Employer’s health insurance
A healthy and motivated employee is the employer’s most precious asset.
Why employer’s health insurance?
In Estonia, the national health insurance is at a good level; however, it is difficult to access medical services due to long waiting lists. ERGO employer’s health insurance complements the national health insurance and is a good source of added value in the employee motivation package. Voluntary health insurance covers the costs of paid medical services (such as dental care, rehabilitation, vaccinations, and paid doctor’s appointments) through insurance.
Complements the motivation scheme
An employer who supports health promotion is valued by every employee. Added value without additional tax expense.Reduced cost of employee health promotion
It is possible to cover the costs of the mandatory occupational health check, purchase of glasses, and vaccination.The employee is more efficient
Having received a quick solution to a health problem, the employee will return to their daily activities faster.What does ERGO employer’s health insurance cover?
Depending on the risk factors in the work environment, the needs of employees may differ. The employer can assemble the most suitable insurance solution for their company from different insurance covers.
Digital clinic services
In cooperation with Meliva, an employee insured at ERGO can use the general practitioner’s and family physician’s remote consultation service, regardless of location. A health problem can be solved even if you are unable get an appointment with your family physician, but medical care is necessary.
Outpatient family medicine and specialised medical services
The insurance cover for outpatient treatment includes the consultation fee of a paid family physician or medical specialist, as well as the costs of diagnostics, analyses, and examinations prescribed by the doctor.
Mental health cover
The insurance cover for outpatient treatment also allows the use of the cost of consultation with a paid psychiatrist and psychologist (including psychotherapist) and the cost of indicated diagnostics and examinations.
Hospital treatment
Hospital treatment insurance cover includes the indemnification of the cost of treatment for both inpatient and day-care services that are indicated to the insured person.
Vaccination
The insurance covers the costs of vaccinations performed during the insurance period.
Rehabilitation prescribed by a doctor
Covers the costs related to the services necessary for rehabilitation indicated by the doctor, including physiotherapist consultation, therapeutic massage, therapeutic gymnastics, etc.
Prophylactic health check
We will indemnify the insured employee at their own request and without a doctor’s referral for the cost of a paid examination, medical examination, analysis package, and health audit.
Dental treatment
We will indemnify the costs of the services provided by the dentist, including the visit fee, preparation of a treatment plan, dental treatment and hygiene services, and necessary examinations prescribed by a doctor, such as the X-ray. In addition, it is possible to insure the costs associated with orthodontics, implants, prosthetics, and the repair of prostheses.
What does ERGO employer’s health insurance cover?
Depending on the risk factors in the work environment, the needs of employees may differ. The employer can assemble the most suitable insurance solution for their company from different insurance covers.
In cooperation with Meliva, an employee insured at ERGO can use the general practitioner’s and family physician’s remote consultation service, regardless of location. A health problem can be solved even if you are unable get an appointment with your family physician, but medical care is necessary.
The insurance cover for outpatient treatment includes the consultation fee of a paid family physician or medical specialist, as well as the costs of diagnostics, analyses, and examinations prescribed by the doctor.
The insurance cover for outpatient treatment also allows the use of the cost of consultation with a paid psychiatrist and psychologist (including psychotherapist) and the cost of indicated diagnostics and examinations.
Hospital treatment insurance cover includes the indemnification of the cost of treatment for both inpatient and day-care services that are indicated to the insured person.
The insurance covers the costs of vaccinations performed during the insurance period.
Covers the costs related to the services necessary for rehabilitation indicated by the doctor, including physiotherapist consultation, therapeutic massage, therapeutic gymnastics, etc.
We will indemnify the insured employee at their own request and without a doctor’s referral for the cost of a paid examination, medical examination, analysis package, and health audit.
We will indemnify the costs of the services provided by the dentist, including the visit fee, preparation of a treatment plan, dental treatment and hygiene services, and necessary examinations prescribed by a doctor, such as the X-ray. In addition, it is possible to insure the costs associated with orthodontics, implants, prosthetics, and the repair of prostheses.
Additional health insurance covers
Additional health insurance covers are helpful in cases that are less frequent but may involve higher costs.
Additional cover for post-accident rehabilitation and aids
We will indemnify the costs of rehabilitation and aids necessary after hospitalisation, including crutches, wheelchair, support devices, support bandages, etc.
Additional cover for post-accident dental treatment
We will indemnify the costs of dental services necessary after an accident, including, for example, the costs of repairing and replacing damaged teeth, plastic surgeries, etc.
Additional cover for critical illnesses
The insurer will indemnify the cost of a serious illness or operation for the insured person. The insurer will indemnify the costs of outpatient or inpatient treatment for a critical illness, medicinal products prescribed during treatment, and rehabilitation, including aids.
The following are considered to be critical illnesses: active tuberculosis, Alzheimer’s disease before the age of 65, aortic surgery, aplastic anaemia, bacterial meningitis, hepatitis C, Crohn’s disease, organ or bone marrow transplantation, benign brain tumour, idiopathic Parkinson’s disease before the age of 65, HIV disease, complete loss of limb or limb function, complete and irreversible impairment of the ability to hear in both ears, partial or complete loss of speech ability, liver failure, multiple sclerosis, malignant tumour, cerebral stroke, Lyme disease, tick-borne encephalitis, coronary artery grafting, severe chronic renal failure, heart surgery, acute myocardial infarction, burns of the III and IV degree.
