How to book a covered treatment or request a reimbursement

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How to book a medical service or apply for a claim refund
Employees of Institutions – Members

To request a medical service under direct agreement or a reimbursement of the healthcare costs incurred:

  • if you are a worker with the qualification of worker or employee, you must present, in the manner described in point 3) the correct form*, completed and signed to the Fondo Sanedil to which you are registered or declared via Mut or other equivalent system;
  • if you are a worker with employee status and you are not declared through Mut or another equivalent system, you must submit, in the manner described in point 3) the appropriate form*, completed and signed to the Fondo Sanedil of the area where the company is based where you are employed.

Tax-dependent family members To request a medical benefit or reimbursement of healthcare expenses attributable to the insurable member’s family unit (spouse with tax liability and family status and children with tax liability), it is necessary to send the Fondo Sanedil one of the following forms.

  • In the case of a member’s spouse/children who are of age, the family member’s benefit/reimbursement application form must be filled out and signed by the family member interested in the benefit, who may choose, indicating the details, to receive reimbursement of the expenses incurred, even on his/her own bank/post account, different from that of the registered member. The form also includes a section in which the family member may delegate the member to provide and receive information on claims and guarantees, as well as to receive and deliver/send the relevant health documentation to the Fondo Sanedil.
  • In the case of the member’s minor children, the application form for the benefit/reimbursement of minor children must be completed and signed by the insured worker who is the policyholder, who must also provide the bank details for crediting the relevant reimbursement of expenses incurred.

The applicant must attach to these forms the medical and administrative documentation required under point 2 below. Alternatively, the member can register the dependent family member directly from their dedicated area of the S.I.Sanedil Portal, entering the personal data of the family member in the “Family Members” section (on the “Profile” page) and uploading in the same section the certification of the insurable household. 

Please note: For the Fund to correctly process a benefit request concerning a dependent family member for tax purposes, the certification of the insurable family unit, duly completed and signed by the employee, must first be submitted/sent. Please note that this certificate must only be resubmitted if there has been a change in the originally declared insurable household. Failure to sign the forms, including the “Privacy Policy” section, will result in the request not being processed.

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Documents required for the proper processing of health care claims and reimbursement of expenses

The following must be attached to the application forms referred to in point 1:

COPIA DELLA PRESCRIZIONE MEDICA/ IMPEGNATIVA

When applying for benefits under direct agreement:

  • COPY OF THE MEDICAL PRESCRIPTION/REFERRAL with an indication of the pathology reported (certain or suspected) and of any diagnostic tests required.

COPIA DELLA PRESCRIZIONE MEDICA/ IMPEGNATIVA

When claiming reimbursement of health care costs incurred (including those from the SSN):

  • COPY OF THE MEDICAL PRESCRIPTION/REFERRAL with an indication of the pathology reported (certain or suspected) and of any diagnostic tests required
  • COPIES OF INVOICES/RECEIPTS OF EXPENDITURE
  • COPY OF AN IDENTITY DOCUMENT*
    *This is only required in cases where the request is submitted by email.

COPIA DELLA PRESCRIZIONE MEDICA/ IMPEGNATIVA

In case of a reimbursement request for an external dental service, consult the dedicated page.

We recommend that you always keep a copy of the documentation sent to the Fund and the originals of the invoices/receipts for expenses.

Please note that failure to comply with any one of the above indications will not allow the health service to be activated or the expenses incurred to be reimbursed.

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How to submit claims for medical benefits and reimbursement
E-MAIL/RECOMMENDATION

Persons interested in requesting a medical service or reimbursement of an expense incurred must forward the documentation referred to in points 1 and 2 to the Sanedil Fund at the e-mail address prestazioni@fondosanedil.it or by registered mail with return receipt to be delivered to Casella Postale 7249 c/o
Ufficio Postale Roma Nomentano, 00162, Rome.

IT-Portal portale.fondosanedil.it

After registering in the Private Area of Fondo Sanedil’s web portal, members or their families can request a service from a network of approved partners or the reimbursement of a medical expense that will be taken over by a Fondo Sanedil operator. 
Learn the instructions or watch the video tutorials.

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REQUESTING A SERVICE IN AUTHORISATION MODE

authorisation process

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Upon submitting the request for a service and once the Fund operator has completed entering the relevant data, the applicant, if in good standing with the insurance cover, will receive a text message and/or an email confirming authorisation, with instructions on how to make the booking of the affiliated healthcare facility independently.

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By clicking on the link in the email and/or text message, the applicant accesses the page for choosing the affiliated healthcare facility. The page offers a list of facilities to choose from.

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Upon clicking on the chosen facility, the applicant displays the facility’s contact details to make the appointment. The applicant must also indicate the doctor with whom the service will be provided. When contacting the health facility, the applicant must remember to inform them that they are insured with Fondo Sanedil – UniSalute.

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Should the applicant wish to choose a facility other than the three automatically proposed by the system, he/she can independently consult the list of affiliated facilities on the Fondo Sanedil website and then click on the appropriate link at the bottom of the page (see example below).

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The applicant must indicate the date and time of the appointment already agreed with the chosen health facility.

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The applicant, having taken note of the summary of the appointment with the date and time entered, will now see all the information relating to the booking, including any fee to be paid by the applicant. By clicking on “Confirm” he/she proceeds to send the information to UniSalute.

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Upon completion of the booking procedure, the applicant receives a text message and/or email confirming the booking.

Please note that after receiving the booking authorisation text message, the applicant has 15 days to make the booking at the affiliated facility, after which it will be necessary to submit a new authorisation request to the Cassa Edile/Edilcassa.

The associated facilities can be consulted here.

