Frequently Asked Questions
1- What is private health insurance?
Private Health Insurance is an insurance model where the cost of treatment the insured member receives in case of an illness or an injury, is financed by private health insurance companies, within the general and special terms and the limits of the insurance policy.
2- What are general terms?
General Terms is the legal framework indicated by the Treasury of the Turkish Republic, where the mutual rights and responsibilities of the insured members and the insurance companies that operate in the field of health insurance in Turkey are defined.
3- What are special terms?
Special Terms are the terms defined by the insurance companies complementing the general terms, where the coverage details, limits, deductibles and co-payments are indicated.
4- Can insurance companies act to the contrary of general or special terms?
No. Insurance companies cannot act against the general terms. Special Terms also constitute a legal contract between the insured member and the insurance company and cannot be altered without mutual consent until the expiry of the policy. Therefore private health insurance is a reliable system where mutual rights and responsibilities are protected by law.
5- Who is a policy holder?
Policy holder is the party who applies to purchase an insurance policy for himself/herself or a third party and whose application is accepted by the insurance company, who assumes the responsibilities of the insurance contract and who acts on behalf of the insured member/s. Policy holder can be a real person or an entity.
6- Who can become an insured member?
The policy holder himself/herself, his/her spouse, his/her children under 18 or his/her children under 25 who study at a University and who do not work as well as the personnel of the policy holder can become insured members.
7- How can newborns or children can become insured members?
Newborns and children can be insured along with their parents. If the mother is already an insured member and wishes the newborn also to be insured, she has to apply for insurance within 10 days after birth, submitting also the birth certificate to the insurance company. In this case it will be possible to start the insurance coverage of the newborn from the date of Birth.
8- Can a spouse or a child be included in the policy after start date?
Yes, a spouse or a child can be included in a policy as a midterm endorsement or at renewal of the policy.
9- Is there an age limit to become an insured?
Yes, there is an age limit for those who would like to have an insurance policy for the first time. Although this age limit is generally 65 years old, it can differ according to the risk assessment criteria of insurance companies or the features of insurance products.
10- Is there an age limit after being insured?
An age limit is not enforced after being insured and a lifetime renewal guarantee can be granted. Therefore the insured member can continue renewing his/her policy after he/she is over 65.
11- Is there a nationality restriction to become an insured?
It is not a prerequisite to be a Turkish national to become an insured in Turkey. Any national can purchase private health insurance in Turkey as long as his/her residency is in Turkey.
12- Can people whose residency is in abroad purchase private health insurance in Turkey?
No. To purchase a private health insurance in Turkey, one must have his/her residency in Turkey.
13- Is there an occupation restriction to become an insured?
It is possible that those involved in occupations that have a high risk of illness or injury can be declined from being an insured member or accepted with an additional risk premium.
14- Are there restrictions for the sport activities that the applicant is involved?
Sport activities undertaken under a sports license as well as motorcycling, racing with motor vehicles, parachuting, scuba diving, mountaineering, aviation and similar activities that are considered dangerous, must be declared during insurance application. Depending on the level of risks involved in the activity and the frequency, medical costs due to an activity can be excluded from the insurance policy or accepted with additional risk premium.
15- Are there restrictions concerning the height and weight of the applicant?
A risk assessment is undertaken according to the Body Mass Index (BMI) of the applicant. BMI is the proportion of weight (in kg) to the square of height (in meters).
E.g. BMI of a person whose weight is 80kg and height is 1.75m is 26.12. Health authorities regard BMI values between 18 – 30 as normal. Insurance companies undertake a risk assessment for values outside this range and may ask for additional risk premium.
16- What is risk assessment?
Health insurance is an insurance type that is based on declarations. This declaration is made by the policyholder or the insured member at the application form of the insurance company. The application form consists questions that enable the insurance company to envisage the costs that the health status of the insured member may lead. The insurance company evaluates the risk associated with the applicant based on the information provided in the application form such as health condition, lifestyle, sport activities as well as personal information and based on this assessment can accept the application with standard terms, decline the application or accept the application under special terms i.e. after applying special exclusions, waiting periods, additional premium, deductible or limits related with certain conditions.
17- What does standard acceptance of an application mean?
Standard acceptance of an application means, acceptance of the application with no restricting additional terms and conditions but only under the general and special terms of the policy.
18- Can only healthy people purchase private health insurance?
No, people with certain health problems can also purchase private health insurance. Such people can be insured covering existing health problems under standard terms or with additional risk premium for those existing health problems or by excluding existing health problems.
19- What does application of special terms mean? When are special terms applied?
