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Home   >  Corporate insurance   >  Employee insurance   >  Health insurance   >  Spend wisely!

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Spend wisely!

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We are glad that you are holder of the JSIC "Seesam Latvia" Health Insurance Card, which is designed to help you deal with situations related to health problems, if such might occur during the period of validity of your health insurance policy.

Use the card options wisely!

Remember that each health insurance service – both outpatient and in-patient - has a certain limit. All the manipulations performed during the year will be added together. If the total amount for the services exceeds the limit set, you must pay the difference. Therefore, we recommend that you carefully read the advices on how to wisely use the health insurance card.

Advices on how to wisely use the Health Insurance Card:

  • When you receive the health insurance card, carefully read your health insurance program and its conditions. The health insurance program always contains specification of the annual insurance amounts/medical service limits to be paid by the insurer. Additional information can be obtained from JSIC „Seesam Latvia” by calling the customer information line 67 06 10 23.
  • In the case of a health problem you should at first go to your family doctor. If you are not registered at a family doctor or if you don’t remember who your family doctor is, please call the toll-free number 80 00 12 34 of the Health Payment Centre (HPC), to obtain the information required.
  • Always control that you are charged only the patient contribution fixed by the state in every case you receive a service prescribed by your family doctor. Costs of services prescribed by your family doctor are patient contributions in amount from LVL 1 and up to LVL 25. You can get information on amounts of patient contributions by visiting the website of the HPC at http://www.vnc.gov.lv/ or by calling the toll-free number 80 00 12 34.
  • It is important to clarify what services can be obtained at public expense, in order to retain possibility to receive any paid services in situations where they are really needed.
  • Prior to reception of a service find out the price of the particular service and only then present your health insurance card. Otherwise, it is not excluded that the service will be provided to you as an insured person at a higher price than to those patients who are not insured. If the price of services is different, then please report immediately to JSIC “Seesam Latvia", by sending a message to the e-mail: veseliba(a)seesam.lv or by calling tel. No. 67 06 10 37.
  • When receiving any services for pay from an institution, which is not a contractual organisation of JSIC “Seesam Latvia”, please ascertain that the institution is registered in the Register of Medical Institutions and Certification of the RL. You can do it by visiting the website of the Health Inspectorate at http://www.vi.gov.lv/ or by calling tel. No. 67 06 10 37 of JSIC „Seesam Latvia”. Services received from a non-certified institution will not be covered.
  • Remember that  JSIC „Seesam Latvia” compensate costs according to cash receipts only after receiving the service. For example, costs of season tickets of sports and other services are compensated only when the subscription period is ended.
  • Upon receipt of services, never sign a blank receipt form and never put your signature if you have not received the service. By signing a receipt, you confirm that you have received the service and you confirm the price of the service.
  • Control that the insurance amounts and the limits specified in insurance programs are not exceeded because in the case of an exceeded limit you shall pay a recourse invoice to JSIC “Seesam Latvia”. To get information on limits, send a message to the e-mail address veseliba(a)seesam.lv or call the telephone number 67 06 10 23.

If you suspect that a service provider has acted unfairly towards you, please contact us by phone 67 06 10 37 or e-mail: veseliba(a)seesam.lv.

Example

During the insurance period Margaret Flower felt sick and needed hospitalization.
What would be the likely costs, if.
  
  •  the money is spent wisely, using the possibility of receipt of services through referral of your family doctor and thus paying only costs of patient contribution;
  •  the money is spent unwisely, receiving only services for pay. 
       
 

Outpatient services, total limit LVL 300.00

  Spent wisely (referrals through family doctor). LVL Spent unwisely  (only services for pay). LVL
Consultations, laboratory and diagnostic tests
Family doctor 1.00 20.00 
Electrocardiography 1.00 5.00
Ultrasonography 3.00 20.00
Specialist consultation 3.00 20.00
Laboratory services
~ 1.00 ( blood test)
30.00
X-ray 2.00 15.00
Ambulatory surgery 3.00 20.00
Endoscopic examination 5.00  100.00
Computer tomography 10.00 80.00
Nuclear magnetic resonance 20.00 120.00
Minimum attendance of institution in the case of sickness, in total ~49.00 430.00
If you need additional out-patient rehabilitation, then:
 Massages 4.00 x 10 =40.00 (massage services in a contractual organisation) 100.00 (massage services in private practice). The policy covers LVL 40.00; you must use your personal funds, and submit cash receipts for compensation. Remember: the insurer will cover the massage costs, if the institution is registered in the Register of Medical Institutions and Certifications!
Physiotherapy session 2.00 x 10 = 20.00  5.00 x 10 = 50.00
Rehabilitation course in total 60.00 150.00; policy covers LVL 90.00
Result: The limits are not exceeded; therefore, you can continue to use your HI policy until the end of your insurance period.
The total outpatient limit is exceeded by LVL 220.00, and you must repay this sum to AAS „Seesam Latvia”. Any further costs of outpatient services shall be borne by you!


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