What is a compulsory medical insurance policy and what services are included in it? Why was a program for informing the population about the cost of medical services provided under the OMC policy created?

Payment of contributions to the FIU and honey. insurance is compulsory for all employers and entrepreneurs. In order to transfer health insurance premiums, you need to know the BCF and the interest rate. In the article, we will consider what the rate and percentage of deductions are in the FFOMS.

How to calculate the contribution rate

Most employers calculate the FFOMS rate at the current rate of 5.1%. There is no ceiling for these premiums. Regardless of how much the employee earned in a year, a deduction for honey must be made from each payment. insurance. Contributions depend on minimum wage labor, so the calculation will not be difficult.

On the example of IE contributions for "myself" Consider the amount of compulsory insurance in 2017:

• Pension - 7,500 * 26% * 12 \u003d 400 rubles.
• Honey. insurance of the merchant's contributions - 7,500 * 5.1% * 12 \u003d 4,590 rubles.

So, insurance premiums for merchants who pay for themselves amount to 27,990 rubles in 2017. This amount is usually divided over four quarters. At the end of the quarter, merchants are obliged to pay a single contribution in the amount of 6,997.5 rubles. The monthly rate is 2,332.5 rubles.

Knowing the annual amount, these contributions can be paid as a single payment or quarterly. Almost all merchants make quarterly payments. They are fixed for entrepreneurs with no employees. For all employers, the insurance premium and its rate depend on the chosen taxation system, on the amount that was charged to the employee during the year.

Policyholders who have employees, make deductions at the following rates:

• PFR - 22%. This amount fluctuates and depends on the hazard of work in the enterprise. Can be installed additional contributions, about which in a separate notification the fund informs the head.
• FSS - 2.9%. Contributions for hazard and injury are assessed. The amount of this contribution is determined for each enterprise separately.
• FFOMS - 5.1%.

If the company is on a simplified system and at the same time is engaged in a “preferential” type of activity, then the size insurance premium will be different.

To take advantage of preferential contribution, you need to check if the code applies economic activity to "beneficiaries", the list of which was established on the basis of Federal Law No. 212. For such companies and entrepreneurs, contributions to the FIU are 20%, and insurance premiums to honey. fear 5.1%.

If pension contribution can reach the limit and decrease, then the medical rate has no limit, therefore the 5.1% deductions are valid all year round.

FFOMS contribution rate in 2017

The changes that will affect all taxpayers in 2017 are, first of all, the transfer of powers from some regulatory authorities to others. Now they will be engaged in checking the correctness of accrual and payment tax authorities... The federal law will no longer be in effect, it will be replaced by NK.

Verification of the activities of entrepreneurs and organizations will be carried out on the basis of new legislation. This is the single most important change in 2017. What percentage of deductions to FFOMSnas expects can be seen in the table:

As we can see, insurance rates will not change and will remain at the same level. The regulatory authorities did not cancel the reduction of contributions, it is just that not all employers will be able to take advantage of it. Changes in the size of the insurance premium will be felt by the merchants who paid for themselves.

An increase in the minimum wage by 7,500 rubles will lead to an increase in the amount of taxes on compulsory insurance.

Who does not pay dues

Who can not pay the dues? These include:

• Pharmacies, merchants licensed to conduct pharmaceutical activities.
• Organizations engaged in the field of social services for citizens.
• Charity organisations.
• Research and development companies.

These organizations have a 0% tariff rate.

The rate of 4% on accrual of insurance mandatory contributions the following policyholders can use the FFOMS:

• Information technology companies.
• Merchants and organizations that are engaged in inventions and scientific developments.
• Tourist organizations.

In this way, interest rate for payment of the contribution is directly dependent on the type of activity of the entrepreneur and organization. As much as the structure is active in state and charitable financing, the rate of contributions also decreases.

Some changes in 2020 in terms of mandatory contributions will partially affect and health insurance... From 1.01.2020, a different fixed amount will be applied for individual entrepreneurs without workers. It is planned that it will not depend on the minimum wage. No innovations are expected in terms of the tariff rate and the maximum base.

The unified 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 rise to 34%.

Benefits for reduced MHI rates will also remain unchanged. Their size (from 0 to 4%) and conditions of use are discussed 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 may be mandatory and preferential. In isolated situations, policyholders are exempted from paying them.

When calculating the amount of the OMI contribution to be paid, 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 OMS contributions, KBK 182 1 02 02101 08 1013 160 is recorded.

Insurance premiums for compulsory medical insurance of entrepreneurs from 2020

Entrepreneurs calculate the amount of compulsory 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 to be paid has reached the numerical value of 4 590 at this time.

