Regulations No 52 (Applicable from 3 April 2012)
APPROVED by Resolution No 90 of the Board of “BTA” Joint-Stock Insurance Company 1.20. Insurance risk – a probability for the event insured to occur in future beyond
of 19 October 2010 as amended by Resolution No 50 of the Board of ”BTA Insurance control of the Policyholder and/or Insured Person.
Company” SE of 7 June 2011 (regarding change of the name) 1.21. Insurance benefit – an amount of money payable upon occurrence of the
event insured or delivery of services if so is stipulated in the insurance contract.
GENERAL TERMS AND CONDITIONS 1.22. A written document:
a) A document executed in writing and containing all necessary particulars, including
1. Definitions as used in the insurance contract signature affixed in accordance with valid legislation of the Republic of Lithuania;
1.1. The Insurer – „BTA Insurance Company“ SE Lithuanian branch, hereinafter b) An electronic document containing a safe electronic signature.
referred to as BTA. 2. Validity of insurance cover
1.2. The Policyholder – a person who has applied to BTA to contract for insurance
or to whom BTA has offered to enter into an insurance contract, or who has signed an 2.1. A period of insurance means a period when insurance cover is in force.
insurance contract with BTA for own benefit or for benefit of other persons. 2.2. The insurance cover shall come into force at 00:00 o’clock on the date indicated
1.2.1. Persons associated with the Policyholder and/or Insured Person to whom Poli- in the insurance contract, but not earlier than the premium or its first installment is
cyholder’s obligations are also binding: paid down, if:
a) persons living together with the Policyholder or the Insured Person; 2.2.1. the date of paying the premium or its first installment is not indicated in the
b) persons responsible for insurance object pursuant to an agreement with the Poli- insurance contract;
cyholder or the Insured Person; 2.2.2. the beginning of the insurance period coincides with the date of payment of the
c) persons sharing insurance interests together with the Policyholder or the Insured premium or its first installment;
Person, or other persons named in the insurance contract; 2.2.3. the time limit for paying the premium or its first installment precedes the begin-
d) persons related to the Policyholder or the Insured Persons under employment, ning of the insurance period.
service delivery or other legal relationships and bound to act in conformity with the 2.3. Where coming into force of the insurance cover is linked to the payment of the
safety requirements. insurance premium or its first installment, the insurance cover shall come into force at
1.3. The Insured Person – a person whose interests shall be covered: 00:00 o’clock the next day after receipt of the payment.
a) In case of property insurance – the owner of property covered by the insurance 2.4. Where the insurance premium is paid after the date indicated in the insurance
contract or other person named in writing in the contract; contract and the event insured occurs prior to the date of payment, the insurance
b) In case of third party liability insurance – a person whose property interests arising cover shall not come into force.
from third party liability are covered; 2.5. Where the insurance contract stipulates that the premium should be paid after
c) In case of person’s insurance – a natural person indicated in the insurance contract, the first day of the insurance period, the cover shall come into force at 00:00 on the
whose health, life or physical condition is covered under the insurance contract. first day of the insurance period.
1.4. The Beneficiary – a person named in the insurance contract or a person ap- 2.6. The insurance contract expires at 24:00 o’clock on the last day of the insurance
pointed by the Policyholder or, in cases stipulated in the insurance contract, by the period specified in the insurance contract unless terminated earlier for other reasons.
Insured Person and entitled to receive insurance benefits.
1.5. Third party – (refers to third party liability insurance) a person who suffers loss 3. Policyholder’s duty to disclose
due to Insured Person’s acts or omissions, entitled to insurance benefits in accordance 3.1. Prior to signing the insurance contract, the Policyholder undertakes to provide
with the terms and conditions of the insurance contract. BTA with true and complete information requested by BTA in relation to the insurance
1.6. The parties to the insurance contract – the Policyholder and BTA. object and necessary for the assessment of insurance risks.
1.7. Insurance object – property interests relating to human life and/or health, Where the Policyholder knowingly conceals information necessary for the assessment
property or third party liability. of the insurance risk or knowingly provides incorrect or incomplete information, BTA
1.8. Application to contract for insurance – a document in the form established shall be entitled to claim nullification of the insurance contract and retain the paid
by BTA for the Policyholder to provide with information required for the entering into down insurance premium.
the insurance contract. The application shall not be required, if the Policyholder pro- 3.2. The Policyholder is required to promptly notify of any changes occurring during
vides BTA with information which BTA considers sufficient to assess insurance risks. validity of the insurance contract and likely to increase the insurance risk. The changes
Acceptance of the application to contract for insurance does not obligate BTA to sign required to be disclosed include but are not limited to:
the insurance contract. a) significant changes relating to the insurance object;
1.9. Insurance contract – an agreement between BTA and the Policyholder, where- b) changes in the manner/ways of using the insurance object;
under the Policyholder undertakes to pay insurance premiums specified in the insur- c) other circumstances specified in the Special Part of the Regulations.
ance contract by the agreed time limits and to fulfill other obligations stipulated in the 3.3. Where information provided to BTA about the insurance object and risks covered
insurance contract, and BTA undertakes to pay down the benefit upon occurrence of changes and this results in insurance risk increase, as well as in case BTA is misled
the event insured (risk covered), as defined in the insurance contract. by minor misrepresentations of the Policyholder, BTA shall be entitled to offer the
1.10. Insurance policy – a document confirming the entering into insurance con- Policyholder, within a period of 1 month from the date of getting aware, to amend the
tract and covering the terms and conditions of the insurance contract agreed by BTA terms and conditions of the insurance contract, including the amount of the insurance
and the Policyholder. premium.
