Voluntary health insurance (VHI)– This is a form of personal or self-insurance. It allows you to use medical services in specialized medical institutions, private clinics, or in state and semi-state clinics that provide services on a paid basis (depending on the package of services chosen).

In this case, the object of insurance is not the patient’s health, but the costs of his treatment. Therefore, VHI makes it possible to partially or fully reimburse expenses for medical care. What a VHI policy is will be discussed in our article.

Main types

VHI has two forms depending on the number of insured persons:

1. Private or individual voluntary health insurance. Issued by an individual for himself and/or for each individual member of his family. This VHI policy provides a wider range of services provided, including accident insurance.
   • Additional private voluntary health insurance (partially covers the costs of those services that are included in the compulsory health insurance program).
   • Independent private voluntary health insurance (fully covers the costs of services provided by compulsory health insurance).
2. Collective or corporate voluntary health insurance. Insurance for legal entities. Issued by the employer for its employees.

Who has the right to issue

Any individual or legal entity with legal capacity has the right to receive a VHI policy. Citizens of the Russian Federation or foreign citizens, and stateless persons can act as insured persons.

Insurers are both individual capable persons and organizations representing their interests.

Who can be refused

Refusal to obtain a VHI policy may apply to persons declared incompetent. As well as persons suffering from diseases for whose treatment funds are used from the state budget - sarcoidosis, tuberculosis, mental and venereal diseases, especially dangerous infections (typhoid, plague, anthrax, smallpox, etc.), requiring quarantine measures and cancer patients (with moment of diagnosis).

Pros and cons

For a private person:

1. The insured person receives freedom of choice, i.e. the ability to independently choose a clinic, specialist and services offered.
2. The holder of a VHI policy saves his time by receiving high-class medical services without standing in queues.
3. Having a paid voluntary health insurance policy for the entire period insures against increases in tariffs for the services of medical institutions.
4. The insurance company independently settles claims that the patient has against the medical institution during the insurance period.
5. Possibility of making appointments with doctors on-line.
6. The disadvantage of this type of health insurance for some individuals may be the high price.

For the employer:

1. This form of insurance increases the loyalty of employees to their company and the head of the company.
2. Staff motivation.
3. It becomes possible to clearly account for the costs of medical care.
4. Possibility to independently include certain services in the policy.
5. Possibility of early closure of the policy in case of employee dismissal.
6. A company that provides free voluntary health insurance policies to employees has a competitive advantage.
7. Reducing the tax base.
8. The disadvantages of purchasing this type of insurance are the need for scrupulousness when concluding contracts, the additional amount of work for accounting and the high price.

Standard package program

Outpatient treatment

Issues of diagnosis and treatment are dealt with by a specific specialist who operates within the scope of services:

• Electroencephalography.
• Diagnosis of blood circulation using the RVG method.
• Electrocardiography, including VEM and ECG recording over a long period of time.
• X-ray, including tomography.
• Endoscopic studies.
• Laboratory research (analysis).

Treatment, consultation and diagnostic appointments with doctors

The program includes assistance in the main specialties: cardiology, internal medicine, pulmonology (except for tuberculosis and cancer patients), pediatrics, neurology, urology, proctology, gastroenterology, rheumatology, surgery, endocrinology, obstetrics and gynecology, orthopedics, otolaryngology.

Providing emergency (ambulance) medical care

Emergency assistance is guaranteed to be provided by the insurer 24 hours a day. The need to provide this service arises in life-threatening situations.

Emergency services include:

• departure of the brigade to the place of call;
• medical examination and assistance;
• accelerated laboratory examination (if necessary);
• emergency provision of necessary medical procedures;
• transporting the patient to the hospital.

Hospitalization (emergency and planned)

The need for hospitalization is determined by the attending physician. The specialist may be a representative of the clinic where the patient is being treated, or an ambulance worker. A doctor can also be provided by the insurer.

The attending physician also determines the necessary therapeutic and diagnostic procedures within the following list of services.

Laboratory tests performed for diagnostic purposes:

• clinical;
• bacteriological;
• immunological;
• hormonal;
• biochemical;
• serological.

Other diagnostic tests:

• radioisotope diagnostic methods;
• radiography;
• computed tomography scan;
• fluoroscopy (including surgical);
• functional diagnostics (including ultrasound).

If the insured person was hospitalized in an institution that is not covered by the contract, he can be redirected to a hospital that has an agreement with the insurer.

This operation is carried out taking into account the wishes and general condition of the patient. In this case, all costs associated with transporting the patient are paid by the insurer.

Sanatorium-resort or rehabilitation treatment

The program comes into force if the patient has suffered a disease included in the list of insured events. This type of treatment is carried out in sanatoriums, hydropathic clinics, physical education clinics, rehabilitation treatment clinics, and rehabilitation centers.

Medical services provided:

• physiotherapeutic treatment (laser treatment, ultrasound, magnetic fields, EHF, electrotherapy, electrosleep, treatment in a pressure chamber, etc.);
• herbal treatment (herbal medicine);
• hirudotherapy;
• massage;
• balneotherapy;
• therapeutic swimming;
• thalassotherapy;
• mud therapy;
• homeopathic treatment;
• manual therapy;
• postzymometric relaxation (PIR);
• diet therapy and starvation treatment.

Family (personal) attending physician

Therapeutic and outpatient care under the basic VHI program can be provided at home or in a clinic. These services are assigned to the (personal) attending physician of the therapy department.

• monitoring and treatment by a personal physician in the event of exacerbation of chronic and the appearance of acute diseases in an outpatient setting;
• therapeutic and diagnostic procedures carried out by a personal doctor at home with the involvement of specialists for consultation (if necessary);
• diagnosis and treatment as prescribed by your personal physician;
• physiotherapy, exercise therapy, massage;
• receiving help from other specialists as directed by the family (personal) attending physician;
• maintaining hospital documentation (history, sick leave certificates, certificates, extracts);
• hospitalization when indicated with the patronage of a family doctor during the patient’s stay in the hospital.

Dentistry

An insurance contract may provide for the provision of dental care. Institutions for the provision of these services are also provided for by the agreement:

• diagnostics, outpatient dental services (consultations, x-rays, etc.);
• therapeutic and surgical procedures;
• orthodontic and periodontal dentistry;
• implementation of the prosthetic procedure (including preparation);
• other services provided according to medical indications.

