What DMS is and how it differs from OMS

Voluntary medical insurance (DMS — dobrovolnoe meditsinskoe strakhovanie) is a contract under which an insurance company pays for the insured person's medical services at clinics on an agreed list. Unlike compulsory medical insurance (OMS), which operates under Federal Law No. 326-FZ and provides free care under the state guarantee programme, DMS is optional and governed by the Civil Code of the Russian Federation (Chapter 48) and Russian Federation Law No. 4015-1 "On the Organisation of Insurance Business in the Russian Federation".

DMS does not replace OMS — it complements it. You keep your OMS policy in any case, while DMS gives access to selected private and departmental clinics, shortens waiting times and widens the range of services.

What a DMS programme consists of

The programme is the core document of the contract. It lists the clinics and types of care. Typical modules:

  • Outpatient care — appointments with a GP and specialists, lab tests, diagnostics (ultrasound, X-ray; CT and MRI often subject to the insurer's approval).
  • Home visits — a doctor called out for an acute condition.
  • Emergency care — a private ambulance team.
  • Inpatient care — emergency and planned hospitalisation.
  • Dental care — treatment; prosthetics and implants are usually excluded.
  • Telemedicine — online consultations, explanation of test results.

The more modules and the higher the level of clinics, the more expensive the policy. You can build a programme around specific needs — for example, outpatient and dental care only, without inpatient cover.

How to use the policy

Most insurers follow the same scheme. You are served by a medical assistance desk — the insurer's service that organises care:

  1. Call the desk (the number is on the policy or in the insurer's app) or submit a request in your personal account.
  2. Describe your symptoms — the operator books you with the right doctor at a clinic in your programme.
  3. The clinic provides care and invoices the insurer; you pay nothing (unless there is a deductible).
  4. Expensive tests and hospitalisation are approved in advance — the insurer issues a letter of guarantee.

Many programmes let you book directly with the clinic using the policy, without calling the desk. In an emergency, call an ambulance first and notify the insurer as soon as you can.

Corporate and individual DMS

For employees

Most DMS contracts in Russia are concluded by employers. For a company it is part of the benefits package: it helps to retain and hire people, and employees get back to work faster. The Tax Code supports such contracts: the cost of employee DMS under contracts of one year or more is deductible for profit tax purposes up to 6% of payroll costs, and employer contributions, subject to the conditions of the Tax Code, are exempt from personal income tax and social contributions. Learn more in DMS for employees.

For individuals

An individual policy is available too, but the terms are stricter. The insurer assesses the risk using a health questionnaire, may decline cover for chronic conditions or exclude them, applies age limits and waiting periods for certain services. The reason is simple: people often buy a policy when they already need treatment, and such contracts are loss-making. That is why individual DMS is usually more expensive than corporate cover with a comparable programme.

Russian tax residents can get back 13% of the policy cost through the social tax deduction if the contract covers only medical services and the insurer is licensed. The deduction is granted within the overall limit for social deductions of RUB 150,000 per year.

Concluding a contract: the steps

  1. Define your needs. What matters: clinics near home or office, dental care, pregnancy care, children's programmes.
  2. Agree the programme. Choose the clinics and modules and check the limits on the number of appointments and tests.
  3. Fill in the application. For a corporate contract — a list of employees; for an individual one — a health questionnaire.
  4. Study the rules and exclusions. Discuss any contentious points before signing.
  5. Sign and pay. The contract takes effect on the date stated in it, usually after payment.

What to look for in the contract

  • Exclusions. Usually not covered: acute exacerbations of chronic diseases, cancer, HIV, psychiatric care, cosmetology, treatment of the consequences of intoxication. The list differs from insurer to insurer.
  • Limits. Caps on the number of appointments, massage and physiotherapy sessions, and the overall sum insured.
  • Deductible. If you pay part of each visit, the policy is cheaper, but this does not suit everyone.
  • Clinic replacement. Whether the insurer may remove a clinic from the programme during the year and what will replace it.
  • Termination. How the unused part of the premium is refunded on early termination.

How much DMS costs

DMS rates are not set by the state — the insurer sets the price based on the programme, the level of clinics, the region, the age and the number of insured persons. A corporate programme for a team usually costs less per person than individual policies. To avoid overpaying, compare several offers with the same set of clinics — the difference can be significant.

Polis Re specialists will help you put together a programme and compare the terms of different insurers. Submit a request or explore the DMS section.