What is included in VHI for dentistry in 2022: pros and cons of the policy

By taking out additional health insurance, the insured person has the opportunity to receive quality medical care in many areas. The list of the most common conditions under a voluntary medical insurance (VHI) policy includes dental services. You will find out below what manipulations and procedures are provided by the VHI dentistry option.

What is included in VHI in dentistry?

There are two ways to purchase voluntary medical insurance with dentistry: become a participant in the corporate insurance program through your employer or take out a policy individually.

The basic VHI program does not include dental services - this is an addition to the list of standard services, which is added at the request of the policyholder. Dentist medical care within the framework of the additional insurance policy includes:

• examination and diagnosis of the oral cavity;
• X-ray and other necessary examinations;
• therapeutic treatment (treatment of acute superficial, medium and deep caries, pulpitis, nerve extraction, canal filling, placement of fillings, pain relief);
• surgery (removal of wisdom teeth, chewing teeth, incisors, benign formations, treatment of inflammation in the mouth, salivary glands, maxillofacial nerves);
• treatment of gums and oral mucosa;
• aesthetic treatment: removal of tartar and plaque, installation of veneers, coating with fluoride varnishes;
• emergency 24-hour free assistance in the clinic.

The above list of standard services does not include implantation and prosthetics. By the way, insurers are very reluctant to agree to add these options to the VHI Dentistry program.

Therefore, if a client hopes to receive this type of treatment, it is necessary to study the contract very carefully. Typically, only maxillofacial trauma is a strong indication for prosthetics.

Good to know! If a tooth is destroyed due to natural reasons - age, caries, etc., the implant is placed at the patient’s expense, which is absolutely unprofitable for the policy owner. Under such circumstances, the insured may never use the dental services provided for by the terms of insurance and regret the money spent.

How to understand whether it is worth buying a VHI policy

To find out whether it is worth buying a policy, you need to do a little:

1. Calculate how much you spend on treatment.
2. Find out what service packages you need.
3. Check which insurance companies provide the policy and for what amount.

Last year, I didn’t spend much on treatment in commercial clinics and sought help mainly for preventive examinations (the table shows rounded data, prices are relevant for my region):

A calculator from one of the insurance companies calculated that the minimum policy, which would include dental services, would cost me 35,000 rubles per year. At the same time, I will also spend money on treatment, because all prevention, if you believe the insurance rules, will fall entirely on my wallet. That is, massage, teeth cleaning and medicine purchases - the most expensive items on my list - will remain outside of insurance.

You can purchase a policy that will cover these costs. But its price will be sky-high - under a hundred thousand rubles.

Out of curiosity, I called two more insurance companies, where honest employees directly said that for individuals, the VHI policy is unprofitable, and if you are worried about the risk of injury or illness, then it is more logical to conclude an insurance contract against accident or illness: it is several times cheaper .

What do you have to pay for out of pocket?

When signing a contract, the policyholder cannot provide for everything - some cases are not covered by the insurance. They are classified as additional medical services of dental care. Among them:

• teeth whitening and inlay (decoration with rhinestones);
• restoration of enamel and coating it with protective agents;
• replacement of fillings at the request of the patient for preventive and aesthetic purposes;
• implantation and prosthetics of lost elements of the dentition;
• orthodontics (correction of bite, alignment of teeth through the installation of braces and other methods, treatment of periodontal tissue, ozone treatment).

The listed services are mostly related to cosmetology, and this type of service is not provided for by the VHI policy.

Advantages of voluntary health insurance

The advantages here are the same as those of paid treatment over free:

1. Service in private clinics with a higher level of comfort and technical equipment.
2. No queues.
3. Quality service. This includes the polite treatment of the staff and such little things as free shoe covers and other disposable consumables.

In addition, the patient pays for the VHI policy once, and then the insurance company reimburses the costs to the medical institution. This approach reduces the number of unnecessary examinations and prescriptions that doctors sometimes do in paid centers: the insurance company simply will not approve manipulations that are not part of the standard of treatment.

A little about corporate insurance

It cannot be said that the quality of dental services under the VHI policy is better. In contrast, corporate insurance options are usually quite limited. However, there is a very significant plus - the insured person will not pay for dental treatment under voluntary health insurance in the amount provided for by the policy.

Considering that additional medical insurance is not a cheap pleasure, small organizations cannot always afford to include the “VHI” option in the contract. But huge holdings with thousands of employees receive significant bonuses from the insurer, so adding this service does not affect their financial condition. What you need to know about corporate insurance:

1. Seeing a dentist under a VHI policy is not always “geographically” convenient, because you can get examined and receive treatment in just a couple of medical institutions located at different ends of the city.
2. Typically, corporate insurance has limitations, for example, no more than 2 teeth can be treated per year, and only if it is average caries and the crown is destroyed by no more than 50%. For the rest you will have to pay extra, albeit taking into account the discount.
3. If the collective agreement specifies a certain number of people who can receive treatment during the year, and more employees from this company contact the clinic, this may entail a lengthy showdown with the insurance company. It is possible that some insured persons will have to use paid services.
4. When an employer saves on the “Dentistry” option and chooses clinics with a lower quality of service, one can also expect that cheap materials may be used during treatment. In addition, it is more profitable for a doctor to accept clients who pay for treatment, so VHI holders are “leaked” to inexperienced trainees. Fortunately, this is a rare occurrence.
5. You must make an appointment in advance

Thus, corporate insurance, which provides the opportunity to treat teeth under a VHI policy, is beneficial for the insured, especially if he works in an enterprise with hazardous production, where abrasives, chemicals, etc. are used. Service under such a program is better than under free compulsory medical insurance, and worse than visiting a paid dentist individually at your own expense.

