The terms and conditions of health insurance and voluntary accident insurance policies vary depending on the insurance company and the type of insurance. In the event of an accident at work, personal injuries caused in traffic or an occupational disease, the treatment practices are determined by law.
When you need a doctor:
- Check your insurance terms and conditions or check with your insurance company what procedures and medical services are covered by your insurance.
- If you experience an accident at work, you should inform your supervisor without delay, and he or she will inform you of how the company’s statutory insurance works.
- As a client of LocalTapiola’s health, treatment cost, accident and travel insurance, you have access to TerveysHelppi. In TerveysHelppi, Mehiläinen’s nurses and doctors handle your health-related matters quickly and at the time that best suits you, every day from 7:00–23:00. In most cases, the doctor can assess and treat your problem and give you advice remotely. If the matter requires a physical doctor’s appointment, one will be booked for you. You can chat through the TerveysHelppi application or call 0206 1000.
- Find out whether the invoices for appointments and procedures can be sent directly to your insurance company or whether you need to pay for your visits yourself and then apply for reimbursements from the insurance company.
- As a client of If’s health insurance, you only pay a possible deductible for a doctor’s appointment, and Mehiläinen will apply for reimbursements directly from If. If direct reimbursement can also be granted for digital visits.
- As a client of Pohjantähti, you have access to a direct invoicing service. You will therefore pay only the deductible if you have received approval for direct invoicing from Pohjantähti prior to your appointment.
- As a Pohjola Insurance personal insurance customer, you have access to the Pohjola Health Advisor service. When you initiate your care through the Pohjola Health Advisor service, you will receive a decision on compensation right away. No separate loss report is needed, and all you need to pay out of pocket at the doctor’s appointment is your deductible, if applicable. You can contact a health advisor by phone (call 0100 5225) or via the app. Read more about the Pohjola Health Advisor service.
When you visit a doctor, the insurance usually works as follows:
- If you have a voluntary insurance (private accident, treatment cost, travel and license insurances), you pay for your visits yourself and then apply for reimbursement from the insurance company.
- When it comes to statutory insurance (accidents at work and car insurance), we can send the invoice for the first visit directly to the insurance company after receiving information on the insurance company from your employer (e.g. insurance certificate).
Accidents must be reported to the insurance company
- If an accident happens at work, the employer or supervisor must send a damage report to the insurance company to explain what has happened. Each insurance company has its own form for damage reports, which can usually be filled in online.
- If you have a voluntary insurance, you should report any accidents to the insurance company yourself. Each insurance company has its own form for damage reports, which can usually be filled in online.
For treatments and examinations, the insurance usually works as follows
- For more expensive treatments or examinations (e.g. surgery, MRI scans), the doctor requests a payment commitment from the insurance company.
- When the insurance company grants a payment commitment, we can send invoices for the more expensive treatments and examinations directly to the insurance company.
- When it comes to voluntary insurance, we can also request a payment commitment from your insurance company for an examination or procedure prescribed by a doctor.