Organization of compulsory health insurance oms. Medical insurance in Russia is compulsory and voluntary - the procedure for concluding an agreement and issuing a policy. Emergency help is always free

The Russian system of compulsory health insurance (MHI) has recently undergone major changes

A number of significant innovations and reforms were implemented jointly by the Ministry of Health of the Russian Federation and the Federal Compulsory Medical Insurance Fund. The modernization of the CHI system and the underlying CHI law adopted in 2010 have been warmly welcomed by many experts and government officials. According to T.A. Golikova: “The adoption of the law on compulsory health insurance is an important stage in the modernization of health care. We are moving to a competitive model in which the patient and the quality of medical care come to the fore. " Unfortunately, over time, some experts and officials began to publicly criticize those basic principles of the modern CHI system, in the development and implementation of which they themselves were directly involved.

So what has the modernization of the compulsory medical insurance system brought to the Russians? How do insurance medical organizations (HMO) and territorial CHI funds interact today? MK understood this.

The compulsory health insurance system was introduced in the 90s with the main goal of saving healthcare in the face of shrinking budgets and guaranteeing free medical care to Russians. The CHI coped with these tasks, but they were replaced by new ones: the modernization of the medical industry, the introduction and widespread availability of new treatment technologies, the transition from medical care mainly in emergency situations to the preservation of health, the prevention of diseases and the prevention of the development of severe forms of dangerous diseases. Recently, the Ministry of Health and the MHIF have done a lot to develop the MHI system in these areas. Today, at the expense of the compulsory medical insurance, a program of medical examination of the population is carried out and high-tech medical assistance is provided in the treatment of complex diseases.

In addition, the procedure for the operation of the compulsory medical insurance system is being improved: more effective methods of paying for medical services are being introduced, new mechanisms are being created to control the quality of medical care and protect the rights of insured citizens. Thus, a single compulsory medical insurance policy has been introduced, according to which every citizen can receive medical care in any corner of the country. The Russians received the right to independently choose clinics and an insurance medical organization.

There is enormous competition in the HIO market today. There is a real struggle for patients, which means that there are more and more incentives to expand the range of services and improve their quality.

Registration of the insured and issuance of the policy

According to the law, a patient can change the HMO at least every year. What if you decide to change the insurer or change the old-style policy to a new one? You should contact one of the regional branches of insurance companies. Regardless of which company you prefer, the insurer will tell you about the procedure for obtaining an OMI policy, your rights in the OMI system, answer all your questions, accept your application and inform you about the terms and procedure for obtaining the policy.

What happens then? If you change the old policy to a new one, the insurer will check your data with the database, immediately print and issue you a temporary certificate (acts as an OMI policy until the latter is received), update its register of insured persons, and send the data to the territorial CHI fund on the same day. In turn, the territorial fund collects all applications received during the day from all insurers in the region and checks whether the information is duplicated at the level of the regional health insurance organization. Then the fund sends the received data to the general database of the Federal Mandatory Health Insurance Fund with an application for a new policy. FFOMS, on the other hand, is already verifying the received data for duplication throughout the country and orders the production of a personal compulsory medical insurance policy on a secure form in Goznak. As soon as it is ready, FFOMS will send the policy to the territorial fund, where it will be handed over to the insurer. The latter will inform the citizen about the readiness of the policy and, accordingly, issue it. In general, the production and delivery of the policy takes no more than 30 working days.

This procedure not only makes it possible for each insured person to receive medical care in any locality of the country and prevents duplication of costs, but also ensures reliable accounting and proportional funding of federal programs by region.

Professional patient support

As already mentioned, today insurance medical organizations are interested in providing the highest quality services to their insured. The patient can contact his health care center for almost any issue related to the provision of medical care. For example, if you are offered to wait a long time for a doctor's appointment or are dragged out with a study, if it seems to you that medical care was provided to you of poor quality, or if you suddenly demanded money for what you are entitled to for free, feel free to contact your insurer. In any of these situations, CMO is not only obliged, but also interested in helping you. The insurer will explain to you what needs to be done to resolve the issue, join in solving the problem, call the head doctor of your clinic or hospital where you are being treated.

