The document provides an overview of the voluntary health insurance (VHI) market in Russia. It discusses the basic VHI packages that are commonly offered, including packages for adults, children, pregnancy/labor, dentistry, travel, and special needs. It also examines how the VHI market changed during the economic crisis, with many companies reducing budgets by cutting coverage, services, or staff. Exclusions that are typically included in VHI policies are also outlined. Tables in the document compare how companies in different industries and of different sizes reduced their VHI budgets. It provides an example of how one company optimized costs by renegotiating its policy to exclude underutilized medical facilities.

1. FINASSIST
FinAssist Independent Center for Strategic Insurance Market
Research
Voluntary health insurance market overview

2. FinAssist 2
Table of contents
............................................................................... 5
BASIC VHI PACKAGES......................................................................................................... 5
: ............................................. 5
VHI AND THE CRISIS: CHANGES THAT TOOK PLACE .............................................. 5
(THE CONTENTS OF THE BASIC PACKAGES)8
................................................................................................................................ 8
................................................................................................................................. 9
............................................................................................... 10
– .......................... 10
PACKAGE FEATURES – THINGS TO PAY ATTENTION TO...................................... 10
.................................... 10
THE MAIN INSURANCE EXCLUSIONS ARE AS FOLLOWS ...................................... 10
1. ,
1 2010 . ................................................................... 13
APPENDIX 1. THE TOTAL LIST OF COMPANIES OPERATING IN THE VHI MARKET
AND THEIR CHARGES IN THE 1ST QUARTER OF 2010............................................. 13

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The FinAssist Independent Center for Strategic
Insurance Market Research presents an
overview of the market for voluntary health
insurance (VHI). This research work features
the information that will help to better
understand this branch of the insurance
industry, namely the insurance companies that
provide VHI services, market leaders, prices
and the coverage of major VHI offers. The
study also presents a list of major "pitfalls" to
note when concluding VHI contracts. The final
part of the review provides information on
what changes the VHI market has undergone
during the crisis, and what new opportunities
it came up with.
We hope that this overview will become your
guide to the VHI market and help you to
better orient in its numerous offers.
1. , Table 1. Main players, market size
*
11 310 432
3 256 200
1 964 002
1 840 364
- 1 668 151
1 492 442
1 422 414
1 213 622
1 119 308
1 005 911
-
875 865
38 494 678
*- 1 2010 , . .
.
Insurance company City VHI charges *
Sogaz Moscow 11 310 432
ROSNO Moscow 3 256 200
AlfaStrahovanie Moscow 1 964 002
INGOSSTRAKH Moscow 1 840 364
RESO-Garantia Moscow 1 668 151
ZHASO Moscow 1 492 442
Transneft Moscow 1 422 414
Surgutneftegas Surgut 1 213 622
Kapital Insurance Kogalym 1 119 308
MAKS Insurance Moscow 1 005 911
VSK Insurance Company Moscow 875 865
In all on the market
of VHI
38 494 678
*- 1 quarter of 2010, thousand rubles,
according to FSIS.

4. FinAssist 4
(Shares of major players)
1 2010 , .
70% .
1st quarter of 2010, according to FSIS.
Leaders possess more than 70 per cent of the
market.
- ( )
VHI - the most popular type of insurance in Russia (in terms of the volume of charges)
,
1 2010 (
).
26% (
)
.
The share of insurance premium charges,
attributable to various types of insurance in the
1st quarter of 2010 (according to FSIS).
26 per cent of the total insurance market (except
for compulsory health insurance) are accounted
for VHI.

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50-60 .
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36-162 .
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2-25 .
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Basic VHI packages
In most cases VHI is a set (package) of
medical services focused on a particular
category of insured persons. Packages can
vary in terms of service range, offered service
volume, policy territory, age of insured
persons, etc.
Table 2. Basic VHI packages
Package Typical contents Approximate
price
Basic Package Health insurance for
adults aged 18-60
years. Usually includes
doctor’s visits,
outpatient treatment,
hospitalization,
emergency care, dental
care (with some
exceptions).
30-40
thousand
rubles per
person per
year
Child Package Insurance for children
aged 0 to 1 year, 1 to 3
years, 3 to 18 years.
Includes outpatient
treatment, laboratory
and diagnostic tests,
treatment procedures,
emergency care, dental
care (with some
exceptions),
hospitalization, doctor’s
visits.
50-60
thousand
rubles
Pregnancy and
labor
This program provides
for a comprehensive
survey and monitoring
women at any stage of
pregnancy personal by
an obstetrician-
gynecologist.
36-162
thousand
rubles
Dentistry Includes only dental
care. Typically, to a
greater extent than in
the base package.
2-25 thousand
rubles
Travel
packages
Tourist insurance.
Medical care in foreign
journeys in the event of
illness or injury.
From 1 euro
per person per
day
Special
packages
Insurance for athletes,
drivers, extreme
sportsmen.
n a case-by-
case basis
:
1
2009 . 11%
( )
, 24%
,
65%
,
VHI and the crisis: changes that took place2
In 2009, 11 per cent of Russian companies
reduced the budgets of employee voluntary
health insurance (VHI) programs at the
expense of certain categories of staff, 24 per
cent reduced the cost of health insurance
policies to all employees, 65 per cent of
employers didn’t change their VHI budget,
according to the specialists from Renaissance
Insurance and HeadHunter who surveyed the
1
« »
2
According to Vedomosti newspaper

