According to the Federal Compulsory Medical Insurance Fund, more than half of Russians (85 million out of 146.5 million) are considered unemployed. These are the most diverse groups - children, pensioners, the disabled, those who were nicknamed in the government. They are entitled to health care in the same way as workers. Since we have compulsory health insurance, the system receives contributions for each citizen. Employees pay contributions from their salary (or rather, they are deducted by the employer). And for the unemployed, their region pays contributions. It was planned that in 2017 contributions for the non-working population would amount to (and for the working population - 1 trillion rubles).

Finding these 619 billion rubles is difficult. In 2016, 10 constituent entities of the Russian Federation experienced "permanent difficulties in paying contributions for the non-working population." About it said in a letter from Deputy Head of the Ministry of Health Dmitry Kostennikov dated November 21, 2016, which was sent to the Ministry of Labor, the Ministry of Foreign Affairs, the Ministry of Finance and other departments (Life has a copy). It is not specified which regions exactly, and the federal CHI has not yet responded to our request.

Of course, the main burden that officials want to rid the system of is parasites. A bill is currently being developed, according to which citizens who do not work without a good reason will have to pay a tax for the use of medical infrastructure.

Children and wives of labor migrants will be left without compulsory medical insurance

But the Ministry of Health continues to think through other ways to shed the "ballast".One of the proposals is to deprive migrants from the EAEU countries (Belarus, Kazakhstan, Armenia, Kyrgyzstan) and their families of the right to CHI (this proposal is discussed in Kostennikov's letter). To do this, it is necessary to amend the Treaty on the Eurasian Economic Union.

This agreement states that labor migrants from these countries and their families have the same rights to medical care as Russian citizens (and vice versa, Russians who came to work, for example, in Belarus, will have the same rights as Belarusians).

The Ministry of Health proposes to change the wording so that it turns out like this: " Citizens of the EAEU member states working in the state of employment on the basis of employment contracts are subject to compulsory health insurance. "At the same time, all other categories of migrants, as well as members of families of labor migrants, are excluded from the CHI system."

One of the arguments of the Ministry of Health: to Russia from Belarus, Kazakhstan, etc. travel much more often than vice versa, so that Russia has more expenses, which is unfair. In addition, not all EAEU countries have a CHI system, which means that parity is violated.

The Ministry of Labor has already considered the proposal of the Ministry of Health (deputy head of the Ministry of Labor Alexei Cherkasov sent a response to the Ministry of Health on December 27, Life has a copy). The position of the Ministry of Labor is that labor migrants from the EAEU countries who work not under an employment contract, but under a civil law contract, should also be left in the MHI. After all, the salaries of these migrants pay contributions to the Russian compulsory medical insurance system.

The difference between the contracts is, for example, that according to civil law, an employee does not receive a salary strictly twice a month, and when he performs a certain amount of work, he may not be paid for sick leave and vacation.

At the same time, the Ministry of Labor did not object to the exclusion of families of migrants from the EAEU countries from compulsory medical insurance.

Servicemen who fail to submit their CHI policy on time will receive a fine of 5,000 rubles

The second proposal of the Ministry of Health is a draft law "On Amendments to Certain Legislative Acts of the Russian Federation on Issues of Personal Accounting in the Sphere of CHI". The measures that are prescribed there should reduce the unreasonable costs of the CHI system.

The draft law more clearly indicates who is not insured in the CHI. These are military personnel, employees of the Ministry of Internal Affairs, the Ministry of Emergency Situations, employees in the National Guard and other categories. They have their own, departmental, medicine, they receive medical care at the expense of the budget, and not at the expense of compulsory medical insurance. The Accounts Chamber, after analyzing the bill, proposed to include in this list also prosecutors and employees of the Investigative Committee (they receive medical care according to the same principles).

