Students Health Insurance Plus

Personal Information
Health Questions
Data Protection
Payment Details
Summary

Order Number

Personal Information

Gender *

Male Female

First Name: *

Last Name: *

Street (Address in Austria) *

House Number *

Door Number *

Postal Code *

City *

Citizenship *

Date of birth: *

E-Mail Address *

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.

This is the 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

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 do you attend? (please specify) *

If other, please specify

How did you hear about us? *

If other, please specify

Until when are you approx. planning to stay in Austria?
(Your best guess)

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".

Yes

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

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 professional? (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*

confirm 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) *

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 Plus
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-Plus- Insurance(German & English)*
Distribution & Withdrawal Information*
Factsheet (German)*

confirm_avb

I hereby confirm that I have downloaded and read the terms and conditions of the contract

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!