Upon the occurrence of an insured event, LCA gives the insured child the right to receive comprehensive medical care provided for by the insurance program. Organizes the receipt of medical and other assistance for the insured child, and also the insurance company pays related expenses on the basis of a voluntary insurance contract with the child’s parents (other legal representatives).
- The insurance company pays the bills for the medical services rendered to the child within the insurance amount, which is about ten times more than the cost of the insurance itself.
- Parents will protect themselves from searching for the necessary specialists, medical institutions, etc. in an emergency situation. Specialists of the insurance company will arrange for the child to receive medical care. Moreover, if in some clinic the necessary specialist or equipment does not appear, then the insurance company will provide all this in another medical institution. In addition to medical care (prophylactic, diagnostic, treatment, rehabilitation, counseling), the LCA program may include transportation services to a medical facility, drug delivery, etc.
- The insurance company is legally responsible for the quality, timing and amount of medical services provided, which are supervised by the company’s experts.
- The insurance company protects the interests of clients (child) in any disputable situations. For example, it is dealt with a medical institution in the event of ineffective treatment, incorrect behavior of medical staff, etc.
- The insurance company guarantees the invariability of the insurance premium (insurance value) for the entire duration of the policy and thereby assumes the risk of increasing the cost of medical services in a medical institution.
- Individual approach: the child will be treated as required by the peculiarities of his state of health.
- Variety of insurance programs: parents can choose a program, be guided by the state of their health.
- The possibility of choosing a medical institution: parents can choose several different medical institutions and diagnostic centers in which they would like to observe and treat the child.
- Saving time: thanks to the round-the-clock dispatching service, parents can make an appointment to see a doctor at a convenient time for them, call emergency medical care, and receive expert advice from doctors at any time of the day and regardless of the child’s location.
The insured event is the treatment of the insured child to a medical institution (from the number stipulated by the insurance contract) in case of acute illness (condition), exacerbation of chronic illness, injury, burn, frostbite, poisoning and other accidents provided for by the insurance program. The number of insurance claims may be unlimited.
The insurance company pays (within the insurance amount) bills for medical services rendered to the insured child directly to the medical institution. Parents do not receive reimbursement.
Thus, parents pay only once – when they buy a VHI policy (insurance premium), and all expenses for medical care for the child during the insurance period are borne by the insurance company.
Hurry with payment should not be. The doctor may not know the features of the insurance program in each case. You must first ask this question to the medical supervisor or the specialists of the round-the-clock dispatching service of the insurance company (the phone numbers are listed in the insurance policy or in the “Insurer’s Memo”).
If you pay for the services yourself, and then it turns out that they are included in your child’s insurance program, the medical institution has the right not to refund you.
If the insurance coverage limit is exhausted in the course of medical care, then the insurance contract is terminated and, therefore, the child loses the right to receive medical care under the VHI contract. However, the insurance amount during the term of the VHI contract can be increased by agreement with the insurance company for an additional fee and by signing an additional agreement.
To obtain a VHI policy, you need to fill out a form, enter into an insurance contract and pay an insurance premium. The questionnaire can be obtained by e-mail (to do this, call the insurance company or make a request through the website). In the questionnaire, you must specify the data:
- child (he will be insured): name, birth certificate data, address of actual residence, gender;
- one of the parents (will be the Insured): name, passport details, address of residence, contacts for communication, place of work, position.
In addition to general data, it will be necessary to answer in detail questions about the state of health of the child (at present and in the past – over the past 3 years), about the course of pregnancy and childbirth (for children under 3 years of age), about chronic diseases of parents, about the existing insurance experience in past and other questions. Based on the answers, the cost of insurance will be calculated.
When filling out the questionnaire should be extremely honest to answer questions. If a child subsequently has a disease that is not indicated on the questionnaire, but which existed before it was filled out and is known to parents, then the insurance company may in court seek financial compensation and recognition of the insurance contract as invalid. Most often, the questionnaire is filled out enough, but sometimes the employees of insurance companies asked to show the medical record of the child.
The insurance program may include both individual services and their combination. The basic programs are: “Outpatient care”, “Personal doctor (Home care)”, “Emergency medical care”.
