According to the law, employees of commercial, industrial, manufacturing and service institutions must be covered by one of the insurance organizations such as social security organization, medical services, armed forces, etc. These organizations compensate expenses such as doctor's visit fees, medicine, tests, and treatment costs in the hospital according to their tariffs, which are far lower than the tariffs applied by the treatment network. This tariff difference has caused the insured person to bear most of the costs, especially hospital costs.
Organizations, companies, factories, institutions, commercial complexes, etc., whose number of employees is more than 50 people, can purchase this insurance policy and benefit from its benefits.
For this reason, "Bimama Ma" company designs and supplies appropriate excess treatment insurance or supplementary treatment insurance for the excess costs that the primary insurer does not compensate and the burden is on the insured. Employers, managers, guilds, organizations and institutions can purchase this insurance policy for their employees if they wish.
Supplementary health insurance
Since not all people are members of an organization or organization and company that can use supplementary medical insurance as a group, our insurance company has offered supplementary insurance plans for individuals and families. In individual and family supplementary insurance, the company shall pay the same obligations based on the terms of the insurance policy and the agreed deductible.
The family treatment insurance policy of "Ma" insurance company is offered simultaneously with the purchase of the life and investment insurance policy under the title of "Sepas Plus" through all branches and agencies across the country.
Eligible groups to receive supplementary medical insurance
The group was formed for a purpose other than the use of supplementary health insurance benefits.
Have a primary insurance group
At least 70% of the group members should apply for insurance based on the list of insurance premium payments to the primary group insurance
To have a group of documents and documents such as activity license, business license, etc. from competent authorities.
Medical insurance coverage
The insurer's obligations are to compensate all the medical and hospital expenses of each of the insured, which can be paid based on the terms of the contract and according to the obligations in the table below and in compliance with the agreed upon deductible.
Reimbursement of hospitalization expenses for medical treatment, general and specialized surgeries
Reimbursement of childbirth expenses including natural childbirth, cesarean section and diagnostic curettage
Reimbursement of paraclinical expenses including: ultrasound, mammography, radiotherapy, types of scans, types of CT scans, MRI, echocardiography, exercise test, muscle tape, nerve tape, brain tape, and eye angiography.
Compensation for the costs of outpatient surgeries including: fractures, casts, circumcision, sutures, cryotherapy, excision, lipoma, cyst drainage and laser therapy.
Reimbursement of the costs of fixing refractive errors of the eye
Reimbursement of ambulance service costs
Reimbursement of dental expenses
Reimbursement of drug, visit, test and radiology expenses
Eligible people to receive medical insurance coverage
All official, contract and contractual employees who are employed full-time by the insured, along with their dependents.
Male children up to the age of 22 years and in the case of full-time studies with a full-time education certificate up to the age of 25 years. In the case of students, by presenting the education certificate up to the age of 25 years and in the case of medical and doctorate students up to the age of 26 years.
Female children until marriage or study
Babies from birth
In case of the death of the main insured during the contract period, his family will be covered under the condition of paying the insurance premium until the end of the contract.
If the age limit of the insured reaches the quorum during the contract period, they are covered subject to the payment of the insurance premium until the end of the contract.
In supplementary medical insurance, there are cases in which the reimbursement of treatment costs is not part of the insurer's obligation, and in other words, it is outside the scope of the insurer's obligations, these cases are under the heading of exceptions as follows:
Costs related to mental disability and total disability.
Hygiene and cosmetic products that do not have a medicinal aspect, except for the diagnosis of the trusted physician of the insurer.
Congenital defects, unless, according to the diagnosis of the attending physician and the approval of the company's trusted physician, its removal has a therapeutic aspect.
Surgery performed for cosmetic purposes, unless it is caused by an accident during the contract period.
Abortion, except in necessary and legal cases with the diagnosis of the attending physician.
Direct side effects caused by the consumption of narcotics, psychedelics and alcoholic beverages as determined by the attending physician.
Suicide and criminal acts insured as determined by competent authorities.
Natural disasters such as earthquakes, floods, volcanoes
War, rebellion, disturbance, riot, riot, strike, uprising, coup, military government and precautionary measures of military and police authorities, sabotage operations and according to the approval of competent authorities..
The cost of a private room, except in necessary cases, according to the diagnosis of the attending physician and the approval of the trusted physician of the insurer.
The cost of accompanying patients between 10 and 70 years old, except in necessary cases, as determined by the attending physician and approved by the insured's trusted physician.
Costs of group checkups and group examinations and occupational medicine.
Jaw surgery unless it is covered due to tumor or accident.
Correction of refractive errors of the eyes in cases where the degree of myopia, farsightedness, astigmatism or the sum of the absolute value of the visual impairment of each eye is less than 3 diopters according to the opinion of the trusted doctor of the insurer.
All medical expenses that are in the research stages and the Ministry of Health, Treatment and Medical Education has not announced their treatment tariff.