Each insurance company works with different VHI programs.

Therefore, the list of provided guarantees may vary. But in any case, health insurance can be basic or additional. The main one covers the costs of providing medical care according to indications necessary for life. Additional covers the costs of services accompanying the main treatment: prosthetics, dental care, etc.

What is not an insured event

The services provided are limited to the scope of the voluntary health insurance agreement. Insured events and exclusions from them must be clearly stated in the contract or policy.

The following situations are not covered by the insurance contract:

• illnesses and injuries resulting from alcohol or drug intoxication, the use of toxic drugs and other psychoactive substances;
• injuries and pathological conditions that occurred due to the insured committing illegal actions;
• intentional self-infliction of injury and mutilation by the insured person, suicide attempts.

Also, the patient’s treatment of injuries received in the following circumstances is not an insured event:

• radioactive contamination, exposure to radiation as a result of a nuclear explosion;
• injuries and illnesses received during military operations, military maneuvers and other military events;
• injuries, injuries, illnesses received during the Civil War, civil unrest, strikes;
• injuries, loss of health during hurricanes, storms and other natural disasters.

Validity period

A voluntary health insurance contract is concluded for any period, but not less than 1 month. But according to established tradition, insurance companies enter into contracts for a period of 1 year. Payment for health insurance is made in a lump sum. During the insurance period, the list of services cannot be changed.

Differences between VHI and compulsory medical insurance

Voluntary health insurance- type of personal insurance. In particular, it allows you to receive assistance in medical and preventive institutions (HCIs) that do not operate under the compulsory medical insurance program.

Compulsory health insurance (CHI)- a type of compulsory social insurance, which is a system of legal, economic and organizational measures created by the state aimed at ensuring, in the event of an insured event, guarantees of free medical care to the insured person at the expense of compulsory health insurance funds within the territorial compulsory health insurance program and in cases established by Federal Law, within the framework of the basic compulsory health insurance program.

Main differences:

• VHI is a personal choice of the patient, while compulsory medical insurance is mandatory for the population.
• The conditions of VHI are determined by insurance companies; in the case of compulsory medical insurance, they are determined by the state.
• A VHI policy provides a wider list of medical services provided than a compulsory medical insurance policy.
• VHI gives the opportunity to independently choose a clinic, while patients with compulsory medical insurance receive medical care in institutions attached to their place of residence.
• VHI allows you to independently choose insurance programs; compulsory medical insurance programs are determined by the state.

How is the contract drawn up?

Typically, the parties signing this contract are the policyholder (business) and the insurer (insurance company).

It states:

• insurance amount - money that the insurer pays to the policyholder when an insured event occurs;
• insurance premium – expenses borne by the policyholder to the insurer;
• insured persons (employees), insured events and risks - with a comprehensive listing of all conditions for the provision of assistance, up to restrictions on the age of the employee;
• the start date of the contract (either from the day of signing or from a certain date).

In addition to those mentioned earlier, there are the following features of tax accounting for expenses for medical insurance of employees (Article 272 of the Tax Code of the Russian Federation):

• the insurance premium is taken into account in the reporting period for which it was made;
• if the agreement states that the contribution is made at a time, then if the agreement lasts longer than one reporting period, the costs are distributed evenly.

Insurance premiums under the VHI system do not participate in the formation of personal income tax. This also applies to cases where medical care is provided to family members of the insured.

Also, expenses for voluntary health insurance contracts for a period of more than 1 year are not subject to contributions to OSS (compulsory social insurance).

Policy cost

Prices vary depending on the range of services, quality of service and purpose. The simplest and most inexpensive types of VHI provide care in a good clinic, but do not include complex diagnostic methods, such as tomography.

If you wish, you can only receive a package for providing emergency medical care only, for example, for injuries resulting from an accident. Estimated cost 8000 rubles.

Advanced Programs will cost more, they include doctor services (including tests) at home and in the clinic, inpatient, emergency and dental care. The full VHI program also applies to persons staying abroad. Approximate cost 12000 rubles.

The most expensive types of VHI provide treatment in foreign medical clinics. The annual fee for concluding a contract under this program is calculated thousands of dollars.

So, purchasing a Voluntary Health Insurance policy is a profitable alternative to receiving medical services under the Compulsory Health Insurance program.

The insurance procedure applies to both one person and the whole family. This type of insurance includes a wider range of high-quality services. When choosing this type of insurance, an important point is the choice of the insurance company. Pay attention to its rating, reputation, customer reviews.

– life and health insurance between a citizen and the insurance service on a voluntary basis. As a rule, insurance includes one or more insurance programs.

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Objects of insurance are:

• Monetary and other expenses for health restoration, rehabilitation, sanatorium and resort treatment.
• Income that was lost during a person's illness for the entire period of illness. If you become disabled, your income is also reimbursed. The legislation of the Russian Federation limited only payments for medical expenses and no more.

The subjects of insurance are:

• Individual citizens who decide to voluntarily insure their health.
• Enterprises whose competence includes representing the interests of their employees.

The insurers are:

• Firms on a legal basis that have the right to engage in medical activities (insurance).

Insurance cases

Events that occurred during the validity of the insurance contract.

From this moment on, an insured event occurs, which seeks compensation for monetary costs incurred for treatment or rehabilitation.

Compensation is possible only if the event occurred was stipulated in the contract.

Opportunity for a person to go to a medical facility. The insured person can come to any medical institution that is specified in the contract.

Types of medical care of the Insured person

Outpatient care:

• Reception by specialists in hospitals, clinics, medical laboratories, at the appointed time, if possible without a queue.
• Increased volume of medical diagnostics (MRI, CT, radiation diagnostics), study of immune systems, laboratory tests (general and biochemical blood tests, virological, venereological, etc.).
• Prevention of diseases through preliminary, systematic medical examinations.

Inpatient care:

• Assistance in hospitals is provided only if there are indications for hospitalization. This procedure is carried out by a general practitioner or an expert doctor from an insurance company.
• Consultation with a specialist doctor.
• Carrying out medical diagnostics.
• Physiotherapeutic and surgical care.
• Drug treatment.