1.11. Sum insured – a sum of money specified in the insurance contract or a sum Where the Policyholder disagrees to the amendment of the terms and conditions of
of money calculated in the procedure described in the insurance contract which is the the insurance contract or fails to give any answer to BTA within 1 (one) month from
limit of indemnity (insurance benefit). the date of dispatch of the notice of the proposed amendments, BTA shall be entitled
1.12. Underinsurance – cases when the established sum insured is less than the to terminate the insurance contract upon expiration of the time limit stipulated in this
value of insurance. In such cases, upon occurrence of the event insured BTA shall paragraph without any further notice.
indemnify a portion of the benefit in proportion to the ratio of the sum insured and Where BTA proves that, being aware of the risk increase, it would have not entered
the value of insurance. into the insurance contract, BTA shall be entitled to claim termination of the insurance
1.13. Insurance exceeding the value of insurance – cases when the sum insured contract within 2 (two) months from getting aware of the risk increase.
exceeds the value of insurance as of the date of contracting for insurance. In such 3.4. Violation of the Policyholder’s duty to disclose information shall also incur other
cases, the benefit shall be paid down within the limits of the loss suffered. legal consequences entrenched in the legislation of the Republic of Lithuania.
1.14. Double insurance – cases when the Policyholder signs several insurance con-
tracts with different insurance undertakings to cover the same risks. In such cases, 4. Insurance premium and payment procedure
the Policyholder should notify BTA in writing about other insurance contracts entered,
4.1. The Policyholder must pay insurance premium to BTA in the amount and by the
sums insured and other contractual terms and conditions. Otherwise, the Insurer shall
time limit set in the insurance contract.
be entitled to recover insurance benefits being paid down. This provision shall not ap-
4.2. The premium shall be deemed paid:
ply when, in accordance with the insurance contract, BTA is obliged to pay insurance
4.2.1. when paid in cash – at the moment of paying the premium to BTA’s officer or
benefit not related to property damage (insurance of sums).
1.15. Additional insurance – cases when only a portion of the value of property
4.2.2. when paid by a bank transfer – at the moment the relevant amount of money is
or risk is insured. In such cases the Policyholder shall be entitled to enter into an
credited to BTA or its authorized insurance intermediary’s bank account.
additional insurance contract with the same or any other insurer. However, the total
4.3. In case of failure to pay the premium by the time limit set in the insurance
sum insured under all insurance agreements shall not exceed the value of insurance.
contract, the Policyholder shall pay BTA a default interest in the amount of 0.02%
1.16. Deductible – a portion of insurance benefit stipulated in the insurance contract
for each day overdue. The above-indicated default interest shall not apply in the fol-
as not to be indemnified by BTA. The deductible shall be defined as a specific amount
of money or a percentage unless the policy specifies otherwise. Where the insurance
a) the premium is paid as a lump sum;
contract provides for several types of deductible in respect of the same risk, the de-
b) in respect of the first payment, if the premium is paid in installments.
ductible which is bigger shall always apply.
4.4. Should the Policyholder fail to pay in the premium or any part thereof by the
1.17. Insurance premium – an amount of money set in the insurance contract
deadline fixed in the insurance contract (with the exception of case when coming into
which is payable by the Policyholder to BTA under the terms and conditions of the
force of the insurance contract is linked to payment of the insurance premium or any
insurance contract for the insurance cover.
part thereof), BTA must inform the Policyholder to this effect in writing indicating that
1.18. Event insured (risk covered) – incidents stipulated in the insurance contract
in case of latter’s failure to pay in the premium or any part thereof in 15 days after
upon occurrence of which BTA is obliged to pay the insurance benefit.
receipt of the notice, the insurance cover shall be suspended and renewed only after
1.19. Exclusions (risks uncovered) – occurrences when BTA is not obliged to pay
the payment of the premium or any part thereof by the Policyholder.
4.5. BTA shall not be obligated to pay down the insurance benefit, if the event insured
occurs during suspension of the insurance cover. In case of third party liability insur- 8.1.5. To provide with any information and documents requested by BTA, including
ance, if the insurance contract stipulates that the event insured is lodging of a claim commercial secrets, if any, known to the Policyholder or the Insured Person so that
for damages, commitment of the activity which causes the damage during the period BTA would be able to identify the causes and size of damage;
of insurance cover suspension shall entitle BTA to disallow payment of insurance ben- 8.1.6. Unless instructed by BTA otherwise, to preserve, where possible, the scene
efit irrespective of whether or not the claim for damages is lodged after expiration of unchanged while waiting for BTA’s representative. This paragraph shall not apply in as
the insurance cover suspension. much as it is necessary to fulfill the requirements in paragraph 8.1.3 above.
