Insurance rating Medical insurance. Ratings of insurance companies operating in the DMS market. Company "Renaissance Insurance"

If, with thoughts about the state clinic, you already become bad, then you can buy medical insurance and be treated with comfort. We tell how much it costs and what to check before buying the policy, so as not to spend money in vain.

What depends on the price

Tariffs in the insurance business are quite difficult. The cost of the Voluntary Medical Insurance Policy (DMS) can affect several factors:

the level of the selected clinic;

additional options (dentistry, a doctor call to the house, the possibility of emergency hospitalization, etc.);

the state of your health;

your age.

Depending on all these circumstances, prices for annual service in the clinics range from several thousand to several hundred thousand rubles.

Clinic status

Everything is simple - the more prestigious clinic, the more expensive it is to be serviced. Thus, in the insurance company "Alliance Life", the policy can be purchased from 13.3 thousand rubles (service in the clinic "Oris") up to 165 thousand rubles (Clinic "Medsi" in Rorcholsky Lane), tells the head of the Individual Insurance Department of Innocent Maskaleson. In GK "Rosgosstrakh", the price variation is even wider: in the department of the insurer, correspondent comparable to.ru they said that the prices for policies begin from 17,000 in low-cost clinics up to 300 thousand in the status establishments.

Stomatology

Dental care increases the cost of the policy on average by 10-30%. Thus, in the company "Reso-Guarantee", the additional option of dental care will cost from 5.2 to 11.2 thousand rubles. And in the insurance company SCS, the addition of dental services will cost 2-15 thousand rubles.

Hospitalization

In the "Stuffing" of the Polis, it is also possible to include the possibility of emergency hospitalization - as a rule, these are several thousand rubles to the cost of insurance. For example, the CC "Consent" the possibility of emergency assistance within the Moscow Ring Road will cost an additional 3,420 rubles.

Individual parameters

To determine the exact cost of DMS for a particular person, the insurer will most likely offer to fill out a medical questionnaire. It takes several pages and contains health questions. For example, you may have to answer if you have a headache and how often do you take regularly any medicines, with what diseases you appeal to doctors before, etc. The older man, the greater the likelihood that such a survey will be mandatory.

Most of the insurers do not take into account the floor of the client. But there are exceptions. For example, in the company Ingosstrakh Polis for women is more expensive than for men.

"On the basis of statistics (not only our company, but also other insurers), women are more likely to seek medical attention. This is due to the fact that they are inclined to take care of their health. This is primarily expressed in "preventive" campaigns in a clinic with minor health complaints. Men have a certain psychological barrier in front of doctors. They seek help at much less often, but in more complex cases, which affects the severity of the disease, "explains the Deputy Director of the Ingosstrakh Medical Insurance Department Nikolay Owl.

How much is the policy standing

To understand how much the policy is on the average for people of different ages, we interviewed call centers and press services of the 10 largest insurance companies. Details about this process can be read at the end of the text. We learned the prices of insurance in which the dentistry is included, a doctor call to the house and, if necessary, the possibility of emergency hospitalization within the Moscow Ring Road. And that's what happened.

The average cost of the PMC policy in Moscow, rub.

It turned out that for people aged between the 20th and 50 years, within the framework of one company, the cost of the policy changes slightly. But the difference in the price of various companies can be significant. For example, the cost of the most affordable policy in the category of citizens up to 50 years - 29,470 rubles, the most expensive in the same category - 99,600 rubles.

Cost seriously increases polis DMS. For older people. Starting from 55-60 years, companies begin to use special coefficients that increase the price of insurance. For example, in the "reso-guarantee" for citizens over 60, the coefficient is valid, the increasing cost of the policy is 1.6 times, and for those who are over 70 years old - 2 times.

"For those who over 60, the tariffs will be individual and on average, 2-3 times higher than the standard," says Innokenti Maskaleson from Alliance Life.

There are situations in which the insurer may and at all refuse to sell the PMS policy. It has the right not to be insurance for persons who are registered in the drug treatment, psychoneurological, anti-tuberculosis, skin-venereological, oncological and other dispensaries, as well as in the Centers for the Prevention and Control of AIDS, or having the disability of the I-II group. "If we are talking about chronic diseases that lead to death, for example, diabetes of a certain group, then we have the right to not sell insurance," says Yegor Safrygin, director of the Marketing Department of the Block "Medicine".

