​​ Frequently Asked Questions

On the central right side of your insurance certificate, you will find a QR code of the Insurance Plan. Scanning it will redirect you to a webpage with detailed descriptions of all available plans. On the central left side, your insurance package (columns) and coverage (rows) are indicated. To understand your coverage, match your package and coverage types with their respective limits, waiting periods and eligibility criteria.

Before any compensation is approved, your physician identifies with section and item of your insurance policy applies to your claim. Based on this, they determine: ·         Whether the event is eligible for compensation ·         If it is excluded from the policy ·         If any waiting periods apply

A claim limit is the maximum refundable amount EFES will pay for a specific service during the policy term.

Any illness or condition that was diagnosed or objectively originated before the insurance policy took effect is considered a pre-existing condition and is not covered. Example: If a patient visits a urologist in the 4th month of the coverage and is diagnosed with a 0.6 cm kidney stone, the treatment (e.g. lithotripsy) is not eligible, even if the patient was unaware. The condition existed months or even years prior to actual diagnosis and contract initiation.

Any condition that arises or is diagnosed during the waiting period is treated similarly to a pre-existing condition and is not eligible for compensation. Example: After purchasing a policy, a person experiences chest pain and shortness of breath, then undergoes angiography and is diagnosed with 70% coronary artery stenosis requiring stenting. Since symptoms and diagnosis occurred within the waiting period, no compensation is granted, regardless of the insured person’s awareness.

Emergency medical care refers to immediate medical intervention required to prevent death or severe disability. Services rendered under such circumstances are considered part of emergency care.

If a condition requires surgery that can be delayed without immediate health deterioration, it is classified as an elective procedure. These surgeries typically lead to complete recovery or improvement of a non-urgent condition. Examples include: ·         Vein removal for varicose veins ·         Gallbladder removal for gallstones ·         Uterus removal for fibroids The surgery aims to treat or improve a chronic or non-acute condition.

Some preventive check-up services are more frequently available to those with a direct family history of the condition in question. This refers to a parent who has been diagnosed with the same illness.

If you are a tax-paying resident of Armenia and file an annual income tax declaration, you can receive partial refund for your non-cash (card or bank transfer) expenses related to healthcare: doctor visits, treatments, medications or education: tuition, educational supplies. You must keep invoices and payment confirmations and include them in your tax return to claim this refund.

Armenian residents, who filled or must file an annual income tax return in 2025 for the year 2024 and are income taxpayers are eligible for the program. This benefit may be applied to expenses not only for yourself but also for your family members (spouse, parent or child).

Eligible expenses include those related to: ·         Health insurance premiums purchased from a licensed Armenian insurer ·         Dental services rendered by licensed clinics All payments must be made via non-cash methods.

No. Expenses for medical examination, surgeries or similar services do not qualify for social credit refund. Only the following are eligible: ·         Purchase of a health insurance package ·         Dental services during the declaration year

Just follow these 2 simple steps: ·         Step 1: Obtain an invoice from the insurance company ·         Step 2: File your income tax declaration, including the social expenses in the relevant section

An invoice is an official document proving that you made payment for a service or a product

Step 1: Go to the electronic services portal for individuals: self-portal.taxservice.am:(http://self-portal.taxservice.am) (https://self-portal.taxservice.am/sign-in/)or use the Self Portal app (available on IOS and Android). From the homepage, select Tax Refunds, then under Social Expenses you will see your eligible refund amount. Step 2: Return to the homepage and go to Declarations Choose Applications for Refund from Unified Account Step 3. In the opened window, fill in your bank account number and the amount you want refunded. The bank name will auto-fill after entering the account number. Click Submit Step 4. After submission, a new screen appears. Click Pay/Refund to confirm your request. Step 5. The application will now appear under Completed Declarations. Click Sign choose your signature method and electronically sign the form. Finally, click Submit to SRC Done։ The refund will be transferred to your specific bank account within 3 working days.

You can get up to 50,000 AMD annually for healthcare and a maximum of 100,000 AMD annually per taxpayer, including both education and healthcare expenses. Example: You paid 120,000 AMD for tuition and 30,0000 for healthcare. You will be refunded only 100,000 AMD total, due to the set cap.

To terminate your EFES insurance policy, you may submit a termination request via: -         In-person meeting at the EFES office -         Email, sent from the address listed on your insurance policy Once your request is received, your contract will be terminated after 15 days. Note: Premiums already paid are non-refundable, even after cancellation.

The insurance contract is terminated early in the following cases: • In the event of the death of the insurer or the insured person. • If the insurer fulfills its obligations by paying the full amount of the insurance benefit. • If either party withdraws from the contract at any time, provided that the withdrawing party notifies the other party at least 15 days in advance. • If the insurer disagrees with the insurer’s proposal to amend the contract and/or pay an additional premium. • In the event of non-payment of the insurance premium by the insurer within the specified timeframes. • If either party commits a substantial breach of the contract. • In other cases as stipulated by the laws of the Republic of Armenia, regulations, or the contract.

According to the relevant application, the Policyholder/insured person has the right to receive a copy of the Agreement in case of loss, damage or destruction of the original.