FeelSafe Academics Health Insurance

Step 1 of 7 - Personal Information

Personal Information
I hereby confirm, that at the point of buying this insurance I am 18 years old or older. If you are filling this form out for an underage relative, please select "No" and follow the expanded instructions.*
- Yes
- No
Insurance Holder
If you are younger than 18 years old, only your parent or legal guardian in Austria can buy this product for you. Please ask your parent or legal guardian to fill out and purchase the rest of this form and product. They are the "Insurance Holder" and below you, as the academic, are the "Insured Person".
Gender ParentGaurdian
Gender
- Male
- Female
First Name Parent
First Name: (required*)
Last Name Parent
Last Name: (required*)
Street Parents
Street: (required*)
House Number Parents
House Number: (required*)
Door Number Parents
Door Number: (required*)
Postal Code Parents
Postal Code: (required*)
City Parents
City: (required*)
Citizenship Parents
Citizenship: (required*)
Date of birth Parents
Date of birth: (required*)
DD slash MM slash YYYY
Email Parents
E-Mail Address: (required*)
Phone Parents
Phone number (in case of emergency): (required*)
Insured Person
Gender*
- Male
- Female
Your Citizenship*
First Name:*
Last Name:*
Street Name (Address in Austria):
You can use the address of someone you know (if they are fine with it) until you have your own address in Austria and let us know as soon as you have your own address: www.feelsafe.at/change - Please note: You CANNOT use the address of the University/ institution!
Street*
House Number:*

(e.g.: Mariahilferstrasse 100/6 --> 100 is the house number; 6 is the door number)
Door Number:*

(If you don't have your door number yet, please put "1")
City*
Postal Code:*
Date of Birth*
DD slash MM slash YYYY
Hidden
Age*
Hidden
Insurance Age*
E-Mail Address:*

Please note: Please don't use a YAHOO e-mail address. For some reason our confirmation e-mails get blocked by their SPAM detector.
Your Phone number*
Start Date of Insurance Period:

You can choose the start month of your insurance (always the 1st of the month).
If you want to be insured immediately, please chose the current month.

If you select the current month, the insurance coverage will start with the date you receive the insurance confirmation (via e-mail) and you have to pay the premium for the whole month. Insurance coverage (payment for expenses for medical treatment) will not start before we have accepted your application for insurance (The e-mail confirmation).

You will be insured instantly after receiving the insurance confirmation e-mail (within 1 working day) if you select the current month as start time, otherwise with the 1st day of the month you select as the start month.

To be up-to-date, the insurance start date can be max. 3 months in the future!
For the contract time please read below "End date of insurance"
Choose start date of insurance:*
DD slash MM slash YYYY
End date of insurance:

There is NO specified end date of the insurance. The general contract time is 3 years, but the insurance will be valid as long as you qualify for the status requirements for your respective insurance product.

For this reason, this insurance is valid for your residence permit and the prolongation of the residence permit (All-risk long-term health insurance).

There are several options to cancel the insurance every month.
Read about it here: www.feelsafe.at/cancel

Status Info:
I hereby confirm that I am accepted to a University or other Academic Institution or am currently a student with less than 4 ECTS points, a language school student, a researcher or a lecturer.*
- Yes
- No
Which of the following are you?*
Which language school do you attend?*
Which university/institution do you attend?*
If other, please specify
How did you hear about us?*
If other, please specify
Protecting your personal data:*
Please set a password for your personal data. After the purchase you will need the password to access the summary of your personal data you have provided for your FeelSafe Insurance for you to verify.
Enter Password Confirm Password

FOR STATISTICAL REASONS ONLY - NOT THE CONTRACT TIME:

How long are you planning to stay/study/work in Austria?
(If everything goes as planned).
How long are you planning to stay in Austria? (Month)*
How long are you planning to stay in Austria? (Year)*
FeelsLikeHome:

To buy this insurance, you need to be a part of the FeelsLikeHome.at community.

FeelsLikeHome.at is a completely FREE information platform for expats and international students that provides useful information for your move to Austria. There is NO membership fee or anything like that.

It is a free community from internationals - for internationals.

FeelsLikeHome will NOT receive any health-related information. Your personal data will be treated strictly confidential and will not be forwarded to any 3rd party.

What you have to do:
Just check the box below and click on "Next Page".
I hereby join the FREE FeelsLikeHome community.*
Sign up: I hereby join the FREE FeelsLikeHome community. I agree to the Terms & Conditions and Privacy Policy*
- Yes
- No

Are you planning on traveling outside of Europe during your residence in Austria? Maybe visiting family or just some adventure trips?*
- Yes
- No
We highly recommend you to add the optional global insurance coverage for only €3.64/month.*
It covers you for the first 4 weeks when you leave the EU for any trip worldwide.
Example: You leave the EU during your stay to visit your family and friends back home during your holidays.
Do you want to add private hospitals coverage?*
When you include the coverage for private hospitals you can choose your private doctor (specialist) and there are no waiting times for operations.
- Yes, I want to include coverage for private hospitals for a monthly addition of only -
- No, I want to keep only the public hospitals coverage for a total monthly price of -
Do you want/need additional personal consultation in order to buy this product?*
- No, I do not request an additional consultation regarding the chosen insurance product. (Buy directly online)
- I request an additional personal consultation regarding the chosen insurance product. (Purchase must be completed offline and will take longer; up to 3 working days; requires additional paperwork)
IF you want/need additional personal consultation, please enter your phone number here

Data Protection Policy

The legally binding language of all documents and information is German! If you have any questions regarding the data protection policy, please get in touch with us.