What to check before buying

1. What is included in the policy

Each company has its own policy filling. For example, planned inspections (clovers, check up) in the classic DMS are not an insured event.

"This is a separate program developed by individual queries," says the managing director of the DMS Renaissance Insurance Group Natalya Kharina. Therefore, before buying, be sure to study, which is included in your policy, which is considered an insured case, etc. It may take time, but then you will not face unpleasant surprises.

2. In which polyclinics and hospitals can be addressed

Look at the list medical institutionswhich are included in the program. "Make a choice in favor of a network clinic, which has the above-mentioned team, as well as the ability to visit not one, and at once several clinics of the network. It is better to choose those closer to geographically, "Egor Safrygin advises the director of the Marketing Department of the Block" Medicine ".

3. How can I sign up for doctors

It is important that you have the opportunity to quickly sign up for doctors. The fact is that many DMS polishes are built in such a way that you first need to call the insurance company, it can coordinate something for a long time and then gives direction. "The client should have the opportunity to directly call the clinic, which he chose, and promptly sign up for a doctor," says Yegor Safrygin.

4. What are the exceptions

Each company has its exceptions from programs. And sometimes the usual user they may seem completely illogical. Usually exceptions are prescribed at the end of the contract with the insurance. Spend time and read them.

Do not forget about the tax deduction!

If you bought a PMD policy for yourself or the closest relatives (spouse, parents, children under 18), then you can arrange tax deduction And return 13% of its cost. However, you can return no more than 15,600 rubles.

Submit an application for a tax deduction in the FNS department, by mail, through personal Area Taxpayer.

Set of necessary documents:

• declaration (available on the FTS website);
• copy of the passport;
• help 2-NDFL from work;
• application for tax refund;
• policy, license insurer, payments.

As we thought

We chose 10 insurance companies, which, according to the results of the first half of 2016, in terms of contributions in the DMS segment. In this ranking included insurance companies

The share of Russian expenses for health care in the total mass of their expenses over the past 15 years has grown from 2.2% to 3.6%. This is the current side of the state savings on free medicine. It is clear that with such a trend, no one will give up the Voluntary Medical Insurance Policy (DMS), especially if the employer pays it. That's just the macroeconomic situation of the last 2.5 years forcing employers to save employers on DMS. And workers - adapt to this economy. How does this affect the position of insurance companies? We analyze the Russian and St. Petersburg Top 10.

On federal scale

According to Central Bank Russia, federal collection According to Voluntary Health Insurance (DMS) for 2016 increased by 6.8% compared with the level of 2015 - to 137.8 billion rubles. (against 129 billion rubles. for 2015).

Detailed processing of all indicators insurance market For many years, the group "Insurance today" is held. This time, the estimates of the DMS market were such:

DMS. Top 10: The largest insurance companies (Russia, 2016)

One more very an important indicator The work of the insurance company (perhaps even more important than the absolute value of fees) is the share of payments from the amount of money collected by the insurer. In 2016, in the market of the DMS, this share on average in Russia amounted to 73%. For comparison: in the first "crisis" of 2015, it was 77.3%, in the latter relatively "full" 2014 - M - 76.7%, and in 2013 - 78.2%.

FROMtax of payments and fees,%(Russia, 2016)

Source: "City 812".

As we can see, in the upper part of the top 10 in terms of charges, such insurance companies have gathered mainly, in which the share of payments was noticeably less than in the ideal version (73-78%). But, apparently, their insufficient readiness for payments was compensated by the reliability, the magnitude of branch networks and brand fame.

Regional scale

In the St. Petersburg market, the DMS (it is occupied separately from the regional) in 2016 worked 51 insurance Company, moreover, the 6 most unlucky of them sold DMS in sum from 2 thousand to 71 thousand rubles.

DMS. Top-10: The largest insurance companies in St. Petersburg (2016)

Sources: Central Bank of the Russian Federation; MiG "Insurance today".

As can be seen from the table, the company VSK, the participant of the regional top-10 in terms of fees, is not included in the same top in terms of payments, and the SG "URALSIB" is the opposite. These two companies destroyed the complete unity of two regional top 10.