If the insurer deems it necessary or at your request, an assessment of the quality of the medical care provided to you will be carried out. If during this check violations are revealed, the medical organization may be fined. CMO will provide you with consulting and legal support. Now these types of control have become a constant practice: for example, in the period 2014-2015, insurance organizations reviewed more than 60 million complaints from patients. However, if it seems to you that insurers are evading their duties, you can turn to the territorial CHI fund with a complaint - and then the insurers themselves are waiting for a check.

It is worth dwelling in more detail on the medical and economic examination and examination of the quality of the medical care provided. Today, this is not only the main function of the insurer, but also the only mechanism for non-departmental control of medical organizations. Under the law, insurers have the right to impose sanctions on polyclinics or hospitals if they provided poor quality medical care. In some cases, this turns out to be a serious incentive for improving the quality of medical services. Such examinations are now carried out by expert doctors, both full-time and freelance. So that such examinations are not carried out for show, there is selective control by the TFOMI, which can conduct a re-examination. And if it turns out that the initial examination of the insurance company was carried out poorly, the territorial CHI fund will fine the insurer itself. To avoid a conflict of interest, doctors who do not work in the organizations that are being inspected are necessarily involved in the examination. And in especially difficult cases, insurers (usually federal) carry out examinations by experts from other entities and with higher qualifications from the country's leading medical organizations. In 2014-2015, according to the results of medical and economic control, 42.6 million accounts were identified, containing 52.6 million violations.

Payment for medical services

And a few more words about how medical care rendered to Russians is paid for today. All the money is accumulated in the FFOMS, from where it is transferred to the TFOMS, which distribute it to their “wards” health insurance companies, depending on the number of insured persons and a number of other indicators. All medical organizations in each Russian region collect monthly bills for all services and send them to insurers. For example, in the Tula region, where there are more than 60 medical organizations included in the compulsory medical insurance system, they all form registers of accounts for payment of medical care, depending on the insurance belonging of patients and send registers to the branches of medical insurance present in the local market. Insurance companies, before paying bills, conduct a medical and economic control to establish the legality of payment (for example, whether the insured company is the right company, whether the service is included in the compulsory medical insurance, etc.). This is done to ensure that government money is used for its intended purpose.

At the end of the inspection, medical organizations receive payment from insurers. However, if the invoice was rejected due to a technical error, the clinic or hospital may issue a second invoice - the insurer is obliged to check it again and, if everything is correct, pay. The money to pay the bills of medical organizations appears on the accounts of medical organizations from TFOMS within a strictly designated period and only for 3 working days: during this time, insurers must accept and process all bills, pay them, and return the balance of funds (if any) to TFOMS. Violation of the deadlines threatens with strict sanctions from the TFOMS, which monitors the quality of the work of the health insurance company. The TFOMI independently carry out only inter-territorial settlements (when the insured in one region of the Russian Federation received medical assistance in another region). However, the volume of such payments is negligible in comparison with the local ones, carried out by the CMO forces.

The system of interaction between the participants of the CHI system, which has been built today, where funds and medical insurance organizations ensure the functioning of the entire system and the possibility of realizing the rights of citizens to high-quality and free medical care, experts recognize as optimal and logical. Of course, this does not mean that there is absolutely nothing more to improve. Changes in this area are ongoing. For example, on the initiative of the Ministry of Health, an institute of insurance representatives has been created and has already begun its work, whose task is to raise the awareness of patients about their rights, to protect their interests even more closely.

And yet, a lot today depends on the activity of the patients themselves, on their desire to take care of their health, and for this - to constructively interact with insurers and protect their rights. If we all demand that medical services be provided to us with high quality, it is within our power to bring the level of health care to a level that we can rightfully be proud of.

The state is ready to provide free medical care to everyone living on its territory, subject to the issuance of an appropriate policy. An agreement or policy of medical insurance in Russia provides equal rights to receive medical and pharmaceutical care for citizens of the Russian Federation and foreigners. This system will help preserve human life and health.

What is health insurance

Medical insurance means protecting the interests of the population in the field of health protection. Payment or provision of free medical services in the event of an insured event at the expense of the funds accumulated by the fund is guaranteed. The insurance medical organization bears the costs in the event of a violation of human health from the moment of the conclusion of the contract and the payment of the first contribution to the fund. In this case, the violation must fall under one of the registered insured events.

