State guarantees of free provision of medical care to citizens, approved by the Government Russian Federation.

2. The basic program of compulsory medical insurance determines the types of medical care (including the list of types of high-tech medical care, which includes methods of treatment), the list of insured events, the structure of the tariff for paying for medical care, methods of paying for medical care provided to insured persons under compulsory medical insurance in the Russian Federation at the expense of compulsory medical insurance, as well as criteria for the availability and quality of medical care.

3. The basic program of compulsory medical insurance establishes requirements for the conditions for the provision of medical care, standards for the volume of medical care provided per insured person, standards financial costs per unit volume of medical care, the standards for financial support of the basic program of compulsory medical insurance per insured person, as well as the calculation of the coefficient of appreciation of the basic program of compulsory medical insurance. The standards of financial costs per unit volume of medical care provided in this part are also established according to the list of types of high-tech medical care, which includes, among other things, methods of treatment.

(see text in previous edition)

4. Insurance coverage in accordance with the basic program of compulsory medical insurance is established based on the standards of medical care and procedures for the provision of medical care established by the authorized federal agency executive power.

5. The rights of insured persons to free medical care, established by the basic program of compulsory medical insurance, are uniform throughout the Russian Federation.

6. Within the framework of the basic program of compulsory health insurance, primary health care is provided, including preventive care, emergency medical care (with the exception of air ambulance evacuation carried out by aircraft), specialized medical care, including high-tech medical care, in the following cases:

(see text in previous edition)

2) neoplasms;

3) diseases of the endocrine system;

4) eating disorders and metabolic disorders;

5) diseases of the nervous system;

6) diseases of the blood, blood-forming organs;

7) individual disorders involving the immune mechanism;

8) diseases of the eye and adnexa;

9) diseases of the ear and mastoid process;

10) diseases of the circulatory system;

11) respiratory diseases;

12) diseases of the digestive system;

13) diseases of the genitourinary system;

14) diseases of the skin and subcutaneous tissue;

15) diseases of the musculoskeletal system and connective tissue;

16) injuries, poisoning and some other consequences of external causes;

17) congenital anomalies (malformations);

18) deformities and chromosomal disorders;

19) pregnancy, childbirth, postpartum period and abortions;

20) individual conditions that occur in children during the perinatal period.

7. The structure of the tariff for paying for medical care includes the cost of wages, accruals for wages, other payments, purchase of medicines, consumables, food, soft inventory, medical instruments, reagents and chemicals, etc. inventories, the cost of paying for the cost of laboratory and instrumental studies conducted in other institutions (in the absence of medical organization laboratory and diagnostic equipment), catering (in the absence of organized catering in a medical organization), expenses for payment for communication services, transport services, utilities, works and services for the maintenance of property, expenses for rent for the use of property, payment for software and other services, social security for employees of medical organizations established by the legislation of the Russian Federation, other expenses, expenses for the acquisition of fixed assets (equipment, production and household inventory) worth up to one hundred thousand rubles per unit.

The overwhelming majority of citizens of our country restore their health using the possibilities of the system of compulsory medical insurance (CHI). Examination by specialists, medication, dental treatment, and so on have become familiar realities of our days. But CHI provides an opportunity to carry out more responsible medical interventions, including surgical ones, free of charge. You will learn how to make an operation under the CHI policy below.

What operations can be done under the CHI

Periodic changes are made to the list of free surgical operations aimed at expanding the ability of citizens to restore health through surgical intervention. Updated List free transactions send, registered CHI medical institutions and insurance companies. The information is public.

Free access is provided by placement on the information stands of medical institutions, their websites, as well as informing, at the consultations of the attending doctor, which operations are performed free of charge.

The list of free operations under the MHI policy for 2020 includes the following interventions:

1. Surgical operations on the eyes:

• with cataract of the lens of the eye;
• intervention for strabismus, including strabismus in children;
• traumatic deformation of the retina;
• glaucoma;
• detection of congenital anomalies.

