Announcement. Compulsory health insurance in the Russian Federation in 2020. Design features and necessary knowledge.
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Many citizens have already appreciated the value of compulsory health insurance. That is why he does not save on his health and actively pays for the pole.
So what is compulsory health insurance in Russia? And what are the main nuances of this procedure?
What you need to know
In accordance with the law, all citizens included in the system are entitled to receive free medical care throughout the Russian Federation.
How is the organization and financing of the fund
The Compulsory Medical Insurance Fund is an independent state credit company that implements state policy in the medical industry.
Such organizations are designed to accumulate insurance premiums, as well as ensure financial stability.
This is already regulated by an additional agreement on the part of the medical institution and the applicant.
In the clauses of the contract, you need to display:
- date of conclusion;
- the name of the insurer;
- basis for activity;
- subject of the contract;
- volume of medical care;
- date and signature.
Required documents
For registration you will need:
- passport of a citizen of Russia;
- birth certificate, if it is a minor citizen;
- statement of the established form.
For refugees, you must provide an additional certificate of recognition as such. A foreigner must provide a residence permit or a passport.
Stateless persons must provide registration and passport details.
Calculation procedure
How to calculate compulsory health insurance, according to the Federal Law, payment for medical care is carried out after the medical organization provides a register of accounts and an invoice for payment within the established limit.
Insurance Company:
- submits to the territorial body an application for receiving a target remuneration with an advance payment;
- apply for a refund for services rendered.
Then the territorial body considers the application and satisfies it, transferring the required amount.
Detailed information about insurance premiums for compulsory health insurance (CHI)
The duration of the billing period is determined for each year of hours worked. This is how accounting works.
The duration of the provision of the service is the entire life of the insured person. Paying insurance premiums - an individual or an employer.
If a person is not employed, then he can independently contribute money to the FSS. Insurance premiums are credited to the federal fund.
The rights of the patient of the Federal Law 323 article "On the basics of protecting the health of citizens" are expressed in the provision of free medical care in any specialized institution of the country, subject to the provision of a compulsory medical insurance policy. The only exceptions are private organizations and services provided on a paid basis.
Rights and obligations of the patient
Each patient must clearly know their rights and obligations. This will help avoid disputes and protect your interests.
The patient's duties include strict adherence to the prescribed treatment method (with consent to it), reliable informing the doctors about the state of health and the appearance of signs of the disease in order to make the correct diagnosis. The patient is also obliged to communicate with the medical staff with restraint and conciseness, without raising his voice and becoming personal.
The list of patient rights includes:
- Free provision of medical care.
- Respectful and humane attitude from medical workers.
- The choice of the attending physician and medical institution.
- Conducting meetings and consultations.
- Get accurate information about your health.
- Consent or, inpatient treatment.
- Compensation for damages due to improper treatment or negligence of the attending physician.
- Obtaining free legal assistance in case of going to court to resolve medical disputes.
The above rights apply to any patients, regardless of the place of their treatment (public clinic, private hospital). Below we propose to consider the most significant rights of citizens in more detail.
Right to free medical care
Citizens of the Russian Federation have the right to receive free assistance in any municipal or state medical institution under the CHI policy. In the absence of it, it is possible to provide free emergency assistance.
Here it is necessary to understand that doctors do not have the right to refuse a citizen if they feel unwell, they are obliged to provide first aid, regardless of the availability of a policy.
Within the framework of free medical treatment, various types of assistance are provided:
- preventive;
- health-improving;
- denture;
- gynecological;
- dental;
- rehabilitation;
- medical and diagnostic.
The patient also has the right to apply for free help in some private clinics., subject to the provision of a medical policy. You can find out which institutions this right applies to by calling the insurance company or by looking at the register of the same name.
The compulsory medical insurance policy is issued free of charge to all citizens of the Russian Federation immediately after birth. Refugees and foreign citizens residing in the Russian Federation on temporary registration also have the right to receive it.
The policy is issued on an indefinite basis. However, if a citizen of another country leaves the Russian Federation, the document is terminated ahead of schedule.
What types of medical care can be obtained free of charge?
The health insurance system provides for basic and territorial programs. They apply to all residents of the country, while directly dependent on the nature of the disease or the need for a preventive examination.
The basic program allows you to receive free medical care in any corner of the Russian Federation, regardless of permanent residence or registration of citizens. So, if a person goes on vacation or on a business trip to another city, he has the right to contact any clinic for free assistance. They cannot legally refuse him.
