Insured Person’s Zone

POLISA ZDROWIE (Policy “Health”) gives a possibility to make use of services covered by the insurance in any medical facility in Poland.

You may use services in medical facilities and doctors’ offices that are not part of TU ZDROWIE partnership network on a reimbursement basis, i.e. the cost of the service will be returned to you.

This gives you freedom of choice as to where you wish to undergo a treatment.

• Make an appointment directly at a chosen medical facility
• Pay for the service
• Ask for a receipt or an invoice with your name on it.
• Fill in a Benefit Claim Form – a paper version or an electronic version on the Insured Person’s Platform
• Send the form to TU ZDROWIE

Within 30 days of receiving a set of documents, TU ZDROWIE will reimburse allocated amount for the service to a bank account provided in the claim form.

Remember that the cash benefit (reimbursement) is limited by the Upper Payment Limit (UPL) and is paid out for a specific medical service covered by the insurance.

NOTE: The invoice/receipt must be issued to the Insured Person (in case of a child, to a legal guardian) and contain the following information:

• name of the medical service
• quantity of each medical service provided
• date of the service
• cost of the provided service

If the service was provided to an insured child, please write the name of the child in the description of the claim form. 

NOTE: Make sure that your insurance covers the possibility to make use of medical services on the basis of reimbursement – return of the medical services costs payable up to the Upper Payment Limit (UPL)

1. 1. Log in to the Insured Person’s Platform
2. 2. Click the “Benefit Claim Form” tab
3. 3. Fill in the form and attach a legible scan or photo of the receipt/invoice (containing all the necessary details) and of a doctor’s referral if you claim reimbursement for diagnostic tests or rehabilitation
4. 4. Submit the form via the Insured Person’s Platform.

WHEN IS A REFERRAL NECESSARY?

A doctor’s referral is necessary only in case of diagnostic tests and some of medical treatments.

If you need to have a CT or MRI scans done, or you require rehabilitation treatments, prior to using the service, you should send a copy of the referral to an email ubezpieczenia@tuzdrowie.pl

You may send the referral via the Insured Person’s Platform by filling in the APPLICATION FOR AN INDIVIDUAL CONSENT TO CLAIM BENEFITS.

If you have preferences as to where the medical services should be performed, please provide details (name and address) of the medical facility in the message or in the note section of the form.

Remember that referrals for diagnostic tests are valid for 3 months from the date they were issued, and referrals for rehabilitation treatments for 1 month from the date they were issued.

WHEN IS A SERVICE AUTHORISATION NEEDED?

Service authorisation is necessary if you need to have a CT or MRI scans done, or you require rehabilitation treatments.

Before having any of those services performed, you should send a copy of the referral to ubezpieczenia@tuzdrowie.pl or in a form of MMS to phone number 723 444 999.

You may send the referral via the Insured Person’s Platform by filling in the APPLICATION FOR AN INDIVIDUAL CONSENT TO CLAIM BENEFITS.

If you have preferences as to where the medical services should be performed, please provide details (name and address) of the medical facility in the message or in the note section of the form.

Remember that referrals for diagnostic tests are valid for 3 months from the date they were issued, and referrals for rehabilitation treatments for 1 month from the date they were issued.

WHAT DOCUMENTS SHOULD YOU TAKE WITH YOU?

You should have a document confirming your identity with you.

The primary document is your ID card. Additionally, it is recommended that you have your Insurance Card. 

If the medical service requires a referral you should have it with you when going to a medical facility or a doctor’s office.

CASH BENEFIT CLAIM FORM (paper version):

1. 1. Download the Benefit Claim Form
2. 2. Fill in, print out and sign the form
3. 3. Attach the original or a legible copy of the invoice/receipt (containing all the necessary information)
4. 4. Attach a copy of a doctor’s referral, if you claim reimbursement for diagnostic tests or rehabilitation
5. 5. Send the set of documents to TU ZDROWIE’s following address:
   TU ZDROWIE S.A.

   ul. Śląska 17

   81-319 Gdynia

   „Benefit Claim Form"

In the Insured Person’s Platform by clicking the “Check Your Insurance Scope” tab, or by calling our Contact Center to the number 58 888 2 999.