Application of special terms is the situation where the insurance company restricts certain benefits, applies special exclusions that leave certain conditions out of insurance coverage, applies waiting periods, limits or deductibles. Special terms are applied when the age, occupation, social or sports activities or illnesses (past or current) affects his/her insurance risk.
20- What does special exclusion mean? How an insured member would know whether a special exclusion is applied?
Special exclusion is the exclusion of a condition from coverage that would otherwise be covered by the policy, following the risk assessment made on the application. The insurance company informs the applicant about the suggested special exclusion prior to the acceptance of the application. Policy is issued if the policy holder accepts the special exclusion and the special exclusion is clearly indicated at the front page of the policy.
21- What does exclusion mean in private health insurance? Which exclusions are there?
Exclusions are conditions of which the treatment costs are left outside the coverage of private health insurance. These are:
a) General exclusions: Conditions that are indicated at Private Health Insurance General Terms Article -2 and Article -paid yet
3 (Please see. )
b) ) Standard exclusions: Conditions that are left outside the coverage as indicated in the special terms of the selected insurance plan. If you have a health insurance please review the respective chapter of the special terms.
c) Special exclusions: Exclusions that are applied specially for the insured member, based on the risk assessment undertaken by the insurance company. Special exclusions are indicated on the front page of the policy or certificate.
22- What does waiting period mean? In which circumstances and for how long are waiting periods applied?
Waiting period is an exempted (not covered) period related with certain medical conditions or procedures that starts by the start day of the insurance and ends when the defined period ends. The insurance company, depending on the type and features of the product, determines waiting periods. Coverage for these temporarily exempted conditions or procedures starts as the waiting periods end. These are categorized as standard waiting periods. If the insurance company applies any additional waiting periods specifically for the insured member other then those listed within the standard waiting periods, these conditions/procedures and respective waiting periods are also indicated on the policy.
23- What does scope of benefit mean and where is it indicated?
It is the extend of covered medical costs that the insurance company guarantees to finance through the selected health insurance policy. Those medical expenses that will be financed are indicated in the special terms.
24- When does the insurance coverage start?
Under normal circumstances, insurance coverage starts as of the date of application. Start and expiry (end) dates are indicated at the front page of the policy. Unless otherwise indicated coverage starts at 12:00 noon on the start date and ends at 12:00 noon on the expiry date.
25- What does Geographical Scope of Coverage? Where is Geographical Scope of Coverage indicated?
The geographical area where the insurance benefits (coverage) is valid is called the Geographical Scope of Coverage. Medical costs incurred out of the indicated Geographical Scope of Coverage are not covered. There are insurance plans that are valid only in Turkey (Turkish Republic of Northern Cyprus included) as well as Europe including Turkey or valid worldwide.
A benefit of an insurance plan might be valid worldwide while another benefit of the same insurance plan can be valid only in one geographical area. Moreover limits and co-payments of a benefit may differ per different geographical areas
The geographical scope of a benefit, differences in limits and co-payments per geographical areas of an insurance plan are indicated on the policy or in the benefit table or special terms provided as an annex to the policy.
26- What does insured member co-participation (co-payment)?
Insured member co-participation (co-payment) is the percentage of the medical costs that will be assumed (financed) by the insured member. Insured member co-participation is applied after the deductible amount is deducted (if exists) and up to the limit of the plan (if exists).
Example 1: Physician consultation benefit: %20 co-participation without deductible; Physician consultation invoice TRY 100 Insurance Company part TRY 80, insured member part (co-participation) TRY 20
Example 2: Physician consultation benefit: %20 co-participation with TRY 50 deductible; Physician consultation invoice TRY 100. Deductible (insured member part 1) TRY 50. Remaining amount subject to insured member co-participation TRY 50. Company part TRY 40, insured member part (co-participation) TRY 10 (20% of TRY 50 which remained after the TRY 50 deductible)
Different insured member co-participation percentages can be applied for different benefits of an insurance plan. Insured member co-participations are indicated in the benefit table or in the special terms that are provided as annexes to the policy.
27- What does deductible amount mean, how is it applied?
Deductible amount is the amount that will be financed by the insured member out of the medical expenses that are within the scope of benefits of the insurance. Whether there is a deductible at the selected insurance plan and the logic of application of the deductible is indicated at the policy or in the benefit table or in the special terms. In general, 2 types of deductible are applied:
a) per case deductible : It is the amount that would be financed by the insured member for each expense transaction concerning a benefit. The deductible amount is deducted from the invoice (if a limit exists the amount up to the limit is taken into account and the deductible is deducted from this amount) and the rest will be the insurance company part. E.g. Physician consultation benefit with a per case deductible of TRY 30; Invoiced amount is TRY 50. Insurance company part would be TRY 20. Insurance company does not make any payment for invoices equal or below the deductible amount.
b) Annual aggregate deductible : It is the annual aggregate amount that will be financed by the insured member concerning a benefit. Deduction ends once this annual aggregate deductible amount is deducted during the policy year.