4.6. If suspension of the insurance cover on the ground of failure to pay down the 8.2. Where the Policyholder or Beneficiary deliberately or by gross negligence fails to
premium lasts for a period exceeding 3 months, BTA shall be entitled to terminate the fulfill the obligations stipulated in the Regulations, BTA shall be entitled to reduce or
insurance contract unilaterally. disallow payment of the insurance benefit.
5. Contracting for insurance by means of telecommunication terminal 9. Insurance benefits
9.1. The insurance indemnity (benefit) must be paid down within 30 days after re-
5.1. Insurance contract between the Policyholder and BTA may be entered by means ceipt of all information required for the establishment of the fact, circumstances and
of telecommunication terminal equipment. When entered this way, insurance con- consequences of the event insured as well as for the identification of the amount of
tracts shall be deemed concluded between the Policyholder and BTA by post, online, insurance benefit.
e-mail, telephone or other means of information exchange. 9.2. If the event is the risk covered, but the Policyholder and BTA fail to agree as to the
5.2. If an insurance contract is made by means of telecommunications terminal equipment: amount of benefit, on the Policyholder’s request BTA must pay down an amount equal
a) The insurance contract shall come into force the next day after full payment of to the benefit indisputable by the parties, if definite establishment of the amount of
insurance premium fixed by BTA; damage lasts for a period exceeding 3 months.
b) By paying the premium, the Policyholder confirms that he is familiar and agrees 9.3. Where BTA delays payment of the benefit for its own fault, BTA shall pay a default
with all the terms and conditions of the insurance contract; interest in the amount of 0.02% of the outstanding benefit for each day overdue.
c) The absence of a written policy does not affect validity of the insurance contract; 9.4. For the purpose of paying insurance benefits, all insurance premiums for a cur-
d) If so requested by the Policyholder, BTA is obliged to issue a copy of the policy to rent insurance year, which are mature on the date of paying the benefit, shall be
the Policyholder within 5 (five) working days. accounted. Pending premiums can be also accounted if so agreed by the Policyholder.
If the insurance object is killed, destroyed or lost as a result of the event insured,
6. Expiration and amendment of the insurance contract all premiums pending in accordance with the insurance contract shall de deducted.
6.1. The insurance contract shall expire at 24:00 on the last day of the insurance 10. Dispute settlement procedure
period unless otherwise agreed by the Policyholder and BTA.
6.2. The Policyholder shall be entitled to terminate the insurance contract at any time 10.1. Any disputes between the parties shall be settled by negations. In case of failure
giving a 15 days’ notice to BTA in writing. In this case, the insurance contract shall be to agree, all disputes arising out of the insurance contract and relating to violation,
deemed terminated as of the date indicated in the notice, but not earlier than on the termination or invalidity of the insurance contract shall be settled in compliance with
15th (fifteenth) day after receipt of the notice of termination. the law of the Republic of Lithuania and in courts of the Republic of Lithuania accord-
Such being the case: ing to the place of head office of BTA.
6.2.1. Where there was no payment of insurance benefit effected and no claims were
lodged within the period of validity of the insurance contract, the Policyholder shall be 11. Management of personal data
repaid, within 15 (fifteen) calendar days from the receipt of the Policyholder’s notice,
11.1. By entering into the insurance contract, the Policyholder and/or the Insured
the insurance premium, less costs of conclusion and performance of the insurance
Person expresses his consent that BTA would manage, as a data controller, personal
contract (30% of the sum to be repaid);
data of the Policyholder (except for special categories of personal data) in accordance
6.2.2. Where the benefit was paid down and/or pending or a claim was lodged during
with the provisions of the Law on Legal Protection of Personal Data to an extent it is
validity of the insurance contract, the Policyholder shall be repaid, within 15 (fifteen)
necessary for the assessment of risks, solvency and debt management as well as for
calendar days from the receipt of the Policyholder’s notice, a part of the premium
the purpose of direct marketing and statistics. The Policyholder and/or the Insured
which is equal to the difference between the unused portion of the premium for the
Person further agrees that BTA would disclose data on debtors, including personal
remaining period of the contract and paid down and/or pending benefit, reduced with
identification numbers, to other data controllers who process consolidated debtor
the costs of conclusion and performance of the insurance contract (30% of the sum
files. In addition, the Policyholder agrees that BTA would receive information from
to be repaid).
data controllers processing personal data, when such information is necessary for
6.3. The terms and conditions of the insurance contract may be modified or amended
BTA for the aforementioned purposes and requirements of legal acts of the Republic
only upon a written agreement between BTA and the Policyholder.
of Lithuania are not violated. BTA must process personal data accurately, fairly and
6.4. The insurance contract may be terminated on other grounds stipulated in the
lawfully as well as take measures to ensure protection of personal data. BTA shall be
insurance legislation of the Republic of Lithuania governing legal relationships in in-
liable for violations of the Law on Legal Protection of Personal Data in compliance with
legislation of the Republic of Lithuania.
