- Claim Request Form Л3-53
- Outpatient card with all particulars filled in and indicated illness onset – a copy
- Doctor’s Prescription - a copy
- A detailed invoice, issued in the Insuree’s name (reflecting the type and price of medicinal products/optical goods) and a fiscal receipt, attached to it – an original
- An official document, containing the Insuree’s bank account, if it has not been indicated in Form ЛЗ 53 – a copy
- Upon individual insurance:
- Insurance policy
- Upon group insurance at the Employer’s expense:
- Company Certificate from the Employer that the person is insured - an original
- Upon group insurance at the Insurees’ expense:
- A copy of the insurance policy and the list of Insurees’ names.
In case the sums will not be received by the eligible person:
Notarized power of attorney from the entitled person, if the sums will be received by another person. The power of attorney must contain a statement (text) that the eligible person has been notified that he is entitled to receive the sums in person.