28- Are the premiums of plans with deductibles lower?
Yes, plans with deductibles have lower premiums compared to those plans without deductibles but otherwise similar benefits. Premiums decrease as deductible amounts increase.
29- What are the important aspects at the health declaration?
The questions that are asked at the application form must be replied in a correct and complete way. The policyholder as he/she completes the application form also on behalf of the people that will be included in the policy, must also reply the questions concerning his/her spouse, children or other individuals in a complete and correct way. A complete declaration enables the insurance company to assess the risk of the insured members correctly and prevents rejection of claims due to incomplete declarations. There shouldn’t be any wiping, scraping, scribble on the application form. Any amendments should be initialized.
30- Which type of health problems should be declared at the health declaration?
Known (diagnosed), noticed, sensed health problems, disorders and diseases and health complaints must be declared. Even if a disorder/disease is not diagnosed or a physician is not consulted at all (for those complaints) noticed, sensed health problems, disorders should be indicated. A complete declaration enables the insurance company to assess the risk of the insured members correctly and prevents rejection of claims due to incomplete declarations.
31- - What are the consequences of an incomplete or incorrect health declaration?
The insurance company reserves the right of canceling the policy, rejecting the claim or applying special terms concerning the medical condition subject to the incomplete or incorrect declaration depending to the degree of risk associated with the incomplete or incorrect declaration as well as the nature of the incomplete or incorrect declaration i.e. done intentionally or unintentionally (by fault).
32- Under which circumstances can an insurance company cancel a policy, or cancel the insurance of an insured member included in an insurance policy?
An insurance company can cancel a valid insurance policy or the insurance policy of an insured member included in this policy under 2 circumstances:
a) Intentional incomplete or incorrect declaration: Intentional incomplete or incorrect declaration at the application form where this incomplete or incorrect declaration is related with a medical condition which would normally lead to the denial of the application,
b) Default in payment of the insurance premium in time and the completion of the default period.
33- Can the insurance company cancel a policy due to a major illness or accident or excessive claims, before the expiry date defined at the policy?
The policy cannot be cancelled by the insurance company for a reason other then incomplete or incorrect declaration or default in payment of policy premiums. A major illness, accident or excessive claims cannot be a reason to terminate a policy before the expiry date of the policy. The insured member however can unconditionally terminate a policy, without presenting a reason at anytime before the expiry of the policy.
34- What are the consequences of default in timely payment?
The full policy premium or the first installment if it is mutually agreed that the policy premiums would be paid in installments has to be paid as soon as the contract is signed or at the latest when the policy is delivered. The liabilities of the insurance company do not start if the full policy premium or the first installment is not paid, unless otherwise agreed.
If it is agreed that the policy premiums would be paid in installments, installment amounts and due dates are indicated on the front page of the policy.
In case the policy premium is not paid in time, a default period starts. On the 15th day after the due date coverage stops. The Insurance company reserves the right to cancel the policy on the 30th day after the due date if the policy premiums hasn't been paid yet.
35- In which time period should the policy renewal be done?
Policy renewal should be done in the time period 30 days before and 30 days after the expiry of the policy.
36- Are the acquired rights lost if the policy renewal is not made on time?
Yes. Acquired rights such as "No Claims Bonus", "Renewal Guarantee" or the completed time necessary to get the "Renewal Guarantee", completed "Waiting Periods" are lost if the policy is not renewed within a maximum of 30 days after the policy has expired.
37- Is MedNet an insurance company?
No. MedNet is not an insurance company. It is a Third Party Administrator that provides the insurance companies it co-operates and their insured members with a wide range of services. MedNet provides the following services at the highest quality expected in the private health insurance field:
establishment of the widest health care provider network,
development of health insurance products according to the needs,
design of new products,
undertaking of policy and insured member enrollment and preparation of the policy packages,
organisation of emergency medical care, ambulance transportation (including sea and air ambulances),
provision of preadmission certifications and organisation of hospitalisations on a 7/24 basis, within Turkey and worldwide,
impartial, fast and precise adjudication of the claims according to the benefits and terms and conditions of the policy and identification of the amounts to be paid by the insurance companies,
provision of customer service and
provision of information technologies to the use of insured members, insurance companies and network providers.
The insured member and the insurance company are the only parties of an insurance contract.
38- Does MedNet pay for the medical expenses?
No. MedNet adjudicates the claims according to the benefits and terms and conditions of the policy and submits the payment lists, ready for payment, to the insurance companies. The insurance companies then make payments.
