What is included in the list of free medical services provided under the CHI policy? What is included in the free medical care under the OMS policy Insurance system within the framework of medicine.
One of the important conditions social protection population of the country - providing its citizens with the necessary medical care. Health care services that allow you to receive timely medical intervention are based on health insurance. The state provides an opportunity for its citizens and other persons to receive compulsory health insurance (CHI) with a sufficient range of services that can support people's health in the event of insured events. So what is compulsory health insurance (CHI)? How are the rights of citizens to free medical care constitutionally protected? What does the CHI system guarantee to citizens? We will answer these and other questions in this article.
CHI basics
Compulsory health insurance is a set of measures to protect health, provide free medical care within the framework of the current legislation, as well as the implementation of preventive measures. Insurance provides citizens with equal opportunities when medical intervention is needed. Article 41 of the Constitution of the Russian Federation guarantees every citizen the right to health care and free medical care in state (municipal) institutions, which is provided through the payment of insurance premiums, funds from the budget and other revenues. Providing medical services made from previously formed funds. Key guaranteed services include:
- Ambulance (this does not include sanitary and aviation services);
- Primary provision of medical care;
- Therapeutic and preventive measures;
- Specialized assistance;
- Provision of services within the framework of the current CHI.
Implementation of the mandatory health insurance occurs through specialized legal organizations - insurance companies. Among the main tasks is to provide the population with the necessary medical care through the conclusion of contracts. In addition, through the funds, payment is made for the services rendered to insured persons (patients) to medical institutions, protection of the rights of the population.
Source of health insurance funding
To implement the program of providing free medical care, it is necessary to have a substantial financial base. battery Money in the CHI system is the Federal Compulsory Medical Insurance Fund (FOMS). The main goal of the fund is presented as providing all persons participating in insurance with the necessary medical and medicinal assistance. Funding comes from the following sources:
- Contributions to the MHIF of employers for their employees;
- Receipts in the form of fixed payments from individual entrepreneurs and self-employed persons;
- Receipts from the budgets of the constituent entities of the Russian Federation for the unemployed.
Insurance premiums as income from employers are charged at established rates for wages hired workers. Payers are the majority of organizations and employers-entrepreneurs, with the exception of some representatives of small businesses, which are exempt from paying such payments.
Formerly fund compulsory insurance was divided into federal and territorial, payments had to be transferred to each of these structures. Starting from 2012, the territorial MHIF was abolished. Currently, payments are made only to the federal MHIF at the basic rate of 5.1%.
CHI policy
Guaranteed medical service confirmed by the presence of a policy. This document can be obtained from the medical insurance company after concluding an appropriate agreement with it. The issuance of these documents in the MHI system is carried out for almost all persons, including:
- Citizens of the country;
- Non-working population and persons under the age of majority;
- Temporarily or permanently residing on the territory of the Russian Federation;
- Persons without citizenship;
- Refugees.
The duration of the policy depends on the status of the insured person. For citizens of the Russian Federation and those permanently residing on the territory of the country, the document is open-ended. For temporary residents, including refugees, the policy is limited to a fixed period of stay within the country.
The provisions on the rights of insured persons in the presence of a policy are listed in the law dated November 29, 2010 No. 326-FZ “On Compulsory Medical Insurance in the Territory of the Russian Federation”. Without presenting a document individual can only count on emergency free medical care. The policy covers the entire territory of the Russian Federation. In case of refusal of medical institutions to provide free services within the framework of compulsory medical insurance, it is allowed to file a complaint at the location of the insurance company. The presence of a CHI policy gives some rights to its owners. With the help of the document become available the following types medical care:
- Emergency medical services;
- Outpatient treatment in polyclinics, including diagnostic procedures and medical examinations, while free provision drugs in this case, as a rule, are not provided;
- Inpatient treatment, including emergency hospitalization in order to maintain health, including during childbirth and exacerbation of chronic diseases.
Often medical policy provides an opportunity to diagnose diseases with the help of special equipment. The owner of the document, if indicated, can become a participant in rehabilitation, preventive and recreational activities. For privileged categories of the population, a policy is required to confirm the right to free medicines. In addition, the owners CHI document the right to receive routine vaccination and undergo a fluorographic examination. The presence of a CHI policy makes basic medical services available to the general population. This factor is especially important for the poor and socially unprotected persons.
