According to the adopted legislation, almost every person registered and living on the territory of the Russian Federation has the right assigned to him to apply to any medical institution to receive appropriate treatment if such a need arises. However, there is one important nuance - services of this kind, as well as the right to receive medications free of charge, that is, free of charge, are provided only if the citizen has a document such as a compulsory health insurance policy.

Who can receive free medical services?

Any citizen who owns the following has the right to use the services of medical institutions:

• Employed citizens. That is, the category of persons who regularly pay taxes to the state budget. That is, in essence, he pays for his treatment in advance.
• Unemployed citizens. In this case, 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.

If a person is officially employed, he has the right to register, as well as . If he is not employed, works unofficially, or has not reached the age of majority, you can apply for the specified document to any company that provides insurance services.

In the event that a citizen needs to see a specialist who is receiving treatment outside the locality where the specified individual lives, a 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:

1. Emergency assistance, that is, the departure of an ambulance when a patient is called. This service is provided free of charge not only to persons who have, but also to those who do not have this document. In the recent past, there were unreliable rumors that if a person does not have a compulsory health insurance policy, he will have to pay about one and a half to two thousand rubles to call an emergency room. This is wrong. This service is provided absolutely free of charge in any case.
2. Ambulatory treatment in a medical institution that is part of the insurance system and includes a number of different manipulations: examination and diagnosis of the patient’s disease, performing the necessary procedures and prescribing adequate treatment. However, when a patient is under so-called outpatient, daytime or home treatment, all necessary medications must be purchased by him at his own expense, since there are no benefits in this case.
3. Working with the public to raise awareness of sanitary and hygienic issues. That is, holding various lectures, seminars and so on.
4. 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.
5. Diagnosis of the disease followed by hospitalization.
6. in dental clinics and offices that have state status.

Free services under compulsory medical insurance policy

For example, while undergoing treatment in a state hospital, a citizen has the right to receive free services for the treatment of diseases of the following kind: support of pregnancy during its 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 , causing bodily harm and so on. In this case, the provision of medications necessary for adequate treatment is free of charge.

The diseases that, according to the list, are treated free of charge include the following:

1. Diseases of an infectious nature, with the exception of those categories classified as sexually transmitted infections.
2. Various diseases of the blood, vascular system, heart.
3. Diseases of the stomach, as well as the gastrointestinal tract in general.
4. Any disease caused by a nervous disorder.
5. Diseases of joints, bones, muscles and so on.
6. All kinds of defects in vision, hearing, speech.
7. Tumors of both benign and malignant nature.
8. Diseases of tissues and skin.
9. Diseases of the genitourinary area.
10. Diseases of the respiratory system.

What to do if treatment is denied if you have a policy?

Currently, not every citizen is fully aware of the rights that are granted to him in accordance with this law, which is often taken advantage of by unscrupulous workers in this field of activity, demanding payment of a certain fee for the provision of 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. The specified institution is obliged to admit him and carry out appropriate diagnosis, treatment, as well as other manipulations that are necessary. However, it often happens that doctors, as well as hospital staff, refuse to admit the patient in such cases. This is not legal and violates human rights. It is important to produce.

To restore the violated right, a person who has been denied medical services must file a complaint with the medical service, whose employees will take appropriate measures. If such a case is detected, administrative penalties may be applied to medical service workers.

What can you expect with a compulsory medical insurance policy?

In order to know which services the compulsory health insurance policy gives you, you need to carefully read 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 due to the fact that a certain amount intended specifically for this purpose is deducted from the salary of each employed citizen every month. Consequently, in this way, each individual pays in advance for his treatment in a government-type institution. In our other articles you can familiarize yourself with and .

The provision of medical care and treatment to citizens is regulated by the norms of the “Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens” dated July 22, 1993, and the Law of the Russian Federation “On medical insurance of citizens” dated June 28, 1991.

And other acts. In accordance with Art. 41 of the Constitution of the Russian Federation, all citizens of Russia have the right to free medical care in the state and municipal healthcare systems.

The volume of free medical care for citizens is provided in accordance with compulsory health insurance programs.

Health insurance is a form of social protection of the population’s interests in health care, the purpose of which is to guarantee citizens, in the event of an insured event, receiving medical care from accumulated funds and to finance preventive measures. It is carried out in two types: mandatory and voluntary.

