Who is not subject to compulsory health insurance. Natalya Stadchenko: The new law will exclude medical insurance of citizens who are not subject to compulsory medical insurance. Types of financial support for these individuals

"Personnel officer. Labor law for a personnel officer", 2010, N 11

EXCLUDED FROM THE CHI SYSTEM

Who pays for medical services for police officers, prosecutors, and military personnel? Whether the scope of rights and obligations in the legal relationship on compulsory health insurance (OMS) depends on the labor status of insured persons, how and how it is necessary to insure foreign workers, where refugees have the right to apply - read the material.

On 01.01.2010 Federal Law of 24.07.2009 N 212-FZ "On Insurance Contributions to the Pension Fund of the Russian Federation, Social Insurance Fund of the Russian Federation, Federal Fund of Compulsory Medical Insurance and Territorial Compulsory Medical Insurance Funds" entered into force (as amended on 25.11. 2009). The unified social tax has now been abolished, insurance premiums for compulsory medical insurance are paid in accordance with the said Law.

Persons insured in the CHI system are:

Employees under an employment contract;

Working under civil law contracts for the performance of work and the provision of services;

Persons who receive remuneration under agreements on the alienation of the exclusive right to works of science, literature, art, publishing licensing agreements, licensing agreements on granting the right to use works of science, literature, art.

Non-working persons (disabled: pensioners, minors; adult students: students, graduate students, able-bodied non-working citizens) are also entitled to free medical care, although no insurance premiums are paid for them. The cost of the medical services rendered by him is reimbursed from the budgets of various levels.

Who is not in the CHI system

In the Russian Federation, there are certain categories of citizens who, in accordance with the current legislation, are excluded from the CHI system. These include military personnel, employees of internal affairs bodies, the State Fire Service of the Ministry of the Russian Federation for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters (EMERCOM of Russia), the penal system, prosecutors, and some others.

In accordance with Art. 25 of the Fundamentals of the Legislation of the Russian Federation on the Protection of the Health of Citizens of July 22, 1993 N 5487-1 (as amended on July 27, 2010, hereinafter - the Fundamentals of the Legislation on Health Protection) military personnel, citizens subject to conscription and entering military service under a contract, have the right to receive medical care in institutions of the state health care system. The procedure for organizing such assistance to servicemen is established by the legislation of the Russian Federation, regulations of the Ministry of Defense of Russia and other federal executive bodies, in which the law provides for military service.

Clause 2 of Art. 16 of the Federal Law of 27.05.1998 N 76-FZ "On the status of military personnel" (as amended on 22.07.2010) states that military personnel and citizens called up for military training have the right to free medical care, free provision of medicines, medical products in medical, military medical units, units and institutions of federal executive bodies, in which military service is provided for by federal law (military medical institutions). In the absence at the place of military service or place of residence of military medical institutions or corresponding departments in them or special medical equipment, as well as in urgent cases, medical assistance is provided in institutions of the state or municipal health systems.

Thus, medical assistance is provided to servicemen and persons called up for military training by the network of medical institutions of the Ministry of Defense of Russia or by medical and preventive institutions of the state and (or) municipal health systems at the expense of funds allocated from the federal budget to the Ministry of Defense of Russia.

The legislation of the Russian Federation establishes a similar procedure for the provision of medical care for police officers, for all employees of the system of internal affairs bodies of the Russian Federation, for employees of the penal system: the right to free medical care (including the provision of medicines) is proclaimed for employees of the corresponding system of executive bodies in medical institutions specially created to provide medical care to this category of employees. If such institutions are absent at the place of service or residence of employees of the relevant system of executive bodies, then medical assistance should be provided to them in institutions of the state and municipal health systems. The costs of these health care institutions for the provision of medical care are reimbursed at the expense of the budget at the rates agreed upon in the agreement concluded between the territorial body of the federal executive body and the relevant medical and prophylactic institution providing medical assistance to employees of the corresponding system of executive bodies.

Prosecutors and judges have been excluded from the CHI system. In accordance with paragraph 6 of Art. 44 of the Federal Law of 17.01.1992 N 2202-1 "On the Prosecutor's Office of the Russian Federation" (as amended on 01.07.2010) medical care (including the provision of medicines) of prosecutors and their family members living with them is carried out at the expense of the federal budget. Clause 5 of Art. 19 of the Law of the Russian Federation of June 26, 1992 N 3132-1 "On the status of judges in the Russian Federation" (as amended on March 29, 2010) reads: "A judge and his family members have the right to medical care, including the provision of medicines, which is paid for They also have the right to sanatorium-resort treatment, which the judge, his spouse and minor children are paid for from the federal budget. These rights remain with the judge even after his retirement (removal) or retirement At the same time, medical care for a retired or retired judge and his family members is provided at the expense of the federal budget in the same medical institutions where they were registered. "

As for public civil servants, then, according to paragraphs. 5 p. 1 of Art. 52 of the Federal Law of July 27, 2004 N 79-FZ "On the State Civil Service of the Russian Federation" (as amended on February 14, 2010), civil servants are guaranteed medical insurance of a civil servant and his family members, including after a civil servant leaves seniority pension, in accordance with this Federal Law and the Federal Law on Health Insurance of Civil Servants of the Russian Federation. There are no other provisions in the said Federal Law concerning medical support for civil servants, but a special law has not yet been adopted to regulate the issues of health insurance for civil servants. In this regard, before the adoption of such a law, this category of workers is subject to general provisions on compulsory health insurance in the Russian Federation.

Thus, the majority of Russian citizens are insured persons in the CHI system (medical assistance is provided to them at the expense of CHI funds). However, there are some categories of citizens that are not subject to compulsory medical insurance (medical care provided to them is financed from budget funds). All citizens of the Russian Federation, regardless of whether they are employed or not, are subject to compulsory health insurance or not, have the right to receive free medical care in state and municipal health care institutions.

The question arises: in what order is medical care provided to foreign citizens, stateless persons, refugees and internally displaced persons?

