On a personal calculation: employers began to worsen the conditions of the VMI

Employers have begun to worsen conditions under the LCA: the policy increasingly includes a deductible — the employee himself must cover part of the amount after contacting a doctor, Izvestia found out. In this case, minor expenses are borne by the client, but with large medical expenses, insurance will still cover most of them. The share of such policies has begun to grow, it is already reaching a third of the market volume. At the same time, in recent years, conditions, on the contrary, have been improved in order to attract workers against the background of a shortage of personnel. Companies' spending on VMI has not decreased, but due to rising prices for medical services, the amounts are no longer enough. Some organizations have also begun to choose cheaper clinics, and small and medium-sized enterprises are more likely to exclude relatives of insured persons from their policies.

Why employers worsen VMI conditions for employees

Despite the ongoing shortage of staff, companies have begun to worsen VMI conditions for employees. Last year, employers sought to limit their costs for such policies, according to the Central Bank's material on the development of the insurance market. It clarifies: to do this, they signed contracts with a lower set of risks (that is, they cut coverage).

This is evidenced by the reduction in the average amount of insurance per employee by almost half, to 6.6 million rubles, the Central Bank noted. At the same time, the average contribution per person — how much the company pays for his policy — has not changed and amounted to 7 thousand rubles. If coverage had remained at the level of 2023, then this figure should have increased, because services have become more expensive, the Central Bank explained.

That is, employers do not reduce the cost of VMI on average per employee. At the same time, due to inflation, it turns out to include fewer and fewer risks in the policy, Natalia Krasnenkova, medical commercial director of the Luchi insurance company, confirmed. According to her, employers compensate for this through flexible insurance programs.

Clinics are changing price lists and reaching a real inflation rate of 15-20%, and in some cases the price of treatment increases to 60%, said Pavel Ozerov, co-owner of insurance broker Mainsgroup. He added: this affects the calculation of the cost of the policy. And the question arises as to how employers can restrain budgets.

Basically, companies are not so much reducing the list of risks as reviewing the terms of service, Natalia Krasnenkova said. For example, they are introducing franchises, choosing cheaper clinics, and also connecting telemedicine and virtual medical facilities, which is especially popular in the regions. This allows you to reduce the cost of programs without losing the quality of medical care.

A VMI policy with a deductible is more profitable for an employer, because a person pays for up to 30% of services on their own after treatment, explained Anton Meltsov, founder of Insurance Broker AMsec24.

If in 2022 only 15% of employers issued franchise policies, now every third company uses them, Pavel Ozerov estimated. In his opinion, in one or two years the figure will reach 50%. Over the past year, employers have started to include a franchise about 10% more often, Anton Meltsov from AMsec24 confirmed the trend.

Elena Dybova, Vice President of the Chamber of Commerce and Industry (CCI), also noted the more frequent use of the franchise. According to her, some employees may perceive it as a decrease in the quality of the social package, especially if the size of the franchise is significant. In addition, there is a risk that employees will seek medical help less often due to additional costs, which may lead to a deterioration in their health and, as a result, to a decrease in labor productivity.

What employers exclude from LCA coverage

LCA remains an important element of the social package, an important tool for attracting new employees and retaining highly qualified personnel, said Diana Loginova, Product Manager of LCA RESO-Garantia. According to her, instead of completely eliminating insurance coverage, companies chose various cost-reduction strategies. For example, reducing the list of clinics or choosing cheaper organizations.

Ingosstrakh's practice shows that employers are more likely to change the set of medical organizations in order to reduce the cost of insurance programs, said Anastasia Skurikhina, director of the company's health insurance department. They also actively use the franchise.

— Sometimes "reducing the set of risks" means that certain groups of employees are not provided with the insurance program that is available to the bulk of the team. For example, employees with up to one year of experience may not receive coverage with dental services or with planned hospital treatment. They get access after a certain period of work," Anastasia Skurikhina added.

The so-called "hidden deterioration" effect is now being observed, said Elena Dybova from the CCI. For example, the limit on dentistry is decreasing (if it used to be about 50 thousand, now it is 30 thousand). "Optional" services, such as psychotherapy, are also excluded. Employers save money, but try to keep basic coverage. Premium clinics are also going under the knife, the expert said.

Zetta Life Insurance reported that the companies are not cutting coverage under VHI programs. If one of them is not ready for a double-digit increase in the cost of the contract caused by the rate of medical inflation, then he introduces a deductible for employees. However, this is not a trend, they clarified. The deductible makes it possible to significantly reduce the cost of the insurance program for the company while maintaining its quality and usefulness for the employee, Sogaz confirmed. They clarified that now about 20% of their customers use this tool.

At the same time, the programs are becoming more flexible, said Olga Kuptsova, Deputy Director of the Methodology and Underwriting Department of Rosgosstrakh Personal Insurance. In order to meet the budget that the client has planned, insurance companies continue to develop remote medical care.

In 2024, about 15% of employers began to optimize VMI programs, the VSK said. The main tools include changing the list of clinics and reducing the volume of services.

— In addition, dentistry was excluded from the VMI packages. This is primarily due to its strong rise in price in recent years, especially in the regions," said Olga Rumyantseva, Head of the Personal Insurance Underwriting Department at Absolut Insurance.

According to the company "Rays", the most noticeable changes also relate to coverage for relatives of employees, primarily in the segment of small and medium—sized businesses. While large organizations continue to offer expanded programs, including family insurance, SMEs strive to minimize such costs, Natalia Krasnenkova added.

The shortage of personnel continues to increase. Therefore, LMS remains in demand as a way to retain staff, said Alexander Lapunov, Director of the Department of Underwriting and Methodology of LMS AlfaStrakhovanie. Employers are aware of the importance of the social package in conditions of personnel shortage, so a sharp decrease in the quality of VMI programs is not expected, Natalia Krasnenkova is sure.

As soon as the economic situation recovers, many companies will return to maximum packages, says Elena Dybova from the CCI. Almost 80% of the surveyed owners of organizations noted the optimization of coverage as a temporary measure.