The quality of medical services is one of the first things that we begin to think about how only we have funds. I don't want to go to the district clinic «Communication» for every case of life - too. The question arises: not to acquire a policy of voluntary health insurance?
Content
Choose optimal insurance is not so easy. This in the American TV shows the citizen waving the policy can come to any clinic and receive treatment within the sum insured. In Russia, insurance companies cooperate only with certain clinics and within various insurance programs provide a different set of services. That is why it is necessary first of all to decide which program suits you.
Types of programs
In the main programs included
- Outpatient polyclinic service
- Hospitalization
- Family (personal) doctor
- Ambulance
Special programs
- Alternative stomatology
- Maintain pregnancy and childbirth
- Spa treatment
Service B
Polyclinic
The client is attached to a specific clinic (sometimes to several). As a rule, the insurance company pays the following:
- reception of the therapist and specialist doctors;
- diagnostic studies (within the capabilities of the clinic and strictly according to the testimony of the doctor);
- Recovery treatment (physiotherapy, healing physical education, massage and t. NS.);
- In most cases, the insured package also includes a doctor to a house;
- Dental services may also include, but often the most inexpensive: x-ray, treatment of caries without filling channels and without light-cured seals, removal of the dental stone and T. D.
Since the clinic has all the necessary documents, it can produce hospital sheets and write a recipes (except for preferential).
This program for those in general on health does not complain, but would like to get high-quality assistance, if suddenly there is ailment. Insurance of this type usually gives companies to their employees within the framework of the social package.
Prices for more or less standing outpatient and polyclinic service start from 12,000 rubles. in year. The amount depends on the prestige of the clinic, the set of specialists and medical services, the presence in the doctor's call to the house, ambulance, as well as from the age and health status of the insured.
Hospital
You can choose the hospital from the list of those that collaborate with the company. You will be provided:
- one-double ward, improved meals;
- Services of specialists and research provided for in the contract.
Of course, in the hospital they give the hospital and keep as much as they need. However, do not secessive: the quality of the help that doctors are provided on mandatory and voluntary insurance, in principle, the same. If you present the PMD policy, it does not mean that you will be treated better. You overpay mainly for the opportunity to get into a good clinic and for comfortable accommodation.
Such a contract usually concludes older people in order to pass a systemary examination and treat chronic «Boycles».
Depending on the status of the hospital, the presence of expensive equipment and the number of hospitalizes in it can vary from 16,000 rubles. up to 27,000 rubles. and higher.
Personal doctor
With the insured client communicates a general practice doctor. Non-serious problems of the type of ORVI and influenza, he solves independently, if necessary, sends to specialists. Personal physician is available by phone during the day (sometimes around the clock) and can go to the house.
Also, the contract usually includes:
- Services of medium medical personnel (injections, tests of analyzes and t. NS.);
- maintenance in the clinic in the direction of a personal doctor;
- hospitalization;
- Quite often a challenge.
This program is suitable for those who carefully monitor their health and prefers to be observed at one doctor. From the point of view of the insurer, a personal doctor is a person who solves most patient problems and does not overload professionals, therefore the price of the policy is not too high - an average of 20,000 rubles.
This type of insurance includes «Children's» insurance. Usually for the child observes a personal pediatrician. First, he knows the features of the child's health, secondly, soothes too distinctive parents who are often disturbed without a special reason, thirdly, accessible around the clock. IN «Children's» Insurance almost always includes planned vaccines with high-quality vaccines. Sometimes additional vaccinations are offered. Average price - 22,000 rubles. Insurance for children of the first year of life is more expensive for 10 000-15 000 rubles.
And as abroad
In countries with a developed insurance system, absolutely all representatives of the population can be covered by medical insurance services. At the same time, for each age there is a tariff. So, in Germany, the average price of the policy is calculated on a man at the age of 41, therefore, any other representative of the strong sex pays insurance with an increase or lower payment by the coefficient. So, the 18-year-old young man pays only 30% of the cost, and an elderly person - all 200%. Women of childbearing age up to 35 years old overtake men in the cost of treatment, so their policy is more expensive. But after 35 years old, the picture changes dramatically: men are more often sick - it became, the price of the female policy is declining.
