Health Insurance

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Insurance conditions
Health insurance
Valid from 1 January 2022

Folksam mutual non-life insurance
C ontact with F olksam

Customer Service: 0 7 7 1 - 9
5 0 9 5 0 Care advice or reporting damage: 0 7 7 1 - 9 6
8 6 3 6 Website: f olksam. see
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Content
Insurance conditions Medical insurance................................................ .........................4

Insurer ....................... ................................................... ....................................... 4 Who can
take out the insurance?...... ................................................ .....................................4 Protection
of personal data......... ................................................ ......................................... 4 Damage
registration....... ................................................ ................................................ ...... 5 Tax
rules................................... ................................................ ..............................5
Explanations of important terms................................................... ........................................ 6
General provisions................................................ ................................................ ..8 Group

agreement .............................................. ................................................ .......................... 8
Insurance notice and invoice/premium notification.................. ............................................... 8
When newly signed and changed insurance comes into effect................................................. .................
8 If incorrect information is submitted to Folksam.......................... ................................................8
Right of withdrawal in case of voluntary insurance ............................................... ............................8
The prize................... ................................................ ................................................ ........9
Premium payment................................... ................................................ ......................... 9
When provided the hedge ceases to apply .............................................. ...............................................
9 Actions for payment of compensation................................................... ................................10
Late payment interest................ ................................................ ................................................10
Limitation................................................. ................................................... .....................10
Transfer................................ ................................................ ............................................. 10
Limitations on the validity of the insurance. ................................................ .......................11
Gross negligence........................ ................................................ ......................................11
Stay abroad................................................... ................................................ ...........11
War................................................. ................................................... ................................11
Damage caused by nuclear reaction or by biological/chemical/nuclear substance.... ......11
Force majeure........................................ ................................................... ......................... 12
Special provisions................................................ ................................................... 13

Qualification rule................................................... ................................................... .......... 13
General information about the insurance................................... ................................................... .............13
Health insurance Basic................................... ................................................... ................14
Health care insurance Between............................... ................................................... .............
15 Health insurance Large................................... ................................................ ............... 16
Limitations in the scope of the insurance............................... .......................................... 16
Aftercare and Continuation insurance................................................ ........................ 18

Aftercare........................ ................................................... ................................................18
Continuation insurance ................................................... ................................................... ..18
We want you to be satisfied............................................. ................................................ .20
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Insurance conditions Health insurance
These insurance conditions apply from January 1, 2022 until the new insurance conditions
come into effect. Insured events that occur during this period must therefore be regulated according to these
conditions.
For the insurances, what is stated in the insurance statement and what is determined in the group
agreement, the Insurance Contracts Act and general Swedish law in general also apply.
Special provisions in the group agreement take precedence over provisions in these terms and conditions.
The insurance terms apply to both group members and any co-insured.
When we use the words "you", "you", "your", "yours" in the terms and conditions, we mean - unless otherwise
stated - each insured person, who can be a group member as well as a co-insured. In cases where different rules
apply to group members and co-insured, this is stated separately. "We", "us", "our" refers to the insurer, i.e.
Folksam.
The group agreement shows which insurance policies the contracting group has taken out in Folksam. In the
insurance notice, you can see which of these supplements you are covered by.
Insurer The insurer for Health

Insurance is Folksam omsesidig sakförsäkring, organization number 502006-1619.
Address 106 60 Stockholm and telephone number 0771-950 950. The company is referred to below as Folksam.
Folksam's business is insurance and savings. The business is under the supervision of the Financial
Supervisory Authority, and Folksam's marketing is governed by Swedish law.
The insurance conditions are provided in Swedish and all communication between you and Folksam takes place in
Swedish. All mailings regarding your insurance holdings are made to your civil registration address, unless we
agree otherwise.
Who can take out the insurance?

The person seeking insurance and whose health the insurance applies to must: •
be resident and registered in Sweden • be registered with the Swedish Social
Insurance Agency • aged 16 but not 65. For minors, the guardian's signature is
required • be fully able to work.
Protection of personal data We protect

your personal integrity and want you to feel secure in how we handle your data. When you enter into an
insurance contract with us, we need to handle your personal data in order to administer the insurance
relationship, handle reported damages, calculate insurance premiums or to provide relevant information and
marketing to you. The information we process may be your name and address, health information, if there is co-
insured, information about insurance cases and other relevant information. Most of the personal data is collected
from you, but we may also collect data from a third party or from public sources. The personal data is mainly
processed so that we can fulfill our obligations according to the insurance agreement. We may also need to process
the data to fulfill a legal obligation, to establish, assert or defend a legal claim or when we have a legitimate interest
in processing your data.
Contact details for the Folksambolag that is responsible for handling your personal data can be found in your
insurance statement. From 25 May 2018, you can also contact Folksam's data protection officer at
dataskyddsombud@folksam.se.
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We will save your personal data for as long as we need it to fulfill the purpose for which it was collected.
We then delete the data.
Your personal data is handled confidentially. Your address details and basic information about
your agreement are handled in a common customer register for Folksambolagen for, among other
things, automatic address updating and coordination of the companies' information and marketing to
you. We may also need to disclose certain personal data to reinsurance companies.
If the data is transferred to a country outside the EU, we ensure that such transfer is legal, for example
by using the standardized model data transfer clauses adopted by the European Commission and
available on the European Commission's website.
You have the right to receive information about which data we process about you, to have incorrect
data corrected, to request that we limit our processing and that your data be transferred to another party,
and to object to the processing we carry out. You also have the right to lodge a complaint with the
responsible supervisory authority.
Read more about our handling of personal data and your rights at folksam.se/persondata
Claim registration We use

