISTANCE SERVICES are valid from the date of official exit of Iran for travel and/or stays abroad, which do not exceed maximum of 92(ninety two)consecutive days, unless shorter period of cover in the travel insurance policy has otherwise been agreed. The policy covers unlimited number of travels during the period of its validity.
D) Time Bar: every claim in respect of a covered event shall be time barred within one year from the date of occurrence of such event.
E) Subrogation: The(SIC) shall take the place of the insured, to the extent of the cost incurred or indemnity paid, in the right and action of the insured against anyone responsible for an accident causing a claim for one of the herein-listed benefits. When the service provided by the(SIC)are covered in whole or in part by another scheme, the(SIC)shall be subrogated to the rights and causes of action of the insured against said schemes.
Part2: TRAVEL ASSISTANCE SERVICES
Saman Insurance Company (SIC) will provide these benefits only when the insured is traveling outside the usual country of residence up to a maximum of 92 consecutive days.
1) Medical expenses and hospitalization abroad
In the event of sudden illness or injury of the insured occurring outside the usual country of residence, the usual country of residence, the assistance, the assistance company will meet the usual, customary, necessary and reasonable costs of hospitalization, surgery, medical team will maintain the telephone contacts necessary with the center and with the doctors attending to the insured to supervise the provision of proper health care.
EUR 25 excess is applicable per claim, except in case of bodily injury and/or hospitalization for at least 24 hours.
2) Transport or repatriation in the event of illness or accident sustained by the insured during the course of a trip.
In the event of an accident or sudden illness, the assistance company will take charge of transferring or repatriating the insured to a properly equipped health center or to his/her usual country of residence.
The assistance company, through its medical team, will decide which health center the insured is transferred to or whether repatriation is necessary, depending on the situation or gravity of the state the letter is in.
Afterwards, the assistance company’s medical team will maintain the telephone contacts necessary with the medical center and with the doctors attending to the insured, and on the basis minor or less serious illnesses or accidents, which in the opinion of the medical team do not require repatriation, transfer will be performed in ambulance or another means of transport, to the place where adequate medical assistance can be provided.
3) Emergency Dental Care.
The assistance company will pay on behalf of insured dental expenses incurred by him/her or any person acting on his behalf in emergency cases, arising as a result of a bodily injury or of an acute and sudden illness, with the exclusion of any kind of prosthesis and/or definitive filling. The coverage is also restricted to the treatment of pain infection and removal of the tooth affected [only the first visit in case of emergency].
EUR 25 excess is applicable.
4) Repatriation of mortal remains.
In the event of the death of the insured, the assistance company will make the arrangements necessary for his/her transport or repatriation and will meet the cost of the transfer expenses to the place [which the insured had already left the country from it.]
Payment of expenses for interment, cremation or funeral ceremony is excluded from this cover.
5) Repatriation of the immediate family member traveling with the insured.
Should the insured be hospitalized due to sudden illness or accident for more than ten days or deceased, the assistance company will meet the cost in respect of any family member(s) accompanying the insured at the moment of the event, having the same country of residence as the insured considering this immediate family member is unable to travel by his /her own means of transport or the means of transport used for the initial trip. The assistance company shall take place of the insured and so would be eligible to recover any cost, if it’s possible.
6) Travel of one immediate family member.
In the event that the insured should be admitted to hospital for more than ten days as a result of an accident or illness covered in the policy, the assistance company will take charge of the transfer of an immediate family member from the usual country of residence of the insured, including meeting the cost of the outbound and return journey to the place of the hospitalization and the accommodation expenses there, up to limit of EUR 60 per day for a maximum of 15 days.
7) Legal assistance
The SIC undertakes to organize and pay on behalf of the insured up to equivalent amount in local currency of EUR 1500 for legal defense of the insured, should be prosecuted for civil liability according to the civil code in force in the country further to accidental damage caused to a third party or involuntary violation or no respect of the laws and local settlement of the administrative nature in private life situation, as simple citizen, with exclusion of the claims arising out of the use, possession of safe –keeping of a motor vehicle.
8) Loss of passport, driving license, national identity card abroad.
In the case of loss of the insured party s passport, driving license national identity card while abroad, the assistance company will provide the insured with the necessary information regarding the formalities to be fulfilled with the appropriate local authorities or entities in order to obtain the replacement of such lost or stolen document. The assistance also will take charge of the expenses of the displacements necessary for the obtaining a new passport driving license, national identity card or equivalent consular document, up to EUR 200.
