If's Health Insurance Advantages
If Mobile Baltics application
A convenient and secure way to manage your health insurance on your smartphone.
e-Doktor
No queueing to see a doctor and get a remote consultation from a family doctor paid for in full by the If health policy.
Broadest range of medical services
No hidden restrictions, exclusions are clearly described. Treatments of previously diagnosed and oncological diseases are also covered.
What does the policy cover
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Covered
The costs of paid consultations of family physicians or medical specialists services without the referral of your family physician. We will indemnify the consultation fee and the medically indicated procedures , laboratory analyses , diagnostics or high-technology instrumental diagnostics prescribed by the doctor. Outpatient treatment coverage also includes day treatment and e-Doctor telemedicine service.As deviation from the p. 54.1 of the "Health insurance conditions for private customers THE-ER-20231" the consultation fee of the psychiatrist and/or psychologist shall be compensated on the basis of the outpatient treatment insurance coverage, prescription drugs related to the treatment are not covered.
Not covered
The costs of homeopathy treatment, food and nutrition specialist, narcologist, speech therapist, trichologist, sleep studies (sleep disorders and apnea), sexual pathologist or immunotherapy; costs of infertility diagnosis and treatment, sterilization, vasectomy and artificial insemination; medical expenses for any mental illness, addiction, drug addiction, alcoholism, venereal diseases, AIDS and HIV; costs of alternative and/or complementary medical services (e.g. Ayurveda, aromatherapy, etc.); costs of cosmetic and beauty services; costs of whole body magnetic resonance imaging (MRI), positron emission tomography, capsule endoscopic gene analyses, genetic analyses, except genetic analyzes related to pregnancy monitoring; cost of food intolerance tests. A full list of exclusions is provided in the Terms and Conditions.
Consider
To apply a claim it is also necessary to add a referral for analyses, tests and examinations prescribed by the doctor.
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Covered
The e-Doctor telemedicine service gives a possibility to consult a doctor online, receive health-related recommendations and extend medical prescriptions. During remote consultations the doctor can prescribe further treatment, issue referrals for additional examinations or consultations of medical specialists. The service is provided in Estonian, Russian and English. The e-Doctor service is simple, convenient and accessible regardless of your location. The service can be used in the If Mobile Baltics mobile app or www.if.ee website.
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Covered
The costs of out-patient rehabilitation treatment: e.g., physical therapy procedures (ultrasound treatment, taping, shockwave therapy, electrotherapy, light therapy, magnetic therapy, salt room, etc.), medical massage, therapeutic exercise in groups and individually, therapeutic swimming, mud treatments, stretching therapy, manual therapist’s and osteopath’s appointments, as well as repeated consultations of a physiotherapist, ergotherapist, kinesiologist, rehabilitation doctor; appliances (e.g., crutches, orthoses, wheelchairs, etc.) prescribed by the doctor.
Not covered
The costs of general body massage, vacuum massage, cryomassage, lymphatic drainage and massage.
Consider
The costs are covered if the provider of rehabilitation services (except for swimming pools) holds an activity licence or a professional certificate to provide of the relevant outpatient medical rehabilitation service. A doctor’s referral must be attached to the claim application.
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Covered
The costs of inpatient care while in hospital, including accommodation in a superior service ward and meals, surgeries, anaesthesia, and examinations. All types of surgery using the latest technologies, including spinal, neuro-surgical, micro-surgical, laparoscopic, cardiovascular, arthroscopic, etc. surgery, are indemnified.As deviation from the p. 29 of the "Health Insurance Terms and Conditions for private customers THE-ER-20231", the costs of a paid ward and hospital meals related to childbirth are reimbursed from the hospital care compensation limit. The special condition does not extend to other obstetric costs.
Not covered
The costs of obstetrical expenses, cosmetic surgery, plastic surgery, vision correction, stomach reduction surgery, diastasis surgery, surgery related to infertility and tubal patency surgeries, vein surgery, sclerotherapy, gender reassignment surgeries, as well as gratitude payments or gifts to the doctor as a token of appreciation.
Consider
The hospital treatments must be previously agreed with If.
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Covered
The costs of diagnosis and treatment of chronic and oncological diseases, even if the disease was diagnosed before the policy came into force. We pay indemnity for both outpatient and inpatient l treatment services (including radiation and chemotherapy).
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Covered
The costs of glasses or contact lenses. As deviation from the p 38 of "Health Insurance Terms and Conditions for private customers THE-ER-20231", glasses, contact lenses are also reimbursed on the basis of insurance cover for the cost of glasses and contact lenses, provided that no change in the visual acuity of the insured has been detected.
Not covered
The costs of glasses cases, cleaning and storage appliances as well as the cost of repairing or replacing existing glasses, optical sunglasses and glasses with blue light lenses.
