Why you need health insurance
Voluntary health insurance (VHI) pays for medical services in the clinics the insurer works with, within the program and limits. It complements the state system — the guaranteed volume of free medical care and compulsory social health insurance — and gives more freedom: a choice of clinic and doctor, shorter waiting times, and access to services not included in the basic package. A policy appeals to those who value quick access to specialists, families with children, people who want to be treated in private clinics, and those not covered by an employer's corporate program.
What a program may include
- Outpatient care — doctor appointments, diagnostics, tests, procedures.
- Inpatient care — emergency and planned hospitalisation, surgery, a hospital room.
- Ambulance and urgent care, home doctor visits.
- Dentistry — usually treatment of acute pain, sometimes an extended program.
- Additional options — telemedicine, medication cover, vaccination, rehabilitation, preventive check-ups.
Programs can be individual or family; a family program can include spouses and children, sometimes with a different scope of cover for each.
What is usually not covered
- treatment of conditions diagnosed before the contract was concluded, unless they are separately included;
- chronic and oncological diseases, HIV, tuberculosis and a number of other diseases whose treatment is provided by the state;
- cosmetology, plastic surgery, prosthetics and orthodontics without a special option;
- pregnancy care and childbirth, unless provided for by the program;
- consequences of intoxication and of intentionally harming one's own health;
- services outside the program's clinics without the insurer's approval.
What determines the price
The cost of a policy depends on the set of services, the level and number of clinics in the program, limits by type of care, the age and health of the insured, a deductible or a co-payment for each visit, and the number of people insured in the family. The insurer may ask you to complete a medical questionnaire and is entitled to decline cover or change the terms if significant risks are identified. The information in the questionnaire must be accurate: errors or omissions may become grounds for refusing payment.
How to choose a program and what to look for in the contract
- Clinic network — whether there are suitable clinics near your home or work and whether you can get care in other cities.
- Territory — one city, all of Kazakhstan, or also trips abroad.
- Limits — the overall limit and restrictions by type of care, number of visits or hospitalisations.
- Waiting period — from what moment individual services apply, for example planned hospitalisation or dentistry.
- Deductible — whether you have to pay a share for services.
- Service procedure — booking through the insurer's call centre, a mobile app or directly with the clinic, and the procedure for approving expensive tests.
How to get care under the policy
- Contact the insurer's 24-hour service or use the app and obtain a referral to a clinic.
- Bring your ID and the policy or its electronic copy.
- Check in advance whether the prescribed service is included in the program, so that you do not have to pay for it yourself.
- In an emergency, call an ambulance and inform the insurer of the hospitalisation as soon as possible.
- If you paid for a service yourself by agreement, keep the receipts and reports and submit a reimbursement claim within the set period.
How Polis Re can help
Polis Re analyses your needs and compares the programs of different insurers by clinic network, limits, exclusions and service procedure. We will help you understand which options are really needed and which you can give up without losing protection. Employers may find corporate programs for employees suitable, for trips abroad there is travel insurance, and additional protection is provided by personal accident insurance. To receive a selection of programs, send a request to the broker.