Compulsory health insurance is an integral part of state social insurance and provides all citizens of the Russian Federation with equal opportunities to receive medical and pharmaceutical care provided at the expense of compulsory health insurance in the amount and on conditions corresponding to compulsory health insurance programs.

Voluntary health insurance is carried out on the basis of voluntary health insurance programs and provides citizens with additional medical and other services in addition to those established by compulsory health insurance programs. It can be collective and individual.

The subjects of health insurance are: citizen, policyholder, medical insurance organization, medical institution.

On the territory of the Russian Federation, stateless persons and foreign citizens permanently residing in Russia have the same rights and obligations in the health insurance system as citizens of the Russian Federation, unless international treaties provide otherwise. Medical insurance for Russian citizens abroad is carried out on the basis of bilateral agreements between the Russian Federation and the countries where citizens reside.

Insured for compulsory health insurance

are executive authorities of the constituent entities of the Russian Federation and local governments - for the non-working population; organizations, individuals registered as individual entrepreneurs, notaries engaged in private practice, lawyers, individuals who have entered into employment contracts with employees, as well as paying remuneration under civil contracts, on which, in accordance with the legislation of the Russian Federation, taxes are charged in part subject to enrollment in compulsory health insurance funds - for the working population.

Insured for voluntary health insurance

Individual citizens with civil capacity or enterprises representing the interests of citizens act.

The financial resources of the state compulsory health insurance system are generated through contributions from policyholders for compulsory health insurance to the Federal and territorial compulsory health insurance funds, which act as independent non-profit financial institutions. The funds are intended to accumulate financial resources for compulsory health insurance, ensure the financial stability of the state system of compulsory health insurance and equalize financial resources for its implementation. The financial resources of the funds are in the state ownership of the Russian Federation, are not included in the budgets or other funds and are not subject to withdrawal.

Medical insurance organizations are legal entities that provide medical insurance and have a state permit (license) to engage in medical insurance. They are independent economic entities, with any forms of ownership provided for by the legislation of the Russian Federation, possessing the authorized capital necessary for the implementation of medical insurance and organizing their activities in accordance with the law. Medical insurance organizations are not part of the healthcare system.

To ensure the sustainability of insurance activities, medical insurance organizations create reserve funds and do not have the right to refuse the insured to enter into a compulsory health insurance agreement.

Medical institutions in the health insurance system are licensed treatment and preventive institutions, research and medical institutes, other institutions providing medical care, as well as persons engaged in medical activities, both individually and collectively.

Medical care in the health insurance system is provided by medical institutions with any form of ownership. They are independent economic entities and base their activities on the basis of agreements with medical insurance organizations. They have the right to issue documents certifying the temporary disability of the insured and are responsible for the volume and quality of medical services provided, including refusal to provide medical care.

Payment for services of medical institutions by insurance organizations is made in the manner and within the time limits stipulated by the agreement between them, but no later than a month from the date of submission of the payment document.

A health insurance contract is an agreement between the policyholder and a medical insurance organization, according to which the medical insurance organization undertakes to organize and finance the provision of medical care to the insured population of a certain volume and quality or other services under compulsory medical insurance and voluntary medical insurance programs.

The health insurance contract is considered concluded from the moment of payment of the first insurance premium, unless otherwise provided by the terms of the contract. Every citizen in respect of whom a medical insurance contract has been concluded or who has concluded such an agreement independently, receives a medical insurance policy, which is in the hands of the insured and is valid throughout the territory of Russia, as well as in the territories of other states with which the Russian Federation has agreements on medical insurance of citizens.

Primary medical care is the main type of medical care free of charge for every citizen and includes treatment of the most common diseases, as well as injuries, poisoning and other emergency conditions, carrying out sanitary and hygienic and anti-epidemic measures, medical prevention and other activities related to the provision of health care to citizens at their place of residence. .

This type of assistance is provided by institutions of the municipal health care system and the sanitary-epidemiological service.

Its volume is established by the local administration in accordance with the territorial compulsory health insurance program.

Emergency medical care is provided free of charge to citizens in conditions requiring urgent medical intervention; carried out by medical and preventive institutions, regardless of territory, departmental subordination and form of ownership, by medical workers, as well as by persons obliged to provide it in the form of first aid by law or by special rule.

