Compulsory health insurance entitles the citizens of the Russian Federation to free treatment and medical assistance. Along with obtaining a compulsory medical insurance policy from an insurance company, a citizen of Russia receives certain rights and obligations. What are these rights, who are they developed and what is required by law for an insured patient? We will try to answer these questions in detail in this article.

The rights of a citizen participating in the CHI program

In the Federal Law No. 323 "On the basics of health protection" you can find a list of obligations and rights assigned to the insurance participant. The document was issued on November 21, 2011, and the latest amendments to the law entered into force on 01/09/2017. In accordance with the specified Federal Law, patients insured in the CHI system have the right to:

  • Choose a doctor, medical institution at your discretion;
  • Get diagnostics, preventive procedures and examinations, rehabilitation in honey. centers and organizations; at the same time, health care facilities (medical and preventive institutions) must comply with all legally established sanitary and hygienic rules;
  • Receive timely advice from general practitioners and specialists;
  • Get medicines and medical interventions that can relieve pain in various diseases;
  • Be informed about their responsibilities, rights, health;
  • Select other citizens to whom information about the state of his health will be transferred;
  • Keep information about your health in confidence and receive protection from unauthorized access by third parties to this data;
  • Refuse any kind of medical care.

Patients undergoing treatment in a medical facility on a 24-hour and day-long stay or receiving an ambulance and emergency care have the right to receive medicines free of charge. This is done in accordance with a special list of vital and essential drugs. It contains the most important and vital medicines. A participant in the CHI program has the right to admit him to a medical institution for a priest. It is not prohibited to obtain a separate room, if it exists, and if it does not contradict the internal laws of the healthcare facility.

There are times when a citizen with a compulsory medical insurance policy is offered to receive any procedure, an examination for money, or to buy medicines. In this case, it is worth checking whether these services and medicines are included in the compulsory medical insurance program. To do this, you can contact the insurance company in person or call the phone number, usually it is indicated on the policy.

Note! If the hospital staff cannot fulfill all the necessary appointments for the patient, then the free receipt of services is organized in another institution. This is ensured by the healthcare facility to which the citizen initially applied. If damage to health is recorded due to improper actions of medical personnel, the victim has the right to compensation for damage.

All citizens of the Russian Federation have equal rights to health care, medical care and responsibilities common to all. However, some categories of citizens, for example, military personnel, minors, persons with disabilities, due to the specifics of their activities, age or state of health, have special rights in the field of health protection. Detailed information on the formed rights of certain categories of citizens is contained in the following articles:

What responsibilities are assigned to citizens participating in the CHI program

In addition to rights, citizens who have drawn up a compulsory medical insurance document have a number of responsibilities. They are enshrined in Article 27 of the Federal Law of November 21, 2011 No. 323-FZ, as well as in Article 16 of the Federal Law of November 29, 2010 No. 326-FZ. Normative acts oblige citizens to:

  • When choosing a health insurance company in the territory of residence, independently or with the help of a representative, submit an appropriate application;
  • When contacting clinics, hospitals, sanatoriums, dispensaries and other medical organizations, it is imperative to present an insurance document - a policy. In the event of emergency care, this rule is canceled;
  • In cases of changes in passport data, addresses, notify the insurance company within 1 month.

If the place of residence has changed and the former insurance company does not geographically serve this region, you must choose another OMS insurance organization operating in the new place of residence.

The compulsory health insurance policy provides access to free health care services. But does everyone know what opportunities the compulsory medical insurance policy provides, what is included in the free service, what types of examinations and operations can be carried out?

Legislative acts regulating the CHI system

Free health care services are provided under compulsory health insurance. The compulsory medical insurance system guarantees citizens equal rights to receive medical services. It is regulated by a number of normative legal acts:

  • Law No. 326-FZ "On Compulsory Medical Insurance in the Russian Federation";
  • government decree No. 1403 "On the program of state guarantees for free provision of medical care to citizens for 2017 and for the planning period of 2018 and 2019", which contains the basic compulsory medical insurance program. This document, in particular, explains what is included in the MLA in 2017;
  • a number of other acts allowing citizens to receive the minimum guaranteed volume of services.

