Health Insurance

With DSS Hälsa´s health insurances, employees receive help regardless of whether it is covered by the insurance or not.

The health team is on hand to provide professional help and advice. We make sure that you get help when employees are treated within
public and private care. We help with all types of health problems through navigation, advice, help to prevent and ensure the right treatment at the right time.

DSS Hälsa och Sundhedsgruppen currently insures more than 517,000 employees and we look forward to companies moving or establishing health insurance with us.

We cover your needs. Choose between:

Hälsa BAS

Care planning and healthcare advice

  • DSS Hälsa's Health Team helps the insured with medical advice from registered nurses by phone on 08 – 40 00 61 21 or digitally via My DSS where you can report a case to us 24 hours a day. Our Health Team has many years of experience from different specializations, and they offer professional advice on all health problems, including those that do not require professional treatment or are not covered by insurance.

Health Navigator

  • Through our unique Health Navigator concept, we also offer advice on the public healthcare system's treatment options, such as patient rights, appeals process, guidance on waiting times, how to best approach your local healthcare center, or how to take advantage of the right to choose where you want to seek care. All examinations and public options in primary care are included. We also help review medical records and notes from hospitals and doctors, as well as other help if needed.

  • In the event that an injury can only be treated within public healthcare or is not compensated by the insurance, we offer the insured advice and support regarding the care and treatment that takes place within public healthcare.

Medical care and surgery

  • The insurance covers costs for necessary and reasonable examination, treatment or surgery in a compensable claim and is carried out by a doctor appointed by us. The examination may include diagnostic imaging and tests that are necessary and relevant to establish a diagnosis. A referral must be issued by a physician or licensed therapist. The examination and treatment must primarily be carried out by a doctor as close to the insured's home in Sweden as possible.

Psychologist/psychotherapist

  • The insurance reimburses a maximum of 10 treatment sessions per compensable claim for necessary and reasonable treatment by a licensed psychologist or psychotherapist, if we believe it is possible to achieve a significant and lasting improvement in health. For the treatment to be reimbursable, a referral from a physician may be required unless we determine that an appropriate treatment within our network of providers is preferable. We will continuously evaluate how many treatments the insured needs and whether the treatment is appropriate. In order for the treatment to be replaced, it is a requirement that there is a medically documented need for the treatment and that it intends to lead to an improvement of the condition.
     
  • If the insured chooses a psychologist/psychotherapist without a care agreement who is not part of DSS Hälsa's care network, the customer is reimbursed SEK 800 per treatment session.

Health care guarantee

  • The insured is guaranteed a reimbursable examination and/or treatment within 7 working days at a specialist in private healthcare, after we have approved the examination/treatment.
  • For an insurance event that involves surgery or hospitalization, the insurance guarantees the insured the right to surgery within 20 working days from the time we approve the request.

Conversational support

  • Counseling over the phone regarding questions about well-being is available to the insured through our quality-assured network of psychologists, psychotherapists and other health professionals. The need for counseling can arise through various influencing causes such as private problems with relationships, lifestyle, addiction, stress, or work-related problems such as burnout, dismissal, bullying and conflicts. There may also be a need for professional coaching when you are a manager.

Patient fees

  • The insurance reimburses your patient fees as a patient for public care up to the high-cost cover. Also applies to patient fees in connection with emergency visits to publicly funded care.

Travel and accommodation costs

  • The insurance reimburses necessary and reasonable transport costs between the insured's home and hospital/clinic in connection with care covered by the insurance and which has been planned and arranged by our health team when the total journey exceeds 200 kilometers, round trip. The compensation per kilometer is compensated with a standard amount in accordance with the Swedish Tax Agency's rules for mileage compensation. The insurance covers accommodation costs with a maximum of SEK 1,500 per day. The need must be approved by our health team in advance.

