Health insurance


Seesam health insurance covers unexpected expenses of employees for medical aid in case of an illness.

If an employee gets ill, it may affect not only the employee, his or her family but also the interests of an employer. By purchasing the health insurance for the employee the employer ensures receiving of good quality treatment services, possibility to get well and return to work faster.

Check the insured amounts and remaining limits of the insurance programs by calling to Seesam helpdesk 67011000.

Why to purchase Seesam health insurance?
  • The offer is prepared according to wishes and needs of each company 

In various companies employees require different insurance support. Thereby “Seesam” offers quick preparing of the offer for each employer taking into account the area of operation and employer’s wishes according to the goals set by the company and staff motivation policy.

  • Tax discounts for a company 

The employer is eligible to decrease the company’s profit for the amount spent on health insurance policies – this amount is an exempt of corporate income tax. If the insurance premium does not exceed 10 % of the insured person’s gross income and also does not exceed EUR 426.86 then it is an exempt of personal income tax and is not included in the object of compulsory social insurance contributions.

  • The employee health insurance facilitates continuous operation of the company 

The employee health insurance facilitates faster return of employees back to work after they have been ill. Possibilities of health insurance policy help to discover serious health problems at an early stage and faster recovery decreasing employer’s costs for covering of sick leaves. Shorter periods of sick leave also decrease costs related to replacing of employees.

  • Reputation of a socially responsible employer 

Employee health insurance is an expression of the employer’s good will as well as care and in its turn it motivates employees and increases their loyalty to the company.

  • Seesam does not apply an extra payment for split payments 

The insurance premium for the policy can be paid in several payments and no extra expenses are applied.

  • Seesam offers an open policy 

Open policy offers a possibility to pay for services that are not included in an insurance contract. Insurance holder sets insured sum of an open policy and it can be increased during the entire insurance period for an unlimited amount.

  • Seesam also insures employees of small companies 

Seesam offers a possibility for every employer to insure employees without envisaging any restriction like minimum number of insured employees.

  • Beneficial and flexible policy purchase for new employees 

During the entire insurance period it is possible for the employer to insure new company’s employees who can be added to the selected insurance program under the same conditions as the initial contract was concluded. In case the number of insured individuals is increased the insured amount for each employee will not be decreased.

  • Discounts or other kinds of Seesam services 

The company as a legal entity and insured company’s employees as individuals have possibility to receive discounts for other Seesam services if Seesam and the employer has made such an agreement. Call us to 67061000 and ask.

  • For convenience of clients – health insurance self-service site 

For the convenience of clients Seesam has created insurance self-service site ensuring clients not only with digital health insurance card and access to its data but also much more comfortable and faster service.

  • “Seesam” health insurance now is also available on the phone! Mobile app is available for both Apple iOS (iPhone, iPad) and Google Android smart devices. 

Benefits: 
1. Simple and convenient use 
In the initial version of the app two essential sections are available – a digital card and an application of insurance indemnity. 
Product section will be available soon. It is being tested at the moment. (Additional information will follow)
2. Information is easy to review 
All information on the policy, insurance risks, limits, programs and history will be at the same place and client will be able to access it through the phone. It will be easy to review it at any time and place. 
3. Eco-friendly solution 
Mobile app is nature friendly as no waste is created. 
 

About health insurance programs

Out-patient paid-services 

Paid-services are services not covered from the state budget:

  • Consulting of a family doctor, general medical practitioner, internist or paediatrician.
  • Home visit of a family doctor.
  • Consulting of a competent doctor. 
  • Consulting of a highly qualified specialist (assistant professor, professor).
  • Consulting of physical therapy doctor, physiotherapist, rehabilitologist
  • Treatments (injections, infusions, blockades).
  • Manipulations made by a specialist, laboratory and diagnostics examinations prescribed by a treating doctor, including expensive examinations.
  • Medical expenses related to pregnancy within the service framework set in this program.
  • Physiotherapy treatments as prescribed by the treating doctor (short wave therapy, electrophoresis, ultrasound, magnetic therapy, laser therapy, light therapy, etc.). 
  • Medical certificates (for weapon acquisition permit, driver’s commission) and inspections related to them.
  • Mandatory health inspections related to work specifics, including an individual’s medical record  in the amount and procedure of the legislations enactments of the Republic of Latvia.
  • State emergency medical treatment.
  • Paid emergency medical treatment at “ARS” in Riga and Riga area.

