Health insurance during the crisis

Alexey Zhukov, Pavel Zagursky
"Medical Navigator"Health insurance:

what is that?The phrase "health insurance" is becoming more and more common.

In my opinion, there is a certain problem in understanding what it is. The purpose of this material is to clarify this issue. Perhaps after reading it, it will be easier for you to navigate and form your position on this topic. In order to understand each other, you need to understand the terms used equally. The words "insurance" and "medicine" have many complex, obscure definitions. The following seem to me the most successful and understandable: "Insurance is a tool to eliminate uncertainty from a person's daily life." "Medicine is the art of healing." Therefore, medical insurance is a tool to eliminate uncertainty in a situation when you have to turn to the art of healing.

What kind of uncertainties exist in the case of illness (as a rule, we turn to the art of healing at this very moment)?

Where to find a good doctor and a good hospital is the first uncertainty. The second uncertainty is whether I will be able to pay for high–quality medical treatment.

Health insurance is a tool that gives a person confidence that a good doctor will treat them, and payment for treatment will not be very burdensome.Health insurance for yourself and your family.

Illness is an unpredictable thing and can happen to anyone. You can solve problems as they arrive, this is a completely normal position for those conditions and diseases in which no immediate reaction is required and treatment is not expensive. For example, the treatment of caries, you can wait a week or two and the cost of one filling is not very large. If the situation requires an immediate reaction, for example appendicitis, pancreatitis, or the price of treatment is quite serious and comparable to the family's half-year income, then it is better to think about the protection system in advance.

Medical insurance is an effective tool for the head of the enterprise. Let's make a reservation right away: the arguments that we will give are valid only in relation to employees who bring income to the enterprise. If such an employee is in the workplace, there is income, if there is no employee, then there is no income. In this situation, the manager is interested in the employee getting sick less often, and being treated quickly and effectively. If we compare employees with a car in a transport company, then the manager does not care where and how the car is repaired, therefore, a competent manager also cares where and how his employees are repaired. If the company employs mostly workers who do not bring income, then it is necessary to optimize production processes, and not insurance.

Medical insurance in the narrow sense of the word. These are the mechanisms that are described in the Law of the Russian Federation "On Medical Insurance of Citizens of the Russian Federation" This law provides two options:

The first is compulsory medical insurance (CHI), insurance of employees at the expense of taxes paid by the company, accruing wages. For the unemployed population, the fee is paid by the administration of the region. Due to this system, citizens are provided with a certain amount of medical services, these services are provided without additional payment. The main drawback of the model is that the volume of services is declared large, but it is not provided with money, so it is very difficult to realize your right to a free medical service. Of course, medical institutions and insurance companies are not to blame for this, they do not determine either the amount of payments or the volume of medical services that they promised would be provided to the population for free.

The second is voluntary medical insurance (VMI), insurance of citizens at their own expense and at the expense of the employer. The amount of payment and the amount of services that can be obtained for this payment is determined by the parties at the time of conclusion of the contract. This option has many advantages (the state has provided significant tax benefits to enterprises and citizens using such an insurance option), but there are also very serious disadvantages. The negative aspects are laid down both by the regulatory framework in accordance with which we have to work, and by the disadvantages of insurance products offered by insurance companies.

Health insurance in the broadest sense of the word. These are all mechanisms that also help a person to eliminate uncertainty in case of illness, and not only those that fall under the Law of the Russian Federation "On Medical Insurance of Citizens of the Russian Federation". These mechanisms also have both positive and negative sides.

For example:

• life insurance or accident and illness insurance is a good mechanism for solving financial problems in case of serious illness;
• buying a subscription and attaching it to a medical institution is a good mechanism for partially solving organizational issues related to finding a qualified doctor;
• buying a universal discount card, the bearer of which is entitled to discounts in a number of medical institutions, is a good option to reduce treatment costs;
• attachment with the help of an assistance company to the leading blades in case of acute illness
• membership in the health insurance fund will help pay for medical services in installments;
• a targeted premium or financial assistance to pay for treatment is sometimes more effective than a voluntary health insurance contract.

