Confido Health Plan is a non-life insurance service (hereinafter health insurance) developed by the insurer, within the framework of which AS Arstikeskus Confido (hereinafter Confido, registry code 12381384, address Veerenni 51, Tallinn, 10138 Harju County) itself or through its cooperation partners or other healthcare providers offers its healthcare services for employees (and, if applicable, also their close relatives) within the limits of the agreed health insurance risk.
Indemnity limit is the maximum amount compensated per insured event. The indemnity limit is reduced by the indemnity paid.
Claims handling includes receiving and processing of loss reports, customer service, proposing a decision on compensation of damage to the insurer, and making a disbursement on behalf of the insurer.
Insured object is the health of the insured person and the risk of incurring costs related to the provision of health services necessary to maintain it, that is, the insurance risk.
Insured person is the employee referred to as the insured person in the insurance contract or their close relative. On the basis of the insurance contract, the health insurance risk related to the insured person as a third party is insured. If the policyholder excludes an employee from the insurance contract, it is assumed that this person is no longer an insured person.
Insurance agent is Tervisekindlustusagent OÜ (registry code 16572262, address Veerenni 51, Tallinn, 10138 Harju County).
Insurer is AS LHV Kindlustus (registry code 14973611, address Tartu mnt 2, Tallinn, 10145 Harju County).
Insured event is the provision of a healthcare service to the insured person during the period of valid insurance coverage, or the reimbursement of another health-related expense covered under the insurance contract, to the extent agreed in the insurance contract.
Insurance coverage is the insurer’s obligation, as defined by the terms of the insurance contract, to pay an insurance indemnity in the event of an insured event occurring during the insurance period, or to fulfil other obligations set out in the insurance contract.
Insurance contract is a health insurance contract concluded between an insurer and a policyholder, on the basis of which health insurance cover is provided based on the principles of non-life insurance. The insurance contract consists of the policyholder’s statement, conditions, description of insurance coverage, insurance policy, information sheet, and other documents proving the agreements concluded between the policyholder and the insurer. The insurance contract makes it possible to provide insurance coverage to the policyholder’s employees and, with an additional written agreement, also to the close relatives of the insured person. The conclusion of the insurance contract is intermediated by the insurance agent.
Insurance premium is the fee agreed in the insurance contract and paid by the policyholder or, if applicable, a close relative for insurance coverage.
Insurance period is the period of time specified in the insurance contract, during which the insurance coverage agreed with the insurance contract is in effect. If the insured person receives insurance coverage for the duration of the insurance period based on the insurance contract, then the insurance coverage applies to them from the time they join the insurance contract until the end of the insurance period unless the policyholder stops offering them insurance coverage under the insurance contract earlier.
Insurance policy is a document that confirms the conclusion and validity of an insurance contract and is communicated by an insurance agent to the policyholder after the conclusion of the insurance contract, amendment, or extension of the insurance period.
Sum insured or insurance amount is the maximum sum specified in the insurance contract, which is compensated for insured events per insured person during the insurance period. The sum insured is reduced by the benefits paid out.
Policyholder is a legal entity that wishes to provide health insurance to its employees and, if applicable, the close relatives of its employees and undertakes the obligation to pay the insurance premiums.
Close relatives are family members of the policyholder’s employee. Family members are spouses or partners, parents, and children up to 18 years of age. A close relative is an insured person under the insurance contract if the close relative has given a relevant confirmation. Unless otherwise indicated by the context, the same applies to the close relative to the employee specified in the terms and conditions.
Deductible is the part of the damage specified in the insurance contract, the costs of which are borne by the insured person in the event of an insured event.
Information sheet is the standard form of the insurance product information document stipulated by the European Commission Implementing Regulation (EU) No. 2017/1469.
Healthcare service is the activity of a healthcare worker or institution to prevent and diagnose health problems and to restore health (including the sale of goods specified in these terms and conditions or in the insurance contract, such as glasses, contact lenses, orthopaedic aids, prescription medicines, or other such items).
Healthcare service provider is a healthcare provider registered in the Republic of Estonia who is entered into the Health Board registry, has a corresponding licence to provide healthcare services or has a valid professional certificate.
Marketing includes, among other things, the conclusion, amendment, and termination of insurance contracts, as well as the collection of insurance premiums.
Employee is a person who works on the basis of a valid employment contract, management board member agreement, or other service relationship contract for the benefit of the policyholder.
Supplementary insurance coverage is protection granted to the insured person by additional agreement, which is subject to the same principles and limitations as the primary insurance coverage, unless otherwise provided in the contract.
Authorized person is a person designated by the insurance agent and the policyholder whom they have authorized for data exchange in connection with the conclusion and execution of the insurance contract, including the transmission of encrypted data.