Who pays for the medical policy? What is a CHI policy and what services does it include? Benefits of private health insurance clinics

Under the MHI policy, you can take tests for the diagnosis and treatment of most diseases for free. Forcing a patient to pay for tests in most cases is illegal, but in order to avoid unnecessary expenses or return funds for paying for procedures in public clinics, it is necessary to know the legal basis for the interaction between medical institutions, their patients and the insurance company.

What tests can be taken for free

The procedure for providing citizens with free medical care under compulsory medical insurance policies is regulated by the following regulations:

• Law No. 326;
• Decree No. 1403;
• the laws of the subjects of the Russian Federation.

All citizens of the Russian Federation who have received a compulsory medical insurance policy are guaranteed medical care, both under the basic and additional (regional) programs. The main program includes not only the treatment of pathologies established by the doctor, but also the timely detection of such pathologies, as well as preventive measures.

The list of diseases subject to free therapy throughout the Russian Federation is briefly presented in paragraph 6 of Art. 35 of Law No. 326, and in more detail is given in the List of Section 4 of Decree No. 1403.

Free analyzes are prescribed for the following purposes:

1. treatment of the pathology present in the List;
2. diagnosis of this pathology;
3. diagnosis of possible comorbidities;
4. prevention of suspected pathology and concomitant diseases.

For example, a doctor, based on the symptoms described by the patient, suspects a specific pathology, which is often accompanied by another pathology. If tests for the presence of the underlying disease are free, then tests for the presence of a concomitant disease must also be performed as part of the services paid by the insurance company.

The main medical standards for the treatment of diseases listed in the basic and additional programs can be viewed on the website of the Ministry of Health of the Russian Federation.

Among the main free types of analyzes are the following:

• blood test for syphilis - markers, HIV, and other infections;
  blood and plasma tests for the content of the main elements (red cells);
• biochemical studies of blood and lymph;
• analysis of the content of hormones;
• tissue biopsy;
• high-tech analytical studies of tissues and organs (MRI, CT);
• x-ray studies;
• ultrasound analyzes of tissues and organs;
• scrapings and smears of the skin, foreskin and saliva.

Only expensive tests for suspected rare autoimmune or genetic diseases, which occur less frequently than in 0.01% of cases, as well as aesthetic medicine tests, can be paid.

How to check if analysis is free

To determine the legality of sending a doctor to take paid tests, you need to find out if the necessary analysis is included in the list of services provided under the basic insurance program.

It is important to know that the basic list of medical services provided throughout the country can be supplemented by:

• regional medical programs;
• employer programs.

Regional programs are budget subventions for paying for services that are not on the All-Russian list, and which are provided free of charge only in a specific subject of the federation. Only patients who are registered in the region and have received an insurance policy from local insurers can receive these services.

In addition, large employers who pay insurance premiums for their employees can provide additional packages of services for free examinations.

To check the possibility to pass the analysis prescribed by the doctor for free, you need to perform the following steps:

1. View the presence of the pathology suspected by the doctor in the main list approved by Resolution No. 1403.
2. In the absence of a disease in this list, find out if it is in the list of services provided by the insurers of the given region or the patient's employer.
3. Find out the list of tests necessary for the diagnosis and treatment of this disease from the standards on the website of the Ministry of Health.

The list of additional regional services can be viewed on the website of the regional Ministry of Health, and the services provided under insurance from the employer are listed in the appendix to the employment agreement.

If the diagnosed disease is in one of the free programs, and the prescribed tests are included in the standard for the treatment of this disease determined by the Ministry of Health, then the patient has the right to take this analysis free of charge.

How to get a referral

At the initial appointment, the patient is often given a referral for tests to a paid clinic under the pretext that the necessary equipment or reagents are not available in this clinic. It is important to know that only the patient has the right to choose where medical services are provided. The doctor can only issue a referral for analysis, and the place of delivery and processing of the results is determined by the patient.

Getting a referral for free tests is as follows:

1. the patient goes to a specialist doctor to diagnose the disease;
2. the doctor determines which tests the patient needs to pass and issues a referral;
3. if it is not possible to conduct an analysis in this clinic, the doctor issues a referral to another medical institution;
4. if the clinic employee refuses to give a referral for a free analysis, it is necessary to write a complaint addressed to the head or chief physician.

If the appeal to the management of the clinic did not bring results, and the necessary analysis is included in the list of basic or regional services provided under the CHI policy, then the patient should contact the representative of his insurance company.