39- What are the advantage of being under MedNet umbrella?
MedNet is the first and the strongest company offering Third Party Administration services in the field of private health insurance, in Turkey. Its mission is to provide the insurance companies and their insured members with the highest quality services through its experience in the field of private health insurance and through the advanced technologies it employs.(Please see "
About MedNet")
MedNet is a service company that offers the full range of services expected from private health insurance on a 7/24 basis, around the world, benefiting from its international partners and experience. Currently MedNet companies operate in 8 other countries and all MedNet companies belong to the Munich Re, one of the world largest reinsurers.
Mednet is an entity that adjudicates the claims in an impartial way and makes sure that the terms and conditions stipulated by the policy contract are fully and timely fulfilled.
40- What are the procedures to be followed in case of admission to a MedNet network provider?
MedNet, directly contracts with medical providers that are needed to offer the range of services included in the insurance benefits. When you apply to a MedNet network provider for a consultation, treatment, a diagnostic procedure or to get your prescribed medicines please present your insurance id, indicate that you are under the MedNet umbrella and start the precertification procedure. The precertification allows you to receive the medical services without making any out-of pocket payment other then the co-participation indicated by your policy (if any). Insurance company part of the incurred expenses will directly be paid by your insurance company to the network provider.
41- Does MedNet provide Emergency Medical Care or Ambulance services?
Requests for emergency medical care and ambulance transportation can be made to MedNet on a 7/24 basis. MedNet will direct the closest and most convenient emergency care and ambulance company/organisation to the insured member.
42- Is it possible to contact MedNet to receive information on any health problem?
Is it possible to contact MedNet to receive information on any health problem?
43- Why is it necessary to get a pre-certification prior to the treatment?
Certain diseases and procedures are excluded from private health insurance (Please
see item 21. What does exclusion mean in private health insurance? Which exclusions are there?) The procedures to be undertaken might be related with those exclusions. In such cases the claim might be rejected, as the insurance company will not cover the respective expenses. Such a rejection after the expenses are incurred may cause financial distress on the insured member. This is why it is important to get a pre-certification (pre-approval / payment guarantee) if possible (in an emergency situation getting a pre-approval may not always be possible) before the procedure is undertaken i.e. before the treatment is performed.
44- How is a pre-certification application made before a hospitalisation?
The
MedNet Özel Sağlık Sigortası Hasta Bilgi Formu has to be used by the network providers for hospitalisations. This form needs to be completed by the attending physician and faxed to MedNet. (0212 347 24 00)
45- What needs to be done at a provider outside Turkey?
First and foremost, the insured member should make sure that he/she knows he/she has the right international coverage, whether there are limits and co-payments for the procedure. MedNet will be pleased to inform the insured member on the geographical scope of coverage, limits and deductibles. (MedNet Call Center 0212 347 35 00)
It is recommended that the insured member calls MedNet for elective cases (planned procedures) and inform MedNet beforehand if the international healthcare provided is already selected to initiate the pre-certification process early enough to establish the necessary co-ordination with the provider.
In case of a sudden illness or an accident while your stay in abroad, you are most welcome to immediately call MedNet and request assistance. If you have already applied to a provider, MedNet should be informed about the situation and the provider contact details should be provided or Provider should be asked to contact MedNet to start the pre-certification process (MedNet International Pre-certifications Center +90 212 347 62 66)
46- What needs to be done for outpatient procedures?
MedNet provides the network physicians, hospitals, clinics, imaging centers, laboratories, pharmacies and physiotherapy centers with 7/24 pre-certification services in Turkey.
This service is provided via MedNet On-line (Internet application) as well as via the MedNet Call Center.
Please remind the network provider to get a pre-approval if you apply to one of those network providers.
Please ask your physician to complete separate claim forms
Tazminat Talep Formu to be given to the lab or pharmacy if lab test will be undertaken at another provider or if your physician prescribes medicines.
47- What needs to be done if medical care is received at a non-network provider?
In case of receiving inpatient medical care at a non-network hospital, the "MedNet, Private Health Insurance Patient Information Form"
MedNet Özel Sağlık Sigortası Hasta Bilgi Formu should be completed by the attending physician. The originals of the invoices as well as the "MedNet, Private Health Insurance Patient Information Form" must be submitted to MedNet for the reimbursement of the claim.
In case of receiving outpatient services at a non-network provider a claim form
Tazminat Talep Formu should be completed by the attending physician. Lab tests request document as well as a copy of test results if test are requested, the prescription as well as the drug labels if drugs are prescribed and the originals of the invoices must be submitted to MedNet along with the claim form, for the reimbursement of the claim.