Compulsory Health Insurance Fund. Features of the activity and structure of the compulsory health insurance fund Characteristics of the compulsory health insurance fund of the Russian Federation

According to the Law Russian Federation "On health insurance of citizens in the Russian Federation" dated 28.06.91 No. 1499-1 (as amended on 29.05.2002 No. 57-FZ), federal and territorial compulsory health insurance funds have been created. Legal base the functioning of these funds are the Charter of the Federal Fund of Compulsory Medical Insurance, approved by the Decree of the Government of the Russian Federation of July 29, 1998 No. 857 and the Regulation on the territorial fund of compulsory health insuranceapproved by the Resolution of the RF Armed Forces dated 24.02.93 No. 4543-1 (as amended on 24.03.2001 No. 33-FZ).
Activities of the named funds directed for the implementation of state policy in the field of compulsory health insurance of citizens as an integral part of state social insurance... The federal fund is created by the Government of the Russian Federation, and the territorial funds are formed, respectively, by the representative executive authorities of the republics within the Russian Federation and other subjects of the federation.

The main sources education federal and territorial funds are insurance premiums of business entities for compulsory health insurance, budget allocations and other receipts. Received facilities are sent on financing of compulsory health insurance and other related activities. The budget of the Federal Mandatory Medical Insurance Fund and the report on its implementation are reviewed by the State Duma annually.
Medical insurance is provided in the form of the contract concluded between the subjects of health insurance. Contract medical insurance is an agreement between the insured and an insurance medical organization, in accordance with which the latter undertakes to organize and finance the provision of medical care to the insured contingent of a certain volume and quality or other services under the program of compulsory medical insurance and voluntary medical insurance (Article 4 of the Law of the Russian Federation "On Medical Insurance citizens in the Russian Federation ").
Health insurance contract considered prisoners from the moment of payment of the first insurance premiumunless otherwise provided by the terms of the contract (ibid.).
Insurance contributions are established as the rates of payments for compulsory health insurance in amounts that ensure the implementation of health insurance programs and the activities of an insurance medical organization.
Insurance medical organizations are legal entities that carry out health insurance and have permission from a state body (that is, licenses) to engage in such activities.
Medical institutions in the health insurance system are licensed medical and preventive institutions, research and medical institutes, other institutions providing medical care, as well as persons engaged in medical activities, both individually and collectively.
Insurance medical organization endowed with a set of rights and obligations. Insurance medical organization it has right:

is free to choose medical institutions for the provision of medical care and services under health insurance contracts;
establish the amount of insurance premiums for voluntary health insurance;
take part in determining tariffs for medical services; at
to bring a claim in court to a medical institution or a medical worker for material compensation for physical and moral damage caused to the insured through their fault.
Insurance medical organization obliged:
conclude contracts with medical institutions for the provision of medical assistance to the insured under compulsory health insurance

The purpose of health insurance is to guarantee citizens when there is insured event receiving medical care from the accumulated funds and financing preventive measures.

Medical insurance is carried out in two types: compulsory and voluntary.

Compulsory health insurance is an integral part of state social insurance and provides all citizens of the Russian Federation with equal opportunities to receive medical and drug assistance provided at the expense of compulsory health insurance in the amount and on terms corresponding to compulsory health insurance programs. (question 30)

Voluntary medical insurance is carried out on the basis of voluntary medical insurance programs and provides citizens with additional medical and other services in excess of those established by compulsory medical insurance programs. Voluntary health insurance can be collective and individual. (Question 31)

The subjects of health insurance are: a citizen, an insured, an insurance medical organization, a medical institution.

The insurers for compulsory medical insurance are: for the non-working population - the governments of the republics within the Russian Federation, government bodies of the autonomous region, autonomous okrugs, territories, regions, cities of Moscow and St. Petersburg, local administration; for the working population - enterprises, institutions, organizations, persons engaged in self-employment, and persons of free professions.

The insurers for voluntary health insurance are individual citizens with civil legal capacity, and / or enterprises representing the interests of citizens.

Medical insurance organizations are legal entities that provide health insurance and have a state permit (license) for the right to engage in health insurance.

Medical institutions in the health insurance system are licensed medical and preventive institutions, scientific research and medical institutes, other institutions providing medical care, as well as persons carrying out medical activities, both individually and collectively.

The object of voluntary medical insurance is the insurance risk associated with the costs of providing medical care in the event of an insured event.

Health insurance is carried out in the form of an agreement concluded between the subjects of health insurance. Subjects of medical insurance fulfill obligations under the concluded agreement in accordance with the legislation of the Russian Federation.

Every citizen in respect of whom a health insurance contract has been concluded or who has entered into such an agreement independently receives insurance medical policy... The medical insurance policy is in the hands of the insured.

Medical insurance organizations are legal entities that are independent economic entities, with any forms of ownership stipulated by the legislation of the Russian Federation, possessing the statutory fund necessary for medical insurance and organizing their activities in accordance with the legislation in force in the territory of the Russian Federation.

Health insurance activities in Russia are subject to licensing. A state license for the right to engage in health insurance is issued by bodies supervising insurance activities in accordance with the legislation in force in the territory of the Russian Federation.

Insurance premiums are established as payment rates for compulsory health insurance in amounts that ensure the implementation of health insurance programs and the activities of an insurance medical organization, and are established by the legislation of the Russian Federation and the subjects of the Federation.

Voluntary health insurance is carried out at the expense of the profit (income) of enterprises and personal funds of citizens by concluding an agreement. The amount of insurance premiums for voluntary medical insurance is established by agreement of the parties.

Public organizations of persons with disabilities, enterprises, associations and institutions, which are owned by these organizations, and created for the implementation of their statutory goals, are exempted from paying contributions for compulsory health insurance.

In accordance with the Law of the Russian Federation "On Health Insurance of Citizens in the Russian Federation", federal and territorial compulsory health insurance funds have been created, legal framework functioning of which are the corresponding Regulations approved by the Resolutions of the Supreme Soviet of the Russian Federation of February 24, 1993 (as amended on August 5, 2000).

The activities of these funds are aimed at implementing the state policy in the field of compulsory health insurance of citizens as an integral part of state social insurance. The federal fund is created by the Government of the Russian Federation, and the territorial funds are formed, respectively, by the representative executive authorities of the republics within the Russian Federation and other subjects of the federation.

Main sources of education federal and territorial funds are insurance premiums of business entities for compulsory health insurance, budget allocations and other receipts. The funds received are used to finance compulsory health insurance and other related activities. Budget Federal Fund compulsory health insurance and a report on its implementation are reviewed annually The State Duma.

Medical insurance is carried out in the form of an agreement concluded between the subjects of medical insurance. Health insurance contract is an agreement between the insured and an insurance medical organization, in accordance with which the latter undertakes to organize and finance the provision of medical care to the insured contingent of a certain volume and quality or other services under the program of compulsory medical insurance and voluntary medical insurance (Article 4 of the Law of the Russian Federation "On health insurance of citizens in the Russian Federation").

Health insurance contract considered a prisoner from the moment of payment of the first insurance premium, unless otherwise provided by the terms of the contract (ibid.).

Insurance premiums are established as the rates of payments for compulsory health insurance in amounts that ensure the implementation of health insurance programs and the activities of an insurance medical organization.

Insurance medical organizations are legal entities that carry out health insurance and have permission from a state body (that is, licenses) to engage in such activities.

Medical institutions in the health insurance system are licensed medical and preventive institutions, research and medical institutes, other institutions providing medical care, as well as persons engaged in medical activities, both individually and collectively.

Medical insurance organizations are endowed with a set of rights and obligations. Medical insurance organization has the right to:

Freely choose medical institutions for the provision of medical care and services under health insurance contracts;

Establish the amount of insurance premiums for voluntary health insurance;

Participate in determining tariffs for medical services;

Submit a claim in court to a medical institution or a medical worker for material compensation for physical and moral damage caused to the insured through their fault.

In accordance with the Law of the Russian Federation "On medical insurance of citizens in the Russian Federation" dated June 28, 1991, the following were created: federal and territorial compulsory medical insurance funds, legal framework functioning of which are the relevant Regulations approved by the Resolutions of the Supreme Soviet of the Russian Federation of February 24, 1993.

The Federal Fund is an independent state non-profit financial and credit institution, recognized legal entity, carries out its activities in accordance with the legislation of the Russian Federation and the Regulations on the Federal Fund of Compulsory Medical Insurance.

Main sources of educationfederal and territorial funds are insurance premiums of business entities for compulsory health insurance, budget allocations and other receipts. The funds received are used to finance compulsory health insurance and other related activities. The budget of the Federal Mandatory Medical Insurance Fund and the report on its implementation are reviewed by the State Duma annually.

Health insurance is carried out in the form of an agreement concluded between the subjects of health insurance.

Health insurance contract -an agreement between the insured and an insurance medical organization, in accordance with which the latter undertakes to organize and finance the provision of medical care to the insured contingent of a certain volume and quality or other services under the compulsory health insurance program and voluntary health insurance (Article 4 of the Law of the Russian Federation "On health insurance of citizens in RF ").