As a rule, they are sold as a single complex. Additional programs are “Dental care”, “Diagnostic program” and “Emergency hospital”.
Many insurance companies offer VHI programs for children in age categories (from birth to one year, from 1 to 3 years, from 3 to 7 years, from 7 to 17 years), which allows you to choose the right program and range of medical services related to stage of maturation of the child.
In Russian practice, a VHI contract is concluded for a period of one calendar year (unlike the MLA, which is unlimited).
As for the moment when medical aid is available to the child, various options are possible. Thus, in some insurance companies, the contract comes into force from 00.00 of the day following the day the insurance premium is paid (or the insurance premium is paid to the insurer’s cash desk). In other companies, the contract comes into force no earlier than 5 calendar days (for some, 15 days) from the date of the transaction.
Thirdly, from the moment the insured child is attached to a medical institution (which depends on the procedure adopted by the company, for example, 2 times a month – on the 1st and 15th). And under the “Hospital Emergency” program, a temporary deductible is usually valid (the period during which hospitalization is not an insured event and is not paid by the insurer) for a period of one month from the date the contract begins.
This condition applies only to the first year of the policy.
In this situation, you need to look at what is written in the insurance contract. For example, in some insurance companies they assure that they will pay for the stay and treatment of a child up to discharge. Other insurance companies report that after the expiration of the policy, they will pay the costs associated with the insured event that occurred during the validity period of the insurance contract, until the threat to the life of the insured is removed.
And in the third companies they warn that planned hospitalization is possible not less than 14 days before the expiration of the contract. In case of planned hospitalization, the services provided for by the insurance contract, rendered to the insured child before the expiration of the insurance contract, are subject to payment.
Then – at the expense of the insured (parents).
In some insurance companies, parents need to call the insurance company’s dispatcher service by calling the phone numbers listed on the child’s insurance card. A specialist with medical education will determine which specialists, diagnostic and treatment procedures may be needed, and will organize the process of receiving medical care for the child.
In another case, you should apply directly to the health facility to which the child is attached.
The provision of services to the insured child is carried out upon presentation by the parents of the VHI policy (insurance card) of the child.
Most insurance companies give the policyholder the opportunity. For example, to change (expand or reduce) the list of insurance risks, insurance programs, medical and other institutions, to increase the size of the sum insured.
To do this, it will be necessary to conclude an additional agreement and pay the insurance premium.
The cost of a medical insurance policy depends on many factors. In this case, the top bar is not limited.
For example, there are VIP-programs that are formed taking into account the individual wishes of parents and contain a minimum of exceptions and a maximum of coverage.
The decisive role in shaping the final cost of insurance is played by insurance programs, as well as the number of medical services and additional options that the child will be entitled to receive during the insurance period. It is also important which service you choose: at home or in the clinic.
The cost of the policy varies depending on the level of medical institutions in which the child’s medical care will be provided: the higher the status of the medical institution, the higher the rates for medical services and the more expensive the insurance will cost.
The age of the child is also important. For example, the price of a voluntary medical insurance policy for a child under one year is significantly higher than for older children. Indeed, at this age, regular patronage at home, medical examinations, timely vaccinations and testing are required.
Yes, and the likelihood of the insured event (illness) and the severity of the consequences they have higher. But the older the child, the lower the price will be, if, of course, the child is healthy.
Increase the cost of insurance (approximately 40−80%) can various chronic diseases. If the insurance program provides for the possibility of visiting the insured child at home and leaving the ambulance, the cost of insurance is also affected by the place of residence of the insured child. Another important pricing factor is the amount of insurance coverage, within which medical and other assistance to the child is guaranteed.
The lower the insured amount, the lower the cost of insurance.
Typically, insurance companies offer discounts on voluntary medical insurance to customers who already have policies of this company for other types of insurance. Another option to reduce the cost – if, in addition to the child, will be insured even close relatives.
There will be a discount if you make an application for the purchase of insurance through the site or mobile application.
Choose an insurance company in which VHI is one of the main activities (or at least has significant volumes). After all, medical institutions give a big discount for insurers who attach a significant number of patients (a kind of wholesale sale of medical services).
As an advantage, the insurance company has its own network of clinics, a private ambulance service, and a dispatch service.