a common claim registration register (GSR) for the insurance industry.
This register contains certain information about the damage as well as information about who
requested compensation and is only used in connection with claims settlement. This means that we find
out if you previously reported any damage to another insurance company or authority that handles
similar compensation claims. The purpose of the GSR is to provide a basis for insurance companies and
authorities that handle similar compensation claims to identify unclear insurance cases. In this way,
companies and authorities can counteract the payment of compensation based on incorrect information.
The data can also be used in de-identified form for statistical purposes.
The personal data controller for GSR is Skadeannällningsregister (GSR) AB, Box 24171, 104 51
Stockholm. See www.gsr.se for more information on the processing of data that appears in the register.
We can also provide information about, among other things, thefts and wanted goods to Larmtjänst AB,
an industry-wide organization that works to combat insurance-related crime.
Tax rules The

insurances are, in the sense of tax law, capital insurances. The premium is not deductible in the income
tax return. Insurance amounts that are paid out are free of income tax.
If the employer pays the premium for the employee, part of the premium is subject to benefit
taxation. For more information see folksam.se.
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Explanations of important concepts
Liability period
The longest period during which compensation can be paid for an insured event. The liability period is counted from the
day the insured event occurred.
Incapacity for work

Incapacity for work means that due to illness or accidental injury, you have lost or reduced your ability to work. Folksam's
assessment of your right to compensation is based on the provisions of the Social Insurance Code and the Social
Insurance Agency's decision. If you collect sick pay, according to the Act on sick pay, you are also considered unable to
work.
Fully able to work
To be considered fully able to work, you must be able to carry out your usual work at the workplace or at home without
restrictions.
Not fully functional

Not fully functional
• those who have full or partial sickness pay, sickness benefit, rehabilitation benefit,
activity allowance, sickness allowance or the equivalent • the person
who has dormant sickness allowance or the equivalent • the person for
whom care allowance has been granted.
Insured The
person whose life or health the insurance applies to.
Eligible group for insurance A specific

group of people who, according to a group agreement, may have the right to join group insurance, for example members
of a trade union.
Insurance notice Provides

an overview of the scope of the insurance.
Insurance event The

event which, according to the insurance conditions, may give the right to compensation.
Time of the insurance case: • In the

case of accidental damage: the time of the accident • In the case
of illness: the time when the illness started. Debut means when you became or
should have become aware of the disease or symptoms of the disease.
Policyholder Policyholder
is the person who entered into an agreement on the insurance. In the case of compulsory insurance, the contracting group
is the policyholder. In the case of voluntary insurance, the group member is the policyholder. However, every insured
person, both group member and co-insured, is considered a policyholder when it comes to, for example, the right to
insurance compensation and the right to deposit for monthly policy holders.
In Continuation insurance, the policyholder and the insured are always the same person.
Insurance period The

time during which you are covered by the insurance.
Group agreement
Agreement entered into between a group and Folksam regarding insurance for the group's members. A group agreement
normally applies for one calendar year at a time.
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Group representative
The person appointed to represent the group in contacts with Folksam.
Group member
Person who belongs to the group entitled to insurance as determined by the group agreement.
Qualification rules Special

requirements that are set so that you can be covered by the insurance or by a section of the insurance.
Medically motivated Care and
treatment based on science and proven experience, as well as evidence when this is available.
Co-insured Group
member's spouse/registered partner/cohabitant or child/grandchild who is insured according to the group agreement.
Patient fee
Personal fee that you pay in public care.
Registered partners Registered

partners mean two people of the same sex who have entered into a registered partnership.
The law on registered partnerships ended on 05/01/2009, when marriage became gender neutral. Those who are
registered partners under the previous law continue to be so unless the partnership ends or is converted into marriage
by notification to the Swedish Tax Agency or marriage.
Referral If
the insurance was taken out with a referral, it is clear from the group agreement and the insurance notice.
Referral means that care and treatment in specialist care must have been preceded by a thorough medical
examination by a general practitioner or company doctor operating in Sweden.
Cohabitant
Cohabitant refers to two unmarried persons who have a joint household and who permanently live together in a couple
relationship according to the Cohabitation Act.
Deductible
Part of the damage cost for which you yourself are responsible.
Symptoms
In Health Insurance , symptoms mean that signs of illness are present regardless of whether the symptoms have stopped
due to medication or other treatment.
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General provisions
Group
agreement An insurance agreement, a so-called group agreement, has been drawn up between the insured group
and Folksam. The group agreement states, among other things, the validity period of the agreement, which insurance/
reimbursement elements are included, the premium and how the premium is to be paid. The group agreement also
shows how you, as a group member, can connect yourself, your spouse/registered partner/cohabitant and your children/
grandchildren to insurance.
A group agreement normally applies for one calendar year at a time and can be terminated by both the group and
Folksam.
What is further described in this terms booklet applies to you as an individual insured within the framework of what
is determined in the group agreement.
Insurance statement and invoice/premium notification The insurance

statement shows which insurances apply to you as well as the extent of the insurance cover and the size of the
insurance amount.
Invoice/premium notification provides information about the current premium.
As a group member, you must check that you and any co-insured have valid insurance with the correct insurance scope
and pay the correct premium.
When newly signed and amended insurance begins to apply,