How to get an OMS policy?
The policy as a document confirming the right of its owner to receive free medical care must be carried with you. It is presented for treatment in hospitals, clinics and ambulance services.
The policy is issued by insurance companies in any region of the country. The choice of the insurance company itself is the right of any citizen and other person. Although, as a rule, the result is determined by the territorial presence of the insurance company. At the same time, there are no significant differences in the choice of companies. The range of services provided is the same, although some insurance companies have the right to attract customers with various bonus programs. To obtain a CHI policy, you must provide insurance companies with the following documents:
- Identification;
- SNILS;
- Other documents, depending on the status of the insured person (birth certificate, proof of temporary residence, etc.).
Often, when applying initially, insurance companies issue a temporary policy. Its validity is limited to a period of 1 month, after which the current document is replaced with a current sample. A temporary policy has the same powers as a permanent one. In case of loss of the policy, change of the name of the owner, a replacement is assumed.
The policy, as a document of compulsory health insurance, is best done in advance. In this case, when unexpected health problems appear, there will be no bureaucratic obstacles in obtaining medical care.
What does free medical care include?
Free medical care, which citizens insured in the MHI system can count on, is included in the basic program. The list of diseases in connection with the occurrence of which assistance is available under the CHI system is quite extensive. This includes the following insured events:
- Pregnancy, childbirth, childcare;
- Infectious and bacterial diseases;
- Diseases of the endocrine system;
- Problems with the digestive organs;
- Diseases of the ears, eyes;
- Diseases resulting from chromosomal abnormalities;
- Decreased immune forces of the body;
- poisoning;
- Diseases of the nervous system;
- Other insured events.
The right to receive free assistance is regulated by law Russian Federation, and the assistance included in the basic program (preventive, special, high-tech, ambulance) is regulated by Article 35 of the Federal Law of November 29, 2010 No. 326-FZ (as amended on December 28, 2016) “On Compulsory Medical Insurance in the Russian Federation”.
Conclusion
The rights of citizens to receive free medical care are regulated by the Constitution of the Russian Federation, according to which there are special programs to protect the health of the population of Russia. The general CHI mechanism is an obligation imposed on certain persons by law to make contributions to the CHI fund for insurance and protection of interests related to medical care costs. For the working population, such persons are employers, for the unemployed - regional authorities.
Compulsory health insurance (CHI)- a type of compulsory social insurance, which is a system of legal, economic and organizational measures created by the state aimed at ensuring insured event guarantees of free provision of medical care to the insured person at the expense of compulsory medical insurance within the limits of the territorial program of compulsory medical insurance and within the limits established by this federal law cases within the basic program of compulsory health insurance ().
The basic program of compulsory health insurance is approved Decree of the Government of the Russian Federation within the framework of the Program of state guarantees for the provision of free medical care to citizens of the Russian Federation. It defines the rights of insured persons to provide them with free medical care at the expense of compulsory medical insurance throughout the territory of the Russian Federation, contains the types and volumes of medical care that should be provided to the insured person in any constituent entity of the Russian Federation free of charge, regardless of the region of residence, upon the occurrence of an insured event ( diseases) and and establishes uniform requirements for territorial programs of compulsory medical insurance;
Territorial programs of compulsory medical insurance- are developed and approved by the executive authorities of the constituent entity of the Russian Federation on the basis of the Basic CHI Program. It defines the rights of insured persons to free provision of compulsory medical care at the expense of funds. The types and volumes of medical care included in the Territorial Program cannot be less than those in the Basic CHI Program. At the same time, if there are financial and material resources in a subject of the Russian Federation, the volumes and types of medical care can significantly expand. At the same time, a resident of this constituent entity of the Russian Federation will receive free medical care in the amount of the Territorial Compulsory Medical Insurance Program, and a citizen arriving from another region will receive according to the Basic Compulsory Medical Insurance Program.
Insured persons- citizens of the Russian Federation permanently or temporarily residing in the Russian Federation Foreign citizens, stateless persons (with the exception of highly qualified specialists and members of their families in accordance with the Federal Law of July 25, 2002 N 115-FZ "On the legal status of foreign citizens in the Russian Federation"), as well as persons entitled to medical care in accordance with with the Federal Law "On Refugees":
federal fund CHI- a non-profit organization established by the Russian Federation in accordance with this Federal Law for the implementation public policy in the field of compulsory health insurance. The insurer for compulsory medical insurance is the Federal Fund as part of the implementation of the basic program of compulsory medical insurance.