Types of health insurance

Medical insurance in the Russian Federation is divided into the following types:

Required.
Voluntary.

Compulsory medical insurance (MHI) is part of the state social insurance system for Russian citizens. This health insurance provides equal rights to provide the necessary care to the patient. At the same time, the volume and conditions for receiving medical care corresponds to the volume and conditions that are declared by the CHI program.

The package of voluntary medical insurance (VHI) services is somewhat broader than that provided by the basic MHI. The rules for voluntary medical insurance are established directly by the insurance company, but the order of conclusions is made within the framework of the general provisions of the relevant law. Certain minor points of contracts with different insurance companies on the issue of medicine may differ.

Compulsory health insurance in Russia

List of free services provided by compulsory health insurance in Russia:

Emergency medical care.
Outpatient care in a polyclinic: diagnostic examination, treatment of diseases in a hospital, at home, in a day hospital. If there is a need to provide emergency medical care, services are provided on holidays and weekends.
Hospital care for: pathologies of pregnancy, abortion, childbirth, exacerbation of chronic diseases, poisoning, acute diseases, injuries requiring immediate therapy, round-the-clock supervision.
Medical care requiring the use of high technologies: a range of treatment and diagnostics services in a hospital setting using unique and complex techniques.
Educational work with the population. Conducting sanitary and hygienic measures.

CHI system

Subjects of compulsory medical insurance:

Insured persons.
Policyholders.
Federal fund.

Objects of compulsory medical insurance:

Territorial funds.
Insurance medical organizations.
Medical organizations.

Understanding the interaction of subjects and objects of CHI will allow a better understanding of the functioning of the structure. The CHI system is a set of subjects and relations between them on the formation of insurance funds and the use of funds associated with the provision of medical care. The bulk of the compulsory medical insurance financing for medical care of the population comes from the Russian budget and is regulated by the compulsory medical insurance system.

Scheme of work

Key points of the scheme of the CHI work, how the budget is distributed between the subjects of the system:

Within the framework of the compulsory medical insurance, cash payments to the population are not made. They go to pay for medical services, which are provided by insurance medicine to patients free of charge. The funds go directly to the system of medical and preventive institutions.
There is limited compensation for medical expenses only, which does not include temporary disability coverage.
The individual principle is that insurance premiums are paid separately for each individual insured, in contrast to the family principle, which operates outside the borders of Russia.
Payment of contribution rates is carried out by the state and the employer. In this case, the state acts as an insurer. Employees are not participants in the financing of the CHI system.

Territorial programs

In accordance with the rules of the basic program of the CHI of Russia, territorial programs (TPOMS) are being developed. The document of the territorial program defines the rights to free provision of medical care to insured persons on the territory of a constituent entity of the Russian Federation. It complies with the unified norms of the main CHI program. At the same time, the financing of the health care of the territorial program is carried out at the expense of payments from the constituent entities of Russia.

Payments go to the budget of the territorial fund are determined as the difference between the standard of financial support for the territorial and the basic compulsory medical insurance program, taking into account the number of insured persons on the territory of the constituent entity of the Russian Federation. The amount of assistance established by the TPOMI of the constituent entity of Russia in which the insurance policy was issued includes the amount of data of insured persons outside the territory of a particular constituent entity.

OMS contract

Obligations of the insured person:

Make insurance contributions to the account of the CHI fund, established by the procedure.
Show the compulsory medical insurance policy when applying for help, with the exception of emergency situations.
Submit an application for choosing an insurance medical organization in accordance with the rules in person or through a representative.
Notify the medical insurance organization about changes in identity documents, place of residence within 1 month from the day when the changes occurred and no more.
Choose another insurance medical organization at a new place of residence for 1 month and no more.

Obligations of a medical insurance organization:

Inform the insured person in writing within 3 working days from the date of receipt of information about the fact of insurance and receipt of the compulsory medical insurance policy from the territorial fund.
Ensure the issuance of an OMI policy to the insured person in the manner prescribed by this federal law.
Provide information to the insured person about his rights and obligations.