Folksam's liability (insurance cover) begins the day after the day on which the application for insurance was made or
an offer of insurance from Folksam was accepted, provided that • complete application documents have been submitted
to Folksam • the insurance can be granted on normal terms • the it does not appear from the application documents or
in any other way that the insurance shall start to apply at a different time.
If insurance or certain parts of an insurance can only be granted with special conditions or a reduced insurance amount,
Folksam's liability only begins after we have offered you insurance on these conditions and you have accepted the offer.
For an increase in the insurance amount or other extension of the insurance cover in insurance that requires full
ability to work, it is assumed that you are also fully able to work at the time from which the change is to apply. If
this is not the case, you must wait to make the change until you are fully functional again.
If incorrect information is provided to Folksam Incorrect or

incomplete information can result in the insurance becoming invalid or us being free from liability according to the
provisions of the Insurance Contracts Act and general Swedish law in general. The premium paid is not refunded in
such a case.
Right of cancellation for voluntarily signed insurance

When you have taken out insurance, you have the opportunity to cancel the insurance contract within 30 days from
the time you received the insurance documents (insurance notice) from us.
If you want to use your right of withdrawal, contact Folksam, either by phone, e-mail, or by writing to us. You can also
use a cancellation form that you can find at konsumerverket.se. If you change your mind, you must notify us within
these 30 days.
We always have the right to demand a premium for the time the insurance was valid.
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The
premium The premium is calculated for one calendar year at a time and is determined on the basis of the
scope of the insurance, the composition of the group and Folksam's premium tariff.
If the insurance amounts are linked to the price base amount, they can vary from year to year, calculated in
kronor. This means that the premium may also change.
Premium payment
The first premium must be paid within 14 days from the day we sent the invoice or premium notice. If the
premium is not paid on time, we cancel the insurance, which ceases to apply 14 days after the time of
cancellation, if the premium is not paid within this time.
The renewal premium is paid in advance for each payment term. If the premium is not paid on time, we will
cancel the insurance, which will cease to apply 14 days after the time of cancellation, if the premium is not paid
within this time.
The termination date is the day on which we sent notice of termination.
If the insurance has lapsed because the renewal premium has not been paid, it can be revived by paying the
premium within three months from the day the insurance lapsed.
Premium must be paid for the entire premium period for which the premium was unpaid. The insurance then
becomes valid again from the first day of the premium period.
When applying for re-entry later than three months from the day the insurance has ended, a new application
with a health declaration must be submitted to us. The insurance then becomes valid from the day we grant it.
If the premium could not be paid within the 14-day period due to you as a group member becoming seriously
ill, deprived of liberty, not receiving a pension or salary from your main employment or if a similar obstacle
occurred, the termination will take effect no earlier than one week after the obstacle has disappeared , but no
later than three months after the 14-day deadline.
When the insurance ceases to apply,

the Group insurance is valid until you, as a group member, reach the final age specified in the insurance
notice or group agreement.
During the insurance period, you can cancel the insurance at any time. We always have the right to demand a
premium for the time the insurance has been valid.
Insurance for you as a group member and any co-insured ceases to apply before then in the following cases: •
The group agreement expires. • You withdraw from the group eligible for insurance. • You cancel the insurance
for yourself and/or co-insured. • You do not pay the premium on time, see General regulations, Premium
payment.
Insurance for co-insured also ceases to apply in the following cases: • The group
member dies. • The marriage/registered partnership or cohabitation with the group
member
dissolves.
Insurance for a co-insured child ends when the child reaches the final age specified in the insurance terms.
Notify change
As a group member, you must notify Folksam as soon as possible
if • you withdraw from the group eligible for insurance • the marriage/
registered partnership or cohabitation with a co-insured up
solved.
Reimbursement of premiums
Folksam refunds premiums that have been paid for a period after the insurance would have ended, but not for
a longer period than the last six months.
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Measures for the payment of compensation
When requesting compensation from Health Insurance , the following applies: •

Notification of illness or accidental injury that results in the insured being in need of care or treatment must
always be made to us as soon as possible.
• In the event of an insured event and all continued care, our healthcare planning must be contacted. • The
claim must then be made as soon as possible. • Before treatment takes place or before travel for hospital
treatment begins, our
healthcare planning is contacted for approval. • Costs
must be substantiated with original receipts. • The cost of
certificates and examinations requested by us is reimbursed by us. • The treating care
provider may provide us with documents and information that we consider to be important for the assessment
of the compensation issue. • Other documents and information, which we consider to be important for the
assessment
the compensation issue, must be provided to us at our request.
Late payment
interest Payment must take place no later than one month after the person claiming compensation has
completed what is required according to the General Regulations, Measures for the payment of compensation.
If there is reason to investigate whether any information used as a basis for the insurance contract was incorrect
or incomplete, the payment does not have to take place until one month has passed after such investigation has
been completed. The investigation must be conducted promptly.
If payment is made later than stated above, Folksam pays late payment interest according to the Interest Act.
Prescription
The right to insurance compensation or other insurance coverage ceases if the person claiming compensation
does not bring an action against us within ten years from the time when the situation which, according to the
insurance contract, entitles to such coverage occurred.
By relationship is meant the prerequisites in the insurance agreement/group agreement, the insurance statement
and the insurance conditions that must be met in order for the right to compensation to exist. The prescription
period begins to run when the right to compensation from the insurance exists.
However, whoever presented their claim to us within the time specified here always has at least six months to
file a claim against us from the day we have declared that we have taken a final position on the claim.
Transfer The
policies may not be transferred.
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Limitations on the validity of the insurance

