Առողջության ապահովագրության Բրոշյուր · in-patient treatment for...
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Dear Costumer,
We are pleased to announce that medical insurance contract signed between “INGO
ARMENIA” Insurance CJSC and “VMWare Eastern Europe” LLC has been renewed with
improved coverage.
This brochure provides details of insurance coverage, application procedures, and the
list of partner medical institutions.
Contact us and we will take care of your health.
Please get acquainted with health insurance’s terms and conditions.
Please call INGO ARMENIA 24/7 Call Center in case of questions or for getting further
information:
+374 (10) 59-21-21
24/7 medical hotline (call center) as well as consultations of General Practitioner
Emergency medical aid of any type
Emergency medical repatriation and medical evacuation.
Medical consultations
Laboratory diagnostics
Instrumental diagnostics
Out-patient treatment for medical manipulations
Out-patient treatment for therapeutic diseases, which does not claim
in-patient conditions
Out-patient treatment for planned and urgent surgery
Out-patient treatment for traumas (fractures, dislocations, soft tissue bruises, wounds or
their combinations) in out-patient conditions
Out-patient treatment for burns, frostbite and electrical injuries
Out-patient treatment for infectious diseases
Out-patient treatment for mild cases of acute poisonings
Out-patient medicine
Medical supplies: syringes, intravenous drip systems, bandages, cotton
Required standard vaccinations and vaccinations proposed by the Chief Sanitary Inspector
of the RA in case of epidemic, if vaccinations are not carried out within State sponsored
programs
Home visit services (from out-patient medical center mentioned by Insurer)
Home laboratory instrumental examinations.
In-patient treatment for urgent therapeutic diseases
patient treatment for urgent therapeutic diseases
Surgical and conservative treatment
Laboratory and instrumental diagnostics
In-patient treatment for infectious diseases
In-patient treatment for traumas (fractures, dislocation, soft tissue
bruises)
OUT-PATIENT TREATMENT
IN-PATIENT TREATMENT
AMBULANCE
WHAT IS COVERED
In-patient treatment for internal and external hemorrhage
In-patient treatment for burns, frostbites and electrical injuries
In-patient treatment for acute poisonings
Intensive therapy and reanimation requiring urgent treatment conditions
Neurosurgical operations
Medical supplies: corsets, elastic socks, immobilization appliances, plastic mesh of hernia
up to AMD 50,000
Metallic constructions used for surgical treatment of traumas
Surgical treatment of the deformation of internasal septum and its complications up to
AMD 200,000 (the limit includes expenses for all pre-surgical laboratory and instrumental
examinations)
Compensation for hospital accommodation: AMD 15,000 per day.
Medicinal treatment of acute conditions of dystrophic spinal degenerative deteriorations
(osteochondrosis), as well as intervertebral disks degenerative deteriorations, hernias
Physiotherapy methods following drug treatment of dystrophic spinal degenerative
disorders (osteochondrosis), as well as intervertebral disks degenerative deteriorations,
hernias: electrophoresis, phonophoresis, UHF therapy, amplipulse therapy, ultraviolet
irradiation therapy, kinesitherapy, therapeutic massage: 2 courses during the Contract
period, each course 10 sessions
Surgical treatment of spinal hernia
Special Note: Health insurance contract does not cover diagnosis of degenerative spinal disorders through MRI, except for cases when Insured person undergoes the surgery of spinal hernia following MRI.
Electrotherapy: exercise therapy, electrophoresis, phonophoresis, UHF therapy, amplipulse
therapy, ultraviolet irradiation therapy, kinesitherapy, therapeutic massage - 2course of 10
sessions during the Contract period.
Refraction detection
Refractometria
Therapeutic ophthalmology
OPHTHALMOLOGY
VERTEBROLOGY
PHYSIOTHERAPY
Surgical ophthalmology, including cataract surgery
In case of dioptrias change optical lenses, spectacle frames and optical glasses
coverage with the limit up to AMD 20,000.
Prenatal care and related expenses for supervision of normal pregnancy which are out
of scope of state order are covered with the limit of AMD 60,000
Child delivery expenses, which are out of scope of state order are covered with the
limit of AMD 150,000, for child delivery through cesarean section AMD 220,000.
Reimbursement of inpatient medical expenses for complicated pregnancy
and/or costs related to complicated child birth/delivery and mother care
(compensation of parent’s hospital room price while the child stays in the hospital)
with the limit of AMD 350,000.
Special Note: For Insured persons, which are insured under this Contract for the first time 9
months waiting period is applied to this coverage.
Cardio-surgery (open hurt surgery)
Cardio-surgery (percutaneous coronary intervention).
Treatment of acute conditions of chronic diseases
Surgical treatment of chronic diseases, which leads to full or partial recovery of disease
or condition (planned surgery).