Health insurance contract considered a prisonerfrom the moment of payment of the first insurance premium, unless otherwise provided by the terms of the contract.

Insurance premiumsare established as the rates of payments for compulsory health insurance in amounts that ensure the implementation of health insurance programs and the activities of an insurance medical organization.

Insurance medical organizationsare legal entities that carry out health insurance and have a permit from a state body (that is, a license) for the right to engage in such activities.

Medical insurance organizations are endowed with a set of rights and obligations. Medical insurance organization has the right to:

1) freely choose medical institutions for the provision of medical care and services under health insurance contracts;

2) establish the amount of insurance premiums for voluntary health insurance;

3) take part in the determination of tariffs for medical services;

4) bring a claim to a medical institution in court or
medical worker for material compensation for physical and
moral damage caused to the insured through their fault.

Medical insurance organization undertakes:

1) conclude contracts with medical institutions for the provision of medical care to the insured under compulsory health insurance;

2) conclude contracts for the provision of medical, health and social services to citizens on voluntary medical insurance with any medical and other institutions.

To implement the state policy in the field of compulsory health insurance, the Federal and territorial funds of compulsory health insurance have been created as independent non-profit financial institutions.

The Federal Compulsory Medical Insurance Fund (hereinafter referred to as the Federal Fund) implements public policy in the field of compulsory health insurance of citizens as an integral part of state social insurance. The Fund is a legal entity, has an independent balance sheet, separate property, accounts in the institutions of the Central Bank of the Russian Federation and others credit institutions, seal with its name, stamps and letterheads of the established sample.

The main tasks of the Federal Fund are:

· Financial support of the rights of citizens to medical care established by the legislation of the Russian Federation at the expense of compulsory medical insurance funds for the purposes provided for by the Law of the Russian Federation "On medical insurance of citizens in the Russian Federation";
· Ensuring the financial stability of the compulsory health insurance system and creating conditions for equalizing the volume and quality of medical care provided to citizens throughout the Russian Federation within the framework of the basic compulsory health insurance program;
· Accumulation of financial resources of the Federal Fund to ensure the financial stability of the compulsory health insurance system.

In order to fulfill the main tasks, the Federal Fund:

1) performs alignment financial conditions activities of territorial compulsory health insurance funds within the framework of the basic compulsory health insurance program;
2) develops and in the prescribed manner submits proposals on the amount of contributions for compulsory health insurance;
3) in accordance with the established procedure, accumulates the financial resources of the Federal Fund;
4) allocates funds in accordance with the established procedure to territorial funds of compulsory health insurance, including on a non-refundable and repayable basis, to fulfill territorial programs compulsory health insurance;
5) together with the territorial compulsory medical insurance funds and the bodies of the State Tax Service of the Russian Federation, exercise control over the timely and complete transfer of insurance contributions (deductions) to compulsory medical insurance funds;
6) together with the territorial compulsory health insurance funds, exercise control over the rational use of financial resources in the compulsory health insurance system, including by conducting appropriate audits and targeted inspections;
7) carries out, within its competence, organizational and methodological activities to ensure the functioning of the compulsory health insurance system;
8) submits, in accordance with the established procedure, proposals for improving legislative and other regulatory legal acts on compulsory health insurance;
9) participates in the development of the basic program of compulsory health insurance of citizens;
10) collects and analyzes information, including on the financial resources of the compulsory health insurance system, and submits relevant materials to the Government of the Russian Federation;
11) organizes, in the manner prescribed by the Government of the Russian Federation, the training of specialists for the compulsory medical insurance system;
12) studies and summarizes the practice of applying regulatory legal acts on compulsory health insurance;
13) ensures, in the manner prescribed by the Government of the Russian Federation, the organization of research work in the field of compulsory medical insurance;
14) participates in the procedure established by the Government of the Russian Federation in international cooperation on compulsory health insurance;
15) annually in the prescribed manner submits projects to the Government of the Russian Federation federal laws on the approval of the budget of the Federal Fund for the corresponding year and on its implementation.

Territorial funds of compulsory health insurance in the field of financial and credit activities and control over the rational use of financial resources in the compulsory health insurance system perform the following main functions:

· Accumulate financial resources of territorial funds;
· Carry out financing of compulsory medical care provided by medical insurance institutions;
· Carry out financial and credit activities to ensure the compulsory health insurance system;
· Equalize the financial resources of cities and districts allocated to the compulsory health insurance;
· Together with the bodies of the state tax service of the Russian Federation, they exercise control over the timely and complete receipt of insurance premiums into the territorial fund, as well as the rational use of the funds received;
Agree, jointly with the executive authorities, professional medical associations, the tariffication of the cost of medical care, the territorial program of compulsory medical insurance of the population, make proposals on financial resourcesnecessary for its implementation, on tariffs for medical and other services for compulsory health insurance.

