Health insurance is not an innovation. This program was launched so that all categories of the population could receive the basic minimum medical care.

During the time that it has been in effect, people have managed to form their own opinions about different companies, and if some insurers are not satisfied, then you can always turn to others.

1. The selection and replacement of the insurance company can be carried out by a person who has reached the age of majority from among the organizations represented in the area of ​​residence:
in the case of children, the right to vote remains with their legal representatives;
replacement can be carried out once a year until November 1, which guarantees smooth and systematic financing of all programs;
To make the transition, you only need to submit an application to the selected company.

2. An exception to the rule is a change of residence, when the choice is necessary due to the absence of an old insurance company office in the area. In addition, a change of company can be made at any time if insurance organization ceased to exist.

The location of the office plays a decisive role when you have to obtain a policy yourself. It is also worth paying attention to the availability of a 24-hour support service in the company.

An insured event can occur at any time and, accordingly, consultation may be needed even at night.
Which company is better

Compulsory health insurance is quite well developed and has detailed explanations. But for a person with little knowledge of legislative framework these comments may remain unclear.

Using the policy in full is often not possible without a specialist’s explanation and consultation with an expert doctor.

1. If the time has come and you need to obtain or change a compulsory medical insurance policy - which one? insurance company choose to receive a policy, you need to think about it in advance. The belief that all insurance companies work according to the same rules and, accordingly, their services are no different is extremely incorrect:
The larger the company, the larger its financial base, which means insurance assistance can be provided anywhere and in full;
Insurance companies that have been operating for a long time have gained a certain reputation, which can be studied by looking at reviews about them on the Internet. New companies are a “pig in a poke” from which you don’t know what to expect.

2. A big difference can be seen by comparing the offers of federal and regional levels. They differ not only in the composition and number of insurers:
in the first case, there is no connection to a specific area. Customer support is provided anywhere upon request;
in the second, the insurers are geographically tied to their area beyond the limit of which their coverage does not extend.

In addition, more qualified specialists who are able to provide better protection of clients’ interests cooperate with large companies.

The choice of insurance company should be approached responsibly. It is she who is the guarantor of payment for treatment in the event of an accident and ensures the provision of free medical services.

All citizens of the Russian Federation, without exception, are insured in the compulsory medical insurance system. Eligibility insurance policy have foreigners permanently residing in Russia.

The policyholders in the system of this type are:

• institutions;
• enterprises;
• directly the state.

Enterprises transfer 5.1% of the total amount of wages to territorial or federal compulsory medical insurance funds. Medical insurance for unemployed citizens is paid directly by the state.

The most important component of compulsory health insurance are special funds. They represent non-profit organizations, in which all are accumulated money transfers in favor of the system health insurance.

They provide financial stability, and also, if necessary, provide financial support to insurance companies.

The direct participants of compulsory medical insurance are commercial insurance companies. They are required to have the appropriate state license to carry out insurance activities.

They enter into contracts with medical institutions to provide services to their clients, issue medical policies, and monitor the quality and timing of medical care.

Medical facilities are the ultimate compulsory medical insurance segment. Citizens of the Russian Federation turn to them to receive appropriate assistance. The presence of a policy of the described sample gives full right to free receipt medical services.

Law on Compulsory Medical Insurance

Today the basis for compulsory medical insurance actions is the Federal Law “On Compulsory Health Insurance in the Russian Federation”.

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

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

Complement the effect of Federal Law No. 326:

• Law of November 21, 2011 “On the fundamentals of protecting the health of citizens of the Russian Federation”;
• Law of July 16, 1999 “On the basics of compulsory medical insurance.”

Relationships between subjects compulsory medical insurance systems are also regulated by various other provisions and acts of the regions of the Russian Federation. Each insured event is considered separately, on an individual basis.

Compliance with the law in question is primarily monitored by the federal and regional compulsory medical insurance fund.

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

What does the policy provide?

Compulsory medical insurance policy confirms that a citizen has the right to receive free medical care.

If available, the insured person has the right to contact the following institutions:

• the clinic to which the insured person is registered;
• traumatology;
• dentistry;
• oncology departments, dispensaries;
• hospitals participating in compulsory medical insurance.

Having a compulsory health insurance policy allows you to financial costs receive almost any medical care.

This document is currently mandatory for submission to medical institution when contacting. If for some reason there is no compulsory medical insurance policy, then an individual can receive medical care on a paid basis.

