326 on compulsory health insurance. Federal Law “On Compulsory Medical Insurance in the Russian Federation. And participants in compulsory health insurance

1. Insured persons have the right to:

1) free provision of medical care to them by medical organizations upon the occurrence insured event:

a) throughout the territory Russian Federation in the amount established by the basic compulsory health insurance program;

b) on the territory of the constituent entity of the Russian Federation in which the policy of compulsory health insurance was issued, in the amount established by the territorial program of compulsory health insurance;

2) selection of an insurance medical organization by submitting an application in the manner prescribed by the rules of compulsory medical insurance;

3) replacement of an insurance medical organization, in which the citizen was previously insured, once during a calendar year no later than November 1, or more often in the event of a change of residence or termination of the contract on financial support of compulsory health insurance in the manner prescribed by the rules of compulsory health insurance, by submitting an application to a newly selected medical insurance organization;

4) the choice of a medical organization from medical organizationsparticipating in the implementation of the territorial compulsory medical insurance program in accordance with the legislation in the field of health protection;

5) selection of a doctor by filing an application personally or through his representative addressed to the head of a medical organization in accordance with the legislation in the field of health protection;

6) obtaining from the territorial fund, medical insurance organization and medical organizations reliable information on the types, quality and conditions for the provision of medical care;

7) protection of personal data necessary for maintaining personalized records in the field of compulsory health insurance;

8) compensation by an insurance medical organization for damage caused in connection with non-fulfillment or improper fulfillment by it of its obligations to organize the provision of medical care, in accordance with the legislation of the Russian Federation;

9) compensation by a medical organization for damage caused in connection with non-fulfillment or improper fulfillment of its obligations to organize and provide medical care, in accordance with the legislation of the Russian Federation;

10) protection of rights and legal interests in the field of compulsory health insurance.

2. The insured persons are obliged to:

1) present a policy of compulsory medical insurance when applying for medical care, except in cases of emergency medical care;

2) submit to an insurance medical organization, personally or through a representative, an application for choosing an insurance medical organization in accordance with the rules of compulsory medical insurance;

3) notify the medical insurance organization about the change in the last name, first name, patronymic, data of the identity document, place of residence within one month from the day when these changes occurred;

4) make a choice of an insurance medical organization at a new place of residence within one month in the event of a change of residence and the absence of an insurance medical organization in which the citizen was previously insured.

3. Compulsory medical insurance of children from the date of birth until the expiration of thirty days from the date of state registration of birth is carried out by an insurance medical organization in which their mothers or other legal representatives are insured. After thirty days from the date of state registration of the birth of a child and until he reaches the age of majority or until he acquires legal capacity in full, compulsory medical insurance is carried out by an insurance medical organization chosen by one of his parents or other legal representative.

4. The choice or replacement of an insurance medical organization is carried out by an insured person who has reached the age of majority or acquired legal capacity in full (for a child until he reaches the age of majority or until he acquires legal capacity in full - by his parents or other legal representatives), by submitting an application to the medical insurance an organization from among those included in the register of medical insurance organizations, which is located in mandatory by the territorial fund on its official website on the Internet and may additionally be published in other ways.

5. To select or replace an insurance medical organization, the insured person personally or through his representative applies with an application for the choice (replacement) of an insurance medical organization directly to an insurance medical organization or other organizations of his choice in accordance with the rules of compulsory medical insurance. On the basis of this application, the insured person or his representative is issued a policy of compulsory health insurance in the manner prescribed by the rules of compulsory health insurance. If the insured person has not submitted an application for the choice (replacement) of an insurance medical organization, such a person is considered insured by the insurance medical organization with which he was previously insured, except for the cases provided for in paragraph 4 of part 2 of this article.

6. Information about citizens who did not apply to an insurance medical organization for the issuance of compulsory medical insurance policies, as well as who did not replace the insurance medical organization in the event of termination of the contract on financial support of compulsory medical insurance in connection with the suspension, revocation or termination of the license of medical insurance organizations, monthly by the 10th day, are sent by the territorial fund to medical insurance organizations operating in the field of compulsory health insurance in the constituent entity of the Russian Federation, in proportion to the number of insured persons in each of them to conclude agreements on financial support for compulsory health insurance. The ratio of working citizens and non-working citizens who did not apply to an insurance medical organization, as well as who did not replace an insurance medical organization in the event of termination of the contract on financial support of compulsory medical insurance in connection with the suspension, revocation or termination of the license of an insurance medical organization, which is reflected in the information sent to medical insurance organizations should be equal. Article 46 Procedure for issuing a compulsory health insurance policy to an insured person

1. To obtain a policy of compulsory health insurance, the insured person personally or through his representative submits, in accordance with the procedure established by the rules of compulsory health insurance, an application for choosing an insurance medical organization, under paragraph 2 of part 2 of article 16 of this Federal Law.

