Not a single person is insured against all kinds of diseases, including viral infections, damage to the body. The course of the disease can disrupt normal life activities, adversely affect the ability to work. System health insurance is designed to support people during the period of illness, ensuring that they receive medical services and paying sick days. What is the difference between compulsory health insurance and voluntary? What are the advantages and disadvantages of both insurance systems? We will answer these questions in this article.
Health insurance and its types
Health insurance is one of the types social protection citizens. Its main purpose is to provide the necessary medical services in case of illness, material support for the period of disability of working insured persons. Basic health care in the presence of insurance policy turns out to be free. A more extended list of services depends on existing agreements with specialized insurance companies. The right to receive medical care by citizens is enshrined in the Constitution of the Russian Federation (Article 41).
Health insurance is a set of social measures aimed at providing assistance during the period of illness and material support. Services offered may include the following:
- Providing first aid;
- Carrying out medical and sanitary measures;
- Disease prevention activities;
- Vaccination;
- Possibility of receiving expensive treatment within the framework of federal programs;
- Medical care in the presence of congenital anomalies;
- Other help.
In the Russian Federation, the health insurance system is developing quite intensively. Along with the basic package of services, which includes the necessary measures to support the health of the population, the possibilities of obtaining additional insurance. And if compulsory medical insurance (CMI) is guaranteed by the state for every citizen, then voluntary medical insurance (VHI) already has a more expanded package of services. In other words, VHI is a type of personal insurance that allows you to receive assistance in organizations that do not work under CHI system. This, as a rule, includes services in paid medical institutions. With a VHI policy, you can already qualify for more expensive treatment, such as dental services. Additional insurance provides, as a rule, a better level of medical care.
What is OMS?
Compulsory health insurance is understood as a set of standard medical services provided free of charge to patients at the expense of the state and employers' insurance premiums. The basic measures are:
- Primary medical and preventive care;
- Ambulance.
Depending on the current regional laws, the volume of free medical services may be increased. Both working citizens and the unemployed, as well as minors and pensioners, can act as insured persons. At the same time, working citizens are guaranteed compensation for a period of temporary disability or payment for the care of sick children and relatives.
The sources of replenishment of funds allocated for the payment of medical services are insurers under compulsory medical insurance. These include employers and themselves individuals, periodically transferring funds to social funds. Base rate for insurance premiums for such persons is set at 5.1%.
What is included in the DMS?
The insurance market in the Russian Federation is actively developing, and the provision of medical services is no exception. In addition to CHI, there is also voluntary medical insurance (VHI). If there is a VHI policy, the patient can count on an extended list of services as part of the policy payment. Under other circumstances, such medical care would have been paid. The VHI policy is recognized as more privileged. Its presence allows you to get better medical services, including with the assistance of high-tech medical equipment.
VHI should be considered as a type of personal insurance. The volume of potential services to be received depends on the selected insurance program when concluding contracts. In addition, treatment on the basis of voluntary insurance involves treatment in clinics with a high reputation.
The VHI policy is provided as a result of an independent appeal of citizens to the insurance company or subject to the action of such social programs at the employer. According to their characteristics, these policies can be of a standard nature, as well as have extended powers. The standard procedures received under the VHI policy include:
- Outpatient and inpatient treatment;
- Call an ambulance;
- Doctor's consultations at home;
- Provision of medicines;
- Basic examination of the body.
In addition, when applying for voluntary medical insurance, you can choose narrower medical specializations, specific clinics that provide necessary services, non-standard options medical care. So, in addition to the document, it is allowed to include the following procedures:
- Dental services in terms of prosthetics;
- Medical assistance abroad;
- Spa treatment;
- Management of pregnancy with accompanying services;
- Other medical care.
More expensive treatment is typical for VHI policies with an extended list of services. This includes, for example, an MRI examination. The final cost will depend on the amount of assistance included. Various insurance companies offer almost identical initial set, but the final result can be determined individually.
Some clients may be denied services even under the VHI policy. It's about about complex diseases such as diabetes, oncology, the presence of mental disorders. Deliberate actions to cause harm to health, injuries received while under the influence of alcohol or drugs may not be considered as insured events.
The VHI policy is quite accessible to all segments of the population. Its cost starts from about 10,000 rubles. For the elderly and children, the price may be slightly higher. In any case, it is possible to choose the optimal package of services.
The main differences between CHI and VHI
Compulsory health insurance is a type of health insurance guaranteed by the state, which includes a minimum required package services. The VHI policy has a more extended list of medical care. It is assumed that the owners of VHI can count on medical types care is much better.
