Rules for the provision of medical care to nonresident citizens. A complete list of free medical services and assistance from the state. What you are not eligible for under the compulsory medical insurance policy

In accordance with article 41 of the Constitution Russian Federation every citizen has the right to health care and free medical care, provided in a guaranteed volume without charging fees in accordance with the Program of State Guarantees of Free Provision to Citizens medical care (hereinafter - the Program), annually approved by the Government of the Russian Federation.
The main state sources of funding for the Program are funds from the compulsory health insurance system and budget funds.
On the basis of the Program, the constituent entities of the Russian Federation annually approve territorial programs of state guarantees for free provision of medical care (hereinafter referred to as territorial programs).

1. What types of medical care are provided to you for free

The Program provides free of charge:
1. Primary health care, including:
- primary pre-medical care, which is provided by paramedics, obstetricians and other medical workers with secondary medical education on an outpatient basis, in conditions day hospital;
- primary medical care, which is provided by general practitioners, district therapists, pediatricians, district pediatricians and general practitioners (family doctors);
- primary specialized medical care, which is provided by specialist doctors.
2. Specialized medical care, which is in inpatient conditions and in a day hospital by specialist doctors, and includes the prevention, diagnosis and treatment of diseases and conditions, including during pregnancy, childbirth and the postpartum period, requiring the use of special methods and complex medical technologies.
3. High-tech medical care with the use of new complex and (or) unique methods of treatment, as well as resource-intensive treatments with scientifically proven efficacy, including cell technologies, robotic technology. With a list of types of high-tech medical care, containing, among other things, methods of treatment and sources of financial support. You can find it in the appendix to the Program.
4. Ambulance, which turns out to be state and municipal medical organizations in case of diseases, accidents, injuries, poisoning and other conditions requiring urgent medical intervention. Medical evacuation is carried out if necessary.
To get rid of pain and alleviate other severe manifestations of the disease, in order to improve the quality of life of terminally ill patients, citizens are provided with palliative medical care on an outpatient and inpatient basis.

The above types of medical care include free of charge:
- medical rehabilitation;
- in vitro fertilization (IVF);
- various types of dialysis;
- chemotherapy for malignant diseases;
- preventive measures, including:
- preventive medical examinations, including children, working and non-working citizens studying in educational institutions full-time, in connection with physical education and sports;
- prophylactic medical examination, including those staying in inpatient institutions for orphans and children in difficult life situations, as well as orphans and children left without parental care, including those adopted (adopted), taken under guardianship (guardianship) in foster or foster family. Citizens undergo prophylactic medical examination free of charge in a medical organization in which they receive primary health care. Most of the events within the framework of clinical examination are carried out once every 3 years, with the exception of mammography for women aged 51 to 69 years and fecal occult blood tests for citizens from 49 to 73 years, which are carried out once every 2 years;
- dispensary observation of citizens suffering from socially significant diseases and diseases that pose a danger to others, as well as people suffering from chronic diseases, functional disorders, and other conditions.

In addition, the Program guarantees that:
- prenatal (prenatal) diagnosis of developmental disorders of the child in pregnant women;
- neonatal screening for 5 hereditary and congenital diseases in newborns;
- audiological screening for newborns and children of the first year of life.

Citizens are provided with medicines in accordance with the Program.

2. What are the time limits for your waiting for medical care

Medical care is provided to citizens in three forms - planned, urgent and emergency.

Emergency form provides for the provision of medical care in case of sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the patient's life. At the same time, emergency medical assistance is provided medical organization and a medical worker to a citizen without delay and free of charge. Refusal to provide it is not allowed.

Emergency form provides for the provision of medical care in case of sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the patient's life.

Planned form provides for the provision of medical assistance during preventive measures, for diseases and conditions that are not accompanied by a threat to the patient's life, do not require emergency and urgent medical care, and a delay in the provision of which for a certain time will not entail a deterioration in the patient's condition, a threat to his life and health.

