Specialty Care Coverage
Our standalone subscription which includes services entitling you to benefit from and use Covered Services at our cost, in accordance with this Agreement.
Specialist doctor services, analyses, tests, procedures that are medically necessary, and day care that are not excluded by this Agreement.
The period when the Specialty Care Coverage is valid. It starts 30 days from the moment you subscribe to the Specialty Care Coverage, and lasting for 12 months thereof, unless we are entitled to refuse to render Services to you or terminate this Agreement.
Referral, Refer or Referring
During an online chat on the Platform, our Medical team refers you to use Covered Services in writing. The referring is made and a referral is issued when our Medical team explicitly and in writing (e.g., via chat consultation) confirms you have a medical need to visit a specialist doctor and this cost is covered by us.
The maximum amount 500 euros (includes all costs, expenses, taxes, fees, etc.) you are entitled to use the Covered Services during the Coverage Period. At no point are we obliged to reimburse or pay for Covered Services that exceed the Cost limit.
- As part of our Specialty Care Coverage subscription, we enable you to use specialty medical care services (in Estonian: eriarstiabi) and you undertake to pay Fees for the Speciality Care Coverage, in accordance with this Agreement.
- By subscribing to and purchasing Speciality Care Coverage, you are entitled to use the Covered Services during the Coverage Period, provided that such medical service was duly Referred and we are responsible for the cost according to the Agreement.
- We reserve the unilateral right to determine, define and specify which services or products are covered by the Covered Services. Should you have any doubts if and to what extent certain services are covered by the Specialty Care Coverage, you must turn to our customer support (email@example.com) or to our Medical team via online consultation on our Platform.
- The Specialty Care Coverage subscription is an annual subscription. By purchasing it, you are entitled to benefit from the Specialty Care Coverage and commit to pay for recurring monthly fees for 12 months as of its purchase date. You agree to pay the Fees specified on the Platform.
- You may use the Covered Services personally, and not for any third person. To use the Covered Services, we need to identify you.
- You can use the Specialty Care Coverage only if you are a resident in Estonia.
- The Speciality Care Coverage applies only in Estonia. This means, we cover or reimburse the cost only if the services covered by the Specialty Care Coverage are provided within Estonia.
- As part of the Specialty Care Coverage, you are entitled to use the Covered Services, provided the these are not excluded by this Agreement.
- You are entitled to the Covered Services only in case, according to our Medical team, you have a medical need for a specific Covered Services. Our Medical team issues a Referral to you in case they determine such medical need. For the avoidance of doubt, you are not entitled to the Covered Services if there is no medical need for the Covered Services as per our Medical team’s opinion.
- This Agreement determine the Covered Services, its limitations, exclusions, etc. We shall apply the Specialty Care Coverage ToS which were valid as of the moment when our Medical team Referred you to use the Covered Services, as may be amended from time to time.
- If you want to use the Covered Services, you need to get a Referral before using the Covered Services. We are not obliged to reimburse or carry any cost or expense if you did not have a Referral at the moment of using the Covered Services (e.g., by getting a Referral after the use).
- If this Agreement ends between you and us, then the Speciality Care Coverage ends on the date when this Agreement ends.
Covered Healthcare Services
- “Day care” refers to outpatient services requiring short-term monitoring of the patient, after which they leave the healthcare provider the same day.
- For specialist services, we cover the consultation fees and any tests, studies, or procedures ordered by the specialist.
- For analyses, tests, and procedures, we cover the cost as long as you do not stay overnight in the hospital.
- For day care, we cover the cost of consultations, procedures, surgeries and related services, medications, and supplies used by doctors and nurses, as long as the surgical procedure is done during day care without an overnight stay (e.g., removal of a birthmark or wart, or drainage of an abscess).
- The Specialty Care Coverage does not cover the following services: primary care, general practitioner or family doctor consultation, virtual nurse or doctor consultation, outpatient rehabilitation (e.g., massage, magnetic therapy, laser therapy, physiotherapy), dental care, maternity care, hospital treatments and/or rehab with an overnight stay, vaccinations, prescription drugs, occupational health checks, health certificate issuance (including COVID tests and antibodies, COVID documentation), glasses, contact lenses, preventive specialist consultations, preventive analyses or exams, and pre-travel medical consultations.
- The services, products and related costs set out in this Agreement are excluded from the Specialty Care Coverage. For the avoidance of doubt, we are not obliged to cover, compensate, nor pay for any cost related to such services, products, events or circumstances.
- Excluded services
The Specialty Care Coverage does not cover primary care tests/analysis, procedures, and tests for the following indicators: CRV, quick urine test, TSH, CRP, LDL-cholesterol, HDL-cholesterol, ECG, cholesterol, triglycerides, hemogram with 5-part leukogram, creatinine, GGT, ALT, vitamin B12, glucose. These services may be covered by Salu monthly or annual subscription, in case our Medical team determines there is a medical need for it.
- The following exclusions apply to both primary care and specialty care services. These services or products are excluded from the Covered Services.
