მადლობა, ჩვენი წარმომადგენელი დაგიკავშირდებათ უახლოეს დროში
PROVIDE YOUR PERSONAL INFORMATION
Provide your personal information
Travel Insurance for Tourists Visiting Georgia
₾Limit:
Period:
The insurance will activate after the first payment, at 00:00.
ADD VISITOR
No insured persons added yet
0 insured visitor(s) added
Terms of Service
Electronic Website Terms and Conditions
Welcome,
You are on the electronic website of JSC "Risk Management and Insurance Company Global Benefits Georgia." The use of this website is governed by these rules and conditions established by JSC "Risk Management and Insurance Company Global Benefits Georgia" (identification number: 404526777).
Please be informed that your use of the website and our services are governed by the rules and conditions set out below.
The terms "Company," "we," "Benefits" refer to JSC "Risk Management and Insurance Company Global Benefits Georgia," while the terms "you," "user" refer to a natural or legal person who uses the company's website.
Please read these terms and conditions carefully before using our services.
When using any service on the website, you agree to these terms and conditions, which may be unilaterally changed by JSC "Risk Management and Insurance Company Global Benefits Georgia" from time to time, which will be reflected on this website, and your visit to it means agreement to the conditions. The last update date will be provided at the beginning of the terms and conditions.
In the event that you do not agree with these terms and conditions, please leave the company's website.
Use of the Website
When using the website, you confirm that you are at least 18 years old.
The information on the website is intended only for the user's personal use and/or for the interests of a minor child (in the case of legal guardianship—the person under guardianship).
The user is responsible for any action taken by them on the website.
You will use the website personally, as well as through a legal guardian/representative, and accordingly, you confirm that you will strictly protect the security and confidentiality of your personal account. Disclosing the said information to a third party is prohibited, in order to protect the information on your personal profile.
You bear responsibility for preventing unauthorized use of your profile. If an unauthorized person enters our website and uses your profile, we will rely on the profile data and assume that you were using the website, within the scope of the authorizations provided by law.
In the case of registration or entering information on the website, you agree that you will provide accurate, complete registration information and will update this information if it changes. Furthermore, your personal number, name/surname, and date of birth can only be changed by contacting us.
For security purposes, please notify us immediately if you learn that your profile is being used without your authorization.
On the website, as well as on the company's other website (if such exists), the following are prohibited: defamatory, obscene, discrediting actions that damage the company's reputation, that cause civil or criminal liability, or the uploading of such information. Also prohibited is causing damage to the website through any malicious software.
The company is released from liability for damages incurred due to disruption of website access.
The company reserves the right to refuse to provide service and/or to cancel your profile, which includes but is not limited to the indication that the user violated the legislation of Georgia or other relevant legislation, or that their action conflicts with our interests.
User Registration Rules
To request the provision of services through the website, the following is mandatory:
Registration of the subject on the website;
Familiarization with the rules established for the provision of services (insurance conditions and website conditions) during registration and expressing agreement to them (marking the "Yes" button in the relevant window on the website is considered an expression of agreement).
The user is obligated, during registration and afterwards, to indicate the real data requested by the company (including but not limited to): name, surname, personal number, contact number, email address, gender, actual and legal addresses, and year of birth, otherwise Benefits reserves the right to refuse compensation for an insurance event, cancel the registration, and close the user's profile.
During registration, indicating another person's data is prohibited.
Verification of Personal Information
Benefits thanks you for your trust and for the personal information you have provided. Please note, we treat the protection of personal information conscientiously and with due attention. Our priority is the inviolability of your personal information. Accordingly, Benefits ensures the protection of the confidential information provided with a high standard of diligence, in accordance with the procedure established by the legislation of Georgia.
We request personal information based on necessity, in the volume required to provide effective insurance services in accordance with the procedure established by the legislation of Georgia. The user can request information from the company at any time regarding the processing of their personal information.
The collection and protection of personal data is ensured by JSC "Risk Management and Insurance Company Global Benefits Georgia" (identification code: 404526777), address: Tbilisi, G. Chanturia #5. In case of questions regarding the application and/or the company's practice of processing personal data, contact us: Personal Data Protection Officer: Ana Tavkhelidze. Telephone number +995 591 800 982).
