Ekuz Wniosek Wypełnienia – Wzór



Ekuz Wniosek Wypełnienia
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Ekuz Wypełnienia
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Wzór Ekuz Wniosek Wypełnienia

Dane podmiotu ubiegającego się o ubezpieczenie zdrowotne w Polsce na podstawie unijnego wzoru Ekuz

Dane osoby ubiegającej się o ubezpieczenie zdrowotne:

  1. Imię: (wpisz imię)
  2. Nazwisko: (wpisz nazwisko)
  3. Data urodzenia: (wpisz datę urodzenia)
  4. Numer dowodu osobistego: (wpisz numer dowodu osobistego)
  5. Adres zamieszkania: (wpisz adres zamieszkania)
  6. Numer telefonu: (wpisz numer telefonu)
  7. Adres email: (wpisz adres email)

Dane osoby kontaktowej:

  1. Imię: (wpisz imię osoby kontaktowej)
  2. Nazwisko: (wpisz nazwisko osoby kontaktowej)
  3. Numer telefonu: (wpisz numer telefonu osoby kontaktowej)

Informacje dotyczące wyboru publicznego lub prywatnego systemu opieki zdrowotnej w Polsce:

  • Wyboru systemu opieki zdrowotnej: (wybierz publiczny/prywatny)
  • Adres publicznej/prywatnej placówki medycznej: (wpisz adres placówki medycznej)

Informacje dotyczące ubezpieczenia zdrowotnego za granicą:

  • Kraj, w którym obecnie jesteś ubezpieczony/a: (wpisz kraj)
  • Numer ubezpieczenia zdrowotnego w obecnym kraju: (wpisz numer ubezpieczenia)
  • Termin ważności ubezpieczenia zdrowotnego w obecnym kraju: (wpisz termin ważności)

Informacje dodatkowe:

  • Czy posiadasz Kartę Pobytu w Polsce? (tak/nie)
  • Czy posiadasz Kartę Polaka? (tak/nie)
  • Czy posiadasz Kartę Stałego Pobytu w Polsce? (tak/nie)

Dodatkowe uwagi:

(wpisz dodatkowe uwagi, jeśli występują)

Deklaruję, że wszystkie powyższe informacje są prawdziwe i zgodne z moją wiedzą. Oświadczam również, że zapoznałem się z warunkami ubezpieczenia zdrowotnego w Polsce i akceptuję je.



Jak napisać Ekuz Wniosek Wypełnienia



1. What is Ekuz?
Ekuz stands for European Health Insurance Card, which is a document that provides access to healthcare services when traveling within the European Union.
2. Who can apply for Ekuz?
Any resident of the European Union who is insured under a national health insurance scheme can apply for Ekuz.
3. How do I apply for Ekuz?
To apply for Ekuz, you need to fill out the Ekuz application form, which can be obtained from your national health insurance institution. Complete the form with accurate information and submit it to the relevant authorities.
4. Where can I use the Ekuz card?
The Ekuz card can be used in all European Union countries, as well as in Iceland, Liechtenstein, Norway, and Switzerland. It provides access to necessary healthcare services during your temporary stay in these countries.
5. Is Ekuz free of charge?
Yes, the Ekuz card is free of charge. However, it is important to note that it does not cover the cost of private healthcare services or any additional expenses such as repatriation or preventive treatments.
6. How long is Ekuz valid for?
Ekuz is usually valid for five years from the date of issue. However, it is recommended to check the expiration date on your card and ensure its renewal before it expires.
7. Can Ekuz be used for planned medical treatment abroad?
Yes, Ekuz can be used for planned medical treatment abroad. However, it is necessary to get prior authorization from your national health insurance institution and follow the required procedures.
8. What do I do if I lose my Ekuz card?
If you lose your Ekuz card, you should immediately inform your national health insurance institution. They will provide you with the necessary instructions for obtaining a replacement card.
9. Can I use Ekuz for dental treatment?
Yes, Ekuz covers necessary dental treatment. However, it is important to note that it may not cover cosmetic dental procedures or treatments that are not deemed medically necessary.
10. Can Ekuz be used for maternity care?
Yes, Ekuz can be used for maternity care. It covers necessary healthcare services related to pregnancy and childbirth. However, it is advisable to check with your national health insurance institution for specific guidelines and requirements.
11. Can I use Ekuz if I have a pre-existing medical condition?
Yes, Ekuz covers necessary healthcare services for pre-existing medical conditions. However, it is important to provide accurate information about your condition when applying for the card.
12. Can Ekuz be used for emergency medical treatments?
Yes, Ekuz covers emergency medical treatments. In case of an emergency, you can seek necessary healthcare services in any European Union country or the designated countries mentioned earlier.
13. Can I use Ekuz if I am a student studying abroad?
Yes, Ekuz can be used if you are a student studying abroad. It provides necessary healthcare coverage during your stay in the host country. However, it is important to check the specific guidelines and requirements set by your national health insurance institution.
14. Can Ekuz be used for travel outside of Europe?
No, Ekuz only provides coverage within the European Union, Iceland, Liechtenstein, Norway, and Switzerland. If you are traveling outside of these regions, you should consider obtaining additional travel insurance.
15. What should I do if my Ekuz application is rejected?
If your Ekuz application is rejected, you should contact your national health insurance institution to understand the reasons for the rejection. They will provide you with further guidance on how to proceed.
  Wniosek Pkk Wypełnienia - Wzór

In conclusion, the Ekuz card is an essential document for residents of the European Union who wish to access necessary healthcare services during their temporary stay in other European countries. It is important to apply for the card accurately and follow the guidelines provided by your national health insurance institution.



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