Service authorisation is necessary if you need to have a CT or MRI scans done, or you require rehabilitation treatments. 

Before having any of those services performed, you should send a copy of the referral to ubezpieczenia@tuzdrowie.pl or in a form of MMS to phone number 723 444 999.

You may send the referral via the Insured Person’s Platform by filling in the APPLICATION FOR AN INDIVIDUAL CONSENT TO CLAIM BENEFITS    

If you have preferences as to where the medical services should be performed, please provide details (name and address) of the medical facility in the message or in the note section of the form. 

Remember that referrals for diagnostic tests are valid for 3 months from the date they were issued, and referrals for rehabilitation treatments for 1 month from the date they were issued. 

A doctor’s referral is necessary only in case of diagnostic tests and some of medical treatments. 

If you need to have a CT or MRI scans done, or you require rehabilitation treatments, prior to using the service, you should send a copy of the referral to an email ubezpieczenia@tuzdrowie.pl or in a form of MMS to the following phone number 723 444 999.

You may send the referral via the Insured Person’s Platform by filling in the APPLICATION FOR AN INDIVIDUAL CONSENT TO CLAIM BENEFITS    

If you have preferences as to where the medical services should be performed, please provide details (name and address) of the medical facility in the message or in the note section of the form. 

Remember that referrals for diagnostic tests are valid for 3 months from the date they were issued, and referrals for rehabilitation treatments for 1 month from the date they were issued. 

You should have a document confirming your identity with you.
The primary document is your ID card. Additionally, it is recommended that you have your Insurance Card.
If the medical service requires a referral you should have it with you when going to a medical facility or a doctor’s office.  

POLISA ZDROWIE provides access to a wide range of medical services such as medical consultations, diagnostic tests, preventive vaccinations, house calls, rehabilitation and more. The scope will differ, depending on the chosen variant. 

You can check your scope of insurance any time via the Insured Person’s Platform or by calling the Contact Center.

Keep in mind that diagnostic tests, selected procedures and rehabilitation are performed on the basis of medical indications – confirmed by a doctor’s referral 

TU ZDROWIE accepts referrals for diagnostic tests from all practitioners with a licence to practice. 

If you request a service via the Contact Center (CC), TU ZDROWIE guarantees the best service availability standards on the market:

• up to 1 working day – internists, paediatricians, GPs
• up to 3 working days – specialist practitioners ( up to 5-7 days in case of rare specialities)

or 100% reimbursement of cost incurred for a consultation in a freely chosen medical facility with any practitioner of a given specialisation, should meeting the standards be impossible.
In cases where a consultation with a SPECIFIC doctor of in a SPECIFIC medical facility is needed, the service performance times stated above may be extended, depending on an individual schedule of the given medical practitioner or facility.
All medical consultations, paediatric specialists included, are available without a referral, which also shortens the time of obtaining a service.
Details regarding service performance time guarantee can be found in the Catalogue of Benefits of POLISA ZDROWIE insurance.

Every insured person may choose the most convenient way for them to use the medical services, i.e: 

• Making appointments via the Contact Center (CC)
• Making appointments directly in medical facilities
• Requesting appointments via TU ZDROWIE website
• Online appointment booking in the Insured Person’s Platform (directly in doctor’s schedule)
• Reimbursement (cost return), e-reimbursement included
  
  

Every insured person can check their scope of insurance in the Insured Person’s Platform or by contacting the Contact Center.

Being covered by POLISA ZDROWIE (Policy „Health”), allows you to get treatment in any medical facility operating in the territory of Poland.

In the Insured Person’s Platform click the “Find Medical Facility” tab to easily check which medical providers in the TU ZDROWIE’s network are nearest to the location you choose.

By clicking the name of the medical facility you will find information such as: services that the facility provides and ways of making an appointment, as well as contact details.