Compulsory health insurance policy

A document on compulsory medical insurance is issued by an insurance medical organization to a citizen completely free of charge. Insurance is also provided for non-working citizens. You can get the document yourself or through your representative. Who is the compulsory medical insurance policy issued to and its validity period:

Citizens of Russia - unlimited validity period.
Persons who have the right to receive medical care in accordance with the Law "On Refugees" - a paper policy for a period until the end of the year, not exceeding the period of stay specified in the documents.
Employees of the EAEU member states temporarily staying in Russia - a paper policy until the end of the year, not exceeding the term of the employment contract concluded with the employees.
Citizens of other countries temporarily residing in Russia, stateless persons - a paper policy until the end of the year, not exceeding the validity period of a temporary residence permit.
Foreign citizens temporarily staying on the territory of Russia who belong to the category of members of the Commission of officials and employees of the EAEU bodies - a paper policy until the end of the year, not exceeding the term of execution of the corresponding powers.

Voluntary health insurance

The system of voluntary medical insurance (VHI) is a type of personal insurance that guarantees free medicine, provided for by an agreement with an insurance medical organization. The voluntary medical insurance policy includes preventive, rehabilitation, medical and diagnostic assistance. List of additional VHI services:

dental care (consultation, reception, surgery, physiotherapy, prosthetics);
cosmetic procedures (manual therapy, aesthetic surgery);
treatment of critical diseases (cancer, exacerbation of chronic diseases);
personal options (including additional clinics, consultations and treatment abroad).

For Russian citizens

The contract of voluntary medical insurance in Russia for citizens of the Russian Federation will expand the range of free medical care services, not excluding paid medical institutions. The insurance is valid on the territory of a certain constituent entity of Russia (settlement, region). In addition, the standard VHI agreement provides for the treatment of typical diseases in a child, a number of benefits for pregnant women and women in labor.

For foreign citizens

The VHI policy for foreign citizens provides a guarantee of assistance in the territory of the Russian Federation, stipulated by the agreement. This document is required for citizens of other countries to legally stay on the territory of Russia. Its registration must be started on the first day of stay in the country. Since 2016, a fine has been introduced for the absence of this policy among foreign citizens. At the same time, a foreigner will receive medical care without a VHI policy on the territory of Russia, if his state of health is critical, there is a direct threat to his life.

When applying for a VHI policy for foreign citizens, it is necessary to consult with a specialist. The document can be drawn up by any insurance company with an appropriate license. The cost of the policy is not strictly fixed. The amount depends on the list of medical services that it includes. The place of residence of the foreigner should be taken into account. In addition, if a citizen of another country does not speak Russian, it is necessary to make sure that the selected institution has a medical staff who speaks one of the foreign languages.

There is also a separate type of insurance for migrants. It is mainly used by foreigners from neighboring countries. This document is required for crossing the border with Russia and for legal employment. Often, the VHI policy for migrants differs from the standard VHI contract. It includes a limited set of services at a low cost.

Video

Medical insurance is a form of social protection of the interests of the population in health protection.

The most important regulatory legal act governing compulsory health insurance is the Federal Law of the Russian Federation of November 29, 2010 No. 326-FZ "On compulsory health insurance in the Russian Federation" (hereinafter referred to as the Law).

The law establishes the legal, economic and organizational foundations of health insurance for the population in the Russian Federation, defines the means of compulsory health insurance as one of the sources of financing for medical institutions and lays the foundations for an insurance model for financing health care in the country.

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 terms consistent with compulsory health insurance programs.

As subjects and participants of compulsory health insurance, the Law defines: insured persons, policyholders, the Federal Fund for Compulsory Health Insurance, territorial funds, medical insurance organizations, medical organizations.

Currently, the implementation of the state policy in the field of compulsory health insurance, in addition to the Federal MHI Fund, is carried out by 86 territorial compulsory health insurance funds.

In 2018, in the Russian Federation as a whole, the CHI system received 12,722.4 rubles of insurance premiums per person insured under CHI, which is 1,081.4 rubles (9.3%) more than in 2017. At the same time, for 1 employed person insured under compulsory medical insurance, insurance premiums were received for compulsory medical insurance 19 544.1 rubles, which is 1 802.5 rubles (10.2%) more than in 2017, for 1 unemployed - 7 789.1 rubles , which is 532.3 rubles (7.3%) more than in 2017.