9) Return of child(ren) left unattended
When an insured has been evacuated and/or repatriated as per the assistance service(2) "transport or repatriation in case of illness or accident" or (4)"repatriation of mortal remains", and is no longer able to attend to any child under the age of fifteen, who maybe travelling with him/her at the time of occurrence of the assistance event, the assistance company will organize an play on behalf of the insured for the return of such child to Iran, under the supervision of an adult person.
10) Relay of urgent massages and medical referral
The assistance company will take charge of relaying the urgent massages of the insured parties, relating to any of the events covered in the policy.
Under demand of the insured, the assistance company provides the insured with basic information such as: name of doctor, specialist, dentist or paramedical staff nearby, location of hospital, medical center, drugstores, ambulance, with the exclusion of any medical diagnosis.
11) Emergency return home following death of a close family member.
When the insured has to curtail his/her journey because of the death of a close family member [up to second grade), the assistance company will meet the cost of the travel to his/her usual country of residence, whenever he/she is unable to travel by his/her own means of transport or the means of transport hired for the trip.
The insured shall furnish the evidence, documents or certificate or the event, which caused the journey to be cut short (death certificate).
12) Delivery of medicines.
The assistance company will cover the expenses of sending medicines , in case of emergency, which are prescribed by the doctor of the beneficiary, even if this prescription is previous to the trip, and or not available at the place where she/he is staying.
13) Delay in arrival of luggage
If the beneficiary s accompanied checked-in luggage is temporarily lost during his journey and has not returned to him within twelve(12)hours of the beneficiary arrival at the scheduled destination point of his flight but not to his home country Iran, the assistance company will indemnify the insured for charges incurred at such scheduled destination in respect of the emergency purchase of essential clothing and toiletries up to amount mentioned in the schedule within forty eight(48)hours or prior to the return of the luggage whichever is sooner.
A written declaration and/or certificate from airline carrier(or their handling agents) confirming in writing of the number of hours of delay and the reason for delay as well as the original invoices shall be requested by the SIC from beneficiary before any compensation.
14) Loss of registered luggage
If the beneficiary s accompanied checked –in luggage has not been delivery to him/her within21 days of the beneficiary arrival at the scheduled destination point of his flight but not to his home country Iran, the assistance company will indemnify the insured up to amount mentioned in the schedule bases on a indemnification of EUR 20 per kilo and for a maximum of forty kilo (40Kgs).
A written declaration and/or certificate from airline carrier confirming loss and number of kilos of registered luggage shall be requested by the assistance company from beneficiary before the compensation.
15) Location and forwarding of baggage and personal effects.
The assistance company will furnish the insured with advice on reporting the robbery or loss of his/her baggage and personal possession, and will collaborate in arrangements for locating them.
In the event that the aforesaid possession should be recovered, the assistance company will take charge of forwarding them to the place of the trip planned by the insured or to his/her usual country of residence. In this event, the insured is under an obligation to return the compensation received for the loss in accordance with this policy.
16) Delayed departure
When the departure of the means of public transport contracted by the insured for traveling abroad is delayed by at least six(6)hours, the assistance company, subject to presentation of the corresponding original invoices, shall reimburse any additional expenses incurred (transport and hotel accommodation, as well as meals)as a result of the said delay, with the following limits:
- Up to EUR 45, where the delay is in excess of six hours.
- EUR 45 more in the event of a delay in excess of twelve hours.
- EUR 45 more in the event of a delay in excess of eighteen hours.
- EUR 45 more in the event of a delay in excess of twenty-four hours.
The maximum limit for all concepts under this cover is EUR 180
17) Advance of funds.
If, during a trip abroad, the insured were deprived of cash as a result of robbery, loss of baggage, illness or accident, duly proved by the presentation of the corresponding documentary proof (receipts, certificates, formal complaints, etc.) The assistance company shall arrange to forward up to EUR 850, provided that the amount requested is deposited beforehand at the registered officer of the SIC in Iran, in the form of transfer of in cash.
18) The SIC will advance fund for any legal bond required on behalf of an insured up to EUR 850.
The insured will be required to provided that the amount requested is deposited beforehand at the registered officer of the assistance company in Iran, in the form of transfer or in cash.
19) Special term and conditions of burglary cover (theft with force entrance)
Clause 1-limits of insurers cover
SIC would indemnify losses as result of burglary of insured s personal digital asset s up to amount mentioned in the schedule, less the amount of deductible.
Below conditions are known as "Burglary" in this policy:
Climbing up of wall of insured s temporary home, destroying door or wall or similar parts of building.
Thefts as result of rubbery or mugging in public places.