Depending on these forms, the Government of the Russian Federation establishes waiting times for medical care .
So, the waiting time for rendering primary health care in an emergency should not exceed 2 hours from the moment the patient contacts a medical organization.
Terms of waiting for rendering medical care in a planned form for:
- admission by district general practitioners, general practitioners (family doctors), district pediatricians should not exceed 24 hours from the moment the patient contacts a medical organization;
- consultations of specialist doctors should not exceed 14 calendar days from the date of the patient's appeal to a medical organization;
- carrying out diagnostic instrumental (X-ray examinations, including mammography, functional diagnostics, ultrasound examinations) and laboratory examinations in the provision of primary health care should not exceed 14 calendar days from the date of appointment;
- carrying out computed tomography (including single-photon emission computed tomography), magnetic resonance imaging and angiography in the provision of primary health care should not exceed 30 calendar days, and for patients with cancer 14 calendar days from the date of appointment:
- specialized (with the exception of high-tech) medical care should not exceed 30 calendar days from the date the attending physician issued a referral for hospitalization, and for patients with oncological diseases - 14 calendar days from the date of the diagnosis of the disease.

The time of arrival to the patient of the ambulance teams in the provision of emergency medical care in an emergency form should not exceed 20 minutes from the moment of its call. At the same time, in territorial programs, the travel time of ambulance teams can be reasonably adjusted taking into account transport accessibility, population density, as well as climatic and geographical features of the regions.

3. What you shouldn't pay for

In accordance with the legislation of the Russian Federation in the field of public health, when providing medical care under the Program and territorial programs, the following are not payable at the expense of citizens' personal funds:
- provision of medical services;
- appointment and use in stationary conditions, in a day hospital, in the provision of medical care in an emergency and urgent form of drugs for medical indications:
a) included in the list of vital and essential medicines;
b) not included in the list of vital and essential medicinal products, in cases of their replacement due to individual intolerance, for health reasons;
- appointment and use of medical devices, blood components, medical nutrition, including specialized medical nutrition products for medical reasons;
- accommodation of patients in small wards (boxes) for medical and (or) epidemiological indications;
for children under the age of four, the creation of conditions for stay in stationary conditions, including the provision of a bed and food, when one of the parents, another family member or other legal representative is in a medical organization, and for a child over the specified age - in the presence of medical indications ;
transport services when a medical worker accompanies a patient being treated in an inpatient setting, if it is necessary to conduct diagnostic tests for him in the absence of the possibility of conducting them by a medical organization providing medical care.

4. About paid medical services

In accordance with the legislation of the Russian Federation, citizens have the right to receive paid medical services provided at their request in the provision of medical care, and paid non-medical services (household, service, transport and other services) provided additionally in the provision of medical care. At the same time, paid medical services can be provided in full scope of medical care, or at your request in the form of individual consultations or medical interventions.
Medical organizations participating in the implementation of the Program and territorial programs have the right to provide you with paid medical services:
on other terms than provided by the Program, territorial programs and (or) targeted programs:
- when providing medical services anonymously, except cases provided for by the legislation of the Russian Federation;
- citizens of foreign states, stateless persons, with the exception ofpersons insured under compulsory health insurance, and citizens of the Russian Federation who do not reside permanently on its territory and who are not insured under compulsory health insurance, unless otherwise provided by international treaties of the Russian Federation;
- when self-applying for medical services, with the exception of:
a) an independent appeal of a citizen to a medical organization chosen by him no more than once a year (with the exception of changing his place of residence or place of stay);
b) providing medical assistance in an emergency and urgent form when a citizen independently applies to a medical organization;
c) referrals for the provision of medical services by a general practitioner
district, district pediatrician, general practitioner (family doctor), specialist doctor, paramedic, as well as provision of primary specialized health care,
specialized medical care in the direction of the attending physician;
d) other cases provided for by legislation in the field of health protection.

The refusal of the patient from the offered paid medical services cannot be the reason for the decrease in the types and volume of medical care provided to such a patient without charging a fee within the framework of the Program and territorial programs.