Territorial CHI funds- non-profit organizations created by the constituent entities of the Russian Federation in accordance with this Federal Law for the implementation of state policy in the field of compulsory medical insurance in the territories of the constituent entities of the Russian Federation.
Medical organizations(providing medical care under compulsory medical insurance programs), having the right to exercise medical activities and included in the register of the Territorial CHI Fund. A medical organization operates in the field of compulsory medical insurance on the basis of an agreement for the provision and payment of medical care under compulsory medical insurance concluded with an insurance medical organization, and is not entitled to refuse to provide medical assistance to insured persons in accordance with the territorial program of compulsory medical insurance.
Insurance medical organization operating in the field of compulsory medical insurance (hereinafter referred to as CMO), - insurance organization licensed by federal body executive power, carrying out the functions of control and supervision in the field of insurance activities. An insurance medical organization exercises certain powers of an insurer in accordance with 326-FZ and an agreement on the financial support of compulsory medical insurance concluded between territorial fund and an insurance medical organization (hereinafter referred to as the agreement on the financial provision of compulsory medical insurance).
On other pages of our website you will find detailed information about obtaining a CHI policy in our Company, about medical organizations working in the compulsory medical insurance system, about their rights and obligations when receiving free medical care in the compulsory medical insurance system
Policy Compulsory health insurance is a system that allows you to receive most medical services free of charge in any region. It works as follows: every month, everyone who works in the Russian Federation makes contributions to the Compulsory Medical Insurance Fund. These funds go to insurance medical organizations operating in the CHI system. And already they pay for the work of employees of polyclinics, hospitals, dispensaries and other medical organizations - according to the number of patients served and the services provided to them.
In order to receive medical services free of charge, you must confirm that you are in the CHI system. This can be done by presenting the CHI policy.
"\u003e compulsory medical insurance (OMI) - a document confirming your right to free medical care in public medical institutions throughout Russia.2. How to apply for an OMS policy?
To apply for an OMS policy, you will need:
- passport or temporary identity card if you are changing it;
- insurance number of an individual personal account (SNILS).
If you are taking out a policy for a child, you will need:
- application (to be completed at the reception);
- birth certificate of the child;
- a document confirming that you can represent the interests of the child: your passport, an act of the guardianship and guardianship authority on the appointment of a guardian or trustee, a court decision, and so on;
- SNILS of the child (for children under 14 years old - if available, for children over 14 years old - mandatory).
If the documents will be submitted by your representative, for registration you will additionally need:
- representative's passport or temporary identity card, if he changes it;
- power of attorney for insurance in the selected organization.
MHI policy can also be issued To apply for a CHI policy, a foreigner will need:
- application (to be completed at the reception);
- passport of a foreign citizen or other document recognized in the Russian Federation as an identity document of a foreign citizen in accordance with international treaty;
- a residence permit for permanent residents of Russia or a mark on a temporary residence permit in the Russian Federation in a foreign citizen's passport or other identification document for temporary residents of Russia;
- SNILS (if available).
- application (to be completed at the reception);
- a document recognized in the Russian Federation as identification of a stateless person in accordance with an international treaty, or a document issued in the Russian Federation to a stateless person who does not have identification documents;
- a residence permit for permanent residents of Russia or a mark on a temporary residence permit in the Russian Federation in an identity document for temporary residents of Russia;
- SNILS (if available).
- application (to be completed at the reception);
- one of the following documents: a refugee certificate, a certificate of consideration of an application for recognition as a refugee, a copy of the complaint against the decision to deprive the refugee status to the Federal Migration Service with a note of acceptance for consideration, a certificate of temporary asylum on the territory of the Russian Federation.
You can submit documents to an insurance medical organization from the register of the Moscow City Compulsory Medical Insurance Fund. Citizens of the Russian Federation registered in Moscow (both adults and children) who have never previously received a CHI policy can apply for a policy both at an insurance company and at any center of public services, regardless of the area of registration.
Please note: Before the child's birth is registered and for 30 days thereafter, the child's health insurance is provided by the same insurance company that insured the child's mother or other legal representative. After this period, one of the parents or other legal representative may choose another insurance company for the child.
