Yuriy Nikanyonok  

Health Insurance: Ukraine’s Market Realities

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If you are a lucky one using the benefits of health insurance in Ukraine sooner or later you come across the dilemma of whether or not specific illness, injury or other cause of health problems fall within the category of insured events and are to be covered by the insurance company.  Trust me, you are not the only one who has such doubts. This article is aimed at offering you a brief outline of programs under Ukraine’s health insurance programs.

Though every insurer has its own wording of insured event definition, they all come down to the following – newly diagnosed illness, acute exacerbation of a chronic disease, traumas and injuries unless, of course, they are excluded from the coverage in accordance with the policy. Make sure to double check whether your case can be qualified as an exception, Before calling to the assistance to claim the insured event it’s reasonable to make sure your case doesn’t fall within the exceptions section. If assistance manager recognized your case as not an insured one, here is what you can do to turn the situation around.

Remember that assistance doctor cannot issue diagnoses over the phone
- The case can be qualified as an exception only based upon the doctor’s opinion. Ukraine’s health insurance policies foresee that the insurance company cannot diagnose you with anything. The main task of their assistance is to define the doctor of which can help the insured best and arrange for the necessary visit accordingly. Remember that assistance doctor cannot issue diagnoses over the phone.

- If you have already been to the doctor but feel that your diagnosis is incorrect, do not forget that since health insurance in Ukraine offers quite flexible coverage, in most cases you are entitled to alternative consult. However, some policies can impose certain limitations on that.

- What if your doctor is uncertain about the final diagnosis and needs additional procedures and labs to confirm it? As to the wording of health insurance Ukraine’s companies have their own policy regarding the coverage of diagnosing expenses. In this case the clauses in your health insurance policy which refer to the diagnosis are of most importance.   Some insurance companies cover all the medical procedures needed to diagnose a patient. Others stipulate that you have to pay for the procedures prior to final diagnosis yourself. Of course, it is not the best option for you, so this aspect should be paid special attention to.


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