VOLUNTARY HEALTH INSURANCE PROGRAM "STANDARD PLUS"
The procedure for the provision of medical services under voluntary programs health insurance as part of a pilot project
"Voluntary medical insurance" for the period from 01.12.2011. until 31.12.2012 for the territory of the Perm urban district
General conditions of provision:
1. Under voluntary health insurance programs, additional medical services(DMU) and additional service(DU), which are in excess of the territorial Compulsory Health Insurance Program (TPOMI), i.e. not included in TPOMI, or included in TPOMOS, but provided on terms more beneficial for the citizen than the conditions provided for by TPOMI.
2. DMU and DU are provided to the insured in medical institutions that have contracts for the provision of medical and preventive care to the insured (in accordance with the voluntary medical insurance program), and who work both in the CHI system and not working in the CHI system in the Perm Territory with a mandatory compliance with uniform medical and economic standards established in the territory of the Perm Territory (MES) (The list of medical institutions is an integral annex to the contract (policy) of voluntary medical insurance).
3. DMUs are provided exclusively outside of working hours medical professionals, in which they are obliged to provide medical assistance under the CHI, and without prejudice to the medical care provided under the CHI.
4. Scheduled DMUs are provided if there is a referral from the attending physician of the medical organization-fund holder, with the exception of cases of medical assistance by a district general practitioner, general practitioner (family doctor).
5. Payment for the DMU and DM is made exclusively at the expense of voluntary medical insurance funds.
DMU and DU provided on an outpatient basis:
1. Provision of primary health care on a local basis, including servicing calls at home, in the conditions of the fund holding of compulsory health insurance and mainly in private medical institutions specified in the contract (policy) of voluntary health insurance.
2. DMU and DU are provided to the insured person at a convenient time for him, including in the evening, on weekends and non-working holidays.
3. The list of DMU and DU: diagnosis, diagnostic procedures, consultation and treatment by specialist doctors, including specialists with an academic degree and (or) academic title, working at the clinical departments of medical universities; procedures performed by doctors; services provided by nurses; services rendered in a day hospital at a polyclinic, including conservative and operational, including using innovative methods, methods of treating the disease that caused the seeking of medical care.
DMU and DU provided in a hospital:
1. Planned hospitalization of the insured person is carried out for medical reasons, provided there is a referral from the attending physician, the results of the prehospital examination and the presentation of other documents established by legal acts in the field of healthcare.
2. Emergency hospitalization of the insured person is carried out with the development of diseases that threaten life and require urgent treatment in inpatient conditions. In urgent cases, the insured person is hospitalized in accordance with the established procedure in a medical organization, as a rule, having a contractual relationship with the Insurer.
3. The provision of DMU in a hospital is carried out according to the disease that served as the basis for hospitalization, its complications, as well as concomitant diseases that determine the severity of the underlying disease.
4. The list of DMU and DU: diagnosis, diagnostic procedures, consultations and treatment by specialist doctors, including specialists with an academic degree and (or) academic title, working at the clinical departments of medical universities; procedures performed by doctors; services provided by nurses; conservative and operational, including using innovative techniques, methods of treating the disease that caused hospitalization, its complications and concomitant diseases that determine the severity of the underlying disease; diagnostics, course treatment of concomitant disease (without exacerbation) at the request of the insured in the presence of medical indications during the period of treatment for the underlying disease in agreement with the representative of the Insurer; diagnostic services for the underlying disease that caused hospitalization, in excess of the standards of medical care at the request of the insured in agreement with the representative of the Insurer; accommodation in superior wards (no more than 2 beds) with a separate bathroom, TV, cutlery and personal hygiene items, with additional medical nutrition, taking into account the diet prescribed by the attending physician (menu at the patient's choice). In the absence of an opportunity emergency hospitalization in the wards of the specified category, the Insurer organizes the hospitalization of the insured to a free bed in a ward of a different category, followed by no later than 2 days from the date of hospitalization, transfer to the ward of the above category. Provision of medicines (by trade names) in excess of the List of vital and essential medicines approved by the Law of the Perm Territory on the Program of state guarantees for the provision of free medical care to the population of the Perm Territory for the current financial year, but within the framework of the MES by appointment of the attending physician and in agreement with the representative The insurer; Organization of individual (additional) nursing care as prescribed by the attending physician and in agreement with the representative of the Insurer.
The list of medical services provided under the STANDARD PLUS voluntary medical insurance program
1. Outpatient and polyclinic care
1.1. Advisory assistance:
Primary, repeated, consultative appointments of specialist doctors, including candidates and doctors of medical sciences in the following specialties: therapist, surgeon, neurologist, otolaryngologist, ophthalmologist, urologist, dermatovenerologist, obstetrician-gynecologist. In the direction of the attending physician, consultations of doctors are carried out: a cardiologist, an endocrinologist, an infectious disease specialist.