The compulsory medical insurance policy will be ready within 30 working days after the registration of the application and the documents submitted by you. At this time, on the day of the application, you will be given a temporary policy, which you can use as usual.
3. How to change or restore the CHI policy?
If you are satisfied with your Insurance Company, you need to change the CHI policy or issue a duplicate of it in cases where:
- you changed your place of residence, full name or other data in your identity document - within a month;
- you have discovered an inaccuracy in the personal data specified in the document;
- you have a policy CHI of the old sample (green A4 sheet or plastic card), and you want a new type of document (a blue A5 sheet or a three-color plastic card);
- you have damaged or lost the CHI policy.
To replace or obtain a duplicate policy, you will need the same documents as for initial clearance. If your personal data, place of residence has changed, or inaccuracies are found in the issued CHI policy, you will also need documents confirming this.
You need to contact your insurance company. IN
If you want to change the insurer, you need to apply for a new policy in the organization you like. But pay attention to general rule You can change the insurance company no more than once a year. If you have changed your place of residence or your insurance company has ceased operations - as often as possible. At the same time, from November 1 to December 31, applications for changing the insurance company are not accepted.
Within 30 days after the registration of the application and documents submitted by you, you will be issued a CHI policy of a new sample (old-style policies are no longer issued). During this time, you will be given a temporary policy, which you can use as usual.
4. Can I apply for an OMS policy online?
Documents for issuing (replacing, restoring) a CHI policy online can be submitted by adult users of the Official website of the Mayor of Moscow website, who have a full (confirmed) account, who have personal account specified by SNILS.
To apply for (replace, restore) an MHI policy online, you will need:
- scanned copy of an identity document;
- Black and white photo 320x400 pixels, up to 5 MB in format: JPG, JPEG, JPE.">photo(when ordering a CHI policy in the form plastic card with electronic media)
- Scanned copy of the signature in black and white, size 160x736 pixels, up to 5 MB in size: JPG, JPEG, JPE. The size of a handwritten signature should not exceed 10x46 mm.">Scanned copy of the signature(when ordering a CHI policy in the form of a plastic card with an electronic carrier);
- CHI policy number (if any).
After you submit the documents, a temporary certificate will be available for you to download in your personal account. The CHI policy itself will be ready within 30 days after registration of the submitted documents. You can get it at your chosen point of issuing policies of an insurance medical organization or at the center of public services (depending on which method of receipt you indicate when submitting documents).
5. How can I check if my CHI policy is valid?
6. What medical services can be obtained free of charge under the CHI policy?
Under the CHI policy throughout Russia (regardless of where it is issued), you can receive free Medical services are provided in medical organizations participating in the implementation territorial programs Compulsory medical insurance, in the amount established by the basic program of compulsory medical insurance.
A citizen with a compulsory medical insurance policy reserves the right to count on the passage of the main types of examinations within the framework of a specially designed program.
If the current condition endangers the life of the patient, the medical institution assumes the responsibility of accepting the patient, regardless of whether there is compulsory medical insurance or not.
Free services with compulsory medical insurance policy
Scroll free services according to the CHI policy in 2019, they include consultations, surgery, tests, diagnostics, etc.
Operations
Free operation before our eyes possible in case:
- cataracts of the lens of the eye;
- detection of strabismus, including strabismus in children;
- identified traumatic retinal deformity;
- definitions of glaucoma;
- various anomalies.
Senoplasty according to compulsory medical insurance is prescribed if available the following indications:
- problems with respiratory function;
- no sense of smell;
- establishment of mucosal edema;
- persistent SARS;
- abnormal breathing, snoring;
- the presence of dryness in the sinuses, continuous pain, etc.
Free removal available gallbladder in the presence of cholecystitis and disorders of the functioning of the digestive tract.
Can be held Marmara operation(venous disease of the reproductive system in men) in the presence of the following indications:
- varicocele of the second and subsequent stages;
- lack of possibility of fertilization;
- severe pain;
- aesthetics;
- change in scrotal tissue;
- joint arthroscopy.
Additionally, surgical intervention is possible:
- in case of venous diseases - on the veins;
- in the field of gynecology;
- oncology, pathological changes, including the lungs.