Opening a door with a counterfeit key or other objects which are unusual for opening a door.
Enter during night into private temporary home of insured (without his/her consciousness).
Entrance with threatening the Insured, his/her close family member or any person working as a waiter.
Thefts which are occurred as a result of fire, explosion, flood or earthquake.
Clause 3-Subject matter of insurance
Insurer’s liability is limited to personal digital assets, including laptop, cellphones, tablets, mp3 player, and calculators, a written list of insured s digital assets (mentioned on this document) must be delivered to insurer before the start of an insured trip.
The below conditions are generally excluded from the burglary cover:
Theft which are occurred as a result of war (whether declared or not), riot, invasion, rebellion, insurrection and civil commotion.
Thefts which are occurred by any close family member, hotels waiters or any other person who lives with the insured.
Normal wear and tear, gradual depreciation and any inherent product defects.
Defects caused by vermin.
Burglary from a car left unattended, without presence of any passenger or without any force entrance.
Mysterious disappearance, i.e. items which disappear without any evidence of a wrongful act.
Clause 5-Insureds obligations
In addition to premium delivery to insurer, the insured should take usual care of his/her property and in case of theft occurred must do the below actions:
-call the police or any other authorized forces in order to get a report of the occurrence and take action in order to arrest the burglars. Providing a complete police report is obligatory for claim process and payment.
-insured must call the insurer obligatory after 24 hours of theft occurrence, and provides a brief explanation of the burglary.
Provide a written list of digital asset which were stolen, due in 2 days to the insurer.
If there would be any further information grant with regard to the burglary, transfer them to the insurer.
If any of above were not delivered by the insured, the insurer may refuse to pay some part or total amount of the loss occurred due to burglary.
Amount of 20% from each and every burglary would be deducted by the insurer.
20) Trip interruption benefits
A) Post-Departure Trip Interruption
If the insured were unable to continue his/her covered trip for one of the reasons mentioned in advance, the assistance company will arrange to reimburse expenses occurred, less any refund paid or payable for unused travel arrangements plus the following:
I. The additional transportation expenses by the most direct route from the point which trip were interrupted (a) to the next scheduled destination where the insured can catch up to his/her covered trip: or (b)to the final destination trip.
II. The additional transportation expenses incurred by the insured by the most direct route to reach his/her original covered trip destination he/she delayed and leave after the scheduled departure date.
Coverage is provided for the following unforeseeable events or their consequences which occur while coverage is in effect under this policy if there is a change in plans by the insured, an immediate family member traveling with the insured:
III. Sickness, injury or death of the insured or his/her close family member, traveling companion or business partner. The sickness must commence while coverage is in effect, require the examination of a physician, in person, at the time of trip interruption and, in the written opinion of the treating physician, be so disabling as to prevent insured from continuing his/her covered trip.
IV. Common carrier delays resulting from inclement weather, mechanical breakdown or organized labor strikes that affect public transportation.
V. Arrangements cancelled by an airline, cruise line, motor coach company. Or tour operator, resulting from inclement weather, mechanical breakdown or organized labor strikes that effect public transportation.
VI. Arrangements cancelled by a tour operator, cruise line, airline, rental car company, hotel, condominium, railroad, motor coach company, other supplier of travel service, resulting from financial insolvency.
VII. Being directly involved in a documented traffic accident while en route to departure.
VIII. Being hijacked, quarantined, required to serve on a jury, or required by a court order to appear as a witness in a legal action, provided you, family member traveling with you or a traveling companion is not 1 )a party to the legal action, or 2)appearing as a law enforcement officer.
IX. Insured s homemade uninhabitable by fire, flood, volcano, earthquake, hurricane or other natural disaster.
X. Insured s destination made uninhabitable by fire, flood, volcano, earthquake, hurricane or other natural disaster.
XI. Mandatory evacuation ordered by local authorities at your destination due to hurricane or other natural disaster.
XII. A documented theft of passports or visas.
XIV. Insured s host at destination is hospitalized or dies.
XV. A terrorist act which occurs in your departure city or in a city which is a scheduled destination for your covered trip provided the terrorist act occurs within 30 days of the scheduled departure date for a covered trip.
B) Pre-Departure trip cancellation
If the insured prevented from taking his/her covered trip for of the covered reasons, the assistance company will reimburse expenses. Up to the amount in the scheduled for the amount for forfeited, and prepaid, non-refundable, and unused payments or deposits that the insured paid for his/her covered trip.
The assistance company will also pay any additional cost as a result of a change in the per person occupancy rate for prepaid travel arrangements if a traveling companions covered trip is cancelled and your covered trip is not cancelled.