It is worth noting that in the St. Petersburg rating of the largest insurers, DMS found a place for two local companies - "Capital Polis" and "MedExpress". At the same time, they look very adequately and in the rating based on the ratio of fees and payments (see below).

Top 10 by the ratio of payments and fees,%(Petersburg, 2016 year):

Source: "City 812".

Due to the incomprehension of the two Top-10, we managed to part only 9 companies from 51, who worked in 2016 in the St. Petersburg market. As we can see, in St. Petersburg, the CC "consent" spent money for the treatment of its customers much more actively than in the country as a whole, and "Ingosstrakh" - on the contrary, he did not even hit this criterion in the top 10.

The best client is a rich foreigner

In 2015-2016, the St. Petersburg market of the DMS in terms of fees actually stood on the spot. But in each insurance company individually, the results differed in the cardinal.

For example, in the St. Petersburg branch of Alfactor in 2016, fees decreased by 3%. The head of the DMS branch of Lidia Berezka branch explains this by the fact that customers' company, retaining the number of their insured and the volume of services for them, nevertheless choose more economical options for DMS programs for some customers.

It is clear that with this approach, it can be saved, only lowered the class of medical institutions.

In turn, in a larger Rosgosstrakh, DMS fees in 2016 decreased by 49.5%. There were also such clients who have ceased to insure at all. Victor Stools, head of the DMS of Rosgosstrakh-North-West, says: "From my customers who were insured for 10-15 years, about 10% of enterprises ceased to insure the DMS and went to nowhere. Those. No insurance company agreed to serve them on the conditions they put.

Victor Staff gives a price reference point: the cheapest corporate program that includes only emergency assistance and emergency hospitalization, costs for large groups of 2.5-3.5 thousand rubles per person per year. That is, in 2016, enterprises decided to save on such small amounts.

However, there are insurance companies in regional top 10 and such insurance companies that demonstrated growth in all criteria - and by the number of insured, and on the volume of DMS programs paid for them. For example, Deputy Director for Medical Insurance of the Branch in St. Petersburg SK Alliance Life Infigration of Majorova reported that in 2016 this branch collected 8% more than in 2015. (778.7 million rubles instead of 720.7 million).

"In St. Petersburg, our fees are more or less permanent, there is a small increase. New customers are primarily an IT-company, "Majorov's Iphigenians noted. - In 2016, all our insureders have retained for their employees of DMS in the same volume, and even with an increase. "

At the end of 2016 - early 2017, extended DMS agreements in the Alliance Life increased in price by 5-7%. The same, according to Ms. Majorova, will be in 2017.

"It is inevitable, since medical inflation in 2016 amounted to 8.2%," says Majorova. - Part of the medical institutions raised prices in the fourth quarter of 2016, and the rest - in the first quarter of 2017. On average by 7%. "

The reasons for the fact that the fees of this company are not just persisted, but also grow, Ms. Majorova explains this way: "Our customers are still mostly foreign enterprises. And by industry affiliation - tobacco, automotors, programmers. Such enterprises in the crisis suffer less. "

Who is the main pair of "Insurer - Clinic"?

In the past few years, the market is dictated by insurers. Thus, Victor Stools (Rosgosstrakh - North-West) says: "The main trend of the past and current years is to reduce the flow of the insured (and therefore patients) in the clinic. Therefore, RGSs last year decided to terminate contracts with those clinics with which he did not work in 2016 (although the treaties were) or worked in small volumes (5-10 thousand rubles per year are nothing, in essence). We have already terminated 150 contracts from the range of 480, and this process continues. About 50 clinics remained in the priority list. In the same, we convinced the companies that buy DMS: it is better to have less clinics in the list of DMS, but everything is very reliable, and most importantly - in order for the insurance company in them. "

Galina Sergeyev, Deputy Director for Personal Insurance of the North-West Branch of the British Insurance House (His charges in St. Petersburg in 2016 increased by 8.2%). According to Sergeyeva, the outflow of customers in the branch in 2016 was 15%, but the remaining programs did not decrease completely. Not declined, including because the BSD is thoroughly selecting medical institutions personally for each of its customers.