1.2. Issuance of medicaldocumentation
Issuance of the necessary medical documentation to the Insured in accordance with the current regulatory documents (except for certificates to the pool, certificates for applicants to educational institutions, for the driver's commission, foreign business trips, for carrying weapons), including:
Extracts from outpatient cards;
Prescriptions other than preferential ones;
Issuance and extension of certificates of incapacity for work.
1.3. Diagnostic tests
Laboratory research methods: blood tests and other biological media of the body: general clinical (clinical blood test, general urine analysis), biochemical (blood glucose, ALT, AST, GGT, creatinine, urea, bilirubin and its fractions, cholesterol, CPK MB), bacteriological (primary diagnosis of diphtheria and intestinal infections), bacterioscopy of a smear from the genitourinary organs, cytological examination of a gynecological smear.
hormonal: no more than 3 thyroid hormones TSH, T3, T4 - 1 time during the term of the contract);
X-ray research methods (except for MRI, CT);
Ultrasound research methods: ultrasound of the abdominal cavity, ultrasound of the thyroid gland, ultrasound of the kidneys and bladder, ultrasound of the female genital organs, ultrasound of the prostate gland, ultrasound of the lymph nodes)
Endoscopic research method: esophagogastroduodenoscopy (FGS)
Functional diagnostics (including electrocardiography (ECG), examination of the function of external respiration, electroencephalography (EEG).
All of the above diagnostic tests are carried out according to medical indications for a specific insured event.
1.4. Medical outpatient manipulations
1.4.1. Medical and diagnostic manipulations in surgery, otorhinolaryngology, ophthalmology, gynecology, urology, aimed at stopping and diagnosing an acute or exacerbation of a chronic disease.
1.4.2. One-day inpatient treatment - outpatient procedures and procedures (except for urological, gynecological, surgical and endoscopic operations under general anesthesia); conservative treatment (dressings, intravenous fluids and droppers, other injections).
1.5. Physiotherapy treatment
Electric, magnetic, light and thermal therapy, laser therapy (except for LOC), inhalation (10 sessions of one of the types of treatment during the term of the insurance contract)
Services provided in a day hospital at a polyclinic, including conservative and operative, including with the use of innovative techniques, methods of treating the disease that caused the seeking of medical help.
1. Inpatient services: inpatient medical care is provided for the main and concomitant (if medically indicated) disease
1.1. Hospital stay (food, nursing staff, medication provided by the hospital), accommodation in 1-2-bed wards ;
1.2. Provision of medical care and consultations of specialist doctors in the following specialties: therapy, cardiology, neurology, rheumatology, gastroenterology, pulmonology, nephrology, endocrinology, anesthesiology and resuscitation, gynecology, urology, surgery, coloproctology, otolaryngology, traumatology and orthopedics, dermatology, proctalmology , hematology, allergology, immunology, infectious diseases.
1.3. Laboratory research methods for medical indications: clinical, biochemical, serological, hormonal, immunological, cytological, histological.
1.4. Instrumental diagnostic studies: functional (ECG, ECHO-KG, PCG, ECHO-EG), endoscopic, ultrasound, radiological (including MRI CT), radioisotope.
1.5. Therapeutic procedures, including physiotherapy: - electro-, magnetic, light-, balneo-, heat - laser therapy (except for LOC), inhalations, therapeutic massage, exercise therapy, manual therapy.
1.6. Medical treatment provided by a medical facility; the use of dressings, in accordance with the available medical indications.
1.7. Anesthetic benefits;
1.8. Operational interventions;
1.9. Resuscitation measures;
2.10 Treatment in the intensive care unit
2.11 Nursing staff care.
Exclusions from insurance coverage
1. THE INSURED EVENT is not and is not paid for the visit of the Insured to a medical institution regarding:
alcoholic, narcotic or toxic intoxication, as well as injuries, burns, frostbites, acute poisoning, internal injuries or other health disorders received by the Insured in this state; deliberately inflicting bodily harm on oneself, including attempted suicide.
2. Medical services not included in Insurance program and not paid by the Insurer: Diagnostics and treatment of male and female infertility, impotence, family planning issues (including contraception issues), IUD insertion and removal (without medical indications). Termination of pregnancy (without medical indications).
