Claim under private health insurance (Romania)

Published byDocMuse

The claim to an insurer in Romania for medical costs covered by a private health policy: the policy, the event, the healthcare provider and treatment period, the sum claimed and the documents attached — medical and payment ones. A refusal must be reasoned, and the next step is ASF, SAL-FIN or the courts.

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Common questions

What documents does a Romanian insurer want for a health claim?

As a rule, the medical documents — the referral, the medical or discharge letter, test results — and the payment documents: invoices and receipts in the insured person's name. The exact list is in the policy terms, and the claim lists what is attached.

How soon must the health insurer be told?

Within the time set in the policy terms. The Civil Code requires the insured to tell the insurer the insured event has happened within the time the contract sets, and delay can complicate the payment.

What if the insurer refuses to pay?

The refusal must be reasoned. The insured can turn to the Financial Supervisory Authority, to the SAL-FIN alternative dispute resolution body or to the courts. Insurance claims are, as a rule, time-barred after 2 years (art. 2519 of the Civil Code).