My 7-Year Experience with SOGAZ DMC Policies: Was the Franchise Fee Worth It?

I've been dealing with SOGAZ insurance company for over 7 years regarding DMC policies. I've got a pretty good impression, but I still approach insurance companies with some skepticism, because there are enough bad reviews about them, and SOGAZ is no exception. This review is going to be a long one, covering all 7 years of using DMC from this company, but I'll focus mainly on the policy I bought on my own.

Location - St. Petersburg.

I had 3 DMC policies from SOGAZ. One I bought myself, and two were given to me by my employers.

Firstly, the one from my employer was with RZhD, and it's the most comprehensive DMC policy I've ever had. It covers everything, including hospitalization. But there's a downside: you can only use it at RZhD-Medicine polyclinic, and it's just like any other polyclinic – crowded, with arrogant doctors, although the facilities are better, and some doctors are actually knowledgeable. But if you work for RZhD, this policy is a great deal, and I've been using it for over 5 years without any complaints.

Secondly, I bought a policy with a deductible, and I spent a lot of time researching different policies from various companies, including ones with and without deductibles. I chose this one because it seemed like a good value for money. I liked it overall: the price was reasonable, the service was okay, and there were plenty of clinics to choose from. However, the deductible was a bit of a hassle – sometimes I had trouble keeping track of when the payments would be deducted. But I'll get into more details about this policy later.

Thirdly, my current employer gave me a policy, but I have no idea how they negotiated it. Almost all the clinics I can use are in one area of the city, and the list of clinics isn't very extensive. It feels like my employer was sold a state-funded OMS policy instead of a real DMC policy. The prices are outrageous, and when I did a quick calculation of the amount my employer paid for the policy, I realized that I would have been better off with a more comprehensive policy, even if it cost more.

Franchise - that's the percentage of the service cost that your insurance company covers, and you pay the rest yourself. This type of policy has been around for ages, and it's mostly related to property and real estate. For example, let's say your neighbors flood your place, the insurance company assesses the damage and covers a portion of it, while you pay the rest. The big advantage of these policies is that they're cheaper. Lately, they've started to be used in voluntary medical insurance, and I decided to give it a try.

I'll walk you through the process of buying a policy from the app, but the same applies if you buy it on the website.

Under the 'Buy a Policy' section, there's a subcategory called 'Life and Health', which lists all the main types of policies:

Choosing a Policy The 'Doctor Like' policy with a franchise from SOGAZ is the one I opted for.

In the app (and on the website), there's a more detailed description of this type of policy:

Policy Description To calculate the cost, you need to input your personal details (age, sex, region). This determines the policy's price.

Next, you need to choose the franchise size. Below, it explains what a franchise is. For example, if you choose 50%, the insurance company covers 50%, and you pay the other 50%. If you choose 25%, the insurance company covers 75%, and you pay 25%. A policy with a 25% franchise will be more expensive. When I bought the policy, the franchise was 40% and 60%.

After that, you need to choose the policy type: 'Polyclinic + Telemedicine' or 'Polyclinic + Telemedicine + Dentistry'. I saw other types (like Clinics Premium), but I'm not sure when they appear or under what conditions. Maybe they only apply to Moscow and the Moscow region. For a basic policy without dentistry, there's also a 'Subscription' option, where you pay for each actual month of using the policy. However, when I bought the policy, this option wasn't available.

If the policy includes dentistry, there's no subscription option:

You can use a promo code to buy the policy or purchase it for someone else, like a child.

It's essential to remember that DMS doesn't cover the entire list of services and treatments. As a rule, the list is limited, and SOGAZ has it clearly stated in the contract what's included and what's not. Also, the policy won't be valid under certain conditions:

