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

Who can receive free medical services?

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

• Employed citizens. That is, the category of persons who regularly pay taxes to the state budget. That is, in essence, he pays for his treatment in advance.
• Unemployed citizens. In this case, payment of funds for the treatment of these persons also occurs at the expense of the federal budget.
• Children, teenagers, and who have not reached the age of eighteen and are not taxpayers.

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

In the event that a citizen needs to see a specialist who is conducting an appointment outside the locality where the specified individual lives, a referral from the attending physician is also required.

There is a certain list of medical services, the provision of which is free of charge. These include the following:

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

Free services under compulsory medical insurance policy

For example, while undergoing treatment in a state hospital, a citizen has the right to receive free services for the treatment of diseases of the following kind: support of pregnancy during its complicated course, as well as in the presence of pathologies of any kind, medical abortion, the presence of chronic diseases, or in case of exacerbation of the disease, poisoning , causing bodily harm and so on. In this case, the provision of medications necessary for adequate treatment is free of charge.

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

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

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

Currently, not every citizen is fully aware of the rights that are granted to him in accordance with this, which is often taken advantage of by unscrupulous workers in this field of activity, demanding payment of a certain fee for the provision of the necessary assistance.

What to do if your rights are violated

Every citizen of the Russian Federation who has insurance has the right to seek help from any medical institution located on the territory of the state. The specified institution is obliged to admit him and carry out appropriate diagnosis, treatment, as well as other manipulations that are necessary. However, it often happens that doctors, as well as hospital staff, refuse to admit the patient in such cases. This is not legal and violates human rights. It is important to produce.

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

What can you expect with a compulsory medical insurance policy?

In order to know which services the compulsory health insurance policy gives you, you need to carefully read the list of services provided to the population free of charge.

It should be remembered that, in essence, these services are not at all free due to the fact that a certain amount intended specifically for this purpose is deducted from the salary of each employed citizen every month. Consequently, in this way, each individual pays in advance for his treatment in a state-type institution. In our other articles you can familiarize yourself with and .

The vast majority of citizens of our country regain their health using the capabilities of the compulsory health insurance system (CHI). Examination by specialists, medication provision, dental treatment, etc. have become common realities of our days. But compulsory medical insurance provides the opportunity to carry out more critical medical interventions, including surgical ones, free of charge. You will learn further how to perform an operation under the compulsory medical insurance policy.

What operations can be done under compulsory medical insurance?

Periodic changes are made to the list of free surgical operations aimed at expanding the ability of citizens to restore health through surgical intervention. An updated list of free operations is sent to medical institutions and insurance companies registered under compulsory medical insurance. The information is open.

Free access is ensured by placement on information boards of medical institutions, their websites, as well as information during consultations with the attending doctor about which operations are performed free of charge.

The list of free operations under the compulsory medical insurance policy for 2020 includes the following interventions:

1. Eye surgeries:

• with cataracts of the lens of the eye;
• intervention for strabismus, including strabismus in children;
• traumatic deformation of the retina;
• glaucoma;
• detection of congenital anomalies.

1. Sentoplasty (correction of the nasal septum), for the following indications:

• respiratory functions are impaired;
• lack of smell;
• swelling of the mucous membrane;
• not resistant to ARVI;
• abnormal breathing, snoring;
• excessive dryness of the sinuses, systematic pain.

1. Removal of the gallbladder in the presence of cholecystitis, functional disorders (cholesterosis, gallstone manifestations).
2. Marmara operation (diseases of the veins of the male reproductive system) for indications:

• varicocele of the second and subsequent stages;
• impossibility of fertilization (sperm release);
• painful sensations;
• aesthetics;
• changes in scrotal tissue.

1. Arthroscopy of joints.
2. Vein operations for venous diseases.
3. Diseases in the field of gynecology.
4. Thoracic (oncology, pathological changes in the lungs).
5. Valgus feet.

The presented list is not a complete list of gratuitous surgical interventions permissible in the presence of a compulsory medical insurance policy. However, interventions of a cosmetic nature (for example: bariatric surgery) are not considered free medical care.

