What is included in the free service under the compulsory medical insurance policy. What free services can you get under the compulsory medical insurance policy - complete list

29.05.17 165 133 0

The doctors were shocked when I showed...

About the magical power of your insurance policy and how to get treatment under it for free

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.

If you don’t have SNILS, you 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:

1. Select a clinic. Any, not necessarily the one that is closer to home.
2. 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.
3. Come to the insurance office with your passport and SNILS and fill out an application for a replacement policy.
4. Get a temporary certificate. It works like a policy for a month.
5. 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 dermatovenerology clinic. 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:

1. Any treatment without a doctor's prescription.
2. Conducting surveys and examinations.
3. Treatment at home is optional, not for special indications.
4. Vaccinations outside government programs.
5. Sanatorium-resort treatment, if you are not a sick child or a pensioner.
6. Cosmetology services.
7. Homeopathy and traditional medicine.
8. Dentures.
9. Superior rooms - with special meals, individual care, TV and other amenities.
10. 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 your local hospital may simply not have painkillers. 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 facing 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 assistance 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 somewhere in his childhood his father 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

1. If you don’t have a policy, drop everything and go get one.
2. With a compulsory medical insurance policy, you should be treated for free in any state clinic throughout Russia.
3. The treatment is free only for you. The hospital and doctor will receive money for this treatment from the health insurance fund.
4. 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.
5. In any unclear situation, call your medical insurance company. The number is on the policy. Put it in your phone right now.
6. If your insurance doesn’t save you, call the Federal Compulsory Health Insurance Fund: +7 499 973-31-86.
7. 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.
8. Emergency assistance is always free, even if you do not have documents.

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 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.

Invalid Displayed Gallery

On the back there is the following information:

• signature of the policyholder;
• photograph of the policyholder;
• validity;
• 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.

Agreement conditions

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 help;
• 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

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 taken out by relatives, then they must present:

• identification;
• 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 month;
• 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 A5 policy 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

The care and love of parents is the most important thing that a newborn baby needs first of all. In an emergency, a child may require urgent medical care, so the best way to show concern on the part of parents is to issue a compulsory medical...

Now basic health insurance in Russia has become mandatory. Every citizen needs to have a compulsory medical insurance policy to receive basic medical care. This product is offered by many companies, including VTB Insurance. Features of the policy in the company...

Compulsory medical insurance is not just an innovation designed to fill the budgets of clinics and hospitals with contributions from organizations and citizens. This is one of the state’s social programs designed to provide guaranteed and free medical care to all citizens, albeit in a minimum amount established by the state. Insurance...

The compulsory medical insurance policy is a mandatory document for every citizen. An insurance policy is required when visiting a medical facility. In the article we will answer the question “what to do if the insurance policy is lost?” Why do you need insurance? The name of the certificate – “compulsory health insurance policy” – speaks for itself. For...

What does the abbreviation compulsory medical insurance hide, what are the features and conditions of health insurance, in what cases does a citizen have the right to use an insurance policy - the answer to such questions should be found. This will allow you to fully exercise your insurer's right and receive compensation from your health insurance...

The insurance company "MAX" was founded in March 1992. Over the years of its activity over a 20-year period, it has gained popularity for its impeccable work in the insurance market. The company is developing, improving its programs, increasing the volume of services provided to the population. It consists of two joint stock companies...

The Medical Insurance Company URALSIB appeared on the insurance market in 1994. It provides its services to Russian citizens, attracting clients to enter into compulsory health insurance contracts. Over the years, the company has become one of the leading ones, gaining fame among the population. Developed...

The compulsory medical insurance policy is absolutely free for all citizens of the Russian Federation. At the same time, its presence is mandatory when receiving medical care in government institutions. A person can have only one policy. Advantages of taking out a policy in a company In 2013, AlfaStrakhovanie OJSC took sixth place in the collection of insurance premiums....

In many countries, they are gradually coming to understand that insurance medicine is a 100% guarantee of receiving reliable, timely, high-quality and highly qualified medical care. Moreover, examinations and treatment will take place using modern devices and equipment. System...

All Russian citizens must have compulsory health insurance policies. In the Russian Federation, more than 60 insurance companies and 200 of their branches, including 13 leaders, compete with each other in this market. These include the RESO group of companies. Features of the company's policy When seeking medical help, it is important to be sure...

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

Legislative acts regulating the compulsory medical insurance system

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

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

Who is entitled to free health care?

Both Russians (for an indefinite period) and persons without Russian citizenship (with a limited validity period) can receive a compulsory medical insurance policy. The presence of this document means that the patient is under the protection of the insurance company with which he has entered into an agreement.

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

List of services under the compulsory medical insurance policy

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

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

– in cases of exacerbation of diseases;
– referral for treatment and operations (available services include chemotherapy, removal of prostate adenoma, treatment of gynecological diseases, etc.);
– medical services for pregnant women, as well as childbirth, recovery after it, abortions;
– when intensive care is required (in case of poisoning, severe injuries);

• high-tech;
• palliative.