Based on Part 1 of Art. 41 of the Constitution of the Russian Federation, everyone has the right to health protection and medical care. However, only Russian citizens are guaranteed free medical care in state and municipal health care institutions at the expense of the corresponding budget, insurance premiums and other receipts.

Foreign citizens

According to Part 3 of Art. 62 of the Constitution of the Russian Federation, foreign citizens in Russia enjoy the rights and bear obligations on an equal basis with the citizens of the Russian Federation, except for cases established by federal law or an international treaty of the Russian Federation. A foreign citizen in accordance with Art. 3 of the Federal Law of May 31, 2002 N 62-FZ "On Citizenship of the Russian Federation" (as amended on June 28, 2009, hereinafter referred to as the Citizenship Law) is a person who is not a citizen of the Russian Federation and has citizenship (nationality) of a foreign state. In accordance with Art. 18 of the Fundamentals of Legislation on Health Protection to foreign citizens located on the territory of the Russian Federation are guaranteed the right to health protection in accordance with international treaties of the Russian Federation. The procedure for providing medical assistance to foreign citizens is determined by the Government of the Russian Federation.

In accordance with the Rules for the provision of medical care to foreign citizens on the territory of the Russian Federation, approved. By the Decree of the Government of the Russian Federation of 01.09.2005 N 546, emergency medical care is provided to temporarily staying (temporarily residing) foreigners or foreigners permanently residing in the territory of Russia free of charge and without delay. After receiving emergency medical care and after recovering from conditions that pose an immediate threat to life or require urgent medical intervention, routine medical care can be provided to foreign citizens. This type of assistance is provided on a paid basis in accordance with an agreement for the provision of paid medical services or an agreement of voluntary and (or) compulsory medical insurance. To obtain it, a foreign citizen must have the necessary medical documents, as well as guarantees to pay for the cost of medical services and make an advance payment for treatment. Upon completion of the treatment, an invoice is issued either to the foreign citizen himself, or to a person, an organization representing his interests (in the case of medical insurance, this is an insurance medical organization).

The procedure for medical insurance of foreign citizens depends on whether a foreigner is temporarily staying in Russia or residing permanently.

Federal Law of 25.07.2002 N 115-FZ "On the Legal Status of Foreign Citizens in the Russian Federation" (as amended on 23.07.2010) does not contain such a concept as "a foreign citizen temporarily staying in the Russian Federation". In paragraph 1 of Art. 2 of this Law there are concepts such as "a foreign citizen temporarily residing in the Russian Federation" and "a foreign citizen temporarily residing in the Russian Federation".

A foreign citizen who has arrived in Russia on the basis of a visa or in a manner that does not require a visa and who has received a migration card but does not have a residence permit or temporary residence permit is considered to be temporarily staying in the Russian Federation.

A foreign citizen who has received a temporary residence permit is recognized as temporarily residing in the Russian Federation.

First, the above categories of foreign citizens are temporarily on the territory of the Russian Federation. Secondly, their very presence in Russia must be legal, that is, there must be all the necessary legal grounds for this: in the first case - a visa, a migration card without a residence permit or a temporary residence permit, in the second - a temporary permit residence. These differences affect the legal status of a foreign citizen, his specific rights and obligations in various spheres of life. However, in the field of medical care and health insurance, there is no difference in the amount of rights granted. The concept of "a foreign citizen temporarily residing in the territory of Russia" is general in relation to the concepts "temporarily staying" and "a foreigner temporarily residing in the Russian Federation" and covers both of these concepts.

Regulation on medical insurance for foreign citizens temporarily staying in the Russian Federation, approved by Resolution of the Government of the Russian Federation of 11.12.1998 N 1488 does not apply to certain categories of foreigners, for example: foreigners permanently residing in the Russian Federation; working under an employment contract; entitled to free medical care in accordance with international agreements. It provides for the provision of medical care to them, including medical transport services, on the basis of a health insurance contract and in accordance with the amount of the actually paid insurance premium. The volume of medical care provided cannot be less than the minimum list of medical services provided in the health insurance system to insured foreign citizens temporarily staying in the Russian Federation. Such a list of services is approved by Order of the Ministry of Health of Russia dated 06.08.1999 N 315 "On the minimum list of medical services provided in the health insurance system to insured foreign citizens temporarily in the Russian Federation." It includes:

Emergency;

Medical assistance in outpatient and inpatient medical institutions in case of sudden health disorders and accidents to the extent necessary to eliminate the threat to the patient's life and (or) relieve acute pain;

Transportation by medical transport or other means of transport, including medical escort (medical team, doctor, nurse), from the place of the disease (incident) to the medical institution;

Posthumous repatriation (transportation) of remains.

Medical insurance of foreign citizens temporarily staying in the territory of the Russian Federation is carried out by Russian insurance organizations on the basis of a license. Medical insurance for these foreign citizens can be carried out by a foreign insurance organization that has concluded an appropriate agreement with a Russian insurance organization, or with a service organization that provides the organization of medical care (medical transport services). In any case, the organization and financing of medical care is carried out in a volume not less than that provided for by the minimum list of medical services.

A foreign citizen permanently residing in the Russian Federation is a person who has received a residence permit. This category of foreign citizens has the same rights in the field of medical insurance as citizens of the Russian Federation, unless otherwise provided by an international agreement. The citizens of the Russian Federation insured under the CHI are provided free medical care in accordance with the basic CHI program, which is part of the program of state guarantees for the provision of free medical care to the citizens of the Russian Federation for the next year. The provisions of the basic CHI program also apply to foreign citizens permanently residing in Russia.

Thus, foreign citizens are guaranteed the right to health protection in accordance with international treaties of the Russian Federation. They have the right to receive medical care on the territory of Russia in the manner determined by the Government of the Russian Federation:

Ambulance is provided to them free of charge;

Scheduled - on a paid basis. There are two procedures for payment of planned medical care:

a) on the basis of a contract for the provision of paid medical services;

b) on the basis of a voluntary medical insurance agreement (VHI) and a compulsory health insurance agreement (MHI). For the foreigner himself, routine medical care can be free, since contributions to VHI and CHI are made not by him himself, but by the insured.

