Employee health insurance at the company’s expense
ERGO health insurance for the company’s employees is an effective incentive tool that provides the opportunity to use health care and wellness services by paying for them with insurance funds. If you have any questions, we will help you choose the most suitable insurance for your company.
Employee health insurance
ERGO health insurance provides the opportunity to use health care services, receive a physician’s consultations and undergo prescribed tests in both public and private medical institutions throughout Lithuania, as well as purchase medicines or use other health promotion services.
We care not only about people’s physical health, but also about their emotional well-being, which is why we were one of the first in the health insurance market to introduce a separate limit for psychological consultations. Emotional health is a new service which, if selected, will pay for consultations with a psychologist or psychotherapist without a physician’s appointment.
Professional customer service
We take care of you, so you can always easily reach us by calling the short telephone number 1887.
Quick claim settlement
With our mobile app, you can quickly and conveniently fill out a claim for compensation.
Possibility to choose
You will be able to choose the scope of insurance coverage according to your needs.
What services are compensated by ERGO?
Additional health insurance for employees
All services
In the event of health problems, the personal health insurance will reimburse the following services, depending on the chosen insurance coverage:
- outpatient treatment;
- inpatient treatment in public and private medical institutions;
- preventive examination, prenatal care and vaccination;
- optics;
- vitamins, food supplements, non-prescription medicines;
- critical illnesses;
- rehabilitation treatment;
- dentistry services;
- medical services;
- emotional health;
- prescription medicines and orthopedic technical devices.
Important: this is the broadest insurance option, each valid insurance scope may differ from the insurance coverage described here or mentioned in the Rules.
Outpatient treatment
In case of outpatient treatment, the following services are paid:
- consultations of a general practitioner in a health care facility and home visits;
- consultations and examinations of other medical specialists;
- consultations of a psychiatrist, psychiatrist-psychotherapist (up to 10 times during the insurance period), after the psychiatrist has diagnosed the disease and prescribed treatment;
- Remote medical consultations.
Inpatient treatment
In case of inpatient treatment, the following services are paid:
- comfort (single or double ward);
- consultations of medical specialists and their diagnostic and therapeutic treatments;
- diagnostic tests prescribed by a physician;
- nursing services by a physician’s appointment;
- medical aids prescribed by a physician and used in an inpatient facility, medicinal products, care products, orthopedic equipment.
Preventive examination, prenatal care and vaccination
In case of preventive examination, prenatal care and vaccination, the following services are paid:
- according to the nature of the work, a health examination is mandatory in accordance with the law;
- tests carried out at the request of the insured person;
- tests that are not necessary and medically justified in a specific clinical situation;
- psychotherapeutic treatment (a physician’s appointment is not necessary);
- comfort services (single or double ward) during pregnancy, childbirth and postnatal care;
- pregnant women’s examinations, a physician’s consultations and tests prescribed by them to monitor the course of pregnancy (laboratory, instrumental);
- diagnosis of pregnancy complications (a physician’s consultations and tests);
- childbirth care (services of nurses and physicians during childbirth (including a premium for a pre-selected physician or midwife of the same medical institution), painkillers, birth-inducing drugs, lard, vacuum aid device);
- a physician’s consultations regarding vaccinations and vaccines chosen by the insured person or prescribed by the physician and vaccination.
Optics
Paid optical services:
- glasses selection and production service;
- frames for glasses are purchased together with corrective lenses (glass, plastic, photochromic, progressive);
- corrective lenses (glass, plastic, photochromic, progressive);
- contact lenses (lenses);
- eye lenses used during surgery;
- myopia and hyperopia vision correction surgeries.
Vitamins, food supplements, non-prescription medicines
The following products purchased in pharmacies or e-pharmacies are paid:
- food supplements and vitamins;
- non-prescription medicinal products.
Rehabilitation treatment
In case of rehabilitation treatment, the following services are paid:
- consultations of a physiotherapist, occupational therapist, speech therapist;
- physiotherapy sessions;
- individual and group physical therapy classes in the hall and in the water;
- water and mud treatments;
- manual therapy sessions;
- therapeutic massages.