"Each medical institution decides on changes in prices for its services, based on a variety of factors. It is a medical institution profile, and the amount of services provided, and the amount of work on the DMS, and many others, "she explains. - The rise in prices, of course, is, but not for all types of services ... and not even in all LPU ... Therefore, we have the opportunity to choose the option for everyone and maintain flexibility with respect to our customers. "

Small insurance companies are forced to be even more inventive. So, for example, Alexander Lazarev, Vice-President Metlamif (fees in St. Petersburg for 2016 grew by 9.6%) tells: "Last year, in order to help customers, to maintain the filling of DMS programs, we began to pay more attention to medical examination and evaluate the work of medical institutions based on so-called medical and economic standards (MES). MESS is based on the value of the value of standard treatment programs. Then, based on this cost, the price of the entire complex of services rendered to the patient is calculated. He never overpays anything and even saves. "

This year, Massa expects further computerization.

"In our plans for 2017 - automation of processing processes from the clinics, says Lazarev. "This will not only increase the effectiveness of our accounting, but also will allow us to exclude the subjective human factor when working with our partners."

Workers involve in co-financing

According to Galina Sergeyeva from the British Insurance House, in 2016 and 2017 increased compared with 2015 the share of corporate clients who offer their employees to partially pay for DMS. The employer can pay, depending on his employee's assessment, from 30 to 100% DMS prices.

Ms. Sergeeva categorically disagree with a common thesis that only those who know about their diseases in advance about their diseases and 100% intends to have a 100-percentage of DMS on the co-financing.

"Not all workers refuse to surrender, because people are accustomed to DMS (first of all to the service, as well as the possibility of choosing an area and a doctor)," she says. - And surcharge 50% of 16-20 thousand rubles (i.e., from the price of a business-level program), paid during the year from the salary, is quite sulfilled for any employee. "

General situation in the Voluntary Medical Insurance Market

According to the results of the 9 months of 2015, the increased by only 3%. Unlike other types of insurance -, or, which is pretty fever, for various reasons, the DMS remains a certain quiet harbor, where everything goes to his woman and without great upheavals.

According to DMS for 3 quarters, it has changed as follows. The insurance premium fees amounted to 108.5 billion rubles, an increase with the figures of 2014 by 3.2%. Payments insurance compensation Grew a little faster - plus 5.8% to the mark of 73.5 billion rubles.

The overall level of payments (the ratio of payments to fees) increased by 1.6 percentage points to 67.7%.

Market concentration

As for the concentration of the market in the hands of leading players, then the DMS goes to step with all other types of insurance.

For 9 months of 2015 30 largest companies accumulated 91.7% of all fees in the country. A year earlier, this figure was 90.1%.

The main reason for the growth of concentration is the policy of the Central Bank of the Russian Federation, aimed at the systematic cleansing of the market from unscrupulous insurers. The review of licenses releases market share, which is naturally distributed among the current players.

It is not necessary to talk about monopolization, because inside the "thirty" fees are distributed quite evenly. With the exception, which, thanks to the accent on the needs of the oil and gas sector, holds a third of the entire DMS market. What mirrors repeats where one third fees falls on.

Top 30 Insurers DMS

Now take a look at how the rating of the largest insurance companies on the DMS.

The first is to cast companies and, exchanged 3 and 5 places, respectively. Despite the fact that DMS has become the main priority of the alliance, the active rebuilding of the company and the refusal of a number of insurance species has also affected the preparations of medicine (minus 11%).

The second - pushing into the first ten. Announces the battle of auto insurance and opening an embrace for DMS, the company is actively increasing the turnover - an increase of more than 70% to the volume of fees in 2014.

The most interesting, as usual, at the bottom of the rating.

In the TOP-30, 4 newcomers appeared at once. Companies independent insurance Group and significantly improved their fees and confidently occupied debut places in the "thirty" leaders.

From significant falls left the trace only, with the reservation that in 2014 the Insurer held 32 place with fees in 301 million rubles. In early 2015, the company fully turned a business for health insurance, and in November, the Central Bank of the Russian Federation recalled its license.

Keep for updates. Analytics on the ratings of insurers comes out on a regular basis.

What the article will help: you will learn 9 nuances that will make it easier to choose an insurance company.

