Health Insurance

Health insurance provides financial protection in the event of health problems and access to a range of health-promoting activities, such as therapeutic exercise, sports classes, swimming pool visits, etc. Employee health insurance is gaining popularity in Latvia, but it is also available to private individuals.

Employee health insurance

Latvia's healthcare system is not always able to respond quickly to people's needs for medical services, so more and more employers are choosing to insure their employees to ensure timely medical care and a quicker return to work. Both the employee, who can benefit from a wider range of medical services, and the employer benefit by reducing the worries associated with prolonged sickness absence. Employee health insurance also increases motivation and loyalty to the employer.

Taking into account the specific nature and characteristics of a company's work, it is possible to tailor health insurance coverage to meet the needs of a particular employer as closely as possible.

Health insurance for individuals

Employers do not always purchase health insurance for their employees, so private individuals can also take out individual health insurance to cover unexpected expenses in the event of sudden illness. Similar to health insurance for employees, health insurance for private individuals includes a range of paid outpatient and inpatient services, as well as health promotion measures.

Most often, such individual health insurance provides for a gradual increase in coverage to avoid situations where the customer wants to cover pre-planned medical expenses. This means that by the time the doctor orders surgery or expensive tests, the purchase of health insurance is already overdue. The coverage will be lower in the first year of the policy, but will increase with each subsequent year.

International health insurance

If your company employs foreign nationals, or if your employees frequently travel or are sent to work abroad, you can ensure that these employees are also covered and protected by purchasing International Health Insurance. The policy will also cover serious illnesses, such as oncological or cardiological diseases, and will cover almost all medical expenses, so it will have significantly higher coverage amounts and limits. The price of the policy will depend mainly on the territory covered (Europe or the rest of the world except the USA), the cover, the age of the insured person, the number of persons covered.

The premium or price of a health insurance policy is determined by a number of factors and can vary considerably from one insurance company to another.

The price of an employee health insurance policy is mainly determined by:

• the coverage or content of the programme; *(To explain, insurers have different levels and contents of programmes, such as a percentage or limited programme, where each service has its own limit. For example, a specialist doctor's consultation is covered up to €30 or 50% of the price charged by the medical institution, for example);
• limits and sub-limits for certain services; *(For example, for expensive diagnostic tests, a sub-limit of no more than €200 per year)
• number of insured employees; *(Explanatory note: If a company has a large
• number of insured employees, it will be possible to buy more comprehensive cover at a relatively low cost)
• the nature of the work to be performed; *(Explanatory note: For example, administration, light manual workers or workers with high physical demands)
• history of previous cooperation; *(Explanatory note - cost statistics for previous periods of insurance)
• Policy payment principles (with or without employee co-payment);
• etc.

The health insurance premium for individuals is determined by:

• age of the insured person;
• the insured person's state of health;
• the policy coverage;
• the amount of the indemnity;
• history of previous cooperation.

Employee health insurance provides employers with tax relief. If the premium for employee health insurance does not exceed 10% of the insured employee's gross annual salary (but not more than €750), this amount will not be subject to corporate income tax, personal income tax and social tax. This means that the employer can reduce the company's profits by the amount spent on employee health insurance, thus benefiting financially. Health insurance is a better investment than, for example, paying a premium or a salary supplement of the same amount.

Like companies, individuals also benefit from tax incentives for purchasing a health policy. The payment for a health insurance policy is an eligible expense and can be used to recover overpaid personal income tax from the State. To receive 20% of the premium payments included in eligible expenses, the person must submit an annual income tax return to the National Revenue Service.

Important! Both employees and individuals can also submit as eligible expenses payments made for the part of medical services not covered by the insurance policy.

Depending on the insurance company, health insurance can have very different coverages, or the range of health services covered. The following medical services are usually included in a basic programme:

• Outpatient and inpatient co-payments or patient contributions;
• paid consultations with general practitioners and specialist doctors;
• various medical procedures and manipulations (injections, infusions, blockades, manipulations in gynaecology, urology, surgery, dermatology, etc.);
• preventive check-ups;
• laboratory examinations;
• a wide range of diagnostic examinations (computed tomography, magnetic resonance imaging, ultrasonography, X-ray, etc.);
• compulsory health checks;
• medical certificates (e.g. drivers' medical certificates);
• etc.

Important! Insurance programmes have maximum amounts and limits for different services, beyond which the policyholder must cover the excess. Depending on the terms of the policy, services are covered in full or in part.

To provide more comprehensive coverage, your health insurance policy may also include a variety of additional medical or health-improvement services, such as:

• outpatient rehabilitation (therapeutic massage, water treatments, manual therapy, therapeutic gymnastics, etc.);
• physical therapy treatments;
• vaccinations;
• paid hospital services (hospital fees, manipulation, surgery costs, high-service ward stays, etc.);
• dental care;
• purchase of medicines;
• Opticians (purchase of spectacles or contact lenses on the basis of a prescription from a doctor);
• sports activities (gym, swimming pool, tennis, aerobics, etc.).

The health insurance contract specifies the services that are not covered by the insurer. The range will depend on the insurance company, but most often the following medical services are not covered:

• Aesthetic cosmetology and plastic surgery;
• treatment of illnesses that started before the policy started (unless otherwise stated in the insurance contract);
• treatment of congenital diseases;
• treatment of health problems caused by alcohol, drugs or psychotropic substances;
• treatment of sexually transmitted diseases and diseases caused by the HIV virus;
• anonymous treatment;
• non-traditional medical services;
• treatment scheduled before the policy is purchased;
• medicines not included in the Register of Medicinal Products;
• family planning and fertility treatment;
• Injuries sustained in professional sport;
• etc.

• Before using the insurance policy, you should read the policy conditions carefully.
• To use the services covered by the health insurance policy, you should consult the list of outpatient and inpatient facilities, or contracted facilities, where you will not have to pay out of pocket or only partially pay out of pocket as provided for in the contract.
• When you arrive at the facility, you must show your insurance card and passport or identity card before you receive the service. Several insurance companies provide digital cards in a phone app, which makes it easier to receive the service and reimbursement.
• If you receive the service in an establishment with which the insurance company does not have a contract, you will have to pay for it with your personal funds and then provide proof of receipt for reimbursement. In this case, it is essential to keep the payment documents, referrals or prescriptions and to submit them to the insurer as soon as possible, together with a completed claim form. After the claim has been processed, the insurer will credit the claim to the current account specified in the claim.

Important! As health insurance has limits on the amount of services you can receive, we recommend combining it with state-funded medical services. This way, the policy will not be exhausted at the beginning of the year and you will be supported in case of unexpected health problems.