Choose the optimal insurance is not so simple. It is in the American television series waving national policy can come into any hospital and receive treatment within the sum insured. The Russian insurance companies cooperate only with certain hospitals and within the different insurance programs provide a different set of services. That is why we must first decide which program is right for you.
Types of programs
The basic program includes
- Ambulatory care
- Family (personal) doctor
- Alternative dentistry
- Pregnancy and childbirth
- Spa treatment
Client attached to a specific out-patient department (sometimes several). As a rule, the insurance company will cover the following:
- receiving physician and medical specialists;
- Diagnostic tests (within the clinic features and strictly on the testimony of the doctor);
- rehabilitation treatment (physiotherapy, physiotherapy, massage, etc...);
- in most cases, the insurance package also includes a call of the doctor on the house;
- also can mean dental services, but often the most inexpensive: X-rays, treatment of caries without sealing channels and without light-curing fillings, teeth cleaning, etc...
Since the clinic has all the necessary documents, it can issue a sick leave and write prescriptions (except soft).
This program is for those who are generally on health is notShe complains, but I would like to receive quality care, if something goes ill. Insurance of this type are usually issued by the company to its employees as part of the social package.
Prices are more or less worthwhileoutpatient service will start from the level of 12 000 rubles. in year. The amount depends on the prestige of the clinic, a set of specialists and medical services, the availability of the program calling a doctor, an ambulance, as well as the age and health of the insured.
Hospital you can choose from a list of those that collaborate with the company. You will be provided:
- single and double room, better food;
- professional services and research provided for in the contract.
Of course, in the hospital and the hospital issuekept as long as necessary. But make no mistake: the quality of care being provided by doctors on compulsory and voluntary insurance, in principle, the same. If you show the policy LCA, that does not mean that you will be treated better. You overpay mainly for the opportunity to get in a good clinic and comfortable accommodation.
Such an agreement usually make older people in order to pass the examination system and treat chronic "sores".
Depending on the status of the hospital, in the presence of her expensive equipment and the number of hospital admissions policy costs can vary between 16 and 000 rubles. up to 27 000 rubles. and higher.
With the insured client communicates GPpractice. Non-serious problems such as SARS and influenza, he decides on their own, referred to specialists as needed. Personal doctor is available by phone throughout the day (sometimes hours) and can go home.
Also in the contract usually includes:
- services nursing (injections, sampling tests and so on..);
- service in the clinic towards personal physician;
- often call an ambulance.
This program is suitable for those who carefully watchestheir health and prefer to watch one of the doctor. From the point of view of the insurer's personal physician - a man who solves most of the problems of the patient and does not overload the doctors-specialists, so the price of the policy is not too high - an average of 20 000 rubles.
By this type of insurance applies to "children"insurance. Usually the child is watching the personal pediatrician. Firstly, it knows the features of Child Health, secondly, it soothes too highly sensitive parents often worry that without special occasion, thirdly, available around the clock. The "child" insurance almost always includes vaccinations quality vaccines. Sometimes offer additional vaccinations. The average price - 22 000 rubles. The insurance for the first year of life is more expensive by 10 000-15 000 rub.
In countries with developed insurance systemmedical insurance services may be covered absolutely all members of the population. In addition, for each age has its own tariff. For example, in Germany the average policy price is calculated on a man at the age of 41, therefore, any representative of the stronger sex pays insurance to raise or lower pay rate. Thus, the 18-year-old boy pays only 30% of the cost, and an elderly man - all 200%. Women of childbearing age to 35 years, overtaking men in the cost of treatment, so their policy is more expensive. But after 35 years, the picture changes dramatically: more common in men - hence, the price of women's policy is reduced.
Doctors usually "fast" will certainly rush tonext to the patient, you will have to pay him for "special treatment." Doctor working in DMS system will give the patient as much time as you need, and all the services will be paid by the insurance company. Even the machines on which alternative ambulance arrives, better equipped, and therefore of care and diagnosis more opportunities. This program can be purchased separately or as a complement to any of the previous three. Usually it is chosen by people with specific health problems that require emergency care. The average cost - 5500 rubles. within the Ring Road and 7 500 rubles. a 30-kilometer zone.
The standard package usually includes:
- medical consultations;
- removal of seals;
- X-rays and radioviziografiya (sighting shots);
- therapeutic treatment of teeth using a photocurable and himiootverzhdaemyh seals while maintaining the tooth crown is not less than 50%;
- mechanical and pharmacological treatment of canals, dental treatment with gutta percha;
- Removing tartar with ultrasound (once a year);
- Treatment of periodontal disease first degree;
- surgical treatment: removal of teeth, abscesses autopsy, etc...
Usually they are not paid by the insurance companyprosthetics and the preparation for it, restoring teeth destroyed by more than 50% orthodontics, plastic surgery, cosmetic procedures, chemical teeth whitening.
"Alternative dentistry" will cost you an average of 20 000 rubles.
Council: before buying a policy, go to the consultation in a private dental clinic and ask a doctor to assess the amount of work in terms of money, correlate it with the cost of insurance and the cost of services to which it does not apply. Perhaps the payment after the treatment is cheaper.
Pregnancy and childbirth
You can conclude a contract only on the maintenance of pregnancy, or just to give birth, and you can buy a whole package. Instead, you are guaranteed:
- all standard routine examinations and tests;
- Hour Consultation obstetrician-gynecologist on the phone with the possible departure of the house;
- support to the maternity hospital;
- sometimes personal obstetrician-gynecologist at birth;
- the possibility of the presence of the father (or other close person) at birth;
- individual post-natal ward increased comfort with the possibility of co-host mother and baby;
- registration card exchange and the hospital;
- a consultant on breastfeeding, a psychologist.