Your personal information will not be transferred to any company or individual without your permission, except for conditions directly defined by the legislation of Georgia, and furthermore:
The user agrees that, for insurance purposes and in the relevant volume, Benefits may verify the user's personal information in all necessary and relevant databases (including but not limited to the National Agency of Public Registry, the Public Service Development Agency, the Civil Registry National Agency, and the unified data exchange databases).
The user agrees that, for the purposes of automobile insurance and in the relevant volume, Benefits may verify the information about the automobile indicated in the application in all necessary and relevant databases (including but not limited to the unified database of the Ministry of Internal Affairs Service Agency).
The user agrees that Benefits may process their personal data for insurance purposes and in the relevant volume.
We, as an insurance company, in accordance with the current legislation of Georgia, need information to conclude an insurance contract, and we obtain this information directly from you. The category of data processed by the company depends on the type of insurance offered and may include the following:
Name, surname, address, place of work, contact information, insurance object.
Information relating to those employed by the company and those seeking employment. This includes information obtained during the organization of selection, employment, and termination of an employment contract.
In addition, special categories of personal data related to your health and physical condition may also be requested and processed from you, including: the presence of symptoms related to specific diseases, past/existing diseases. Also, information about the services provided to you and the products you have received from the company, data obtained as a result of communication with you, and any other information that we are obligated to process by law.
The collection of data processed by us is necessary to ensure legislative or contractual obligations, and also includes payments to be made and made, the form of payment (in the case of non-cash settlement, banking details), the insurance package you have chosen, the coverage territory, limits, and the amount of the insurance premium. When collecting data, we will inform you which data is mandatory to provide and what consequences may arise in case of failure to provide it.
We may process detailed information about your vehicle and license plates. Also, information stored at the Ministry of Internal Affairs Service Agency about your vehicle.
Personal data is processed only for the purpose for which you provide it to us. Employees and contractors of the insurance company who, within the scope of their competence, have access to certain categories of personal data, based on the contract concluded with them, are bound by the obligation to keep the data confidential and to refrain from unauthorized disclosure. Your data is processed only to the extent necessary to achieve the legitimate purpose and only for the period necessary to achieve the purpose of data processing.
Benefits is authorized to process the personal information provided to it by the user, also for direct marketing purposes—to offer new insurance products and services. The data subject has the right to request at any time that the insurer stop using their data for direct marketing purposes in the same form in which direct marketing is carried out—by means of written, electronic, or telecommunication contact to the insurer. You can also carry this out by sending a written notice to our legal address, by contacting our telephone number +995 322 50 00 01, by sending an electronic notification to our email address: info@benefits.ge, or by making a request at any of our offices.
In the event that, after registration, including before the occurrence of a loss, it turns out that the information indicated by the user is inconsistent with reality, the insurer is released from the obligations imposed by the insurance contract.
Indirect Information
Indirect information is information that does not identify a specific person. This type of information includes: your internet protocol IP address and other information that we use through third parties to carry out marketing and analytical purposes. We and/or persons authorized by us may automatically receive this information at the time you visit our website.
Receipt of Notifications
The user agrees, for the purposes of a high standard of service and insurance interests, to receive telephone SMS notifications, postal and/or electronic letters at the addresses indicated by them in the application. A notification (electronic letter and/or short text message) sent to the data indicated by the user will be considered officially received.
The sending of a notification from the insurer to the insured will be made to the latter's actual address indicated in the application (if such exists) or in the insurance policy, or—regarding a change of address, in accordance with the procedure provided by these conditions—to the last address declared to the insurer. Any notification/correspondence sent to such an address will be considered received by the insured, even if the addressee no longer lives and/or is not located at that address, or the address was provided inaccurately to the insurer.
Benefits has the right to itself check and determine whether the information provided by the user is accurate and consistent with the insurance contract. In case of inconsistency, Benefits is authorized to act in accordance with the procedure provided by the insurance contract and/or to cancel the electronic registration/application without prior notice.
Change of Conditions
Benefits is authorized to unilaterally, without prior notice to the user, make changes and additions to the electronic website conditions. The user's subsequent use of the website will be considered agreement to the changes and additions.
Confidentiality
Any type of information provided by the parties to each other in any form (oral or written) is considered confidential and cannot be transferred to a third party without the prior consent of the other party, except for cases provided by the current legislation of Georgia and these conditions.
