Seesam health insurance

Expenses reimbursable under the Outpatient Treatment program:

1. Medical services:

• ambulance;
• family doctor consultations and home visits;
• specialist medical consultations, medical procedures and home visits (except for specialist doctors whose services are remunerated under other insurance schemes, whether or not that insurance scheme is chosen and specified in the insurance policy;
• psychotherapeutic treatment by a medical psychotherapist;
• expenses of processing and submitting of medical documents (provision of examinations, records and other information media as a separate service);

2. Nursing services: the services of nurses under a doctor’s prescription (e.g. injection of medicines, blood collection, wound dressing);

3. Diagnostic tests prescribed by a doctor that are medically necessary:

• laboratory tests (clinical, biochemical, immunoenzymatic, hormonal, microbiological-bacteriological, cytological-histological and other tests);
• instrumental examinations (ultrasound, radiological, endoscopic, functional and other examinations);
• computer-assisted tomography, magnetic resonance imaging, positron emission tomography.

Diagnostic tests are performed only with a doctor's referral (Form 027/a).

4. Day surgery and day hospital services:

• day surgery services in accordance with the valid list of day surgery services approved by the Ministry of Health (MoH) of the Republic of Lithuania;
• day hospital services prescribed by a doctor in accordance with the valid list of day hospital services approved by the MoH.

Expenses of computer-assisted tomography, magnetic resonance and positron emission tomography, day surgery and day hospital services are paid only if the insured informed the insurer in advance in writing before performing these examinations and received the written consent of the insurer to reimburse the costs of these diagnostic examinations.

The Outpatient Treatment program does not reimburse the costs of medical consultations and/or services and/or goods that are reimbursed under the Inpatient Treatment, Medicines, Over-the-Counter Medicines, Food Supplements and Vitamins, Dental Treatment, Optics, Preventive Health Checks, Vaccinations, Medical Rehabilitation, Pregnancy Care, Wellness Services, Aesthetic Procedures insurance programs in accordance with these terms and conditions, regardless of whether that insurance scheme is selected and specified in the insurance policy.

Under the Inpatient Treatment program, depending on the insurance option selected by the policyholder, expenses are reimbursed for one of the following items:

• a single or double room in a public hospital;
• a single or double room, treatment, operations, nursing, medicines and medical products and nursing facilities in a public hospital;
• a single or double ward, treatment, surgery, nursing, medication, and medical care and nursing facilities in a public or private hospital.

The Inpatient Treatment insurance option chosen by the policyholder from the above list is indicated in the insurance policy or its annexes.

The Inpatient Treatment program does not reimburse the costs of services and/or goods that are reimbursed under the Outpatient Treatment, Over-the-Counter Medicines, Food Supplements and Vitamins, Dental Treatment, Optics, Preventive Health Checks, Vaccinations, Medical Rehabilitation, Pregnancy Care, Wellness Services, Aesthetic Procedures insurance programs, regardless of whether that insurance program is selected and specified in the insurance policy.

Under this program, you will have your expenses reimbursed when you purchase the following prescription items from a pharmacy:

• medicines;
• medical aids:

• premiums for medicines and/or medical aids, partially reimbursed from the budget of the Compulsory Health Insurance Fund.

The Over-the-counter Medicines, Food Supplements and Vitamins program reimburses the following:

• over-the-counter medicines (according to the manufacturer's instructions for use);
• food supplements (according to the manufacturer's instructions);
• vitamins (according to the manufacturer's instructions);
• bandages (gauze, silicone, hydrocolloid), lignin, hydrogel, gauze, patches, cotton wool, disposable syringes.

Under the Dental Treatment program, the costs are reimbursed for:

• oral hygiene: oral hygiene assessment, removal of hard and soft plaque from teeth, fluorine applications, oral hygienist consultation (hygiene training);

• dental treatment: general dental, endodontic, periodontal and surgical treatment of dental and maxillofacial diseases, restoration of dental solid tissue defects with fillings, inlays, overlays and laminates; radiological examination of teeth, analgesia, tooth extraction;

• dental prosthetics: dental consultations on dental prosthetics, implants and orthodontic treatment; manufacture, restoration and repair of removable and non-removable dentures; dental implants, dental implants, orthodontic treatment with braces, graves, orthodontic plaques.

The Optics program reimburses the costs of:

• consultations of an ophthalmologist or optometrist regarding the appointment of corrective spectacles;
• corrective spectacles (spectacle frames, spectacle lenses and spectacle manufacturing service) or contact lenses prescribed by an ophthalmologist or optometrist;
• corrective eyesight surgery prescribed by a doctor (including operations performed using laser technology or refractive corneal treatment);
• moisturizing eye drops (artificial tears) and a contact lens cleaning solution purchased at an optician (e-optics) or pharmacy (e-pharmacy).