The basic program provides for the provision of emergency, primary and specialized medical care. Thus, a citizen has the right to call an ambulance, apply to a medical institution for a diagnosis, treatment and other purposes.
Territorial programs operate exclusively on the territory of the region that issued the policy. They include a wide range of medical services.
If we talk in more detail about the types of medical care, citizens have the right to turn to any specialist free of charge: a therapist, ophthalmologist, neuropathologist, gynecologist, pediatrician and others. The reverse situation is when there is no necessary doctor in the city (village). In this case, the patient is referred to a regional or district clinic.
The right to receive reliable information about the diagnosis
When applying for medical assistance, a citizen has the right to learn full information about his state of health, including:
- diagnosis;
- test results;
- the chosen method of treatment;
- list of prescribed medications;
- treatment results.
This information must be provided by the attending physician. He does not have the right to hide any facts, to disclose knowingly false information, to deceive. Even when making an incurable diagnosis, the physician is obliged to notify the patient, regardless of the complexity of the situation and the requests of relatives.
- disabled persons;
- minor children;
- drug addicts.
Obtaining information about the diagnosis is not the responsibility of the patient. This means that the doctor may be prohibited from disclosing it. A variant of obtaining information by the official representative of the patient (relatives) is possible.
Separately, it is worth noting the need to maintain medical secrecy. The physician cannot transfer information about the diagnosis or treatment method to an outsider. This will result in the imposition of an administrative or disciplinary penalty.
Right to damages
Unfortunately, in domestic medicine, medical errors are quite common. The patient or his relatives have the right to demand compensation for moral and material damage in court, in the event of:
- causing harm to the health of the patient, due to the appointment of inappropriate treatment;
- lethal outcome, subject to evidence of the guilt of physicians.
Such cases also include unqualified or untimely provision of assistance, negligence and other actions, the result of which negatively affected the patient's condition.
You can claim damages from a doctor or medical institution. This is purely individual, depending on the factors that led to harm to health.
The right to refuse hospitalization and surgery
Citizens have the right to make their own decisions. No one can force a patient to go to the hospital under duress. The task of the physician is to make the correct diagnosis and prescribe treatment, if his prerequisite is a stay in the hospital, he is obliged to convey to the patient the seriousness of the situation and explain the possible occurrence of complications.
A refusal can be written for any medical institution, this applies to the departments of pediatrics, gynecology, maternity hospital, therapy, surgery and others. The prescribed treatment should be carried out by the patient at home.
The only exception to the refusal is the provision of emergency assistance. It is also worth considering that the responsibility for minor children and incapacitated persons lies with official representatives. If the doctor sees an inappropriate attitude towards the patient, or considers hospitalization extremely necessary, he can convene a council to take coercive measures.
This mainly concerns minor children whose parents, for religious reasons, do not allow medical measures aimed at cure.
The patient has the right to refuse surgical intervention. However, in practice it can cost lives. Also, as in the case of refusing hospitalization, the doctor can convene a council or take advantage of an emergency.
Respectful attitude from medical workers
The right to respectful and humane treatment is one of the most important for patients. It was not in vain that it was singled out separately. Unfortunately, not all medical workers, including middle and junior staff, behave with patients with dignity.A citizen must be completely sure that he will not only be provided with qualified medical care, but also treated with respect. Threats, rudeness, boorish expressions should not be heard from doctors and other personnel. Even a slight increase in voice is prohibited.
The inappropriate behavior of health workers is often justified by the low level of wages. However, the patient is not to blame for the financial difficulties of the attending physician or his nurse. Any rudeness may result in disciplinary action.
The patient has the right to file a corresponding complaint directly with the management of the clinic, which is obliged to punish the guilty person. As a rule, the physician is deprived of incentives or part of the salary is withdrawn as a fine.
The choice of the attending physician and medical institution
The introduction of the CHI policy made it possible for patients to choose their own doctor and medical institution free of charge. A citizen can write a statement refusing the services of a pediatrician or therapist, asking to be sent to the site to another specialist. The same goes for other doctors.
For example, a woman expressed a desire to register for pregnancy with a gynecologist attached to another district. She argued her request with her previous positive experience of contacting this specialist.