Intellectual Property
All objects placed on the Benefits website constitute the property of Benefits, including but not limited to: design elements and features, logo, text, graphic images, programs, illustrations, and any other type of object. Accordingly, taking into account the conditions established by the legislation of Georgia, the following are prohibited: copying, reprocessing, distributing, publishing, downloading, transmitting, selling, or using in any other way the content or any part of it, without the written permission of Benefits.
Jurisdiction
By agreeing to these conditions and receiving our services, it is considered that the contract is concluded in Georgia, specifically in Tbilisi.
Insurance Terms
HEALTH AND ACCIDENT INSURANCE FOR INCOMING TOURISTS TO GEORGIA — GAMARJOBA START
1. General Provisions
1.1. The Insurance Terms and Conditions and the Insurance Policy/Electronic Policy (hereinafter referred to as the "Policy") shall be construed jointly and together constitute the insurance agreement. In the event of any inconsistency between the Terms and the Policy, the provisions set forth in the Policy shall prevail.
1.2. In the event of discrepancies between different language versions of these Terms, the Georgian version shall prevail.
2. Definitions
2.1. Insurer — JSC "Risk Management and Insurance Company Global Benefits Georgia," which conducts insurance activities in accordance with applicable legislation and enters into an insurance agreement with the Policyholder.
2.2. Policyholder — A person who enters into the insurance agreement and pays the insurance premium (unless otherwise specified in the Policy, the Policyholder may also be the Insured).
2.3. Insured — A tourist for whom mandatory health and accident insurance is provided and in whose favor the Policy is issued.
2.4. Insurance Policy / Electronic Policy — A document confirming the existence of insurance coverage and containing the individual insurance terms.
2.5. Insurance Period — The period from the start date/time indicated in the Policy until the end date/time indicated therein, but not earlier than the Insured's entry into Georgia and not later than the Insured's departure from the territory of Georgia.
2.6. Territory of Insurance — The territory of Georgia (excluding occupied territories), unless otherwise specified in the Policy.
2.7. Insured Event — A condition occurring during the insurance period within the territory of insurance, caused by sudden illness or accident, requiring emergency/urgent medical treatment and meeting the conditions defined by the Policy.
2.8. Sudden Illness — An unexpected deterioration of health that commenced during the insurance period and requires urgent medical intervention.
2.9. Accident — An unforeseen and unexpected event caused by visible external force(s) (physical, mechanical, thermal, chemical), resulting in bodily injury, disability, loss of working capacity, or death of the Insured.
2.10. Emergency/Urgent Medical Care — Medical assistance without which the patient's death, disability, or severe deterioration of health would be unavoidable.
2.11. Emergency Outpatient Services — Emergency medical services that do not require hospitalization exceeding 24 hours.
2.12. Emergency Inpatient Services — Coverage of medical expenses (including medication, diagnostic procedures, therapeutic and surgical treatment) arising from life-threatening emergency conditions caused by accidents occurring during the insurance period, where hospitalization exceeds 24 hours, in accordance with the Policy terms, and where postponement of treatment for more than 24 hours would result in the death of the Insured.
2.13. Emergency Dental Services — Medically necessary primary dental treatment in case of acute tooth pain, including tooth extraction and pain management (anesthesia).
2.14. Ambulance / Medical Transportation — Emergency ambulance services provided on urgent medical indication, including transportation and referral of the Insured from the place of incident to a medical facility for the purpose of maintaining vital functions.
2.15. Repatriation — Transportation of the deceased Insured's body from Georgia to the nearest international airport or border checkpoint of the relevant country, within the limits specified in the Policy.
2.16. Assistance — The Insurer's assistance service, providing 24/7 telephone consultation and organization of services covered under the insurance policy.
2.17. Medical Provider — A duly licensed medical institution that, based on an agreement with the Insurer, provides medical services to the Insured in accordance with medical necessity and the insurance agreement.
2.18. Sum Insured (Aggregate Limit) — The maximum amount payable under the Policy during the insurance period for all insured events combined.
2.19. Sublimit — The maximum reimbursable amount allocated for a specific service within the aggregate limit.
2.20. Deductible — The portion of the loss arising from an insured event that is not reimbursed by the Insurer and remains the responsibility of the Policyholder/Insured, as specified in the Policy.
2.21. Necessary Expense — The cost of medical intervention (treatment or examination) determined by a physician of the relevant specialty/subspecialty in accordance with nationally accepted protocols and guidelines.