For diseases that require special treatment methods, diagnostics and the use of complex medical technologies, specialized medical care is provided. This type of assistance is provided at the expense of budgets of all levels, trust funds intended to protect the health of citizens, personal funds of citizens and other sources not prohibited by the legislation of the Russian Federation.

Medical care for citizens suffering from socially significant diseases is provided free of charge or on preferential terms by the relevant treatment and preventive institutions. The list and types of benefits for the provision of this type of medical care are established by the State Duma and the Government of the Russian Federation; as well as by the governments of the republics that are part of the Russian Federation, local authorities and management.

Rights of certain population groups in the field of health care: 1.

Family rights. Every citizen has the right, for medical reasons, to free consultations on family planning, the presence of socially significant diseases and diseases that pose a danger to others, on medical and psychological aspects of family and marital relations, as well as to medical and hygienic and other consultations and examinations in institutions state or municipal health care system in order to prevent possible hereditary diseases in offspring.

A family, by agreement of all its adult members living together, has the right to choose a general practitioner (family doctor), who provides medical care at the place of residence.

Families with children have the right to social support measures in the field of protecting citizens' health. One of the parents is given the right, in the interests of the child’s treatment, to stay with him in the hospital during the entire period of his stay, regardless of the child’s age. A person staying with a child in a hospital facility is issued a certificate of incapacity for work. 2.

Rights of pregnant women and mothers. The state ensures pregnant women the right to work in conditions that meet their physiological characteristics and health status. Every woman during pregnancy, during and after childbirth is provided with specialized medical care.

The procedure for providing nutritious food to pregnant women, nursing mothers, as well as children under three years of age, including through special food outlets and shops based on the conclusion of doctors, is established by the legislation of the constituent entities of the Russian Federation. 3.

Rights of minors. In the interests of health protection, minors have the right to: dispensary observation and treatment in children's and adolescent services; sanitary and hygienic education, training and work in conditions that meet their physiological characteristics and health status; free medical consultation when determining professional suitability; obtaining the necessary information about their health status in a form accessible to them.

Minors - drug addicts over the age of 16 years, other minors over the age of 15 years have the right to voluntary informed consent to medical intervention or to refuse it. Minors with disabilities in physical or mental development, at the request of their parents, may be kept in institutions of the social protection system. 4.

The rights of military personnel, citizens subject to conscription and entering military service under a contract.

Military personnel have the right and undergo a medical examination to determine suitability for military service and early dismissal from military service based on the conclusion of a military medical commission. They have the right to receive full information about medical contraindications for military service and indications for deferment or exemption from conscription for military service for health reasons. In case of disagreement with the conclusion of the military medical commission, they have the right to conduct an independent medical examination and (or) appeal the conclusions of the military medical commission in court. 5.

The rights of persons detained, serving a sentence in the form of arrest, prisoners in custody, serving a sentence in places of deprivation of liberty or administrative arrest, to receive medical care.

Persons detained, serving sentences in the form of arrest, prisoners in custody, serving sentences in places of deprivation of liberty or administrative arrest, including pregnant women, women during childbirth and in the postpartum period, have the right to receive medical care in necessary cases in institutions state or municipal health care system at the expense of the relevant budgets.

In places of deprivation of liberty where mothers and children under one year of age are to be kept together, nurseries with qualified personnel are created.

Testing new methods of diagnosis, prevention and treatment, as well as medicines, conducting biomedical research involving the listed categories of citizens as objects is not allowed.

The procedure for organizing medical care is established by the federal executive body that carries out legal regulation in the field of healthcare, together with the interested federal executive bodies.

Questions for self-control 1.

Characteristics of health insurance and types of medical and social care. 2.

Rights of certain population groups in the field of health care.

Compulsory health insurance- one of the types of compulsory social insurance of citizens. It is a system of legal, economic and organizational measures that are created by the state to ensure that the insured person receives free medical care (in the event of an insured event). Implementation is carried out at the expense of compulsory medical insurance within the conditions established by the compulsory health insurance program.

Object of compulsory health insurance- insurance risk associated with the occurrence of an event that is an insured event.

Insurance risk- an expected event, the occurrence of which leads to the need to pay for medical care provided to the insured person.

Insurance case- an accomplished event (illness, injury, other state of health of the insured person, preventive measures), upon the occurrence of which the insured citizen is provided with insurance coverage in accordance with the territorial compulsory medical insurance program. Insured events include illnesses, injuries, other health conditions requiring medical care, as well as preventive measures.