In order to choose the best option for protecting the family of employees, it is important to correctly use the positive aspects of each of the mechanisms. On the pages of the Medical Navigator, we will try to give specific recommendations on building an optimal model for protecting families and employees of the enterprise in case they have to turn to the art of healing. We will definitely consider issues related to the insurance of individuals. Starting from December 2008, articles will be posted on the site to help you understand the issues of health insurance and choose the best option.

Voluntary health insurance during the crisisIs it worth insuring the remaining employees after the reduction

In the conditions of the financial crisis, the issue of cost reduction comes to the fore for each enterprise.

To survive these difficult times, managers have to save on everything, and first of all – on the workforce. However, when cutting staff, not everyone thinks about the problem of increased workload on the shoulders of the remaining employees. When a manager has to save on a system of personnel interchangeability, the illness of any employee entails more serious consequences for the enterprise.

In such a situation, it becomes harmful not to think about the health of employees. Solving the problems of his employees, the head takes care of his business first of all. The only question is how to optimally solve the problem of employee health.

Voluntary health insurance and its benefitsOne of the effective mechanisms of organization and rational way of payment for medical services is voluntary medical insurance (VMI).

The main advantage of voluntary insurance is the availability of tax benefits provided to the employer by the state, i.e. VMI is essentially a tax-free form of remuneration. When an employee is sick, he will spend money to pay for medical services. But if this "health" budget is formed at the expense of voluntary medical insurance, then it is replenished without paying personal income tax and UST.

At the same time, solving the health problem of employees through insurance is not as simple as it seems at first glance. Building a rational system of employee protection in case of illness is a complex problem that requires a professional approach. The use of inefficient VMI options often negates all the economic benefits from tax benefits, and even brings additional costs.

What to choose first of all: an insurance company or the best optionThe choice of an insurance company in a crisis for certain reasons fades into the background.

At a time when the financial structures of the first hundred of the world ranking are collapsing, it becomes irrational to focus on the financial indicators of past periods and previous history. The larger the insurance company, the greater the burden of obligations it bears. Therefore, the choice of the insurance option most suitable for a particular enterprise becomes a priority issue.

What insurance companies offer. Advantages and disadvantages of different variants of VMIRegulatory organizations recognize only the classic version of voluntary health insurance.

At the time of conclusion of the contract, the parties determine a clear list of insured persons, each of whom receives an insurance policy, a program and an insurance amount.

The classic insurance option has a number of disadvantages. Among them is the lack of real financial assistance in situations where it is really necessary. Employees are not motivated to "be healthy" at all, family members do not receive any protection at all. From a financial point of view, the usual option is considered ineffective, since up to 45% of the premiums paid remain in the insurance company.

The individual deposit option of the VMI assumes that each insured employee can spend a certain amount on medical services. However, there are "buts" here too. The money that one employee did not use does not go to the treatment of another who needs medical services more. Therefore, the insured do not receive the necessary financial assistance to pay for expensive medical services, family members are not protected again, and there is still no motivation to "not get sick". In addition, there are difficulties with the use of funds: insurance companies often do not want such services as prosthetics or spa treatment to be indicated in the bills.

The deposit collective option consists in the fact that the amount transferred to the insurance company is not actually distributed among employees. The "gentleman's agreement" with the insurance company, characteristic of this option, involves the use of at least 85-90% of the funds transferred to pay for medical services centrally ordered by the enterprise for its employees.

But even this option of voluntary insurance has drawbacks. In particular, in situations where expensive medical care is required, it is necessary to count only on the funds of the enterprise previously transferred to the insurance company. In addition, the option assumes additional responsibilities for monitoring the balances of funds held by the insurance company. And you need to spend money during the limited period of the contract, even if there is no need for medical services.

According to most experts, only the rational use of a combination of the listed options for voluntary health insurance gives the expected effect. And only a competent specialist with experience in solving insurance issues can take into account all the factors affecting the effectiveness of VMI. Therefore, sometimes it is better not to insure employees at all than to choose the first uncomplicated option that comes along.

What do you pay the insurance company forVoluntary medical insurance (VMI) as a tax-free form of remuneration for employees is becoming increasingly popular with employers who know how to count money.

But along with the obvious advantages of the VMI, there are very serious hidden disadvantages that can negate all the economic benefits obtained through preferential taxation.

