TYPE OF CARD

employee card ( tax base)

additional family partner card,
(brother,sister,mother,father,pare
nts-in-law no age limit )
Singular Specialised Family
Member(sister,brother,spouse/pa
rtner, singular child )
family card: spouse/partner,all
children up to 26 /LuxMed, up to
18 /MEDICOVER.)
family card (when both parents
work in the UL)
senior(parents, parents-in-law )
Lux Med =additional
familypartner card
senior up to 65 (parents,
parents-in-law )
senior between 65 - 75(parents,
parents-in-law)
senior older than 75 (parents,
parents-in-law)
stomatology in Complex package
( obligation to pay for 12 months)
stomatology PRIMA(obligation to
pay for 12 months)
stomatology OPTIMA(obligation
to pay for 12 months)
stomatology MAXIMA(obligation
to pay for 12 months)

MEDICOVER
Warszawa
4.67 z

70,61 z/ osoba

123.40 z
59.84 z

x
75.10 z
135, 59 z
219.03 z
x
14.11 z
49.02 z
103.26 z

LUX MED.
Warszawa
10 z

95 z/person

65 z
x

95 z
x
x
x
45 z
x
x
x

MEDICOVER
EMPLOYEE PACKAGE
1.Occupational medicine (for employees)
2. Complex specialist consultation
3. Complex diagnostic tests
3.Hot Line and emergency ambulance to the home
4. Emergency assistance Ambulatory Primary

5. Unlimited consultations with specialists of all specialisations defined in the cope of

services, with no referral from a GP; the exceptions are the following specialisations with
annual limits of appointments per each person in the medical package:
- a psychologist and a psychiatrist - up to 3 appointments a year
- a sexologist up to 3 appointments a year
- a dietician up to 3 appointments a year
- speech therapy specialists up to 30 appointments a year

6. Pregnancy care + midwife visit after the childbirth

7 Rehabilitation(with limit up to 40 procedures each medical treatment is counted
separately per each person in the medical package.)
8. Dental care_The package includes the following services available in dental centres
approved by Medicover:
- an annual dental check-up
- a 10 % discount for all conservative and surgical dentistry services, as well as
radiovisiographic x-ray.
Employees may pay for additional care plan (3 scopes of services in two versions
individual and family: Prima, Optima, Maxima_description on a separate tab

9. Home visits:
- a house call of a primary care physician (an internist, a pediatrician or a family
doctor) after a Medicover Hot Line operator who received a request has decided that such
house call is necessary due to medical reasons.
- a house call of a nurse who has to perform intervention ordered or confirmed by a
physician which could not be performed in the medical centre due to medical reasons.
There is a limit of 8 house calls a year per each person in the medical programdistance 30 km from CM Medicover
10. Flu vaccinations ( 1x/year)

11. prophylactic health checks: determined on an individual basis by a Medicover

physician;scheme for women,scheme for men
12. prophylactic health checksscheme for women,scheme for men

13.Szpital Medicover_Rabat 15% na hospitalizacj,rabat 5% na pord

SINGULAR SPECIALIZED FAMILY MEMBER ( singular spouse/partner, child ,sister,brother )
the scope of the package is the same like for employee
SPECIALIZED FAMILY PROGRAMME (employees spouse or partner as well as his or her
children until 18 years of age)
the scope of the package is the same like for employee
SENIOR PACKAGES
UP TO 65
the scope of the package is the same like for employee_with rehabilitation
Dental care_The package includes the following services available in dental centres
approved by Medicover:
- an annual dental check-up
- a 10 % discount for all conservative and surgical dentistry services, as well as
radiovisiographic x-ray.
No additional stomatology care plans
limitations_3 home visits
BETWEEN 66 AND 75
the scope of the package is the same like for Senior up to 65_ without rehabilitation
Dental care_The package includes the following services available in dental centres
approved by Medicover:
- an annual dental check-up
- a 10 % discount for all conservative and surgical dentistry services, as well as
radiovisiographic x-ray.
No additional stomatology care plans
limitations_3 home visits
OLDER THAN 75
the scope of the package is the same like for Senior up to 65_ without rehabilitation
Dental care_The package includes the following services available in dental centres
approved by Medicover:
- an annual dental check-up
- a 10 % discount for all conservative and surgical dentistry services, as well as
radiovisiographic x-ray.
No additional stomatology care plans
limitations_3 home visits