Medical rehabilitation and spa treatment:

• The need for rehabilitation is determined by a medical expert based on an extract from the medical record.
• The insured person is provided with rehabilitation treatment after an illness.
• The stay and medical assistance in rehabilitation are paid.
• Therapeutic exercise, swimming, massage, herbal medicine, hippotherapy, dolphin therapy, etc.
• Treatment with natural resources (water procedures, mud baths, climatotherapy).

Dental care:

Dental treatment in dental organizations or from a private dentist with a guarantee for all types of work.

Emergency assistance:

Providing emergency medical care.

Each insurance company has its own list of types of medical care. The article provides only traditional types of insurance.

In what cases is assistance provided by medical workers?

• acute course of the disease;
• exacerbation of a chronic disease;
• injuries;
• poisoning;
• emergency assistance;
• management and control of pregnancy;
• assistance during childbirth, etc.

Health insurance contract

Position 1. The contract is concluded for any period, but not less than 1 month. As a rule, the average insurance period is 12 months.

Position 2. The agreement is concluded only with a legal entity in writing.

Position 3. If a collective agreement is concluded, the number of insured persons is not limited.

Position 4. The agreement between the Insurer and the Insured is drawn up according to the type of contract that has legal force.

Position 5. The contract must specify the insured person, the event that entails the insurance payment, the amount of payment and the duration of the contract.

Before concluding a contract, the insurance company may require a medical examination at the insurance company's expense in order to assess the actual condition of the person.

What is not an insured event under VHI

1. Cases if they are not included in the list of events specified by the insurance program.
2. Cases involving injuries due to the use of alcohol, drugs, toxic substances, drugs that affect the psyche of the insured person.
3. Receiving injuries as a result of illegal actions.
4. Intentional infliction of harm to health by third parties, including incitement to suicide. An exception is if the insured person was brought to such a state by illegal acts.
5. Monetary compensation is not paid when:
   • the person suffered harm to health in cases of radiation exposure;
   • the person was injured during hostilities;
   • the person was harmed during an emergency.

VHI program

PDMS- this is a list of services provided by the insurer, which indicates the amount of payment in the event of an insured event, as well as a list of treatment points and types of assistance provided.

The program provides:

• undergoing treatment in inpatient clinics and hospitals;
• services provided by a dentist;
• provision of first aid;
• treatment with medications.

Types of attachment to insured medical institutions

1. Fixed attachment. With such an attachment, the patient can only go to one medical clinic, which is specified in the contract.
2. Network attachment. Under this condition, the patient can choose in which medical institution he can undergo treatment, limited only by the list of institutions specified in the insurance contract.

How can an insured person get to a medical facility?

1. Direct access. The insured person can come to the clinic himself and make an appointment with a doctor through the reception desk.
2. Access through an intermediary. The insured can make an appointment with a doctor through the attending physician or a 24-hour remote control .

Insurance rules

• A person from 0 to 90 years old can be insured. Insurance firms may limit the issuance of policies to individuals if they have reached the age of 65.
• It is impossible to insure people if they have mental disabilities. Patients with AIDS, disabled people of the first and second groups, who use drugs, will also be turned away. If a person hides this data, the contract is considered invalid .
• The policyholder has no right to disclose health data to third parties.

What is the difference between VHI and compulsory medical insurance?

Compulsory medical insurance (compulsory health insurance) – receiving free medical care with state support. In this case:

• the MS program is the same for everyone, it may depend only on the region;
• insufficient funding of compulsory medical insurance, which leads to the fact that patients themselves must pay for part of the services provided, which leads to poor service.

In this case, VHI:

• provides an individual approach to each insured person, depending on the wishes;
• it is possible to receive medical services at a high level;
• provides high service and the possibility of examination with the latest technology;
• The insurance group controls the entire process of medical care and provides full legal protection.

What is the difference between servicing a healthcare facility through an insurance company and working with a healthcare facility directly?

Service in health care facilities through an insurance company includes:

• servicing the insured person in various medical institutions provided for by the contract;
• in health care facilities, direct service is limited to only one medical institution;
• providing home visiting services on holidays and weekends;
• in cooperation with health care facilities, direct home visits are possible only during the institution’s working hours;
• medical services are limited only to medical indications;
• in healthcare facilities directly, medical services are limited to the services provided by one healthcare facility;

VHI tax benefits

Benefits for legal entities

• Income tax. Contributions from policyholders under voluntary insurance contracts are included in labor costs provided:
  • if the employer indicated in the contract of contract that services are provided at his expense;
  • the contract is concluded with a company that has permission to provide health insurance;
  • the contract was drawn up directly with the employee;
  • concluding a contract for a period of 1 year;
  • contributions for annuity payments do not exceed 6% of the salary.
• Insurance premiums. Contributions to the Pension Fund, Social Insurance Fund and other funds, amounts of insurance payments are not subject to insurance premiums, provided:
  • the VHI agreement is concluded for at least 1 year;
  • The VHI agreement pays financial expenses to the insured persons. VAT:
  • According to the Tax Code of the Russian Federation, Article 149, monthly contributions throughout the entire insurance period are not subject to taxation.

Benefits for individuals:

1. Personal income tax:
   • insurance premiums are not subject to personal income tax if the employer pays daily contributions;
   • Insurance payments are also not subject to taxation.

1. Tax deductions:
   • the taxpayer has the right to receive tax deductions;
   • Tax deductions can be obtained provided that monthly payments were made at the expense of the insured person and not the employer.

How to choose an insurance company

In order to choose the right insurance company for you, you must:

1. Carefully study all the organization's insurance rules.
2. Check the availability of a permit or license to carry out business activities.
3. Pay attention to negative reviews and find out the reason why the insured person was not satisfied with this organization.
4. Study a standard contract for the provision of medical services.

Everything is learned by comparison. You should not focus your attention on any one insurance company; it is better to analyze several, and only then choose the right one.

Validity period of the VHI policy

A voluntary health insurance policy can be issued for a period from one month to the period specified in the contract, usually up to one year.

Types of VHI policies

1. Collective. A group of people is being created to receive VHI. This type of pole is more common among insurance companies.
2. Monopoly. The insured person first buys a VHI policy, and then receives the right to treatment.
3. VHI policy against accident. Receipt of such a policy guarantees only the provision of medical care, and not the payment of funds.
4. Long term policy. It is quite difficult to obtain such a policy, since before obtaining it a person undergoes a thorough medical examination.

