Specific Conditions

Specific Conditions in respect of MEDICAL TREATMENT BENEFITS

1. If You or an Insured Person wants TOURMED to pay for any medical expenses in excess of R2,000 TOURMED must be contacted and our prior written agreement must be obtained. If not approved by TOURMED, our liability will be limited to R 2,000 for any one incident.
    
2. We shall have the right to access any prior medical records of the Insured Person in order to finalise and/or proceed with the assessment of a claim and/or render medical assistance.
    
3. Emergency Medical Expenses shall only be paid by TOURMED until such time as a Medical Practitioner, appointed by TOURMED decides that an Insured Person is capable of being Repatriated.
    
4. Passengers in Transit on an Insured Journey to and from the Area will have Cover for a maximum of 12 hours whilst in transit on the outbound and inbound insured Journey.
    

Specific EXCLUSIONS

1. Recoverable by You from any other policy, medical aid or benefit or compensation of a similar nature from any other source; or
    
2. Incurred outside of the Area notwithstanding that such expenses may arise from an Injury or Illness suffered by You during the period of an Insured Journey; or
    
3. Incurred when You are traveling against medical advice or to seek medical attention or with a terminal condition which was diagnosed prior to the Insured Journey or when You were unfit to do so; or
    
4. Incurred for continuing treatment, including any medication commenced prior to the commencement date of the Insured Journey, which You have been advised to continue whilst on an Insured Journey; or
    
5. Incurred in connection with Your unreasonable delay in seeking medical advice and/or treatment either prior to or after the commencement of the Insured Journey; or
    
6. Incurred due to investigatory treatment that is not specified by a Medical Practitioner as immediately necessary; or
    
7. Incurred in connection with acute and/or chronic psychiatric, psychological or emotional conditions; or
    
8. For specialist medical treatment without referral from a Medical Practitioner; or
    
9. Relating to contraceptive devices, prosthetic devices, medical appliances and/or artificial aids; or
    
10. Preventative treatment, including but not limited to any vaccination and/or immunisation.

Specific Conditions in respect of MEDICAL EVACUATION BENEFITS (Repatriation)

1. If You or an Insured wants TOURMED to pay for the emergency transportation services, TOURMED must be contacted and our prior written approval obtained. (This requirement does not include in-country emergency ambulance transfers from place of Injury to a Hospital, which will be paid for by TOURMED provided such service was medically necessary or was authorized by a local authority example: police or medical officer).
    
2. TOURMED will decide where and how to move the ill or injured Insured Person depending on the medical advice received.
    
3. TOURMED will use the Insured Person's return ticket towards the costs if the Insured Person is returned to his or her Country of Residence.
    
4. TOURMED shall have the right to access any prior medical records of the Insured Person in order to finalize and/or proceed with the assessment of a claim and/or render medical assistance.

It is a condition of this Section that should the Insured Person need to return to his/her Country of
Residence, TOURMED must be contacted beforehand to confirm this. TOURMED will also assist with the travel arrangements.
 

Specific Conditions in respect of CLAIMS

1. After suffering Illness or Injury for which compensation under the TOURMED Policy may be due, the Insured Person will, when required by Us, submit to medical examination and undergo any further treatment specified. We will not be liable for payment unless this condition is complied with to our satisfaction.
    
2. Medical Treatment shall be sought and followed promptly on the occurrence of an Injury or Illness and TOURMED shall not be liable for that part of any claim which in the opinion of a Medical Practitioner arises from the unreasonable or willful neglect or failure of any Insured Person to seek and remain under the care of a qualified Medical Practitioner.
    
3. All claims are to be reported whilst You are in the Area, and all claim payments will be settled whilst You are still in the Area.
    
4. All claims, other than local medical costs within the Area, which will be settled directly with the medical service providers, will be settled in Rands in South Africa.
    
5. The due observance and fulfillment of the Terms, Conditions, Exclusions and endorsements of this Policy insofar as they are related to anything being done or complied with by You or the Insured Person shall be a condition precedent to liability to make any payment under this Policy.
    
6. If at any time any claim to indemnify You or the Insured Person arises under this Policy and there be any other insurance covering the same expense, loss, damage or liability or any part thereof, TOURMED shall not pay more than our rateable proportion.
    
7. We must confirm all claims in respect to Evacuation or Repatriation in writing, prior to such an event taking place.

Emergency Medical Expenses

1. All bills to be submitted with claims.
2. If Illness is possibly pre-existing then You are to supply Your normal Medical Practitioner’s report stating what treatment was received prior to the commencement of the Insured Journey.
3. Name of the Medical Practitioner as well as his address and telephone number.

Cancellation or Curtailment

1. Relevant Medical Certificates or Death Certificates in the case of death.
2. Original air-tickets or Insured Journey documents.
3. Proof of deposit not recoverable.
4. Proof of material loss.