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Application for restitution of the health insurance expenses

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

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
PasirinkimasSuma
Outpatient assistance
Inpatient treatment
Dental treatment
Rehabilitation services
Medicines and medical aid
Preventive health checks of employees
Optical aids and services
Wellness services
Prenatal care services
Additional medical services
Other services
I hereby request compensation of the health insurance expenses incurred during receipt of the following services:
Attach the documents
Physician’s referral, medical excerpt, prescription, receipt of expenss, etc.
Physician’s referral, medical excerpt, prescription, receipt of expenss, etc.