Who can receive free medical services

All categories of citizens who have entered into compulsory medical insurance agreements in accordance with the established procedure have the right to receive free assistance in the country, including:

• having labor relations with enterprises and organizations in the sphere of production, consumption and distribution of material goods;
• receiving funds or remuneration under licensing, scientific, publishing alienation agreements;
• private entrepreneurs and other categories that provide for themselves;
• managers and participants of farming enterprises;
• community members involved in folk crafts and tribal economic activities;
• citizens who do not have a job (children under eighteen years of age, adults on pensions, teenagers undergoing training, the unemployed, a guardian up to the age of three for a child, caring for a disabled person of the first group or an adult after the age of eighty)
• military personnel, employees of special organizations, including medical workers;
• foreigners legally residing in the country and engaged in labor activities, within the framework permitted by regulatory legal acts of the state;
• persons who have received refugee status in accordance with the established procedure.

Institutions of the Ministry of Health do not have the right to refuse to provide emergency free medical care, including specialized care, to persons who have not concluded a compulsory medical insurance agreement or with missing information about their policy in the unified Compulsory Medical Insurance database.

Where can I get treatment for free?

The above categories of citizens have the right to receive medical care free of charge under compulsory medical insurance throughout the country, regardless of the presence of registration at the place of residence, place of stay or lack thereof at the time of application.

In the category of medical care related to planned surgical interventions, the insured person has the right to choose any specialized medical institution in Russia, in his opinion, capable of performing the operation with the best results. At the same time, the medical institution must, in accordance with the established procedure, participate in the Compulsory Medical Insurance System.

Medical institutions (hospitals, clinics and others) become participants in the system after concluding a cooperation agreement with compulsory medical insurance. If there is a quota, they cannot refuse the opportunity to perform surgical intervention when the operation is indicated.

It should be remembered that the waiting period for a planned operation in another region, as well as at the patient’s place of residence, can take considerable time. This is due to strict quotas for operations, due to the significant financial costs of performing it, as well as the large number of patients applying.

When choosing a medical facility for elective surgery, you should consider the following:

• insurance coverage applies only to the operation;
• the quality of work of practicing surgeons is approximately equal, both in clinics of metropolitan regions and local medical institutions, where in the first case the operation is accompanied by the most advanced equipment, in the second - experience in performing multiple operations;
• the waiting time for a free operation, where in large cities it can take a long time (up to a year or more), during which side effects can occur, while for local surgery the wait will take up to several months;
• the cost of payment for services not covered by compulsory medical insurance.

Of no small importance is the opportunity to consult during postoperative rehabilitation with the surgeon who performed the operation. If a medical facility is located at a considerable distance, additional financial expenses are expected.

How to perform surgery under compulsory medical insurance policy for free step by step

Obtaining surgical care under compulsory medical insurance coverage is a simple procedure that includes the following steps:

1. Visit to the attending physician at the assigned medical facility. After studying the tests and examining the patient, he evaluates the indications for surgical intervention. If they are present, the doctor is obliged to write out a referral to a specialized clinic. The patient has the right to declare his referral for surgery to a previously selected medical institution.
2. After receiving the referral, the patient registers for an appointment for consultation at the selected institution. Registration is carried out by personal visit or in another manner prescribed by the hospital.
3. To complete the paperwork and consultation, arrive at the appointed time to see the hospital doctor. Provide him with a referral, an identification document, an insurance contract (policy), research results and a medical record. The doctor decides whether admission to the hospital is necessary. Explains what is considered free help and what you will have to pay for.
4. The decision to place the patient in a hospital for the duration of the operation is accompanied by additional research and analysis.
5. Within ten working days, the patient is notified of the date of the surgical intervention.
6. On the appointed day, the patient is hospitalized.

About the quota. They are determined depending on the financial capacity of the Compulsory Medical Insurance Fund, territorial branches of the regions, to compensate for the expended consumables, the work of specialists and personnel during a certain number of surgical operations.

State medical institutions participating in the compulsory medical insurance system purchase medicines, medicines, and equipment for surgical operations within the limits of funding. Procurement is carried out on the basis of organizing competitions. Where is the determining factor. The final delivery price is presented. Thus, when carrying out operations under compulsory medical insurance, one should not rely on advanced models of endoprostheses and other things.

Do I need to pay extra for services provided?

