DMS insurance - what it is and the cost of voluntary health insurance

Voluntary Medical Insurance (DMS) - This is a form of personal or independent insurance. It allows you to use medical services in specialized medical and preventive institutions, private clinics or in state and semi-state clinics that provide services on a paid basis (depending on the package of selected services).

The object in this case of insurance is not the health of the patient, but the cost of its treatment. Therefore, DMS makes it possible a partial or complete reimbursement of medical care expenditures. About what is a PMC policy will be discussed in our article. Medical supplies

Main species

DMS has two forms depending on the number of insured persons:

  1. Private or individual DMS. It is drawn up by an individual for himself and / or for each individual member of his family. Such a PMD policy provides a wider range of services provided, including accident insurance.
    • Additional private DMS (partially covers the costs for the services that are included in the Mandatory Medical Insurance Program).
    • Independent private DMS (fully covers the costs of services provided by OMS).
  2. Collective or corporate DMS. Insurance for legal entities. It is drawn up by the employer for its employees.

Who has the right to issue

Any physical or legal person who is capable has the right to receive the PMC policy. Citizens of the Russian Federation or foreign citizens can act as insured, and individuals of national citizenship.

Insured people act as separate capabilities and organizations representing their interests.

Who can refuse

Refusal to receive the PMC policy may concern those recognized as incapable. As well as persons suffering from diseases, for the treatment of which means from the state budget - sarcoidosis, tuberculosis, mental and venereal diseases, especially dangerous infections (typhus, plague, Siberian ulcers, natural suite, etc.), requiring quarantine events and oncological patients (with The moment of diagnosis).

Advantages and disadvantages

For a private person:

  1. The insured gets freedom of choice, i.e. the possibility of independent choice of clinic, specialist and offered services.
  2. Holder of the PMC Polis saves its time to receive high-end medical services without standing in queues.
  3. The presence of a paid PMC policy for the entire period insures from increasing tariffs for medical institutions.
  4. The insurance company itself deals with the settlement of claims arising from the patient to a medical institution during the period of insurance.
  5. Ability to recording to doctors in on-line mode.
  6. The disadvantage of this type of health insurance for some individuals can be a high price.

For an employer:

  1. This form of insurance increases the loyalty of employees to their enterprise and the head of the enterprise.
  2. Motivation staff.
  3. The possibility of clear accounting of medical expenses appears.
  4. The possibility of independent inclusion in the policy of certain services.
  5. The possibility of early closure of the policy in the event of the employee's dismissal.
  6. The company providing free PMC policies to employees has a competitive advantage.
  7. Reducing the tax base.
  8. The disadvantages of the acquisition of this type of insurance is the need for scrupulusity when concluding contracts, additional work for accounting and high price.

Cash bills

Standard Package Program

Ambulatory treatment

Questions of diagnosis and treatment are engaged in a certain specialist who operates as part of the services:

  • Electroencephalography.
  • Diagnosis of blood circulation by the RVG method.
  • Electrocardiography, including VEM and ECG registration for a long time.
  • X-ray, including tomography.
  • Endoscopic studies.
  • Ultrasound.
  • Laboratory studies (analyzes).

Medical, consulting and diagnostic techniques for doctors

The program includes assistance for the main specialties: cardiology, therapy, pulmonology (except tuberculosis and oncological patients), pediatrics, neurology, urology, proctology, gastroenterology, rheumatology, surgery, endocrinology, obstetrics and gynecology, orthopedics, orthopedics, orthopedics.

Emergency (emergency) medical care

Emergency care is guaranteed by the insurer 24 hours a day. The need to provide this service arises in situations threatening life.

Ambulance includes:

  • Departure Brigade in the call place;
  • medical examination and help;
  • Accelerated laboratory survey (if necessary);
  • Emergency support for the necessary medical manipulations;
  • Transportation of a patient to the hospital.

Hospitalization (emergency and planned)

The need for hospitalization is determined by the attending physician. A specialist can be a representative of the clinic in which the patient is treated, an ambulance worker. The doctor may also be provided by the insurer.

The attending physician also defines the necessary healing and diagnostic manipulations within the next list of services.

Lab analyzes conducted for diagnostic purposes:

  • clinical;
  • bacteriological;
  • immunological;
  • hormonal;
  • biochemical;
  • serological ones.

Other studies for the purpose of diagnostics:

  • radioisotope diagnostic methods;
  • radiography;
  • study on a computed tomograph;
  • radioscopy (including surgical);
  • Functional diagnostics (including ultrasound).

If the insured was hospitalized to the institution, which does not apply to the Agreement, it can be redirected to a hospital, which has an agreement with the insurer.

This operation is carried out taking into account the wishes and the overall condition of the patient. In this case, all costs associated with the transportation of the patient are paid by the insurer.

Sanatorium-resort or rehabilitation and reducing treatment

The program comes into force if there is a fact that the disease is transferred to a disease that is included in the list of insured events. This type of treatment is carried out in sanatoriums, waterproofs, physical scientific dispensaries, clinics of reducing treatment, rehabilitation centers.

Medical services provided:

  • Physiotherapeutic treatment (treatment with a laser, ultrasound, magnetic fields, EHF, electrical treatment, electrosone, treatment in the barocamera, etc.);
  • LFK;
  • Treatment of herbs (phytotherapy);
  • Hirudotherapy;
  • massage;
  • Balnesehese;
  • Medical swimming;
  • thalassotherapy;
  • mud;
  • homeopathic treatment;
  • manual therapy;
  • postzymometric relaxation (feast);
  • Dietecé and hunger treatment.

Family (Personal) attending physician

Therapeutic and outpatient assistance in the base program of the DMS can be carried out at home or in the clinic. These services are assigned to the (personal) physician of the treatment of therapy.

  • implementation of observation and treatment with a personal doctor in case of exacerbation of chronic and emergence of acute diseases in outpatient polyclinical conditions;
  • therapeutic and diagnostic manipulations carried out by a personal doctor at home with the involvement of specialists for advice (if necessary);
  • diagnosis and treatment according to the appointment of a personal doctor;
  • physiotherapy, leafc, massage;
  • obtaining the help of other specialists in the direction of the family (personal) attending physician;
  • making hospital documentation (history, hospital sheets, certificates, extracts);
  • Hospitalization in the event of indications with the patronage of the family doctor during the patient's stay in the hospital.

Stomatology

The insurance contract may be ensured by the provision of dental care. Institutions for the provision of services are also provided for by the Treaty:

  • Diagnosis, outpatient polyclinic dental services (consultations, x-rays, etc.);
  • Therapeutic and surgical manipulations;
  • Orthodontic and paradontological dentistry;
  • implementation of the prosthetics procedure (including preparation);
  • Other services conducted under medical testimony.

Each Insurance Company works with different DMS programs.

Therefore, the list of guarantees provided may differ. But in any case, medical insurance can be basic or optional. The main covers the costs for the provision of medical care on the testimony necessary for life. Additional covers the cost of services accompanying the main treatment: prosthetics, dental maintenance, etc.

What is not an insured event

Services provided are limited to the framework of the Voluntary Medical Insurance Treaty. Insurance cases and exceptions should be clearly spelled out in the contract or in the policy.

The following situations are not provided for by the Insurance Treaty:

  • diseases and injuries resulting from alcohol or narcotic intoxication, with toxic toxic agents and other psychoactive substances;
  • injury and pathological conditions that occurred due to the insured against unlawful actions;
  • Intentional causing injuries and injured by the insured face, suicide attempts.

Also is not an insurance case, the treatment of a patient with damage obtained in the following circumstances:

  • radioactive infection, effects of radiation as a result of a nuclear explosion;
  • injuries and diseases obtained in hostilities, military maneuvers and other military events;
  • injury, injury, diseases received during the civil war, folk unrest, strikes;
  • Injuries, loss of health with hurricanes, storms and other natural disasters.

Validity

Voluntary health insurance contract is any term, but not less 1 month . But at the current tradition, insurance companies conclude agreements for a period of 1 year. Payment of medical insurance is performed at the same time. During the period of insurance, the list of services is not subject to change.

DMS DMS from OMS

Voluntary medical insurance - Presentation of personal insurance. It, in particular, makes it possible to receive assistance in medical institutions (LPU), not working under the CHA program.

Mandatory Medical Insurance (OMS) - the type of compulsory social insurance, which is a system of legal, economic and organizational measures created by the state, upon the occurrence of the insured event, the guarantees of free provision of medical care at the expense of compulsory medical insurance within the territorial program of compulsory medical insurance and in cases established by federal law within the basic compulsory health insurance program.

Main differences:

  • DMS is a personal choice of the patient, while the OMS is mandatory for the population.
  • The conditions of DMS are determined by insurance companies, in the case of OMS, they are determined by the state.
  • The PMD policy provides a wider list of medical services provided than the CHI policy.
  • The DMS makes it possible to independently choose the clinic, while patients with OMS receive medical care in institutions attached to their place of residence.
  • DMS allows you to independently choose insurance programs, OMS programs are determined by the state.

How the contract is issued

Usually, the parties signed by this Treaty are the Insured (Enterprise) and the Insurer (insurance company).

It indicates:

  • Insurance amount - money that the insurer pays to the insured when an insured event comes;
  • Insurance premium - the costs that the insured is in front of the insurer;
  • Insured persons (employees), insurance cases and risks - with an exhaustive transfer of all assistance conditions, up to restrictions on the age of the employee;
  • The deadline for the start of the contract (either from the date of signing or from a certain date).

In addition to those mentioned earlier, there are the following features of tax accounting of expenses for medical insurance staff (Art. 272 ​​of the Tax Code of the Russian Federation):

  • The insurance premium is taken into account in the reporting period, for which he was made;
  • If the contract states that the contribution is made at the same time, then if the contract is valid for longer than one reporting period, costs are distributed evenly.

Insurance contributions for the DMS system are not involved in the formation of tax on the income of individuals. This also applies to cases when members of the insured families use medical care.

Also, the costs of DMS agreements for more than 1 year are not subject to contributions to the OSS (compulsory social insurance).

Cost of the Polis

Prices vary depending on the set of services, quality of service and destination. The simplest and inexpensive types of DMS provide service in a good clinic, but does not include complex diagnostic methods, for example, tomography.

If you wish, you can only get a package for the provision of only emergency medical care, for example, in injuries as a result of an accident. Approximate value 8000 rubles .

Extended programs It will be more expensive, they include services of doctors (including surrenders) at home and in the clinic, stationary, urgent and dental care. The full DMS program applies to persons abroad. approximate cost 12000 rubles .

The most expensive types of DMS Provide treatment in foreign medical clinics. Annual contribution to the conclusion of the contract for this program is calculated Thousands of dollars .

So, the acquisition of the Voluntary Medical Insurance Policy is a profitable alternative to obtaining medical services under the Mandatory Medical Insurance Program.

The insurance procedure applies to both one person and for a whole family. This type of insurance includes a wider range of high-quality services. When choosing this type of insurance, an important point is the choice of an insurance company. Pay attention to its rating, reputation, customer reviews.

Photo: Mystrahovki.ru.
Photo: Mystrahovki.ru.

DMS is deciphered as voluntary medical insurance. It differs from the mandatory in what guarantees the presentation of additional medical services (private medical centers, individual chambers, etc.), which are fully paid for the insurance company. This insurance allows you to select the type of insurance program. Let's deal with together what DMS is, and what is his advantages.

What is DMS?

In this abbreviation, the value has every word, so we will analyze them individually, starting from the end.

Insurance. DMS is the financial service of large insurance enterprises or companies. Tens of thousands of insured organizations make minor contributions to the General Fund. If an insured event occurs at one of the clients, the company makes payments proportionate to helping expenses.

Imagine the situation: 1000 people invested 1000 rubles to the General Insurance Fund. As a result, the Foundation will be 1,000,000 rubles. One person from a thousand demanded a doctor's services to which he spent 30,000 rubles. Insurance company covers these costs and 970 thousand remains in the fund.

DMS applies to situations that are associated with human health. If the client fell ill, he will be able to apply to the hospital in a short time, to surveys and get the necessary assistance without serious costs. In case, in the time of the policy, there will be no health problems with health, the funds will remain in the account and will help those who are less fortunate.

Insurance rather can be attributed to financial services, and not to medical. Medical services have hospitals, and the insurance company simply covers their cost. There are situations where you yourself pay for treatment, and the insurance company translates you to the money.

Medical. There are many companies engaged in health and life insurance companies in the service sector: from damage, injury, diseases, accidents and death. Usually they pay a fixed amount of money, which should cover the treatment, but most often, this money is not enough even for analyzes. All problems with the search for the desired clinic and the doctor will have to be solved on their own.

DMS acts otherwise. The company concludes a contract with specific clinics so that the owners of the policy receive services out of turn and without any problems. A person should not worry about money and issues that are not directly related to the disease. He must come to the hospital with his problem and leave, successfully solving it.

Voluntary . In the Russian Federation, there is a so-called compulsory insurance . It applies to all citizens. Executions B. OMS Foundation Performed by all employers, it will not work out. The rules are the same for all citizens, only lists of services and the amount of payments are distinguished, depending on the registration site.

DMS fully voluntary service. There is a desire - get the policy. No - Your right. Fully private enterprise with individual conditions on any request.

There are employers who draw out the staff of the DMS within the framework of the employment contract. This does not cancel the voluntary basis of the program. Decor insurance is the right to company, but it is not a duty.

If you have a question for a lawyer, ask it in the form:

Companies are also issued by DMS Polis not any person. They evaluate all risk factors, the history of the disease, and, if they do not refuse to conclude a contract, the price is artificially awake.