Dentistry services
In case of dental treatment, oral hygiene, prosthetics, the following services are paid:
- consultations of a dentist, dental specialist and oral hygienist, consultations on dental prosthetics, implantation and orthodontic treatment;
- removal of dental concretions, plaque cleaning;
- fluoride applications;
- endodontic, periodontal, therapeutic and surgical treatment of dental diseases, mouth, its mucous membrane and jaw diseases, anesthesia, X-ray examination;
- production, restoration and repair of removable and non-removable dental prostheses;
- dental implantation, dental implants, orthodontic treatment, braces, therapeutic aligners for orthodontic treatment, myorelaxation trays, aesthetic filling.
Medical services
Paid medical services:
- services provided in healthcare facilities: a physician’s consultations, diagnostic tests, surgeries, nursing services, rehabilitation treatment, prenatal care, prevention, vaccination, psychotherapeutic treatment;
- services purchased in pharmacies/e-pharmacies, stores/e-stores of orthopedic technical devices: medicinal products, food supplements, medical aids, orthopedic technical devices;
- in optical stores/e-optical stores: contact lenses (lenses), corrective lenses, and frames purchased together with corrective lenses, safety glasses, glasses selection and production services, eyeglass care products (solutions for contact lenses and liquid cleaners for eyeglass lenses), eye lenses used during surgery;
- dental treatment services: dental treatment, oral hygiene, prosthetics, implantation, orthodontic treatment, braces, therapeutic caps for orthodontic treatment, myorelaxation caps, aesthetic filling;
- in health care institutions: physiotherapy sessions, occupational therapy sessions, halotherapy, physiotherapy classes, water and mud treatments, manual therapy sessions, therapeutic massages.
Medical services do not require a physician’s appointment/prescription/referral.
Emotional health
Paid emotional health services:
- a psychiatrist consultations;
- a psychiatrist-psychotherapist consultations;
- a psychologist-psychotherapist consultations;
- a medical psychologist, psychologist consultations.
A physician’s appointment is not necessary.
Prescription medicines and technical orthopedic devices
Paid medicines and technical orthopedic devices:
- prescription medicinal products;
- orthopedic technical devices purchased in stores/e-stores of orthopedic technical devices and/or pharmacies/e-pharmacies, orthopedic inserts, orthopedic socks and compensatory equipment, elastic and compression socks.
Additional health insurance for employees
In the event of health problems, the personal health insurance will reimburse the following services, depending on the chosen insurance coverage:
- outpatient treatment;
- inpatient treatment in public and private medical institutions;
- preventive examination, prenatal care and vaccination;
- optics;
- vitamins, food supplements, non-prescription medicines;
- critical illnesses;
- rehabilitation treatment;
- dentistry services;
- medical services;
- emotional health;
- prescription medicines and orthopedic technical devices.
Important: this is the broadest insurance option, each valid insurance scope may differ from the insurance coverage described here or mentioned in the Rules.
In case of outpatient treatment, the following services are paid:
- consultations of a general practitioner in a health care facility and home visits;
- consultations and examinations of other medical specialists;
- consultations of a psychiatrist, psychiatrist-psychotherapist (up to 10 times during the insurance period), after the psychiatrist has diagnosed the disease and prescribed treatment;
- Remote medical consultations.
In case of inpatient treatment, the following services are paid:
- comfort (single or double ward);
- consultations of medical specialists and their diagnostic and therapeutic treatments;
- diagnostic tests prescribed by a physician;
- nursing services by a physician’s appointment;
- medical aids prescribed by a physician and used in an inpatient facility, medicinal products, care products, orthopedic equipment.
