The application to compensate the costs of health insurance can only be submitted by the Insured, which has received Health Care Services. Health Care Services shall mean the treatment, consultation, diagnostic tests, rehabilitation, pharmaceuticals purchase, optics, odontology, disease prevention, and wellness services and/or goods, stated in the Agreement and provided to the Insured.
By submitting an electronic application form, please attach the following duly scanned documents as required by the terms and conditions on health insurance:
- Invoice and payment cheque/receipt voucher/payment receipt certifying the health care services received; If you have paid for the received health care services via a bank transfer, be sure to enclose a document evidencing a completed payment; If the services were provided by a person engaged in an individual activity or a person working under a business license, a copy of such individual activity certificate or business license must be enclosed.
- Excerpts from medical documents or copies thereof, which certify the fact and circumstances of the insurable event. The documents must be certified with a doctor’s signature, stamp and seal of a health care institution (valid for compensation from the insurance program „Ambulatory treatment and diagnostics”, “Odontology services”, “Prenatal care, childbirth and postnatal care”).
- Prescription for medicine or certified copy thereof certified with a doctor’s signature and stamp (valid for compensation from the insurance program “Pharmaceuticals and medical aids”).
- Prescription or certified copy thereof for glasses lenses and contact lenses certified with a doctor’s signature and stamp (valid for compensation from the insurance program “Optics”).
We will not be able to process the application received without the documents required.
Insurance benefit will be paid out within 30 (thirty) days from the date of the receipt of all required documents and information, significant for determination of the fact, circumstances and consequences of the insurable event and the amount of insurance benefit.
If you want to fill in the application please enter identification information: