Federal Law of the Russian Federation on Compulsory Health Insurance. Legal framework and regulation of VMI insurance. Compulsory health insurance

GUARANTOR's comment

See graphic copy of the official publication

Federal Law of November 29, 2010 N 326-fz "On mandatory health insurance in the Russian Federation "(as amended on June 14, November 30, December 3, 2011)

GUARANTOR's comment

Cm. comments to this Federal Law

Chapter 1. General Provisions

Article 1. The subject of regulation of this Federal Law

This Federal Law regulates relations arising in connection with the implementation of compulsory health insurance, including determining the legal status of subjects of compulsory health insurance and participants in compulsory health insurance, the grounds for the emergence of their rights and obligations, guarantees for their implementation, relations and liability associated with the payment of insurance contributions to the non-working population.

GUARANTOR's comment

Cm. comments to Article 1 of this Federal Law

Article 2. Legal basis for compulsory health insurance

1. Legislation on compulsory health insurance is based on Of the Constitution Russian Federation and consists of Fundamentals of legislation Of the Russian Federation on the protection of the health of citizens, Federal law of July 16, 1999 N 165-FZ "On the foundations of compulsory social insurance", this Federal Law, other federal laws, laws of the constituent entities of the Russian Federation. Relations associated with compulsory health insurance are also governed by other regulatory legal acts of the Russian Federation, other regulatory legal acts of the constituent entities of the Russian Federation.

GUARANTOR's comment

Cm. the federal law of November 21, 2011 N 323-FZ "On the basics of health protection of citizens in the Russian Federation"

2. In the event that an international treaty of the Russian Federation establishes rules other than those provided for by this Federal Law, the rules of the international treaty of the Russian Federation shall apply.

3. For the purpose of uniform application of this Federal Law, if necessary, appropriate explanations may be issued in okay established by the Government of the Russian Federation.

GUARANTOR's comment

Cm. comments to Article 2 of this Federal Law

Article 3. Basic concepts used in this Federal Law

For the purposes of this Federal Law, the following basic concepts are used:

1)compulsory health insurance- type of mandatory social insurance, which is a system of legal, economic and organizational measures created by the state aimed at ensuring, in the event of an insured event, guarantees of free provision of medical care to the insured person at the expense of compulsory medical insurance funds within the territorial compulsory medical insurance program and in cases established by this Federal Law within the basic compulsory health insurance programs;

2)compulsory health insurance object-insurance risk associated with the emergence insured event;

3)insurance risk- the anticipated event, upon the occurrence of which it becomes necessary to incur expenses for the payment of medical care provided to the insured person;

4)insurance case- an event that has taken place (illness, injury, other state of health of the insured person, preventive measures), upon the occurrence of which the insured person is provided with insurance coverage for compulsory health insurance;

5)insurance coverage for compulsory health insurance(hereinafter - insurance coverage) - fulfillment of obligations to provide the insured person with the necessary medical care in the event of an insured event and to pay for it to a medical organization;

6)insurance premiums for compulsory health insurance- compulsory payments, which are paid by the policyholders, have an impersonal character and the purpose of which is to ensure the rights of the insured person to receive insurance coverage;

7)insured person- an individual who is covered by compulsory health insurance in accordance with this Federal Law;

8)basic compulsory health insurance program- an integral part of the program of state guarantees for the free provision of medical care to citizens, which determines the rights of insured persons to provide them free medical care at the expense of compulsory medical insurance throughout the territory of the Russian Federation and establishes uniform requirements for territorial compulsory medical insurance programs;

9)territorial compulsory health insurance program- an integral part of the territorial program of state guarantees for the free provision of medical care to citizens, which determines the rights of insured persons to provide them with free medical care in the territory of the constituent entity of the Russian Federation and meets the uniform requirements of the basic compulsory medical insurance program.

Chapter 1. General Provisions

Article 1. Subject of regulation of this Federal Law

Article 2. Legal basis for compulsory health insurance

1. Legislation on compulsory health insurance is based on the Constitution of the Russian Federation and consists of the Fundamentals of the Legislation of the Russian Federation on the Protection of Citizens' Health, Federal Law of July 16, 1999 N 165-FZ "On the Fundamentals of Compulsory Social Insurance", this Federal Law, and other federal laws , laws of the constituent entities of the Russian Federation. Relations associated with compulsory health insurance are also governed by other regulatory legal acts of the Russian Federation, other regulatory legal acts of the constituent entities of the Russian Federation.

3. For the purpose of uniform application of this Federal Law, if necessary, appropriate explanations may be issued in the manner established by the Government of the Russian Federation.

Article 3. Basic concepts used in this Federal Law

1) compulsory health insurance - a type of compulsory social insurance, which is a system of legal, economic and organizational measures created by the state aimed at ensuring, in the event of an insured event, guarantees of free provision of medical care to the insured person at the expense of compulsory health insurance funds within the territorial compulsory health insurance program and in the cases established by this Federal Law within the framework of the basic compulsory health insurance program;

2) the object of compulsory medical insurance is the insurance risk associated with the occurrence of an insured event;

3) insurance risk - an anticipated event, upon the occurrence of which it becomes necessary to incur expenses for payment of medical care provided to the insured person;

4) insured event - an event that has occurred (illness, injury, other state of health of the insured person, preventive measures), upon the occurrence of which the insured person is provided with insurance coverage for compulsory health insurance;

5) insurance coverage for compulsory health insurance (hereinafter - insurance coverage) - the fulfillment of obligations to provide the insured person with the necessary medical care in the event of an insured event and to pay for it to a medical organization;

6) insurance premiums for compulsory health insurance - compulsory payments that are paid by policyholders, have an impersonal nature and the purpose of which is to ensure the rights of the insured person to receive insurance coverage;

7) insured person - an individual who is covered by compulsory medical insurance in accordance with this Federal Law;

8) the basic program of compulsory medical insurance - an integral part of the program of state guarantees of free provision of medical care to citizens, which determines the rights of insured persons to provide them free medical care at the expense of compulsory medical insurance funds throughout the territory of the Russian Federation and establishes uniform requirements for territorial compulsory medical insurance programs ;

9) a territorial compulsory health insurance program - an integral part of the territorial program of state guarantees for free provision of medical care to citizens, which determines the rights of insured persons to free medical care in the territory of a constituent entity of the Russian Federation and complies with the uniform requirements of the basic compulsory health insurance program.

Article 4. Basic principles of implementation of CHI

1) ensuring, at the expense of compulsory health insurance funds, guarantees of free provision of medical care to the insured person in the event of an insured event within the framework of the territorial compulsory health insurance program and the basic compulsory health insurance program (hereinafter also referred to as the compulsory health insurance program);

2) stability financial system compulsory health insurance, provided on the basis of the equivalence of insurance coverage with the means of compulsory health insurance;

3) the obligation for insurers to pay insurance premiums for compulsory health insurance in the amount established by federal laws;

4) the state guarantee of the observance of the rights of insured persons to fulfill obligations for compulsory health insurance under the basic compulsory health insurance program, regardless of financial situation insurer;

5) creation of conditions for ensuring the availability and quality of medical care provided within the framework of compulsory health insurance programs;

6) parity of representation of subjects of compulsory health insurance and participants of compulsory health insurance in the governing bodies of compulsory health insurance.

Federal Law of 29.11.2010 N 326-FZ "On Compulsory Health Insurance in the Russian Federation" Chapter 4, Article 16

1. Insured persons have the right to:

o 1) free provision of medical care to them by medical organizations in the event of an insured event:

§ a) throughout the territory of the 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 medical insurance was issued, in the amount established territorial program compulsory health insurance;

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

o 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;

o 4) selection of a medical organization from medical organizations participating in the implementation of the territorial compulsory medical insurance program in accordance with the legislation of the Russian Federation;

o 5) the choice of a doctor by submitting an application personally or through his representative addressed to the head of a medical organization in accordance with the legislation of the Russian Federation;

o 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;

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

o 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;

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

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

2. The insured persons are obliged to:

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

o 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;

o 3) notify the medical insurance organization about the change in the surname, name, patronymic, place of residence within one month from the day when these changes occurred;

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

3. Compulsory health insurance for children from birth to day state registration birth is carried out by an insurance medical organization in which their mothers or other legal representatives are insured. After the day of state registration of the child's birth and until he reaches the age of majority or after he acquires legal capacity in full and until he reaches the age of majority, 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 before reaching the age of majority (for a child until he reaches the age of majority or after he has acquired full legal capacity before reaching the age of majority - by his parents or other legal representatives), by contacting an insurance medical organization from among those included in the register of insurance medical organizations, which is posted 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 to the chosen insurance medical organization with an application for the choice (replacement) of this insurance medical organization. On the basis of the specified application, the insured person or his representative is issued by the insurance medical organization 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, under paragraph 4 of part 2 of this article.

6. Information about citizens who have not applied to an insurance medical organization for the issuance of compulsory health insurance policies to them is sent monthly by the 10th day by the territorial fund to insurance medical organizations operating in the field of compulsory health insurance in a constituent entity of the Russian Federation, in proportion to the number of insured persons in each of them for the conclusion of contracts on the financial provision of compulsory health insurance. The ratio of working citizens and non-working citizens who have not applied to a medical insurance organization, which is reflected in the information sent to medical insurance organizations, must be equal.

7. Insurance medical organizations specified in part 6 of this article:

o 1) within three working days from the date of receipt of information from the territorial fund, inform the insured person in writing about the fact of insurance and the need to obtain a compulsory health insurance policy;

o 2) ensure the issuance of a compulsory medical insurance policy to the insured person in the manner prescribed by Article 46 of this Federal Law;

o 3) provide the insured person with information about his rights and obligations.

In accordance with Part 2 of Article 51 of the Federal Law of 29.11.2010 No. 326-FZ "On Compulsory Medical Insurance in the Russian Federation", Clause 30 of Chapter IV of the CHI Rules, approved by Order of the Ministry of Health of the Russian Federation of 28.02.2011 No. 158, in accordance with included in OMS rules changes approved by Order of the Ministry of Health of the Russian Federation of June 21, 2013 No. 396-n, compulsory medical insurance policies issued before 01/01/2011, as well as compulsory medical insurance policies issued for the period from 01/01/2011 - 05/01/2011, are valid (without an additional mark on the extension on the policy form OMS) before replacing them with policies of a new type, including in the form of a universal electronic card.

Relevance of compulsory medical insurance policies registered on the territory of the Khanty-Mansiysk Autonomous Okrug-Yugra, can be checked on the official website of TFOMS Ugra at www.ofoms.ru in the section "Citizens".

Insured persons registered on the territory of another constituent entity of the Russian Federation can check the validity of their CHI policy on the website of the Territorial CHI Fund of their constituent entity of the Russian Federation, or by contacting the medical insurance organization that issued the CHI policy.

Federal Law 326 regulates and controls legal relations between citizens and insurance companies. With the help of the 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 of the Russian Federation was adopted The State Duma November 19, 2010, and approved by the Federation Council on November 24, 2010. The last changes in it 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 health insurance(Federal Law on insurance in the Russian Federation), regulation of the provisions, rights and obligations of employees and the population, 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 constituent entities 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 the categories of persons are given, details of the purchase of 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 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;
In the eighth chapter, lists and categories are drawn up with a description of contracts in the field of honey. insurance;
Chapter Nine describes the ways and processes of control over 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 unified record of citizens who have received insurance. Legal relationship between honey. institutions and foundations;
In ch. 11 given 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 free medical care.

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, with the adoption of Federal Law No. 493. 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 with 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, pensioners, 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-numbered peoples of the North and living in the respective 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 insurance category 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;
Change of 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, persons considered to be insured have obligations:

When providing medical assistance by a doctor, show the policy;
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 full name, address or passport data;
Apply for honey. insurance.

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

The text of the new edition 326 FZ

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.

"On compulsory health insurance in the Russian Federation" Federal Law of November 29, 2010 N 313-FZ "On Amendments to Certain Legislative Acts of the Russian Federation in Connection with the Adoption of the Federal Law" On Compulsory Health Insurance in the Russian Federation "* 1

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*one. The texts of the documents are not provided. Texts of all normative documents see the website www.site.

Comment

L.P. Fomicheva
auditor, tax consultant

New Law on Compulsory Health Insurance

Medical insurance in the Russian Federation is provided in two types: compulsory and voluntary.

Compulsory health insurance (MHI) is an integral part of state social insurance and provides all citizens of Russia with equal opportunities to receive medical and pharmaceutical care provided at the expense of compulsory medical insurance funds in the amount and on the terms of the respective programs.

The current Law of the Russian Federation of June 28, 1991 N 1499-1 "On health insurance of citizens in the Russian Federation" was adopted in difficult conditions. The need for its adoption was primarily caused by insufficient budget funding. Russian healthcare... The introduction of insurance made it possible to preserve the system of medical services for the population, prevent a landslide drop in the level of financing of medical institutions and begin a consistent reform of healthcare.

At the same time, many provisions of this Law do not work, since they are declarative in nature, are not supported by the material and technical condition of medical institutions and their funding necessary for their implementation. This led to the development of a new Federal Law adopted by the State Duma on November 19 and approved by the Federation Council on November 24, 2010.

Federal Law of 29.11.2010 N 326-FZ (Further - Law N 326-FZ ) entered into force on January 1, 2011, with the exception of the provisions that come into force on January 1, 2012. The purpose of the law is to strengthen the guarantees of citizens' rights to free medical care and to regulate relations arising in connection with the implementation of compulsory medical insurance.

Law N 326-FZ will allow gradually, during 2012-2014, to increase financing of health care, to ensure a balance of state guarantees for free medical care for the population with financial commitments state, to strengthen the material and technical base of health care and, as a result, to increase the availability and quality of medical care.

Article 4 of Law N 326-FZ the basic principles of compulsory health insurance are established: availability and quality of medical care; guarantees of free provision of medical care to the insured person within the framework of compulsory medical insurance programs, regardless of the financial situation of the insurer; autonomy of the financial system.

Also defined legal status and the powers of the Federal (FFOMS) and territorial (TFOMS) compulsory health insurance funds, medical insurance organizations and medical organizations in the CHI system; their rights, duties and responsibilities; rights and obligations of insured persons and policyholders.

The relations concerning the financial support of compulsory health insurance have been settled: the procedure for the formation of compulsory medical insurance funds has been prescribed; the size of the insurance premium for the compulsory medical insurance of the non-working population; period, procedure and terms of payment of insurance premiums; responsibility for violations in the area of their payment; the procedure for setting tariffs for paying for medical care under compulsory medical insurance; the procedure for the formation and spending of funds by an insurance medical organization.

Generally Law N 326-FZ regulates in sufficient detail the rights and obligations of all subjects and participants of compulsory health insurance, their relationship, provides for the modernization of compulsory health insurance and is aimed at the further development of health care.

Let's consider the main provisions of the Law in more detail.

Insured persons

IN article 10 of Law N 326-FZ it was established that the insured persons are:

- citizens of the Russian Federation (working and non-working);

- foreigners permanently or temporarily residing in our country, and stateless persons (with the exception of highly qualified specialists and their family members in accordance with Federal Law of 25.07.2002 N 115-FZ "On legal status foreign citizens In Russian federation" );

Persons entitled to medical care in accordance with the Federal Law of 19.02.1993 N 4528-1 "On Refugees" .

Actually, these same persons were insured earlier, according to the previous legislation.

Foreigners, incl. citizens of the member states of the Commonwealth of Independent States permanently residing in the Russian Federation had the same rights and obligations in the field of health insurance as Russian citizens, unless otherwise provided by international treaties (Article 8 of Law No. 1499-1). Foreign citizens permanently residing in Russia include persons who have an appropriate permit and residence permit issued by the internal affairs bodies.

Income foreign workers who had a temporary residence permit in Russia were subject to insurance premiums in 2010, so they were also entitled to medical assistance under the compulsory medical insurance policy.

Such workers could receive sick leave certificates in the polyclinic in case of temporary disability. This is confirmed by clause 1 of the Procedure for issuing certificates of incapacity for work by medical organizations, approved. by order of the Ministry of Health and Social Development of Russia dated 01.08.2007 N 514 : sick leave certificates are issued to citizens of Russia, as well as to foreigners with a residence permit or a temporary residence permit.

Foreign workers permanently or temporarily residing in the territory of the Russian Federation are entitled to receive benefits for temporary disability upon the occurrence of a corresponding insured event, if they work under an employment contract ( Art. 2 of the Federal Law of December 29, 2006 N 255-FZ "On compulsory social insurance in case of temporary disability and in connection with motherhood" ).

A refugee and his family members who arrived with him have the right to medical and drug assistance on an equal basis with Russian citizens in accordance with federal law, unless otherwise provided by international treaties of the Russian Federation (sub. 7 clause 1 of Art. 8 of the Federal Law of 19.02.1993 N 4528-1 "On Refugees" ). Required condition- the establishment by the Federal Migration Service of the legal status of a refugee and the issuance of the corresponding "Certificate of a forced migrant".

Foreign citizens temporarily staying in the Russian Federation are not named in the new Law. They enter the territory of Russia according to valid documents and are required to register their foreign passports or documents replacing them with the internal affairs bodies in the prescribed manner and leave our country after a certain period of stay. Temporary resident status implies that a foreign citizen has migration card, a document that only confirms the right of a foreign citizen to be on the territory of Russia (clause 1 of article 2 of Law N 115-FZ). Since 2010, the amounts of payments and other remuneration under labor and civil law contracts in favor of foreign citizens and stateless persons temporarily staying in the territory of the Russian Federation are not subject to insurance premiums ( sub. 15 p. 1 of Art. 9 of the Federal Law of 24.07.2009 N 212-FZ "On insurance contributions to Pension Fund Russian Federation, Social Insurance Fund of the Russian Federation, Federal fund compulsory health insurance and territorial compulsory health insurance funds " ; Further - Law N 212-FZ ). If a foreign citizen has the status of temporarily residing in the territory of Russia, he is not an insured person and, accordingly, insurance contributions for compulsory pension insurance are not charged on payments in his favor. Of Art. 2 of Law N 255-FZ It also follows that foreigners and stateless persons temporarily staying in the territory of Russia, since 2010, are not insured and do not have the right to receive mandatory social insurance coverage.

The law does not provide for the possibility of voluntary payment of insurance premiums by the employer for such citizens. If the company includes in the employment contract concluded with such an employee, the condition of payment to him sick leave and voluntary transfer of contributions, the FSS of Russia will not reimburse these benefits in any case. The letter of the Moscow regional branch of the MHIF dated January 29, 2010 N 04-03-11 / 652 explains: since such persons do not fall under the MHI, employers should not issue them MHI policies. If the policy has already been issued, the document must be returned to the insurance company.

Medical insurance for foreigners temporarily staying in Russia, incl. citizens of the CIS member states, carried out in the manner determined Decree of the Government of the Russian Federation of 11.12.1998 N 1488 "On medical insurance of foreign citizens temporarily staying in the Russian Federation and Russian citizens when leaving the Russian Federation" , which approved the Regulation on medical insurance for foreign citizens temporarily staying in the Russian Federation.

As a rule, such persons have the opportunity to receive free only emergency and emergency medical care for conditions requiring urgent medical intervention (in case of accidents, injuries, poisoning and acute diseases). In this case, medical care is provided to them at the expense of budgets of all levels by medical and preventive institutions of the state and municipal systems health care workers, as well as by medical professionals or persons obliged to provide first aid by law or special rule. From the moment when the threat to the patient's life or the health of others is eliminated and the patient can be transported, the payment for the provided medical care is charged as planned.

Routine medical care of all types can be provided to citizens of this category only on the basis of voluntary health insurance or on a paid basis.

Unified insurance policy for all territories of Russia

One of the big disadvantages the existing system is the inability to receive medical care under the compulsory medical insurance policy, while in another region. Currently, the compulsory medical insurance policy is not the same for all regions of Russia. Each insurance company printed its own policies for its insured, which needed to be changed as it expired. When changing the place of work, a person was obliged to hand over the OMS policy to the employer and get a new one where he was employed. This took time, during which the employee, with whom wages contributions to the MHIF were paid, in fact, he had no opportunity to receive medical assistance. And when moving to the category of non-working, he had to get a policy from an insurance medical organization, which, according to the results of a competition, insured non-working citizens.

Formally, a citizen can still receive medical care under the compulsory medical insurance policy outside the place of registration. But hospitals and clinics most often, in violation of the current law, refuse to admit nonresident citizens and citizens living in another area of the city. This happens for several reasons: firstly, there is no single base of insured persons, according to which it would be possible to determine where the money for the patient will come from, and whether it will come. Secondly, in large regions, such as Moscow or St. Petersburg, the compulsory medical insurance program is much more expensive than in the country as a whole, hence the reluctance to accept "other people's" patients. In this regard, medical institutions often refuse to take into account the policies issued in other regions and try to treat nonresident only for money.

Law N 326-FZ provides for the development of basic and territorial CHI programs ( Art. 3 of Law N 326-FZ ). In chapter 7 The law specifies what types of assistance are included in each of them. Since 2013, emergency medical care has been included in the basic compulsory medical insurance program, and high-tech - since 2015 ( Art. 51 of Law N 326-FZ ). Programs are approved at the federal and regional levels, respectively. The basic program operates throughout the territory of Russia, and the territorial one - within the limits of the constituent entity of the Russian Federation. Subjects will have the right to add types of medical care to the basic program and insured events that are not included in the CHI, and finance them additionally.

For the realization throughout the territory of the Russian Federation of the rights of citizens to receive free medical care Law N 326-FZ the following is stipulated: starting from May 2011, citizens will be issued compulsory medical insurance policies uniform sample guaranteeing the receipt of free medical care under the basic compulsory medical insurance program in any region of the country, regardless of the place of residence of the insured (Article 45). On the territory of the constituent entity of the Russian Federation, where the compulsory medical insurance policy was issued, citizens can count on assistance in the amount of the territorial compulsory medical insurance program (Article 3). The policy may not be presented if emergency medical assistance is required (clause 2, article 16).

Replacement of issued and valid regional compulsory medical insurance policies for policies of a single sample will be made not suddenly, but gradually (Article 51).

Until May 1, 2011, if necessary, old-style policies will be issued in the same manner, and from May 1, 2011 to January 1, 2012 - new policies of the same standard. The electronic policy will be valid throughout Russia. Outwardly, "substitutes" for the usual paper documents resemble plastic cards with a chip and represent an electronic card of a single sample. This policy is designed for machine reading of patient information.

The new perpetual policy will be valid even if the person did not manage to get insured with the insurance company. It will serve as a guarantor of medical care in any region of the country, regardless of place of residence, and will be issued to everyone - both working citizens and the unemployed. Replacement of the policy is assumed only due to its loss or wear, change of the surname, name, patronymic of the insured. When changing an insurance medical organization, place of residence, status of the insured, replacement is not provided.

Polices Compulsory medical insurance of the old sample issued to persons insured under compulsory health insurance prior to entry into force Law N 326-FZ , are valid until they are replaced with compulsory medical insurance policies of a single sample or universal electronic cards of a citizen of the Russian Federation. All medical institutions after January 1, 2011 are obliged to admit patients under the old policies.

Policies must be replaced if a person wants to change insurance organization, either will expire, or in the event of a change of residence. In order not to have problems with the provision of medical care, all citizens insured in the CHI system should look into the document and inquire about the expiration date of its validity. The complete replacement of old-style "paper" policies with electronic cards should be completed by January 1, 2014.

From January 1, 2012, the compulsory medical insurance policy will be included in the composition of the universal electronic citizen card in accordance with Federal Law of 27.07.2010 N 210-FZ "On the organization of the provision of state and municipal services" ( Art. 45 of Law N 326-FZ ).

Moscow will switch to a universal electronic card during 2011. It will begin to replace the compulsory health insurance policy and certificate for Muscovites. pension insurance... In addition, with the help of this card it will be possible to pay for travel in public transport and exercise their right to receive most public services. The new electronic document will retain all the possibilities that it provides today social card Muscovite.

In 2014, a single universal "three-in-one" card will start operating in Russia, including a medical policy, a pension insurance policy, and information on benefits due to a person.

Of course, new policies will allow citizens to receive help needed on vacation or on a business trip. At the same time, for the introduction in Russia of a single electronic policy a new sample requires special preparation: special equipment for the production of the document, and so that hospitals and clinics could "read" it.

For the first time, a strict norm is established by law on the timing of payments for medical care provided to patients. Medical institutions now have a guarantee of payment for assistance provided to a nonresident citizen, and now they will be interested in providing it.

In the event of a delay in payment, an insurance medical organization, at its own expense, pays to a medical organization a penalty in the amount of 1/300 of the refinancing rate of the Central Bank of the Russian Federation, in effect on the day of the delay, from the amounts not listed for each day ( clause 7 of Art. 39 of Law N 326-FZ ).

Apart from a single medical policy the possibility of replacing the usual paper stories diseases to electronic. For reception nonresident citizens the doctor needs a history of his illness. After all, this person was not observed in the clinic, and most often he does not carry a medical history with him. If to a single policy automatically attached medical history, would be great. Better yet, have your own treatment card online, in in electronic format... This is important, especially for those who often travel on business trips, travel. In this case, a doctor from any clinic in the country will be able to obtain all the information about the state of human health. At the same time, the diagnostic time is reduced, which, in some diseases, can save lives.

At the same time, in some European countries using electronic maps in the global network is prohibited, because no reliable data protection. In addition, information posted on the Internet may become available not only to a doctor. And violation of confidentiality threatens to turn into a lawsuit against a medical institution.

Personalized medical records

The lack of a unified database of insured persons leads to the fact that the number of insured under compulsory medical insurance exceeds the number of Russian citizens.

In order to implement the rights of citizens to receive free medical care throughout the territory of the Russian Federation, it is planned to create a unified information space, including all subjects and participants of compulsory medical insurance, and to introduce a personalized record of information about insured persons and the assistance provided to them ( ch. 10 of Law N 326-FZ ).

From January 1, 2011, the creation of a unified database will begin, which will allow citizens to receive medical care in any region of Russia. The electronic database of the insured will be created as they seek medical help, as well as replace old policies with new ones.

A single database will ensure reliability and eliminate duplication of information about the insured. Within two years, the bulk of the insured will be included in this electronic database.

Ideally, thanks to the creation of a single information base, everyone will be able to make an appointment with a doctor without leaving home - from their home computer via the Internet.

Law N 326-FZ established the procedure for the implementation of personalized (individual) accounting in the CHI system, as well as procedures for interaction between medical, insurance medical organizations and the territorial fund in the system of personalized accounting of information about medical care provided to the insured person.

Determines the procedure for maintaining personalized accounting in the field of compulsory health insurance FFOMS ( Art. 7 of Law N 326-FZ ).

Article 16 of Law N 326-FZ establishes that insured persons have the right to the protection of personal data necessary for maintaining personalized records in the field of compulsory health insurance.

In articles 47and 48The Law establishes the procedure for interaction between medical insurance and medical organizations with the TFOMI when maintaining personalized records of information about medical care provided to insured persons, in Art. 49- the procedure for interaction of the territorial body of the PFR with the TFOMS and insurers for non-working citizens.

In pursuance of this Law, Federal Law of 29.11.2010 N 313-FZ (Further - Law N 313-FZ ), making the appropriate changes to the personified (individual) accounting. We'll look at it separately.

The choice of an insurance company, clinic and doctor is up to the patient

The role of the insurance organization is somewhat different compared to the current system. Now the choice of the insurance organization remains with the insured, i.e. the employer for whom the person works, since he pays insurance premiums for the employee. Regional authorities provide insurance for unemployed people. As a result, it turns out that insurance companies have no motivation to fight for consumers of services.

According to Art. 16 of Law N 326-FZ a citizen gets the right to independently choose an insurance medical organization dealing with compulsory medical insurance. At the same time, the right to this of the employer and municipal authorities is excluded.

The choice can be made by a citizen who has reached the age of majority. From the day of birth to the day of registration of their birth, children are insured by organizations where their mothers or legal representatives are insured. After the child is registered and until the age of majority, he is insured by the insurers chosen by one of the parents or their legal representative.

If a person does not choose a company or does not submit an application to change it, it is considered that he is insured in the organization where the insurance was carried out earlier. The only exception is a change of residence. In this case, within a month, the citizen is obliged to choose a new organization in the absence of the previous insurer on this territory. A person must notify the insurer about a change of residence, surname, name, patronymic within a month.

If citizens have not chosen an insurer, the TFOMS sends information about them to insurers on a monthly basis until the 10th day. The division of the number of citizens between insurance companies is made in proportion to the number of insured persons in each of them, and the ratio of working and non-working citizens who have not applied to an insurance medical organization, which is reflected in this information, should be equal. Insurers who have received such information from TFOMS send a letter to the citizen. It confirms the fact of insurance in this organization and informs about the need to obtain an OMI policy.

The insured person will have the right to replace the chosen medical insurance organization with another one. Medical insurance organizations have no right to refuse such a choice.

However, one should not hope that the number of medical services depends on the choice - they will be the same in all companies. Everything Insurance companies will have contracts with all clinics of the compulsory medical insurance system. Insurance companies will perform intermediary functions, act as advocates for patients, defend their rights, organize independent expertise services rendered by physicians. Experts do not predict a massive transition from one company to another. Most likely, the majority will remain in companies where they are already insured.

As a rule, the desire to change the insurance company arises at critical moments when the patient realizes that in a difficult situation assistance was not provided in full, and the company was unable to protect his rights, i.e. has not fulfilled its basic obligations. The replacement of an insurance medical organization, where a citizen was previously insured, can be carried out once during a calendar year, but no later than November 1. More often - in case 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 with which he would like to cooperate. On the basis of this application, an OMI policy is issued to the insured person or his representative by the medical insurance organization.

Insurance organizations working with CHI will be tightly controlled. They are required to be stable in their activity. For this, the new Law prescribes an increase in authorized capital such companies doubled - from 30 to 60 million rubles. Insurance medical organizations are not entitled to carry out other activities, except for compulsory and voluntary medical insurance ( Art. 14 of Law N 326-FZ ).

Today medical institutions in most cases, they are supported by budgets of various levels. At the same time, they receive money regardless of how many patients were admitted and cured. And even more so regardless of the quality of the treatment.

The new Law changes this situation - the money will go after the patient, i.e. the service provided is financed, not the institution.

From the list of medical institutions working in the compulsory medical insurance system, citizens will be able to choose the hospital where they would like to receive help. Their list is available on the official websites of the territorial CHI funds. At the same time, a medical institution included in the register and having entered into an agreement for the provision of services under the compulsory medical insurance program has no right to refuse to provide assistance to the insured person.

Upon written application, the patient can choose the attending physician in accordance with the legislation of the Russian Federation (after all, the territorial principle of medical care, for example, the new Law does not cancel). True, there is one caveat - with the consent of the doctor. If a person lives in one area of the city, and wants to be treated by a doctor working in another area, you need to ask his consent - is he ready to go to the call across the city. Therefore, a doctor's home call will need to be made in the clinic serving the patient's territory. The right to choose a hospital becomes legal. The polyclinic doctor who is prescribing the referral will now have to listen to our wishes.

Another requirement of the new Law is that now all medical institutions must have their own sites on the Internet with detailed information.

If we assume that patients still get a real right to choose a clinic and a doctor, medical institutions will find themselves in a highly competitive environment. After all, the more patients, the more money the insurance company will pay the hospital.

The right to choose a doctor and a medical institution has long been enshrined in the Federal Laws "On the Protection of Citizens' Health" and "On Medical Insurance of Citizens in the Russian Federation", but in fact this does not happen. Most of the townspeople are treated according to the territorial principle: in the municipal clinic at the place of residence. And we are not talking about any choice of a medical institution, and even more so a doctor. Here it is appropriate to recall the birth certificates, which also gave expectant mothers the right to seek help from any maternity hospital that has free places. However, in reality, the promises turned out to be empty. Will the same situation be repeated now?

Fundamental innovation Law N 326-FZ is to provide medical services in the MLA can not only state (municipal) medical institutions, but also organizations of any organizational and legal form, as well as individual entrepreneurs engaged in private medical practice ( Art. 15 of Law N 326-FZ ). The main thing is that they have the right (license) to carry out medical activities, they must be included in a special register of medical organizations and keep separate records for operations with compulsory medical insurance funds and other operations. The register of such organizations is maintained by the TFOMS and published on the Internet or in any other way. The register contains the name, address of medical organizations and the list of services provided by them within the framework of the territorial compulsory medical insurance program. The procedure for maintaining, the form and the list of register information are established by the rules of compulsory medical insurance.

Previously, "private traders" also worked with the local self-government bodies, but received special permission from the city administration for certain services. Now private clinics can simply register to join the system.

But here a reasonable question arises: will private clinics be interested in the scanty money that the MHIF departments pay for each citizen under the policy? Recall: the annual per capita standard for the state program for the provision of free medical care is 4059 rubles. 60 kopecks Nobody is going to revise it yet.

The tariffs for the compulsory medical insurance system are significantly lower than in private clinics, and it is prohibited by law to make a "discount" from the policy to patients. According to insurers, this is done to protect us from manipulation of consciousness. You should not expect that a person from the street can come with a policy and receive treatment. These clinics will be given a referral for a certain service under the state order. For example, the clinic will receive a government order for dental prosthetics for veterans. Then the pensioner will receive a referral to this clinic. The same will happen with complex operations or technologies. OMS policy may be used by private clinics, but in complex treatment, where some of the services will be free, and some will be for decent money.

The Law more clearly spelled out the rights of medical insurance organizations to control the provision of medical care. Protection of the rights of the insured should become the basis in relations with consumers and include such parameters as the selection of a medical organization to provide care, management of its client at all stages of its provision and control over how it was provided. If a person comes with a policy to the hospital, and they begin to demand money from him for the services they are entitled to for free, he must first call his insurance company with the requirement to understand the situation. And the insurance company becomes a "lawyer" defending his rights. This is not bringing to court, but proceeding at the earliest stage of the conflict.

Article 16 of Law N 326-FZ gives patients the right to compensation for damage caused by medical insurance or medical organizations in connection with non-fulfillment or improper fulfillment of their obligations to provide medical care. Article 31 of Law N 326-FZ the procedure for such compensation has been determined in a situation where the damage is not related to a serious industrial accident that has occurred. If the latter took place, you should contact Art. 32 of the Law , which found that after a serious injury at work should be treated at the expense of funds received by the FFOMS in accordance with Federal Law of 24.07.1998 N 125-FZ "On compulsory social insurance against industrial accidents and occupational diseases" (Further - Law N 125-FZ ).

Unfortunately, our state is practically not engaged in educational activities in the field of patients' rights. We have almost no lawyers dealing with jurisprudence on medical topics. In addition, there must be an institution of independent medical experts who cannot be influenced by the medical community. After all, this is the only way to give an independent opinion on the quality and correctness of treatment. So far, no one talks about such things, but for the correct receipt medical services we need to have information on hand to challenge doctors' misconduct and prosecute those responsible. And for this you need to have a really working judicial mechanism, which, alas, does not exist today.

Chapter 9 of Law N 326-FZ a system of examinations of the quality of medical care is established - the identification of violations in the provision of medical care, incl. assessment of the correctness of the choice of medical technology, the degree of achievement of the planned result and the establishment of cause-and-effect relationships of the identified defects in the provision of medical care. It is indicated who can act as an expert. It was established that a medical organization does not have the right to prevent experts from accessing the materials necessary for conducting a medical and economic examination, examination of the quality of medical care, and is obliged to provide experts with the requested information. The results of the examination are formalized by the relevant acts in the forms established by the FFOMS.

Based on the results of monitoring the volumes, terms, quality and conditions for the provision of medical care, the measures provided for Art. 41 of Law N 326-FZ and the terms of the contract for the provision and payment of medical care under compulsory medical insurance. In addition to non-payment for poor-quality care, the medical organization will compensate the harm caused to the patient through its fault.

Financial security

The management structure of the CHI system is changing. The FFOMS is recognized as the insurer within the framework of the implementation of the basic CHI program; from 2012, all medical contributions will be transferred to it. This is a non-profit organization created by the Russian Federation to implement public policy in compulsory health insurance ( Art. 12 of Law N 326-FZ ).

Chapter 5 of Law N 326-FZ the issues of financial support of compulsory medical insurance were settled (including the procedure for the formation of compulsory medical insurance funds); the procedure and terms for payment of insurance premiums have been determined; liability for violations in the area of their payment has been established; the procedure for calculating tariffs for paying for medical care under compulsory medical insurance has been determined.

Compulsory medical insurance funds are formed at the expense of:

Income from payment of insurance premiums for compulsory medical insurance;

- arrears on contributions, tax payments;

- accrued interest and fines;

- funds federal budget transferred to the FFOMS budget in cases established by federal laws, in terms of compensation for lost income in connection with the establishment of reduced rates of insurance premiums for compulsory medical insurance; funds from the budgets of the constituent entities of the Russian Federation transferred to the budgets of the TFOMS in accordance with federal and regional legislation;

- income from the placement of temporarily free funds;

- other sources stipulated by Russian legislation ( Art. 21 , 26and 27 of Law N 326-FZ ).

The procedure and conditions for the placement of temporarily free funds of the Federal and territorial CHI funds are established by the Government of the Russian Federation ( Art. 29 of Law N 326-FZ ).

For the first time in the Law, a norm appeared indicating that the funds of the CHI fund can be used not only in Russia, but also in medical institutions of foreign countries, but there is no specific information about what kind of medical institutions these will be.

Separate powers of the insurer will be exercised by TFOMI and medical insurance organizations ( Art. 13 and 14 of Law N 326-FZ ).

The legal status of FFOMS and TFOMS is defined in ch. 6 of Law N 326-FZ ... It is envisaged to strengthen the role of TFOMI as a controlling organization. Within the framework of his powers, he will conduct inspections of the intended use of compulsory medical insurance funds not only in insurance medical companies but also in medical organizations, as well as, regardless of the insurer, carry out all types of medical examinations of cases of treatment of insured citizens ( Art. 40 of Law N 326-FZ ). TFOMS is controlled and subordinated to FFOMS.

The Ministry of Health and Social Development of Russia has already developed a draft standard provision on TFOMS, a draft departmental order of December 6, 2010 on its approval is presented on the official website of the ministry. According to the TFOMI document is non-profit organization, created by a constituent entity of the Russian Federation for the implementation of state policy in the field of compulsory health insurance in the region. The document approves the main tasks, functions and means of TFOMI, as well as the procedure for control over their activities and the mechanism for their liquidation.

Organizations, individual entrepreneurs and individuals not recognized by individual entrepreneurs ( clause 1 of Art. 11 of Law N 326-FZ ). A separate group includes individual entrepreneurs, private notaries and lawyers. The insured is registered with the territorial bodies of the Pension Fund of the Russian Federation. The specifics of registering certain categories of policyholders and paying them insurance premiums for compulsory medical insurance from January 1, 2012 are established by the Government of the Russian Federation. Policyholders are payers of compulsory health insurance contributions in accordance with Law N 212-FZ ( Art. 22 of Law N 326-FZ ).

Territorial FIU authorities provide information on the payment of insurance premiums for the compulsory health insurance of the working population in the TFOMI in the manner determined by the agreement on information exchange between the PFR and the FFOMS.

The insurers for non-working citizens are the executive authorities of the constituent entity of the Russian Federation ( clause 2 of Art. 11 of Law N 326-FZ ). Now the regional authorities transfer money for them to the MHIF according to the leftover principle, as much as possible. This leads to an imbalance in the compulsory medical insurance system and, accordingly, to an inadequacy of the standards of medical care required for Russian citizens.

For the first time Art. 23 and 24 of Law N 326-FZ a phased transition to a fixed payment for the non-working population was established. This payment will be the same for all regions of the Russian Federation due to the fact that it is the same insurance premium as the employer's payments in the compulsory medical insurance system. Article 25 of this Law, liability is established for non-payment of these contributions.

In 2011, payments to the non-working population are rigidly fixed at the 2010 level. From 2012, a single one for the whole country will be established OMS tariff to the non-working population. The law on establishing payments to the compulsory health insurance system for the non-working population is planned to be adopted in the first half of 2011.

Medical rates will become the same for all insurance medical organizations that pay for medical care provided in one medical organization.

The tariff for the payment of medical care is established by an agreement between the authorized regional body, the TFOMI, representatives of medical and insurance organizations, professional medical associations, trade unions of medical workers ( Art. 30 of Law N 326-FZ ).

The provisions defining the legal status, the peculiarities of the formation and expenditure of funds of insurance medical organizations have been clarified. Such funds are divided into targeted and own ( Art. 14 of Law N 326-FZ ).

Medical insurance organizations keep separate records of their own funds and compulsory medical insurance funds intended to pay for medical care. Earmarked funds cannot pass into the ownership of an insurance organization ( Art. 28 of Law N 326-FZ ), with the exception of cases stipulated by this Law.

System of contracts

A citizen receives free medical care under compulsory medical insurance on the basis of an agreement concluded in his favor by participants in this form of service.

A medical organization provides compulsory medical insurance services on the basis of an agreement for the provision and payment of medical care, concluded with an insurance organization. A medical organization has no right to refuse to provide medical assistance to insured persons in accordance with the territorial compulsory medical insurance program ( Clause 5, Art. 15 of Law N 326-FZ ).

An insurance medical organization directs a medical organization targeted funds to pay for medical care under such contracts ( clause 2 of Art. 28 of Law N 326-FZ ). She receives these funds from TFOMI. Funds are sent to the medical organization initially in advance, the unused earmarked funds must be returned by the medical organization to the insurer, and then to the TFOMI. Responsibility for misappropriation of funds has been established.

IN Chapter 8 of Law N 326-FZ the system of contracts in compulsory medical insurance and the mechanism for organizing control of the volumes, terms, quality and conditions of providing medical care to insured persons have been defined in detail.

In the standard forms of contracts approved by the Ministry of Health and social development RF, these rights and obligations will be specified, and penalties are provided for each violation of the terms of the agreement.

Modernization of healthcare

Since 2011, contributions to the FFOMS will grow by 2%. The money, as you know, will be used to modernize healthcare. Regional modernization programs provide for an increase in the availability of outpatient care, within the framework of which the salaries of specialist doctors working in polyclinics should be increased. The situation is similar with doctors in hospitals.

Chapter 11 "Final Provisions" of Law N 326-FZ it was determined: in order to improve the quality and availability of medical care provided to the insured, during 2011-2012, regional programs for the modernization of healthcare of the constituent entities of the Russian Federation and programs for the modernization of federal government agencies providing medical care, the norms, rules are prescribed transition period for 2011-2012.

