Group Health Insurance LUX MED Panaceus The Insured Party s Guidebook

Transcription

1 Group Health Insurance LUX MED Panaceus The Insured Party s Guidebook

2 I. Health Insurance LUX MED Panaceus 1. What is the Health Insurance LUX MED Panaceus? The subject of the insurance is health and the consequences of unfortunate accidents of the insured employee. Thanks to the Health Insurance LUX MED Panaceus, when you get ill and receive a prescription from a doctor for medicines, you will be able to purchase them with an additional subsidy, in accordance with the scope bought by your employer. In the case of death as a result of unfortunate accident, the person indicated by you will obtain a determined by the terms of the agreement sum of insurance. 2. How does the Health Insurance LUX MED Panaceus work? When you get ill and receive a prescription from the doctor, you can realise the health benefits at nearly pharmacies in the whole Poland. As the Insured Party, you will pay for the medicines subject to the scope of the insurance not more than PLN 3 or PLN 5 per package depending on the variant of the insurance selected by the employer insuring you. The remaining part of the price for the medicine will be covered by LUX MED Insurance (LUX MED Ubezpieczenia) in the framework of the health benefit. The upper limit of the health benefit value (that is the maximum total amount of subsidies to the medicines purchased by you) realised within the insurance period (12 months) amounts to PLN 1 000, PLN or PLN 5 000, depending on the variant of the insurance. In order to realise the health benefit it is sufficient to go to the pharmacy providing the services in the framework of the Health Insurance LUX MED Panaceus and present your Individual Insurance Card and the prescription issued to your first name and surname. The insurance cover does not comprise the cases in which the medicine is refunded with the public sources by the National Health Fund (NFZ), but purchased by the Insured Party with a full payment (without NFZ refund). 3. Where can I obtain information about the scope of my insurance? Information concerning the held variant of the insurance can be obtained from the employer or on the page 4. What is the period of the insurance? The insurance cover may last even up to 12 months, depending on the date on which your employer reported you to the insurance. 5. Within what time can I use the insurance sum? The insurance sum, the upper limit of the health benefits value (that is the maximum total amount of subsidies to the medicines purchased by you) realised within the insurance, is granted for a year and it may be used at any time during the insurance period.

3 II. CARD 6. Where can I use the Insured Party s Individual Card? You can use the Insured Party s Individual Card at one of almost pharmacies in the whole Poland. 7. If holding the Health Insurance LUX MED Panaceus, can I realise benefits from the Insured Party s Individual Card? Insured Party s Individual Card enables verification of your rights. In order to use the benefit you need a valid prescription with the proper PESEL number entered by the doctor and the Insured Party s Individual Card, both issued for the same insured person. The card with the prescription shall be presented to the pharmacist during the visit at the pharmacy. In the case of a lack of PESEL number on the prescription, the pharmacist will ask you to give the number during realisation of the benefit. PESEL number is among other in your identity card. 8. Do I have to go to the pharmacy in person with the Insured Party s Individual Card and prescription in order to buy the medicines? No. If you have the Health Insurance LUX MED Panaceus and a doctor have issued a prescription for you, you can transfer thereof to any person so as he/she can buy the medicines at a pharmacy on your behalf. The person has to present the pharmacist the card and prescription. Of course, medicines for other person may not be bought for your Insured Party s Individual Card. 9. What shall I do if I lose the card? In the case of losing or destruction of the card, you shall inform thereof your employer who will transfer the information to LUX MED Insurance (LUX MED Ubezpieczenia). A duplicate of the card will be immediately transferred to your employer. Additionally, upon request of your employer it is possible to issue a replacement Insured Party s Card. In such a case, your employer within 2 full working days at the latest of the notification shall receive to the address a PDF file with an electronic version of your Insured Party s Individual Card. The image of the card in the electronic form that was given to you via the employer by electronic way shall be printed out and presented at the pharmacy during realisation of the prescription. This will make it possible to use the Health Insurance LUX MED Panaceus during waiting for the duplicate of your Insured Party s Individual Card. 10. Where can I check what value of the insurance sum remained on my Insured Party s Individual Card? The current value of the funds available can be checked at a pharmacy during shopping. You can also call Info Line LUX MED Insurance (LUX MED Ubezpieczenia) at The Info Line operates on the working days, Monday to Friday, from 8.00 to