1. Sentoplasty (correction of the nasal septum), with the following indications:

• impaired respiratory function;
• lack of smell;
• swelling of the mucosa;
• not resistant to SARS;
• not standard breathing, snoring;
• excessive dryness of the sinuses, systematic pain.

1. Removal of the gallbladder in the presence of cholecystitis, functional disorders (cholesterosis, gallstone manifestations).
2. Operation Marmara (diseases of the veins of the organs of the reproductive system of men) with indications:

• varicocele of the second and subsequent stages;
• impossibility of fertilization (sperm excretion);
• painful sensations;
• aesthetics;
• scrotal tissue changes.

1. Joint arthroscopy.
2. Operations on the veins in venous diseases.
3. Diseases of the field of gynecology.
4. Thoracic (oncology, pathological changes in the lungs).
5. Stop valgus.

The presented list is not a complete list of gratuitous surgical interventions that are permissible, in the presence of a compulsory medical insurance policy. However, cosmetic interventions (for example: bariatric surgery) are not included in free medical care.

Who can get free health care

All categories of citizens who have concluded, established order, MHI agreements, including:

• having labor relations with enterprises, organizations in the sphere of production, consumption and distribution of material goods;
• receiving funds or remuneration under licensing, scientific, publishing alienation agreements;
• private entrepreneurs and other categories providing for themselves independently;
• leaders and participants of farm enterprises;
• community members involved in folk crafts and tribal economic activities;
• citizens who do not have a job (children under the age of eighteen, adults on pension provision, adolescents - undergoing training, unemployed, guardian up to the age of three of a child, caring for a disabled person of the first group or an adult after the age of eighty)
• military personnel, employees of special organizations, including medical workers;
• foreigners legally staying on the territory of the country and engaged in labor activities, within the limits permitted by the regulatory legal acts of the state;
• persons who, in accordance with the established procedure, have received the status of refugees.

Institutions of the Ministry of Health do not have the right to refuse to provide emergency free medical care, including specialized, to persons who have not concluded an MHI agreement or with missing information about their policy on a single database of the MHIF.

Where can I get treatment for free

The above categories of citizens have the right to receive free medical care under compulsory medical insurance throughout the country, regardless of the presence of registration at the place of residence, place of stay or lack thereof, at the time of application.

In relation to the category of medical care related to the conduct of planned surgical interventions, the insured person has the right to choose any specialized medical institution in Russia, in his opinion, capable of performing the operation with the best results. At the same time, the medical institution must, in accordance with the established procedure, participate in the MHIF system.

Medical institutions (hospitals, clinics and others) become participants in the system after concluding a cooperation agreement with the CHI. If there is a quota, they cannot refuse the possibility of performing an operative intervention if the operation is indicated.

It should be remembered that the length of the waiting period for a planned operation in another region, as well as at the place of residence of the patient, can take a significant amount of time. This is due to the strict quota of operations, due to the significant financial costs of its implementation, as well as the large number of patients who apply.

When choosing a medical institution for a planned operation, the following should be considered:

• the insurance coverage covers only the operation;
• the quality of the work of practicing surgeons is approximately equal, both in polyclinics of the capital regions and local medical institutions, where in the first case the operation is accompanied by the most advanced equipment, in the second - experience in performing multiple operations;
• waiting time for a free operation, where in large cities it can take a long time (up to a year or more), during which side effects can be provoked, while waiting for local surgery will take up to several months;
• the cost of paying for services not covered by compulsory medical insurance.

Of no small importance is the opportunity to consult during postoperative rehabilitation with the surgeon who performed the operation. If the medical institution is located at a considerable distance, additional cash costs are expected.

How to make an operation under the CHI policy for free in steps

Obtaining surgical care under compulsory medical insurance coverage is a simple procedure that includes the following steps:

1. Visiting the attending doctor in the attached medical institution. The field of study of analyzes and examination of the patient, he evaluates the indications for surgical intervention. If they are available, the doctor is obliged to write out a referral to a specialized clinic. The patient has the right to declare his referral for surgery to a pre-selected medical institution.
2. After receiving the referral, the patient is registered for an appointment for a consultation at the selected institution. Registration is carried out by personal visit or in another manner provided by the hospital.
3. Arrive at the appointed time to the hospital doctor for paperwork and consultation. Provide him with a referral, an identity document, an insurance contract (policy), research results and a medical card. The doctor decides on the need for admission to the hospital. Explains what is free and what you have to pay for.
4. The decision to place, for the duration of the operation in the hospital, is accompanied by additional studies of analyzes.
5. Within ten working days, the patient is notified of the date of the surgical intervention.
6. On the appointed day, the patient is hospitalized.

