The dissertation is aimed at studying the current theoretical and practical issues of civil law regulation of the relations under a medical insurance contract, developing scientifically substantiated provisions and conclusions on improving the current legislation regulating the relations under a medical insurance contract.
The paper analyzes the history of the legislation on medical insurance in order to determine the patterns of its development, the specifics of its legal regulation and ways of its further improvement.
On the basis of the study of the current Civil Code of Ukraine, the Law of Ukraine “On Insurance” and works of legal scholars, the concept and legal nature of a medical insurance contract is analyzed. The paper substantiates that a medical insurance contract is a bilateral, paid, aleatory, integrated, real contract, a type of an adhesion contract and can be concluded in favor of a third party. A medical insurance contract is an unnamed subtype of an insurance contract, which is a type of service contracts.
A medical insurance contract is defined in the thesis as an agreement between the insured and the insurer, according to which the insurer undertakes to pay for medical services provided to the insured or another person specified in the medical insurance contract by the insured, in whose favor the medical insurance contract is concluded within the medical insurance program; the insured undertakes to make insurance payments within the terms specified in the contract and to fulfill other conditions of the contract.
The subject matter of a medical insurance contract is defined and other essential conditions of a medical insurance contract are analyzed. The author’s definition of an insured event under a medical insurance contract and a medical insurance program is proposed. An insured event under a medical insurance contract is a request from the insured during the term of the said contract to medical, pharmaceutical or preventive medical institutions with a preventive purpose or in case of acute illnesses, exacerbation of chronic diseases, injuries, poisonings or other accidents that occurred during the term of the said contract in order to receive medical help, preventive help and/or professional medical advice within the selected medical insurance program. A medical insurance program includes the types and scope of medical services, the procedure for their provision and financing agreed with the insurer and the insured in a specific medical insurance contract, as well as a list of medical institutions the insured has the right to seek help from in case of an insured event.
The procedure for concluding a medical insurance contract is studied, the grounds and procedures for changing and terminating the said contract are outlined. The paper states that a medical insurance contract differs from other contracts due to its individuality, determined by the individual characteristics of the insurer or the insured, the medical insurance program; therefore, the use of public offer in concluding medical insurance contracts seems impossible.