Despite the fact that the change of doctor is allowed by law, here you can encounter an ambiguous situation. It concerns the call of a specialist at home. This question should be discussed with the doctor in advance. Here it is worth understanding that all areas are divided into sections, to which certain doctors are attached. A specialist from another site is unlikely to come to the call, except perhaps on a paid basis.
Changing the attending physician, as a rule, requires a direct appeal to the head of the clinic. It is he who gives the appropriate permission, and also accepts applications from citizens.
The choice of a medical institution may be limited by the conditions of territorial programs. In this regard, it is worthwhile to find out in advance information about the clinic and the possibility of servicing it free of charge under the policy.
Protection of the rights of patients
Violation of the rights of the patient causes a lot of controversy. Each situation has its own characteristics and consequences. For example, someone is ready to go to court with complaints about the boorish attitude of a doctor, and someone calls the hotline in case of improper treatment.
To resolve issues, the patient must contact the Ministry of Health. All accepted complaints, including electronic versions, are redirected to the administration of the medical institution for further resolution. In addition, you can write a complaint:
- directly to the head physician or head of the clinic;
- to the city administration;
- prosecutor's office or police;
- territorial branch of the insurance company;
- Rospotrebnadzor or Roszdravnadzor.
Before filing any complaint, it is worth visiting a qualified lawyer. He will help to understand the essence of the problem, justify it from a legal point of view and help draft the text of the document.
The result of the complaint may be the award of material or moral compensation, the imposition of disciplinary punishment, administrative fines, deprivation of the right to provide medical activities, deprivation or restriction of liberty.
The severity of the punishment depends solely on the amount of damage caused to the patient and the violation of his rights. In case of defamation, a doctor or medical institution may file a counterclaim against a negligent patient, which will entail administrative or criminal liability.
Patient rights: summarizing
The rights of patients are prescribed in the current legislation of the Russian Federation. Their violation leads to the punishment of medical personnel: administrative, disciplinary, criminal.
A citizen has the right to receive qualified medical, health-improving or preventive procedures free of charge. The patient has the right to choose the attending physician, medical institution, write a refusal of surgical intervention or hospitalization.
The duty of a visitor to a clinic or any other medical institution is to provide a compulsory medical insurance policy. It is issued immediately after the birth of a child or a person's registration of citizenship of the Russian Federation. The policy gives the right to receive free medical services not only in public, but also in some private clinics.
In case of violation of rights, the patient or his representative may file a complaint with a higher authority.
Free question to a lawyer
The information on the site is provided for informational purposes only. Each situation is unique and requires personal consultation with an experienced lawyer. In this form, you can ask a question to our medical lawyers.
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 of the Russian Federation apply to them to receive 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 not very high quality can be used as a photo. 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 who own 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 itself 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 wage fund, 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 electronic form have one important advantage over paper ones - 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 legislation in force 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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According to the adopted legislation, practically every person registered and residing in the territory of the Russian Federation has the right assigned to him to apply to any medical institution for appropriate treatment if such a need arises. However, there is one important nuance - services of this kind, as well as the right to receive medicines free of charge, that is, free of charge, are provided only if the citizen has such a document as a compulsory medical insurance policy.
Who can receive free medical services?
Any citizen who is the owner of:
- Employed citizens. That is, the category of persons who regularly pays taxes to the state budget. That is, in fact, he pays for his treatment in advance.
- unemployed citizens. In this case, the payment of funds for the treatment of these persons also occurs at the expense of the federal budget.
- Children, teenagers, and who have not reached the age of eighteen and are not taxpayers.
In the event that a person is officially employed, he has the right to issue, as well as . If he is not employed, works unofficially, or has not reached the age of majority, you can apply for this document at any company that provides insurance services.
In the event that any citizen needs to contact a specialist who conducts an appointment outside the locality where the specified individual lives, an additional referral from the attending physician is also required.
There is a certain list of medical services, the provision of which is free of charge. These include the following:
- Help of an emergency nature, that is, the departure of an ambulance on a call from a patient. This service is provided free of charge not only to persons who have, but also do not have this document. In the recent past, there were unreliable rumors that if a person does not have a compulsory medical insurance policy, he will have to pay about one and a half to two thousand rubles for calling an emergency. This is not true. This service is provided in any case absolutely free of charge.
