What does a medical insurance policy give. Basic rights of a patient in the Russian Federation when applying for and receiving medical care Rights under a compulsory medical insurance policy

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23.07.2021

The rights and obligations of patients in the compulsory health insurance system are what the patient and the doctor should be guided by when concluding an agreement for the provision of medical care and service for patients in the framework of inpatient and outpatient treatment. To ensure that the basic human rights of independence of expression, decision and action, concern for human dignity and human relationships are preserved for all patients, and to define the responsibilities of the patient, it is necessary to follow the policy of the health system within the MHI. The work of the health sector is to respect the individual rights of all persons arriving at this “site” to provide assistance. Patients' rights include the ability to decide whether or not to receive health care.

The patient may formulate advance directives (written instructions such as a living will or durable health care power of attorney recognized by law). Patient responsibilities include those actions on the part of patients that are necessary to enable healthcare professionals to provide appropriate care, make accurate and responsible care decisions, and meet the needs of patients.

Individuals are provided with impartial access to treatment that is medically accessible, regardless of race, creed, sex, national origin, religion, sexual orientation, nationality, disability or social class and source of funds. The patient has the right to permanent and Attentive attitude to himself under any circumstances, recognizing his personal dignity and worth.

He also has the right, in accordance with the law, to personal confidentiality and confidentiality of information, which is manifested in the right:

  1. Refuse to speak to anyone not officially associated with the hospital, including visitors, persons officially employed there but who are not directly related to the institution.
  2. Wear appropriate personal clothing and religious or other symbolic items unless they compromise safety or interfere with diagnostic procedures or treatment.
  3. Have your own medical record accessible only to persons directly involved in treatment or quality monitoring, and to other citizens only with the written permission of the patient or his legally authorized representative.
  4. Expect information provided to interested family members or other legally qualified person to be kept confidential.
  5. Request a transfer to another room if another patient or visitors in that room are unreasonably disturbing the patient.

The rights of citizens in the health insurance system are also regulated by the legislative framework of the Russian Federation, in particular, Article 42 of the Constitution of the Russian Federation. It also provides for car insurance for persons who are officially employed citizens on the basis of the Compulsory Health Insurance Fund.

The patient has the right to expect a safe relationship, which excludes medical errors and negligence. Other security measures include limited access to the patient through the use of electronic access cards and readers at external entrances, video monitoring in many areas of federal facilities, and the use of employee identification marks, which must be clearly displayed. This applies to those cases when a prisoner or a particularly dangerous criminal who is in danger or who is dangerous to society is in the hospital. In private hospitals there are special wards that provide for the maintenance of such patients with the assignment of a security system increased in severity.

The patient has the right to know by sight and the professional status of the doctors providing services, or those who are primarily responsible for his care. This includes the patient's right to know that there are any professional relationships between people who treat him, as well as relationships with any medical or educational institutions in charge of his care.

Patient participation in research programs or in the collection of data for research purposes must be voluntary with signed informed consent.

The patient has the right to receive from the practitioner responsible for coordinating his care full and up-to-date information about his diagnosis (to a certain extent), treatment and known prognosis. This information should be communicated in terms that can be explained to the patient. If medical assistance is not necessary or possible to provide such information to the patient, it is provided to a legally authorized person.

In addition to all the rights mentioned, in addition to them, patients can expect from hospital staff and other measures aimed at the urgent recovery of patients. If the situation requires it, the person admitted to the emergency room must be provided with all the conditions and urgent assistance, which is equivalent to salvation. He has the right to communicate with people outside the hospital, as well as through oral and written communication. The patient may request that he or she not be included in the patient's register. Enabling means that the patient's name, room number, and general status report can be provided to people who ask about the patient by name. Such situations are possible if a person is in danger and he really needs the help of the police or guardianship authorities.

A prisoner has the right to receive visitors only if they are approved by the head of the prison of the penitentiary institution where the citizen is under arrest. It is lawful to keep confidential all information about the patient's health if he gave the order and consent to the safety of information. Otherwise, if the disclosure of data has led to an "information leak", this has affected the image or reputation, then this act is severely punished. Also, it is impossible to distribute false data about persons, no matter what crimes they have committed. Doctors of a medical institution are obliged to provide full treatment, even if there is a criminal in the hospital.