7. General exclusion clause
7.1. Unless the insurance contract stipulates otherwise, BTA shall not pay insurance
benefits for: 12.1. The Insurer shall acquire the right of subrogation against the persons at fault
7.1.1. Terrorist acts (the acts involving the use of, or threatening to use, force or after payment of insurance benefit to indemnify for this loss (subrogation). The Poli-
violence, committed by a group of persons acting independently or on behalf of any cyholder (Beneficiary) must provide BTA with all and any information required for the
organization or government, committed for political, religious, ideological or ethnic Insurer to properly implement this right of recourse.
ends for the purpose of putting in fear or exerting influence on the government, public
or any section of the public); losses incurred in relation to the prevention of terrorist 13. Confidentiality
acts shall not be compensated either.
13.1. The parties are obligated not to disclose any confidential information received
7.1.2. War, invasion, hostile acts of foreign countries or other operations attaining
on the basis of contractual or pre-contractual legal relations to any third persons, as
the same level, such as civil war (whether or not the war is declared), riots, strikes,
well as not to use it against the interests of the other party. BTA shall be entitled to
rebels, commotions, revolution, military situations, marauding, vandalism, sabotage;
provide all relevant information, as received on the basis of the contractual or pre-
strike, lockout, public disorder attaining the level of a coup or riot, seizure of property,
contractual legal relations, to independent experts and reinsurers, as well as to store
nationalization, when this is caused or authorized, whether legally or not, by the pub-
such information in BTA’s databases. This duty shall not apply when the parties are
lic authorities; other political risks and any other losses or costs directly or indirectly
obligated to disclose information to the authorized public authorities in as much as it
sustained in relation to the prevention of such acts shall not be compensated either;
is necessary to observe the requirements of the legal acts of the Republic of Lithuania.
7.1.3. Direct or indirect nuclear explosion, nuclear power or impact of radioactive
substances; direct or indirect radioactive contamination;
14. Procedure of ceding the Insurer’s rights and obligations under the
7.1.4. Other circumstances classified as force majeure pursuant to the legislation of
insurance contract to other insurers
the Republic of Lithuania;
7.1.5. Malicious acts by the Policyholder, Insured Person or Beneficiaries. 14.1. BTA is entitled to cede its rights and obligations to other insurance undertakings
in the statutory procedure.
8. Policyholder’s obligations upon occurrence of an event which can be
14.2. If the Policyholder disagrees with the Insurer’s intention to transfer its rights and
recognized as the risk covered
obligations under the insurance contract, the Policyholder is entitled to terminate the
8.1. In order to qualify for insurance benefits in case of occurrence of the event in- insurance contract within one month from the cession of the rights and obligations.
sured, the Policyholder or the Insured Person is obliged: In this case the Policyholder shall be refunded the paid in premiums for the remaining
8.1.1. To give a prompt notice within 3 working days (unless specified otherwise in the period of the insurance contract validity.
special terms and conditions of the Regulations) to BTA about occurrence of the event
15. Notice giving procedure
likely to be recognized as the risk covered in the procedure laid down in the special
terms and conditions of the Regulations. Where the Policyholder or the Insured Per- 15.1. Any notice to be communicated by the Policyholder or BTA to each other shall
son notifies BTA of the occurrence likely to be recognized as the event insured (risk be delivered by the time limits set in the Regulations in one of the manners below:
covered) after expiration of the set time limit, the Policyholder or the Insured Person 15.1.1. by handing a notice to the parties at the address indicated in the policy or
must prove that it was impossible to give notice on time; other documents;
8.1.2. To immediately report to competent authorities (e.g., medical establishments, 15.1.2. by certified mail;
the Fire and Rescue Department, the police, emergency services, etc.); 15.1.3. by a facsimile transmission.
8.1.3. To follow all instructions given by BTA and to take all and any measures to
mitigate the damage and prevent its occurrence or increase; 16. Miscellaneous
8.1.4. To make it available for BTA to inspect the scene of the event likely to be recog- 16.1. Unless specified by the Policyholder otherwise upon signing the insurance con-
nized as the risk covered, to investigate it and examine witnesses so that BTA would tract, the Policyholder agrees that BTA would send him insurance offers concerning:
be able to identify the causes and size of damages;
a) extension of existing insurance contracts; 4. Exclusions
b) entering into new insurance contracts in whatsoever class of insurance.
16.2. Contractual insurance relations shall be governed by the law of the Republic of 4.1. The event shall be attributed to exclusions and BTA shall not indemnify the In-
Lithuania. sured Person’s expenses if the Insured Person’s health disorder arises from:
16.3. The insurance contract shall be signed on the basis of the general and special 4.1.1. perpetration of criminal acts;
terms and conditions. In case of any differences between the special and/or individual 4.1.2. active participation in military acts, military operations, mass and civil commo-
insurance terms and conditions, as stipulated in the insurance contract (policy), and tions, riots, strikes;
the general terms and conditions herein, the special and/or individual insurance terms 4.1.3. diversions, natural disasters, ecological catastrophes, chemical contamination,
and conditions shall take precedence. exposure to nuclear energy;
16.4. The Policyholder, Insured Person, Beneficiary and other persons acquiring any 4.1.4. deliberate self-injury or attempted suicide.