About the quota. They are determined depending on the financial ability of the MHIF, territorial departments of the regions, to compensate for the expended consumables, the work of specialists and personnel during a certain number of surgical operations.

State medical institutions participating in the CHI system purchase medicines, medicines, equipment for surgical operations within the framework of the funding. Procurement is carried out on the basis of the organization of tenders. Where is the determining factor. The final delivery price is shown. Thus, when performing CHI operations, one should not count on advanced models of endoprostheses and other things.

Do I need to pay extra for services?

Surgical intervention according to compulsory medical insurance is free of charge. It includes: direct operation, anesthesia (if necessary), consumables, use of specialized equipment. The requirement of the institution for additional payment is not legal. But the patient independently finances travel to the place of the operation and back, preoperative accommodation outside the medical institution. The possibility of providing paid additional opportunities is allowed in relation to the receipt of services not included in the list CHI systems, among them:

• conducting anonymous diagnostics at the request of the patient (excluding HIV);
• manipulations carried out with a visit to the patient at home (diagnosis, consultation, medical treatment), with the exception of the physical impossibility of the patient to come to the medical facility for this;
• diagnostics and medical procedures for sexual pathology;
• speech therapy activities of the adult population;
• vaccinations, with the exception of those provided for by compulsory medical insurance;
• post-operative measures, including sanatorium, if they are not provided for by the insurance program;
• cosmetic procedures;
• prosthetics of the oral cavity, with the exception of the cases provided for by compulsory medical insurance;
• psychological support of the patient;
• methodological measures for familiarization with patronage, provision of first aid and the like.

Medical institutions that provide, along with free, paid services, are obliged to inform about their existence by posting lists and price lists on the reception stands. At the same time, when deciding on hospitalization, the patient is personally acquainted with paid opportunities to improve the conditions of stay in the inpatient department of the hospital.

The insured person has the right to contact the insurer or the MHIF to clarify the legality of the claim additional funds while in a medical facility. Paying for certain services and drugs.

What to do if you are denied treatment if you have a policy

The low awareness of the population about their rights to medical care under compulsory health insurance often leads to conciliation in case of an unreasonable refusal to provide medical care or claiming additional money for procedures, including surgical operations. The situation is changed by the opportunity to get acquainted with the conditions, procedure and list of services on the official websites of the Ministry of Health and FFOMS.

Establishing the fact of a violation should be accompanied by measures to protect personal rights, including appeals:

1. Management of the medical facility.
2. District (city) health department.
3. An insurance company that accompanies the MHI agreement.
4. Territorial subdivision of the MHIF.
5. Federal Office of OMS.
6. Commission expert arbitration.
7. Judicial authorities.

A statement of violation of the patient's legal rights in the provision of compulsory medical insurance coverage is drawn up in a businesslike, discreet style and contains:

• information about the person whose rights have been violated;
• information on the conclusion of an insurance contract (policy);
• details of the medical institution that refused to provide medical care, or committed other violations;
• the period of medical procedures or improper maintenance in hospital treatment;
• the course of events, the circumstances that forced the patient to spend personal cash, their volume.

The application is accompanied by the medical and financial documents necessary to prove the violation (extracts from the history, checks for paying for medicines, etc.).

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The basic program of the CHI policy is a component unified system social guarantees. It guarantees free medical care for Russian citizens, temporarily staying foreigners, stateless people. It provides funding for aid provided from CHI fund. In addition to the federal one, each region forms its own territorial program. They determine the rights of insured people to provide the necessary assistance, including highly specialized in various areas. The basic list includes a detailed enumeration of insured events, payment principles and social tariff structures. Regional versions of CHI are approved in accordance with the federal one. Program of mandatory guarantees for the provision medical services, which are included in the CHI policy, is approved annually.