4 III. MEDICINES SUBJECT TO THE SCOPE OF THE HEALTH INSURANCE LUX MED PANACEUS 11. What medicines are included by the insurance? The Health Insurance LUX MED Panaceus comprises the medicines issued by prescription only. Depending on the variant of the insurance selected by your employer, the scope comprises the medicines used in the case of the most frequently occurring sudden illnesses, chronic illnesses, as well as serious ailments. 12. What does the entry medicine by prescription mean? If Vitamin C will be prescribed, is it also subject to the subsidy? No. The Insurance comprises the medicines that were classified by the Minister of Health as medicines issued by prescription only. The Insurance does not comprise the medicines issued without prescription that is so called over-the-counter medicines or diet supplements. 13. How can I learn whether the medicine prescribed by the doctor is available in the framework of the insurance? So as to check whether a given medicine is subject to the subsidy in the scope of the insurance, you shall enter in the search engine on the page number of the Insured Party s Individual Card and name of the active substance of a given medicine or its trading name. On the basis the search engine shall provide the information whether a given medicine is subject to the scope of your Insurance. 14. What shall I do if the medicine in the dose prescribed is not visible on the www page? Medicines have got various doses, in relation therewith it is possible that a given product with a weaker dose is available without prescription and the stronger one requires doctor s prescription. In such case you should check the details of the product that is its name, dose and form of the medicine. IV. PHARMACY 15. Where can I check the address of the closest pharmacy recognising the Insured Party s Individual Card? The information about the closets pharmacy where you can realise the benefit can be obtained on the page entering to the search engine: number of the Insured Party s Individual Card and approximate location of the pharmacy. On the basis thereof the search engine will give information where the closest pharmacy recognising the Insured Party s Individual Card is located. 16. What shall I do if the medicine is not available at the pharmacy? The pharmacy is not obliged to have all medicines. In the case of a medicine that is rarely issued, the pharmacist the most frequently proposes ordering of the product within 2 working days or shall propose a substitute thereof.

5 17. What shall I do if a problem occurred while realising the prescription? In the case of a problem while realising the prescription, the pharmacist may clarify thereof on a current basis with the Operator. If there is no possibility of solving the problem on the spot at the pharmacy, the Insured Party may address LUX MED Insurance (LUX MED Ubezpieczenia), via sending a notification to [email protected] or to the seat of LUX MED Insurance (LUX MED Ubezpieczenia): LMG Forsakrings AB Spółka Akcyjna oddział w Polsce ul. Postępu 21C Warszawa In the notification you shall provide card number, date and place of the transaction and describe the problem that occurred while realising the prescription. If due to technical reasons, beyond control of the Insured, purchase of a medicine with the Insured Party s Individual Card at a pharmacy realising the services was not possible within 2 working days, then the Insured Party has the possibility of buying the medicine with his/her own funds for an invoice, and then obtaining of the benefit via complaint. You shall attach to the notification the invoice issued by the pharmacy realising the services for the Insured (it shall include first name, surname and PESEL of the Insured on the prescription) which will detail only the medicines from the prescription issued for the Insured. The invoice can be obtained in the pharmacy within 7 days of the date of the medicines purchase. V. CONTACT Should you have any questions please contact Info Line of LUX MED Insurance (LUX MED Ubezpieczenia) at The consultants of the Info Line LUX MED Insurance (LUX MED Ubezpieczenia) shall provide you the information concerning the Health Insurance LUX MED Panaceus held and the method of realisation of the benefits. Info Line operates on the working days, Monday to Friday, from 8:00 to 18:00.