2.22. Pre-existing and/or Chronic Diseases — Any disease, symptom, or condition existing prior to the start of the insurance period and/or requiring medical supervision or treatment.
2.23. Exclusion — Any circumstance/event/expense not subject to reimbursement under the Policy terms and conditions.
2.24. Loss / Claim — A request submitted by the Insured/Policyholder to the Insurer for reimbursement, together with supporting documentation.
2.25. Claims Settlement — The process by which the Insurer reviews the event/documents/expenses and makes a reimbursement decision.
2.26. Documentation — Medical and financial documents (medical reports/diagnoses/prescriptions, invoices/receipts, etc.).
2.27. Certificate from Competent Authority — A document issued by the police/emergency services/other authorized body confirming the fact and circumstances of the accident (where such documentation exists or is required).
3. Insurance Coverage, Limits and Sublimits (Gamarjoba Start)
3.1. Only emergency/urgent medical services necessary for stabilization of the condition and supported by medical documentation shall be covered.
Service
Coverage
Limit per Insurance Period (GEL)
24/7 Medical Assistance
100%
Unlimited
Emergency Ambulance Services
100%
Unlimited
Inpatient Treatment Due to Accident
100%
10,000 (1,000 per bed day)
Emergency Inpatient Services
100%
10,000 (1,000 per bed day)
Emergency Outpatient Services
100%
10,000
Emergency Dental Services
100%
10,000
Repatriation
100%
10,000
Sum Insured
50,000
3.2. Services and limits apply as stated above.
3.3. Aggregate limit (sum insured) — minimum GEL 30,000 or higher (as specified in the Policy).
3.4. The Insurer reimburses only necessary and non-exclusive expenses.
3.5. Only medical expenses incurred within Georgia are reimbursable; services received outside Georgia are not covered.
4. Procedure for Receiving Services (Assistance)
4.1. Upon occurrence of an insured event, the Insured/authorized person must immediately, but no later than 24 hours thereafter, contact the Assistance Service for organization of services (Tel.: +995 32 2 500 001). If immediate contact is impossible for valid reasons, notification must be made within 24 hours and before completion of medical treatment.
4.3. The Assistance Service identifies the Insured based on Policy/passport details and proof of entry into Georgia, after which the Insured will be referred to the relevant providers.
4.4. Upon submission of complete documentation by the provider institution (Form #100, list of services rendered, invoice, copies of the Insured's passport and insurance policy, and in case of accident — certificate issued by the competent authority), the Insurer shall settle payment directly with the clinic within the limits specified in the Policy and after deduction of any applicable deductible.
4.5. If the Insured independently applies to a medical institution and pays for services without prior approval from the Insurer, the Insurer reserves the right to deny reimbursement.
4.6. If it is objectively confirmed that contacting Assistance was impossible, notification must be made at the earliest opportunity and no later than completion of medical treatment. Failure to comply with this requirement constitutes grounds for refusal of reimbursement.
5. Deductible
5.1. Unless otherwise specified in the Policy, the deductible shall be GEL 100 per insured event.
5.2. The deductible applies to all services except repatriation and emergency ambulance services.
6. Claims, Documentation and Verification
6.1. If the Insured independently paid for services and/or applied to a clinic not included in the Insurer's provider network, reimbursement must be requested within 30 calendar days from the date of payment, provided the notification requirements under Clause 4.1 have been fulfilled.
6.2. At minimum, the following documents are required for reimbursement/settlement:
6.2.1. Medical documentation related to the services rendered (indicating dates of treatment and document issuance, signed and stamped by the authorized person, including diagnosis and relevant classification code);
6.2.2. Detailed calculation and invoice for medical services rendered;
6.2.3. Cash receipt, fiscal receipt, POS terminal slip, or equivalent proof of payment;
6.2.4. Copy of the Insured's passport and Policy;
6.2.5. In case of accident — certificate issued by the Ministry of Internal Affairs and/or other competent authorities regarding the circumstances of the event (if required).
6.3. In emergency dental cases, the Insurer reserves the right to request an additional dental chart (dentogram).
6.4. Submission of original documents (or certified copies) requested by the Insurer is a precondition for reimbursement. Failure to provide originals entitles the Insurer to suspend or deny reimbursement until compliance.
6.5. The Insurer reserves the right to verify the insured event and the accuracy of incurred/projected expenses, request additional information/documents from third parties, and, where necessary, engage medical experts.