When the patient does not speak or understand the state language or the one in which he is addressed, he has the right to invite his representative or interpreter. This is especially true when language barriers are an ongoing problem for complex treatment appointments. Since it is not possible to make a diagnosis without a complaint survey, or it would be considered an incomplete picture, it is worth considering such a human right.

Also, the rights of patients under compulsory medical insurance policies are reflected in the following:

  1. A person has the right to reasonably informed participation in decisions related to their health care.
  2. To the greatest extent possible, this should be based on a clear, concise explanation of his condition and any proposed technical procedures, including the possibility of any risk of mortality or serious side effects, problems associated with recovery or complication, and the likelihood of success.
  3. A person should not be subjected to any procedure without his voluntary, competent consent or legal representative. Where medical alternatives exist for treatment, the patient should be informed of them.
  4. A person can refuse treatment to the extent permitted by law. When refusal of treatment interferes with the provision of appropriate medical care in accordance with ethical and professional standards, the relationship with the patient may be terminated with a notice of discharge.
  5. If the patient is unconscious or considered mentally incompetent and consent cannot be obtained from the relevant family member, urgent action may be taken to obtain a court order for diagnostic and therapeutic procedures. In life-threatening emergencies where the person is incompetent or unconscious, appropriate treatment may be provided without consent.

Also, even refusing a specific method of treatment, a citizen cannot be transferred to another institution if he has not received a full explanation of the need for transfer and alternatives to such a situation. Regardless of the source of payment, the patient has the right to request and receive a detailed explanation of his payment for services provided in the hospital.

The citizen has the right to file a complaint about the services. He also has the right to receive data on the mechanism of the hospital's work in order to understand how and within what time limits complaints are considered.

If the competent authorities of the Russian Federation do not accept written statements about the violation of human rights in the field of medical insurance, the citizen will be able to demand that his complaints be considered in the presence of the commission. In the case when the board of doctors cannot come to a consensus regarding treatment, indicate the rights of citizens of the Russian Federation in the health insurance system, and a list of measures will be quickly compiled in your presence. However, remember that reporting on the activities of doctors is also prohibited. This is discussed in Patient Responsibilities, and more on that later.

Responsibilities of patients in the course of treatment

Every citizen also has obligations and responsibilities that come with health protection when they enter a medical facility. These data are reflected in the law FZ-323, as well as the Constitution of the Russian Federation. A Russian, as a person living and working in Russia, is obliged to respect and know the laws and constitutional provisions.

The main responsibilities are presented as follows:

  1. Follow the rules of the hospital and use its prescriptions properly.
  2. Treat all staff (medical or non-medical) as well as other patients and their families with respect.
  3. Observe general health regulations as well as certain behavioral patterns set by the health authorities.
  4. In the event of a denial of the proposed treatment, sign a document stating your denial after receiving sufficient information.

The rules also apply to all citizens of the country who are registered with family doctors. All able-bodied persons, as well as schoolchildren and university students, must provide certificates for registration educational institutions. This is legal and provides for the protection of all persons who may come into contact with a sick person. Before the start of the school year, parents and children undergo a medical examination to prevent the epidemic from starting en masse.

This applies to children and adults:

  1. Annual examination and preventive measures to establish the level of health. This is a mandatory measure, since "neglect" can cause complications.
  2. Early diagnosis is the key to successful and short-term treatment. In order to avoid negative consequences, not to come to complex methods of diagnosing a disease based on several symptoms, people are required to notify family doctors about their condition.
  3. Moms and dads are required to undergo a monthly medical examination with the child. If a family wishes to have IVF, they must obtain a referral for this procedure in order to receive benefits. This is provided for by law.

Benefits in the field of healthcare also apply to the disabled, orphans and residents of boarding schools. Pensioners receive mandatory discounts during the start of insurance. The health insurance policy must be kept and renewed by filing an application, as well as by submitting a tax return at enterprises. That is, the policy is automatically paid, and its validity period is extended by a legal entity. Since there is no liability for non-fulfillment of obligations in the field of medical insurance, all measures are considered formal, but mandatory for citizens.

Persons who hold positions in the field of catering, work with people are required to undergo an annual medical examination to confirm the status of a healthy person. If a disease such as tuberculosis is acquired during this period, the management of the organization cannot allow the employee to carry out activities, as this can harm customers and visitors. In other cases, when it comes to working with other objects where contact with people is limited (production, driving a car, remote work), a legal entity is obliged to employ a citizen in accordance with the Labor Code of the Russian Federation or on the basis of an agreement, deducting interest to the social and pension fund.

