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General Terms and conditions

GENERAL CONDITIONS OF ACCESS AND USE OF THE ONLINE CLAIMS SERVICE FOR REIMBURSEMENT OF MEDICAL EXPENSES

 

The Humanis Group makes available to you, as beneficiary of a healthcare expenses contract managed by WELCARE, an online claims service for reimbursement of your medical expenses (hereafter called “the Service”).

The access to the online service for reimbursement of Medical Expenses is subject to acceptance of the present General Conditions of Access and Use. Acceptance of these General Conditions of Access and Use, subject to French law, is automatically given on line each time the User enters data on line for a reimbursement request and such acceptance is deemed to be the equivalent of the User’s signature on the aforementioned General Conditions. The Conditions can be freely modified by the Humanis Group, wholly or partially and/or be supplemented by specific conditions and procedures of use for certain features, without prior notification and information.

Users of the Service are assumed to know the terms in the latest version of the General Conditions of Access and Use of the Service. It is therefore the User’s responsibility to consult them regularly.

The Service is hosted on the host servers of:

OVH

Simplified joint-stock company with a capital of €10,000,000

Trade and Companies Register – Tourcoing 424 761 419 00045

Telephone: +33 (0)899 701 761

 

ARTICLE 1: Purpose of Service

The present General Conditions describe all the conditions of access and use of the online claims Service for reimbursement of medical expenses as well as its features and all the information held within it.

The present Service thus aims to improve speed and simplicity of the procedure for requesting reimbursement of medical expenses in that it dematerialises the making and managing of claim requests.

 

ARTICLE 2: Definitions

Beneficiary: designates the person who benefits from the service due from the Insurer in the event of a claim covered by this healthcare expenses contract managed by WELCARE, namely:

- the subscriber,

- otherwise the members of his/her family insured under the said contract.

 

CFE: designates the “Caisse des Français de l’Etranger” (French Expatriates Fund), a private organisation that manages a public service and regulated by the French Social Security Code, covering expatriates against the risks of illness-maternity-invalidity, occupational accidents and diseases, and old age.

CNIL: designates the “Commission Nationale de l'Informatique et des Libertés” (French National Commission for Data Protection).

Service: designates the different features of the online claims Service for reimbursement of medical expenses.

WELCARE: Service of Humanis Assurances (Incorporated company regulated by the Insurances Code with a paid-up share capital of € 13,565,655, registered in the Paris Trade and Companies Register under number 447 883 661, with its head office at 29 boulevard Edgar Quinet, 75014 PARIS, France), specialist in the social welfare protection of persons with international mobility.

User: designates the person authorised to access the Service.

The terms and definitions relating to the healthcare expenses Contract are themselves defined in the Contract.

 

ARTICLE 3: Access and use of the Service

Access to the Service is free and optional. It is subject to the interested party having the status of subscriber.

The User goes to his/her customer area accessible on the website https://espace-sante-international.humanis.com/particulier and accesses the tab “Make a claim” then “Request a healthcare reimbursement”. The User is then invited to complete the online form in order to provide personal information and data relating to the entitlement and subject of the online reimbursement request. The User can give information for a maximum of 10 healthcare entitlements with each claim. The service is available for bills of less than 500 Euros excluding hospitalisation and thermal cures.

 

For each entitlement completed, the User must upload and attach the supporting healthcare documents for which he/she is claiming reimbursement.

Such receipts etc. can be scanned or photocopied (including by a Smartphone), subject to satisfactory legibility and integrity (no modifications or voluntary/involuntary deletions) of the document. All photo editing of supporting documents is strictly prohibited.

By the act of uploading, the User authorises WELCARE, as well as the CFE, to store the information in order to process the claim. It is imperative that the User keeps the original bills for a minimum period of 2 years from the date on which the reimbursement request was made, period during which WELCARE, as well as the CFE, reserve the right to demand the original copies from the User in order to process the request.

The User can consult the exhaustive list of supporting documents required, provided for this purpose. He/she can thereby attach a maximum of 5 supporting documents for each entitlement.

A summary of claims is visualised by the User before he/she accesses the validation command. Afterwards, the User can follow the processing of his/her claim, which may be assigned different statuses:

  • “In progress”;
  • “Validated”: the claim may have been wholly or partially accepted, to the extent that some entitlement claims may be refused;
  • “Rejected”: the claim is deemed to be wholly unfounded by the administrative services (lacking supporting documents, illegible or inappropriate supporting documents, expiration of policy rights).

 

Access to the Service may be suspended or terminated as under article 4 hereafter.

ARTICLE 4: Probative force of documents

The User agrees not to contest the admissibility, validity, binding or probative force of elements in electronic format, based on their electronic nature. Unless proved otherwise, these elements shall be valid and binding in the same manner, under the same conditions and with the same probative force as any original document that would have been drawn up, received or kept in writing.

ARTICLE 5: Suspension and termination of the Service

In the event of repeated non-compliance with the provisions contained in the present General Conditions of Access and Use of the Service, in particular concerning the criteria of legibility and integrity of supporting documents transmitted, User access to the Service may be suspended. The suspension of the Service to the User results in the systematic rejection of claims by the administrative services.

 

The termination of the Service can also be executed in the event of clearly substantial and inappropriate behaviour by the User (illicit or fraudulent) in the use of the Service.

Access to the Service can also be terminated in the event where the person no longer has the status of beneficiary following termination of the healthcare expenses insurance contract managed by WELCARE. In this case, the customer area and its associated features remain active for a period of two years.

ARTICLE 6: Personal Data Protection

The personal data collected in accordance with the present Service is necessary to enable the User to access the different features of this Service. This data is intended for use by WELCARE and the CFE. No data of a personal nature concerning the User is transmitted to any third party other than those entities which the Humanis Group calls upon in order to ensure the smooth running of the Service.

The collection and processing of personal data is carried out in accordance with Act no. 78-17 of 6 January 1978 on Data Processing, Files and Individual Liberties, amended by Act no. 2004-801 of 6 August 2004, by virtue of which the User disposes of the right of access, rectification and deletion of personal data concerning him/her by writing to the following address: Humanis Group - CNIL cell - client satisfaction - 303 rue Gabriel Debacq - 45777 Saran Cedex, France. Any such demand must be accompanied by a copy of a currently valid identification document.

The User also disposes of the right of opposition, for legitimate reasons, to the processing of his/her personal data as well as the right of opposition to such data being used for the purpose of commercial prospection.

Personal data is stored for a period of two years from the end of the contractual relationship.

Personal data collected in accordance with the present Service is processed in France.

The Humanis Group takes measures in accordance with the state of the art to ensure the security, integrity and confidentiality of personal data, in accordance with the provisions of the abovementioned legislation.

ARTICLE 7: General Conditions of Use of the Humanis Customer Area

The present General Conditions of Access and Use of the Service supplement the General Conditions of Use of the Humanis Customer Area accessible here. 

ARTICLE 8: Applicable law and competent jurisdiction

The present General Conditions of Access and Use of the Service, are exclusively subject to French law and in the event of translation into a foreign language, only the French version is valid.

Any dispute arising from the execution, non-execution or interpretation of the General Conditions of Access and Use shall be subject to the competent French jurisdiction.