When considering the issue of health insurance for foreign citizens, the status of a foreign citizen matters. If he permanently resides on the territory of Russia, then he is subject to insurance on an equal basis with citizens of the Russian Federation. If he is temporarily in the Russian Federation, then his medical insurance is carried out in the manner determined by the Government of the Russian Federation: in accordance with medical insurance contracts and the amount of the actually paid insurance premium, but in an amount not less than that provided for by the minimum list of medical services. Until 01.01.2010 foreign citizens temporarily staying in Russia and working under labor and civil law contracts were subject to compulsory health insurance. Currently, for foreign citizens temporarily staying in the territory of the Russian Federation, receiving remuneration under labor contracts and civil law contracts, no insurance premiums are made for compulsory medical insurance. Accordingly, the specified category of foreign citizens is not subject to compulsory health insurance. Apparently, when providing medical assistance to foreign citizens temporarily staying in Russia, the above Regulation on medical insurance for foreign citizens temporarily staying in the Russian Federation should be applied.

Stateless persons

Let's move on to considering the issue of providing medical assistance to stateless persons, refugees and internally displaced persons.

Labor Law Dictionary. A stateless person is a person who is not a citizen of the Russian Federation and does not have proof of citizenship of a foreign state.

According to Part 3 of Art. 62 of the Constitution of the Russian Federation, stateless persons in the Russian Federation enjoy the rights and bear obligations on an equal basis with the citizens of the Russian Federation, except in cases established by federal law or an international treaty of the Russian Federation.

In accordance with Art. 18 of the Fundamentals of Legislation on Health Protection Stateless persons permanently residing in the Russian Federation enjoy the right to health care on an equal basis with citizens of the Russian Federation, unless otherwise provided by international treaties of the Russian Federation The procedure for providing medical care to this category of persons is established in accordance with the legislation of Russia. Article 7 of the Law on Health Insurance says that on the territory of the Russian Federation, stateless persons have the same rights and obligations in the health insurance system as citizens of the Russian Federation.

Thus, the current legislation consistently enshrines the principle of equality of rights of citizens of the Russian Federation and stateless persons (stateless persons) in the field of health care in general and in obtaining medical care in particular. This category of persons has the right to receive free medical care under the federal program of state guarantees for the provision of free medical care to citizens of the Russian Federation. But in practice, stateless persons have a lot of problems associated with their registration at a certain place of residence, with freedom of movement, with getting a job, studying, attaching to a medical and preventive institution, receiving medical care, and others. It is difficult to imagine how a person who does not have a passport - a document proving the identity and citizenship of a person - can exercise the rights proclaimed in laws, and even on a par with a citizen of Russia. It seems correct to consolidate at the legal level the rights of stateless persons in the field of health protection on an equal basis with the citizens of the Russian Federation in this area, but it is necessary to achieve a real embodiment of the proclaimed rights in life.

Internally displaced persons

An internally displaced person is:

A citizen of the Russian Federation forced to leave his place of residence on the territory of a foreign state and arrived in the territory of Russia;

A citizen of the Russian Federation forced to leave his place of residence on the territory of one constituent entity of the Russian Federation and arriving on the territory of another constituent entity of the Russian Federation.

Labor Law Dictionary. An internally displaced person is a citizen of the Russian Federation who left his place of residence as a result of violence or persecution in other forms committed against him or his family members, or as a result of a real risk of being persecuted on the basis of race or nationality, religion, language, as well as on the basis of belonging to a particular social group or political convictions that have become a pretext for conducting hostile campaigns against a specific person or group of people, mass violations of public order.

An internally displaced person is also recognized as a foreign citizen or stateless person who permanently resides legally on the territory of the Russian Federation and who have changed their place of residence within the territory of the Russian Federation due to the circumstances provided for in paragraph 1 of Art. 1 of the Law of the Russian Federation of 19.02.1993 N 4530-1 "On Forced Migrants" (as amended on 23.07.2008, hereinafter referred to as the Law on Forced Migrants).

An internally displaced person is also a citizen of the former USSR who permanently resided in the territory of the republic that was part of the USSR, received refugee status in the Russian Federation and lost this status in connection with the acquisition of citizenship of the Russian Federation in the presence of circumstances that prevented this person from settling in during the period of refugee status. on the territory of the Russian Federation.

In accordance with paragraphs. 5 p. 1 of Art. 4 of the Law on Forced Migrants, a person who has received a certificate of registration of the application, and family members who have arrived with him who have not reached the age of 18, have the right to medical and drug assistance in state and municipal health care institutions in accordance with the legislation of the Russian Federation. This means that the procedure for rendering medical assistance to forced migrants is different depending on which group of forced migrants the person belongs to.

If an internally displaced person is a citizen of the Russian Federation, then he or she has the right to receive free medical care in state and municipal healthcare institutions on an equal basis with other citizens of Russia. If a forced migrant is a stateless person, a foreigner permanently residing in the territory of the Russian Federation, or a refugee, the procedure for providing him with medical assistance is established in accordance with the legislation of the Russian Federation. The analysis of the legislation in the field of health protection and the provision of medical care to these categories of persons allows us to conclude that a unified procedure for the provision of medical care has been established for most groups of forced migrants - they have the right to free medical care on an equal basis with Russian citizens.

Bibliography

1. Chernykh VD Population health is the most important factor of social and economic development of society / Information and analytical department of the Office of the Federation Council of the Federal Assembly of the Russian Federation. [Electronic resource]. URL: budgetrf. ru / Publications / Magazine s / Ve stnikSF / 2000 / ve stniksf 125-13 / vestniksf125-13000.htm. Date of treatment - 09/07/2010.

2. Shleneva EB On the correlation of the constitutional right to health protection with other constitutional rights and freedoms of man and citizen. M .: Manuscript, 2003.