    Free medical care in medical organizations in the event of insured event(illness, injury, etc.) throughout Russia in the amount established by the basic CHI program and in the territory in which the policy was issued - in the amount of the territorial CHI program (each region has its own).

    The choice of an insurance medical organization in the manner prescribed by the rules of compulsory medical insurance by submitting an application

    Replacement of the insurance medical organization in which the citizen was previously insured, once during the calendar year, but no later than November 1 (or more often in the event of a change of residence or termination of the agreement on the financial provision of CHI in relation to your insurance medical organization) by submitting an application to newly selected health insurance organization

    Selection of a medical organization from those participating in the implementation of the territorial CHI program

    Choosing a doctor by submitting an application addressed to the head of a medical organization personally or through his representative

    Obtaining from the territorial fund, insurance medical organization and medical organizations reliable information about the types, quality and conditions for the provision of medical care under compulsory medical insurance

    Protection of personal data collected for personalized accounting in the MHI

    Compensation by the insurance medical organization for damage caused in connection with the non-fulfillment or improper fulfillment by the insurance medical organization of its obligations to organize the provision of medical care in accordance with the legislation of the Russian Federation

    Compensation by a medical organization for damage caused due to non-fulfillment or improper fulfillment by a medical organization of its obligations to organize and provide medical care, in accordance with the legislation of the Russian Federation

    Protection of rights and legitimate interests in the field of CHI

What are the obligations of the Insured Citizens under CHI?

    Present the compulsory medical insurance policy when applying for medical care, except in cases of emergency medical care.

    Submit an application for the choice of an insurance medical organization to an insurance medical organization personally or through your representative in accordance with the rules of compulsory medical insurance.

    Notify the medical insurance organization of the change in last name, first name, patronymic, place of residence within one month from the day these changes occurred.

    To carry out the choice of an insurance medical organization at a new place of residence within one month in case of a change in the place of residence and the absence of an insurance medical organization in which the citizen was previously insured.

What is the procedure for choosing an insurance medical organization?

    the insured person has the right to choose or replace an insurance medical organization (HIO) from among the HIOs, the list of which is posted by the territorial MHI fund on its official website on the Internet and may additionally be published in other ways

    in order to select or replace a medical insurance company, the insured person personally or through his representative applies to the insurance medical organization of his choice with an application for the choice (replacement) of the medical insurance company. To apply for a compulsory medical insurance policy, you must contact any office of the branch convenient for you. Familiarize yourself with the application form and the list of required documents for issuing an MHI policy.

The choice or replacement of the CMO is carried out by the insured person who has reached the age of majority or who has acquired legal capacity in full before reaching the age of majority. Compulsory medical insurance of children from the date of birth until the expiration of thirty days from the date of state registration of birth is carried out by HMOs in which their mothers or other legal representatives are insured. After thirty days from the date of state registration of the child's birth and until he reaches the age of majority or until he acquires legal capacity in full, compulsory medical insurance is provided by HMOs chosen by one of his parents or another legal representative.

The insured person has the right to replace the HMO once during the calendar year no later than November 1, or more often in the event of a change of residence or termination of the activity of the HMO in which the citizen was insured earlier. If the place of residence changes and there is no health insurance in which the citizen was previously insured, the insured person chooses the health insurance at the new place of residence within one month. HMO notifies the insured persons of its intention to terminate its activities ahead of schedule three months before the date of termination of activities. In case of early termination of the activity of the HMO, the insured person, within two months, submits an application for the choice (replacement) of the HMO to another HMO.

If the insured person does not submit an application for the choice (replacement) of an insurance medical organization, then such a person is considered insured by the insurance medical organization in which he was previously insured.

Who will protect your rights?

An insurance medical organization issues policies, keeps records of insured citizens and the medical care provided to them, is obliged to inform its insured about the types, quality and conditions for providing them with medical care, to protect their rights and interests. Remember, the medical insurance organization is your assistant in solving problems and contentious issues related to obtaining medical care under the compulsory medical insurance program. If you are insured in one of our companies, you can contact our representative offices for advice, legal support, professional help, to resolve a conflict with a medical institution or doctor.