Surgical intervention is free of charge under compulsory medical insurance. It includes: the actual operation, anesthesia (if necessary), consumables, and the use of specialized equipment. The institution's demands for additional payment are illegal. But the patient independently finances travel to and from the site of the operation, as well as preoperative accommodation outside the medical institution. The possibility of providing additional opportunities for a fee is allowed in relation to receiving services not included in the list of the compulsory medical insurance system, including:

• Conducting anonymous diagnostics at the request of the patient (excluding HIV);
• manipulations carried out with a visit to the patient’s home (diagnosis, consultation, treatment), with the exception of the physical impossibility of the patient to come to the medical institution for this;
• diagnostics and medical procedures for sexual pathologies;
• speech therapy activities for the adult population;
• vaccinations with the exception of those provided for by compulsory medical insurance;
• post-operative measures, including sanatorium, if they are not provided for by the insurance program;
• cosmetological manipulations;
• oral prosthetics, except in cases provided for by compulsory medical insurance;
• psychological support for the patient;
• methodological activities for familiarization with patronage, provision of pre-medical care, etc.

Medical institutions that provide paid services in addition to free services are required to inform about their existence by posting lists and price lists on reception stands. At the same time, when deciding on hospitalization, the patient is personally informed about paid opportunities to improve the conditions of stay in the hospital’s inpatient department.

The insured person has the right to contact the insurer or the Compulsory Medical Insurance Fund to clarify the legality of requesting additional funds while staying in a medical institution. Payment for certain services and medications.

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

Low awareness of the population about their rights to medical care under compulsory health insurance often leads to agreement in the event of an unreasonable refusal to provide medical care or the demand for additional money for procedures, including surgical operations. What changes the situation is the opportunity to familiarize yourself with the conditions, procedures and list of services on the official websites of the Ministry of Health and the Federal Compulsory Medical Insurance Fund.

Establishing the fact of a violation must be accompanied by measures to protect personal rights, including appeals:

1. The management of the medical institution.
2. District (city) health department.
3. The insurance company accompanying the compulsory medical insurance contract.
4. Territorial division of the Compulsory Medical Insurance Fund.
5. Federal Department of Compulsory Medical Insurance.
6. Commission expert arbitration.
7. Judicial authorities.

An application for violation of a patient’s legal rights when providing compulsory medical insurance coverage is drawn up in a business-like, discreet style and contains:

• information about the person whose rights were violated;
• information about the conclusion of an insurance contract (policy);
• details of the medical institution that refused to provide medical care or committed other violations;
• period of medical procedures or improper inpatient care;
• the course of events, the circumstances that forced the patient to spend personal funds, their volume.

The application must be accompanied by medical and financial documents (extracts from history, receipts for payment of medications, etc.) necessary to prove violations.

You will learn more about how the system works and how to get a new sample below.

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Which medical services are free and which ones will you have to pay for? Why do you need a health insurance policy and how to get it? How to register with a clinic and how long to wait to see a specialist? Why might you be denied an ambulance call and where to complain if you are faced with rudeness or negligence of doctors?

Free services and medicines

The right to free medical care is guaranteed by Article 41 of the Constitution of the Russian Federation. But what does the concept of “free medicine” include, if in practice you have to pay for a lot?

According to the law, patients are entitled to the following free medical services:

• emergency assistance (ambulance)


• outpatient care in a clinic (examinations and treatment)


• inpatient medical care:

1. - abortion, pregnancy and childbirth


2. - in case of exacerbation of chronic and acute diseases, poisoning, injuries requiring intensive care or round-the-clock medical supervision


3. - planned hospitalization

• high-tech medical care, including the use of complex and unique treatment methods, new technologies and equipment


• medical care for people with incurable diseases.

A complete list of cases in which you are entitled to free medical care is included in the basic compulsory health insurance program. To check this list, you can contact your insurance company (the company's phone number can be found on your policy).

Please note that you are also entitled to free medicines if your disease is rare, life-shortening or disabling. The list of vital and essential drugs has been approved by the state and is spelled out in the text of the law.

You will have to pay for other services and medications.