You can contact both with the help of the hotline, and in person, at the representative office of this insurer in the locality. Most insurance companies have special departments whose work is aimed at resolving conflicts between medical institutions and patients.

If, after the attempts made, a referral for a free analysis is not received, then you should contact the regional health insurance fund. Such funds monitor the activities of private insurers in the context of respecting the rights of insured patients.

In some cases, the funds spent by the patient on free tests can be returned. You can return funds in 2 ways:

• at the cash desk of the clinic;
• in an insurance company.

If the patient was referred for a paid analysis at the treatment clinic, then to return the funds, you need to do the following:

1. draw up an application addressed to the head physician for the return of funds;
2. attach to the application a check for payment for tests and an agreement on the medical services provided;
3. receive an order-resolution on the payment of compensation;
4. apply with a copy of the order and a passport to the accounting department of a medical institution.

The application indicates the full name of the patient, his address at the registration and passport data, then you need to state the reasons for the return of funds, indicate the amount spent and the number of the insurance policy. The basis should indicate the presence of the passed analysis in the basic list of services that holders of compulsory medical insurance policies can apply for.

For a refund, you must keep a receipt for payment for services and an agreement on paid services.

If the patient was sent to a private clinic for testing, the money spent is refunded through the insurer that issued the policy. To do this, you must contact the representative office of the insurance company of the municipality and draw up an application for a refund based on the occurrence of an insured event - the need to pass an analysis from the basic or additional lists.

Transfer of money through the insurance company is usually carried out within 3-8 business days. If the employer pays the contributions for the CHI policy, then the compensation can be transferred through the cash desk of the enterprise or to a salary card.

Difficult situations

When applying for compensation or when requesting a referral to another medical facility, the patient may experience a refusal or a severe delay in responding to the appeal. In most cases, the situation is resolved by a call to the specialists of the insurance company that issued the policy, or a complaint to the regional MHI fund.

If the prescribed tests are included in the basic list and are an expensive procedure, then the patient has the right to demand the provision of this service free of charge through the judicial authorities. It is important to bear in mind that a referral for tests to another locality or a paid clinic can only be issued under the following circumstances:

• the inability to conduct these studies in public clinics of the municipality;
• the absence at the moment of the necessary specialists in the clinic;
• the absence of an assigned analysis in the basic and additional lists of free services;
• application of a person from another region for a service provided within the framework of the program of the subject of the federation.

The doctor must inform the patient about the free equivalent of any medical service provided. Often, patients are deceived by giving a referral for paid tests with the promise of subsequent compensation, to which the patient will not be entitled due to a personal refusal of a free service.

To avoid such deception, you need to carefully review the contract offered for signature when passing paid analyzes for the presence of a clause on the refusal of a free service. In the presence of this item, the money spent can be returned only by a court decision.

If the patient, when providing a paid service, is refused to issue a contract and a check, you need to refuse payment and file a complaint with the head doctor and the insurance company, since these actions of the staff are illegal.

Conclusion

Most of the tests in public clinics can be taken by holders of compulsory health insurance policies free of charge. In order to exercise your rights, you should look for the prescribed analysis in the list of free services and, if necessary, require referral to another medical institution, and in order to return the money spent, it is important to keep a copy of the contract and receipt. Most difficult situations are resolved by contacting representatives of the insurance company.

Some changes in 2020 in terms of compulsory contributions will partly affect health insurance. From 01/01/2020, a different fixed amount will apply for individual entrepreneurs without employees. It is planned that it will not depend on the minimum wage. No innovations are expected in the tariff rate and marginal base.

The single tariff rate of contributions, taking into account the amount of compulsory medical insurance, will not change from the new year. Its total size remains the same - 30%, which is regulated by the Tax Code of the Russian Federation, Art. 425 and 426. It is assumed that the total rate will remain unchanged until 2020, after which it will increase to 34%.

Benefits in terms of reduced compulsory medical insurance rates will also not change. Their size (from 0 to 4%) and the conditions of application are specified in detail in Art. 427 of the Tax Code of the Russian Federation.

The data in the table indicate that compulsory medical insurance contributions for employees can be mandatory and preferential. In isolated situations, policyholders are exempted from paying them.