rights on the basis of the insurance contract are required to fulfill the obligations 4.2. Unless the insurance contract provides otherwise (such arrangement must be
stipulated in the Regulations. clearly expressed and recorded in writing), the following events shall also be attrib-
16.5. The Regulations are effective from the date of being approved by the BTA board uted to exclusions:
unless it provides for another date for the Regulations to come into effect. 4.2.1. diagnostics and treatment of sexually transmitted diseases (syphilis, gonor-
16.6. In case of any differences or discrepancies between the languages, the wording rhoea, trichomoniasis, chlamydiosis, human papillomavirus, herpes genitalis, etc.),
in the Lithuanian language shall override. genital warts, AIDS and HIV;
16.7. The Regulations are available on BTA’s web site at http://www.bta.lt. 4.2.2. diagnostics and treatment of infertility and potency disorders;
4.2.3. treatment of epilepsy;
4.2.4. blood donorship, haemodialysis, transplantation of organs and tissues;
4.2.5. treatment of intoxication or poisoning with alcohol, drugs, toxic substances
APPROVED by Decision No 40 of the Board of “BTA Insurance Company” SE of 27 resulting from their abuse;
March 2012 4.2.6. therapeutic, surgical, chemotherapeutic and radiation treatment of oncological
SPECIAL TERMS AND CONDITIONS
4.2.7. plastic aesthetic surgical treatment, cosmetology procedures, transplantation
1. Explanations of terms used in these Regulations of tissues and organs, treatment of congenital anomalies and their complications;
4.2.8. pregnancy care, treatment of pregnancy or procreation affected by procreation
Health care institution – means institution or entity authorised to provide health and health disorders;
care, health promotion and pharmaceutical services in the manner established by 4.2.9. pregnancy termination without medical reasons;
legal acts of the Republic of Lithuania. 4.2.10. postnatal care and treatment of postnatal condition related pathologies;
Health care service – means qualified service of individual health care and health 4.2.11. consultations on family planning matters, implantation, control and removal
promotion provided in a health care establishment. of contraceptive devices, diagnostic tests before prescription of contraceptive devices
Physician – means person authorised to provide health care services in the manner and tests for avoiding complications caused by their use;
established by legal acts of the Republic of Lithuania. 4.2.12. permanent nursing (regular, long-lasting nursing of elderly people, disabled or
Out-patient treatment – means specialised qualified health care provided in the sick people, people suffering from chronic diseases, including care services at home,
out-patient health care institution. nursing establishment, medical centre, social care institution);
In-patient treatment – means therapeutic and (or) surgical health care provided in 4.2.13. acquisition of joint endoprosthesis and joint endoprosthesis surgery;
the in-patient health care institution. 4.2.14. therapeutic and surgical treatment of obesity;
Rehabilitation – means coordinated, complex application of medical, social and 4.2.15. treatment of warts and moles, benign dermal tumours, uveal tumours, spots,
pedagogical means to achieve maximum functional activity of the rehabilitated person pigmentation disorders;
with disorders of biosocial functions. 4.2.16. surgical treatment of benign tumours;
Preventive treatment – means preventive examination of health of Insured Per- 4.2.17. intervention treatment (sclerotherapy) of vein/capillary diseases and surgical
sons and (or) preventive flue, encephalitis, etc. vaccinations. treatment of vein varicose;
Insurance book (book of accounting for insured events) – means book of 4.2.18. congenital diseases, anomalies and surgical treatment of their complications;
the form established by BTA issued to each Insured Person specifying insurance con- 4.2.19. more than 10 sessions of psychotherapy;
ditions under which the Insured Person is insured. In the event of contradictions 4.2.20. diagnostics and treatment using methods of treatment of complementary
between the conditions of insurance and conditions specified in the Insurance Book, medicine or other similar services (diagnostic and treatment methods and services
priority shall be given to the conditions specified in the insurance contract. not licensed by the Ministry of Health of the Republic of Lithuania).
Health disorder – means change in health or physiological condition of the Insured 4.3. BTA shall not indemnify expenses related with the acquisition of medicines, such
Person (in cases of acute disease, exacerbation of chronic disease and (or) trauma), as anabolic steroids, medicines used for treatment of obesity and impotency, con-
requiring medical treatment, application of diagnostics or measures of preventive traceptives, medicines intended for treatment of different addictions, diseases and
treatment or health promotion, other health care services. health disorders specified in points 4.2.1, 4.2.2 and 4.2.3, not registered in the Regis-
Treatment – means Physician’s consultations, medical procedures, medicines in- ter of Medicinal Products of the Republic of Lithuania.
tended for treatment of a disease or for protection from health disorder. 4.4. Unless agreed otherwise in the insurance contract, BTA shall not compensate
Acute disease – means sudden manifestation of short-lasting health disorder with expenses for:
very distinct disease symptoms. 4.4.1. services the need for which is not supported by medical documentation;
Chronic disease – means long-lasting health disorder with distinct disease symptoms. 4.4.2. dietary supplements;
Exacerbation of chronic disease – means condition of chronic disease with acute 4.4.3. medicinal products for systemic therapy of enzymes;
disease symptoms. Exacerbation of chronic disease is proved by distinct and medically 4.4.4. hydrocolloid dressings, fentanyl stick-plasters (transdermal treatment system);
justified factors. 4.4.5. articles of hygiene, thermometers, inhalators, testers, warmers, hearing aids,
Medically justified service – means service the purpose of which at the time of scales and blood pressure apparatuses;
visit of the Insured Person is diagnosing and (or) curing the Insured Person’s health 4.4.6. eyeglasses care products and accessories (cases, cleansers, etc.), goggles and
disorder and which is related with acute manifestation of a health disorder for which sunglasses;
the Insured Person applies. 4.4.7. compensatory equipment (wheelchairs for the disabled, functional beds).