Consultations and laboratory-instrumental diagnostics with the purpose of
palliative supervision of chronic diseases, not listed in the Exclusions of the Contract.
Routine annual health check up is provided once in a Policy period at the following medical
centers:
ANNUAL HEALTH CHECK-UP
CARDIO-SURGERY
CHRONIC DISEASES
PREGNANCY AND CHILDBIRTH
“Vardanants” Innovative Medical Center,
“Dialab” Clinical Diagnostic Laboratory,
“Medline” Medical center,
“Elite-Med” Medical center,
“Shengavit” Medical center,
“Arabkir” MC
Specialist consultations:
General practitioner (pediatrist) Ophthalmologist (including visus test) Dentist Gynecologist/Urologist
Laboratory examination:
General blood test with leyko formula Urine general test Glucose analysis Lipid profile PAP test (for women) PSA test (for men above 45)
Instrumental examination:
Electrocardiogram Ultrasound of abdominal organs and small pelvis Ultrasound of thyroid gland, breast Test for thyroid gland hormones (TSH, T4Free)
To receive dental insurance coverage, Insured persons must undergo a preliminary medical examination at a medical center designated by the Insurer. The medical examination shall be conducted at the expense and the amount prescribed by the Insurer. Dental screening cards are not provided to Insured Persons. Claims of the Insured persons, not passing medical examination will be declined.
DENTISTRY
Below mentioned illnesses, cases, types of medical assistance,
examinations, conditions and other services, all these and any
related expenses are excluded from the coverage stated in the
Contract and are not subject to compensation despite of the fact
they are included in the insurance coverage separately.
Sexually transmitted diseases, identification analysis of it (syphilis, gonorrhoea, chlamydiosis, bacterial vaginosis (gardnereliosis), trichomoniasis, mycoplasmosis, ureoplasmosis, genital fungal lesions (candidiasis), cytomegalovirus, anal, genital herpes, herpes zoster etc.)
Surgical correction of diopter, treatment of keratoconus, including any method of its treatment
Supportive medicinal treatment of chronic diseases and conditions. Age-related changes or deteriorations where treatment is aimed at maintenance of
remission, Congenital anomaly, developmental defects (excluding surgical treatment of deformation
of intranasal septum, its complications), genetic diseases (periodic diseases etc.) All pre-existing diseases, injuries,medical conditions, whether declared or not, occurred
prior to commencement of the insurance policy, irrespective of whether the Insured
person knew about the disease, whenever the illness occurred objectively․ This exclusion
applies to Insured persons, who have been insured under the contract signed between the Insured and Insurer for the first time
Diabetes mellitus (I, II type), its consequences Diseases, when extrarenal blood cleaning is needed, including chronic renal insufficiency Sterility (primary, secondary) treatment, treatment of sexually dysfunctions,
contraception, artificial ovum fertilization, abortion, excluding involuntary emergency abortion by doctor’s prescription diagnosis, treatment of hormonal dysfunctions (dysmenorrhea, other hormonal disfunctions), diagnostic, other measures to ascertain other reproductive disbalances
HIV/AIDS, hepatitis B, C, D, E, F, its consequences, liver cirrhosis Mental, nervous disorders, borderline states, neurosis, compulsive thoughts, etc. Sleep and movement disorders Epilepsy, infantile cerebral paralysis Physiotherapeutic procedures not mentioned in the Contract, non-scientific (alternative)
diagnostic, treatment methods: homeopathy, phytotherapy, aromatherapy, hydrotherapy, mud cure, acupuncture, bio resonance diagnostics, diagnostics with Foll method, iridology, magneto therapy, energymedicine, scenar therapy, manual therapy, traditional systems of health improvement, experimental, exploratory treatment, telemedicine related services, extra corporal treatment
Cosmetic surgery, including plastic, reconstructive surgery (except in the case of such surgery following an accident occurred during the Policy period), neoplasms of derma, mucous tunic, birthmarks, polypus, papilloma, buttercups, etc.
Medical, other paramedical equipments, appliances, obtaining, placement, replacement of cardiac rhythm stimulating, regulating equipments, cardio rhythm disorder revealing, regulating operations (electrophysiological examinations, electroablation, etc.), cardioverter-defibrillators, hearing, visus aids, implants, as well as other corrective medical devices, appliances, including adjustment, obtaining, installation costs, prothetics, endoprothetics, all types of prosthetics, preparation to them, except for the cases, when this treatment is necessary as a result of injury occurring during the Policy period. Exceptions of this point are cases covered by the contract.
