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T R AV E L I N S U R A N C E
CERTIFICATE OF COVERAGE
No: EM-VBOQ-C-104804
Operation Date: 04 Jan 2021

Beneficiary Name Birth Date Passport No. Gender

MOUSTAPHA DIA 04/12/1994 A02547615 Male

Coverage Details: Address Details:

Period of Coverage: 04 Jan 2021 to 02 Feb Country of Residence: Worldwide
2021
No of Days: 30 days Permanent Address: Unknown - b2b@princesstourism.com
-
Destination: United Arab Emirates Telephone: +97143257744
Area of Coverage: United Arab of Emirates
Medical Coverage: 50,000 USD

Premium
As per attached receipt voucher No. RV 107327
This policy is valid for both single & multiple entry trips.

Period of coverage will automatically be extended up to 10 days from the expiry date of your visa to provide cover during the 10-day grace period
allowed by the local authorities.
If your date of entry into UAE changes from the cover dates shown on your certificate of insurance, your cover dates will be automatically amended
to start from the date you entered the UAE (as stamped on your passport) and run for the same duration as the original policy period.
Should the need arise to extend your policy cover period as a result of extending your visa, please reach out to the agent/broker that issued your
policy who will be able to arrange an extension for an additional premium. Medical and Hospitalization Expenses up to 50,000 USD- Excluding
COVID-19
Medical Evacuation/Repatriation up to 25,000 USD- Excluding COVID-19
COVID-19 Medical and Hospitalization Expenses up to 50,000 USD
Emergency Dental Care up to 200 USD

In case of death:
Repatriation of Mortal Remains up to 25,000 USD - Excluding COVID-19
COVID-19 Quarantine Expenses up to 5,000 USD

Deductibles per claim (applicable on both COVID-19 and Medical expenses benefits):

USD 100 if the beneficiary is under 70 years old

USD 250 if the beneficiary is between 71 and 75 years old
USD 500 if the beneficiary is between 76 and 85 years old

Kindly contact Eurocross Assistance within 48 hours from occurrence of an accident or a sudden illness on : 00961-4-
548311.
By receiving this certificate, the beneficiary agrees on the terms, exclusions, and limitations of the General Conditions
attached. Travel Insurance Policies can be falsified, check the Authentication Key or QrCode on the following website:
www.mideast-assistance.com to avoid legal pursuit.
Certificate of Coverage authentication key: J4812-54V69-LD4LS-2PYYK-PINKP-MOQQ
(if Key is blank, then certificate is not valid)
For and on Behalf of
Eurocross Insurance B.V.

With the compliments of DSC35

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Tohme Bldg 955A, 3rd floor, near le Mall, MTV Nacchache Road, Dbayeh, Lebanon Tel: +961 4 548300
www.mideast-assistance.com e-mail: claims@mideast-assistance.com

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General Condi ons

A. Plan Specifications
Period of Coverage: Up to 92 consecutive days per trip from the Country of Permanent Residence and back to it.
Scope of Coverage: As issued on the attached certificate of coverage (excluding the Country of Permanent Residence e.g.: carte de séjour, green card, etc…).
Conditions: As herein defined
Age Limit: From 3 months to 85 years.

The travel assistance plan covers and assists travelers anywhere in the world in the event of a sudden illness or accident during journeys outside their country of permanent residence. The
insurer of this Medical coverage under this agreement is Eurocross Insurance B.V

A- Definitions:
The words and phrases defined below shall have the following meanings wherever they appear in this document:
Accident or Sudden Illness or Sudden Injury mean a sudden, unexpected, unusual, specific, unforeseen, external event which occurs at a single identifiable time and place and
independently of all other causes, resulting directly, immediately and solely in physical bodily injury or trauma and requiring immediate medical intervention treatment. An event which
directly or indirectly exacerbates a previously existing pathology and/or a physical bodily injury shall not be considered an Accident.
Beneficiary means any of the covered persons whose name is stated on the certificate of coverage.
Country of Permanent Residence means the country in which the Beneficiary normally resides, whether or not he/she holds its citizenship.

Deductible means the first amount of the claim which is payable by the Beneficiary, where applicable.

Medical Emergency means an unforeseen and non-recurrent sudden pathology which requires an emergency treatment to prevent or alleviate existing danger to life or health. An
emergency no longer exists when medical evidence indicates that the Beneficiary is able to return to his/her Country of Permanent Residence to seek and/or continue treatment. A
pathology related to a pre-existing medical condition does not fall under the definition of a sudden pathology. Each time the patient is able to visit the doctor’s office in person; such case
shall not be considered an emergency.