DMS DMS from OMS

Voluntary medical insurance has a large number of differences from the mandatory, which is established by the legislation of the Russian Federation.

In the framework of compulsory insurance, all citizens receive Medical Policy giving the right to a specific list of services. It enshrines a particular clinic for people at the place of registration, a precinct therapist and the possibility of treatment in the hospital ward, having received inexpensive medicines. Or opportunity to get mediocre dental treatment , defending a huge queue.

It happens that a citizen with a policy of the OMS manages to obtain proper and high-quality treatment, stuffing the queue that can last for several years. Due to the fact that the list of guarantees that our state provides is relatively small, there is a need for everything to pay extra: spend money on expensive medicines, pay extra doctors from private clinics, because the precinct is sick, sitting on vacation or is simply not interested in your treatment.

DMS Polis will save from these problems, because you can be treated in that hospital that you are better suited to pass the surveys on modern technique, communicating with benevolent staff and do not worry that you will cover with obscene brand, if suddenly the Soviet ECG apparatus suddenly fail.

About paying for certain types of services you will be ignited before the conclusion of the contract, and you decide how much it is profitable for you and conveniently.

Subjects of DMS.

Photo: Mystrahovki.ru.
Photo: Mystrahovki.ru.

The main subjects of the DMS system are:

  • The insured is the one who concludes a contract and receives the PMC policy. The insured can be any citizen of the Russian Federation, a legal or individual / company.
  • The insured person is a person who enjoys the services of DMS (the insured or other physical person. A person in respect of whom the contract was concluded). You can become any citizen of Russia or another country.
  • The insurer is a company that has received a license for providing such services.
  • Medical organization - a licensed clinic, having powers to provide such services and concluded an agreement with the insurer

Principle of operation of the DMS system

To obtain the policy you need to take a passport, come to the insurance company and write a written application. In some cases, the surcharge and additional medical examination will be proposed.

Upon the occurrence of the insured event, you should contact the organization with which the contract is concluded. It will fulfill all the necessary assistance measures, including the provision of the Brigade of Doctors.

Of course, in emergency situations you should call an ambulance on the general phone - 112.

After hospitalization, refer to your insurer, name the number and address of the hospital so that it will have a positive effect on the conditions of treatment and paid drugs.

Obtaining medical care in the PMS policy is true:

  • visit the doctor and receiving areas for the required surveys and analyzes;
  • appeal to the insurer and the provision of received areas;
  • coordination of the place and time of obtaining medical services;
  • Obtaining medical services.

When performing these conditions, all expenses covers the insurance company. They are limited to the amount specified in the DMS contract, and those services that are included in the individual policy.

Financing DMS.

Voluntary medical insurance is funded, as any other insurance system. Poland owners make contributions during the entire period of their action or pay the whole amount of it, when concluding the contract.

Insurance company, in the fund of which contains invested funds, has the right to dispose of them by investing into any financial structures, such as securities. The resulting interest from investments go to pay for DMS services or are profit of the company.

How to use DMS.

If you already have a policy, the services of an insurance company can be obtained in two ways.

Direct access. The client receives a list of a polyclinic from the policyholder, where you can undergo a survey and treatment on the PMS policy. The insured may simply contact the address, without the prior notice of the company.

Call insurer. Before visiting a medical institution, the client needs to call the 24-hour telephone of his insurance company. He will receive an answer from the operator about the possibility of providing medical services. As a rule, operators work people having medical education.

They analyze the complaints of the insured client, are looking for the necessary institution, accounting for the calculation, which services received by the applied client. If the list of services is covered by acting insurance, the operator refers to the clinic with the accompanying warranty letter, in which it swings to pay all the necessary costs.

It is very convenient if the client infrequently visits the hospital or he needs help outside working time when the closures are closed. Operators own all information about working hours of hospitals, quality of medical services, prices, and can direct you in place with the most suitable query.

If you have problems or some kind of legal difficulties, you can always ask for help by calling a free number: 8 (495) 877-46-44.

Types of voluntary health insurance

There are various types and classifications of the DMS. Let's figure it out in the main.

In relation to the system of compulsory medical insurance:

  • replacing - Apply instead of fixed insurance. Clients who do not participate in the obligatory insurance due to high revenues, self-employed and non-official citizens, as well as people who, for one reason or another, do not have a state-of-state sample policy.
  • parallel - Used to receive medical services that are not provided for by the CHA program or require additional financial and time costs. To their number, many dentists services can be attributed, visiting sanatoriums, rehabilitation courses, treating individual drugs and much more.
  • Expanded - It is possible to partially replace those services that are provided with mandatory insurance, but at a higher and high-quality level. For example, improved meals and a comfortable chamber with hospitalization. A visit to specialists takes place not only in the district polyclinic, but also in other organizations included in the list specified in the contract. A visit occurs out of turn.

The form and method of paying the range of services that the DMS system provides:

  • Compensation DMS. - The client fully pays for all the necessary services, after which there is a certificate and checks of the insurance company, and it compensates for the costs. This insurance is often used by people with a high income, which have the necessary means for independent payment of treatment. And the compensation level is so high due to major contributions to the insurer fund from the Employer Company on the DMS system.
  • Returnable DMS. - The policyholder is one-time pays the amount specified in the contract, and after, if one of the insured events arises, the money will take away from there. The remnants will be returned to the client after the expiration of the contract, minus a small percentage as a premium of the insurance company. It is quite rare, because such relationships are almost unable to the insured.
  • Non-return DMS - If the amount of insurance premiums still has not dried, but was used with insured cases, the refund does not occur. This is a common practice for modern insurance companies. In it, the main principle and the essence of insurance is the difference in the payment of policyholders at the same payment of the same service.

What is the standard DMS programs

Many people perceive DMS as a unlimited pass to the private clinic, as if the subscription to the city library. Of course, there are also such programs, but they do not have relation to insurance, but rather carry a private character as comprehensive offers of individual clinics.

DMS is an insurance program with a sudden illness: cold, poisoning, accident, and so on.

In most part programs, the DMS is not a regular visit to the doctor, receiving certificates for the employer or driver's license. There are three categories of DMS and depends on the list of services that a citizen can get. Types of categories:

  • basic;
  • extended;
  • Full category.

Basic category DMS - the price of 20,000 rubles

This is a list of services that corresponds to the list presented with OMS, but differs in high quality and reliability:

  • Outpatient or inpatient treatment as in the state clinic, but without queue.
  • Ambulance for private basis and call a personal doctor to the house. Limited number of calls per month.
  • Consultation of narrow specialists. But the list of doctors is incomplete, for example, may not be a dermatologist.
  • Surveys and analyzes. X-ray, blood test, ultrasound. In the amount of up to 10 procedures per year.
  • Physiosocations: Magnetotherapy, Medical Massage and Inhalation. Also up to 10 procedures per year.
  • Hospitalization in private clinics and the most comfortable state clinics chambers in the event of an emergency need for operating, threat of life. For example, appendicitis.
  • Payment of medicines appointed by the doctor during hospitalization.
  • Dentistry: hygiene, treatment, anesthesia and prevention.
  • Hospital sheets for the employer.

Extended category DMS. Price from 50 000 rubles

All services of the basic insurance program and additionally:

  • The ability to be treated in certain mid-class clinics or an extended list of medical institutions agreed with the contract of owner of the DMS.
  • Unlimited opportunity to do analyzes, with the exception of high-tech costly types.
  • Unlimited opportunity to make physiothereders.
  • A wide list of additional specialists of a narrow direction, which can be surveyed and treatment. For example, a dermatologist, a mammologist or a proctologist.
  • Planned hospitalization and receipt of the necessary procedures or surveys, on average for a period of 10 to 15 days.
  • Additional insurance for a period of business trips or tourist travel.
  • Influenza vaccination.
  • The ability to receive personal care services and the right to receive advice by phone at any time of the day.
  • Planned medical examinations to identify risk and disease factors.
  • Sanatorium-resort treatment in recreation homes, with which the insurance company has been concluded.

Full category DMS Price from 100 000 rubles

All services that provide basic and extended insurance of DMS and an additional service package, which includes:

  • The opportunity to be treated in expensive private clinics and government agencies with a high reputation.
  • High-quality expensive tests, right up to tomography.
  • Hospitalization in the chamber of the Lux Class, both on scheduled procedures and in cases of emergency.
  • High-level dentistry. Starting from whitening to prosthetics or implantation.
  • Taking birth, preservation and full pregnancy.
  • Help psychotherapist - examination, treatment, extract and payment of drugs.
  • The possibility of treatment and diagnosis in expensive foreign medical centers.
All conditions are indicative. Insurance company has the right to add or eliminate services from the general list, and in some cases, in general, to deny the contract and issuing the policy.

There is no single sample contract for DMS. Each company has the right to dictate its conditions and form a list at its discretion, so carefully read the contract and specify the nuances from the employee of the company. Before paying the policy, re-read all the apps. All conditions are written in them, in what cases you can get payments, and in which it will be denied.

If you have problems or some difficulties of a legal nature, you can always call a toll-free number: 8 (495) 877-46-44.

But we can safely assure that high competition and customer loyalty do not allow insurance companies to overestimate prices and reduce the quality of services. You can always spend a sign equals between the price and quality of help. And in some cases, the quality is even higher.

Types of DMS in detail

Any insurance case has its own list of medical or preventive services. The insured companies themselves also have differences in the form of the price difference and the list of procedures.

Ambulatory treatment

An outpatient treatment consists of the following items:

  • Reception and examination by the therapist.
  • Reception and examination by the doctors of narrow specializations.
  • Reception, examination and treatment in the medical center or clinic, hospital.
  • Reception, analyzes and surveys in specialized laboratories.
The list of services depends on the type and value of the Voluntary Medical Insurance Policy and may vary in private.

Also in this list includes certain diagnostic procedures that are performed in the outpatient conditions:

  • functional diagnostics;
  • MRI;
  • radiation diagnosis;
  • complete blood test;
  • ECG;
  • fluorography.

The list also modifies depending on the terms of the concluded contract. In the list of outpatient care services, preventive inspections may additionally be provided. Both preliminary and systematic.

Emergency medical care

Emergency assistance includes:

  • Departure of emergency ambulance brigade. Takes up to the highest possible time.
  • First aid during diseases and injuries, a full course of treatment and surveys.
  • Full course of laboratory tests and diagnostics, without a queue.
  • First aid in place. Qualified doctors will provide first aid urgently right at the place of departure. For all owners of the DMS.
  • Fast transportation to the hospital if there are appropriate testimony at the time of treatment for help.

Hospital treatment

The decision on hospitalization depends on the hospital's attending physician with which the DMS contract was concluded.

The list of stationary services included in the DMS consists of the following positions:

  • Consultation of a specialized physician according to your disease.
  • Diagnosis and examination of the disease. All types of laboratory tests: clinical, biochemical, bacteriological, hormonal, serological and many others.
  • Functional diagnostics, ECG, ultrasound, FKG, tomography, x-ray and many others.
  • Necessary surgical intervention in the hospital provided by the DMS.
  • Physiotherapy.
  • Necessary drugs, depending on the disease.
The volume of material assistance is determined individually, depending on the situation that has arisen and the necessary costs.

If the state ambulance took the patient to a hospital, not falling into the jurisdiction of the DMS, it can be transported to another institution, depending on the state of health. Transportation costs are covered by an insurance company from the total cash fund.

Spa Treatment and Medical Rehabilitation

Rehabilitation from the effects of diseases or injuries can also be provided by the DMS package. Certain events are recommended by the attending physician and are checked by a medical expert in an insurance company. A list of necessary services is also appointed, in accordance with the contract concluded.

This list of therapeutic and health services can be included:

  • Stay and receiving medical services in rehabilitation centers, sanatoriums, pre-satellite, dispensaries or waterproofs.
  • Physiotherapy, Garocamera, Magnet, Laser, Electronicone and many other procedures.
  • Full course of therapeutic physical education.
  • All types of massage, from general to narrow, on a certain recommendation of the attending physician.
  • Mud bathrooms, salt chambers, drainage.
  • Homeopathy for rehabilitation after long-term diseases or injuries.
  • Manual therapy.
  • Diets and personal food courses in the framework of a sanatorium stay.
  • Other types of medical rehabilitation.

Provision of dental care services

The dental care package may include various services, their presence depends on the type of concluding contract. Usually the package contains the following types of procedures and rehabilitation practices:

  • consultation and preventive inspection of a dentist specialist;
  • preliminary inspection, diagnosis and x-ray of the oral cavity;
  • Restoration and removal of teeth / dentures of any degree of complexity;
  • Preparing for prosthetics and installation of prostheses;
  • Services of the orthodontist for bite correction;
  • periodontol services for the treatment of jaw tissue inflammation;
  • aesthetic dentistry for medical testimony (recovery after jaw injuries and other situations);
  • Other services prescribed by the Treaty and recommended by the attending physician.

Family treatment services by a doctor

Represents standard therapeutic assistance. When using OMS with this, many problems may arise. For example, queues, no doctor, chaotic movement between cabinets, strong bureaucracy at low qualifications of doctors. The Voluntary Insurance Program provides a chance to use the help of a personal therapist and receive the following list of services as part of the policy.

  • Regular monitoring of the patient's health at any convenient time to visit.
  • Outpatient conditions are treated on sharp and chronic diseases. Treatment is carried out without a queue.
  • The possibility of conducting many procedures (including analyzes) at home with a challenge of relevant specialists.
  • It is possible to pass the healing physical culture, a massage course and physiotherapy. To any convenient time for the holder time.
  • Narrow specialists are involved in consulting if necessary.
  • Full reporting and the entire list of necessary medical records.
  • Depending on the indications, hospitalization is made out of turn. There is also a long-term observation by a personal therapist, the entire period of treatment in the hospital.
Depending on the type of policy, individual services and procedures may be provided. Contents in the Paid Chamber of the Institution, coverage of the treatment costs, the provision of services of foreign clinics and other types of services.