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« » HeadHunter,
424 ,
.
managers of 424 small, medium and large
companies in various business sectors.
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2008 17% 43% 14% 23% 29%
20%
67% 43% 43% 38% 47%
20%
17% 14% 43% 38% 24%
100% 100% 100% 100% 100%
4.
?
50 50
100
100
300
300
1000 1000
2008
38% 20% 11% 38% 17%
20%
38% 20% 44% 50% 58%
20%
44% 60% 25% 13% 25%
100% 100% 100% 100% 100%
,
, 14%
, ,
59%
,
27% .
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HeadHunter,
10-20%.
38%
20% ( . 3).
(2009 .),
5% 25%
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Reducing the VHI budget
Table 3. Depending on the industry the company is
operating in
Howdidthe
VHIbudget
reduce?
Industry,
constructio
nand
transport
Communicati
ons,IT
Commerce,public
catering,domestic
servicing
Finance,
loan
services,
insurance
Other
Remainson
thelevelof
2008
17% 43% 14% 23% 29%
Reducedby
lessthan20%
67% 43% 43% 38% 47%
Reducedby
morethan
20%
17% 14% 43% 38% 24%
Total 100% 100% 100% 100% 100%
Reducing the VHI budget
Table 4. Depending on the number of company’s
personnel
HowdidtheVHI
budgetreduce?
Upto50
people
50–100
people
100–300
people
300–
1000
people
Over1000
people
Remainsonthe
levelof2008
38% 20% 11% 38% 17%
Reducedbyless
than20%
38% 20% 44% 50% 58%
Reducedbymore
than20%
44% 60% 25% 13% 25%
Total 100% 100% 100% 100% 100%
As for the employers who had to cut the
budget at the expense of health insurance, 14
per cent did so by reducing the number of
insured persons, 59 per cent excluded high
cost options and services from their insurance
programs, while 27% changed the list of
polyclinics. According to the survey the most
popular VHI options still include ambulatory
medicine, hospitalization, ambulance, calling a
doctor and dentistry.
The study conducted by HeadHunter suggests
that differentiation of insurance programs for
various categories of staff and changes in
program conditions have allowed most of the
surveyed companies to reduce the VHI budget
by 10-20 per cent. 38 per cent of respondents
have reduced their budgets by more than 20
per cent (see table 3).
According to the KPMG benchmarking system
of personnel management (2009), the cost of
benefits depending on the market sector can
range from 5 to 25 per cent of all personnel
expenditures, and health insurance is one of
the most expensive components of the benefit
package. "It is not surprising that after having
exhausted all possible budget items the HR
specialists finally came to insurance costs", -
notes Antonina Krasik, HR and individual
taxation Senior Consultant at KPMG in Russia
and CIS.

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10-15%
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According to the data that were obtained
during the first stage of benchmarking, many
companies sought to reduce their
expenditures on health insurance by
conducting tough negotiations with insurance
companies, sometimes involving insurance
brokers in order to obtain more favorable
pricing. Many of them changed their insurers.
Some have chosen to change the contents of
the insurance package by reducing the
number of clinics and a set of services in the
package. Some of them even gave up on such
an important service as emergency
hospitalization, and replaced it with a deposit.
It was found that such a step often leads to
increased costs, not to saving.
According to Krasik, the crisis has made the
market more flexible: there’s now an
opportunity to significantly improve the
standard packages offered by insurance
companies, making them more responsive to
the needs and requirements of a particular
company, without increasing the cost and
sometimes even reducing it. "The desired
effect of reducing (or maintaining the same
level of) costs can be sometimes achieved
without radically altering either the number of
the insured, or without filling the package -
she notes. - But before making changes in the
health insurance program and risking to
discourage employees the employers should
clearly define their insurance product
requirements.
The participation of an insurance broker in the
process of optimizing the cost of health
insurance in most cases provides additional 10
- 15 per cent savings in the budget due to
better knowledge of the market - the broker
will get the clients more concessions from the
insurance company, and in case it is not
possible, we can always advise a more pliant
insurance company.