Consider
In order to receive the compensation, a prescription issued during the insurance period must be submitted.
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Covered
The costs of medical examinations without a doctor’s referral (e.g., complex eye examinations, sports examinations, foetal 3D/4D ultrasound examinations, antibody tests.), if the services (examinations or analyses) are provided at the facilities of a medical institution. As deviation from the p. 57.12 of the "Health insurance conditions for private customers THE-ER-20231" food intolerance test performed in a health care instituiton and licensed medical institution is also compensable.
Not covered
The costs of preventive examinations for venereal diseases, food intolerance tests and sleep tests. As deviation from the Health Insurance Terms and Conditions , If does not indemnify the cost of a prophylactic medical examination if the health examination procedure (e.g. blood sampling, etc.) has been carried out outside the premises of the medical institution.
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Covered
The costs of consultation, preparation of a treatment plan, dental treatment, tooth extraction, oral hygiene services (e.g., soda wash, pearl wash, tartar removal), dental surgery, X-ray, anaesthesia, treatment of parodontosis, orthodontics, prosthetics, crowns, dental implants, aftercare of prostheses, crowns and implants, tooth restoration using laboratory-made ceramic or metal fillers, e.g., inlay, onlay or overlay, installation of porcelain dental implants, installation of facets, caps.
Not covered
The costs of whitening of the teeth and tooth ornaments.
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Covered
The costs of consultation and any vaccines related to vaccination.
Consider
The costs are covered if the vaccination is conducted at the facilities of a medical institution or pharmacy.
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Covered
The costs for medicines sold on the basis of a prescription, which are registered in the Estonian Register of Medicinal Products.
Not covered
The costs of vaccines, antidepressants, contraceptives and aids.
Consider
The original or a copy of the doctor’s prescription must be attached to the claim application.
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Covered
The costs of visits of specialists as phlebolog, as well as the cost of medically necessary analyses and diagnostics as Duplex USG, and procedures including sclerotherapy prescribed by the doctor.
- Example 1: If you go to the doctor and your invoice is 50 euros, If will indemnify 35 euros (compensation rate 70%)
- Example 2: You go to the dentist repeatedly and your dental care limit residue is 150 euros before the visit. The invoice for the visit is 200 euros, from which If will indemnify 150 euros because the dental care limit has been reached.
Questions & Answers
What to do in case of illness or need for other treatment?
In case of illness or need for other treatment, choose a suitable medical institution in Estonia. You can visit medical specialists without a referral of the family physician. For additional examinations, tests, procedures, etc., you need a doctor’s referral or the part of your case history including the treatment prescribed (available on digilugu.ee website). Hospitalisation must be agreed with If beforehand. Before receiving the medical service, it must be checked whether the service provider has an activity licence or professional licence. You must initially pay for the service yourself and then file a claim to If for the indemnity of expenses via If Mobile Baltics app or in If self-service. We will indemnify the expenses to the maximum amount of the insured sum of the insurance cover, subtracting the deductible.
How to receive the indemnity?
To receive the indemnity you need to complete a health claim application in the If Mobile Baltics app or in If self-service.
You must enclose treatment documents (referral, certificate, extract from your medical history, etc.) with the health claim. Originals are not required – it is sufficient to upload photographs of the documents with your health claim.
To whom must the expense receipts be issued?
The submitted documents must show that the service has been provided to the insured person. Generally the insured person is the company employee and the insurance does not cover their family members.
Which documents are required when applying for indemnification?
To be able to decide on indemnification for the claim, we need all the documents related to the claim event. Thus, your cooperation is very important when solving a claim event.
Insurance cover
Documents
How can I check the balance of my health insurance limit?
The most convenient way to keep track of your limits is in the If Mobile Baltics app. You can also do it in If self-service.
Can my employer see my medical history?
In case of a health insurance insured event, the employee submits all the required documents directly to If and the employer receives an anonymous general summary about the usage of the insurance covers from If. The employee does not need to submit documents about their health condition or medical expenses to the employer.
What is not covered by health insurance?
Make sure to check the exclusions that are not covered by health insurance. Exclusions are listed in the health insurance conditions for employers.
How can I make sure that cost of treatment will be indemnified?
For confirmation whether the treatment you need is covered, please write e-mail kahjud@if.ee or call our insurance line 777 1211.
How to use If Mobile Baltics app and self service portal?
Read more here
Terms
- Insurance provider - If P&C Insurance AS
- Insurance period - 12 months
- The insurance policy validity area - Estonia
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Please study the documents regulating health insurance in the Insurance Company's website www.if.ee in the Health Insurance section Terms and conditions:
- Health Insurance Conditions
- General Insurance Conditions
- Health Insurance Product Information Page
- The content and exclusions of the insurance cover are specified in the insurance terms and conditions
- Handling personal data: https://www.if.ee/isikuandmed