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

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

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

Terms of payment of contributions and submission of reports on CHI from 2020

Compulsory compulsory health 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 that follows the month of assessing contributions. The basis is the Tax Code of the Russian Federation, Art. 431, p. 3.

This applies general rules transfer of weekends and holidays to the first working day. That is, if the deadline for payment fell on a weekend (holiday), payment can be made on the following first business day.

For entrepreneurs, there are separate rules for paying a fixed amount under the compulsory health insurance. In 2020, they are offered the choice of making an insurance payment at a time or in installments. So, the established value of 5,840 rubles. The individual entrepreneur has the right to split and pay every month, quarterly or once every six months. A condition that must be met at the same time: meet with one-time and partial insurance payments should be until December 31 of the reporting year.

The obliged person is accountable for the payments of compulsory medical insurance as part of a single new form calculation of 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 / 551 @ dated 10.10.2016.

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

The deadline for the submission of a single calculation has been set - the 30th day of the month that follows the reporting month. In order of priority, taking into account weekends and holidays, the current dates will be:

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

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

Resident of the Russian Federation L.R. Vasilchenko received the status of an entrepreneur on 02/15/2020. After working for several months on his own, without workers, 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 compulsory contributions for the medical part. For the calculation, the fixed value of 2020 is taken into account - 5,840 rubles.

The calculation sequence will be as follows. First, the amount for compulsory medical insurance is calculated separately for incomplete months of work, that is, 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 total amount of the OMI payment to be paid is obtained.

So, the procedure for calculating compulsory medical insurance payments by individual entrepreneur L.R. Vasilchenko is as follows: (click to disclose)

1. Compulsory health insurance payment per month: 5,840 / 12 months \u003d 486 rubles.
2. OMS payment for incomplete February: 486/28 days of February * 13 working days \u003d 226 rubles.
3. OMS payment for incomplete October: 486/31 days of October * 14 working days \u003d 523 rubles.
4. Compulsory medical insurance payment for whole months of work: 486 * 8 whole working months \u003d 3 888 rubles.
5. Summation of the calculated values \u200b\u200bfor incomplete and whole months of work of the IP L.R. Vasilchenko: 226 + 523 + 3 888 \u003d 4 637 rubles.

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

With the annual income for 2017 exceeding RUB 300,000, the deadline for the additional payment (1% of the exceeded 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: Is it necessary for an individual entrepreneur who did not carry out activities during 2020 to deduct compulsory medical contributions?

Yes, because medical contributions, like pension contributions, are considered compulsory 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, medical fees will have to be paid. Consequently, for 2020 the individual entrepreneur will be obliged to pay a fixed amount - 5,840 rubles.

Question 2: How to calculate the amount of compulsory 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 exceeded amount? An entrepreneur without workers.

For compulsory insurance payments for the medical part, a fixed amount is established (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.

What medical services are free and what do you have to pay for? What is a health insurance policy for and how to get it? How to attach to the clinic and how long to wait for a specialist appointment? Why can you be denied to call an ambulance 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?

Patients are entitled by law to the following free medical services:

• emergency help ( ambulance)


• outpatient care in a polyclinic (examinations and treatment)


• inpatient medical care:

1. - abortion, pregnancy and childbirth


2. - with exacerbation of chronic and acute diseases, poisoning, injuries requiring intensive therapy 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 techniques


• medical care for people with incurable diseases.

Complete list cases in which you are entitled to free medical care are included in the basic compulsory health insurance program. To check this list, you can contact your insurance company (you will find the company's phone number on your policy).

Please note that you are also eligible for free medication if your medical 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 drugs.

Medical policy

A compulsory medical insurance policy (compulsory medical insurance policy) is a document that allows a person to receive free medical care in hospitals and clinics throughout the Russian Federation. It is issued by insurance companies that are licensed to operate in this area. The insurance company that issued you an OMI policy pays for medical services and protects your interests in conflicts with medical institutions. Keep in mind that you must have a policy with you to get free medical services. Without its presentation, only emergency assistance is provided. The compulsory medical insurance policy can be obtained by everyone who is on the territory of the Russian Federation, including foreigners and refugees.

How to get a compulsory medical insurance policy?

To do this, you need to contact an insurance company that has the appropriate license. The official rating of insurance medical organizations will help in choosing it. 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 1.

What documents are needed to issue a compulsory medical insurance policy?

For a citizen of the Russian Federation under 14 years old,:

• birth certificate


• passport of a legal representative (for example, one of the parents)


• SNILS (if available).

For a citizen of the Russian Federation over 14 years old, you need:

• passport of a citizen of the Russian Federation


• SNILS (if available).