When calculating the amount of the MHI contribution payable, the current rates and the employee's earnings are taken into account. The calculation formula for payments is standard: earnings * 5.1%. In payment documents, when paying compulsory medical insurance contributions, BCC 182 1 02 02101 08 1013 160 is recorded.

Insurance premiums for compulsory health insurance for entrepreneurs from 2020

Entrepreneurs calculate the amount of obligatory medical contributions in 2017 taking into account the minimum wage, but regardless of the amount of profit. The calculation formula is used: minimum wage × MONTHS × 0.051. The fixed amount in Russian rubles payable at this moment has reached the digital value of 4,590.

As part of the new trend in legislation from 2020: (click to expand)

• the binding of a fixed amount on compulsory medical insurance to the minimum wage is cancelled;
• the applied fixed amount was increased to 5,840 rubles, which is 1,250 more than the indicator of the previous year.

This means that for 2020 the individual entrepreneur will be obliged to pay for compulsory medical insurance contributions by transferring 5,840 rubles. in the FTS. At the legislative level, it is determined that a fixed value will be indexed annually

Deadlines for payment of contributions and submission of reports on compulsory medical insurance from 2020

Compulsory compulsory medical insurance contributions are calculated from the employee's earnings on a monthly basis. It follows from this that the timing of their payment directly depends on the payments to the employee. The law establishes the deadline for payment - the 15th day of the month following the month in which contributions are calculated. The basis is the Tax Code of the Russian Federation, art. 431, para. 3.

In this case, the general rules for transferring weekends and holidays to the first business day apply. That is, if the payment deadline falls on a weekend (holiday), it will be possible to pay on the next business day following it.

For entrepreneurs, separate rules for paying a fixed amount for compulsory medical insurance are defined. In 2020, they are offered the choice of making an insurance payment in a lump sum or in installments. Thus, the established value of 5 840 rubles. An individual entrepreneur has the right to divide and pay every month, quarterly or once every six months. A mandatory condition that will need to be observed in this case is that lump-sum and partial insurance payments should be met before December 31 of the reporting year.

An obligated person reports for CHI payments as part of a single new calculation form KND 1151111, which combines all types of insurance premiums. It was introduced by order of the Federal Tax Service of the Russian Federation No. ММВ-7-11 / [email protected] from 10.10.2016.

For the first time, they began to draw up and submit it from the 1st quarter of 2017. It will also be applied next year. This reporting document is issued on an accrual basis for the whole year.

The deadline for submitting a single calculation is the 30th day of the month following the reporting month. In order of priority, taking into account weekends and holidays, the actual dates will be:

1. 05.2017.
2. 07.2017.
3. 10.2017.
4. 04 2020.

Example 1. Calculation and payment of MHI contributions by an entrepreneur for incomplete 2020

Resident of the Russian Federation, L. R. Vasilchenko received the status of an entrepreneur on February 15, 2020. After working for several months on his own, without employees, in the same year, on November 15, 2020, he was deregistered.

The entrepreneur's profit for the period of his work from February to November reached 1,000,000 rubles. For the specified period of activity, he must pay for himself the obligatory contributions for the medical part. For calculation, a fixed value of 2020 is taken into account - 5,840 rubles.

The calculation sequence will be as follows. First, the amount of compulsory medical insurance is calculated separately for incomplete months of work, i.e. for February (13 days) and November (14 days). Then the calculation is carried out for whole months of work in 2020, and this is the period from March to October (total 8 months). Then everything is summed up and the final amount of the CHI payment payable is obtained.

So, the procedure for calculating the obligatory medical insurance payments of IP L. R. Vasilchenko is as follows: (click to expand)

1. CHI payment per month: 5,840 / 12 months = 486 rubles.
2. CHI payment for incomplete February: 486 / 28 days of February * 13 working days = 226 rubles.
3. CHI payment for incomplete October: 486 / 31 days of October * 14 working days = 523 rubles.
4. Compulsory medical insurance payment for whole months of work: 486 * 8 whole working months = 3,888 rubles.
5. Summation of the calculated values ​​for incomplete and whole months of work of IP L. R. Vasilchenko: 226 + 523 + 3,888 = 4,637 rubles.

The total amount of payments for compulsory medical insurance by L. R. Vasilchenko for the period of his being in the status of an entrepreneur in rubles amounted to 4,637.

With an annual amount of income for 2017 exceeding 300,000 rubles, the deadline for the additional payment (1% of the excess amount) was postponed. From 2020, the surcharge will need to be paid no later than July 2, 2020.