These varieties are far from exhaustive. It must be understood that cosmetic surgery cannot be performed free of charge.
Analyzes
It is customary to refer to free tests that are prescribed for the purpose of:
- treatment and detection of disease;
- identifying accompanying disorders in the human body;
- disease prevention.
For example, the attending specialist makes a preliminary diagnosis based on the patient's symptoms. Moreover, if the analysis for the presence of the underlying disease is carried out free of charge, then in order to determine the accompanying pathology, they are paid by the insurance agent.
Key medical standards, on the basis of which drug or other treatment will be initiated, are set out in specially developed basic and additional programs listed on the official portal of the Ministry of Health of Russia.
Among the most significant free types of analyzes are the following types:
- a blood test to detect syphilis, HIV, hepatitis, tuberculosis;
- diagnostics of blood and plasma for the content of the main components - red bodies;
- biochemical study of blood and lymph;
- hormone analysis;
- tissue biopsy, hysteroscopy;
- laparoscopy;
- high-tech analytical diagnostics of tissues and organs in particular;
- smears of the skin, saliva, etc.
Important: an exceptionally expensive type of research can be paid if there are suspicions of rare autoimmune or genetic diseases that are very rare (in about 0.01% of situations).
Diagnostics
According to the terms of the contract under the MHI policy, it is possible to conduct the following types of free diagnostics:
- fluorography;
- Ultrasound of the pelvic organs and the thyroid gland in particular;
- Ultrasound of the mammary glands, provided that the patient's age does not exceed 35 years;
- mammography - if the age is more than 35 years;
It is necessary to pay attention to the fact that the shelf life of the results obtained varies from three months to a year.
Dental
Patients of a medical institution who participate in the compulsory health insurance system have the right to count on:
- reception, consultation and examination;
- prevention and treatment of diseases associated with the oral cavity;
- filling of teeth;
- surgical intervention, including: tooth extraction, abscess, etc.:
- x-ray diagnosis.
There are also some restrictions on the services of professional dentists. For example, filling does not require any financial costs provided that a standard cement slurry is used. The light seal is installed exclusively on a paid basis.
Certain types of services are provided only if there is an appropriate referral, for example, a surgeon can cut the frenulum of the tongue only if there is a certificate from the orthodontist.
Other examinations
In most cases, the all-Russian and territorial lists of analyzes are as follows:
- testing for the detection of syphilis, HIV, etc .;
- general and clinical analysis of blood;
- ultrasound, MRI, CT;
- x-ray, fluorography;
- biopsy;
- stool analysis.
For your information: depending on the region of residence, the detailed list of medical services varies.
How to apply the CHI policy
To be able to organize treatment, each patient must be assigned to a specific medical institution. It is installed:
- remoteness;
- ease of use;
- other factors.
Possibility to change the polyclinic with frequency once a year.
Regardless of whether there is a compulsory insurance policy or not, all citizens of Russia have the right to use the services of emergency assistance.
There are specially developed standards that regulate the activities of an ambulance.
The ambulance service assumes the obligation to respond to the accepted emergency call within the first 20 minutes in case of a life threat, namely:
- accident;
- injury or injury;
- exacerbation of the disease;
- poisoning, burns of any degree, etc.
In the absence of a threat to life ambulance will arrive within two hours.
How to file a complaint about free service if it is not available or of insufficient quality
In case of conflict situations, for example, rude treatment or insufficient level of services provided, it is possible to file a complaint:
- in the name of the head physician of the polyclinic;
- to the Ministry of Health;
- insurance agent;
- in Roszdravnadzor.
Maximum period for consideration of a complaint does not exceed 30 calendar days. Based on the review, an appropriate decision is made.
If necessary, the patient reserves the right to change the doctor - just write an application.
List of new services for 2019
In 2019, the list of services provided under the compulsory insurance policy was expanded with joint replacement of the lower and upper limbs in case of obvious deformity, dysplasia and ankylosis, including the use of computer navigation.
Additionally, the list includes coronary myocardial revascularization using angioplasty directly with stenting in case of ischemia.
Additional new methods of treatment in the field of maxillofacial surgery are being added to the basic CHI program. In particular, citizens will have access to free surgical intervention to eliminate defects and deformities with the additional use of materials for the purpose of transplantation and implantation, and the exclusion of neoplasms.
The rights of patients in receiving free services under the MHI policy are presented below in the video.