5. Where to go on emerging issues and in case of violation of your rights to free medical care

On issues of free provision of medical care and in case of violation of the rights of citizens to provide it, resolution of conflict situations, including refusals to provide medical care, collection money for its provision, you should contact:
- the administration of a medical organization - to the head of the department, the head of a medical organization;
- to the office of an insurance medical organization, including an insurance representative, - in person or by phone, the number of which is indicated in insurance policy;
- the territorial body of health care management and the territorial body of Roszdravnadzor, the territorial fund of compulsory medical insurance;
public councils (organizations) for the protection of patients' rights under the state authority of the constituent entity of the Russian Federation in the field of health care and territorial body Roszdravnadzor;
- professional non-profit medical and patient organizations;
- federal authorities and organizations, including the Ministry of Health of the Russian Federation, Federal fund compulsory health insurance, Roszdravnadzor, etc.

6. What you need to know about insurance representatives of health insurance companies

An insurance representative is an employee of an insurance medical organization who has undergone special training, represents your interests and provides your individual support in the provision of medical care as provided for by law.

Insurance representative:
- provides you with reference and advisory information, including the right to choose (replace) and the procedure for choosing (replace) an insurance medical organization, a medical organization and a doctor, as well as the procedure for obtaining a compulsory health insurance policy;
-informs you about the need to undergo medical examination and asks for the results of its passage;
- advises you on the provision of medical care;
-informs about the conditions for the provision of medical care and the availability of free places for hospitalization in a planned manner;
-helps you to choose a medical organization, including one providing specialized medical care;
-controls the passage of your medical examination;
-organizes the consideration of complaints of insured citizens about the quality and availability of medical care.

In addition, you can contact the office of an insurance medical organization to an insurance representative when:
- refusal to make an appointment with a specialist in the presence of a referral from the attending physician;
- violation of the deadlines for waiting for medical care in planned, urgent and emergency forms;
- refusal to provide free drugs, medical devices, medical nutrition - everything that is provided for by the Program;
-situations when you are asked to pay for those medical services that your doctor has prescribed for medical reasons. If you have already paid for medical services, be sure to keep your cashier's receipt, sales receipts and contact an insurance medical organization, where they will help you establish the legality of the collection of funds, and in case of illegality, arrange for their refund;
- in other cases when you believe that your rights are being violated.

1. Everyone has the right to medical assistance.

2. Everyone has the right to medical care in a guaranteed volume, provided free of charge in accordance with the program of state guarantees of free provision of medical care to citizens, as well as to receive paid medical services and other services, including in accordance with a voluntary medical insurance contract.

3. The right to medical assistance of foreign citizens residing and staying in the territory of the Russian Federation is established by the legislation of the Russian Federation and the relevant international treaties of the Russian Federation. Stateless persons permanently residing in the Russian Federation enjoy the right to medical care on an equal basis with citizens of the Russian Federation, unless otherwise provided by international treaties of the Russian Federation.

4. The procedure for rendering medical assistance to foreign citizens is determined by the Government of the Russian Federation.

5. The patient has the right to:

1) the choice of a doctor and the choice of a medical organization in accordance with this Federal Law;

2) prevention, diagnosis, treatment, medical rehabilitation in medical organizations in conditions that meet sanitary and hygienic requirements;

3) obtaining advice from specialist doctors;

4) relief of pain associated with the disease and (or) medical intervention, available methods and drugs;

5) obtaining information about their rights and obligations, the state of their health, the choice of persons to whom information about the state of their health can be transferred in the interests of the patient;

6) receiving medical food in the event of a patient being treated in a stationary setting;

7) protection of information constituting a medical secret;

8) refusal from medical intervention;

9) compensation for harm caused to health in the provision of medical assistance;

10) admission of a lawyer or legal representative to him to protect his rights;

11) admission of a clergyman to him, and in the case of a patient being treated in a stationary environment - to provide conditions for the administration of religious rituals, which can be carried out in stationary conditions, including the provision of a separate room, if this does not violate the internal order of the medical organization.

Rules for the provision of medical care to foreign citizens on the territory of the Russian Federation

(Resolution of the Government of the Russian Federation of March 6, 2013 N 186, Moscow "On approval of the Rules for the provision of medical care to foreign citizens on the territory of the Russian Federation")

1. These Rules determine the procedure for providing medical care to foreign citizens on the territory of the Russian Federation.

