We're supposed to! What can you get for free under a compulsory medical insurance policy? A complete list of free medical services and assistance from the state List of operations performed under compulsory medical insurance
29.05.17 241 023 10
The doctors were shocked when I showed...
Over the weekend, I was at home with an impossible sore throat and a temperature of 39.6.
Taking another dose of paracetamol that day, I called an ambulance. I was told that it was a sore throat and that I should call the local police officer on Monday. The ambulance didn't arrive.
Zhenya Ivanova
was treated and recovered
I typed in the search bar: “What to do if the ambulance refuses to go.” I saw advice on the forum: “Say threateningly that you should call the insurance company now. They'll come right away." I did so. The ambulance has arrived. Afterwards, I threatened the doctors twice more with calling the insurance company, and once I actually called the number listed on the policy. It helped every time.
The insurance company protects my rights and actually guarantees free treatment. But if you don’t know the laws, then unscrupulous doctors will be able to deceive you, refuse treatment, and demand additional payment.
I recovered and decided to figure out what your compulsory health insurance guarantees you.
Get to know your compulsory medical insurance policy
Most likely, you already have a compulsory health insurance policy. Your parents made it for you immediately after birth. It is either in your passport or in the box with all your important documents.
If you don't have a policy, drop everything and go get one.
Without a policy, you will not get any free treatment. Fortunately, you can get or exchange a policy in any city without residence permit or registration. To do this, take your passport and SNILS with you and go to an insurance company that is convenient for you, which issues these policies.
This is a card If you don’t have SNILS, first go to the insurance company with your passport, then wait 21 days and only then get the policy. Citizens of the Russian Federation, foreign citizens permanently or temporarily residing in the territory of the Russian Federation, refugees and stateless persons can obtain the policy. Citizens of the Russian Federation are issued a policy without limitation of validity period. According to the law, even if you have an old policy and it is expired, the insurance will still work. Only until you change your passport details: first name, last name, place of residence.
If you come to the clinic with an old expired policy and are denied treatment, this is illegal. You must be accepted. Clinics ask everyone to change their policies to new documents, but for now 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.
Which insurance companies provide compulsory medical insurance policies?
Compulsory medical insurance is an insurance program, that is, everyone pays a little into a common pot, and then they pay from it to those who need it. The state collects the common pot from entrepreneurs and distributes it through an extensive system of funds, which, in turn, pay hospitals. And the insurance company is an intermediary manager who connects you, the hospital and the state.
Insurance companies make money from compulsory medical insurance in the same way as from other services. They are also responsible for the quality of services and discipline in the system. Your first point of contact is the insurance company.
Each region has its own registries of companies that issue compulsory medical insurance policies. Just Google it.
Where can you get treatment with a compulsory medical insurance policy?
To get to a clinic in another city or region, you need:
- Select 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 company description on the CMO website. Everyone has the same insurance, but some have more offices, while others have 24-hour support.
- Come to the insurance office with your passport and SNILS and fill out an application for a replacement policy.
- Get a temporary certificate. It works like a policy for a month.
- Return to the clinic. Tell the receptionist the code phrase “I want to join your clinic.” Receive an application form, fill it out and return it to the registration office.
Now you can be treated for free at this clinic.
If your insurance company services the clinic to which you are going to attach, then you do not need to change your policy. But you need to inform the insurance company that you have moved and want to be treated in another place. Otherwise, the new clinic will not receive money for your treatment.
Why do you need to join a clinic?
You need to be attached to a clinic because our country has a per capita financing system. Money for your treatment is given only to the institution to which you are assigned. Therefore, you cannot be assigned to several clinics at once. You can also officially change clinics no more than once a year. Previously, this could only be done if you moved. In this case, the new clinic will ask you to write an application addressed to the chief physician.
You cannot attach to a research institute or hospital, only to a district clinic. And there your local therapist will write out referrals to specialized specialists: an eye surgeon, a cardiologist, a chiropractor. Without a referral from your attending physician or emergency specialist, specialized clinics can only admit you for a fee.
What is EMIAS
In Moscow, the data of all patients is entered into EMIAS - a unified medical information and analytical system. This simplifies the process of making appointments with specialists: you can get a doctor’s voucher, cancel or reschedule an appointment, and receive a written prescription electronically. EMIAS even has a mobile application.
Please note: if you have moved and decided to join a new clinic, you cannot simply do it through the system. You need to write an application addressed to the chief physician and wait until the bureaucratic apparatus approves it. This may take 7-10 business days. If you are registered on the Moscow government services portal, you can submit an application electronically. They promise to review it within 3 business days.
When I faced such a problem, I needed help urgently. And by law they are obliged to help me without any multi-day delays. But the clinic is afraid that if they treat me before the clumsy machine enters new data into EMIAS, then 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 compulsory medical insurance treatment?