Registration of a VHI policy by foreign citizens

Registration of a voluntary health insurance policy is possible not only for citizens of the Russian Federation, but also for visitors from abroad. Providing a policy is possible only if the foreign citizen has a temporary residence permit.

How to get a VHI policy

In order to become an owner you must:

1. Come to the insurance company in person.
2. Write an application for a VHI policy.
3. One of the conditions for obtaining a policy may be passing a medical examination, on the basis of which a decision will be made to issue the policy.

What affects the price of a VHI policy?

1. The gender and age of the applicant, prices for children and adults are different.
2. The client's health status, the presence of chronic diseases, concomitant diseases, predisposition to diseases, heredity - all this can significantly affect the price of the policy.
3. Client's field of activity. Depending on whether there is a risk to a person’s health at his work, the cost of the policy will depend. The greater the risks, the more expensive the cost of the policy.
4. The more services the insurance company provides to the insured person, the higher the cost of the policy will be.
5. The more medical clinics an insurance company provides for health improvement, the more expensive the policy will be.

VHI is used by only 2% of the Russian population, and then in most cases when traveling abroad.

Voluntary health insurance (VHI) is a form of social protection of the population's interests in health care, expressed in the guarantee of payment for medical care in the event of an insured event at the expense of funds accumulated by the insurer.

The purpose of VHI is to guarantee to insured persons in case of illnesses or damage to health the provision of medical care and services that are not included in the compulsory medical insurance program, but provided for by VHI programs. At the same time, the insurer guarantees full or partial compensation for expenses that an individual is forced to bear when visiting medical institutions. However, competition among insurers encourages them to develop VHI programs with a wider range of medical services and their different composition. Some of them are reflected in compulsory medical insurance programs.

VHI includes a much larger volume of medical services than compulsory medical insurance. If, within the framework of compulsory health insurance, medical institutions participating in the territorial compulsory medical insurance program provide a certain list of medical services, determined by this program and paid to the institution at the rates approved by the tariff agreement, then the medical services received by the insured patient within the framework of voluntary medical insurance may include expensive complex medical services (in the field of dentistry, ophthalmology, plastic surgery, etc.), and pediatric patronage of a commercial clinic, and expensive tests, and much more.

As part of the voluntary health insurance program, the insured patient can receive not only medical, but also other services: part 5 of Art. 1 of the Law of the Russian Federation “On Medical Insurance of Citizens in the Russian Federation” No. 1499-1 of June 28, 1991, the task of this type of medical insurance is to ensure that insured citizens receive additional medical and other services in addition to the established compulsory medical insurance programs. In other words, the contract may provide for the patient’s use of a superior ward, receipt of improved nutrition, related services, etc.

Voluntary health insurance relations are regulated by an agreement, the form of which is established by Decree of the Government of the Russian Federation No. 41 of January 23, 1992.

In voluntary health insurance, the subjects of insurance are the citizen, the policyholder, the insurer, and the medical institution. (Fig. 2)

Insurers providing voluntary medical insurance may be:

1) medical insurance organizations providing compulsory medical insurance (according to the law, a medical insurance organization, in addition to medical insurance, does not have the right to carry out other types of insurance activities, but has the right to simultaneously provide compulsory and voluntary medical insurance);

2) other insurance organizations licensed to provide voluntary types of health insurance.

Insured for voluntary health insurance are individual citizens with civil legal capacity and/or enterprises representing the interests of citizens. If the court recognizes the insured as incompetent in whole or in part during the validity period of the VHI contract, his rights and obligations are transferred to a guardian or trustee acting in the interests of the insured.

Medical insurance organizations are legal entities that provide voluntary medical insurance and have a state permit (license) for the right to engage in voluntary medical insurance.

health insurance voluntary compulsory

Rice. 2

A standard VHI policy does not provide for payment of insurance compensation. The insurance company pays bills for medical services provided to the owner of the VHI policy directly to medical institutions. Thus, the insured pays only once when purchasing a VHI policy, and all costs for treatment are borne by the insurance company. If it is necessary to receive medical care, the insured person contacts the insurer's control center (this may be a coordinating doctor) by telephone, which is specified in the insurance contract (insurance policy). The insured person provides his first and last name, his policy number and the reason for the request, after which the coordinating doctor provides all the necessary information regarding the further actions of the insured person. When applying for medical help or related services (transportation to a medical facility, etc.), you must present a VHI policy and an identity document. When visiting a doctor, it is recommended to have with you extracts and certificates from other medical institutions related to the disease for which you are seeking medical help. Payment of insurance compensation is carried out by the insurer by transferring funds to the account of the medical institution for the actual medical care provided. If the insured person, in agreement with the insurer, paid the cost of medical care provided or purchased medications according to prescribed prescriptions, the amount spent is returned to him based on the documents provided. The insurer has the right to refuse to pay for medical services if the insured person received services that were not provided for in the insurance contract, and also did not follow the doctor’s recommendations, which led to a deterioration in his health. The insurance contract defines the conditions under which the insurer will refuse to pay insurance compensation.

A VHI agreement is an agreement entered into voluntarily by the parties. The voluntariness of VHI lies in the fact that the insurance contract with the insurer is concluded at one’s own request, equivalence is determined by the choice of the VHI program for which the policyholder pays an insurance premium, urgency implies the presence of a certain time for which the insurance contract is concluded, since one of the essential conditions in the insurance contract is term of the contract.

Voluntary health insurance is divided into:

1. Individual - each person, at his own request and at his own expense, issues a VHI policy. He selects the choice of an insurance company, the list of services and many other factors individually, based on his needs.

2. Collective - the organization issues a voluntary health insurance policy for its employees, adding it to the social package. That is, while a person works for this organization, he has the right to receive paid medical services for free, this is a very powerful means of motivation. It is the presence of a good VHI policy in the social package that is the decisive condition when a person chooses his place of work and the factor that keeps a person at his job, because upon dismissal, the employee is obliged to hand over his VHI policy. The advantage of group insurance is its lower cost.