2. Medical assistance to foreign citizens temporarily staying (temporarily residing) or permanently residing in the Russian Federation is provided by medical and other medical activity organizations, regardless of their organizational and legal form, as well as individual entrepreneurscarrying out medical activities (hereinafter - medical organizations).

3. Medical assistance in emergency form in case of sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the patient's life is provided to foreign citizens by medical organizations free of charge.

4. Foreign citizens who are insured in accordance with the Federal Law "On Compulsory Medical Insurance in the Russian Federation" are entitled to free medical care within the framework of compulsory medical insurance.

5. Ambulance, including specialized ambulance, medical care is provided to foreign citizens in case of illness, accidents, injuries, poisoning and other conditions requiring urgent medical intervention.

Medical organizations of the state and municipal health care systems provide this medical assistance to foreign citizens free of charge.

6. Medical assistance in urgent form (except for emergency, including emergency specialized, medical care) and planned form is provided to foreign citizens in accordance with contracts for the provision of paid medical services or voluntary medical insurance contracts and (or) concluded in favor of foreign citizens specified in clause 4 of these Rules, contracts in the field of compulsory health insurance.

7. Medical care in a planned form is provided subject to the presentation by a foreign citizen of written guarantees of the fulfillment of the obligation to pay the actual cost of medical services or prepayment of medical services based on the expected volume of provision of these services (except for cases of medical care in accordance with paragraph 4 of these Rules), as well as the necessary medical documentation (extract from the medical history, data of clinical, radiological, laboratory and other studies), if any.

8. After completing the treatment of a foreign citizen in his address or the address of a legal or natural personrepresenting the interests of a foreign citizen, in agreement with the said citizen, an extract from the medical documentation is sent, indicating the period of medical care in the medical organization, as well as the measures taken for prevention, diagnosis, treatment and medical rehabilitation.

Medical documentation sent from the Russian Federation to another state is completed in Russian.

9. Invoices for actually provided medical care within 10 days after the end of treatment are sent by a medical organization to the address of a foreign citizen or a legal or natural person representing the interests of a foreign citizen, unless otherwise provided by the contract under which it was provided (for except for cases of medical assistance in accordance with paragraph 4 of these Rules).

10. Disputes related to the provision of medical care or untimely payment of invoices for actually rendered medical care are resolved in the manner prescribed by the legislation of the Russian Federation.

11. If an international treaty of the Russian Federation establishes a different procedure for the provision of medical assistance to foreign citizens, the rules of the international treaty shall apply.

Emergency and urgent medical care is provided to citizens who are outside the territory of the constituent entity of the Russian Federation in which the citizen lives (hereinafter referred to as nonresident citizens) promptly and free of charge.
Otherwise, in accordance with Article 35 Federal law of November 29, 2010 No. 326-FZ "On compulsory medical insurance in the Russian Federation", all citizens have the right to receive medical care included in the basic compulsory medical insurance program (link), including outside the constituent entity of the Russian Federation in which the policy was issued OMS.

To be attached to a medical organization to receive medical care outside the territory of the constituent entity of the Russian Federation in which a citizen lives, a citizen must apply to the medical organization of his choice with a written application (application).
When choosing a medical organization, a nonresident citizen also has the right to choose a doctor.
If the clinic refuses to attach or choose a doctor, you have every reason to file a complaint.

PROCEDURE AND TERMS OF CONSIDERATION OF AN APPLICATION OF ANOTHER CITIZEN

Free medical care in medical organizations upon the occurrence insured event (illness, injury, etc.) throughout Russia in the amount established by the basic CHI program and in the territory in which the policy was issued - in the amount of the territorial CHI program (each region has its own).