What is the validity period of the compulsory medical insurance policy?

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

In what cases can a compulsory medical insurance policy be replaced with a new one?

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

• with a planned change of the compulsory medical insurance policy (for example, when a new sample is introduced)


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


• upon detection of inaccuracies or errors in the policy


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


• upon loss of the policy


• when changing the personal data of the policyholder (name, passport data, place of residence).

Polyclinic

Upon receipt of the compulsory medical insurance policy, a polyclinic is selected to which you will apply for 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, dacha). The only condition is that she must be able to accept a new patient (the planned load is determined by the standards).

How to attach to the clinic?

Your attachment to the clinic at your place of residence happened automatically if:

• you live under the same registration as when you received your policy


• you live at the same address that you called when you received the policy (even if it differs from 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 the clinic outside your place of residence, you will not be able to call a doctor at home.

Remember that by law you can change the clinic no more than once a year, unless you change your place of residence or stay.

What documents are required to be attached to the clinic?

List of documents for a child under 14 years old:

• oMS policy (original and copy)


• birth certificate


• identity document of the child's legal representative (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


• oMS policy (original and copy)


• passport of a citizen of the Russian Federation


• SNILS (if available).

Can you be refused to be assigned to the clinic and why?

They may refuse to enroll if the selected clinic is overcrowded and is not in the area of \u200b\u200byour 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.

Appointment to a doctor. How to get to it and how long will you have to wait?

You can make an appointment with a doctor (receive a voucher for an appointment) 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 nearest appointment with doctors may be only after a few months or be absent altogether (“there are no coupons”). How long can you wait according to the law, and what to do if you are not provided with the service on time?

Each region independently sets the waiting time for medical care on its territory. You can get information about the terms in effect in your region from the territorial compulsory health insurance fund or from your insurance company (you will find the company's phone number in your compulsory health insurance policy).

As an example, we will cite the deadlines set in Moscow. According to the decree of the Moscow Government, 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 a medical organization cannot meet the specified deadlines, there is no necessary specialist or equipment, then according to the 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 with other institutions, which we describe in the section "Where to complain?"

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 submit an application addressed to the head of the medical institution. You can change your doctor no more than once a year, unless you change your place of residence or stay.

Emergency

TO free medicine the ambulance also applies. It can be used by everyone on the territory of the Russian Federation, 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 time of arrival of a 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 come to 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 patient's life. 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 learned truth from childhood that to call an ambulance it is enough to call "03". Landline telephones eventually become a thing of the past, being replaced by mobile communications. Almost everyone has a mobile phone at hand, but not everyone knows how to call an ambulance from it.

You can call an ambulance by numbers:

• 03 from a landline phone


• 103 s 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 if your balance is zero, your SIM card is blocked, or if it is not in your phone. However, this service currently does not work in all regions of the Russian Federation.

When will an ambulance arrive:

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


• in case of 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 activity of the cardiovascular and nervous system, respiratory organs, abdominal cavity, and so on;


• during childbirth and violation of the course of pregnancy;


• for any reason for children under 1 year old;


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

In what case the ambulance will not arrive:

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


• when calling to patients with alcoholism to relieve hangover;


• to provide dental care;


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


• to issue sick leave, recipes and references;


• for the issuance of forensic and expert opinions;


• to draw up an act of death and examination of a corpse;


• for transportation of patients from hospital to hospital or home.

What are the responsibilities of an ambulance?

The arrived team will provide emergency medical care and, if necessary, will hospitalize you in the hospital. The team doctors can give oral recommendations on treatment, but they do not issue certificates and sick leave.

Where to complain about your 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 make a complaint is to write a statement addressed to the head physician. This will help resolve the problem 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 have not been able to resolve the problem at the local level, then you can contact the Ministry of Health. You can submit a complaint in person at the reception of the ministry, send it to the usual 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 exercises control in the health 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 audit the work of government agencies.


6. If the conflict was still not resolved in the indicated ways, 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 links to the relevant articles of the laws), attach documents proving the defendant's guilt.


7. Calling the police is appropriate if a doctor has deliberately harmed your health, threatened, extorted or insulted your honor and dignity.

Please note that the processing time for applications in each case is 30 calendar days by law.

CHI is a state system that guarantees all citizens a minimum amount of medical care. It is financed by the federal compulsory health insurance funds (FFOMS). They receive contributions from employers from wages all officially employed citizens. From the state budget, the source of which is the taxes of citizens, funds are received for the treatment of unemployed persons. Funds of insurance medicine and pay bills for treatment under the compulsory medical insurance policy, presented by medical institutions. Providing patients with information about the cost of services rendered attracts them to control the cost tax funds medical purposes.

