Insured Event in Medical Insurance

1. Contact the Medical Assistance of the Insurance Company before applying to the health care facility using the following contact details:

• The general lines of the Medical Assistance: 044 225 61 03, 096 170 03 72 (Kyivstar), 050 170 03 72 (Vodafone), 093 170 03 72 (Lifecell);
• For urgent help: 067 464 56 22
• Telegram, Viber chat via public account UNIQAua

2. When applying for Medical Assistance, please provide the following information:

• full name, date of birth of the Insured Person;
• policy number;
• reason for application;
• do you need health leave;
• the Insured Person’s actual location address and contact phone numbers;
• other information at the request of the Insurance Company.

3. Follow the instructions and recommendations of the employee of the Medical Assistance of Insurance Company (doctor-coordinator). He/she will inform you about further actions and arrange medical care.

4. During your visit to the health care facility you must present the identification document with photo (passport, driver's license, etc.) or confirm the registration in the MyUNIQA mobile application by presenting the relevant page of the mobile application containing information about the Insured Person's name, number and validity of his policy at the request of the health care facility.

You can independently apply to a health care facility if it has no contractual relationships with the Insurance Company, and independently pay for medical services or medications in such health care facility, and then submit the documents to the Insurance Company for indemnification of the money spent.

In this case, you should:

1. Contact the Insurance Company according to the previous section "Your Actions" not earlier than 10 (ten) calendar days before the date of application to the health care facility and not later than the date and time of visiting the health care facility, and notify the Insurance Company of the date and reasons for the visit.

2. If, based on the results of your independent planned visit, you have been prescribed with additional examinations, consultations and/or treatment, notify the Medical Assistance of the Insurance Company within 2 (two) working days after the date of prescription.

3. Submit the documents for indemnification following the section "Documents Required for Insurance Indemnity Payment".

You also have the right to independently apply to the health care facility without first contacting the Insurance Company in the case of urgent (emergency) medical care being necessary. In this case, you should inform the Medical Assistance of the insured event occurrence as soon as this becomes possible, but not later than 2 (two) calendar days after the date of payment for medical services/medications, or dismissal from the hospital.

In the case of applying to the health care facility without the prior notification of the Insurance Company, except for cases when applying for urgent (emergency) medical care, the Insurance Company has the right to refuse to pay you the insurance indemnity.

Depending on the option you selected in the Insurance Claim Form, the payment is made:

• to your bank account (account of your legal representative, trustee)
• via Aval Express System (at any branch of Raiffeisen Bank Aval PJSC in Ukraine upon presentation of a passport and registration number of a taxpayer/tax ID number).

The insurance indemnity payment is transferred in accordance with the Insured Person's (or other persons in accordance with the current legislation of Ukraine) bank details. Payment of funds to the representative of the Insured Person is possible subject to a power of attorney from the Insured Person, issued under the procedure established by the law. If the Insured Person is a minor, one of the parents (guardian) shall be the beneficiary.
If the Insured Person is legally incapable, the beneficiary of the insurance indemnity shall be the Insured Person's lawful representatives.

Terms* of indemnity payment by the Insurance Company:

• The decision about payment is made within 15 (fifteen) working days after receiving the complete package of documents from you.
• Transfer of funds is made within 10 (ten) working days after the date of making the decision.

^{* the stated terms may differ from the payment terms stipulated in a specific insurance contract}

The above documents shall be provided to the Insurance Company not later than 30* (thirty) calendar days after the date of payment for medical services or medications, except for cases of inpatient treatment, where the submission of documents is allowed within 30 (thirty) days after discharge from the hospital.

^{* the stated terms may differ from the payment terms stipulated by a specific insurance contract}

Additional documents submitted to the Insurance Company together with the Insurance Claim Form should be:

• presented in the form of original copies or notarized copies;
• issued in accordance with the current legislation of Ukraine;
• signed by authorised persons, indicating the full name and position of the signatory.