In case of preventive examination, prenatal care and vaccination, the following services are paid:
- according to the nature of the work, a health examination is mandatory in accordance with the law;
- tests carried out at the request of the insured person;
- tests that are not necessary and medically justified in a specific clinical situation;
- psychotherapeutic treatment (a physician’s appointment is not necessary);
- comfort services (single or double ward) during pregnancy, childbirth and postnatal care;
- pregnant women’s examinations, a physician’s consultations and tests prescribed by them to monitor the course of pregnancy (laboratory, instrumental);
- diagnosis of pregnancy complications (a physician’s consultations and tests);
- childbirth care (services of nurses and physicians during childbirth (including a premium for a pre-selected physician or midwife of the same medical institution), painkillers, birth-inducing drugs, lard, vacuum aid device);
- a physician’s consultations regarding vaccinations and vaccines chosen by the insured person or prescribed by the physician and vaccination.
Paid optical services:
- glasses selection and production service;
- frames for glasses are purchased together with corrective lenses (glass, plastic, photochromic, progressive);
- corrective lenses (glass, plastic, photochromic, progressive);
- contact lenses (lenses);
- eye lenses used during surgery;
- myopia and hyperopia vision correction surgeries.
The following products purchased in pharmacies or e-pharmacies are paid:
- food supplements and vitamins;
- non-prescription medicinal products.
In case of rehabilitation treatment, the following services are paid:
- consultations of a physiotherapist, occupational therapist, speech therapist;
- physiotherapy sessions;
- individual and group physical therapy classes in the hall and in the water;
- water and mud treatments;
- manual therapy sessions;
- therapeutic massages.
In case of dental treatment, oral hygiene, prosthetics, the following services are paid:
- consultations of a dentist, dental specialist and oral hygienist, consultations on dental prosthetics, implantation and orthodontic treatment;
- removal of dental concretions, plaque cleaning;
- fluoride applications;
- endodontic, periodontal, therapeutic and surgical treatment of dental diseases, mouth, its mucous membrane and jaw diseases, anesthesia, X-ray examination;
- production, restoration and repair of removable and non-removable dental prostheses;
- dental implantation, dental implants, orthodontic treatment, braces, therapeutic aligners for orthodontic treatment, myorelaxation trays, aesthetic filling.
Paid medical services:
- services provided in healthcare facilities: a physician’s consultations, diagnostic tests, surgeries, nursing services, rehabilitation treatment, prenatal care, prevention, vaccination, psychotherapeutic treatment;
- services purchased in pharmacies/e-pharmacies, stores/e-stores of orthopedic technical devices: medicinal products, food supplements, medical aids, orthopedic technical devices;
- in optical stores/e-optical stores: contact lenses (lenses), corrective lenses, and frames purchased together with corrective lenses, safety glasses, glasses selection and production services, eyeglass care products (solutions for contact lenses and liquid cleaners for eyeglass lenses), eye lenses used during surgery;
- dental treatment services: dental treatment, oral hygiene, prosthetics, implantation, orthodontic treatment, braces, therapeutic caps for orthodontic treatment, myorelaxation caps, aesthetic filling;
- in health care institutions: physiotherapy sessions, occupational therapy sessions, halotherapy, physiotherapy classes, water and mud treatments, manual therapy sessions, therapeutic massages.
Medical services do not require a physician’s appointment/prescription/referral.
Paid emotional health services:
- a psychiatrist consultations;
- a psychiatrist-psychotherapist consultations;
- a psychologist-psychotherapist consultations;
- a medical psychologist, psychologist consultations.
A physician’s appointment is not necessary.
Paid medicines and technical orthopedic devices:
- prescription medicinal products;
- orthopedic technical devices purchased in stores/e-stores of orthopedic technical devices and/or pharmacies/e-pharmacies, orthopedic inserts, orthopedic socks and compensatory equipment, elastic and compression socks.
Why to choose ERGO insurance?
The opportunity to take better care of your health will ensure a better well-being of employees and higher work efficiency. Additional insurance also promotes employee loyalty.
Taking care of your employees will have a positive impact on your company’s image.
Your employees will be able to choose the desired public or private medical institution, specialist physician and receive services quickly and in a high quality manner.
Health insurance-reimbursed treatment services will allow employees to return to work faster after illness, which will reduce the number of days off.
How to use health insurance and receive a compensation?
