The object of voluntary health insurance is the property interests of the Insured Person (individual) related to the payment for the organization and provision of medical and medicinal assistance (medical services) and other services due to a health disorder of the individual or a condition of the individual requiring the organization and provision of such services, as well as the implementation of preventive measures that reduce the degree and/or eliminate threats dangerous to the life or health of the individual.
INSURANCE RISK, INSURED EVENT
Insurance Risk is a presumed event, possessing signs of probability and randomness of its occurrence, for the event of realization (occurrence) of which insurance is provided.
An Insured Event is an event that occurs during the validity period of the Insurance Contract, upon the occurrence of which the Insurer becomes obligated to pay for medical and other services, of appropriate quality, nomenclature, service, and conditions of their provision, provided for by the Voluntary Health Insurance Program chosen by the Policyholder (Insured Person) and its appendices, in a medical organization from among the organizations listed in the appendix to the insurance policy, upon deterioration of the Policyholder's (Insured Person's) health due to circumstances defined by the Voluntary Health Insurance Program.
The Voluntary Health Insurance Program may provide for the Policyholder (Insured Person) to receive therapeutic, advisory, rehabilitation, balneological, preventive, diagnostic, pharmacological, and other assistance.
Under the insurance contract, the occurrence of circumstances requiring the provision of medical and other health-related services to the Insured Person is recognized as insured events. Under the terms of the concluded insurance contract, the Insurer guarantees the Insured Person the provision and payment of services in medical organizations specified in the insurance contract, or reimbursement of expenses for medical and other services on the terms agreed upon by the Parties in the insurance contract, in accordance with the Voluntary Health Insurance Programs (including appendices).
SUM INSURED
The Sum Insured is a monetary amount determined by agreement of the Parties in the insurance contract, based on which the amount of the insurance premium (installments) and the amount of the insurance payment upon the occurrence of an insured event are established.
INSURANCE RATE
The insurance premium (installments — when paying the insurance premium in installments) paid by the Policyholder under the insurance contract is established depending on the insurance risks chosen by the Policyholder, the list of medical and other services, the conditions of their provision, the amount of the sum insured, the insurance term, the results of a preliminary medical examination (if provided for by the Program), and other conditions specified in the insurance contract.
The Insurance Rate is the rate of the insurance premium per unit of the sum insured, taking into account the object of insurance and the nature of the insurance risk, as well as other insurance conditions. The insurance rate for a specific insurance contract is determined by agreement of the parties.
The amount of the insurance premium is determined based on the sum insured agreed upon by the parties, the base tariff rate, and adjustment factors.
In this case, the Insurer has the right to introduce an increasing coefficient for Insured persons over 60 years of age, as well as increasing or decreasing coefficients to the insurance rates, determined expertly based on the results of a preliminary medical examination of the Insured Person, established based on the analysis of other information obtained when concluding the insurance contract, based on the Insured Person's occupation, and the presence of habits affecting the state of health.
When determining the amount of the insurance premium, the person for whom the insurance contract is being concluded may be asked to fill out a medical questionnaire. If necessary, to clarify data about the person in whose favor the insurance contract is being concluded, the Insurer has the right to send them for a medical examination. In case of refusal to fill out the medical questionnaire or undergo a medical examination, the scope of which is determined by the Insurer, the Insurer has the right to refuse to conclude the insurance contract with the Policyholder.
The insurance premium under the insurance contract can be paid by the Policyholder in a lump sum – a single payment for the entire insurance period or in installments (payment of insurance installments) – in the manner established by the insurance contract.
INSURANCE PERIOD
The insurance contract is concluded for a period of one year, unless otherwise provided by the terms of the contract.
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