Definition of a claim

A claim or insurance claim is when an event (illness, accident, maternity) results in an insurance benefit.

What do I have to do in case of a claim?

The procedure to follow depends on the event, chosen insurance model and supplementary insurance.

What to do in case of illness?

Insurers who have chosen Sanitas TelMed (Compact One and CallMed variants) are obliged to first seek medical advice from the telemedicine center before visiting a doctor. CallMed insurers can also contact a partner pharmacy for an initial consultation.

What to do in case of an accident?

If you are employed for at least 8 hours a week with the same employer, accidents are processed directly via the employer’s accident insurance. If you are not in employment, your health insurance is responsible, provided that you have included the risk of accident in your basic insurance.

In each case, you have to complete an accident report and send it to the accident insurance company.

What to do in case of pregnancy?

Health insurance covers maternity benefits from the 13th week of pregnancy until 8 weeks after the birth without applying the deductible or copayment. To benefit from this rule, it is important that you inform Sanitas of your pregnancy as early as possible.

You can find more information about pregnancy here.

How do health insurers reimburse costs?

For the reimbursement of costs, it depends on which system the health insurance company uses to settle costs with the  healthcare provider