Financial resources Federal funds are federal property, are not part of the budgets, and other funds are not subject to withdrawal.

The financial resources of the Federal Fund are formed from:

1) parts of insurance premiums (deductions) of economic entities and other organizations for compulsory medical insurance in the amounts established by federal law;
2) appropriations from federal budget for the implementation of federal targeted programs within the framework of compulsory health insurance;
3) voluntary contributions from legal entities and individuals;
4) income from the use of temporarily free financial resources;
5) normalized safety stock Federal Fund;
6) receipts from other sources not prohibited by the legislation of the Russian Federation.

Insurance contributions (deductions) to the Federal Fund are transferred by business entities and other organizations in accordance with the established procedure.

Temporarily free financial resources of the Federal Fund in order to protect them from inflation are placed in bank deposits and can be used to purchase highly liquid government securities.

Income from the use of temporarily free financial resources and the standardized reserve stock of the Federal Fund may be used to finance only those activities that are carried out in accordance with the tasks of the Federal Fund provided for in this charter.

The costs of maintaining the Federal Fund, creating and maintaining its material and technical base are carried out within the funds provided for these purposes by the budget of the Federal Fund. Financial resources not spent in the past year are not subject to withdrawal even when approving allocations from the federal budget for next year not taken into account. The federal fund has the right to carry out income-generating activities. The income received from such activities, as well as income from the use of the property under operational management, and the property acquired at the expense of these incomes are directed to the implementation of the statutory tasks of the Federal Fund. The federal fund annually develops a budget and a report on its implementation, which, upon the proposal of the Government of the Russian Federation, are approved by federal law.

On November 19, 2010, the State Duma of the Russian Federation adopted the basic law "On compulsory health insurance in the Russian Federation". This law is aimed at strengthening the guarantees of insured citizens to receive free medical care within the basic and territorial compulsory medical insurance programs.

Insured persons (working and non-working citizens, foreigners and stateless persons, refugees) are entitled to receive free assistance in medical organizations in the event of an insured event (throughout the Russian Federation - in the amount of the basic compulsory medical insurance program, in the territory of the region in which compulsory medical insurance policy, in the scope of the territorial CHI program).

Citizens also have the right to an annual choice and replacement of an insurance organization, a doctor, a policy uniform samplewhich does not require replacement when changing the insurer and is valid throughout the entire territory of the Russian Federation.

It is envisaged to switch to predominantly single-channel financing of healthcare organizations through the compulsory medical insurance system and pay for assistance at the full rate, while the rate should include all items of expenditure, except for the cost of purchasing equipment worth over 100 thousand rubles. A declarative procedure for participation in the compulsory health insurance system and equal conditions for medical organizations of any organizational and legal form, as well as private practitioners, are being introduced.

In 2011-2012, within the framework of the healthcare modernization program, regional programs and programs for the modernization of federal state healthcare institutions are being implemented. Financing of regional programs is carried out at the expense of revenues coming to the budget of the Federal Fund from insurance contributions for compulsory medical insurance in the amount of 2%, the budgets of the constituent entities of the Russian Federation and the budgets of territorial funds.

It is envisaged to establish a social payment for the provision of medical care to non-working pensioners - at the expense of the Federal Fund in the amount of one thousand rubles a year. From May 1, 2011, until the introduction of a universal electronic citizen card on the territory of the constituent entities of the Russian Federation, a medical insurance policy will be issued to the insured in accordance with the procedure established by oMS rules... Ambulance health care will be included in the basic compulsory medical insurance program from 2013, and high-tech medical care - from 2015.

The second bill introduces changes to the legislation in connection with a change in the organization of management of the compulsory medical insurance system and clarification of the powers for financial provision of medical care in state and municipal clinics at the expense of medical insurance funds.

Inter-budgetary transfers from the FFOMS budget are provided in the form of subventions to the budgets of territorial CHI funds. In 2011 and 2012, financial support from budget allocations in federal budgetary institutions is carried out in the form of subsidies, while regional state institutions and municipal institutions participating in the implementation of territorial compulsory medical insurance programs cannot be created in the form of state institutions. Minimum size authorized capital an insurer carrying out exclusively medical insurance should be 60 million rubles.