Monitoring pregnancy over 8 weeks. Obstetrics. Cosmetology services and services of a dermatological office: removal of benign neoplasms (papillomas, condylomas, etc.). Therapeutic measures related to contact vision correction. High-tech methods of examination and treatment of diseases of the heart, blood vessels, nervous system, organs of vision and senses, musculoskeletal system, requiring their transplantation, autotransplantation, prosthetics, including endoprosthetics, reconstructive surgical treatment. Extracorporeal methods of treatment (plasmapheresis, hemosorption, LOC, UV blood). Psychotherapy (including biolocation diagnostics and correction, suggestive therapy, neurosensory unloading). Consultations with a nutritionist, cosmetologist, audiologist, somnologist, homeopath, barotherapist - after the diagnosis of a disease that is not an insured event has been established. Ozone therapy. Immunoprophylactic measures. The following types of massage and physiotherapy rehabilitation: classical massage, percussion massage; massage using a mechanical couch; periosteal massage; connective tissue massage; massage with massagers; massage "Acupress"; acupressure; massage with medications. Gymnastics for obesity; gymnastics to strengthen muscles using fitness balls; individual exercise therapy classes. Coverage for glasses, contact lenses, hearing aids, implants, and other additional medical devices and supplies. Any genetic and cytogenetic studies, studies of metabolic disorders, mineral metabolism and markers of bone resorption. Densitometry. Methods of traditional medicine: hirudotherapy, homeopathy, herbal medicine, acu-, auriculo-, electropuncture, iridodynamics, breathing exercises, qigong gymnastics, Any medical services not prescribed by a doctor. Any medical services not covered by this insurance program.
3. Diseases and conditions that are not an insured event and the treatment of which cannot be paid for by the Insurer: Sexually transmitted diseases (HIV, syphilis, gonorrhea, chancre, etc.) and their complications.
Mental illnesses and their complications, organic mental disorders (including symptomatic), alcoholism, drug addiction, substance abuse and their complications, epilepsy, and its complications. Diabetes mellitus type I and II and its complications. Tuberculosis, sarcoidosis, cystic fibrosis, regardless of the clinical form and stage of the process. Chronic renal and hepatic failure requiring extracorporeal treatment. Diseases of organs and tissues requiring their transplantation, autotransplantation, prosthetics, including endoprosthetics. Acute and chronic radiation sickness. Chronic hepatitis, liver cirrhosis. Systemic connective tissue diseases (scleroderma, systemic lupus erythematosus, dermatomyositis, rheumatoid arthritis, polymyalgia rheumatica) and their complications, systemic vasculitis and their complications, demyelinating diseases of the nervous system, autoimmune diseases and their complications. Immunodeficiency states, deep and widespread mycoses, psoriasis and its complications, eczema, neurodermatitis, especially dangerous infections, occupational diseases.
LIST OF MEDICAL AND PREVENTIVE INSTITUTIONS-PARTNERS
IN THE PILOT PROJECT "MEDICAL CERTIFICATE"
1. Basic medical facilities
The name of the healthcare facility
The address
companies MEDSI »Perm branch
G. Perm, st. Pushkin 109
center "Philosophy of beauty and health"
G. Perm, st. Kim, 64
polyclinic "
G. Perm, st. Makarenko, 21
"UralMed" ("Hope")
G. Perm, st. Krisanova, 13
ANO "MO" Realmed "
2. The name of the healthcare facility for receiving inpatient care
Name
The address
MUZ "City Clinical Hospital No. 2 named after The doctors "
Perm, Kirov st., 111
GUZ "Perm Regional Clinical Hospital No. 2" Heart Institute "
GUZ "Perm regional" Order of the Badge of Honor "clinical hospital"
MUZ "City Clinical Hospital No. 1"
MUZ "City Clinical Hospital No. 7"
Perm, st. G. Hasan. 24
MUZ "Medical unit No. 7"
MUZ "City Clinical Hospital No. 4"
MUZ "City Clinical Infectious Diseases Hospital No. 1"
FGUZ "Medical and sanitary unit No. 000"
GUZ "Perm Regional Hospital of War Veterans" GUZ Perm
St. Gorky, 15
MUZ "City Clinical Hospital No. 6"
MUZ City Clinical Hospital No. 3
MUZ Medical and sanitary unit No. 9 named after
Medical unit No. 000 of the Federal Medical and Biological Agency, FGUZ
Perm, Gagarin Boulevard, 68
MUZ "City Hospital No. 21"
MUZ "Medical and sanitary unit No. 11"
G. Perm, A
3. The name of the healthcare facility involved in consulting services
No. P.