For all citizens on the territory of Russia, the law provides for compulsory medical insurance. Each person becomes the owner of the CHI policy, on the basis of which he has the right to guaranteed medical care. But not everyone knows what range of services is included in this program. Many citizens, even presenting an insurance policy at a polyclinic, today face a refusal to provide medical care of one kind or another. And not everyone is ready to defend their rights. Often this is due to a low level of public awareness about what guarantees each A5 blue sheet or a progressive plastic electronic card provides, and what scope of services the owner of one of these documents can claim. We will talk about this in this article.

The essence and purpose of the CHI policy

The compulsory health insurance policy is official document, which is designed to certify the right of the insured person to receive medical care free of charge in the amount provided for in the basic CHI program. The functions of the policy, as well as its guarantees, are determined by the Law of the Russian Federation “On Compulsory Medical Insurance in the Russian Federation” No. 326-FZ, adopted on November 29, 2010.

According to the provisions of the above normative act, the policyholder must have it with him at all times in order to take advantage of the opportunity to receive free medical services in the required amount in the event of an insured event. Art. 16 of the law provides that, in the absence of an insurance policy, a citizen can only rely on emergency assistance. The insured has the right to use the document in the medical institution to which he is attached according to his document.

Medical care under the compulsory medical insurance policy is provided for citizens absolutely free of charge and is financed by Money insurance funds - territorial and federal, which accumulate their funds at the expense of regular contributions of insured persons. For those who work, such contributions are made by their employers from the wage fund, and for the unemployed - the state. As a result, the entire population of the Russian Federation, regardless of age, gender, type of employment, social or material status, has the right to care in medical institutions in equal volumes and of the same quality.

The policies of the new model, the issuance of which started in 2011, are of an indefinite nature, i.e., they will be valid throughout the life of the owner, and when changing the workplace, it will not be necessary to replace them. Also, the law discussed above saved the new document from being tied to the place of residence of a person - the medical policy became valid throughout Russia. More detailed information about the procedure for registration and types of documents can be found in the articles:

What rights and guarantees does the policy provide to its owner?

Each insured citizen has the right to receive only one copy of the document, which only he himself can present. Attempts to use someone else's personal data are classified as offenses and are punishable by law. The medical insurance policy provides for the following rights and guarantees for insured citizens:

  • Receiving free medical care within the territorial boundaries of Russia: while staying within their permanent place of residence - on the basis of the regional CHI program, and outside it - in accordance with the federal CHI program;
  • Implementation of the choice of an insurance medical organization (state clinic, private center, etc.) among those institutions that participate in the implementation of the CHI program;
  • Attachment to a medical institution not by registration, but by actual place of residence (if they differ);
  • Changing the medical institution in connection with the move (unlimited number of times) or according to personal preferences (no more than once a year);
  • The choice of the attending doctor by submitting an application addressed to the management of the medical institution;
  • Obtaining complete and accurate information about the volume, quality of medical care within the framework of regional and federal CHI programs;
  • Privacy and protection of personal data;
  • Compensation for damage by a medical organization as a result of its failure to fulfill its obligations to the insured person;
  • Protection of personal rights in the field of CHI.

If the owner of the compulsory health insurance policy is faced with the refusal of health workers to provide him with the required medical services, with the provision of poor-quality, incomplete or untimely assistance, the RF Law "On Compulsory Medical Insurance in the Russian Federation" provides for the right to file a complaint against the specified clinic. It can be addressed both to the management of the insurance organization that issued the document, and to the territorial or federal compulsory health insurance fund.

Loss or damage to the policy does not entail a complete loss of the citizen's right to legally guaranteed free medical care. In the event of such cases, a person needs to contact the insurance company for. Until that moment, he will be issued a temporary document (for one month), allowing him to use medical services in the same volume.

What medical services can be obtained under compulsory health insurance?

The owner of the CHI insurance policy has the right to receive free of charge only those medical services that are provided for by the content of the regional and federal CHI program. Surcharges can be requested from a citizen only if the amount of medical care necessary to save his life or maintain his health exceeds the base provided by the policy. The CHI policy includes the following assistance:

  • Emergency, which is an emergency medical care necessary to eliminate the threat to human health and life;
  • Outpatient, which is provided in polyclinics and provides for diagnostic procedures, scheduled medical examinations, treatment of diseases at home or in day hospitals. According to the CHI program, outpatient medical care does not include free provision of medicines to citizens during treatment;
  • Inpatient, which turns out to be in the form of planned and emergency hospitalization in such cases as pathologies or termination of pregnancy, childbirth, exacerbation of chronic ailments, referrals to polyclinics, situations associated with the need for intensive care.