What is not included in the policy of DMS

DMS can cover and compensate far from all types of expenses.

Chronic diseases

If a person at the time of filing the statement is already sick for a long time and expects a long-term treatment, the company can generally refuse him to grant the DMS policy, as it will be too expensive and unprofitable. Here is a list of some problems that are not solved by voluntary insurance:

  • Most of the oncological diseases.
  • Serious infectious diseases: smallpox, tuberculosis, cholera, plague.
  • Venereal diseases.
  • An acquired immune deficit (AIDS) syndrome.
  • Diabetes.
  • Mental deviations and diseases.
  • Hepatitis.
  • Congenital diseases.
  • Diseases associated with pregnancy and its flow.
  • Infertility / impotence.
In DMS, chronic diseases are treated only in the stages of exacerbation, when there is a risk of a real threat to life. But to pass inspections to avoid this risk, the DMS will definitely not be released in the system.

If the client is diagnosed with diabetes, hepatitis or cancer already during the period of operation of the DMS, the insurance company will cover all the necessary procedures until the diagnosis is confirmed. Further treatment of a citizen will pay independently.

All that is not included in the contract

If the medium of the policy causes a private ambulance brigade for a person who does not participate in the DMS system or will miss the appointed visit to the doctor, the company will require compensate all costs.

Insurance company in any case will not pay the treatment that was not appointed by the doctor. When self-medication and independent purchase of drugs, insurance will not cover the costs either.

The insurance company will also not pay if the client appeals to the institution that is not included in the list provided by the DMS, or execute the procedure not prescribed insurance program.

To avoid misunderstandings, it is recommended to immediately contact the insurer and clarify which services are included in the Voluntary Insurance Systems List. In general, if any controversial issues and misunderstandings occur, call the insurance company and check everything.

Medical services in other cities

The place of action of the PMS policy is limited by the city, which is listed in the initial contract. Therefore, just to go and be treated in another city, while covering costs with the help of DMS, most likely will not come out.

There are insurance companies that sometimes in the form of a bonus provide the owners of the PMC policy of emergency services. Of course, it's just marketing and advertising. Legislation obliges emergency assistance throughout the Russian Federation.

Aesthetics question

As a rule, the DMS package does not include cosmetology procedures related to the change in appearance. And the psychiatrist assistance is provided only with full package of voluntary insurance.

You can also use the services of an ophthalmologist, when the cataract is formed. But it will not be possible to correct vision on the DMS. Since myopia or hyperopia is not considered a disease.

Consequences of drinking alcohol or suicide attempt

No insurance company will pay treatment for injuries or poisoning, if it is proved that they are obtained in alcohol or narcotic intoxication.

Also, DMS will not cover the cost of treatment after deliberate damage to his health or suicide attempts.

Insurance also does not cover the treatment in the following situations:

  • as a result of radiation irradiation;
  • as a result of hostilities, scuffle or folk unrest;
  • terrorist acts;
  • natural Disasters;
  • As a result of other emergencies.

Who has the right to issue a PMD policy?

Any citizen of the Russian Federation, independently or with the help of the employer, can arrange a policy of voluntary health insurance.

Collective registration of DMS.

Before concluding the contract, the problem of finding an insurer who is suitable is better. The employer must necessarily issue an order for the procedure, develop a position on the DMS and conclude an agreement with the company's employees. Employees should be refused to read the contract before agreeing on its terms.

Individual design DMS.

For all citizens there is an age limit. Policy can be obtained from 18 to 75 years. A number of reasons in which the insurer may refuse to conclude a contract, we have submitted above. The deadline for issuing voluntary health insurance is up to 20 days, when concluding a contract, you must fill out a questionnaire and provide passport data.

There are situations where employees of an insurance company can request a certificate of the health status of the client. According to the results of the survey, the decision will be made to conclude a contract.

Foreign citizens should fill out a migration card and receive a certificate of accounting in the migration service. If the client is employed, then the obligation to conclusted the DMS employer should take over.

Who can't get DMS

There are three main groups of citizens who are denied the execution of the PMC policy insurance companies. It:

  • Incapable persons (minors, disabled, etc.).
  • Persons who have diseases whose treatment is fully covered by an OMS policy and requiring quarantine content. These are: Venusal diseases, tuberculosis, psyche disorders, deadly infections and many others.
  • Persons with any type of oncological diseases since the diagnosis is established.

Cost of DMS.

The cost of DMS is formed due to various factors and aspects. This is what affects the final amount:

  • List of services included in the Voluntary Insurance Program: Recording from specialists, analyzes and diagnostics, inpatient treatment, call to a doctor's house or ambulance brigades. The wider the list, the greater the cost of the PMC policy for the person concluded.
  • Selected List of medical institutions , their high-quality and price level, their number.
  • Personal data Insured face. Paul, age, marital status, etc.
  • Health status : The presence of any diseases, from temporary to chronic, increases the cost of the insurance policy.
  • Place of work I. Professional risks Insured (harmful or dangerous conditions). The likelihood of injury and diseases.
  • The term of the concluded agreement The ownership of the DMS polis is: the more period, the lower the cost of the policy, based on the size of monthly contributions.

Insurance conditions and the set of services provided by the company are always vary.

The price of the Voluntary Insurance Policy of the DMS among individuals is always fixed and does not imply unplanned expenses. This means that the policy can be purchased a one-time, without additional contributions.

You may not doubt the invariance of the contract. All services prescribed in it remain in the same quantity and quality as it was found when signing the documents. And remain unchanged for the entire term of the policy.

How to pay for the policy less

The cost of obtaining the personal policy of the DMS cannot be called small. It often happens that this acquisition is disadvantageous and inappropriate, due to the fact that rare visits to the state clinic on OMS will cost cheaper for a person who almost does not suffer. But there are methods to reduce the cost of voluntary health insurance and make acquisition much more profitable for your budget.

Detailed assessment of possible insurance claims

  • Carefully appreciate your history of visiting medical institutions over the past two years. The number of appeals to doctors, the purpose of the appeals, the cost of one-time visit, summarize all the costs of medical services, including any procedures and analyzes.
  • Make a list of priority services for you and begin to compare all suggestions of insurance companies.
  • Choose those that most comply with your requests.

If the insurance contract allows you to replace the services established initially to others at your request and necessity, then use this opportunity. Thus, your money will never go to pay those services that you may not take advantage of ever in life.

Purchase Polis "Without Gloss"

Insurance companies are not very profitable to sell individual polis, because of this, insurers often fill the package provided with additional products with high cost. Treatment in elite medical institutions, consultations of world-famous specialists, rare services that nobody use almost no one, but they are worth a fortune.

Most often to such methods are resorted to large megalopolis, where there are serious demand for status and elite medical services. But if you are not interested in the external chic, and you are not going to maintain a reputation in a similar way, then when drawing up a contract, you can refuse the "promoted" clinics. There is always a choice of strong middle peasants who are responsible for quality and maintain a high level of service due to great competition in this market.

Also you can refuse expensive services that never take advantage of and thus reducing the final value of your policy. Without brilliance and luxury, but reliably and efficiently.

Refusal of dental services

This is the easiest way to lower the price of insurance of DMS almost twice. Dental services constitute a large share of the cost of the policy due to the fact that this service itself is very expensive. Annual expenses for visiting the dentist and evaluate, whether you will use the services so often that the inclusion of them in the policy has become profitable.

In addition, most of the dentists from the private clinics on combination operates in state. Therefore, there is a high chance to get free on the reception to a professional doctor with extensive experience. And all this happens in the framework of compulsory health insurance. Calculations should be made and help references about the availability of good doctors in your city. As a rule, all the information can be found on the official websites of the clinic.

Use DMS with franchise

The definition of the "franchise", as applied to the insurance system, it means that some part of the costs you cover from your funds, and the second part is paid by the Insurer from the General Fund. The total cost of the PMC policy decreases significantly, as a rule, one and a half - twice. Franchise is beneficial for those who rarely use the services of doctors, but wants to protect themselves in case of illness or injuries, from which no one is insured (except for insurance holders).

There are two types of franchise referring to the DMS:

  • Conditional franchise - when used, a certain amount is established, which is paid by the patient, and the remaining costs carries the insurer. If the service of a certain doctor costs 10 thousand rubles, you can pay 5 of them, and the remaining 5 will pay the company with which the contract was concluded.
  • Unconditional franchise - you cover the whole amount, and the company pays a non-medical institution, but translates to your personal account.

The DMS with a franchise is often drawn up for the provision of medicines (since the pharmacies are important to receive "live" money at least in the minimum volume immediately - to maintain working capital).

What documents will required for registration?

Only a passport or any other document certifying the identity of the client will be required.

For what period can be issued a policy of DMS

The insurance of DMS is executed for a period of a month before the calendar year. The shortest time in the tourist policies. Often insurers use polishes 4, 6 and 8 months. But the most common term, the most common in legal entities - 12 months.

Where to arrange the PMD policy?

Additional medical insurance offer various insurance companies. Most often, the execution of the TIS policy is proposed (medical insurance of citizens traveling beyond the Russian Federation). Here is a list of the most popular and quality proposals:

  • Alfapture - It is proposed to form a policy of adaptation for tourists and travelers.
  • Ingosstrakh - You can also arrange additional medical insurance when traveling abroad.
  • Cherehapa. - Popular traveler insurance recently.
  • Polis 812. - There are several insurance options.
  • TripInsurance - It suggests to issue a parasta.
  • Instore Travel. - Policy for leaving abroad.
  • Liberty insurance - Policy takes.
  • Renaissance insurance .
  • Consent .
  • Zetta Insurance - There is insurance when traveling abroad, and you can also issue a policy of DMS in the territory of the Russian Federation, separately for adults and for children.

DMS and tax payments

Tax benefits upon receipt of DMS are marked with individuals and legal entities.

Benefits for legal entities

The tax deduction for the profit of the organization can be obtained when performing all these conditions:

  • If the DMS contract states that medical services to employees are due to the employer;
  • if the company signed an agreement with an organization that owns a license for medical insurance;
  • If health insurance agreements are imprisoned by the insurance company with all employees of the company;
  • provided that the contract is signed for 12 months;
  • If the insurance fee for each policy is not more than 6% of the salary of any employee of the company.

Default on insurance charges in the FSS and the FIU firms are obtained provided that:

  • The contract was signed for 12 months;
  • The contract is written that the employer covers an employee all the costs of medical care for voluntary insurance.

The deduction on VAT occurs according to paragraph 7 and paragraph 3 of Article 149 of the Tax Code of the Russian Federation - all monthly insurance payments of the Organization were released from this tax.

Benefits for individuals

Insurance charges, if, with a corporate DMS contract, the employer covers the employee for medical care, is not subject to tax on personal income tax (NDFL).

The owner of the DMS individual policy is relying a social tax deduction in the amount paid for the amount of insurance services (in the hands of a person receives 13% of his payments).

Example. Citizen A. acquired Polis DMS for a period of 1 year for 50 thousand rubles. By law, it is deduction of the same amount of income from the general list, taxed by NDFL. Imagine his annual income is 1,000,000 rubles. Ndfl from this amount he paid 130,000 rubles. If you apply a social deduction in the amount of the cost of the insurance policy of the DMS, then the taxable will be the amount: 1,000,000 - 50,000 = 950,000 rubles. And the tax is paid less: 950 000 * 13% = 123 500. The owner of the policy will pay the difference: 130,000 - 123 500 = 6 500 rubles.

Answers to frequently asked questions of readers

I am the owner of the DMS policy, and I know my diagnosis. Can I immediately sign up for a doctor, but for a survey?

According to the regulation of the DMS, the insured event can be considered only certified by the appointment of the attending physician appeal to it at certain services. On your own initiative (with the recommendations of the insurance agent), you can get medical services only at the therapist. The therapist either will provide all the necessary assistance, or will write directions for diagnosis, analyzes, examination or other specialists.

There is a single exception - these are children's vaccinations that are included in the vaccination card. They can be stailed using the DMS policy (if the policy is decorated to the child's name) at any convenient time in the procedural office.

Do we write out in clinics and medical centers to customers, with the PMD policy, hospital sheets for the employer and certificates for kindergarten or school?

Yes. The preparation of all related medical records is included in the standard DMS program, which provides for maintenance in clinics and higher level services.

None of the DMS programs provide for the issuance of certificates and the passage of inspections to obtain the rights, wearing weapons and classes in sports sections.

What to do in case of loss of the insurance policy of the DMS?

In the event of a plastic sample of the PMS policy, you should write a statement in the office of the insurance company and you will be given a duplicate on the same day. The map is only a conditional document confirming your health insurance.

When visiting the clinic and presentation of the PMC policy with the direction of the doctor for treatment, received the answer that all services need to be paid, as they are not provided for by the Voluntary Insurance Program. What to do?

If you are the owner of the compensation type of insurance (and you have enough funds to pay for treatment), you can cover the costs and get the required medical services. After that, it should be called an insurance agent and clarify whether these services are in the list applied to the contract. If there is - then all expenses will be commemmed in due size. If not, then you will simply save time, because payment should still be done by you.

If you are the owner of the PMD policy of another type, you need to call an insurance agent and clarify whether the refusal to provide services is legitimate. After that, the clinic and the insurance company will independently negotiate services, and you will be notified about the results.