What is a CHI insurance policy

Payment for the policy and medical services

The basic program for the current year is adopted by a decree of the government of the Russian Federation. Accordingly, the state authorities in the regions develop and adopt territorial programs. This document also details the structure of the single tariff for the provision of assistance and examinations in medicine. It includes:

• wage;
• obligatory accruals for wages;
• purchase of medicines;
• purchase of tools, equipment, reagents.

It also includes payment for the cost of laboratory tests and other diagnostic measures.

Legislation

The provision of medical care free of charge to all citizens of Russia, permanently living foreigners and people without citizenship is provided by the following legislative and regulatory acts:

• Federal Law No. 29.11.2010;
• federal law of November 21, 2011 N 323-FZ "On the basics of protecting the health of citizens in the Russian Federation".
• Federal Law No. 326-FZ of November 29, 2010 (as amended on January 9, 2017) “On Compulsory Medical Insurance in the Russian Federation.

Read also about plastic policy.

They detail the content of the basic program and a list of vital medicines and devices provided free of charge. This list varies by region. There are also regional regulations.

The basic program defines the scope of medical services provided at the expense of budgets of various levels.

What is included - a list of basic services

Program state guarantees defines a complete list of diseases and other pathologies subject to free treatment. The scope of guaranteed medical services includes diagnostics and preventive treatment. The basic program involves, among other things, the provision of high-tech specialized assistance (for example).

All types of medical services that are not included in the basic list will be paid.

The program of state guarantees involves the provision of medical care in the following areas:

• primary health care (except for sanitary and aviation export from hard-to-reach areas);
• ambulance and emergency (emergency treatment);
• outpatient (appointment of the attending physician in the clinic or at home).
• stationary;
• preventive
• palliative.

Read how to get a medical policy for a newborn.

It is necessary to distinguish between emergency and urgent care. In the first case, we are talking about conditions that threaten life. The second refers to emergency assistance in a situation where there is no danger to life.

The package also includes routine vaccination, as well as in connection with the epidemic of high-risk infections. Inpatient treatment under the MHI policy has the following varieties:

• acute diseases and exacerbation of chronic diseases;
• conditions requiring the use of intensive care or epidemiological isolation;
• severe poisoning;
• trauma;
• burns;
• pathology of pregnancy, childbirth and the postpartum period;
• abortions.

Dental services (dental treatment in dentistry)

This also includes emergency and planned dental care, except for prosthetics and aesthetic dentistry. Basic ones include:

• emergency dental care
• examination and consultation:
• treatment of diseases of the oral cavity;
• treatment of pathologies of the salivary glands;
• surgical manipulations on soft tissues;
• removal of tartar.

Also includes extraction of teeth, extraction of foreign bodies from the internal canal and pediatric dentistry. The list also includes planned inpatient treatment, diagnostics or rehabilitation measures.

Examination and treatment in a day hospital

If appropriate, they can be carried out on a day hospital. The fundamental package of the CHI policy includes the provision of specialized assistance in the following areas:

• neurological diseases;
• pathology of the endocrine system;
• diseases of the respiratory system;
• ENT pathologies (including ear diseases);
• diseases of the hematopoietic system;
• congenital pathologies or anomalies.

See the list of free operations under the policy.

They also include:

• pathology of the digestive system;
• violation of the musculoskeletal system;
• diseases of the genitourinary system;
• diseases of the skin and internal tissue (including infectious);
• chromosomal pathologies and deformities.

This list also includes the diagnosis and treatment of severe infectious diseases. A separate list includes pediatric care, as well as the treatment of perinatal pathologies. The standard includes:

• primary care;
• planned medical examination;
• specialized service;
• carrying out preventive examinations;
• treatment of congenital malformations and pathologies.

The basic list does not include treatment programs that are at the stage of clinical trials.