The choice of an insurance medical organization in the manner prescribed oMS rules by submitting an application

Replacement of an insurance medical organization, in which a citizen was previously insured, once during a calendar year, but no later than November 1 (or more often in the event of a change of residence or termination of the contract on financial support CHI in relation to your medical insurance organization) by submitting an application to the newly selected medical insurance organization

Selection of a medical organization from those participating in the implementation of the territorial CHI program

Choosing a doctor by filing an application addressed to the head of a medical organization in person or through his representative

Obtaining from the territorial fund, medical insurance organization and medical organizations reliable information about the types, quality and conditions for the provision of medical care under compulsory medical insurance

Protection of personal data collected for personalized accounting in the CHI

Reimbursement by an insurance medical organization of damage caused in connection with non-fulfillment or improper fulfillment by an insurance medical organization of its obligations to organize the provision of medical care in accordance with the legislation of the Russian Federation

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

Protection of rights and legitimate interests in the field of CHI

What are the obligations of the Insured Citizens under the CHI?

Present the compulsory medical insurance policy when applying for medical care, except in cases of emergency medical care.

Submit an application for choosing an insurance medical organization to an insurance medical organization in person or through your representative in accordance with the rules of the CHI.

Notify the medical insurance organization about the change in the last name, first name, patronymic, place of residence within one month from the day when these changes occurred.

Carry out the 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.

What is the procedure for choosing an insurance medical organization?

the insured person has the right to choose or replace an insurance medical organization (HMO) from the HMO, the list of which is posted by the territorial CHI fund on its official website on the Internet and may additionally be published in other ways

to select or replace the medical insurance company, the insured person personally or through his representative applies to the chosen medical insurance organization with an application for the choice (replacement) of the medical insurance company. To apply for a compulsory medical insurance policy, you must contact any branch office convenient for you. Get acquainted with the application form and the list of necessary documents for issuing an OMI policy.

The choice or replacement of a medical insurance company 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. Compulsory health insurance for children from the day of birth until the expiration of thirty days from the date of state registration of birth is carried out by medical insurance companies in which their mothers or other legal representatives are insured. Upon the expiration of thirty days from the date of state registration of the birth of a child and until he reaches the age of majority or until he acquires legal capacity in full, CHIs provide CMOs, chosen by one of his parents or other legal representative.

The insured person has the right to replace the health insurance company 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 activity of the health insurance company in which the citizen was previously insured. If the place of residence is changed and there is no health insurance company in which the citizen was previously insured, the insured person chooses the health insurance company at the new place of residence within one month. CMO notifies insured persons of their intention to terminate their activities ahead of schedule three months before the date of termination of activities. In case of early termination of the activities of the HI, the insured person within two months submits an application for the choice (replacement) of the HI to another HI.

If the insured person does not submit an application for the choice (replacement) of an insurance medical organization, then such a person is considered insured by the insurance medical organization in which he was previously insured.

Who will protect your rights?

An insurance medical organization issues policies, keeps records of insured citizens and medical care provided to them, is obliged to inform its insured about the types, quality and conditions for providing them with medical care, to protect their rights and interests. Remember, an insurance medical organization is your assistant in solving problems and controversial issues related to receiving medical care under the CHI program. If you are insured in one of our companies, you can contact our offices for advice, legal support, professional help, to resolve a conflict with a medical institution or doctor.

In accordance with Article 21 of the Federal Law of 21.11.2011 No. 323-FZ "On the Fundamentals of Health Protection of Citizens in the Russian Federation", when providing a citizen with medical care under the program of state guarantees of free provision of medical care to citizens, he has the right to choose a medical organization in the manner approved by the authorized federal executive body, and the choice of a doctor subject to the doctor's consent.

When rendering medical care to a citizen within the framework of the program of state guarantees of free provision of medical care to citizens, the choice of a medical organization (except for cases of rendering emergency medical care) outside the territory of the constituent entity of the Russian Federation in which the citizen lives is carried out in the manner established by the authorized federal executive body.

In accordance with the order of the Moscow City Health Department and the Moscow City cHI fund dated 11.10.2010 No. 1794/130 "On approval of the procedure and conditions for the provision of medical care under the Moscow city CHI program" implementation of the right of citizens insured under CHI in the city of Moscow to choose a medical institution in the system OMS city Moscow is carried out on the basis of a written application addressed to the chief physician in accordance with the resource capabilities of the institution.

