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.

Important! If the disease does not fall under one of the options, you will have to pay for medical services.

Medicines are provided at the expense of the budget to people suffering from the following types of diseases:

• shortening lifespan;
• rare;
• leading to disability.

Attention! A complete and detailed list of drugs is approved by government decree.

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New in legislation since 2017

Government Decree No. 1403 dated December 19, 2016 provides a more detailed breakdown of medical services provided free of charge. In particular, primary health care stands for. It is divided into subspecies. Namely the primary one:

• pre-medical (primary);
• ambulance;
• specialized;
• palliative.

Attention! As part of the program, palliative medical care has been added to the list of services provided free of charge.

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.

Attention! The document contains a list of diseases that doctors are obliged to treat free of charge.

Medical policy

A document guaranteeing the provision of care to patients is called a compulsory health insurance policy (CHI). This paper confirms that the bearer is insured by the state, that is, all the professionals listed above are obliged to provide services to him.

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).

Important! The described document is issued only by licensed insurance companies. They are allowed to be changed, but not more than once a year (before November 1 of the current period).

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.

Attention! A new compulsory medical insurance policy is issued without paying a fee.

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.

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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 measures;
• 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.

Important! You are allowed to change medical facilities no more than once a year. The exception is a change of residence.

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 at the same registration desk.

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).

Important! If the clinic is unable to meet the patient’s needs, he should be referred to the nearest institution that provides the necessary services under the compulsory medical insurance program.

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.

Important! The decision about which team will respond to a call is made by the dispatcher, based on the client’s information.

How to call an ambulance

There are several options for seeking emergency medical help. They are:

1. From a landline phone, dial 03.
2. 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.

Important! The service goes to children under one year of age for any reason.

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).

Attention! The ambulance provides only emergency assistance. May transport patient to inpatient facility if necessary.

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.

Latest 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 Medical Insurance Fund (through a single portal) the number of those enrolled, the number of people under dispensary observation, plans and schedules of medical examinations/dispensary examinations with a quarterly/monthly breakdown by therapeutic areas; work schedules);
• every day on weekdays before 9 am, clinics must report (through the TFOMS portal) on insured persons who have undergone a medical examination, as well as on persons undergoing medical examination;
• medical organizations, medical insurance organization (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 complaints, conducts a medical and economic examination and an examination of the quality of medical care.

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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 a clinic no more than once a year, with the exception of cases of change 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 selected 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 it is enough 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, 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.

Insurance premiums for compulsory health insurance for the working population

According to Article 22 of the Federal Law of November 29, 2010 No. 326-FZ “On Compulsory Medical Insurance in the Russian Federation”, the obligation to pay insurance premiums for compulsory medical insurance of the working population, the amount of insurance premium for compulsory medical insurance of the working population and relations arising in the process of implementation control over the correctness of calculation, completeness and timeliness of payment (transfer) of these insurance premiums and bringing to responsibility for violation of the procedure for their payment are established by the legislation of the Russian Federation on taxes and fees.

The main administrator of budget revenues of the Federal Compulsory Medical Insurance Fund from the payment of insurance premiums for compulsory medical insurance from January 1, 2017 is the Federal Tax Service, until January 1, 2017 - the Pension Fund of the Russian Federation.

For the main category of payers, insurance premiums for compulsory medical insurance of the working population are paid based on the rate of insurance contribution to the Federal Compulsory Health Insurance Fund in the amount of 5.1%, for “preferential” categories of payers of insurance premiums for compulsory health insurance - based on reduced rates of insurance premiums established by Article 427 of the Tax Code of the Russian Federation.

Payers of insurance premiums who do not make payments for other benefits to individuals pay insurance premiums for compulsory health insurance in a fixed amount. The procedure for their calculation and payment is established by Articles 430 and 432 of the Tax Code of the Russian Federation.