Pre-existing Medical Condition means a pre-existing physical defect, infirmity, injury, sickness, pathology, disease, affliction, anomaly that could be congenital or acquired, major risk
factor, or any other medical condition, whether known or unknown to the Beneficiary, which he/she was suffering from prior to his/her date of travel from his/her country of permanent
residence.

B -Benefits
1. Travel Information Service
The Beneficiary may, prior to his/her departure, call the appropriate Assistance Alarm Center on the assistance number mentioned on his policy, in order to obtain important administrative
or medical advice regarding passport and visa processes, vaccination requirements, taxes, customs duties, currencies, and other various requirements.
2. Referral to Medical Correspondents Abroad
While abroad, the Beneficiary may call the Alarm Center of the Company in order to obtain referral to the nearest qualified medical correspondents (One or more options upon availability).
The company shall not be held liable for any medical malpractice or inadequate or deficient treatment that might incur following that referral.
3. Long Distance Medical Advice
Should the Beneficiary, during his/her journey abroad, need medical advice which is not available at their location, he/she may call the appropriate Alarm Center and get medical advice
from a qualified physician. A telephone conversation does not permit the establishment of a diagnosis and must therefore be considered as mere advice. The Company and the physician
shall not hold any malpractice liability to his/her medical opinion.
4. Dispatch of a Specialist Physician
In such cases where medical repatriation proves to be impossible due to the patient’s condition, the Company may, at its discretion, pay for the dispatch of a specialist physician to make
on-site evaluation with the attending physician and arrange for the eventual medical repatriation of the Beneficiary.
5. Delivery of Urgent Messages
In the event of an emergency calling for assistance, the Company shall transmit any urgent messages of the Beneficiary to his/her family or employer and keep them informed of any
arrangements made to provide the required assistance.
6. Cover of Medical Expenses and Hospitalization Abroad
The Company shall cover only reasonable medical emergency expenses for accidents. Accidents and medical emergency as defined above under definitions section at chapter A, as well
as hospitalization costs resulting from it, up to a limit specified in the certificate of coverage according to the minimal and standard costs of hospitalization in the country where the
Beneficiary is being treated.
This coverage is complementary and only takes place if no other medical or insurance coverage is available. Nevertheless, the Company upholds her right to recovery at any time it
appears that the Beneficiary’s holds a valid medical insurance that covers medical expenses outside his/her country of permanent residence.
Therefore, the beneficiary authorizes the Company to claim back any paid medical costs from his/her primary medical insurance that provides travel coverage abroad, and undertake to
hand over all requested documents for such recovery.
The cover of medical and hospitalization expenses is subject to the following deductibles per person per claim:
-USD 100 if the Beneficiary is under 71 years old.
-USD 250 if the Beneficiary is between 71 and 75 years old.
-USD 500 if the Beneficiary is between 76 and 85 years.
The coverage is only valid for sudden illness or injury, meaning that this sudden illness or injury has no relation with any pre-existing medical condition or existing major risk factor,
whether known or unknown, prior to the departure date of the current travel.
7. Evacuation &/or Medical Repatriation
If the Company’s physicians decide that medical transportation of the Beneficiary is necessary, the Company shall arrange and cover the expenses of the medical evacuation of the
Beneficiary. The evacuation could be done by helicopter, road or air ambulance, scheduled airline flight, or other means of transport to a hospital where he/she can receive adequate
treatment. As soon as the Beneficiary`s condition permits him to travel, the Company may arrange , if necessary, the repatriation back to his Country of Permanent Residence (home or
hospital) on a regularly scheduled airline flight.
A direct medical repatriation may likewise be considered, depending on the medical case and the distance to be covered. Expenses incurred during the Beneficiary’s medical evacuation
and repatriation shall be covered by the Company up to an amount specified in the certificate of coverage.