In order to understand what you are buying from an insurance company, you need to understand the structure of voluntary health insurance.

Voluntary health insurance as a service consists of two main parts:

• organizational component;
• the financial component.

The organizational component of voluntary medical insurance is the services of an insurance company for the organization of medical care. This is attachment to a good hospital, selection of the optimal solution to a particular medical problem, accompanying the patient through the confusing corridors of medical institutions, etc. The price of this service is 7-15% of the total amount transferred to the insurance company. Very carefully clarify which model of organization of the provision of services the insurance company will offer you. The danger is that you may be offered an organization in cases where you do not need it, and when it is better to implement the search for the right medical institution and doctor through your friends.

The financial component of voluntary health insurance consists of two elements:access to tax benefits;

• help with money, if necessary, to pay for medical services.

Voluntary health insurance and tax benefits When money is in transit from an employer through the CFR to a medical institution, in fact, an employee who receives medical services does not need to pay personal income tax and UST.

In the structure of the price of insurance services, this is usually about 5%. If a citizen pays contributions independently, then he receives a personal income tax benefit.

Voluntary medical insurance and assistance with money, if necessary, to pay for medical services. Here's how it works. The employer paid a certain fee to the insurance company for his employee. Under certain conditions, an employee can receive medical services in the amount of more than the employer paid. In the price structure, the cost of this service can reach 60%. In order to understand whether you need help from an insurance company in paying for treatment, it is necessary to compare the total amount that you are required to pay under the insurance contract with the maximum amount of assistance from the insurance company that your individual employee can receive and the probability of such events. For example, you pay 2,000 – 3,000 rubles for a policy, and the insurance company is ready, if necessary, to pay for treatment at the cost of 150 000 – 200 000 rubles. The normal option. Just make sure that with the help of other limiters, the insurance company has not reduced its liability to 4000 – 5000 rubles. This is done very simply: all cases when really expensive treatment is required are excluded from the insurance program. If there is no such trick, then the option deserves attention. I do not recommend you to consider options when the ratio between the amount of the contribution and the actual assistance of the insurance company is less than 1 to 10. But even with this ratio, the conclusion of a contract may be unprofitable. This happens in situations where you have to sign an insurance contract for several people at once. You should always sum up the contributions that you will have to pay for each employee. Basically, the insurance company redistributes money from one employee to another, someone was treated for a larger amount, someone less. In situations where you need more money than the company as a whole has paid to the insurance company, you may find yourself without real financial support.

Conclusion. The choice of insurance option should be approached very carefully. Instead of real financial assistance in a difficult situation, you can buy a redistribution of money from one employee to another and lose up to 40% of the funds transferred. You can buy organizational assistance in planned situations, and in the most difficult situations (acute illnesses), you and your employees will receive medical services on a common basis.

Health insurance during the crisis: useful tips

Complete failure is dangerousIn a period of austerity, the issue of health insurance for employees of the enterprise requires the closest attention.

As a rule, there is a reduction in staff, and not always at the same time the total amount of work decreases and, consequently, the burden on the remaining employees increases. The most qualified employees who are able to cope with this load remain.

In this situation, additional risks arise, which it is important to correctly identify, evaluate and manage them competently.

What risks should an employer assess in the current situation:

1. The risk of illness of a key employee in the absence of an adequate replacement (understudy reduced).
2. The risk of dismissal of a key employee. If an employee is forced to perform an increased amount of work without adequate compensation, then the risk of his dismissal increases. Paradoxically, but in the conditions of the financial crisis, competition for a qualified employee who alone can do the work of 2-3 people is increasing.

Health insurance is a tool that will help minimize these risks.

Conclusion: it is dangerous to completely abandon health insurance, it can lead to the loss of key employees and loss of income.

It is important to choose the right optionSo, you have decided not to let the problem take its course and implement a system of employee protection in case of illness at the enterprise.

Choosing a medical insurance option is a very important moment. It is necessary to take into account many factors, for example, the taxation system applied at the enterprise, the peculiarities of the age and gender composition of employees of enterprises, the level of income, the place of residence of employees, the peculiarities of the financial situation in the country, the presence of connections in medical institutions and much more. The optimal model is a combined model that provides for the use of several options for solving organizational and financial problems.

