Supplementary medical insurance is a type of additional insurance coverage to the basic insurance. Supplementary health insurance covers the costs of various medical services such as hospitalization, outpatient surgery, and even severe diseases such as cancer or heart attack up to the specified coverage limit in the insurance policy. On the other hand , the supplementary treatment insurance policy includes some costs of medical and treatment services that are not covered by the basic insurance (such as dental and vision costs).
%20(1).jpg "Supplementary medical insurance is a type of additional insurance coverage to the basic insurance. Supplementary health insurance covers the costs of various medical services such as hospitalization, outpatient surgery, and even severe diseases such as cancer or heart attack up to the specified coverage limit in the insurance policy. On the other hand , the supplementary treatment insurance policy includes some costs of medical and treatment services that are not covered by the basic insurance (such as dental and vision costs).")
Additional treatment insurance inquiry
Inquiring about supplementary medical insurance is necessary in the following conditions:
Inquiring about the authenticity of supplementary medical insurance to know about the validity of the insurance policy by referring to the Sanhab system of the Central Insurance Organization
Inquiring about the price of additional medical insurance to compare the coverage and price of additional insurance in different insurance companies by referring to the price inquiry and purchase page on the Ezki website.
Types of supplementary insurance
Supplementary medical insurance is provided in the form of different plans. Supplementary insurances are categorized as follows:
Individual supplementary insurance
Group supplementary insurance
Supplementary family insurance
Individual supplementary insurance
Individual supplementary insurance is a type of single and separate health insurance policy that is issued only for one person. Everyone can get additional insurance by having basic insurance. Individual supplementary insurance includes all group supplementary insurance coverages. Only the price of individual supplementary insurance is higher than group or organizational supplementary insurance. Of course, the amount of individual supplemental treatment insurance premium depends on the limit of selected obligations of the insurance policy and the type of coverage, and the higher the limit of obligations we choose, the higher the amount of individual insurance premium.
In addition, this organization provides additional individual social security insurance for the retirees of the social organization.
Supplementary family insurance
Family supplementary insurance is actually the same individual supplementary insurance that a person can simultaneously cover himself and his family members under a medical insurance policy. If the head of the household does not have additional insurance from the workplace, he can buy additional family insurance and insure his wife, children, and even his parents.
group supplementary insurance (organization)
All companies, workshops and all types of work environments can buy group or organizational supplementary medical insurance for their personnel and employees. Premiums for group supplementary insurance are lower than individual supplementary insurance policies. At the time of purchasing supplementary organizational insurance , the employer himself chooses the type, number of coverages and also the limit of obligations for his personnel. In addition, the insured can cover their dependents such as first-degree family members (father, mother, spouse and children) under the organizational supplementary insurance.
Types of supplementary medical insurance coverage
Depending on the type of insurance policy and the conditions of individual or family supplementary insurance, the coverage of each supplementary health insurance is different. In general, the list of supplementary medical insurance covers are:
Row
Supplementary insurance coverage
Hospitalization costs for surgery (general and specialized), types of stone breakers, chemotherapy, radiotherapy, cardiac angiography (general and specialized) and Gamanaife in hospitals and surgical centers of the contracting party
The cost of highly specialized and sensitive surgeries such as specialized surgeries related to cancer, heart, brain and central nerves and spinal cord, gamma knife, kidney transplant, liver transplant, lung transplant and bone marrow transplant.
The cost of diagnostic paraclinical services such as ultrasound, mammography, scans, CT scans, endoscopy, MRI, echocardiography, stress echo, densitometry
The cost of other diagnostic services such as exercise test, allergy test, breathing test (spirometry-PFT), muscle tape (EMG), nerve tape (NCV), brain tape (EEG), bladder tape (cystometry or cystogram), audiometry, optometry, Holter monitoring Heart and angiography
The cost of permitted outpatient surgeries, including fractures and dislocations, casts, circumcision, sutures, cryotherapy, excision lipoma, cyst drainage, laser therapy, and biopsy.