Budget revenues of TFOMI in 2018 were formed in the amount of 2,067.6 billion rubles, which is 340.8 billion rubles or 19.7% more than in 2017. Subventions of the Federal MHI Fund, which amounted to 1,870.6 billion rubles (90.4%), were the main source of financial support for the implementation of territorial compulsory health insurance programs. In addition, the budgets of the TFOMI received interbudgetary transfers from the budgets of the constituent entities of the Russian Federation for additional financial support for the implementation of territorial CHI programs in the amount of 95.4 billion rubles (4.6%).

In 2018, medical assistance in the field of compulsory medical insurance was provided by 9303 medical organizations, 36 medical insurance organizations (HMOs) and their 205 branches in 85 constituent entities of the Russian Federation and in the city of Baikonur.

In the structure of receipts of compulsory medical insurance funds in medical insurance organizations, the main share is made up of funds transferred by territorial compulsory medical insurance funds to pay for medical care in accordance with an agreement on financial support for compulsory medical insurance. For these purposes, 1,784.0 billion rubles were received in 2018 (which is 19.4% more than in 2017) or 95.4% of the total amount of funds received. 18.1 billion rubles (1.0%) were received for the management of the HIO business.

In 2018, 98.5% (1,834.4 billion rubles) in the overall structure of expenditure on compulsory medical insurance by health insurance organizations are the costs of paying for medical care provided to insured persons in accordance with contracts for the provision and payment of medical care concluded with medical organizations. On the formation of own funds of health insurance organizations in the field of compulsory health insurance, 20.3 billion rubles were allocated, or (1.1%).

In 2018, medical organizations received 1,933.1 billion rubles, which is 19.3% more than in 2017. The expenditure of compulsory medical insurance funds by medical organizations in 2018 amounted to 1,908.4 billion rubles, which is 18.4% more than in 2017. In the structure of expenses of medical organizations, the share of expenses on wages and charges on payments for wages amounted to 70.7%, for the purchase of medicines and dressings - 10.0%, food - 1.1%, soft inventory - 0.1 %, other expenses 18.1%.

The number of persons insured under compulsory health insurance as of April 1, 2017 amounted to 146.4 million people, including 61.4 million employed and 85.0 million non-working citizens.

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 will receive free medical care (in the event of an insured event). The implementation is carried out at the expense of the compulsory medical insurance funds within the conditions that are established and / or the compulsory health insurance program.

Compulsory health insurance object- insurance risk associated with the occurrence of an event that is an insured event.

Insurance risk- the alleged event, the occurrence of which leads to the need to pay for the 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 diseases, injuries, other health conditions requiring medical assistance, as well as preventive measures.

Compulsory health insurance coverage- fulfillment of obligations to provide (and pay) medical care in the event of an insured event.

Compulsory health insurance premiums- payments that are obligatory made by policyholders. The contributions are impersonal, their 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 who are not recognized as individual entrepreneurs), as well as individual entrepreneurs engaged in private practice, notaries, 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" (defines the rights and obligations of the insured).

Basic compulsory health insurance program- part of the program of state guarantees designed to provide free assistance. Defines the rights of the insured, exercised at the expense of compulsory medical insurance funds throughout the entire territory of the Russian Federation. Establishes uniform requirements for the respective 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, exercised at the expense of compulsory medical insurance funds in the territories of the constituent entities of the Russian Federation, which meet the uniform requirements of the basic program. LLC AlfaStrakhovanie-OMS 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 Territory; Veliky Novgorod and the Novgorod region, Chelyabinsk and the Chelyabinsk region, Tula and the Tula region, Bryansk and the Bryansk region.

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The doctors were shocked when I showed ...

On weekends, I lay at home with an impossible sore throat and a temperature of 39.6.

Throwing in not the first dose of paracetamol for the day, I called the ambulance. They told me that it was a sore throat and that I should call the district police officer on Monday. The ambulance didn't come.