Video

conclusions

The standard list under the MHI policy includes primary, emergency, outpatient, inpatient and palliative programs, including rehabilitation techniques. Each of the areas includes highly specialized treatment in the main areas. A separate list includes pediatric care provided by basic list MHI policy for newborns.

Citizens of Russia are guaranteed free medical care by the state. A policy is issued to people - a document embodying support state system healthcare in case of illness.

And what does it really mean? What types of services in the clinic are required to provide without additional payment, and for which you have to pay yourself? Under what circumstances is a free medical examination carried out? Let's look at all the questions in detail.

About free medicine

The 41st article of the Constitution of the Russian Federation lists guarantees to citizens of the country from the state. In particular, it says:

“Everyone has the right to health care and medical care. Medical assistance in state and municipal health care institutions is provided to citizens free of charge at the expense of the relevant budget, insurance premiums, and other revenues.

Thus, the list of free medical services should be determined by the relevant government bodies i.e. the healthcare system. This happens on two levels:

• federal;
• regional.

Important! The budget fund for the development of medical institutions is formed from several sources. One of them is tax revenues from citizens.

What types of services are guaranteed by the state

By virtue of the current legislative acts, patients are guaranteed the right to the following types medical care:

• emergency ( ambulance), including special
• outpatient treatment, including examination;
• hospital services:
  • gynecological, pregnancy and childbirth;
  • with exacerbation of ailments, ordinary and chronic;
  • in cases of acute poisoning, in case of injury, when intensive care is required, associated with round-the-clock supervision;
• planned outpatient care:
  • high-tech, including the use of complex, unique methods;
  • medical care for citizens with incurable ailments.

Important! If the disease does not fall under one of the options, you will have to pay for medical services.

Medicines are issued at the expense of the budget to people suffering from the following types of diseases:

• shortening life;
• rare;
• leading to disability.

Attention! A complete and detailed list of drugs is approved by a government decree.

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New in legislation since 2017

The government decree of December 19, 2016 N 1403 provides a more detailed breakdown of medical services provided free of charge. In particular, primary health care is deciphered. It is divided into subspecies. Namely, the primary

• pre-medical (primary);
• ambulance;
• specialized;
• palliative.

Attention! As part of the program, palliative care has been added to the list of free medical care.

In addition, the text of the document contains a list of medical professionals who are subject to the obligation to treat patients without charging money.

These include:

• paramedics;
• obstetricians;
• other health workers with secondary specialized education;
• general practitioners of all profiles, including doctors of family medicine and pediatricians;
• doctors-specialists of medical organizations providing specialized, including high-tech, medical care.

Attention! The document contains a list of diseases that doctors are required to treat free of charge.

Medical policy

A document guaranteeing the provision of assistance to patients is called a compulsory medical insurance policy (CHI). This paper confirms that the bearer is insured by the state, that is, all the professionals listed above are required to provide services to him.

Important! CHI policy have the right to issue not only citizens of the Russian Federation. It is issued (for a small fee) to foreigners permanently residing in the country.

The MHI policy has the following semantic content:

• the citizen is guaranteed medical support;
• medical organizations perceive it as a client identifier (for it, the hospital will transfer funds from the Compulsory Medical Insurance Fund).

Important! The described document is issued only by licensed insurance companies. They are allowed to be changed, but not more than once a year (until November 1 of the current period).

How to get an OMS policy

The document is issued by the relevant companies operating within the framework of the legislation of the Russian Federation. Their rating is regularly printed on official websites, allowing citizens to make their choice.

To be issued a CHI policy, you must provide a minimum number of documents.

Namely:

• for children under 14:
  • birth certificate;
  • parent's (guardian's) passport;
  • SNILS (if any);
• for citizens over 14 years old:
  • passport;
  • SNILS (if available).

Important! For citizens of the Russian Federation, the policy is valid indefinitely. Only foreigners are provided with a temporary document:

• refugees;
• temporarily residing in the country.

Rules for replacing the compulsory medical insurance policy

In some situations, the document is supposed to be changed to a new one. These include the following:

• when moving to a region where the insurer does not work;
• in case of filling out the paper with errors or inaccuracies;
• in case of loss or damage to the document;
• when it fell into disrepair (dilapidated) and it is impossible to make out the text;
• in the event of a change in personal data (marriage, for example);
• in the case of a planned update of the sample form.