V. Vlasenkova

Assistant

department of Labor Law

faculty of Law

Moscow State University M. V. Lomonosov

Signed to print

Labor law

Keywords:

1 -1

Commentary on Article 10. Insured Persons

1. The concept "insured person" was not applied in the previously effective Law of the Russian Federation of June 28, 1991 N 1499-1. Instead, the term "citizen" was used. Citizens (they are also insured persons) acted as subjects of health insurance along with the insured, an insurance medical organization, and a medical institution. From the norms of Articles 2, 7, 8 of the said law, it followed that both citizens of the Russian Federation and foreign citizens and stateless persons (stateless persons) could act as the insured.

The commented article clearly lists the categories of insured persons. The legislator names the concept of "insured person" in Article 2 as one of the most important for the enforcement of the commented Law.

The following can be named as criteria for assigning individuals to the category of insured persons:

Belonging to one or another citizenship (citizen of the Russian Federation, foreigner or stateless person),

The fact of residence in the Russian Federation (within or outside Russia),

Employment (working or not working),

Occupation (employee, individual entrepreneur, notary in private practice, lawyer, member of a peasant (farm) farm, etc.),

In some cases - the presence of a certain status, for example, the status of a refugee or a highly qualified specialist or a member of his family (for foreign workers).

2. First of all, you should decide on the attribute of citizenship.

The insured persons are all citizens of the Russian Federation who are not working (the list of persons not working under an employment contract in clause "g" of clause 5 of article 10 is not exhaustive and is subject to broad interpretation).

All working citizens of the Russian Federation residing in the territory of the Russian Federation are subject to compulsory medical insurance. This applies to those working under an employment contract, under a civil law contract, the subject of which is the performance of work, the provision of services, under a copyright contract or a license contract, as well as persons who independently provide themselves with work, and others.

As follows from article 14 of the Federal Law of August 15, 1996 N 114-FZ "On the procedure for leaving the Russian Federation and entering the Russian Federation" (hereinafter - the Federal Law "On the procedure for leaving the Russian Federation and entering the Russian Federation") payment of medical assistance to a citizen of the Russian Federation, with the exception of a citizen of the Russian Federation sent on a business trip, when leaving the Russian Federation is carried out in accordance with the conditions provided for by a medical insurance policy or a document replacing a policy valid for receiving medical care outside the territory of the Russian Federation, as well as with a guarantee of physical or legal a person inviting a citizen of the Russian Federation to reimburse the costs of providing medical care (treatment in a medical institution) to a citizen of the Russian Federation. If these documents are not available, then the citizen shall bear the costs of providing medical care to a citizen of the Russian Federation outside the territory of the Russian Federation independently. In the event of an insured event, assistance to citizens of the Russian Federation who are on the territory of another state is provided by a diplomatic mission or consular office of the Russian Federation.

In some cases, the insured persons are foreign citizens, stateless persons.

In relations on health insurance, the legislator equates the status of a foreign citizen and a stateless citizen with the status of a citizen of the Russian Federation, since the "binding" is made to the place of residence of such a person, and the law of the Russian Federation applies to him, since he is located on its territory. This rule seems to be quite fair, since legal relations with the participation of stateless persons are governed by the norms of Russian law (see, for example, paragraph 4 of article 156 of the RF IC, paragraph 1 of article 3 of the Criminal Code of the Russian Federation, article 2.6 of the Administrative Code of the Russian Federation and many others. ).

Foreign citizens and stateless persons can act as policyholders or insured persons under health insurance contracts, including they can take part in all types of health insurance, independently choose an insurance medical organization, monitor compliance with the terms of the health insurance contract, etc. It should be remembered that a stateless person will not be able to register and carry out activities as an individual entrepreneur, notary, lawyer.

Interestingly, the general rule of Article 34 of the Law of the Russian Federation "On the Organization of Insurance Business in the Russian Federation", which concerns all types of insurance and is general in relation to the commented special rule, states that "foreign citizens, stateless persons and foreign legal entities on the territory of the Russian Federation enjoy the right to insurance coverage on an equal basis with citizens and legal entities of the Russian Federation. "

If a stateless person is invited to enter the Russian Federation, then in order to issue the invitation, the inviting party presents, among other documents, its letters of guarantee to the inviting party on the assumption of obligations for material, medical and housing support of the invited stateless person for the period of his stay in the Russian Federation ( for more details, see clause 25 of the Decree of the Government of the Russian Federation of October 8, 2007 N 655 "On approval of the Rules for issuing invitations to enter the Russian Federation for foreign citizens and stateless persons").

In order to enjoy their rights on the territory of the Russian Federation, stateless persons are obliged to submit to the territorial body of the federal executive body in the field of migration a notification confirming their residence in the Russian Federation (see Rules for submitting a notification by a foreign citizen or stateless person confirming his / her residence in the Russian Federation , approved by the decree of the Government of the Russian Federation of January 17, 2007 N 21). The established deadline for submitting such a notification is two months from the date of the expiration of the next year from the date of obtaining a temporary residence permit.

3. Separately, it is worth dwelling on foreign citizens and stateless persons who have the status of highly qualified specialists and their family members in accordance with the Federal Law "On the Legal Status of Foreign Citizens in the Russian Federation".

A highly qualified specialist is a foreign citizen who has work experience, skills or achievements in a specific field of activity, if the conditions for attracting him to work in the Russian Federation imply that he will receive a salary (remuneration):

In the amount of at least one million rubles per year (365 calendar days) - for highly qualified specialists who are researchers or teachers, if they are invited to engage in research or teaching activities by state-accredited higher educational institutions, state academies of sciences or their regional branches, national research centers or state scientific centers, as well as for highly qualified specialists involved in labor activities by residents of industrial, tourist and recreational, port special economic zones (with the exception of individual entrepreneurs);

In the amount of at least seven hundred thousand rubles per year (365 calendar days) - for foreign citizens involved in labor activities by residents of the technical and innovative special economic zone (except for individual entrepreneurs);

Without taking into account the wage requirements - for foreign citizens participating in the implementation of the Skolkovo project in accordance with the Federal Law of September 28, 2010 N 244-FZ "On the Skolkovo Innovation Center";

In the amount of at least two million rubles per year (365 calendar days) - for other foreign citizens.

