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General  Conditions

Between NICON Insurance Ltd and the Policyholder, the following insurance contract shall be entered into, to be governed according to these General Conditions and the Special and Specific Conditions that are an integral part thereof.

ART⁰  1⁰  –  DEFINED TERMS

Insurer –  NICON Insurance Ltd, Nigeria

Assistance Service – the entity that organizes and provides, on account of the Insurer and on behalf of the Insured Persons, the money payments and services provided in the policy.

Policy Holder  –  the natural person or legal entity taking out this contract with the Insurer and that is responsible for the payment of the premium.

Subscriber:  1 Insured Person  –  the natural person, with usual place of residence and fiscal address in Nigeria, designated by the Policyholder to the Insurer and who underwrites the coverage provided in this insurance contract and on whose behalf the underwritten coverage shall be provided, according to the Special and Specific Conditions, designated by the  Subscriber or the Policyholder to the Insurer at the time that the contract is executed.

Policy  –  written document containing the terms and conditions of the insurance contract, including the General Conditions, the Special Conditions and the Specific Conditions, as well as other addenda or appendixes that complete or modify it.

Claim or Emergency   –  any unforeseen event that may bring the contract coverage provided in the Special Conditions into operation.

Maximum Coverage  –  Maximum and minimum values, defined in the Specific and / or Special Conditions or the Payments Table attached hereto, applicable to the claims covered by the policy.

Premium   –   price of the insurance policy in addition to the tariffs and taxes applicable by law.

 

ART⁰ 2⁰– COVERAGE

The cover is specified in the Special and Specific Conditions.
ART0 3⁰ –  EXCLUSIONS

Without prejudice to the exclusions provided in the Special Conditions, the following are not covered by this contract:

 

1. Claims that occurred before the policy was taken out, even if its consequences were prolonged until after that date.
2. Claims that occurred at times other than the effective term of the contract;
3. The claims, and their consequences, caused by criminal actions, intentional actions, successful suicide attempt or injury caused to oneself, by the Subscriber or the Insured Persons;
4. The Losses suffered by the Subscriber or the Insured Persons as a result of dementia, influence of alcohol through blood alcohol contents equal to or above those which, if driving under the influence, would mean an administrative or criminal offences, or due to taking drugs and stupefacient without medical prescription;
5. Claims occurring when the vehicle is being driven by a person who is not lawfully qualified to do so or whose legal permit has been suspended;
6. Claims resulting from events of war, hostility between countries, sabotage, rebellion, acts of terrorism, civil unrest, insurrection, industrial action disturbances, strikes, lockouts, acts of vandalism and other disturbances to the public order;
7. The claims arising due to earthquakes, volcanic eruptions, flood, or any other cataclysm;
8. The claims caused by explosive or incendiary devices;
9. The claims resulting directly or indirectly from the splitting or fusion of atoms, artificial particle acceleration or radioactivity;
10. Claims or losses that are not verified to have occurred by the Insurer.

 

ART⁰ 4⁰. –  EFFECTIVE TERM

Taking into account that provided in the Special Conditions, the contract shall be entered into for one year and shall be automatically renewed at the end of the annuity, unless notice of termination of the  Policyholder or the Insurer in writing with previous history minimum of 30 days from the date of maturity.  With regard to the Subscriber, the cover shall commence and finish on the dates indicated by the Policyholder to the Insurer.

 

ART⁰     5⁰.  –  TERMINATION

Either party may terminate the contract at any time, as long as they notify the other party in writing at least 30 days before the date that cover was specified to become effective.

The value of the premium to be returned shall be calculated according to the difference between the premium already paid and the premium that should be paid for the period that effectively passed.

In the event of termination performed according to law and regulation in force, due to failure to pay the premium, this premium shall be due and payable in its entirety, whereby no reimbursement shall be given.

Until the end of the contract and during its effective term, the Insurer is entitled to be informed by the Policyholder, the Subscriber and / or the Insured Persons as to any facts or circumstances which, at any time, may modify the insurance risk situation, or shall be liable for the losses and damages that  result from the omission of such facts or circumstances.

