Students Health Insurance Basic

Personal Information
Health Questions
Data Protection
Payment Details
Summary

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Personal Information

Gender *

Male Female

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 CAN'T use the address of the University!

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

City

Postal Code:

Citizenship

Date of birth:

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.

Optional: 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 cover (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).

To be up-to-date, the insurance start date can be max. 3 months in the future!

Choose start date of insurance:

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

Student Info:

I hereby confirm that I am currently a student or that I have been accepted to an Austrian University / Academic Insitution or a pre-language course

Yes

IMPORTANT: If you are not a student but going to a school (high-school), please contact office@feelsafe.at
This product is NOT the right one for you and you will not be accepted.

Which university/institution do you attend? (Please select from list or select

If other, please specify

How did you hear about us?

If other, please specify

FOR STATISTICAL REASONS ONLY - NOT THE CONTRACT TIME:

How long are you planning to stay/study in Austria?
(If everything goes as planned).

Month

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".

Health-related questions

Are you currently or have you been treated for one of the following health impairments?*

cancer

diabetes

HIV-positive results

excessive overweight (body Mass Index over 38)

chronic liver disease

chronic inflammable bowel disease

chronic kidney disease

chronic lung disease

Are you currently or have you been treated for one of the following health impairments? cancer, diabetes, HIV-positive results, excessive overweight (body Mass Index over 38), chronic liver disease, chronic inflammable bowel disease, chronic kidney disease, chronic lung disease_answer
Yes No

Are you currently or have you been treated for one of the following health impairments?*

heart attack

chronic heart disease

vascular disease (e.g. PAOD/peripheral arterial occllusive disease, aneurysm ...)

blood-clotting disorders (also caused by medication)

blood diseases (e.g. haemolyitic anaemia such as sickle cell anaemia)

congenital anomalies (e.g. metabolic diseases, hormone disorders, cleft lip/palate)

Are you currently or have you been treated for one of the following health impairments? heart attack chronic heart disease, vascular disease (e.g. PAOD/peripheral arterial occlusive disease, aneurysm ...) blood-clotting disorders (also caused by medication), Blood diseases (e.g. haemolyitic anaemia such as sickle cell anaemia), rheumatic diseases (e.g. chronic polyarthritis) Congenital anomalies (e.g. metabolic diseases, hormone disorders, cleft lip/palate)_answer
Yes No

Are you currently or have you been treated for one of the following health impairments?*

autoimmune diseases

neurologic diseases (e.g. multiple sclerosis, Morbus Parkinson, stroke, epilepsy, benign brain tumour, cerebrocranial trauma, paraplegia)

eye diseases which can lead to severe visual impairment (e.g. macular diseases, retinal diseases, glaucoma)

mental illnesses (including mental handicaps, dementia, psychological illness)

Are you currently or have you been treated for one of the following health impairments? autoimmune diseases neurologic diseases (e.g. multiple sclerosis, Morbus Parkinson, stroke, epilepsy, benign brain tumour, cerebrocranial trauma, paraplegia) eye diseases which can lead to severe visual impairment (e.g. macular diseases, retinal diseases, glaucoma) mental illnesses (including mental handicaps, dementia, psychological illness)_answer
Yes No

Have you had any medical required treatments (inc. drug therapy) or contact to a medical specialist within the last 12 months? (also for any psychological treatments)

Yes

No

If Yes: Which medical required treatment, why have you contacted a medical specialist?

Have you planned any out-patient treatment, in-patient hospital stay or a stay at a health resort or rehabilitation centre, or has such stay been advised by a doctor?
Yes No

Are you doing sports professionally? (If sport is your main source of income)
Yes No

If female: Are you currently pregnant?
Yes No / Male

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*

data

➢ 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)

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.

2. Your Product:

Student Health Insurance Basic
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 Student-Basic- Insurance (German & English)*
Distribution & Withdrawal Information*
Factsheet (German)*

confirm_avb

➢ I hereby confirm that I have downloaded and accepted all terms of insurance

Privacy Statement*

privacy_policy

I hereby confirm that I have downloaded and read the privacy policy

Sorry!

You have answered one or more of the health questions with "YES".
Therefore you cannot take out the insurance online.

But don't worry - we will find a solution for you.
We have received your contact information and will shortly get in touch with you for an individual quote.