utenti collegati Aglea Salus - garanzie erogate

Major Surgery

In the case of hospitalization for major surgery, as a result of an illness or injury covered by the healthcare scheme, the costs related to the illness and/or injury incurred in the 90 days prior to hospitalization will be reimbursed:
- diagnostic tests including medical fees and specialist examinations;
- physiotherapy and rehabilitation treatments.

Aglea Salus also reimburses the costs incurred during hospitalization for:
- services provided by the surgeon, helpers, anaesthetist, as well as operating theatre fees and operating equipment;
- medications and tests;
- medical and nursing assistance;
- therapeutic devices and endoprostheses deployed during surgery;

Reimbursement is also provided for expenses incurred in the 90 days following hospitalization for:
- diagnostic tests including medical fees and specialist visits;
- physiotherapy and rehabilitation treatments:
- diagnostic examinations and specialist visits;
- medical services;
- physiotherapy and rehabilitation treatments;
- medicines (with medical prescription);
- spa treatments (excluding hotel expenses).

No fee will be charged to the Member if the hospitalization services, with or without surgery, are carried out within the Centres affiliated with the Health Control Centre. In cases where the above services are provided in Centres not affiliated with the Health Control Centre, the member will be charged with a fee provided by the selected healthcare scheme. If the services for hospitalization are provided by affiliated Centres, but by non-Contracted doctors, the above-mentioned fees for not affiliated Centres will be applied to the latter.

SERVICES Aglea Salus, within the annual maximum amount indicated in the technical data sheet of the selected healthcare scheme, in case of illness or accident that can be reimbursed in accordance with the terms of the subscribed Healthcare Scheme, will provide for the reimbursement of the expenses incurred by the member.

Admission with or without surgery

In the event of hospitalization, with or without surgery, made necessary by illness or injury that are included in the terms of the subscribed Healthcare scheme, the costs related to the illness and/or injury incurred during hospitalization for diagnostic tests including medical fees and specialist visits in the 90 days prior to and after hospitalization will be reimbursed. Without prejudice to the provisions of art. 11, Aglea Salus shall reimburse the expenses for the services indicated below, at no cost to the Member and within the maximum limits, whether they are carried out in health facilities affiliated with the Health Control Centre or not:

a) Natural childbirth
b) C-section and therapeutic abortion, hospitalizations or Day Hospital surgeries
c) Outpatient surgeries, any other procedure (laser, cryotherapy, etc.).
d) Benefits for refractive surgery and treatments with excimer lasers limited to those performed:
- in the case of anisometropia of more than three dioptres;
- in the case of visual impairment equal to or greater than 5 dioptres for each eye, within the limits laid down by the healthcare scheme chosen;

Alternative hospitalisation

In the event the Member must be hospitalized in National Health Service facilities as a result of illness, accident or childbirth, which can be reimbursed according to the selected healthcare scheme, the Member can ask for the payment of a daily sum in lieu of the reimbursement of expenses. The reimbursement due under the above terms is due from the day of admission to the day prior to discharge.

Fees due for Accompanying Persons

Aglea Salus reimburses the expenses incurred by the member for food and overnight stay in a nursing home, or hotel, for an accompanying person of the patient who is ill within the daily limit set by the selected healthcare scheme.

Examinations and Check-ups

Aglea Salus, within the annual sublimit indicated in the selected healthcare scheme, in case of illness or accident, even without hospitalization or surgery, upon medical prescription indicating the clinical reasons, provides for the reimbursement of expenses for specialist medical examinations and diagnostic tests carried out by the Member, within the limits and exemptions provided for. Dental and orthodontic examinations, tests and diagnostic examinations are excluded from the reimbursable expenses provided for in this article.