Insurance coverage for compulsory medical insurance- fulfillment of obligations to provide (and pay for) medical care upon the occurrence of an insured event.

Insurance premiums for compulsory health insurance- payments that must be made by policyholders. Contributions are impersonal in nature, their intended purpose is to exercise the right of the insured person to receive insurance coverage. For non-working citizens, the insured are the executive authorities of the constituent entities of the Russian Federation. For workers - employers (individual entrepreneurs; individuals not recognized as individual entrepreneurs), as well as individual entrepreneurs, notaries engaged in private practice, lawyers, arbitration managers.

Insured person- an individual who is covered by compulsory health insurance in accordance with Federal Law No. 326-FZ “On compulsory health insurance in the Russian Federation” (determines the rights and obligations of the insured).

Basic compulsory health insurance program- part of a program of state guarantees designed to provide free assistance. Determines the rights of the insured, implemented at the expense of compulsory medical insurance funds throughout the Russian Federation. Establishes uniform requirements for relevant territorial programs.

Territorial compulsory health insurance program- part of the territorial program of state guarantees, designed to provide free assistance. Determines the rights of the insured, implemented at the expense of compulsory health insurance funds in the territories of the constituent entities of the Russian Federation, which meet the uniform requirements of the basic program. AlfaStrakhovanie-OMS LLC ensures the implementation of the rights of insured citizens in Murmansk and the Murmansk region, Rostov-on-Don and the Rostov region, Kemerovo and the Kemerovo region, Tver and the Tver region, Krasnodar and the Krasnodar region; Veliky Novgorod and the Novgorod region, Chelyabinsk and the Chelyabinsk region, Tula and the Tula region, Bryansk and the Bryansk region.

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

The policyholders in the system of this type are:

• institutions;
• enterprises;
• directly the state.

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

The most important component of compulsory health insurance are special funds. They are non-profit organizations that accumulate all money transfers in favor of the health insurance system.

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

The direct participants of compulsory medical insurance are commercial insurance companies. They are required to have the appropriate state license to carry out insurance activities.

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

Medical institutions are the final segment of compulsory medical insurance. Citizens of the Russian Federation turn to them to receive appropriate assistance. Having a policy of the described sample gives you the full right to receive free medical services.

Law on Compulsory Medical Insurance

Today, the basis for compulsory medical insurance is the Federal Law “On Compulsory Health Insurance in the Russian Federation”.

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

It also determines the legal status of subjects and objects in compulsory medical insurance. The basis for the adoption and operation of the law in question is the Constitution of the Russian Federation.

Complement the effect 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 basics of compulsory medical insurance.”

The relationships between subjects of the compulsory medical insurance system are 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.

Compliance with the law in question is primarily monitored by the federal and regional compulsory medical insurance fund.

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

What does the policy provide?

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

If available, the insured person has the right to contact the following institutions:

• the clinic to which the insured person is registered;
• traumatology;
• dentistry;
• oncology departments, dispensaries;
• hospitals participating in compulsory medical insurance.

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

Today, this document is mandatory to submit to a medical institution upon application. 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. The appearance depends only on the type of medical policy.

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

Invalid Displayed Gallery

On the back there is the following information:

• signature of the policyholder;
• photograph of the policyholder;
• validity;
• gender and date of birth.

A copy of the image is simply applied to the policy; it is not an electronic signature. Even a picture with not very high quality can be used as a photograph. The duration of a 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 confiscated.

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

It itself is A5 paper and contains the following information:

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

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

Agreement conditions

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

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

The document under consideration necessarily contains clauses to avoid the emergence of various types of conflicts, and the boundaries of responsibility are indicated.

The section “Subject of the contract” stipulates the conditions under which the insurer provides its services to the policyholder. A certain amount (insurance premium) is paid to the insurance company.

Based on this, when an insured event occurs, the company pays for its client to go to a medical facility.

This section identifies the object of insurance – the client’s property interest. That is, in fact, the compulsory medical insurance policy protects its owner, first of all, from financial damage. This section also defines the concept of an insured event.

