Employer´s Health Insurance Information Leaflet

What should I do if I fall ill or need other treatment?

  1. In the event of illness or other need for treatment, the insured person can go to a suitable medical institution that is authorised to provide health services.
  2. Appointments with medical specialists can be made without a referral from a family doctor.
  3. A doctor’s referral is always required for tests, except in the case of prophylactic birthmark checks and if insurance cover for prophylactic tests has been chosen.
  4. The expenses related to hospitalisation and rehabilitation in a hospital must be approved by PZU in advance.
  5. The insured person pays for the services themselves (except in the case of an occupational health check) and sends the documents to the insurance company for indemnification as soon as possible, preferably not later than within 90 days.
  6. The insurance indemnity will be paid to the bank account of the insured person indicated by the insured person.
  7. PZU indemnifies the expenses to the maximum extent of the indemnity limit and the sum insured of the respective insurance cover and withholds the deductible if this is agreed in the contract. You will find information on effective insurance coverage and unused limits by logging in the PZU self-service.
  8. PZU may be contacted for a letter of guarantee if the insured person is unable to pay for the service themselves.

Notifying about an insured event

The insured person must notify the insurer as soon as possible of the occurrence of an insured event in a format that can be reproduced in writing. You can send information quickly and easily via the PZU self-service, by telephone on 622 4599, by sending an email to lahendus@pzu.ee, or via the insurer’s website www.pzu.ee.

Documents required for requesting indemnity

In the case of services provided without a referral: personalised payment documents: receipts or invoices indicating the date, the insured person’s first name, surname and personal identification code, and the name and price of the service with the document certifying payment for the service.

In the case of services prescribed by a doctor: Doctor’s referral, electronic referral, entry in medical records or decision of the occupational health specialist, etc., which must be issued before the analysis, test or procedure that is subject to be indemnified is carried out.

Depending on the nature of the case, the insurer may request additional documents and the insured person will be informed about this separately, if necessary.

Outpatient treatment

 

An extract from the electronic health record, a copy of medical records or the health card, x-ray images and other medical documents describing the need for medical assistance by the insured person. Documents evidencing the cost of using the health service (e.g. receipts, invoices, payment orders).
Prescription medicines
(if this insurance cover was selected)
A receipt evidencing purchase of the medicine and a copy of the prescription or an extract from the electronic health record (www.digilugu.ee).
Hospital treatment
(if this insurance cover was selected)
Document evidencing the cost of the treatment and extract from the medical records of the person who received treatment, copy of the referral.
Rehabilitation
(if this insurance cover was selected)
Document evidencing the cost of the treatment, extract from the medical records of the person who received treatment, copy of the referral (www.digilugu.ee).
Daily allowance
(if this insurance cover was selected)
Copy of certificate of incapacity for work, extract from electronic health record (www.digilugu.ee).
Dentistry
(if this insurance cover was selected)
Document evidencing the cost of the treatment and extract from the medical records of the person who received treatment (certificate about the treatment that was administered).
Occupational health checks
(if this insurance cover was selected)
Documents evidencing the cost of using the health service (e.g. receipts, invoices, payment orders).
Prophylactic tests
(if this insurance cover was selected)
Documents evidencing the cost of using the health service (e.g. receipts, invoices, payment orders, which indicated the tests that were performed and for whom they were performed).
Vaccination
(if this insurance cover was selected)
Document evidencing the cost of vaccination and a copy of the vaccination certificate.
Glasses, contact lenses
(if this insurance cover was selected)
A receipt regarding the purchase of glasses or contact lenses and a certificate of prescription of glasses/contact lenses issued by a doctor/optometrist.

PZU is AB "Lietuvos draudimas" Estonian Branch trademark in Estonia. AB "Lietuvos draudimas" is Lithuanian insurance company, that is part of the international PZU Group. Before entering into an insurance contract, please examine the terms and conditions or dial +372 622 4599 for additional information.