Answers to frequently asked questions

Question 1: Does an individual entrepreneur who did not carry out activities during 2020 need to deduct compulsory contributions for medicine?

Yes, because medical contributions, like pension contributions, are considered obligatory payments. Profit, lack of movement in bank accounts, the implementation of activities do not play a role here. Until the status of an entrepreneur is lost, you will have to pay medical fees. Therefore, for 2020, the individual entrepreneur will be obliged to pay a fixed amount - 5,840 rubles.

Question 2: How to calculate the amount of obligatory medical contributions of an individual entrepreneur for the whole of 2020 if his annual profit was more than 300,000 rubles? Do I need to pay extra 1% of the excess amount? Entrepreneur without employees.

For obligatory insurance payments for the medical part, a fixed amount is set (5,840 rubles), and it will have to be transferred before December 31 of the reporting year.

1% of the excess amount of income (with a profit of more than 300,000 rubles per year) is calculated and paid for the pension part once.

At the weekend I lay at home with an impossible sore throat and a temperature of 39.6.

Throwing not the first dose of paracetamol for the day, I called an ambulance. They told me that it was a sore throat and that I should call the district police officer on Monday. The ambulance didn't come.

I typed in the search bar: "What to do if the ambulance refuses to go." I saw advice on the forum: “Say menacingly that you should call the insurance company now. They'll come right away." I did so. The ambulance arrived. After that, I threatened the doctors twice more with a call to the insurance company and once I actually called the number indicated on the policy. Helped every time.

The insurance company protects my rights and really guarantees free treatment. But if you do not know the laws, then unscrupulous doctors will be able to deceive you, refuse treatment, demand an additional fee.

I recovered and decided to find out what your mandatory health insurance guarantees you.

Get to know your CHI policy

Most likely, you already have a compulsory health insurance policy. It was made for you by your parents right after you were born. It is either in your passport or in a box with all important documents.

If you don't have a policy, drop everything and go to apply

Without a policy, you won't get any free treatment. Fortunately, you can get or exchange a policy in any city without a residence permit and registration. To do this, take your passport with you and SNILSi go to the insurance company that is convenient for you, which draws up these policies.

If there is no SNILS, first go to the insurance company with your passport, then wait 21 days and only then receive the policy.

Citizens of the Russian Federation, foreign citizens permanently or temporarily residing on the territory of the Russian Federation, refugees and stateless persons can obtain a policy. The policy is issued to citizens of the Russian Federation without limitation of validity period. By law, even if you have an old-style policy and it is overdue, 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 you are denied treatment, this is illegal. You must be accepted. In polyclinics, everyone is asked to change policies for new documents, but so far this is only a recommendation. Of course, it is better to heed this recommendation: when a law comes out that terminates old-style policies, it will not take you by surprise.

Which insurance companies provide CHI policies

Compulsory health insurance is an insurance program, that is, everyone pays a little bit into the common pool, and then they pay out of it to those who need it. The common cauldron collects the state from entrepreneurs and distributes it through an extensive system of funds, which, in turn, pay hospitals. And the insurance company is such an intermediary manager that connects you, the hospital and the state.

Insurance companies earn on CHI in the same way as on 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 registers of companies that make CHI policies. Just google it.

Insurance companies with CHI

Where can I get treatment with a CHI policy

You have the right to treatment in any public clinic throughout Russia. The only difficulty is that different regions of the country work with different insurance companies.

To get to a clinic in another city or district, you need:

1. Select a clinic. Any, not necessarily the one closer to home.
2. Find out at the reception which insurance companies work with this clinic. If you have a choice, look at the description of the company on the CMO website. Everyone has the same insurance, but some have more offices, and some have round-the-clock support.
3. Come to the insurance with a passport and SNILS, fill out an application to replace the policy.
4. Get a temporary license. It works like a policy for a month.
5. Return to the clinic. Say the code phrase “I want to attach to your clinic” at the reception. Get the application form, fill it out and return it to the registry.

Now you can be treated for free in this clinic.

If your insurance company serves the clinic to which you are going to attach, then you do not need to change the policy. But you need to inform the insurance that you have moved and want to be treated elsewhere. Otherwise, the new clinic will not receive money for your treatment.