- Ambulatory treatment in the medical institution that is included in the insurance system and includes a number of many different manipulations: examining and diagnosing the patient's disease, performing the necessary procedures and prescribing adequate treatment. However, when the patient is on the terms of the so-called outpatient, day care or home treatment, all the necessary medicines must be purchased by him at his own expense, since there are no benefits in this case.
- Work with the public to raise awareness of sanitary and hygienic issues. That is, holding various lectures, seminars and so on.
- Diagnosis and treatment of the population using expensive innovative drugs and methods. For example, in some regions of the Russian Federation, in vitro fertilization is carried out free of charge.
- Diagnosis of the disease with subsequent hospitalization.
- in dental clinics and offices with state status.
Free services under the MHI policy
For example, while being treated in a state-type hospital, a citizen has the right to receive free services for the treatment of diseases of the following kind: pregnancy support in case of a complicated course, as well as in the presence of pathologies of any kind, medical abortion, the presence of chronic diseases, or in case of exacerbation of the disease, poisoning , bodily harm and so on. In this case, the provision of medicines necessary for adequate treatment is free of charge.
The diseases, the treatment of which, according to the list, is free of charge, include the following:
- Diseases of an infectious nature, with the exception of those categories that are classified as sexually transmitted infections.
- Various diseases of the blood, vascular system, heart.
- Diseases of the stomach, as well as the gastrointestinal tract in general.
- Any disease caused by a nervous breakdown.
- Diseases of the joints, bones, muscles and so on.
- All kinds of defects in vision, hearing, speech.
- Tumors, both benign and malignant.
- Diseases of tissues and skin.
- Diseases of the urinary tract.
- Diseases of the respiratory system.
What to do if you are denied treatment if you have a policy?
At present, not every citizen is fully aware of the rights that are granted to him in accordance with, which is often used by unscrupulous workers in this field of activity, demanding a certain fee for providing the necessary assistance.
What to do if your rights are violated
Every citizen of the Russian Federation who has insurance has the right to seek help from any medical institution located on the territory of the state. In the indicated institution, he is obliged to accept and carry out appropriate diagnostics, treatment, as well as other manipulations that are necessary. However, it often happens that doctors, as well as hospital staff, refuse to admit a patient in such cases. This is not legal and violates human rights. It's important to produce.
To restore the violated right, the person who was denied the provision of medical services must file a complaint with the company, whose employees will take appropriate measures. If such a case is detected, administrative penalties may be applied to employees of the medical services sector.
What can you expect with a CHI policy?
In order to know the right to use which services the compulsory medical insurance policy gives, you need to carefully familiarize yourself with the list of services provided to the population free of charge.
It should be remembered that, in essence, these services are not at all free of charge due to the fact that a certain amount is deducted from the salary of each employed citizen every month, intended specifically for this purpose. Therefore, in this way, each individual pays in advance for his treatment in a state-type institution. In our other articles you can read and .
Almost every Russian has a compulsory medical insurance policy, but not everyone has a clear idea of where and what kind of medical care can be obtained under it. About what rights we are entitled to under the compulsory medical insurance policy and how to use it correctly, including in a foreign city, and when the policy may be useless, in the educational program from the expert of the Interregional Union of Medical Insurers Tatyana Serebryakova.
What treatment does not give the right to the MHI policy and do not need to insist on it?
The patient cannot qualify for treatment under the CHI policy in the two most common situations.
Firstly, when applying to a medical institution that is not funded by compulsory medical insurance in a certain profile. Each medical organization, both private and public, once a year is declared to participate in the CHI system. Moreover, not “in general”, but for specific profiles and types of treatment. And it’s not a fact that the hospital or clinic you have chosen provides exactly the services that you need under the CHI policy. That is, when applying to a medical institution, it is necessary to find out two main parameters: whether it participates in the compulsory medical insurance system, and for what types and conditions (for all or some specific ones) in the context of profiles, medical specialists, assistance to children or adults.
Secondly, if the treatment itself is not among those financed by the CHI. This concerns, for example, sexually transmitted diseases, HIV, AIDS, tuberculosis, mental and behavioral disorders, palliative care (both inpatient and outpatient). Such medical care is financed from other sources of the State Guarantee Program - funds from the federal, regional or local budget. The compulsory medical insurance policy does not cover the treatment of citizens outside the Russian Federation, plastic aesthetic surgery (if there are no medical indications for this), preferential dental prosthetics, sanatorium treatment, as well as the provision of medical care in conditions exceeding the level of comfort established by the program.