Conclusion

The Voluntary Medical Insurance Program is a reliable way to get medical services, the expenses for which the insurance company will suffer. You only need to make insurance contributions to its foundation. Having received a policy, you contact specialists and, from this minute, the DMS system comes into effect.

If the diagnosis delivered to you falls into the list specified in the Base Contract, you can get free outpatient and inpatient treatment, emergency assistance, qualitative tests, diagnostics, surveys and many other services. Their full list is prescribed in the policy and directly depends on the magnitude of the insurance premiums.

In modern realities, approximately 9 out of 10 DMS agreements are corporate. They consist of companies and organizations for their employees. Individual voluntary medical insurance is in high demand primarily in those people who have high incomes and wishes to receive medical services in an elevated level without being lost in the crowd.

The cost of the insurance policy depends on the selected package of services. The basic package can cost many times cheaper than advanced or full. And prices for elite policies that provide treatment in foreign clinics and famous doctors can reach several hundred thousand rubles. The package price also affects many different factors. Paul, age, marital status and customer health.

Purchase Polis DMS is possible in any insurance company that provides this service. But it will be more reliable to contact verified insurers who have a good reputation and many positive feedback. The experience and period of existence in this market also talk about the reliability of the institution and professional attitude towards the issue of life insurance and human health.

The unconditional advantages of voluntary health insurance can be attributed:

  • The ability to independently choose medical centers from the list.
  • Lack of queues and time savings.
  • The possibility of obtaining higher quality services in comparison with the system of mandatory insurance.
  • No concern about relationships with medical personnel. Responsibility for it assumes the insurance company.
  • For the employer, the availability of DMS services in the social package increases the loyalty of employees, reduces senseless loss of working time and helps to save on taxes.

Minus at the DMS system with a neighbor only one. But this minus is quite serious - the high cost of the policy. For this reason, personal insurance in many cases is unprofitable and unprofitable for both parties to the contract.

If you have problems or some difficulties of a legal nature, you can always call a toll-free number: 8 (495) 877-46-44.

A source: Mystrahovki.ru.

Hello, friends!

Every citizen of Russia has a policy of compulsory health insurance, which allows you to get a minimum of medical services for free, mainly in state clinics. The quality of service causes many complaints from the people, especially in the regions where hospitals and polyclinics were not repaired for decades, and talented doctors seek to leave there, where working conditions are better, and the work is assessed above. To correct the situation, you can wait for the next reform of health care, and you can use insurance services. We will analyze what DMS is how to get and properly use medical insurance, pros and cons of voluntary insurance.

Features of voluntary insurance

DMS (Voluntary Medical Insurance) is special programs developed by insurance organizations for legal entities and individuals in order to provide medical services on special conditions.

Participants of the DMS program:

  1. The Insurer - a company that has a relevant license concludes an insurance contract with an organization or a private person and an agreement with medical institutions for the provision of services.
  2. The policyholder is a legal or individual, in the name of which the insurance contract is issued.
  3. The insured person is a company or private person, including a foreign citizen who uses medical services in the DMS policy. Often, the policyholder-legal entity issues the DMS contract for its employees, who will be considered insured by the program.
  4. The medical institution is an organization that has a license and concludes an agreement with an insurance company for servicing his clients in the DMS policy.

Program financing scheme:

  1. A private or legal person concludes an agreement with an insurance company. The latter should receive complete information on the health status of the future of the Insured Customer. To this end, you need to fill out a questionnaire or pass a medical examination. Introduction to delust the insurer is better to immediately exclude. Cheating will easily open, and the client can lose the policy and money
  2. The policyholder is unite or regularly for the year pays the insurance premium under the contract. From other clients, they also receive money, so the insurer has a monetary fund, from which the medical services are paid to those with ill customers. If during the year the insured person did not get sick, then there was no return of money, other customers were treated at his expense.
  3. The insurer concludes an agreement on the provision of services with selected medical organizations. It may be one or more clinic, so before signing the contract it is worth introducing a list and read reviews on the forums about doctors working there. The insurance company will not compensate for the cost of treatment in other medical institutions.
  4. At the occurrence of the insured event, the Insurer pays the value of the services provided by the Insured person if they are provided for by the Treaty. For example, somewhere dental care is included in the list of mandatory services under the contract, somewhere not. You need to carefully read the conditions before signing the documents. In most cases, the client can choose additional services that will enter the contract.

The main advantage that gives the PMC policy is the opportunity to get medical services quickly and efficiently. Although the quality of the quality is controversial. Many doctors work in state clinics, and work in private. In fact, if he is noncompeatient in his profession, then for the money his professionalism is hardly an increase. But politeness and distillation accurately appear when improving the working conditions.

If the policy buys a private person on himself, his spouse / spouse, parents, children under 18, he has the right to social tax deduction in the amount of 120,000 rubles. in year. Return will be no more than 15,600 rubles.

Criteria for choosing an insurer

There are two possible ways to get a PMS policy:

  1. At his employer, if he gives such an opportunity. Not always the service is available immediately upon employment. It must be earned, so many enterprises give insurance after several months of work.
  2. Alone to buy polis. To do this, you need to choose the insurer and apply. Many companies offer to do it online. On sites there are calculators that will help determine the approximate cost of the policy.

The most difficult insurance procedure is to choose the insurer, not only the price of the policy will depend on this, but also your health. Criterias of choice:

Insurance applies to financial services, so the activities of insurance companies are watching the Central Bank of the Russian Federation, it also gives a license to this type of activity. The presence of a document resolving work in the insurance market is the first criterion for which the insurer should be chosen.

  • Medical institutions that will serve under the contract

Each insurance company has their own or even one. List of different in each region. You can fully arrange the terms of the contract, but you never will never go to the doctors of a particular clinic, because in the city it uses, for example, a bad reputation.

Examine the contract and all applications to it. There must be a list of services that fall under its action, and medical costs, the costs of which will never compete. In addition, it is worth seeing the terms of termination of the contract. For example, in the case of intentional hiding information on the presence of severe disease.

After reading, you will understand how to stop working for a penny on the unloved work and start living truly freely and with pleasure!

In addition to the list of insurance cases, pay attention to the procedure for their occurrence. Somewhere enough to contact the medical institution specified in the contract without notifying the insurer. Somewhere you need to first call your insurance company (an exception is an emergency with emergency call), which will send to a particular clinic and notify it about it.

It depends not only on a particular insurer, but also from the type of program. In one company you can offer several packages. For example, standard, optimal and advanced. The price will be the higher, the older the client, the more chronic diseases. Even the floor is influenced by the price, for women, as a rule, services are more expensive, a type of professional activity. The inclusion of additional options, for example, dental services, also leads to an increase in the price.

Terms of Use of the PMS Polis

The rules for using the DMS policy are governed by the contract of a specific company and the insurance program, which is usually on the site. You must learn them from the first letter to the last.

What should be interested in first:

  1. The name of medical institutions that will serve on the PMS policy. Sometimes it is one, sometimes the network of the clinics. Basically, all of them are in the same region. A small part of insurance companies permits to be treated in another area.
  2. Types of medical care payable. For example, in one of the companies in the insurance program indicated: outpatient maintenance, dental care, home assistance, stationary assistance, including hospital technology (hospital of one day, day hospital), ambulance and emergency medical care, rehabilitation treatment.
  3. Services that will pay insurance within each type of medical care. For example, receptions, consultations and manipulations of specialists, functional diagnostics, ultrasound diagnostic studies, laboratory studies, x-rays and computed tomography, etc.
  4. List of services not included in the insurance program. Most insurers will not pay medical services for the treatment of malignant tumors, AIDS, venereal diseases, epilepsy, tuberculosis, radiation disease, family planning services, deactivation and a number of diseases. Getting certificates in the pool, in children's health camps, sanatoriums, the driver's license, weapons wearing, etc. are not related to insured events.
  5. How to use the policy when an insured event occurs. Options may be different. In one case, you can immediately contact the clinic attached to the policy, and then contact the insurance company. The latter will send a warranty letter and pay the services rendered. In another case, you must first contact the insurer, it will prompt further algorithm. Violation of the procedure taken is threatened by the fact that the company will not pay for the treatment account.

Here is such a picture on one of the insurance company's sites. Under each case hides their own instruction. In some, it is required to fill out a questionnaire with a description of the symptoms of the disease, in the other there is a hotline phone that works 24/7.

Review of proposals from insurers

Many voluntary health insurance programs. But they are very different under the conditions. Consider offers from leading companies.

SOGAZ

SOGAZ offers DMS service only to corporate clients, but with any profile of activities and the number of employees. Insurance features:

  1. Individual program for each client, taking into account his wishes and health status.
  2. You can include not only yourself, but also members of your family. They will also be serviced on preferential terms.
  3. The basic list of services can be expanded with the specifics of the activities of the enterprise and the characteristics of the client. For example, include specialized types of treatment and surveys, treatment at Russian and foreign resorts, etc.
  4. SOGAZ cooperates not only with Russian, but also foreign medical institutions.
  5. A corporate agreement is accompanied by a curator who advises, organizes treatment, controls its move and quality.

Main types of services:

The cost of the policy is calculated individually.

Reso-guarantee

The reso-warranty offers a wide range of DMS programs:

This is an individual program for which the Policy can buy both citizens of Russia and foreigners. Large drawback - the list of cities is limited. The base package does not include dental services, oncolic treatment, emergency hospital. But they, like a diagnostic program for children and adults, can be enabled additionally.

The feature of the program is the services and observation of a personal physician for adults and children, including newborns. Such polis is available only to residents of Moscow and the region, St. Petersburg and the region. Personal doctor - doctor from the network clinic Medswiss.

  • DMS for Moscow: medswiss with franchise

Polis is available for people from 1 to 75 years, only for residents of Moscow and the region. Services are provided online Medswiss Clinic. The cost starts from 13 100 rubles. in year:

The program for those who do not turn out often for medical care, but only in emergency cases. The base package includes emergency hospital, ambulance, telemedicine. The diagnostic program can be enabled additionally.

Policy DMS for labor migrants. The program fully complies with the requirements of legislation and is sufficient for employment or the preparation of a patent. Policy is valid on all territories of the Russian Federation. At the occurrence of the insured event, it is enough to call by phone at any time of the day, the operator will prompt further procedure.

The approximate cost of the DMS fields can be determined using the Calculator on the site.

Ingosstrakh

Ingosstrakh for individuals developed 5 DMS products:

  1. Basic - from 37 700 rubles. Only polyclinic service.
  2. Standard - from 48 200 rubles. Polyclinic + dental services.
  3. Optimal - from 59 900 rubles. Extra stationary help is added.
  4. Premium - from 64 700 rubles. Plus to the previous package pharmacy service.
  5. Platinum - from 71 700 rubles. Maximum coverage of services, including a personal doctor.

You can buy a PMS policy for children. The cost depends on the category of the clinic, the age of the child and personal data. Starts with prices of 47,400 rubles.

In a separate category, maternity services are allocated, including:

  • maintaining pregnancy - from 251 256 rubles;
  • Birth - from 77 940 rubles.

For residents of Moscow, Ufa, St. Petersburg, Sochi, Krasnodar and Kazan, the program "Check yourself". It includes services for the diagnosis of men and women, as well as for individual profiles (ophthalmological, cardiological, gastroenterological, endocrinological). Cost - 6 430 rubles. Insurance amount - 1,000,000 rubles.

Rosgosstrakh

Rosgosstrakh encompass individual and collective insurance contracts. The company has a wide coverage of therapeutic institutions throughout Russia.

Available products for an individual client:

  1. "Health is more expensive" - ​​in case of detection of an oncological disease. Provides a one-time payment of 250,000 rubles. and payment of treatment up to 8,000,000 rubles. in leading Russian clinics. Insurance Prize - 9,800 rubles. for 1 year.
  2. "Dr. Onelai" for remote counseling with leading doctors without limiting the number of consultations per year. Insurance Prize - 4 900 rubles. in year.
  3. "Protection against tick." There are two options with one-time payment of 100,000 rubles. Upon the occurrence of an insured event without it. The first option is 399 rubles., Insurance amount 1,500,000 rubles. The second option is 499 rubles. and the amount of up to 3,000,000 rubles.
  4. "Treatment without borders" makes it possible to be treated in leading Russian and foreign clinics (except for the USA). Insurance amount up to 18,000,000 rubles.
  5. "Second Opinion" for rechecked diagnosis.
  6. "Health Protection" offers emergency outpatient and inpatient assistance as a result of poor worsening due to injury obtained during the period of the policy. Cost per year - 2 000 rubles, coverage up to 200,000 rubles.
  7. "RGS Guest" for students, labor and non-medical migrants.

Consent

IC "Consent" developed 3 products for individuals:

  1. "Anticleus" operates in the territory of the Russian Federation, the age of the insured from 0 to 75 years.
  2. The treatment program abroad is valid after the diagnosis of complex diseases, including oncological, and provides for treatment in leading foreign clinics. Initially, the contract is concluded with the client whose age does not exceed 64 years. Prolongation is available up to 85 years.
  3. Migrant acts for labor migrants, which are obliged to have a PMC policy to work in Russia.

The cost of the policy on the site is not specified, is determined individually.

Pros and cons non-state medical insurance

Insurance in Russia is not the most popular financial product. Citizens of our country find many minuses. Consider what exactly, but first about the pros:

  • the ability to choose that clinic where you want to get medical services, and not where it is fixed geographically;
  • Saving time, because you do not need to receive a reception coupon in a specialist who can only be available in a few months;
  • Furnishing service, doctors in private and state clinics have a habit of behaving in different ways, comfortable accommodation in hospitals;
  • Qualitative diagnosis and treatment, as a rule, insurance companies conclude agreements with modern clinics equipped with all necessary and staffed medical professionals;
  • The ability to make an individual insurance program, unnecessary services to remove, needed to include;
  • The ability to get a tax deduction from no more than 120,000 rubles. in year.