The family members of a highly qualified specialist include his spouse, children (including adopted children), children’s spouses, parents (including adoptive ones), parents’s spouses, grandparents, grandchildren. We are talking only about those family members who arrived in Russia as foreign citizens together with a highly qualified specialist.

The status of highly qualified specialists and their family members is defined in detail by the Federal Law "On the Legal Status of Foreign Citizens in the Russian Federation". In accordance with clause 14 of article 13.2 of this law, a highly qualified specialist and members of his family who have arrived in the Russian Federation, who are foreign citizens, must have a health insurance contract (policy) in force in the Russian Federation or must have the right on the basis of an appropriate contract concluded by the employer or the customer of work (services) with a medical organization, to receive primary health care and specialized medical care.

From the above norm it follows that the employer of a highly qualified specialist is obliged to ensure that the latter and the family members of the specialist have an insurance policy issued under a voluntary medical insurance contract.

The presence of a policy of a highly qualified specialist and his family members who arrived with him of the specified medical care during the period of validity of an employment contract concluded with this highly qualified specialist or a civil law contract for the performance of work (provision of services) is a prerequisite for the specified employment contract.

If it is necessary to extend the validity of a work permit for a highly qualified specialist, the employer or customer of work (services), no later than 30 days before the expiration of such a permit, must submit to the federal executive body in the field of migration or its territorial body a corresponding application, to which, in addition to other documents are attached with a copy of the contract (policy) of medical insurance or an agreement concluded by the employer or customer of work (services) with a medical organization for the receipt of primary health care and specialized medical care by a highly qualified specialist and his family members permanently residing in the Russian Federation together with him who are foreign citizens.

4. Among foreigners and stateless persons, the legislator has separately defined the category of persons with the status of a refugee or a member of the family of a refugee (that is, a person entitled to medical assistance in accordance with the Federal Law "On Refugees").

A refugee is a person who is not a citizen of the Russian Federation and who, due to well-founded fears of becoming a victim of persecution on the basis of race, religion, citizenship, nationality, belonging to a particular social group or political opinion, is outside the country of his citizenship and cannot enjoy the protection of this country or does not wish to benefit from such protection due to such concerns; or, not having a certain nationality and being outside the country of his former habitual residence as a result of such events, is unable or unwilling to return to it because of such fears.

Refugees receive medical and drug assistance on an equal basis with citizens of the Russian Federation, unless otherwise provided by international treaties of the Russian Federation, i.e. in the volumes and on the terms established by the commented Law.

In accordance with the Federal Law "On Refugees", not only persons directly belonging to the category of refugees, but also persons who have applied for refugee status and have a certificate of consideration of their application for recognition as a refugee on the territory of the Russian Federation, have the right to receive medical and drug assistance in accordance with the Federal Law "On Refugees"

The named certificate is an identity document of a person applying for refugee status. The certificate is the basis for the applicant and his family members to receive a referral to a temporary accommodation center.

Information about the family members of the person applying for refugee status who have arrived with him, who have not reached the age of 18, shall be entered in the certificate of one of the parents, and in the absence of the parents, in the certificate of the guardian or in the certificate of one of the family members who has reached the age of 18 and voluntarily taking responsibility for the behavior, upbringing and maintenance of family members under the age of 18. Thus, the certificate also certifies the right of the children indicated in the certificate to receive medical care.

Meanwhile, a mandatory requirement for persons who received a certificate and members of his family who arrived with him is to undergo a mandatory medical examination in the established volume of the requirements of the medical certificate.

The authorized federal body in the field of compulsory medical insurance determines the procedure for providing medical and drug assistance to refugees, as well as to persons who have received a certificate of recognition as a refugee in the territory of the Russian Federation, and his family members who have arrived with him.

5. It is worth dwelling in somewhat more detail on the types of activities that insured persons can engage in.

Most of the insured persons work under an employment contract or a civil law contract, the subject of which is the performance of work, the provision of services, as well as under a copyright contract or a license contract.

For employees under an employment contract, the employer undertakes to provide work for a specified labor function, to ensure the working conditions provided for by labor legislation and other regulatory legal acts containing labor law norms, a collective agreement, agreements, local regulations and this agreement, timely and in full pay to the employee wages. The parties to the employment contract are the employer and the employee.

Under contracts of a civil nature, executed on a reimbursable basis (for a fee), on which, in accordance with the legislation of the Russian Federation, taxes are charged in the part subject to enrollment in compulsory health insurance funds, are understood contracts, the subject of which is the performance of work (for example, a contract , the subject of which is the manufacture of forged gratings on the windows), the provision of services (for example, an agreement on the provision of services for cleaning the adjacent territory of an individual residential building).

Civil law contracts also include contracts of author's order, contracts on the alienation of the exclusive right to works of science, literature, art, publishing license contracts, license contracts on granting the right to use a work of science, literature, art.

Some insured persons independently provide themselves with work (individual entrepreneurs, notaries in private practice, lawyers, arbitration managers).

On the status of individual entrepreneurs, as well as notaries, lawyers and bankruptcy administrators in private practice, see the commentary to Article 11 of the Law.

The insured persons who independently provide themselves with work include the heads of peasant (farmer) households.

A peasant (farm) economy is an association of citizens related by kinship and (or) property, having property in common ownership and jointly carrying out production and other economic activities (production, processing, storage, transportation and sale of agricultural products) based on their personal participation (Article 1 of the Federal Law of June 11, 2003 N 74-FZ "On the peasant (farm) economy").

A peasant (farm) economy can be created by one citizen.

The head of a peasant (farm) enterprise operates as an individual entrepreneur (as an individual entrepreneur, he is registered in the Unified State Register of Individual Entrepreneurs).