The simplest and not requiring any material costs is the conclusion of an MHI contract with an insurance company, which, as a bonus, issues discount cards to employees, according to which employees will be able to pay for medical services at a discount that are not included in the Territorial Compulsory Medical Insurance Program. It is optimal to use 3-4 variants of contracts, which are concluded by both the company and the employees themselves.

Choose the option first, not the insurance companySometimes companies hold tenders to determine the health insurance insurer.

Experience shows that the employees of the enterprise responsible for conducting such tenders have a very vague idea of what they want and what problems they will solve with the help of insurance. Choosing a company, they focus on the size of the authorized capital, reliability ratings, the number of programs, the content of programs, the number of medical institutions, etc. But this is a dead-end path that does not allow you to evaluate the product you want to buy. It may turn out that what you need, for a very reasonable price and good quality, is available from a not very large regional insurance company. Therefore, before choosing a partner, clearly identify the risks that you want to minimize or eliminate and only then choose a partner.

Don't transfer a lot of moneyOnce again about choosing an insurance company during the financial crisis.

No matter what they tell you, but today no one can know what will happen to this or that insurance company in 6-7 months. Therefore, you should not strain yourself too much. Use a fairly simple way to solve the problem. Do not transfer the annual payment immediately, choose the option with a monthly payment. Let it be a little more expensive, but much calmer.

Set prioritiesIn conditions of lack of money, it is necessary to take an even more careful approach to the procedure for using the allocated funds.

It may be necessary to refuse to allocate funds for prevention and medical examination. Dental services can also be postponed. We do not recommend saving on the organization and guarantees of payment for acute diseases, especially if hospitalization and surgery are necessary. Timely execution of high-tech operations can significantly reduce the time of disability of employees.

Motivate the non-illWe recommend that you include the mechanism of motivation of those who are not ill.

Of course, it is necessary to do this if there are funds left after solving the problem of acute diseases. There are quite a lot of mechanisms and methods of motivation, including the expansion of the program through dentistry and spa treatment.

Introduce the principle of complicityThis principle is usually applied in two ways.

The first is complicity at the time of transfer of funds (to an insurance company or other structure with which contracts are concluded). The second option is complicity in paying for treatment, when the company assumes compensation for only a certain share of the costs of paying for treatment. We recommend changing the ratio of the shares of the company and the employee in the payment of treatment, depending on the price of medical services. The more expensive the service, the more significant the company's assistance. That is, the company helps mainly in those situations when it is really difficult for an employee to find the necessary amount for treatment, and the employee copes with problems that do not require significant costs on his own.

Control the use of fundsMonitoring the use of funds allows you to manage the situation.

If there is a shortage of funds, you can reduce the program; if funds remain, you can revise the amount of payments, expand the program, increase the number of employees, project participants. The danger is not that the funds may not be enough, but that they will remain. In today's situation, you should not completely trust the promise of insurance company managers to take into account the remaining funds when concluding a contract for the next year. Firstly, you will be tied to this company, even if for some reason it no longer suits you; secondly, in conditions of financial instability, these promises, not backed up by legal obligations, may remain promises.

Do not hope that the unused funds will be counted by the insurance company at the conclusion of the contract for the next yearOnce again, I would like to note that these promises, as a rule, are not recorded in documents, and the insurance company has no legal obligations to do this.

Promises are usually made by a representative of an insurance company, and decisions are made by the head. The representative may work for another company by the end of the contract. If the company has large obligations for other types of insurance, then there can be no question of any accounting of unused funds, it is necessary to fulfill the obligations recorded on paper.

General recommendations

In a crisis, those who have used the insurance mechanism should not completely abandon it, although cost reduction will certainly occur. You should carefully analyze the statistics of previous years and choose the option more carefully, determining priorities.

It is dangerous not to use the mechanism of medical insurance as a means of reducing the loss of working time of highly qualified workers and securing them at the enterprise. In conditions of increasing pressure on a qualified specialist, competition for him in the labor market is also increasing.

Portal "Eternal youth" www.vechnayamolodost.ru13.01.2009