Inpatient rehabilitation
The insurer will indemnify the costs of inpatient rehabilitation after hospitalisation if rehabilitation has begun within 90 days after the end of active hospitalisation.
Mandatory occupational health check
The insurance contract can also cover the costs of the employer’s occupational health check pursuant to law.
Repatriation costs
The insurer will indemnify the costs of transporting a non-resident insured person to their country of permanent residence on the prescription of a doctor. In the event of the death of the insured person, the costs of cremation and burial in Estonia or the costs of repatriation of the insured person will be indemnified.
Prescription medications
We will indemnify the costs of medicinal products registered in the European Union and the related deductible, determined on the basis of a doctor’s prescription.
Cost of purchasing glasses and contact lenses
In the event of a change in visual acuity confirmed during the insurance period, the insurer will indemnify the cost of glasses and contact lenses determined on the basis of a doctor’s prescription.
Additional health insurance covers
Additional health insurance covers are helpful in cases that are less frequent but may involve higher costs.
We will indemnify the costs of rehabilitation and aids necessary after hospitalisation, including crutches, wheelchair, support devices, support bandages, etc.
We will indemnify the costs of dental services necessary after an accident, including, for example, the costs of repairing and replacing damaged teeth, plastic surgeries, etc.
The insurer will indemnify the cost of a serious illness or operation for the insured person. The insurer will indemnify the costs of outpatient or inpatient treatment for a critical illness, medicinal products prescribed during treatment, and rehabilitation, including aids.
The following are considered to be critical illnesses: active tuberculosis, Alzheimer’s disease before the age of 65, aortic surgery, aplastic anaemia, bacterial meningitis, hepatitis C, Crohn’s disease, organ or bone marrow transplantation, benign brain tumour, idiopathic Parkinson’s disease before the age of 65, HIV disease, complete loss of limb or limb function, complete and irreversible impairment of the ability to hear in both ears, partial or complete loss of speech ability, liver failure, multiple sclerosis, malignant tumour, cerebral stroke, Lyme disease, tick-borne encephalitis, coronary artery grafting, severe chronic renal failure, heart surgery, acute myocardial infarction, burns of the III and IV degree.
The insurer will indemnify the costs of inpatient rehabilitation after hospitalisation if rehabilitation has begun within 90 days after the end of active hospitalisation.
The insurance contract can also cover the costs of the employer’s occupational health check pursuant to law.
The insurer will indemnify the costs of transporting a non-resident insured person to their country of permanent residence on the prescription of a doctor. In the event of the death of the insured person, the costs of cremation and burial in Estonia or the costs of repatriation of the insured person will be indemnified.
We will indemnify the costs of medicinal products registered in the European Union and the related deductible, determined on the basis of a doctor’s prescription.
In the event of a change in visual acuity confirmed during the insurance period, the insurer will indemnify the cost of glasses and contact lenses determined on the basis of a doctor’s prescription.
Why choose ERGO health insurance?
A personal insurance solution and advisor for each company.
The insurance contract and the application for indemnity are conveniently available in the ERGO treatment app.
Wide network of medical partners.
ERGO health app
With the ERGO treatment app, insured employees can see the insurance covers selected for the insurance contract and submit an application for indemnity.
Company Health Insurance Medical Partners
By taking out insurance with ERGO, you can offer your employees worry-free claims handling, because at ERGO’s medical partners, the employee pays only the deductible.
Good to know / FAQ
Yes. In the case of a medical institution outside the list of ERGO partners, the insured person first pays for the outpatient medical care themselves and then submits an application for indemnity to ERGO together with a document certifying payment and a medical certificate. In addition, the following documents have to be attached to the medical bill:
- in the case of examinations and analyses, an extract from the medical history must also be submitted to ERGO;
- in the case of dental treatment, an invoice with a list of dental services issued in the name of the person who has received the treatment.
The family physician sees a valid contract for ERGO health insurance only if they are a partner of ERGO. In other cases, the family physician does not see the ERGO insurance contract.
The insurer indemnifies the costs up to the indemnity limit specified in the insurance policy. The indemnity limit is determined for the insurance period, not for the insured event.
If the dental treatment indemnity limit is used during the current period, then this cover will no longer be available during this period. In the new period, the dental treatment indemnity limit will be restored to the extent of the amount specified in the policy. The indemnity limit will not be restored in the new period with additional cover for critical illnesses in the case of a critical illness diagnosis that has already been indemnified.
The insurance cover starts after the conclusion of the insurance contract and after the expiry of the waiting period specified in the insurance contract.
Terms and conditions and information documents
General terms and conditions of health insurance contracts TI.0190.20
Effective as of 01.07.2020
Special terms and conditions of ERGO business health insurance TI.0191.20
Effective as of 01.07.2020
