Several years ago, a system began to operate in the Russian Federation that allows you to receive medical insurance using a new type of policy - plastic. Registration of an electronic policy is not complicated, it is free. To accomplish this, you need a minimum list of documents and a little time. In the future, the benefits will be obvious, since the card will always be with you and in a neat form.

The electronic version of the policy is presented in the form of a plastic card, similar to a bank card. For this reason, it is compact and can be stored together with other cards and business cards. Let's look at its distinctive characteristics.

Front side:

• at the top is the coat of arms of Russia, the name of the document and a logo reflecting affiliation with the compulsory medical insurance
• in the central part there is a chip with data about the policyholder, insurer, features of the proposed program
• at the bottom is written a code consisting of a sequence of 16 digits
• to the right of the chip – information on the insurance company (name, contact information)

Inner side:

• TFOMS phone number is written at the top, there is a signature of the policyholder, a blue POMS icon is displayed
• in the central part there is a hologram necessary to confirm the authenticity of the document
• below – data on the card holder, card serial number, expiration date, gender of the insured, his date of birth

Where can I get it?

If there is a need to obtain an electronic policy, and this is really convenient if reading devices are installed in the medical institutions where services are performed, you should contact the office to order it.

You can contact:

• to your insurance company. If you don't know where to go. You can ask at the hospital at the place of attachment. You can read about what documents are needed for this in the article further in the text or on the company’s website or by calling the operator
• to any insurance company that has a license to work with compulsory medical insurance products. If it is necessary to change the company, the list of employees in this direction can be found on the TFOMS website for your region
• through the State Services website. You need to be registered on it. In the section regarding compulsory medical insurance, you can apply for the required service, except in situations where the option does not work in the region, since the work in this part on the site has not been completed in full
• at the MFC. To do this, you need to visit the center and if they serve clients on this issue (you can find out by phone), write an application and submit the documents necessary for processing
• in the human resources department at the place of work. In some organizations, insurance is carried out centrally, including the replacement of cards and the issuance of new policies. If you are the only one with a problem, you still need to contact the HR department, who can order a policy for you

Do you need an electronic compulsory medical insurance policy if you have a paper one?

Paper type insurances remain valid until their expiration date and medical institutions are required to provide services based on them. The law does not require electronic versions. They can be issued during initial registration or when issuing a duplicate, in case of replacement. Since health insurance was previously issued with a validity period, replacement will occur over time.

Advantages and disadvantages

If medical insurance has improved the quality of medical care for citizens and provided the opportunity to perform many expensive procedures for free, then the introduction of electronic policies has simplified the operation of the system. Those who use the new contract options have managed to appreciate the advantages, but also emphasize the presence of disadvantages.

Advantages:

1. Compactness. Its small size and dense material allows it to be placed next to other cards in your wallet.
2. Wear resistance. Even with prolonged use, the card remains readable and does not tear.
3. If necessary, a free replacement is provided.
4. Protection. The card can only be used by its owner, since it contains all the holder’s information, a photo, and requires entering a PIN code when used.
5. Access to online services. Using the card, you can make an appointment with a doctor by registering on the State Services website.

Flaws:

1. Not all medical institutions have card readers
2. Not all insurance companies issue EPOMS
3. If it is necessary to enter data about data changes, adjustments cannot be made; a new version must be released

Documents required

The list of documents for registration of a compulsory medical insurance policy is the same for all insurance companies. In rare cases, additional ones may be required, but this happens individually. Consider an option for adults and children.

For adults

The standard list of documents required to be provided to adult policyholders consists of:

• ID card (civil passport)
• statement written by the insurer
• SNILS number – insurance number of an individual personal account
• old contract if the service is performed by the same company (optional)

For foreigners, in addition to the specified list, a document confirming the right to stay in the country, confirming temporary registration or refugee status (or confirmation of its registration) is required.