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

Is it allowed to carry out therapeutic massage, remove papillomas, warts - are such procedures provided by the compulsory medical insurance policy, which is included in the program? Having indications for the procedure will allow you to take a massage course free of charge. As for skin defects, the operation will be performed free of charge if the growth is bleeding or damaged, that is, there is a danger to the life and health of the patient.

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

From time to time, the media report on public initiatives to add or remove this or that service from the list. Thus, proposals to exclude abortion from the compulsory medical insurance system and include the work of a nutritionist in it were previously discussed, but they were not reflected in legislative acts.

Dental services under compulsory medical insurance policy

Is free dentistry available under the compulsory medical insurance policy? This question interests many, since dentists’ services, as we know, are not cheap. So, what opportunities does dentistry provide under the compulsory medical insurance policy, and what is included in the free service?
A visitor to a clinic participating in the compulsory medical insurance system can count on:

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

Please remember that dental services are also subject to restrictions. For example, filling will not require payment if cement material is used during the treatment. But they won’t install a light seal for free.

Certain services are possible with a referral, for example, the surgeon will perform trimming of the tongue frenulum upon presentation of a certificate from the orthodontist.

How to find out if a service is included in the compulsory medical insurance program?

Information on services provided free of charge is contained in the regulatory documents adopted in a particular subject. A detailed list is also provided by healthcare institutions and insurance companies operating in the compulsory medical insurance system.
There is no list of compulsory medical insurance services on the official healthcare website in 2018, but from the Ministry of Health resource you can go to the Compulsory Medical Insurance website, where all the regulations relating to the compulsory health insurance system are posted.

In case of illness, the state guarantees its citizens support in the field of health care, which is provided from funds coming from the budget, through contributions and other deductions. Assistance with examination and treatment is provided to people who are holders of a compulsory medical insurance policy.

You can become a member of the system at any age, regardless of nationality or place of work. To do this, you need to sign an agreement with the state or an insurance company that has received a license under which it carries out this type of activity.

When to count on free help

The policy is issued after signing the document to citizens and foreigners for the duration of their stay in the state. Treatment services are provided by institutions of various types of ownership.

A person is allowed to change his family doctor, clinic, and even insurance organization once a year.

The compulsory medical insurance policy confirms that a citizen or foreigner is insured and can apply without payment:

• to the oncology department;
• dispensary;
• to a trauma center;
• to a hospital inpatient department;
• to the dentist's office.

In the absence of a document, medical services are provided for money. The policy has recently been issued in the form of a plastic card with an individual number. The new sample document contains the photo and signature of the insured person, his date of birth and gender. It is issued to citizens of the country for an indefinite period.

Benefits of the new program

Rights and guarantees of owners

Residents of Russia who participate in the compulsory medical insurance system do not always know what treatment assistance they are entitled to and where to turn if it was denied. The rights of policy holders are regulated by the country’s laws “On the Fundamentals of Health Protection” and “On Compulsory Health Insurance in the Russian Federation” and include:

1. Free assistance in case of illness according to the state and territorial program.
2. Choosing an insurance and medical institution.
3. Possibility of changing specialist.
4. Refusal of the proposed operation.

A person has the right to expect that damage caused to health as a result of erroneous therapy will be compensated. A church minister and a lawyer must be allowed to see the policy owner. The insured person has the right to receive information about his health and what medical services he is entitled to.

A person is required to provide insurance upon admission to a hospital or clinic that provides treatment. He needs to provide information to the insurance company that he is changing his last name or moving to another city.

What's included

According to Art. 41 According to the Constitution, persons who have signed a health insurance agreement are provided with emergency assistance, which is provided in case of accidents such as frostbite, burns, fractures, childbirth, and acute pathologies that threaten human life.

List of available services

The list of guarantees that a person who owns a compulsory medical insurance policy can count on includes treatment of chronic and acute pathologies in a hospital, which includes:

1. Examination and management of pregnancy.
2. Childbirth and rehabilitation.
3. Intensive therapy for injury and poisoning.
4. Outpatient care and diagnostics.

Diagnostics includes ultrasound, endoscopy, computer and magnetic resonance therapy. The list of services compiled on the basis of the decree “On the program of state guarantees of free medical care” includes massage procedures, if there are indications for them. Operations to eliminate defects on the skin are provided if they are dangerous to human life.

The number of services provided by health care institutions operating in the regions is greater than in the basic insurance system. In many cities, tests are performed to detect sexually transmitted diseases, and samples are taken to determine the causative agent of allergies. No money is taken for this.

The list of free assistance does not include homeopathic services or cosmetic procedures. The list does not include treatment for intimate problems.

To manage your pregnancy, you can also choose a doctor from the antenatal clinic

Is MRI included?

In many cases, when examining a person, it is impossible to do without magnetic resonance therapy, since this diagnostic method allows one to determine the problem with great accuracy. For money, the procedure is performed in private centers and clinics, and in hospitals and clinics that are state property.

You can get an MRI if, when signing an insurance contract, this examination technique was included in the list of free medical services. If there is a referral from a family doctor or a specialist of another profile, the owner of the compulsory medical insurance policy is put on a waiting list for the procedure, where it is done without paying any money.