The law on compulsory health insurance gives us all the right to treatment for free. And even if your policy has expired, you can still use it.
If you don’t have the insurance policy with you, you can still make an appointment with a doctor; they don’t have the right to refuse you.
Although for nurses this is additional concern, so most likely they will try to convince you that this is impossible. If this happens, just call your insurance company.
In any unclear situation, call your insurance company.
The minimum amount of assistance is described in the basic compulsory health insurance program. Each region decides independently whether to add anything else to this list. The exact list of insurance claims can be found in any clinic or found 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 for free. 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 to you, you will have to accept 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 | Brushing your teeth because it prevents caries |
| Get imported Japanese adult diapers by choosing your own brand | Get diapers for an elderly person |
| Remove a couple of extra pounds. Your figure is not insured by the state | Remove boil |
| Wait for exercises from hatha yoga or a modern gym during physical therapy | Go to physical therapy |
| Contact a dermatologist if you are simply concerned about increased oiliness of your facial skin. | See a dermatologist if you have a serious skin rash |
| Make a denture | Remove the tooth |
Teeth whitening is an aesthetic procedure
Brushing your teeth because it prevents caries
Get imported Japanese adult diapers by choosing your own brand
Get diapers for an elderly person
Remove a couple of extra pounds. Your figure is not insured by the state
Remove boil
Wait for exercises from hatha yoga or a modern gym during physical therapy
Go to physical therapy
Contact a dermatologist if you are simply concerned about increased oiliness of your facial skin.
See a dermatologist if you have a serious skin rash
Make a denture
Remove the tooth
When something hurts, you can see a therapist for free, who will write a referral to a specialist. If indicated, the therapist must write out referrals to any doctors who work in public clinics.
Without a referral, you can make an appointment with a surgeon, gynecologist, dentist and dermatologist at the dermatovenerological dispensary. Or register your child with a child psychiatrist, surgeon, urologist-andrologist or dentist. Compulsory medical insurance 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 whether everything is in order with your health. A medical 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 it won’t be possible to write down once or twice in which cases you are entitled to free insurance assistance, and in which cases you will have to pay on your own. There are a lot of nuances in this matter. If you have a rare disease or a difficult situation, contact the Federal Compulsory Medical Insurance Fund.
What exactly is not included in the compulsory medical insurance program
The state will not pay for:
- Any treatment without a doctor's prescription.
- Conducting surveys and examinations.
- Treatment at home is optional, not for special indications.
- Vaccinations outside government programs.
- Sanatorium-resort treatment, if you are not a sick child or a pensioner.
- Cosmetology services.
- Homeopathy and traditional medicine.
- Dentures.
- Superior rooms - with special meals, individual care, TV and other amenities.
- Medicines and medical devices, if you are not in a hospital.
If the hospital asks for money for services that are not on this list, just in case, call your insurance company and find out if it is legal.
Privileges
For people with disabilities, orphans, large families, participants in military operations and other citizens who are entitled to social benefits, the state is ready to pay for more medical services. Each category has its own lists of benefits; you can find them at the social security department or find them on the Internet.
Sometimes you are legally entitled to free treatment, but doctors just shrug their shoulders. There may be a waiting list of up to several months for free rehabilitation, and painkillers may simply not be available at 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, some doctors are more interested in getting a lot of money from you right now than getting a little less money from the insurance company much later. Therefore, a whole illegal practice of extorting money for treatment under compulsory medical insurance has grown in Russia.
This extortion is based on legal illiteracy. All a doctor needs to do is pretend to be smart and take a stern tone so that frightened patients will start throwing money at him. But the slightest sign that the doctor is dealing with a legally savvy patient, and the tone changes. Therefore, it is very useful to know what medical services are required to be provided to you free of charge.
Remember that treatment is free only for you. The hospital and doctor will receive money for this treatment from the health insurance fund. This money was paid into the fund by entrepreneurs, including your employer.
You do not have to pay out of pocket a second time for what the state guarantees to you. Moreover, the doctor will most likely receive payment from the fund, even if you are forced to pay.
You do not pay for 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 behaves defiantly, you can turn on the recorder, this is legal. If even this does not help, call the department for the protection of citizens' rights in the compulsory medical insurance system.
7 499 973-31-86 - telephone number of the department for the protection of citizens' rights in the compulsory medical insurance system
Emergency assistance is always free
If something really bad happens - you lose consciousness, break your leg or feel acute pain - you should be helped in any public clinic, even if you don’t have any documents with you and you’ve never received a policy.
The hospital does not have the right to refuse care to newborns and children under one year of age, even if the child’s parents do not have an insurance policy or registration. They cannot refuse pregnant women either - they can go to any antenatal clinic and any maternity hospital, even without documents.
