How medical insurance works

If you become ill or are injured while travelling abroad, medical insurance helps arrange care and pay for expenses covered by your policy. The key is to know whom to contact, how to agree on treatment arrangements and which documents to keep.

This article explains the procedure under voluntary medical insurance for travellers going abroad. Your policy and insurance rules determine the insured events, available services, notification deadlines and reimbursement conditions.

What is a medical assistance service?

An assistance service is a company that arranges help for an insured traveller during a trip. You contact its coordination centre by telephone or through another channel listed in your policy. The service records the circumstances, identifies a suitable medical facility and coordinates practical arrangements within your insurance programme.

The assistance service and the insurer have different roles: the former coordinates care, while the insurer is responsible for its obligations under the insurance contract. Coverage and payment are subject to the policy terms.

Step 1. Contact the call centre using the details in your policy

If you experience a sudden illness, injury or another event that may be covered, contact medical assistance and agree on the next steps. As a general rule, do this before visiting a clinic independently or paying for services, if your condition allows.

Ask to communicate in a language you are comfortable with. Many services offer Russian and English, but check the available languages and operating hours for your policy before travelling. If the traveller cannot speak personally, a relative, travelling companion or someone nearby may contact the service.

Step 2. Explain what happened and where you are

Have your policy and passport ready. The operator will usually need:

• the insured person’s first and last name, policy number and insurer’s name;
• the country, city and exact location, including hotel, room number or landmarks;
• a telephone number where you can be reached;
• what happened and when the symptoms started or the injury occurred;
• information about the traveller’s condition and any care already received.

You do not need to diagnose yourself. Describe the symptoms and circumstances and answer the operator’s questions. Note the case reference number and instructions, and keep any messages where possible.

Step 3. Obtain a referral to a clinic

Depending on the circumstances and available care, assistance may arrange a clinic appointment, organise a doctor’s visit or help coordinate an ambulance and hospital admission. Medical professionals determine the urgency and necessary scope of care.

Care arrangements vary between countries and locations. If there is no partner clinic nearby, agree with assistance on using an available medical facility. Confirm its name, address, admission process and payment arrangements. The absence of the assistance company’s own office in the area does not, by itself, mean that help is unavailable or that you must pay personally.

Step 4. Confirm who will pay for treatment

Option 1. Direct payment to the medical facility

If direct settlement has been agreed, assistance arranges confirmation of payment for covered services with the clinic. You will generally not need to pay the approved expenses yourself. However, you may have to pay the policy deductible, costs above the applicable limit and services outside the cover.

Option 2. Pay yourself and claim reimbursement

In some situations, the traveller pays for services and later claims reimbursement from the insurer. Where possible, obtain approval in advance and confirm which services and amounts have been authorised, which documents are required and whether originals must be provided.

If the clinic requests a deposit, additional tests or payment for surgery, inform assistance before paying whenever this can be done without delaying necessary emergency care.

Step 5. Receive care and collect the documents

Insurance does not mean that every service chosen by the traveller will be paid for. Cover applies to necessary medical services that meet the contract terms, subject to approval requirements, limits, exclusions and any deductible. These may include consultations, diagnostic tests, prescribed medicines, inpatient treatment or surgery if the programme covers the relevant expenses.

After your appointment or when discharged, request documents showing what happened, the diagnosis and the treatment provided. To substantiate expenses, you will usually need:

• A medical report or discharge summary showing the patient’s details, dates of care, diagnosis and treatment.
• Test results and the doctor’s instructions, including prescriptions for medicines purchased.
• Itemised bills or invoices listing the services and their prices.
• Receipts and other proof of payment for medical services and prescribed medicines.
• Hospital admission and surgical records if inpatient care or surgery was required.

Check that names and dates are correct and that the documents are legible. Photograph them and keep the originals. A receipt alone may not be enough: it proves payment but does not establish why the treatment was medically necessary. Ask your insurer about the exact document list and any translation or certification requirements.

Step 6. Submit your claim to the insurer

If you paid for approved treatment yourself, submit a claim and supporting documents using the procedure and deadlines in your contract. Notify the relevant service about the event during your trip; do not wait until you return home.

In addition to medical and payment records, you may need your policy, an identity document, bank account details and evidence of your trip. Depending on the circumstances, police or other official reports may also be required. Ask your insurer for the list applicable to your case.

The insurer reviews the claim, checks the circumstances and expenses and may request further information. If the event is accepted as an insured event, payment is made under the contract terms, within the cover and applicable limits and subject to any deductible. Paying for medical services yourself does not guarantee that all your expenses will be reimbursed. If the clinic has been paid directly, the traveller cannot receive a second payment for those same expenses.

What to check before travelling

Save your policy and assistance contact details on your phone and make them available offline. Give a copy to someone close to you. Check the insured territory and dates, limits, deductible and cover for planned activities such as active recreation or sports. Clarify in advance how flare-ups of chronic conditions and other conditions subject to special terms are handled.

The key rule: contact assistance when an event occurs, agree on care and payment arrangements, keep medical documents and meet notification and claim deadlines. If there is a threat to life, obtaining emergency medical care comes first.