The DMS program attracts highly qualified personnel to the company, motivates employees without increasing wagesReduces the frequency and duration of stay on the hospital. Specialists who are in demand in the market will not even meet with a potential employer, if he does not offer a medstrash. By purchasing DMS staff, you will reduce tax payments. However, all the advantages can be obtained, only carefully choosing an insurance company. What parameters should pay attention to first?

Insurance company rating.
Status Insurance companies are assigned independent rating agencies. For example, "Expert RA" (RAEX) - Russian and international rating agency, accredited under the Central Bank and the Ministry of Finance of Russia. Status is assigned on the basis of financial indicators of insurers: from the best A ++ (the maximum level of creditworthiness / financial reliability / financial stability) to the worst D - (the object is in a state of default). Choose insurance companies with a rating not lower than B ++ (moderate level of creditworthiness / financial reliability / financial stability). Such a rating gives hope that financial stability Companies will allow it to fulfill their obligations and attract highly qualified specialists to the execution of contracts.

License for DMS.
The regulator in the field of insurance is the Central Bank. Data on valid, suspended and revoked licenses can be clarified on the Bank's website. If the insurance company has been withdrawn or suspended a license, it does not have the right to conclude new and extend the existing contracts. If the license restrictions entered into force at the time of the insurance contract, according to paragraph 4.1 of Article 32.8 of the Law of the Russian Federation of 27.11.1992 NO4015-1 "On the organization of insurance in Russian Federation"In connection with the review of the license, insurance contracts and reinsurance contracts are terminated after 45 calendar days from the date of entry into force of the decision of the insurance supervision authority to revoke a license. Interrupted the contract for this reason, you will return part of the funds - the difference between the payment for which the insurance contract was concluded, and the period of which he acted.

Volume of fees.
Insurance insurance fees can be viewed on insurance sites (for example, "insurance today", "711.ru"), on the website of the Central Bank in the section "Publishing the reporting of the subjects of the insurance business" and on the sites of insurers in sections related to the disclosure of financial information. These information is presented in the form of a rating, where companies are indicated as leaders with the highest fees. The volume of charges shows how active the insurance company works in this direction: the more fees, the greater the interactions with other market participants - therapeutic institutions, brokers, partners who are not involved in insurance, but ready to provide discounts on services to customers of insurance companies. This allows the insurer to receive the most favorable tariffs for customers and conditions. Wholesale prices are always cheaper than retailers, tariffs for insurance companies and individuals may differ within 30-70%.

Affiliate network.
With a large number of medical facilities, the insurer cooperates, the more clinics in the program he will be able to offer your company in any price segment, from economy to premium. The number of clinics and hospitals on the network, in general practice, does not affect the price of the company's employee insurance program. But the wider the proposed network, the more convenient to use insurance: each employee can pick up the clinic next to the house, office. And the wider geographical covering can provide an insurance company, the higher the probability to ensure all employees with high-quality medical help. The price from the region does not depend. Only included risks and a set of medical institutions affect the cost of services. The rule also works for Moscow, and for regions.

Insurance amounts.
Insurance amount - a limit of payments for risks for each insured person for the entire insurance period or the amount, within which the Insurance Company pays the costs of the owner of the policy of medical services. Now the main insurers in the DMS market are set insurance sums, It is almost impossible to exhaust.

Reviews of the company.
Collect and analyze reviews about the intended insurance company on insurance sites:
"Banks.ru", "Compare.ru", ASN. Inscribe colleagues and partners. Get acquainted with insurers in specialized portals, survey employees. Of course, often reviews are subjective in nature, but with their sufficient quantities (at least 10-15) it is possible to identify positive and negative trends, for example: the quality of the dispatching panel, the speed of resolving issues. Please note whether there were appeals to the insurer in case negative reviews And what were the response actions. Working with complaints and complaints is an indicator of a professional and reliable market participant taking care of their clients and reputation.

Contract price.
Evaluating the proposals of various insurance companies, make sure that they compare the price identical parameters. It is worth comparing: a list of risks, a set of medical institutions for each risk, the volume of services and exceptions. The cost of the voluntary health insurance contract varies from ten thousand rubles for the budget level clinic to several hundred thousand rubles for international medical centers.

Services for a fee.
Find out why your employees will have to pay separately. Preventive measures, cosmetology services, family planning services and other are usually not included in the DMS programs. Not all insurers include outpatient treatment of oncological and professional diseases, Restrictions on analyzes, immunological, allergological research are introduced.