Zhenya Ivanova

was treated and recovered

I typed in the search bar: "What to do if the ambulance refuses to go." At the forum I saw the advice: “Tell me threateningly that now call the insurance company. They will come right away. " I did so. The ambulance arrived. After that, I twice threatened the doctors with a call to the insurance company and once actually called the number indicated on the policy. It helped every time.

The insurance company protects my rights and really guarantees free treatment. But if you do not know the laws, then unscrupulous doctors can deceive you, refuse treatment, and demand additional payment.

I recovered and decided to figure out what your compulsory health insurance guarantees you.

Meet: your compulsory medical insurance policy

Most likely, you already have a compulsory health insurance policy. Your parents made it to you immediately after birth. It is either in your passport or in a drawer with all the important documents.

If you don't have a policy, drop everything and go to register

Without a policy, you will not get any free treatment. Fortunately, you can get or exchange the policy in any city without registration and registration. To do this, take your passport and SNILS with you and go to an insurance company convenient for you, which draws up these policies.

This is a card If there is no SNILS, go first with a passport to the insurance company, then wait 21 days and only then get the policy.

Citizens of the Russian Federation, foreign citizens, refugees and stateless persons permanently or temporarily residing in the territory of the Russian Federation, can obtain a policy. Citizens of the Russian Federation are issued a policy for an unlimited period of time. By law, even if you have an old-style policy and it is expired, the insurance will still work. Only until you change your passport data: name, surname, place of residence.

If you came to the clinic with an old expired policy and you are denied treatment, it is illegal. You must be accepted. In clinics, everyone is asked to change policies for documents of a new type, but so far this is only a recommendation. Of course, it is better to heed this recommendation: when a law comes out that terminates the old-style policies, it will not take you by surprise.

What insurance companies provide compulsory medical insurance policies

Compulsory medical insurance is an insurance program, that is, everyone pays a little into the common boiler, and then from it they pay those who need it. A common pot is collected by the state from entrepreneurs and distributes funds through an extensive system, which, in turn, pay to hospitals. And an insurance company is an intermediary manager that connects you, the hospital and the state.

Insurance companies make money on compulsory medical insurance in the same way as on other services. They are also responsible for the quality of services and discipline in the system. Your first point of contact is an insurance company.

Each region has its own registers of companies that make CHI policies. Just google it.

Where can you be treated with a compulsory medical insurance policy

To get to a clinic in another city or area, you need:

Choose a clinic. Any, not necessarily the one that is closer to home.
Find out at the reception which insurance companies work with this clinic. If you have a choice, look at the description of the company on the CMO website. Everyone has the same insurance, but some have more offices, and some have round-the-clock support.
Come to the insurance company with a passport and SNILS ohm, fill out an application to replace the policy.
Obtain a temporary certificate. It works like a policy for a month.
Return to the clinic. Say the code phrase "I want to attach to your clinic" in the registry. Receive the application form, fill it out and return it to the registry.

Now you can get treatment in this clinic for free.

If your insurance company serves the clinic to which you are going to attach, then you do not need to change the policy. But you need to inform the insurance company that you have moved and want to be treated elsewhere. Otherwise, the new clinic will not receive money for your treatment.

Why do you need to attach to the clinic

You need to attach yourself to the polyclinic, because in our country there is a system of per capita financing. Money for your treatment is given only to the institution to which you are assigned. Therefore, you cannot attach to several clinics at once. You can also officially change the clinic no more than once a year. Previously, this can only be done if you have moved. In this case, in the new clinic, you will be asked to write a statement addressed to the head physician.

You cannot attach to a research institute or a hospital, only to a district clinic. And already there, your local therapist will write out referrals to narrow-profile specialists: an eye surgeon, a cardiologist, a chiropractor. Without a referral from the attending physician or an ambulance specialist in specialized clinics, you can only be admitted for a fee.

What is UMIAS

In Moscow, the data of all patients are entered into the UMIAS - a unified medical information and analytical system. This simplifies the process of making an appointment with a specialist: you can get a ticket to a doctor, cancel or postpone an appointment, and receive a written prescription in electronic form. UMIAS even has a mobile app.

Please note: if you have moved and decided to attach to a new clinic, then you cannot just take it and do it through the system. You need to write an application addressed to the chief physician and wait for the bureaucratic apparatus to approve it. It may take 7-10 business days. If you are registered on the portal of Moscow state services, then you can submit an application in electronic form. They promise to consider it in 3 working days.

