Are pre-existing medical conditions
covered?
Generally speaking, pre-existing medical conditions are not covered. When you complete your application for medical insurance, it is important that you declare all medical conditions/symptoms, either current or in the past that you have received medical treatment for. Subsequently, there are three possibilities: any past or existing medical condition will be excluded, any past or existing medical condition will be covered, or a premium charge rate will be applied so that you can benefit from medical insurance coverage.Are there waiting periods before insurance takes effect?
There are waiting periods for the following benefits:
- Maternity – 12 consecutive months of coverage;
- Preventive treatment – 10 consecutive months of coverage;
- “Dental and Optical” optional plan – 6 consecutive months of coverage and 2 years, respectively (for orthodontics)
All other identified benefits become available as soon as the policy comes into effect.
What should I do if I have a medical emergency?
In the event of an emergency, if the Insured Person cannot get in touch with us immediately, a person designated by the Insured Person must contact us on behalf of the Insured Person as soon as possible.
Alternatively, please make sure the hospital is aware of the patient having a valid insurance policy with us. Subsequently, we will contact the hospital representatives to arrange direct settlement of any costs incurred that are covered by the policy.
Outside MediHelp’s working hours, call the following number in case of emergency or for evacuation and repatriation requests:
(+40) 31 730 99 39.
If you receive outpatient treatment costing less than EUR 500, and the costs do not require pre-authorization, you can pay the costs in full at the time of receiving the treatment. Afterwards, you must file a claim for reimbursement of the incurred costs.
Can I access medical services anywhere I want, or are they available only in the partner network? What happens if the medical service can be performed in Romania as well (e.g. surgical intervention). Am I required to stay in Romania or am I allowed to go anywhere I want?
The international health insurance plans offered by MediHelp give you the opportunity to choose any healthcare service provider in your coverage area. Our partner network includes 1.4 million clinics with which we have already concluded a direct settlement agreement for hospitalization services.
By accessing https://select.axaglobalhealthcare.com/s/?expId=AXA_MDH_607 you can find a list of the healthcare service providers we have a direct collaboration with.
What is a deductible and how does it apply?
You may choose to apply an insurance deductible in order to reduce the annual cost of your insurance premium. If you then make a claim under the insurance policy, you will have to pay the amount of the deductible, and the insurer will settle the difference up to the limit of the benefits of your insurance plan. The deductible applies to each insured member per year of insurance.
What documents are necessary to make an insurance claim? How long will it take until my costs are reimbursed?
The costs are reimbursed within 7 (seven) working days of your sending the complete documentation to us, which must include:
- The Claim form, filled in entirely;
- A medical report;
- A detailed invoice;
- The proof of payment.
Unders which circumstances can an insurance claim be rejected?
The insurance claim can be rejected for any of the following situations:
- The submitted documents are incomplete;
- The submitted documents are illegible;
- The requested healthcare services are not covered by the insurance policy;
- The Insurance claim is sent to us after 6 months from the date of healthcare service provided;
- The limit of the benefit has been reached;
- The insurance claim submitted is for costs higher than EUR 500 that have not been pre-authorized;
- Additional information is required - in this case, the insurance claim will be re-examined after you provide us with the requested details.
What is the procedure for the pre-authorization of costs?
All costs in excess of EUR 500 must be pre-authorized. In the event of a planned medical treatment, we must be contacted at least:
• 48 hours in advance for outpatient treatment,
• 5 days in advance for inpatient treatment,
When you request pre-authorization for healthcare services, you will have to submit the following information:
- The date of the planned service;
- The name of the healthcare provider;
- The estimated costs;
- The type and the speciality of the medical service;
- Medical documents
Is support available (will I have access to a call-center)?
Support is available in Romanian 24/7.
From Monday to Friday, from 9 a.m. to 5:30 p.m., you will receive full support from the dedicated customer care department. The dedicated phone number is: +40 0311 097 046, and the e-mail address is: client@medihelp.ro
Outside working hours and on public holidays, please call the following telephone number: (+40) 31 730 99 39 - available only for emergencies.
Who is the Insurer? Who reimburses my medical costs?
MediHelp will help with the management of medical cases, with processing insurance claims, with the collection of insurance premiums, while the medical risk is taken over by Inter Partner Assistance (AXA Group).In a medical situation, will I be able to request recommendations from MediHelp (doctors/hospitals)?
Through your insurance policy, you can not only choose the clinic where you want to be treated, but you can also choose your doctor. We can help you with information about the clinics in your vicinity or in the country where you want to be treated, but the decision regarding the choice of the clinic and the doctor is yours.
Is direct settlement also possible for outpatient services?
Direct settlement is only available for inpatient services. For medical services performed on an outpatient basis (without hospitalization), when the costs are less than EUR 500, we provide a payment card.
With a payment card, you can pay the costs of the medical services directly to the healthcare provider of your choice. The card holder must inform MediHelp by phone at: (+40) 311 097 046, or by e-mail at: client@medihelp.ro at least 24 hours before the medical appointment, providing the following information: the date of onset and symptoms, the estimated cost, the chosen healthcare provider, the medical service required, and the speciality.
Within 48 hours of receiving the treatment, the Insured Person will be required to send MediHelp all relevant documents (the medical report, the detailed invoice etc.)
When costs are in excess of EUR 500, please obtain pre-authorization from us first.
Does a discount apply if I choose annual payments? What payment methods are available? Can I also pay in RON?
The insurance premium can be paid monthly, quarterly, semi-annually or annually. NO discount applies if you choose annual payment.
The premiums can only be paid in EUR, by bank transfer, by online payment platform, or by cash deposit in the account indicated in the payment notification.
Are there family packages available?
No, there are no family packages available; but family members can also be covered, and the premium is individual.
What the insurance does and does not cover?
Please access the Individual plans section, where you can find out which benefits are included or excluded in each individual plan. For further details, please contact us: contact details to be added
Can I only get my child insured?
Children under 18 can only be insured as a dependent on the insurance policy of one of the parents, who already benefits from a MediHelp insurance plan.
Will the insurance premiums increase every year? What if I use the policy?
Insurance premiums are reviewed on a yearly basis and they may increase for the following reasons:
- Moving to another age group;
- Medical cost inflation.
Unlike motor car insurance, your annual premium will not increase if you make a claim for medical treatment. Any increase in medical insurance premiums will apply to all insured persons, not individual persons.
Can I purchase an insurance plan for myself and a different insurance plan for my child?
The insurance conditions must be the same, because the child can only be insured as a dependent on the insurance policy of one of the parents until the age of 18.
If I have this insurance, do I need to purchase a travel insurance policy for when I am abroad?
The insurance policy will provide the coverage you opted for when you concluded the policy. You are also covered in emergency medical situations; in case you are hospitalized. Please compare your current MediHelp policy against and offered holiday insurance policy to see if the holiday insurance policy provides additional coverage. It is then up to you to decide if you need additional holiday insurance coverage.