LUX MED.
EMPLOYEE PACKAGE
1.Occupational medicine (for employees)
2. Complex specialist consultation
3. Complex diagnostic tests
3.Hot Line and emergency ambulance to the workplace
4. Consultation outpatient procedures

5. Complex unlimited specialist consultations ; limitations:

psychiatry
psychology
sexology
andrology
3 consultations a year for each of these specialties

6. Pregnancy care
7.Rehabilitation_bez limitu

8. Comfort pluspackage -Dental screening once a year ; Complex plus package :free
prophylactic dentistry,Dental X-ray -50% discount, Non-invasive dentist -50% discount,
Dental surgery-50% discount

9.Home visits_the service encompasses internal diseases, paediatrics or family

medicine exclusively in situations where the patient is unable to get to the outpatient
clinic indicated by the Insurer, i.e. in cases of sudden onset of an illness or sudden
exacerbation, including exacerbation of chronic conditions, excluding direct lifethreatening situations_no limit, distance 30 km from CM Lux Med.
10. Flu vaccinations/tetanus vaccine(1x/year)
11Prevention without a referral_once a year without having referral:
analysis
Blood count + platelet count + automated smear
Total cholesterol
Glucose tolerance test, fasting

12.Health check-up Healthy Woman, Healthy Man

Urine

13. Lux Med Group Discount_10 % discount on all medical services offered by
LUX MED Group Medical
14.Refund 70/30_In the case of the provision of services in health care facilities
other than those indicated by the Lux Med Group, the contractor will reimburse the
cost of benefits to the amount of 500 PLN / quarter / person. Reimbursed is 70% of the
invoice manifested.
15.10% discount for hospital procedures, in Lux Med Hospital
ADDITIONAL PARTNER PACKAGE Comfort,Complex( sister,brother, parents/parents inlaw )
the scope of the package is the same like for employee

FAMILY PACKAGE Comfort, Complex( children up to 26 )

the scope of the package is the same like for employee
SENIOR=PARTNER PACKAGE Comfort, Complex
the scope of the package is the same like for employee

LUX MED-DENTAL PACKAGE

Prophylactic dentistry [Complex package
only)

Dental services include dental screening one a year, and

free for services along with the necessary materials:

Teeth fluoride treatment;

Prophylactic fissure sealing
Painting of teeth
Periodontal scaling
Air polishing
Deposit removal sandblasting

The price of services provided by dental surgeons includes

50% discount.

MEDICOVER-DENTAL PACKAGES
Conservative dentistry
Treatment of dental hard tissue defects and other diseases of
the oral cavity

Endodontics
Diagnosis and treatment of the tooth pulp and periapical
tissue diseases
Dental surgery
Procedures concerning the alveolar process and soft tissues of
the oral cavity, performed in the outpatient setting

Dental prophylaxis

Diagnostics
Prosthetics
Treatment of dentition defects by using prosthetic
supplements in order to restore the functional capacity of the
oral cavity, while preserving the esthetics of the dentition

Implantology
Orthodontics
Prophylaxis and treatment of malocclusions

Periodontics
Prophylaxis and treatment of the parodontium (gingiva,
mucosa of the palate, cheeks and tongue) diseases
Emergency dental service 24/7
Guarantee on fillings

Dental X-ray (imaging result

on a medium conforming
with the standard applicable
in a given clinic): [Complex
package only)

Non-invas

Services offered by dentists. The range of

dentistry services include 50% discount for
services along with the necessary materials,
After the treatment and another dental
examination that confirms sanitation of the
oral cavity, further treatment (services and
materials) is free of charge, provided that
the patient has regular dental examinations,
at least every 12 months. The scope of dental
care available in a subscription:
The service is performed at the place
indicated by the Contractor and
include
the following:
Single
tooth X-ray

Specialist consultations:

Standard orthopantomogram

Periodontologist
Prosthodontist
Orthodontist
Dentist
Dental surgeon
Services with the necessary materials:
Examination of tooth vitality
Treatment of sensitive teeth
Impregnation of dentin
Indirect pulp capping - setting up a
double liner

Dental surgery_50% rebate on the follow

Surgical wound management (large or Apiectomy of a posterior tooth, of a posterior
small wound up to 3 alveoli);
tooth with retrograde filling;
Apiectomy of a front tooth, of a front tooth with
Tooth hemisection;
retrograde filling;

Abscess incision and drainage;

Temporary management of fractured maxilla;
Closure of oroantral communication or
Suture removal in the oral cavity;
fistula;
Extraction of a uniradicular tooth, uniradicular
Frenoplasty, meloplasty, glossoplasty; deciduous tooth;

Prima

Optima

Oral health check-up once a year

Oral health check-ups

Fillings:

Fillings

Doctors work covered by the pre-paid fee

Preparation and treatment of a tooth prior to permanent

filling temporary and therapeutic fillings (e.g. medicine
placement)

15% discount on materials

Anesthesia

10% discount on other procedures,

including root canal therapy

Treatment of mucosal membrane lesions (e.g. aphthae)

15% discount on other procedures, including
root canal therapy

10% discount

15% discount

10% discount

Tooth extraction
Abscess treatment
Post-extraction treatment
Anesthesia
15% discount on other procedures

10% discount

Scaling once a year

15 % discount on other procedures

Radiovisiographic x-ray

10% discount

Consultation
10% discount on other procedures

Consultation
10% discount on other procedures

Consultation
10% discount on other procedures

18 months

Covered by the pre-paid fee

18 months

Non-invasive dentist (Complex)_50% rebate on the following services

Direct pulp capping

Medicinal dressing in the tooth fixed

Dressing therapeutic milk tooth
Fill a milk tooth crown loss
Fill cavity of a tooth crown
Trepanation dead tooth loss with the supply of
dressing
Devitalization of pulp cavity with dressing supplies
Amputation of the performance test in the tooth pulp
with unformed roots
Extirpation of the performance test of the pulp
Extirpation of the devitalizated pulp
Amputation of a milk tooth devitalizated pulp
Total preparation and disinfection of the channel
Re-filled channel unblocking

% rebate on the following services

Extraction of a tooth by intra-alveolar chiselling ;

Extraction of a multiradicular tooth, multiradicular deciduous
tooth;

Resection of nodule, nodule-like lesion;

Removal of salivary duct calculi;
Enucleation of odontogenic cyst;

Maxima
Full range of services, including root canal therapy
Anesthesia

Full range of services

Tooth extraction
Abscess treatment
Post-extraction treatment
Anesthesia
20% discount on other procedures
Scaling and sealing with no limitations
15 % discount on other procedures
Radiovisiographic x-ray
Consultation
15% discount on other procedures

Consultation
10% discount on other procedures
Consultation
15% discount on other procedures

Consultation
15% discount on other procedures
Covered by the pre-paid fee
18 months

% rebate on the following services

The temporary canal

filling

Local anesthesia in dental intraoral wire

Filling the channel

Local anesthesia in dental extraoral wire

The total development

and reconstruction of the defect

Treatment of sensitive teeth

The total development

and reconstruction of damaged
teeth
incisal
anglecover enamel

Cosmetic

Fill cavity of a tooth crown

Treatment of dental pulp gangre

hypoplasia
Cover cosmetic
discoloration of dentin in the
anterior
Internal tooth whitening
method
Gingival pocket lavage
and drug application
Treatment of the oral
mucosa
Simple curettage
Open curettage
Local anesthesia in
dentistry surface
Local anesthesia in
dentistry infiltration

Surgical dressing;
Periodontal dressing;

Depending on the capabilities of a specific

institution, dental services also include night duty
(emergency) between 8 pm and 8 am. Services
included in the package are offered free of charge
between these hours in the case of pain and in an
Note:
emergency. The physician on duty decides if
emergency treatment is needed.
The medical care package does not include:
orthodontics, prosthetics, periodontal treatment or
implants

Closure of a sinus opened

during tooth extraction;
Bleeding control in the oral
cavity.