Aftercare and medical rehabilitation

  • The insurance replaces medical rehabilitation with a maximum of 10 treatment sessions per injury case for necessary and reasonable outpatient treatment carried out by a physiotherapist, naprapath and/or chiropractor in direct connection with a compensable insured event in the musculoskeletal system. The rehabilitation must be prescribed by the treating medical specialist. Group exercise instructed by a physical therapist is reimbursed if it is approved by us and is part of a reimbursable rehabilitation plan. Group training is reimbursed with the corresponding amount for the insured's cost of the group training.

Hälsa PLUS

Hälsa BAS

  • In addition to the elements described above under Hälsa BAS, the following elements are also included in Hälsa PLUS, unless otherwise agreed in the group agreement and shown in the insurance statement.

Psychologist/psychotherapist

  • The insurance covers necessary and reasonable t costs for reatment by a licensed psychologist or psychotherapist, if we believe it is possible to achieve a significant and lasting improvement in health. For the treatment to be reimbursable, a referral from a physician may be required unless we determine that an appropriate treatment within our network of providers is preferable. We will continuously evaluate how many treatments the insured needs and whether the treatment is appropriate. In order for the treatment to be replaced, it is a requirement that there is a medically documented need for the treatment and that it intends to lead to an improvement of the condition.
     
  • If the insured chooses a psychologist/psychotherapist without an agreement and who is not part of DSS Health's care network, the customer is reimbursed SEK 800 per treatment session.

Physiotherapist, chiropractor, naprapath, osteopath

  • The insurance covers necessary and reasonable costs for treatment by a physiotherapist, naprapath, chiropractor and osteopath. In order for the treatment to be replaced, it is a requirement that there is a medically documented need for the treatment and that it intends to lead to an improvement of the condition. Based on the medical evaluation, we will refer the insured to relevant treatment. We will continuously evaluate how many treatments are needed and whether the insured is receiving the correct treatment.
     
  • If the insured chooses a physiotherapist, chiropractor, chiropractor, or osteopath without an agreement and who is not part of DSS Health's care network, the customer is reimbursed SEK 500 per treatment session.

Acupuncture, Reflexology

  • The insurance covers necessary and reasonable costs for treatment through acupuncture or reflexology. Treatment is reimbursed with a maximum of 10 treatments per diagnosis/injury. In order for the treatment to be replaced, it is a requirement that there is a medically documented need for the treatment and that it intends to lead to an improvement of the condition. For acupuncture to be reimbursed, it is also required that the underlying condition is on the World Health Organization's (WHO) list of conditions where acupuncture has had a positive effect.
     
  • Based on a medical evaluation, we will refer the insured to the relevant treatment. We will continuously evaluate how many treatments are needed and whether the insured is receiving the correct treatment.
  • If the insured chooses acupuncture or reflexology with a healthcare provider without an agreement and who is not part of DSS Hälsa's healthcare network, the customer will be reimbursed SEK 500 per treatment session.

Crisis therapy

  • The insurance covers crisis therapy if we believe that the insured has experienced an acute psychological crisis due to any of the following: 
    • If the insured has experienced a sudden serious event/accident, where the insured has been in danger.
    • If the insured has been the victim of robbery, assault, violence or kidnapping, fire, explosion or burglary in the insured's private home or business (must be reported to the police).
    • If the insured is diagnosed with a life-threatening illness.
    • Death within the insured's immediate family*.
    • If a member of the insured's immediate family is diagnosed with a life-threatening illness.
    • If the insured experiences the sudden, unexpected death or sudden, serious event/accident of a family member or colleague.

 

  • It is not a requirement with a referral from a doctor. We assess whether crisis therapy or other treatment is required.

Dietitian

  • The insurance covers medically justified treatment by an authorized clinical dietitian. The insurance covers the number of necessary treatments that can be considered justified for health reasons, up to a maximum of ten treatments per illness/injury and a maximum of ten treatments per calendar year including 1 diet plan per illness/injury. The treatments are distributed in rounds and the health team will continuously evaluate how many treatments are necessary.
     
