What does Health Insurance cover?

At its most extensive scope, Health Insurance by Pohjola Insurance covers treatment expenses for illnesses and injuries as well as the costs of pharmaceutical products and rehabilitation. Read examples of coverage situations to see what the insurance covers and which losses or damage remain your responsibility.

What Health Insurance covers

Below are examples of loss situations involving Health Insurance for a newborn, child and adult. We describe the situation and whether the loss is generally covered by the insurance. Please note that we handle every claim individually, and the nature of the event may determine whether we can pay compensation.

 

Will Health Insurance cover: My child fell ill

It is early autumn, and Claire is preparing for the coming school year with her 8-year-old son Oliver. A few weeks before school is set to begin, Oliver starts to complain of a tummy ache. Claire first attempts a few home remedies and keeps a closer eye on the boy’s diet. As Oliver’s stomach pains worsen, however, Claire decides it is best that they see a doctor. Claire calls Pohjola Health Advisor, who evaluates the boy’s symptoms and schedules an appointment with a suitable specialist. The doctor prescribes Oliver medication, and the boy gets better in just a matter of days. Thanks to the quick treatment, he is healthy to start the new school year.

Answer: Claire has insured Oliver with child Health Insurance, in other words insurance for children that includes Medical Treatment Cover against injuries and illnesses. The costs of the doctor’s examination and prescription medication are covered by Medical Treatment Cover. 

Good to know

Health Insurance grows with your child and remains valid until the age of 100. Depending on your choice, Health Insurance Medical Treatment Cover may compensate injuries and illnesses, injuries and illnesses specified in the insurance terms, or injuries only. Medical Treatment Cover compensates the following expenses incurred by you or your child:

  • fees when a GP, specialist or nurse, for example, examines or treats you, or you need an operation. Coverable examinations include laboratory, endoscopy, X-ray, ultrasound and MRI examinations and CT scans.
  • costs of pharmaceutical products and wound dressings sold at pharmacies.
  • daily hospital charges at a public or private hospital.
  • the first orthopaedic brace you buy owing to a coverable operation or accident, for up to 500 euros per operation or accident.
  • rental costs of forearm or underarm crutches.

Pohjola Health Advisor at your service

By insuring yourself or your child with Health Insurance, you get access to the Pohjola Health Advisor service. In the event of health concerns, you can contact the Health Advisor from the Pohjola Hospital app, either by phone or chat. The Health Advisor will evaluate the situation and refer you to the appropriate specialist if necessary.

 

Will Health Insurance cover: Sprained ankle while running

Chris is passionate about fitness. He goes to the gym several times a week and runs the year round. The damp and dark autumn nights play a trick on him, however, as Chris missteps clumsily while on an evening run on a bumpy forest trail. His left ankle is sprained badly. Chris is able to limp on, but as he gets back home, he notices that the ankle has become swollen up and is looking serious. Without further hesitation, Chris calls Pohjola Health Advisor. The Health Advisor evaluates the ankle’s condition, gives Chris home care instructions, and schedules an appointment with a specialist. The doctor examines the ankle, which was in perfect health until the accident, and refers Chris for a more detailed MRI scan. The MRI scan reveals a bone fracture that will require surgery to fix. After the surgery, Chris rehabilitates the ankle with exercises and is back up and running the following autumn.

Answer: Chris has taken out Health Insurance against injuries. The insurance is valid when Chris practices exercise for his own pleasure. The costs of the injury, from the doctor’s examination to rehabilitation, are covered by Chris’s Health Insurance Medical Treatment Cover and the Supplementary Medical Treatment Cover he has selected for musculoskeletal therapy expenses.  

Good to know

Health Insurance covers sports injuries that occur when exercising for your own pleasure, whether running, skiing or playing football with friends, for example. If you engage in competitive sports with a club or in high-risk sports, you either need to expand your Health Insurance with supplementary cover for athletes or take out Sports Cover when obtaining your sports licence. Our experts will be happy to go over the differences between Sports Cover and Health Insurance extended to competitive sports with you.

Children and young people often try out various sports. For this reason, Health Insurance for under 16-year-olds can be chosen to cover all competitive sports (excluding high-risk sports such as American football or downhill cycling). By choosing to include this option, you do not need to worry about the validity of insurance if your child decides to switch from football to ice hockey, for example. 

If necessary, you can also insure your child’s individual sport hobby. If the insurance of an under 16-year-old covers only an individual sport instead of all competitive sports, the insurance cover continues after the child has turned 16.