A distinctive feature of voluntary insurance policies for their owners is the absence of queues and unscheduled appointments with doctors. In addition, VHI service has the following advantages:
- Protection of the interests of the insured person in the event of conflicts with medical institutions;
- Possibility of obtaining medical care not available in within the CHI;
- The choice of an insurance company, a medical institution, an individual insurance program;
- The insurance provides services to persons traveling abroad, while ordinary policy OMS does not perform such actions.
Citizens who make a choice in favor of voluntary health insurance should be guided not only positive sides of this type of insurance, since treatment under VMI may be accompanied by some negative nuances, including:
- The high cost of the policy;
- The risk of receiving low-quality assistance, the discrepancy between the qualifications of specialists and the declared quality;
- Probability of non-coverage full cost medical services received;
- Existence of the fact of overpayment for the services imposed by the insurance company.
The MHI policy does not have such extended powers as VHI, but at the same time it is guaranteed to each insured person. There are no difficulties with its registration, it is provided free of charge, it has the minimum necessary range of services. At the same time, the presence of a compulsory medical insurance policy alone cannot guarantee the receipt of the highest quality medical care. Due to lack of funding, the cost of treatment may be covered budget funds not completely.
Conclusion
Thus, compulsory health insurance is available to all segments of the population, including the unemployed and the poor, and is issued absolutely free of charge. Voluntary insurance is paid service and is issued for a fee set by the insurance company. CHI services are limited to the list of free medical services, VHI services have a wider range and opportunities.
VHI (decoding - voluntary medical insurance) is a form of insurance in which medical services are provided within the framework of the selected program. The client pays only the cost of the policy, and compensation for expenses upon occurrence insured event assigned to the insurer.
Services provided under VHI
Did you know?
Insurance organizations offer exclusive programs that include home delivery of medicines.
Voluntary health insurance programs are different. The main services included in the VHI policy set:
- outpatient care,
- dentistry,
- receptions and consultations of medical specialists,
- emergency Medical Care,
- preventive checkups,
- inpatient care (hospitalization + surgical treatment).
A special set of services is available for pregnant women and children. The client himself chooses what services he needs. We will tell you more about children's VHI programs in the article.
Attention! VHI operates on the principle that the more services provided, the more expensive the policy is.
Differences between VHI and CHI policies
| CHI | VHI |
|---|---|
| What diseases are covered (not covered) by the policy | |
| Treatment of most diseases in accordance with Decree of the Government of the Russian Federation No. 1492 of 2017 | The list of covered diseases is determined by the insured independently before the conclusion of the contract |
| Procedure for visiting doctors | |
| Admission is on a first-come, first-served basis | Priority service - by appointment |
| General analyzes and laboratory tests | |
| covered | Covered, BUT there may be restrictions on the number in a certain period of time |
| Specialized analyzes or studies (biopsy, MRI, etc.) | |
| Not covered, carried out for a fee | Covered (if provided by the insurance contract) |
| Who finances | |
| From the state budget | From the personal funds of the insured |
| Who determines the terms of insurance | |
| General conditions are regulated by the state for all categories of policyholders | Individual conditions are determined by the insurance organization with the participation of the client |
| Validity of the insurance policy | |
| Unlimited insurance period - no renewal required | The standard term of insurance is 1 year, it is not automatically renewed |
You can find a list of free medical services for CHI in this article.
Advantages and disadvantages of VHI
Advantages of DMS:
- additional medical services (in comparison with CHI),
- comfortable conditions for treatment,
- independent choice of insurance package,
- protecting the interests of the insurer,
- saving time (priority service),
- high quality of medical services.
Cons of DMS:
- high,
- imposition by the insurer of unnecessary services to the client,
- temporary restriction (the need for annual renewal).
Types of VHI policies
Individuals can apply for VMI of any kind in the territory of the Russian Federation.
DMS happens:
- Individual. Personal insurance– registration of an individual VHI policy for the client who applied.
- Corporate. Collective insurance – entity draws up VHI for employees upon employment after a probationary period (this can be private companies, enterprises, etc.).
- Long-term. It is concluded for a 5-year period, and requires a complete preliminary medical examination of the client.
- From an accident. It provides for the provision of medical care in case of injury as a result of an accident.
Issuing a VHI policy
A VHI policy can only be issued insurance organization with a license to insurance activity. The company is chosen by the client himself according to the programs, prices and its reputation in the market.