Minuses:

  • high cost of the policy;
  • limited selection of medical institutions;
  • Danger to get the same quality of services as on mandatory health insurance, especially in the regions;
  • A large number of restrictions that are easy to disrupt and not get compensation for treatment.

Conclusion

DMS can be an excellent addition to the compulsory insurance policy already existing. The latter gives a minimum of medical services guaranteed by the state. Voluntary insurance will help expand this minimum to the optimal list, which is necessary for a specific insured person. Problems with queues, Hamsky attitude, terrible conditions in hospitals, shortage of drugs, equipment and specialists in medicine are solved, if on the hands of the PMD policy. But this is the perfect picture, which in the regions takes a completely different appearance. I wish everyone!

Regards, Chistyakova Julia

My wife broke the leg in 6 days before the wedding travel.

Mikhail Kenegez

Dreams of DMS

We rushed into the attendant at duty to make x-rays. There was old equipment, and the doctor could not understand for a long time, there is a fracture or not. As a result, he decided to progress and still put the plaster, saying that in 10 days in the hospital will make a normal picture and then everything will be clear.

It was on Friday night. In the afternoon on Saturday, we received a surgeon in a private medical center, in which the wife is serviced by DMS. . On modern equipment, the doctor made one more picture and determined that it was not a fracture, and the crack. Gypsum is not needed, on vacation you can go to crutches.

Quick reception at the doctor, x-ray and further surveys did not cost us, but the correct diagnosis allowed us to go on a journey. After this incident, I also wanted myself a policy DMS. And I decided to figure it out how he was arranged.

The main thing per minute

DMS. - not a subscription to a private clinic, and insurance in case of disease.

DMS. It will be useful if you have nervous or physically difficult work or you are not ready to sit in line and to endure rudeness in public hospitals.

If you have DMS. From the employer, but you do not know what is included in it, call the insurance company, which is listed on the policy. You can also ask the Appendix to the Contract in the personnel department.

Can be agreed with colleagues and pay DMS. In the fold, placing it through the employer. It is much cheaper than buying an individual policy.

DMS. For a private person is expensive, but if an insured event comes, the policy will save much more.

If you yourself bought yourself or close polis DMS. Do not forget to declare the tax deduction.

Read articles on mandatory health insurance and deductions for treatment.

What is DMS.

In the voluntary health insurance scheme, all three of these words are important. Start from the end.

Insurance.  DMS. - This is the financial service of large insurance companies. Thousands of customers pay minor contributions to the General Insurance Fund. If someone from the insured occupies an insured event, the company compensates for its costs on this occasion.

Simplified example: 100 people paid 1000 rubles to the insurance fund. In total in the insurance fund of 100,000 rubles. One person from a hundred fell ill and spent 50,000 rubles for treatment - the insurance transferred this money to the clinic from his foundation. The foundation has another 50 thousand.

В DMS. The insured event is associated with the health of the client: if he sits something, he will be able to quickly get to the doctor, pass the examination and immediately begin treatment, avoiding additional spending. If, during the time of the policy, nothing happens, the money will remain in the fund, of which they will pay other, less successful insured.

Insurance is not a medical, but a financial service. Medical services are provided by clinics, and the insurance simply pays them. In some cases, you first pay the clinic yourself, and then the insurance lists you money.

Medical. There are many programs for life insurance and health programs in the market: from injuries, accidents and even sudden death. Usually they suggest the payment of a fixed amount, which will help cover the cost of treatment, but more often it looks more like compensation for moral damage. In any case, the search for the right doctor will have to be independently.

DMS. It works differently: the insurance company negotiates with certain clinics, so that its insured clients take and treated without queues and financial problems. The patient should not know anything about the cost and money. He should simply come to the clinic with a complaint and get healthy.

Voluntary. In Russia, there are compulsory medical insurance that applies to all (roughly speaking). Contributions to the Foundation OMS Do all employers, you can not pay. The rules on the whole country are uniform, only lists of services covered from the region are changed to the region.

DMS. - Voluntary matter: you want - you enter the program, you do not want - you do not enter. Private shop, service list and clinics have their own, insurance conditions for their own, their tariffs. As they want, do it.

Some companies comply with employees DMS. As part of the employment contract. This does not cancel the fact that the program is voluntary: make out DMS. - This is the right of the company, not a duty.

Insurance companies can also take on DMS. Not all clients. If the insurance sees that the client is going to be much and often treated, she can refuse him to include in the program or highly overstate the price of the policy.

The same doctors, other conditions

DMS. Represent both "medical insurance, but with a normal service." It is understood that on this program you will have access to good doctors in good clinics, without queues and paper rolls.

But here there are some debris. The insurance company does not directly affect the quality of medical services - it can only negotiate with the necessary clinics on the conditions of service. And treat your doctors' appointments.

Some doctors combine shifts in public and private clinics. Today you have nahamli in the clinic and sent to a painful procedure on writing at eight in the morning, and tomorrow the same doctor in a private clinic politely will conduct a similar procedure immediately in the office. The magic of this conversion for us is still incomprehensible.

This does not mean that by DMS. You will get rudeness or music, on the contrary, insurance companies are trying to work with good clinics. The intrigue is that in good clinics there may be the same doctors as in bad.

How to use DMS.

If you have already decorated DMS. For help in case of illness, you can refer to two ways.

Direct access. Insurance issues a list of medical facilities to the Client, in which you can be treated by DMS. . The insured simply addresses one of the specified clinics, no need to notify the insurance.

Call to the "Medical Remote". Before going to the hospital, the client calls for the 24-hour insurance company. He is responsible for the operator who confirms or does not confirm that insurance is ready to pay the desired service. Usually, people with medium and higher medical education work as such operators. They listen to the client's complaints and select the necessary clinic, calculating in advance what kind of services will be rendered to the patient. If the required procedures fall under insurance, the operator records the client to receive and sends a warranty letter to the clinic: they say, treat this citizen, and we will pay for these procedures.

It is convenient if the insured rarely visits the hospital or if something happened to him at the weekend, when the desired clinic is closed. In theory, insurance staff should know well where, how and at what prices there are medical services in both planned and emergency situations: in which clinic, strong therapists, in what a good cardiologist, and where in general it is not worth going.

What will be treated by DMS

Sometimes people think that DMS. - This is such an unlimited pass to the private clinic, as a subscription to the pool or gym. There are such proposals on the market, but this is not insurance, but batch programs of specific medical centers.

For example, a clinic can offer a program "Diagnostics of headaches" for 100 thousand rubles, there will be several dozens of research. Is not DMS. .

DMS. - Insurance from diseases: colds, poisoning, injury, and so on. In most programs DMS. There is no planned visit to the doctor, receiving certificates for rights, permits for weapons or sports. Services to which you can count depends on the category of your program DMS. . It happens the basic, extended and complete category.

I made averaged lists of medical services and programs DMS. Who could receive in insurance companies. But if you want to calculate DMS. Alone, to help:

TEXTBOOK

Tell how to be treated correctly

Course on how to choose medical services, medicines and insurance in order not to lose money

Start learning

Basic DMS program, from 20,000 Р

These are medical services, the free analogues of which can be obtained by OMS In the usual clinic:

  1. Access to the limited number of the middle-level clinic in coordination with the insurance.
  2. Outpatient treatment as in the usual clinic, only without a queue.
  3. Private ambulance and call a doctor at home, the number of departures per week or month is limited.
  4. Consultation of narrow specialists. This includes not all experts - for example, a mammologist may not be.
  5. Diagnostics and tests: X-ray, ultrasound, blood test - usually total up to 10 procedures per year.
  6. Physiostaries: Medical Massage, Inhalation, Magnetotherapy, LFK - Usually a total up to 10 procedures per year.
  7. Hospitalization in private medical centers and chambers of increased comfort of the state clinic, but only in the event of a threat to life, for example, if you need to cut Appendix.
  8. Payment of drugs for the appointment of a doctor during hospitalization.
  9. Dentistry: anesthesia, treatment, light fillings, tradegigine.
  10. Issuing hospital sheets.

Extended DMS program, from 50,000 Р

All that in the basic, plus:

  1. Direct access to certain medium-level clinics or access to the extended number of clinics in coordination with the insurance.
  2. Unlimited tests, except high-tech.
  3. Unlimited number of physiotherapy.
  4. Advanced list of narrow specialists, including dermatologist, mammologist, proctologist.
  5. Hospitalization according to planned indicators, for example, to lie down under the drip and to be token, but usually only for a period of 10-15 days.
  6. Medstrashovka for travel or tourist trip.
  7. Influenza vaccination.
  8. Services of a personal doctor - the ability to call and consult with the desired specialist 24 hours a day.
  9. Periodic medical examinations for health control.
  10. Spa treatment.

Full DMS program, from 100,000 Р

All in the basic and extended, plus:

  1. Access to expensive private clinics and state hospitals with loud names.
  2. Expensive high-tech tests, such as tomography.
  3. Hospitalization of both emergency and planned indicators in individual luxury chambers.
  4. Dentistry includes whitening, prosthetics and implantation.
  5. Maintaining pregnancy and childbirth.
  6. Services of the psychotherapist.
  7. Diagnosis and treatment in overseas medical institutions.

These lists are approximate - the insurance can offer you other conditions, remove or add services or deny. Always read the contract so that there are no surprises.

Unified Contract for Insurance DMS. No - every insurance prescribes its conditions in a convenient form for it. Before paying the policy carefully examine all the applications to the contract - there should be detailed in detail, where and from what they will be treated at the expense of insurance, and in what cases the insurance will refuse.

On DMS will not be treated

Chronic diseases

If the client already suffers from some serious diseases and he has long treatment and rehabilitation, insurance may generally refuse to conclude a contract with him. DMS. : For her it is too expensive. Here are the most common incredigible cases:

  1. Oncological diseases.
  2. Dangerous infections: smallpox, cholera, plague.
  3. Venericual diseases.
  4. AIDS.
  5. Tuberculosis.
  6. Diabetes.
  7. Mental diseases.
  8. Hepatitis.
  9. Congenital diseases.
  10. Subjects associated with pregnancy and difficulties of its flow.
  11. Problems of infertility.

Chronic diseases of PA DMS. Will be treated only in the stages of exacerbation when there is a threat to life. At the same time, periodic examinations are for exacerbations not, by DMS. Most likely it will not work.

If the client find sugar diabetes, hepatitis or cancer already during the period of the policy, the insurance will pay all the procedures until the diagnosis is set. For subsequent treatment, the patient will have to pay himself.

This is only a small part of the list of exceptions from insurance coverage.
This is only a small part of the list of exceptions from insurance coverage.

Even if the client succeeds in hiding from the insurance presence of a serious illness, it can be detected in the treatment during the period of action DMS. . If the insurance will understand that it was misled, it has the right to break the contract. The client will lose money.

On DMS will not be treated

All that is not under the contract

If the client triggers a private ambulance brigade for a relative not insured by DMS. , Or without warning will miss the appointed visit to the doctor, the insurance will require compensate losses and threatens to cancel the contract.

Insurance will definitely not pay the treatment that was not appointed by the doctor. For example, if you make an x-ray of the lungs just in order to overall health monitoring.

In the x-ray policy, they will pay only in case of illness with a strong cough and in the direction of the therapist. If the patient is self-medication, buys some special medicines and goes to a familiar homeopath, DMS. It will not cover it either.

Insurance will refuse to pay, if the insured appeals to a medical institution, which is not specified in the contract DMS. , or will hold a procedure that is not included in the insurance program.

To avoid such problems, it is better to call on the phone written in the Polish, and to clarify everything. You must clarify what is included in your program and what to do to get the necessary help. In general, if any doubts immediately call the insurance.

On DMS will not be treated

Medservants in other cities

Usually the field of action area DMS. Limited by the cities of the client - this is indicated in the contract. Therefore, to go for free to be treated in the capital clinics, issued DMS. In another region, most likely will not work.

Some insurance companies sometimes make the "gift" customers - include emergency assistance throughout Russia in the program DMS. . Often it is just a marketing stroke: by law In the threat of life, medical care is found throughout the country, any citizen and always free.

On DMS will not be treated

The beauty of unearthly

In basic and advanced programs DMS. Practically never aesthetic medicine and cosmetology: removal of moles and papilloma, teeth whitening, plastic operations. Psychotherapist services are usually included in the full insurance package.

If they hurt eyes, DMS. You can operate with cataract, but it is impossible to make an operation to improve vision, because myopia or hyperopia does not affect the patient's health.

On DMS will not be treated

Consequences of County and Attempts by Suicide

Under any conditions, insurance will not pay the patient's treatment if it determines that injuries it received in a state of alcoholic, drug intoxication or toxicological poisoning.

Also, insurance will not pay treatment after intentional harm to their own health or suicide attempts.

Back to the list of insurance cases, it does not include harm to health as a result of radiation irradiation, hostilities, folk unrest, terrorist attacks, natural disasters and other emergencies.

How to issue

Get DMS at work

Advantages DMS. Mostly enjoy the inhabitants of large cities working in prestigious organizations. But corporate DMS. - This is not only a pleasant bonus, but also a control tool. What services and how much falls into the policy DMS. , determined by many factors: post, experience, value for the company. In more qualified workers, the conditions are better, and the insurance coverage is wider.