29.05.17 241 023 10
The doctors were shocked when I showed...
At the weekend I lay at home with an impossible sore throat and a temperature of 39.6.
Throwing not the first dose of paracetamol for the day, I called an ambulance. They told me that it was a sore throat and that I should call the district police officer on Monday. The ambulance didn't come.
Zhenya Ivanova
treated and recovered
I typed in the search bar: "What to do if the ambulance refuses to go." I saw advice on the forum: “Say menacingly that you should call the insurance company now. They'll come right away." I did so. The ambulance arrived. After that, I threatened the doctors twice more with a call to the insurance company and once I actually called the number indicated on the policy. Helped every time.
The insurance company protects my rights and really guarantees free treatment. But if you do not know the laws, then unscrupulous doctors will be able to deceive you, refuse treatment, demand an additional fee.
I recovered and decided to find out what your mandatory health insurance guarantees you.
Get to know your CHI policy
Most likely, you already have a compulsory health insurance policy. It was made for you by your parents right after you were born. It is either in your passport or in a box with all important documents.
If you don't have a policy, drop everything and go to apply
Without a policy, you won't get any free treatment. Fortunately, you can get or exchange a policy in any city without a residence permit and registration. To do this, take your passport and SNILS with you and go to the insurance company that is convenient for you, which issues these policies.
This is a card If there is no SNILS, go first with your passport to the insurance company, then wait 21 days and only then receive the policy. Citizens of the Russian Federation, foreign citizens permanently or temporarily residing on the territory of the Russian Federation, refugees and stateless persons can obtain a policy. The policy is issued to citizens of the Russian Federation without limitation of validity period. By law, even if you have an old-style policy and it is overdue, insurance will still work. Only until you change your passport details: first name, last name, place of residence.
If you come to the clinic with an old expired policy and you are denied treatment, this is illegal. You must be accepted. In polyclinics, everyone is asked to change policies for new documents, but so far this is only a recommendation. Of course, it is better to heed this recommendation: when a law comes out that terminates old-style policies, it will not take you by surprise.
Which insurance companies provide CHI policies
Compulsory health insurance is an insurance program, that is, everyone pays a little bit into the common pool, and then they pay out of it to those who need it. The common cauldron collects the state from entrepreneurs and distributes it through an extensive system of funds, which, in turn, pay hospitals. And the insurance company is such an intermediary manager that connects you, the hospital and the state.
Insurance companies earn on CHI in the same way as on other services. They are also responsible for the quality of services and discipline in the system. Your first point of contact is the insurance company.
Each region has its own registers of companies that make CHI policies. Just google it.
Where can I get treatment with a CHI policy
To get to a clinic in another city or district, you need:
- Select a clinic. Any, not necessarily the one closer to home.
- Find out at the reception which insurance companies work with this clinic. If you have a choice, look at the description of the company on the CMO website. Everyone has the same insurance, but some have more offices, and some have round-the-clock support.
- Come to the insurance company with a passport and SNILS, fill out an application to replace the policy.
- Get a temporary license. It works like a policy for a month.
- Return to the clinic. Say the code phrase “I want to attach to your clinic” at the reception. Get the application form, fill it out and return it to the registry.
Now you can be treated for free in this clinic.
If your insurance company serves the clinic to which you are going to attach, then you do not need to change the policy. But you need to inform the insurance that you have moved and want to be treated elsewhere. Otherwise, money for your treatment new clinic will not receive.
Why you need to join the clinic
You need to join a polyclinic, because our country has a system of per capita financing. Money for your treatment is issued only to the institution to which you are assigned. Therefore, you can not attach to several clinics at once. You can also officially change the clinic no more than once a year. Previously, this could only be done if you moved. In this case, the new clinic will offer you to write an application addressed to the head physician.
You cannot attach yourself to a research institute or a hospital, only to a district polyclinic. And already there, the local therapist will write out referrals to highly specialized specialists: an eye surgeon, a cardiologist, a chiropractor. Without a referral from the attending physician or an ambulance specialist, you can only be admitted to specialized clinics for a fee.
What is EMIA
In Moscow, the data of all patients are entered into EMIAS - a unified medical information and analytical system. This simplifies the process of making an appointment with specialists: you can get a ticket to the doctor, cancel or reschedule an appointment, and receive a written prescription electronically. EMIAS even has mobile app.