Why you need to join the clinic

You need to join a polyclinic, because our country has a system of per capita financing. Money for your treatment is issued only to the institution to which you are assigned. Therefore, you can not attach to several clinics at once. You can also officially change the clinic no more than once a year. Previously, this could only be done if you moved. In this case, the new clinic will offer you to write an application addressed to the head physician.

You cannot attach yourself to a research institute or a hospital, only to a district polyclinic. And already there, the local therapist will write out referrals to highly specialized specialists: an eye surgeon, a cardiologist, a chiropractor. Without a referral from the attending physician or an ambulance specialist, you can only be admitted to specialized clinics for a fee.

What is EMIA

In Moscow, the data of all patients are entered into EMIAS, a unified medical information and analytical system. This simplifies the process of making an appointment with specialists: you can get a ticket to the doctor, cancel or reschedule an appointment, and receive a written prescription electronically. EMIAS even has a mobile app.

Please note: if you have moved and decided to attach to a new clinic, then you cannot just take it and do it through the system. You need to write an application addressed to the head physician and wait until the bureaucracy approves it. This may take 7-10 business days. If you are registered on the Moscow public services portal, then you can apply. It is promised to be reviewed within 3 working days.

When I faced such a problem, I needed help urgently. And by law they are obliged to help me without any many days of delay. But the polyclinic 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.

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 until now everyone treats me very carefully.

What is included in CHI treatment

The law on obligatory medical insurance gives the right to all of us to be treated free of charge. And even if your policy has expired, you can use it.

If you don’t have a 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 an additional concern, therefore, most likely, they will try to convince you that it is impossible to do this. If this happens, just call your insurance company.

In any unclear situation, call the insurance

The minimum amount of assistance is described in the basic program of compulsory health insurance. Whether to add something else to this list, each region decides independently. The exact list of insured events 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 this 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 you can most likely do it just for money. If the state can help you, but the level of this assistance seems too low for you, you will have to accept or pay extra.

Examples of what can and cannot be done under the CHI policy

When something hurts, you can get a free appointment with a therapist who will write a referral to a specialist. When indicated, the GP should issue 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 a dermatological and venereal dispensary. Or enroll your child to a child psychiatrist, surgeon, urologist-andrologist or dentist. CHI does not guarantee free tests and examinations without a referral from the attending physician.

Once every three years, you can go through a free medical examination and find out if everything is in order with your health. 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 CHI program also includes free pain relief and rehabilitation after illnesses and injuries. But it’s impossible to write down once or twice in which case you are entitled to free insurance assistance, and where you have to pay on your own. There are a lot of nuances in this case. If you have a rare disease or a difficult situation, contact .

What exactly is not included in the CHI program

The state will not pay for:

• any treatment without a doctor's prescription;
• carrying out inspections and examinations;
• home treatment at will, and not for special indications;
• vaccinations outside state programs;
• spa treatment, if you are not a sick child or a pensioner;
• cosmetic services;
• homeopathy and traditional medicine
• dentures;
• superior comfort rooms - with special meals, individual care, TV and other joys;
• 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 the insurance company and check if it is legal.

Privileges

For people with disabilities, orphans, families with many children, participants in hostilities 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 in the department of social protection or find them on the Internet.

Sometimes you are legally entitled to free treatment, but doctors just shrug. There may be a waiting list for free rehabilitation for several months, and painkillers in your district hospital may simply not be available. It's illegal, but it's a fact of life.

If you spend money on treatment because you tried it, but you can’t get it for free, then you can return the money through the courts.

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 and much later. Therefore, a whole illegal practice of extorting money for treatment under compulsory medical insurance has grown in Russia.

At the heart of this extortion is legal illiteracy. It is enough for a doctor to make a smart face and take a strict tone so that frightened patients begin to throw 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 you are required to provide for free.

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 to the fund by entrepreneurs, including your employer.

You do not need to pay a second time out of your own pocket for what the state guarantees you. Moreover, the doctor, most likely, will receive payment from the fund anyway, even if you are forced to pay.

You don't pay for the treatment, but the hospital gets paid 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. Even if this does not help, call the department for the protection of the rights of citizens in the CHI system.

Emergency assistance is always free

If something really bad happened - you lost consciousness, broke your leg or feel a sharp pain - you should be helped in any state clinic, even if you don’t have any documents with you and you never received a policy.

The hospital has no right to refuse assistance to newborns and children under the age of one year, even if the child's parents do not have a policy and registration. Pregnant women cannot be refused either – they can go to any antenatal clinic and any maternity hospital, even without documents.