8. Repatriation of Mortal Remains

In the event of an accidental or a sudden death of the Beneficiary as a result of a sudden non pre-existing illness, the Company shall assist with the necessary procedures and shall cover
only the expenses of transportation for repatriation of the mortal remains back to the last airport of the permanent residence country, up to a limit specified in the certificate of coverage.
The ground repatriation, the administration and the funeral expenses at the destination (including the purchase of the coffin) are not covered.
The request of Repatriation of Mortal Remains resulting from death because of a pre-existing medical condition (which is not covered as per the policy conditions) shall NOT be covered
either.
9. Emergency Dental Care
The Company shall cover the dental expenses incurred by the insured in emergency cases, arising as a result of a bodily injury or of an acute and sudden illness, with the exclusion of any
kind of prosthesis and /or definitive filing. The coverage is restricted to the treatment of pain, infection and removal of tooth affected. Expenses are covered up to a limit specified in the
certificate of coverage.
10. Loss of passport
In case of loss of the Beneficiary’s passport while abroad, the Assistance Company will take charge of the expenses of the replacements necessary for obtaining a new passport or
equivalent consular document, up to a limit of 100 USD.
All such claims shall be accompanied by a police report certifying the loss or theft of such documents.
11. Compensation for the Total Loss or Disappearance of Baggage:
The coverage shall apply in the event of the total loss or disappearance of baggage whilst in the custody of an air carrier and will be calculated according to IATA Rules and regulations. The
Company will pay compensation equal to the amount paid by the airline company, up to a limit of USD 300.
The 48-hour exclusion does not apply to this benefit.
12. Compensation for Flight Cancellation (4-hours delay)
In the event that a flight is delayed for more than 4 hours AND THEN cancelled by the airline company outside the country of permanent residence, an indemnity of USD 200 shall be paid
to the Beneficiary, provided that proof of such delay and cancellation is submitted to the Company. In the case of connection flights for example, the case of a delay in the first flight
leading to missing the second flight will not be covered by this benefit. This benefit aims to compensate only for basic expenses incurred by the beneficiary during the delay period.
The 48-hour exclusion does not apply to this benefit.
13. Covid-19 cover
13. 1.Medical expenses due to COVID-19:
It is hereby agreed and understood that contrary to any other stipulation, condition or exclusion contained in its general or particular conditions, the Company shall cover reasonable, usual
and customary (UCR) medical costs and expenses (up to a limit specified in the certificate of coverage) which may be incurred consequent to the Beneficiary’s becoming infected with an
agent of an epidemic/pandemic disease, while this policy is in force in respect of In-hospital treatment provided that:
1. For the purpose of this clause, Epidemic/Pandemic disease shall be defined as a general and widespread sudden outbreak of an acute and severe infectious disease caused
by a defined infectious disease pathogen (including all types of viruses, bacteria, parasites etc.), that affects simultaneously numerous individuals worldwide and that is
officially declared as a new, sudden and acute epidemic/pandemic disease exclusively by the World Health Organization.
2. Usual, reasonable and customary (UCR) is defined as treatment consistent with generally accepted standards of medical practice set by World Health Organization in
respect of the agent of the epidemic/pandemic disease at the time of the current incident.
Special Limitations/Exclusions applicable to this cover
This cover will be only granted if the Beneficiary's PCR test result , done at UAE airport upon his/her arrival is negative.
The Company does not cover the following conditions, the complications and the consequences arising therefrom:
a. Out of hospital medical expenses including ambulatory services, screening tests, medication, vaccination and doctors’ consultations.
b. Outpatient quarantine period and systematic isolation expenses upon arrival to country.
c. Homecare and any expenses linked to paramedical expenses and medical equipment at home
d. Any expenses incurred in the country of permanent residence
e. Childbirth and pregnancy treatment as any of their complications.
f. Treatment of pre-existing medical conditions and their complication arising from or during the period of any Epidemic/Pandemic hospital treatment shall be subject to the same limit as
stated in the above scope of coverage.
g. All chronic or slow spreading infectious diseases other than COVID-19 such as but not limited to HIV, hepatitis, tuberculosis, HPV infections… etc.
h. Epidemic/Pandemic events caused by biological weapons/terrorism.
i. Expenses that cannot be proven to be caused by the epidemic/pandemic disease.

13.2 Quarantine Fees (Out of hospital confinement):

Out of hospital confinement refers to the stay of the beneficiary in quarantine centers or at the hotel in addition to any treatment that can be undergone under the out of hospitals
services and is recommended by a recognized treating physician.

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The insurance company shall cover on evidence, the accommodation and treatment expenses of the beneficiary during his quarantine stay up to a maximum of USD 5,000 excluding PCR
test fees.
This cover is provided upon the beneficiary's arrival to the United Arab Emirates airport.
C- Obligations of the Beneficiary
In the event of an accident or a sudden illness, the Beneficiary releases from professional secrecy all doctors and paramedical staff who might examine him/her both before and after the
accident.
Any reluctance or failure to declare a fact or circumstance limiting the benefits under this contract gives the Company the right to terminate the contract as soon as it acquires knowledge
of such fact or circumstance.
The Beneficiary must fully cooperate with the Company to provide the documents required (ex. medical report) in order to evaluate the claim.

