Students Health Insurance Basic

Personal Information
Health Questions
Data Protection
Payment Details
Summary

Company

Personal Information

Gender *

Male Female

First Name: *

Last Name: *

Street (Address in Austria) You can use the address of someone you now (if they are fine with it) until you have your own address in Austria. Please inform us as soon as possible in that case when you have your own address: www.feelsafe.at/change - Please note: You CAN'T use the address of the University! *

House Number (The first number after the street name) e.g.: Mariahilferstrasse 100/2/6 --> 100 is the house number; 6 is the door number *

Door Number (If you will stay in a dormitory but don't have your door number yet, please put *

Postal Code *

City *

Citizenship *

Date of birth: *

E-Mail Address *

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.

Phone number (in case of emergency)

Which university/institution do you attend? (Please select from list or specify below) *

If other, please specify

How did you hear about us? *

If other, please specify

How long are you approx. planning to stay/study in Austria?
(Your best guess).
This information is just for statistical reasons.
It is not your contract time!

Month *

Year *

FeelsLikeHome:
In order to buy this insurance, you need to be a part of the FeelsLikeHome.at community. FeelsLikeHome.at is a FREE information platform for expats and international students that provides all necessary information for your relocoation process. 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.

How to sign up:
Just check the box below and click on "Next Page".
This will automatically sign you up for FeelsLikeHome.

Yes

Health-related questions

Have you been in treatment or are you currently being treated against one of the following:*

cancer
stroke
heart attack
chronic hearth disease
neurological disease such as multiple sclerosis, Crohn's Parkinson
psychic disorders (also mental and psychic disabilities, dementia)
chronic pulmonary diseases
chronic inflammatory intestinal diseases
kidney failure
Body Mass Index over 38 (pronounced obesity)
bone disease
diabetes
chronic liver disease
chronic polyarthritis
HIV-positive results
traumatic brain injury
spinal paralysis
coagulation disorders
eye diseases, which could lead to severe visual impairment (macular degeneration, retinal disorders, glaucoma)

check_1_diverse

Yes No

Have you planned any operations within the next 2 months? *

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

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

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

3) Nach einem Versicherungsfall darf UNIQA meine Gesundheitsdaten zur Direktverrechnung mit dem Gesundheitsdienstleister einholen (Seite 12). 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) *

Yes

Start Date of Insurance Period:

You can choose the start date 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).

Choose start date of insurance: *

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

2. Your Product:

Student Health Insurance Basic
Price: EUR ?.- / month
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.

We will contact you as soon as your application has been reviewed!