Money can be returned

If you needed to be treated urgently and you decided not to understand the laws, but to pay money, then you can contact the insurance company for compensation. Collect checks, make a copy of the contract for the provision of medical services, write a free-form application and send it all to the insurance.

An alternative option is to return the money for treatment in the form of a tax deduction. But you can return only 13% of the amount spent and no more than 15,600 rubles.

I understand your indignation

A moment of moralizing from the chief editor.

In the comments to this article, all hell breaks loose about how bad things are with Russian medicine, how there are no medicines in hospitals, how cleaners are waving dirty rags, and how a surgeon demands a bribe for pain relief. Forgive me for being direct, but we ourselves are to blame for this.

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 this is not the healthcare system, it is this particular surgeon, his parents and teachers. So, his father, somewhere in his childhood, set an example for him that a bribe is normal. How do you feel about bribes?
• If a hospital says it doesn't have money for medicines, it's not Putin's fault, but some officials who don't know how to draw up budgets. Or the head physician who does not know how to manage money. You have a lot of acquaintances who do the same thing at their jobs.
• After all, when you get paid in an envelope, it's your employers who underpay your health insurance. Where will the money for your medicines come from, if you have allowed not to pay for them?

It turns out to be mild schizophrenia: the same person maintains a gray salary and complains about insufficient funding for hospitals.

Putin, Navalny, Medvedev, Tinkov or Trump will not solve our health problems. We will solve this problem ourselves if we give our children an example of a conscientious attitude to work and the law. To skip classes at the institute was not a feat, but a shame. It was embarrassing to take tests for money. To give bribes was against our principles. To know and stand up for your rights was a duty, not a superpower.

In short: no one will fly in and give us free medicine as 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 contributions. I have everything, thanks. Sorry for the moralizing tone, but I just got tired of this whining.

Remember

1. If you don't have a policy, drop everything and go apply.
2. With a compulsory medical insurance policy, you should be treated free of charge at any state clinic throughout Russia.
3. 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 you are denied treatment, this is illegal.
5. In any unclear situation, call your health insurance company. The number is on the policy. Write it down on your phone right now.
6. If the insurance company does not save you, call the Federal Compulsory Medical 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 - they should return the money to you.
8. Emergency assistance is always free, even if you do not have documents.

What medical services are free, and what will you have to pay for? Why do I need a health insurance policy and how to get it? How to attach to the clinic and how long to wait for an appointment with a specialist? Why can 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 is included in the concept of "free medicine" if in practice you have to pay for a lot?

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

• emergency (ambulance)


• outpatient care in the polyclinic (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 methods of treatment, 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 program of compulsory health insurance. To check this list, you can contact your insurance company (you can find the company's phone number on your policy).

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

You will have to pay for other services and medicines.

Medical policy

A compulsory medical insurance policy (OMS 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 work in this area. The insurance company that issued you the CHI policy pays for medical services and protects your interests in conflicts with medical institutions. Keep in mind that in order to receive legally free medical services, you must have a policy with you. Without presenting it, only emergency assistance is provided. Anyone who is on the territory of the Russian Federation, including foreigners and refugees, can receive a CHI policy.

How to get an OMS policy?

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

What documents are needed to apply for an OMS 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 of age,:

• passport of a citizen of the Russian Federation


• SNILS (if available).

What is the validity period of the MHI policy?

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

In what cases can the CHI policy be replaced with a new one?

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

• with a planned change of the CHI policy (for example, with the introduction of a new sample)


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


• when inaccuracies or errors are found in the policy


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


• in case of loss of the policy


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

Polyclinic

Upon receipt of the compulsory medical insurance policy, a polyclinic is selected to which you will seek medical help (that is, you are “attached” to it). You have the right to choose any clinic that will be convenient for you to visit (closer to home, work, summer cottage). The only condition is that she must be able to accept a new patient (the planned load is determined by the standards).

How to join the clinic?

Your attachment to the polyclinic at the place of residence occurred automatically if:

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


• you live at the same address that you mentioned when you received the policy (even if it is different from the registration).

For self-attachment, you will need to write an application to the administration of the clinic. Keep in mind that if you are attached to a polyclinic not at your place of residence, then you will not be able to call a doctor at home.

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

What documents are required to attach to the clinic?

List of documents for a child under 14 years old:

• CHI policy (original and copy)


• birth certificate


• identity document of the legal representative of the child (for example, a parent)


• SNILS (if available).

