Insurance Against the Flu: What You Need to Know About Policies and Offers

Some insurance companies offer voluntary health insurance (VHI) programs for protection against the flu and acute respiratory diseases, but there is no unified approach to this issue. Some programs include mandatory vaccinations and compensation for illness, while others provide flu treatment within broader insurance plans without having separate programs. Specialized flu insurance may exist, but difficulties in diagnosis and determining the connection between complications and the flu can lead to disputes over claims. Overall, while specialized programs may be more affordable, the uncertainty in diagnosis makes them less appealing to insurers.

Challenges: The main issue with flu insurance is the difficulty in diagnosing influenza distinctly from other respiratory infections. Insurers require a clear flu diagnosis to determine coverage, leading to potential disputes over claims. If complications arise, the insured may face challenges if the insurer questions the flu's role in those complications.

In conclusion, while specialized flu insurance programs may be more affordable than standard VHI, the uncertainty in diagnosis and the complexities of flu-related complications make them less appealing to insurers. Most insurance companies include flu coverage within broader health insurance plans rather than as standalone products.

Key Offerings:

GUTA Insurance has introduced a program called "Protection from Influenza," which includes mandatory vaccinations and compensation for illness or complications within a year of vaccination. The policy costs 450 rubles and covers up to 50,000 rubles for hospitalization.
Ingosstrakh does not have a specific flu insurance program but provides coverage for acute illnesses, including influenza, as part of broader health insurance. They may offer flu vaccinations as an add-on.
ROSNO also lacks a dedicated flu insurance program but includes flu treatment in comprehensive health insurance options, with vaccinations available upon request.
Energogarant offers a specific flu insurance program that covers outpatient and inpatient care for flu and its complications, emphasizing that ARVI is not included as an insured event.

As winter approaches, many of us develop symptoms of colds, including sneezing and coughing. To address this seasonal issue, some insurers offer specialized voluntary medical insurance programs for individuals prone to flu or acute respiratory diseases. But can such policies effectively protect holders from these common winter illnesses?

Insurance companies engaged in voluntary health insurance (VHI) have not yet developed a unified approach to protecting against influenza. Some have offered citizens vaccinations, followed by insurance coverage for the disease itself. For instance, about a month ago, a company announced a VHI program called 'Protection from Influenza.' This program mandates vaccination using WHO-recommended vaccines and provides compensation in case of illness or complications within a year after vaccination. In other words, the vaccine is expected to remain effective for one year. The policy, with an insured amount of 50,000 rubles, costs only 450 rubles. The company guarantees that, in the event of infection and hospitalization, the client will receive compensation for each day spent in the hospital.

The offer is tempting: for a small fee, clients receive vaccinations and guaranteed treatment if the vaccine proves ineffective. It is unclear why other insurers have not offered similar services. 'Ingosstrakh organizes and pays for outpatient and inpatient services provided to the insured in cases of acute illnesses or exacerbation of chronic diseases, including influenza,' says Andrey Dmitrenok, deputy director of Ingosstrakh's health insurance department. According to Dmitrenok, 'There is no separate insurance program for influenza. It is impossible to single out this disease, as it is often difficult to differentiate between acute respiratory infections and other viral infections. Additionally, complications such as pneumonia or endocarditis may require further diagnostics and treatment.' Indeed, pneumonia is not necessarily a consequence of influenza; it may have other causes. However, Ingosstrakh may offer clients a flu vaccination as an add-on to the basic program.

ROSNO does not have a program that provides insurance solely against influenza. 'A comprehensive voluntary health insurance program may include outpatient care, emergency medical care, and inpatient care based on the chosen option, providing medical care for a wide range of diseases, including influenza,' says Nina Egorkina, Head of the Health Insurance Center at ROSNO. She stresses that influenza immunoprophylaxis is not included in the basic version of the comprehensive program but can be added at the client's request.

The Energogarant insurance company offers a separate program for those who wish to purchase flu insurance. 'Our company provides a comprehensive flu insurance program,' says Natalia Klimenko, director of the personal insurance department at Energogarant. 'It includes outpatient and inpatient medical care in case of flu and its complications. The insurance company organizes and pays for treatment based on medical indications and the severity of the insured's condition.' Klimenko emphasizes that a 'flu' diagnosis should not be confused with ARVI, as ARVI is not an insured event due to its different clinical symptoms and causative agents. Moreover, 'the final diagnosis can be made only after the influenza strain has been isolated.' When concluding a contract under the 'Influenza and Its Complications' program, the insurance company offers treatment at various facilities specializing in infectious diseases. The cost of the program depends on the level of the treatment facility, and the insurance company will cover treatment only if the complications are caused by influenza.

It can be assumed that the main problems are related to complications that arise. What should the insured do if the doctor doubts that the complication is flu-related? The insured has no choice but to agree. However, the insurance company is interested in a clear flu diagnosis because it determines whether the company will pay for the medical institution's services. According to Energogarant, if the insurance company believes the diagnosis is unjustified, the insured person is referred to a clinical-expert commission. This commission is available at any medical institution and includes several highly qualified doctors. If the commission's conclusion is not satisfactory to the insurance company, an independent expert is called in, and the dispute is resolved in court.

In general, it is clear that avoiding the flu is preferable to prevent unnecessary proceedings. The only advantage of a specialized program may be its affordability compared to the standard VHI program, which most insurance companies include for flu treatment. However, this argument primarily concerns the insured. As for insurers, the main reason separate flu programs are not popular with them is, of course, the uncertainty of diagnosis. 'Influenza is an acute disease,' explains Olga Karpicheva, head of the Medical Programs Department at OJSC 'Kapital Insurance.' 'Any acute illness (in this case, influenza) is an insured event. Therefore, medical services rendered to the insured under our "Polyclinic" program in connection with the flu are paid by the insurance company.'

Alexander Lapunov, the deputy head of the medical insurance department at Alfa Insurance Group, shares a similar view. In his opinion, 'influenza is not a specific disease and cannot be considered an independent risk, meaning it cannot be calculated as a separate insurance product. However, flu is included in almost any insurance program that encompasses ambulatory and polyclinic services.'

Key Findings on Flu Insurance

Lack of a Unified Approach: The voluntary health insurance market does not have a standardized approach to flu protection, making it challenging for clients to choose suitable programs.
Variety of Offerings: Some companies provide programs that include mandatory vaccinations and compensation for illnesses, while others incorporate flu treatment into broader insurance plans.
Diagnostic Challenges: Issues with clearly diagnosing the flu and its complications can lead to disputes between insured individuals and insurers, complicating the claims process.
Specialized Programs: While specialized flu insurance programs may be more affordable, the uncertainty in diagnosis and difficulties in determining the connection between complications and the flu reduce their appeal to insurers.
Importance of Vaccination: Vaccination remains a crucial element in combating the flu, and programs that offer it as a mandatory condition may be more beneficial for clients.

The voluntary health insurance market lacks a unified approach to flu protection, making it challenging for clients to choose suitable programs. Some companies offer mandatory vaccinations and compensation for illnesses, while others include flu treatment within broader insurance plans. Diagnostic issues related to the flu and its complications can lead to disputes between insured individuals and insurers, complicating the claims process. While specialized flu insurance programs may be more affordable, the uncertainty in diagnosis reduces their appeal to insurers. Vaccination remains a crucial element in combating the flu, and programs that offer it as a mandatory condition may be more beneficial for clients.

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