How does supplemental health insurance reimbursement work?

Reimbursement is the process by which a health insured person is reimbursed for medical services covered by supplemental health insurance.This only applies to costs recognized by the insurer.

What services are refundable?

Additional health insuranceusually covers:

• Examinations by specialists– cardiologists, dermatologists, neurologists, etc.;
• Laboratory studies– blood tests, hormone panels and microbiology;
• Diagnostic procedures– X-ray, ultrasound, MRI and scanners;
• Physiotherapy and rehabilitation– for injuries and chronic conditions;
• Medicines purchased– with a prescription and recommendation from a doctor;
• Hospital stay– under certain conditions.

Each insurance company has a specific list of covered services, limits and exclusions.The conditions are described in the individual health plan.

What are the refund terms?

Insurers usually require:

• The service was performed in a licensed medical facility;
• Documents to be submitted on time (usually up to 30 or 60 days);
• The service was performed after the start date of the insurance;
• The costs are not covered by the NHIF or another insurer.

Important:Not all services are 100% covered by international insurance.Many plans have an annual limit (e.g. BGN 1,000) or a reimbursement rate (e.g. 80%).

What mistakes to avoid?

• Submission of documents outside the deadline;
• Lack of original receipts or invoices;
• Mismatch between the name in the document and the name of the insured;
• Receiving medical assistance in a non-accredited medical facility.

Incomplete or inaccurate documents will result in denial of refund.

Въпрос?	Отговор:
Какво представлява възстановяване на разходи?	Това е процес, при който застрахованият получава обратно суми за медицински услуги, покрити от допълнителната здравна застраховка.
Какви услуги се покриват?	Прегледи, изследвания, диагностика, лекарства, физиотерапия, болничен престой – според условията на плана.
Каква е процедурата за заявяване на възстановяването?	Чрез попълнено заявление, фактури, медицински документи – подават се онлайн, по имейл или в офис.
Какви условия съществуват?	Здравно заведение с лиценз, спазване на срокове (30–60 дни), валидна застраховка, услуги извън НЗОК, покритие според лимит.
Какви грешки да се избягват при възстановяването на разходи при допълнително здравно осигуряване?	Просрочени документи, липсващи оригинали, грешки в данните, услуги извън обхвата – водят до отказ за възстановяване.