And if these people, when receiving their status or position, do not hand over their CHI policies on time, they receive a fine of 5 thousand rubles. And if insurance companies, tax authorities and regional compulsory medical insurance funds provide false information to the unified register of the insured (that is, for example, they indicate among the insured military personnel), they must pay a fine of up to 100 thousand rubles (if repeatedly - up to 200 thousand rubles).

Previously, insurers recognized that the state could pay twice for the treatment of such groups of citizens.

A citizen who has the right to departmental medical care (for example, a military man) and who has a passport of a citizen of the Russian Federation in his hands applies for an OMI policy to an insurance company without reporting his departmental affiliation, - said Alfastrakhovanie-OMS Development Director Alexander Troshin. - As a result, funds for the provision of medical care to such a citizen begin to be budgeted both through the department and through the CHI.

True, as stated Director of the Institute for Health Economics at the Higher School of Economics Larisa Popovich, it happens that departmental clinics agree on cooperation with clinics working in compulsory health insurance - and then military personnel go there quite legally.

Another innovation spelled out in the bill: the regional CHI funds are obliged to check whether insurance companies correctly provide information about the insured. But the Accounts Chamber objects: "The proposed novelty is obviously impracticable, since the territorial funds of compulsory medical insurance are not endowed with a sufficient amount of administrative and power powers."

From the rich to the smokers. Who else can be thrown overboard?

Doctor of Economic Sciences, one of the creators of the CHI system Vladimir Grishin said that "in a number of countries, people who receive incomes above a certain level are excluded from the CHI."

For example, if a person receives more than 10 million rubles a year, he said.

True, in Russia this measure would not make sense: rich people do not go to district clinics anyway.

Previously, he told Life that people who are addicted to smoking should not be treated within the CHI system.

If a person wants to receive a service, he goes to a paid doctor or through voluntary health insurance, he said. - This, at least, will stimulate to think whether he should smoke or not. Are we going to include all types of addiction in the CHI system? No one increases contributions, we do not have enough money for high-tech types of assistance, and we will treat addictions. Everything is real, but what will it look like? I treat him, and tomorrow he smoked again! Money down the drain, money down the drain, - said Grishin.

And the vice-mayor of Moscow for social development, Leonid Pechatnikov, earlier proposed issuing compulsory medical insurance policies only to those who have undergone a medical examination. According to his idea, policies will have to be changed every three years - and once every three years a person will be forced to undergo medical examination. This will help to detect diseases in a timely manner - thus the patient will be healthier, and the money for his treatment will be spent more economically.

On August 10, Federal Law No. 268-FZ of July 29, 2018 “On Amending Certain Legislative Acts of the Russian Federation and Recognizing Paragraph Eleven of Part Two of Article 16 of the Federal Law “On Individual (Personalized) Accounting in the Compulsory Pension Insurance System” as invalidated ".

Most of the amendments are clarifying and editorial in nature. Basically, the changes affected the Federal Law of November 29, 2010 No. 326-FZ "On Compulsory Medical Insurance in the Russian Federation" (hereinafter - Federal Law No. 326). A considerable part of the changes is related to information interaction in the conduct of personalized accounting by the bodies - we will start with them.

Now Federal Law No. 326 contains an indication that interaction between bodies is carried out through the use of unified system of interdepartmental electronic interaction and connected to it regional systems of interdepartmental interaction.

The territorial fund has a new authority - to conduct verifying the accuracy of information about insured persons provided by insurance medical organizations, based on information received as part of information interaction, including by sending requests to the authorities that issue and replace documents proving the identity of a citizen of the Russian Federation.

As part of information interaction, the bodies have new responsibilities:

  • The territorial fund must quarterly, no later than the 15th day of the third month following the reporting period, provide the insurer for non-working citizens with information about non-working insured persons. Insured persons whose details are not provided will be counted as non-working insured persons.
  • On a quarterly basis, no later than the 15th day of the month following the reporting period, the Ministry of Internal Affairs of Russia is entrusted with the obligation to transfer information to the Federal Fund:
    • on persons whose Russian citizenship has been terminated;
    • about foreign citizens, stateless persons, in respect of which the residence permit has been cancelled;
    • about foreign citizens, stateless persons, in respect of which the temporary residence permit has been cancelled;
    • about the loss of refugee status or the deprivation of refugee status by persons who had such status.
  • On a quarterly basis, no later than the 15th day of the month following the reporting period, military commissariats must transmit to the territorial funds information about citizens called up for military service, as well as information about the beginning, duration and end of military service.

