Insurance Policy

ISIP-222033
Date: 21.02.2019
INTERNATIONAL STUDENT INSURANCE
For international students and academics
General Information

Policyholder Premium payer Correspondence

Grace YANO Grace YANO Grace YANO

PO Box 15725 PO Box 15725 PO Box 15725
1001NE Amsterdam 1001NE Amsterdam 1001NE Amsterdam
Netherlands Netherlands Netherlands

Email: summer-gsss@uva.nl
Phone Number: 205253776

Insured Person(s)

Ahmed DARWEESH | Male | 28/01/1997 Nationality: Iraq

Insurance Summary - Plan Premium

Destination Netherlands

Territories Worldwide excluding USA, Canada Schengen countries are included

No waiting period are applied Prescript

Notification The plan is without deductible
medicine

Emergency medical cover • Sickness and

Medical cover Max. € 500'000 accident • Hospital in-outpatient • General
practitioners & specialist • Prescript medicine

Search and rescue Max. € 20'000

Emergency medical evacuation Max. € 150'000

By sea - air - ground
Medical repatriation Max. € 50.000

Repatriation of mortal remains Max. € 30'000

Luggage Max. € 1'000 Loss, damage, robbery or theft

Accidental death Max. € 25'000

Lump sum
Accidental disability Max. € 50'000

Damages covered to third parties for corporal

Third party liability Max. € 500'000
and material destructions

The insurer will pay the medical provider directly if required by the law.
EMERGENCY ALARM CENTER ( 24 / 7 ) : +49 699778899-999

Insurance Conditions
Start date Last date Nr. days Premium Paid on GIC edition

28.06.2019 15.07.2019 18 EUR 15.39 12.03.2019 ISIS-09.2018

Legal notice : Anker Insurance Company n.v., having its registered office at Paterswoldseweg 812 at 9728 BM Groningen, in these policy conditions referred to as
"Anker". Anker is registered with the Autoriteit Financiële Markten (AFM) (the Dutch Authority for the Financial Markets) under number 12000661 and is authorised
by De Nederlandsche Bank ("DNB").The Insurance broker is Swisscare Services Ltd., Alte Landstrasse 6, 9496 Balzers (Principality of Liechtenstein). The
company is authorized and regulated by the financial market supervisory authority of the Principality of Liechtenstein, reference number 10095. Swisscare
Services Ltd. is registered in the company index in the Principality of Liechtenstein under the number FL-0002.465.148-2. Swisscare ® is a registered trademark
owned by Swisscare Services Ltd.

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 Insurance Policy
ISIP-222033
Date: 21.02.2019

BENEFITS LIST

Medical Assistance Standard Comfort Premium

Worldwide excluding USA/Canada

Territories covered
Schengen countries are included

Maximum sum per event € 250'000 € 250'000 € 250'000

Emergency medical evacuation € 150'000 € 150'000 € 150'000

Medical repatriation € 50'000 € 50'000 € 50'000

Local ambulance € 5'000 € 5'000 € 5'000

Medical assistance during transportation included included included

Sea and mountain search and rescue € 20'000 € 20'000 € 20'000

Indication of local medical specialists included included included

Repatriation of mortal remains € 30'000 € 30'000 € 30'000

Expenses for accompanying relative of the repatriated € 80 per day for a maximum of 7 days

Accommodation costs for accompanying for next of kin staying at the

€ 500 € 1000 € 2000
hospital

Flight ticket for relative visiting the insured in the hospital included included included

Repatriation of accompanying person travelling with the insured included included included

Advance of emergency funds to be reimbursed by the insured € 500 € 500 € 500

Dispatch of urgent messages included included included

Long-distance medical advice 100% 100% 100%

Medical Expenses Standard Comfort Premium

Worldwide excluding USA/Canada

Territories covered
Schengen countries are included

Maximum sum per event € 50'000 € 150'000 € 500'000

Inpatient treatment/Hospitalization included included included

semi private semi private semi private

Hospital accommodation
room room room

Outpatient treatment / ambulatory included included included

Prescription medication and material (inpatient and daycare) included included included

Surgical fees, anaesthesia, and operating theater charges included included included

Surgical appliances and prosthesis included included included

Rehabilitation services € 1'000 € 2000 € 3000

CT, MRI scan, PET and CT-PET scan (inpatient) included included included

Daycare services and outpatient surgery included included included

Practitioner fees and prescription medication included included included

Specialist fees included included included

Diagnostic fees included included included

Max. € 20 per Max. € 20 per Max. € 20 per

Prescribed physiotherapy following hospitalization day and max day and max day and max
15 days 15 days 15 days

Emergency dental treatment maximum sum per insurance period € 300 € 500 € 1'000

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 Insurance Policy
ISIP-222033
Date: 21.02.2019

Luggage Standard Comfort Premium

Worldwide excluding USA/Canada

Territories covered
Schengen countries are included

Maximum sum per event € 2000 € 2500 € 3500

Loss, damage, robbery or theft of luggage (limited € 50 per item) € 1000 € 1500 € 2500

Delayed luggage > 8h Max. € 600 Max. € 600 Max. € 600

Delayed luggage > 48h Max. € 250 Max. € 250 Max. € 250

Accidental Death Or Disability Standard Comfort Premium

Worldwide excluding USA/Canada

Territories covered
Schengen countries are included

Maximum sum per event € 50'000 € 50'000 € 50'000

In case of death € 25'000 € 25'000 € 25'000

In case of disability € 50'000 € 50'000 € 50'000

Third Party Liability Standard Comfort Premium

Worldwide excluding USA/Canada

Territories covered
Schengen countries are included

Maximum sum per event € 500'000 € 500'000 € 500'000

Bodily harm of a third party € 500'000 € 500'000 € 500'000

Material / Immaterial damage € 100'000 € 100'000 € 100'000

Legal notice : Anker Insurance Company n.v., having its registered office at Paterswoldseweg 812 at 9728 BM Groningen, in these policy conditions referred to as
"Anker". Anker is registered with the Autoriteit Financiële Markten (AFM) (the Dutch Authority for the Financial Markets) under number 12000661 and is authorised
by De Nederlandsche Bank ("DNB").The Insurance broker is Swisscare Services Ltd., Alte Landstrasse 6, 9496 Balzers (Principality of Liechtenstein). The
company is authorized and regulated by the financial market supervisory authority of the Principality of Liechtenstein, reference number 10095. Swisscare
Services Ltd. is registered in the company index in the Principality of Liechtenstein under the number FL-0002.465.148-2. Swisscare ® is a registered trademark
owned by Swisscare Services Ltd.

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