A Sneak Peek at My Contract

Cons:I've noticed that the app didn't have normal feedback for a long time, and it kept getting updated. At first, there was a form for submitting feedback, but then it disappeared, and I was only able to call the hotline. It seemed like they eventually fixed the feedback issue. But to be honest, I'm not even sure if it's a minus for the app or the company.It often happened that when I called the hotline personally, they would respond quickly, but when doctors called the hotline for doctors, it would take a long time. Sometimes doctors wouldn't answer and would send me a referral without talking to the SOGAZ insurance company, but then they would call me and say they would contact the insurance company, and I would just need to check with the clinic if the service was approved or not. And yes, they would actually call. But some doctors didn't want to waste their time on this and would just give me a referral and tell me to contact the insurance company myself. I understand them, because with my neurologist, we waited for 30 minutes for a response. Maybe this is just a thing with the MEDIKS clinic, but it's a plus for the clinic, not the insurance company. The insurance company is a minus because it forces doctors to wait on the hotline, and sometimes it's easier for clients to call themselves.If there's a promotion at the clinic, it doesn't apply to the policy. The franchise is calculated from the original price. This is a minus for me, although most promotions work this way.In the app, half of the history of my inquiries disappeared. The financial part remained, but not all of it, and the guarantee letters were completely gone. I also don't have a history of old, expired policies. Who knows, maybe I'll need them someday. It would be great if everything was saved.I still don't understand the calculation of the franchise. Sometimes it felt like they were charging less than they should, sometimes more. I'm not sure what price they were using. I compared it with the prices of clinics on their website and calculated it according to the franchise conditions. Sometimes they would charge extra for a service that's included in the doctor's visit according to the price list, but in the calculation, it was separate, and the doctor's visit was charged less than I calculated. It's not very transparent.The same goes for the refund of funds for the franchise. I was told by the insurance company that the money would be deducted from my card two months after I visited the clinic. But it was all over the place. Sometimes they would deduct money almost immediately, sometimes it would take four months. Then I realized that the deduction of funds depends on when the clinic sent the information to the insurance company about the procedures I underwent. So, the hotline was giving me incorrect information.As for the deduction itself, the amount appears in the app and I have three days to have the money on my card. After that, it's automatically deducted. Otherwise, it doesn't work, and I can't pay the bill myself, at least not at that time. The franchise doesn't start working if I haven't connected my card. It's similar to how Yandex.Taxi works. And, for a while, I wasn't receiving an email about the upcoming deduction, and if I forgot to check the app, I wouldn't know that my card would be charged soon. It was only later that this issue was resolved, but I still have a bad feeling about it. Examples of deductions that were saved in the app in the section Insurance scenariosI've seen doctors struggle to get the best possible conditions and maximum alignment for their patients. I've witnessed doctors taking a deep breath when it comes to insurance coordination. It's disheartening to see them treat their clients like partners, rather than people who matter. Thankfully, my insurance provider was cooperative with me!DMC dentistry is severely limited across all SOGAZ policies. You can only visit the dentist with an acute pain issue or once a year for a cleaning. Even in the RZhD polyclinic, it wasn't a full-fledged service. I never went there for dental issues, as I was advised against it by local doctors.Insurance sometimes took their time sending out guarantee letters. The issue is that a doctor's appointment has a limited validity period. If you visit the clinic again within 14 days, it's considered a repeat visit, which is cheaper. However, insurance would send the guarantee letter on the day before, and you'd rush to get the necessary tests done, especially if you've already scheduled a repeat visit.Regarding X-rays and MRIs, insurance doesn't always choose the best clinics (if you request a clinic selection). I once got incredibly lucky, as insurance booked me with a clinic that had terrible reviews. However, the clinic called me back and reassigned me to a different location with better equipment and doctors. It was a mixed bag, to say the least.Since the franchise was a relatively new service at the time of my policy purchase, clinics weren't always familiar with how to work with it or even knew it existed. They'd have to consult with the insurance provider. However, this became less of an issue over time.Pros:I've had the chance to see some good doctors through my DMS, but unfortunately, not all of them had a great attitude. They seemed to be genuinely interested in helping me, but I'd be lying if I said it didn't feel a bit weird, considering I wasn't paying out of pocket. I made sure to choose clinics and doctors carefully, though. Some doctors I visited were outside of my DMS plan, but I still wanted to see them, so I paid out of pocket for those visits instead. This review isn't about the doctors, though - it's about the policy.One of the benefits of having a DMS policy is that you can get a tax refund. I actually took advantage of this, and it's a pretty sweet deal. To get the refund, you'll need to fill out a form on the SOGAZ website, which is relatively easy to do. You'll just need to select your policy, upload a receipt and a bank statement, and they'll send you a form within 30 days. I was pleasantly surprised when they actually sent it to me within a week, but there was a catch - they sent it via registered mail, which took a bit longer than I'd have liked. It would have been nice if they just sent me a scan of the form instead, but I guess they're being cautious about personal data.The app is constantly improving, and they're adding more clinics to the list all the time. You can even book appointments directly through the app.Now, let's talk about the economics of it all. I know some people might be thinking, 'Is it really worth it?' Well, here's my breakdown:As you can see from the screenshot, I calculated that I saved a total of 27557.76 rubles by using the policy. Not bad, right? But let's not forget that I did have to pay for the policy itself, which was 15030 rubles. So, if we factor that in, my total savings would be 12079.76 rubles.