If a person just got a job in the company, most likely, he still does not have access to corporate DMS. . Some companies give a policy in three months, somehow later. Some are waiting for a year. But when the employee decides to quit, the employer may annul it DMS. Immediately, although it has yet to work for 14 days.

The main minus corporate DMS. : The insurance program chooses the employer, and the employee has to simply agree with this. It happens that the collective insurance contract has established a small insurance amount per person. If the insured will exceed it, then he will have to pay for treatment from his pocket.

If the company offers its employees an expanded insurance program, it may ask them to pay a part of the insurance premium on their own, for example 3000 Рfrom the conditional 10 000 Р. But it will even work out much cheaper than buying a policy individually.

The most generous companies pay DMS. Not only to employees, but also their spouses. Policy for children up to 18 years and older parents can also be included in the corporate DMS. . For him already have to pay independently, but the insured will give a discount.

Leading insurance companies in the Russian DMS market in 2017, according to the expert rating agency
Leading insurance companies in the Russian DMS market in 2017, according to the expert rating agency

How to issue

Buy DMS through the employer to the folder

Even if the company does not offer its employees with medical insurance, they can throw off and buy a collective agreement DMS. through the employer. This is beneficial to all: the employer, making up corporate DMS. will be able to reduce its taxable base, and the staff will receive the policies much cheaper than if they bought them separately.

The cost of the basic policy DMS. For a private person begins from 20,000 Р. If a DMS. Bought on the team, in terms of each person, the price of the policy begins with 10,000 Р. It is beneficial, if you consider that only one doctor in the doctor in the private medical center costs from 800 Р, and the departure of the brigade of private ambulance or challenge a specialist at home - from 2000 Р.

On the other hand, in a healthy and lucky person, these costs are not justified and he will pay his contribution for others.

Usually insurance companies sell policies DMS. working groups from 10 people. Often insurance do not check whether a person works in this organization or came from the part - the main thing is the size of the group. So you can offer friends and acquaintances too to join your corporate DMS. .

Intermediary companies operate on the market, offering all those who wish to attach to large corporate insurance programs. Promise to take into account the wishes of the client to fill the program and give a 50% discount and more. The reliability of such intermediaries and legal organization of relations with them is unclear.

How to issue

Buy DMS as a private person

Insurance companies reluctantly sell policies DMS. Individually. It works negative selection: roughly speaking, when a person pays 50 thousand rubles for insurance, he will very try to recover by 70 thousand. Insurance does not want to carry losses, therefore either establishes charge tariffs, or refuses to take the client.

To assess risks, insurance will ask for a fill in the questionnaire and specify all health problems. If the client smokes, he has overweight or it works in harmful production, it falls into a risk group for a number of diseases. Such a person will install the raising coefficient, and the price of the policy will increase for it. DMS. For young children, pregnant women and the elderly, it is more expensive.

In the questionnaire it is better to write only the truth. If it turns out that the client hid something, the insurance may cancel the PMS policy, and its cost will have to return through the court
In the questionnaire it is better to write only the truth. If it turns out that the client hid something, the insurance may cancel the PMS policy, and its cost will have to return through the court

Usually DMS. For physicals, only those insurance companies offer their own medical centers. So they control customer treatment costs. For example, "Ingosstrakh" owns the clinic "Be's" clinic, at AlfaStrakhnia, the regional network of Medical Center for Health, the resolution manages the "Medsviss" clinics. With the high probability of their customers, they will be sent to these medical institutions, at least in the basic program.

One of the advantages of self-purchase DMS. - Ability to choose all the necessary components and conditions of insurance program yourself. When buying the policy, be sure to check:

  1. What is included in the insured event.
  2. What is included in the list of exceptions.
  3. Whether the number of specific analyzes and procedures is limited.
  4. What clinics will be available to you.
  5. Whether every time you can coordinate a visit to a doctor with insurance or direct access is possible.
  6. Policy DMS. It works only in the city of residence or throughout the country.

Purchase of voluntary health insurance is spending on treatment. If you are issued DMS. yourself, spouse, children under 18 years old or parents, paying out of their pocket, you relies with a tax deduction - 13% of the cost of the policy, but not more than 15,600 Рin year. How to get a tax deduction for treatment, we wrote in detail in a separate article.

How to reduce the price of DMS

If the employer has no voluntary health insurance program, but you understand that you really need it, try to reduce the price of an individual policy DMS. .

Estimate insurance risks. Think exactly what medical services you need first. Often for this enough to remember the history of their appeals to the doctor over the past year.

Abandon dentistry on DMS. .Treatment of teeth is a lion's share of value DMS. . At the same time, basic procedures guaranteed by the Mandatory Medical Insurance Program are most often assumed. It is possible to treat a qualitative teeth. OMS , Attaching good private dentistry.

Avoid popular clinics. At the time of buying DMS. It is important which clinics for treatment you will choose. If consultations are not required of domestic medicine, it is better for you to better abandon medical institutions with loud names and choose several ordinary clinics near the house. Will be cheaper.

Buy DMS. With franchise. Franchise is when you agree to cover part of the expenses at the occurrence of the insured event.

There is a conditional franchise - when the patient himself pays for treatment within the amount of the franchise, for example 10,000 Р. If the treatment cost more, for example, 11,000 РAll expenses will cover the insurance.

There is an unconditional franchise - when the insurance compensates for the client the difference between the general expenses and the price of the franchise. For example, if with a franchise at 10,000 РTreatment cost the same 11,000 Р, Insurance compensates for the patient difference - 1000 Р.

There is still a temporary franchise - when after concluding the contract, the action of the policy begins only after time. So the client confirms that for him DMS. - It is an insurance for the future, and not a way to get enough insurance right now.

Franchise benefits people with good health who are ready to independently carry small treatment costs, but want to protect themselves from large spending in case of serious illness. It allows you to buy DMS. With a wide insurance coating and in some cases save up to a third of the cost of the policy.

Some companies offer their employees an expanded social package, which provides voluntary medical insurance. This policy allows you to get better treatment. But unfortunately, not everyone uses them, since employees do not know what DMS is, do not recognize about all the possibilities.

What is DMS and why he need

DMS for employees of the organization: what it is and what it gives how to arrange how to use the policy

Voluntary medical insurance is provided by the employer. It differs from the mandatory in what includes an extended list of medical services. Voluntary insurance is regulated by the law "On the organization of insurance affairs in the Russian Federation" and the Law "On Medical Insurance of Citizens in the Russian Federation".

It is not free, for him you need to pay an insurance company, but pays for insurance is not insured, but an employer. Insurance applies immediately to all employees, and not one, but everyone has its own Personal Policy. More often it is provided to employees working in the company for more than 1 year, in which the employer is confident. Insurance is not cheap, therefore, to give it to interns or people who have just worked out, no sense.

The employer himself chooses a set of services that will cover medical insurance. If he wants to save money, then can order a limited coating program. But in any case, the owner of the policy has the right to treatment and diagnosis not only in state hospitals, but also private clinics, count on a higher quality of service.

There are 3 subjects in the DMS system: organization, SC and staff. The policyholder is an enterprise, which employs people. He has a contract with an insurance company. Each employee is issued a medical policy with which he must contact the clinic in case of illness or other health problems.

Note! All DMS conditions are registered in the insurance program. It contains information about institutions where you can see for free treatment.

How does medical insurance work? Insurance case is the appeal of a person to the hospital for medical care in illness or injury. The insurer pays an employee only treatment according to the testimony of the doctor. If a person appealed to the hospital for examination with a prophylactic goal, then it is not worth counting on compensation. We'll have to pay from your pocket.

Important! The insurer can partially pay for treatment if the amount for it exceeds the value indicated in the insurance contract.

Pros and Cons DMS

DMS for employees of the organization: what it is and what it gives how to arrange how to use the policy

DMS opens new opportunities before employees and employers. Firms thus show their care for personnel, increase their attractiveness and competitiveness, create improved working conditions. This is the ability to attract highly qualified personnel. Organizations also benefit from the DMS for workers and from a financial point of view. Due to the reduction of profit, taxes are reduced.

What gives DMS to employees? They receive such benefits:

  • the opportunity to be treated in private centers and get quality service;
  • buy discount medications;
  • undergo a survey on modern accurate equipment;
  • free to pass expensive tests;
  • Do not stand in queues;
  • be treated at home;
  • undergo rehabilitation in sanatoriums or specialized resort hospitals;
  • to be treated in the hospital, being in a separate ward with all the amenities;
  • receive professional dental care;
  • Fasting medical examinations.

Due to the quality and correct treatment, the working faster recovers and proceeds to work, increasing the company's profits.

Plus insurance is also a DMS for relatives. The action of the policy can spread to children and spouses. But such privileges for relatives require large costs from the employer, so they are rarely included in the program. Mainly this option is used to further stimulate valuable frames.

The disadvantage of insurance of workers is the fact that a person cannot choose the institution with which the SC does not cooperate.

List of medical services

DMS for employees of the organization: what it is and what it gives how to arrange how to use the policy

If the firm offers its employees of the DMS, then you need to clarify that it covers. In general, the list may look like this:

  • challenge emergency or doctor at home;
  • outpatient polyclinic treatment;
  • diagnostics;
  • procedures;
  • family physician services;
  • Stomatology ;
  • emergency hospitalization;
  • hospital treatment;
  • Sanatorium resort improvement;
  • Immunoprophylaxis.

SK will pay only services appointed by the doctor. For those medicines that the patient will "write down" himself, will have to pay independently.

The medstrashovka can have many pitfalls concerning not only the list of services, but also the multiplicity of appeal to the hospital. For example, it happens that only 2-3 consultations of doctors for the year is provided for the Policy. For the rest of the visits, you will need to pay or go to the State Hospital for OMS.

Another exception may be a kind of illness with which the employee will appeal to the clinic. If the patient has an oncological disease, hepatitis or diabetes, then he should not count on free help. Treatment free of charge will be provided only in the event of a threat to life.

How to issue

DMS for employees of the organization: what it is and what it gives how to arrange how to use the policy

The collective medical insurance procedure is quite laborious. First of all, it should be provided for by the labor or collective agreement that operate in the enterprise.

To the selection of the UK, it is necessary to approach responsibly, choose the best. Before concluding a contract, you must request a license and permits, make sure that it works in accordance with the law, as well as assess the insurer for these criteria:

  • Rating in the SC registry;
  • Customer reviews;
  • History of insurance payments;
  • Network clinics;
  • The cost of insurance services.

After the employer decides with the SC, you can make a DMS for employees. To do this, it is necessary to submit a written statement ( sample ). In addition to him, the insurer must provide all the registration and constituent data of the company, the list of employees who will insure. It is also necessary to determine the medical insurance program. From it will depend on the amount of insurance payments.

At the same time, the organization must have issued a voluntary health insurance order for working. Next, a local regulatory act is published, each employee is tamed with the terms and samples in the registry.

After the conclusion of the contract with the SC, employees must pick up their policies from the insurer. They will additionally be informed about all insurance conditions.

Selection of the program

DMS for employees of the organization: what it is and what it gives how to arrange how to use the policy

SC offer organizations of a program intended for:

  • leaders;
  • middle managers;
  • simple workers.

The higher the position, the longer the amount of services.

Conclusion of the contract with the SC

The employer concludes an agreement with the SK on behalf of the personnel. It should contain such information:

  • The haugh known list of employees;
  • Insurance amount for medical services;
  • contract time;
  • The procedure for payment of insurance premiums and compensation;
  • Responsibilities and rights of all subjects (insurer, insured and insured persons).

You can conclude an agreement in the IC "MTS", " SOGAZ "," Rosgosstrakh "," Alfapture "," VSK "," VTB "and others.

Note! Insurance is valid for 1 year. The insured can be treated in the amount of from 10 to 310 thousand, depending on the tariff plan.

Cost

DMS for employees of the organization: what it is and what it gives how to arrange how to use the policy

Calculate the cost of DMS is quite simple. To do this, you need to know the number of employees and the selected program. On average, the insurance of one employee is within 6-10 thousand rubles. The more services are contained in the program, the more expensive the policy.

Note! SC offers firms to reduce the cost of DMS with each new insured employee.

By entering into an insurance agreement for 1 year, the firm receives tax breaks. Contributions are expenses of the company, paid from the company's profits. When calculating, they are taken into account in the amount of 6% of wages. From the total amount of contributions is not taken by the ESN and NDFL. During the calculations, employers are guided by the Regulations of Article 17 of the Federal Law No. 1499-1.

If the employee passed the sanatorium-resort treatment, then the company is also exempt from the payment of NDFL. As for the insurance of relatives, the employer does not receive any additional tax benefits, so reluctantly orders this additional service.

How to use DMS.

In the insurance company or at the collective assembly will tell how to use DMS. If an insured event occurred, you need to contact the clinic, having a policy with you.

Note! If you can not get medical services in the DMS, you can use OMS.

To check which institution you can contact, you need to go to the "Personal Account" on the SC website. The employee has the opportunity not only to clarify all the necessary information, but also to make an appointment.

How to get compensation

DMS for employees of the organization: what it is and what it gives how to arrange how to use the policy

Payment of insurance premiums in the monetary equivalent should not be expected. The process looks like this:

  • The insured person appeals to the medical institution receives the necessary medical care;
  • The insurance company agrees with the hospital the cost of treatment, an account is set, which is paid by non-cash;
  • The company pays the SC.

However, when buying medicines issued by the doctor's prescription, payments can be obtained in cash. But it is advisable to consult in advance with the insurance agent.

Whether the policy acts after dismissal

After the employee is dismissed from the organization, he must pass the policy. A person has no right to use it next.