Emergency
help
Normal doctor «Emergency» Surely will rush to the next patient, you will have to pay extra for him for «Special relation». The doctor working in the DMS system will pay a patient as much time as needed, and all services will be paid by the insurance company. Yes, and the cars themselves, on which an alternative emergency comes, are better equipped, and therefore the possibilities of medical care and diagnostics are wider. This program can be bought both separately and as a supplement to any of the three previous. It usually chooses people with specific health problems that require emergency care. The average cost - 5,500 rubles. within the Moscow Ring Road and 7 500 rubles. in the 30-kilometer zone.
Stomatology
The standard package, as a rule, includes:
- Consultation doctors;
- anesthesia;
- Removing seals;
- X-ray and radio visiography (aiming pictures);
- therapeutic treatment of teeth using light-cured and chemotransparable seals under the condition of preserving the crown part of the tooth at least 50%;
- mechanical and drug treatment of channels, teeth treatment with the use of guttaperch pins;
- removal of the dental stone with ultrasound (once a year);
- treatment of first degree periodontal
- Surgical treatment: dental removal, autopsy abscesses and t. D.
Usually not paid by the insurance company prosthetics and preparation for it, the restoration of teeth, destroyed by more than 50%, orthodontics, plastic surgery, cosmetology procedures, chemical teeth whitening.
«Alternative stomatology» will cost you an average of 20,000 rubles.
Tip: Before buying a policy, go to a consultation to a private dental clinic and ask the doctor to evaluate the amount of the upcoming work in the monetary equivalent, relate it to the cost of insurance and expenses for services to which it does not apply. Perhaps payment on the fact of treatment will cost cheaper.
Pregnancy and childbirth
You can conclude a contract only for pregnancy or only for childbirth, but you can buy the whole package entirely. In return you are guaranteed:
- all standard planned surveys and analyzes;
- round-the-clock consultation of the obstetrician-gynecologist by phone with possible departure to the house;
- accompaniment to the maternity hospital;
- Sometimes a personal obstetrician-gynecologist during childbirth;
- The possibility of the presence of the father (or another close person) during childbirth;
- Individual postpartum chamber of increased comfort with the possibility of a joint stay of Mom and the kid;
- registration of the exchange card and hospital;
- Help Consultant for breastfeeding, psychologist.
Usually, such a contract concludes pregnant women in order not to stand in queues in women's consultations and get into a good hospital to a certain doctor. Pregnancy cost - about 20,000 rubles., Birth - from 20,000 rubles. (insurance is cheaper than paying directly maternity hospital, since the insurance company buys a service «wholesale»).
Treatment in resorts
In essence, this acquisition of a ticket to the sanatorium of your profile both in Russia and abroad. Pros of cooperation with the insurance company is that it (in contrast to the tour operator) will control the treatment process. Price scatter is very large - from 16,000 to several tens of rubles per week.
Important moments insurance
With external adventure, which is evacuated from the description of insurance programs, problems may arise with insurance.
First of all, it is desirable to understand how the company conducts calculations with the medical institution - based on this can be predicted, how you will be treated.
Programs like A - This is when the Insurance Company provides a list of medical services in a specific clinic and, as soon as the client used one of them, translates the doctors money. In this situation, doctors are interested in treating you carefully, and appoint more analyzes and procedures. However, not everyone will like such high attention from medical personnel.
Programs type B - This is when the insurance company redeems a ready-made package of services at the clinic. Doctors in this case are not profitable once again to examine the patient: money has already been paid. However, there are no cases when the doctor appoints more research not taken into account, in the interests of the native clinic.