Who is eligible for free health care?

Both Russians (indefinitely) and stateless persons of the Russian Federation (with a limited period of validity) can get a compulsory medical insurance policy. The presence of this document means that the patient is under the protection of the insurance company with which he entered into a contract.

Medical care is provided by the healthcare organization (both public and private institutions participate in the CHI system) to which the patient is attached. At the same time, he has the right to change the clinic and the attending physician once a year and an unlimited number of times - when moving to another place of residence. Once a year, it is allowed to change the insurer, this must be done no later than November 1.


List of services under the compulsory medical insurance policy

What types of medical care are available under the policy, does it include high-tech diagnostic methods, is MRI included in the list of free compulsory medical insurance services?
The legislation provides for the following forms of medical care:

  • emergency (ambulance);
  • outpatient, including examinations (the basic list includes MRI, ultrasound and endoscopic methods (gastroscopy, colonoscopy, etc.);
  • stationary:

- in cases of exacerbation of diseases;
- referral to treatment and operations (among the available services - chemotherapy, removal of prostate adenoma, treatment of diseases in gynecology, etc.);
- medical services for pregnant women, as well as childbirth, recovery after them, abortion;
- when intensive therapy is required (in case of poisoning, severe injuries);

  • high-tech;
  • palliative.

The last item concerning serious illnesses was added in 2017. In total, the basic list includes about 20 cases for which free medical care is available.

Is it allowed to carry out therapeutic massage, remove papillomas, warts - are such procedures provided by the compulsory medical insurance policy, which is included in the program? Taking a massage course at no cost will allow the availability of indications for the procedure. With regard to skin defects, the operation will be carried out free of charge if the growth is bleeding or damaged, that is, there is a danger to the life and health of the patient.

Within the framework of the CHI system, there are basic and territorial programs: the first is applied throughout the country, the rest - within a specific constituent entity of the Russian Federation. The list of services for regional programs is wider. For some of them, free tests for chlamydia and spermogram, some allergy tests are provided (such types of examinations, for example, are carried out under the compulsory medical insurance policy in Moscow, in the Moscow region and in St. Petersburg).

From time to time, the media report on public initiatives to add or delete a particular service from the list. Thus, earlier proposals were discussed to exclude abortion from the compulsory medical insurance system and to include the work of a nutritionist in it, but they did not find reflection in legislative acts.


Dental services under the compulsory medical insurance policy

Is free dentistry available under the compulsory medical insurance policy? This question is of interest to many, since the services of dentists, as you know, are not cheap. So, what opportunities does dentistry provide under the compulsory medical insurance policy, what is included in the free service?
A visitor to a clinic participating in the CHI system can expect:

  • for an appointment, examination and consultation;
  • for the prevention and treatment of inflammation of the oral cavity;
  • for filling teeth;
  • for surgical intervention (tooth extraction, abscess opening, etc.);
  • for an x-ray examination.

Please be aware that there are also restrictions on dental services. For example, filling will not require payment if cement is used during the treatment. But the light seal will not be delivered free of charge.

Certain services are possible if there is a referral, for example, the surgeon will cut the frenum of the tongue upon presentation of a certificate from the orthodontist.

How to find out if a service is included in the CHI program?

Information on services provided free of charge is contained in the regulatory documents adopted in a particular subject. A detailed list is also provided by health care institutions and insurance companies operating in the CHI system.
The list of compulsory health insurance services on the official health care website in 2018 is absent, but from the resource of the Ministry of Health you can go to the MHIF website, where all the regulations relating to the compulsory health insurance system are laid out.

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

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

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

The essence of the insurance lies in the fact that upon the occurrence of an insured event, the patient's treatment is paid by the insurer. There are many medical insurers in Russia, and the most famous among them are Max-M, SOGAZ-Med, ROSNO-MS

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

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

Features of insurance

Compulsory medical insurance is a set of state measures aimed at providing free medical care to a citizen of the Russian Federation in the event of an insured event.

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

The state not only provides free medical care for the patient, but also makes sure that it is of high quality and follows the law.

Compulsory health insurance takes place under the compulsory medical insurance policy. This policy has a unified state model, which is approved by Federal Law No. 326 "On Compulsory Health Insurance".