The provision of primary health care is carried out on the basis of the order of the Ministry of Health and Social Development of Russia dated 15.05.2012 N 543n (as amended on 30.09.2015) "On approval of the Regulation on the organization of the provision of primary health care to adults" (Registered in the Ministry of Justice of Russia on 27.06.2012 N 24726)

According to the order of the Ministry of Health of the Russian Federation dated December 21, 2012 No. 1342n "On approval of the procedure for choosing a medical organization by a citizen (except for cases of providing emergency medical care) outside the constituent entity of the Russian Federation, in which a citizen lives, when providing him with medical assistance under the state guarantees free provision of medical care "for the provision of medical care outside the territory of the constituent entity of the Russian Federation in which the citizen lives, the citizen personally or through his representative applies to the medical organization of his choice with a written application for choosing a medical organization, presenting originals or certified copies of the following documents:

• a passport of a citizen of the Russian Federation or a temporary identity card of a citizen of the Russian Federation, issued for the period of registration of the passport;
• compulsory health insurance policy (temporary compulsory medical insurance policy);
• SNILS (if available).

Citizens insured under compulsory medical insurance in the city of Moscow receive medical assistance upon presentation of a compulsory health insurance policy (when first contacting a medical and prophylactic institution, in addition to the compulsory health insurance policy, you must present a passport). In the absence of a compulsory medical insurance policy in patients (in case of emergency contact), medical institutions carry out measures to identify the patient in order to identify the insurer or classify him (according to the passport) as nonresident citizens or unidentified patients.

Scheduled inpatient medical care for citizens insured under compulsory medical insurance in the city of Moscow is provided in the direction of an outpatient clinic to which they are assigned for medical care.

To receive specialized medical care in a planned form, the choice of a medical organization is carried out in the direction of the attending physician.

Ambulance and emergency medical care, including inpatient care, is provided to all citizens in Moscow free of charge, at the expense of the city budget, regardless of the presence of a certificate of registration in Moscow and a compulsory medical insurance policy.

The Department of Health of the city of Moscow in connection with the numerous appeals of citizens regarding the provision of medical care in medical organizations of the state health system of the city of Moscow informs

In accordance with the order of the Moscow Health Department of 11.10.2012 No. 1090 "On Amendments to the Order of the Moscow Health Department of 02.11.2009 No. 1400" the decision on the possibility of providing planned consultative and diagnostic and inpatient medical care to nonresident and foreign citizens at the expense of the budget of the city of Moscow (planned medical care not included in the basic program of compulsory health insurance, planned medical care in medical organizations that do not work in the compulsory health insurance system, program and peritoneal dialysis, hemosorption, organ and / or tissue transplantation, chemotherapy treatment, receipt of expensive drugs for blood diseases, multiple sclerosis, systemic collagenosis, after organ and / or tissue transplantation) is accepted by the Moscow City Health Department upon a written application from the patient or his legal representative I am addressed to the head of the Moscow City Health Department.

The written application of the patient (legal representative of the patient) must contain the following information: last name, first name, patronymic of the patient, date of birth, citizenship, registration address at the place of residence, postal address at the place of actual residence (stay), contact numbers, information about the legal representative of the patient ( if any), the essence of the appeal. The following documents are attached to the written application: copies of identity documents, citizenship and registration at the patient's place of residence (stay), a copy of the patient's compulsory medical insurance policy (if any), a copy of a certificate confirming the presence of disability (if any), an extract from medical documentation , the results of studies carried out on the patient's disease profile, other medical documentation (if any).

If the patient's legal representative applies, the set of documents additionally includes: a copy of the identity document of the patient's legal representative, a copy of the document confirming the powers of the patient's legal representative.

In accordance with the Law of the Russian Federation "On medical insurance of citizens in the Russian Federation", the Rules of compulsory medical insurance for the population of the city of Moscow, the Territorial program of state guarantees for the provision of free medical care to the population of the city of Moscow, and we order insurance:

1. To approve the Procedure and conditions for the provision of medical care under the Moscow City MHI Program ().

2. Heads of health departments administrative districts of Moscow, the heads of medical and preventive establishments shall bring this document to the attention of subordinate medical and preventive establishments and structural units for management and execution.