What does he look like

Today, the compulsory health insurance policy has a standard form. Moreover, its format does not depend on the services of which insurance company the citizen uses. The appearance depends only on the type of medical policy.

Recently, reform of the health insurance system has been carried out. It is in this regard that a new type of insurance policy was issued. It looks like plastic card, on front side which contains an individual card number.

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On back side The following information is available:

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

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

There is also another type of policy - temporary. It is issued for a period of 30 days in the event of a situation where the plastic policy is confiscated.

This happens if a person previously simply did not have a policy of the type in question, or if it is being replaced. Upon expiration of thirty days from the date of receipt, the temporary policy ceases to be valid.

It itself is A5 paper and contains the following information:

• date of issue;
• signature of the policyholder;
• name of the representative of the medical insurance organization.

Previously, old-style policies were in effect. They were in A3 format and contained information similar to that presented on temporary policy Compulsory medical insurance.

Agreement conditions

The terms of the compulsory health insurance agreement were approved by the Director of the Federal Compulsory Medical Insurance Fund A.M. Taranov 03.10.03.

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

The document under consideration necessarily contains clauses to avoid the emergence of various types of conflicts, and the boundaries of responsibility are indicated.

The section “Subject of the contract” stipulates the conditions under which the insurer provides its services to the policyholder. A certain amount (insurance premium) is paid to the insurance company.

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

This section identifies the object of insurance – the client’s property interest. That is, in fact medical insurance Compulsory medical insurance protects its owner, first of all, from financial damage. This section also defines the concept of an insured event.

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

When taking out a standard policy Compulsory medical insurance given there is no section - it is displayed in the agreement between the insurance company and the regional (federal) compulsory medical insurance fund. The section “Duration of the agreement” determines the duration of the agreement of the type in question.

The clause “rights and obligations of the parties” states the obligations arising between the policyholder and the insurer in the event of its conclusion.

The rights of the parties are also discussed in as much detail as possible. The occurrence of serious violations of at least one clause is a serious reason for termination of the contract.

The insurance company must ensure the confidentiality of information relating to the policyholder. Exceptions are possible only in cases provided for by the current legislation of the Russian Federation.

The following information is confidential:

• content of the agreement, its form;
• the health status of the policyholder, all existing cases of seeking medical help;
• personal data of the policyholder (place of residence, home telephone number, etc.).

The section “Change and termination of the contract” lists situations when it is possible to make any amendments to the text of the document.

All cases when the contract can be terminated and the procedure for carrying out this process are listed. At the end of the agreement, the details of the parties are indicated: actual and legal addresses, telephone numbers.

Validity

Several years ago, different policies were issued in different regions compulsory insurance. That is why their validity period varies significantly. In 2011, a gradual transition to a unified compulsory health insurance policy began.

Today, policies of this type, which are a plastic card, usually do not have expiration dates. The only exception is the issuance of a policy to a foreign citizen.

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

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

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

Necessary documents for registration

The list of documents required to apply for a compulsory medical insurance policy varies depending on the age, as well as the legal status of the person applying to the insurance company.

To obtain a policy, children over 14 years of age (citizens of the Russian Federation) must provide the following documents to the insurance company:

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

If the papers for issuing a policy of the appropriate type are provided by a parent or guardian, then a passport or other identification document is required.

If the policy is taken out by relatives, then they must present:

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

Citizens of the Russian Federation who have not reached 18 years of age, but have overcome the age threshold of 14 years:

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

Persons over 18 years of age:

• identity document or passport;
• SNILS.

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

• petition;
• certificate of the appropriate type;
• an appeal against a court decision to deprive refugee status to the Federal Migration Service;
• document confirming receipt of temporary asylum.

For individuals, who do not have permanent citizenship, but have real estate, a residence permit:

• passport foreign citizen;
• SNILS (if available);
• resident card.

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

• identity card and document confirming lack of citizenship;
• SNILS (if available);
• resident card.

In the absence of any document, obtaining an insurance policy becomes simply impossible.

Insurance premiums

Insurance premiums for compulsory medical insurance are payments transferred to the Federal Compulsory Medical Insurance Fund of the Russian Federation.

Today, payers of compulsory medical insurance premiums, according to the Federal Law “On Compulsory Medical Insurance” are:

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

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

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

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

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

Register of services provided

IN basic list compulsory health insurance includes the following types help:

• emergency medical service;
• preventive;
• primary health care.