List of documents for citizens over 14 years old:

• application addressed to the head physician of a medical organization


• CHI policy (original and copy)


• passport of a citizen of the Russian Federation


• SNILS (if available).

Can you be denied attachment to a polyclinic and why?

They can refuse to attach if the selected polyclinic 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.

Doctor's appointment. How to get there and how long will you have to wait?

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

Each region independently sets the waiting time for medical care in 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 CHI policy).

As an example, let us cite the deadlines set in Moscow. According to the decree of the Government of Moscow, the maximum terms are set:

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


• for appointments with specialist doctors - up to 7 working days;


• the urgency of laboratory and instrumental studies is determined by a specialist doctor, 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 the medical organization cannot meet the specified deadlines, there is no necessary specialist or equipment, then by law the patient must be sent to the nearest medical institution for diagnostics, and absolutely free of charge. If these provisions are violated, then you can file a complaint against the medical organization with your insurance company or other institutions, which 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 (district doctor, general practitioner, pediatrician, general practitioner and paramedic). To do this, you need to apply to the head of the medical institution. You can change a doctor no more than once a year, except in cases of a change in place of residence or stay.

Emergency

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

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


• urgent care. It deals with the same cases as an ambulance, but only in the absence of a threat to the life of the patient. This help must arrive within two hours.

It is up to the dispatcher to decide what type of assistance to send to you.

How to call an ambulance?

We all remember the memorized truth from childhood that to call an ambulance it is enough to call the number "03". Landline telephones eventually become a thing of the past, they are 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 calling:

• 03 from a landline


• 103 from mobile phone


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

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

When will an ambulance arrive?:

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


• during catastrophes 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 violation of the course of pregnancy;


• for any reason to children under 1 year old;


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

In which case the ambulance will not arrive:

• when the patient's condition worsens, which is observed by the district doctor;


• when calling to patients with alcoholism to relieve a hangover syndrome;


• to provide dental care;


• for the provision of medical procedures prescribed in the order of planned treatment (dressings, injections, etc.);


• for the issuance of sick leave, prescriptions and certificates;


• for the issuance of forensic and expert opinions;


• for drawing up an act of death and examination of the corpse;


• to transport patients from hospital to hospital or home.

What is the duty of an ambulance?

The arriving team will provide emergency medical care and, if necessary, hospitalize you in the hospital. The doctors of the brigade can give verbal recommendations for treatment, but they do not write out certificates and 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? To complain.

1. The easiest way to complain is to write a statement addressed to the head physician. This will help resolve the issue locally.


2. If you have complaints about the quality of service in a medical institution or you 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, then you can contact the Ministry of Health. You can file a complaint in person at the ministry’s reception, send it to the regular postal or e-mail address of the department, and also leave an appeal on the official website.


4. If your problem has not been resolved by the Ministry of Health, then you can contact Roszdravnadzor, which controls the healthcare sector. The application can be left on the website of the department, sent by regular or e-mail.


5. If the previous actions did not lead to the desired result, then you can contact the prosecutor's office. She will check the work of state institutions.


6. If the conflict still has not been resolved by the indicated methods, then you can go to court. In the claim, it is necessary to indicate the essence of the case, explain what rights were violated (with references to the relevant articles of the laws), attach documents proving the defendant's guilt.


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

Keep in mind that the period for consideration of applications in each case, according to the law, is 30 calendar days.

Contributions for compulsory health insurance are deductions made by various categories of citizens to the Federal Compulsory Medical Insurance Fund. The majority of legal entities, some individuals and entrepreneurs are insured. Insurance premiums are paid by people who have a private practice (doctors, lawyers, notaries, lawyers, private detectives and others.

Definition - what is a CHI policy

Compulsory health insurance becomes under the guise of social protection. It guarantees the provision of free basic services. At the same time, it is a state system that includes legal, economic, and social components. They allow, in the event of an insured event, to have access to high-quality treatment:

• citizens of the Russian Federation;
• foreigners during their stay in Russia;
• stateless people.

Legislation of the Russian Federation

The provision of public medical care is mandatory under the federal law of November 29, 2010 N 326-FZ “On Compulsory Medical Insurance in the Russian Federation”. A complete list of insured events, as well as the volume of medical care provided, is determined by:

• federal law of November 21, 2011 N 323-FZ "On the basics of protecting the health of citizens in the Russian Federation".
• Federal Law of November 29, 2010 N .