Farm members can be:

Spouses, their parents, children, brothers, sisters, grandchildren, as well as grandparents of each of the spouses, but no more than three families. Children, grandchildren, brothers and sisters of members of a farm may be admitted to a member of a farm upon reaching the age of sixteen;

Citizens who are not related to the head of the farm. The maximum number of such citizens cannot exceed five people.

The insured persons are citizens - members of family (clan) communities of the indigenous peoples of the North, Siberia and the Far East of the Russian Federation, living in the regions of the North, Siberia and the Far East of the Russian Federation, engaged in traditional economic sectors.

Family (tribal) communities of small peoples are forms of self-organization of persons belonging to small peoples, united by consanguinity, leading a traditional way of life, carrying out a traditional economy and engaged in traditional crafts.

Communities of small peoples are organized on a voluntary basis at the initiative of people belonging to small peoples who have reached the age of 18. The will to join the community of small peoples should be expressed in the form of a written statement or in the form of a record in the minutes of the general meeting (gathering) of members of the community of small peoples (meetings of authorized representatives of small peoples).

Family (tribal) communities of small peoples, as well as their members, enjoy the rights established by the Federal Law of July 20, 2000 N 104-FZ "On general principles of organization of communities of indigenous small peoples of the North, Siberia and the Far East of the Russian Federation."

Firstly, all minors, without exception, including children left without parental care, who are fully supported by the state or are being raised in foster families.

Secondly, the insured persons are non-working pensioners, regardless of the basis for granting a pension.

The majority of pensioners are citizens receiving retirement age pensions. As a rule, the retirement age begins for women from 55 years old, and for men from 60 years old. The grounds for granting a pension can be the achievement of the specified age, the assignment of a disability (state disability pension, labor disability pension), reaching a certain age and lack of the required length of service (state social pension), etc.

Thirdly, the insured are students studying full-time in educational institutions of primary vocational, secondary vocational and higher vocational education. This refers to all educational institutions accredited in accordance with the current legislation, both public and private.

Fourthly, the insured persons include unemployed citizens registered in accordance with the employment legislation. The main regulatory legal act governing employment is the Law of the Russian Federation of April 19, 1991 N 1032-1 "On employment in the Russian Federation."

Unemployed citizens are recognized as able-bodied citizens who do not have work and earnings, are registered with the employment service in order to find a suitable job, are looking for work and are ready to start it. At the same time, payments of severance pay and retained average earnings to citizens dismissed in connection with the liquidation of an organization or the termination of activities by an individual entrepreneur, reduction in the number or staff of employees of an organization, an individual entrepreneur are not taken into account as earnings.

Registration of citizens as unemployed is carried out by state institutions of the employment service on the basis of decisions on recognizing citizens registered in order to find suitable work as unemployed.

Citizens under the age of 16 cannot be recognized as unemployed; those who have been assigned an old-age labor pension (part of an old-age labor pension), including early, or an old-age or seniority pension under state pension provision; convicted by a court decision to correctional labor, as well as to punishment in the form of imprisonment; some other categories of persons.

The registration of unemployed citizens is regulated by the order of the Ministry of Health and Social Development of the Russian Federation of September 30, 2010 N 847n "On approval of the registration procedure for unemployed citizens."

Fifth, one of the parents or guardian who takes care of the child until the age of three.

A parent or other person (guardian) is employed in caring for a child during the period of caring for a child aged one and a half to three years. Care can be carried out for one child or several at the same time, including the adopted child (children). During this period, the parent or guardian is awarded a childcare allowance.

In addition, the insured persons include able-bodied citizens who are caring for disabled children, disabled people of group I, persons who have reached the age of 80.

The category "disabled child" is established for persons under the age of 18. Adult citizens with disabilities, depending on the degree of disorder of body functions and limitation of vital functions, to persons recognized as disabled, are assigned a certain group of disability. In total, there are three groups of disabilities, of which group I is the most severe. Recognition of a person as a disabled person is carried out by the federal state institution of medical and social expertise in the manner established by the Government of the Russian Federation of February 20, 2006 N 95 "On the procedure and conditions for recognition as disabled").

Persons over the age of 80 are another category of citizens that require special care, since elderly people of this age can rarely be sufficiently independent.

Citizens involved in caring for people in need of this actually carry out socially useful activities, and therefore are subject to compulsory health insurance.

7. The list of non-working citizens is formulated as non-exhaustive; other citizens who do not work under an employment contract and citizens who are not specified in subparagraphs "a" - "f" of clause 5 of the commented article, with the exception of military personnel and persons equated to them in the organization of medical care, may be considered non-working.

Servicemen and persons equated to them in compulsory state insurance receive medical assistance in a special order.

Equated to military personnel are:

Employees of the internal affairs bodies of the Russian Federation,

Employees of the State Fire Service of the Ministry of the Russian Federation for Civil Defense, Emergencies and Elimination of the Consequences of Natural Disasters, the penal system,

Persons of the commanding staff of the federal courier communications,

Employees of the penal system.

Some categories of citizens who are equated to military personnel are entitled to receive certain types of medical care free of charge after dismissal. Thus, the right to free production and repair of dentures (with the exception of dentures made of precious metals and other expensive materials), provision of medicines and other medical equipment according to prescriptions issued by doctors of medical institutions of the system of the Ministry of Internal Affairs of Russia, are enjoyed by some employees of the State Fire Department who were dismissed with the right to retire. services of EMERCOM of Russia with 20 years of service or more.

The procedure for providing medical assistance to military personnel and persons equated to them is regulated by the Government of the Russian Federation of December 31, 2004 N 911 "On the procedure for the provision of medical care, sanatorium-resort provision and the implementation of certain payments to certain categories of military personnel, law enforcement officers and members of their families" ...

In particular, emergency medical care is provided to servicemen and employees without hindrance and free of charge by all healthcare institutions, regardless of territorial and departmental subordination and form of ownership in conditions requiring urgent medical intervention (accidents, injuries, poisoning, other conditions and diseases).