Medical policy

A compulsory health insurance policy (CHI policy) is a document that allows a person to receive free medical care in hospitals and clinics throughout the Russian Federation. It is issued by insurance companies that are licensed to operate in this field. The insurance company that issued your compulsory medical insurance policy pays for medical services and protects your interests in conflicts with medical institutions. Keep in mind that in order to receive free medical services by law, you must have the insurance policy with you. Without its presentation, only emergency assistance is provided. Anyone who is in the territory of the Russian Federation, including foreigners and refugees, can receive a compulsory medical insurance policy.

How to get a compulsory medical insurance policy?

To do this, you need to contact an insurance company that has the appropriate license. The official rating of medical insurance organizations will help you choose it. Over time, you can change the insurer if you are unhappy with the quality of its work. Remember that by law this can be done no more than once a year and no later than November 1.

What documents are needed to apply for a compulsory medical insurance policy?

For a citizen of the Russian Federation under 14 years of age,:

• birth certificate


• passport of the legal representative (for example, one of the parents)


• SNILS (if available).

For a citizen of the Russian Federation over 14 years old, required:

• passport of a citizen of the Russian Federation


• SNILS (if available).

What is the validity period of the compulsory medical insurance policy?

For citizens of the Russian Federation, the policy is indefinite; a temporary policy is made for refugees and foreigners temporarily residing in the territory of the Russian Federation.

In what cases can a compulsory medical insurance policy be replaced with a new one?

Despite the fact that the policy is unlimited, it can be replaced with a new one:

• during a planned change of compulsory medical insurance policy (for example, when a new model is introduced)


• when changing residence within the Russian Federation, if the insurer does not have a representative office at the new place of residence


• if inaccuracies or errors are detected in the policy


• when the policy is dilapidated, which creates an identification problem


• upon loss of the policy


• when changing the personal data of the policy owner (full name, passport details, place of residence).

Clinic

When receiving a compulsory medical insurance policy, a clinic is selected where you will seek medical care (that is, you are “attached” to it). You have the right to choose any clinic that is convenient for you to visit (closer to home, work, dacha). The only condition is that she must be able to accept a new patient (the planned workload is determined by the standards).

How to attach to the clinic?

Your appointment to the clinic at your place of residence occurred automatically if:

• you live under the same registration as when you received the policy


• you live at the same address that you gave when receiving the policy (even if it differs from your registration).

To attach yourself, you will need to write an application to the clinic administration. Keep in mind that if you are assigned to a clinic other than your place of residence, you will not be able to call a doctor to your home.

Remember that by law you can change your clinic no more than once a year, with the exception of cases of change of place of residence or stay.

What documents are required to register with the clinic?

List of documents for a child under 14 years of age:

• compulsory medical insurance policy (original and copy)


• birth certificate


• identification document of the child’s legal representative (for example, parent)


• SNILS (if available).

List of documents for citizens over 14 years of age:

• application addressed to the chief physician of a medical organization


• compulsory medical insurance policy (original and copy)


• passport of a citizen of the Russian Federation


• SNILS (if available).

Can you be denied access to a clinic and why?

They may refuse your appointment if the chosen clinic is overcrowded and is not located in your area of ​​residence. You have the right to demand a written refusal, on the basis of which you can complain to the insurance company, the Ministry of Health or Roszdravnadzor.

Make an appointment with a doctor. How to get to him and how long will you have to wait?

You can make an appointment with a doctor (receive an appointment voucher) in person through the registry of a medical organization or remotely through an electronic registry (if available). But doing this often turns out to be quite difficult. The next appointment with doctors may be only a few months later or may not be available at all (“no coupons”). How long can you wait by law, and what to do if you are not provided with a service on time?

Each region independently sets waiting times for medical care on its territory. You can obtain information about the terms in force in your region from the territorial compulsory health insurance fund or from your insurance company (you will find the company's telephone number in your compulsory medical insurance policy).

As an example, we will give the deadlines established in Moscow. According to the resolution of the Moscow Government, maximum terms have been established:

• the initial appointment with a local therapist, local pediatrician and general practitioner (family doctor) occurs on the day of treatment;


• for appointments with medical specialists - up to 7 working days;


• The urgency of laboratory and instrumental studies is determined by a medical specialist; the waiting period should not exceed 7 working days. An exception is angiography, computed tomography and magnetic resonance imaging, the waiting period for which can be up to 20 working days;

If a medical organization cannot meet the specified deadlines or does not have the necessary specialist or equipment, then according to the law the patient must be sent to the nearest medical institution for diagnostics, absolutely free of charge. If these provisions are violated, you can file a complaint against the medical organization with your insurance company or other institutions that we talk about in the “Where to Complain?” section.

