Health insurance


After the insured event you must notify Seesam as soon as possible but not later than in 90 (ninety) days.

The insurance claim may be filed only by the insured person who has received medical, dental, optical, medical, sports services.

How to receive an indemnity?
What to do if you have lost or must change your health insurance card?

If your last name or personal data has changed or if your health insurance card is lost:

  • It is necessary to send the insured person’s application to the e-mail info@seesam.lv with the request to change the health insurance card and attach thereto a copy of the passport or ID card (in case of change of the personal data).
  • The address to which the new card is to be sent must be indicated.
  • The fee for the production of a new card is EUR 4.00. (The policy can contain a condition that making a new health insurance card is free of charge in all cases)

If your health insurance card is stolen:

  • It is necessary to send the insured person’s application to the e-mail info@seesam.lv with the request to change the health insurance card and attach thereto the police certificate about theft of the documents.
  • The address to which the new card is to be sent must be indicated.
How to receive indemnity if you have paid for services from your personal funds?

The insured person shall use his/her personal funds to pay for services received from institutions other than contractual organisations as well as in cases when it is impossible to receive the service from a contractual organisation or if the cost of a service is not reimbursed in full.

In order to assess the insured event and the related health insurance claims, as well as to cover the costs of the insured person, the insured person shall immediately and, in any case not later than within 90 (ninety) days following the moment when it has become possible, submit to the insurer the following:

Health Insurance Claim:

Original cash register receipt or accountable cash payment receipt (specifying the date, number and paragraph of the SRS order permitting operations without using cash register receipts) containing the following information:

  • Service provider's name, registration number, legal address;
  • First name, surname, identity number of the service recipient- insured person;
  • Service reception date;
  • Description (detailed description) and number of services received;
  • Price of the service received.

Extract from out-patient and/or dental patient and/or in-patient medical record that attests the received services and specifies full diagnosis, treatment used, and tests made and confirming the diagnosis.

Dentistry:

Indemnity will be paid after submission of the insurance claim, an extract from the dental medical card containing information about the treated tooth number and manipulations performed, a personalized payment document (an electronic cash register receipt and/or an accountable cash payment receipt), to the insurer.

Sports:

Indemnity will be paid after submission of the insurance claim and a personalized payment document to the insurer.

Documents to be submitted:

  • an electronic cash register receipt and/or an accountable cash payment receipt in which the service reception date and/or the period of validity of sports subscription certificate is specified;
  • or payment order where in the line „Payment Purpose” there is specified the number of the agreement on automatic billing concluded between the sports club and the person insured by Seesam.
  • Sports subscription certificate must be submitted after the expiration date of the certificate, but no later than 90 days from the last date of reception of the services. If the price of sports activities and/or the subscription certificate price is higher than the amount specified in the program, then the insured person shall cover the difference from his/her personal funds.

Medicines and optics:

A copy of the doctor’s prescription must be submitted in respect of medicines and optics which are specified in the health insurance program as medicines and optics requiring doctor’s prescription.

Indemnity will be paid after submission of the insurance claim, copies of prescriptions and a personalized payment document (an electronic cash register receipt and/or an accountable cash payment receipt and description of the medicines purchased) to the insurer.

If the insurance indemnity is received by an authorized representative, a notarially certified power of attorney must be presented.

Other documentation required by the insurer as additional information to evaluate the health insurance claims and occurrence of an insured event.

Where can I use Seesam health insurance without having to pay from my personal funds?

To avoid necessity to pay from personal funds for services included in the health insurance card, visit our contract organisations or contract organisations SP - 2.3

 


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.