For children

In order for an electronic policy to be issued to a child, he must be accompanied by a parent. In this case, both the minor and the parental representative (guardian) must have documents with them: birth certificate, passport, document confirming legal authority in relation to the child. SNILS for children under 14 years of age is not required.

Which insurance company to choose

In determining a suitable insurance company, you can be guided by recommendations from advertising, friends, and reviews on the Internet. After analyzing the information, determining the rating of the insurance company regarding the fulfillment of its obligations and the convenience of the office location in the area of ​​your residence, you can go to apply for a policy. If the conditions of the company where the paper policy is issued are satisfied, you can apply for a plastic sample without having to look for other alternatives.

Step-by-step instructions for receiving

The steps to replace an old paper contract with a new plastic one consist of performing the following steps:

1. Decide on the insurance company that will provide the service. You can contact the same one where the paper version was issued or a new one if you are not satisfied with its work. Before your trip, you can call and find out if they issue plastic contracts, since it may be that a particular branch does not do this.
2. Come to the IC office.
3. Write an application (a form is usually provided), provide the necessary documents.
4. Get a temporary policy. After 10 – 30 days you can get the desired electron option.

How to use the new electronic policy

A medical insurance policy is required to be provided when visiting medical institutions. For this reason, it is advisable to always have it with you. If you request a plastic version, a paper version will also be provided. It can be kept at home as a backup or in case the card is lost, for those hospitals that are not equipped to use modern versions.

How to use them will be easier for those who have already used bank cards from the moment they were received to the withdrawal of money; it is not difficult to understand the principle of use. In addition to the card, you also receive paper with a pin and pack. These codes are necessary to confirm that the card is being used with the owner's knowledge and to unlock it if the PIN code is entered incorrectly. The card is activated automatically upon first use.

To sign up for a queue, you need to turn to the help of electronic terminals that are installed in medical institutions. Looking at its front side, you can see:

• coupon connector
• window for reading the paper version of the policy
• connector for supplying a universal card (for installing an electronic policy). Here the card is accepted, information is read from it and issued back to the owner
• contactless card field for social card entry

By entering information about yourself, you can make an appointment one by one with the desired doctor.

Conclusion

By analogy with bank electronic cards, compulsory medical insurance is also convenient and functional. Having it with you, you can ask for help at any time. Long-term use does not cause significant harm, which cannot be said about paper shrouds. If desired and if necessary. Every citizen can order their own card to experience the benefits of owning it in a new format.

Insurance company offices on the map

Several years ago, compulsory health insurance policies of a new type began to be issued in the Russian Federation. Now, instead of paper, you can get a mobile and convenient plastic card. You will find out what an electronic compulsory medical insurance policy looks like and what it is further.

Appearance of the new compulsory medical insurance policy

The electronic compulsory medical insurance policy (EPOMS) has the form of a plastic card. It is the same size as a bank card. It is compact and easily fits in a wallet along with other cards and business cards.

On the front side of the card you can see:

• in the upper part - the coat of arms of the Russian Federation, the name of the document “Compulsory Health Insurance Policy”, the logo of the compulsory medical insurance system;
• in the middle - a microchip for reading data from the electronic compulsory medical insurance policy about the insured person, the insurer, and the features of the insurance program;
• Below is an individual 16-digit insurance code.

To the right of the chip is an imprint of the insurance organization with its name, the name of the branch, and its contact information.

Example:

The reverse side of the document looks like this:

• in the upper part - contact telephone number of the Territorial Compulsory Medical Insurance Fund (TFIF), signature of the insured, blue POMI badge
• in the middle there is a holographic sign confirming the authenticity of the document;
• below – full name and photograph of the owner, serial number (under it), validity period of the document, gender of the insured person, date of birth.

Example:

Advantages and disadvantages of EPOMS

Each innovation has its pros and cons. An electronic compulsory health insurance policy began to be issued in order to improve the health insurance system. Its owners are faced with the advantages and disadvantages of this document.