Gross negligence The
insurance compensation can be reduced in whole or in part if your injury was caused by or its consequences worsened
by your being grossly negligent, for example by the influence of alcohol, other intoxicants, narcotic preparations or
doping preparations or by the influence of medicines, which have not been used in medical purpose according to
doctor's prescription.
The insurance compensation can also be reduced in whole or in part if it must be assumed that you took an action or
failed to act knowing that the action or failure to act entailed a significant risk of the damage occurring.
Reduction of the insurance compensation according to the first and second paragraph is not made if you were
under 20 years of age or seriously mentally disturbed.
If the damage was caused by or worsened by your participating in or carrying out a criminal act, which according to
Swedish law can lead to imprisonment, the insurance compensation can be reduced in whole or in part if you were not
under 15 years of age or seriously mentally disturbed.
The restrictions do not apply to life insurance.
Stay abroad When staying

abroad, which is not affected by the restrictions in the event of war, the insurance applies as follows: The insurance
applies to care and treatment in Sweden.
If the need for care arose outside the Nordic region, the insurance only applies if the insured has temporarily stayed
outside the Nordic region for a maximum of 45 days from the departure date.
A stay outside the Nordic region is not considered interrupted by a temporary stay of no more than 45 days for
doctor's visits, hospital care, business, vacation or the like within the Nordic region.
War
The restrictions below apply in the event of war in Sweden or outside Sweden. War means a state of war, warlike
conditions, war-like unrest, civil war, revolution or insurrection.
War in Sweden If
Sweden is at war or in a situation that the government equates to war, Folksam's responsibility and right to collect war
premiums in accordance with what is stated in the act on insurance operations during war or war risk etc. applies
While there is war or within one year after the end of the war, compensation is not provided for insured events related
to the war. The limitations do not apply to death and disability.
War outside Sweden If,

despite the Ministry of Foreign Affairs' advice, you travel to an area outside Sweden where there is a war, compensation
will not be provided if the insurance case is caused by the war. If war breaks out during the stay in the council, however,
the insurance applies without special restrictions during the first three months.
Compensation is not provided for insured events that occur during participation in war. Also, for example, a military
surveillance mission under the auspices of the UN or another similar organization is counted as participating in war
during the time you are in the area to which the mission refers.
Damage caused by nuclear reaction or by biological/chemical/nuclear substance Compensation is not

provided for insurance cases whose origin or scope is directly or indirectly related to nuclear reaction.
Compensation is also not provided for insurance cases arising from biological, chemical or nuclear substances that
have been spread in connection with acts of terrorism.
Terrorist act means a harmful act which is punishable where it is committed or
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where the insured event occurs and which appears to have been carried out with the aim
of • seriously intimidating a population • improperly forcing public bodies or international
organizations to carry out or refrain from carrying out certain action or
• seriously destabilize or destroy the basic political, constitutional, economic or social structures of a country or of an
international organization.
Force majeure If an
investigation of an insurance case or payment of an insurance amount is delayed due to force majeure, i.e. an event
beyond Folksam's control, Folksam cannot be held responsible for the delay. This given that we have done what can
reasonably be requested to limit the damages that may occur.
Examples of such events that may constitute force majeure are changed legislation, official action, war,
war-like events, acts of terrorism, natural disaster, fire, strike, blockade, boycott, lockout or other similar circumstance.
Regarding strikes, blockades, boycotts and lockouts, the above applies even if it is Folksam that is the subject or takes
such conflict measures.
Folksam is also not responsible for damage caused by errors in the telephone network or other technical issues
equipment that does not belong to us.
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Special provisions
The insurance can provide compensation for medically justified care and treatment that has been prescribed by
us.
The insurance notice shows the extent of the insurance cover.
Under General provisions, Measures for payment , it is stated which measures and documents are required for us to
be able to examine the right to compensation. Compensation is provided according to the insurance conditions that
apply at the time of the insured event.
Qualification rule Unless

otherwise stated in the application documents, you are required to be fully able to work at the time the insurance
starts to apply to you. If you are not fully able to work and therefore do not meet the qualification rule, you can
apply for the insurance again if you are fully able to work again within 90 days from the date of entry/employment.
If more than 90 days have passed since entry or the day of employment when you apply for the insurance, you
must submit a health declaration. This also applies when the insurance cover is extended.
See the definition of fully capable under Explanations of important concepts.

Something else may have been agreed upon and is then stated in the application.
General about the insurance The

insurance applies to necessary and reasonable costs for care as a result of illness or accidental damage that occurs
during the insurance period. All care and treatment must be carried out in Sweden and approved by us in advance.
For illness or accidental injury that has started before the insurance is taken out, you must be symptom- and treatment-
free for at least two years in order for the insurance to apply to the renewed need for care. Use of medication,
prosthesis or similar aids is not considered a symptom- and treatment-free period. If the insurance has been granted
after an approved health declaration, the insurance applies without a requirement for a symptom- and treatment-free
period.
Illness or ailments with a medical connection are counted as one and the same insurance case.
If you have been symptom- and treatment-free for more than twelve consecutive months after you were last subject
to treatment within your healthcare insurance, a new insurance case is considered to have occurred.
See the definition of symptoms under Explanations of important terms.
Groups changing insurers may be subject to transitional rules. These have been announced at the time of the
transition. In the event of a takeover, Folksam's terms and conditions also apply.
Care advice and care planning If you need