Please download and read the data protection policy:
Data Protection Policy Concent*
Data Protection Policy*
- ➢ I hereby confirm that I have downloaded and accepted the data protection policy
Important:

If you answer the following questions with "YES", a directly payment with hospital, doctors, laboratories, X-ray centers and pharmacies will be possible (also using the LARA network).

Otherwise, by answering "NO" you have to pay all of your bills up-front, and have to collect all of your health data to submit to UNIQA if needed.
1) When closing the contract or changing the contract, UNIQA as the insurance provider is allowed to collect my health data from doctors or medical insitutions (page 10); Bei Vertragsabschluss oder einer Vertragsänderung darf UNIQA meine Gesundheitsdaten bei Ärzten oder Krankenanstalten einholen (Seite 10)*
- Yes
- No
2) In case of an insurance claim, UNIQA as the insurance provider is allowed to collect health data from 3rd parties in order to examine my claim. (pre-authorization) (page 11); Nach einem Versicherungsfall darf UNIQA meine Gesundheitsdaten bei Dritten einholen und prüfen, ob ich Anspruch auf Leistung habe (Vorausermächtigung) (Seite 11)*
- Yes
- No
3) In case of an insurance claim, UNIQA as the insurance provider is allowed to collect my health data for the direct billing with the health-provider (page 12). Nach einem Versicherungsfall darf UNIQA meine Gesundheitsdaten zur Direktverrechnung mit dem Gesundheitsdienstleister einholen (Seite 12).*
- Yes
- No

Bank Details:

Please enter your European Bank Account.

The payment will be withdrawn from your account automatically. The money will be taken from your account once the insurance is active (start date)

Please note: You can also use the bank details of a person you know and allows you to use it. Please update us as soon as you have your own bank account and want to switch the payment: www.feelsafe.at/change
Bank Name*
IBAN Code (20 digits)*
BIC*
Please enter a valid European IBAN Code
Payment method:
Direct Debit SEPA-Direct Debit Mandate (Authorization to collect the receivables via SEPA Direct Debit)

I/We allow the named recipient of payments to withdraw payments from my/our bank account via SEPA-Direct Debit.
In addition, I/we authorize my/our credit institution to transfer the claims made by the named recipient of payments from my bank account via SEPA-Direct Debit.
I/We can request within eight weeks from the debit date a refund of the charged amount. The agreed upon with my/our credit institution conditions are valid in this case.

IBAN Payment recipient:
UNIQA Österreich Versicherungen AG
Creditor-ID: AT10AT00000001017
A-1029 Wien, Untere Donaustraße 21
Payment method confirmation*
- I hereby confirm the payment method
Payment Info:

The money for the insurance will be taken from your bank account each month automatically
You don't have to transfer any money!
The payment is usually taken between the 1st and the 5th of each month.

IMPORTANT:

With your printed insurance contract (Your insurance policy) via regular mail, you will also get a payment slip.
If there are only stars (***) on the EUR amount, you can ignore this slip.

Whenever you recieve a payment slip WITH an amount filled in, there has been an issue with taking the money from your account.

Then you should pay with this payment slip and get in touch with our team in order to put you back on automatic payment and to make sure that you are fully insured at any time.

1. Personal Information:

Name: {First Name::3} {Last Name::4}

Street: {Street:6}, {House Number::7}, {Door Number::8}

Citizenship: {Citizenship:11}

Date of Birth: {Date of Birth:12}

E-mail:: {E-Mail Address::17}
2. Your Product

FeelSafe Academics Health Insurance

Insurance provided by: UNIQA

The legally binding language version of all documents and information is German.

Documents and information given in English shall be only of an informative nature!
2. Your Product

FeelSafe Academics Health Insurance including Private Hospital Upgrade

Insurance provided by: UNIQA

The legally binding language version of all documents and information is German.

Documents and information given in English shall be only of an informative nature!
General Terms and Conditions of Insurance*
Terms and Conditions of Academics Health Insurance (German & English)*
Distribution & Withdrawal Information*
General Terms and Conditions of Insurance*
Terms and Conditions of Academics Health Insurance (German & English)*
Distribution & Withdrawal Information*
Factsheet (German)*
Factsheet (German)*
- ➢ I hereby confirm that I have downloaded and accepted all terms of insurance
Terms and Conditions of Complementary global travel insurance*
Terms and Conditions of Complementary global travel insurance*
- I hereby confirm that I have downloaded and accepted the Terms and Conditions of the Complementary global travel insurance
Privacy Statement*
Privacy Statement*
- I hereby confirm that I have downloaded and read the privacy policy
3. Bank Details:

Bank Name: {Bank Name:73}
IBAN: {IBAN Code (20 digits):74}

4. Your Price:
Complementary Insurance for Trips Outside of Europe € {We highly recommend you to add the optional global insurance coverage for only €3.64/month.:131:price} /month
Academics Health Insurance including Private Hospital Upgrade:
€ {Are you interested in having coverage for private hospitals:140:price} /month
Academics Health Insurance:
€ {Are you interested in having coverage for private hospitals:140:price} /month
Total
€ 0.00

FeelSafe Academics Health Insurance

Step 1 of 7 - Personal Information

Personal Information

Insurance Holder

Insured Person

Start Date of Insurance Period:

End date of insurance:

Status Info:

FOR STATISTICAL REASONS ONLY - NOT THE CONTRACT TIME:

FeelsLikeHome:

Health-related questions

Data Protection Policy

Bank Details:

Payment Info:

IMPORTANT:

1. Personal Information:

2. Your Product

2. Your Product

3. Bank Details:

4. Your Price: