Hepsi Birlikte Health Insurance

You can develop your own plan by choosing in-patient and out-patient coverage depending on your needs. You can get additional out-patient treatment coverage catered to you, however you cannot choose out-patient treatment coverage as a stand-alone option.

You should read the medical application forms carefully and fill them out completely. Any questions left unanswered on the application form will be considered as a “NO” response. Furthermore, leaving any question or section unanswered can delay the issuance of your policy, or prevent your application from being considered. You should answer the questions in the application form with statements about any past and present complaints and conditions, even if no doctors were consulted and no treatment was received for them. Any matters that you know are significant in terms of assessing the covered risk should be specified during the application, even if we don’t ask about them in the application form. If any changes occur after making the contract, you must report these to the insurer.

The In-Patient Treatment Coverage provides assurances for hospital stays related to internal medicine and/or surgery, emergency medical cases that may be life-threatening for the Insured and small interventions, subject to the special and general terms of insurance, provided that such are required on a medical basis and are justified in detail by the doctor, in his or her report.
If the Insured receives in-patient treatment at a hospital the following costs shall be considered for coverage and paid for in accordance with the Special and General Terms of Insurance, in line with the coverage limit and contribution rates specified on the certificate;

• Daily room charges (up to the charges for a standard single-room)
• Food and attendant charges
• Doctor fees
• Medicines
• Operating room
• Surgeon
• Anaesthetist
• Nurse (up to standard nursing fees)
• Intensive care
• Expenses for any kind of consumables
• Chemotherapy
• Radiotherapy
• Dialysis
• Coronary angiography
• Kidney stone treatment (ESWL)

Physical therapy related to a condition within the scope of the coverage (having commenced during the hospital stay or within 3 months of it)

Out-Patient Treatment Coverage is not offered as a stand-alone option, but can be received alongside In-Patient Treatment Coverage.
It covers the following treatment expenses:

• Medical examination
• Prescribed medicine
• Diagnostic tests (radiology, laboratory, etc.)
• Modern diagnosis (MRI, BT, etc.)
• Physical therapy and rehabilitation

The claims figure arising under the Insurance Agreement will be taken into consideration with reference to the following.
Exceptions Review: The claim will be reviewed with respect to the exclusions stated on the Insurance Agreement as well as the special exclusions, if any, introduced by the Insurer, to see if any such exclusion applies to the present case.
Service Level Review: The special exclusions, restrictions, limits, co-pay or minimum deductible limits applicable in the policy will be taken into consideration through this review.
Service type, Territory and Contracted Institution Review: The Insurer’s liability is based on the type of service, inherent emergency, territory and the type and contracted status of the service provider. The Plan/Program attached to the policy specifies all the countries where the coverage is valid and the borders of that coverage. The amount remaining once the co-payment and/or deductibles are taken from the expenses made for the medical services received from a specific provider in a given Territory, reflects the amount the Insurer is required to cover.
Overall Minimum Deductible Review: Any Overall Minimum Deductible amounts will be deducted from the Admissible Expenses identified through the previous reviews.
Overall Limit Review: Admissible Expenses identified through the previous reviews will be paid up to the overall limit.

Provided that you have maintained insurance in a given plan for a continuous period of 3 years, received insurance coverage before the age of 55, and had a loss ratio of less than 80% in the last three years, you will be entitled to consideration for “Guarantee for Renewal without a New Risk Assessment”.

This is the waiting period required before certain conditions can be covered by the insurance. The waiting periods apply only in the first year of the policy and will cease to be applicable for renewal.

Exclusions are those cases detailed in the Special and General Terms of the Policy and left outside the scope of coverage provided by your policy.

You can make your premium payments in cash, with a credit card, by bank transfer or by cheque.

A policyholder who is conscripted into the military cannot benefit from the rights conferred in the Medical Insurance. This is why the insured should leave the Medical Insurance policy when he is conscripted and a portion of the premium he paid will be returned, on a pro-rata basis.

Should you choose to receive your treatment at a non-contracted medical provider, upon submitting the applicable documents and invoice to us, your expenses will be taken into consideration subject to your payment rate, special and general terms of the policy, and the coverage and limits specified on your certificate.

Pre-authorizations received for treatments provided at contracted medical providers shall stand for 7 days. A new pre-authorization will be required for any procedures that were not performed during the said time frame. MAPFRE GENEL SİGORTA A.Ş. is entitled to refuse any procedures that have not been executed within 7 days and for which a new pre-authorization has not been obtained.
In all hospital admittances for which a pre-authorization has been received, the Insurer’s renewed authorization will be required on the 11th day, to enable the coverage of the relevant expenses incurred after the 10th day.

Provided that there are no missing documents and that the cost incurred is covered by the special and general terms of the policy, the payments are sent to your account within a maximum of 5 working days.