All participants in the healthcare system are just people: someone’s 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 it’s not the healthcare system, it’s this particular surgeon, his parents and teachers. This means that his father, somewhere in his childhood, set an example for him that a bribe is normal. How do you feel about bribes?
- If a hospital says that it doesn’t have money for medicine, it’s not Putin’s fault, but some officials who don’t know how to draw up budgets. Or the head physician who doesn’t know how to manage money. You have plenty of friends who do the same thing at their jobs.
- After all, when you receive your salary in an envelope, it is your employers who underpay into the health insurance fund. Where will the money for your medications come from if you have given permission not to pay for them?
It turns out to be mild schizophrenia: the same person supports mediocre salaries and complains about insufficient funding for hospitals.
Putin, Navalny, Medvedev, Tinkov or Trump will not solve our healthcare problems. We will solve this problem ourselves if we set an example for our children of a conscientious attitude towards work and the law. To skip classes at the institute was not a feat, but a shame. It was a shame to take tests for money. It was against our principles to give bribes. Knowing and standing up for your rights was a responsibility, not a superpower.
In short: no one will fly in and give us 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 with paying taxes and fees. I have everything, thank you. Sorry for the moralizing tone, but I'm just tired of this whining.
Remember
- If you don’t have a policy, drop everything and go get one.
- With a compulsory medical insurance policy, you should be treated for free in any state clinic throughout Russia.
- The treatment is free only for you. The hospital and 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 are denied treatment, this is illegal.
- In any unclear situation, call your medical insurance company. The number is on the policy. Put it in your phone right now.
- If your insurance doesn’t save you, call the Federal Compulsory Health Insurance Fund: +7 499 973-31-86.
- If you spent money on treatment, which should be free by law, write a statement to the insurance company - you should get your money back.
- Emergency assistance is always free, even if you do not have documents.
Russian citizens are guaranteed free medical care by the state. People are given a policy - a document that represents the support of the state healthcare system in the event of illness.
What does it really mean? What types of services are the clinic required to provide without additional payment, and which ones will you have to pay for yourself? Under what circumstances is a free medical examination carried out? Let's look at all the questions in detail.
About free medicine
Article 41 of the Constitution of the Russian Federation lists guarantees to citizens of the country from the state. In particular, it says:
“Everyone has the right to health care and medical care. Medical care in state and municipal health care institutions is provided to citizens free of charge at the expense of the corresponding budget, insurance premiums, and other revenues.”
Thus, the list of free medical services should be determined by the relevant government bodies, that is, the healthcare system. This happens on two levels:
- federal;
- regional
Important! The budget fund for the development of medical institutions is formed from several sources. One of them is tax revenues from citizens.
What types of services are guaranteed by the state?
By virtue of current legislation, patients are guaranteed the right to the following types of medical care:
- emergency (ambulance), including special;
- outpatient treatment, including examination;
- hospital services:
- gynecological, pregnancy and childbirth;
- with exacerbation of ailments, ordinary and chronic;
- in cases of acute poisoning, in case of injury, when intensive therapy associated with round-the-clock monitoring is necessary;
- planned care in inpatient settings:
- high-tech, including using complex, unique methods;
- medical care for citizens with incurable illnesses.
Medicines are provided at the expense of the budget to people suffering from the following types of diseases:
- shortening lifespan;
- rare;
- leading to disability.
Do you need information on this issue? and our lawyers will contact you shortly.
New in legislation since 2017
- pre-medical (primary);
- ambulance;
- specialized;
- palliative.
In addition, the text of the document contains a list of medical specialists who are subject to the obligation to treat patients without charging money.
These include:
- paramedics;
- obstetricians;
- other health workers with secondary specialized education;
- general practitioners of all profiles, including doctors of family medicine and pediatricians;
- medical specialists from medical organizations providing specialized, including high-tech, medical care.
Medical policy
Important! Not only citizens of the Russian Federation have the right to take out a compulsory medical insurance policy. It is issued (for a small fee) to foreigners permanently residing in the country.
The compulsory medical insurance policy has the following semantic content:
- the citizen is guaranteed medical support;
- medical organizations perceive it as a client identifier (for it, funds from the Compulsory Medical Insurance Fund will be transferred to the hospital).
How to get a compulsory medical insurance policy
The document is issued by the relevant companies operating within the framework of the legislation of the Russian Federation. Their ratings are regularly published on official websites, allowing citizens to make their choice.
To issue a compulsory medical insurance policy, you must provide a minimum number of documents.
Namely:
- for children under 14 years old:
- birth certificate;
- passport of the parent (guardian);
- SNILS (if any);
- for citizens over 14 years old:
- passport;
- SNILS (if available).
