To get Planned Out Sample Clauses

To get Planned Out. Patient Care the Health Insured contacts 24-hour Call Centre and/or appeals directly to his/her personal doctor in the Medical Institutions pointed out by the Insurer. The personal doctor identifies the problem and provides the Health Insured with all necessary tests and medical referral(s) to Provider/non-provider Medical Institutions. If the Health Insured has enjoyed outpatient medical services in provider clinic under the Private Doctor’s prescription, also in case the additional medical examination prescribed by specialist in provider clinics is confirmed by the Private Doctors prescription, the Health Insured pays only his/her share from the Co-Payment (if such is considered under the corresponding Card) and is free from paying the remaining part of the cost of medical service. If the Health Insured has enjoyed outpatient medical services in non-provider clinic under the personal doctor’s prescription, he/she has to pay the total costs for medical services personally. In such cases the Health Insured shall refer to Insurer, who upon its sole discretion decides the issue of medical service reimbursement after receiving all necessary documents, according agreement conditions and if the costs are subject of reimbursement, they will be reimbursed according to relevant co-payment share indicated in the card. If the services conducted in provider/non-provider clinics are not confirmed by personal doctor’s prescription, costs of such services shall not be reimbursed.
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