2. Object of insurance 5. Sum insured and deductible
2.1. Object of insurance – means property interests of the Insured Person related with 5.1. Sums insured for each Insured Person shall be established by mutual agreement
payment of the Insured Person’s treatment expenses provided for in the insurance of the Policyholder and BTA and shall be specified in the insurance contract.
contract and other health services resulting from insured events. 5.2. Sums insured shall not be revolving, i.e. upon payment of the insurance benefit
3. Insured events BTA obligation to pay insurance benefits shall apply to the remaining part of the sum
3.1. Insured event means expenses incurred by the Insured Person as a result of visit- 5.3. The deductible or part of refundable medical costs covered by BTA shall be speci-
ing the health care institution due to health disorder or change in physiological condi- fied in the insurance contract separately for each clause of the insurance cover.
tion the diagnosing and curing of which needs medically justified tests and treatment
prescribed by the physician as well as application of preventive treatment and health 6. Insurance benefit and its payment
promotion services during the period of validity of the insurance contract. 6.1. Insurance benefits shall be paid for the insured events provided for in the Regu-
3.2. The scope of the insurance cover agreed upon between the Policyholder and BTA lations and within the limits of insurance cover of the insurance contract, having
shall be specified in the insurance contract. deducted franchise provided for in the insurance contract, if the insurance scheme
3.3. Unless the insurance contract specifies otherwise, the insurance cover shall apply selected by the Policyholder includes franchise.
only in the territory of the Republic of Lithuania. 6.2. Insurance benefits shall be paid by BTA to the health care institution that has
3.4. BTA shall indemnify to the Insured Person the losses: provided health care services to the Insured Person or to the Insured Person if the
3.4.1. related with health care of the Insured Person; latter himself paid to the health care institution for the provided health care services.
3.4.2. consistent with the programmes and sums insured specified in the insurance 6.3. The Insured Person or the Policyholder applying for payment of insurance ben-
contract; efits shall submit the following documents:
3.4.3. not indemnified or only partly indemnified in observance of the Republic of 6.3.1. completed BTA form of notification about the event;
Lithuania Law on Compulsory Health Insurance, i.e. indemnified shall be only all or 6.3.2. medical documents to the health care institution that provided the services of
part of losses that are not indemnified from the compulsory health insurance budget; treatment, health care and rehabilitation containing the following details: the patient’s
3.4.4. arising during the insurance contract validity period. forename, personal identification number (or date of birth), date pf visiting the health
3.5. If the insurance contract specifies insurance conditions that are inconsistent with care institution, diagnosis, list of provided medical services, price of each provided
the conditions of these regulations, the conditions specified in the insurance contract medical service and total price of all provided services;
shall prevail. 6.3.3. original bills and (or) payment cheques to the health care institution that sold
the products of medical treatment, health care and rehabilitation, containing the fol-
lowing details: date of acquisition of the products, list of acquired products, price of
each acquired product and total price of all acquired products;
6.3.4. all required documents and information about cases and consequences of the
insured event necessary for determining the amount of the insurance benefit, in-
cluding documents confirming the existence of the insured event, extent of claim,
incurred financial losses, etc.
7. Other conditions
7.1. The insurance contract shall terminate prematurely in the following cases:
7.1.1. upon payment by BTA of all benefits under the insurance contract;
7.1.2. upon liquidation of the Policyholder (legal entity) when there is no successor of
the rights and obligations of the Policyholder;
7.1.3. upon death of the Insured Person if the insurance contract has been concluded
for the benefit of the group entities the insurance contract shall cease only for the
7.1.4. when there are other reasons for cessation or termination of the insurance
contract provided for in laws of the Republic of Lithuania or insurance contract.
7.2. All matters not covered by these Regulations shall be addressed in observance of
legal acts of the Republic of Lithuania.