- If the circumstances, events or conditions specified in the exclusions apply, then such event or costs related to such events are not part of the Covered Services and are not covered, compensated nor reimbursed by us.
- We do cover the cost nor provide any compensation if the expense does not meet the criteria set out in this Agreement.
- We do not cover the cost nor provide any compensation if the healthcare service provider providing the Covered Services does not have all the required professional certification or activity license.
- Excluded Conditions
- We do not cover the cost nor provide any compensation related to bodily injury, illness or health condition that occurred before the start of the Coverage Period.
- We do not cover the cost nor provide any compensation related to the following conditions or services: fatigue, burnout, depression, mental illness, addiction, sleep disorders, sexually transmitted diseases, AIDS and HIV (excluding Papilloma tests like the PAP test).
- Excluded Specialists and Services
- We do not cover the cost nor provide any compensation related to the services of the following professionals: psychiatrists, psychologists, psychotherapists, family therapists, mental health nurses, coaches, holistic therapists, rehabilitation doctors, physiotherapists, masseurs, osteopaths, chiropractors, narcologists, speech therapists, geneticists (unless related to pregnancy monitoring), trichologists, sexopathologists, nutritionists, dieticians.
- We do not cover the cost nor provide any compensation related to alternative or complementary medicine services like acupuncture, aromatherapy, reflexology, bioresonance diagnostics, homeopathy, hydrocolonotherapy, iris diagnostics, Ayurvedic therapy, kinesiology, etc.
- We do not cover the cost nor provide any compensation related to family planning, including contraception, infertility diagnosis, treatment and related research, sperm analyses, artificial insemination, laparoscopic operations related to fallopian tube patency or adhesion removal, sterilization, vasectomy.
- We do not cover the cost nor provide any compensation related to the following services: full-body MRI, laser eye surgery or other vision correction surgeries, gene analyses (except for pregnancy monitoring), positron emission tomography, immunotherapy, capsule endoscopy, sleep studies, physical exercise test or sports examination, cosmetic surgery or plastic surgery, vein treatment and sclerotherapy, gastric bypass surgery, food intolerance studies, health capsule services, prostate and gynecological massage, lymphatic massage, vacuum massage, cryomassage, biostimulation, cosmetic and beauty services, manicure (including therapeutic), pedicure (including therapeutic).
- Excluded Products and Medicines
- We do not cover the cost nor provide any compensation for hygiene products and purchased medicines, including over-the-counter and prescription drugs.
- We do not cover the cost nor provide any compensation for orthotic devices, crutches, wheelchairs, and similar aids.
- We do not cover the cost nor provide any compensation for dietary supplements, diet food, vitamins.
- Palliative and Hospice Care
We do not cover the cost nor provide any compensation for palliative treatments and hospice services.
- Customer Transportation
We do not cover the cost nor provide any compensation for transportation costs.
We do not cover the cost nor provide any compensation for money paid as a gratuity to medical workers or for gift expenses.
- Trainings, Seminars, and Lectures
We do not cover the cost nor provide any compensation for participation in medical training, lectures, or seminars.
- Illegal Treatment
- We do not cover the cost nor provide any compensation if the healthcare provider did not hold a valid professional certification or licensure as required by law.
- We do not cover the cost nor provide any compensation if the healthcare provider used a treatment methodology or technology not authorized for use in Estonia.
- Deliberate Harm and Risk-Taking
We do not cover the cost nor provide any compensation if the necessity or use of the Covered Services was caused or exacerbated by the customer knowingly endangering their life or health (e.g., initiating a fight, self-harm, suicide or suicide attempts).
- Criminal Actions
We do not cover the cost nor provide any compensation if the necessity or use of the Covered Services was caused or contributed to by you committing a crime.
- Reckless Driving and Device Usage
We do not cover the cost nor provide any compensation if the necessity or use of the Covered Services was caused or contributed to by you speeding, driving without a license, or using a phone or smart device without a hands-free setup while driving.
- We do not cover the cost nor provide any compensation if the necessity or use of the Covered Services was influenced by your alcohol, narcotic, or toxic intoxication.
- We do not cover the cost nor provide any compensation if the necessity or use of the Covered Services was caused or contributed to by a drunk driver known by you.
- We do not cover the cost nor provide any compensation treatment or medication costs for alcoholism or drug addiction.
- We do not cover the cost nor provide any compensation for treatment and medication costs if the illness was caused or contributed to by the use of alcohol or drugs.
- Disobeying Medical Instructions
We do not cover the cost nor provide any compensation if the necessity or use of the Covered Services was caused or contributed to by you not following the instructions of a doctor or nurse, such as discontinuing treatment, not taking prescribed medication, or failing to attend a follow-up appointment.
- Specialty Care Coverage Amount, Compensation Limits, and Deductibles
- The Cost limit is a sum that represents the total limit of the compensations paid for all insured events occurring during the Coverage Period per customer (i.e., you).
- The Cost limit is reduced by the sum of benefits paid out.
- Personal Data Processing Principles
Our personal data processing policy can be found here.