TERMS OF INSURANCE CONTRACT
Insurance is a tool to protect against financial loss. In accordance with the principle of insurance and on the basis of mutual assistance, persons seeking to avoid the realization of a certain similar risk collect their funds at the insurer so that some of them receive insurance benefits in the event of a negative consequence. Thus, the principle of insurance is the distribution of the damages (claims) between a large number of persons carrying the same risk.
Dental insurance, like any other insurance, is to prevent and diminish your potential risks. In the case of dental insurance, these risks are the dental costs that you may incur in the future.
All procedures listed in Annex A of the terms and conditions of your dental health insurance contract are reimbursable by the dental health insurance.
The insurance period is 1 year. The dental insurance contract is concluded for an indefinite period and is renewed on the date of renewal of the insurance contract for the next 12 months if the insurer or policyholder has not expressed a wish to terminate the contract by notifying 1 month before the end of the current insurance period.
Qualifying (waiting) period is a period between the policy commencement date and the point at which insurer will reimburse claims for dental treatment. Qualifying periods do not apply in case of emergency and accident treatment or upon renewal of the policy.
No you dont have to. For dental isurance cover you can receive treatment in your favorite clinic or, if necessary, receive treatment in any dental clinic in Estonia, or in case of an accident, in a dental clinic abroad.
If you have joined to insurance and your dentist is doing filling during the waiting period then insurance would not cover this treatment. Insuranceance would cover your fillings made after waiting period.
No, these procedures are so-called beauty or cosmetic procedures which are excluded by dental insurance terms. Dental insurance is covering real dental treatment procedures up to certain benefit level.
The benefit plan cannot be changed during the insurance period. This can only be changed when the insurance contract is renewed for a new insurance period.
The terms and conditions of the insurance contract that were in force at the moment of joining your dental insurance insurance apply to you. The insurance period is 1 year and the terms and conditions of your insurance contract are also valid for 1 year, even if the insurer issues adjusted or amended insurance terms and conditions during your insurance period. The version of the terms and conditions of the insurance contract valid for you (HRK-2, HRK-3 or HRK-4) is stated in your insurance policy document.
This is the maximum amount that can be reimbursed by the insurance per procedure. If it happens that the price of treatment is lower on the dental invoice, the insurance will reimburse you for the price of the dental clinic. If the price of the treatment is higher on the dental invoice, the insurance will only reimburse you for the reference price or sum insured per procedure indicated in Annex A to the insurance contract.
JOINING TO DENTAL INSURANCE
No, you don’t have to provide it. Dental health insurance can be taken out by anyone between the ages of 21 and 70, regardless of the current condition of the teeth, but the insurance does not apply to the replacement of teeth that were extracted before the date of the insurance period, on that date or removed during the waiting period.
Yes, you can but dental insurance would not cover the replacement of that tooth or these teeth with the implant, bridge or denture.
You can join immediately by selecting the appropriate insurance benefit plan (bronze, silver or gold) and the appropriate payment method (in parts 3, 6 or 12) and confirming your choice by clicking on the link “JOIN AND PAY” on home page.
You can terminate the insurance contract only by giving at least 1 month’s notice at the end of the current insurance period, taking into account that the contract expires on the end date of the insurance period.
It is very important that the claims handler can follow the indemnity rules established in the terms and conditions of the insurance contract (eg 1 filling per tooth). If the invoice that you submit to the Insurer does not have a tooth number (or a tooth formula), the claims handler will ask you to submit a medical card (Ravikaart) with a tooth number. The dentist can also write the tooth number on the invoice by hand.
Yes, it is recommended. By doing it the claims handler has an overview of the treatments performed on the different teeth, which may be necessary information for reimbursing your invoices after the waiting period.
Handling of claims can take up to 3 weeks. Completion of your claims will be confirmed by a indemnity notification sent to your e – mail address. The insurance indemnity will be paid to your bank account within 5 working days from the receipt of Notice of claim payment.
Upon joining the dental insurance you submitted your insurance application to the insurer through the website tooandja.cavitas.ee. of the insurance broker who is a distributor of the dental insurance. The claim portal is managed by the claims adminsitrator – Denis Europe OÜ – which is a company dealing with insured events authorized by the insurer. When you join the insurance, your data is synchronized with the database of the claims administrator. By registering as a user of the claims portal, you confirm that you are a policyholder and that you have the right to enter this portal to submit the claims and receive compensation.
In order to receive the insurance indemnity payment, you must enter your IBAN account number in to the claims portal. Make sure that the IBAN account number belongs to you and that it is entered without errors. Otherwise, the insurance indemnity payment will not reach to you. The insurance indemnity will be paid to your bank account within 5 working days from the receipt of the Notice of claim payment.
The claim submission form is necessary for faster processing of your claims.
This form allows the claims handler to understand the information on your dental invoice correctly and faster.
As you are entitled to a deductible from the sum insured per procedure in case of major treatments, in first place it is beneficial for you to get to know which services and to what extent are subject to reimbursement. With this information, you can either 1) negotiate the price of the treatment with your dentist, or b) find an alternative dental clinic that is willing to offer a better price. Both you and the insurer will benefit from one or the other.