 

ART⁰.    6⁰. – TERRITORY

The contract coverage is valid in the territories defined in the Special Conditions, understood as the location where a claim occurs and the assistance is provided.

 

ART⁰    7⁰. – PREMIUMS

1. –  The Insurer shall provide the coverage provided in the Special and Specific Conditions on payment of the respective premium by the Policyholder, with the value resulting from the applicable tariffs that are an integral part of this contract.
2. – During the effective term of the contract, the Insurer shall inform the Policyholder in writing, with at least 60 days notice, as to the deadline for payment of the premium, the value to be paid and also the means and place for payment.

3. – Failure to pay the premium an installment thereof until the payment deadline indicated shall result in non-renewal or automatic and immediate termination of the insurance contract on the date of the payment deadline.

 

ART⁰  8⁰  – CLAIMS

In order to benefit from the cover of this contract, it is an essential condition that the Subscriber or the insured Persons:

1. Immediately contact the Assistance Service, by telephone, through number +351217225546, describing the event and providing all the necessary information in order to receive the requested assistance;
2. Follow the instructions given by the Assistance Service and take all necessary and possible steps in order to prevent the aggravation of the consequences of the claim;
3. Obtain the agreement of the Assistance Service before making any decision or expense;
4. Answer the requests for information made by the Assistance Service, sending them any notices, summons or services of process that received;
5. Collect and make available to the Assistance Service the relevant information in order to activate third party liability when

 

ART⁰  9⁰.  – SUBROGATION

Following payment or after the services are provided the Insurer is subrogated in the corresponding rights of the Policyholder, Subscriber or Insured Person, against any third parties with liability that are not also insured persons under the terms of the same insurance policy contract.

 

ART⁰  10⁰.  – FINAL PROVISION

1. The payments that were not demanded beforehand from the Assistance Service or that were performed without its prior approval, except in cases of force majeure or proven impossibility, are not covered by this insurance.
2. If it is not possible for the Assistance Service to organize the payments due within the defined territory, it shall reimburse the Insured Person for the expenses borne, within the limits defined by this insurance and the applicable coverage.
3. The processing of any reimbursements requires that the insured Person submit the respective original documentation proving the expenses performed.

ART⁰  11⁰  – RESOLUTION OF CONFLICTS BETWEEN THE PARTIES

Any dispute between the Insured Persons, the Subscriber or the Policyholder, and the Insurer arising from this contract, shall be settled through arbitration, according to the law in force at that given time, applying the Arbitration Law Regimen.

That provided in the above number shall not prejudice the right of the Policyholder, the Subscriber or the Insured Persons to start lawsuits or to lodge appeals in relation to the opinion of the Insurer, at their expenses, which will be reimbursed in the event that they obtain a more favorable decision by those means.

 

ART⁰  12⁰    –  APPLICABLE LAW

This contract shall be governed according to Portuguese Law.

 

ART⁰.  13⁰. – JURISDICTION

Any litigation arising from this contract shall be submitted to the jurisdiction of the courts of the district of Lisbon

 

Special Travel Assistance Conditions

 

ART⁰ 1⁰.  –  SCOPE OF INSURANCE

Ensuring assistance to Insured Persons, as defined above, within the scope of travel outside Nigeria and in conformity with the General, Special and Specific Conditions.

 

ART⁰  2⁰.  – TRANSPORT REIMBURSEMENT

The Insured persons who have used transport services provided under this contract shall take the necessary steps in order to recover unused transport tickets, delivering the sums they recover to the Assistance Service.

 

ART⁰     3⁰.  – COMPLEMENTARINESS

The duties and indemnities given are paid in addition to and as a complement to other insurance contracts that already exist and that provide coverage regarding the same risks.

The Insured Persons undertake to take every step necessary to obtain the reimbursements provided in those contracts and to return them to the Assistance Service, in the event and to the extent that this party made payments in advance.