And here we move on to the most interesting. Chapter 10 of the Federal Law No. 326 was supplemented with a new article 49.1 on the suspension of the compulsory medical insurance policy and its invalidation.

Now the CHI policy is invalidated if:

  • termination of citizenship of the Russian Federation (in the absence of grounds for recognition as an insured person);
  • cancellation of a residence permit for foreign citizens and stateless persons;
  • cancellation of a temporary residence permit for foreign citizens and stateless persons;
  • loss or withdrawal of refugee status.

The policy in these cases is invalidated. from the date of receipt by the Federal Fund of information from the Ministry of Internal Affairs(just these are the new duties of the Ministry of Internal Affairs, as we wrote above).

The CHI policy is suspended if call (receipt) for military service or service equivalent to it for the period of passage of such service by the insured person. Moreover, such citizens (with the exception of those undergoing military service on conscription) are required to hand over the CHI policy or report its loss by submitting an application to any insurance medical organization or territorial fund. In principle, a policy will not be needed in military (equivalent to it) service, because military personnel receive medical care in military medical organizations in accordance with Federal Law No. no, then in the Ministry of Defense of the state or municipal health care system, which subsequently reimburse the costs from the federal budget, taking into account Decree of the Government of the Russian Federation of December 31, 2004 No. 911).

At the same time, how then to “return” the policy back is not said. Sanctions for non-compliance are not yet provided. At the same time, the Ministry of Health, back in 2017, expressed its “wishes” on the introduction of a fine of 5,000 rubles for failure to submit the CHI policy. So we are watching - maybe changes in the Code of Administrative Offenses are just around the corner.

Free medical care, which is guaranteed by a compulsory medical insurance policy, is not supposed to be for all citizens of Russia. Military personnel, for example, do not have such a right, since they are attached to departmental medical institutions. However, due to the unsuccessful reform of military medicine, people in uniform in a number of regions are experiencing problems with medical care.

How is this not required by the policy? - my former colleague captain Roman Severin was amazed. - I recently went to the insurance company and calmly received it. Just do not need to say that you are wearing shoulder straps, because they do not require a certificate from the place of work, but only a passport and a pension insurance card ...

It turns out that all those military personnel who today have a green plastic card that guarantees free medical care throughout Russia either received it before 2004 or deceived representatives of insurance companies. This, by the way, applies to employees of both the police and other law enforcement agencies, who, in accordance with paragraph 2 of Article 245 of the Tax Code of the Russian Federation, as amended on June 24, 2004, do not pay tax in part of the amount credited to the Social Insurance Fund. Namely, it is from it that compulsory medical insurance funds should receive contributions, through which municipal polyclinics and hospitals are financed.

After the release of the amendments, the military, of course, did not turn over policies to insurance companies. Many keep them “just in case”: for example, to receive medical assistance on vacation or a business trip, where it is not easy to get to a departmental hospital. In addition, it was possible to obtain several policies in different insurance companies, because the creation of a single database of insured persons was started only this year, after the Law “On Compulsory Medical Insurance in the Russian Federation” came into force on January 1. On May 1, citizens began to receive a new compulsory health insurance policy. The preparatory work made it possible to create a single base. In an interview with the correspondent of "Parliamentskaya Gazeta", the chairman of the MHIF Andrey Yurin said that its absence led to the fact that the number of insured as of January 1, 2009 exceeded the population by 700,000.

