How does health insurance work?

By default, the TU Zdrowie health insurance contract provides reimbursement of the cost of a consultation with any doctor. The benefit amount varies depending on the terms and conditions of the contract and may amount up to 100% of the value of rendered services. Importantly, the Insured has no prior need to inform TU Zdrowie about their intention to seek reimbursement. It is sufficient that the Insured fills in an electronic request form and attaches a scan or photo of the bill via the Insured’s panel or application. TU Zdrowie will then make the reimbursement, and the benefit will be paid out within a few days.
Moreover, health insurance guarantees accessibility, making it especially important in times of the pandemic and restricted access to public health care. Contracts concluded with TU Zdrowie guarantee access to internists, pediatricians and family doctors within one day, and to the most frequently consulted specialists within a maximum of three days. The exception is a few rare specialties, where the appointment waiting time may stretch out by 5 to 7 days. Under the terms and conditions of the contract, the insurer is obliged to reimburse 100% of the costs incurred by the Insured in case of failure to meet these deadlines. Importantly, the availability standards also specify the maximum travel distance between the place of service and the place indicated by the Insured. Moreover, a physician working with TU Zdrowie may order examinations and select treatment methods following, first of all, their medical knowledge and experience as opposed to costs.
We do not report situations, in which our Insured would complain about the lack of doctors’ availability. The Insured enjoy absolute freedom to decide whether they prefer a telemedicine or stationary consultation, regardless of the region of Poland they live in or their current location. The contract guarantees finding a medical facility within a radius of up to 40 km, and if this condition cannot be met, TU Zdrowie reimburses 100% of the incurred costs - says Dariusz Grądziel, Sales Director at TU Zdrowie.
The insurance model provides numerous benefits also for the employer. First of all, it arranges the performance of employee medical examinations in accordance with the binding legal regulations. Personnel departments are provided with a free management program - E-platform for Occupational Medicine, allowing them to supervise the timing of preventive examinations for employees, issue referrals for preventive examinations and coordinate additional preventive actions, such as vaccinations or screening tests. With HR departments in mind, TU Zdrowie has also launched a new functionality - e-Declarations. Upon its launch, the HR department enters into the system a list of employees eligible for benefits and the appropriate insurance variant(s). Then it is enough to redirect the employee to their account in the Insured Panel, where they can electronically declare the choice of medical package for their employer. Upon acceptance by the Employer, the data entered by the Employee are automatically transferred to the list of persons covered by the insurance coverage.