There is also a list of specialized services that are provided completely free of charge or on a preferential basis.

Under the compulsory health insurance policy, you can have an abortion, childbirth or the postpartum period free of charge.

The compulsory medical insurance system provides the following types of medical care:

• dental, oncological (list approved by the Health Committee of the Russian Federation);
• implementation of preventive fluorographic studies in order to detect tuberculosis in the early stages;
• prevention of various diseases using special types of vaccines;
• preferential prosthetics, provision of medicines;
• inpatient, provided in special outpatient departments.

Dental treatment according to the policy

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

Free of charge, subject to availability:

• conducting an initial examination and consultation (including for patients who are unable to move independently);
• drawing up a preventive disease map;
• treatment:
  • carious formations;
  • pulpitis;
  • periodontitis;
  • periodontal diseases;
  • diseases of the oral cavity, mucous membrane;

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

For children under 14 years of age, many clinics provide treatment:

• non-carious lesions of hard dental tissues;
• demineralization;
• orthodontics using special removable equipment.

What are the types

Today there are three types of compulsory medical insurance policy:

• a sheet of A5 paper with a special barcode on it;
• a plastic card, which is a studded electronic medium;
• electronic application with a number printed on the UEC (universal electronic card).

Previously, until 2011, compulsory medical insurance policies were issued different formats. Today, this area of ​​insurance is more streamlined.

Amendments have been made to the legislation allowing any citizen to choose the policy format independently.

Policies in electronic form have one important advantage over on paper– there is no need to extend them.

A standard A5 policy can be obtained at any issuing point. To obtain a universal electronic card or a plastic card, you need to visit a specialized issuing point.

The legislation in force on the territory of the Russian Federation allows all citizens to receive medical care in full free of charge. Only in certain cases will it be necessary to make a payment, but this applies only to very rare cases.

Most often, when visiting a clinic, you just need to provide the compulsory medical insurance policy to the registry - this will be enough.

Video: Protecting patients' rights in the compulsory medical insurance system

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Get a policy Replace [restore]

Reasons for replacing or reinstating a compulsory medical insurance policy:

• when changing the last name, first name, patronymic, date of birth, place of birth, insured person;
• establishing inaccuracy or erroneous information;
• dilapidation and unsuitability of the policy for further use;
• loss of the policy.

draw your attention to that in the event of a change of place of residence (another region) or the choice of another insurance company, the policy cannot be replaced, and the insurance company’s seal is placed on the reverse side of the paper form or changes are made to electronic policy Compulsory medical insurance, with PIN and PUK codes.

To replace (restore) a compulsory health insurance policy:

To obtain a compulsory health insurance policy:

Who will be covered by the compulsory health insurance policy?

To yourself To another person

Documents for registration of compulsory medical insurance policy. Select your population category:

Adult citizens of the Russian Federation (except for military personnel and those equivalent to them)

1. Birth certificate

3. SNILS - certificate of compulsory pension insurance for a child (if available).

1. Identification document (passport of a citizen of the Russian Federation, temporary identity card of a citizen of the Russian Federation, issued for the period of registration of the passport)

2. Identity document of the child’s legal representative

3. SNILS - certificate of compulsory pension insurance for a child

1. A refugee certificate or a certificate of consideration of an application for refugee recognition on the merits, or a certificate from the Federal Migration Service about the acceptance of a complaint against a decision to revoke refugee status or a certificate of temporary asylum in the territory of the Russian Federation

2. Residence permit

1. Passport of a foreign citizen or other document established federal law or recognized in accordance with international treaty of the Russian Federation as an identity document of a foreign citizen with a mark on permission for temporary residence in the Russian Federation

1. A document recognized in accordance with an international treaty of the Russian Federation as an identification document of a stateless person

2. Residence permit

3. SNILS - certificate of compulsory pension insurance (if available)

1. A document recognized in accordance with an international treaty of the Russian Federation as an identification document of a stateless person, with a note indicating a temporary residence permit in Russian Federation

2. SNILS - certificate of compulsory pension insurance (if available)

1. Passport of a foreign citizen or other document established by federal law or recognized in accordance with an international treaty of the Russian Federation as an identification document of a foreign citizen

2. SNILS - certificate of compulsory pension insurance

3. Employment contract of a working member state of the EAEU

4. A detachable part of the notification form about the arrival of a foreign citizen or stateless person at the place of stay or a copy thereof indicating the place and period of stay

1. Passport of a foreign citizen or other document established by federal law or recognized in accordance with an international treaty of the Russian Federation as an identification document of a foreign citizen

2. SNILS - certificate of compulsory pension insurance

3. A document confirming the person’s relationship to the category of officials, employees of EAEU bodies

Power of attorney and identification document of the representative. To register a compulsory medical insurance policy for minors, a power of attorney from a legal representative is required.