The Insured Persons shall proceed in the same manner regarding Social Security contributions or those made to any other institution to which they are entitled.

 

ART⁰  4⁰.  –  EFFECTIVE TERM

Without prejudice to that provided in the General Conditions, coverage in relation to each insurance policy contract, shall automatically expire on the date that:

1. The underlying situation that led to applying for the insurance policy contract.
2. For Insured Persons who celebrate their 75^th birthday during the effective term of the contract, it shall remain valid until the final date and shall then expire.

 

ART⁰  5⁰. –  TERRITORY

The coverage provided in this contract is valid all over the world except Nigeria, unless, due to internal conflicts, warlike situations or other reasons of force majeure for which the Assistance Service is not at fault. It is not possible to ensure a safe and effective provision of service.

 

Personal Assistance Coverage

 

ART⁰.   1⁰.   – DEFINITIONS

• Accident –  The claim arising due to an event that is accidental, unforeseen and outside the control of the Insured Person, that causes physical injury that are objectively verifiable, temporary or permanent incapacity or death.

• Illness –  Involuntary change to the health outside the control of the Insured Party and that is not caused by accident that is revealed through evident symptoms and is acknowledged and certified by an authorized doctor.

 

ART⁰.  2⁰  – COVERAGE

In the event of accident or sudden and unforeseeable illness, occurring during the  effective term of the policy and within the limited established in the Specific Conditions, the Assistance Service shall offer the following coverage:

 

1. Payment of medical expenses, surgery medication and hospital care abroad|
   If the Insured Person required medical assistance, surgery, medication or hospitalization, the Assistance Service provides coverage upto the established limited for:

1. Doctor and surgical costs and fees;
2. Expenses with medications prescribed by a doctor;
3. Costs regarding hospitalization

   In the event of hospitalization, the Insured  Person shall arrange for the Assistance Service to be informed on that day or, at the latest, during the following 48 hours, except in the event of demonstrated physical impossibility to do so.

   From the time that the repatriation of the Insured Person is possible and advisable, the Assistance Service shall cease to cover hospitalization costs.

   The Assistance Service shall pay for surgery only when it is not possible to await the return of the Insured Person to their home country, due to its pressing and urgent nature of the surgery.

 

2. Companion for the Hospitalized Insured Person.

   If, during the journey, the Insured Person is suddenly and unforeseeable hospitalized and their condition does not recommend repatriation or an immediate return to Nigeria, the Assistance Service shall cover the expenses with accommodation in hotel, not initially forecast, for a relative or person they designate, already on location, to accompany them.

   The Assistance Service shall also take care of the return of the companion to the place of residence of the Insured Person in Nigeria, if the initially provided means cannot be used.

   This cover is strictly subject to the Assistance Service medical term.

 

3. Round trip Transportation for relative and respective stay

   If the Insured Person is travelling unaccompanied and the hospitalization period is expected to last more than 5 days, the Assistance Service shall cover the return journey for one family member setting out from the place of residence of the Insured Person in Nigeria in order to allow that person to stay with them.  In this case, the Assistance Service shall also cover the costs with accommodation.

 

4. Extension of stay in hotel

   If the health of the Insured Person does not justify their continued hospitalization or medical transport, but they cannot return to Nigeria on the initially planned date, the Assistance Service shall cover the expenses effectively borne with accommodation at a hotel, as long as this was not originally planned, for them and for the person who stays in their company.

   When their health so permits, assistance Service shall take care of the return of the Insured Person, as well as their companion, if applicable to the former’s place of residence, in Nigeria, in the event that the initially planned means cannot be used.

5. The cover is strictly subject to the Assistance Service medical team.

 

5. Repatriation or medical transport of injured or sick persons and medical observation

1. When the health situation so justifies, the Assistance Service shall cover, up to the established limited:

   a. Ambulance transport service, or another means considered appropriate, from the place of the occurrence to the nearest hospital;
   b. Transport expenses involved in the transfer of the Insured Person to another more appropriate medical centre or to their place of residence in Nigeria, if applicable.