Fine Diagnostics

• Angiography
• Phlebography
• Scintigraphy
• Nuclear MRI
• Artography
• Bronchography
• Mammography
• Myelography
• Urography
• Axial Tomography
• CT
• Digital Arteriography
• Bronchoscopy
• Cystography
• Colonoscopy
• Coronoscopy
• Echocardiography
• Echocardiogram
• Doppler,
• Echo-doppler and colourdoppler
• Electrocardiography
• Electroencephalography
• Radionephrogram
• Dialysis
• Amniocentesis
• Digital Angiography
• Digital Arteriography
• Chemotherapy
• Cobalt therapy
• Radiological diagnostics
• Ultrasound
• Laser therapy
• Telecardiogram
• Gastroscopy
• Rectoscopy
• EGDS (esophagoscopy + gastroscopy + duodenoscopy)
• Radionephrogram
• Urography

Reimbursement of Co-pay fees

If the Member carries out specialist examinations and diagnostic tests using the S.S.N., Aglea Salus, upon submission of the original expense invoices, shall reimburse 100% of the expenses for co-pay fees within the limit set by the selected healthcare scheme.

Long-Term Care

The "Long-Term Care" scheme is available in the occurrence of unforeseen and disabling events of the contracting member, resulting both from accident and illness, such as to lead to a state of incapacity for self-sufficiency for which the member cannot carry out basic daily activities on their own. A person is not considered to be self-sufficient if he or she is physically unable, as clinically ascertained, to perform at least 4 out of 6 of the following activities:
- Washing
- Dressing
- Eating
- Mobility
- Continence
- Moving

Permanent Accident Disability Assistance

If the accident results in the permanent disability of the Member, either totally or partially, within two years from the day of the accident (even if coverage has expired in the meantime), Aglea Salus shall pay compensation equal to the maximum sum provided for, by applying a 5% allowance to the Member, corresponding to the certified percentage level of permanent disability. The degree of permanent disability is determined by referring to the values indicated in the INAIL Permanent Disability Chart.

Assistance for Death by Accident

If the accident results in the death of the contracting Member, Aglea Salus shall pay a lump sum corresponding to the amount provided for in the selected healthcare scheme to the beneficiaries or, failing that, to the legitimate or testamentary heirs.

Assistance for Loss of Employment

The Mutual Society undertakes to exempt the member from the payment of the healthcare scheme, for up to one semester, in case of involuntary loss of employment. This guarantee ensures the suspension of the payment of the following contributions due for the selected healthcare scheme. If, on the other hand, the member has chosen to pay a lump sum for the year, the Mutual Society undertakes to extend these guarantees for another six-month period, without any additional charge to the member. For this guarantee to be valid, the Member must have had an open-ended employment contract (of at least 16 hours per week) for at least twelve (full) months, upon signing the application form for membership of the Mutual Society and this healthcare scheme.

24/7 Central Services

24/7 Medical advice by telephone
If the Member needs to assess his or her state of health, he or she may contact 24/7 the doctors at the Health Control Centre by phone at 800.035.666 and ask for a telephone consult. The service is free and does not provide diagnosis or prescriptions.

Selection and Booking of Hospital Facilities
If, following an accident or illness and after a medical consult, the Member needs surgery, he or she may call the Operations Centre, which, after a thorough review of the patient's clinical profile and having ascertained the need for the service, will locate and book a hospital facility equipped for the procedure in Italy and abroad, taking into account current availability. The service is provided from 9.00 a.m. to 6.00 p.m. from Monday to Friday, except on public holidays.

Selection and booking of specialist examinations, diagnostic tests and blood tests
in Italy If, following an accident or illness, the Associate needs a specialist examination and a diagnostic or blood test, he may call the Operations Centre which, after consulting the attending physician, will locate and book, taking into account current availability, the specialist examination and diagnostic test or the blood test centre, in agreement with the Member.