Typically, such a contract is concluded for the pregnantIn order not to stand in queues in antenatal clinics and get in a good hospital to a particular doctor. The cost of pregnancy -. About 20 000 rubles, delivery - from 20 000 rubles. (The insurance is cheaper than paying directly to the maternity hospital, as the insurance company to buy "wholesale" service).
Treatment at the resorts
In fact, it is the acquisition of permits in sanatoriumyour profile both in Russia and abroad. Advantages of cooperation with the insurance company is that it (unlike the tour operator) will monitor the treatment process. price range is very large - from 16 000 to several dozen rubles a week.
Important moments insurance
The external beauty of which emerges from the description of insurance programs, treatment for the insurance can be a problem.
First of all, it is desirable to understand how the company carries out calculations with a medical institution - on the basis of this we can predict how you will be treated.
Program Type A - This is when the insurance company providesa list of medical services in a specific clinic and as soon as the consumer uses one of them takes money to doctors. In this situation, doctors are interested to treat you carefully and prescribe more tests and procedures. However, not everyone will like such attention by medical personnel.
Program Type B - This is when the insurance company buys readypackage at the clinic. Doctors in this case is not profitable once again examine the patient: the money has already been paid. However, there are cases when the doctor prescribes more research, not recorded by insurance, in the interests of the native hospital.
The second important point - this is the understanding thatInsurers fear of private clients at the conclusion of major contracts. It is one thing - to insure wealthy corporation young careerists who go to the doctors once. And another thing - "individual". Usually people will go for the insurance when they have a health problem. Accordingly, such patients to spend more. In addition to the insurance of the social package person tends to remember from time to time, but about paid cash and always remembers struggling to use it to the maximum, picking up 98-100% of the amount. For this reason, and also because of the cost of the policy of corporate discounts for a private person up 5 000-15 000 rub.
Finally, it is important to know that not every disease will be treated under the insurance.
Percentages and ratios
The cost of individual health insuranceIt depends not only on the program. About twice as expensive insurance policy cost for children up to one year and pensioners, while a person older than 70 years will insure not every company. In addition, most insurers pay close attention to the health of potential customers, requiring the latter to the conclusion of the contract to fill in health declaration (questionnaire), which reflects the presence of chronic diseases, surgeries, bad habits, and so on. D. At the declaration analysis results of the insurance company can apply a multiplying factor, which ranges from 1.1 to 3.0.
At the same time, almost all insurersprovide discounts on medical care for family members and a bonus for those who not only have bought the policy LCA, but also brought friends. In this case, the individual insurance cost is reduced by 5-15%. By the way, such "benefits" you can count on at the same time the design of two or more agreements, such as the purchase of LCA policy against accidents.
The decisive "No"
The treatment of socially significant diseases -venereal, mental health, tuberculosis, diabetes - the state takes over. Therefore, these people assist system is derived from the field of LCA. You can only make a diagnosis of these diseases, but have to be treated in the district hospital or a special clinic.
The insurance indemnity is uniquely denied to those who had been injured in a condition of alcoholic, narcotic or toxic substances, and intentionally caused bodily harm yourself.
The vast majority of insurers will notto pay for services for the treatment of infertility, impotence, choice of contraceptive methods (including insertion and removal of IUD), even if the contract appear gynecologist. Transplantation and prosthetics, surgical treatment of cardiovascular disease, cancer treatment and solution of orthodontic problems are not covered by insurance: costs are high, and the results are unpredictable. However, the list of non-insurance cases to be contained in the contract.
Where will insure
Choosing an insurance program, it is important to decide onWhat dance from an insurance company or from the clinic. Knowledgeable people recommends that you take care of the clinic, and then find out which companies to work for it. This is especially true of special programs.
Before signing the contract makes sense to evaluatesolvency and financial stability of the insurer. An ordinary man in the street it is extremely difficult to do so is to rely on the experts. Ask the company rating (details can be found on the Internet), which are planning to appeal. It is reliable, if is a leader in not one but several types of insurance. The more diverse range of services, it is clear that the risk portfolio is balanced, which means that ultimately protected from financial losses.
Separately should be said that some companiesThey have their own medical facilities. At the moment, only in Moscow insurers more than ten clinics. In ROSNO is the American Medical Centers (AMC), clinics under the brand name "Medexpress". The "RESO-Garantia" also has its own network of clinics: Medilux and MedSwis, dental "Good Doctor". MAX owns clinics "Medical Center" and "Mositalmed" in "Ingosstrakh" - "TEAM-Clinic", the "Renaissance Insurance" - a service company "Medkorp", which is not an independent polyclinic institution, but it has a staff of doctors leaving to the patient's home.
Signing a contract
And finally, one more important tip: carefully read the insurance contract, paying particular attention to the following points.
whether the number of doctor visits in the house is limited,number of visits to specialists, massage courses, physiotherapy and other procedures? How much should you pay extra if you exceed the limit? The "children's" contract is better to take unlimited communication with your pediatrician.
The list of exceptions (diseases and conditions inthat the insurance company does not pay for treatment in a hospital). The client has the right to expand its insurance program, transferring some of the non-insurance cases (except those listed above) to insurance - for an additional fee, of course.
If the insurance includes provision of medicines or materials (eg, vaccines for children), which is to be applied?
Are you comfortable to get to the clinic? What part of the services will have at home? If it is a contract for a child or an elderly person, it makes sense to pay extra for that, except for complex studies, the majority of manipulations carried out at home.