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

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

The state program of informing citizens about how much "free" medical services cost was launched on 25.07.2014 on the instructions of the President of the Russian Federation - "Order No. Pr-1788" And on July 28, 2014, the FFOMS Order No. 108 "On the implementation of a system for informing insured persons about the cost of medical care" was issued. Since September 2014, in seven regions of Russia, medical institutions began to issue certificates to patients about what kind of medical care they received and what the amount of its cost. At the beginning, the experiment to inform the population faced difficulties and misunderstandings, including:

• Overload of medical personnel, forced to calculate the volume and cost of services for each patient, write out certificates, explain their purpose, collect signatures on receipt or refusal;
• Misunderstanding and wary attitude of patients to certificates. Some asked what to do with them; others accepted them at the expense of their own pocket; still others were amazed at how cheap the compulsory health insurance policy was.

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

Goals and objectives of the communication program

The program, the development of which was the initiative of the President of the Russian Federation, contributes to the solution of several tasks. So, the need for information was initially explained by psychological factors: knowing the cost of insurance medicine services, citizens will begin to understand the expense budget funds, take care of your health, etc. But such a measure pursues primarily a practical goal: to establish control over the spending of state budget funds for medical purposes. Receiving a certificate of the assistance that was provided to him, the patient thereby finds out how much the insurance fund transfers for his treatment, whether the volume and quality of services corresponds to state guarantees. In addition, a certificate indicating the tariffs for free assistance allows citizens to clearly understand what the required mandatory minimum is provided by insurance medicine, and for which services they will have to pay out of pocket.

Receiving information about medical care through personal Area on the website of public services, a citizen can find services that were not provided to him, but are recorded in his book. According to experts, medical institutions are engaged in registration in order to attract additional funds to finance their urgent needs. Therefore, such a base is also useful for state control bodies. FFOMS spending becomes transparent, easier to account and regulate.

How much does it cost to treat a patient?

The money for compulsory health insurance funds comes from several sources. Enterprises donate 5.1% of their payroll funds to provide health care to their employees and their families. The state budget finances the treatment of non-working citizens, some types of socially dangerous diseases (HIV, tuberculosis, etc.). Based on the law signed by the President of the Russian Federation of July 3, 2016 No. 286-FZ, from January 1, 2017, high-tech free service patients will not be paid state budget, and FFOMS. Some regions contribute additional funds to territorial funds Compulsory medical insurance to expand opportunities for free treatment of its population.

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

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

Based on data Tariff agreement in the compulsory health insurance system of the Kaliningrad region for 2017 and the planned period of 2018 and 2019

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

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

The issuance of certificates on the volume of medical services rendered is carried out by order of the FFOMS dated October 19, 2015 No. 196 on the basis of the "Rules for compulsory medical insurance" in the new edition, approved by order No. 536n of the Ministry of Health of the Russian Federation dated August 6, 2015. The specified information is issued by the insurance company that issued the policy, medical organizationwho carried out medical activities or on the portal of public services and on the websites of insurance companies, where the patient can create a personal account and receive, upon request, all information in in electronic format.

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

Conclusion

The program of informing the population about the cost of treatment for compulsory health insurance involves the population in control over the spending of tax funds. It also determines the directions for optimizing health insurance: the creation of electronic medical records, the introduction of OMS plus policies, etc.

All citizens are insured in the CHI system Russian Federation without exception. Foreigners permanently residing in Russia are eligible for 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 the territorial or federal funds of the compulsory medical insurance. Health insurance for unemployed citizens is paid directly by the state.

The most important link in the CHI is special funds. They are non-profit organizations that accumulate all the money transfers to the health insurance system.

They ensure financial stability and, if necessary, carry out material support insurance companies.

Immediate oMS participants are commercial insurance companies. They are required to have an appropriate state license to carry out insurance activities.

They conclude contracts with medical institutions for the provision of services to their clients, issue medical policies, control the quality and timing of medical care.

Medical institutions are the final segment of compulsory medical insurance. Citizens of the Russian Federation apply to them to receive appropriate assistance. The presence of the policy of the described sample gives the full right to receive medical services free of charge.

CHI Law

Today, the basis for oMS actions is the Federal Law “On Compulsory Health Insurance in the Russian Federation”.

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

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

Complement the action of the Federal Law No. 326:

• the law of 21.11.11 "On the basics of health protection of citizens of the Russian Federation";
• the law of 16.07.99 "On the basics of compulsory medical insurance".

Relationship of subjects cHI systems are also governed 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 under consideration is primarily monitored by the federal and regional CHI fund.