Service services.
Find out what services is ready to provide you with the company. For example:
Personal curators that respond to all issues that arise and promptly solve problems;
Personal account, where you can get all the information on the policy without contacting the insurer, make an appointment in the online mode;
Additional discounts on other products of the company (OSAGO, CASCO, property insurance);
additional services and bonuses (polls of traveling abroad, discounts from partner companies, expansion of the insurance program).

Who to instruct the analysis of the insurance market.
Usually in large and medium-sized companies this task is performed by HR service staff or procurement service. But more efficiently, if both departments will interact when choosing an insurer.

Summary

Optional development: As part of the modernization of the OMS system, the state seeks to minimize the volume of the DMS market, which can adversely affect the entire health care system. In health development strategies until 2020, it is said that the work of the DMS market leads to a "reduction in accessibility and quality medical care The population serviced by the program state guarantees" Based on this, the state does not support the development of the DMS market.

However, the conditions of insufficiency of funding for the health system such a position will lead to an increase in shadow payments and reduce the effectiveness of the entire OMS system. According to Expert RA, the work of the DMS market has a number of positive external effects: the growth of social stability, a decrease in information asymmetry in the market medical services, improving the effectiveness of the health care system and investment growth in construction medical centers. Considering these external effects, the state, on the contrary, should contribute to the development russian market DMS.

"Expert RA" has developed the main provisions of the DMS market development strategy that should become part of Health care system concepts. The main directions of the strategy: a clear separation of OMS and DMS systems, renewal of the product line and standardization of DMS contracts, as well as simplifying tax benefits.

Pricing is clarified: a direct dependence of the cost of medical services from the service and quality of equipment has appeared on the LPU market. A few years ago, the correlations between these indicators were not traced. The total increase in the quality of medical institutions was noted compared to 2006. In general, the evaluation of departmental clinics in all parameters turned out to be higher than private. The private polyclinic for adults revealed the inverse dependence of the cost of services from the professionalism of medical personnel.

The highest indicators for the price / quality ratio of the study were obtained:

1. NUZ Central Polyclinic of Russian Railways (Polyclinic Services for Adults);
2. Branch No. 5 of FSU "3 CVKG them. A.A. Vishnevsky Ministry of Defense of Russia "(polyclinic service for children);
3. NUZ "Central Clinical Hospital No. 1 of JSC" Russian Railways "(hospital for adults);
4. State Unitary Enterprise "Research Institute of Emergency Children's Surgery and Traumatology" Department of Health of Moscow (hospital for children).

Fiscal effect: The growth of deductions on OMS from 3.1 to 5.1% will reduce the budgets for the DMS.Especially noticeably this measure will affect the still unstable demand from small and medium-sized businesses, which grew up with the expansion of tax benefits in 2009 (the rate of assigning awards for the DMS to the cost increased from 3 to 6%). Nevertheless, the growth of the DMS market will continue at least by inflation of the cost of medical services. According to the "Expert RA" forecasts in 2011, the volume of the DMS market will be 89.6 billion rubles (+ 10%), in 2012 - 100.3 billion rubles (+ 12%).

The possibility of choosing an area and doctor oMS program, as well as the inclusion of a private clinics in the system of the individual clinics will lead to the redistribution of the DMS market. In this situation, 2 scenarios for the development of events are possible:

1) If it is possible to choose from the HDC clinic program with a high level of service and the quality of the services provided, there is no need to purchase the PMC policy. In the future, the OMS system may well provide serious Competition of the DMS.

2) High-level clinics will not want to log in into the OMS system, and instead they will include clinics low level. Then the demand for DMS will increase, and due to the lack of high-quality competition between clinics there will be no incentives for improving the service and quality of services provided by municipal clinics.

Treatment at the expense of insurers: Loss of business on DMS for 2010 exceeded 100%.The average significance of the combined loss-net coefficient for the first 9 months of 2010 was 99% (for 9 months of 2009: 90%). The main reasons for the growth of unprofitability: dumping, "cheats" of the LPU and the incorrect organization of the loss settlement system - payments are not carried out as a result of the offensive insurance case, but on the fact of visiting LPU.