In addition to these types of services, the CHI policy guarantees its owner the opportunity to use medical care associated with the use of modern high-precision technologies and techniques - both for the purpose of conducting a study for diagnosis, and directly for treatment (with the exception of cosmetic, plastic surgery). The document of the insured person also provides that its owner can become a participant in preventive, rehabilitation, health-improving, informational activities organized by doctors as part of educational work with the population. For privileged categories of the population, it is also necessary when receiving free medicines.

For which diseases can you get free medical care?

The Law of the Russian Federation on Compulsory Medical Insurance provides for a wide list of diseases for which the policyholder can receive free diagnostics and therapy. Turning to the health care institution to which he is attached, he will need to present a document at the registry. Free medical services can be obtained at:

On a free basis, the holders of the CHI policy undergo routine vaccination, as well as annual fluorography. Having a document, once every three years you can take the opportunity to undergo examinations and a medical examination within the framework, as well as be under dispensary observation, call a doctor at home, and undergo other free procedures provided for by law.

On the territory of the Russian Federation, a compulsory medical insurance policy can be issued not only to residents who have Russian citizenship, but also to foreign citizens, stateless persons, as well as those with refugee status. All categories of the population are entitled to equal service in medical institutions. The only difference between the documents is their validity period: if for Russian citizens they are indefinite, then for persons temporarily staying on the territory of the Russian Federation, they are considered valid until they leave the country.

Conclusion

The compulsory medical insurance policy is issued to the insured person after the conclusion of an agreement with an insurance medical organization. This document is proof of the right to receive free medical care under the current program of state guarantees. Guarantees provided by the state for policyholders make it possible to cover the most vulnerable categories of the population with qualified assistance, for whom it would otherwise be inaccessible.

Compulsory health insurance (CMI) provides citizens of the Russian Federation with high-quality medical care.

We will tell you what help you can get, how to do it and where you can turn if your rights are violated.

Medical insurance is the main form of social protection of citizens of the Russian Federation in the field of health care.

The essence of insurance lies in the fact that in the event of an insured event, the insurer pays for the treatment of the patient. There are many medical insurers in Russia, and the most famous among them are Max-M, SOGAZ-Med, ROSNO-MS

This article describes in detail the rights of patients under the system of compulsory health insurance. After reading the content of the article, you will find out in which cases free medical care is provided.

Sometimes a patient may be denied medical care, and he will have to protect his rights. Learn more about who can help with this.

Features of insurance

OMS is a complex government measures which are aimed at providing free medical care to a citizen of the Russian Federation in the event of an insured event.

To pay for assistance, special funds of compulsory medical insurance are used. The insurance program includes legal, economic and organizational measures.

The state not only provides free medical care for the patient, but also ensures that it is of high quality and occurs according to the law.

Compulsory health insurance occurs under the CHI policy. This policy has a single state sample, which is approved by Federal Law No. 326 "On Compulsory Medical Insurance".

The current policy was put into circulation in the spring of 2011. Any violation of health is considered an insured event under compulsory medical insurance.

A person who for some reason does not have compulsory medical insurance cannot claim free medical care

What does the Law say?

The Law "On Health Insurance of Citizens of the Russian Federation" in Article 15 says that insurers are obliged to protect the interests of the insured.

Based on this, CHI is a set of rights, interests and obligations of a citizen. He has only one obligation - to insure under compulsory medical insurance.

In the "Fundamentals of the legislation of the Russian Federation on the health care of citizens", in articles 19 and 20, the rights of patients are formulated:

  1. for free medical care in the healthcare system, including municipal
  2. to obtain information about factors that affect health
  3. for a range of additional medical services

In the same document, in articles 30-32, it is indicated what the patient can count on:

  • respect and humane attitude of medical staff
  • for treatment and examination in conditions that comply with sanitary and hygienic standards
  • for additional consultations and consultations at the request of the patient
  • to relieve pain with the help of available means and methods
  • on the confidentiality of information about seeking medical care
  • to keep confidential information about the state of human health
  • refusal of surgical and other interventions

The Law "On Health Insurance of Citizens in the Russian Federation" in Article 6 provides the following rights:

  • for medical insurance on a mandatory and voluntary basis
  • at the choice of an insurer at one's own discretion
  • choice of doctor and desired medical institution
  • to receive assistance throughout the country, even far from the place of registration
  • to receive medical care of the volume and quality that corresponds to the insurance contract
  • to file a claim in case of refusal of medical care or its inadequate quality, even if the claim is not provided for by the insurance contract

These are only the basic rights of patients under CHI. To learn all the rights, we recommend that you read the indicated documents and articles in full.