medical advice, you can get help with it from our registered nurses weekdays from 8 am to 9 pm and weekends from
8 am to 5 pm. Appointments for caregivers can be made on weekdays from 8 a.m. to 5 p.m.
Care guarantee
The insurance provides a care guarantee. This means that in the event of a compensable insurance event, you are
guaranteed contact with a specialist within seven working days or time for surgery within 21 working days. If we do
not fulfill the care guarantee, we provide compensation of SEK 500 per weekday for up to 30 weekdays per insurance
case. The care guarantee only applies to the first visit to a care provider and only to care providers that we designate.
Compensation is paid: •
from the 8th weekday until the date of first contact with specialist competence • from the 22nd weekday until
the date of registration for surgery.
A prerequisite for us to issue a care guarantee is that we have received complete medical documentation and that
you have fulfilled your obligations.
If care or treatment must be postponed for medical reasons or if you do not accept the time offered for care or
treatment, the care guarantee does not apply.
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Health insurance Basic, Medium and Large

Base Between Big
Care advice X X X
Care planning X X X
Care guarantee X X X
Medical treatment X X X
Hospital care and surgery X X X
Psychologist and psychotherapist X X X
Travel and accommodation X X X
Aftercare and rehabilitation X X X
Aid X X X
Patient fees X X X
Health service X X X
Physiotherapist, naprapath and chiropractor X X
Dietician X X
Speech therapist X X
Medicine costs X X
Help at home after surgery X X
New medical assessment X
Deductible elimination for emergency care abroad X
Health examination X
Deductible
If the insurance was taken out with a deductible, this is shown in the group agreement and the insurance notice.
Referral
If the insurance was taken out with a referral, it is clear from the group agreement and the insurance notice.
Referral means that care and treatment in specialist care must have been preceded by a thorough examination
medical examination by a general practitioner or company doctor operating in Sweden.
Health insurance Bas

Medical treatment
Compensation is provided for costs in connection with examination, diagnosis and treatment carried out by doctors
appointed by us.
Hospital care and surgery

The insurance covers costs in connection with:
• hospital care
• preoperative examinations
• operations
Examination, surgery, care and treatment take place in a private hospital or another hospital
which from a treatment point of view is more appropriate. The right to surgery and hospital care begins when
medical examination is completed and the attending physician has issued a referral for surgery
or hospital care.
Psychologist and psychotherapist

The insurance covers the cost of up to ten treatments per insurance case at a psychologist
after referral from treating physician. The referral must not be older than six months. Other can
have been agreed and is then evident from the group agreement and the insurance notice.
Travel and accommodation
The insurance provides compensation for your necessary and reasonable travel and accommodation expenses i
Sweden that arises in connection with a compensable insurance event, if these are approved by
Folksam in advance. Compensation is provided for trips that exceed 100 km per one-way trip.
The insurance then provides compensation for the entire trip. The accommodation costs must be reasonable, however
a maximum of SEK 2,000 per night, and approved by Folksam in advance. The insurance can, if you have to
undergo a major operation, provide compensation for a close relative's travel and accommodation expenses.
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Aftercare - rehabilitation The

insurance covers necessary and reasonable costs for aftercare and medical
rehabilitation referred by a doctor in connection with reimbursable hospital care or surgery. Compensation
is provided for up to six months per insurance case.
If the aftercare or rehabilitation refers to treatment with an overnight stay, the insurance provides
compensation for up to 21 days for each insured event.
If the aftercare or rehabilitation concerns physiotherapy, the insurance provides compensation for up
to ten treatments per insurance case.
Aftercare and rehabilitation must have been preceded by a medical examination from your attending
physician. If possible, it must be located at the place of residence or as close to it as possible.
Reimbursement is only provided for costs approved in advance by us.
Aids The
insurance covers reasonable costs for necessary aids for the healing of the illness or accidental
injury. Compensation is provided for one (1) test and one (1) aid of the same type per insurance case.
The aid must be prescribed by the attending physician and is reimbursed with up to 0.5 price base amount
per insurance case.
Patient fees The

insurance provides compensation for patient fees within public care up to the limit of the high-cost
cover. If the insurance was taken out with a referral, patient fees incurred after receiving a referral to
specialist care are reimbursed.
Health service
The insurance includes an opportunity for health promotion measures via the web.
Health Insurance Between In addition to

what is included in Basic Health Insurance, the following elements are also included.
Physiotherapist, chiropractor and chiropractor

The insurance reimburses the cost of up to ten treatments per insurance case by a
physiotherapist, chiropractor or chiropractor, if the form of treatment used is medically justified
and referred by the attending physician. The referral must not be older than six months. Something
else may have been agreed and is then evident from the group agreement and the insurance statement.
Dietitian
The insurance covers the cost of up to five treatments per insurance case at an authorized
dietitian after referral from the attending physician.
Speech
therapist The insurance reimburses the cost of up to five treatments per insured case at a speech
therapist after referral from the attending physician.
Medicines
The insurance provides compensation for the co-payment up to the limit of the high-cost cover for
prescription drugs prescribed by a doctor in connection with a reimbursable insurance case.
Help at home after surgery The

