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Terms and Conditions Essentialvård Valid from 2021 01 01 ESSENTIALVÅRD Insurance Terms and Conditions Contents 1 General ......................................................................................................................................... 3 1.1 About the insurance ............................................................................................................ 3 1.2 Definitions ............................................................................................................................... 3 1.3 When does the insurance apply ................................................................................................. 4 1.4 Where does the insurance apply ................................................................................................ 4 1.5 Transfer from other group or insurance company ........................................................................ 4 1.6 Renewal and changes ................................................................................................................ 5 1.7 Personal data ........................................................................................................................... 5 1.8 The Swedish claims register ....................................................................................................... 6 1.9 The premium ........................................................................................................................... 6 1.10 Post-employment cover .......................................................................................................... 6 1.11 Continuation insurance ........................................................................................................... 7 1.12 Transfer and pledge ................................................................................................................ 7 2 Who the insurance covers ........................................................................................................... 7 2.1 Insured ................................................................................................................................... 7 2.2 Co-insured ............................................................................................................................... 7 2.3 Requirements .......................................................................................................................... 8 3 Using the insurance......................................................................................................................... 8 3.1 How to make a claim ................................................................................................................. 8 3.2 Examination and treatment must be pre-approved ...................................................................... 9 3.3 Pre-existing conditions .............................................................................................................. 9 3.4 Choice of treatment and provider ............................................................................................... 9 3.5 Examination and treatment guarantee ........................................................................................ 9 3.6 Annual maximum insurance cover ............................................................................................ 10 3.7 Deductible ............................................................................................................................. 10 3.8 Period of limitation ................................................................................................................. 10 3.9 Right of recourse .................................................................................................................... 10 4 What the insurance covers............................................................................................................. 10 4.1 Expenses for treatment ........................................................................................................... 10 4.2 HealthNavigator ..................................................................................................................... 11 4.3 Chronic diseases* ................................................................................................................... 11 4.4 Pain diagnosis ........................................................................................................................ 11 Page | 1 DSS Hälsa AB | Torshamnsgatan 20, 164 40 Kista, Sverige | Reg.no. 556751–0424 | Health department: +46 8 4000 6121 | Sales: +46 8 4000 6122 | www.dss-halsa.se 4.5 Medical doctors ..................................................................................................................... 11 4.6 Digital health service ............................................................................................................... 12 4.7 Follow-up examinations .......................................................................................................... 12 4.8 Medical rehabilitation after surgery/hospitalization ................................................................... 12 4.9 Home assistance..................................................................................................................... 13 4.10 Prescribed medicine .............................................................................................................. 13 4.11 Transport expenses ............................................................................................................... 13 4.12 Physiotherapist, naprapat, chiropractor and osteopath ............................................................. 13 4.13 Psychologist/psychotherapist ................................................................................................. 14 4.14 Trauma counselling ............................................................................................................... 14 4.15 Hotline for well-being ............................................................................................................ 15 4.16 Dietician .............................................................................................................................. 15 5 Optional covers ............................................................................................................................ 15 5.1 Addiction treatment ............................................................................................................... 15 6 What the insurance does not cover ................................................................................................. 16 6.1 Medical conditions and diagnoses ............................................................................................ 16 6.2 Treatments and forms of treatment ......................................................................................... 18 6.3 General limitations ................................................................................................................. 19 6.4 Force majeure ........................................................................................................................ 20 7 If you are dissatisfied .................................................................................................................... 20 7.1 Complaints submitted to the Company’s Insurance Board ........................................................... 20 7.2 Public complaints offices ......................................................................................................... 20 7.3 General court ......................................................................................................................... 21 7.4. Independent advice ............................................................................................................... 21 Glossary ......................................................................................................................................... 22 Fully fit for work .......................................................................................................................... 22 Completely healthy ...................................................................................................................... 22 Chronic diseases .......................................................................................................................... 22 Immediate family ......................................................................................................................... 22 Musculoskeletal system ................................................................................................................ 22 Obesity and overweight ................................................................................................................ 22 Professional sport ........................................................................................................................ 22 Contact information ........................................................................................................................ 23 Page | 2 DSS Hälsa AB | Torshamnsgatan 20, 164 40 Kista, Sverige | Reg.no. 556751–0424 | Health department: +46 8 4000 6121 | Sales: +46 8 4000 6122 | www.dss-halsa.se 1 General 1.1 About the insurance The insurance consists of: 1. The group agreement, 2. the insurance policy with related documents and 3. these terms
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