The section “Amount insured, the procedure for its payment” explains these two terms in detail. 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 compulsory medical insurance policy, this section is absent - it is displayed in the agreement between the insurance company and the regional (federal) compulsory medical insurance fund. The section “Duration of the agreement” determines the duration of the agreement of the type in question.

The clause “rights and obligations of the parties” states the obligations arising between the policyholder and the insurer in the event of its conclusion.

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

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

The following information is confidential:

• content of the agreement, its form;
• the health status of the policyholder, all existing cases of seeking medical care;
• personal data of the policyholder (place of residence, home telephone number, etc.).

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

All cases when the contract can be terminated and the procedure for carrying out this process are listed. At the end of the agreement, the details of the parties are indicated: actual and legal addresses, telephone numbers.

Validity

Several years ago, different compulsory insurance policies were issued in different regions. That is why their validity period varies significantly. In 2011, a gradual transition to a unified compulsory health insurance policy began.

Today, 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 of its validity directly on it.

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

After which it was necessary to carry out their extension. The expiration of the policy is grounds for its replacement.

Necessary documents for registration

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

To obtain a policy, children over 14 years of age (citizens of the Russian Federation) must provide the following documents to the insurance company:

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

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

If the policy is taken out by relatives, then they must present:

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

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

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

Persons over 18 years of age:

• identity document or passport;
• SNILS.

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

• petition;
• certificate of the appropriate type;
• an appeal against a court decision to deprive refugee status to the Federal Migration Service;
• document confirming receipt of temporary asylum.

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

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

Individuals who do not have citizenship (refugees or otherwise) require the following documents to participate in compulsory medical insurance:

• identity card and document confirming lack of citizenship;
• SNILS (if available);
• resident card.

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

Insurance premiums

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

Today, 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 (conducting 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 paid to employees.

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

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

Register of services provided

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

• emergency medical service;
• 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 compulsory medical insurance system provides the following types of medical care:

• dental, oncological (list 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 using special types of vaccines;
• preferential prosthetics, provision of medicines;
• inpatient, provided in special outpatient departments.

Dental treatment according to the policy

Today, the list of services provided under the compulsory medical insurance policy includes dental treatment.

Free of charge, subject to availability:

• conducting an initial examination and consultation (including for patients who are unable to move independently);
• drawing up a preventive disease map;
• treatment:
  • carious formations;
  • pulpitis;
  • periodontitis;
  • periodontal diseases;
  • diseases of the oral cavity, mucous membrane;

• treatment of injuries through surgery, removal of foreign bodies from dental canals;
• removal of teeth and malignant tumors;
• operations on soft tissues of the oral cavity;
• reduction of various types of dislocations.

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

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

What are the types

Today there are three types of compulsory medical insurance policy:

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

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

Amendments have been made to the legislation allowing any citizen to choose the policy format independently.

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 issuing point. To obtain a universal electronic card or a plastic card, you must visit a specialized issuing point.

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 certain cases will it be necessary to make a payment, but this applies only to very rare cases.

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

Video: Protecting patients' rights in the compulsory medical insurance system

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Insurance case- an event that makes it necessary for the insured person to receive medical care, upon the occurrence of which the insurer undertakes to ensure its provision and payment in the manner and under the conditions determined by Federal Law.

Insurance coverage– payment to a medical organization of expenses associated with the provision of medical care to the insured person in accordance with the territorial compulsory medical insurance program.

Health care– a set of measures, including medical services, organizational and technical measures, preventive measures, drug provision, aimed at meeting the needs of the population in maintaining and restoring health.

Medical service– an event or set of actions aimed at preventing diseases, their diagnosis and treatment, which have independent significance and cost.

Health insurance is a system of public health mechanisms, the economic basis of which is financing from special insurance funds.

Health insurance is a new economic relationship in healthcare under market conditions, that is, the creation of a health care and social security system that would actually guarantee all residents of the Russian Federation freely accessible qualified medical care, regardless of their social status and income level.

Thus, in health insurance, the insured event is not an illness or accident that leads to damage to health, but the costs associated with obtaining the necessary medical care included in the insurance program.

Therefore, health insurance is insurance for the costs of medical care in case of illness. We are talking about paying for expenses associated with staying in the hospital and visiting doctors. Health insurance covers only part of the costs associated with the risk of illness, but does not take into account loss of income during the period of temporary disability.

In the Russian Federation, medical insurance is provided in two types: compulsory (CHI) and voluntary (VHI).