Is it possible to change the attending physician and how?

Yes, according to the law, you can change not only the medical organization, but also the attending physician (local doctor, general practitioner, pediatrician, general practitioner and paramedic). To do this, you need to submit an application addressed to the head of the medical institution. You can change your doctor no more than once a year, with the exception of cases of change of residence or stay.

Ambulance

Free healthcare also includes emergency care. Anyone in the Russian Federation can use it, including those who do not have a compulsory medical insurance policy. Many people complain about the waiting time for an ambulance, but not everyone knows that the arrival time of a medical team primarily depends on its type, their two:

• ambulance service. She responds to emergency calls if there is a threat to the patient’s life: injuries, accidents, acute diseases, poisoning, burns and others. According to the standard, this assistance must arrive at the patient within 20 minutes;


• urgent Care. Deals with the same cases as an ambulance, but only if there is no threat to the patient’s life. This assistance must arrive within two hours.

The dispatcher decides what type of assistance to send to you.

How to call an ambulance?

We all remember the truth learned by heart from childhood that to call an ambulance you just need to call the number “03”. Landline telephones are becoming a thing of the past over time and are being replaced by mobile communications. Almost everyone has a mobile phone at hand, but not everyone knows how to call an ambulance from it.

You can call an ambulance by numbers:

• 03 from a landline


• 103 from a mobile phone


• 112 from a mobile phone (single emergency number).

Number 112 is universal. Using this number you can call the fire department, police, ambulance, emergency gas service, and rescuers. You can call this number even if you have a zero balance, a blocked SIM card or if it is not in your phone. However, this service does not currently work in all regions of the Russian Federation.

In what cases will an ambulance arrive?:

• for acute diseases that occur at home, on the street or in a public place;


• in case of disasters and mass disasters;


• in case of accidents: burns, injuries, frostbite and others;


• in case of sudden diseases that threaten human life: disruption of the cardiovascular and nervous systems, respiratory organs, abdominal cavity, and so on;


• during childbirth and disruption of pregnancy;


• for any reason to children under 1 year of age;


• to psychoneurological patients with acute mental disorders that threaten the safety of others.

In what case will the ambulance not arrive?:

• if the patient’s condition worsens and is observed by a local doctor;


• when calling to patients with alcoholism to relieve hangover;


• to provide dental care;


• to provide medical procedures prescribed as part of planned treatment (dressings, injections, etc.);


• for issuing sick leave certificates, prescriptions and certificates;


• for issuing forensic and expert reports;


• to draw up a death certificate and examine the corpse;


• for transporting patients from hospital to hospital or home.

What are the responsibilities of an ambulance?

The arriving team will provide emergency medical care and, if necessary, admit you to a hospital inpatient unit. The team's doctors can give oral recommendations for treatment, but they do not issue certificates or sick leave.

Where can I complain about my doctor?

There are times when a conflict arises between you and your doctor. What to do in such a situation? Complain.

1. The easiest way to complain is to write a statement addressed to the chief physician. This will help resolve the problem at the local level.


2. If you have complaints about the quality of service in a medical institution or are offered to pay for medical services that are free by law, you can contact your insurance company.


3. If you are unable to resolve the problem at the local level, you can contact the Ministry of Health. You can submit a complaint in person at the ministry’s reception desk, send it to the department’s regular postal or email address, or leave a complaint on the official website.


4. If your problem has not been resolved by the Ministry of Health, then you can contact Roszdravnadzor, which exercises control in the healthcare sector. The application can be left on the department’s website, or sent by regular mail or email.


5. If previous actions did not lead to the desired result, you can contact the prosecutor's office. She will conduct an audit of the work of government agencies.


6. If the conflict is still not resolved by these methods, then you can go to court. The claim must indicate the essence of the case, explain what rights were violated (with references to the relevant articles of law), and attach documents proving the defendant’s guilt.


7. Contacting the police is appropriate if the doctor intentionally caused harm to your health, threatened, extorted or insulted your honor and dignity.

Please keep in mind that the legal period for consideration of applications in each case is 30 calendar days.