Voluntary health insurance in case of surgical interventions, i.e. operations, and critical illnesses

Voluntary health insurance in case of surgical interventions, i.e. operations, and critical illnesses is a type of supplementary voluntary health insurance, which provides a single payment of the stipulated indemnity to the insured in case of occurrence of critical illness or surgical intervention, i.e. operation.

How is voluntary health insurance written?

Voluntary health insurance can be written as group insurance, for all employees, members of one and the same organization, etc., according to the official records of the policyholder – legal entity, or according to the list of insured persons. Insurance premium can be paid by the policyholder – legal entity, or by insureds via deductions from salary.

What is covered by the policy of voluntary health insurance in case of surgical interventions, i.e. operations, and critical illnesses?

Voluntary health insurance may be stipulated as follows:

• in case of surgical interventions, i.e. operations and/or;
• in case of critical illnesses.

Insurance in case of surgical interventions, i.e. operations covers surgical interventions and operations performed during the insurance period, and provided for by the Special Terms and Conditions for voluntary health insurance in case of surgical interventions, i.e. operations (heart operation, abdominal, urinary-genital, orthopedic and other operations, i.e. surgical interventions).

Insurance in case of critical illnesses covers illnesses that occurred and were indisputably determined during the insurance period, and are provided for by the Special Terms and Conditions for voluntary health insurance in case of critical illnesses (all malignant illnesses, cerebral infarction, myocardial infarction, etc.).

What does premium depend on?

Premium depends on the level of insured sums and the number of persons, for whom insurance is written.

Example of group voluntary health insurance

What does the level of indemnity depend on?

The amount of indemnity depends on the stipulated insured sum and surgical intervention or operation that was carried out, i.e. critical illness that occurred during the insurance period, and that is covered by this insurance. Indemnity is paid out in the corresponding percentage of the insured sum, pursuant to Special Terms and Conditions.

What is paid out in case of surgical intervention, i.e. operation?

When the insured undergoes a surgical intervention, i.e. operation during the insurance period, the insurer pays out the stipulated indemnity on the level of the corresponding percentage of the stipulated insured sum for surgical interventions, i.e. operations that are covered by insurance, pursuant to Special Terms and Conditions.

The location in which the surgical intervention, i.e. operation was performed, whether the insured bore the costs, whether he refunded them or was reimbursed for them from any other basis, have no relevance for the realization of rights stemming from this insurance.

What is paid out in case of critical illnesses?

When the insured falls critically ill during the insurance period, the critical illness being covered by this insurance, the insurer pays out the stipulated indemnity on the level of the stipulated sum or portion of insured sum (50% or 75%), pursuant to Special Terms and Conditions.

The right to the stipulated indemnity is independent of possibly realized costs from another basis, and may be cumulated with other rights.

What is not covered by insurance?

This insurance does not cover illnesses that the insured had prior to writing insurance, surgical interventions and operations that were performed prior to writing insurance, i.e. for which the need was determined previously, nor illnesses, surgical interventions and operations that are not listed in Special Terms and Conditions.

How can right to indemnity be realized?

Once the stipulated insured event occurs – the existence of a critical illness is undoubtedly determined, or a surgical intervention, i.e. operation is performed, the insured should submit a written notification on the insurer’s form, and enclose the relevant medical documentation (discharge papers, specialist’s report, and other necessary medical documentation upon the insurer’s request), whereby proving the right to payment of the stipulated indemnity.