Federal Law 326 regulates and controls legal relations between citizens and insurance companies. With the help of obligatory honey. insurance, the state establishes certain financial and organizational measures to improve the efficiency and protection and safety of the population. At the same time, according to the described law, the state guarantees the population the timely provision of medical care of the highest level.

General provisions of the law

Federal Law 326 on compulsory health insurance RF was adopted by the State Duma on November 19, 2010, and approved by the Federation Council on November 24, 2010. The last changes took place on December 28, 2016. It has 11 chapters and 53 articles. a brief description of Federal Law on compulsory health insurance - regulation and control of legal relations between citizens and institutions conducting compulsory medical insurance (Federal Law on insurance in the Russian Federation), regulation of the provisions, rights and obligations of employees and the public, the amount of payment of contributions, processes and methods of implementation, the nuances of events.

Summary of Federal Law 326 "On Compulsory Health Insurance":

The first chapter describes general provisions law. The goals, objectives and what area the law affects are described. Other laws, regulations and acts have been formalized that affect this area. A list of concepts and terms used in the text and definitions of these terms is given. The basic obligations and principles of implementation of honey are described. insurance;
Chapter two lists the rights, duties and powers of state bodies. authorities and federal bodies of the subjects of the Russian Federation in the field of providing the population with honey. insurance;
In chapter number three, the categories of persons and entities obliged to insurance are formalized. Descriptions of categories of persons are given, details of purchasing insurance for each category. Describes the institutions located in different territories of the country, where you can get health insurance;
In the fourth chapter. lists of the rights and obligations of citizens receiving insurance, persons providing it and all medical organizations where it can be purchased;
In ch. five formalized the economic side of this law. Cost Lists Provided different types insurance, methods of payment, the size of contributions, terms and procedure of payment are described. Responsibility of citizens in case of refusal to pay and receive health insurance has been formalized. The budgets of funds and organizations, methods of replenishing reserves, tariffs for payment, etc. are described;
The sixth gives and describes other laws and regulations governing the Federal and Territorial Foundations;
The seventh describes the basic and territorial processes, activities and programs for honey. insurance;
The eighth chapter contains lists and categories with a description of contracts in the field of medical insurance;
Chapter Nine describes the methods and processes for monitoring organizations and institutions that provide health insurance. The reasons for filing a complaint, methods and form of filing have been formalized;
Chapter number ten describes policies and a single record of citizens who have received insurance. Legal relationship between honey. institutions and foundations;
In ch. 11 provides the final and additional requirements, terms and conditions of the law.

Medical insurance on the territory of the Russian Federation is compulsory for every citizen. During insured events, with the help of a policy, a citizen can receive a free medical assistance.

The latest amendments to the Federal Law on environmental impact assessment can be found

What changes have been made?

The latest amendments to the Federal Law on medical insurance were introduced on December 28, 2016, when Federal Law No. 493 was adopted. Changes have occurred in article 31 , in the first part of it, the phrase "treatment of the insured person immediately after the serious accident at work)" was replaced by the phrase "medical care (primary health care, specialized, including high-tech, medical care) to the insured person immediately after the serious accident in production ". And in article 32 all words about the treatment of insured persons were changed to the phrase “medical assistance to the insured person”.

In Art. 10 of Law 326 FZ, the last changes were introduced in 2013. This article provides a list of persons considered to be insured:

Employees who have entered into an employment contract, including the sole managers of organizations. Persons who have entered into other types of contracts related to the performance of work or services, including copyright orders, etc .;
Citizens who do not have a job, but who are minors, caring for incapacitated relatives or disabled people, retirees, guardians or one of the parents of a child under three years old, studying in the state. educational institutions registered in accordance with the employment law;
Self-employed workers like individual entrepreneurs or private legal consultants;
Family members belonging to the small peoples of the North and living in the corresponding territories, engaged in traditional farming;
Members of peasant communities and farms.

According to Article 16 of the described law, there is a list of certain rights and obligations of persons considered to be insured. Such persons have the right:

For free honey. help;
To protect their own rights when obtaining health insurance;
Choice of the category of insurance when applying;
To compensate for any damage caused, in case of poor-quality performance of duties or non-performance of duties in general by medical organizations;
For changing medical institution once a year;
Confidentiality of personal data;
At the choice of an insurance medical organization;
To receive information about the types and quality of honey. help;
At the choice of a doctor when applying.