7.3. These Regulations are posted on the internet website at: www.bta.lt.
7.4. These Regulations shall apply to all insurance contracts concluded from 3 April
2012, unless the Parties have agreed on other conditions when concluding the insur-
TRAVEL RISKS INSURANCE
Regulations No 52 Annex 1
DESCRIPTION OF INSURANCE SCHEMES AND INSURED EVENTS 3.1.1. examination of pregnant women, Physicians’ consultations, prenatal tests in
Health care services shall be compensated in full or in part in observance of terms and observance of the applicable version of Order No V-1135 of the Minister of Health of
conditions of the insurance contract. the Republic of Lithuania 26 December 2006 on Prenatal Health Examinations;
3.1.2. procreation care, health disorders identified during planned visits of a pregnant
1. Out-patient diagnostics and treatment woman, diagnostics and treatment of prenatal complications;
1.1. BTA shall indemnify expenses for: 3.1.3. postnatal care and diagnostics and treatment of pathologies related with this
1.1.1. Physician’s services – consultations of the Physician (general practitioner, condition.
special physician) in a health care institution, home visits when the insured person’s 4. Dentistry
condition does not allow him (her) to visit a health care institution or when the In-
sured Person’s journey to the health care institution might worsen his (her) present 4.1. BTA shall compensate:
condition (excluding transport expenses): 4.1.1. dental treatment: general endodontic, periodontal and surgical treatment of
18.104.22.168. consultations of a Physician – psychiatrist or psychotherapist, psychotherapy dental diseases, treatment of cariotic dental disorders and their complications, teeth
sessions for treatment of emotional, behavioural and mental disorders shall be paid filling, dental radiography;
for up to 10 units (sessions) during the period of validity of the insurance cover; 4.1.2. oral hygiene: preventive consultation of a dentist, oral hygienist (hygiene edu-
22.214.171.124. in the event of health disorder the Insured Person may apply to all practi- cation), removal of dental concrements, calculus, fluoride applications;
tioners in the Republic of Lithuania who are licensed to engage in such activities. A 4.1.3. dental prosthesis – dentist’s consultations about prosthetics, implantation, pro-
referral shall not be required when the Insured Person visits special physicians (except duction, restoration and mending of removable and fixed dental prosthesis, implants.
those indicated in subitem 126.96.36.199); All dentistry services shall be subject to the general limit for the insurance year.
188.8.131.52. a Physician’s referral shall be required when the Insured Person visits re- 4.2. BTA shall not compensate expenses related with: teeth whitening, laminating
search physicians (endoscopists, echoscopists, clinical physiologists, radiologists) and (veneering), covering with sealants, crowns (treatment, whitening, against bruxism).
physical medicine and rehabilitation specialists; 5. Medicines and medical aids, other conditions
184.108.40.206. if the Insured Person is referred to the specialists indicated in subitem 220.127.116.11
by another Physician in such case the Physician shall support the purpose of the refer- 5.1. BTA shall compensate:
ral by data of objective tests; 5.1.1. when a Physician diagnoses the Insured Person’s health disorder and pre-
18.104.22.168. BTA shall indemnify expenses for prescribed tests that are related only with scribes medicines (writes a prescription) – expenses for medicines registered by the
the differential diagnostics of the complaint (health disorder) due to which the Insured State Medicines Control Agency in Lithuania and purchased in pharmacies (medicinal
Person applied; products and herbal and homeopathic products) as well as prescription medicinal
22.214.171.124. medical extracts shall contain detailed information: date of visit, circum- products;
stances of arising complaint, disease development process, objective condition of 5.1.2. medical aid and orthopaedic equipment – sterile and non-sterile bandages,
the patient, prescribed tests related with arising complaint or disease, diagnosis and stick-plasters, disposable syringes, test strips of glucose meter, iliac and sub-lumbar
treatment. The extract shall be accompanied by copies of performed tests. supports (textile-based), including supports after abdominal wall or groin ruptures,
1.1.2. Nursing services – services and procedures (injections, infusions, dressing lower limbs support system (textile-based), upper limbs support systems (portable),
wounds or other services on prescription of the Physician) in a health care institution foot supports (shoe inserts), blood circulation system treatment aids (elastic compres-
and at the Insured Person’s home when health condition of the Insured Person pre- sion stockings), sticks and crutches, acquisition / rent of auxiliary self-service aids
vents him (her) from visiting the health care institution. compensated by BTA for the purposes of treatment of the Insured Person according
1.1.3. Diagnostic tests – laboratory (clinical, biochemical, immunoenzyme, hor- to the prescription of the treating Physician;
mone, microbiological-bacteriological, cytological histological tests), functional, radio- 5.1.3. if medicines ad medical equipment specified in item 5.1.2 above are compen-
logical and instrumental tests prescribed by the Physician and necessary for diagnosis sated from the compulsory health insurance fund BTA shall compensate in full only
and treatment of a disease and related with the health disorder about which the the difference between basic and retail price. The basic price means a component of
Insured Person complained: a retail price of a medication for which it is sold in the pharmacy. The basic price shall
126.96.36.199. referrals of special research physicians (endoscopist, echoscopist, clinical be established by the Ministry of Health in the List of Basic Prices of Compensable
physiologist, radiologist) shall be insufficient for the purpose of recognising the event Medicines.
as the insured event and for payment of the insurance benefit; 6. Over-the-counter drugs, food supplements
188.8.131.52. the Insured Person may perform diagnostic tests in a health care institution
of his choice; 6.1. BTA shall compensate for the food supplements and over-the-counter drugs reg-
184.108.40.206. if the Insured Person arrived with the referral of another health care institu- istered in Lithuania by the State Public Health Care Service and the State Medicines
tion, diagnostic tests shall be compensated to the Insured Person as a diagnostic Control Agency and purchased in a pharmacy without the physician’s prescription.
service, provided that the referral contains both parts specified below:
220.127.116.11.1. a document specifying: the date of referral, seal of referring health care
institution, the Physician’s seal with signature, personal data of the Insured Person; 7.1. BTA shall compensate:
18.104.22.168.2. the submitted referral shall specify the purpose of referral, diagnosis and 7.1.1. lenses for spectacles (1 pair) prescribed by the oculist (plastic, glass, photo-
particular tests. If the submitted referral does not specify the diagnosis, particular chromic, progressive) and contact lenses required in cases of eyesight impairment
tests and purpose of the referral or it contains a reference “for preventive purposes”, throughout the entire agreement validity period;
such tests shall not be compensated; 7.1.2. vision correction surgery required for medical treatment purposes.
