Medical and personal insurance with care from the best doctors

Are you concerned about your health and looking for ways to protect it? This speaks to the fact that you are a holistic and successful individual who strives to enjoy life as long as possible, and we warmly welcome you to our website!

So what is "health insurance" all about?

Health insurance (often scientifically understood as continuous health insurance) is one of the types of personal insurance. Therefore, we suggest that you consider the types of personal insurance to clearly define concepts and future obligations of the insurance company towards you.

Personal insurance is a type of insurance that covers life, health, ability to work, and additional pension insurance for insured persons.

Personal insurance is divided into three branches. Their existence is associated with different durations of insurance contracts and different amounts of insurance liability (list of events for which insurance is provided). The branches of personal insurance are insurance against accidents, medical insurance, and life insurance. Within these branches, types of insurance are distinguished.

Accident insurance combines short-term (usually up to one year) types of personal insurance. The scope of liability for the types included in this branch provides for the payment of the insurance amount or its part in the event of:

- the death of the insured person;
- permanent disability (establishment of disability);
- temporary incapacity for work.

A necessary condition for the insurer's liability is for the events listed to be the result of an accident specified in the insurance contract.

The second branch of personal insurance is medical insurance. It emerged and began to develop in our country relatively recently, although Western countries already have quite a bit of experience in this matter. During the Soviet era, there supposedly was no need for medical insurance, as medical care was provided free of charge. With the transition to market relations, the situation changed. The high cost of qualified medical care led to an interest in medical insurance, which contributed to its development. Medical insurance as an independent branch of personal insurance combines all types of insurance related to the reimbursement of expenses of the insured person in connection with illness and the need for treatment.

Another feature of medical insurance is that the insurance payment can be made by the insurer in two ways: firstly, directly to the policyholder (insured) in the form of the full insurance amount or its part; secondly, in the form of payment to a medical institution of the cost of treatment of the insured (including payment for staying in a hospital, physiotherapy procedures, consultations with leading specialists, expenses for purchasing medicines, etc.).

As we are most interested in medical insurance itself, let's delve into its subtypes more thoroughly.

1. Health insurance for illness covers medical expenses for a specific illness specified in the insurance contract. For example, these may include various infectious diseases, cardiovascular diseases, and respiratory system diseases. The insurance contract can be concluded for a single disease or a range of diseases that concern the insured party. In the event of an insurance claim, the insurance company pays out the insurance amount or a portion thereof to the insured individual. To receive the money, it is necessary to provide the insurance company with medical documentation confirming the illness. The insurance company, in compliance with the terms of the contract, will make a fixed payment according to the contract terms. The amount to be paid depends solely on the diagnosed condition and is paid to the insured person.

Advantages of this subtype:

- simplicity in relations between the insurance company and the insured individual;
- speed of payment;
- transparency in calculating the amount to be paid.

Disadvantages of this subtype:

- lack of control over the quality of treatment of the insured individual;
- the insured person must find the clinic and doctor independently;
- discrepancy between the amount to be paid and the actual treatment expenses;
- lack of legal support and supervision of the treatment process;
- lack of interest of the insurance company in the final outcome of the treatment.

2. Medical expenses insurance covers medical expenses under certain conditions (outpatient, inpatient, emergency care) specified in the insurance contract. For example, this may include compensation for the insured individual's expenses during outpatient treatment, or only treatment in inpatient facilities, or treatment in any municipal or state-owned medical institution. In the event of an insurance claim, the insured individual organizes and pays for necessary medical services and medical supplies (medications) independently, carefully collecting supporting documents such as certificates, statements, invoices, and work completion reports. After recovery, the collected documents are submitted to the insurance company. Based on the provided documents, the insurance company makes a payment (reimburses actual expenses) within the insurance coverage and under the terms of the insurance contract. The amount to be paid depends on the extent of the insured individual's expenses and the terms of the insurance contract.

Advantages of this subtype:

- payment corresponds to actual expenses;
- simplicity in relations between the insurance company and the insured individual;
- transparency in calculating the amount to be paid.

Disadvantages of this subtype:

- lack of control over the quality of treatment of the insured individual;
- the insured person must find the clinic and doctor independently;
- the insurance company pays for treatment after recovery, i.e., the patient finances the treatment process themselves;
- lack of legal support and supervision of the treatment process;
- lack of interest of the insurance company in the final outcome of the treatment.

3. Continuous health insurance involves the organization, quality control, and payment of medical services necessary for the treatment of the insured individual. Medical services can be grouped into the following categories:

- primary medical care;
- secondary (specialized) medical care;
- tertiary (highly specialized) medical care;
- emergency and urgent medical care;
- medical evacuation;
- dental medical care;
- medical rehabilitation;
- prevention;
- provision of medications.

Continuous health insurance covers acute illness or exacerbation or complication of chronic conditions. The duration of the insurance event is determined by the duration of the treatment process. Some insurance programs may also include a rehabilitation course after hospital treatment in a specialized sanatorium. Insurance contracts are concluded for a period of not less than one year. In the event of an insurance claim, the insurance company organizes and pays for the necessary medical services.

Advantages of this subtype:

- the insurance company organizes the provision of medical care;
- the insurance company controls the volume and quality of medical services;
- the insurance company pays for all services at once, and the insured individual does not incur expenses during treatment;
- the insurance company organizes the provision of medications and medical supplies as needed;
- convenience of receiving services;
- legal support and supervision of the process of providing medical services;
- the insurance company's interest in the insured individual's health.

Disadvantages of this subtype:

- somewhat higher cost of insurance compared to previous types of medical insurance.

For the insurance company "Misto," the development of continuous health insurance is a priority. Therefore, when we refer to "medical insurance," we specifically mean "continuous health insurance."

The third branch of personal insurance is life insurance.

This branch includes long-term types of personal insurance, the scope of responsibility for which, according to current legislation of Ukraine, provides for a one-time or deferred payment of the insurance amount in case of:

- death of the insured individual during the term of the insurance contract (or a court decision declaring the insured individual deceased);
- survival of the insured individual until the end of the insurance contract term;
- reaching a certain age by the insured individual: pension (pension insurance) or an age specified in the insurance contract;
- the occurrence of an event in the life of the insured individual specified in the insurance contract (marriage, birth of a child, enrollment in an educational institution, etc.).

The insurance company "Misto" does not provide life insurance services.