For reimbursement of expenses, incurred by the Insuree for medical examinations and tests, as a result of an accident or illness, the following documents are required:

1. Claim Request Form Л3-53
2. Copy of the identity card of the eligible person for Life insurance and Group Risk Life insurance
3. Outpatient card with all particulars filled in – a copy
4. Medical referral and tests results, if expenses for tests have been incurred – a copy
5. A detailed invoice, issued in the name of the Insuree (with description of healthcare services by type and price) and a fiscal receipt, attached to it – an original
6. An official document, containing the Insuree’s bank account, if it has not been indicated in Form ЛЗ 53 – a copy
7. Upon individual insurance: Insurance policy
8. Upon group insurance at the Employer’s expense: Company Certificate from the Employer that the person is insured
9. Upon group insurance at the Insurees’ expense: A copy of the insurance policy and the list of Insurees’ names

Upon an ACCIDENT, the Insuree should provide the following additional documents:

1. ACCIDENT Information Form ЛЗ 51
2. Upon an Accident at Work– a Declaration Statement to NSSI about an Accident at Work – a copy
3. NSSI order about an acknowledged Accident at Work – a copy

In case the sums will not be received by the eligible person:

Notarized power of attorney from the entitled person, if the sums will be received by another person. The power of attorney must contain a statement (text) that the eligible person has been notified that he is entitled to receive the sums in person.

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