To stop the insurance, it is necessary to contact the insurance company with a written agreement. This should not be engaged in the insured itself, but a representative of the insured. The application must be attached to the list of dismissed employees, indicating the date of termination of the employment contract.

If the employer for any reason will forget to contact the SC, and the dismissed employee will continue to use the policy, the firm may require the recovery of insurance premiums. However, prove the fact of fraud will not be easy.

When making a DMS for employees, all parties benefit, but it is worth attracting an experienced lawyer to this process, which will help to make the right choice. Insurance companies can work dishonestly, do not tell about all pitfalls, which is why unpleasant surprises arise in the process of cooperation. Knowing features and average DMS rates, you can bypass the side of unreliable partners.

A source: https://gidpostrahovke.ru/zhizn-i-zdorove/dms/chto-takoe-dms-doma-sotrudnikov.html

One of the types of insurance products offered by insurers is the provision of financial protection for the treatment and related services for the disease. This service is offered on OMS. What is DMS insurance for many is a mystery or many questions arise regarding its features. This type of insurance has the difference from the mandatory species, cannot cover all the estimated costs, but the benefits of its presence have already managed to evaluate many citizens of the Russian Federation and people without Russian citizenship.

Main species

If compulsory medical insurance, the Law of the Russian Federation obliges to execute all citizens of the country, then the DMS refers to voluntary. It is drawn up to expand the ability of medical care. Buy yourself, but some companies are issued for their employees.

Depending on the classification, the DMS happens:

  1. Regarding the designer:
  • individual. In this case, a person makes it independently when the employer does not want to take the burden on paying the insurance premium, does not employ a person or the person unemployed;
  • corporate. The company buys policies by corporate scheme with the number of insurers from 2 people (depending on the company) and most often this option is more profitable;
  • family. Costs cheaper than individual, applies to protect risks regarding family.
  1. According to functionality, relevance:
  • replacing when a person does not have an OMS policy;
  • Parallel, she is complementary. Expands the list of services for the OMS, improves their availability: service out of turn, cost coverage that are not provided with mandatory insurance;
  • Extended. It assumes the addition of services that are not present in the OMS, but are not designed for treatment on existing diseases.
  1. According to the scheme of cooperation, which depends on the payment in the identification of the disease:
  • The compensation on which compensation is paid on the basis of already paid checks. The advantage is the service in different clinics in different types of assistance. Is issued by the employer;
  • Return, accessible to individuals, companies. Upon the occurrence of the insured event, the amount of treatment on the policy is paid. If for the period of the contract of the treatments for illness was not, then part of the funds returns;
  • Non-return, premium insurance. In the first case, the payment on the policy is not made if the term of the contract has ended. The basis for the payment is only an insurance case. In the second case, to cover the insurance costs SK calculates some amount from the one that goes to pay for treatment.

Build an insurance policy "Your Personal Doctor" on the VTB website Insurance Formation of the Insurance Policy "Children's Doctor online" on the VTB website Insurance, the Insurance Policy "Manage Health Online" on VTB Site Insurance is a unique insurance program for assistance in cancerism In Zetta Insurance

Who can issue

As already mentioned, the insurance of DMS can be arranged independently or through the employer. In each case, the execution of the contract precedes the stage of searching for a suitable insurer. For the employer, the publication of the order of the procedure is mandatory, the development of the provision on the DMS, the conclusion of agreements with employees. Employees are recommended before putting their signature in the Policy, familiarize themselves with the terms of the agreement.

For an individual must comply with the age condition. Polis can arrange a person who has been 18 years old, but not more than 75 years old, it may also be a foreigner. It should be borne in mind that the insurer has the right to refuse maintenance in the presence of chronic diseases. The Voluntary Medical Insurance policy is issued for about 20 days. The obligatory procedure is to fill the questionnaire and the provision of a passport.

In some cases, SC specialists may request a certificate of health status. Based on the result, the decision will be made to conclude a contract. Foreigners fill another migration card, make a certificate of accounting in the federal migration service. If such an insurer is employed, the employer takes all concerns about these requirements for himself.

Check Prices for PMD Polisys on Ingosstrakh website

Standard Package Program

Even the basic set of services for the DMS will be large compared to the OMS. This applies to the advantages of consulting from specialists, surveys, payments for medicines.

Outpatient polyclinic service

Assistance in outpatient treatment is the most popular. It provides for an appeal to the therapist, cardiologist, endocrinologist, surgeon, other doctors in accordance with the work regimen of the clinic. Doctors can advise, give recommendations, treat, issue disability leaves, send to a survey. You can also get help in the treatment of physiotherapy, call home your doctor.

Basic stomatology

Standard services for assistance in the treatment of the dental unit for the DMS provide consulting from a specialist, the use of local anesthesia, the performance of X-ray. Also prescribed by expensive composite materials, the installation of pins, the restoration of the teeth in the case of its loss by 50%. Once a year, you can contact for removal of the dental stone. You can perform fluoridation of teeth, treatment of paradont 1, 2 degrees. Surgery covers simple and complex dental removal.

Basic surveys and procedures

Many surveys on the DMS, as well as the surrenders of the tests are carried out on a similar list with OMS, but the advantage is to pass without a queue, in an emergency, there is the possibility of contacting private clinics. Each insurance company has its own lists and need to be specified during the execution of the contract, especially if the presence of certain of them is paramount.

Hospitalization

When placed in the hospital, there is the choice of chambers, the best will be food, specialist services. The volume of services may be similar to OMS, but payment is greater. For this reason, the Voluntary Insurance policy is the most valuable for people of middle, older, as comfort will be higher than usual. It is important to conclude an IC contracts with good clinics and they should be recognized in advance.

Providing medicines

Similar to all services for voluntary health insurance, requires clarification from the insurer and a list of paid drugs, as each company develops its own. The advantage is the inclusion of expensive, which will not cover the OMS. This applies to urgent state medicines, for the treatment of acute diseases, exacerbation of chronic states, others.

Ambulance

Ambulance brigades leave regardless of the selected insurance program. DMS maintenance involves the implementation of the primary inspection, the necessary express diagnostics, processing of the Russian Academy of Sciences, injection of drugs, delivery to the hospital with which the insurer has a contract.

Call a doctor

Calling a doctor home allows, in the absence of opportunity to visit the medical institution to produce the necessary examination, counseling. At the same time, the departure is carried out not only at the place of residence, but also at the place of work. This service is relevant for young mothers, if necessary, escorting people in serious condition, for primary, repeated examinations. It also applies to the provision of services with junior medical personnel if it is necessary to determine the pressure, injection injection, to collect analyzes. You can call for paperwork, including sheets of disability.

From which the cost depends

The cost of insurance for DMS is determined individually. It depends on the supply of an insurance company, tariffs, the clinics level with which the cooperation agreements are signed.

Also the price depends on other factors:

  1. Age and sex of the insurer. More profitable medical insurance are for younger age. Since 30 years, tariffs begin to increase. At the age of 50 - 55 years, the cost increases by almost 1.3 times. For children, tariffs are others. It can also concern men, so their work is associated with a risk for health more than women.
  2. Hercid volume. There is a dependence of the amount of services provided, their volume. If there is a desire to expand the proposed list, then you will have to pay extra.
  3. The presence of chronic diseases. In this paragraph, it should be due to the fact that insurance covers risk, unpredictability. It is impossible to apply for the service of financing on the existing disease. You can insure with the disease, but the conditions will be different. Waiting period may be proposed for about 6 months.
  4. The size of the sum insured. It is negotiated in advance before signing the contract. Here there is a direct dependence: the more insurance coverage, the greater the price of the policy. It can be enlarged during the period of insurance, making an extra charge.
  5. Region of residence. The insurer has the right to increase the cost of insurance in the event of a person in another city, the region.

How much is

The definition of the price of voluntary health insurance insurance has an influence of a large number of factors.

This refers to:

  1. Insured Category: Children, Pregnant, Pensioners, Minors. The risk for SC is more, the price will be higher.
  2. Insurance program. The more risks are provided, more expensive options, the price is greater.
  3. Insurance conditions for specific IC.

What is included in the expanded package

The list of services for the expanded policy is similar to the standard, but complemented by other services, offers.

This refers to:

  • Maintenance of pregnant women. Women can count on pregnancy, taking birth, ultrasound, which allows not only to hope for qualified assistance, but also plan costs. You can also use the possibility of round-the-clock counseling, choose a female consultation in which mainly observation;
  • Protection in case of tick bite. It is relevant for regions in which there are many of them or for people going to go there. This option covers the costs of inspection by a doctor, insect removal, its research on the definition of type, drug prevention, hospitalization, rehabilitation procedures, the discharge of the hospital leaf;
  • Medical assistance abroad provides for assistance to intermediary companies that are responsible for servicing in clinics with which the contracts are signed. Depending on the conditions, the tourist can pay for expenses independently, but to reimburse the costs to contact the IC upon arrival home, providing payment documents, extracts, other;
  • Dentistry. Advanced Policy is complemented by implantation services, prosthetics, but the latter can be provided in case of injury. If prosthetics are necessary due to treatment neglection, may refuse to reimburse costs;
  • Services of a personal doctor are relevant to people who want to be observed at one doctor who will observe them;
  • Sanatorium-resort treatment allows rehabilitation in a sanatorium-resort institution, if the Agreement provides for such a service;
  • service in medium-level medical institutions or in more advanced states;
  • lack of restrictions on the number of times for testing, except high-tech;
  • lack of a limit on physiothereders;
  • A larger list of doctors, including mammologist, proctologist, dermatologist;
  • treatment in the hospital Even with the need to stagnate a dropper;
  • coating with drips, business trips;
  • Influenza vaccination.

What does not cover

When buying a DMS, it should be remembered that each insurer has restrictions. Even the advanced policy does not make it possible to reimburse in some cases, if they are not covered:

  1. Diseases transmitted by inheritance, genetic anomalies, diseases requiring transplantation, diabetes mellitus, tuberculosis transmitted by sexual, cosmetology operations, alcoholism, epilepsy, HIV, mental illness.
  2. Treatment with the participation of alternative medicine.
  3. Experimental treatment.
  4. Some types of diagnostics.
  5. Medosprocessors who contribute to or preventing fertilization, including diagnostics.
  6. Plasmapheresis, hemosorption for the purpose of prevention or in chronic diseases.
  7. Wellness treatments (massage, solarium), except for those assigned to treatment within the insured event.
  8. Finding in the hospital if necessary for the patient, as well as escort in the sanatorium.
  9. Some types of drugs, medical equipment, glasses, hearing aids and expenses for their correction.
  10. Treatment in institutions with which the CC contracts are not concluded, except for cases of exception.
  11. Getting medical assistance without medical prescriptions, on their own initiative.

Where could I buy

The list of companies selling voluntary health insurance agreements extensive. Different is their level, the cost of insurance and services, which includes.

Insurance companies selling DMS in Russia:

Name of insurance company Services under the standard contract
Rosgosstrakh
  • Ambulatory and Polyclinic Help
  • Dental services
  • Ambulance
  • Emergency hospitalization and hospital treatment
SOGAZ
  • Outpatient polyclinic service
  • Ambulance
  • Dental care
  • Emergency and planned stationary service
  • Consultative and diagnostic services
Reso-guarantee
  • Outpatient help
  • Help at home
  • Ambulance
Jaso.
  • Inspection, consultation
  • diagnostics
  • Ambulator service
  • Dental services (sealing, cost of materials, surgery and prosthetics)
  • Emergency Help at home
  • vaccination
Ingosstrakh
  • Outpatient polyclinic service
  • Pharmacy service
  • Stomatology
  • hospitalization
Society of Jaso
  • Ambulatory and Polyclinic Help
  • treatment in hospital
  • diagnostics
  • Stomatology
  • Medicinal support
  • Influenza vaccination, tick-borne encephalitis

DMS Insurance in SK DOODMS Insurance in the SK Russian StandardDMS Insurance in Rosgosstrakh

Validity

The deadline for which the person who issued the insurance of the DMS can apply for costs or servicing is prescribed in the contract itself. Usually, it equals 1 year.

Important! If the term is not specified, with the insurance case, the company has the right to recognize it invalid, since from a legal point of view the date should stand.

The policy comes into force from the moment of its payment and setting signatures of the parties. Some companies provide the "expectant period", according to which the appeal may begin only at its end.

DMS DMS from OMS

Different insurance products have different conditions for maintenance, but there is also similarities. The main difference is the cost, since when choosing a DMS, you need to pay and amounts can be significant, which depends on the program. At the same time, the level of services will be significantly more. Essential differences will be presented as a table.

Differences between insurance policies of OMS and DMS in Russia:

Criteria name Type of insurance
OMS DMS.
Cost is free from 5 000 rub.
Validity Without limit more often 1 year
Service list Standard List of Diagnostics, Treatment Various types of surveys, medical events
Quality of services Standard High
Clinic status State, municipal Private and government with high level of comfort

How the contract is issued

To obtain a voluntary MS contract, there are several purchase options:

  • personal visiting office insurer
  • Online buying on the official website of the SC
  • through an intermediary online or personally
  • through the employer

The design process consists of several stages:

  1. Determine for yourself the insurer who can entrust medical care and identify a suitable program.
  2. Get acquainted with the conditions on it (read, refine incomprehensible).
  3. Remit payment.
  4. Get a document on the hands and clarify when it comes into force.

Causes of refusal

The law does not regulate the conditions for refusing to maintain insurers for medical care. This moment each company covers in its own way.