Dental treatment according to compulsory medical insurance

Money

Compulsory health insurance (CHI) is a system familiar to everyone since childhood, which allows anyone to receive free medical care in Russia.

But “free” here is very conditional. Every worker monthly gives the state 5.1% of his salary to the federal compulsory health insurance fund, which then distributes it. And through insurance companies, the money goes to medical organizations, compensating the costs of your treatment and the salaries of doctors in public clinics.

Due to the fact that every month you pay part of your salary, at the moment when you need to improve your health, with compulsory medical insurance you don’t have to think about money - you have already financed your treatment in advance. Or someone did it for you if you are not working. The illusion of freeness comes from the fact that you do not see this money, as well as your own pension contributions and income tax paid - the employer does this for you, but not from his own money, but from your money.

Quality

Under compulsory medical insurance, you can receive almost all dental services except prosthetics, implants, installation of mouth guards and braces.

Treatment of caries, pulpitis, cleaning, filling are also included in compulsory medical insurance. But there is a significant drawback to this treatment - reliable light fillings are not installed for free. You will have to pay extra for them and for high-quality pain relief. The good news is that, as a rule, municipal clinics in big cities always have them in stock.

There can be no good fillings according to compulsory medical insurance. We had chemical-curing fillings installed under the compulsory medical insurance program. This is the last century. Even if they paid me, I wouldn’t put such a filling on myself

According to expert Maria Matievskaya, it is possible to receive high-quality treatment under compulsory medical insurance, but you still need to prepare for certain financial investments. For example, go to treat caries for free, but agree with a doctor to install a high-quality light filling for an additional fee.

You can come under the compulsory medical insurance program and say directly: “I want to get a good filling, good treatment. What does that require?" You don't have to get treatment right away, but you can listen and find out what options the doctor suggests. First of all, I would recommend consulting and then making a decision

In addition, the compulsory health insurance system includes teeth brushing to a limited extent. You can count on tartar being removed from your teeth without affecting the spaces between your teeth. Often clinics simply do not have such technology. As for surgical dentistry, it makes sense to contact public clinics under the compulsory medical insurance program. This is due to the fact that doctors in private medical institutions that accept voluntary health insurance work part-time in several branches of dentistry. It turns out that if you need to see a specialist, it will be easier to find one in a state clinic, where there are more staff members and “generalists” are less common.

Compulsory medical insurance in private clinics

Yes, some private hospitals and clinics receive funding from the compulsory medical insurance fund, which means you can be treated there for free. You can find out which private medical center you can go to with your compulsory medical insurance policy on the website or by calling your regional compulsory insurance fund. Here are the sites of Moscow and St. Petersburg.

To contact a private clinic, you will need a compulsory medical insurance policy, a passport and SNILS. But be prepared to wait - there may be separate reception hours, separate queues, and a very limited list of services for you.

When does it make sense to go to a private clinic under compulsory medical insurance? For example, when tests, high-tech research (MRI, CT) or an operation covered by compulsory medical insurance are urgently needed.

You can also get dental care, but here you need to clarify in advance what kind of manipulations the private clinic is ready to perform with you.

What could be the pitfalls?

You should familiarize yourself with the disadvantages of dental care before purchasing a policy. Pitfalls that the insured person may encounter:

• inability to change clinics at will. According to the terms of the contract, during the insurance year the client can only be served in the institution that was selected when receiving the policy;
• lack of highly specialized specialists in clinics. According to the rules of VHI insurance, the patient does not have the right to use the services of a prosthetist and orthodontist - he only claims to provide primitive care. The same applies to diagnostic measures - such examinations are limited by agreement;
• drawing up an agreement with a franchise. This will reduce the amount of the insurance premium, but if an insured event occurs, you will have to partially pay for the treatment out of your own pocket. If the franchise is 2000 rubles, then upon initial application you will have to pay this amount;
• chronic diseases. If there are any, VHI registration is usually refused. There is no point in hiding this fact, because if it reveals itself, you will have to pay a huge fine and reimburse the insurance company for all funds spent.

Another significant problem is that not all insurers want to cooperate with individuals and provide dental care. For them, corporate insurance is more profitable. It is difficult to find such companies; not all of them exist on the market.

Good to know! Some individuals join groups of 10-20 people and receive insurance on the same terms as large companies. This allows the insured to save on purchasing a policy.

