The Health insurance company enters into health insurance contracts, against the premium paid, and by these contracts provides specified health services and goods to the insured persons within the term of the health insurance contract. The financial provision includes the refunding of expenses incurred by the health insured person and payment of sums of the providers of the medical assistance, who provided treatment for the insured persons.
The health insurance contracts can be individual, family or group.
Age of the insured persons – 0 to 64 years.
The insurance is ad personam, the Insurer issues a personal card to the insured person.
HEALTH INSURANCE COVERAGE
Pre- hospital care – includes examinations and tests, provided by freely chosen doctor.
Hospital care – includes diagnostics and treatment in hospital conditions at hospital and clinics, medical tests, manipulations and operational treatment.
Health improvement and illness prevention – includes preventive medical activities, related to the provision of early diagnosis of an illness.
Additional health services and goods – medical drugs products for home treatment, facilities, hospital transport etc.
Dental assistance.
The coverages are valid in case of accident and illness.
Insurance premium:
Premium payment – depending on the contract and health insurance company.
The age and the health state of the insured person are of essence.
Insurance term – 1 year
Relations in case of the occurrence of insurance event:
The insured persons have the right to use the agreed health services and goods at any place at the territory of Bulgaria, to freely select General practitioner and medical center among the Providers of medical assistance.
When the health services and goods are provided by a Medical center with whom the Insurer has a contract:
– The insured person, before using the services and goods, contacts the coordinating doctor of the team of the Provider who directs the treatment and prepares the required medical and insurance documents. The Insurer provides to the Insured person a list of names of the coordinating doctors, when the health insurance contract is entered into, together with the list of medical centers with which the Insurer has signed contracts.
– The payment of the health services and goods is performed by the Insurer to the amount of the insured sum and the limit of the liability, stated in the health insurance contract, without the participation of the Insured person.
When the health services and goods are provided by Providers of medical assistance with which the Insurer does not have a signed contract, they are paid by the Insured person and based on the presented documents, the Insurer refunds the expenses incurred to the amount of the agreed insured sum or limit of the liability.
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