The cost of laboratory services including pathology, pathology and medical genetics, types of radiography, ECG, physiotherapy
City and intercity ambulance fees
Other supplementary health insurance coverage
Additional insured can add the following coverages to the insurance policy if needed:
Costs of childbirth, both natural and caesarean section
Costs related to infertility and infertility, including related surgeries such as IUI, ZIFT, GIFT, microinjection and IVF
Chemotherapy
Reimbursement of the cost of correction of refractive errors of the eye
Visit and medicine
The cost of emergency services in non-hospital cases
Dentistry (tooth extraction, massaging, brosage, restoration and filling, root and crown treatment)
The cost of procuring natural body organs for transplantation is up to the amount of the basic annual commitment
Costs of fetal abnormalities and diseases (screening tests)
Preparation of erots
Benefits of supplementary medical insurance
The payment share of basic insurances such as social security insurances or medical services for covered medical and treatment expenses is usually at most 30%. But in most cases, the cost of treatment and diagnostic work, even a test or a simple CT scan, is very high. Many clinical, laboratory and paraclinical services are practically not covered by basic insurance. The main advantage of supplementary treatment insurance is the maximum compensation of the cost of medical and hospital work. This insurance policy compensates almost all or at least a large part of medical expenses.
Individual and family supplementary insurance conditions
Issuance of individual and family supplementary insurance has the following conditions:
The age of the main insured should be at least 18 years and at most 70 years.
The insured must have basic insurance such as social security insurance or medical services. (Of course, some companies, such as Saman Insurance, issue individual supplementary insurance without basic insurance, but in this case, the premium for supplementary treatment is higher.)
Male children up to the age of 22 and female children up to the age of 18 can be covered by supplementary family insurance. Of course, unmarried girls over 18 years old and boys over 22 years old who are studying are still considered dependent on their parents.
Calculating the cost of additional insurance
The price of supplementary insurance is calculated based on the number of requested coverages and the limit of selected obligations of the insurance policy. That is, the higher the number of insurance policy covers and the higher the payment of obligations, the higher the cost of additional insurance. On the other hand, insurance premiums are higher for older people. For example, the cost of individual supplementary insurance for people aged 60 to 70 and also between 71 and 80 years old is added with different percentages.
Most insurance companies have different plans for supplementary insurance that have different types of coverage and limits of obligations.
Medical insurance deductible
The amount of medical insurance deductible is calculated between 10 and 30 percent according to the conditions of the insurance policy. That is, the share of the insured will be 10 to 30 percent of the medical expenses, and the insurance company will pay 70 to 90 percent of the cost. If the insured has basic insurance, the basic insurer will pay 30% of his deductible. Otherwise, the franchise share will be deducted from him.
Additional insurance premium payment
The supplementary insurance premium can be paid in one go or in installments of six, eight or twelve months from receipt.
Payment of supplementary medical insurance
To receive damages from supplementary insurance, we can act in two ways:
To perform medical services in the centers of our supplementary insurance contract:
In these centers, there is no need to pay for testing or taking a CT scan photo, etc., and we only need to declare the insured's national code to the reception of the contracting party's medical center. Of course, sometimes some centers ask for a letter of introduction from the supplementary insurance company.
Refer to the non-contracting centers:
In these centers, we have to pay the cost ourselves first and then get the cost from the insurance company. Of course, we must deliver the invoice of the treatment costs along with the original certificate and doctor's order, the original images of radiography, ultrasound, angiography, etc. to the insurance company. In fact, we must inform the insurance company of the cost of the services performed at most 5 to 10 days after receiving medical services.
Buy additional medical insurance from Ezki website
To buy additional insurance from the Ezki site, you must complete the following 6 steps:
Select the individual or family option and then enter the basic information including the age of the insured and the name of the basic insurance. If the buyer of supplementary insurance does not have basic insurance, he must select the option "I do not have basic insurance".
According to the entered information, a list of supplementary insurance plans is displayed to the buyer and he can compare the prices, coverages and limits of supplementary insurance obligations of different insurance companies.
After choosing the selected supplementary insurance plan and his approval, the profile of the insured and the limit of the obligations of the plan will be displayed for him. At this stage, the buyer can return to the previous stage to change his plan.
The buyer must enter his full information including name, surname, contact number, residential address, national code and zip code in the form.
Download two questionnaire forms for health certificate and supplementary insurance proposal and select the information confirmation option.
At the last stage, upon receiving the order number, amount and date of registration, the purchase process is completed and Ezekiel experts will contact the insurance buyer to follow up on the order.
The following documents are required to purchase additional individual or family insurance
Completed supplementary treatment insurance policy application form
Completed health questionnaire form
The first page of the birth certificate and national card (in supplementary family insurance, it is required separately for all family members.)
A copy of the first page of the insurance book with at least one month validity (in supplementary family insurance, it is required separately for all family members.)