Your employees may choose the desired public or private medical institution, specialist physician and receive services quickly and in a high quality manner. For your convenience, we provide a list of medical institutions where you can receive the State-paid services. Going to these medical institutions for medical consultations or tests can save your insurance funds and allocate them to other higher expenses.
How to apply for a compensation of claims?
- Keep a record of your doctor’s appointment, prescription or referral for tests and treatments, documents of payment for the provided services and provide them to us as soon as possible.
- You can submit documents quickly and conveniently using the ERGO mobile app, My ERGO self-service portal.
- You can also submit a request by e-mail sveikatos_zalos@ergo.lt after additionally completing the application for reimbursement of expenses, which is available in Self service portal.
- After receiving the necessary documents, we will transfer the payment to you within 2-3 working days.
ERGO mobile health app for companies
We invite you to use the ERGO mobile app – it is the most convenient way to apply for reimbursement of health insurance costs. In the mobile app, you will be able:
- make claims for reimbursement of expenses;
- check the health insurance limits;
- read the policy information;
- see the reimbursed services, the necessary documents;
- view the electronic health insurance card.
How to log in and use the app:
- first, log om to your account on the smart phone via e-banking. Later, you can log in using a quick identification method: PIN code, fingerprint and face recognition function, depending on the capabilities of your device;
- by selecting the SUBMIT menu item, you will register a request for reimbursement of expenses;
- when registering an insurance benefit for the first time, enter your contact details, select the limit from which you wish to receive reimbursement;
- attach documents (e.g. cheque, invoice, medical record, etc.) or their photos;
- make sure the details you provide are correct;
- familiarise yourself with the policy rules and submit an application;
- we will process the submitted application within 2-3 working days and contact you by e-mail.
Frequently asked questions about employee health insurance
The non-taxable part of the health insurance premium is that which covers the employee’s consultation on health, preventive examinations, diagnosis, treatment, rehabilitation after illness, nursing care, including vitamins, supplements, medical devices necessary to treat, improve or restore health, and provide health-related services.
It is not prohibited to include such services that are not related to health care, such as exercise in sports and health clubs, SPA treatments, cosmetic, plastic treatments or surgeries, non-therapeutic massages, protective sunglasses (not for health purposes), eye care tools, accessories, cosmetics and similar expenses are not subject to personal income tax relief in the health insurance contract.
The part of the health insurance premium that covers services that are not related to health care is attributed to the employee’s income in kind and is taxed as the resident’s employment-related income.
To request reimbursement for expenses, you need to submit the following documents:
- Invoice;
- Detailed description of the service(s): service name (e.g., neurologist consultation, filling of tooth #24, etc.), quantity, price, and date of service;
- Cash receipt/bank statement, which must include:
- Service provider’s details;
- Service recipient’s full name.
The claims administrator may request additional documents, such as a medical visit summary, prescription, or a referral for tests and procedures, etc.
The easiest way to submit a reimbursement request is through the ERGO Lietuva mobile application. Alternatively, you can submit the request via email at sveikatos_zalos@ergo.lt or through the Mano ERGO self-service portal.
A physician’s referral is required when referring to medical examiners (endoscopist, echoscopist, clinical physiologist and radiologist), diagnostic tests, psychotherapy sessions, rehabilitative treatment, surgeries, reimbursement of nursing services.
Referral is not required when addressing specialist physicians (e.g. general practitioner, cardiologist, neurologist, endocrinologist, etc.).
The health insurance limit is the maximum amount of money specified in the insurance contract, which the insurance company pays for the provided health care services.
Documentation for reimbursement of expenses must be provided no later than within 30 calendar days from the date of the insured event.
The insurance company reimburses medicines registered in the Register of Medicinal Products of the Republic of Lithuania (including homeopathic ones) and purchased in pharmacies/e-pharmacies, as well as branded medicinal preparations registered in EU countries and in the country of manufacture. Information about registered medicines and homeopathic products can be checked on the website of the State Medicines Control Agency of Lithuania at https://vapris.vvkt.lt/vvkt-web/public/medications
Prescription is required when non-prescription medicines are reimbursed from the “Medicines and orthopaedic devices” limit. Information on prescription and non-prescription medicines can be found on the website of the State Medicines Control Agency of Lithuania.
