В чем разница между программами добровольного медицинского страхования, страхования от несчастных случаев и смертельно опасных заболеваний. Узнаем как выбрать страховку максимально соответствующую вашим запросам.

В чем различия между ДМС, НС и СОЗ

Все граждане России, имеющие хотя бы временную регистрацию, могут совершенно бесплатно получить полис обязательного медицинского страхования (ОМС). Однако у таких полисов есть свои серьезные ограничения, которые многих не устраивают.

В этой статье сравним такие виды медицинского страхования, как ДМС, НС и СОЗ. Выясним, что у них общего, в чем основные различия, и разберемся, как выбрать оптимальный вариант для себя.

Начнем с самого популярного после ОМС страхового продукта — ДМС, то есть добровольного медицинского страхования. Его покупают, когда хотят получить более качественное медицинское обслуживание, пользоваться услугами в том числе платных клиник, проходить обследования без очередей и сэкономить на оплате лечения.

Работает ДМС следующим образом: страховая компания заключает договоры на оказание услуг с конкретными клиниками, чтобы ее клиенты без очередей и дополнительной оплаты проходили там лечение. О цене медицинского обслуживания клиенту при этом знать необязательно, он платит не клинике за стоимость медицинских услуг, а страховой компании страховую премию по договору ДМС.

Список медицинских учреждений клиенту страховщика могут выдать напрямую, а могут консультировать в каждом отдельном случае — куда пойти к кардиологу, куда к стоматологу и так далее.

Обычно в ДМС входят следующие услуги:

• доступ в клиники, которые заключили договоры со страховой компанией;
• ambulatory treatment. Как в государственных поликлиниках, но без очередей, в удобное время, в том числе в выходные дни;
• частная скорая помощь, вызов доктора на дом. В договоре страховщик укажет, например, сколько раз в месяц клиент может воспользоваться этой услугой;
• консультации узкопрофильных специалистов. Нужно узнать, какие именно сюда включены: например, есть ли маммолог, эндокринолог и так далее;
• анализы и диагностика, включая УЗИ, рентген, анализы мочи и крови. Следует уточнять, как часто можно пользоваться такими медицинскими услугами, (количество в год чаще всего ограничено);
• физиопроцедуры — ингаляции, лечебный массаж и так далее. Число процедур, как правило, тоже будет ограничено;
• госпитализация в палаты повышенной комфортности при государственных клиниках и в частные медицинские центры, если есть угроза жизни;
• оплата лекарственных препаратов, назначенных врачом;
• стоматологические услуги, в том числе анестезия;
• выдача больничных листов, чтобы подтвердить факт заболевания на работе.

Расширенные программы ДМС могут включать в себя ведение беременности и роды, имплантацию зубов, возможность круглосуточно консультироваться с личным врачом, томографию, палаты класса люкс, услуги психотерапевта, лечение за границей.The more services VHI includes, the more expensive it is.

Accident insurance

An accident is something that happens suddenly and adversely affects the health and life of a person. For example, injuries resulting from an accident, falling down stairs or just on the street, dog attacks, and so on. That is, if something unforeseen and unpleasant happens to the insured, up to death as a result of an accident, he or his heirs will receive an insurance payment.

Payouts may vary. In the event of the death of a client, the insurance company usually pays out the entire sum insured under the insurance contract, while payments in other cases are calculated based on the severity of the consequences of the accident. For example, if he broke his arm, the payment will be 10,000 rubles, he ended up in the hospital with a severe leg fracture, and the amount will be three times higher. Each insurance company has its own payment tables for specific insurance products with the calculation of the sums insured for each accident.

Depending on the terms of the insurance contract, the insured risks may include injuries, including minor injuries resulting from falls, accidents, careless handling of the tool, during sports, professional activities, and so on. Insured risks do not include cases when a person is guilty of an injury himself, for example, he intentionally harmed his health or was in a state of alcoholic intoxication, drove a car under the influence of drugs and alcohol, etc.

Deadly Illness Insurance (DOP)

This is a special type of health insurance specifically for diseases that may threaten life. Most often, these are oncological problems, neoplasms, as well as cardiovascular diseases – stroke and heart attack. There are mono insurances, for example, only against oncological diseases, and there are against several types of POPs.

If a person ends up in a hospital with a stroke or heart attack or needs oncological treatment, the insurance company will provide a payment in the amount established by the insurance contract.

Alternatively, the insurer can pay for treatment, offer to undergo it at a specific medical center, organize consultations, that is, take on everything that a person who has just learned about a terrible diagnosis is not able to do on his own.

What are the similarities and differences between the three types of insurance

VMI policy differs significantly from accident insurance and POPs. VHI does not provide for the payment of the sum insured in case of illness. It is the treatment and diagnostics, medical care in a limited number of clinics that are paid for. No need to pay every time for a visit to the doctor: the services included in the list are completely free.

Accident insurance is another insurance option.Its difference is that in the event of an insured event, a one-time insurance payment is made in the amount stipulated by the contract. Diagnostics and analyzes are not paid by the insurer – it is impossible to predict when an accident will occur. Insured events are most often considered temporary or permanent, complete or partial disability, death as a result of an accident, injury and disability.

POPs insurance is an even narrower type of health insurance. At the same time, as a rule, it is the costs of treatment or rehabilitation in the event of an SOP that are the most significant, because we are talking about organ transplantation, rehabilitation after a stroke or heart attack, and oncology treatment. It is necessary to pay attention to the limitations and exceptions provided for by the contract: for example, the insurer can only pay for operations on the vessels and the heart.

How to choose the best insurance

It all depends on what the insured person wants, what they are most afraid of. The VHI policy is universal insurance for literally every day. It was necessary to pass tests – please, you need to call an ambulance to bring down the high temperature – they will come to you. An extended VHI program may include treatment abroad and many other costly services.

POPs health insurance programs can be focused on a one-time payment or payment for treatment. If you hope that you will rarely have to go to the doctors, it makes sense to choose programs like "Health Standard Classic" with payments from 500,000 to 1,000,000 rubles. when diagnosing POPs and a refund of 20% of the cost of insurance, if the insured event did not occur during the period of its validity.

More popular is the Health Standard Plus insurance, which provides not only one-time payments (for example, 1,000 euros in case of a stroke or heart attack), but also payment by the insurer for inpatient treatment in clinics in Europe or Russia in the amount of up to 2,113,000 euros.

To insure against an accident means to get a “airbag” in case you had to leave work due to an injury. But unexpected costs can also threaten if a dangerous disease is detected, which often requires immediate treatment. In this case, POPs insurance will come in handy. For example, if the family has poor heredity and relatives had heart disease, purchasing such an insurance product would be very advisable.

In any case, you should compare insurance programs in the field of life and health of trusted insurance companies, analyze which specific insured events are insured, what payments you can receive.