Good to know – employer´s health insurance

On this page, you will find information about all things related to employer´s health insurance..

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

  • 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.
  • Appointments with medical specialists can be made without a referral from a family doctor.
  • 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.
  • 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.
  • The insurance indemnity will be paid to the bank account of the insured person indicated by the insured person.
  • 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.
  • PZU may be contacted for a letter of guarantee if the insured person is unable to pay for the service themselves.

• Meliva Digital Clinic

  Meliva Digital Clinic provides you primary care seven days a week without having to wait in a queue.
  Mon-Fri 08:00-20:00
  Sat-Sun and public holidays 09:00-16:00
  Cost-sharing does not apply to the visit fee of the Digital Clinic. The visit fee of EUR 19.90 will be deducted from the indemnity limit for outpatient treatment.

  More information about the Digital Clinic can be found here.

• 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.

• Documents required for requesting indemnity

  To handle an insured event, the person insured must provide their medical documents describing the need for medical attention, as well as the invoice for care services together with a document that proves the service was paid for. You can find details on the required documents in the table under insurance cover.

  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 (if this insurance cover was selected)	Documents evidencing the cost of using the health service (e.g. receipts, invoices, payment orders),  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
  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.
  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)	documents evidencing the cost of the treatment, extract from the medical records of the person who received treatment, copy of the referral, name and professional certificate number of the health service provider.
  Psychological and psychiatric counseling and treatment (if this insurance cover was selected)	Documents evidencing the cost of the treatment, name and professional certificate number of the health service provider.
  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.

• My health insurance covers and unused limits

  You can find information on your insurance covers and unused limits by logging in to our self-service.

  You can find a link to a video introducing the self-service here.

• How can I check if the service provider has the required licence or professional certificate?

  The existence of a healthcare service provider licence can be checked on the website of the Health Board  and the existence of a professional certificate can be checked on the website of the Estonian Qualifications Authority.

• Is my healthcare service covered by my insurance?

  You can find detailed information on the reimbursable and non-reimbursable costs under the insurance covers of your employer’s health insurance contract in the chapter on insurance conditions (Insurance Covers). Please pay attention to the exclusions in the policy conditions. You can read the insurance terms and conditions here.