The program of Preventive Health Checks reimburses the costs for:

• health checks (mandatory in accordance with the procedure established by law according to the nature of work);
• tests performed at the request of the insured;
• health check programs established at and approved by the health care institution;
• consultations, tests and procedures carried out to determine the susceptibility to the disease or to prevent possible illness.

The Vaccination program reimburses the costs of:

• a doctor's consultation on vaccination;
• vaccinations (chosen by the insured or prescribed by a doctor) and vaccination service.

Under the Medical Rehabilitation program, the costs of the following medically justified medical rehabilitation services provided in a health care institution with a referral from a treating physician are reimbursed:

• consultations of a rehabilitator, physiotherapist, occupational therapist, speech therapist, psychologist;
• physiotherapy;
• physiotherapy (individual and group classes in the gym and in the water);
• halotherapy;
• pregnancy exercise and water aerobics;
• water and mud treatments;
• therapeutic massages;
• manual therapy.

The program Pregnancy Care, depending on the insurance option selected by the policyholder, reimburses the costs of:

• periodic examinations of pregnant women, medical consultations and examinations to monitor the progress of pregnancy, exercise for pregnant women and water aerobics;
• diagnosis and treatment of pregnancy complications, forced termination of pregnancy;
• childbirth and postnatal care and paid wards in public hospitals;
• childbirth and postnatal care and paid wards in public and private hospitals.

The Pregnancy Care insurance options as chosen by the policyholder from the list above are indicated in the insurance policy or its appendices.

Under the Critical Illnesses program, depending on the insurance option chosen by the policyholder in case of critical illness, the following are paid:

• the costs of treatment of critical illnesses in a state medical institution;
• a lump sum equal to the sum insured.

The list of critical illnesses is as follows:

The insurance benefit will not be paid if the critical illness:

• occurred within 45 days from the date of concluding the insurance contract;
• the diagnosis did not meet the definition of a critical illness;
• the critical illness occurred at the time when the insured is infected with HIV or has AIDS.

Any services listed in the insurance programs are reimbursed under the Extended Health Insurance:

• Outpatient treatment
• Inpatient treatment
• Medications
• Over-the-counter medications, dietary supplements, vitamins
• Dental treatment
• Optics
• Preventive health examinations
• Vaccinations
• Medical rehabilitation
• Pregnancy care
• Critical illness treatment costs

Additionally, reimbursement will extend to the expenses for:

• interventional treatment of vascular diseases (sclerotherapy) and treatment of varicose veins of the legs;
• diagnosis of sexually transmitted diseases;
• consultations on family planning and contraception, insertion, control or removal of contraceptives, diagnostic tests before prescribing contraceptives and tests to avoid complications due to the use of these contraceptives;
• diagnosis and treatment of non-malignant tumours, warts, papillomas, moles, benign skin lesions;
• eyelid surgery only if it is performed by an ophthalmologist.

Under the Wellness Services program, expenses are reimbursed for:

• gym classes, aerobics, yoga, fitness, kalanetics, Pilates;
• tennis, badminton, squash;
• swimming (in a pool);
• massages (without a doctor's prescription);
• water and mud procedures (mineral, carbonic, herbal, pearl, whirlpool, vertical water baths; therapeutic showers; mud, mineral-mud baths) (without a doctor's prescription);
• physiotherapy, physiotherapy (without a doctor's prescription);
• consultations of a psychologist, nutritionist, homeopath, sports medicine doctor;
• non-traditional medical services provided by a health care institution licensed by the State Accreditation Service under the Ministry of Health or a health care professional licensed for this activity (e.g. acupuncture, electroacupuncture, bioresonance computer-assisted diagnostics, food intolerance tests, hydrocollonotherapy, phytotherapy, treatment with leeches, aerophytotherapy, music therapy, chromotherapy, ozone therapy);
• other physical culture services (discussed individually and specified in the insurance contract).

The Aesthetic Procedures program reimburses the costs of:

• blood plasma, hyaluronic acid, botulinum injections;
• cosmetic, plastic surgeries, plastic aesthetic surgeries for eyelids, cosmetological and beauty procedures (facial cleansing, aesthetic, body line improvement, anti-cellulite, body scrubbing, wrapping, rubbing, hair removal, etc.);
• treatment of aesthetic dermatology, as well as acne, rosacea, erythema, dilated blood vessels, vascular structures, blemishes, pigmentation disorders, scars, stretch marks and the like. treatment, and the use of functional, diagnostic equipment, devices, tools directly related to these procedures (including phototherapy, photodynamic therapy, pulsed light therapy, laser treatment);
• consultations of a trichologist, dermatologist-trichologist, diagnosis and treatment of hair loss;
• teeth whitening, lamination, aesthetic filling.