Claims Conditions
In order to receive the benefits under this travel plan, the Beneficiary must contact the appropriate Alarm Center within 48 hours of the occurrence of the event by phone or email:

In the Middle East Rest of the World:

Tel: +961 4 548 311 Tel: +420 234 622 727
Fax: +961 4 548349 Fax: +420 296 339 630
Email: claims@mideast-assistance.com

If the Beneficiary is not in a position to contact the appropriate Alarm Center, notification given by a close person, the police, the hospital, the fire brigade, or any person having intervened
upon the occurrence of the damage will be considered of the same worth as a call from the Beneficiary him/herself.
The Company reserves the right to verify the truthfulness of the damage declared. Failure to submit such required documents within a period of two months from the occurrence of the
accident/sudden illness gives the Company the right to deny any benefits and/or reimbursement in relation with the incurred costs.
Furthermore, if the Company approves the coverage of the claim, the Beneficiary must provide the requested original documents within twelve months.

1. The damage:
-Official statement of accident issued by the police authorities.
-Copy of passport and visa (where applicable).
-Complete medical file established by the doctor or the hospital visited at the place of the accident, Medical prescriptions.
-Medical and hospital bills.
2. The loss of luggage:
-Copy of check reimbursed from the Airlines.
-Letter from the Airlines.
3. Flight Cancellation:
- Proof of the delay or cancellation (boarding passes, letter from the Airlines, flight history).

D- Limitation of Coverage
1- Coverage under this plan is secondary, which means that the Company will not pay any cost which is recoverable from the National Health System and any other insurance, fund or
institution, except eligible amounts that exceed the limits covered by that other insurance, fund or institution, subject to the General Conditions of this contract, and up to the limits herein
set.
2- The Company shall not be held liable for the consequences of medical malpractice or inadequate or deficient treatment.
3- The Company shall not be held liable for any medical post-treatment or follow-up incurred by the incident.

E- Exoneration from Providing Benefits

The Company is released from any obligation to provide benefits in the following cases:
1- Failure by the Beneficiary to notify the Company within 48 hours of the event.
2- All files or bills treated outside a guarantee of payment or a previously written authorization from The Company, if accepted, are subject to reimbursement according to the Company’s
standard prices in the incident country.
3- Failure by the Beneficiary to submit to the Company all documents required for setting the case of the accident.
4- Committing by the Beneficiary of a crime or an offense, which was the cause of the accident.
5- Denial of the compulsory prior approval by the Company for the organization and financing of the assistance. Any decisions to undergo treatment, transfer to a different medical facility,
or perform a necessary procedure, such as a surgery, or additional investigation, such as MRI or scanner, during an approved hospitalization must be subject to the Company’s prior
approval. Failure to notify the Company of such decision will result in the denial of coverage.
6- Failure by the Beneficiary to notify the Company of the existence of another insurance covering the same risks.
7- Failure by the Beneficiary to take measures which reasonably ought to have been taken to avoid the accident.
8- Failure by the Beneficiary to provide the Company with the information it needs, and to give it honest and complete answers.
9- Refusal by the Beneficiary or the person who decides for him/her to receive those benefits provided by the Company and mutually agreed upon by the Company doctors and those
present at the place of the damage. Such refusal will result in the cancellation of the contract, unless the Beneficiary changes his/her mind before the expiration of the contract.