Regarding the payment of insurance premiums for compulsory medical insurance of the working population for reporting (calculation) periods expired before January 1, 2017, you should contact the branches of the Pension Fund of the Russian Federation at the place of registration, after January 1, 2017 - to the tax authorities at the place of registration accounting

Insurance premiums for compulsory medical insurance of the non-working population

In accordance with Part 2 of Article 23 of Federal Law No. 326-FZ, the annual volume of budgetary allocations provided for by the budget of a constituent entity of the Russian Federation for compulsory medical insurance of the non-working population cannot be less than the product of the number of non-working insured persons in the constituent entity of the Russian Federation on January 1 of the year preceding the next , and the tariff of the insurance premium for compulsory medical insurance of the non-working population, established by Federal Law of November 30, 2011 No. 354-FZ “On the amount and procedure for calculating the tariff of the insurance premium for compulsory medical insurance of the non-working population.”

In accordance with Part 2 of Article 10 of Federal Law No. 326-FZ, the procedure and methodology for determining the number of insured persons, including non-workers, for the purpose of forming the budget of the Federal Fund, the budgets of the constituent entities of the Russian Federation and the budgets of territorial funds are established by the Government of the Russian Federation. According to the Rules for determining the number of insured persons for the purpose of forming the budget of the Federal Compulsory Medical Insurance Fund, the budgets of the constituent entities of the Russian Federation and the budgets of territorial compulsory medical insurance funds, approved by Decree of the Government of the Russian Federation of November 9, 2018 No. 1337, the number of insured persons, including non-working persons, is determined based on personalized accounting data in the field of compulsory health insurance.

The insurance premium rate for compulsory medical insurance of the non-working population in a constituent entity of the Russian Federation is calculated as the product of the insurance premium rate in the amount of 18,864.6 rubles, the differentiation coefficient and the coefficient of increase in the cost of medical services. These coefficients are determined in accordance with the appendix to Federal Law No. 354-FZ and are established annually by the federal law on the budget of the Federal Compulsory Medical Insurance Fund for the next financial year and planning period.

The main administrators of the budget revenues of the Federal Compulsory Medical Insurance Fund from the payment of insurance premiums for compulsory medical insurance of the non-working population are the territorial compulsory medical insurance funds.

Insurers for non-working citizens quarterly, no later than the 20th day of the month following the reporting period, submit to the territorial compulsory health insurance funds at the place of their registration a calculation of accrued and paid insurance premiums for compulsory medical insurance of the non-working population in the form approved by order of the Ministry Healthcare of the Russian Federation dated April 2, 2013 No. 182n.

In case of non-payment or incomplete payment of insurance premiums for compulsory medical insurance of the non-working population no later than the 28th day of the current calendar month, the policyholder independently charges penalties for the entire amount of arrears for the period of delay in the manner established by Article 25 of Federal Law No. 326-FZ.

Penalties are paid simultaneously with the payment of insurance premiums for compulsory medical insurance of the non-working population or after payment of such amounts in full, and in case of non-payment by policyholders on a voluntary basis, territorial compulsory medical insurance funds ensure their recovery in court.

Compulsory medical insurance is a state system that guarantees all citizens a minimum amount of medical care. It is financed by the federal compulsory health insurance funds (FFOMS). They receive employer contributions from the wages of all officially employed citizens. Funds for the treatment of unemployed persons come from the state budget, the source of which is citizens’ taxes. Medical insurance funds also pay bills for treatment under the compulsory medical insurance policy presented by medical institutions. Providing information to patients about the cost of services provided attracts them to control the expenditure of tax funds for medical purposes.

For what purpose was a program created to inform insured persons about the cost of services provided? When did the program come into effect and what law is it regulated by? Why does the insured person need to know about the cost of services provided? In what form does the information take place? We will answer these questions in this article.

Legislative basis for informing about the cost of treatment under compulsory medical insurance

The state program for informing citizens about the cost of “free” medical services was launched on July 25, 2014, on the instructions of the President of the Russian Federation - “Instruction No. Pr-1788”. And on July 28, 2014, FFOMS Order No. 108 “On the introduction of a system for informing insured persons about the cost of medical care” was published. Since September 2014, in seven regions of Russia, medical institutions began issuing certificates to patients stating what kind of medical care they received and what its cost was. At the beginning, the public information experiment encountered difficulties and misunderstandings, including:

• Overload of medical personnel forced to calculate the volume and cost of services for each patient, issue certificates, explain their purpose, collect signatures on receipt or refusal;
• Misunderstanding and wary attitude of patients towards certificates. Some asked what to do with them; others accepted them on account to pay out of their own pockets; Still others were amazed at how cheap services under the compulsory health insurance policy are priced.

The first difficulties were overcome. In 2015, medical institutions in almost all regions of Russia entered into a system of mandatory informing patients about the cost of care provided to them under compulsory medical insurance policies.

Goals and objectives of the awareness program

The program, the development of which was an initiative of the President of the Russian Federation, helps solve several problems. Thus, the need for information was initially explained by psychological factors: knowing the cost of insurance medicine services, citizens will begin to be understanding about the expenditure of budget funds, take care of their health, etc. But such a measure primarily pursues a practical goal: establishing control over the expenditure of state budgetary funds for medical purposes. By receiving a certificate of assistance that was provided to him, the patient thereby finds out how much the insurance fund is transferring for his treatment, whether the volume and quality of services correspond to state guarantees. In addition, a certificate indicating the tariffs for free care allows citizens to clearly understand what the required minimum is provided by insurance medicine, and for which services they will have to pay out of their own pocket.

By receiving information about medical care through a personal account on the government services website, a citizen can discover services that were not provided to him, but are recorded in his book. According to experts, medical institutions are engaged in registrations in order to attract additional funds to finance their urgent needs. Therefore, such a database is also useful for state control authorities. The expenditure of FFOMS funds becomes transparent, easier to account for and regulate.

How much does it cost to treat a patient?

Money for compulsory health insurance funds comes from several sources. Enterprises allocate 5.1% of wage funds for these needs to provide medical care to their employees and their families. The state budget finances the treatment of unemployed citizens and some types of socially dangerous diseases (HIV, tuberculosis, etc.). Based on Law No. 286-FZ of July 3, 2016, signed by the President of the Russian Federation, from January 1, 2017, high-tech free patient care will be paid not by the state budget, but by the Federal Compulsory Medical Insurance Fund. Some regions contribute additional funds to territorial compulsory medical insurance funds to expand the possibilities of free treatment for their population.

The problems of distribution of funds in the compulsory medical insurance system are evidenced by the following figures - 1.7 trillion. rub. - this amount was managed by the FFOMS in 2017, which is 7.8% more than the funds in 2016. For each average owner of a compulsory medical insurance policy, the planned expenditure is 9.1 thousand rubles, while in Moscow it was about 24 thousand rubles in 2014. The cost of most medical services according to the price list of basic compulsory medical insurance services is an order of magnitude lower than in paid clinics, which is not always economically justified. The table below shows data on tariffs for some types of medical care and services provided under compulsory medical insurance.

Table - Tariffs for payment for certain types of medical services under the compulsory health insurance program in 2017, rubles.

Types of medical care	Medical service	Tariff (cost)
Primary in an outpatient clinic	Appointment with a therapist	327
	Oncologist appointment	348
	Neurologist appointment	333
	Gynecologist appointment	406
Specialized in hospital (including day care)	Oncology procedures	40 000 - 200 000
	Procedures for cardiac and pulmonary pathologies	15 000 - 120 000
	Procedures for orthopedic pathologies	55 000 - 250 000
High tech	Balloon angioplasty for pulmonary valve stenosis	128 190
	Kidney transplant	800 000
	Treatment of diabetes	166 495

Based on data from the Tariff Agreement in the compulsory health insurance system of the Kaliningrad region for 2017 and the planning period of 2018 and 2019

Free treatment of serious diseases is difficult, since there are long queues, lack of quotas, and low level of service. Obtaining information about the cost of treatment will force patients to take their health more seriously and not neglect the opportunity for free medical examinations and preventive examinations under the compulsory medical insurance policy, so as not to trigger incipient diseases.

Ways to obtain information about the cost of treatment under compulsory medical insurance

The issuance of certificates on the volume of medical services provided is carried out by order of the Federal Compulsory Medical Insurance Fund dated October 19, 2015 No. 196 on the basis of the “Rules of Compulsory Medical Insurance” as amended, approved by Order No. 536n of the Ministry of Health of the Russian Federation dated August 6, 2015. This information is issued by the insurance company that issued the policy, by the medical organization that carried out medical treatment, or on the government services portal and on the websites of insurance companies, where the patient can create a personal account and receive all information in electronic form upon request.

The requested information on paper is provided only upon written application from the citizen (or his representatives with a legally certified power of attorney), upon presentation of a passport. Receipt is confirmed by a receipt from the patient. The content of such a certificate includes the patient’s personal data and a list of diagnostic and treatment procedures with an indication of their cost.

Conclusion

The program for informing the population about the cost of treatment under compulsory health insurance involves the population in controlling the expenditure of tax funds. It also determines the directions for optimizing health insurance: creating electronic medical records, introducing compulsory medical insurance plus policies, etc.

All citizens of the Russian Federation, without exception, are insured in the compulsory medical insurance system. Foreigners permanently residing in Russia have the right to receive an insurance policy.

The policyholders in the system of this type are:

• institutions;
• enterprises;
• directly the state.

Enterprises transfer 5.1% of the total amount of wages to territorial or federal compulsory medical insurance funds. Medical insurance for unemployed citizens is paid directly by the state.

The most important component of compulsory health insurance are special funds. They are non-profit organizations that accumulate all money transfers in favor of the health insurance system.

They provide financial stability and, if necessary, provide material support to insurance companies.

The direct participants of compulsory medical insurance are commercial insurance companies. They are required to have the appropriate state license to carry out insurance activities.

They enter into contracts with medical institutions to provide services to their clients, issue medical policies, and monitor the quality and timing of medical care.

Medical institutions are the final segment of compulsory medical insurance. Citizens of the Russian Federation turn to them to receive appropriate assistance. Having a policy of the described sample gives you the full right to receive free medical services.

Law on Compulsory Medical Insurance

Today, the basis for compulsory medical insurance is the Federal Law “On Compulsory Health Insurance in the Russian Federation”.

The main function of this law is to regulate the relationships of all participants in the compulsory health insurance system (insurers, policyholders, funds, government bodies).

It also determines the legal status of subjects and objects in compulsory medical insurance. The basis for the adoption and operation of the law in question is the Constitution of the Russian Federation.

Complement the effect of Federal Law No. 326:

• Law of November 21, 2011 “On the fundamentals of protecting the health of citizens of the Russian Federation”;
• Law of July 16, 1999 “On the basics of compulsory medical insurance.”

The relationships between the subjects of the compulsory medical insurance system are also regulated by various other provisions and acts of the regions of the Russian Federation. Each insured event is considered separately, on an individual basis.

Compliance with the law in question is primarily monitored by the federal and regional compulsory medical insurance fund.

Each organization has a special legal department that performs the function of supervision in the field of compliance with the legislation in force in the Russian Federation.

What does the policy provide?

The compulsory medical insurance policy confirms that a citizen has the right to receive free medical care.

If available, the insured person has the right to contact the following institutions:

• the clinic to which the insured person is registered;
• traumatology;
• dentistry;
• oncology departments, dispensaries;
• hospitals participating in compulsory medical insurance.

Having a compulsory health insurance policy allows you to receive almost any medical care without any financial costs.

Today, this document is mandatory to submit to a medical institution upon application. If for some reason there is no compulsory medical insurance policy, then an individual can receive medical care on a paid basis.

What does he look like

Today, the compulsory health insurance policy has a standard form. Moreover, its format does not depend on the services of which insurance company the citizen uses. The appearance depends only on the type of medical policy.

Recently, reform of the health insurance system has been carried out. It is in this regard that a new type of insurance policy was issued. It looks like a plastic card with an individual card number on the front side.

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On the back there is the following information:

• signature of the policyholder;
• photograph of the policyholder;
• validity period;
• gender and date of birth.