Name
The address
MUZ "GKB No. 2 named after The doctors "
Perm, Kirov st., 228
MUZ "PKOD"
"Medlife", "Medlife"
GUZ "PKKB No. 2" Heart Institute "
G. Perm, st. Lenin, 40
GUZ "PKKB" "Order of the Badge of Honor"
MUZ "KMSCH No. 1"
MUZ "Medical unit No. 7"
G. Perm, st. Pisareva, 56
MUZ "GP No. 2"
Perm, Ignatiev Brothers st., 3
MUZ "GKB No. 1"
MUZ "GKB No. 7"
Perm, st. G. Hasan. 24
MUZ "GKB No. 4"
MUZ "GKB No. 6"
"Dentist"
MUSES "GKIB No. 1"
"Doctor-experience and competence"
center "Range"
clinic"
Perm, Gagarin Boulevard, 49
FGUZ "MSCh No. 000"
MUZ "GB No. 21"
MUZ "GP No. 7"
"PKGVV" GUZ, Perm
G. Perm, st. Podlesnaya, 6
Director of the Perm branch
For tourists over 65, rates for medical insurance are doubled, over 80 years old - 4 times
OPTIMA sum insured 50000/100000 | STANDARD PLUS sum insured 40000/50000/100000 |
|
| 1. outpatient treatment and inpatient treatment; | 100% | 100% |
| 2. relief of acute toothache; | 250/300 | 200/250/300 |
| 3. medical transportation and evacuation; | 100% | 100 % |
| 4. return of the Insured and his accompanying person during the trip; | 100% | 100% |
| 5. return home of minor children of the Insured; | 100% | 100% |
| 6. assistance as a result of terrorist attacks; | 100% | 100% |
| 7. assistance as a result of natural disasters (floods, tsunamis, tornadoes, etc.); | 100% | 100% |
| 8. repatriation in case of death; | 100% | 100% |
| 9. visit of a third party in an emergency with the Insured in the event of his hospitalization for more than 7 days; | 125/150 | 100/125/150 |
| 10. payment for telephone conversations with the service center; | 100% | 100% |
| 11. early return of the Insured; | 100% | 100% |
| 12.temporal return of the Insured | 100% | 100% |
| 13. search and rescue activities; | 100% | 100% |
| 14. outpatient and inpatient expenses as a result of a sudden complication of the course of pregnancy or an accident threatening the life and health of the Insured; | 100% (for the entire duration of the trip, up to 31 weeks) | 10 000 (first 10 days, up to 24 weeks) |
| ! Help with premature birth; | 100% | NO |
| ! Helping a newborn | 10 000 | NO |
| 15.payment of expenses in case of loss or theft of documents | 250/300 | 200/250/300 |
| 16. legal assistance (first legal advice and translation services in case of litigation); | 2 500/3 000 | 2 000/2 500/3 000 |
| 17.expenses in connection with breakdown, loss (theft, theft) or damage to ground vehicle | 1 500/2 000 | 1 000/1 500/2 000 |
| 18.expenses due to delayed scheduled flights | 150/200 | 100/150/200 |
| As well as ! First aid for cancer | 5 000 | 1 000 |
| ! Help in the presence of alcoholic intoxication | 5 000 | NO |
| 19. Accident | 10 000/15 000 | |
| 20. Civil responsibility | 35 000/75 000 | |
| 21. Luggage insurance | 2 000/ 2 500 |
The price of all tours includes standard medical insurance (in ski tours - ski insurance) for a tourist under 65 years old.
The cost of standard medical insurance for a tourist under 65 is $ 1 / day (the currency depends on the currency of the country of travel)
The cost of standard ski medical insurance for a tourist under 65 years old - 2 cu / day
For a tourist aged 65 to 79, inclusive, additional payment for standard medical insurance + 1 USD / day (currency depends on the currency of the country of travel)
Ski standard medical insurance for a tourist from 65 to 79 years old inclusive surcharge+ 2 USD / day (currency depends on the currency of the country of travel)
For a tourist aged 80 and over, additional payment for standard medical insurance + 3 USD / day(currency depends on the currency of the country of travel)
Ski standard medical insurance for a tourist 80 years and older surcharge+ 5 USD / day (currency depends on the currency of the country of travel)
- Payment for necessary medical care as a result of complications of existing and exacerbation of chronic diseases, sunburn and allergies;
- Insurance for active recreation and extreme tourism with multiplying coefficients
- Insurance of expenses related to complications of pregnancy;
- Payment for search and rescue assistance;
- There are no age restrictions (insurance for persons over 80 years old);
When the Insured person contacts the service center, the operator immediately starts organizing assistance.