Due to the confusion, the Compulsory Medical Insurance Fund received money from working citizens in the form of taxes for the treatment of "dead souls". And for military personnel who illegally have a policy, the state pays twice. The first time - in the form of defense spending, the second time - through the municipalities, which pay funds to the Compulsory Medical Insurance Fund for non-working citizens. If for employers the amount of the insurance premium is determined at the legislative level and amounts to 5.1 percent of the wage fund, then for the non-working population there was no single tariff for CHI before. Each region, depending on the filling of the budget, set its own amount - from 300 rubles to 15 thousand per person per year. The law "On Compulsory Health Insurance in the Russian Federation" provides that after the transition period, a single minimum payment for the entire country for the non-working population will be established, below which no region will be able to set its own bar. Since the financial situation of the subjects of the Federation differs, territorial coefficients have been developed that will take into account climatic conditions, the level of morbidity, mortality and other factors. According to the chairman of the Compulsory Health Insurance Fund, the national average for such a payment will be about six thousand rubles. There is no time for "dead souls".

“After work began on the formation of a unified database, it turned out that there are 2.5 million fewer insured people than the population as a whole,” Andrey Yurin noted. “The difference in numbers is understandable, for example, military personnel are not included in the CHI system.”

By law, the old-style compulsory health insurance policy remains valid until January 1, 2014. The rest do not need to change the policy urgently. Now it is issued to newborns, people who have changed their last name, first name, patronymic or a medical insurance organization. However, it is planned that from January 1, 2012, universal electronic cards will be introduced, which will contain all social guarantees of a citizen, benefits, disability, medical insurance. Consequently, deception of the insurance company will become impossible: the base will show that the citizen wears shoulder straps and has no right to receive a policy. From January 1, 2011, this is regulated by paragraph "g" of Article 10 of the Law "On Compulsory Medical Insurance in the Russian Federation".

Back in 2004, the government provided for the possibility of treating servicemen in municipal medical institutions. The rules for the provision of medical care to patients in uniform, approved by Decree of the Government of the Russian Federation of December 31, 2004 No. 911, indicate that in the absence of a serviceman, residence or other location of a military man, as well as in urgent cases, medical care is provided in state or municipal health care system with subsequent reimbursement of expenses incurred. However, far from all municipal medical institutions, the Ministry of Defense has signed service agreements. And often the patient in uniform has to prove at the reception that assistance can and should be provided to him according to the law, and the costs of the clinic will subsequently be reimbursed. Therefore, it is easier for a soldier to pretend to be unemployed with a policy than to do everything according to the law.

Today, far from all types of medical care are paid from the money of the Compulsory Medical Insurance Fund. For example, if a citizen does not have a policy, he will still be provided with emergency, high-tech, psychiatric care and assistance during childbirth. However, the new law on compulsory medical insurance provides for a gradual, until 2013, inclusion in the system of compulsory medical insurance of all the listed areas of medicine. Consequently, in the near future, the absence of a policy will mean for the military an infringement of the rights to free medical care.

When asked how a serviceman should act in this regard, Andrey Yurin replied that in the future every citizen should have a compulsory medical insurance policy.

“If we talk about the future, then everyone who is not insured today and uses separate, special conditions for receiving medical care will sooner or later join the general compulsory medical insurance system,” he stressed. - This help is more accessible, it is clear where and how to get it. Today, a reform is underway, the infrastructure of the Armed Forces is being built in a new way, and I am sure that the number of those who are not included in compulsory health insurance will decrease. It is clear that military medicine has special tasks, but primary care can also be provided in civilian medical institutions.

A few years ago, this problem did not really bother the military. There was a system of medical care that fully provided for the needs of the army. Before the start of bringing the Armed Forces “to a new look”, the staff of medical officers was more than 20 thousand, and there were almost 150 thousand civilian employees in medical institutions. More than six million officers, ensigns, retirees and members of their families were treated in military medical institutions. Since the fall of 2008, the situation has changed dramatically. Military medicine also fell into the millstones of the reform. According to some reports, more than 60 departmental hospitals and more than 80 polyclinics were liquidated. Because of this, for many military personnel and pensioners, medical care has become inaccessible. There are now no medical facilities on the territory of 18 regions, 30 military units are deployed at a considerable distance from them. Such data was given at a meeting of the Coordinating Council for the Social Protection of Military Personnel, Law Enforcement Officers and Members of Their Families by Chairman of the Federation Council Valentina Matviyenko. According to her, the parliamentarians are ready to initiate the necessary bills aimed at improving military medicine.