In addition, the number of services that are not financed by compulsory medical insurance, and therefore are not provided under the policy, does not include social benefits. For example, related to preferential drug provision for outpatient treatment. That is, if all medicines are provided free of charge in a hospital, then a patient who does not have the right to benefits pays for the prescription received at the clinic. Not related to the compulsory medical insurance policy and sick leave payments - this is a type of social benefit that is paid from social insurance funds.
Does it matter that a person fell ill while being in a place where he does not have a permanent registration?
You can get treatment for free anywhere in the country, the main thing is not to forget to take a compulsory medical insurance policy on your trip. But this applies to medical care under the basic compulsory medical insurance program, which is approved by the Decree of the Government of the Russian Federation and is absolutely the same in all regions of Russia. That is, any acute condition or exacerbation of a chronic disease, toothache, bruises, poisoning, allergies or sunstroke - all these are reasons to seek free help at a polyclinic or hospital operating in the CHI system.
If your condition worsens, you are also entitled to free ambulance and emergency outpatient care. Moreover, when providing emergency medical care in cases that threaten a person’s life, the presentation of a CHI policy is not required. Such assistance is provided to all, without exception, free of charge and without delay.
However, in other cases, there is a difference between the permanent place of residence and the region of temporary residence. This difference applies to those medical services that are provided in addition to the basic CHI program. For example, in a number of regions of the Russian Federation with a high level of socio-economic development, the Territorial Compulsory Health Insurance program is much wider - due to certain types of high-tech medical care that are not included in the basic program. In addition, the scope of preventive measures can be expanded due to the “super-basic compulsory medical insurance program”. But the extended program is available only for residents of that particular region. A non-resident patient will not be provided with services in excess of the basic compulsory medical insurance program free of charge under the compulsory medical insurance policy.
And if the disease is associated with some local features? For example, a Muscovite traveling in Transbaikalia was bitten by a tick.
Medical assistance under the compulsory medical insurance policy (including removing a tick) is required at any emergency room. If a disease associated with a bite develops, then it should also be treated free of charge - at the expense of compulsory medical insurance. This also applies to other similar situations, regardless of where the sick person is.
Is it possible to get sick leave if you get sick while traveling?
A person has the right to receive a sick leave in any region of the country. It all depends on the medical indications that indicate that he is unable to work. If you cannot go to the clinic, call the doctor at home. Medical care at home should also be provided under the CHI policy.
If the situation is not urgent, but a person on vacation just has time to deal with his chronic illness, will he be provided with planned assistance?
The compulsory medical insurance policy allows you to apply for planned medical care anywhere in the country. The profiles of diseases for which such assistance is provided are listed in the basic CHI program. However, planned treatment, for example, insulin dose adjustment or selection of a hypertensive drug, is a rather lengthy process that requires a lot of examinations, additional consultations, etc. Therefore, it is better to do it at home, in consultation with your doctor. If you plan to leave for another region for a long time and know that at this time you may need planned medical care, attach yourself to the clinic at the place of stay.
Or can they say in another region that the CHI policy is invalid?
The current policy guarantees the provision of free medical care under the basic CHI program throughout Russia. Enter your insurance company's hotline number in your mobile phone book and call it in any dispute. If you have not used the policy for a long time, call the hotline of your insurance company (the phone number is indicated on the policy), check if there is information about it in the relevant register of insured persons. Best of all - replace it with a new CHI policy of a single sample. To do this, it is enough to contact any insurance company, but it is better to plan a visit to it 1.5 months before the intended trip.
What if the patient is forced to pay for treatment?
Contact the head of the medical organization, call the Territorial Compulsory Medical Insurance Fund of the region where you are not at the place of insurance, and where you were denied medical care or demanded to pay for it. To date, in each subject of the Russian Federation, the work of Contact Centers in the field of compulsory medical insurance has been organized, the telephone number of such a Contact Center should be posted on stands in each medical institution, on the website of each Territorial Fund for Compulsory Medical Insurance. This number and other details of the Contact Center will always prompt you if you call the hotline of your insurance company.
If you had to pay, keep the receipt and warn that you will appeal this forced payment (write a complaint). If you are offered to sign a contract for the provision of paid services (in another way, payment for medical care in the Russian Federation is not legal) - carefully read it and do not sign if it indicates that you are aware that you can receive medical care for free, but voluntarily decided pay.