22.214.171.124.3. BTA shall not compensate the services if the Insured Person applies to
8. Preventive health examinations
a health care institution without any specific complaints (only to examine his (her)
health), and also when diagnostic tests are performed without any existing medical 8.1. BTA shall compensate:
indications and no health disorders are diagnosed. 8.1.1. tests performed on request of the Insured Person;
1.1.4. Day-care in-patient department – planned therapeutic surgery, urology, 8.1.2. consultations and tests according to health examination programmes prepared
orthopaedic traumatology, obstetrics-gynaecology, ophthalmology, otorhinolaryngol- and approved in a health care institution;
ogy health care activities applying local, regional or complete analgesia: 8.1.3. consultations, tests or procedures carried out in order to identify the risk of a
126.96.36.199. compensated shall be specialised examination and treatment in the in-patient disease or to prevent a potential illness;
individual health care institution for a certain limited number of hours per day (without 8.1.4. tests that are not necessary and medicinally unjustified in a particular clinical
spending a night and receiving meals in a hospital). situation;
The disease treatment profiles are specified in Order No V-1102 of the Minister of 8.1.5. preventive Physician’s consultations and tests necessary for regular monitor-
Health of the Republic of Lithuania of 30 December 2009; ing of the health condition of the Insured Person who suffers from a chronic disease
188.8.131.52. compensated shall be day-time surgery services provided during the Insured (without distinct indications of acuteness of the disease) or is after surgery, when
Person’s placement in the in-patient department for up to 24 hours (without meals); it is necessary to observe the health condition and treatment with medicines is not
these services are approved by Order No V-668 of the Minister of Health of the Re- prescribed.
public of Lithuania of 21 August 2009.
2. In-patient treatment
9.1. Compensation shall be paid for vaccines selected by the Insured Person and
2.1. When the in-patient treatment is required BTA shall compensate the services prescribed by the Physician, vaccination, vaccination consultations.
provided in the in-patient health care institution (public and (or) private, depending
10. Rehabilitation treatment
upon the insurance conditions that have been selected and specified in the insurance
contract), provided that such services are not compensated from the compulsory 10.1. Medicinally justified continuation of the previously started treatment of conse-
health insurance fund: quences of a disease or trauma prescribed by the Physician – out-patient rehabilita-
2.1.1. luxury services (placement in a single-bed or two-bed ward); tion and (or) in-patient rehabilitation:
2.1.2. surcharges for medical aids (other than joint endoprosthesis) and nursing aids 10.1.1. physiotherapy procedures (light therapy, ultrasound, microwaves, TENS,
and medicines; impulse therapy, dorsonvalization, electrolysis, phonophoresis, halotherapy, induc-
2.1.3. in-patient therapeutic and surgical treatment services. tothermy, magnetotherapy, laser therapy, paraffin applications, low-frequency and
3. Pregnancy procreation and postnatal care medium-frequency wave therapy):
10.1.2. individual and group kinesitherapy sessions in the gym and in the swimming
3.1. The amount provided for in the insurance contract for the pregnancy care may be pool and massage therapy (manual therapy) procedures;
used to pay compensations for: 10.1.3. speech therapist’s services shall be compensated when the Insured Person
has the Physician’s referral and when vocal and speech disorders as well as commu-
nicative and cognitive disability have been diagnosed.
11. Health promotion services
11.1. Services provided for the purpose of health promotion of the Insured Person in
sports clubs, sanatoriums, SPA, health promotion or rehabilitation centres:
11.1.1. physical training exercises in sports clubs (aerobics, fitness, trainers, yoga,
tennis, squash); kinesitherapy sessions in the gym and swimming pool, stretching of
cervical and lumbar parts of the spine, individual ergotherapy;
11.1.2. water procedures (swimming pool; mineral, carbonic, herbal, pearl, turbulent,
vertical water, mud, mineral–mud baths, remedial showers);
11.1.3. massages (manual therapy sessions): remedial, relaxation, underwater mas-
sages and acupuncture;
11.1.4. services of complementary medicine (provided by the Physician, in licensed
health care institutions);
11.1.5. peloid therapy, balneotherapy procedures.
12. Free limit
12.1. Within the limit of the sum insured compensation shall be paid for all health
care services specified in these Regulations and provided in health care institutions,
pharmacies, sanatoriums, sports clubs and specified in the insurance contract. These
medical aids, medicines and services shall be compensated without the Physician’s
referral or prescription. Exclusions mentioned in Section 4 of the Regulations shall not
apply to this item.