insurance reimburses necessary and reasonable costs for help at home after your return home from
surgery that is reimbursed within the scope of the insurance, if the medical condition justifies such help.
Help in the home refers to help with, for example, chores or cleaning. The insurance provides
compensation for up to 20 hours per insured event during a continuous period of 14 days counted from
the day after your return home. The specified hours also include any travel costs. Folksam determines
what is to be considered reasonable costs in each individual case. Help in the home must be carried out
by a company that holds an F tax certificate.
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Large Health Insurance In addition

to what is included in Basic and Intermediate Health Insurance, the following elements are also included.
New medical assessment In

special cases, the insurance may give you the right to a new medical assessment carried out by
independent specialist doctors whom we have appointed. A new medical assessment means that, if you are
faced with difficult medical decisions in the case of a serious diagnosis or treatment, you may be entitled to
another assessment carried out by another specialist doctor in our healthcare provider network. You are entitled
to a new medical assessment once per insurance case.
Deductible elimination for emergency care abroad In the

event of an insured event that occurs during your temporary stay abroad, the insurance replaces the deductible
regarding compensation for the costs of care from another insurance (for example, home or travel insurance) up
to SEK 5,000.
Health examination The

insurance includes a health examination every two years. The first health examination can be used during the
second insurance year. If you do not undergo the health examination, no compensation or refund of the
premium paid will be provided. The examination applies without any deductible or referral requirement.
Limitations in the scope of the insurance

Liability period
The liability period is unlimited as long as the insurance is in force and the premium is paid. If the
insurance expires or is left unpaid, the liability period also ends.
When you have reached the end age of the insurance, the liability period is a maximum of twelve months for an
insurance case that occurred during the insurance period. The liability period is counted from the day the insured
event occurred.
What the Health Insurance does not apply to
Special illnesses and diagnoses The

insurance does not apply to the following items and their consequences: • Illness, or
accidental injury for which you had symptoms or received care or medication before the insurance began to
apply. However, if you have been symptom-free and treatment-free for at least two years for an existing illness
or accident, the insurance applies to the renewed need for care.
• Illnesses/diseases that were excluded when applying for the insurance, as well as their consequences •
Investigation and treatment of neuropsychiatric disorders (eg ADHD, autism). • Pain conditions in the back, joints
and muscles that lack objectively determined findings. Medical treatment
or examination required to establish that the exception is applicable is reimbursed, if the examination/cost is
approved in advance by us.
• Treatment, control, investigation or complications in connection with pregnancy, childbirth,
abortion, fertility or sexual dysfunction. • Such illness as is covered by the Infection Prevention
Act and its consequences. • The care guarantee does not apply if there is a pandemic, epidemic,
or in the event of a strike
care staff, as well as in the event of any consequences of these events that affect accessibility to care.
• Such deterioration of the state of health which, according to medical experience, is due to abuse i
various forms, for example abuse of alcohol, narcotics, drugs, gambling addiction or the like. • Eating disorders
and their consequences. • Correction of vision and refractive errors in the eye. • Control and treatment of
overweight, obesity, underweight. • Care or treatment of or as a result of dementia. • Treatment of psychotic
condition. • Investigation and treatment of snoring and sleep apnea (breathing pauses during sleep). • Examination
and treatment of varicose veins in the legs which are assessed as level 1, 2 or 3 according to the CEAP scale.
• Menopausal symptoms.
• Examination, dental treatment, dental diseases or dental damage, which is not a consequence of a
compensable insurance event
• jaw and bite physiology including booking regardless of the reason.
16
Certain care and certain treatments: •

Patient fee with a private healthcare provider not appointed by us. • Medical
care that is not available privately. If you are referred to public health care in contact with care planning, we are
responsible for any deductible according to the group agreement.
• Medical care or treatment when you are absent from the booked treatment time will be charged to you.
Cancellations must be made to our care consultancy no later than 24 hours before the booked treatment time.
• Medical certificate not requested by us. •
Illness or accidental injury as a result of you using alcohol, other intoxicants,
sleeping pills or narcotic preparations. •
Massage. • Health examination (can be included
every two years if the element has been subscribed. This is then shown in the insurance notice). • Preventive care
and treatment. • Emergency medical care. • Coronary angiography (coronary x-ray/PCI) and subsequent
treatments thereof. • Cosmetic treatments and operations or their consequences. Consequences of compensable
illness or accidental damage can in some cases be compensated if it is medically justified. • Organ transplants. •
Alternative forms of treatment that are not under the supervision of the National Board of Health and Welfare. •
Aids for constant use. • Folksam is not responsible towards the insured for the care or medical advice provided
through the insurance. This means that any claims due to care, medical advice, determination of diagnoses or
other measures taken by a care provider or partner must be made against the current care provider or partner.
Special risky activity (where the injury is directly related to the exercise):
The insurance does not apply to illness or accidental damage that occurred: • in the case of sports/
sports/training where your practice brings in an income or sponsorship
with more than 0.5 price base amount per year.
• in elite sports, i.e. sports at championship level (second highest division or higher or national sports high school) or
training for this.
• when you have participated in expedition or adventure activities under individual management or in a group or in
comparable practice.
• when you have participated in climbing on a mountain, ice, rock, glacier or comparable exercise. •
when you have participated in diving at depths greater than 30 meters, solo diving, ice, wreck or
cave diving. •
injuries incurred while practicing motor sports. • when practicing
boxing or other martial arts where punches, kicks or the like are included • as a direct or indirect cause of your use of
performance-enhancing agents including, but not limited to, anabolic steroids, stimulants and corticosteroids regardless
of whether these are prescribed by a competent doctor or not. Medicine prescribed by a doctor for a specific disease
is not covered by the exception.
17
Aftercare and Continuation Insurance
Group member/co-insured has the right to post-coverage or continuation insurance as follows:
Post-coverage
Group member/ co-insured who has been covered by insurance for at least six months has extended insurance
cover (post-coverage) for three months if the group member leaves the insured group.
For the co-insured, additional cover also applies when • the

marriage/partnership/cohabitation is dissolved • the group member dies.
The right to post-coverage does not apply if