Who provides protection and how?

Protection of rights is provided by insurance medical organizations. Their duty under the law is to defend the interests of insured citizens of the Russian Federation.

Insurers are obliged to pay for medical care if it is provided in accordance with the compulsory insurance contract.

This is the main means of ensuring the protection of patients' rights. Other responsibilities for protecting the rights of patients include:

  1. quality control, volumes, terms and conditions of medical care
  2. conducting medical and economic examinations and control, if necessary
  3. creation of reports on the results of control or examination

The insurance medical organization fully assumes the responsibility to protect the rights of the patient. If these obligations have not been fulfilled or insufficiently fulfilled, then the citizen can file a lawsuit against his insurer.

What medical assistance can be obtained?

AT basic program OMS includes:

  1. primary health care
  2. emergency
  3. preventive care
  4. additional medical care

You can find out what additional assistance is offered under the CHI policy in your city at any state medical institution. Specialized ambulance (sanitary and aviation) is not included in the basic CHI program

How to receive

In order to receive free medical care, a citizen of the Russian Federation must submit his CHI policy to the medical facility.

Before this, you need to make sure that the insured event (health disorder) complies with the terms of the insurance contract.

Medical services should be chosen independently, although on the recommendation of a doctor.

If you give the right to choose services to employees of the institution, then they may go beyond the scope of the insurance contract, and the patient will have to pay. General algorithm of actions:

  1. Contact a medical facility
  2. Show valid CHI policy
  3. Choose the medical care that is included in the scope of the insurance contract
  4. Get medical help

If a person becomes ill on the street, and he does not have a CHI policy with him, he will still receive free medical care. The law defines emergency assistance as free, even if it is not included in the terms of the insurance contract.

What to do in case of refusal?

AT public institutions failures are extremely rare. But municipal and other medical institutions “sin” from time to time.

They may refuse free treatment, referring to the cost of medicines or other factors, or they may provide medical care with violations, of poor quality.

Where to go in such a situation?

All citizens of the Russian Federation, without exception, are insured in the CHI system. Foreigners permanently residing in Russia have the right to receive an insurance policy.

The following are the insurers in the system of this type:

  • institutions;
  • enterprises;
  • the state directly.

Enterprises transfer 5.1% of the total amount of wages to the territorial or federal compulsory medical insurance funds. Health insurance for non-working citizens is paid directly by the state.

Special funds are the most important part of compulsory medical insurance. They are non-profit organizations that accumulate all cash transfers in favor of the health insurance system.

They provide financial stability and, if necessary, provide financial support to insurance companies.

Commercial insurance companies are the direct participants of MHI. They are required to have an appropriate state license to carry out insurance activities.

They enter into contracts with medical institutions to provide services to their clients, issue medical policies, control the quality and timing of medical care.

Medical institutions are the final segment of CHI. citizens Russian Federation contact them for appropriate assistance. The presence of a policy of the described sample gives the full right to free medical services.

Law on CHI

To date, the basis for the action of compulsory medical insurance is the Federal Law "On Compulsory Medical Insurance in the Russian Federation".

The main function of this law is to regulate the relationship of all participants in the compulsory health insurance system (insurers, policyholders, funds, state bodies).

It also determines the legal status of subjects and objects in the MLA. The basis for the adoption and operation of the law under consideration is the Constitution of the Russian Federation.

Supplement the action of Federal Law No. 326:

  • Law of November 21, 2011 “On the Fundamentals of Protecting the Health of Citizens of the Russian Federation”;
  • Law of July 16, 1999 "On the Fundamentals of Compulsory Medical Insurance".

The relationship between the subjects of the CHI system is also regulated by various other provisions and acts of the regions of the Russian Federation. Each insured event is considered separately, on an individual basis.

The observance of the law under consideration is primarily monitored by the federal and regional compulsory medical insurance fund.

Each organization has a special legal and legal department that performs the function of supervision in the field of compliance with the legislation in force on the territory of the Russian Federation.

What does the policy give

The MHI policy confirms that a citizen has the right to receive free medical care.