Important! For citizens of the Russian Federation, the policy is valid for an indefinite period. Only foreigners are provided with a temporary document:
- refugees;
- temporarily residing in the country.
Rules for replacing a compulsory medical insurance policy
In some situations, the document must be replaced with a new one. These include the following:
- when moving to a region where the insurer does not operate;
- in case of filling out paper with errors or inaccuracies;
- if a document is lost or damaged;
- when it has become unusable (dilapidated) and it is impossible to make out the text;
- in case of change of personal data (marriage, for example);
- in case of planned updating of sample forms.
What is included in the free service under the compulsory medical insurance policy?
Clause 6 of Article 35 of Federal Law No. 326-FZ provides a complete list of free services under a medical policy provided to document holders. They are provided in:
- clinic;
- outpatient clinics;
- hospital;
- Ambulance.
What can owners of a compulsory medical insurance policy expect?
In particular, patients have the right to free medical care and treatment in the following situations:
Dentists, like other professionals, are required to work with patients without pay.
They provide the following types of assistance:
- treatment of caries, pulpitis and other diseases (enamel, inflammation of the body and roots of the tooth, gums, connective tissues);
- surgical intervention;
- jaw dislocations;
- preventive actions;
- research and diagnostics.
Important! The following services are provided to children without paying a fee:
- to correct the bite;
- strengthening enamel;
- treatment of other lesions not related to caries.
How to apply the compulsory medical insurance policy
In order to organize treatment for patients, they are assigned to a clinic. The choice of medical institution is at the client's discretion.
It is defined:
- ease of visiting;
- location (near the house);
- other factors.
How to “attach” to the clinic
This can be done with the help of the insurer (select an institution when receiving the policy) or independently.
To be assigned to a clinic, you must go to the institution and write an application there. Copies of the following documents are attached to the paper:
- ID cards:
- passports for citizens over 14 years of age;
- birth certificates of a child under 14 years of age and passports of the legal representative;
- compulsory medical insurance policy (the original is also required);
- SNILS.
Important! Citizens registered in another region can be legally denied access to a clinic if the institution is overcrowded (the maximum number of patients has been exceeded).
In case of refusal, it should be requested in writing. You can complain about a medical institution to the Ministry of Health of the Russian Federation or Roszdravnadzor.
Visit to the doctor
In order to get help from a specialist, you need to make an appointment with him through the reception desk. This department issues admission vouchers. The terms and rules for registration and patient services are established at the regional level. They can be found in the same registry.
In addition, the insurer is required to provide this information to clients (you need to call the number indicated on the policy form).
For example, in the capital the following rules apply for providing patients with medical services:
- referral to an initial appointment with a therapist or pediatrician - on the day of treatment;
- voucher for medical specialists - up to 7 working days;
- carrying out laboratory and other types of examinations - also up to 7 days (in some cases up to 20).
Ambulance
All people in the country can use emergency medical services (compulsory medical insurance is not required).
There are regulations governing the activities of ambulance teams. They are:
- The ambulance service responds to emergency calls within 20 minutes when there is a threat to people's lives:
- accidents;
- wounds and injuries;
- exacerbation of the disease;
- poisoning, burns and so on.
- emergency assistance arrives within two hours if there is no threat to life.
How to call an ambulance
There are several options for seeking emergency medical help. They are:
- From a landline phone, dial 03.
- By mobile connection:
- 103;
Important! The last number is universal - 112. This is the coordination center for all emergency services: emergency services, fire, emergency and others. This number works on all devices if there is a network connection:
- with zero balance;
- with a missing or blocked SIM card.
Ambulance Response Rules
The service operator determines whether the call is justified. The ambulance will arrive if:
- the patient has signs of an acute illness (regardless of its location);
- there was a catastrophe, a mass disaster;
- information has been received about an accident: injuries, burns, frostbite, and so on;
- disruption of the functioning of the main body systems, life-threatening;
- if labor or termination of pregnancy has begun;
- the neuropsychiatric patient's disorder threatens the lives of other people.
Calls caused by the following factors are considered unreasonable:
- patient's alcoholism;
- non-critical deterioration in the condition of a clinic patient;
- dental diseases;
- carrying out procedures in the order of planned treatment (dressings, injections, etc.);
- organization of document flow (issuing sick leave, certificates, drawing up a death certificate);
- the need to transport the patient to another place (clinic, home).
Where to file complaints against doctors
If conflict situations arise, rude treatment, or insufficient level of services provided, you can complain to the doctor:
- chief physician (in writing);
- to the insurance company (by telephone and in writing);
- to the Ministry of Health (in writing, via the Internet);
- The prosecutor's office (also).
Attention! The period for consideration of a complaint is 30 working days. Based on the results of the inspection, the patient is required to send a reasoned response in writing.
