What is health insurance, what services can be obtained, who pays for insurance, if a person receives it for free
Diagnostics has now achieved such success that there are practically no healthy people left. Therefore, health insurance is something that almost everyone has encountered. But not everyone understands the nuances: what is health insurance, what services can be obtained, who pays for insurance if a person receives it for free. Let’s figure it out.
Types of health insurance
There are two types of medical insurance in Russia: the first is compulsory insurance, the second is voluntary. Both types allow you to receive medical care through their programs. They differ in the volume of services, the nature of medical care, the quality of service, the variety of options that can be obtained without additional payment.
What are compulsory medical insurance and voluntary medical insurance?
If you are a citizen of the Russian Federation, then you are given the chance to use several types of health insurance programs: compulsory medical insurance and voluntary medical insurance.
- The first option is free to receive any resident of the country.
- To purchase the second option, the policyholder must conclude a contract on his own initiative or at the request of his employer.
How do compulsory medical insurance and voluntary medical insurance work
Compulsory health insurance is a compulsory type of health insurance. Of course, conditionally: if you do not issue a policy, you will not have it. Thanks to compulsory medical insurance, people living on the territory of the Russian Federation can get medical help for free. An insured event established by the legal standard is any deterioration in health. But still, in both options, there is often a need for additional costs. For example, payment of necessary drugs or funds spent on travel to a medical facility.
Differences between compulsory medical insurance and voluntary medical insurance
The quality of the services provided directly depends on the direction and qualifications of the medical institution to which you apply. In the CHI you can change the clinic no more often than once a year, in the VHI there are no such limits.
VHI implies the provision of assistance in medical institutions, the list of which is prescribed in the insurance program. As a rule, we are talking about clinics and hospitals with very good service. Everything is individual here: there is no general list, it all depends on the insurance company and what is written in your policy. LCA is more flexible and in many ways more comfortable, but not available for everyone.
What services are included in compulsory medical insurance and voluntary medical insurance
Under compulsory medical insurance, there is a minimum basic program prescribed by law, which prescribes general cases in which assistance can be obtained. For example, it is prescribed that the patient can receive help in such cases:
- infectious and parasitic diseases, with the exception of sexually transmitted diseases, tuberculosis, HIV infection, and acquired immunodeficiency syndrome;
- endocrine system diseases;
- eating disorders and metabolic disorders;
- diseases of the nervous system;
- diseases of the blood, blood-forming organs;
- certain disorders involving the immune mechanism;
- diseases of the eye and its adnexa;
- diseases of the ear and mastoid;
- diseases of the circulatory system;
- respiratory diseases;
- diseases of the digestive system;
- diseases of the genitourinary system;
- diseases of the skin and subcutaneous tissue;
- diseases of the musculoskeletal system and connective tissue;
- injury, poisoning and some other consequences of external causes;
- congenital anomalies (malformations);
- deformations and chromosomal abnormalities;
- pregnancy, childbirth, the puerperium, and abortion;
- certain conditions that occur in children during the perinatal period.
These rules establish a general framework for all regions, but the set of free services itself may differ depending on the regions.
Both compulsory medical insurance and voluntary medical insurance cover basic medical services: this is primary polyclinic care, doctor’s consultation at home, inpatient treatment, ambulance. The compulsory medical insurance also includes the help of a dentist within certain limits, but dentistry is not always included in the health insurance policy, it all depends on the program – there are policies that do not include the services of a dentist, and there are premium programs that cover almost any possible dental care – it’s a matter of the price of insurance.
The VHI may include specialized medical care, modern diagnostics, and even treatment abroad.
The cost of who pays for compulsory medical insurance and voluntary medical insurance
Everything is financed from the funds of the compulsory health insurance fund, that is, from the state treasury. Each employer is obliged to make monthly contributions to the compulsory health insurance fund – this is 5.1% of the employee’s salary. There are also fixed contributions. They are obligatory for individual entrepreneurs and some categories of self-employed. Due to this, the fund’s piggy bank is replenished, and it has the ability to pay for insurance.
In the VHI, the insurance premium is paid by the person who buys the policy or his employer (here we can talk about both full and partial compensation of the cost of the VHI policy as a bonus).
Pros and cons of compulsory medical insurance and voluntary medical insurance
- If a person pays for VHI on their own, then they can choose an insurance program based on their needs and capabilities.
- With a VHI policy, it is easier to get high-quality and highly qualified service. The clinics often provide excellent service.
- The holder of the VHI policy in most cases (except, perhaps, for the coronavirus, where VHI does not give any special advantages in practice) will be placed not in the nearest medical institution, but in the one that he chose himself, or in the one that has concluded an agreement with the insurance company.
- There are fewer opportunities for maneuver under compulsory medical insurance, because, ideally, to be attached to the clinic at the place of residence. This is not a requirement, but if you need help at home from a local doctor, it is important to attach it to a nearby clinic. The Potential Free Help Package is one for everyone.
- There are no such restrictions in the VHI: you can be served at least in all polyclinics that are included in your policy within the agreed package of services, and doctors can come to the other end of the city if you complained about your temperature. But, of course, a lot depends on the situation and conditions of the program.
- There is also an unobvious minus of VHI: if you have insurance with a minimum set of medical care (the most budgetary policy), coming to a private clinic, you may face serious costs or, feeling uncomfortable, you will have to look for other doctors – perhaps even under a policy OMS.
- The compulsory medical insurance policy can be obtained for free, even if you do not officially work.
- VHI policy is not a cheap pleasure. Not all employers are ready to pay such a bonus.
Medical insurance for traveling abroad (travelers)
A policy for traveling abroad is a contract with an insurance company, which guarantees that a person will be provided with the necessary assistance in the event of an insured event. Often, the presence of such a policy is a prerequisite for obtaining a visa, since the host country wants to have guarantees that a traveler without money will not get into an unpleasant situation when he is unable to pay for himself in the hospital. In the basic version, travel insurance is a medical policy that provides emergency and other medical care.
As a rule, the insurance includes:
- emergency medical and dental care,
- use of the necessary medical equipment,
- medical transportation,
- transportation of remains,
- return from a trip.
But many situations are not included in the insurance: you need to study the conditions of a specific offer from the insurance even before the trip in order to understand what you have the right to count on. For example, an important point is the exacerbation of chronic diseases. It is not always found, but it is better than it was.
The policy for traveling abroad often provides for a franchise, but nevertheless allows you to receive medical care for a fairly substantial amount.
But if, for example, a trip involves outdoor activities or sports, you will need to pay extra for the risks of possible injuries.
The policy can be issued both for the dates of one trip and for multiple entries or for a whole year. Read about how you can save on travel insurance in a separate article.