However, the persons considered to be insured have obligations:

Show the policy when the doctor provides medical assistance;
In case of relocation or other change of residence, contact new organization to select an insurance institution;
Submit new personal data when they change, if it is name, address or passport data;
Apply for honey. insurance.

FZ 326, article 35 the basic program of honey is described. insurance of citizens. This program is confirmed and approved by the Government of the Russian Federation every year. This program lists the cases covered by the insurance, it contains the categories of medical care, rates and payment methods. The government also approves in this program the quality of medical care provided to citizens. It is in the basic program that the requirements are established for citizens applying, citizens receiving medical care under insurance and for employees of insurance medical organizations. Article 35 "On Compulsory Medical Insurance" of Law 326 defines the standards and procedures.

The text of the new edition 326 ФЗ

The law on compulsory medical insurance was created in accordance with the Constitution of the Russian Federation. It is thanks to this law adopted by the state that Russian citizens can receive high-quality free and timely medical care. If a person thinks that his rights or guarantees given by law have been violated, it is recommended to study it. The law defines the rights and obligations, as well as the scope of authority of employees of not only insurance institutions, but also other medical organizations.

This law guarantees free medical care to Russian citizens by creating a compulsory health insurance system. A regulatory document (Federal Law of the Russian Federation 326 on compulsory health insurance) regulates relations between structural units, the procedure for financing and control.

The structure of the social system for providing the population with medical services

The system of compulsory health insurance (CHI), as well as, includes policyholders, the insurer and the insured.

OMC participants:

citizens;
organizations and enterprises;
medical institutions;
insurance organizations;
Social Insurance Fund;
territorial funds.

The insurer is the state represented by the Government of the Russian Federation. It transfers part of its functions to the localities, to the heads of the subjects of the federation. The regulatory framework, including tariffs, determination of the list of services, is established by the Government.

The video simply and clearly tells about compulsory health insurance:

On the basis of the State Program, territorial conditions are developed and implemented.

The essence of the system is the receipt of the basic package of medical care at the place of residence. An emergency ambulance is available throughout the territory.

Policyholders - legal entities, individual entrepreneurs paying insurance premiums in the FSS.

It can be:

state;
municipal;
private enterprises.

Insured persons - working citizens who have compulsory medical insurance policy.

Fund social insurance was created as a non-profit organization and has its own structural units in the form of territorial funds. Its functions include the accumulation of insurance premiums, co-financing of regional programs.

The rights and obligations of the FSS:

is one of the developers of the state program of guaranteed receipt of free medical care;
monitors and manages financial assets;
keeps records of all insured persons;
determines the number of regional insurance organizations;
medical institutions providing services;
checks the competence of territorial funds;
cooperates with international organizations in the field of compulsory medical insurance.

Territorial funds are representatives of a regional insurer, which is the highest body of local executive power.

Functions of territorial funds:

collection, accounting and spending of social insurance funds;
development of regional programs based on the federal one, including per capita standards;
formation of a register of policyholders;
insured persons;
protection of the rights of citizens when receiving low-quality assistance;
audit of the activities of medical institutions and medical insurance organizations.

Medical insurance organization - an intermediate link between the terfond and medical institutions, between the insured persons and the polyclinic (hospital).

She concludes an agreement on the provision of services with each institution and monitors their implementation. Based on the data provided, the regional fund allocates funds for a health insurance company, which subsequently disposes of them in accordance with the agreed conditions.

To provide outpatient, inpatient, emergency services, you must obtain a state license.

If you ask yourself a question, then to participate in the state CHI program you need to submit an application to the terfond. Organizations of all types of ownership have the right to be included in the register of medical institutions that provide compulsory medical services.

Legal guarantees and obligations of medical organizations:

timely and full receipt of funds for the insurance services provided;
appeal against actions of insurance organizations;
provision of free medical care in accordance with the compulsory medical insurance, in some cases the patient is provided;
providing the necessary information to patients about the services provided, the mode of operation;
keeping records of insured persons;
informing the territorial fund about the services provided.

In the case of incomplete assistance, poor quality funding is reduced, or the issue of license revocation is resolved.

The video explains the difference between compulsory and voluntary health insurance:

Financing of the state program of compulsory medical insurance in accordance with federal law

Contributions for each insured person to the insurance fund are made by enterprises and organizations registered in the territory of the Russian Federation. Do you need OSAGO, if there is a comprehensive insurance, find out.

