Tourist Signup In Israel
I the undersigned (hereinafter, the “insurance applicant”)ask of “Harel” Insurance Company Ltd. (hereinafter, the “Insurer”) to insure me, based on all the infomation in this Application.
If the answer to any of the questions above is “Yes”, you must send an up-to-date report from the attending physician regarding the stated problem, test results, the manner of the treatment and the current condition to Leon: email@example.com
Insurance Applicant’s Statement
Insurance Applicant’s Statement
b. I/we hereby declare that all the answers are correct and complete and are provided out of my/our own free will.
c. The answers specified in the Health Statement and any other information to be submitted to the Company as well as the Company’s customarily prevailing terms and conditions in this matter shall be essential terms, conditions of the insurance contract between you and the Company, and constitute an inseparable part thereof.
d. The Company may decide to either accept or reject the Application. For your information, the insurance contract shall come into force only after the Company issues a written confirmation of admission of all the insurance applicants.
For your Information
2. Preexisting medical condition: an insurance event, substantially caused by the normal course of a preexisting medical condition, which occurred to the Insured during the period in which a restriction applies. A restriction because of a preexisting medical condition, concerning an insured whose age at the beginning of the insurance period is:
1. Less than 65 years – Shall apply for a period not exceeding one year from the beginning of the insurance period.
2. 65 years or more – Shall apply for a period not exceeding half a year from the beginning of the insurance period.
3. This medical insurance is subject to a qualification period of 48 hours.
4. I am aware that the insurance contract shall come into force only after the Company issues a written confirmation of admission regarding the Insurance Applicant. In any case, the insurance period shall begin from the date of confirmation by the Insurer, as said above.
5. Waiver of medical confidentiality: I, the undersigned, hereby give permission to the HMO (kupat holim) and/or its medical institutions and/or the all other physicians and psychiatrists, medical institutions, and hospitals, and/or any other insurance company and/or any institution and other party, insofar as necessary in order to examine the rights and obligations according to the policy and/or for the purpose of the procedure of examining of my acceptance for the insurance requested, to provide Harel with all the information and details held by the company, without exception, in the form requested by the Requester/s, regarding my health condition, including any disease that I suffered from in the past and/or that I suffer now and/or that I will suffer in the future, and I relieve you from the duty of maintaining medical confidentiality and waive confidentiality in favor of the “Requester”. This waiver is binding of my/our estate and my legal representatives and anyone substituting for me.