Please refer to the terms regarding coverage for the precise description as this is an overview.
Our healthcare team consisting of experienced doctors, nurses, physiotherapists and other healthcare professionals has many years’ experience from various areas of specialisation and they offer professional advice on health and diseases. You are offered consultation with a nurse or doctor by telephone for all health problems, including those that do not require actual treatment or which are not covered by the insurance.
Through our unique SundhedsNavigator and coordinator concept, we offer you help to organise and carry out the course of examinations and treatments, as well as provide guidance on the public health care system’s treatment options, e.g. patient rights, complaint procedures, guidance regarding waiting times, free choice of hospital and examination and treatment guarantees. We also help you review medical records from hospitals and doctors, book appointments for treatment or examination, arrange transportation or other assistance if necessary.
In cases where the injury can only be handled in the public sector or is not covered by the insurance, we offer you advice and to organise your course of treatment in the public health care system.
Treatment by a physiotherapist, chiropractor or psychologist
The insurance covers reasonable and necessary treatment based on a medical needs assessment (there must be a healthcare need for treatment). Preventive treatment is not covered and the treatment must lead to significant and lasting improvement of the condition in order to continue to qualify for the insurance cover. Treatment is covered in our countrywide, quality-assured network or at a therapist of your own choice. Treatment is covered in Denmark, Norway and Sweden corresponding to the Danish rates. Any additional services will be self-payment.
Physiotherapy requires referral from a doctor. Chiropractor treatment does not require a doctor’s referral, but is covered on the basis of a medical assessment.
Treatment by a psychologist is covered for treatment-requiring disorders and must always be justified from a healthcare perspective. In some cases, we will thus request a doctor’s referral/recommendation. In the case of work-related stress requiring treatment, we can refer directly to treatment in our network or to a therapist of your own choice based on a professional assessment. The insurance covers the patient share in connection with psychological therapy prescribed by a doctor, with a psychologist who has an agreement with the health insurer. In the case of treatment by a psychologist without an agreement with the public health insurance, the therapist’s fee will be covered up to a maximum of DKK 1,000 per treatment.
For treatment by a physiotherapist, chiropractor or psychologist in our quality-assured network, there is no limit set on the amount and the required number of treatments is covered based on a professional assessment.
Emergency trauma counselling
The insurance covers emergency trauma counselling by a crisis psychologist in our network, if you have experienced an acute psychological crisis due to one of the following:
- If you have experienced a sudden serious incident/accident, where you have been in danger.
- If you are subjected to a robbery, assault, violence or kidnapping.
- Fire, explosion or burglary in your private residence or your own business (must be reported to the police).
- If you are diagnosed with a life-threatening disease.
- Death within your immediate family.
- If a member of your immediate family is diagnosed with a life-threatening disease.
- If you experience a family member’s or colleague’s sudden, unexpected death or sudden serious incident/accident.
Examination and treatment by a medical specialist
You are guaranteed that an examination and/or treatment at a medical specialist will be initiated within 10 working days in the public or private healthcare system, after we have received and approved your notification. You must always have a valid referral from your doctor. Ultrasound scanning, X-ray examinations and MRI scans also require a referral.
The insurance covers the examination and treatment of cancer diseases if the diagnosis is made during the insurance period. In case of cancer diseases which is a part of a comprehensive treatment package in the public healthcare system, the public offer must always be activated and used. The healthcare team provides counselling regarding the further process and the insurance covers in cases where we consider that there is unnecessary waiting time in the public sector process or where the intentions of the treatment package are not fulfilled.
The insurance covers the necessary outpatient follow-up examinations after surgery/hospital treatment for up to 6 months. The examinations must be prescribed by a relevant medical specialist.
Rehabilitation after surgery
The insurance covers outpatient rehabilitation at a physiotherapist and chiropractor after a coverable operation on the musculoskeletal system. The musculoskeletal system means tendons, muscles and joints of the back, shoulders, neck, knees, hips, elbows and wrists. The rehabilitation must be prescribed by the attending medical specialist. Rehabilitation is covered in our quality-assured network or at a therapist of your own choice.
Home nursing care and home-help
The insurance covers reasonable and necessary expenses for temporary assistance in the home in direct connection with a coverable operation in the public or private sector. The help must be prescribed by the attending medical specialist and is covered for up to 6 months after the discharge date.
The insurance covers reasonable expenses for personal temporary aids, which are necessary in connection with a coverable procedure or treatment for up to 6 months after the discharge date. The aid must be prescribed by the attending medical specialist.
The insurance covers an impartial consultation with a relevant specialist if you have a life-threatening or particularly serious illness or injury, or if you are faced with the choice of receiving particularly hazardous treatment that can be life-threatening or cause permanent injury.
The healthcare team offers counselling in connection with alcohol and drug addiction and can advise on public treatment services.