Attention! New policy OMS is issued without paying a fee.

What is included in the free service under the MHI policy

In paragraph 6 of Article 35 federal law No. 326-FZ provides a complete list free services By medical policy provided to document owners. They are provided in:

• polyclinic;
• dispensaries;
• hospital;
• Ambulance.

Download for viewing and printing:

What can OMS policy holders expect?

In particular, patients are entitled to free medical care and treatment in the following situations:

Dentists, like other professionals, are required to work with patients without pay.

They provide the following types of assistance:

• treatment of caries, pulpitis and other diseases (enamel, inflammation of the body and roots of the tooth, gums, connective tissues);
• surgical intervention;
• dislocations of the jaws;
• preventive actions;
• research and diagnostics.

Important! Services for children are provided free of charge:

• to correct an overbite;
• enamel strengthening;
• treatment of other lesions not related to carious.

How to apply the CHI policy

In order to organize the treatment of patients, they are attached to the clinic. The choice of a medical institution is given to the choice of the client.

It is defined:

• convenience of visiting;
• location (near the house);
• other factors.

Important! Change medical institution allowed no more than once a year. The exception is a change of residence.

How to "attach" to the clinic

You can do this with the help of an insurer (choose an institution when receiving a policy) or on your own.

To attach to the clinic, you should go to the institution and write an application there. Copies of the following documents are attached to the paper:

• identity cards:
  • passports for citizens over 14 years old;
  • birth certificates of a child under 14 years of age and passports of a legal representative;
• compulsory medical insurance policy (original is also required);
• SNILS.

Important! Citizens registered in another region can legally refuse to attach to a polyclinic if the institution is overcrowded (the maximum norm of patients has been exceeded).

In case of refusal, it should be requested in writing. You can complain about a medical institution to the Ministry of Health of the Russian Federation or Roszdravnadzor.

Visit to the doctor

In order to get help from a specialist, you must register with him through the registry. This department issues admission vouchers. Terms and rules of registration, patient care are established on regional level. They can be found in the same registry.

In addition, the insurer must provide this information to customers (you need to call the number indicated on the policy form).

For example, in the capital there are such rules for providing patients with medical services:

• referral to an initial appointment with a therapist, pediatrician - on the day of treatment;
• coupon to specialist doctors - up to 7 working days;
• carrying out laboratory and other types of examination - also up to 7 days (in some cases up to 20).

Important! If the polyclinic is unable to meet the needs of the patient, he should be referred to the nearest institution where the necessary services are provided under the CHI program.

Ambulance

All people in the country can use emergency medical services (the presence of a CHI policy is optional).

There are regulations governing the activities of ambulance crews. They are:

• the ambulance service responds to emergency calls within 20 minutes in case of a threat to people's lives:
  • accidents;
  • wounds and injuries;
  • exacerbation of the disease;
  • poisoning, burns and so on.
• emergency care arrives within two hours if there is no threat to life.

Important! The dispatcher decides which team will go on the call based on the information of the client.

How to call an ambulance

There are several options for seeking emergency medical assistance. They are:

1. From a landline, dial 03.
2. By mobile connection:
   • 103;

Important! The last number is universal - 112. This is the coordination center for all emergency services: hide, fire, emergency and others. This number works on all devices if there is a network connection:

• with zero balance;
• with the absence or blocking of the SIM card.

Ambulance Response Rules

The service operator determines if the call is justified. An ambulance will arrive if:

• the patient has signs of an acute illness (regardless of its location);
• there was a catastrophe, a mass disaster;
• received information about the accident: injuries, burns, frostbite, and so on;
• violation of the activity of the main body systems, life-threatening;
• if childbirth or termination of pregnancy has begun;
• the disorder of the neuropsychiatric patient threatens the lives of other people.

Important! For children under the age of one year, the service leaves for any reason.