A copy of the image is simply applied to the policy; it is not an electronic signature. Even a picture with not very high quality can be used as a photograph. The duration of a document is determined by many factors.

There is also another type of policy - temporary. It is issued for a period of 30 days in the event of a situation where the plastic policy is confiscated.

This happens if a person previously simply did not have a policy of the type in question, or if it is being replaced. Upon expiration of thirty days from the date of receipt, the temporary policy ceases to be valid.

It itself is A5 paper and contains the following information:

• date of issue;
• signature of the policyholder;
• name of the representative of the medical insurance organization.

Previously, old-style policies were in effect. They were in A3 format and contained information similar to that presented on the temporary compulsory medical insurance policy.

Terms of the agreement

The terms of the compulsory health insurance agreement were approved by the Director of the Federal Compulsory Medical Insurance Fund A.M. Taranov 03.10.03.

All documents of this type must be formed only taking into account this provision and not contradict it. Otherwise, this agreement may be considered partially invalid.

The document under consideration necessarily contains clauses to avoid the emergence of various types of conflicts, and the boundaries of responsibility are indicated.

The section “Subject of the contract” stipulates the conditions under which the insurer provides its services to the policyholder. A certain amount (insurance premium) is paid to the insurance company.

Based on this, when an insured event occurs, the company pays for its client to go to a medical facility.

This section identifies the object of insurance – the client’s property interest. That is, in fact, the compulsory medical insurance policy protects its owner, first of all, from financial damage. This section also defines the concept of an insured event.

The section “Amount insured, the procedure for its payment” explains these two terms in detail. The amount of the insurance premium, the limit of liability, the procedure for paying the insurance premium and the moment of this operation are also indicated.

When applying for a standard compulsory medical insurance policy, this section is absent - it is displayed in the agreement between the insurance company and the regional (federal) compulsory medical insurance fund. The section “Duration of the agreement” determines the duration of the agreement of the type in question.

The clause “rights and obligations of the parties” states the obligations arising between the policyholder and the insurer in the event of its conclusion.

The rights of the parties are also discussed in as much detail as possible. The occurrence of serious violations of at least one clause is a serious reason for termination of the contract.

The insurance company must ensure the confidentiality of information relating to the policyholder. Exceptions are possible only in cases provided for by the current legislation of the Russian Federation.

The following information is confidential:

• content of the agreement, its form;
• the health status of the policyholder, all existing cases of seeking medical care;
• personal data of the policyholder (place of residence, home telephone number, etc.).

The section “Change and termination of the contract” lists situations when it is possible to make any amendments to the text of the document.

All cases when the contract can be terminated and the procedure for carrying out this process are listed. At the end of the agreement, the details of the parties are indicated: actual and legal addresses, telephone numbers.

Validity period

Several years ago, different compulsory insurance policies were issued in different regions. That is why their validity period varies significantly. In 2011, a gradual transition to a unified compulsory health insurance policy began.

Today, policies of this type, which are a plastic card, usually do not have expiration dates. The only exception is the issuance of a policy to a foreign citizen.

If an individual uses an old policy (today this is quite acceptable), then you can find out the expiration date of its validity directly on it.

Most often this information is present at the back of the document. Previously, contracts for compulsory medical insurance policies were most often concluded for 12 months.

After which it was necessary to carry out their extension. The expiration of the policy is grounds for its replacement.

Necessary documents for registration

The list of documents required to apply for a compulsory medical insurance policy varies depending on the age, as well as the legal status of the person applying to the insurance company.

To obtain a policy, children over 14 years of age (citizens of the Russian Federation) must provide the following documents to the insurance company:

• identification document (birth certificate or other document);
• (if available).

If the papers for issuing a policy of the appropriate type are provided by a parent or guardian, then a passport or other identification document is required.

If the policy is issued by relatives, then they must present:

• ID card;
• a document allowing registration as an insured person (power of attorney).