7. Exclusions
7.1. The following shall not constitute insured events and shall not be reimbursed by the Insurer:
7.1.2. Pre-existing and/or chronic diseases, conditions and their complications; cardiac surgery and invasive cardiac treatment expenses; oncology-related medical services; prosthetics, implantation and transplantation expenses; vaccination-related expenses.
7.1.3. Conditions/treatment that are not emergency/urgent and may be postponed without additional health risk.
7.1.4. Services received from unlicensed institutions/persons; self-treatment; alternative/traditional/non-traditional/experimental medicine; rehabilitation treatment.
7.1.5. Cases where the Insured cannot provide proper medical/financial documentation confirming the expenses/event.
7.1.6. Cases caused by the influence of alcohol, narcotic, or psychotropic substances and related complications.
7.1.8. Professional sports and/or high-risk/extreme sports unless specifically covered by the Policy.
7.1.9. War, terrorism, civil unrest, military actions or exercises.
7.1.10. Radioactive exposure.
7.1.11. Expenses incurred outside the territory of Georgia (including after returning home).
7.1.12. Any exclusive services, including non-standard/premium medical services, upgraded hospital rooms, privately hired physicians, and non-medical expenses.
7.1.13. Services not defined in the Definitions and Insurance Coverage sections.
8. Confidentiality and Data Protection
8.1. When processing data, the Insurer shall fully comply with the requirements of the Law of Georgia on Personal Data Protection. Information exchanged between the parties is confidential and shall not be disclosed to third parties without prior consent, except where permitted by law or these Terms.
8.2. The Insured/Policyholder authorizes the Insurer to process personal data (including special category data) for the purposes of insurance services and claims settlement within the limits permitted by law.
9. Policy Termination and Dispute Resolution
9.1. The Policy shall automatically terminate if:
(a) the Policy period expires; and/or
(b) the reimbursement limit provided under the Policy is exhausted.
9.2. Termination of the Policy at the initiative of the Insured shall be effected by written notice to the Insurer at least 5 days in advance. If the Policy is terminated after the start of the insurance period, the premium shall not be refundable.
9.3. Any dispute arising between the parties shall be resolved through mutual agreement. If no agreement is reached, the dispute shall be resolved in the competent court in accordance with the legislation of Georgia.
10. Contact Information (24/7)
10.1. Medical Assistance: +995 32 2 500 001
10.2. Email: assistance@benefits.ge
HEALTH AND ACCIDENT INSURANCE FOR INCOMING TOURISTS TO GEORGIA — GAMARJOBA ADVANCE
1. General Provisions
1.1. The Insurance Terms and Conditions and the Insurance Policy/Electronic Policy (hereinafter referred to as the "Policy") shall be construed jointly and together constitute the insurance agreement. In the event of any inconsistency between the Terms and the Policy, the provisions set forth in the Policy shall prevail.
1.2. In the event of discrepancies between different language versions of these Terms, the Georgian version shall prevail.
2. Definitions
2.1. Insurer — JSC "Risk Management and Insurance Company Global Benefits Georgia," which conducts insurance activities in accordance with applicable legislation and enters into an insurance agreement with the Policyholder.
2.2. Policyholder — A person who enters into the insurance agreement and pays the insurance premium (unless otherwise specified in the Policy, the Policyholder may also be the Insured).
2.3. Insured — A tourist for whom mandatory health and accident insurance is provided and in whose favor the Policy is issued.
2.4. Insurance Policy / Electronic Policy — A document confirming the existence of insurance coverage and containing the individual insurance terms.
2.5. Insurance Period — The period from the start date/time indicated in the Policy until the end date/time indicated therein, but not earlier than the Insured's entry into Georgia and not later than the Insured's departure from the territory of Georgia.
2.6. Territory of Insurance — The territory of Georgia (excluding occupied territories), unless otherwise specified in the Policy.
2.7. Insured Event — A condition occurring during the insurance period within the territory of insurance, caused by sudden illness or accident, requiring emergency/urgent medical treatment and meeting the conditions defined by the Policy.
2.8. Sudden Illness — An unexpected deterioration of health that commenced during the insurance period and requires urgent medical intervention.
2.9. Accident — An unforeseen and unexpected event caused by visible external force(s) (physical, mechanical, thermal, chemical), resulting in bodily injury, disability, loss of working capacity, or death of the Insured.