The second important point is an understanding that insurers are fear of private clients when concluding the main contracts. It's one thing - to insure a rich corporation of young careerists who once have no time for doctors. And other things - «individual». Usually people themselves go for insurance when they have health problems arise. Accordingly, on such patients more spending. In addition, the insurance of the social equipment is inclined to remember occasionally, but about the paid cash, he always remembers and struggles to use it to the maximum, choosing up to 98-100%. For this reason, as well as due to corporate discounts, the cost of the policy for a private person above is 5,000-15,000 rubles.
Finally, it is important to know that far from any disease will be treated by insurance.
Interest and coefficients
The cost of individual health insurance depends not only on the program. Approximately twice as much as the policy costs children to one year and retirees, with a person over 70 years old will insure far from each company. In addition, most insurers pay close attention to the health of potential customers, demanding from the latter before the conclusion of the contract fill the health declaration (questionnacence), which reflects the presence of chronic diseases, transferred operations, harmful habits and T. D. According to the results of the analysis of the declaration, the insurance company can apply an increase in the coefficient that ranges from 1.1 to 3.0.
At the same time, almost all insurers provide a discount on medical care for family members and a bonus for those who not only bought the Polis of DMS, but also brought friends. In this case, the cost of individual insurance decreases by 5-15%. By the way, on a similar «Benefit» You can count on the simultaneous design of two or more contracts, for example, when buying a DMS policy and accidents.
Decisive «No»
Treatment of socially significant diseases - venereal, mental, tuberculosis, diabetes - the state takes over. Therefore, the system of assistance to such people is removed from the field of DMS. One can only diagnose these diseases, but it will be treated in a district clinic or a specialized dispensary.
In the insurance compensation, unambiguously refuse those who were injured in a state of alcoholic, narcotic or toxic intoxication, and also deliberately caused injuries.
The overwhelming majority of insurers will not pay for the treatment of infertility, impotence, the selection of methods of contraception (including the introduction and removal of the Navy), even if the contract is found in the contract. Transplantation and prosthetics, surgical treatment of cardiovascular diseases, cancer treatment and solving orthodontic problems are also not covered by insurance: the cost is great, and the results are unpredictable. However, a complete list of non-trap cases should be contained in the contract.
Where we will insure
Choosing an insurance program, it is important to decide what to dance: from the insurance company or from the clinic. Knowledgeable people recommend first to take care of the clinic, and then learn what companies work with it. This is especially true of special programs.
Before concluding the contract, it makes sense to assess the solvency and financial sustainability of the insurer. A simple man in the street is extremely difficult, so it remains to rely on experts. Ask the company's rating (data can be found on the Internet) in which you plan to contact. It is reliable if it occupies a leading position not in one, but in several types of insurance. The more diverse the range of services, the more obvious that the risk portfolio is balanced, which means it is extremely protected from financial losses.
Separately, it should be said that some companies have their own medical institutions. Currently only in Moscow for insurers more than ten clinics. Rosno is American Medical Centers (AMS), clinics under the brand «MedExpress». W «Reso-guarantees» There is also its own network of clinics: medilux and medswis, dental «Good doctor». Max owns clinics «Medical Center» and «Mositalmed», W «Ingosstraha» - «Tim clinic», W «Renaissance insurance» - service company «Medcorp», which is not an independent polyclinic institution, but she has the staff of doctors leaving to the patient to the house.
We subscribe to the contract
And finally, another important advice: carefully read the insurance contract, paying special attention to the following points.
Is the number of visits of a doctor at home, the number of visits to experts, massage courses, physiotherapy and other procedures? How much do you need to pay, if you exceed the limit? IN «Children's» contracts better take unlimited communication with pediatrician.
The list of exceptions (diseases and conditions under which the insurance company does not pay for the treatment of the medical institution). At the same time, the client has the right to expand its insurance program, translating some of the non-persecutive cases (with the exception of those listed above) in insurance - for an additional fee, naturally.
If the insurance includes providing drugs or materials (for example, vaccines for children), which will be applied?
Is it convenient for you to get to the clinic? What part of the services will have at home? If we are talking about a contract for a child or an elderly person, it makes sense to pay extra for, besides complex research, most of the manipulations were carried out at home.