Basic principles of health insurance in the Russian Federation:

Universal participation of citizens in the compulsory medical insurance system;

Equal rights of the insured;

Free within the compulsory medical insurance system (for citizens);

Division of powers between the budget and extra-budgetary fund;

A combination of the compulsory medical insurance system and, as an addition to it, the VHI system;

Contractual relationships between participants in the compulsory medical insurance system;

The principle of social solidarity is when the “rich” pays for the “poor”, the “young” - for the “old”, the “healthy” - for the “sick”;

The principle of irrevocability of paid contributions;

The principle of the right to choose insured health care facilities and a doctor (today this right is not fully realized);

Availability of independent organizations in the system - medical insurance organizations;

Financing of health care facilities based on the obtained license;

The main role of the state is that it determines the rules of the game, monitors their compliance, and also takes an active part in financing the compulsory medical insurance system.

The main goal of compulsory health insurance is to capitalize funds and provide credits using collected medical care funds and in guaranteed amounts

Purpose of health insurance- guarantee that citizens receive medical services from accumulated funds in the event of an insured event and finance preventive measures.

In addition, improve the quality and expand the volume of medical care through:

radically increasing spending on health care;

material interest of medical workers in the final results;

economic interest of enterprises in preserving the health of workers;

economic interest of each person in maintaining his health.

Thus, the compulsory medical insurance system should be considered from two points of view. On the one hand, it is an integral part of the state social protection system along with pension and social insurance, on the other hand, compulsory medical insurance is a financial mechanism for providing additional funds to the budget allocations for financing healthcare and paying for medical services.

Compulsory health insurance

Compulsory medical insurance is a system of relations that ensure protection of the financial and social status of the insured persons and guarantee the provision of medical care in the event of an insured event defined by the legislation of the Russian Federation.

Compulsory medical insurance is a type of compulsory social insurance.

Providing accessible, free medical care and equal opportunities to maintain health levels through the introduction of a health insurance system is recognized by everyone and is an essential part of state social policy.

To ensure guarantees of the rights of citizens to protect their health and receive free, high-quality medical care, a system of compulsory health insurance (CHI) was introduced in Russia, which determined the formation of a budgetary and insurance model for financing healthcare and was supposed to become the economic basis for carrying out real reforms of the healthcare system.

In the difficult conditions of a transition economy, it would be impossible to ensure the availability of free medical care without a new financial mechanism that corresponds to new economic changes.

The basis for the Law “On Health Insurance of Citizens in the Russian Federation” adopted by Russia was the Dutch model of organizing health insurance. Its attractiveness lay in the active role of the state in the formation of a socially oriented system aimed at reducing differences in the social status of those citizens who received medical services in the social insurance system (low-income segments of the population) and those who had to insure themselves (highly paid citizens) in voluntary insurance system.

At the same time, in Russia, preparation for the implementation of the Law in terms of the elaboration of its norms, the availability of the necessary calculations, personnel training, and medical outreach work among the population were practically absent. Thus, it turned out that for voluntary insurance the Law came into effect one year earlier, although there were no economic conditions for this.

In many regions of the Russian Federation, the introduction of compulsory health insurance met with significant resistance among managers at all levels, the majority of whom had no interest in implementing the new Law.

At the same time, in a number of constituent entities of the Russian Federation, leaders showed interest in implementing the reform and were ready to take charge of this process - Kemerovo, Samara, St. Petersburg, etc.

It became obvious that in order to achieve the main goal of health insurance, namely protecting the interests of all citizens of the country in the field of protecting their health, amendments to the Law cannot be done without amendments. And in 1993 Resolution of the Supreme Council of the Russian Federation No. 45-43-1 was adopted, and then the Law of the Russian Federation “On Amendments and Additions to the Law of the RSFSR “On Medical Insurance of Citizens in the RSFSR”.

These were fundamental legal acts, the implementation of the main goal of state policy in compulsory medical insurance to ensure equal opportunities to receive medical and drug care at the expense of compulsory medical insurance to all citizens of the Russian Federation required the creation of a new workable infrastructure, that is, a system of institutions capable of implementing the Law in practice. Such infrastructure was created by the Federal Compulsory Medical Insurance Fund of the Russian Federation, and in the regions by the Territorial Compulsory Medical Insurance Funds.