Coverage is provided for the following the insured, or any traveling companion:
XVI. Sickness, injury or death of the insured or his/her close family member, traveling companion or business partner. The sickness must commence while coverage is in effect, require the examination of a physician, in person, at the time of trip interruption and, in the written opinion of the treating physician, be so disabling as to prevent you from continuing your covered trip.
XVII. Common carrier delays resulting from inclement weather, mechanical breakdown or organized labor strikes that affect public transportation.
XVIII. Arrangements cancelled by an airline, cruise line, motor coach company, or tour operator, resulting from inclement weather, mechanical breakdown or organized labor strikes that affect public transportation.
XIX. Arrangements cancelled by a tour operator, cruise line, airline, rental car company, hotel, condominium, railroad, motor coach company, other supplier of travel service, resulting from financial insolvency.
XX. Being directly involved in a documented traffic accident while en route to departure.
XXI. Being hijacked, quarantined required to serve on a jury, or required by a court order to appear as a witness in a legal action, provided you, family member traveling with you or a traveling companion is not 1)a party to the legal action, or2)appearing as a law enforcement officer.
XXII. Insured s homemade uninhabitable by fire, flood, volcano, earthquake, hurricane or other natural disaster.
XXIII. Insured s destination made uninhabitable by fire, flood, volcano, earthquake, hurricane or other natural disaster.
XXIV. Mandatory evacuation ordered by local authorities at your destination due to hurricane or other natural disaster.
XXV .being called into active military service to provide aid or relief in the event of a natural disaster.
XXVI. A documented theft of passport or visas.
XXVII. Insured’s host at destination is hospitalized or dies.
XXVIII. A terrorist act which occurs in your departure city or in a city which is a scheduled destination for your covered trip provided the terrorist act occurs within 30 days of the scheduled departure date for a covered trip.
Part 3: General exclusions
On a general basis for all the guarantees and coverage, the consequences of the following are excluded from the guarantee object of this agreement:
1. Those caused directly or indirectly by the bad faith of the insured, by his/her participation in criminal acts, or as a result of his/her fraudulent, seriously negligent or reckless actions. The consequences of the actions of the insured in a state of derangement or under psychiatric treatment are not covered either.
2. Extraordinary natural phenomena such as avalanches, floods, limnic eruption, tsunami, blizzards, drought, hailstorm, heart waves, tornados, wildfire, earthquakes, landslides, volcanic eruptions, atypical cyclonic storms, falling objects from space and aerolites, solar flares, gamma ray burst, and in general any extraordinary atmospheric, meteorological, seismic or geological phenomenon.
3. Events arising from terrorism, mutiny or crowd disturbances.
4. Events or actions of the armed forces or security forces in peacetime.
5. Wars, with or without prior declaration, and any conflicts or international interventions using force or duress.
6. Directly or indirectly caused by contributed to buy or arising from ionizing radiation or contamination by radioactivity from any irradiated nuclear fuel or the radioactive toxic explosive or other hazardous properties of any explosive nuclear assembly or nuclear component thereof.
7. Those caused when the insured takes part in bets, challenges or brawls, save in the case of legitimate self-defense.
8. Illness or injuries exiting prior to the claim.
9. Those that occur as a result of the participation by the insured in competitions, sports, and preparatory or training tests.
10. Engaging in the following sports: motor racing or motorcycle racing in any of its modes, big game hunting outside European territory, wrestling in any of its modes, martial arts, parachuting, hot air ballooning, free falling, gilding and, in general, any sport or recreational activity that is notoriously dangerous.
11. Participation in competition or tournaments organized by sporting federations or similar organization.
12. Skiing and/or similar sports, winter and/or summer hazardous.
13. Permanent resident and students outside of Iran.
14. The use, as a passenger or crew, of means of air navigation not authorized for the public transport of travellers, as well as helicopters.
15. The accidents deemed legally to be work or labour accidents, consequence of a risk inherent to the work performed by the insured.
Note: if an additional premium considered for sport activities mentioned in above article number 10, 11 & 12 were paid due to policy terms, exclusion would t be applied to that specific activity.
16. Furthermore are excluded the claims:
F) the insured will not be entitled to the reimbursement of the expenses directly paid by him or by any person on insured s behalf without the previous declaration to and the authorization of the assistance provider alarm center, as defend in part 4.
G) Resulting from treatments provided before the period of actual coverage.
H) Resulting from travels with a therapeutic objective
I) Resulting from prophylactic treatments or vaccinations.