Getting a tax refund Calculating savings I didn't get my money's worth from the policy for 3,000 rubles.

But!

If I had visited the clinics on my own, I would have paid the full 38,000 rubles, maybe even more. I could have saved some money and done everything for free under the OMS, but for this amount, I got a lack of services that are usually provided, as if I were visiting clinics myself, not through insurance (doctors like to do this, but the insurance company limits them), fast service (unlike state polyclinics, where you can wait months for an appointment), respectful attitude, and so on. I paid for comfort and saved a bit on that. But I didn't have any particularly tough treatment, thankfully, so I don't know what the final cost would have been.Actually, I only used the DMS policy with a franchise for six months. Then I was given a corporate policy, and I started using it, but I didn't give up the policy with a franchise, and it simply expired. If I had continued using the franchise or visited doctors more often, the difference in cost would have been more apparent, and the policy would have paid for itself in full, plus I would have saved a few thousand extra.Telmedicine. For me, it's a mixed bag - I don't use it, but it's nice to have the option to consult with a doctor without visiting. You never know when you might need it.Communication with staff. They were always very polite and responsive, quickly translated me to a case manager, and it was the same with both phone and chat communication. I even had some unexpected requests, like using two different policies at once, and they responded to those too.Yes, I was able to use two DMS policies at once. One I bought, and then my workplace gave me another. I asked the insurance company if I could use both simultaneously, and they said yes. The list of clinics didn't overlap much, so I combined the two policies to visit different clinics. Sometimes I paid extra, sometimes the insurance covered everything. It's convenient to have a choice.Mostly, doctors are aware of which services or appointments are included in the policy and which aren't. But in some cases, they're unsure and write 'direct access' but ask the insurance company to clarify. That's how I found out that ultrasound is included in the DMS policy, and it doesn't require additional approval - the insurance company confirmed this by email:

Overall, I find it hard to support the mixed reviews left on this and other websites because, personally, everything went smoothly for me. However, there's a feeling that SOGAZ is making a nice face for clients to buy their policies, but at the same time, they're not above manipulating corporate partners and clinics in some way. But that's just my outside observation, as I don't have direct contact with clinics or organizations.It's also worth remembering that DMS is a service provided by the insurance company, and you pay for it. If you think your rights have been violated or the contract terms have been breached, you have the right to contact Roszdravnadzor or Rospotrebnadzor.

My overall experience with SOGAZ was pretty positive, and I'd definitely recommend it to others. However, a corporate policy might not be the best choice for everyone - it's worth considering your options. I did have some issues, but the good stuff made up for it, and if I didn't already have a corporate policy, I'd probably go back to SOGAZ if I couldn't find a better deal. Still, it's not worth relying solely on insurance. Take your time to explore all the possibilities - use your OMS, pay out of pocket, or take advantage of your DMS. If you've already got a DMS policy, though, make sure to use all its benefits.

I've gotta say, my interactions with SOGAZ were pretty smooth. I didn't encounter any major issues - they didn't deny me service, weren't rude, sent out all the necessary documents, and coordinated everything with the doctors. I feel like I got lucky, but my experience was pretty normal. Of course, people's experiences can vary. I did run into some minor annoyances, but they were just that - annoying - and didn't completely turn me off from the company. All those issues are listed above.