Voluntary health insurance is in demand mainly by corporate clients. They account for about 90% of contributions collected under VHI programs. There are several explanations. On the one hand, this is the growth of social responsibility of business, when employee insurance is becoming an integral part of the compensation package in an increasing number of companies. At the same time, voluntary health insurance programs at many enterprises, especially in high-tech industries, are no longer considered only as a way to provide financial incentives for employees, but also as an important tool for increasing business efficiency by improving staff health. On the other hand, it is often much easier for citizens to contact a medical institution directly, bypassing the insurance company. After all, unlike companies that have tax benefits when using VHI programs, individuals do not receive such benefits.

It is also easier for the insurance companies themselves to work with corporate clients, since when insuring large groups, the risks are evenly distributed among all employees, and accordingly, there is no need to conduct a survey and assess the risks for each insured person. In addition, with VHI for individuals, anti-selection (worsening selection) of risks occurs, in which people who apply for insurance policies are mainly people who already know that in the near future they will have to use medical services. All this significantly increases the cost of voluntary health insurance policies for individuals, and makes them less attractive compared to corporate insurance.

The most common voluntary health insurance programs in Russia are:

· Outpatient service, eliminating expensive diagnostic methods.

· More expanded program: specialist services, the ability to take tests at home and in the clinic, inpatient treatment, dentistry, emergency care, assistance abroad.

· Comprehensive insurance for the whole family.

· Travel insurance: insurance is valid for the entire trip.

· Standard policy: emergency care for injuries or poisoning, acute diseases, exacerbation of one of the chronic diseases; emergency dentistry; doctor consultation; hospitalization, etc.

· Help at home. Insurance for those who are unable to get to the clinic. Includes consultation with a specialist at home, testing, injections, cardiogram, etc.

· Call a paid ambulance. Insurance - both separate and as part of a specific insurance package.

· Personal doctor: consultations, examinations, referrals and prescriptions from a personal general practitioner.

· Dentistry: emergency care, regular examinations, treatment, etc.

· Emergency and planned inpatient care. Insurance is relevant if you have chronic diseases, if there is a risk of going to the hospital, if there are indications for staying in the hospital.

· Pregnancy and childbirth: support and observation during pregnancy, hospitalization and delivery, postpartum support.

· Children's programs: preventive examination, specialist consultations, vaccinations, emergency care, etc.

· Sanatorium-rehabilitation program.

· Treatment abroad.

· Insurance programs for the elderly.

Voluntary health insurance is carried out at the expense of the profits (income) of enterprises and personal funds of citizens through the conclusion of an agreement. The amounts of insurance premiums for voluntary health insurance are established by agreement of the parties. The insurance premium is the insurance payment that the policyholder is obliged to pay to the insurer in accordance with the voluntary health insurance agreement.

Tariffs for medical and other services under voluntary health insurance are established by agreement between the medical insurance organization and the enterprise, organization, institution or person providing these services. The insurance tariff is the rate of insurance premium per unit of sum insured or object of insurance. Tariffs must ensure the profitability of medical institutions and the modern level of medical care.

Pros of VHI:

Ш Freedom of choice. The citizen himself chooses the insurance company, program and medical institutions from those that are offered to him.

Ш Save time. You won’t have to wait in queues and wander around the city in search of a decent medical facility.

Ш High quality of medical services.

Ш Possibility of receiving those services that are not available under the compulsory medical insurance policy.

Ш Protection of the interests of the insurer by the insurance company in the event of controversial issues.

Ш A wide list of services provided and a wide selection of institutions where these services are provided.

Ш The ability to choose an insurance package in accordance with your requirements and needs - a minimum package, home care, etc.

Ш Possibility of making an appointment with a doctor via the Internet without leaving home.

Ш The attitude of staff towards patients, taking into account the interest of staff in their work.

Disadvantages of VHI:

Ш VHI insurance is paid for by the citizen, and the services are very expensive.

Ш The risk of imposing on a citizen services that he does not need.

Ш The qualifications of specialists providing VHI services do not always correspond to what is stated.

Ш Exceptions from insured events not covered by insurance. Many people miss this moment. Certain diseases (the list is very wide) are not covered by VHI insurance.

Ш VHI does not provide treatment for certain significant diseases (for example, tuberculosis, diabetes, mental and sexually transmitted diseases) - only diagnostics, and then for a fee.

VHI in Russia is gaining popularity. Moreover, if previously such policies were purchased mainly by employers for their subordinates, now our citizens turn to insurance companies on an individual basis. The insurance market participants themselves associate this with an increase in the level of prosperity among the population, with economic growth in the country, as well as with the development of the Russian insurance market. The reasons may be that compulsory health insurance is not very effective.

Smart people care about their health, and in this process they often have questions about the essence of voluntary health insurance. Speaking about this, it’s worth saying right away that voluntary health insurance is a useful service. The modern Russian state provides a guarantee of receiving the necessary medical care. Compulsory health insurance includes a list of services. But some types of additional services, such as preventive measures, diagnostics, rehabilitation treatment, etc. still require additional costs and effort, due to which the quality indicator of service still remains without significant positive changes. Agree that in almost any current hospital in Russia you can still find rudeness on the part of the staff, inattentive attitude towards patients, a lack of qualified specialists and much more, which negatively affects the quality of care in the field of medicine.

Voluntary health insurance acts as a supplement to the compulsory medical insurance system.. VHI makes it possible to partially or fully compensate for all medical care costs on a paid basis. The main idea of ​​VHI is a one-time payment of the insurance premium, which allows you to receive high-quality medical care throughout the policy period. It is worth noting that the choice of program is carried out independently.

The voluntary health insurance program is a list of medical services established within the framework of the insurance contract, indicating the total insured amount of funds, individual insurance amounts for all types of assistance. Regarding the cost, let’s say that it directly depends on the list of medical services specified in the insurance contract. Nowadays, there are two main types of insurance programs: individual and standard.

More specifically about the paid service

VHI gives its owner a lot of advantages. The main and most important advantage of the policy, which is called voluntary health insurance, is that it is much more profitable than going to the clinic directly. Thus, a patient with VHI does not need to pay for medical services at the moment when the need exists. This is due to the fact that the company providing it provides a fairly large influx of customers. It follows that the insurer has significant discounts when paying for medical services.

Nowadays, it will not surprise anyone that modern “doctors” try their best to prescribe as many procedures as possible, as well as tests that are not necessary. Naturally, this is done with the aim of making money from patients. It is the lack of control over such actions on the part of doctors that gives them a free hand. The insurance company, in turn, does not allow this.