3. The Moscow City Compulsory Medical Insurance Fund shall ensure that the population of Moscow is informed about the procedure and conditions for providing medical care under the Moscow City Compulsory Medical Insurance Program.

4. To consider as invalid the order of the Moscow City Health Department and the Moscow City Compulsory Medical Insurance Fund dated November 14, 2008 No. 931/131 "On approval of the Procedure and conditions for the provision of medical care under the Moscow City MHI Program"

5. Control over the execution of this order shall be entrusted to SV Polyakov, First Deputy Head of the Moscow City Health Department. and Deputy Executive Director of the Moscow City Fund of Compulsory Medical Insurance Yuriev T.I.

application
to the Department
health care in Moscow
and the Moscow City CHI Fund
dated October 11, 2010 N 1794/130

Terms and conditions
provision of medical care under the Moscow city compulsory medical insurance program

1. Medical care within the framework of the Moscow city program of compulsory medical insurance (MHI) is provided by medical institutions operating in the MHI system of Moscow to citizens subject to compulsory health insurance:

Citizens insured under compulsory medical insurance in Moscow;

Citizens who are insured under compulsory medical insurance on the territory of other constituent entities of the Russian Federation (hereinafter - "nonresident citizens");

Patients, for objective reasons not identified (for compulsory medical insurance policy) when providing them with primary health care and specialized medical care for emergency indications, on an outpatient or inpatient basis (hereinafter referred to as "unidentified patients").

2. Citizens insured under the compulsory medical insurance in Moscow receive medical assistance upon presentation of the compulsory health insurance policy (when first contacting a medical institution, in addition to the compulsory medical insurance policy, you must present a passport).

In the absence of a compulsory medical insurance policy in patients (in case of emergency contact), medical institutions carry out measures to identify the patient in order to identify the insurer or classify him (according to the passport) as nonresident citizens or unidentified patients.

Scheduled inpatient medical care for citizens insured under compulsory medical insurance in Moscow is provided in the direction of an outpatient clinic to which they are assigned for medical care.

Medical assistance to citizens insured under compulsory medical insurance in Moscow, in departmental and non-state medical institutionsparticipating in the implementation of the Moscow city CHI program is provided taking into account the volumes (types) of medical care planned by the medical institution and approved by the Moscow City Health Department.

3. Nonresident citizens are provided with routine medical care in the amount of the Moscow City MHI program in medical institutions of the Moscow City Health Department upon presentation of a territorial MHI policy and a passport (in the absence of an MHI policy for objective reasons, only passports, and for children - the passport of one of the parents or others legal representatives).

In order to implement the principle of the availability of free medical care, nonresident citizens living in Moscow are assigned to medical care, and the medical institution is entered into the register of the attached population on the basis of a written application addressed to the chief physician.

Scheduled inpatient medical care for nonresident citizens is provided on the basis of directions issued by the Moscow City Health Department, health departments of Moscow administrative districts (in accordance with the subordination of the institution), as well as directions issued by medical institutions if nonresident citizens are attached to them, incl. h. children and pregnant women for medical care.

4. Diagnostic examinations and consultations are carried out according to medical indications and are appointed by the attending physician.

The attending physician selects specialists for consultations and selects medicines, materials and medical devices.

If the normative load of a specialist and / or a medical institution is exceeded, the receipt of consultative, diagnostic and planned medical care under the compulsory medical insurance program is carried out in order of priority.

5. The exercise of the right of citizens insured under compulsory health insurance in Moscow to choose a treatment and prophylactic institution in the compulsory health insurance system of Moscow is carried out on the basis of a written application addressed to the chief physician, in accordance with the resource capabilities of the institution: capacity, staffing with medical personnel and the Procedure organization of medical services for the population according to the district principle, approved by order of the Ministry of Health and Social Development of Russia dated 04.08.06 N 584.

Home care is provided by medical workers of institutions located in the territory of actual residence of citizens.

The exercise of the right of insured under compulsory medical insurance to choose a doctor, including a family doctor and a doctor, is carried out subject to his consent.