Where to get a compulsory medical insurance policy

To apply for or reissue (replace) a compulsory medical insurance policy, you must contact the company personally or through a representative. RESO-Med has a large number of policy issuing points, this makes it possible to choose a convenient location and reduce the time for obtaining a document. You can find an office by calling or calling the company’s Contact Center at 8 800 200-92-04.

Compulsory medical insurance policy of a single sample

Compulsory medical insurance policy is a document confirming the right of a citizen to receive free medical care (services) in the scope of the basic compulsory medical insurance program throughout the Russian Federation and the territorial compulsory medical insurance program in the territory of the subject of the Russian Federation in which the compulsory medical insurance policy was issued.

According to 326-FZ, the production of compulsory medical insurance policies of a uniform standard is organized Federal Fund compulsory medical insurance of the Russian Federation, and their issuance to insured persons is carried out by insurance medical organizations (IMO) in the manner established by the Rules of compulsory medical insurance.

A compulsory medical insurance policy or, as it is often called, a “medical policy” is necessary not only for receiving medical care. Often a medical policy or a copy of it is asked to be provided when placing a child in kindergarten or school, when applying for a job, as a rule, the organizers of various sports competitions are asked to present a compulsory medical insurance policy.

As for cases of seeking medical help, presenting a compulsory health insurance policy is the responsibility of the insured person, established by federal law (except for cases of emergency care).

Replacing a new policy or reissuing it is required only if the surname, first name, patronymic, date of birth, place of birth, insured person are changed, the information contained in the policy is determined to be inaccurate or erroneous, the policy is dilapidated and unsuitable for further use, or the policy is lost. The insured is obliged to notify his insurance company within a month of changes in his last name, first name, patronymic, place of residence, and identification document details.

With the application for surrender (loss) of the policy, military personnel are presented with the following documents:

1) an identification document (passport of a citizen of the Russian Federation, temporary identity card of a citizen of the Russian Federation, issued for the period of registration of the passport);

3) policy (provided only upon surrender of the policy).

With compulsory health insurance, each citizen can be insured by only one insurance company. medical organization and have only one compulsory medical insurance policy.

A lot of responsibility rests on the individual when choosing an insurance company. With the new law “On Compulsory Health Insurance in Russia,” the level of Russian insurance. A medical insurance policy is a compulsory medical insurance document that guarantees compulsory medical care in the event of an accident throughout the Russian Federation, in connection with the 100% medical education program.

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The right to choose an insurer

Health insurance- part of public protection of a person, which consists in preserving his health. It manifests itself in the guarantee of payment for medical services at the expense of the insurance company in the event of an accident or other unforeseen conditions.

It allows you not to worry about the future and provides people with free provision of a specific amount of medical services in case of an accident (deterioration of well-being), if there is a contract with a medical insurance organization. It is she who bears all the costs of paying for medical services to the institution provided for in the contract.

This counts voluntary insurance, but the very presence of an insurance policy is mandatory for those who travel abroad (), since this is a clear requirement for obtaining a visa to places such as Schengen countries and others. There is a discussion going on about introducing this type of insurance as mandatory when booking a trip through tourist form 15. Because it is precisely this that allows you to get help in medical institutions that do not work for free.

Each subject has the right to:

• Take advantage of all types of honey. insurance;
• Individual choice of medical insurance organization;
• Monitoring the implementation of the terms of the compulsory medical insurance contract.

The above rights of the policyholder are mandatory and are enshrined in the Legislation of the Russian Federation.

Therefore, the advantage of the policyholder, according to compulsory medical insurance, for a role in all types of medical care, means only the likelihood of his participation in helping himself, through free medicine if necessary.

The advantage of certain categories of insured (regulatory authority of a constituent entity of the Russian Federation, district self-government body, municipal, federal, city organizations, etc.) is impossible, according to the law of the Russian Federation. According to it, you need to hold a tender to select an insurance company and select one or two from the list.