A huge advantage, according to many residents of the country, is the fixed fee charged by the insurance company for the VHI policy. It is worth noting that even if the cost of treatment is more than the cost of the insurance policy, the insurance company compensates for the difference.

A useful feature of voluntary health insurance programs is flexibility. This quality, which favorably characterizes VHI, should be understood as medical institutions, an individual approach to each patient when choosing the types and volumes of medical services. In addition, the insurance company’s employees take full control of all issues emanating from the medical institution. Thus, medical care is in the hands of the insurers themselves.

The main advantage of VHI, which distinguishes it from domestic “free” medical care, is the receipt, if necessary, of high-quality medical service in hospitals that have modern and high-quality medical equipment, as well as highly qualified specialists in this industry.

Types of VHI

In modern times, modern insurance companies are able to offer their clients several types of insurance programs, including the following programs:

• Inpatient services
• Outpatient services
• With a personal doctor
• Alternative dentistry
• Alternative emergency care

It is worth noting that it is advisable to purchase voluntary insurance as a package. The role of the basis is performed by the outpatient care program. Regarding the cost of the VHI insurance policy, it is calculated depending on the level of the medical institution, etc.

About the insurance company

When choosing an insurance company, you should adhere to certain factors:

1. State of health and age at the time of insurance. If you are over thirty years old, then there are so-called increasing coefficients. For example, age 50-55 years with VHI has a coefficient of 1.2. Thus, the base price of the insurance policy increases to 1.2 times.
2. Limit of insurance coverage. When an insured event occurs, limiting coverage in the event of overspending may require self-payment.
3. Types of insurance events. Be guided by the thought of what you are insured against, and vice versa - what you are not insured against. Insured events, as well as exclusions, are usually specified in the VHI policy. Thus, diseases such as diabetes, sexually transmitted diseases and cancer may be excluded from insured events.
4. The company providing insurance services is required to have an agreement with a medical institution. In turn, a medical institution must have the appropriate permit (license) to operate. Usually a list of such clinics is attached to the policy.
5. License for insurance activities. The license has a number. It also indicates the legal address, types of insurance activities, as well as the name of the company.

27.11.17 264 503 3

or How to get treatment without rudeness, coupons and queues

In a voluntary health insurance scheme, all three of these words are important. Let's start from the end.

Insurance. VHI is a financial service of large insurance companies. Thousands of clients pay small contributions to the general insurance fund. If one of the insured persons has an insured event, the company will compensate his expenses for this event.

A simplified example: 100 people paid 1000 rubles each to the insurance fund. In total, the insurance fund contains 100,000 rubles. One person out of a hundred fell ill and spent 50,000 rubles on treatment - the insurance company transferred this money to the clinic from its fund. There are still 50 thousand left in the fund.

In VHI, the insured event is related to the client’s health: if he gets sick, he can quickly see a doctor, undergo an examination and immediately begin treatment, avoiding additional expenses. If nothing happens during the policy, the money will remain in the fund and will be used to pay other, less fortunate insureds.

Insurance is not a medical service, but a financial service. Medical services are provided by clinics, and the insurance company simply pays them. In some cases, you first pay the clinic yourself, and then the insurance company transfers the money to you.

Medical. There are many life and health insurance programs on the market: against injuries, accidents and even sudden death. They usually involve payment of a fixed amount that will help cover the costs of treatment, but more often it is more like compensation for moral damages. In any case, you will have to find the right doctor yourself.

VHI works differently: the insurance company negotiates with certain clinics so that its insured clients are accepted and treated without queues or financial hassles. The patient should not know anything about the cost and money. He should just come to the clinic with a complaint and leave healthy.

Voluntary. In Russia there is compulsory health insurance, which applies to everyone (roughly speaking). All employers make contributions to the compulsory medical insurance fund; it is impossible not to pay. The rules are the same throughout the country; only the lists of covered services change from region to region.

Voluntary health insurance is a voluntary matter: if you want, you join the program, if you don’t want, you don’t join. A private shop, each company has its own list of services and clinics, its own insurance conditions, its own tariffs. They do as they want.

Some companies are required to issue voluntary health insurance to employees as part of the employment contract. This does not negate the fact that the program is voluntary: applying for voluntary health insurance is the company’s right, not an obligation.

Insurance companies, too, cannot take on voluntary health insurance for every client. If the insurance company sees that the client is going to be treated a lot and often, it may refuse to include him in the program or greatly inflate the price of the policy.

Same doctors, different conditions

VHI is presented as “health insurance, but with normal services.” This means that under this program you will have access to good doctors in good clinics, without queues or paperwork.

But there is some deceit here. The insurance company does not directly influence the quality of medical services - it can only agree with the necessary clinics on the terms of service. And doctors treat you and give you prescriptions.

Some doctors combine shifts in public and private clinics. Today you were rude at the clinic and sent for a painful procedure by appointment at eight in the morning, and tomorrow the same doctor in a private clinic will politely perform a similar procedure right there in the office. The magic of this transformation is still incomprehensible to us.

This does not mean that under VHI you will receive rudeness or red tape - on the contrary, insurance companies try to work with good clinics. The intrigue is that good clinics may have the same doctors as bad ones.

How to use VHI

If you have already signed up for VHI, you can apply for help in case of illness in two ways.

Direct access. The insurance company provides the client with a list of medical institutions where they can be treated under VHI. The insured simply contacts one of the specified clinics; there is no need to notify the insurance company in advance.

Call to the “medical console”. Before going to the hospital, the client calls the insurance company's 24-hour number. He is answered by an operator who confirms or does not confirm that the insurance company is ready to pay for the required service. Typically, such operators are people with secondary and higher medical education. They listen to the client’s complaints and select the necessary clinic, calculating in advance what services will be provided to the patient. If the required procedures are covered by insurance, the operator makes an appointment for the client and sends a letter of guarantee to the clinic: they say, treat this citizen, and we will pay for these procedures.

This is convenient if the insured rarely visits hospitals or if something happens to him on the weekend when the desired clinic is closed. In theory, insurance employees should know well where, how and at what prices medical services are provided both in planned and emergency situations: which clinic has strong therapists, which is a good cardiologist, and where you shouldn’t go at all.