Manipulations using an electromagnetic field with a 50% discount are carried out:

• pensioners;
• war veterans;
• liquidators of the Chernobyl Nuclear Power Plant;
• disabled people assigned to group 1 or 2.

For women pregnant at 12 weeks, an MRI is performed free of charge when there is a possibility that the fetus is not developing well. Some other categories of citizens can use the benefit.

MRI can be performed without payment according to indications

Surgery

Persons participating in the health insurance system are entitled to surgical treatment. A special coupon is issued for this. It is received upon availability of an extract of their commission protocol and the patient’s card. The patient must submit an application for surgery, provide a compulsory medical insurance policy, and a certificate of a disabled person.

The list of diseases during intervention is updated every year and applies to operations:

• in obstetrics;
• abdominal surgery;
• for severe burns.
• for cancerous tumors;
• in orthopedics.

Childbirth and abortion are also included in the list of services under the compulsory medical insurance policy. Rehabilitation after intervention in most cases is carried out without the payment of money by the insured patient.

Surgical treatment of the chest, cardiac and vascular lesions, blood diseases, eye diseases, and injuries is provided free of charge.

The patient will have to pay if he wants to be transferred to a ward with a special level of care, examined at home, or treated using expensive methods not provided for by the state program.

Surgical treatment is also included in the program, with the exception of cosmetic surgery

Dental treatment

Having a compulsory medical insurance policy, a person can count on the help of a dentist in a public clinic and some private ones. Medical insurance covers services in the form of:

• elimination of caries and periodontal disease;
• therapy for pathologies of the salivary glands;
• removal and filling of teeth;
• surgeries on hard and soft tissues;
• treatment of abscesses and defects;

The policy holder is given anesthesia without payment, an X-ray is taken, and physical procedures are performed. All manipulations take place in the institution provided for in the medical care contract.

According to the state insurance program, the patient should not be required to pay for cement, a composite material that is used to apply fillings.

In the dentist's office, as part of compulsory health insurance, they do not charge for cotton wool, syringes, catgut, or the use of pharmaceuticals.

The insurance includes filling materials and anesthesia

The health insurance system makes it possible to treat serious illnesses conservatively or through surgery. Upon presentation of the policy, expensive medical services are provided free of charge. A person has the right to choose a doctor and a clinic where he wants to be served.

Medicine in Russia has long moved from the category of free to the category of insurance. This means that to receive any type of assistance in medical institutions, a person needs an insurance certificate. With it you can get a limited list of services for free.

The state has established a list of guaranteed services that a citizen or any resident of the country can receive without emptying their wallet. However, for this he will need a special policy - compulsory medical insurance.

Sample compulsory medical insurance policy

Compulsory medical insurance (compulsory medical insurance) is an insurance certificate according to which the state provides citizens and foreigners living in the Russian Federation with free medical care, support, counseling and treatment. In this case, the funds are written off either from the federal budget (if the policy holder is unemployed) or from the holder’s special insurance savings, which are calculated monthly from wages.

The policy itself is issued free of charge for all categories of citizens. It guarantees that the person-holder throughout the country will not be left without the attention of doctors if he falls ill. However, services under this certificate are limited.

Why do you need a compulsory medical insurance policy?

Under compulsory medical insurance, temporarily staying citizens and ordinary citizens of Russia can receive free medical care in medical institutions. Without a policy, you can only count on medical care if the situation is emergency or directly threatens your life. All other types of treatment, examinations and appointments are free only for compulsory insurance policy holders.

Services include primary care, outpatient treatment and hospitalization.

What services can be obtained under the compulsory medical insurance policy?

It is worth noting that the full list of services under the compulsory medical insurance certificate is the same for all regions, however, there may be differences in how exactly the medical institution organizes work with patients.

Basic care provided free of charge under the policy includes the following types and forms of medical services:

• Ambulance. You definitely won’t have to pay anything to call an ambulance - emergency assistance is provided to everyone staying (temporarily and permanently) throughout the country. If you do not have this document and some critical situation occurs, it will still be provided.
• Hospitalization. It is carried out free of charge if a person is poisoned, seriously injured or suffers from a chronic pathology (exacerbation).
• Appointments with medical specialists – all types of outpatient procedures, except for particularly complex ones. You can count on diagnosis of the disease, scheduled and unscheduled examinations, procedures and drawing up a treatment plan, however, you will have to purchase medications at your own expense.
• Education – consultations, seminars, etc. that can increase the medical literacy of the population and prevent the development of serious pathologies.
• Innovative treatments - available only in some regions as part of trial treatment programs.
• Surgical operations of different levels of complexity.
• Providing chronic patients with medications.
• All types of treatment for hazardous workers.
• All types of assistance for pregnant women and newborn babies.

A complete list can be found by contacting your insurance company. In most cases, compulsory medical insurance is enough to completely protect yourself and get the necessary consultation with a doctor or treatment.

The list of treatment methods that are included in the compulsory medical insurance program undergoes adjustments every year, so it is worth checking in time whether a specific procedure is available. This can be done either from your attending physician or from your insurance company.