  • The treatments must, according to our evaluations, lead to a noticeable and lasting improvement in condition, and after a medical evaluation we can refuse to replace treatment of a recurring syndrome/problem. We evaluate whether the insured needs a medical referral.

  • If diabetes, elevated cholesterol, cardiovascular disease, intestinal coma, uric acid, gluten intolerance or PCO/PCOS are diagnosed during the insurance period, a round of treatment can be replaced during the insurance period.

  • Treatment for underweight can be reimbursed if the insured's BMI (Body Mass Index) is lower than 19, and overweight if the BMI is higher than 30.

Care guarantee extended

  • The insured is guaranteed a reimbursable examination and/or treatment within 7 working days at a specialist in private healthcare, after we have approved the examination/treatment.

  • For an insured event that involves surgery or hospitalization, the insurance guarantees the insured the right to surgery within 14 working days from the time we approve the request.

Medical expenses

  • The insurance provides the insured with compensation for the costs of patient fees related to care in publicly funded healthcare in Sweden up to the level of the high-cost cover. DSS health only reimburses costs that can be proven with original receipts. Prescription drugs must be prescribed by the attending physician and be necessary for the medical treatment.

Second, third poinion

  • In some cases, the insurance replaces consultation with a relevant doctor if the insured:
    • Has a life-threatening or particularly serious illness or injury.
    • Faced with the choice of receiving particularly risky treatment, which may be life-threatening or result in permanent damage.

 

  • If we consider that the insured is entitled to a second opinion, a doctor from either a public or private healthcare provider will contact the insured, digitally or via a physical examination. If the insured is faced with a difficult decision or if there is uncertainty regarding a diagnosis or type of treatment, we offer an advisory consultation with dedicated doctors and nurses. If the two doctors do not agree on a diagnosis or type of treatment, we offer a third opinion by telephone.

Temporary aids

  • The insurance covers expenses for personal and temporary aids that are needed after an intervention, or a treatment approved by us. The aids must be necessary and reasonable and must be prescribed by the attending physician. Temporary aids, including rented aids, are reimbursed for a maximum of 6 months.

Travel and accommodation extended

  • The insurance covers necessary and reasonable transport costs between the insured's residence and hospital/clinic in connection with care covered by the insurance and as planned and arranged by our health team when the total journey exceeds 100 kilometers, round trip.

  • The compensation per kilometer is compensated with a standard amount in accordance with the Swedish Tax Agency's rules for mileage compensation.

  • The insurance covers accommodation costs with a maximum of SEK 1,500 per day. The need must be approved by our health team in advance.

  • Travel and accommodation must be approved by us in advance.

Home help after surgery

  • The insurance covers necessary and reasonable expenses for temporary home help in direct connection with an operation that is covered by the insurance. The temporary home help or home health care must be prescribed by the treating medical specialist and approved by us in advance.

  • Temporary help for cleaning, handling, help with personal hygiene and undressing is reimbursed for a maximum of 14 days from the day of discharge from hospital/clinic, and a maximum of 20 hours in total including travel time.

Aftercare and medical rehabilitation expanded

  • The insurance covers medical rehabilitation for necessary and reasonable outpatient treatment carried out by a physiotherapist, naprapath and/or chiropractor in direct connection with a compensable insurance case in the musculoskeletal system*. The rehabilitation must be prescribed by the treating medical specialist.

  • Group exercise instructed by a physical therapist is reimbursed if it is approved by us and is part of a reimbursable rehabilitation plan. Group training is reimbursed with the corresponding amount for the insured's cost of the group training.

Chronic diseases, 6 months after diagnosis

  • The insurance covers the examination and treatment of chronic diseases* and ailments that occur during the insurance period for a period of 6 months from the date of diagnosis, provided that we believe that the treatment will result in a significant and lasting improvement of the condition. Chronic diseases* and ailments that have arisen and/or been diagnosed before the insurance period are not covered by the insurance.

