Voluntary medical insurance in case of illness

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Voluntary medical insurance  is carried out on the basis of voluntary medical insurance programs. Voluntary medical insurance allows the insured to receive timely, high-quality medical services in a comfortable environment.

Voluntary medical insurance is not only a way to get high-quality multidisciplinary medical care, but also a social guarantee of providing employees with timely medical care and motivation that frees staff from financial burden during the treatment stages.

Benefits of LCA for an employer:

  • Long-term investments in staff health, improving its effectiveness and efficiency
  • Social guarantee of personnel protection
  • Detection of diseases of employees at an early stage, reduction in the number of diseases and risk of injury in the workplace
  • Personal participation in the formation of the necessary insurance program, the definition of the types and scope of services
  • Quality control of received services
  • The possibility of visiting doctors by staff during off-hours

The provision of medical services to the employees under the contract is carried out with the help of an assistance company with a staff of family doctors and medical staff of more than 1,600 people who have their own fleet of modern ambulances, a network of basic clinics and accredited health care institutions (in accordance with the scope of services provided by the insurance program and under the terms of the insurance contract).

The interaction of the insurer and the insurer​​​​​​​

Within the framework of differentiated insurance programs, staff members will be able to undergo regular medical examinations, examinations and receive seasonal vaccination.

Under the voluntary health insurance contract, the Insurer guarantees the organization and provision of medical services on the basis of the selected package of services (insurance program) by the Insured attached to the Insurance Contract and an integral part of it.

The coverage territory is the territory covered by the insurance protection under the contract - the Republic of Kazakhstan.

Insured Event: The Insured's application during the term of the insurance contract to doctors and (or) to medical organizations for medical services in case of emergency, acute illness, exacerbation of chronic disease, injury, poisoning and other accidents that occurred during the period of the Agreement and related the occurrence of the costs of the insured.

The insured under the Agreement may be the person in respect of whom the insurance contract is concluded.

At the time of signing the Insurance Contract, the Insurer will issue a personal insurance card to each Insured, which contains information with the individual data of the employee’s name, Company name, insurance card number and insurance period.

The procedure for the provision of medical services: The Insurer organizes the Insured to provide medical services provided for in the Insurance Program of this Agreement through an assistance company. Medical services that comply with the selected insurance program are provided to the Insured in an assistance company or in medical organizations that are part of the medical network..

Medical indications are objective reasons and conditions for obtaining medical services for diagnosing and treating a disease arising from the fact that the disease is present in the Insured, his condition as determined by the doctor of the Assistance company and in accordance with the contract and insurance program.

Dental services for the insured are also provided by Interteach doctors and dental clinics that are included in the assistance.

Actions of the Insured (Insured) upon occurrence of the insured event:​​​​​​​

In the event of an insured event, the Insured must consult a Interteach doctor or call the Call-center on the 24-hour numbers indicated on the insurance card for advice and organization of medical assistance.

The Insured may also contact the personal family doctor directly for consultation, arranging specialist consultations or hospitalization, selection of treatment tactics and coordination of further treatment for outpatient and / or inpatient treatment.

In cases when the Insured is hospitalized in a medical facility that is not part of the Assistance Company Network (List of Medical Network Participants) in case of an emergency or when an emergency insured event occurs, the Insured or his authorized person must notify of the fact of receipt no later than 48 hours from the date of the incident the insured event to a personal family doctor / personal manager or a representative of the Insurance company Interteach and report the following data:

  • Insurance card number, company name, full name The insured;
  • the location of the Insured, contact numbers;
  • provide information with a brief description of the case.

How to choose an insurance company?​​​​​​​

The company decided to conclude an agreement on corporate insurance and you are faced with the question of how to choose a potential supplier and how to determine the leader in this industry?

The criteria for selecting a potential supplier may include the following indicators:

  • The presence of specialization in the field of health insurance (share in the portfolio: at least 90% percent) - the share of at least 20 percent of the total insurance premiums;
  • The potential supplier has at least 10 years of experience in the health insurance market;
  • The presence of a potential supplier of at least 10 clinics (own Assistance company);
  • The presence of the Medical Assistance of its own full-time medical staff of at least 500 people;
  • The potential supplier has a certified quality management system - copies of certificates of compliance with the QMS standards for the development and provision of insurance services (in the field of health insurance).

 

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