2.10. Emergency/Urgent Medical Care — Medical assistance without which the patient's death, disability, or severe deterioration of health would be unavoidable.
2.11. Emergency Outpatient Services — Emergency medical services that do not require hospitalization exceeding 24 hours.
2.12. Emergency Inpatient Services — Coverage of medical expenses (including medication, diagnostic procedures, therapeutic and surgical treatment) arising from life-threatening emergency conditions caused by accidents occurring during the insurance period, where hospitalization exceeds 24 hours, in accordance with the Policy terms, and where postponement of treatment for more than 24 hours would result in the death of the Insured.
2.13. Emergency Dental Services — Medically necessary primary dental treatment in case of acute tooth pain, including tooth extraction and pain management (anesthesia).
2.14. Ambulance / Medical Transportation — Emergency ambulance services provided on urgent medical indication, including transportation and referral of the Insured from the place of incident to a medical facility for the purpose of maintaining vital functions.
2.15. Repatriation — Transportation of the deceased Insured's body from Georgia to the nearest international airport or border checkpoint of the relevant country, within the limits specified in the Policy.
2.16. Assistance — The Insurer's assistance service, providing 24/7 telephone consultation and organization of services covered under the insurance policy.
2.17. Medical Provider — A duly licensed medical institution that, based on an agreement with the Insurer, provides medical services to the Insured in accordance with medical necessity and the insurance agreement.
2.18. Sum Insured (Aggregate Limit) — The maximum amount payable under the Policy during the insurance period for all insured events combined.
2.19. Sublimit — The maximum reimbursable amount allocated for a specific service within the aggregate limit.
2.20. Deductible — The portion of the loss arising from an insured event that is not reimbursed by the Insurer and remains the responsibility of the Policyholder/Insured, as specified in the Policy.
2.21. Necessary Expense — The cost of medical intervention (treatment or examination) determined by a physician of the relevant specialty/subspecialty in accordance with nationally accepted protocols and guidelines.
2.22. Pre-existing and/or Chronic Diseases — Any disease, symptom, or condition existing prior to the start of the insurance period and/or requiring medical supervision or treatment.
2.23. Exclusion — Any circumstance/event/expense not subject to reimbursement under the Policy terms and conditions.
2.24. Loss / Claim — A request submitted by the Insured/Policyholder to the Insurer for reimbursement, together with supporting documentation.
2.25. Claims Settlement — The process by which the Insurer reviews the event/documents/expenses and makes a reimbursement decision.
2.26. Documentation — Medical and financial documents (medical reports/diagnoses/prescriptions, invoices/receipts, etc.).
2.27. Certificate from Competent Authority — A document issued by the police/emergency services/other authorized body confirming the fact and circumstances of the accident (where such documentation exists or is required).
3. Insurance Coverage, Limits and Sublimits (Gamarjoba Advance)
3.1. Only emergency/urgent medical services necessary for stabilization of the condition and supported by medical documentation shall be covered.
Service
Coverage
Limit per Insurance Period (EUR)
24/7 Medical Assistance
100%
Unlimited
Emergency Ambulance Services
100%
Unlimited
Inpatient Treatment Due to Accident
100%
5,000 (500 per bed day)
Emergency Inpatient Services
100%
5,000 (500 per bed day)
Emergency Outpatient Services
100%
5,000
Emergency Dental Services
100%
5,000
Repatriation
100%
5,000
Sum Insured
20,000
3.2. Services and limits apply as stated above.
3.3. Aggregate limit (sum insured) — minimum GEL 30,000 or higher (as specified in the Policy).
3.4. The Insurer reimburses only necessary and non-exclusive expenses.
3.5. Only medical expenses incurred within Georgia are reimbursable; services received outside Georgia are not covered.
4. Procedure for Receiving Services (Assistance)
4.1. Upon occurrence of an insured event, the Insured/authorized person must immediately, but no later than 24 hours thereafter, contact the Assistance Service for organization of services (Tel.: +995 32 2 500 001). If immediate contact is impossible for valid reasons, notification must be made within 24 hours and before completion of medical treatment.
4.3. The Assistance Service identifies the Insured based on Policy/passport details and proof of entry into Georgia, after which the Insured will be referred to the relevant providers.
