Social health insurance is a form of protection of the public interest in health, by providing payment for medical care for the insured in the event of medical necessity.
Health insurance helps ensure citizens a certain amount of free medical services in the event of an insured event (a health problem) if there is agreement with the health insurance company. The health insurance company assumes the risk from the date of payment of the first installment for a citizen of the relevant fund.
Voluntary health insurance is personal insurance. It allows a propective patient to receive assistance in health care facilities (HCF) and pays for the treatment.
Voluntary Health Insurance (VHI) are subdivided into individual and group policies.
Policyholders are the individuals (usually on individual programs – pregnancy, tick-borne encephalitis, etc.) and employers (usually on a group program – outpatient care, hospital care, dental care).
Individuals can act as insured persons. Insured persons receive free medical care at health facilities. The insurer compensates the health care facility for the costs of treatment. In exceptional cases (can not get help with health care facilities provided for in the contract of insurance), compensation may be made by the insurer directly to the insured.
Under Russian law, the following authorities are responsible for safeguarding and protecting the rights of insured persons:
- Legislative body of the Russian Federation
- Executive body of the Russian Federation
- Policyholders (employers)
- Territorial Fund of Obligatory Medical Insurance (for the relevant system)
- Health insurance organizations and their associations
- Health authority
- Professional medical associations
- Health-care facilities (clinics, hospitals)
- Licensing and Accreditation Commissions
- State control (prosecutors, the competition committee, the Commissioner for Human Rights, the Representative of the President of the Russian Federation, RosZdravNadzor)
- Agents of social control (trade union bodies, the Society for Consumer Protection, media, citizen)
- Subjects of pre-trial and judicial resolution of disputes
Voluntary Health Insurance (VHI)
VHI or private insurance provides for the receipt of additional medical and other health care services in excess of the compulsory health insurance underwritten by the state.
The main advantages of private insurance to the compulsory health insurance are that:
- Private insurance provides the opportunity to use more expensive methods of examination and treatment and to rely on an increased level of service. Thus, for insureds with private insurance, there may be reduced waiting times using different medical services.
- Insurance companies guarantee quality control of medical
services, assistance with admission and control the cost of care. Under the contract private insurance may result in due to damages caused by the improper application of medical technology and treatment failure. In cases of dispute, the insurance company can legally be required to protect the client.
- When buying private health insurance policy, chose the most suitable for you in terms of price and the quality and range of services. There are special programs for family, children, pregnant women, etc. You can also offset their medical expenses in full or in part. Some insurance companies are willing to work out an individual insurance model.
- The private insurance company provides treatment to clients in various medical institutions. It is convenient because it offers a choice in health care facilities. The insurance company may refer the client to a highly specialized clinic. If you need medical attention on a weekend, the insurer may refer the client to another health facility that works on that day.
Voluntary health insurance is designed to protect the right of the insured to receive service of medical services in connection with a disease.