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www.e-agentelocaldeseguros.com Spain: Sanitas agent (BUPA Group) Sanitas Multi - General Conditions (English) VII. POLICY-HOLDER'S AND / OR INSURED'S OBLIGATIONS AND DUTIES The Policyholder or, as the case may be, the Insured shall have the following obligations: a) Declare to the Insurer, prior to the conclusion of the contract and in accordance with the questionnaire to which s/he is subjected, all the circumstances known by him / her that may affect appraisal of the risk. S/he will be relieved of this duty if the Insurer does not submit the questionnaire or when, even if it does so, it is a question of circumstances that may affect appraisal of the risk but are not comprised in it. The Insurer may terminate the contract by means of a declaration addressed to the Policyholder within one month of becoming aware of the reservation of the Policyholder's or Insured's inaccuracy. The premiums for the period in progress at the time this declaration is made shall correspond to the Insurer, unless there is fraudulent intent or gross negligence on its part. If the claim arises before the Insurer makes the declaration referred to in the previous paragraph, the benefit for this will be reduced proportionally to the difference between the agreed premium and the one that would have been applied if the true identity of the risk had been known. If there were fraudulent intent or gross negligence on the Policyholder's part, the Insurer would be released from payment of the benefit. b) Notify the Insurer, during the course of the contract and as soon as possible, of all the circumstances that may aggravate the risk and are of such a nature that if they had been known by the Insurance Company at the time of the execution of the contract, it would not have executed it or would have concluded it on more onerous terms. The Insurer may propose an amendment in the contract within two months of the day on which the aggravation was declared to it. In this case the Policyholder has fifteen days as of receipt of this proposal either to accept or reject it. In case of rejection or of silence on the Policyholder's part, the Insurer may terminate the contract at the end of this period, after giving the Policyholder prior notice, offering him / her a further period of fifteen days to answer, after which and within the next eight days notify the Policyholder of the final cancellation. The Insurer may also terminate the contract notifying the Insured in writing within one month as of the day on which it became aware of the aggravation of the risk. If the Policyholder or the Insured has not made his / her declaration and a claim arises, the Insurer is released from its benefit provision if the Policyholder or the Insured has acted in bad faith. Otherwise, the Insured's benefit provision shall be reduced proportionally to the difference between the premium agreed and the one that would have been applied if the true identity of the risk had been known. c) Inform the Insurer as soon as possible of any change of address. If the change of address represents a lowering of the risk, the provisions of article 13 of the Insurance Contract Act shall apply. This states: "In this case, at the end of the current period covered by the premium, the amount of the future premium should be reduced in the corresponding proportion, otherwise the Policyholder would be entitled to terminate the contract and reimbursement of the difference between the premium paid and what s/he should have paid, from the time the Insurer was made aware of the reduction of the risk". If it represents an aggravation of the risk, however, the stipulations of the preceding letter b) shall be applicable. d) Notify the Insurer as soon as possible of new inclusions (by completing the respective health questionnaire application) of Insureds that might take place during the validity hereof. These new inclusions shall take effect on the first day of the month following the date of notification given by the Policyholder, with the resultant adjustment of the premium to the new situation. The Insured's newborn children will be included in the policy with all its rights and obligations, unless expressly excluded by the Insured during pregnancy. e) Lessen the consequences of the claim by using all the means at his/her disposal for early recovery. Non-compliance with this duty with evident intent to harm or deceive the Insurer shall release the latter from all benefit obligations stemming from the claim. f) For the use of the services provided by the physicians referred to as consultants herein, the Insured should obtain the relevant document associated with the care, which should be handed over when any service of this type is given. These services may only be used subject to prior prescription by one of the Insurance Company's specialists and with its authorisation. g) For the use of the relevant services as described in Clause One, the Insured should present his/her Sanitas card, which is a personal and non-transferable document. In case of loss or theft of this card, the Policyholder and / or Insured is / are under the obligation to inform the Insurer thereof within forty-eight hours, whereupon a new card will be issued and the mislaid or stolen one cancelled. In addition, the Policyholder and/or Insured is / are obligated to return Sanitas card(s) to the Insurer in the event of cancellation, termination and, in general, ending of the contractual relationship, irrespective of what the cause thereof may be. Return to Index (English Conditions) For more information your English Sanitas agent is: David Harris Mobile / cell: (00 34) 609 522 300 email: saniprof@wanadoo.es or saniprof@mail.ddnet.es - thanks. (Free messenger service - I cover the whole of Spain (click here...))
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