Before concluding a contract, you can choose a ready-made set of services (“Basic”, “Advanced”, etc.) or draw up an insurance plan yourself. For all questions, please contact the employees of the company for help.
The following documents are required to obtain VMI:
- passport (other identification document),
- medical questionnaire,
- application for insurance (the form is issued by the insurance company).
The policy begins to operate from the moment of signing the contract, or from the payment of the first insurance premium.
The representative of the insurance company will tell you about what services you can get under the VHI policy:
VHI agreement
A VHI policy is issued on the basis of an insurance contract, which specifies the conditions for the provision of services.
The contract states:
- Name of the policyholder and insurer,
- date of signing,
- list of medical services provided,
- method of payment for the policy (single payment / installment plan),
- insurance payment schedule
- features of the refund of funds paid,
- period of validity of the policy
- liability of the parties in case of default.
Carefully study the insurance contract before signing in order to avoid large financial expenses later.
So, the VHI policy is to receive high-quality medical services in comfortable conditions. The list of clinics to which the client can apply for help is determined by the concluded insurance contract.
The specialist will answer your questions in the comments to the article.
Voluntary health insurance (VHI) is a type of personal insurance that provides for the receipt of medical care in predetermined medical institutions under the selected insurance program.
The volume of medical services received and the list of medical institutions depend on the available insurance program.
The system of voluntary medical insurance is aimed at providing medical services in the most optimal terms (without queues) and in the volume necessary for the insured person.
Also, if necessary, a VHI policy can be issued to cover only critical illnesses that require expensive treatment.
The insurance premium is paid from the funds of the Insured (employer, Insured).
What is compulsory health insurance?
Compulsory medical insurance allows a citizen of the Russian Federation to receive free medical services in accordance with the standards established by law in the event of an insured event (health disorder).
Payment for treatment under the compulsory medical insurance policy is carried out by an insurance medical organization financed by the compulsory medical insurance fund ( Federal budget). In accordance with the law of the Russian Federation, the employer is obliged to make monthly contributions to the compulsory medical insurance fund.
The quality of medical services provided, as a rule, depends on the level and specifics of the work of a medical institution, and risk coverage does not always provide for the provision of related (non-medical) services (payment for travel to a medical institution, reimbursement of funds for the purchase of medicines, etc.).
The CHI policy can be issued only for citizens of the Russian Federation, or persons with a residence permit in the Russian Federation.
How is a VHI policy different from a CHI policy?
What diseases are/are not covered?
Visit to a general practitioner and specialist doctor
The appointment with the doctor takes place on a first-come, first-served basis (in some cases, by appointment).
Priority service is provided.
Simple analyzes and studies
Are covered.
Are covered. There may be limits on the number of similar analyzes/studies per certain period time.
Complex or specialized analyzes/ investigations (CT, MRI, biopsy, etc.)
Produced on a general basis or for a fee. Waiting in line can last several months. It is carried out according to the prescription of a doctor.
If it is stipulated in the contract, they are made free of charge without the need to wait in line. It is carried out according to the prescription of a doctor.
Hospitalization
Enabled.
Included if this option is provided in the insurance contract. The terms of the insurance contract may provide for staying in a single ward or in a ward with increased comfort.
Ambulance
Pre-dos-tav-lyatsya, if this option is provided in the insurance contract. Some insurance companies may provide their own ambulances with a separate dispatcher.
Choice of clinic
Is not provided. Treatment or appointment with a specialist is carried out on the basis of a referral from the attending physician (therapist) in the institution to which the insured is assigned.
Possibility to be treated in any institution from the list established by the insurance contract. It is possible to use the resources / equipment of several clinics at the same time.
Leverage on clinics or doctors
Provided by the legislation of the Russian Federation.
Quality control of medical services is carried out by the insurance company. Some VHI insurance contracts may provide for fines/compensation in favor of the insured in case of poor-quality medical services.
The conclusion of the consultation of doctors, the choice of a specific specialist
Not available or only available in emergency cases.
Provided in advanced insurance programs.
Vaccination against influenza, ticks, other seasonal or non-critical diseases
Insurance cover when traveling abroad
Absent.
Depends on the terms of the contract. An insurance company may provide (in some cases for an additional fee) a TCD policy that includes repatriation arrangements.
Expensive / high-tech treatments and drugs
Covered in order general queue. In some cases, treatment is provided by quotas. In the process of treatment, Russian analogues of drugs and medical equipment can be used.
