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10-09-2021

Health insurance guarantees - for every insured

Iliustracija

All persons insured with compulsory health insurance (CHI) have the right to receive treatment and health care services in Lithuania without additional charge. This right is acquired in exchange for fixed monthly CHI contributions. For the population belonging to socially vulnerable groups, CHI contributions are paid for by the state.

What can every Lithuanian resident get by properly paying CHI or when the state pays contributions for him/her? Panevėžys Territorial Health Insurance Fund (THIF) reminds of essential things.

CHI in our country guarantees:

  • family doctor services and disease prevention;
  • dental care;
  • services of medical specialists;
  • emergency medical aid;
  • hospital treatment;
  • medical rehabilitation;
  • nursing services;
  • costly tests and procedures;
  • reimbursable medicines and medical devices;
  • the benefits of going abroad.

When persons covered by CHI becomes ill, they first sees a family doctor at the outpatient or family clinic they are referred to. If emotional help is needed, they contact a mental health centre, which they must also sign up for. The GP may prescribe to the enrolled patients those examinations that fall within his / her competence (for more details see points 6-8). In each case, the doctor assesses (according to the patient's condition) (not the ones the patient wishes) which tests to prescribe, whether to send the patient to the hospital or to a specialist consultation. The family doctor prescribes tests for healthy patients of certain age groups, which are performed according to prevention programs - cervical, breast, colon, prostate cancer and cardiovascular diseases. For CHIF funded vaccines (for more details see points 10-11) or children and certain groups of adults, patients should also consult their GP.

A separate area is dental care. The health insurance fund pays for the work of the doctor, and the patient has to pay for medicines, fillings or other dental materials, disposable items, depending on the amount of materials and instruments used and their purchase prices. The exception applies to children in full-time general education schools, full-time students in vocational schools until they reach the age of 24, and socially disadvantaged people on presentation of an appropriate municipal certificate. Reimbursable primary dental services are provided to insured persons by dentists of those polyclinics or family clinics to which the residents have signed up for, or these services must be provided in another medical institution. Old-age pensioners, children, incapacitated or partially able-bodied persons and patients receiving treatment for oral, facial and maxillofacial oncology are entitled to dental prosthetics (for more details see points 4-7) reimbursed from the CHIF budget. Children under 14 – to dental sealing (for more details see point 3).

Patients, having a referral to the consultation of a specialist doctor (cardiologist, endocrinologist, ophthalmologist, etc.), can choose the medical institution where they wish to receive the services specified in the referral. It is necessary to register within 30 calendar days of receipt of the referral (within 60 days in the event of a declared emergency and/or quarantine). In some cases, the shipment is not required (for more details see point 3).

Please note that emergency medical aid is provided to both CHI insured and non-CHI insured persons. It is provided around the clock in the event of an acute accident in the area specified in the contract with the THIF.

CHI insured residents can receive free treatment at hospitals. In addition to basic inpatient services, hospitals may perform joint replacement surgery (for more details see point 5) with reimbursable joints, eye lens replacement surgeries (for more details see point 5), in which a cloudy eye lens is replaced by an artificial one covered by the CHIF, and various other complex surgeries.

It is essential that in order to restore a patient's impaired biopsychosocial function or in the event of irreversible changes in the body, insured persons can receive free medical rehabilitation, and those with chronic diseases, as well as the disabled and other patients with a clear diagnosis and no need for active treatment and no rehabilitation is possible, to access nursing and supportive treatment services, palliative care and home care services.

Continuous monthly health insurance contributions entitle the residents to computer or magnetic resonance imaging, positron emission tomography, hemodialysis and other costly tests and procedures paid for with CHIF funds. Referrals can only be prescribed by a specialist doctor (not a GP).

The CHI guarantees reimbursable medicines and medical aids to the insured population (for more details see points 1-3): medicines for various diseases, medicines for certain social groups, nursing products, various diagnostic strips, foodstuffs for special medical purposes, etc. The CHIF budget also covers orthopedic technical devices (for more details see point 4), cochler implants (for more details see point 5) that enable hearing, rent of medical appliances/devices (for more details see point 6) - artificial lung ventilation and oxygen equipment, insulin and pain pumps.

In addition to all these important health issues, insured persons in Lithuania can receive a European Health Insurance Card or a certificate replacing this card free of charge, confirming the Insured's right to receive emergency medical care paid for with CHIF funds during a temporary stay in another EU country. Under certain conditions, patients can choose a healthcare provider in another EU country and receive various services abroad (for more details see points 2-3).

You can find much more information about all the listed CHI guarantees here or on the website of the health insurance funds https://ligoniukasa.lrv.lt/en/

Panevėžys Territorial Health Insurance Fund information

The NHIF invites you:

Your questions are welcome by email [email protected] or phone: local (8 5) 232 2222, international +370 5 232 2222.

Last updated: 22-09-2021

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