If it is available, the insured person has the right to apply to the following institutions:

  • the clinic to which the insured is assigned;
  • traumatology;
  • dentistry;
  • oncology departments, dispensaries;
  • hospitals participating in the CHI.

Having a compulsory medical insurance policy allows you to receive almost any medical care without any financial costs.

This document is currently mandatory for submission to a medical institution when applying. If for some reason there is no compulsory medical insurance policy, then an individual can receive medical care on a paid basis.

What does he look like

Today, the compulsory health insurance policy has a standard form. Moreover, its format does not depend on the services of which insurance company the citizen uses. Appearance depends only on the type of medical policy.

Recently, the health insurance system has been reformed. It was in connection with this that a new type of insurance policy was issued. It looks like a plastic card, on the front side of which there is an individual card number.

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The back has the following information:

  • the signature of the insured;
  • photo of the insured;
  • validity;
  • gender and date of birth.

A copy of the image is applied to the policy, it is not a digital signature. Even a picture with a not very good quality can be used as a photograph. high quality. The duration of the document is determined by many factors.

There is also another type of policy - temporary. It is issued for a period of 30 days in the event of a situation where the plastic policy is withdrawn.

This happens if previously a person simply did not have a policy of the type in question, or if it is being replaced. Upon the expiration of thirty days from the date of receipt, the temporary policy shall cease to be valid.

It itself is an A5 paper and contains the following information:

  • date of issue;
  • the signature of the insured;
  • name of the representative of the insurance medical organization.

Previously, old-style policies were in effect. They had an A3 format and contained information similar to that presented on the temporary CHI policy.

Terms of an agreement

The terms of the compulsory medical insurance contract were approved by the Director of the Federal Compulsory Medical Insurance Fund A.M. Taranov 03.10.03.

All documents of this type should be formed only taking into account this provision, not contradict it. Otherwise, this agreement may be considered partially invalid.

The document in question necessarily contains clauses to avoid the occurrence of various kinds of conflicts, the boundaries of responsibility are indicated.

The section "Subject of the contract" specifies the conditions under which the insurer provides its services to the insured. A certain amount (insurance premium) is paid in favor of the insurance company.

Based on this, in the event of an insured event, the company pays for its client to go to a medical institution.

In this section, the object of insurance is indicated - the property interest of the client. That is, in fact, the compulsory medical insurance policy protects its owner, first of all, from financial damage. Also in this section, the concept of an insured event is indicated.

The section “Sum insured, the procedure for its payment” details these two terms. The amount of the insurance premium, the limit of liability, the procedure for paying the insurance premium and the moment of this operation are also indicated.

When applying for a standard CHI policy, this section is absent - it is displayed in the agreement between the UK and the regional (federal) CHI fund. The section “Terms of the agreement” determines the duration of the agreement of the type in question.

The clause “rights and obligations of the parties” reads out the obligations arising between the insured and the insurer in the event of its conclusion.

The rights of the parties are also considered in as much detail as possible. The occurrence of serious violations of at least one clause is a serious reason for terminating the contract.

The insurance company must ensure the confidentiality of information relating to the policyholder. An exception is possible only in cases provided for by the current legislation of the Russian Federation.

The following information is confidential:

  • the content of the contract, its form;
  • the state of health of the insured, all available cases of seeking medical help;
  • personal data of the insured (place of residence, home phone number, etc.).

The section "Change and termination of the contract" lists the situations when it is possible to make any amendments to the text of the document.

Lists all cases when the contract can be terminated, and the procedure for implementing this process. At the end of the contract, the details of the parties are indicated: the actual and legal address, phone numbers.

Validity

Several years ago different compulsory insurance policies were issued in different regions. That is why their duration varies significantly. In 2011, a gradual transition to a single compulsory health insurance policy was launched.

To date, policies of this type, which are a plastic card, usually do not have expiration dates. The only exception is the issuance of a policy to a foreign citizen.

If an individual uses an old policy (today this is quite acceptable), then you can find out the expiration date for its validity directly on him.

Most often, this information is present at the back of the document. Previously, contracts under compulsory medical insurance policies were most often concluded for 12 months.

After that, it was necessary to carry out their extension. The expiration of the policy is the basis for its replacement.

Required documents for registration

The list of documents required for issuing a CHI policy varies depending on the age, as well as the legal status of the person applying to the insurance company.

Children over 14 years old (citizens of the Russian Federation) must submit the following documents to the UK in order to obtain a policy:

  • identity card (birth certificate or other document);
  • (if available).

