Health at the similar price

Having glanced in programs of voluntary medical insurance (ДМС), offered by insurers, it is necessary to be disappointed. How accents especially in budgetary variants of such insurance are placed, you understand that they are calculated exclusively on healthy people, which and so it is a little. How to choose the policy if you only are "almost healthy and you are going to use it as required all the same

Last year my acquaintances have suggested me to get policy ДМС: having hammered together group of 15 persons, they expected to receive from the insurer 10−процентную a discount for "wholesale". The price for the complex program offered by the insurer, first has interested me, but when have shown its conditions, enthusiasm at once was reduced. Judge: even a variant the VIP in cost of 55 thousand rbl. on the basis of really good clinics (besides polyclinic the emergency premise in a hospital, a call of the doctor on the house has been provided, "first aid" and stomatology) had weight of exceptions — from unitary consultations of experts before restriction by quantity of various researches and medical procedures. And a number from them passed under the doubtful formulation «only as agreed with the insurance company». Unfortunately, similar offers with weight of restrictions make the majority in the market — such simply insurers protect themselves from potentially unprofitable clients.
The big difference

One of ways to avoid purchase of policy ДМС with a large quantity of restrictions — to understand insurance conditions. Offers similar at first sight from the different insurers, providing complex service in polyclinic, stomatology and a call of the doctor on the house, can differ at the price of time in two. For example, the complex polyclinic program on base «It of clinics» in РОСНО will cost 28,5 thousand rbl. a year, in «the Renaissance insurance» — 35,9 thousand, in Independent insurance group (НСГ) — 15,8 thousand rbl. on the basis of medical center "Астерия" in «the Renaissance insurance» will offer the Program for 19,7 thousand rbl., and in a similar complete set, but at НСГ — for 12,2 thousand

The difference in the price speaks all the same notorious restrictions, which much more in cheap variants. «When we began to understand, at the expense of what НСГ it was possible to offer the price for the program on 30 % more low, than at competitors, have come across such point: medical aid in-home appears to clients who on a state of health can't independently address in medical institution», — Lyudmila Rostova, the chief executive of agency of insurance service Grandis explains.

Today the bottom price limit with which begin more or less comprehensible variants of policies ДМС with complex programs (providing the reference to all necessary experts), begins from 30-50 thousand rbl.

Anyway, wishing to stop on similar or more modest offers, it is necessary to consult at first to the competent adviser, than you thus risk. For example, many insurers exclude treatment of chronic diseases from an insurance covering, but thus assert that people with such illnesses can be served under such policy, all depends on their kind and a condition, and also age. «We take into consideration an average base state of health, characteristic in our country for the given age category: all the same the majority of our citizens suffer gastritises and other chronic illnesses, — Nina Egorkina, the deputy director of the Center of methodology and control of medical insurance of SK РОСНО explains. — Therefore in the presence of any standard deviations to the client the raising factor as it keeps within a certain average state of health» won't be exposed.
Everything enters that isn't excluded

It is impossible to exclude a situation when the doctor appoints treatment, and the insurer refuses to pay it as it is beyond the program subsequently. «We had one disputable situation: the insurer has refused to pay treatment on the basis of that the given chronic disease is included into number of exceptions, — Michael Kuhtar, the general director of the company“ tells Finam insurance ”. — We have agreed that in exceptions it is, but began to understand. Have glanced in the medical dictionary and have found out that there are certain signs of chronic disease, and on them we have proved that the case in point hasn't something in common with chronic disease, therefore it needs to be treated at the expense of the insurer».

So to study the list of exceptions of the policy at all doesn't place. So you подстрахуете in case in clinic to you will suggest to pay yourselves most for this or that service on the basis of that it isn't included into your program. And meanwhile the error isn't excluded: we will admit, speaking to you it is the expert in experience knows that from your insurer clients with such truncated program usually come, but after all your program can appear much more full. «We had a precedent: to the client have refused additional diagnostics in the specialized center, and he has kept silent, — Lyudmila Rostova tells. — have learned about it only after a while. If he has called at once the curator in the company, instead of discussed this theme with the expert of clinic, a problem and hasn't arisen».

In ours ДМС the principle operates: that isn't excluded under the program, is included in it. Therefore at studying of the exceptions registered in the contract, at times without the expert not to manage. For example, very few people pays attention to width of a stomatologic covering, and here more often the help volume is limited on degree of destruction of tooth (no more than 50 %), separate programs can not include preparation for prosthetics, but all insurers work differently, therefore and lists of exceptions at them considerably differ. Someone excludes from a covering hormonal researches, immunological, and at someone they become covered by the insurance.
Not to overpay

If you select policy ДМС in which wouldn't like to be disappointed, try, that in conditions of insurance offered you there were no at least following five things.

First, as in crisis go bankrupt not only insurers, but also ЛПУ (treatment-and-prophylactic establishments) absence under the contract of alternative clinic in case of bankruptcy the basic calls into question into your further service under the policy. «To me the representative of one insurance company that one of clinics has stopped the existence for two days recently complained. All has disappeared: a management, the equipment, doctors», — Michael Kuhtar tells.

Secondly, at you possibility of replacement of clinic should be provided in case something won't be pleasant to you. The same program on the basis of different clinics will cost differently: it is not excluded that you will need to pay in addition a difference in policy cost, or, on the contrary, it compensate you. On the basis of large versatile clinic with the modern equipment in which staff many known experts (candidates and doctors of sciences), the program will cost more expensively, than in clinic with possibilities is more modest. But it doesn't mean that the insured won't receive any services provided by its policy. «If service which can't be rendered in cheaper clinic suddenly is required, to the patient research on the basis of other clinic — for choice the insurer will be organized, with it will coordinate day and visit time», — Nina Egorkina makes comments. In this case you shouldn't even pay extra.

Thirdly, it is better to stop on the program without quantitative restrictions on number of consultations of experts and spent analyses-researches as it already pseudo-insurance which a little than differs from not insurance programs offered directly by clinics (the last besides and is cheaper). «In the text of contract ДМС there are following reservations:“ Biochemical, общеклинические researches under medical indications no more an once during insurance term ”. That is if the second time is required to hand over blood — excuse, for money, — Lyudmila Rostova explains. — or there is a point on single visiting of doctors-experts (the lung specialist, the cardiologist, the dermatologist, etc.) — actually the insurer speaks: will suffice from you and the therapist».

Fourthly, it will be not out of place to pay attention to the size of the insurance sum. As "unique" offers where the insurance sum hardly probable considerably exceeds the payment sum now began to meet. «In the program there can be everything, but, having come to the third or fourth time to clinic, the person suddenly learns that at it the responsibility limit is settled, — Michael Kuhtar explains. — Those programs which we sell, are made with a stock: limits of the insurer on clinics — about 1 million rbl., on stomatology — 500 thousand rbl. As though who often addressed — it always will suffice».

Fifthly, in the contract there should not be that mention that СК can raise the prices in its action. Insurers, including it, try to level a rise in prices for medical services in clinics, but to pay off for it clients shouldn't.

Inclusion in the option program «the personal doctor» remains to the discretion of insured. In one companies clients remained are happy with this service as she allowed them quickly and conveniently to receive necessary consultations, and somewhere didn't manage and without abusings. «Some“ personal doctors ”had only one function — not to admit you to experts, refusing appointment to them under any pretext», — Lyudmila Rostova tells.
 

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