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

A person who, for some reason, does not have compulsory health insurance, cannot demand free medical care

What does the Law say?

The law "On medical insurance of citizens of the Russian Federation" in article 15 says that insurers are obliged to protect the interests of the insured.

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

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

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

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

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

The law "On health insurance of citizens in the Russian Federation" in Article 6 provides the following rights:

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

These are only the basic rights of patients under compulsory medical insurance. To find out all the rights, we recommend that you familiarize yourself with the specified documents and articles in full.

Who provides protection and how?

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

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

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

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

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

What kind of medical care can you get?

The basic CHI program includes:

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

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

Procedure for receiving

To receive free medical care, a citizen of the Russian Federation must submit his compulsory medical insurance policy to a medical institution.

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

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

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

  1. Contact a medical facility
  2. Show current OMS policy
  3. Choose medical care within the scope of the insurance contract
  4. Get medical help

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

What to do in case of refusal?

In government agencies, refusals are extremely rare. But municipal and other medical institutions "sin" from time to time.

They can refuse free treatment, citing the cost of drugs or other factors, or they can provide medical care with impairments, of poor quality.

Where to go in such a situation?

Almost every Russian has a compulsory health insurance policy, but not everyone clearly understands where and what kind of medical care can be obtained through it. About what rights we are entitled to under the compulsory medical insurance policy and how to use it correctly, including in a foreign city, and when the policy may be useless, in an educational program from the expert of the Interregional Union of Health Insurers Tatyana Serebryakova.

What kind of treatment does the compulsory medical insurance policy give the right and no need to insist on it??

The patient cannot apply for treatment under the compulsory medical insurance policy in the two most common situations.

At first, when contacting a medical institution that is not funded by the compulsory medical insurance for a specific profile. Each medical organization, both private and state, annually declares to participate in the CHI system. Moreover, not "in general", but for specific profiles and types of treatment. And it is not a fact that the hospital or clinic you have chosen provides exactly the services that you need under the compulsory medical insurance policy. That is, when contacting a medical institution, you need to find out two main parameters: whether it participates in the compulsory medical insurance system, and for what types and conditions (for all or some specific) in the context of profiles, specialist doctors, assistance to children or adults.

Secondly, if the treatment itself is not among those financed by the CHI. This applies, for example, to sexually transmitted diseases, HIV, AIDS, tuberculosis, mental and behavioral disorders, palliative care (both inpatient and outpatient). Such medical care is financed from other sources of the State Guarantee Program - funds from the federal, regional or local budget. The compulsory medical insurance policy does not pay for the treatment of citizens outside the Russian Federation, plastic aesthetic surgery (if there is no medical indication for this), preferential dental prosthetics, spa treatment, as well as the provision of medical care in conditions exceeding the level of comfort established by the program.

In addition, social benefits are not included in the number of services that are not financed by the compulsory medical insurance, which means that they are not provided under the policy. For example, related to preferential provision of drugs for outpatient treatment. That is, if in the hospital all the medicines are provided free of charge, then the patient's prescription received at the clinic, who does not have the right to benefits, pays independently. They have nothing to do with the compulsory medical insurance policy and sick leave payments - this is a type of social benefit that is paid from social insurance funds.

Does it matter that a person gets sick while in a place where he does not have a permanent registration?

You can get treatment for free in any part of the country, the main thing is not to forget to take a compulsory medical insurance policy on your trip. But this applies to medical care under the basic compulsory medical insurance program, which is approved by the Decree of the Government of the Russian Federation and is absolutely the same in all regions of Russia. That is, any acute condition or exacerbation of a chronic disease, toothache, bruises, poisoning, allergies or sunstroke - all these are reasons to seek free help from a polyclinic or a hospital operating in the compulsory medical insurance system.

If your condition worsens, you also have the right to free ambulance and emergency outpatient services. Moreover, when providing emergency medical care in cases that threaten a person's life, the presentation of a compulsory medical insurance policy is not required. Such assistance is provided to everyone, without exception, free of charge and without delay.