• during the post-coverage period you received or can obviously receive insurance cover of the same type
as before • the
final age in the insurance policy has been
reached • the group member himself has chosen to cancel the insurance for himself and/or co-insured • the
insurance policy has been canceled because the group member did not pay the premium on time.
If an insured event occurs during the post-coverage period, compensation can be paid from the insurance.
See the definition of insurance cases under Explanations of important terms.
Continuation insurance Group member/

co-insured who has been covered by insurance for at least six months has the right to take out continuation insurance
if the group agreement is terminated by Folksam or by the group, or if the group member leaves the group entitled to
insurance.
The co-insured spouse/ registered partner/ cohabitant also has the right to take out continuation insurance • if
the group member dies • if the insurance is terminated because the group member did not pay the premium on
time • if the marriage or cohabitation relationship with the group member is dissolved or • if the group member
reaches the end age of the insurance before the co-insured
The right to take out continuation insurance does not apply: • if

the group member himself has chosen to cancel the insurance for himself and/or co-insured,
but remains in the insurable group
• in the event of a change in the content of the group insurance
• if the insured has reached the final age in the group insurance • if a new
group agreement is concluded on the same type of insurance for essentially the same group in
Folksam or in another insurance company
The application for continuation insurance must be made within three months from when the previous insurance
ceased to apply.
A prerequisite for continuation insurance to be granted is that the premium is paid for the entire period after the last
paid premium period.
Continuation insurance is taken out without a health examination.
The scope and terms of the continuation insurance may differ from what applies to the original insurance.
The insurance is valid for one year at a time.
The premium for continuation insurance is calculated according to a special tariff.
18
Insurance documents In
connection with taking out continuation insurance, you will receive insurance documents from Folksam.
Insurance notice provides information about the scope of the insurance. Invoice/premium notification
provides information about the current premium. You must check that you have valid insurance with the
correct insurance scope and pay the correct premium.
The insurance conditions

The insurance conditions also apply to continuation insurance where applicable. Under the General
section , however, the following regulations apply instead of what is stated there under General
regulations, When newly signed and changed insurance policies start to apply and When the insurance
ends.
When the insurance takes effect In

order for the continuation insurance to take effect, the rules on the right to take out continuation
insurance must be met. The application for continuation insurance must be sent to us.
Scope of the insurance The

scope of the continuation insurance at the time of taking out cannot be extended during the insurance
period.
When the insurance ends

Continuation insurance can be valid up to and including the calendar year in which you turn 65 or
reach the end age that applied to the original insurance.
The continuation insurance ceases to apply before then in the following cases:
• You cancel the insurance. • You do not pay the premium on time.
19
We want you to be satisfied
It is important that there is a well-functioning complaint handling system so that you, as a customer, can have
your interests met.
Good handling of complaints gives Folksam an opportunity to catch problems and take preventive measures.
You can find more information at folksam.se/klagomal
Contact us first at Folksam Misunderstandings or

disagreements can often be resolved in a simple way. Therefore, first contact the person who handled your
case. If you are still not satisfied, you can contact the administrator's immediate supervisor.
If the disagreement concerns the valuation of damaged property, you can request a statement from an
impartial valuer. You can read more about this in the insurance terms and conditions, which you can find at
folksam.se or at the nearest Folksam office.
Customer ombudsman Folksam If you

are a customer of Folksam, you have the opportunity to have your case reviewed by the customer ombudsman
Folksam, who is independent in relation to Folksam's organization. The customer ombudsman examines most
cases relating to insurance, claims issues and savings. If you are not satisfied with Folksam's final decision, the
Customer Ombudsman can make an impartial assessment of your case. After Folksam has given its final
decision, you have one year to make another complaint to the Customer Ombudsman, provided that the statute
of limitations has not started in accordance with what is stated below in the section "Don't wait too long".
Address: 106 60 Stockholm

Phone: 020-65 52 53 E-mail:
kundombudsmannen@folksam.se Web: folksam.se
Insurance committee If you

are covered by group insurance, it may be possible to have your case heard by an insurance committee. Contact
the Customer Ombudsman Folksam for information about this procedure.
Boards made up of parties If you have

insurance that is based on collective agreements between the parties in the labor market, you can often have
your case heard in a board made up of parties. For information on which party's composite committee applies
to you, contact Folksam's customer service or see Folksam's home page.
Industry-wide committees
In some cases, you can have your case tried in one of the following committees:
The Traffic Injury Board