If necessary, the treating doctor can be changed to another specialist. To do this, you should write an application addressed to the head physician of the hospital. However, it is allowed to change specialists no more than once a year (except in cases of relocation).
Dear readers!
We describe typical ways to resolve legal issues, but each case is unique and requires individual legal assistance.
To quickly resolve your problem, we recommend contacting qualified lawyers of our site.
Last changes
On May 28, 2019, new compulsory medical insurance rules came into force, which provide for the introduction of uniform policies (paper or electronic format) in Russia. In this case, there is no need to replace a previously issued policy. In addition, if it is technically possible to unambiguously identify the insured person in the unified register of insured persons, then instead of a compulsory medical insurance policy, it is allowed to present a passport (Order of the Ministry of Health of Russia dated February 28, 2019 No. 108n “On approval of the Rules of Compulsory Medical Insurance”).
The new Rules provide for stricter control over compliance with the rights of the insured, as well as close electronic interaction between the territorial Compulsory Medical Insurance Fund, insurance organizations and medical organizations:
- Every year, before January 31, clinics will have to report to the Federal Compulsory Compulsory Medical Insurance Fund (through a single portal) the number of those enrolled, the number of persons under dispensary observation, plans and schedules for medical examinations/dispensary examinations with a quarterly/monthly breakdown by therapeutic areas; work schedules);
- clinics every weekday before 9 am must report (via the TFOMS portal) on insured persons who have undergone a medical examination, as well as on persons undergoing medical examination;
- medical organizations, medical insurance organizations (IMO) and TFOMS will exchange information every day in electronic form on the TFOMS portal: hospitals must update data on the implementation of volumes of medical care, free beds, accepted/rejected patients by 9 am; clinics update information about hospital referrals issued yesterday by 9 a.m.; medical organizations that provide specialized, including high-tech, medical care post information about patients who received a telemedicine consultation, and the CMO is obliged to monitor the implementation of recommendations received from doctors of the National Medical Research Center, and has the right to conduct a face-to-face examination within the next 2 working days ;
- Regardless of the above-mentioned interaction, the health care provider every day no later than 10 am informs hospitals about patients sent to such hospitals the day before, and also every day no later than 10 am informs medical organizations about the number of free beds in the context of profiles/departments, about patients whose hospitalization did not take place;
- The CMO, using data from the TFOMS portal, checks during the working day whether patients were correctly referred to specialized medical organizations. If the hospitalization was untimely and not according to the profile, the health care provider must file a complaint with the head physician of the offending medical organization and the regional Ministry of Health, and, if necessary, take action and transfer the patient;
- insurance representatives of the health insurance company received a wide range of responsibilities - working with citizens’ complaints, organizing examinations of the quality of medical care, informing and accompanying them during the provision of medical care, inviting them to medical examination, monitoring its completion, creating lists of “persons for medical examination” and lists of citizens who fell under medical examination observation;
- patients will be able to see when and what medical services were provided to them, and at what cost: in their personal account on the government services portal or through the Federal Compulsory Compulsory Compulsory Medical Insurance (TFOMS) - by authorization in the Unified Identification and Logistics Authority;
- For cancer patients, the health insurance company undertakes to create (on the TFOMS portal) an individual history of insurance claims (based on registers and accounts) throughout all stages of medical care.
The updated Compulsory Medical Insurance Rules directly impose on the CMO the obligation to carry out pre-trial protection of the rights of insured persons. When they file complaints about poor-quality medical care or charging for services under the compulsory medical insurance program, the CMO registers written appeals, conducts a medical and economic examination and an examination of the quality of medical care.
Our experts monitor all changes in legislation to provide you with reliable information.
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The need to perform an operation is often unexpected for many people, which can happen to the person himself or his close circle. Insurance makes the situation easier if the required intervention involves payment within the scope of its coverage. A free operation under the compulsory medical insurance policy includes payment for the manipulations themselves, examination, and medication provision. Read on to learn more about these and other important issues.
The basic assistance program for the compulsory medical insurance policy is part of a unified system that provides social guarantees to citizens of the Russian Federation, as well as certain categories of foreigners or stateless persons. In addition to the federal one, the regions offer a territorial one, the volume of which depends on the allocated funds. The list of surgical interventions that can be performed as assistance to citizens within the framework of compulsory health insurance is open and available for review.
All innovations are promptly sent to insurance companies and medical institutions. It is important to keep in mind that not all events are covered by insurance; different services are also provided depending on the insurance company. To find out which activities will be free and which you will have to pay for, you can contact your doctor directly or the insurer with whom you have an agreement.