In most cases, the costs of health care institutions for the provision of medical care to servicemen and employees are reimbursed by the military district (fleet), the regional command of the internal troops, the territorial body of the corresponding federal executive body in the constituent entity of the Russian Federation, where military personnel and persons equated to them do military service (service) ...

The main purpose of medical insurance in the Russian Federation is to guarantee citizens, in the event of an insured event, to receive medical care at the expense of previously collected funds and to finance preventive measures.

This type of insurance is carried out in two forms: compulsory and voluntary.

Considering compulsory health insurance, it should be noted that it was introduced in 1993. The main task of this type of health insurance is to provide all citizens with the same opportunities to receive medical and drug assistance provided from the funds of this insurance in the amount and on those conditions that correspond to state programs. The main compulsory health insurance program is approved by the Government of the Russian Federation.

This program is aimed at ensuring that every citizen is guaranteed, firstly, primary health care, including emergency medical care, secondly, diagnosis and treatment on an outpatient basis, the implementation of measures for the prevention of diseases and, thirdly, inpatient care. ...

In compulsory health insurance, the subjects are: the insured person, the insurer, an insurance medical organization, a medical institution. The following persons can be insured persons in this type of insurance: citizens of the Russian Federation, persons without citizenship, foreign citizens who permanently reside in Russia. The insurer for unemployed citizens is the state and local government bodies, for the employed - enterprises, institutions and other employers. Insurance medical organizations - these are legal entities that have an appropriate state permit (license) for the right to engage in compulsory health insurance. These organizations are not part of the RF healthcare system. An important feature of medical insurance organizations is that these organizations do not carry out their activities on a commercial basis.

As medical institutions are polyclinics, hospitals, research medical institutes and other institutions that provide medical care, in addition, persons who carry out medical activities, both individually and collectively. All listed entities must be licensed. It is important to note that all income that medical institutions derive from compulsory health insurance programs are not taxable.

Compulsory health insurance contract is, as a rule, not less than one year. The performance of obligations by the insurer arises from the moment the insured event occurs. Such an insured event will be the appeal of the insured person to a medical institution in order to receive medical assistance. Every citizen who has entered into a compulsory health insurance contract is issued a medical insurance policy. The effect of such a policy applies to the entire territory of the Russian Federation.

Medical institutions operating in the compulsory health insurance system and medical insurance organizations conclude an agreement between themselves for the provision of medical and preventive care (medical services).

Under this agreement, the medical institution undertakes to provide all insured persons with medical care of a certain volume and quality within a specific time frame within the framework of the approved compulsory health insurance program. An essential condition of such an agreement is the list of services provided by the institution.

To carry out the main functions of compulsory health insurance, federal and territorial funds have been established as independent non-profit financial and credit organizations. The territorial funds created in the constituent entities of the Russian Federation are in charge of: financing compulsory medical insurance, accumulating financial reserves to ensure the stability of the insurance system, and control over the rational use of funds. The federal fund is developing a basic compulsory health insurance program, leveling the operating conditions for territorial funds by allocating the necessary funds, and also financing targeted federal programs.

The financial base of compulsory health insurance is made up of contributions from policyholders. In the event that the insured person is unemployed, then payments for him are made by state authorities and local authorities on a monthly basis at the expense of funds provided for by the relevant budget. For enterprises, organizations, institutions and other business entities, an insurance rate for compulsory health insurance is established in the form of an interest rate in relation to the accrued wages on all grounds.

Under contract voluntary health insurance the insurer undertakes to ensure the organization and financing of medical services and other services enshrined in the medical insurance program of a certain volume and quality.

Under this agreement, capable citizens can act as policyholders who have entered into an agreement with themselves or third parties (insured), in addition, legal entities can also be policyholders, but only if they conclude an agreement in favor of third parties. Citizens who are registered in narcological, neuropsychiatric, tuberculosis, dermatovenerologic dispensaries are not subject to insurance; HIV-infected; persons with malignant neoplasms. When concluding a voluntary medical insurance contract, the insurer has the right to conduct a preliminary medical examination of persons subject to insurance (to identify the above categories of persons).

When concluding a voluntary medical insurance contract, the insurer issues a medical policy to the policyholder. This medical policy must contain information regarding the validity of the policy, as well as a list of institutions that will provide medical services. The medical policy must be accompanied by the health insurance program chosen by the policyholder. An insured event under this agreement will be the appeal of the insured person to an institution providing medical services contained in the list in case of an acute illness, exacerbation of a chronic disease, injury, poisoning and other accidents for receiving advisory, preventive, diagnostic, medical, rehabilitation and other assistance, which requires the provision of medical services.

In the event that the insured person has been prescribed medical and diagnostic measures that go beyond the chosen voluntary health insurance program, the representative of the medical institution is obliged to notify him.

If the insured person has been provided with medical services that are not provided for by the insurance program, then the insurer has the right not to pay for them.

The category of compulsory social insurance provides for several categories of citizens who can apply for financial support from the FSS in the event of an insured event.

In relation to them, conditions have been developed that regulate the procedure for paying insurance premiums, receiving compensation and their size. The categories of such persons themselves are also determined by state standards.

Who determines the classification of persons subject to compulsory insurance?

The list of persons who can and should be insured under the federal social program is drawn up and established at the state level. These lists can be modified depending on the resolutions adopted by the Duma, allocated annual allocations from the budget reserve and on amendments to federal laws.

The compilation of such a list is based on the priorities of preserving the health of the nation, in respect of which the federal social insurance program operates. In addition, the circumstances accompanying the work activities of different categories of insured persons, the degree of occupational hazard for certain professional groups, as well as social circumstances and requirements for civil liability are taken into account.

Groups of persons that are mandatory for obtaining insurance

There is a clear classification of individual social groups subject to compulsory insurance within the framework of the social insurance fund. They make up the main list, drawn up taking into account the type of social insurance:

Payment of benefits for health reasons;
Financial support for disability;
Subsidies for temporary unemployment;
Temporary disability insurance.