If the papers for issuing a policy of the appropriate sample are provided by a parent, guardian, then a passport or other identification document is required.

If the policy is issued by relatives, then they are required to present:

  • identification;
  • a document allowing registration as an insured person (power of attorney).

Citizens of the Russian Federation who have not reached the age of 18, but have overcome the age threshold of 14 years:

  • temporary identity card or passport;
  • SNILS (if already available);
  • identity card of the representative of the insured person;
  • a power of attorney allowing registration (if the representative is a grandmother or grandfather);
  • representative's ID.

Persons over the age of 18:

  • identity document or passport;
  • SNILS.

Refugees who can legally become members of the health insurance system (Law on Refugees) are required to provide:

  • petition;
  • certificate of the corresponding sample;
  • an appeal against a court decision to deprive the FMS of refugee status;
  • a document confirming the receipt of temporary asylum.

For individuals, who do not have permanent citizenship, but have real estate, a residence permit:

  • passport of a foreign citizen;
  • SNILS (if any);
  • resident card.

Individuals with no citizenship (refugees or otherwise) require the following documents to participate in CHI:

  • identity card and a document confirming statelessness;
  • SNILS (if any);
  • resident card.

In the absence of any document, obtaining an insurance policy becomes simply impossible.

Insurance premiums

Insurance premiums for CHI are payments transferred to the Federal Compulsory Medical Insurance Fund of the Russian Federation.

To date, the payers of compulsory medical insurance premiums, according to the Federal Law "On Compulsory Medical Insurance" are:

  • organizations;
  • individual entrepreneurs;
  • individuals who are not individual entrepreneurs (leading a private practice).

The amount of insurance premiums is calculated and then paid depending on the type of organization, the taxation system used, as well as other factors.

The contribution to the federal compulsory medical insurance fund is 5.1% of the total fund wages which is paid to employees.

The duration of the settlement period for contributions of the type in question is one calendar year. Reporting periods are:

  • quarter;
  • half a year;
  • nine month;
  • twelve months.

Register of rendered services

The basic list of compulsory health insurance includes the following types of assistance:

  • ambulance;
  • preventive;
  • primary health care.

There is also a list of specialized services that are provided completely free of charge or on a preferential basis.

Under the compulsory health insurance policy, you can have an abortion, childbirth or the postpartum period free of charge.

The CHI system provides the following types of medical care:

  • dental, oncological (the list is approved by the Health Committee of the Russian Federation);
  • implementation of preventive fluorographic studies in order to detect tuberculosis in the early stages;
  • prevention of various diseases with the help of special types of vaccines;
  • preferential prosthetics, provision of medicines;
  • inpatient, provided in special outpatient departments.

Dental treatment under the policy

To date, the list of services provided under the MHI policy includes dental treatment.

Free of charge if available:

  • conducting an initial examination and consultation (including for patients who are not capable of independent movement);
  • drawing up a preventive map of diseases;
  • treatment:
    • carious formations;
    • pulpitis;
    • periodontitis;
    • periodontal diseases;
    • diseases of the oral cavity, mucous membrane;
  • treatment of injuries by surgical intervention, extraction of foreign bodies from the canals of the teeth;
  • removal of teeth and malignant tumors;
  • operations on the soft tissues of the oral cavity;
  • reduction of dislocations of various types.

For children under the age of 14, many clinics provide treatment for:

  • non-carious lesions of hard tissues of the tooth;
  • demineralization;
  • orthodontics using special removable equipment.

What are the types

To date, there are three types of CHI policy:

  • a sheet of A5 paper with a special barcode on it;
  • plastic card, which is a spiked electronic media;
  • an electronic application with a number printed on the UEC (universal electronic card).

Previously, until 2011, CHI policies of various formats were issued. Today, this area of ​​insurance is more streamlined.

The legislation was amended to allow any citizen to choose the format of the policy on their own.

Policies in in electronic format have one important advantage over paper - there is no need to renew them.

A standard A5 policy can be obtained at any point of issue. To receive a universal electronic card or a plastic card, you need to visit a specialized point of issue.

The current legislation on the territory of the Russian Federation allows all citizens to receive medical care in full free of charge. Only in some cases it will be necessary to pay, but this applies only to very rare cases.

Most often, when visiting a polyclinic, you just need to provide a compulsory medical insurance policy to the registry - this will be enough.

Video: Protecting the rights of patients in the CHI system

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