In the case of varicose veins, the insurance company pays for a physician’s consultations and diagnostic tests. You can find out whether further treatment of varicose veins (surgical/laser/sclerotherapy) is provided for in a specific insurance contract in the section “Policy” → “Information about your policy” of the mobile app and by calling telephone 1887 or by e-mail sveikatos_zalos@ergo.lt.
The outpatient treatment limit covers services for monitoring and exacerbation of health disorders, injuries, acute illness or chronic illnesses, as well as consultations of a psychiatrist, psychiatrist-psychotherapist (the number of reimbursed visits is specified in your policy), after the psychiatrist has diagnosed the illness and prescribed treatment.
The treatment of warts and moles is not reimbursed, except for: cases of malignant skin disease, if the malignant skin disease is confirmed by histological examination. You can find out whether further treatment of warts and moles is provided for in a specific insurance contract in the section “Policy” → “Information about your policy” of the mobile app and by calling telephone 1887 or by e-mail sveikatos_zalos@ergo.lt.
Usually, the health insurance benefit is paid out within 2-5 working days, but no later than within 30 days from the day when all the information relevant to determining the insured event is received.
The list of institutions with which ERGO Life Insurance SE has signed cooperation agreements can be viewed by clicking on this link.
The medical institution-partner may request the insured person to pay for the services for the following reasons:
- Due to a non-insured event for which compensation from the insurance company is not provided.
- If a deductible is applied to the limit from which the settlement is made, it is paid by the insured person in accordance with the terms and conditions of the insurance contract.
- When the limit of the sum insured from which the payment is made is exceeded.
When health insurance coverage is terminated, health care services are not covered. If, after termination of the insurance coverage, the customer applies to the medical institution that provides him with services, the costs related to these services must be paid by the customer himself.
If you have any questions, you can always contact us by:
- e-mail sveikatos_zalos@ergo.lt;
- or by calling by ERGO insurance telephone 1887.
For personal care services, you can apply to both private and public medical institutions, although they are not on the list of our partners.
The most important thing is that the medical institution has a healthcare licence (You can check here). Please note that direct payment is possible only in medical institutions that have signed a cooperation agreement with ERGO. If the cooperation agreement is not signed, the insured person pays for the service by himself and submits a request for reimbursement to ERGO.
The electronic prescription in PDF format can be accessed by logging in to the personal eHealth (e-sveikata) page on the website → put a check mark on the top → iPasas.lt. When you choose Health data → Medical history, take a photo of the found document and save it in pdf format (Ctrl + P or PrtSc).
Remote family doctor consultations are services provided by family doctors remotely. This service allows you to receive a personal and professional family doctor consultation within a few hours (depending on the availability of doctors) in case of health issues or complaints. If needed, it also enables prescription appointments (e.g., issuing or renewing an e-prescription) or referrals for further tests or specialist consultations. The service is provided by experienced doctors with many years of practice.
Most everyday illnesses or health concerns can be effectively and efficiently addressed remotely, just as they would be during an in-person visit to the doctor.
You can register for a remote family doctor consultation:
- If you have health-related problems, complaints, or acute illnesses (e.g., sore throat, cold, runny nose, fever, dizziness, weakness, urinary tract infection, etc.);
- For non-urgent medical issues that do not require a physical examination;
- For prescribing medication, issuing, or renewing a non-reimbursable e-prescription;
- To avoid potential exposure to additional viruses or infectious diseases (especially during seasonal illness outbreaks or declared epidemics/pandemics);
- If your condition makes it difficult to visit a medical facility physically.
Remote consultations are available regardless of your medical facility.
For more detailed information, check your ERGO health insurance app.
To register for a remote family doctor consultation with Telesante, visit their website at https://telesante.lt/. Detailed information about the service, usage, and payment can be found there.
To register for a remote family doctor consultation with Hila, download their app, available at https://www.uhealth.lt/. Detailed information about the service, usage, and payment can be found there.
