Treatment with a physiotherapist, chiropractor or psychologist

The insurance covers reasonable and necessary treatment based on a medical assessment (there must be a medical need for the treatment). Preventive treatment is not covered and, it is a prerequisite for continued cover that the treatment ensures a significant and lasting improvement of the condition.

Treatment is covered in our national quality- assured network or with a therapist of choice. Treatment is covered in Denmark, Norway, Sweden and Germany corresponding to the Danish amount rates. Any additional benefits will have to be paid by the insured. Treatment by a physiotherapist or a chiropractor does not require a referral by a medical doctor but will be covered on basis of a medical evaluation.

Treatment by a psychologist is covered for disorders that require treatment and should always be medically justified. In some cases, we will therefore ask for a medical referral. Regarding work-related stress disorders that require treatment, we may refer you to a therapist in our network directly or to a therapist of choice, based on our professional evaluation of the situation.  When there is a referral by a medical doctor to a psychologist that has an agreement with the public health care system, the insurance covers the patients share. When the insured receives treatment from a psychologist that does not have an agreement with the public health care system, the insurance covers the therapists´ fee, however to a maximum of DKK 1000 per treatment.

Regarding treatment with a physiotherapist, chiropractor or psychologist in our quality assured network, there is no limitation regarding cost and as many treatments, as the professional evaluation assess necessary, are covered.

The insurance covers up to 10 treatments with acupuncture, reflexology, osteopath or dietitian. Acupuncture, reflexology, and osteopath are covered for illnesses in the musculoskeletal system. A doctor’s referral is not required, and the health team can recommend treatment directly upon making the medical evaluation. You can decide for yourself with provider to use.

The insurance covers emergency trauma counselling if you have experienced trauma due to one of the following:

• If you have experienced a sudden serious incident/accident, where you have been in danger
• If you have been subjected to a robbery, assault, violence or kidnapping
• If you have been involved in fire, explosion or burglary in your private residence or your business (must be reported to the police)
• If you have been diagnosed with a life-threatening disease
• If there has been a death within your immediate family
• If a member of your immediate family has been diagnosed with a life-threatening disease
• If the if you have experienced a family member’s or colleague’s sudden, unexpected death or sudden serious incident/accident.

You are guaranteed that examination and/or treatment with a medical doctor will be started within 10 weekdays from the day that we have received your claim, in either the public or private health care system. You will always need a referral.

Ultra-sound scanning, X-ray examination and MR-scanning also require a referral.

The insurance covers cancer examination and treatment if it is diagnosed within the insurance period. In cases where the cancer diagnosis is one where the public health care system offers a treatment package, this public offer should always be activated and used. The medical team will give advice regarding the treatment process and, the insurance will cover in those events, where we think that there is an unnecessary waiting time in the public treatment plan or where the intention with the treatment plan is not met.

The insurance covers necessary and reasonable outpatient follow-up examination after surgery covered by the insurance for up to 24 months from the date of the surgery. The examination must be prescribed by the relevant medical doctor and approved by us.

The insurance covers outpatient medical rehabilitation performed by a physiotherapist and/or chiropractor in direct connection to a coverable procedure in the musculoskeletal system. The musculoskeletal system means tendons, muscles and joints of the back, shoulders, neck, knees, elbows, hip and wrists. The rehabilitation must be prescribed by the attending medical doctor. Rehabilitation is covered in our quality assured network or by a provider of own choice.  

The insurance covers necessary and reasonable expenses for temporary home assistance in a direct connection with an operation covered by the insurance in the public or private health care. The temporary home assistance or home nursing must be prescribed by the attending medical doctor and is covered for a maximum of 6 months after discharge date from the hospital.

The insurance covers expenses for personal temporary aids, which we consider necessary and reasonable in connection with a procedure or treatment for a maximum of 6 months after the discharge date from the hospital. The aid must be prescribed by the attending medical doctor.

Second/third opinion

In certain cases, the insurance covers consultation with a relevant impartial medical doctor you have a life-threatening or particular serious disease or injury or, if you are faced with the choice of receiving particularly risky treatment, which may be life-threatening or result in permanent injury.

The insurance will cover reasonable expenses for treatment, based on a doctor’s referral, related to addiction and abuse of:
Alcohol, prescriptive medicine, narcotics (drugs that are covered on the Law of Narcotics Drug Act), diagnosed ludomania (addiction to gambling).

The health team also offers advice on different public offers of addiction treatment.