6. Medical institutions provide citizens with free and accessible information:

On the types of medical services provided free of charge within the framework of targeted programs for the development of the capital's health care and Territorial program state guarantees for the provision of free medical care to the population of the city of Moscow, a component of which is the Moscow city program of compulsory medical insurance;

On the types of medical services provided by a medical institution at the expense of citizens' personal funds or other sources of funding within the framework of voluntary medical insurance;

On the possibilities of a medical institution to provide services at the request of citizens for a fee, at prices reflecting the full cost of medical services, and (or) provide services for an additional fee (without paying the full cost of medical services);

On the conditions for the provision and receipt of paid services;

On benefits for certain categories of citizens.

7. The medical insurance organization that issued the MHI policy considers the applications of the insured in order to ensure and protect their rights to receive medical care within the framework of the Moscow City MHI program. In the event that the application of a citizen insured under the compulsory medical insurance claims to the organization and (or) the quality of medical care provided, the medical insurance organization is obliged to organize an examination of the quality of medical care in the manner and terms stipulated by the Regulation on medical and economic control of the volume and examination of the quality of medical care under the CHI program.

If necessary, an insurance medical organization takes measures to provide certain types of medical care to insured persons under compulsory medical insurance in other medical institutions that are in contractual relations with it.

8. Citizens insured under the compulsory medical insurance in Moscow, nonresident citizens and unidentified patients, when receiving free medical care, have the rights established by the Fundamentals of the legislation of the Russian Federation on the protection of public health and the Law of the Russian Federation "On medical insurance of citizens in the Russian Federation".

In case of violation of rights, the patient can apply:

Directly to the head or other official of the medical institution in which he received medical assistance;

To the health department of the corresponding administrative district of Moscow;

The Moscow City Health Department;

To an insurance medical organization that issued an OMI policy to the insured and assumed obligations to protect his interests;

To the City Arbitration Expert Commission (GAEK) if the patient's claims have already been considered by the insurance medical organization and the insured's claims were not satisfied (applications for transfer to GAEK are accepted by the Organization's Office OMS of Moscow city \u200b\u200bfund of compulsory health insurance);

9. Unreasonable refusals to provide insured persons with OMS for citizens free medical care in medical institutions participating in the implementation of the Moscow city compulsory medical insurance program.

Note.

1. In accordance with the Decree of the Moscow Government dated 04.03.2008 N 145-PP, the Moscow City Health Department issues referrals for hospitalization (consultation), including those insured under compulsory medical insurance in the city of Moscow and on the territory of other constituent entities of the Russian Federation, within the framework of The territorial program of state guarantees for the provision of free medical care to the population of the city of Moscow, as well as citizens living in the territory of the CIS countries, at the expense of the "Healthcare" industry within the framework of existing intergovernmental agreements (contracts) that determine the procedure for interaction in the field of healthcare.

2. In accordance with the Decree of the Government of the Russian Federation of 01.09.2005 N 546, emergency medical care for foreign citizens is provided by medical and preventive institutions of the state and municipal health care system in the event of conditions that pose an immediate threat to their lives or require urgent medical intervention free of charge (at the expense of budget). After recovering from these conditions, foreign citizens can be provided with routine medical care on a paid basis. If an international treaty of the Russian Federation establishes a different procedure for the provision of medical care to foreign citizens, the rules of the international treaty shall apply.

Order of the Moscow City Health Department and the Moscow City MHIF dated October 11, 2010 N 1794/130 "On approval of the Procedure and conditions for the provision of medical care under the Moscow City MHI Program"

Document overview

It has been established that medical care under the Moscow city CHI program is provided by medical institutions operating in the CHI system, to citizens subject to compulsory health insurance: insured under the CHI of Moscow; insured in the territory of other constituent entities of the Russian Federation; patients who, for objective reasons, are not identified (according to the compulsory medical insurance policy) when they are provided with primary health care and specialized medical care for emergency indications.

Citizens insured under the CHI have the right to choose a medical and preventive institution in the CHI system. To do this, they need to apply to the name of the head physician.

Unreasonable refusals to provide free medical care to citizens insured under compulsory medical insurance in medical institutions participating in the implementation of the Moscow city compulsory medical insurance program are not allowed.