Corporate health insurance

 

IRAO offers an exclusive terms and conditions of  Health Insurance to each Corporate Client or Organization.

The general terms of Corporate Health Insurance:

IRAO – Assistance:

  • Considers access to 24-hour phone consultation service: the Company’s Hot Line:(+995  32)-2 949 949, provision of comprehensive information regarding health insurance plans and provider clinics, as well as assistance in planning visits to IRAO Family Doctor and arranging medical services for the insured;

Emergency Care:

  • Considers  provision of  first aid emergency medical care by the ambulance crew as well as transportation to an appropriate medical institution in accordance with medical indication;
  • To receive emergency ambulance services the insured should  call to IRAO (+995 32) -2 949 949, which then will arrange the mentioned service;

Family Doctor Services:

  • Considers provision of medical consultation by IRAO Family Doctor, including creating and maintaining medical records for each insured person, controlling reasonableness of prescribed medical examinations and treatment, in case of necessity provides insured with referral letter and monitors health condition of the insurer;
  • To receive family doctor service the insured should call to IRAO-Assistance (+995 32) -2 949 949, which  will arrange the mentioned service;

Prevention Tests/Examinations:

  • Considers provision of medical check-up without any medical evidence and includes general blood test, general urine test, ECG and ultra-sound of one organ.
  • Inured can receive Prevention tests/Examination only at contractor clinics according to IRAO Family Doctor’s location based on the referral letter;

Out-patient Services:

  •  Considers provision of necessary medical interventions at a licensed medical institution due to worsening of health conditions during the insurance period without the need for a patient to stay at the clinic for more than 24 hours;

Emergency Out-patient Care:

  • Considers out-patient  medical interventions due to worsening of health conditions, delay of which will cause the significant worsening of the health condition of the insured, and/or invalidity and/or death
  • To receive emergency out-patient care it is necessary to inform IRAO-Assistance (+995 32) -2 949 949 as soon as the accident happens or before the insured is discharged from the clinic. At the contractor clinic, in case the insurer agrees to reimburse service costs, the insured pays only copayment share. At a non contractor clinic the insured pays a full cost of the service and submits to the  insurer all  the necessary medical and financial documentation certifying the receipt of medical services as well as additional documentation if required within 10 work days.

Planned Out-patient Services:

  • Considers  provision of the following  out-patient services  at an appropriate licensed medical institution based on  the medical evidence and  patient’s  health needs: 1) Consultations by a Specialist Doctor;2) Laboratory tests;3) Instrumental examinations;4) Out-patient interventions and treatment
  • The insured  can receive  Planned  outpatient services  at a contractor medical facility based on the referral  issued by  IRAO Family Doctor, and pays only specified share of the service costs in compliance with the insurance plan.  The insured  can also  receive  planned out-patient  services at an appropriate licensed non-contractor medical services, where he/she pays the full cost of medical services. In this case, the reimbursement  of the relevant  expenses will be made within 10 working days after submitting  to the insurer the  appropriate medical and financial documentation confirming the  obtained medical services, and additional documentation, if necessary.

Medications:

  • Considers  reimbursement of the costs of medicines  for  the insured  based on the  insurance plan and  in accordance with IRAO family doctor’s and / or the relevant licensed specialty doctor  ‘s prescription, which is  based on medical evidence and is necessary for  medical treatment (the subject to approval once at a time is reimbursement of  one month medication only);

Hospitalization:

  • Considers provision of necessary medical interventions at a licensed medical institution due to worsening of health conditions during the insurance period with the need for a patient to stay at the clinic for more than 24 hours;
Urgent Hospital Services:
  • Considers urgent in-patient medical interventions at an appropriate licensed medical institution due to worsening of health conditions, delay of which based on medical evidence may cause significant worsening of the health condition of the insured and/or invalidity and/or death.
  • In order to receive  accident and Urgent Hospital services  the insured should  notify  the insurer about the accident immediately (within 24 hours after hospitalization of the patient)  at IRAO-Assistance (+995 32)- 2 949 949;

Planned Hospital Services:

  •  Considers  provision of planned therapeutic and/or operative in-patient services at an appropriate licensed medical institution based on medical evidence  and  patient’s  health needs;
  •  Cardiac surgery and oncology  services will be reimbursed under the planned hospitalization limit;
  •  Planned hospital services should be agreed with the insurer: all the preliminary medical and financial documentation must be presented to the insurer in advance;

Emergency Dental Services:

  • Dental Services consider such emergency  dental treatment as  acute pain relief, X-ray, channel opening and tooth extraction at a licensed dental  care facility;
  •  In case of need of Emergency  Dental care services  the insured should  inform IRAO Assistance (+995 32 2 949 949) immediately or before the discharge from the medical institution;

Planned Dental Treatment:

  •  Considers compensation of expenses of treatment of caries, diseases of pulp and periapical tissues, as well as planned dental surgery, hygienic teeth cleaning (once a year). The Insurer may not compensate costs for diagnostics and treatment of  periodontal , gingival and edentulous alveolar ridge diseases.
  •  The Insured can receive the services  only at IRAO provider dental clinics after notifying  IRAO Assistance.

Pregnancy:

  • Considers compensation of expenses for pregnancy related medical services and treatment according to medical indications;

Delivery:

  • Considers compensation of expenses for Physiological childbirth  and/or cesarean section (performed based on medical indications).

For more information please call the Company’s Hot-Line: (+995 32) 2 949 949