Health at a reasonable price

How to choose a policy, if you are only "almost" fit and im gonna still use on occasion, understood D Last year, my friends suggested me to purchase insurance LCA: amassed a group of 15 people, they expected to receive from the insurer in 1910 percent discount for the "wholesale". The price for a comprehensive program offered by the insurer, at first I was interested, but when it showed her condition, enthusiasm soon diminished. Judge for yourself: even a VIP version of the cost 55 thousand rubles. on the basis of really good clinics (in addition to clinics was provided in a hospital emergency room, doctor on call at home, ambulance and dentistry) had a lot of exceptions - from single specialist advice to the restrictions on the number of different studies and therapeutic procedures. A number of them were under the dubious phrase "only in agreement with the insurance company." Unfortunately, these proposals with the mass constraints are the majority in the market - so uncomplicated way insurers protect themselves against potentially losing customers. The big difference one way to avoid buying a policy LCA with a lot of restrictions - to understand the conditions of insurance. Similar at first glance, the proposals from different insurers, providing comprehensive services in the clinic, dental and doctor on call at home, the price can vary a factor of two. For example, an integrated polyclinic based program, "he clinics in ROSNO will cost 28.5 rubles. per year, "Renaissance Insurance" - 35,9 thousand, in the Independent Insurance Group (NSG) - 15,8 thousand rubles. Program based on the medical center "Asteria" in the "Renaissance Insurance" will be offered for 19.7 thousand rubles. And in a similar configuration, but the NSG - for 12,2 thousand difference in price is explained by the same notorious restrictions, which significantly more budget options. "When we began to understand, due to which the NSG failed bid for the program is 30% lower than competitors, stumbled on this point: medical care in the home turns out to customers, who for health reasons can not apply independently to the hospital" - explains Ludmila Rostov, executive director of the agency insurance services Grandis. Today, the lower price limit at which to begin more or less suitable options policyholders LCA with integrated programs (providing for appeal to all the necessary specialists), starts from 30-50 thousand rubles. In any case, wishing to dwell on these or the more modest proposals, one should first consult with a competent consultant, than you run the risk. For example, many insurers are excluded from coverage for the treatment of chronic diseases, but argue that people with such diseases can be served by such a policy, depending on their type and condition and age. "We take into account the average baseline health status, which is characteristic of our country for this age group: after all, the majority of our citizens suffer from gastritis and other chronic diseases - explains Nina Egorkin, deputy director of the methodology and verification of health insurance IC ROSNO. - So in the presence of some standard deviations of the client will not be displayed multiplying factor because it fits into some average statistical state of health. " Includes everything that is not possible can not exclude the situation where the doctor prescribes medication, but the insurer refuses to pay for it later, because it is beyond the scope of the program. "We had one controversial case: the insurer refused to pay for treatment on the grounds that this chronic disease is one of the exceptions, - says Mikhail Kuhtar, CEO of the company" Finam Insurance ". - We agreed that the exceptions it is, but began to investigate. They looked at medical dictionary and found out that there are some signs of chronic diseases, and him, we have proved that this case has nothing to do with chronic illness, so it should be treated by the insurer. " So study the list of exceptions to the policy does not fit. So you yourself podstrahuete in case the clinic offers to pay the most for a particular service on the grounds that it is not included in your program. In the meantime, do not exclude errors: suppose I told you these professional knows from experience that on your insurer's clients usually come with such a truncated program, but because your program can be much better. "We had a precedent: the client was denied an additional diagnosis in a specialized center, but he said nothing - says Lyudmila Rostov. - Learned about it only after some time. If he immediately called his supervisor in the company, but did not discuss this topic with an expert clinic, the problem would not have arisen. " In this LCA, the principle: that it is possible to program it on. Therefore, when studying the exceptions prescribed in the agreement, sometimes without the specialist can not do. For example, few people pay attention to the breadth of dental coverage, and here most aid is limited by the degree of tooth decay (no more than 50%) in certain programs may not include preparation for prosthetics, but all insurers operate differently, and therefore lists exceptions they are quite different. Someone excludes from coverage hormonal studies, immunological, and someone they are covered by insurance. Do not overpay If you are looking for a policy of LCA, which would not be discouraged, try to offer you in terms of insurance was not at least the following five things. Firstly, because the crisis has not only become insolvent insurers, and health facilities (health facilities), the absence of contractual alternative clinics in the main event of the bankruptcy puts into question your continued service under the policy. "I recently complained to a representative of one insurance company that is one of the clinics had ceased to exist in two days. Gone is everything: the leadership, equipment and doctors," - says Michael Kuhtar. Secondly, you must be able to replace the clinic in case something you do not like. The same program on the basis of different clinics will be different: it is possible that you will need to pay the difference in value of the policy, or, conversely, it compensates you. On the basis of a large multidisciplinary clinic with modern facilities in the state where many famous professionals (doctors and candidates of sciences), the program cost will be higher than in the clinic with more modest capabilities. But this does not mean that the insured does not receive some services provided by its policy. "If you suddenly need a service that can not be provided to lower-cost clinics, patients will be hosted by another study based on the clinic - the choice of insurer, agreed with him day and time of the visit," - commented Nina Egorkin. In this case you do not even have to pay extra. Thirdly, it is better to stay on the program without quantitative restrictions on the number of specialist advice and ongoing analysis, research, since it is already psevdostrahovanie, which differs little from the non-insurance programs offered by hospitals directly (the latter to the same and cheaper). "The text of the treaty LCA found the following reservations:" The biochemical, clinical research for medical reasons more than once during the period of insurance. "That is, if the second time will need to donate blood - sorry, for the money - says Lyudmila Rostov." - Or found item a one-time visiting medical specialists (pulmonologist, cardiologist, dermatologist, etc.) - in fact, the insurer says: enough with you and the therapist. " Fourth, it is useful to draw attention to the sum insured. Because now began to meet "unique" proposal, where the sum insured is unlikely to significantly exceed the amount of contribution. "The program can be anything, but came in third or fourth time at the clinic, the man suddenly discovers that he has exhausted the limit of liability, - says Mikhail Kuhtar. - The programs that we sell are made with a stock: the limits of the insurer to clinics - about 1 million rubles., Dentistry - 500 rubles. Like a man is often not addressed - there is always enough. " Fifthly, the contract should not be mentioning the fact that the UK may raise prices during the period of its validity. Insurers, including him, trying to neutralize the increase in prices for medical services in clinics, but clients pay for it should not. Inclusion in the program option "personal physician" remains at the discretion of the insured. In some companies, clients were satisfied with this service because it allows them to quickly and conveniently receive the necessary advice, but somewhere not do without abuse. "Some" personal physicians "had only one function - to prevent you to professionals in refusing to appoint them under any pretext," - says Lyudmila Rostov.