Full list of risks:
- 1. outpatient treatment and inpatient treatment;
- 2. relief of acute toothache;
- 3. medical transportation and evacuation;
- 4. return of the Insured and his accompanying person during the trip;
- 5. return home of minor children of the Insured;
- 6. assistance as a result of terrorist attacks;
- 7. assistance as a result of natural disasters (floods, tsunamis, tornadoes, etc.);
- 8. repatriation in case of death;
- 9. visit of a third party in an emergency with the Insured in the event of his hospitalization for more than 7 days;
- 10. payment for telephone conversations with the service center;
- 11. early return of the Insured;
- 12.temporal return of the Insured
- 13. search and rescue activities;
- 14. outpatient and inpatient expenses as a result of a sudden complication of the course of pregnancy or an accident threatening the life and health of the Insured;
- 15.payment of expenses in case of loss or theft of documents
- 16. legal assistance (first legal advice and translation services in case of litigation);
- 17.expenses in connection with breakdown, loss (theft, theft) or damage to a land vehicle
- 18. Expenses due to delayed scheduled flights.
Price insurance policy is 1 EUR / USD per day for 1 person.
Insurance cover:
- Medical insurance for 30,000 Euro
- Health care 24/7
What to do in the event of an insured event?
1. Upon the occurrence of an insured event (while on a trip)
Call the Service Center at the phone numbers listed on your insurance policy or insurance information. be prepared to provide the following information:
- Last name, first name.
- Insurance policy number or insurance information number.
- Location and contact number.
- Circumstances under which the insured event occurred.
- What help is required.
2. Upon the occurrence of an insured event (upon return from the trip and self-payment of expenses)
If you pay the costs associated with an insured event on your own, collect the documents necessary to consider the issue of insurance payment:
- a medical statement indicating the diagnosis, the results of the examinations, the prescribed treatment;
- a paid bill of medical and other institutions with an indication of the list of services provided, indicating the cost of each service, the date of its provision;
- prescriptions for drugs;
- documents confirming the fact of payment for medical and other services, medicines;
Why is it especially important to take out travel insurance during pregnancy?
Any trip abroad without a travel insurance policy threatens to turn into huge expenses on medical care in case of illness or injury. Finding a doctor in an unfamiliar country can be a very big problem, and it will cost a fortune to pay for his services. In case of pregnancy, the situation may be aggravated by the need to get emergency help from a specialist doctor, and any delay can be fatal for the child.
Purchase medical policy, including the risks associated with pregnancy, will help the expectant mother to receive qualified assistance in the shortest possible time and not to pay for the services of a specialist out of her own pocket.
If you decide to go on a trip to get some rest in anticipation of the birth of your baby, then choosing your health insurance wisely should be one of the priority tasks of preparing for the desired vacation.
Different insurance companies have their own maximum possible pregnancy period at which medical care will be paid for by the insurance:
- Up to 31 weeks (or 7 months) - programs " OPTIMA"For single trips," OPTIMA-Multi"For multiple trips for half a year and" OPTIMA Annual»For a year from the insurance company ERV;
- Up to 24 weeks (or 5 months) - programs for single and multiple trips " Standard"From" Liberty Insurance "and one-time programs" Standard Plus»From the ERV company;
- Up to 12 weeks (or 3 months) - programs " Standard" and " Premium"From the Uralsib Insurance company.
What should a pregnancy-friendly policy cover?
There are a number of reasons for complicating pregnancy while traveling. These include:
- Stress during the flight
- Vibration and shaking during long road trips
- Difficulty with acclimatization
Changes in the mom-to-be's lifestyle, time zone, or climate can stimulate a baby to be born ahead of schedule.
Practically no insurance company covers the costs of obstetric care abroad: insurers explain it this way: “Insurance for those traveling abroad, like almost any other insurance, is protection against some unforeseen expenses and losses. In this case, it is clear that pregnancy is not some unforeseen event. The costs associated with childbirth are planned. "
The only insurance that is sold in Russia and covers this risk is the product line “ OPTIMA»From ERV: the expectant mother will be protected if the birth occurs no later than 31 weeks of pregnancy. Insurance Company takes upon himself the organization of a place in the nearest maternity hospital, transportation of the woman in labor to it, delivery, as well as all communication with doctors.
Qualified assistance to a baby born prematurely will become a guarantee of his health.
At the moment, the product line " OPTIMA»ERV is the only company on the Russian market that provides medical protection for a newborn.
Unfortunately, no one is insured against accidents. For pregnant women, accidents are especially dangerous, as they can lead to serious complications. Complication of pregnancy while traveling can pose a strong threat to a woman, and sometimes the only method to save her life may be a forced medical termination of pregnancy.
Program " Standard"Liberty Insurance company guarantees the organization and payment of medical care for this risk, regardless of the gestational age, even if it exceeds 31 weeks.
