Is it worth buying a VHI policy so as not to go broke on treatment and medicines?

2024 Author: Malcolm Clapton | [email protected]. Last modified: 2023-12-17 03:44

It is expensive to get sick, but it is not a fact that a voluntary health insurance policy will help you recover cheaper.

What is VHI and how it works

Voluntary health insurance is insurance that allows you to receive medical care in clinics that do not operate under the compulsory health insurance program. Roughly speaking, with an ordinary policy, they apply to a state clinic, with a VHI policy - to a paid one.

If compulsory insurance is regulated by law, then there is no separate document for additional. That is, each insurance company sets its own rules and decides which conditions to include in the contract.

Usually a policy is a constructor. That is, you are offered a basic service, and a set of additional ones to it. The base is the minimum service in the clinic, and the list of possible options is endless. This is a home call to a doctor, and emergency care, and dentistry, and much more.

In Russia, VHI, as a rule, is drawn up by employers; this is part of an attractive social package for employment. But is it worth it to make an additional policy if it is not at work and is not expected?

Pros of voluntary health insurance

The advantages here are the same as for paid treatment over free:

1. Service in private clinics with a higher level of comfort and technical equipment.
2. Lack of queues.
3. Quality service. This includes courteous treatment by staff and little things like free shoe covers and other disposable supplies.

In addition, the patient pays for the VHI policy once, and then the insurance company reimburses the costs to the medical institution. This approach reduces the number of unnecessary examinations and appointments that doctors sometimes do in paid centers: the insurance company simply will not approve of manipulations that are not included in the standard of treatment.

Cons of voluntary insurance

VHI has one drawback, but a huge one. It is expensive.

The VHI policy is not a subscription with a discount for visiting a hospital, but an insurance product.

It is unprofitable for the insurance company that you are sick a lot and spend all the money you paid for the policy in hospitals, so VHI has many restrictions. The final calculations are often not in the patient's favor.

What you must find out when applying for a policy

If you are thinking about buying insurance or finding a job where employees are provided with voluntary medical insurance, and you want to connect relatives to the program, be sure to clarify a number of questions:

1. List of diseases and conditions under which the policy is not issued. When preparing the article, I re-read the insurance rules of a dozen companies. And everywhere they refuse to conclude a VHI agreement with HIV carriers and cancer patients, as well as people over 65 and people with chronic diseases of the cardiovascular system. From an insurance point of view, this is not profitable.
2. Rules for contacting a medical organization. Under the terms of the contract, it may turn out that before visiting the clinic, you need to contact the insurance company, and the operator there will direct you to the doctor. And if this is not done, then the treatment will be at your expense.
3. Clinics with which the insurance organization works. The fewer the choice and the more modest the clinics, the more likely it is that doctors will not be able to carry out this or that examination or manipulation. Then you have to go elsewhere and spend your money.

In addition, carefully read all the insurance rules and the contract itself, which indicates which cases will be insured and which will not.

What the insurance does not cover

All insurers have different conditions. It is possible that it is in your contract for a certain price that there will be something that is not in other contracts. But the standard policies are the same in most cases. In addition to the already mentioned cases of HIV infection and malignant neoplasms, they do not cover the costs of:

1. Medicines. You will have to buy pills for your own money.
2. Preventive doctor visits. Let's say nothing bothers you, but you know that you need to visit a dentist and gynecologist every year or even twice a year. If you look after yourself, the doctor will confirm that you are healthy. And this appeal will not be considered an insured event. The same can be said about visiting a doctor when you need to stamp a certificate, for example.
3. Pregnancy and childbirth. These events are not considered an insured event, and insurance and clinics have separate offers for medical support of pregnancy.
4. Psychiatric care. You will talk about stress, burnout and depression with a psychotherapist for your own money.

It's easier to say when the basic policy is working: when you have something sick, you went to the doctor and recovered on an outpatient basis. Everything else, including hospitalization (in a comfortable ward), is additional chips for additional money.

How to understand whether it is worth buying a VHI policy

To find out if it is worth buying a policy, you need to do a little:

1. Calculate how much you spend on treatment.
2. Find out what service packages you need.
3. Check in which insurance companies and for what amount the policy is provided.

Last year, I spent not so much on treatment in commercial clinics and turned to help mainly for preventive examinations (in the table - rounded data, prices are relevant for my region):

Service	Cost, rub.)
Gynecologist's appointment	2 300
Analyzes and examinations	3 750
Medical manipulations and treatment	4 540
Preventive examination by the dentist	150
Professional teeth cleaning	3 000
Massotherapy	8 000
Consultation with a therapist	550
Medication	4 724
Total	27 014

A calculator from one of the insurance companies calculated that the minimum policy, which will include the services of a dentist, will cost me 35,000 rubles a year. At the same time, I will also spend money on treatment, because all prevention, according to the rules of insurance, will completely fall on my wallet. That is, massage, brushing your teeth and buying drugs - the most expensive items on my list - will remain out of insurance.

You can purchase a policy that will cover these costs as well. But its price will be sky-high - under a hundred thousand rubles.

For interest, I called two more insurance companies, where honest employees directly said that the VHI policy is unprofitable for individuals, and if I worry about the risk of injury or illness, then it is more logical to conclude an accident or illness insurance contract: it is several times cheaper …

When it makes sense to buy a VHI policy

Voluntary health insurance is beneficial in several cases:

1. With the help of your employer, you connect relatives to the insurance program on favorable terms.
2. You are ill a lot and are treated in paid clinics.
3. You have a lot of money and you want to receive medical care with maximum comfort.

If this is not your case, then leave VHI for employers who think about their subordinates, want to be attractive to cool specialists and not lose people, because they spent the whole day in the queue to the doctor because of a common cold.