Application for restitution of the health insurance expenses

IMPORTANT!

Please enter your phone number (and e-mail) carefully, as we will send you a link to the contact details you provide, by clicking which, you will need to confirm your request.

The decision on the expenses incurred and compensation thereof will be made within 15 calendar days of the receiving of the request.

Insured person

Health insurance card No

For your convenience, the first digits of the health insurance file have been entered – you only need to enter the last 7 digits of the file number

Bank account No

Telephone No

E-mail address

I hereby request compensation of the health insurance expenses incurred during receipt of the following services:

Outpatient assistance	Suma Eur
Inpatient treatment	Suma Eur
Dental treatment	Suma Eur
Rehabilitation services	Suma Eur
Medicines and medical aid	Suma Eur
Preventive health checks of employees	Suma Eur
Optical aids and services	Suma Eur
Wellness services	Suma Eur
Prenatal care services	Suma Eur
Additional medical services	Suma Eur
Telesante remote consultation / other services	Suma Eur

The total amount paid, EUR:

Attach the documents

Drag files here

Physician’s referral, medical excerpt, prescription, receipt of expenss, etc.
Uploaded files must match following requirements:

Max amount of files: 5

I agree that health care institutions or other institutions which I have visited and obtained treatment or other services provide AB Lietuvos Draudimas with all the information related to the services provided to me and the goods sold, including health information, that AB Lietuvos Draudimas could check the data and make sure of the existence of the insured event. I can read more about my rights at https://www.ld.lt/privatumo-politika-LD.

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AB „Lietuvos draudimas“

J. Basanavičiaus g. 10,

01118 Vilnius

Self-service www.savasld.lt

Help by phone:

1828 or +370 5 266 6612

I-IV 8:00-17:00, V 8:00-15:45

Email address [email protected]