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

What does the policy give

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 is assigned;
• traumatology;
• dentistry;
• oncology departments, dispensaries;
• hospitals participating in compulsory medical insurance.

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

This document is currently mandatory for submission to medical institution when contacting. If a compulsory medical insurance policy is missing for some reason, 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.

Reforms of the health insurance system have been carried out recently. It was in this connection that a new type of insurance policy was issued. It has the form plastic card, on the face of which there is an individual card number.

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On the back there is the following information:

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

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

There is also another type of policy - temporary. It is issued for a period of 30 days in case of a situation when plastic policy withdrawn.

This happens if a person previously had no policy of the type in question, or it is being replaced. Upon the expiration of a thirty-day period 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;
• the 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 temporary policy OMS.

Terms of an agreement

The terms of the compulsory medical insurance contract were approved by the Director of the Federal MHI Fund A. Taranov 03.10.03.

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

The document in question in mandatory contains points to avoid the occurrence of various kinds of conflicts, 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 is paid to the insurance company (insurance premium).

Based on this, when the insured event the company pays for its client to visit a medical institution.

This section denotes the object of insurance - the property interest of the client. That is, in fact medical policy OMS protects its owner, first of all, from financial damage. Also in this section the concept of an insured event is indicated.

Section " Sum insured, the order of its introduction ”explains in detail these two terms. The amount of the insurance premium, the liability limit, the procedure for paying the insurance premium and the moment of the operation are also indicated.

When issuing a standard policy OMS given there is no section - it is displayed in the agreement between the UK and the regional (federal) CHI fund. The section "Terms of the agreement" defines the duration of the agreement of the type in question.

The clause "rights and obligations of the parties" discloses the obligations arising between the policyholder and the insurer in the event of its conclusion.

The rights of the parties are also considered in maximum detail. The occurrence of serious violations of at least one clause is a serious basis for terminating the contract.

The insurance company must ensure the confidentiality of information regarding the policyholder. An exception is possible only in cases provided for by the current legislation of the Russian Federation.

The following information is confidential:

• the content of the contract, its form;
• the health status of the insured, all available cases of seeking medical care;
• personal data of the policyholder (place of residence, home phone number, etc.).

The section "Modification and termination of the contract" lists the 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 contract, the details of the parties are indicated: actual and legal address, phone 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 single policy compulsory health insurance.

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

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

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

Required documents for registration

The list of documents required for issuing an OMI policy differs depending on the age, as well as the legal status of the person applying to the insurance company.

Children over 14 years of age (citizens of the Russian Federation) must submit the following documents to the UK to obtain a policy:

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

If the papers for registration of a policy of the corresponding sample are provided by a parent, guardian, then a passport or other identity document is required.

If the policy is issued by relatives, then they are required to present:

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

Citizens of the Russian Federation under the age of 18, but overcame the age threshold of 14:

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

Persons who have reached the age of 18:

• identity document or passport;
• SNILS.

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

• petition;
• certificate of the corresponding sample;
• an appeal against a court decision to revoke refugee status with the FMS;
• document confirming the receipt of a temporary asylum.

For individualswho do not have permanent citizenship, but possess real estate, a residence permit:

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

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

• identity card and document confirming the absence of citizenship;
• SNILS (if available);
• residence.

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.

To date, payers of compulsory medical insurance contributions, according to Federal law "On compulsory health insurance" are:

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

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

Contribution to federal fund The compulsory medical insurance is 5.1% of the total payroll, which is paid to employees.

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

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

Service register

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

• emergency medical;
• 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 CHI system provides the following types of medical care:

• dental, oncological (the list is approved by the Healthcare 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

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

Free of charge, if available, is carried out:

• initial examination and consultation (including for patients who are not able to move independently);
• preparation of a preventive disease map;
• treatment:
  • carious formations;
  • pulpitis;
  • periodontitis;
  • periodontic diseases;
  • diseases of the oral cavity, mucous membranes;

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

For children under the age of 14, many polyclinics provide treatment:

• non-carious lesions of dental hard 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;
• plastic card, which is a spiked electronic carrier;
• an electronic application with a number printed on the UEC (universal electronic card).

Earlier, until 2011, compulsory medical insurance policies of various formats were issued. Today this area of \u200b\u200binsurance is more streamlined.

Amendments were made to the legislation, allowing any citizen to choose the policy format independently.

Electronic policies have one important advantage over paper ones - there is no need to renew them.

A standard A5 policy can be obtained at any point of issue. To obtain a universal electronic card or a plastic card, you must visit a specialized issue 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 some cases will it be necessary to pay, 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 the rights of patients in the CHI system

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