However, in other cases, there is a difference between permanent residence and the region of temporary residence. This difference applies to those medical services that are in excess of the basic compulsory health insurance program. For example, in a number of regions of the Russian Federation with a high level of socio-economic development, the territorial compulsory medical insurance program is much broader - due to certain types of high-tech medical care that are not included in the basic program. In addition, due to the "super-basic compulsory medical insurance program", the scope of preventive measures can be expanded. But the extended program is available only for residents of that particular region. A nonresident patient will not be provided with services in excess of the basic compulsory medical insurance program free of charge under the compulsory medical insurance policy.

And if the disease is associated with some local peculiarities? For example, a Muscovite traveling across Transbaikalia was bitten by a tick.

It is obligatory to provide medical assistance under the compulsory medical insurance policy (including removing the tick) in any emergency room. If a disease associated with a bite develops, then it should also be treated free of charge - at the expense of compulsory medical insurance. This also applies to other similar situations, regardless of where the sick person is.

Is it possible to get sick leave on a trip?

A person has the right to receive a sick leave in any region of the country. It all depends on the medical indications that he is disabled. If you cannot go to the clinic, call the doctor at home. Medical assistance at home should also be provided under the compulsory medical insurance policy.

If the situation is not urgent, and a person on vacation simply has time to deal with his chronic illness, will he be provided with planned assistance?

The compulsory medical insurance policy allows you to apply for routine medical care anywhere in the country. The disease profiles for which such assistance is provided are listed in the basic compulsory medical insurance program. However, planned treatment, for example, adjusting the dose of insulin or selecting a hypertensive drug, is a rather lengthy process that requires a lot of examinations, additional consultations, etc. Therefore, it is better to do this at home, in consultation with your doctor. If you plan to leave for another region for a long time and know that at this time you may need routine medical care, attach to the clinic at the place of stay.

Or can they declare in another region that the compulsory medical insurance policy is invalid?

The current policy guarantees the provision of free medical care under the basic compulsory medical insurance program throughout Russia. Enter the telephone number of your insurance company's hotline in the address book of your mobile phone, and call it in any disputable case. If you have not used the policy for a long time, call the hotline of your insurance company (the phone number is indicated on the policy), check if there is information about it in the relevant register of insured persons. Best of all - replace it with a new compulsory medical insurance policy of a single sample. To do this, it is enough to contact any insurance company, but it is better to plan a visit to it 1.5 months before the intended trip.

What if a patient is forced to pay for treatment?

Contact the head of the medical organization, call the Regional Compulsory Medical Insurance Fund of the region in which you are not at the place of insurance, and where you were denied medical care or demanded to pay for it. Today, in each constituent entity of the Russian Federation, the work of Contact Centers in the field of CHI is organized, the telephone number of such a Contact Center should be posted on the stands in each medical institution, on the website of each Territorial CHI Fund. This number and other details of the Contact Center will always prompt you if you call the hotline to your insurance company.

If you had to pay - save the receipt and warn that you will appeal this forced payment (write a complaint). If you are offered to sign an agreement for the provision of paid services (otherwise, payment for medical care in the Russian Federation is not legal), read it carefully and do not sign it if it states that you are aware that you can get medical care for free, but you voluntarily decided pay.

Since 2010, the rules for the provision of free health care services for people with insurance policies have changed. Now everyone is provided with a document with an unlimited validity period - an OMS policy. Let's figure out in more detail what kind of document it is, to whom it is provided and what services are provided by healthcare institutions upon presentation of this policy by the patient.

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What is a medical insurance policy

Until 2010, health insurance of citizens was provided for one year, then the policy had to be renewed. In the absence of such a document, the medical institution could deny the patient free treatment. Moreover, the employer was obliged to conclude an agreement with the insured company, for the unemployed - the employment service, and for minors - educational institutions.

After the release of the law regulating this aspect of relations, the rules changed. Now each citizen can individually choose an insurer and receive a compulsory health insurance policy from the company. Therefore, the competitiveness of insurance companies has increased, as well as their control over healthcare institutions has increased, because the quality of service has begun to play a large role in the number of attracted clients.