2. The Assistance Service shall also cover the costs of observation through its medical team, in cooperation with the doctor of the Insured Person, in order to determine the most suitable measures regarding the best treatment to apply and the most appropriate means for the transfer, if applicable.
3. Any medical transport or repatriation, and the medical observation, if applicable, shall observe the health regulations in force and may only occur with the prior agreement between the doctor of the Insured Person and the Assistance Service medical team. A declaration by the doctor is not sufficient.
4. Transport Expenses shall be borne by Assistance Service only in such cases in which the means of transport initially planned cannot be used or if its use is not advisable in medical terms.
5. The means of transport to be used shall be defined by the Assistance Service medical term.
6. When the transport and / or repatriation results from infectious-contagious diseases that are hazardous for public health, this shall follow the rules, procedures and technical guidelines issued by the World Health Organization (W. H. O) whereby, potentially, the transport and / or repatriation in question may not be permitted.

 

6. Transport or repatriation following death of the Insured Person
   
   In the event of the death of the Insured Person, due to accident or sudden and unforeseeable illness, the Assistance Service shall cover the expenses with formalities to be carried out at the location, including transport or repatriation of the body to the place of burial in Nigeria

 

7. Cash advance

   In the event of robbery reported to the authorities, or lost luggage and money, that is not recovered within 24 hours, the Assistance Service shall advance the sums necessary to replace the lost property, through prior deposit or certified cheque of identical value.

   Also in the event of prolonged hospitalization, following an accident or sudden and unforeseeable illness, and if the limit provided in this contract of coverage of medical and hospital costs is reached, Assistance Service shall advance the sums that the Insured Person needs up to the established limit, through prior deposit or certified cheque of identical value.

8. Location and shipment of emergency medication abroad
   
   The Assistance Service shall take care of sending indispensible medication prescribed by a doctor habitually used by the Insured Person, whenever it is not possible to obtain them locally or they cannot be replaced by similar or replacement medications.

   The Insured Person shall bear the cost with the medication and the total shipping costs.

 

9. Payment of communication expenses

   The Assistance Service Covers the transmission of Urgent  national or international messages to family members, as long as they are related to a claim covered by this policy.

   It shall also support following submission of proof of payment, the expenses with communication with its services, as long as these are performed by the Insured Person.

 

10. Transport or repatriation of the remaining Insured persons

    In case of transport or repatriation of one or more Insured Person, in case of death, early return under this contact, accident or sudden and unpredictable illness, and for this reason it is jot possible to return by the means originally planned, the Assistance

    Service guarantees the transport to their place of residence in Nigeria.

11. Supervision of children abroad
    
    If the Insured Person, in charge for the custody of a minor under the age of 16 years is suddenly and unforeseeably hospitalized or dies, the Assistance Service shall corer the Round trip transport for one family member, setting out from the place of residence of the Insured Person in Nigeria in order to allow that person to take care of the under aged to Nigeria, also supporting this return if ti can not be accomplished by the  means originally planned.

 

12. Early return of the Insured Persons

    If, during a trip, a family member of the Insured Person dies, the Assistance Service shall take care of their return to the place of burial in Nigeria, the the initially provided means cannot be used.

    This warranty is also provided in case of accident or sudden and unpredictable illness in Nigeria of those family members that requires urgent and compelling presence, confirmed by the Assistance Service.

    Are considered family members, the spouse, ascending or descending of first degree agreed, siblings, in-laws of in-laws of the Insured Person.

 

13. Transport of Personal Luggage

    In case of theft or loss of the personal luggage of the Insured Person, the Assistance Service organizes and supports the cost of its transportation to the place where the Insured Person is, or to their home in Nigeria, provided they are properly packed in Nigeria, provided they are properly packed and in transport conditions.

    The maximum weight of luggage is subject to the limit imposed by the various airlines or bus companies.