Learn more about Sports Insurance

Pohjola Health Advisor at your service

By insuring yourself or your child with Health Insurance, you get access to the Pohjola Health Advisor service. In the event of health concerns, you can contact the Health Advisor from the Pohjola Hospital app, either by phone or chat. The Health Advisor will evaluate the situation and refer you to the appropriate specialist if necessary.

 

Will Health Insurance cover: Treatment during pregnancy

Becky is six months pregnant and eagerly expecting her baby as she enters her third trimester. Preparations for the birth have already been made, and Becky has taken out Health Insurance for the newborn after the structural ultrasound scan. As the pregnancy nears its end, however, Becky is admitted to the maternity ward for intensive monitoring and prescribed medication for high blood pressure until the birth. The medication and rest are successful in treating her, and Becky delivers a healthy full-term baby boy. 

Answer: Medical Treatment Cover for an unborn child covers outpatient clinic fees and daily hospital charges in public healthcare. The insurance also covers the costs of medication sold at pharmacies.

Good to know

Insurance for an unborn child can be applied for the child after screening for structural foetal anomalies up until childbirth begins. Health Insurance grows with your child and remains valid until the age of 100.

Please note that if you are applying for insurance effective only after the birth of the child, the infant’s medical information may affect whether the insurance may be granted and the scope of cover. If the insurance is taken out before birth, the mother’s health declaration is used to determine whether it may be granted and to what scope. 

Learn more about insurance for an unborn child 

Pohjola Health Advisor at your service

By insuring yourself or your child with Health Insurance, you get access to the Pohjola Health Advisor service. In the event of health concerns, you can contact the Health Advisor from the Pohjola Hospital app, either by phone or chat. The Health Advisor will evaluate the situation and refer you to the appropriate specialist if necessary.

Read more about Pohjola Health Advisor

 

Will Health Insurance cover: Accidental tooth fracture

Matt is enjoying the winter weather while practising his new hobby, ice skating in the wilds. The sun shines in the cloudless sky as Matt hurtles ahead on his skates, backpack on his back and sunglasses on his head. Out of carelessness, Matt hits the tip of his skate against the ice at too steep an angle. The skate gets caught, tripping Matt on his nose against the ice with just enough time to soften the landing with his arms. His lower jaw hits the ice, and as he tries to collect himself, Matt quickly realises that his bottom teeth have come out worse for wear from the fall. The two front teeth are chipped. Matt uses the Pohjola Hospital app to message Pohjola Health Advisor. The Health Advisor schedules a dental examination for him. The dentist recommends that Matt’s front teeth are repaired with implant-supported dental prostheses.

Answer: Matt has included optional dental cover in his Health Insurance. Dental Cover compensates dentist’s fees and the costs of implant-supported dental prosthesis resulting from an accident. It also covers the costs of medication sold at pharmacies.

Good to know

You can choose Dental Cover against tooth loss due to either an injury or illness, or due to injury only.

In the event of an injury, we compensate the following expenses

  • expenses for examinations and treatment by a dentist, specialised dentist, dental hygienist or denturist
  • expenses for a fixed dental prosthetic or dentures made by a dentist or denturist, or removable dental prosthetics or implant-supported dental prostheses
  • medication sold at a pharmacy.

In the event of an illness, we reimburse the following expenses

  • examinations and treatment related to the first dental prosthetic of a missing tooth
  • fixed dental prosthetic or dentures made by a dentist or denturist, or removable dental prosthetics or implant-supported dental prostheses when they are related to the first dental prosthetic of a missing tooth
  • medication sold at a pharmacy and related to prosthetic treatment.

 

Will Health Insurance cover: Falling ill while travelling

Kenneth is an avid backpacker. As spring arrives, he sets out on another trip, this time to southern Europe. While travelling across Europe by train, however, Kenneth falls ill. Battling against a rising fever, Kenneth seeks out a local doctor who examines him and prescribes a medication. After a few days’ rest and medication, Kenneth is able to get back on the move. He returns home in good health and is already making plans for his next trip.

Answer: Health Insurance will only cover expenses that arise in Finland, unless the insurance has been separately extended to cover costs abroad. However, Kenneth has also taken out travel insurance that includes Traveller's Medical Treatment Cover. The costs of his treatment and medication are covered under Kenneth’s travel insurance.

Good to know

At best, travel insurance covers both the traveller and luggage. In the event of a travel illness or injury, you can claim compensation from your travel insurance. Travel insurance can also protect your luggage against vandalism, theft and damage. Travel insurance has no upper limit on the amount of compensation. In other words, it will also cover the costs of returning to Finland by a medical flight, if necessary.