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Health insurance My Health - Specialists

The insurance provides covers that will help you maintain health. In case of an illness or injury, it will cover all necessary payable health services for a quick reinstatement of an active lifestyle.

It provides you with the following key services:

Health Assistance services

Provides an easier journey from diagnosis to treatment.

Hello Doctor

It assures immediate video conference with a doctor in approx. 15 min.

Organization & payment of service costs

Early diagnosis, timely operation and efficient rehabilitation.

Specialisti z asistenco

Quick recovery



It allows you to recover an active lifestyle in short time: The persons insured under the My Health – Specialists insurance who use the health services provided under this insurance upon an illness or accident return to their active lifestyle on average 3 months sooner than those who are not insured under the My Health – Specialists insurance.

 

Advantages of the My Health – Specialists health insurance

The insurance provides covers that will help you maintain health or, in case of illness or injury, provide:

  • fast and quality healthcare,
  • a quick diagnosis by a specialist doctor and start of treatment,
  • optimal course of treatment,
  • fast and efficient physiotherapy,
  • a second medical opinion by renowned foreign doctors,
  • timely surgery before one’s condition deteriorates due to excessive waiting periods,
  • consultancy and medical assistance in case of severe trauma, deterioration of medical condition or mental distress,
  • necessary information on one’s medical condition and
  • assistance services that guide you throughout the treatment process.


The preventive services included provide:

  • preventive check-ups of one’s medical condition,
  • early detection of changes to one’s medical condition, and
  • the prevention of further progression of a disease.
     

Three packages with different scopes of cover

The insurance provides covers that will help you maintain health or, in case of illness or injury, provide various covers. The content of a cover depends on the package selected.

Basic package

Basic package

It provides the services of Health Assistance, Hello Doctor, Specialist Treatment, Demanding Diagnostic Tests, Payable Prescription Drugs (up to €200), Second Medical Opinion (cover for the person insured and their immediate family members (partner, children aged 27 or less, parents)) and DNA Analyses.

Basic with physiotherapy

Basic with physiotherapy

In addition to the covers provided under the Basic package, it also provides the services of physiotherapy in the value of up to €400 per year.

Basic with physiotherapy and surgery

Basic with physiotherapy and surgery

In addition to the covers provided under the Basic package, it also provides the services of physiotherapy in the value of up to €400 per year and surgery in the value of up to €8,000 per year.

What does the My Health – Specialists insurance include?

Name of cover

Content of cover

Health Assistance services

-    Information about insurance and terms of its use
-     Information about providers of health services
-    Information about the terms and method of enforcing rights deriving from the insurance, and about the enforcement of rights within the public healthcare system in Slovenia
-    Issue of approvals and organisation of health services
-    Making an appointment with a specialist doctor
-    Organisation of provisional care services
-    Settlement of payments for the services rendered

The information is provided by the Health Assistance service at the Generali insurance company, which is available every working day from 8 a.m. to 4 p.m. at 080 81 10 or at zdravje.si@generali.com.

Hello Doctor

The Hello Doctor provides an immediate video conference with a general practitioner (as a rule within 15 minutes) or a consultation at a previously agreed appointment (video or phone call) every day of the year from 6 a.m. to 10 p.m. The doctor gives the patient a medical report, which may include a referral to a specialist examination within the scope of the Specialists insurance. In such case, the patient needs no referral from their personal physician. Hence, it is possible to discover a medical problem much faster and early enough.
The Hello Doctor cover applies to new and existing medical conditions without a waiting period from the date of inception. The number of remote medical consultations is not limited. The Hello Doctor applies to an illness and accident.

Specialist treatment

The Specialist treatment includes all necessary:
-    specialist examinations,
-    simple diagnostic tests (e.g. ultrasound, X-ray, laboratory), and
-    simple outpatient procedures (such as the application of a block, puncture and similar).

Demanding diagnostic tests

Tests that constitute the continuation of specialist treatment and are in some cases needed to make a diagnosis (e.g. magnetic resonance imaging, CT or gastroscopy).

Payable prescription drugs

It includes payable white-slip drugs that a doctor has prescribed within the scope of a specialist examination, test or procedure. Such medications are payable at the pharmacy by the person insured. The insurance company reimburses such costs in the amount of up to €200 after the person submits a purchase receipt and proof of the prescribed medication.

Second medical opinion

-   Renowned doctors from the Advance Medical international network prepare a second opinion of a diagnosis and propose possibilities for treatment in Slovenia and abroad. After obtaining the second medical opinion, the insurance company organises and pays for any further medical services, depending on the criteria selected.
-    The Second medical opinion is valid for the person insured, their partner, children aged 27 and less and the insured person’s parents. It applies to new and existing medical conditions without a waiting period.
-    The Second medical opinion applies to an illness and accident.