This list also includes payments for maternity, civil liability, financial risks, insurance of members of large families.

What categories of citizens are subject to this?

High-ranking statesmen;
Persons holding positions in municipal government;
Municipal and civil servants;
Priests of various religious denominations registered in the country;
Persons deprived of their liberty by a judgment of the judiciary, and participating in public and industrial work with actual wages;
Foreign citizens working in domestic institutions and organizations, provided that the insured pays contributions in their favor;
Employees of manufacturing, commercial enterprises and the service sector working under labor contracts;
Women who are at any stage of pregnancy before childbirth, as well as after the birth of a child;
Persons who do not have the status of an individual entrepreneur, but carry out a licensed private activity. This category includes, in particular, notaries, lawyers;
Founders, managers and employees of private farms;
Persons carrying out their activities in the framework of individual entrepreneurship;
Persons working in government and commercial institutions on the terms of the staffing table and for whom the employer pays regular insurance premiums.

In this category of persons subject to compulsory insurance, not only the insured person is entitled to compensation from. In case of complete loss of his ability to work or in case of his death, the beneficiaries may be members of his family or close relatives. Also, dependents who are on the provision of the insured person in the event of his death can apply for benefits.

The sum of money is also paid to children who have not reached the age of majority if one of their parents was the insured person. If the children of the insured continue to receive higher education, they are entitled to apply for benefits until the completion of the educational process.

Types of financial support for these individuals

At the state level, a practical scheme of financial support for obligatory insured persons and their family members has been developed. They can receive monetary support in one of the proposed formats: in the form of a one-time insurance payment, in the form of a lump-sum benefit upon disability during the recovery of health. Also, payments are made in the format of regular benefits in case of disability and complete loss of health.

In some cases, the fund pays benefits aimed at covering the additional costs associated with undergoing treatment or staying in a sanitary-resort type. This can be the payment of expenses related to the necessary medical, social or professional rehabilitation after treatment or due to the occurrence of other insured events.

The Social Insurance Fund may decide to refuse payments of various categories of benefits. Such restrictive measures are taken to prevent unjustified payments and to limit the abuse of the fund's funds for personal gain. In addition, there are whole categories of citizens who, for various reasons, simply do not have the right to FSS funds.

For example, no types of benefits will be accrued to persons who have only recently arrived in the territory of the Russian Federation for the purpose of obtaining citizenship, but at the time of filing an application do not have Russian citizenship.

Also, you should not count on social benefits for those who do not have insurance certificates and their own SNILS insurance account numbers. Typically, each citizen is assigned such a number and a certificate of compulsory insurance is issued. However, this rule does not apply to some categories of residents of the country. For example, in some religious movements it is not customary to use the assigned SNILS and identification numbers. Accordingly, such citizens cannot claim to receive insurance payments for compulsory insurance.

Social compulsory insurance funds are not paid to persons who work unofficially in certain categories of payments - in connection with injuries during production processes, for diseases. This also includes those employees who conduct unregistered private activities.

Since the listed categories of citizens will not be able to claim social benefits, they will not be able to become subjects of the social insurance system either - they will be denied this.

In some cases, the social insurance fund may refuse to pay benefits even to some insured persons. Insurance payments will not be made in cases where selfish motives are clearly traced in the actions of the insured person. For example, a person who intentionally injures or injures himself or herself, or otherwise simulates an insured event in order to receive insurance benefits, will be deprived of benefits for disability or illness.

The category of persons who are not eligible for benefits due to disability include those who are undergoing rehabilitation procedures or treatment under the sentence of the judiciary forcibly.

Restrictions can also be used for bureaucratic reasons. This is especially evident in situations when one or more of the required documents are not drawn up correctly or were submitted after the expiration of the specified period.

The State Duma on Friday at a plenary session discussed in the first reading a bill that changes the procedure for determining citizens of the Russian Federation subject to compulsory medical insurance.

Speaking about the novelties of the draft law, Stadchenko noted that the law specifies the categories of categories of persons not subject to CHI, as well as the mechanisms for the suspension and termination of CHI in respect of them.

"This is the subject of our discussion for the second reading (of the bill). We will discuss this at the sites of the health committee. This categorization is not needed to determine the non-working population and the payment of the non-working population. of working age and does not work for various reasons ... in order for the subject of the Russian Federation to work with these people to legalize them in the labor market and to legally pay all insurance premiums, including for compulsory health insurance, "Stadchenko said.

Contributions to the CHI system are now paid by employers for workers, and regional budgets for the non-working population. At the same time, the authorities have long been discussing the problem of taxation of income and payment of contributions for the so-called self-employed - citizens who conduct entrepreneurial activities without registering with the Federal Tax Service, and do not pay taxes and social contributions.

The Accounts Chamber of the Russian Federation, in its response to the bill on personified registration in the compulsory medical insurance system, proposes to give the regions the opportunity to check the reliability of the classification of citizens as non-working when paying social contributions for them.

As the head of the MHIF noted, the draft law also contains regulation of information interaction between federal government agencies and the MHIF when maintaining personalized records of information about insured persons, including the regulation of the procedures and terms for providing information about insured persons and persons not subject to CHI.

The document also states that the territorial CHI funds are empowered to verify the accuracy of the personalized records of insured persons in terms of their compliance with the identity documents of a citizen of the Russian Federation.

The draft law also contains the authority of the Russian government to approve the procedure and methodology for determining the number of insured persons, including those who are not working, for the purpose of forming the MHIF budget, the budgets of the RF subjects and the budgets of the territorial MHI funds, and also provides for the improvement of the mechanism for monitoring citizens' right to MHI. ...

"The bill does not lead to an increase in the expenditures of the budgets of the budgetary system of the Russian Federation. Financial support of medical care provided to persons insured in CHI is carried out within the limits of the subvention approved in the budget of the MHIF for the next financial year and for the planning period," concluded Stadchenko.