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An example of optimizing the VHI cost
The A company asked the insurance broker
about reducing the cost of health insurance.
After analyzing data on the number of
applications in medical and prophylactic
institutions (MPI) of the company's insured
employees in the previous insurance period it
was found that about 25 per cent of health
facilities didn’t get a single application of the
company’s staff in a year and approximately
10 per cent of health facilities provided only
sporadic treatment. After the mutual analysis
of health insurance programs on the market,
the company selected the ones that included
nearly all the health facilities that are most
demanded by company employees, and
excluding the ones of small demand.
As a result of this optimization the VHI budget
was reduced by 15 per cent. Moreover, neither
the number of the insured, nor the quantity or
the quality of popular medical services weren’t
reduced.
(The contents of the basic packages)
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Package features – things to pay attention
to
Selecting the policy of voluntary health
insurance requires the attention not only to
the contents of service package and its cost,
but also to the number of features that do not
normally appear in promotional materials. You
can get to know them by carefully studying
the insurance contract.
1. ,
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The main insurance exclusions are as
follows
1. any medical services not covered by the
program and not prescribed by a doctor;
2. provision of health services (after
establishing the diagnosis) related to the
treatment of:
cancer diseases and their complications;
congenital and hereditary diseases,
congenital malformations of organs and

11. FinAssist 11
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their complications;
sexually transmitted diseases, HIV
infection, AIDS and their complications;
epilepsy (primary and symptomatic),
mental disorders and behavioral disorders,
including alcoholism, drug addiction,
substance abuse, and their complications;
diabetes and its complications;
tuberculosis;
diseases with chronic renal and hepatic
failure, requiring extracorporal methods of
treatment;
acute and chronic hepatitis;
radiation sickness;
dispensary examination;
occupational diseases;
3. provision of the following medical services:
family planning services, infertility
diagnosis and treatment (male and
female), sexual disorders, impotence;
genetic studies;
diagnosis and treatment of STDs:
chlamydia, ureaplasmosis, mycoplasmosis,
trichomoniasis, urogenital herpes,
cytomegalovirus, gardnerellosis, anogenital
warts, further biovar examination after the
detection of ureaplasmosis;
prosthetics of all types, including
transplants, prosthetic dentistry and its
preparatory process, including the removal
of teeth and their pulps, replacement of old
fillings without medical indications, the
treatment of periodontitis, temporary
splinting and so forth; restoration of a 50
per cent damaged tooth crowns damaged,
dental implants;
services provided with preventive and
cosmetic purposes: sealing of fissures, the
removal of dental plaque, teeth coating
with fluoride varnishes, etc., cosmetic teeth
restoration, including the use of veneers
and laminates, teeth whitening, etc.;
medical manipulations on the teeth,
adjusted with orthopedic and orthodontic
appliances, the removal of orthodontic
disorders from children and adults;
extracorporeal methods of treatment,
including hemodialysis program, colon
hydrotherapy, laser and intravenous ozone
therapy, hyperbaric and normobaric
oxygenation, hypoxia, plasmopheresis;
diagnosis, treatment, handling, operations,
etc. to eliminate cosmetic defects, including
the ones improving the psychological
condition of the insured, on the skin and

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hair, as well as vein sclerotherapy; weight
correction;
surgical vision correction, including one
using laser, the confrontation;
standard practice medicine, used for
diagnosis, treatment and rehabilitation,
services provided for health and preventive
purposes;
psychiatrist services;
geneticist services;
vaccinations (except for emergency
prevention of Tetanus);
medical evaluation and issuing licenses for:
weapons-bearing, driving, for trips abroad,
admission to educational institutions and
work based on form No 086-U;
the insurer does not pay the cost of
transplants, prostheses, endoprostheses,
implants and many other similar medical
devices, as well as the cost of purchasing
medical equipment, optics, hearing aids
and medical devices designed to care for
any disease;
allergy diagnosis, immunological and
hormonal studies, PCR diagnosis,
laboratory diagnosis of viral hepatitis;
additional laboratory studies conducted by
the institutions, not belonging to the
structure of the Federal Public
Administration.