Out-patient rehabilitation

Out-patient rehabilitation – massages, manual therapy, water treatments, medically prescribed corrective gymnastics in a group or individually (also medically prescribed corrective gymnastics training packages are covered within the limits). Out-patient rehabilitation can be received only at a medical institution in case of justified indications. Out-patient rehabilitation has a limit for each treatment and number of treatments during the period.

Paid in-patient services

Staying at a hospital and day-care for a fee:
•    Treatment in a hospital
•    Treatment and diagnostics manipulations
•    Laboratory inspections
•    Surgeries
•    With/without treatment in advanced service conditions
Before receiving of the service, i.e. 5 working days before, at the hospital offering services for a fee, including paid days at the hospital outside the insurer’s contract organizations as well as if the in-patient service is not agreed position, it is necessary to have a written consent of the insurer – Guarantee Letter regarding the cover of the services. To make the refund according to the insurer’s guarantee letter then for preparing of the letter, it is necessary to submit to the insurer a treating doctor’s designation and possible cost estimate of services provided.

Paid childbirth assistance services

This coverage in the insurance program can be included only if cover for “paid in-patient services” is selected. Service is covered if the card is effective for a full insurance year and only with Guarantee Letter of the insurer.
Paid childbirth assistance services:
•    Service room;
•    Contract with a doctor or midwife;
•    Analgesia.

In-patient rehabilitation

This coverage in the insurance program can be included only if cover for “paid in-patient services” is selected. Services are paid with the insurer’s guarantee letter.

Paid in-patient rehabilitation:

Treatment at a sanatorium and specialized rehabilitation institutions only after acute health problem, i.e. accident, injury or surgery that have taken place during an insurance period. The in-patient rehabilitation services are agreed with the insurer in prior based on a treating doctor’s designation for a medical rehabilitation according to a diagnosis and medical indications and recommendations.

Dental services

Program covers various kinds of dental services and dental hygiene services. The indemnity is limited by the insured amount per year and ratio (%) discount as set in the program.

Medication

Program ensures cover of the medications required for the treatment process if this medication is registered in the Drug Register of the Republic of Latvia. The indemnity is limited by the insured amount per year and ratio (%) discount as set in the program.

Sports

Sports program covers:
•    Sports classes (gym, pool, tennis, squash, aerobics classes).
•    Indemnity is limited by the insured amount per class in one day and number of classes per month as set in the program.
•    Sports classes also cover one-month memberships (packages) within the limit set in the insured person’s program.
•    Sports classes also cover two-month and three-month memberships (packages) within the limit set for the program, by paying 100 % from personal assets.

Optics

Program covers based on the doctor’s prescription. Optics items can be acquired once a year:
•    Contact lenses, including one-day or month contact lenses.
•    Optical lenses of eye-glasses (including services of optometrist) based on the doctor’s prescription.
The indemnity is limited by the insured amount per year and ratio (%) discount as set in the program.
 

Open policy

Open policy covers unforeseen out-patient and in-patient costs not covered by acquired basic program. Payments of an insurance indemnity from the open policy the insurer makes only to the insured persons included in the insurance policy (employees only) with a written confirmation of the policy holder.

Policy holder determines insured amount of the open policy. Insurer withholds administrative costs. 
 

What to do if an insurance card is lost or needs to be changed?

If personal data/surname changes or health insurance card is lost:

  • It is necessary to send a request to e-mail info@seesam.lv from the insured person asking to change a health insurance card adding passport or ID card copy (if personal information has changed).
  • Indicate address where the new card needs to be sent.
  • Payment for making a new card is EUR 4.00. (Policy may have a condition that new HI card is made for free at any case)

If health insurance card has been stolen:

  • It is necessary to send a request to e-mail info@seesam.lv from the insured person asking to change a health insurance card adding police statement regarding theft of documents.
  • Indicate address where the new card needs to be sent.
     
What to do if health insurance event has occurred?
Get a quote


Terms and conditions


This is a financial service, insurance is offered by Seesam Insurance AS. Before making a purchase, review the
contract terms and conditions at www.seesam.ee and, if necessary, ask for additional information from an insurance specialist.