DNA analyses

After a 12-month period of insurance, the person insured receives an innovative DNA analysis that represents a revolutionary approach to health and well-being, provided that the insured has regularly settled their premiums. Based on the analysis of their genetic predispositions, the insured person receives personalised advice for nutrition and weight management, stress management, sleep enhancement and preservation of health. The test is conducted in a fairly simple manner and may be done from one’s couch, so to speak – it only takes a sample of the insured person’s saliva. The DNA analysis is performed by the company Geneplanet d.o.o. (from Slovenia).

Preventive medical services
(one by choice of the person insured)

The person insured is entitled to one of the mentioned services of their own choice for the first time after one year and then, upon automatic insurance renewal, every two years, provided that the insured person has regularly settled their premium.
-    Laboratory blood and urine tests – blood and urine sampling and laboratory analysis. The doctor reviews the results and prepares a medical report.
-    Ultrasound of the breasts – the procedure is aimed at timely detection of any pathological changes to the breast tissue.
-    Test for persons active in sports – it includes a preventive medical examination, an examination of one’s existing medical documentation, the necessary diagnostic tests and the preparation of a medical report.
-    Bone density measurement (identification of osteoporosis) – measurement of mineral bone density using a special device that operates on the basis of X-rays. The results are examined by a doctor who also prepares a medical report.
-    Physiotherapy examination – a 60-minute overall examination at a physiotherapist’s, who prepares a medical report based on the findings and gives recommendations for further treatment.

Extended medical services 

-    Psychological support – in case of a diagnosed serious medical condition and extraordinary circumstances (complete loss of the capacity to do any job, postnatal depression identified by the selected personal physician) and in case of death of an immediate family member (up to €700 per year).
-    Treatment plan – advice on further treatment following an accident resulting in hospitalisation.

Physiotherapy 

Physiotherapy services that are needed by the person insured following an operation, trauma to the bones and tissue (imaging diagnostics is necessary), and after a Caesarean section. Physiotherapy is conducted manually by attested providers, who are appointed by the Generali insurance company, and lasts 60 minutes.

Surgery 

It includes operations (inpatient and outpatient) for which the public system provides the longest waiting periods, as they are not defined as urgent, for instance arthroscopy of the shoulder or knee, the reconnection of cruciate knee ligaments, surgical treatment of varicose veins, surgery of the carpal tunnel, ultrasonic fragmentation and disintegration of kidney stones and so on. The procedures are listed in the terms and conditions of the insurance.

Provisional care 

It includes:
-    assistance in the performance of basic and supporting everyday tasks,
-    the transport and escort of the insured person to control check-ups and upon discharge from the hospital, and
-    the transport and escort of the insured person to chemotherapy and radiation therapy.
It is expressed as the number of hours of home assistance and the number of transports to control check-ups and upon discharge from the hospital (e.g. 100/4/10).

Provisional care as a result of accident 

It includes assistance in the performance of basic and supporting everyday tasks and the transport of the person insured to control check-ups that they need as a result of an accident. It is expressed as the number of hours of home assistance and the number of transports to control check-ups (and upon discharge from the hospital) per event insured (e.g. 100/4).

Bereavement allowance 

The disbursement of the agreed insurance sum to the beneficiary in the event of the insured person’s death.

Three steps to diagnosis and treatment

What needs to be done to claim the services provided by the insurance?

1. Call to the Health Assistance service of the Generali insurance company at
080 81 10

If you have no referral from your personal physician and seek consultation, you can use the Hello Doctor service – a video consultation with a general practitioner. The doctor prepares a medical report – whereby you obtain a diagnosis and instructions – or issues a medical report with referral to further treatment within the scope of the My Health – Specialists insurance. To use the service, one needs to register on the Hello Doctor website.
If you have a referral from your personal physician for a specialist doctor or if the physician within the scope of the Hello Doctor service has issued a medical report with referral to a specialist examination, please call the Health Assistance service at 080 81 10.

2. The Health Assistance service makes an appointment a dispensary for the person insured

Please complete the sample form “Notification of a need for medical service” and send it to the Health Assistance service. Helpful advisors approve and organise medical services and make an appointment for you with a specialist doctor. The specialist makes a diagnosis and, if necessary, refers you to further treatment (surgery, physiotherapy, etc.)
To organise the service to which you are referred by a specialist doctor, it will suffice that the person sends a notification and medical report to the Health Assistance service. In such case, the insurance company does not need a referral by the personal physician.

3. Generali insurance company pays for the service

The only exception are payable prescription drugs, which you alone pay at the pharmacy.
You then send the notification and purchase receipt to the Health Assistance service. The insurance company will reimburse the cost to you transaction account.

Do you need help?

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