Please note: if you have moved and decided to attach to a new clinic, then you cannot just take it and do it through the system. You need to write an application addressed to the head physician and wait until the bureaucracy approves it. This may take 7-10 business days. If you are registered on the Moscow public services portal, then you can apply electronically. It is promised to be reviewed within 3 working days.
When I faced such a problem, I needed help urgently. And by law they are obliged to help me without any many days of delay. But the polyclinic is afraid that if they treat me before the clumsy machine enters new data into EMIAS, then they will not receive money for me from the insurance.
Right in front of the hospital administrator on duty, I called the insurance company, after which I received the necessary consultations at the hospital for free. I was also examined by a whole commission of department heads, and until now everyone treats me very carefully.
What is included in CHI treatment
The law on obligatory medical insurance gives the right to all of us to be treated free of charge. And even if your policy has expired, you can use it.
If you don’t have a policy with you, you can still make an appointment with a doctor, they don’t have the right to refuse you.
Although for nurses this is an additional concern, therefore, most likely, they will try to convince you that it is impossible to do this. If this happens, just call your insurance company.
In any unclear situation, call the insurance
The minimum amount of assistance is described in the basic program of compulsory health insurance. Whether to add something else to this list, each region decides independently. The exact list of insured events can be found in any clinic or found on the website of the Ministry of Health in your region.
In any case, you can apply this rule: if something threatens your life and health, it is treated for free. If you are generally healthy, but want to feel even better, then you can most likely do it just for money. If the state can help you, but the level of this assistance seems too low for you, you will have to accept or pay extra.
Examples of what can and cannot be done under the CHI policy
| It is forbidden | Can |
|---|---|
| Teeth whitening is an aesthetic procedure | Do brushing your teeth because it is the prevention of caries |
| Get imported Japanese adult diapers by choosing the brand yourself | Get diapers for the elderly |
| Remove a couple of extra pounds. Your figure is not insured by the state | Remove boil |
| Wait for exercise therapy exercises from hatha yoga or a modern gym | Go to physical therapy |
| See a dermatologist if you're just worried about oily skin on your face. | See a dermatologist for severe skin rashes |
| Make a denture | Remove the tooth |
Teeth whitening is an aesthetic procedure
Brushing your teeth, because it is the prevention of caries
Get imported Japanese adult diapers by choosing the brand yourself
Get diapers for the elderly
Remove a couple of extra pounds. Your figure is not insured by the state
Remove boil
Wait for exercise therapy exercises from hatha yoga or a modern gym
Go to physical therapy
See a dermatologist if you're just worried about oily skin on your face.
See a dermatologist for severe skin rashes
Make a denture
Remove the tooth
When something hurts, you can get a free appointment with a therapist who will write a referral to a specialist. When indicated, the GP should issue referrals to any doctors who work in public clinics.
Without a referral, you can make an appointment with a surgeon, gynecologist, dentist and dermatologist at a dermatological and venereal dispensary. Or enroll your child to a child psychiatrist, surgeon, urologist-andrologist or dentist. CHI does not guarantee free tests and examinations without a referral from the attending physician.
Once every three years, you can go through a free medical examination and find out if everything is in order with your health. Medical examination is carried out for everyone every three years - that is, if this year you turn 21, 24, 27 years old and so on.
The CHI program also includes free pain relief and rehabilitation after illnesses and injuries. But for one or two, write down in which case you are supposed to free help on insurance, and where you have to pay on your own, it will not work. There are a lot of nuances in this case. If you have a rare disease or a difficult situation, contact the Federal CHI Fund.
What exactly is not included in the CHI program
The state will not pay for:
- Any treatment without a doctor's prescription.
- Carrying out surveys and examinations.
- Treatment at home is optional, not by special indications.
- Immunizations outside of government programs.
- Spa treatment, if you are not a sick child or a pensioner.
- Cosmetic services.
- Homeopathy and traditional medicine.
- Dentures.
- Superior rooms - with special meals, individual care, TV and other joys.
- Medicines and medical devices, if you are not in a hospital.
If the hospital asks for money for services that are not on this list, just in case, call the insurance company and check if it is legal.