13. FinAssist 13
1. ,
1 2010 .
Appendix 1. The total list of companies operating in the VHI market and their
charges in the 1st quarter of 2010
(Insurance company) (City) *
(VHI charges *)
11 310 432
3 256 200
1 964 002
1 840 364
- 1 668 151
1 492 442
1 422 414
1 213 622
1 119 308
1 005 911
- 875 865
867 458
749 389
539 584
505 392
402 134
-
385 462
371 481
342 957
- 338 521
-
293 957
248 141
231 627
- 223 803
178 083
150 607
149 009
141 749
140 212
- - - 140 090
137 435

14. FinAssist 14
(Insurance company) (City) *
(VHI charges *)
130 939
125 312
121 926
- 121 483
-
-
118 244
- 117 682
116 611
116 179
111 922
100 024
97 909
94 870
86 590
78 585
- 78 300
76 789
75 086
73 452
-
72 125
71 938
67 274
66 279
58 639
58 136
55 289
52 724
52 087
49 935
47 564
- 46 933
- 46 743
46 279
46 229

15. FinAssist 15
(Insurance company) (City) *
(VHI charges *)
-
-
45 267
44 846
44 564
- 42 909
41 572
- 37 893
37 186
- 35 033
33 816
- 32 879
30 928
30 641
( )
-
30 356
30 309
28 712
27 605
- 27 087
26 847
26 777
- 26 355
26 058
- 25 385
- 25 043
24 811
24 276
- 23 829
23 811
- - 23 417
-
23 235
- 22 162
22 018
- - 21 627

16. FinAssist 16
(Insurance company) (City) *
(VHI charges *)
21 548
21 275
21 106
- - 20 681
20 181
- 19 754
19 638
19 493
19 476
18 994
18 630
18 154
17 981
17 762
17 542
16 999
16 883
- 16 753
- 15 317
- 15 096
- 14 731
14 217
12 828
12 686
- 12 534
. 12 516
12 283
- 11 881
- 11 617
11 478
11 116
-
-
11 032
10 915

17. FinAssist 17
(Insurance company) (City) *
(VHI charges *)
10 802
- 10 781
- 10 256
10 251
10 240
10 219
10 147
10 119
-
-
9 857
-
9 698
9 668
9 254
- 9 230
8 806
8 694
8 399
8 201
8 095
-
8 000
- 7 988
7 888
7 451
7 353
7 269
7 111
6 547
6 518
- 6 401
- 6 304
6 228
-
-
6 186

18. FinAssist 18
(Insurance company) (City) *
(VHI charges *)
- 6 043
5 999
-
-
5 677
5 559
-
5 486
5 268
- 5 240
5 161
5 070
- 4 980
- 4 949
4 949
4 941
I
4 927
4 862
4 858
- 4 840
- - 4 778
4 748
4 665
- 4 650
- 4 581
- 4 543
4 540
4 341
- 4 318
4 199
4 198
4 164
- 4 128
- - 4 049
4 023
4 015
4 008

19. FinAssist 19
(Insurance company) (City) *
(VHI charges *)
- - 4 004
3 954
3 905
3 856
3 800
-
3 798
.
3 718
3 691
- 3 687
3 621
- 3 605
- 3 494
- 3 400
3 369
- 3 337
3 313
. 3 212
3 183
3 165
3 145
3 080
2 964
2 889
2 832
- 2 774
2 651
- 2 649
2 617
2 576
2 514
2 491
- 2 462
2 452

20. FinAssist 20
(Insurance company) (City) *
(VHI charges *)
-
2 294
2 246
2 238
2 179
- 2 176
- 2 134
2 125
2 067
- 2 018
2 004
- 2 000
1 923
1 903
- 1 770
- 1 707
- 1 675
1 651
1 595
1 583
1 577
1 393
-
-
1 318
- 1 245
1 234
1 064
1 024
- 971
963
950
- 934
- 913
-
900
- 888
877

21. FinAssist 21
(Insurance company) (City) *
(VHI charges *)
875
- 826
752
743
.
712
693
665
- 661
630
- 625
612
585
- 585
548
533
521
- 512
- 477
475
- - 433
433
426
410
400
- 400
- 394
-
-
365
363
347
- 338
336
328
326

22. FinAssist 22
(Insurance company) (City) *
(VHI charges *)
- 302
300
- - 300
- 269
256
228
227
214
184
177
165
- 158
157
148
- 120
116
106
-
100
96
- 95
-
94
93
93
88
88
-
83
- 76
- 59

23. FinAssist 23
(Insurance company) (City) *
(VHI charges *)
51
- 40
38
29
29
- 20
-
14
12
9
- 7
7
6