What operations can be done
In 2018, the list of free operations is large and is divided depending on the direction:
- Eyes. Treatment is paid for:
- cataract of the lens
- strabismus in children, including strabismus
- glaucoma
- congenital anomalies
- retinal deformation due to trauma
- Nose. Operations on it concern the correction of the nasal septum (senoplasty), which has caused respiratory dysfunction, loss of smell, swelling of the mucous tissue, susceptibility to respiratory diseases, snoring, dry nose and pain
- Removal of the gallbladder for cholecystitis, cholesterosis, cholelithiasis
- Marmara operation for men in case of varicocele at stages 2, 3, inability to release sperm, pain, aesthetics
- Gynecological diseases
- Joint arthroscopy
- Vein operations
- Thoracic region, including oncological diseases
- Valgus feet
There are many diseases that can be treated with surgery. The above list is not complete. Based on the situation, you should look for it in the list of those treated under the compulsory medical insurance program and covered by a specific insurance company, since there may be restrictions.
Important! Surgical cosmetology is not a free service.
Who can receive free medical services
Medical care according to compulsory medical insurance is provided throughout Russia to citizens who have issued an insurance contract. In this case, assistance is provided without reference to the place of residence, but there may be restrictions, since for residents of their region the list of services is more expanded. Help is also provided to people:
- awarded under licensing, scientific, publishing agreements
- who have drawn up an employment contract with enterprises regarding production, consumption and distribution of goods
- farmers
- involved in the production of folk goods, generic economic activities
- the unemployed, which includes children under 18 years of age, guardians of children under 3 years of age, persons caring for disabled people of group 1 or adults over 80 years of age
- medical workers, specialists from other special organizations, military personnel
- foreigners working officially
- refugees
Important! If there is no information about the insured person in the unified MHIF database, and he cannot confirm this with a policy, they have the right to refuse to provide free assistance.
Where can I get treatment for free?
Medical care under compulsory medical insurance is provided throughout the country. This applies to emergency provision of services, during planned or unscheduled visits. The main condition is the participation of the medical institution in the Compulsory Medical Insurance system and assignment to the clinic. There may only be a limitation on services, due to the volume of activities for those patients who are treated on a general basis or under a regional program. In the latter case, more expensive services are paid for, and the list itself is longer.
The medical institution becomes a participant in the program immediately after signing a cooperation agreement under the health insurance program. If he has a quota, then they will not have the right to refuse to provide services. When considering the provision of services, you should know and remember that a planned operation may require waiting time in line. This is due to the limitation of quotas, that is, payment for operations, since, as a rule, they are expensive, and there can be many people willing. The situation is similar with some types of examinations. For this reason, you should contact a neighboring region or a private clinic.
When choosing a hospital for a planned operation, you should pay attention to the following factors:
- Insurance cover. It may not apply to this type of operation (the situation may be different with another insurer, depending on the list of services and coverage).
- Location. Clinics in the capital may have more modern equipment, while local clinics may have more experienced doctors.
- Waiting time in line. In large cities with high population density, you can wait a year. During this time, the health situation may worsen. In other cities, the time frame is several times shorter, which will speed up the process aimed at recovery.
- The cost of activities that need to be paid in addition to those procedures that insurance will cover. Also important are items such as travel and accommodation for relatives, since the further the hospital is located, the more significant the costs.
- Possibility of consulting. For the purpose of rapid rehabilitation and recovery after surgery, it is important to have the opportunity to be observed and learn about measures that are appropriate for a particular person in his situation.
How to apply for a quota for a free operation - algorithm of actions
To receive a quota for a free operation under compulsory medical insurance, it is important to follow a certain sequence of actions, which includes the following steps:
- Visit a doctor at the clinic at your place of attachment for an examination, referral for examination, and testing.
- Based on the information received and the general condition of the patient, the doctor will be able to write a referral to a clinic where operations in the desired direction are performed. If the patient insists on a specific medical institution, a referral can be issued to it.
- Visit a specialized hospital, register, if required by the conditions of the clinic, make an appointment with a doctor.
- Having arrived at the appointed time, take personal documents confirming your identity, a referral from a doctor and all information related to your health: results of examinations, tests, insurance. After conducting an examination and studying the medical documentation, the doctor decides on the need for treatment and placement of the patient in a hospital. It is also within his competence to inform a person about the list of free and paid services. Additional tests may also be prescribed for delivery at the site of the operation.
- Within 10 days, the person is informed about the date of the operation.
- Hospitalization is carried out at the appointed time.
The number of quotas is determined based on the financial resources of the Compulsory Medical Insurance Fund and individual regions to compensate for the costs of consumables, medicines, the work of medical personnel, and surgical interventions. If a medical institution is state-owned, then its activities depend on funding, which is used to purchase everything necessary, including equipment. For this, it is important to hold competitions to determine the most profitable offers. For this reason, to receive assistance under compulsory medical insurance, you should not rely on using the latest generation of consumables; everything that is most optimal and effective for providing assistance and recovery is selected.