The procedure for paying insurance premiums is regulated by Federal Law No. 212-FZ of July 24, 2009 “On insurance premiums to the Pension Fund of the Russian Federation, the Social Insurance Fund of the Russian Federation, the Federal Compulsory Medical Insurance Fund”.

There are also regional regulations that determine the amount of medical and drug care for all subjects of the Russian Federation.

Contributions: how financial contributions are made, the amount

CHI insurance premiums are included in the list of mandatory social financial contributions made by working citizens. Timely and correctly calculated deduction of funds for CHI provides equal rights to receive quality assistance. The budget of funds is formed by 2 types of deductions:

• compulsory medical insurance contributions received from employers;
• regular payments from regional budgets (made for non-working citizens).

Amount of interest on wages

The amount of insurance premiums is calculated in the following way: the base is multiplied by the insurance rate. Since the approval of the unified compulsory medical insurance policy in 2011, the principle of deducting contributions, their size and the value of the tariff have changed significantly. By 2016, the mandatory limit on contributions was abolished, and the tariff was set at 5.1%. There are also fixed fees. They are mandatory for individual entrepreneurs and some categories of self-employed people.

It should be noted that since 2015 the amounts of all insurance premiums are reflected without rounding. Payments are made in full, in rubles and kopecks.

Who produces and where are charged

Payers of insurance premiums for CHI are all citizens who are insurers. These include:

• domestic as well as foreign organizations;
• divisions of organizations, companies and firms that use hired labor of individuals;
• all individual entrepreneurs;
• individual entrepreneurs with private practice (lawyers, lawyers, doctors, notaries and others);
• individuals temporarily employing employees(designers, builders, and others).

The employer is obliged to deduct insurance premiums twice:

• for himself (an individual who has employees);
• for all officially registered employees.

Fixed amount for entrepreneurs - how much they pay

Individual entrepreneurs, for whom a fixed amount of contributions is established, pay them independently.

Entrepreneurs with tax benefits are also required to make insurance premiums. At the same time, there are individual conditions for this category of payers.

Employers' responsibilities include:

• organization of accounting for accruals made to employees(on their basis, the basis for the deduction of contributions is formed);
• making calculations to determine the amount of the contribution;
• reflection of the amount of contributions in the reporting;
• transfer of contributions to the MHIF.

Individual entrepreneurs have a similar procedure for paying contributions.

For all non-working people, deductions to the MHIF are made from regional budgets.

Individuals are required to pay contributions in the following cases:

• at the conclusion between him and the employee of the contract;
• in the event of a civil law contract.

These are the only cases when an individual is required to pay insurance premiums. Until 2012, there was a need to deduct mandatory contributions to the federal and territorial funds. After that, double payment is abolished. Only contributions to the MHIF are required.

How the working population is calculated

The insurance contributions of the working population for the CHI fund are calculated from the following types of payments:

• percentage of wages (regular payments within the framework of labor relations);
• holiday pay (without special cases);
• travel allowances;
• sick leave;
• severance pay;
• bonuses paid to employees;
• remuneration produced under a civil law contract.

Read about free dental services under the MHI policy.

The objects of mandatory insurance contributions are the following types of labor agreements:

• agreement to fulfill the author's order;
• contract for copyright activity;
• an agreement on the transfer of exclusive rights to works of art and other types of intellectual property;
• an agreement (license) giving the right to use an object of art or literature;
• agreement on collective management of rights.

Regular contributions are also deducted from these types of payments. Payment is made in a single amount for all employees. Before that, a breakdown is made for all funds.

Not all types of civil law contract are subject to insurance premiums.

After determining the base (source) for the deduction of contributions and calculating the required amount, another entry is made in the accounting documents. It captures the fact of the accounting entry. Payment of contributions is made by a single bank transfer, commission is not charged. The deadline for payment of contributions is the 15th day of the current month.

Read what is included in the free maintenance of the policy.

Video: insurance premiums about compulsory health insurance

conclusions

The main goal of filling CHI funds is the ability to create equal access to quality medicine for all citizens and even make it. The principle of tariff formation and the amount of contributions are modified every year. The tariff for the MHIF is 5.1%. The insurers are all organizations (together with foreign ones), entrepreneurs and people with private practice. In some cases, individuals are also required to pay contributions. This is done in the case of short-term use of the labor of hired employees.