F- Exclusions:
Expenses and damages resulting from the following events are not covered:
1- The practice of reckless undertakings or needless risk by the Beneficiary or not taking reasonable care, except in an attempt to save human life.
2- Brawl (punches during a violent dispute).
3- The practice of high-risk sports such as, but not limited to: parachuting, acrobatics, spelunking, races using mechanical appliances, high wire, ski jumping, sky flying & surfing,
bungee jumping, Base jumping, hang gliding, open water swimming, scuba diving, jet skiing, kite & windsurfing, water surfing, wakeboarding, rafting & kayaking, shooting, indoor
& outdoor climbing, alpinism, mountain biking, free falling, boxing, motor racing, rugby, aviation, ATV riding, mountain sickness related claims ,as well as all professional
competition sports.
The Company shall study on case by case basis the circumstances related to the practiced sport.
4- War, declared or otherwise, revolution, sabotage actions, terrorism or vandalism strikes, street barricades erected at the time of public demonstrations, and generally troubles of all
kinds and measures taken for restoring order.
5- Telluric movements, floods, volcanic eruptions, or other kinds of natural phenomenon considered as natural calamity.
6- Any expenses related to abuse of consumption of alcohol, narcotics, and/or other hallucinogenic substances.
7- All damage to health brought about by ionizing rays (nuclear radiation).
8- Any loss arising from biological and/or chemical material(s), substance(s), compound(s) or the like used directly or indirectly for the purpose to harm.
9- Expenses related to mental health disorders and any psychiatric disorder or any of its manifestations or complications.
10- Suicide or attempted suicide.
11- Ablation and transplantation of organs, tissues, or cells.
12- All events and accidents associated with or resulting from pregnancy and/or breast feeding, including diagnosis, follow-up treatments, abortion, or delivery.
13- a)Prosthesis, anatomical and orthopedic devices (fixed or removable).
b) All operations related to previous prosthesis, anatomical and orthopedic devices (fixed or removable).
14- Physiotherapy including all forms of physical reeducation.
15- Elective stay at a convalescent home or a revalidation center.
16- All treatments related to congenital or acquired malformations.
17- Endemic, epidemic and pandemic diseases.
18- Venereal and sexually transmitted infections.
19- Any Health Services that are received as out-of-hospital benefits
20- Spontaneous consultations of doctors and specialists, and all kind of check-ups and medical investigations.
21- Treatment, hospitalization or any medical costs related to a pre-existing medical condition (as described in Chapter A under definitions section). This exclusion extends to any
medical situation whether known or unknown, diagnosed or not, treated or not before the Beneficiary current travel dates and possible complications thereto. Pre-existing medical
conditions, and any related treatment, repatriation, evacuation or Emergency Room expenses are not covered under this plan.
22- Any subsequent admission to the hospital, related to the first one, unless considered as an emergency treatment by the Company physicians.
23- Gallstones and cholelithiasis and any complications resulting from that.
24- Nephrolithiasis as well as ureterolithiasis and their complications.
25- Any vascular, cardiovascular, cerebrovascular illness and their related complications are excluded from the coverage of this plan.
26- Any medical condition for which the Beneficiary didn’t take the recommended treatment or prescribed medications as directed by his medical practitioner in his Country of Permanent
Residence.
27- Medicines, prescribed outside the emergency coverage or the hospitalization that follows.
28- Unconventional trips.
29- In case of approval of a non-urgent hospital admission: prior any admission, authorization by the Company doctors concerning the choice of the hospital is mandatory; otherwise, the
hospitalization fees are not covered by this certificate of coverage.
30- Systemic, rheumatologic, endocrine diseases as well as auto-immune, vascular and chronic diseases and allergic reactions.
31- In case of a non-typical or uncommon pathological disorder, failure to present to the Company doctors a clear and definite medical and etiological diagnosis within 3 (three) days of
the hospital admission.
32- Any emergency admission that does not lead to an urgent intervention (medically and surgically) within 24 to 48 hours maximum is no longer considered urgent by this contract even
if it will lead later to a medical or surgical intervention.
33- Every hospitalization undertaken initially in a diagnostic search purpose.
34- Investigations, treatment, or surgery which in opinion of the medical practitioner in attendance and/or the Company doctor can wait until return of the insured to country of permanent
residence
35- No coverage shall be rendered in case the insured has another valid medical or insurance coverage outside his/her Country of Permanent Residence.

In addition, the Beneficiary is not covered when a trip is undertaken:

- Against medical advice.
- Following acknowledgement of a diagnosis establishing an illness in terminal phase.
- With the intention to receive medical treatment, medical investigation or follow-up treatment for a pre-existing medical condition.
- During a period of illness, major treatment, or incapacity to work.
- When a doctor has ordered an operation, which has not yet been performed.

H- Juridiction

Any dispute resulting from the execution or the interpretation of this agreement shall be settled by competent tribunal of the coverage Issuer's country.

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Date: 04 Jan 2021 15.00 USD

Receipt Voucher Number: RV 107327

Received From: MOUSTAPHA DIA

The Sum of: Only Fifteen US Dollars

Description: Settlement of Policy No. EM-VBOQ-C-104804

Tohme Bldg. 955A, 3rd floor ,near le Mall, MTV Naccache Road, Dbayeh, Lebanon - Tel. 00961 4 548 300 , Fax: 00961 4 548301
info@euromed-lb.com . www.mideast-assistance.com. RC 2032247 Baabda ,
MOF # 2775516 , Capital 30 000 000 LL fully paid

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