Member health insurance

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

You can receive compensation in the event of 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)
• Complete the treatment plan according to the doctor’s prescription
• Have had a preventive sickness benefit paid out from the Swedish Social Insurance Agency (Försäkringskassan)

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 insured amount
• 6-10 treatment sessions SEK 2,000 in insured amount
• More than ten treatment sessions SEK 3,000 in insured amount

Member health insurance can provide compensation for loss of income if you become incapacitated due to illness or an accident-related injury. The insurance statement shows the scope of insurance cover and the amount insured. 

Compensation is provided monthly for each day, after the qualifying period has been reached, that you have been incapacitated up to the number of months stated in the insurance statement, until the month you turn 69. Compensation is provided with as much of the amount insured as corresponds to the incapacity to work. 

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

You are covered by the Care of a close relative benefit if the insurance has been in effect for a continuous period of at least 90 calendar days and during this time you have not been entitled to benefits for the care of closely related persons from Försäkringskassan.

Compensation is paid if, after having fulfilled the conditions to be covered by the Care of a close relative benefit, you have received benefits for the care of closely related persons of at least one fourth from Försäkringskassan. Compensation is paid for a maximum of 70 calendar days. Payment is made monthly at 1/30 of the insured amount for every day that you received benefits for the care of closely related persons.

The amount of compensation is affected by the degree of the benefits for the care of closely related persons.

You are covered by the Care of a seriously ill child benefit if the insurance has been in effect for a continuous period of at least 90 calendar days and you have not been entitled during this time to temporary parental benefits in the event of the care of a seriously ill child from Försäkringskassan.

Compensation is paid if, after having fulfilled the conditions to be covered by the Care of seriously ill child benefit, you have received temporary parental benefits in the event of the care of a seriously ill child of at least one-fourth from Försäkringskassan. Remuneration is paid for a maximum of 365 calendar days. Payment is made monthly at 1/30 of the insured amount for every day that you received temporary parental benefits in the event of the care of a seriously ill child.

The amount of compensation is affected by the degree of the temporary parental benefits in the event of the care of a seriously ill child.

A qualifying period refers to the time from the beginning of the period of illness that must pass before you receive the right to compensation.

In order to receive compensation upon incapacity to work, you must have been fully able to work for 90 consecutive days before you were incapacitated. You cannot count time that you are fully able to work that occurs more than 90 days before the insurance begins to apply for you. If you do not meet this requirement, you can still qualify by being fully able to work for 90 consecutive days at some time after the insurance began to apply.

Some restrictions also exist in the event of gross negligence, for compensation in the event of a stay abroad, a war, a nuclear reaction and certain acts of terrorism.

Here, you can download the insurance terms and conditions. There, you can also read in detail what applies for the insurance.