Members’ health insurance

Members’ health insurance is a benefit that the group takes out, and pays, for its group members.

You can receive compensation for preventive care if you have met the qualification rules and then during the insurance period:

• Have a treatment plan issued by a licensed physician (see the definition of treatment plan in the insurance terms and conditions).
• Complete the treatment plan as prescribed by the physician.
• Have received preventive sickness benefit paid from the Social Insurance Agency.

We provide compensation for preventive care as a lump sum. The amount of compensation depends on the scope of the treatment plan:

• 1-5 treatment sessions SEK 1,000 in insurance amount.
• 6-10 treatment sessions SEK 2,000 in insurance amount.
• More than ten treatment sessions SEK 3,000 in insurance amount.

Members’ health insurance can pay compensation for loss of income if you become incapacitated for work due to illness or accidental injury. The policy statement sets out the scope of the insurance cover and the amount of the sum insured.

Compensation is paid monthly for each day, after the qualifying period has been completed, that you have been unable to work for up to two months, up to and including the month you turn 69.

You must, in order to be covered by the insurance, be fully fit for work when you become a member of the group. If you were not fully fit for work at the time you became a member, you can qualify to be covered by the insurance by being fully fit for at least 90 consecutive days at some point after joining the group.

You are covered by "Care of a close relative" if the insurance has been in force for a continuous period of at least 90 calendar days and during this time you have not been entitled to a related party benefit from the Social Insurance Agency.

Compensation is paid if, after having met the conditions for being covered by care of a close relative, you have received a related party benefit of at least a quarter from the Social Insurance Agency. Compensation is paid for a maximum of 70 calendar days. Payment is made monthly at 1/30 of the sum insured for each day that you have received a related party benefit.

The size of the compensation is affected by the degree of related party benefit.

You are covered by "Care of a seriously ill child" if the insurance has been in force for a continuous period of at least 90 calendar days and during this time you have not been entitled to temporary parental allowance from the Social Insurance Agency when caring for a seriously ill child.

Compensation is paid if, after fulfilling the conditions for being covered by care of a seriously ill child, you have received temporary parental allowance to at least a quarter from the Social Insurance Agency for the care of a seriously ill child. Compensation is paid for a maximum of 365 calendar days. Payment is made monthly at 1/30 of the sum insured for each day that you have received temporary parental allowance for the care of a seriously ill child.

The size of the compensation is affected by the degree of temporary parental allowance for the care of a seriously ill child.

The qualifying period refers to the period from the start of the sick period that must elapse before you are entitled to compensation.

To receive compensation for incapacity for work, you must be fully fit for work for 90 consecutive days before you become unable to work. You cannot count time that you are fully fit for work and which falls more than 90 days before the insurance starts to apply to you. If you do not satisfy this requirement, you can still qualify by being fully fit for work for 90 consecutive days at some point after the insurance starts to apply.

Certain limitations also exist in the case of gross negligence, for compensation in case of stay abroad, war, nuclear reaction and certain acts of terrorism.

Here you can download insurance terms and conditions. You can read in detail what applies to the insurance.