What to do in case of damage?

The insured with the private health and personal accident policy will be provided with a Sigal health insurance card which contains a barcode and the name and surname of the insured person. All insured persons have the right to benefit from discounted medical services upon presentation of the insurance card at the clinics of the SIGAL UNIQA medical network.

The insurance card is issued to the insured person so that he can be identified as such in clinics and hospitals whenever he needs medical services. Whenever you show your insurance card, you benefit not only from assistance in the event of a medical emergency, but also from discounted prices for any medical service you receive.

As a general rule, the insured pays each time he/she requires a medical service and then applies his/her medical bills for reimbursement. The insured does not pay only when:

• SIGAL has issued a Payment Guarantee where it has assumed the bill or;
• You have presented yourself to the hospital with a medical emergency and SIGAL has become aware of this

After reading the barcode on the card, you are directed to https//:clients.sigal.com.al. This link, if you enter with your card number that is placed after / (SDXXXX) and your date of birth as a password, see in real time, the refund process, from the moment it is registered to the refund.

Attention: you will not receive an e-mail if your refund application has deficiencies in the documentation. Therefore, always stay logged in to https://clients.sigal.com.al and frequently follow the status of your refund application;

Yes, if you have a Gold or Silver card, you can benefit from “Telehealth” for free.

The steps are:

• Download the application on playstore or appstore by searching for Telehealth
• Open a personal account
• Your password will be sent to your email
• Once you have received your password, log in to the application with your email and the password you received
• In the My Profile/My Registration section/Enter your card number (SCXXX) (GCXXX)
• Be careful, enter the number after the slash

Yes, if you have a Gold or Silver card, you can benefit from “Telehealth” for free.

In the My Profile/My Refund Requests section, see the refund process in real time.

Yes, if you have a Gold or Silver card, you also have an electronic card in the application. The electronic card has the same value as the physical card.

1. Log in to the application and click “New Request”

2. Select the insurance card

3. Select the clinic/hospital where you received the service

4. Select the type of service

5. Fill in:

-Fiscal invoice number and date

-Amount you are requesting reimbursement

6. Attach:

-Fiscal invoice

-Medical documents.

7. If you have more invoices, click “Add Invoice”

After sending the request, you can follow its progress in “Completed Requests” and you will receive notifications in the application for any changes or additional information.

Once you have submitted your reimbursement request in the fpcHealth application, you can follow its progress in the “Completed Requests” category, where all details and processing status are displayed.

SIGAL UNIQA will notify you in real time through the application in the “Comments” section, if your request requires additional documents or clarifications.

⏱ The duration of the process depends on the completeness of the documentation, but generally refunds are processed within a few business days after the correct submission of the request and documents.

Download the direct payment form here https://sigal.com.al/wp-content/uploads/2018/02/AUTORIZIM-PARAPRAK.pdf Whenever the insured person requests the issuance of a payment guarantee, they must keep in mind:
1.Send a notification in the form of a written request (e-mail) by submitting the Assistance Form and all supporting medical documents.
2.For planned services, the notification procedure must be followed at least 5 days before the medical service is scheduled
3.The payment guarantee will be issued if the total amount of expenses is expected to be 20,000 lek or more.

Attention: E-mail will only be considered in cases where the medical service is recommended in an emergency. For all other cases, the request for assistance must be submitted in a sealed envelope and accompanied by supporting medical documents in a sealed envelope to the SIGAL central offices.

1. The insured person notifies the predetermined clinic of the date he has planned for the annual check-up;
   The Hospital Clinic enters the platform https://hcm.sigal.com.al/
2. The Clinic/Hospital confirms the date to the insured person
3. The examinations within the framework of the check-up are carried out, as soon as the insured person has confirmed the schedules by the institution, without having to follow a procedure for a payment guarantee
4. The insured person, in communication with the selected medical institution, completes the check-up analyzes within a reasonable period for the administration of this service for the Health Institution

Caution: If it is the 1st (first) year that you are insured with SIGAL UNIQA, keep in mind that the planned services (including the check-up) are covered by the insurance contract after the waiting period (45 days) has passed. During the waiting period, the insurance contract only covers medical emergencies.

1. Prior authorization must be requested for the following medical services: – Inpatient treatment; – Day surgery; – Nursing service; – Medical evacuation; – Transportation outside Albania; – Repatriation of the body. For the purposes of implementing this contract, communications with the Insurer will be maintained through the address [email protected].

1. Yes, currently you can get more information about Private Health by accessing the official Sigal website at the link: https://clients.sigal.com.al
   

1. Public hospital coverage is granted in cases where:
2. The insured undergoes a surgical intervention in the hospital
3. The benefit in the form of a fixed reward is granted when the insured begins and ends treatment in a public hospital
4. In cases where the insured combines services between a public hospital and a private hospital, the benefit in the form of a fixed reward is not granted, but the services billed in the private hospital are reimbursed, according to the provisions in the list of benefits;
5. SIGAL reserves 21-30 working days to review the documentation submitted for reimbursement. SIGAL sends a written notification in case there are deficiencies in the documentation, but does not bear responsibility and does not make a reimbursement if there are deficiencies in the documentation;
6. SIGAL notifies the insured by e-mail at the time of reimbursement of the value of the value.
7. The insured submits to SIGAL the request for reimbursement accompanied by a copy of the hospitalization card;
8. The insured person for surgical interventions treated in a public hospital does not present invoices for reimbursement even if they are available;

Caution: Read and carefully complete all items of the reimbursement request and attach all fiscal and medical evidence that justifies the medical expenses incurred.

https://sigal.com.al/sherbime-dhe-kontakte/rrjeti-yne-mjekesor/

Caution:

• Always receive services in the SIGAL medical network, otherwise the bills are reimbursed up to 85%.
• Depending on the price of the medical service that has been applied to you, SIGAL reserves the right to refer to the reference prices that apply the prices of the clinics/hospitals of the medical network;
• Always verify whether the medical service you need to receive requires Prior Authorization from SIGAL.
• For these services, if the Prior Authorization procedure is not followed, SIGAL reserves the right to reimburse up to 70% of the medical bill. Depending on the price of the medical service that has been applied to you, SIGAL reserves the right to refer to the reference prices that apply the prices of the clinics/hospitals of the medical network;
• Always verify whether the waiting period has ended. In the first year of insurance for this insurance contract, a waiting period applies. This is the period during which only emergency medical services are reimbursed, so planned services are not reimbursed (such as check-ups or diagnostic medical checks such as CT, MRI, etc.)
• Always show your insurance card when receiving medical services. Clinics/Hospitals of the SIGAL medical network apply preferential prices to SIGAL insured persons. If you do not present yourself as an insured person and consequently standard prices are applied to you. For this difference in price, SIGAL does not make a reimbursement.
  (For example: if the price applied when you show your SIGAL card is 300 Lek and when you do not identify yourself as an insured person is 500 Lek, SIGAL is not responsible for the difference of 200 Lek. Therefore, identification with a SIGAL card is an obligation that must be implemented by the insured person)