The list of reasons for the refusal most often includes the following items:

  • diseases from the list of insurance restrictions (described above);
  • injury, diseases obtained due to alcohol or narcotic intoxication;
  • intentional damage or due to unlawful actions;
  • diseases due to the action of radiation, hostilities, female disasters;
  • Not compliance with the terms of the insurance contract, including relative to the deadlines for submission of documents on the insurance case.

Benefits

DMA insurance is accompanied by the study of the interests of the insured. It has the right to add to himself, to remove the indicated points for services, affect the territory of the action (when leaving the country). It can change the life of insurance. The main advantage of the possession of the policy is to ensure highly qualified help with minimal costs compared to situations when you need to pay all yourself.

DMS insurance

disadvantages

The minuses include:

  • The lack of a fixed cost of the policy, since this parameter depends on different features
  • availability of restrictions, including in complex diseases
  • long-term insurance is not provided

Conclusion

Insurance companies are interested in providing quality services to customers, as it affects their work, the formation and expansion of the Customer Base, the credibility rating. The insured must carefully approach the selection of the SC, the insurance program, evaluating its needs, possibilities. It should be understood that the financial balance is also important in this issue, since the insurers will not work at a loss, and therefore should provide for restrictions, and insurers should carefully choose programs for which they want to be serviced.

Video: What is DMS - myths and reality

Most of the medical services can be obtained absolutely free of compulsory health insurance policy available for each citizen. Thanks to him any person can call the doctor's house, visit the therapist and a number of narrow-wired specialists, as well as to obtain the direction of planned operations.

The problem is only in pretty large queues in the clinics, as well as in the most modern equipment and sometimes found low-qualified doctors. All these problems can solve the Voluntary Health Insurance Policy.

What is DMS and why he need

DMS is deciphered as voluntary medical insurance. This is a paid service, the cost of which is formed from several factors. Large employers pay this policy so that the employee receives highly qualified medical care and as soon as possible returned to the system, so that the company did not lose much money due to possible idleness. Also, this services can be issued and pay independently.

When using the DMS policy, a citizen is able to call a doctor to a house, to visit narrow-controlled specialists without queues, as well as undergo treatment abroad (when acquiring expensive insurance). In the case of calling the ambulance, a person will not be taken to the nearest clinic, but in the one that the citizen chose himself.

DMS DMS from OMS

In addition to the clinic or hospital, which will take a citizen when calling the ambulance car there are some more differences. First of all, this applies to the legal side. The use of OMS and DMS is described in different FZ. In the first case, this is the Federal Law "On Medical Insurance of Citizens in the Russian Federation", and in the second case - the Federal Law "On the organization of insurance affairs in the Russian Federation".

When using OMS, the insurance rules are determined by the state, and the main policyholder itself is the state authorities themselves, in the case of paid insurance, the insurance rules are determined by insurance companies, but are engaged in these insurance companies or individuals. At the same time, mandatory medical insurance is issued to every person who has citizenship of the Russian Federation immediately after birth, and paid is drawn up independently.

It is also worth noting the difference in the services provided. It's no secret that the equipment and qualifications of doctors in private clinics are often better and higher than in similar state medical institutions. In addition, you can additionally pay for pregnancy services and subsequent reception of childbirth.

More attention is paid to the treatment of teeth - a citizen will receive the most modern treatment and related services (x-ray, dental removal, gum treatment). It will not only be possible to fix the bite and conduct other procedures equivalent to cosmetology. In the case of hospitalization, the PMC policy also relies the acquisition of medicines and conduct all necessary procedures.

Types of DMS.

You can classify the PMS policy in several ways, the first of which is the functional value. In this case, we are talking about the importance of this document for a person, there is a replacement, parallel and expanded insurance. The choice of concrete depends on the state of human health and several other factors.

Replacing insurance is used in cases if a person for some reason does not have an OMS policy. Usually the reason is a high income of a citizen or the absence of taxes on medical insurance. In this case, besides the acquisition of the DMS methods, there is no longer insurance. A similar situation is suitable for the unemployed.

The parallel type of DMS is purchased in addition to the OMS. This expands the number of medical services provided, and simplifies the availability of medical care. In the event of health problems, a citizen independently chooses a treatment for treatment and its order. Thanks to this Policy, the DMS can be saved on the acquisition of medicines or passing additional services that are not paid for OMS.

Where to issue a policy of DMS

For registration of the optional medical insurance policy, you need to contact any suitable insurance company. It is easy to choose it. First you need to choose some sufficiently well-known firms, among which one particular will be determined. Almost every bank has its own insurance company, there are also companies providing only such services.

After the formation of the original list, it is necessary to compare the cost of DMS, and then read customer reviews. Valuable information will be carried out not only negative, but also positive comments. Thanks to this, you can choose a fairly good company that will not let go in a difficult moment.

Choosing a suitable program

Insurance companies usually have several diverse packages, which differ not only at cost, but also by the number of services available to it. In the basic case, a person is offered only a campaign to the therapist and a number of narrow specialists, the treatment of teeth and the acquisition of medicines can be connected for an additional fee.

More advanced programs can additionally further comprise emergency hospitalization, hospital treatment, teeth treatment, as well as help a personal doctor. In the most expensive programs, the possibility of treatment abroad is available. The choice of a suitable package directly depends on the person, he himself understands what services it will most likely take advantage of the time.

Cost

The cost directly depends on the selected program and the polyclinic used. The cheapest package usually allows you to be serviced in a private clinic (or in the state, but out of turn), but it is impossible to get an appointment for a complex operation or diagnostic procedures. The cost of such packages begins with 6-8 thousand rubles.

More expensive options begin from 10 thousand rubles and include surcharges at home or in paid laboratories, teeth treatment or gums and much more. In some cases, it is possible to even be treated abroad, but the cost of the PMC policy in this case can be several thousand dollars.

What is not included in the policy of DMS

Even the most expensive paid insurance will not cover all the medical cases that may occur in humans. The entire list of services is indicated in the regulatory work of insurance companies by the Federal Law, as well as in the contract concluded between a citizen and firm.

Usually, non-insured events are injuries obtained due to the use of alcohol or drugs, with intentional damage to health, when trying to suicide. Similarly, it will not be possible to get paid for the treatment, which was conducted after war, civil war, natural disasters or nuclear explosion

In the design of the PMC policy also refuse to people who have chronically diseases. These include HIV, AIDS, disability, tuberculosis and some others. A similar situation may occur if a man has diabetes, but the insurance agent usually offers a slightly different program for the insured.

Conclusion

The policy of voluntary health insurance is an excellent opportunity to supplement the existing mandatory health insurance. The cost can not be very high, but the quality of service and the list of services offered is worth it.

DMS - what is it, appointment, execution of the policy and the difference from the OMS

January 19 2021.

Hello, dear blog readers KtonanovenKogo.ru. Today, we analyze the foundations of health insurance in the Russian Federation, learn who finances honey. Help citizens of Russia.

Consider the concept of DMS, for which it is necessary and how it differs from OMS. We learn what services are included in the policy to whom it can be issued, how much will it cost and that will not be an insured event.

Policy DMS.

What is DMS.

According to the Constitution of the Russian Federation, every citizen of our country has the right to receive free medical care. But since the state economy exists in the conditions of market relations, then honey. Help (free for citizens) in any case Financated From someone's pocket.

Service of the unemployed (who is it?) And disabled citizens (pensioners, children, disabled) is carried out from the budget of the region in which they live. Help employed citizens turns out to be due to contributions to their employers, IP (individual entrepreneurs) make deductions on their own.

Briefly about OMS: Free medical care is fixed by the contract Mandatory Medical Insurance (OMS) With the issuance of the policy. One side of the agreement is the Insurance Company (SC), which has a state license for the health insurance of citizens within the framework of the OMS program. The other party is a citizen of the Russian Federation.

The conclusion of an OMS contract provides that free honey. help can be rendered Only within approved services. Persons who want to receive medical services in an expanded list and volume must pay for it.

It is possible to implement it through the acquisition of the Voluntary Medical Insurance Policy (DMS).

Having this insurance, upon the occurrence of an insured event, a citizen has the right to receive medical services In advanced assortment, and you will pay for them.

Conclusion: DMS is the type of insurance, in which in the case of the insured event occurred, the insurance company organizes free medical care in the selected honey. institution as part of the insurance program.

Consider the scheme for the interaction of all participants of the DMS:

Scheme of interaction

DMS for individuals and legal entities

The insured in the DMS contract is a person who has concluded an agreement with an insurance company on providing a certain honey package. Services.

The insured can be:

  1. individual (who is it?). In this case, insurance has the status of an individual. The insured must be capable (what does this mean?). Not always at the conclusion of an individual contract, the insured and the insured is the same person. For example, a husband may insure a wife, a mother - son, etc. If desired, you can insure even a prannetium;
  2. entity (who is it?). This option is most often found. The policyholder is the organization, caring for the health of its employees or its pensioners. For example, the Central Bank (CB) of the Russian Federation insures the DMS not only of its employees, but also employees who have gone to a well-deserved rest.

    This is the so-called corporate insurance. The cost of "wholesale" insurance for legal entities is more profitable than the insurance of everyone, separately taken.

Who can get this policy

Insure under the contract of DMS, any individual, regardless of its citizenship, is possible:

  1. citizens of the Russian Federation;
  2. citizens of a foreign state;
  3. persons who do not have citizenship in principle.

You can not insure A person who suffers from diseases, the funds for the treatment of which is allocated from the state budget.

These are diseases (subject to official confirmation of the diagnosis):

  1. sarcoidosis;
  2. mental disorders;
  3. venereal diseases;
  4. oncology;
  5. Diseases requiring compliance with quarantine regime:
    1. Tuberculosis in the heavy stage
    2. Tiff
    3. plague,
    4. OSCE, etc.
Process of providing honey help

What is included in voluntary medical insurance

When concluding a contract of DMS, the insured has the right to choose a package of medical services that wishes to receive. This package is called Insurance program .

The cost of the policy depends on the number and prices of each service.

As a rule, the SK is developing standard insurance packages that then offer customers.

In various insurance programs Common services From the following list:

  1. Consultation of doctors when taking a patient in a clinic and at home (including narrow specialization doctors);
  2. laboratory research;
  3. hardware diagnostic methods;
  4. establishing diagnosis;
  5. appointment and treatment of treatment, including in stationary conditions;
  6. recipes extract;
  7. maintaining and issuing a sick leave;
  8. performing hardware and manual treatment procedures (including intramuscular, intravenous injections);
  9. Sanatorium and resort and rehabilitation treatment.

What is not included in the list of insured cases on the DMS

Situations that are not insured occasions are usually prescribed in the DMSU. For information we give them General list :

  1. Diseases and injuries obtained due to alcohol or narcotic Inxication . Example: A cheerful man was insured by DMS, after the New Year's corporate party, slipped, fell, woke up - gypsum. This situation is not an insurance case on DMS. You will have to go to the citizen. Establishment on the Policy of the OMS. But even if he does not have any, the first emergency assistance will be provided for free and in the shortest possible time;
  2. intentional causing themselves injuries, including when trying to suicide (suicide);
  3. injuries obtained when making an insured person illegal actions. Example: I decided the man insured by the DMS, rob my neighbor in the cottage settlement, climbed on the fence, and fell from him. Police arrived, the anti-actions are proved. The injury obtained is not included in the list of insured cases of DMS;
  4. Diseases and injuries obtained as a result:
    1. radioactive infection
    2. military conflicts
    3. natural cataclysms (hurricane, storm, earthquake, etc.).

Where honey is provided. Help on the PMD policy

The Insurance Company guarantees the fulfillment of the conditions of the DMS contract in the medical institutions with which their relevant agreements are concluded.

The list of such clinics, the clinic and hospitals is prescribed in the DMS contract or in a separate appendix to it. If for some reason the insured person can not get help in these organizations, then he needs to contact the SC, which issued the policy.

Insurance can offer an alternative by concluding a one-time treaty with honey. Institution, satisfying the conditions of the client (insured person).

Support services for DMS can medical organizations of any form of ownership. These may be state clinics and hospitals, private clinics, medical and preventive and specialized institutions. The basic condition - they should have a license For the provision of medical services.

DMS DMS from OMS

DMS and OMS
Analysis criteria DMS. OMS
Insurance principle voluntary required
source of financing from the insurer (JUR. or Piz. Persons)
  1. Insurance deductions of the employer for employed citizens;
  2. budget funds for unemployed and disabled persons;
  3. Own funds for IP and self-employed persons
Insurance program Selected by the insured Installed by the state
interaction Do not exclude each other's functions

How to make a policy of DMS

The conclusion of the contract of DMS is applicable. This means that a physical or legal person must personally contact SC. , Write a statement, conclude a DMSA agreement and pay an insurance premium.

The DMS for individuals is issued upon presentation of a passport, and DMS for legal entities - upon presentation of constituent documents and a list of employees for whom policies will be issued.

IMPORTANT: Insured by DMS, a person has the right to receive medical services both by OMS and DMS.

Registration of DMS.

What is the price of the policy of the DMS

The price of the PMC policy for individuals depends on the set of factors:

  1. choice programs insurance;
  2. Age and health status of the insured person. For example, when insuring elderly people with chronic diseases, or pregnant women, when calculating the cost of the policy, an increase of the coefficient is applied;
  3. Quantity I. Level honey. institutions proposed by the SC to appeal when the insured event occurs;
  4. The kind of professional activity and extremality of the hobby (what is it?) The insured person. The increasing coefficient will be applied if the work or passion is associated with physical risk.
DMS for individuals

The article presents the most common information on voluntary health insurance. If you want to know more, read our blog and ask questions.

Good luck to you! Seeing fast meetings on the pages of KtonanovenKogo.ru

Добавить комментарий