  • We offer help with all chronic diseases* through advice, guidance through the treatments offered by the public healthcare system, patient rights, information on waiting times, examination and treatment guarantees and help with booking appointments within the public healthcare system.

Additional insurance

Addiction treatment

  • The policy covers one (1) uninterrupted period of treatment for either alcohol, drug, medication or gambling addiction until the insured has reached the final age to have the right to enter into the group agreement.

 

  • It is a requirement that there is a medically documented need for the treatment to be reimbursed by the insurance. The insured must therefore contact the Health Team and follow the procedures the Company deems necessary to be able to assess the insured's situation. The assessment can be made by specialists within the Company's network or by other suitable suppliers that the Company proposes or approves. The treatment is considered eligible for compensation when the Company has approved the treatment plan proposed by the supplier. The compensation includes the costs that the supplier has had to be able to make an assessment and the subsequent treatment.

 

  • The insured has the right to reject one (1) proposed treatment plan for any reason and without any costs or loss of the right to compensation. If the insured rejects further treatment plans, he or she will be charged any new assessment costs that may arise in connection therewith. In addition, interruption of ongoing treatment will result in the loss of the right to further compensation. Maximum compensation is SEK 100,000 and the Company will inform the insured if the treatment plan is at risk of exceeding the maximum limit.

Hälsa Premium

Hälsa BAS

  • In addition to the elements described above under Hälsa BAS

Hälsa PLUS

  • In addition to the elements described above under Hälsa BAS, the following elements are also included in Hälsa PLUS, unless otherwise agreed in the group agreement and shown in the insurance statement.

Health examination

  • The insurance includes a health examination recommended by DSS Hälsa. The examination must be approved in advance and mediated by the Health Team. The examination takes place at the supplier referred by the Health Team. The insurance covers a maximum of one health examination per year.

Preventive addiction help

  • The insurance includes a digital prevention anonymous addiction help recommended by DSS Hälsa. The service must be approved and mediated by the Health Team.

Addiction treatment

  • The policy covers one (1) uninterrupted period of treatment for either alcohol, drug, medication or gambling addiction until the insured has reached the final age to have the right to enter into the group agreement.

 

  • It is a requirement that there is a medically documented need for the treatment to be reimbursed by the insurance. The insured must therefore contact the Health Team and follow the procedures the Company deems necessary to be able to assess the insured's situation. The assessment can be made by specialists within the Company's network or by other suitable suppliers that the Company proposes or approves. The treatment is considered eligible for compensation when the Company has approved the treatment plan proposed by the supplier. The compensation includes the costs that the supplier has had to be able to make an assessment and the subsequent treatment.

 

  • The insured has the right to reject one (1) proposed treatment plan for any reason and without any costs or loss of the right to compensation. If the insured rejects further treatment plans, he or she will be charged any new assessment costs that may arise in connection therewith. In addition, interruption of ongoing treatment will result in the loss of the right to further compensation. Maximum compensation is SEK 100,000 and the Company will inform the insured if the treatment plan is at risk of exceeding the maximum limit.

The insurance does not cover

The insurance does not cover

  • Emergency medical care
  • Massage
  • Acupuncture
  • Practicing professional sports
  • All forms of contraception and fertility treatment
  • Sexually transmitted diseases
  • Chronic diseases (applies only to Hälsa BAS)
  • Bariatric surgery or treatment
  • Congenital disorders
  • Treatment of sleep apnea
  • Couples therapy
  • Impaired vision and hearing
  • Cardiovascular disorders
  • Side effects of alcohol abuse
  • Preventive examinations and treatment
  • Treatment of phobias, eating disorders, ADHD, autism
  • Damages following civil unrest, nuclear energy and radioactive radiation or radioactivity
  • Epidemics and pandemics