AT insurance program the option of high-tech expensive treatment in specialized clinics both in the Russian Federation and abroad can be included.
Cosmetic surgery and aesthetic prosthetics
It is provided in the part of aesthetic dentistry. Kos-me-to-lo-gi-chesky operations - only by individual agreement with the insurance company.
Physiotherapy
Enabled. It appears in accordance with statutory standards. The list of physio-te-ra-sing-ti-cal events is limited by the possibilities of honey. institutions.
Usually included. Restrictions (for example, age restrictions) may apply.
Rehabilitation
In most cases covered, on a first come, first served basis. In some cases, treatment is provided by quotas. In the process of treatment, Russian analogues of drugs and medical equipment can be used.
It is pre-delivered if this option is provided for in the insurance contract. An extended list of rehab-li-ta-tion activities can be agreed with the insurance company.
What is regulated
Form and conditions for concluding an agreement on compulsory medical insurance reg-la-men-ti-ro-va-ny Za-ko-no-da-telst-vom of the Russian Federation.
Conditions for concluding and terminating the contract reg-la-men-ti-ro-va-ny Civil Code RF.
Conditions for the provision of medical services reg-la-men-ti-ro-va-ny by the Legislation of the Russian Federation.
Treatment of critical illness
Covered.
It can be covered both on the territory of the Russian Federation and abroad, if there is an appropriate condition in the insurance contract.
Treatment abroad
Not provided.
There are special insurance plans.
Who has the right to apply CHI policies and DMS?
Citizens of the Russian Federation, or foreign citizens who have a residence permit in the Russian Federation.
Individually agreed options
Under the compulsory medical insurance agreement, the provision of individual options is not pre-dus-ma-tri-was.
Options are included in agreement with the insurance company.
What are the benefits of a VHI policy for a Russian citizen?
For adults
Allows you to be treated in private (paid) medical institutions. The policy can be issued by a citizen of any country (restrictions may be provided depending on the particular insurance company). Insurance is valid on the territory of a certain administrative unit - a subject of the Russian Federation, a separate locality or region.
Depending on the insurance company, the contract may provide for the treatment of any disease (including serious coverage - oncology, diabetes, AIDS, etc.).
For kids
As a rule, a standard contract of voluntary health insurance for children with a minimum set of risks and services provides for the treatment of diseases typical for a child.
Insurance for children from 1 year old, depending on the terms of the insurance contract, in addition to standard services, can cover:
- observation by a personal doctor - pediatrician (including other necessary specialist), home care;
- collection of analyzes and instrumental studies (including home care);
- scheduled vaccinations;
- medical examination for admission to school or Kindergarten, as well as the passage of other medical examinations with the preparation of the necessary certificates and conclusions;
- physiotherapeutic procedures in a medical institution and at home (including massage, exercise therapy, etc.);
- paperwork, sick leave for parents, etc.
For pregnant women and women in childbirth
Maternity insurance programs can provide either full management of pregnancy or insurance for only childbirth, as well as cover both types of these services at once. The volume of services in different insurance companies may vary, but often the VHI contract for pregnant women provides for:
- primary and repeated consultations of medical specialists (including at home);
- assignment to a personal obstetrician-gynecologist for the entire period of pregnancy;
- laboratory diagnostics - blood tests, urine tests, smears, etc., as well as instrumental studies - ultrasound, ECG, X-ray, in-depth and invasive diagnostics for medical reasons;
- stay in a single room or in a superior room;
- epidural anesthesia during childbirth (with the consent of the insured person);
- measures to preserve pregnancy, incl. hospitalization as prescribed by a doctor;
- registration of the necessary certificates, certificates of incapacity for work and other medical documentation in a short time.
What legislative and regulatory acts protect the rights of the holder of VMI and CHI policies?
Responsibility of medical institutions
Health insurance is divided into two types: basic compulsory and additional voluntary.
Compulsory insurance- This is a standard package that includes the most necessary activities. You can choose which medical institution to apply to yourself, however, the CHI is not a guarantee that you will be accepted there and provided with quality services. As a rule, the standard medical institution is the district clinic with all its shortcomings: queues, lack of specialists, superficial examination, appointment of unnecessary tests, etc. In case of hospitalization, you can count on minimum list services and a limited list of drugs.
All segments of the population are subject to compulsory health insurance. Employed citizens are insured at their enterprise, the unemployed receive a policy from accredited insurance companies at their place of residence.