Transfer to a hospital facility in Italy
Should the Member, as a result of an accident or illness, suffer from a condition which, due to objective reasons, is not treatable in the hospital facilities located in the Member's region of residence and the above-mentioned doctors, after reviewing the clinical profile of the Member in agreement with the attending physician, find justified reasons for transferring him/her to a hospital facility suitable for the treatment of the condition from which he/she is suffering, the Operations Centre shall take the necessary steps:
- to locate and book, taking into account current availability, the Hospital Facility considered to be the best equipped for the Member's condition;
- to organise the Member's transport by ambulance without any restrictions on the journey.
The transport will be entirely organized by the Operations Centre, including medical or nursing assistance during the transfer, should the doctors of the Operations Centre deem it necessary. Aglea Salus shall bear all related costs. The service will be only provided due to the sudden lack of the necessary and suitable clinical instruments for treatment, as certified by the Health Director of the facility concerned. The following are excluded from service:
- disability or injury which, according to the doctors of the Operations Centre, can be treated by hospitals in the Region of residence
- disabilities or injuries that cannot be treated by Hospitals in the Region of Residence due to structural and organizational deficiencies of the facilities
- all cases in which transport involves violations of health regulations.

Transfer back to the hospital facility in Italy
Should the Member, after the "Transfer to a Hospital in Italy" service, be discharged after hospital stay and need to return to their home, the Operations Centre shall arrange for the transfer with the most suitable means of transport for the Member's condition:
- First class train and sleeping car;
- Ambulance, (without mileage limits).
The transport will be organized entirely by the Operations Centre, including medical or nursing assistance during the trip, if the doctors of the Operations Centre deem it necessary.

Home delivery of test results
If, as a result of sudden illness or accident certified by their attending physician, the Member has had diagnostic tests carried out in facilities located in the province of residence and cannot leave their home for serious health reasons certified by their attending physician, the Operations Centre to deliver the results of these tests either to the Insured or to the doctor indicated by them. The Member must provide the name of the attending physician, if any, and a telephone number. The cost of the tests shall be borne by the Member. The service is provided from 9.00 a.m. to 6.00 p.m., Monday to Friday, except for midweek holidays.

Home delivery of emergency medications
If the Member, following a medical prescription, needs medications or medical devices and cannot leave their home for serious health reasons certified by the attending physician, the Operations Centre, after picking up the corresponding prescription from the Member, shall provide for the delivery of the items prescribed by the attending physician. The cost of medications or medical devices shall be borne by the Member. The Associate must state the reason for their request and indicate their address and telephone number.

Health information
If the Member wishes to receive the following information regarding the country to which they intend to travel:
- Mandatory or recommended vaccinations
- Health and food risks
- Sanitary precautions
they may contact the Operations Centre, which will provide the requested information by telephone. The service is available from 9.00 a.m. to 6.00 p.m. from Monday to Friday, except on public holidays.

Referral of a doctor at home, in Italy in emergency cases
If, after a Medical Consult, the Member should need a medical examination, the Operations Centre will arrange, at Aglea Salus' expense, to send one of the doctors affiliated with Aglea Salus to their domicile. Should one of the affiliated doctors be unable to attend personally, the Operations Centre will transfer the Member by ambulance to the nearest medical centre. The service is provided from 8.00 p.m. to 8.00 a.m. Monday to Friday and 24 hours a day, on Saturdays on Sundays and public holidays.

Ambulance service in Italy
Should the Member, as a result of an accident and subsequently following a medical consult, need to be transferred by ambulance, the Operations Centre will arrange for the transfer of the Member to the nearest medical centre. Aglea Salus will bear the costs up to a maximum of € 500,00 per year with a limit of € 250,00 per accident.

Cardio Consult
Should the Member, in case of illness or injury, need an assessment of their state of health to determine the most appropriate service to be provided on their behalf, they may contact the cardiologists at the Operations Centre either directly or through their attending physician. The Member must provide the name and telephone number of the attending physician (if any).

Gynaecological Consult
Should the Member, in case of illness and injury, not be able to find their gynaecologist and need an urgent telephone service, they may contact the doctors of the Operations Centre directly. The Member must communicate the reason for their request and the telephone number.

Geriatric consult
Should the Member, in case of illness or injury, need an assessment of their state of health to decide which is the most appropriate service for them, they may contact the doctors at the Operations Centre directly or through an attending physician. The Member must provide the name of the attending physician (if any) and their telephone number.

Dental consult
Should the Member in case of illness or injury not be able to reach their dentist and need an urgent telephone service, they may contact the doctors at the Operations Centre directly. The Member must provide the reason for their request and the telephone number.

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