When I faced such a problem, I needed help urgently. And according to the law, they are obliged to help me without any delay of many days. But in the polyclinic they are afraid that if they treat me before the clumsy car enters new data into the UMIAS, they will not receive money for me from the insurance company.

Right in front of the hospital administrator on duty, I called the insurance company, after which I received the necessary consultations at the hospital for free. I was also examined by a whole commission of department heads, and to this day everyone treats me very carefully.

What is included in the compulsory medical insurance treatment

The Compulsory Health Insurance Act entitles all of us to receive treatment free of charge. And even if your policy has expired, you can still use it.

If you do not have the policy with you, you can still make an appointment with a doctor, they have no right to refuse you.

Although for nurses this is an additional concern, therefore, most likely, they will try to convince you that this is not possible. If this happens, just call the insurance company.

In any unclear situation, call the insurance

The minimum amount of assistance is described in the basic compulsory health insurance program. Whether to add something else to this list, each region decides on its own. The exact list of insured events can be found at any clinic or on the website of the Ministry of Health in your region.

In any case, you can apply the following rule: if something threatens your life and health, it is treated free of charge. If you are generally healthy, but want to feel even better, then most likely you can only do it for money. If the state can help you, but the level of this assistance seems too low for you, you will have to put up with it or pay extra.

Examples of what can and cannot be done under the compulsory medical insurance policy

It is forbidden	Can
Teeth whitening is an aesthetic procedure	To brush your teeth, because it is the prevention of tooth decay
Get imported Japanese adult diapers by choosing a brand yourself	Get diapers for an elderly person
Remove a couple of extra pounds. Your figure is not insured by the state	Remove boil
Wait on exercise therapy for exercises from Hatha Yoga or the modern gym	Go to physiotherapy exercises
Consult a dermatologist if you are worried about simply increased oily skin of the face	See a dermatologist for a serious skin rash
Make a denture	Remove the tooth

Teeth whitening is an aesthetic procedure

Brushing your teeth because it is caries prevention

Get imported Japanese adult diapers by choosing a brand yourself

Get diapers for an elderly person

Remove a couple of extra pounds. Your figure is not insured by the state

Remove boil

Wait on exercise therapy for exercises from hatha yoga or a modern gym

Go to physiotherapy exercises

Consult a dermatologist if you are worried about simply increased oily skin of the face

See a dermatologist for a serious skin rash

Make a denture

Remove the tooth

When something hurts, you can get an appointment with a therapist free of charge, who will write a referral to a specialist. If indicated, the therapist should write referrals to any doctors who work in government clinics.

Without a referral, you can make an appointment with a surgeon, gynecologist, dentist and a dermatologist at a dermatovenerologic dispensary. Or make an appointment with a child psychiatrist, surgeon, urologist-andrologist or dentist. The OMS does not guarantee free tests and examinations without a referral from the attending physician.

Once every three years, you can undergo a free medical examination and find out if everything is in order with your health. Clinical examination is carried out for everyone every three years - that is, if this year you turn 21, 24, 27 years old, and so on.

The compulsory medical insurance program also includes free pain relief and rehabilitation after illnesses and injuries. But for one or two, it will not work out in which case you are entitled to free insurance assistance, and where you have to pay on your own. There are a lot of nuances in this matter. If you have a rare illness or difficult situation, contact the Federal Compulsory Medical Insurance Fund.

What exactly is not included in the CHI program

The state will not pay for:

Any treatment without a doctor's prescription.
Conducting surveys and examinations.
Home treatment at will, not on special indications.
Vaccinations outside government programs.
Spa treatment if you are not a sick child or pensioner.
Cosmetology services.
Homeopathy and traditional medicine.
Dentures.
Superior rooms - with special meals, personalized care, TV and other pleasures.
Medicines and medical devices if you are not in hospital.

If the hospital asks for money for services that are not on this list, just in case, call the insurance company and ask if it is legal.

Privileges

For people with disabilities, orphans, families with many children, participants in hostilities and other citizens who are entitled to social benefits, the state is ready to pay for more medical services. Each category has its own list of benefits, you can find them in the department of social protection or find them on the Internet.