But, thanks to this seemingly good function, the state limits people’s free choice of compulsory medical insurance. On the other hand, it clearly declares the responsibilities of insurance companies towards clients. Also, all mandatory clauses of the agreement must be specified in the contract signed by the parties when concluding insurance.

Why are insurance companies needed (functions)

Insurance is a special system for protecting people who work, as well as those who are financially dependent on their income. That is, with partial or complete loss of ability to work due to old age, illness, lack of work, pregnancy, maternity or disability.

In Russia there is a list of points on compulsory insurance:

• In case of illness, that is, temporary disability.
• In connection with motherhood.
• In case of an occupational disease or an accident at the enterprise.
• Health insurance.
• Pension insurance.
• In the event of the death of a breadwinner or a family member who has not reached the age of majority.

There is a list of the main functions of insurance companies:

• Protection of the interests of the insured individuals.
• Control of insurance amounts.
• Properties of compulsory medical insurance in a hospital.
• Compulsory medical insurance terms.
• Legal protection of people (if necessary).

In the event of a court case, the compulsory medical insurance may sue the medical institution for material and moral damage that they caused.

Learn more about insurance companies

Insurance companies mainly deal with commercial insurance To carry out this function, the company needs a license from the municipal insurance supervision body.

According to the law of the Russian Federation, there are clear rights and obligations of subjects, objects, insurance organizations and insurance companies.

In the Russian Federation there is a precise classification of insurance companies:

• According to the degree of significance of her work for the country's economy.
• According to the availability and level of the branch network.
• According to the level of qualification and specialization in any one type of insurance.
• By origin of the director or owner of the company.
• According to the audience that the company can reach.

Insurance contract

This is an agreement between the policyholder and the insurance company, in which the insurance company undertakes to compensate for the damage in one form or another or to pay the policyholder or the purchaser the specific required amount upon the arrival of the insurance option provided for in the contract. The policyholder, in accordance with the insurance agreement, undertakes to pay the company the entire required premium, provide compensation for other duties and maintain the limits provided for in the agreement.

Insurance companies that provide life insurance must keep a personalized (personal) record of life insurance contracts in the routine and on the criteria of specific Authorized Bodies. Insurance companies that insure agricultural products with state assistance must separate personalized (personal) records of agreements to insure agricultural products with state assistance. And divide them according to criteria specified by the Authorized Body together with central authority functioning government, ensuring the creation and sale of agricultural production to ordinary people.

Pros and cons for patients

With the new rules, the question remains: was this done for the benefit of the people, or as always?

Many people think that if it is worth paying five thousand rubles, then they will lose the queues at clinics and have peace of mind about their health in case of an unforeseen situation. Others say that the preferred changes should be clearly spelled out in the law, and that private doctors charge too much, and such a price is unaffordable for the average citizen. Therefore, it’s not about a simple doctor, but about the system itself. And you need to change it first of all, and then everything else.

Also, it is worth considering all the laws separately, because every coin has two sides:

1. Despite the clarity of state statistics, they cannot provide clear indicators of the health of citizens and the quality of medical institutions.
2. There is no need for insurance companies to ensure that clients are being treated well.
3. Considering that doctors will not receive more, they are not interested in improving the level of service.
4. The conditions of the regions are uneven, therefore it is not possible to provide the same living conditions for everyone.
5. Often, health insurance acts are unclear, and subsequently the quality of services deteriorates.

Rating of insurance companies

• Rosgosstrakh– the company became a leader in almost all indicators, because it was the company that received expert rating in 1st place, with 129.9 billion rubles, popular opinion gave it 66 points, and in terms of reliability it was assigned the value A++, which is a very good indicator.
• SOGAZ- a company that took second place from experts, 2nd place, but 105.2 billion rubles. Unfortunately, it was she who received a rating from the people of less than 35 points, but her level of reliability is rated A++.
• Ingosstrakh– rightfully received third place with 65.8 billion rubles, a rating from the people of 41 points and reliability levels of A++.
• RESO-Garantiya– was in fourth place, with an estimate for the fourth level and $65.3 billion. She received 42 points from the audience, and A++ in terms of safety.
• Alpha- rightfully took fifth place, because it received a rating of 5 from experts, but for 47.8 billion dollars, and the popular rating is 57 points with an A++ rating.

There are many opinions regarding the new compulsory medical insurance rules. But, no matter how things are, remember one contradiction: you have nothing more valuable than health, and it is expensive today.