The compulsory medical insurance policy has now become indefinite, it does not need to be changed every year, because the contract with the insured is concluded for life. In the event that the policy is lost, you can always contact the office of the company serving this patient and get a duplicate of it.

When applying to the hospital, the patient must present a document confirming the person's participation in the compulsory medical insurance program. The basic services provided for this program are approved each year by the regional government.

Who is eligible to receive a compulsory medical insurance policy

Everyone has the right to provide this document. It does not matter where the person is registered, where his place of residence, what is the age and social status of the insured. Basic services are provided free of charge to every person who visits the hospital and presents a policy.

It turns out that the following people can get an OMS document:

  • Any adult citizen of Russia.
  • Young children under the age of fourteen.
  • A person holding a refugee certificate.
  • A person with foreign citizenship who has a permanent or temporary registration in our country.
  • A person without any citizenship.
  • A person without a permanent place of residence.

Not a single insurer can deny a person to participate in the CHI program due to the lack of registration, citizenship or a certain place of residence.

Legal justification

This aspect of relations is regulated primarily by the Federal Law, which was issued on November 29, 2010. This law No. 326-FZ is called "On compulsory health insurance in the Russian Federation." According to him, universal health insurance in Russia is designed to guarantee the protection of life and health of people. At the same time, stateless persons and refugees are equal in rights with the rest of the inhabitants of our state.

The owner of the policy can get basic medical services without paying a fee. He can choose the policyholder on his own, and if the patient is not satisfied with the quality of service, then once a year he can change it.

After the release of this law, the Duma issued several more acts that amend the current draft law. The last amendment came into effect on January 1 of this year (Law No. 418-FZ).

What you need to participate in the insurance program

It is very easy to obtain a document confirming participation in the health insurance program. It is enough to opt for a suitable insurer and contact the office of their company.

There you will be asked to write a statement, and also asked to provide documents:

  • For an adult resident of the Russian Federation - an identity card (passport).
  • For a young child - a birth certificate, a passport of one of the representatives (parent, guardian).
  • For refugees - a refugee certificate.
  • For foreigners - an identity card, a residence permit or a temporary residence permit in Russia.
  • For those who do not have citizenship at all - an identity card, a mark on a permanent or temporary residence permit (or a residence permit).

In addition, if you have a plastic SNILS card, you must also provide it. When submitting the listed documents, any of these categories of persons can join the CHI program. The only reason for the policyholder's refusal to issue a policy may be the lack of necessary documents.

What else you need to know about the compulsory medical insurance policy

Thus, the presence of a certificate of a participant in the MHI program provides a person with free assistance in the event of an emergency, with a deterioration in his health and a threat to his life. Of course, no hospital will operate for free. Who pays for the treatment of the insured?

Contributions to the CHI system come from employers and from the budget for persons without official employment. This value is equal to 3.6% of the unified social tax.

It is important to know which services are included in the free CHI program. There are frequent cases of disputable situations when medical institutions refuse to provide assistance, because the case is not insured.

So, free insurance includes:

  • Ambulance.
  • Diagnosis and medical care at home and in inpatient settings, while outpatient treatment is not provided with drugs.
  • Inpatient stay in the event of the following situations:
    • acute diseases or exacerbation of chronic diseases that require constant monitoring and control by a doctor;
    • diseases that are epidemic in nature, requiring the isolation of the patient;
    • childbirth, abortion, fetal pathology;
    • acute poisoning;
    • serious injury;
    • rehabilitation after illness, requiring constant medical supervision.

The law does not provide for the provision of the following services to patients free of charge, which are not included in the insurance program:

  • Outpatient examinations, consultations, diagnostics.
  • Special conditions for inpatient treatment of a patient (for example, a ward with an increased level of comfort).
  • Treatment in sanatoriums or resorts.
  • Services when citizens apply anonymously (does not include AIDS diagnostics).
  • Cosmetology services.
  • Dental prosthetics.
  • Preventive treatment of diseases during remission.
  • Not routine vaccines and vaccinations.
  • Sexological pathologies.

The list of services provided free of charge is approved at the regional level; in individual constituent entities of the Russian Federation, they may differ. You can find out this list at the local branch of the CHI or by phone, which is indicated on the policy itself.