Any expenses incurred due to failure, refusal to follow doctor’s prescription Weight correction, speech defects correction Preventive, sanitary arrangements, immunoprophylaxis, training apparatus, solarium,
water treatments, etc. Therapeutic food, nutrition, biological additives (vitamins, etc.), care accessories, mineral
waters, drugs not licensed by RA Drug Inspection Tuberculosis, poliomyelitis Allergodiagnostics, scratch test Dermatomycoses, mycoses of nail, soft tissue, psoriasis, excema Systemic autoimmune diseases,systemic diseases of connective tissue including Systemic
Lupus erythematous, rheumatic arthritis, arthroses, dermatomyositis, systemic vasculitis including modulated periarteritis, hemorrhagic vasculitis
Illnesses raised from the use of alcohol, drugs, toxic substances, other psychotropic agents as well as passing the driving of vehicle by Insured person to person who has used alcohol, drugs, toxic substances, other psychotropic agents; if it is proved that the damage caused by the use of these substances
Within the dental coverage, treatment of teeth with caries, teeth under orthopedic crowns or bridges, teeth which need refilling or have defects of filling according to pre-existing check-up results, as well as aesthetic treatment, experimental methods and cosmetic dentistry, dental orthodontics and implantlogy.
Option 1: Direct payment to partner medical centers: We cooperate with more than 100
partner medical centers in RA and NKR, the list of which can be found here:
http://www.ingoarmenia.am/uploads/files/Medical%20Centers%20English%2011%E2%80%A40
4%E2%80%A42019.pdf:
If you make a claim with this procedure you are free of bringing documentation and making
payments. INGO ARMENIA will do it.
Option 2: Paying compensation to Insured person: When Insured persons visits a doctor without
informing INGO ARMENIA about his/her intention, in this case only, he/she brings the following
documents to INGO ARMENIA either in hard copies, or provides the soft copies of them via:
or via
VIBER +374 41 41 07 03.
Claim form
Medical document: reference form or epicrisis
Financial document: receipt with breakdown, payment receipt, invoice, etc.
You can apply for insurance services even if you have not received health insurance wallet
card.
REASONABILITY
Reasonable and customay charges applied to the medical expenses stipulated under this contract provided that the treatment is recognized by the local medical authorities as essential to the treatment of the disease, injury or medical condition. Within the scope of the Contract Reasonable price for treatment of any desease is considered to be and is subject to compensation:
I. the price of the method of treatment defined in agreement signed between Insurer and the Basic medical center, in case of receiving treatment in this certain Basic medical center,
II. the price of the method of treatment defined in agreement signed between Insurer and any of Basic medical center (with Insured person’s choice), in case of receiving method of treatment with the initiative of Insured person in other medical center not included in the list of Basic medical centers,
III. the price defined by medical center maximum specialized in the method of desease treatment, taking into account the provision of discounts for Insurer (if available) as well, if the method of desease treatment is not possible in the certain Basic medical centers.
In any case, insurance compensation paid within the scope of the Contract cannot exceed actual expenses (paid amounts). Within the scope of the Contract while determining the Reasonable price of any method of treatment Insurer has the right to consider the methods of treatment the same (identic), if they are carried out for the same diagnose and have the same result. The sub-types, modifications, qualifications of treating specialists, academic degree, working experience, as well as the use of additional equipments, substances, lights or rays while treating or treatment with other non-significant differences are not considered as other method of treatment. In each case, if the treatment expenses of Insured person, prices of provided medical aid and services (including medicine, medical supplies, etc.) exceed the Reasonable price, Insured person should pay the exceeding sum to Reasonable price on his/her expenses to medical center for receiving the treatment, services or medicine/medical supplies. The above mentioned points are exceptionally applied for in-patient treatment cases.
The list of Basic medical centers
1. “Erebuni” Medical center 2. “Heratsi” hospital complex №1 (Yerevan State Medical University) 3. "Muratsan" hospital complex clinic (Yerevan State Medical University) 4. Mary Nupar ophthalmological clinic (Yerevan State Medical University) 5. Center of modern surgery 6. Haematology center after professor R.Yeolyan CJSC 7. Nork Republican infectious clinical hospital 8. Ophthalmological Center after S.V.Malayan Eye Clinic CJSC 9. Kanaker-Zeytun MC 10. National Oncological Center named after V.A.Fanarjyan CJSC 11. "Elite-Med" MC 12. Research center of maternal and child health protection 13. Avangard Med Co. Ltd (in connection with surgical treatment of internasal septum) 14. Nork Marash medical center 15. Arabkir Joint Medical Center & Institute of Child and Adolescent Health 16. Research center of radiation medicine and burns 17. “Armenia” Republican medical center 18. “Shengavit” medical center 19. "Nairi" medical center (except for resuscitation measures included in the state order list) 20. "Izmirlian" medical center