Voluntary health insurance in Ukraine

 Voluntary health insurance in Ukraine

Voluntary health insurance in the Ukrainian market is shrouded in a trail of rumors and conjectures, which are based on insufficient awareness of the population. We will help you get acquainted with the features of this insurance service and dispel some stereotypes.

So far, Ukraine has not yet matured to the widespread introduction of insurance medicine. The legal framework for this has been prepared since 2006. Since then, dozens of bills have been submitted for consideration, largely contradicting each other. The final mandatory health insurance for children and adults was to be introduced in 2015. But, times are changing, and work in this direction is not progressing quite successfully.

 

DOES A UKRAINIAN NEED HEALTH INSURANCE?

When the health insurance programs for individuals in Ukraine will become mandatory (as OSAGO is now) is still unknown, but definitely not in the next few years. After all, for this, it is necessary to carry out a deep and thorough reform of the state healthcare system and bring the quality of services provided to a decent level.

 

TYPES OF MEDICAL INSURANCE

Ukraine today offers three types of medical insurance policies:

- Voluntary medical insurance (VHI);

- Medical insurance for traveling abroad (tourist policy);

- Corporate medical insurance.

They differ both in basic services and in tariffs. The latter, in fact, is a kind of voluntary. Its meaning is that the employer, in agreement with the employees, insures them in order to pay sick leave from insurance funds.

The company's medical insurance is, as a rule, a standard package of insurance services, which can be changed at the request of the customer. In order for the entrepreneur to be able to reduce his costs for insurance of employees, several options are provided. One of them is the equity participation of the employee himself. It implies that a person pays part of the insurance premium himself, or this amount is deducted from his salary. The second option, by the way, is possible only with his additional consent.

 

Another way to reduce the cost of corporate insurance policies is through the conditions:

- Franchise - the cost of medical services below a certain amount the employee pays on his own;

- Submit on medicines - insurance with a sublimit of UAH 2000 is cheaper than unlimited, and an ordinary employee is unlikely to "get sick" for such an amount;

- Individual formation of the policy of employees - programs "Elite", "Standard" and basic, depending on the position, labor productivity, and other factors;

- Exclusion of dental insurance (will reduce the cost of the policy by another 1000 UAH).

 

HOW MUCH DOES VOLUNTARY HEALTH INSURANCE COST AND WHAT IS INCLUDED?

voluntary medical insurance policy for an individual includes:

- Treatment in a hospital, the cost of medicines, payment for a hospital stay;

- Outpatient care - medical consultations, doctor's house call, diagnostics, hospital and day hospital;

- Purchase, payment, and delivery of medicines;

- Emergency assistance - calling an ambulance, directly providing assistance, transportation, and providing the necessary drugs;

- Dental services

This scope of medical services includes max health insurance. However, fixed VHI programs practically do not exist anywhere, and for each client, they are assembled as a constructor from various individual services, which affects the cost of the policy. Therefore, your personal health insurance will include only what you cannot do without.

 

The VHI policy does not give the right to unlimited visits to narrow specialists

Medical services assumed when purchasing a VHI policy include outpatient medical care, emergency care without hospitalization, inpatient care, and dental care. The insured has the right to receive appropriate medical care at any time. However, for many clients, it comes as a surprise that there is no possibility of an appointment with a highly specialized specialist.

The patient will be referred only to the specialist whose consultation is necessary and recommended by the leading physician. The VHI agreement will specify the level of medical institutions that will accept the insured. It should also be borne in mind that the cost of a VHI policy will directly depend on the conditions for providing compensation for purchased medicines. For example, a policy with a 20% deductible for the purchase of imported medicines and a 40% deductible for visiting private clinics will cost UAH 10-11 thousand. The price of the policy without a franchise for medicines will be UAH 12,000. The absence of these franchises will raise the cost of the policy to UAH 17,000.

 

Buying a VHI insurance policy is a guarantee of quality medical services

Buying a VHI policy is not about saving money. Appointments in private clinics and the cost of medicines will be slightly different from the cost of the package of medical services offered by the VHI policy. And this is logical since insurance companies would not see a financial effect in providing such a service. The most important advantage of an insured client from an ordinary visitor to a medical institution is service support. It consists of constant monitoring of the quality of medical care provided. Even in public clinics, the insured client gets to see a doctor without a queue, accompanied by a service manager. The owner of the VHI policy is insured against unnecessary visits to specialists, from unnecessary medications, or taking any tests. The insured is guaranteed home delivery of medicines, thereby saving him from visits to pharmacies.

 

What affects the cost of health insurance?

The calculation of the cost of the policy is the result of complex formulas that include adjustment factors, franchise, limits. This is done by a specialist who makes a calculation according to the conditions of the client. Of course, the price of a VHI policy will directly depend on the class (rank) of the medical institution specified in the contract as a place for receiving insurance services.

 

Among the adjustment factors, there is also age, geographical and medical. The cost of a policy for an older person over 60 will be more expensive than for a younger client. With regard to geographical adjustments, the calculation is in accordance with regional adjustments, where the coefficient of a large city is higher than that of small cities and towns.

 

A feature of the voluntary medical insurance contract is a mandatory medical examination before the parties put their signatures on the document. It is understandable since the presence of chronic diseases in the insured will also become a factor affecting the cost of the policy. For example, the presence of gynecological or diseases of the musculoskeletal system have a coefficient of 1.25, and diseases of the gastrointestinal tract are estimated by a coefficient of 1.05.

 

To summarize, having a VHI policy is convenient, reliable, and of high quality. At the slightest indisposition, the owner of the insurance policy has the right to count on a consultation on the "hot" line, a specialist's visit to the house, or the delivery of necessary medicines.

 

MEDICAL INSURANCE FOR GOING ABROAD

So far, health insurance in Ukraine is exclusively voluntary, and you decide whether you need this policy. If you tend to get sick often, then insurance will not be superfluous for you, but if over the past couple of years you have not even suffered from a runny nose, it is unlikely that it will be useful for you. However, there is one and only case when it is impossible to do without a policy. When traveling outside Ukraine, you will need international medical insurance or the so-called "tourist policy". This is the only case where insurance is required. That is, a visa without it will simply not be given to you.

The cost of an insurance policy for traveling abroad will depend on the country to which you plan to travel. Medical insurance for a Schengen visa will cost the most. The tourist policy includes the following services:

 

- Emergency medical care and reimbursement of expenses related to illness;

- Accident insurance;

- Compensation for losses in case of trip cancellation due to a reason beyond your control;

- Luggage insurance;

- Compensation for causing harm to third parties due to your negligence.