Voluntary health insurance allows you to expand the range of services. The package is formed taking into account all your wishes. Except basic service provided by compulsory insurance, it can include a visit to the dentist, a doctor's house call and / or an ambulance. At the conclusion of the contract, it is possible and necessary to discuss the conditions of stay in the hospital. You can choose from a minimum package of services and drugs, or enjoy the right to a full medical examination and treatment without restrictions on the use of certain medications. VHI insurance policy allows for treatment using modern technologies and devices.
The level of the institution is an indicator of the quality of the services provided in it. Choice medical organizations not limited in number. This allows you to include several institutions in the program, which will protect you as much as possible from queues, provide high level service and comfort.
VHI insurance policy, if agreed upon at the conclusion of the contract, allows you to cover the costs of medical service in emergency cases when traveling abroad. Use the services of a beautician. Provide medical care to relatives or organize spa treatment.
Insurance Company with VHI, it acts as a guarantor in obtaining high-quality examination and treatment. She controls not only the quality, but also the cost of treatment. This will allow you not to waste extra energy, time and nerves.
Last time large companies include in the social package voluntary, which has a beneficial effect on labor productivity. Provides a positive psychological climate in the team and reduces staff turnover.
Compulsory medical insurance is a necessary minimum, VMI allows you to bring medical care to a qualitatively new level.
14.03.2013
Today, Russian health insurance exists in two forms: compulsory (CMI) - an element public health, within which insurance premiums are paid by the employer or the administration of the subject (for employed and unemployed citizens, respectively), and as voluntary insurance (VHI insurance), which is paid by the employer of the insured or the citizen himself. Should Russians expect to combine two health insurance policies into one - a question that has been brewing for a long time and has now matured.
The CHI Law, which entered into force on new edition from January 1, 2011, opened the long-awaited opportunity for insured citizens to independently choose an insurer, a medical institution, and an attending physician. The extent to which this plan of the state can be implemented in practice is a rather controversial question (in villages, regional centers and even in small towns of Russia one or two medical institutions often operate), but, undoubtedly, legislative consolidation this right- a great achievement.
The new law has deprived any base of laws of VMI insurance insurers: if the previous law contained at least a mention of this type of insurance, then the new law on voluntary insurance in the field of medicine does not even have a word, and this creates certain difficulties (for example, when checking invoices issued for treatment under VHI by medical institutions).
DMS was originally conceived as a kind of supplement to compulsory insurance which involves paying for services such as outpatient care, stationary and dental treatment, emergency medical care, assistance during pregnancy and childbirth, pediatric services.
The debate about whether two health insurance policies are necessary and under what conditions they should coexist began long before the introduction of the new CHI law, while this particular legislative act"warmed up" it to the temperature of open confrontation: on this moment profile players insurance market they see prospects in combining CHI and VHI, and the Ministry of Health and Social Development - in improving CHI as the most important social instrument.
Among the arguments put forward by insurers is a possible reduction in the cost of VHI when combining two policies: by making the VHI policy legally an addition to the MHI policy, its estimated cost could be significantly reduced.
No less convincing are the opponents of combining the two types of insurance. For example, the question arose of how to separate paid and free medical services in practice? Offer patients with a VHI policy better consumables? Thus, you may be faced with the need to build a completely different treatment algorithm than with compulsory medical insurance...
Despite the opinion of insurers, now there are no plans to merge compulsory health insurance and VMI policies, but this does not mean at all that the current laws in force do not need to be improved. In other words, the prospect of a merger of the two medical policies exist, however, if the process of integrating CHI and VHI is started, then the emerging union should be headed not by the possibility of increasing profits, but by the issue of improving the quality of medical services, which will provide a real benefit for the consumer.
According to professionals, legislative changes, VHI related to the scope of regulation should be provided within the framework of the law on the organization of insurance business in Russia, and such proposals The Ministry of Health and social development plans to prepare in the near future, not forgetting that the system of compulsory medical insurance also fulfills such an important social function as funding for public health organizations.
The idea of combining CHI and VHI was also launched because, after it came into force new law, insurance medical companies began to feel financial difficulties when working in the CHI system. Difficulties arose due to the severe limitation of the standard for deductions of funds for doing business, on the one hand, and with the increase in costs (payment of experts, equipment of policy issuing points, informatization of the population, fines, etc.), on the other.
Experts expect that the final result of such processes will be the withdrawal of weak players from the market (up to 50% of the current number of CHI insurers) and, as a result, an increase in the quality of services provided.