The amount of contributions is approved in each subject on the basis of an agreement between the executive branch, the territorial fund, the insurance organization and the medical institution. The structure of the tariff (cost items) is determined by the federal executive body.

It includes:

staff salaries and accruals;
the cost of drugs, tools, consumables;
nutrition of patients;
payment for diagnostics in other institutions;
communal payments;
social contributions for health workers;
communication services, Internet;
installation software and support;
purchase of equipment up to 100 thousand rubles.

The established rate of reimbursement for the service provided to the insured person in the clinic (hospital) is constant for all insurance companies in the region. He will tell you about car insurance without life insurance.

On the video Financing of the State MHI Program:

Income part Federal Fund consists:

from compulsory insurance premiums;
amounts of fines and penalties;
outstanding payments;
subsidies from the federal budget;
profit from free funds placed with credit or investment organizations. How to add a driver to electronic policy OSAGO learn in.

Expenditure items of the Federal Insurance Fund:

subventions to territorial funds;
fulfillment of the obligations of the Government;
the contents of the apparatus.

The budget of the territorial fund is formed on the basis of:

additional deductions for compulsory health insurance from enterprises and organizations;
regional payments for the provision of services not included in the basic program;
subsidies from the Social Insurance Fund;
accrued arrears, fines, penalties.

In case of insufficient own funds, territorial funds receive subventions (grants) from the Federal Fund.

Financial support is provided under the following conditions:

fulfillment of the requirement for insurance of the non-working population in the amount specified in the regional budget;
its compliance with the indicator calculated according to the federal standard;
monthly transfer of 1/12 of the approved annual amount to the FSS.

Territorial funds' expenses are mainly related to the implementation of regional CHI programs.

As part of the Federal and territorial funds a rationed stock is created, necessary for stable financing, the size and procedure for using which are determined by the highest federal and regional authorities. Read about the compulsory medical insurance policy from Rosgosstrakh.

Basic program of compulsory health insurance of citizens in accordance with the Federal Law of the Russian Federation 326

The federal standard laid down in the CHI is adjusted at the level of the constituent entities of the federation, based on local conditions: age categories, health status of the population and infrastructure. Learn about life and health insurance for a child athlete at.

Territorial programs should ensure a reduction in mortality from diseases and an improvement in the quality of medical services.

The insured citizens who have applied for are entitled to receive all types of assistance free of charge: from emergency to preventive, using modern diagnostic equipment and instruments.

The video shows the basic compulsory health insurance program:

Federal Law 326-FZ, adopted in 2010, is the basis for the functioning of the compulsory health insurance system. The purpose of the document is to establish legal relations between the participants, determine the basic Program, sources of funding and responsibilities of the parties, which is mandatory for.

1. The basic program of compulsory medical insurance is an integral part of the program of state guarantees for the provision of free medical care to citizens, approved by the Government of the Russian Federation.

2. The basic program of compulsory health insurance defines the types of medical care (including a list of types of high-tech medical care, which includes, among other things, methods of treatment), the list of insured events, the structure of the tariff for paying for medical care, methods of paying for medical care provided to insured persons for compulsory medical insurance in the Russian Federation at the expense of compulsory medical insurance, as well as criteria for the availability and quality of medical care.

3. The basic program of compulsory health insurance establishes requirements for the conditions for the provision of medical care, standards for the volume of medical care per one insured person, standards for financial costs per unit of volume of medical care, standards financial security of the basic compulsory health insurance program per one insured person, as well as the calculation of the coefficient of appreciation of the basic compulsory health insurance program. The standards for financial costs per unit volume of medical care specified in this part are also established according to the list of types of high-tech medical care, which includes, among other things, treatment methods.

4. Insurance coverage in accordance with the basic program of compulsory medical insurance, it is established based on the standards of medical care and procedures for the provision of medical care established by the authorized federal executive body.

5. The rights of insured persons to free medical care, established by the basic compulsory health insurance program, are uniform throughout the Russian Federation.

6. Within the framework of the basic program of compulsory medical insurance, primary health care is provided, including preventive care, emergency medical care (with the exception of airborne evacuation carried out by aircraft), specialized medical care, including high-tech medical care, in the following cases :

2) neoplasms;

3) diseases of the endocrine system;

4) eating disorders and metabolic disorders;

5) diseases of the nervous system;

6) diseases of the blood, blood-forming organs;

7) certain disorders involving the immune mechanism;

8) diseases of the eye and its accessory apparatus;

9) diseases of the ear and mastoid process;

10) diseases of the circulatory system;

11) respiratory diseases;

12) diseases of the digestive system;

13) diseases of the genitourinary system;

14) diseases of the skin and subcutaneous tissue;

15) diseases of the musculoskeletal system and connective tissue;

16) injury, poisoning and some other consequences of external causes;

17) congenital anomalies (malformations);

18) deformations and chromosomal abnormalities;

19) pregnancy, childbirth, postpartum period and abortion;

20) certain conditions that occur in children during the perinatal period.