Documents required
Documents confirming the advisability of performing surgical treatment, including those required to undergo the compulsory medical insurance program, must relate directly to the patient’s personality and medical documents relating to his health. This list includes:
- referral from the attending physician for surgery
- extract from the medical history
- survey results
- analysis data
- passport
- original insurance policy
- SNILS
- receipts in case of making any payments (for medicines, examinations)
Do I need to pay extra for services provided?
As already mentioned, surgical procedures are provided free of charge. In addition to the work itself, the costs of anesthesia, consumables, and the use of special equipment are covered. If demands for additional payment are made, this is illegal. Travel, accommodation, and meals outside the hospital are independently financed. Services that are not included in the list of compulsory medical insurance are subject to payment:
- performing anonymous diagnostics upon request (except for HIV)
- diagnostics, procedures in the field of sexopathology
- speech therapist for adults
- vaccinations, except those provided under compulsory medical insurance
- home visits for the purpose of consultation, diagnosis, treatment, except in cases where a person is not physically able to come to the hospital
- postoperative procedures, which also applies to sanatorium treatment, unless it is included in compulsory medical insurance
- cosmetology
- psychological support
- prosthetics, except for services included in compulsory medical insurance coverage
- methodological assistance related to patient care
The duty of medical institutions is to inform patients not only about free services, but also about paid ones. It is useful to use price lists that are posted on special stands in reception areas. During hospitalization, you may be informed about options that are available at an additional cost and that may affect your stay in the hospital. To clarify the requirements that are proposed, the patient has the right to contact the insurer. This also applies to payment for services and medications.
In what cases can they refuse and what to do?
Situations often occur when a person is denied a free operation. Money may also be required for services. In such a situation, people may agree to the statement, but they also have the right to receive written reasons for the refusal and to be aware of the terms and conditions. At the same time, the patient protects his personal rights as a citizen who has taken out an insurance policy. He can contact:
- to the insurer
- to the head physician
- to the district or city health department
- territorial, federal department of compulsory medical insurance
- to court
To get a reasoned decision on a complaint, you need to write a written statement, in which it is important to state the essence of the problem in detail, clearly, and in a business style. Also indicated:
- Full name, position of the person being contacted
- Full name, place of residence of the person whose rights were violated
- insurance policy details
- data (details) of the hospital in which the provision of services was refused and in which there is a violation
- the time during which the treatment measures were carried out, the person was under treatment
- list of events that led to unreasonable waste of personal funds and their cost
When filing complaints, evidence is required to confirm that the applicant is right. These include extracts from the medical history and payment receipts.
Conclusion
The system of assistance to the population has been provided for many years, improving every year and providing better services and a larger number of quotas. To receive free treatment, it is advisable to consult with your doctor, who will advise you on the right decision in your individual case. Do not forget about the possibility of carrying out treatment in other regions, since a queue “at home” can lead to complications, but “in the neighborhood” everything will be completed faster, making the wait easier and speeding up recovery.
Video: Free prosthetics under compulsory medical insurance policy
Free medical care is provided through state insurance. Government bodies of all levels act as insurers: from federal to territorial. Insurer - federal, municipal, village budget. Insured persons are Russian citizens of all ages, working and non-working.
Compulsory health insurance
Emergency medical care can be obtained throughout the Russian Federation.
Planned – at the place of registration of the compulsory medical insurance policy. To receive free medical services, you must obtain a compulsory medical insurance policy.
The conclusion of a contract for compulsory insurance, in contrast to insurance, occurs automatically upon receipt of insurance. Compulsory medical insurance policies are issued by enterprises and organizations or by Territorial Funds (MHIF). When applying for compulsory medical insurance, you will need: a passport with registration confirmation, a work book.
The register of free medical services that a citizen can receive is approved for each territory annually. The clinic has a register of such services, which anyone can view. He will tell you about Article 326 of the Federal Law and compulsory health insurance in the Russian Federation.
On the video - what is included in the compulsory medical insurance policy:
State program for the provision of medical care for 2017-2019. includes:
- primary;
- specialized;
- ambulance;
- palliative (pain relief for incurable diseases) care.
Types of priority assistance and specialists:
- health care (nurses);
- pre-medical (paramedics, obstetricians);
- medical (therapists, pediatricians, family doctors).
Primary care is provided in a clinic, in a day hospital and at home.
The clinic doctor is obliged to:
- admit the patient;
- order an examination;
- to diagnose;
- determine treatment;
- control the course of the disease.
Medications for therapy are not included in the list of mandatory medical services and are purchased by the patient at his own expense. 
Specialized medical care can be obtained at a day hospital from specialist doctors. In this case, high-tech methods and tools are used (genetic engineering, robotic systems).
