1.AREA OF COVER
The ThinkCare plan offers a range of options in relation to geographical cover (Africa & Indian Subcontinents, Europe, South America, Asia, Gulf and Rest of the World only; or The chosen area of cover will be specified in your insurance certificate.
2. TREATMENT PRE-AUTHORISATION/GUARANTEE
Certain treatments and costs require Pre-Authorisation and submission of a Treatment Guarantee Form in advance. Following approval by Think Insurtech & TPA, cover for these required treatments or costs can then be guaranteed.
If Pre-Authorisation is not obtained for the benefits listed below, we reserve the right to decline a claim. We should be contacted at least five working days before receiving treatment, so that we can ensure that there will be no delays at the time of admission. This will ensure that members benefit from cashless access to hospitals for in-patient treatment, where possible, and have their treatment overseen by our team of medical professionals.
In the case of an emergency, we should be informed within 48 hours of the event to ensure that no Pre-Authorisation penalty will apply to the claim. If the respective treatment is subsequently proven to be medically necessary, we will pay only 80% of the eligible benefits.
These benefits are listed below, along with further important details:
• All in-patient & Outpatient benefits listed below
If Treatment Guarantee is not obtained for the benefits listed below, we reserve the right to decline a claim. If the respective treatment is subsequently proven to be medically necessary, we will pay only 50% of the eligible benefits.
• Kidney dialysis.
• Day-care treatment.
• Out-patient surgery.
• MRI (Magnetic Resonance Imaging) scan. Treatment Guarantee may be required for this test if you would like us to settle the bill directly with the medical provider.
• PET (Positron Emission Tomography) and CT-PET scans.
• Nursing at home or in a convalescent home.
• Routine maternity and complications of pregnancy and childbirth (in-patient treatment only).
• Oncology (in-patient and day-care treatment only).
• Occupational therapy (out-patient treatment only).
• Rehabilitation treatment.
• Medical evacuation (or repatriation where covered).
• Travel costs of insured family members in the event of an evacuation/repatriation.
• Repatriation of mortal remains.
• Travel costs of insured family members in the event of the repatriation of mortal remains.
• Expenses for one person accompanying an evacuated/repatriated person.
• Palliative care.
• Long term care.
3. CLAIMS PROCESS AND TURNAROUND
If the policy is in 1st Euro or 1st USD, claims are reimbursed based on medical treatment under the chosen plan. Think Insurtech delegate the claims process to its Third Party Administrator (TPA) and you should send a fully completed claim form, diagnosis, invoice and receipt of payment to them by Scan/Email or through the TPA mobile application. Fully completed claims are processed in 5 working days.
If you are French and the policy is a Top Up of the CFE (Caisse des Français à l’Etranger), you should observe the same process as 1st Euro/1st USD and the TPA will submit claims to CFE. Benefits indicated correspond to the total sum jointly paid by the CFE & Think Insurtech.Note that retirees, whose claims are settled by CPAM of Tours, are required to claim from the CPAM of Tours prior to submitting claim to the TPA.
Think Insurtech and our insurance partners only cover claims that are usual, reasonable, and customary
4. POLICY TERMS AND CONDITIONS
Note that benefits subject to underwriting cover may be excluded for pre-existing conditions, or a higher premium may be applied to reflect the risk to medical conditions. Cover is conditional upon acceptance of your application form which is only confirmed when an insurance certificate is provided including the payment of the premium. Benefits are subject to our policy terms and conditions as detailed in our general conditions issued to members upon policy inception.