J) Resulting from spa cure, physiotherapy, heliotherapy, or aesthetic treatments.
K) Treatment or surgery which in opinion of the medical practitioner in attendance and the assistance provider s medical team can wait until return of the insured of Iran.
L) Any medical condition the insured has, or had, for which the insured is taking prescribed medication or is waiting to receive, or has received treatments (including surgery, test or investigations) within the test last 2 year.
M) Illnesses or injuries arising from chronic ailments or from those that existed prior to the inception date of the policy. The convalescence is considered as a full part of the illness.
N) Any medical condition that according to the opinion of the assistance provider s doctor was predictable / expected and would require medical treatment during the insured s stay abroad.
O) Any pre-existing medical condition for which the insured has not had a diagnosis.
P) Any medical condition the insured has and for which the insured is not taking the recommended treatment or prescribed medication as directed by a medical practitioner.
Q) Those derived from illnesses or pathological states caused by the voluntary consumption of alcohol, drugs, toxic substances, narcotics or medicines acquired without medical prescription (other than drugs taken in accordance with the treatment prescribed and directed by a qualified registered medical practitioner.)
R) Arising out of pandemic, as per world health organization classification and declaration.
S) Resulting from death, injury or illness due to suicide or attempt of same.
U) Those derived from renunciation of or delay, on the part of the insured or persons responsible for him/her, in the transfer proposed by the assistance provider and agreed by its medical service.
V) Rehabilitation treatment.
W) Prostheses, orthopedic material, orthosis and osteosynthesis material, as well as spectacles.
X) Those derived from baggage that is not sufficiently well packaged or identified, as well as fragile baggage or perishable products.
Y) expenses that arise once the insured is at his/her usual country of residence, those incurred beyond the scope of application of the guarantees of the insurance, and, in any case, after the dates of the travel object of the agreement have elapsed or after 92 days has elapsed since the start thereof, notwithstanding what is provided for in the additional clauses or in the private or special conditions.
17. The assistance provider is exempt of liability when, as a result of force , majeure, it is unable to put into effect any of the benefits specifically envisaged in this policy.
Part 4: Obligation of the insured
A) Request for assistance
For any assistance request in any country in the world, the insured must call obligatorily and immediately after the assistance event the following 24 hours a day alarm center:
Lebanon: +961 - (4) - 548356
Before taking any personal action and:
- State his/her full name.
- State his/her policy no, and validity dates of his travel insurance policy.
- State the place and telephone number where he/she can be reached.
- Give a brief description of the problem encountered and nature of the help required.
- Failure to notify the assistance provider.
Declaration: any declaration of a claim shall be made immediately, in any case within maximum 240 hours (10 days) further to the very beginning of the hospitalization or to the date and time of the medical consulting. All declaration made after this delay shall be deemed as nil, and might therefore be rejected by the assistance provider. Life threatening situation: any other of this appendix or of this agreement notwithstanding, in a life-threatening situation, the insured or his/her representative should always try to arrange for emergency transfer to a hospital near the place of occurrence such situation through the most appropriate means, and to call the assistance provider alarm center to provide the appropriate information as soon as practicable.
Hospitalization prior to notice: the assistance provider in any case of illness or bodily injury requiring hospitalization, the insured or any person acting on his behalf must inform the assistance provider within 240 hours (10 days) from the time of occurrence. Failure to do so may entitle assistance provider to invoice the supplementary cost to be borne by the assistance provide which would not have been incurred had this 240 hours (10 days) deadline been respected by the insured.
B) Medical transfer
In the insured claims for medical transfer or repatriation, the following conditions have to be observed:
In order to enable the assistance provider to take action as quickly as possible, the insured or any person acting on his/her behalf must give:
- The name, address and phone number of the hospital where the insured has been taken
- The name, address and phone number of the treating physician and if necessary the Family doctor
The ASSISTANCE PROVIDER’S medical team or agent shall have free access to the insured in order to ascertain his condition. If this obligation is not fulfilled and except justified opposition, the insured will no longer be entitled to medical assistance.
In any case the ASSISTANCE PROVIDER upon agreement with the treating physician will choose the date and means of transportation. Medical transfer or repatriation by air ambulance shall be limited to continental transportation. Should the assistance provider pay for the transportation of the insured, the latter will be asked to hand over to the ASSISTANCE PROVIDER the unused portion of his original ticket or its counter-value.
Limitation: as soon as a claim occurs, the insured must make every endeavor to limit or stop its consequences.
Recovery: the insured will provide the assistance provider with all documents and all necessary formalities so as to enable the assistance provider to recover from relevant sources, if applicable.