Citizens of the Russian Federation who have not reached 18 years of age, but have overcome the age threshold of 14 years:

• temporary identity card or passport;
• SNILS (if already available);
• ID card of the representative of the insured person;
• power of attorney allowing registration (if the representative is a grandparent);
• representative's identity card.

Persons over 18 years of age:

• identity document or passport;
• SNILS.

Refugees who can legally become participants in the health insurance system (Law on Refugees) are required to provide:

• petition;
• certificate of the appropriate type;
• an appeal against a court decision to deprive refugee status to the Federal Migration Service;
• document confirming receipt of temporary asylum.

For individuals who do not have permanent citizenship, but have real estate and a residence permit:

• passport of a foreign citizen;
• SNILS (if available);
• resident card.

Individuals who do not have citizenship (refugees or otherwise) require the following documents to participate in compulsory medical insurance:

• identity card and document confirming lack of citizenship;
• SNILS (if available);
• resident card.

In the absence of any document, obtaining an insurance policy becomes simply impossible.

Insurance premiums

Insurance premiums for compulsory medical insurance are payments transferred to the Federal Compulsory Medical Insurance Fund of the Russian Federation.

Today, payers of compulsory medical insurance premiums, according to the Federal Law “On Compulsory Medical Insurance” are:

• organizations;
• individual entrepreneurs;
• individuals who are not individual entrepreneurs (conducting private practice).

The amount of insurance premiums itself is calculated and then paid depending on the type of organization, the taxation system used, as well as other factors.

The contribution to the federal compulsory medical insurance fund is 5.1% of the total wage fund paid to employees.

The duration of the settlement period for contributions of the type in question is one calendar year. The reporting periods are:

• quarter;
• half year;
• nine months;
• twelve months.

Register of services provided

The basic list of compulsory health insurance includes the following types of assistance:

• emergency medical service;
• preventive;
• primary health care.

There is also a list of specialized services that are provided completely free of charge or on a preferential basis.

Under the compulsory health insurance policy, you can have an abortion, childbirth or the postpartum period free of charge.

The compulsory medical insurance system provides the following types of medical care:

• dental, oncological (list approved by the Health Committee of the Russian Federation);
• implementation of preventive fluorographic studies in order to detect tuberculosis in the early stages;
• prevention of various diseases using special types of vaccines;
• preferential prosthetics, provision of medicines;
• inpatient, provided in special outpatient departments.

Dental treatment according to the policy

Today, the list of services provided under the compulsory medical insurance policy includes dental treatment.

Free of charge, subject to availability:

• conducting an initial examination and consultation (including for patients who are unable to move independently);
• drawing up a preventive disease map;
• treatment:
  • carious formations;
  • pulpitis;
  • periodontitis;
  • periodontal diseases;
  • diseases of the oral cavity, mucous membrane;

• treatment of injuries through surgery, removal of foreign bodies from dental canals;
• removal of teeth and malignant tumors;
• operations on soft tissues of the oral cavity;
• reduction of various types of dislocations.

For children under 14 years of age, many clinics provide treatment:

• non-carious lesions of hard dental tissues;
• demineralization;
• orthodontics using special removable equipment.

What are the types

Today there are three types of compulsory medical insurance policy:

• a sheet of A5 paper with a special barcode on it;
• a plastic card, which is a studded electronic medium;
• electronic application with a number printed on the UEC (universal electronic card).

Previously, until 2011, compulsory medical insurance policies of various formats were issued. Today, this area of ​​insurance is more streamlined.

Amendments have been made to the legislation allowing any citizen to choose the policy format independently.

Policies in electronic form have one important advantage over paper ones - there is no need to renew them.

A standard policy in A5 format can be obtained at any issuing point. To obtain a universal electronic card or a plastic card, you must visit a specialized issuing point.

The legislation in force on the territory of the Russian Federation allows all citizens to receive medical care in full free of charge. Only in certain cases will it be necessary to make a payment, but this applies only to very rare cases.

Most often, when visiting a clinic, you just need to provide the compulsory medical insurance policy to the registry - this will be enough.

Video: Protecting patients' rights in the compulsory medical insurance system

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