Medical Insurance

In-network Coverage:

In-patient:

• Insured amounts: 50,000 Euro - 90% paid by insurer; 10% paid by client, min - 250 Euro, max - 500 Euro
• Surgery to the knee: 80% paid by insurer; 20% paid by client, min - 500 Euro, max - 1,000 Euro

Childbirth and delivery:

• Insured amounts: 2,500 Euro - 90% paid by insurer; 10% paid by client

Out-patient:

• Insured amounts: 2,000 Euro - 90% paid by insurer; 10% paid by client
• Medical appointments: 15 Euro paid by client
• Emergency medical appointments: 37.5 Euro paid by client
• Exams: 10% min paid by client
• Physiotherapy: 10 Euro/session paid by client (up to 500 Euro)
• Speech therapy and kinesiotherapy: 10 Euro/session paid by client (up to 6 sessions)

Out-of-network Coverage:

In-patient:

• Insured amounts: 50,000 Euro - 50% paid by insurer; 50% paid by client
• Surgery to the knee: 40% paid by insurer; 60% paid by client

Childbirth and delivery:

• Insured amounts: 2,500 Euro - 50% paid by insurer; 50% paid by client

Out-patient:

• Insured amounts: 2,000 Euro - 90% paid by insurer; 10% paid by client
• Medical appointments: Max amount reimbursed per appointment is 35 Euro
• Emergency medical appointments: Max amount reimbursed per appointment is 35 Euro
• Physiotherapy: 35% paid by insurer; 65% paid by client (up to 500 Euro)
• Speech therapy and kinesiotherapy: 35% paid by insurer; 65% paid by client (up to 6 sessions)
  

Family Coverage:

Employees can add coverage for family and dependents at their own expense for 39.30 Euro/mo. per dependent.

Grace Periods:

Coverage begins at date of hire for individual employees. Starting from the policy’s renewal date on 25/02/2023, households that were or will be included on the date of employee admission or up to 30 days from that date will not be subject to grace periods, except for Serious illness coverage.

• Hospitalization: 90 days
• Birth: 365 days
• Outpatient assistance: 90 days
• Dental: 90 days
• Vision and medicines: 90 days
• Serious illness: 180 days [This grace period will always apply]

Same as basic plan

Same as basic plan plus increase coverage for the below:

Childbirth and delivery:

• Insured amounts: 3,000 Euro - 90% paid by insurer; 10% paid by client

Out-patient:

• Insured amounts: 5,000 Euro - 90% paid by insurer; 10% paid by client

Dental Insurance

In Network coverage:

• Insured amounts: 500 Euro - 80% paid by insurer; 20% paid by client
• Visits: 10 Euro per medical act paid by client
  

Out Network coverage:

• Insured amounts: 500 Euro - 50% paid by insurer; 50% paid by client

Same as basic plan

In Network coverage:

• Insured amounts: 1,000 Euro - 80% paid by insurer; 20% paid by client
• Visits: 10 Euro per medical act paid by client
  

Out Network coverage:

• Insured amounts: 1,000 Euro - 50% paid by insurer; 50% paid by client

Prostheses and orthotheses (Includes Vision Insurance)

N/A

• Insured amounts: 250 Euro - 80% paid by insurer; 20% paid by client
• Covers: The cost-sharing of expenses for glasses and contact lenses, orthopedic and auditory prostheses and orthoses, and the rental or purchase of wheelchairs and adjustable beds.

• Insured amounts: 250 Euro - 80% paid by insurer; 20% paid by client
• Covers: The cost-sharing of expenses for glasses and contact lenses, orthopedic and auditory prostheses and orthoses, and the rental or purchase of wheelchairs and adjustable beds.

Medicines

N/A

N/A

• Insured amounts: 250 Euro - 80% paid by insurer; 20% paid by client
• Covers: Reimbursement of expenses incurred for medications, registered with INFARMED or similar entities, provided they are prescribed by a doctor.
• Franchise per revenue 3 EUR
  

Serious illness

N/A

N/A

• Insured amount: €1,000,000
• Covers: This coverage ensures, up to the fixed amount specified in the General and Special Conditions, the payment of expenses incurred by the Insured Person for diagnoses, treatments, hospitalizations, services, or medical prescriptions deemed clinically necessary, when these are a result or consequence of any of the Critical Illnesses or clinical situations as indicated in the Special Condition.
  This is applicable only if the first symptoms and their respective diagnosis occur during the coverage period, following the expiration of the waiting period. 

Covered Diseases under Serious Illness Coverage:

Treatment of cancer, including in-situ cancer and pre-cancerous conditions (excluding tumors related to HIV, skin cancer except malignant melanoma, and papillary bladder cancer).
Neurosurgery: surgical intervention on the skull or other intracranial structures, and treatment of benign tumor located in the spinal cord.
Coronary artery bypass surgery (myocardial revascularization) involving at least 2 coronary arteries.
Replacement of a heart valve (valve repair is excluded).
Organ transplantation: transplantation of organs from a living donor and transplantation of organs from a deceased donor, including the heart.