If you independently paid the cost of medical care or medication, regardless of the type of services received/goods purchased, you should submit:

• An insurance claim indicating the method of receiving the funds (the insurance claim form can be downloaded from this page);
• Copy of passport (1, 2 pages and the page with registration stamp);
• Copy of the certificate of assignment of the registration number of the taxpayer's account card (hereinafter – taxpayer's card) or the individual tax identification number (hereinafter – TIN).

Examples of paperwork "Outpatient and polyclinic services"

In the case of legal entities (LLC, PE, etc.):

• Payment document: fiscal (cash) check or bank receipt confirming payment;
• Report of works performed or receipt (if specific services/goods are not specified in the payment document);
• Extract from the patient's outpatient card or a doctor's medical report or a certificate from the health care facility (original or copy, certified by the official round seal of the health care facility);
• Copy of the results of examination/studies (if any).

In the case of individual entrepreneurs:

• Payment document: fiscal (cash) receipt, cash receipt note, bank receipt confirming payment or sales receipt;
• Report of works performed or receipt (if specific services/goods are not specified in the payment document);
• Extract from the patient's outpatient card or a doctor's medical report or a certificate from the health care facility (original or copy, certified by the official round seal of the health care facility) (if the health care facility has one );
• Copy of the results of examination/studies (if any).

Examples of paperwork "Inpatient services"

In the case of legal entities (LLC, PE, etc.):

• Payment document: fiscal (cash) check or bank receipt confirming payment;
• Extract (epicrisis) from the medical history (original or copy, certified by the official round seal of the health care facility);
• Report of works performed or receipt (if specific services/goods are not specified in the payment document);
• Copy of the results of examination/studies (if any).

Examples of paperwork "Medication supply"

In the case of legal entities (LLC, PE, etc.):

• Payment document: fiscal (cash) check or bank receipt confirming payment;
• Invoice/sales receipt indicating the medications (in case of absence of information in the payment document);
• Extract from the medical record or a doctor's medical report or a certificate from the health care facility (original or copy, certified by the official round seal of the health care facility) with the list of prescribed medications.

In the case of individual entrepreneurs:

• Payment document: fiscal (cash) receipt, cash receipt note, bank receipt confirming payment or sales receipt;
• Invoice/sales receipt indicating the medications (in case of absence of information in the payment document);
• Extract from the medical record or a doctor's medical report or a certificate from health care facility (original or copy, certified by the official round seal of the health care facility) with the list of prescribed medications.

Examples of paperwork "Dental care"

In the case of legal entities (LLC, PE, etc.):

• Payment document: fiscal (cash) check or bank receipt confirming payment;
• Report of works performed, certified by the official seal of the institution.

In the case of individual entrepreneurs:

• Payment document: fiscal (cash) receipt, cash receipt note, bank receipt confirming payment or sales receipt;
• Report of works performed, certified by the official round seal of the individual entrepreneur (if any).

Examples of paperwork "Childbirth"

• The original, or a copy of, the certificate from the maternity hospital confirming the birth of the child, certified by the official round seal of the maternity hospital (in the absence of the above document, a notarized copy of the birth certificate of the child);
• A copy of the birth certificate of the child (if the notarized copy is not available).

Examples of paperwork "Therapeutic and health-improving services"

In the case of legal entities (LLC, PE, etc.):

• Payment document: fiscal (cash) check or bank receipt confirming payment;
• Report of works performed regarding health-improving (therapeutic and health-improving) services, certified by the official seal of the facility;

In the case of individual entrepreneurs:

• Payment document: fiscal (cash) receipt, cash receipt note, bank receipt confirming payment or sales receipt;
• Report of works performed regarding health-improving (therapeutic and health-improving) services, certified by the official round seal of an individual entrepreneur (if available).

Examples of paperwork "Ophthalmic services"

In the case of legal entities (LLC, PE, etc.):

• Payment document: fiscal (cash) check or bank receipt confirming payment;
• Prescription with a doctor's official seal with recommendations for vision correction.

In the case of individual entrepreneurs:

• Payment document: fiscal (cash) receipt, cash receipt note, bank receipt confirming payment or sales receipt;
• Prescription with a doctor's official seal with recommendations for vision correction.