4.4. Upon submission of complete documentation by the provider institution (Form #100, list of services rendered, invoice, copies of the Insured's passport and insurance policy, and in case of accident — certificate issued by the competent authority), the Insurer shall settle payment directly with the clinic within the limits specified in the Policy and after deduction of any applicable deductible.
4.5. If the Insured independently applies to a medical institution and pays for services without prior approval from the Insurer, the Insurer reserves the right to deny reimbursement.
4.6. If it is objectively confirmed that contacting Assistance was impossible, notification must be made at the earliest opportunity and no later than completion of medical treatment. Failure to comply with this requirement constitutes grounds for refusal of reimbursement.
5. Deductible
5.1. Unless otherwise specified in the Policy, the deductible shall be GEL 100 per insured event.
5.2. The deductible applies to all services except repatriation and emergency ambulance services.
6. Claims, Documentation and Verification
6.1. If the Insured independently paid for services and/or applied to a clinic not included in the Insurer's provider network, reimbursement must be requested within 30 calendar days from the date of payment, provided the notification requirements under Clause 4.1 have been fulfilled.
6.2. At minimum, the following documents are required for reimbursement/settlement:
6.2.1. Medical documentation related to the services rendered (indicating dates of treatment and document issuance, signed and stamped by the authorized person, including diagnosis and relevant classification code);
6.2.2. Detailed calculation and invoice for medical services rendered;
6.2.3. Cash receipt, fiscal receipt, POS terminal slip, or equivalent proof of payment;
6.2.4. Copy of the Insured's passport and Policy;
6.2.5. In case of accident — certificate issued by the Ministry of Internal Affairs and/or other competent authorities regarding the circumstances of the event (if required).
6.3. In emergency dental cases, the Insurer reserves the right to request an additional dental chart (dentogram).
6.4. Submission of original documents (or certified copies) requested by the Insurer is a precondition for reimbursement. Failure to provide originals entitles the Insurer to suspend or deny reimbursement until compliance.
6.5. The Insurer reserves the right to verify the insured event and the accuracy of incurred/projected expenses, request additional information/documents from third parties, and, where necessary, engage medical experts.
7. Exclusions
7.1. The following shall not constitute insured events and shall not be reimbursed by the Insurer:
7.1.2. Pre-existing and/or chronic diseases, conditions and their complications; cardiac surgery and invasive cardiac treatment expenses; oncology-related medical services; prosthetics, implantation and transplantation expenses; vaccination-related expenses.
7.1.3. Conditions/treatment that are not emergency/urgent and may be postponed without additional health risk.
7.1.4. Services received from unlicensed institutions/persons; self-treatment; alternative/traditional/non-traditional/experimental medicine; rehabilitation treatment.
7.1.5. Cases where the Insured cannot provide proper medical/financial documentation confirming the expenses/event.
7.1.6. Cases caused by the influence of alcohol, narcotic, or psychotropic substances and related complications.
7.1.8. Professional sports and/or high-risk/extreme sports unless specifically covered by the Policy.
7.1.9. War, terrorism, civil unrest, military actions or exercises.
7.1.10. Radioactive exposure.
7.1.11. Expenses incurred outside the territory of Georgia (including after returning home).
7.1.12. Any exclusive services, including non-standard/premium medical services, upgraded hospital rooms, privately hired physicians, and non-medical expenses.
7.1.13. Services not defined in the Definitions and Insurance Coverage sections.
8. Confidentiality and Data Protection
8.1. When processing data, the Insurer shall fully comply with the requirements of the Law of Georgia on Personal Data Protection. Information exchanged between the parties is confidential and shall not be disclosed to third parties without prior consent, except where permitted by law or these Terms.
8.2. The Insured/Policyholder authorizes the Insurer to process personal data (including special category data) for the purposes of insurance services and claims settlement within the limits permitted by law.
9. Policy Termination and Dispute Resolution
9.1. The Policy shall automatically terminate if:
(a) the Policy period expires; and/or
(b) the reimbursement limit provided under the Policy is exhausted.
9.2. Termination of the Policy at the initiative of the Insured shall be effected by written notice to the Insurer at least 5 days in advance. If the Policy is terminated after the start of the insurance period, the premium shall not be refundable.
9.3. Any dispute arising between the parties shall be resolved through mutual agreement. If no agreement is reached, the dispute shall be resolved in the competent court in accordance with the legislation of Georgia.
პოლისის შეძენა