What will be treated under VHI

Sometimes people think that VHI is an unlimited pass to a private clinic, like a subscription to a swimming pool or gym. There are also such offers on the market, but these are not insurance, but package programs of specific medical centers.

For example, a clinic may offer a “Headache Diagnosis” program for 100 thousand rubles, which will include several dozen studies. This is not VHI.

VHI - insurance against diseases: colds, poisoning, injuries, and so on. Most VHI programs do not include a routine visit to the doctor, obtaining certificates for driving licenses, weapons permits or sports permits. The services you can count on depend on the category of your VHI program. There are basic, advanced and full categories.

I compiled average lists of medical services and VHI programs that I was able to obtain from insurance companies. But if you want to calculate VHI yourself, here’s some help:

• VHI calculator for individuals on the Medstrakhovka-ru website;
• VHI calculator for individuals on the “Let's Compare” website;
• VHI calculator for individuals on the website of the insurance company "RESO-Garantia";
• VHI programs for individuals of the Russian Standard Insurance company.

Basic VHI program, from RUR 20,000

These are medical services, free analogues of which can be obtained under compulsory medical insurance in a regular clinic:

1. Access to a limited number of mid-level clinics in agreement with the insurance company.
2. Outpatient treatment is the same as in a regular clinic, but without the queue.
3. Private ambulance and doctor's call at home, the number of visits per week or month is limited.
4. Consultations of narrow specialists. This does not include all specialists - for example, there may not be a mammologist.
5. Diagnostics and tests: x-ray, ultrasound, blood test - usually a total of up to 10 procedures per year.
6. Physiotherapy: therapeutic massage, inhalation, magnetic therapy, exercise therapy - usually a total of up to 10 procedures per year.
7. Hospitalization in private medical centers and luxury wards of public clinics, but only in case of a threat to life, for example, if the appendix needs to be cut out.
8. Payment for medications prescribed by a doctor during hospitalization.
9. Dentistry: anesthesia, treatment, light fillings, professional hygiene.
10. Issuance of sick leave.

Expanded voluntary health insurance program, from 50,000 RUR

Everything in the base plus:

1. Direct access to certain mid-level clinics or access to an expanded number of clinics in agreement with the insurance company.
2. Unlimited number of analyses, except high-tech ones.
3. Unlimited number of physical treatments.
4. An expanded list of specialized specialists, including a dermatologist, mammologist, and proctologist.
5. Hospitalization for planned reasons, for example, to lie down on a drip and receive treatment, but usually only for a period of 10-15 days.
6. Medical insurance for the duration of a business trip or tourist trip.
7. Flu vaccination.
8. Personal doctor services - the ability to call and consult with the right specialist 24 hours a day.
9. Periodic medical examinations to monitor health.
10. Sanatorium-resort treatment.

Full voluntary health insurance program, from RUR 100,000

Everything in Basic and Advanced, plus:

1. Access to expensive private clinics and public hospitals with big names.
2. Expensive high-tech tests, such as tomography.
3. Hospitalization for both emergency and planned reasons in separate luxury rooms.
4. Dentistry includes whitening, prosthetics and implantation.
5. Pregnancy management and childbirth.
6. Psychotherapist services.
7. Diagnostics and treatment in foreign medical institutions.

These lists are indicative - the insurance company may offer you other conditions, remove or add services, or refuse you altogether. Always read the contract so there are no surprises.

There is no single insurance contract for VHI - each insurance company prescribes its own conditions in a form convenient for it. Before paying for the policy, carefully study all the appendices to the contract - it should describe in detail where and what you will be treated for at the expense of the insurance company, and in what cases the insurance company will refuse to pay.

VHI will not treat you

Chronic diseases

If the client already suffers from some serious illnesses and faces long-term treatment and rehabilitation, the insurance company may refuse to enter into a voluntary health insurance contract with him altogether: it is too costly for them. Here are the most common uninsured cases:

Chronic diseases according to VHI will be treated only in the acute stage, when there is a threat to life. At the same time, undergoing periodic examinations to avoid exacerbations will most likely not be possible under VHI.

If the client is diagnosed with diabetes, hepatitis or cancer during the policy period, the insurance company will pay for all procedures until the diagnosis is made. The patient will have to pay for subsequent treatment himself.

Even if the client manages to hide the presence of a serious illness from the insurance company, it may be discovered during treatment during the period of VHI. If the insurer realizes that it has been misled, it has the right to terminate the contract. The client will lose money.

VHI will not treat you

Everything that is not according to the contract

If a client calls a private ambulance for a relative who is not insured under VHI, or misses an appointment with a doctor without warning, the insurance company will demand compensation for losses and threaten to cancel the contract.

The insurance company will definitely not pay for treatment that was not prescribed by a doctor. For example, if you take an X-ray of the lungs simply for general health monitoring purposes.

According to the policy, X-rays will be paid only in case of illness with a severe cough and upon the referral of a therapist. If a patient self-medicates, buys some special medications and goes to a familiar homeopath, VHI will not cover this either.

The insurance company will refuse to pay if the insured goes to a medical institution that is not specified in the VHI contract, or undergoes a procedure that is not included in the insurance program.

To avoid such problems, it is better to call the phone number written on the policy and clarify everything. They must explain to you what is included in your program and what you need to do to get the help you need. In general, if you have any doubts, call your insurance company immediately.

VHI will not treat you

Medical services in other cities

Typically, the coverage area of ​​a voluntary health insurance policy is limited to the client’s city of residence - this is indicated in the contract. Therefore, it most likely will not be possible to go for free treatment in the capital’s clinics by applying for voluntary health insurance in another region.

Some insurance companies sometimes give clients a “gift” - they include emergency assistance throughout Russia in the VHI program. Often this is just a marketing ploy: according to the law, in case of a threat to life, medical care is provided throughout the country, to any citizen, and is always free.

VHI will not treat you

Unearthly beauty

The basic and extended VHI programs almost never include aesthetic medicine and cosmetology: removal of moles and papillomas, teeth whitening, plastic surgery. Psychotherapist services are usually only included in the full insurance package.

If your eyes hurt, cataract surgery can be performed under VHI, but surgery to improve vision cannot be performed, because myopia or farsightedness does not affect the patient’s health.

VHI will not treat you

Consequences of revelry and suicide attempts

Under no circumstances will the insurance company pay for the treatment of a patient if it determines that he received injuries under the influence of alcohol, drugs or toxicological poisoning.

