Nowadays, few people are satisfied with free medicine, more and more people are considering treatment options in paid clinics. The system of voluntary medical insurance (VMI) allows you to receive medical care in commercial hospitals, which are paid by the insurer within the limits established by the insurance program. The vast majority of VHI insured is provided by the employer as part of a social package. For those who do not have such an opportunity, insurers offer to conclude individual contracts. How to choose and use a VHI policy?
Which is better: compulsory medical insurance, VHI or a private clinic?
The MHI policy is provided free of charge and confirms that the insured is attached to the compulsory health insurance program. Under the compulsory medical insurance policy, you can only be served at hospitals participating in the compulsory health insurance program. The list of medical services provided is limited to the territorial program.
The initial objective of the VHI policy was to expand the MHI policy and provide additional insurance coverage. But in practice, the basic VMI policy programs in most cases already duplicate the functions of the VMI program. The main positive difference between VHI and compulsory medical insurance is the provision of a better service. As part of the VHI policy, the client receives the necessary medical services in commercial medical institutions collaborating with the insurer, and not in the district municipal clinic. In commercial clinics, it is usually easier to get an appointment with rare specialists or to be screened with modern equipment. And the level of commercial service is higher. This is especially noticeable not in Moscow, but in other regions of Russia.
The main advantage of the VHI policy is the ability to choose an individual program, which, depending on the needs of the client, will include medical services that are not covered by the territorial compulsory medical insurance program and suitable medical facilities, including abroad. A plus is the presence in the support service of the insurer of doctors who will help you to find out which doctor you need to contact with certain symptoms. This will save time and money.
As an alternative to acquiring a VHI policy, one often considers the option of paying for services directly to the clinic or concluding an agreement with her for annual medical care. With this formulation of the question, the positive qualities of VHI include the presence of a control function by the insurer. Often when directly contacting paid clinics, clients are faced with the appointment of unnecessary additional tests and procedures. Assessing the need for such appointments on their own, without a medical education, is very problematic. As a result, the cost and duration of treatment are significantly increased.
Employees of the insurance company involved in accompanying VHI clients and having a medical education clearly control the volume and quality of the services provided by the clinic. The cost of the policy itself may be cheaper than the cost of treatment in a paid clinic or the conclusion of an annual service contract with the clinic, the possibility of which is far from being provided by all medical institutions. The control function on the part of the insurer is also a minus, since in non-obvious cases of prescribing expensive treatment, the insurer has a “conflict of interest”.
How to choose a VHI policy
Initially, you need to determine the reason for acquiring the policy. If you are not satisfied with the quality of the services provided in municipal clinics, while you do not have serious chronic diseases, and you rarely seek medical care, it makes sense to consider basic VHI programs. If you have a VMI corporate policy in your social package, but it does not provide for the services you are interested in, it makes sense to choose an individual program that includes only the treatment you are interested in. At the moment, insurance companies, in addition to standard VHI policies, including, as a rule, emergency and planned outpatient care, dentistry and a doctor’s home call, offer highly specialized programs. They are focused on the occurrence of a certain insured event (assistance in case of an accident, protection against hepatitis, etc.
When choosing an insurance program, it is important to pay attention to the amount of medical care provided, a list of excluded diseases and medical procedures, and the number of visits to a specialist. The cost of the policy significantly depends on the set of services and on the level of the selected network of clinics. Also, the cost is influenced by factors such as gender and age of the insured, health status (presence / absence of chronic diseases, etc.), type of professional activity, data about which will be requested upon conclusion of the contract. The choice of a network of clinics is an important factor in choosing a VHI policy. You should study the list of medical services provided by the clinic, the availability of specialists and equipment, the territorial location, and reviews of the work. The insurance program may include either a fixed attachment to one, or network attachment to several clinics. The insurance amount under the VHI policy must be established taking into account the level of the selected clinic and the range of services of the insurance program.
How to use VHI
VHI is primarily an insurance contract. To receive a payment in kind (for the organization of treatment), you need an insured event. Such is the occurrence of a new disease or an exacerbation of a chronic one. Just the desire to conduct some kind of survey when purchasing standard programs (both corporate and individual) is not enough.
There are two main ways of providing services – through the insurer’s console or direct access to a medical institution. In the first case, in order to receive the service (to make an appointment with the doctor), you need to call the contact center of the insurance company, in the second – to interact directly with the clinic. Standard medical procedures are performed by default. For the implementation of more expensive procedures, you need to get the approval of the insurance company. Depending on the relationship between the medical institution and the insurer, approval takes place either without the participation of the insured, or after the insured receives a letter of guarantee from the insurer.
Features of VHI for foreign citizens
The requirement to apply for a VHI policy for foreign citizens planning to obtain a patent for work in the Russian Federation came into force on January 1, 2015. The Central Bank of the Russian Federation has developed a draft guideline containing minimum requirements for the conditions and scope of medical insurance. Based on this project, insurers should develop a special insurance program for VHI, providing for the first sanitary-medical and specialized emergency medical care. The insurance amount for this policy should be set at least 100,000 rubles, but may be aggregate (decreases after payment). The validity period is established based on the validity of the patent (up to one year). At the moment, the instruction of the Central Bank has not yet entered into force,
VMI tax deduction
Since the VHI policy is not cheap, it is worth remembering the possibility of obtaining a social tax deduction. Based on Art. 219 of the Tax Code of the Russian Federation, the right to receive a tax deduction arises subject to the following conditions:
· The policyholder is an individual, a resident of the Russian Federation, with income taxable at a rate of 13%;
· VHI policy must be issued for yourself or your spouse, parents, children under the age of 18;
· Payment of the policy should not be made by the employer, but by the policyholder
· The insurer has a license to carry out this type of activity.
The social tax deduction for VHI is established in the amount of actually incurred expenses, but in aggregate no more than 120,000 rubles for all social deductions per year. The maximum amount that can be returned is 15,600 rubles, for which you need to have an official salary of at least 10,000 rubles per month.
The VHI policy can be a good helper in the matter of your health and will help you receive medical care with a higher level of service. But, unfortunately, it can not always affect the quality of medical care. In any field of activity, there are unscrupulous or low-skilled people. Such doctors can be found both in municipal clinics applying for the compulsory medical insurance policy, and in private ones working according to the VHI system. In case of minor illnesses, the function of the policy is actually a service, but in critical cases it can fulfill the initial insurance function – to provide you with financial support.