Article 1: Definitions

Beneficiary: The person entitled to the benefits under this policy, as named in the Insurance Certificate.

Coverage Period: The period from the Inception Date to the Expiry Date, as specified in the Insurance Certificate, for which premium has been paid.

Illness: A sickness or disease which first manifests itself during the Coverage Period.

Injury: Bodily harm caused by an accident occurring during the Coverage Period.

Medically Necessary: A service or supply that is required to diagnose or treat an illness or injury and which is: (a) consistent with the diagnosis; (b) in accordance with standards of good medical practice; (c) not for the convenience of the Beneficiary or the medical provider.

Pre-existing Condition: Any condition for which the Beneficiary received medical advice, diagnosis, care, or treatment within the 24 months prior to the Inception Date.

Article 2: Coverage

2.1 General Scope

The Company agrees to pay for Medically Necessary expenses incurred by the Beneficiary for treatment of an Illness or Injury during the Coverage Period, up to the limits and subject to the terms specified in the Insurance Certificate and these General Conditions.

2.2 Area of Coverage

Coverage is provided within the Coverage Zone specified in the Insurance Certificate. Treatment outside the specified zone is not covered unless for an emergency stabilization, subject to prior approval by the Company.

Article 3: Exclusions

No benefits will be paid for expenses related to or resulting from:

• Pre-existing Conditions, unless explicitly covered by endorsement.
• Treatment that is not Medically Necessary or is experimental/investigational in nature.
• Cosmetic or plastic surgery, unless required to correct an Injury.
• Routine health check-ups, vaccinations, or preventive care, unless specified as a covered benefit in the Insurance Certificate.
• Participation in professional sports, hazardous activities, or any illegal act.
• Self-inflicted injuries, suicide or attempted suicide, whether sane or insane.
• Treatment for alcohol or drug abuse and their complications.
• War, invasion, act of foreign enemy, hostilities, civil war, rebellion, or terrorism.

Article 4: Claims Procedure

4.1 Notification

In the event of a planned hospitalization, the Beneficiary must notify the Company at least 5 working days in advance. For emergencies, notification must be given within 48 hours of admission.

4.2 Submission

All claims must be submitted with original itemized bills, receipts, and a completed claim form within 90 days from the date of service. Failure to do so may result in the denial of the claim.

4.3 Reimbursement

Covered expenses will be reimbursed to the Beneficiary, subject to deductibles, co-payments, and benefit limits. Direct payment to providers (cashless service) may be arranged where available within the Company's network.

Article 5: General Provisions

5.1 Governing Law

This policy shall be governed by and construed in accordance with the laws of Syria.

5.2 Fraud

If any claim under this policy is found to be fraudulent in any respect, all benefits under this policy shall be forfeited.

5.3 Termination

This policy will terminate on the Expiry Date. The Company reserves the right to terminate the policy with 30 days' written notice in case of fraud or non-payment of premium.