7. The structure of the tariff for paying for medical care includes expenses for wages, accruals for wages, other payments, the purchase of medicines, consumables, food, soft inventory, medical instruments, reagents and chemicals, other material supplies, the cost of paying for the cost of laboratory and instrumental research conducted in other institutions (in the absence of medical organization of the laboratory and diagnostic equipment), catering (in the absence of organized meals in the medical organization), the cost of payment for communication services, transport services, utilities, works and services for the maintenance of property, expenses for rent for the use of property, payment for software and other services, social security for employees of medical organizations established by the legislation of the Russian Federation, other expenses, expenses for the acquisition of fixed assets (equipment, production and household inventory) costing up to one hundred thousand rubles per unit.

8. The Government of the Russian Federation, when approving the basic compulsory health insurance program, has the right to establish an additional list of diseases and conditions included in the basic compulsory health insurance program as cases of medical care, and additional elements of the structure of the tariff for paying for medical care to those established by this Federal Law.

9. The basic compulsory health insurance program sets out the requirements for territorial programs compulsory health insurance.

OMS is one of several types of compulsory social insurance for residents of the Russian Federation. To provide insurance to every citizen, a complex of economic, legal and organizational methods is applied. They are aimed at ensuring guarantees for the provision of free medical care to the insured at a high level, in accordance with the volume and deadlines... The payment is made at the expense of the state insurance company.

Acting the federal law created on the basis of the Constitution of the Russian Federation. It regulates the relationship that is formed in the process of obtaining a policy on compulsory insurance (OMS). The law defines the rights of such citizens, their duties, as well as guarantees due to which the state insurance Company is still valid.

The law was passed The State Duma November 19, 2010, and approved by the Federation Council after 6 days. The last changes were made on December 28, 2016.

General provisions of the Federal Law;
Enumeration of the powers of the constituent entities of the Russian Federation in the provision of compulsory insurance services;
Identification of participants and subjects;
Revealing the rights and obligations of the insured persons;
Determination of the amount of compulsory health insurance payments;
Description of the legal position of the law;
List of programs in the field of CHI;
Signing contracts in the field of compulsory medical insurance;
Control of the volume of conditions, quality and timing of assistance;
Registration of each oMS participant according to law;
Final information.

Download

The Law "On Compulsory Health Insurance in the Russian Federation" consists of 11 chapters and 53 articles. It lists the main principles.

What do you know about mandatory pension insurance? Details

These are:

Provision of medical care at the expense of the state insurance company. When an insured event occurs, you can use such services;
High stability financial system for compulsory health insurance;
Obligation to policyholders to pay insurance premiums. The amount of contributions is established in accordance with Federal legislation;
Compliance with the rights of the state side of the insured clients. All obligations for health insurance between the parties must be fulfilled within the period specified in the contract;
Compliance with the conditions to ensure the quality of care and general accessibility to the services of the insurance company.

To download the latest version of the law as amended, supplemented and amended, go to the following.

In addition, you should know the basics of social services for citizens in the Russian Federation. To do this, study.

Recent changes made to the Federal Law "On compulsory health insurance in the Russian Federation"

The last changes were amended on December 28, 2016. Part 1 of Article 31, title of Article 32, Part 1 of Article 32 and Part 2 of Article 32 were amended.

H 1 st 31

Part 1 of Article 31 of the Law describes methods of calculating costs, including cash to buy a health insurance policy. The client is provided with a payment after a serious accident at work or at home. If the company proves that the harm to health was not an accident, then the person who caused the harm to the health of the insured citizen must reimburse the money for the treatment.

Article 32

The title was changed in Article 32 of the Law. Now it sounds like this "Payment of medical care costs to the insured person immediately after a serious accident at work."

Part 1 article 32

The sentence was changed from “treatment of the insured person” to “medical assistance to the insured person”.

Part 2 article 32

In part 2 of article 32 of the law, the proposal was changed from "treatment of the insured person" to "medical assistance to the insured person".

Another article is discussed below.

Article 16

Article 16 of 326-FZ lists the rights and obligations of the insured person.