FULL BOOKING

The process differs depending on whether or not the applicant has already made the appointment with the affiliated healthcare facility. It is understood that the healthcare facility must always be contacted personally by the applicant to establish the terms of the appointment.
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WITH AN APPOINTMENT ALREADY FIXED WITH THE HEALTH FACILITY

The applicant submits the benefit claim to the Fondo Sanedil (point 3).

Having already made a booking with a facility that has an agreement with the hospital, the applicant must indicate on the request form the chosen health facility, the date and time of the appointment. For specialist examinations, the applicant must also indicate the name of the doctor who will perform the examination.

Upon completion of the booking procedure by the Fondo Sanedil operator, the applicant receives a text message and/or email confirming the booking. 

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WITHOUT AN APPOINTMENT

The applicant submits the request to the Fondo Sanedil (point 3).

As the applicant has not yet booked the facility/medical agreement, he/she forwards the requested documentation to the Fondo Sanedil operator (points 1 and 2A) without evidence of the appointment time.

Applicants will then contact the affiliated healthcare facility, make an appointment and promptly notify the Fondo Sanedil operator of the terms of the appointment (healthcare facility, date and time of the appointment, as well as the name of the doctor who will provide the service in the case of specialist examinations). Otherwise, if you do not communicate the terms of the appointment to the Fund’s operator, the reservation will not be confirmed.

Upon completion of the booking procedure by the Cassa staff, the applicant will receive a text message and/or email confirming the booking.

Points of attention in the health service/reimbursement request process

1

To obtain reimbursement of a medical expense incurred, the request must be submitted within 24 months from the date of the invoice.

2

From 1 October 2022, all workers enrolled in the Fund will be entitled to use the Healthcare PLUS Plan, the only plan effective from that date.
For claims with proof of expenditure dated before 1 October 2022, the terms and conditions in force up to that date shall continue to apply. For further details, please refer to the previous guides on the “Documents” page.

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For dental services carried out at affiliated facilities, attributable solely to the DENTAL TREATMENT envisaged by the Health Plan, the applicant must NOT attach any medical documentation, bearing in mind that the dentist will send the treatment plan prepared by the Insurance Company. However, it is necessary for the applicant to expressly indicate, in the reserved space in the form referred to in point 1, the generic wording DENTAL CARE, in order to allow the Fondo Sanedil to transfer the insurance coverage to the insurance company.

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With exclusive reference to the DENTAL PREVENTION guarantee which refers only to the “tartar removal”, carried out at affiliated facilities, the applicant must indicate in the form referred to in point 1, in the space designated for the description of the requested service, the wording DENTAL PREVENTION or TARTAR REMOVAL. ONLY in this case, mentioning in the form the details of the appointment with the dentist for validation of the guarantee, it will not be necessary to send the treatment plan to the Insurance Company. This means it will be possible to take advantage of the service upon receipt of the text message and/or e-appointment confirmation email.

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For all other guarantees other than dentistry, the reimbursement method is offered only where there are no affiliated centres within 15 km from the place of residence/home address of the member. The services provided through the National Health Service, if provided for in the Health Plan, against a proof of expense issued as a Health Ticket are only guaranteed when the reimbursement method is chosen.

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The applicant is required to declare, in the appropriate service/reimbursement request form or accident report, the possible existence of other policies covering the same insured risk. In this case, the same risks covered by two or more insurance policies, even if attributable to Fondo Sanedil (UniSalute and UnipolSai), will be managed, in compliance with the contractually established reimbursement limits, by both companies. 

The applicant, who has already obtained reimbursement from another company for the same insured risk, will only be paid the amount left against him/her in compliance with the deductibles, the coverage caps and net of what has already been reimbursed, the amount of which must be documented and certified.

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The insurance coverage also applies for the 90 days following the state of unemployment (not retirement) of the registered member. These periods are counted from the termination of employment on a monthly basis and not for individual days.

How to claim for an accident

How to report a claim and request reimbursement for treatment or compensation following an accident

The member must send the accident report form to the e-mail address prestazioni@fondosanedil.it or by registered mail to be delivered to Casella Postale 7249 c/o Ufficio Postale Roma Nomentano, 00162, Rome.

Points to note in the reporting process

1

Claims can only be made for claims occurring after 1 October 2020.

2

It is important that the form is completed correctly and signed by the applicant.
This form must be accompanied by the following:

  • MEDICAL DOCUMENTATION already available, as identified in the Accident Insurance Guide.

 

3

Claims must be reported within 24 months of their occurrence.

4

Members are required to send any additional documentation on claims that have already been opened to the Fondo Sanedil.

5

For neuromotor rehabilitation services to be provided in Scientific Hospitals and Hospitals of national importance and high specialisation for neuromotor rehabilitation according to Law no. 833/78 art. 42 and subsequent amendments and integrations, the member shall refer exclusively to the following facilities.

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Members must declare on the form whether they have other policies covering the same insured risk. In this case, the same risks covered by two or more insurance policies, even if they are related to the Fondo Sanedil (UniSalute and UnipolSai), will be managed, per the contractual reimbursement limits, by both companies.

An applicant who has already been reimbursed by another company for the same insured risk shall be paid only the amount remaining for which he/she is responsible, in accordance with the deductibles and maximums and net of the amount already reimbursed, which must be documented and certified.

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The member is entitled to an additional period of insurance cover following loss of employment, for 90 days in the case of the Plus health plan. These periods are counted from the termination of employment on a monthly basis and not for individual days.

Informations and contacts

Members may obtain information on the status of the reported claim by writing to the email address prestazioni@fondosanedil.it and indicating the reference claim number in the subject line of the email.

Upon completion of the investigation, the Company shall pay the amount due directly into the applicant’s bank account by bank transfer.

 

Download required documents

Need support?

Contact Fondo Sanedil, prestazioni@fondosanedil.it