What insurance doesn't cover

All insurance companies have different conditions. It is possible that your contract for a certain price will contain something that is not in other contracts. But standard policies are the same in most cases. In addition to the already indicated cases of HIV infection and malignant neoplasms, they do not cover the costs of:

1. Medicines. You will have to buy tablets with your own money.
2. Preventative visits to the doctor. Let's say nothing bothers you, but you know that you need to visit the dentist and gynecologist every year or even twice a year. If you take care of yourself, the doctor will confirm that you are healthy. And this appeal will not be considered an insured event. The same can be said about visiting a doctor when you need to get a stamp on a certificate, for example.
3. Pregnancy and childbirth. These events are not considered an insured event, and insurance companies and clinics have separate offers for medical support of pregnancy.
4. Psychiatric help. You will talk about stress, burnout and depression with a psychotherapist at your own expense.

It’s easier to say when a basic policy works: when you got sick, you went to the doctor and were treated on an outpatient basis. Everything else, including hospitalization (in a comfortable room), is additional chips for additional money.

Cost of VHI for dentistry in 2022 in the top 5 insurance companies

Some top insurance companies with high reliability ratings do not provide standard programs for individuals for VHI insurance with the option of dental services. For example, those insured who have dental treatment under the policy of VTB or SOGAZ either have corporate insurance or negotiate the terms of insurance individually. The table shows the prices of those organizations that have standard programs that include dental services.

Compulsory medical insurance or VHI

If voluntary health insurance is not offered by your employer, then applying for it yourself does not make much sense. In this situation, it is more profitable to be treated under compulsory medical insurance, choosing clinics based on reviews on the Internet or word of mouth. In order to be treated by a doctor you like in a public clinic, you need to detach yourself from the one to whom you are assigned at your place of residence.

Many are treated in government clinics and are friends with doctors. You come and the doctor performs some manipulations on you under the compulsory medical insurance policy, but at the same time you receive high-quality treatment. Roughly speaking, a filling costs 3 thousand. You pay 1–1.5 thousand into his pocket, and the rest goes according to the policy. And it will be more profitable than going under the VHI program

VHI, if it is paid for by the employer, is beneficial to use for preventive examinations, research, tests, to get general advice, to do high-quality teeth cleaning, which is provided in a greatly reduced version under compulsory medical insurance.

Both under compulsory medical insurance and under VHI, you need to be prepared to pay extra and directly ask the doctor what he would recommend for better treatment.

Also, if you have a VHI policy, you need to know what services are included in your specific insurance so that the doctor does not deceive you. For example, he may say that your tariff does not include consultations, although this is not true. In addition, it is better to choose a clinic and a doctor that have proven themselves well in advance, based on reviews and recommendations. In this case, if the doctor tells you that the materials for treatment are not of very high quality, you will have more reason to trust his words.

How and where to apply

VHI insurance with the “Dentistry” option can be obtained from any of the above companies, or you can first independently monitor the conditions and prices of different insurers and choose a more profitable option. To obtain a policy you will need:

• visit the office of the insurance company, inquire about the provision of such services in the medical institution you like, or leave an application for purchasing a policy on the insurance company website;
• provide a package of documents: passport, SNILS, confirmation of registration, application (filled out on the spot);
• undergo an examination (at the request of the insurer);
• choose a program that provides dental services and sign an agreement;
• pay for the services of the insurance company and obtain a policy.

You can conclude an agreement through an insurance agent, broker or travel agency, but in this case you will have to overpay for mediation. In addition, fraudulent activities are possible, so you need to confirm for yourself the fact of cooperation of a person or organization with the insurer.

When does it make sense to buy a VHI policy?

Voluntary health insurance is beneficial in several cases:

1. With the help of your employer, you connect your relatives to the insurance program on favorable terms.
2. You get sick a lot and are treated in paid clinics.
3. You have a lot of money and want to receive medical care with maximum comfort.

If this is not your case, then leave VHI for employers who think about their subordinates, want to be attractive to cool specialists and not lose people because they spent the whole day in line at the doctor because of a common runny nose.

Where can I buy VHI

There are few companies that cooperate with individuals. Mostly all top insurers with a high customer trust rating enter into contracts with corporate clients. However, you can find a reliable insurance company. This list includes:

• Rosgosstrakh;
• Renaissance;
• Ingosstrakh;
• VSK.

You can try to conclude an insurance contract with Sogaz. VHI Sogaz provides dental treatment in the best foreign dental clinics. The customer support service is available 24 hours a day and you can contact us with any questions.

Is there a program with dental prosthetics?

Dentistry medical insurance in its basic version does not include dental prosthetics. This is due to the high cost of implants. Moreover, they are often made of expensive ceramics or precious metals.

However, in premium and expensive programs, dental prosthetics can be added as an option. But here, too, the client faces restrictions.

For example, it turns out that the contract will stipulate the condition for the need for a prosthesis due to maxillofacial trauma, and not due to untreated caries.

The cost of the program with dental prosthetics included in the package will start from approximately 140,000 rubles / year.