Sometimes you are legally entitled to free treatment, but doctors just shrug their shoulders. There may be a queue of up to several months for free rehabilitation, and there may simply not be any pain relievers in your local hospital. It's illegal, but it's a fact of life.

Extortion

Doctors are people too, and nothing human is alien to them. Like any person, getting a lot of money from you right now is more interesting for some doctors than getting a little less money from insurance and much later. Therefore, a whole illegal practice of extortion of money for treatment under compulsory medical insurance has grown in Russia.

This extortion is based on legal illiteracy. It is enough for the doctor to pretend to be smart and take a stern tone for the frightened patients to start throwing money at him. But the slightest sign that the doctor is legally savvy patient - and the tone changes. Therefore, it is very useful to know which medical services are obliged to provide you free of charge.

Remember that the treatment is free only for you. The hospital and the doctor will receive money for this treatment from the health insurance fund. This money was paid to the fund by entrepreneurs, including your employer.

You do not need to pay a second time out of your pocket for what the state guarantees you. Moreover, the doctor is likely to receive payment from the fund anyway, even if you are forced to pay.

You do not pay for the treatment, but the hospital will receive money for it.

If you know for sure that you should and can be treated for free, but the doctor offers to pay, call the insurance company. The insurance number is written on your policy, the hotline specialists will help you.

If you cannot do this, ask your doctor to write a written refusal to provide free medical care. If the doctor is behaving provocatively, you can turn on the recorder, it is legal. If even this does not help, call the department for the protection of citizens' rights in the CHI system.

7 499 973-31-86 - telephone of the department for the protection of citizens' rights in the CHI system

Emergency help is always free

If something really bad happened - you lost consciousness, broke your leg or feel acute pain - you should be helped in any state clinic, even if you don't have any documents with you and you have never received a policy.

The hospital does not have the right to refuse assistance to newborns and children under the age of one year, even if the child's parents do not have a policy and registration. Pregnant women cannot be denied - they can contact any antenatal clinic and any maternity hospital, even without documents.

All participants in the health care system are just people: acquaintances, friends, brothers, matchmakers and godfathers. They have parents and children. They are all Russians and they work just like any of us.

If a surgeon demands a bribe for pain relief, then this is not the health care system, it is this particular surgeon, his parents and teachers. This means that his father, somewhere in his childhood, gave him an example that a bribe is normal. How do you feel about bribes yourself?
If a hospital says that it has no money for medicines, it is not Putin's fault, but some officials who do not know how to draw up budgets. Or the head physician who does not know how to manage money. You have a lot of people you know who do the same things in their jobs.
After all, when you get your salary in an envelope, it’s your employers who are underpaid to the health insurance fund. Where will the money for your medicines come from, if you have allowed not to pay for them?

It turns out to be mild schizophrenia: the same person maintains a gray salary and complains about insufficient funding for hospitals.

Putin, Navalny, Medvedev, Tinkov or Trump will not solve our health problems. We will solve this problem ourselves if we give our children an example of conscientious attitude to work and the law. To skip classes at the institute was not a feat, but a shame. It was a shame to pass tests for money. To give bribes was against our principles. To know and defend their rights was a duty, not a superpower.

In short: no one will fly in and provide us with free medicine like in paid Israeli clinics. All the hell that we see in hospitals is not hospitals, it is ourselves. And me too.

Let's start by paying taxes and fees. I have everything, thanks. Sorry for the moralizing tone, but I just got fed up with this nagging.

Remember

If you don't have a policy, drop everything and go to register.
With a compulsory medical insurance policy, you should be treated free of charge in any state clinic throughout Russia.
Treatment is free only for you. The hospital and the doctor will receive money for this treatment from the health insurance fund.
The policy works even if it has expired. If you come to the clinic with an old policy and you are denied treatment, it is illegal.
In any unclear situation, call your health insurance company. The number is on the policy. Write it down to your phone right now.
If the insurance company does not save you, call the Federal Compulsory Health Insurance Fund: +7 499 973-31-86.
If you have spent money on treatment, which should be free of charge by law, write a statement to the insurance company - you must get your money back.
Emergency assistance is always free, even if you have no documents.