Also, the insurance company will not pay for treatment after intentional harm to one’s own health or attempted suicide.

The list of insured events also does not include damage to health as a result of radiation exposure, military actions, civil unrest, terrorist attacks, natural disasters and other emergency situations.

How to apply

Get VHI at work

The benefits of VHI are mainly enjoyed by residents of large cities who work in prestigious organizations. But corporate voluntary health insurance is not only a pleasant bonus, but also a control tool. What services and for what amount are included in the VHI policy are determined by many factors: position, length of service, value to the company. More skilled workers have better conditions and greater insurance coverage.

If a person has just joined a company, most likely he does not yet have access to corporate voluntary health insurance. Some companies provide insurance after three months, some after six. Some wait a year. But when an employee decides to quit, the employer can cancel his VHI immediately, although he still has 14 days to work.

The main disadvantage of corporate voluntary health insurance: the employer chooses the insurance program, and the employee simply has to agree with it. It happens that, according to a collective insurance agreement, a small insured amount per person is established. If the insured person exceeds it, he will then have to pay for treatment out of his own pocket.

If a company offers its employees an extended insurance program, it may ask them to pay part of the insurance premium themselves, for example, 3,000 RUR out of a conditional 10,000 RUR. But even this will be much cheaper than buying a policy individually.

The most generous companies pay voluntary health insurance not only to employees, but also to their spouses. A policy for children under 18 years of age and elderly parents can also be included in corporate VHI. You will have to pay for it yourself, but the insurance company will give a discount.

Leading insurance companies in the Russian VHI market in 2017, according to the Expert rating agency

How to apply

Buy voluntary health insurance through your employer and chip in

Even if a company does not offer health insurance to its employees, they can chip in and buy a collective VHI agreement through their employer. This is beneficial to everyone: by applying for corporate voluntary health insurance, the employer will be able to reduce its tax base, and employees will receive policies much cheaper than if they bought them separately.

The cost of a basic VHI policy for a private person starts from RUR 20,000. If VHI is purchased for a group, the price of the policy starts at RUR 10,000 per person. This is beneficial if you consider that just one appointment with a doctor in a private medical center costs from 800 RUR, and a visit from a private ambulance team or calling a specialist to your home costs from 2000 RUR.

On the other hand, for a healthy and successful person these expenses will not be justified and he will pay for others with his contribution.

Typically, insurance companies sell voluntary health insurance policies to work teams of 10 people or more. Often insurance companies do not check whether a person works in a given organization or comes from outside - the main thing is the size of the group. Therefore, you can invite your friends and acquaintances to also join your corporate voluntary health insurance.

There are also intermediary companies on the market offering everyone an individual opportunity to join large corporate insurance programs. They promise to take into account the client’s wishes regarding the content of the program and give a discount of 50% or more. The reliability of such intermediaries and the legal organization of relations with them are unclear.

How to apply

Buy voluntary health insurance as an individual

Insurance companies are reluctant to sell VHI policies on an individual basis. Negative selection works: roughly speaking, when a person pays 50 thousand rubles for insurance, he will try very hard to get cured for 70 thousand. The insurance company does not want to incur losses, so it either sets prohibitive rates or refuses to take on the client.

To assess the risks, the insurance company will ask you to fill out a form and indicate all your health problems. If a client smokes, is overweight, or works in hazardous work, he is at risk for a number of diseases. The insurance company will set an increasing coefficient for such a person, and the price of the policy for him will increase. VHI for young children, pregnant women and the elderly is the most expensive.

Typically, VHI for individuals is offered only by insurance companies that have their own medical centers. This way they control the costs of treating clients. For example, Ingosstrakh owns the Be Healthy clinic network, Alfastrakhovanie has a regional network of Alfa Health Center medical centers, RESO-Garantiya manages Medswiss clinics. With a high probability, they will refer their clients to these medical institutions, at least in the basic program.

One of the advantages of purchasing voluntary health insurance yourself is the ability to choose all the necessary components and conditions of the insurance program yourself. When purchasing a policy, be sure to check:

1. What is included in the list of insured events.
2. What is included in the list of exceptions.
3. Is the number of specific tests and procedures limited?
4. Which clinics will be available to you.
5. Will I have to coordinate each visit to the doctor with the insurance company or is direct access possible?
6. The VHI policy works only in the city of residence or throughout the country.

Purchasing a voluntary health insurance policy is an expense for treatment. If you have taken out VHI for yourself, your spouse, children under 18 years of age, or your parents, paying out of your own pocket, you are entitled to a tax deduction - 13% of the cost of the policy, but not more than RUR 15,600 per year. How to get a tax deduction for treatment,

How to reduce the price of VHI

If your employer does not have a voluntary health insurance program, but you understand that you really need it, try to reduce the price of an individual VHI policy.

Assess insurance risks. Think about what medical services you will need first. Often, this is enough to remember the history of your visits to the doctor over the past year.

Refuse dentistry under VHI. Dental treatment makes up the lion's share of the cost of VHI. In this case, most often basic procedures are assumed, guaranteed by the compulsory health insurance program. You can also get high-quality dental treatment using compulsory medical insurance, by joining a good private dentistry.

Avoid popular clinics. When purchasing VHI, it is important which clinics you choose for treatment. If you do not need consultations with the luminaries of domestic medicine, it is better to abandon medical institutions with big names and choose several ordinary clinics near your home. It will be cheaper.

There is a conditional deductible - when the patient pays for treatment within the deductible amount, for example RUR 10,000. If the treatment costs more, for example 11,000 RUR, the insurance will cover all costs.

There is an unconditional deductible - when the insurance company compensates the client for the difference between the total costs and the deductible price. For example, if, with a deductible of 10,000 RUR, the treatment cost the same 11,000 RUR, the insurance company will compensate the patient for the difference - 1000 RUR.

There is also a temporary deductible - when, after concluding a contract, the policy begins only after a while. This way the client confirms that for him VHI is insurance for the future, and not a way to cash in on insurance right now.

The franchise is beneficial to people in good health who are willing to bear small expenses for treatment on their own, but want to protect themselves from large expenses in the event of a serious illness. It allows you to buy voluntary health insurance with broad insurance coverage and, in some cases, save up to a third of the cost of the policy.