In addition, the low level of remuneration of civilian personnel of departmental medical health institutions provoked an outflow of highly qualified specialists, personnel of middle and junior medical personnel. The level of assistance provided has decreased significantly.

In most cases, unsolvable problems are usually explained by the lack of funds. However, in the case of military medicine, this is not entirely true. Finance Ministry spokesman Aleksey Kaulbars said that 39 billion rubles had been allocated for the health care of the Defense Ministry. A little more than 60 percent of this money has been spent, and only a third has been disbursed in the construction of healthcare facilities. Meanwhile, according to the Accounts Chamber, almost forty percent of the medical units and institutions of the Ministry of Defense are located in buildings that do not meet technical and sanitary standards, and 27 percent of the facilities are in need of major repairs. Because of this, already purchased expensive medical equipment is idle - there is simply nowhere to place it. Military prosecutors have repeatedly drawn the attention of the leadership of the Ministry of Defense to the critical state of military medical institutions, the poor supply of medicines and medicines. The following fact speaks of the disorder in this area: the head of the Main Military Medical Directorate, Major General Alexander Belevitin, was recently removed from his post and arrested.

However, this is of little concern to the "man with a gun." But the lack of access to medical care is a completely different matter.

Dmitry OLISHEVSKY

On the territory of the Russian Federation, a law has been developed that allows you to correct actions related to the suspension or complete termination of insurance. In order to carry out various optimization processes, it was decided to develop documents abolishing compulsory medical insurance for those employees who work in the structure of the Ministry of Internal Affairs and the Federal Penitentiary Service.

On the territory of the Russian Federation on August 10, a new law was launched abolishing the issuance of compulsory medical insurance for persons who work in the Ministry of Internal Affairs and the Federal Penitentiary Service

Official information was provided by the head of the Federal Compulsory Medical Insurance Fund (FFOMS) Natalya Stadchenko. She says that the law abolishes compulsory insurance for those persons who previously issued a compulsory medical insurance policy. After the adoption of this law, the FFOMS budget will be more carefully formed. Also, the adoption of the bill provides for improving the quality of the formation of the necessary budget of all regions of the Russian Federation.

After the introduction of the considered draft law, compulsory medical insurance companies located in the constituent entities of the Russian Federation will form the budget in a different way. The last resort is also subject to a new obligation. Regional CHI will be able to control all the processes that take place at the time of insurance of citizens of the Russian Federation.

In order to determine the reliable number of insured persons in the country, the Cabinet of Ministers will develop a methodology that allows for a full calculation. Despite the fact that employees of the Ministry of Internal Affairs and the Federal Penitentiary Service are no longer required to draw up a compulsory medical insurance policy, the law also establishes a norm for providing information for those institutions that draw up this document.

Every calendar month, compulsory medical insurance funds will provide all the necessary information

Territorial and federal compulsory health insurance funds must prepare information every month regarding the number of insured people. It is also necessary to display objective indicators that relate to the suspension or complete cessation of cooperation between people and the institution.

Now only those people who work in the internal affairs bodies of the Russian Federation, as well as in the fire service, courier communications and the Federal Penitentiary Service are now exempted from compulsory medical insurance. Also, customs officers do not need compulsory medical insurance. The document was adopted because many citizens who become soldiers receive double support from the state.

Regional authorities pay contributions to the MHIF for non-working insured people. In turn, employees of internal affairs bodies receive medical care, which is funded by the state. Entrepreneurial citizens do not close compulsory medical insurance policies, receiving double assistance.