Of course, a one-step transition "to new rails" is, in principle, impossible. Currently, the MHIF, insurance companies, and medical institutions are studying Law N 326-FZ ... Until the financial flows have been debugged, the necessary programs have not been prepared, and an algorithm of actions has not been formed. Everything takes time.

Time will tell whether the working citizen, for whom the FFOMS receives contributions, will become the central figure in healthcare. In the meantime, our health care system is geared more towards retirees rather than working citizens. In other words, the most services are received by those who can spend a lot of time queuing in front of the doctor's office.

And we all are not even interested in how our money comes to compulsory medical insurance system how and on what they are spent there, what are the costs of administrative staff, maintenance of buildings, all kinds of trips, participation of doctors in conferences, etc. But this is all inappropriate spending. As consumers of this service, as citizens, we do not know anything about it, but we pay.

Changes in legislation in connection with the adoption of the Law on CHI

Law N 313-FZ changes some legislative acts in particular in RF Tax Code , Federal Laws N 212-FZ, "On the organization of insurance business in the Russian Federation" , " On individual (personified) accounting in the compulsory pension insurance system ", " About the circulation of medicines ", RF Budget Code , RF Code of Administrative Offenses .

Let's briefly consider the main changes affecting the activities of organizations and entrepreneurs.

In the Law N 212-FZ the mention of TFOMS is excluded

Insofar as Law N 326-FZ since 2012, a single insurer has been established - FFOMS, the mention of territorial CHI funds from January 1, 2012 will be excluded from the title and a number of articles Law N 212-FZ ... For example, in Art. 58 and 58.1 of this Law from the text of tables with a breakdown of insurance rates by extrabudgetary funds the reference to TFOMI will be excluded. Earlier it was established that from 2012 contributions to this fund should be paid at a rate of 0%. Now it has been established that the territories will receive transfers from the FFOMS to finance the powers transferred to the regions in the field of compulsory medical insurance.

IN RF Tax Code prescriptions for benefits for insurers and doctors

IN Tax Code of the Russian Federation amendments are being made to clarify the list of benefits in relation to the amounts paid in the compulsory health insurance system.

First, according to sub. 7 p. 3 art. 149 of the Tax Code of the Russian Federation not subject to VAT for insurance, coinsurance and reinsurance services provided by insurance companies. From January 1, 2012, medical insurance organizations - OMS participants do not pay VAT when receiving funds from TFOMI, if these funds:

- are targeted and are listed on the basis of an agreement on the financial support of compulsory medical insurance;

- are intended for conducting a case under compulsory medical insurance;

- are remuneration for the performance of actions stipulated by the contract on the financial support of the compulsory medical insurance.

The same funds are not taken into account in income when determining the base for income tax (new sub. 14 p. 1 of Art. 251 of the Tax Code of the Russian Federation ). Accordingly, from this date sub. 30 p. 1 of Art. 251 of the Tax Code of the Russian Federation loses its force, and therefore in Clause 48.1 of Art. 270 The Code also clarified the list of costs that are not taken into account when calculating income tax.

The expenses will not include funds transferred to medical organizations to pay for medical care to insured persons in accordance with the contract for the provision and payment of medical care.

Article 294.1 of the Tax Code of the Russian Federation , which establishes the specifics of determining the income and expenses of medical insurance organizations, is set forth in a new edition.

Now the funds received from the TFOMI will be accounted for in income if they are intended for conducting a case under the CHI or are remuneration under an agreement on financial support for the CHI.

Changes in personalized accounting

Law N 313-FZ changes were made to Federal Law of 01.04.1996 N 27-FZ "On individual (personified) accounting in the compulsory pension insurance system" (Further - Law N 27-FZ ). The preamble of the Law is supplemented with the following provision: personalized registration under this Law also applies to persons entitled to receive state social assistance, to additional measures state support in accordance with Federal Law of December 29, 2006 N 256-FZ "On additional measures of state support for families with children" ... This record will be kept for the purposes of compulsory medical insurance by the Pension Fund of the Russian Federation. The FIU will be obliged to submit to the FFOMS information about the working insured persons in the system of individual (personified) accounting required for compulsory health insurance. The procedure for such an exchange of information will be established by an agreement between the FIU and FFOMS ( Art. 16 of Law N 326-FZ ).

Clarifications and in paragraph 1 of Art. 8 of Law N 27-FZ .

It is indicated that documents in electronic form containing information about insured persons sent by the insured to the Pension Fund of the Russian Federation must be certified with an electronic digital signature in accordance with Federal Law of 10.01.2002 N 1-FZ "On Electronic Digital Signature" .

Changes in the situation of insurance companies

In particular, from January 1, 2012, the requirements for minimum size of the authorized capital of an insurer that carries out exclusively medical insurance (changes in clause 3 of Art. 25 of the Law "On the organization of insurance business in the Russian Federation" ).

In accordance with the new edition clause 2 of Art. 18 of Law N 125-FZ the insurer will be obliged to send to the TFOMS information about the decision to pay the costs of treatment of the insured immediately after the serious accident at work, at the expense of compulsory social insurance against accidents at work and occupational diseases. The form and procedure for sending such information must be approved by the insurer in agreement with the FFOMS.

Other innovations

The procedure and conditions for the provision of interbudgetary transfers and subventions from FFOMS budget territorial funds OMC in accordance with Law N 326-FZ (changes made to RF Budget Code ).

IN Federal Law of 12.04.2010 N 61-FZ "On the Circulation of Medicines" numerous changes are made.

For example, in Art. 44 of this Law, it is established that an organization that has received permission to conduct a clinical trial of a medicinal product for medical use is obliged to insure the risk of harm to the life and health of the patient by concluding an agreement compulsory insurance... Patient participation in such a study in the absence of a compulsory insurance contract is not allowed. The procedure for exercising the rights and obligations of the parties under the compulsory insurance contract is established by standard rules.

Besides, in Art. 71 of Law N 313-FZ specified:

- requirements for the information provided by the applicants about medical organizations in which clinical trials of a medicinal product for medical use are supposed to be carried out, and about the quality drugs;

- requirements for the procedure and conditions of life and health insurance of patients participating in a clinical trial of a medicinal product;

- mechanisms allowing to carry out procedures for examination and registration of medicinal products on the basis of documents submitted for registration before September 1, 2010;

- conditions for the circulation of medicinal products in packaging with markings applied in accordance with the requirements in force before September 1, 2010.