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How does health insurance work?

In this article we will guide you how does health insurance work and how you can apply for that.

The essence of medical insurance is that a person who buys an annual policy, upon the occurrence of an insured event (illness or injury), gets the right to free and extraordinary medical care within the framework of the budgets and the list of services that are provided for them. The budgets themselves, the list of services, the level of hospitals and clinics depend on the specific insurer, the price of the policy, as well as the age and state of human health. Roughly speaking, the younger and healthier you are, the cheaper the insurance will cost. As a rule, it guarantees inpatient (treatment in a hospital), outpatient (call a doctor at home), emergency (ambulance departure) assistance, payment and delivery of medicines. Insurance can cover the cost of treatment in whole or in part. If the insured is ill, he needs to call the insurance call center and explain the essence of the problem.

The client will be refused insurance if he has:

  • disability;
  • congenital diseases;
  • disease window
  • diabetes;
  • tuberculosis;
  • HIV
  • chronic renal failure;
  • drug or alcohol addiction.

Depending on the specific IC, the “forbidden” list may change, but not significantly.

In most countries, compulsory health insurance exists when a person is insured by the state or the employer, and the cost of the policy is deducted from the state budget or his salary. Our health insurance is purely voluntary. And you will have to pay for it either yourself, or the employer will do it for you if he considers it necessary.

How did I choose insurance

Alas, I do not have corporate insurance. Therefore, I searched for a policy myself. The “dental package” was decisive for me. I was interested in both planned (prophylactic) and unplanned (sudden toothache) treatment, as well as dental prosthetics. I called the top ten companies – leader rating in the field of health insurance. As it turned out, most of them do not insure individuals and only works with the corporate sector. Only three insurance companies offered individual insurance. In each of them, I considered two policies. The first is the recommendation of the insurance agent based on my wishes for services and price. The second is the policy with the highest limit on dentistry. Here is what came of it.

Terms of registration

To obtain insurance, you need a passport and identification code. To sign the contract you will have to fill out a declaration of health. This is a questionnaire in which you need to answer several questions in detail: indicate the diseases that you previously had, chronic ailments and disabilities, if any, etc. At the same time, consultants recommend not to be cunning, since at the very first insured event the examination will show the patient’s real state. Any indicated untruth may become a reason for the non-payment of compensation for insurance treatment.

The policy takes effect 14 days after signing, but you can agree on an earlier “activation”. The company works with both private and public hospitals and pharmacies. The level of the facility depends on the class of policy. There can be seven of them in the “Provident” for individuals. The cheapest works only with state and departmental hospitals, private clinics appear in the Elite, and VIP guarantees the services of even branded commercial clinics (such as Boris, Dobrobut, etc.). When treating in partner hospitals, the limit covers the full cost of treatment within the limit, in the rest – half. In private clinics and laboratories, a franchise of 25% to 75% is possible. An up-to-date list of partners with the size of payment and interest of franchises is sent by the manager upon request. Medicines can be issued for free only at the network of partner pharmacies, and those drugs that fall under the exception will have to be purchased on their own. Change the clinic or the doctor, if suddenly you are not satisfied with his qualifications, or, for example, he will be a boor, you can call the call center.

Insured events are:

  • acute diseases that threaten health and life;
  • chronic diseases (up to 3 exacerbations per year);
  • accidents arising out of no fault of the client;
  • unscheduled surgical intervention (if an operation is necessary in case of a chronic disease or accident).

The list of exclusions from insurance cases is longer – 2 sheets of A4 12 font. In short: insurance does not cover all cosmetic, preventive, and non-traditional, as well as planned surgical interventions, orthodontics, and prosthetics. If this rule is applied to dentistry, then insurance does not cover preventive brushing, teeth whitening, installation of crowns and braces, as well as consultations with doctors on these issues.

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