Privileges
People with disabilities, orphans, families with many children, participants in hostilities and other citizens who are entitled to social benefits, the state is ready to pay for more medical services. Each category has its own lists of benefits, you can find them in the department of social protection or find them on the Internet.
Sometimes you are legally entitled to free treatment, but doctors just shrug. There may be a waiting list for free rehabilitation for several months, and painkillers in your district hospital may simply not be available. It's illegal, but it's a fact of life.
Extortion
Doctors are people too, and nothing human is alien to them. Like any person, some doctors are more interested in getting a lot of money from you right now than getting a little less money from the insurance company and much later. Therefore, a whole illegal practice of extorting money for treatment under compulsory medical insurance has grown in Russia.
At the heart of this extortion is legal illiteracy. It is enough for a doctor to make a smart face and take a strict tone so that frightened patients begin to throw money at him. But the slightest sign that the doctor is in front of a legally savvy patient - and the tone changes. Therefore, it is very useful to know what medical services you are required to provide for free.
Remember that treatment is free only for you. The hospital and doctor will receive money for this treatment from the health insurance fund. This money was paid to the fund by entrepreneurs, including your employer.
You do not need to pay a second time out of your own pocket for what the state guarantees you. Moreover, the doctor, most likely, will receive payment from the fund anyway, even if you are forced to pay.
You do not pay for treatment, but the hospital will receive money for it
If you know for sure that you should and can be treated for free, but the doctor offers to pay, call the insurance company. The insurance number is written on your policy, experts hotline will help you.
If you cannot do this, ask your doctor to write a written refusal to provide free medical care. If the doctor behaves defiantly, you can turn on the recorder, this is legal. Even if this does not help, call the department for the protection of the rights of citizens in the CHI system.
7 499 973-31-86 - phone number of the department for the protection of the rights of citizens in the CHI system
Emergency assistance is always free
If something really bad happened - you lost consciousness, broke your leg or feel acute pain - you should be helped in any state clinic, even if you don’t have any documents with you and you never received a policy.
The hospital has no right to refuse assistance to newborns and children under the age of one year, even if the child's parents do not have a policy and registration. They cannot refuse pregnant women either - they can go to any antenatal clinic and any maternity hospital, even without documents.
All participants in the healthcare system are just people: someone's acquaintances, friends, brothers, matchmakers and godfathers. They have parents and children. They are all Russians and they work just like any of us.
- If a surgeon demands a bribe for pain relief, then this is not the healthcare system, it is this particular surgeon, his parents and teachers. It means that his father, somewhere in his childhood, set an example for him that a bribe is normal. How do you feel about bribes?
- If a hospital says it doesn't have money for medicines, it's not Putin's fault, but some officials who don't know how to draw up budgets. Or the head physician who does not know how to manage money. You have a lot of acquaintances who do the same thing at their jobs.
- After all, when you get paid in an envelope, it's your employers who underpay your health insurance. Where will the money for your medicines come from, if you have allowed not to pay for them?
It turns out mild schizophrenia: the same person supports gray salary and complains about insufficient funding for hospitals.
Putin, Navalny, Medvedev, Tinkov or Trump will not solve our health problems. We will solve this problem ourselves if we give our children an example of a conscientious attitude to work and the law. To skip classes at the institute was not a feat, but a shame. It was embarrassing to take tests for money. To give bribes was against our principles. To know and stand up for your rights was a duty, not a superpower.
In short: no one will fly in and give us free medicine as in paid Israeli clinics. All the hell that we see in hospitals is not hospitals, it is ourselves. And me too.
Let's start with paying taxes and contributions. I have everything, thanks. Sorry for the moralizing tone, but I just got tired of this whining.
Remember
- If you don't have a policy, drop everything and go apply.
- With a compulsory medical insurance policy, you should be treated free of charge at any state polyclinic throughout Russia.
- Treatment is free only for you. The hospital and doctor will receive money for this treatment from the health insurance fund.
- The policy works even if it has expired. If you come to the clinic with an old policy and you are denied treatment, this is illegal.
- In any unclear situation, call your insurance medical company. The number is on the policy. Write it down on your phone right now.
- If your insurance does not save you, call the Federal Compulsory Medical Insurance Fund: +7 499 973-31-86.
- If you spent money on treatment, which should be free by law, write a statement to the insurance company - you should get your money back.
- Emergency assistance is always free, even if you do not have documents.