Calls due to such factors are considered unreasonable:

• the patient's alcoholism;
• non-critical deterioration of the patient's condition of the clinic;
• dental diseases;
• carrying out procedures in the order of planned treatment (dressings, injections, etc.);
• organization of workflow (issuance of sick leave, certificates, drawing up an act of death);
• the need to transport the patient to another place (clinic, home).

Attention! The ambulance only provides emergency care. If necessary, can deliver the patient to a hospital.

Where to file medical complaints

In the event of conflict situations, rude treatment, insufficient level of services provided, you can complain to the doctor:

• chief physician (in writing);
• V insurance company(by telephone and in writing);
• to the Ministry of Health (in writing, via the Internet);
• Prosecutor's office (also).

Attention! The term for consideration of the complaint is 30 working days. Based on the results of the check, the patient is required to send a reasoned response in writing.

If necessary, the attending doctor can be changed to another specialist. To do this, write an application addressed to the head physician of the hospital. However, the change of specialists is allowed to be carried out no more than once a year (except in cases of relocation).

Dear readers!

We describe typical ways to resolve legal issues, but each case is unique and requires individual legal assistance.

For a prompt resolution of your problem, we recommend contacting qualified lawyers of our site.

Last changes

On May 28, 2019, new CHI rules came into force, which provide for the introduction in Russia of policies of a single sample (paper or electronic format). At the same time, there is no need to replace the previously issued policy. In addition, if it is technically possible to uniquely identify the insured person in single register insured persons, then instead of a compulsory medical insurance policy, a passport is allowed (order of the Ministry of Health of Russia dated February 28, 2019 No. 108n “On Approval of the Rules for Compulsory Medical Insurance“).

The new Rules provide for stricter control over the observance of the rights of the insured, as well as close electronic interaction between the territorial MHIF, insurance organizations and medical organizations:

• polyclinics every year until January 31 will have to report to the TFOMS (through a single portal) the number of those attached, the number of people under dispensary observation, schedules of professional examinations / medical examinations with a quarterly / monthly breakdown by therapeutic areas; work schedules);
• polyclinics every day on working days before 9 am must report (through the TFOMS portal) on insured persons who have passed a medical examination, as well as on persons undergoing medical examination;
• medical organizations, medical insurance organization (HIO) and TFOMS will exchange information every day in electronic form on the TFOMS portal: hospitals must update data on the implementation of the volume of medical care, free beds, admitted / non-admitted patients by 9 am; polyclinics update information on hospital referrals issued yesterday until 9 am; medical organizations providing specialized, including high-tech, medical care post information about patients who have had a telemedicine consultation, and the CMO is obliged to monitor the implementation of the recommendations received from the NMIC doctors, and has the right to conduct an in-person examination within the next 2 working days;
• Regardless of the interaction mentioned above, the CMO informs hospitals every day no later than 10 am about patients referred to such hospitals the day before, and also every day no later than 10 am informs medical organizations about the number of free beds in the context of profiles / departments, about patients whose hospitalization did not take place;
• On the basis of the database from the TFOMS portal, the HMO checks during the working day whether the patients were correctly referred to specialized medical organizations. If hospitalization took place out of time, not according to the profile, the HMO must file a complaint with the head physician of the violating medical organization and the regional Ministry of Health, and, if necessary, take measures and transfer the patient;
• HMO insurance representatives received a wide range of responsibilities - working with citizens' complaints, organizing examinations of the quality of medical care, informing and accompanying them when providing them with medical care, inviting them to medical examination, monitoring its passage, forming lists of "persons for medical examination" and lists of citizens who fell under medical supervision;
• patients will be able to see when and what medical services were provided to them, and at what cost: in personal account on the portal of public services or through the TFOMS - by means of authorization in the ESIA;
• for oncological patients, the HMO undertakes to create (on the TFOMS portal) an individual history of insurance events (based on registers-accounts) throughout all stages of medical care.

Updated CHI rules directly impose on HIOs the obligation to carry out pre-trial protection of the rights of insured persons. When they complain about poor-quality medical care or charging for services for CHI program, CMO registers written appeals, conducts medical and economic examination and examination of the quality of medical care.

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