Holidays are often relaxed. For many people, Pils and Prosecco are part of relaxation. A glass is enough for some, others like to let it rip. But if you fall down the stairs when you are tipsy or have drunk so much alcohol that medical attention is required, you could possibly be left with the costs of the treatment. The Association of Insureds has examined the conditions of travel health insurance and warned three providers of contract clauses that consumer advocates believe are unfair and non-transparent with regard to drug and alcohol consumption and disadvantage consumers.
According to information that was available to the Tagesspiegel in advance, it is ADAC, Europ Assistance and Die Bayerische. The accusation: The insurers try to exclude a benefit in their insurance conditions if the illness or injury occurred as a result of the abuse of drugs, medication or alcohol. However, policyholders do not know what exactly is meant by “abuse”, the consumer advocates criticize. According to general usage, this means “excessive consumption”. But that would also include negligent one-time excesses of alcohol. However, such an exclusion from benefits would be ineffective, since health insurers may only exclude payments in the event of intentional behavior.
In addition, in the opinion of the Federation of Insureds, consumers do not know when the threshold between consumption and abuse has been crossed. In the clauses, the misuse of alcohol and medicines is implicitly equated with the misuse of drugs of any kind. In the case of hard drugs, however, even taking small amounts should be considered abuse. Should that also apply to alcohol? The clause is unclear in this respect, say the consumer advocates, the ambiguity is at the expense of the consumer and the clause is therefore ineffective.
“Health insurance for travel abroad is very important,” said Stephen Rehmke, board member of the Association of Insured, the daily mirror. “The insured must be able to rely on clear announcements that the insurance company will pay in an emergency.” It should not be left to the insurer’s discretion whether someone has gone too far while partying on vacation.
On request, Bayerische confirms that accidents and illnesses that can be traced back to the abuse of alcohol, drugs or medication are not insured. With this passage, however, the insurance does not move in the spectrum of consumption (regardless of the alcohol level), but exclusively in the area of abuse (long-term), a company spokeswoman told the daily mirror. The abuse must also have been the cause of the illness or accident.
The ADAC distinguishes: When it comes to medicines and drugs, misuse is already present if they are either not legitimate at all or not in the amount consumed, i.e. were not prescribed by the doctor, it says on request. In the case of abusive alcohol consumption, on the other hand, the insurance company only refuses to cover the costs if, in the opinion of the doctor, the patient has met the addiction criteria. “If the insured person drank “a few glasses too much” on vacation and then had an accident resulting in injury, we see this as an insured “vacation risk”,” a spokesman told the Tagesspiegel. Incidentally, the 0.5 per thousand limits that are usual in road traffic are not decisive for the term “misuse” in travel health insurance abroad.
Even if there is a dispute about the alcohol clause, the Association of Insured Persons, like all consumer advocates, considers travel health insurance to be a very sensible insurance policy. It covers the costs of medical treatment abroad that statutory health insurance does not pay for. Medical costs, materials, accommodation and meals during a hospital stay, transport to the nearest hospital or doctor are covered by the rescue service. The insurance also pays for return transport to Germany if you cannot be adequately cared for at your holiday destination.
Travel health insurance abroad is therefore also useful for privately insured persons, because such return transport is often not included in private health insurance either. In addition, privately insured persons retain their right to a premium refund if they take out international travel insurance for insured events abroad.