Day hospital means receiving medical care in the form of intramuscular and intravenous injections, physiotherapy, massage, additional instrumental examination, minimally invasive surgical intervention (removal of warts, papillomas, etc.), which does not require hospitalization and health monitoring. Find out about Rosno's health insurance policy.
Citizens can receive all types of emergency care:
- urgent;
- emergency;
- specialized emergency;
- specialized emergency.
Emergency care - when a sharp deterioration in health does not threaten the patient’s life. Emergency is assistance for conditions that are life-threatening to the patient.
Hospitalization, included in compulsory medical insurance, is prescribed for acute conditions, such as: 
- heart attack;
- stroke;
- food intoxication;
- infectious disease (measles, dysentery, etc.);
- severe traumatic injuries.
Palliative services are provided in hospital and outpatient settings. Read what is the maximum length of sick leave.
In the Program for 2017-2019. provided:
- provision of free medications for citizens suffering from serious, chronic, incurable diseases);
- preventive examination of persons working in public catering, educational institutions, hazardous and hazardous industries;
- monitoring the health of orphans, adopted children and under guardianship;
- antenatal examination of women;
- examination of newborns for hereditary diseases and hearing.
What is provided
The list of types of high-tech assistance is approved in the Appendix to the Program for 2017-2019.
The main areas of free high-tech assistance: 
- Surgery. Microsurgical operations (pancreas, liver, intestines).
- Obstetrics and gynecology. Nursing premature babies (genetically engineered drugs, molecular diagnostic methods). Operations for implantation of internal organs.
- Gastroenterology. Therapeutic treatment of stomach and intestinal ulcers.
- Hematology. Therapy of hemolytic anemia, hemorrhagic diseases.
- Surgery of newborns. Defects of the lungs, bronchi, esophagus.
- Dermatovenerology. Severe forms of psoriasis, atopic dermatitis.
- Neurosurgery. Oncological operations.
- Neonatology. Birth injuries, sepsis, respiratory disorders, nursing newborns weighing up to 1.5 kg. Therapy and surgery using additional research methods: MRI, vascular Dopplerography, immunological and molecular genetic. Cryo-, laser coagulation of the retina. (Newborns are treated and examined at the expense of the mother's insurance).
- Oncology. Surgical operations on the stomach, esophagus, rectum, nose, trachea, ear, liver using endoscopic and radiological means.
- Otorhinolaryngology. Surgical treatment of otitis using reconstructive plastic intervention.
- Ophthalmology. Surgical treatment of glaucoma, cataracts, retinal detachment, lens replacement. Implantation of an intraocular lens. Correction of strabismus, ptosis of the upper eyelid.
- Pediatrics. Treatment of hereditary diseases (Gaucher, Wilson), renal, heart failure using MRI, ultrasound, Dopplerography, MCT, ventriculography, coronary angiography, genetic studies.
- Rheumatology. Therapy of severe inflammatory processes.
- Cardiovascular surgery. Implantation of artificial valves and pacemakers.
- Thoracic surgery. Operations to remove a lung or part of it.
- Traumatology and orthopedics. Restoration of intervertebral discs, plastic surgery of the bones of the chest, pelvis, upper and lower extremities.
- Urology. Plastic surgery on the intestines and bladder. Removal of tumors on the prostate gland, kidney, bladder.
- Maxillofacial Surgery. Correction of congenital defects of the lip and hard palate.
- Endocrinology. Treatment of complicated diabetes mellitus.
In addition to the basic list of high-tech medical care, there is a second registry, in which the list of assistance has been expanded (for example, removal of a limb, eyes) and new sections have been added (treatment of all types of burns, organ transplantation). What disability group is assigned for oncology will be told.
Dental care
Dental care included in the compulsory medical insurance system:
- initial examination;
- dental filling;
- removal of teeth, including fragments;
- treatment of gums and teeth (caries, periodontal disease, gingivitis, abscess);
- adjustment of dislocations and subluxations of the jaw;
- treatment of salivary glands;
- removal of tartar and deposits;
- anesthesia;
- X-ray, orthopantography;
- physiotherapy.
In the video - what is included in the compulsory medical insurance policy: dentistry:
In this case, medicines are used according to the approved register.
Children have their teeth straightened and silvered. Find out where and how to get a medical insurance policy.
- pensioners;
- disabled people of WWII, childhood, groups 1 and 2;
- Chernobyl victims;
- persons who have received the highest state awards of the USSR;
- Leningrad siege survivors.
All other types of dental care, drugs and materials not included in the preferential list are paid for.
For each territory at the local level, within the framework of the state program, its own health protection measures are developed. Settlements in remote, hard-to-reach areas can receive free medical care with the help of air ambulances, telecommunications, and mobile outpatient clinics.