 

14. Medical Advice

    Upon request, the medical team of the Assistance Service will provide medical advice by telephone under the conditions that are compatible with the rules of the profession.

    The answers issued are based on information provided by the Insured Person and the Assistance Service shall not be responsible for interpretations of these responses.

    The medical support requested and provided by telephone implies, only and exclusively responsibility arising from this very type of intervention within the environment in which it is practiced.

    This does not replace the resort to an hospital emergency series and is not in itself a medical consultation.

15. General Information

    The Assistance service will provide information:
    Current visa and entry permit requirements for any country;
    Inoculations and vaccinations;
    Embassies and consulates;
    Clinics and Hospitals.

 

ART⁰   3⁰  . – EXCLUSIONS

In addition to the exclusions described in the General conditions, the charges or payments related to the following are also excluded:

1. Events regarding which the Assistance Service was not called to intervene at the time that they occurred, except in cases of force majeure or demonstrated material impossibility to do so;
2. Delays or negligence in seeking to medical assistance for which the Insured Person is at fault;
3. Claims that take place during or as a result of the performance of professional sports and high risk activities such as skiing, jet skiing parachuting, mountaineering., mountain climbing, martial arts, caving and diving;
4. Claims that take place during or as a result of the performance of motor sports and in competition in general, both during the actual competition and during training, wagers and challenges;
5. Rescue operations;
6. Initially planned accommodation and food
7. Medical surgery medication and hospitalization expenses in Nigeria;
8. None urgent surgeries
9. Refusal of failure to observe prescribed treatments;
10. Preventive medicines prescribed, vaccination or similar;
11. Expenses with alternative or traditional medicine;
12. Non urgent physiotherapy balneotherapy, r relaxation, beauty treatments and checkups;
13. Chronic or preexistent diseases, psychiatric disturbances and relapse of previously diagnosed sickness;
14. Injuries resulting from surgery or other medical actions that do not result from a claim covered by the contract;
15. Medical assistance in the field of stomatology, except for provisional oral trauma treatment;
16. Medical assistance related to pregnancy and childbirth, except that requested during the 1^st trimester following unforeseeable pregnancy complications;
17. Urn, funeral and memorial service;
18. Prosthetics, walking canes, crutches or any other orthopedic material, glasses, contact lenses, implants and similar;
19. Luggage that does not observe the requirements established above;
20. Delay or loss of luggage following confiscation or seizure by customs or any other authorities;
21. Theft or robbery that was not reported to the authorities; within 24 hours and confirmed in writing.

 

Specific Conditions

 

1. In relation to all coverage that involves Medical Care, the medical team of Assistance Service shall always play the role of coordinator and final decider regarding the procedures to adopt following a claim.
2. Limits applicable, according to validity of the policy, the different coverage:

 

 

Payment of medical expenses, surgery medication and hospital care abroad

Maximum indemnity value:  C30.000

Companion for the hospitalization Insured Person

Maximum indemnity Value:
Transport:  Unlimited
Stay:
C70/Day
C700 / Maximum

Round trip transportation for relative and respective stay

Maximum indemnity value:
Transport:  Unlimited
Stay:
C70 / Day
C700 / Maximum

Extension of stay in hotel

Maximum indemnity value:
Stay:
C40 / Day
C400 / Maximum

Repatriation or medical transport of injured or sick person and medical observation

Maximum indemnity value:
Transport:  unlimited

Transport or repatriation following death of the Insured Person

Maximum Indemnity Value:
Transport:  unlimited

Transport or repatriation for the remaining Insured Persons

Maximum indemnity value
Transport:  Unlimited

Early return of the Insured Persons

Maximum Indemnity value:
Transport:  unlimited

Transport of personal luggage

Maximum indemnity value:
Transport:  unlimited according with transport conditions
Medical advice
Access to the Service:  Unlimited
Cash advance
Maximum value of advance:  C700

Location and shipment of emergency medication

Access to the Service:  unlimited
Payment of communication expenses
Maximum indemnity value:  Unlimited