The Traffic Injury Board is independent from the insurance companies and works for a uniform and fair
regulation of personal injury in road insurance. Certain compensation issues are mandatory and must always
be examined by the committee. Folksam will help you in connection with the mandatory test.
There are other matters where we are not obliged to obtain an opinion. In these matters, you can request a
review at the Traffic Accident Board via a special form available at the Traffic Accident Board.
Address: Box 24048, 104 50 Stockholm Web:

trafikskadenamnden.se
20
Ansvarsförsäkringens' Personal Injury Board

The Ansbarsförsäkringens' Personal Injury Board hears cases for people who have been injured and are
entitled to compensation for their injuries. It works much like the traffic injury board does for road traffic
victims. Certain compensation issues must always be referred to the committee for an opinion. State your
wishes to Folksam if you want the committee to express an opinion on issues where we are not obliged to
obtain an opinion.
Patientskadennämnden
The Patientskadennämnden is an advisory board to the insurance companies. At the request of the
patient, healthcare provider, insurance company or court, the board must give an opinion in claims related
to patient insurance.
Address: Box 24127, 104 51 Stockholm
The Personal Insurance Board

The Personal Insurance Board hears disputes between the insured (individual consumer) and the
insurance company in matters relating to life, health and accident insurance, in cases where medical
assessments are required.
The Board for Legal Protection

Issues The Board for Legal Protection Issues examines, at the request of the insured, the extent of legal
protection insurance, the question of compensation claims within legal protection insurance and traffic
insurance and the question of review of the suitability of an agent within legal protection insurance and
traffic insurance.
You can yourself request a review at the Personal Insurance Board and the Board for Legal Protection
Issues via a special form available at the Swedish Insurance Board.
Address: Box 24067, 104 50 Stockholm Tel:
08-522 787 20 Web: forsakringsnamnder.se
The report to the Board for Legal Protection Issues must be made no later than one year after you have
presented your complaint to Folksam.
The General Complaints Board (ARN)

ARN is a government authority that hears most disputes about insurance for private individuals free of
charge, but not disputes involving an amount lower than SEK 2,000 or medical assessments and, as a
rule, not cases involving mandatory group insurance. ARN also does not try insurance disputes
concerning insurance based on collective agreements between the labor market parties, if the agreement
prescribes a special dispute resolution procedure. This usually takes place through examination in a panel
composed of the parties. More exceptions exist and can be seen on ARN's website.
The report to ARN must be made no later than one year after you have presented your complaint to
Folksam. If more than a year has passed, you always have the opportunity to submit the report within two
months after the Folksam Customer Ombudsman has given the final notice.
Telephone: 08-508 860 00 E-mail:
arn@arn.se Web: arn.se
General court You

can have your dispute with Folksam tried by the district court. If you have legal protection insurance, it can
cover part of the legal costs.
Konsumenternas Försäkringsbyrå The

insurance agency provides free information and advice on insurance matters, but does not try individual
insurance disputes.
Phone: 0200-22 58 00 Web: konsumernas.se
21
Municipal consumer guidance You can

also get information and advice via your home municipality's consumer guidance.
Don't wait too long If you

wait too long to have your dispute heard, you may lose your right to compensation (prescription). If you
want to avoid the statute of limitations, you must bring an action at the district court within ten years from
the damage event/the time when the condition occurred/occurred which, according to the insurance
contract, entitles you to insurance compensation or other insurance coverage. If that time occurred before
January 1, 2015, you must generally bring an action within three years from the time you became aware
that the claim could be asserted. If an insurance contract entitles to compensation for different
compensation items or different damages at different times, parts of the claim may be time-barred
according to older regulations and other parts according to new regulations.
If you as a private person have reported your damage or your claim before the expiry of the limitation
period, you always have at least six months to file a claim from the time you received the final notification
from Folksam or the Folksam Customer Ombudsman.
22
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Valid from 1 January 2022

C ontact with F olksam

Insurance conditions Medical insurance................................................ .........................4

Explanations of important terms................................................... ........................................ 6

General provisions................................................ ................................................ ..8 Group

Special provisions................................................ ................................................... 13

Aftercare and Continuation insurance................................................ ........................ 18

We want you to be satisfied............................................. ................................................ .20

Insurance conditions Health insurance

Insurer The insurer for Health

Who can take out the insurance?

Protection of personal data We protect

Claim registration We use

Tax rules The

Explanations of important concepts

Incapacity for work

Fully able to work

Not fully functional

person whose life or health the insurance applies to.

Eligible group for insurance A specific

Insurance notice Provides

Insurance event The

Time of the insurance case: • In the

Insurance period The

Qualification rules Special

Medically motivated Care and

Registered partners Registered

Insurance statement and invoice/premium notification The insurance

Invoice/premium notification provides information about the current premium.

When newly signed and amended insurance begins to apply,

If incorrect information is provided to Folksam Incorrect or

Right of cancellation for voluntarily signed insurance

The termination date is the day on which we sent notice of termination.

When the insurance ceases to apply,

Measures for the payment of compensation

When requesting compensation from Health Insurance , the following applies: •

Limitations on the validity of the insurance

The restrictions do not apply to life insurance.

Stay abroad When staying

War outside Sweden If,

Damage caused by nuclear reaction or by biological/chemical/nuclear substance Compensation is not

Terrorist act means a harmful act which is punishable where it is committed or

The insurance notice shows the extent of the insurance cover.

Qualification rule Unless

See the definition of fully capable under Explanations of important concepts.

General about the insurance The

See the definition of symptoms under Explanations of important terms.

Care advice and care planning If you need

Health insurance Basic, Medium and Large

Hospital care and surgery X X X

Psychologist and psychotherapist X X X

Travel and accommodation X X X

Aftercare and rehabilitation X X X

Physiotherapist, naprapath and chiropractor X X

Help at home after surgery X X

New medical assessment X

Deductible elimination for emergency care abroad X

Health insurance Bas

Hospital care and surgery

Psychologist and psychotherapist

Travel and accommodation