Advantages:

1. Convenience and compactness. Thanks to its small size, EPOMS easily fits into a wallet. This is how a paper policy differs from a plastic one.
2. Strength and wear resistance. The plastic does not tear, and the data on it is not erased - the information can always be easily read.
3. Replacing a paper compulsory medical insurance with an electronic one is absolutely free.
4. Only the insured can use the compulsory medical insurance policy in public hospitals and clinics. The card is protected from fraudsters by a pin code, chip, and photo of the owner.
5. Thanks to EPOMS, the insured person can make an appointment with a doctor through his personal account on the Internet portal of public services or through a terminal.

Flaws:

1. Not all clinics are equipped with the necessary equipment and software to work with scanners or chip readers.
2. Not all insurers issue EPOMS.
3. When changing personal data, you cannot simply rewrite it onto the chip - you will have to change the card itself.

Where can I get a plastic health insurance card?

Health insurance holders often put off replacing paper media with EPOMS until later, as they fear that this procedure may take a long time. In fact, getting a plastic policy is not problematic. How to get EPOMS?

You can request a replacement:

• to your insurer. You can find out which company has your insurance at your medical facility. This is usually a local clinic. You can get acquainted with the list of points where insurance is replaced on the website of your insurance organization or regional TFOMS;
• in any insurance organization. If you want to change your insurer, you can view the list of insurance companies on the website of the regional TFOMS, and you can also check the EPOMS there;
• on the government services website. To do this, you need to register on this resource, go to the section “What is a compulsory medical insurance policy and how to get it” and fill out an application. However, this option is currently being finalized, so issuing an electronic compulsory health insurance policy through government services is temporarily not possible. You can order EPOMS online only in some regions of the country, for example, in Moscow or St. Petersburg;
• through MFC. You can get a card at any branch of the MFC by handing over a package of necessary papers to the operator and filling out an application;
• to the employer. Officially employed citizens can notify the human resources department at their enterprise of their desire to receive an electronic policy. Large organizations themselves send the paperwork to the insurer, but you will have to receive the EPOMS in person.

The list of insurers that provide medical insurance includes large and reliable organizations, such as SOGAZ-Med, RESO-Med, Rosgosstrakh-Medicine, Ingosstrakh-M.

Step-by-step instructions for receiving

To replace an old-style contract with a new plastic card, you must follow the following instructions:

1. Find out the contacts of your insurer or choose a new organization and call the main office in advance to find out which branches are issuing plastic cards;
2. Come to the insurer's office;
3. Write an application, provide documents for consideration and receive a temporary certificate of insurance;
4. Come get new insurance. Usually its production takes no more than 10 days. By law, the card must be issued no later than 30 days after submitting the application.

A PIN code and a pack code are issued along with the card. What are they needed for? A PIN code is required to confirm that the information is entered with the user’s knowledge, and a pack code is needed to unlock the card in the event of an incorrect PIN code entered three times. Activation of EPOMS occurs upon first use.

Required documents

To obtain an EPOMS, you need to collect the following papers:

• civil passport or birth certificate of the insured person;
• application for replacement;
• individual personal account insurance number (SNILS);
• old insurance contract (optional).

If the card is issued for a minor, he must be accompanied by a parent with his passport or a legal representative with a passport and a power of attorney, which is dictated by the Rules of Compulsory Health Insurance. For children under 14 years old, having a SNILS is not a requirement.

Do I need to change the old contract to a new one?

It is advisable to replace health insurance contracts received before 2011 with new documents, but this is not a mandatory condition. Insurance is considered valid until its term has expired - this is stated in Art. 51 clause 2 of the Federal Law “On Compulsory Health Insurance in the Russian Federation”. Consequently, health workers do not have the right to refuse to provide medical care upon seeing an old-style document, since it is valid.

Sooner or later, the document will need to be replaced, because previously health insurance was issued with an expiration date. Thus, it is advisable to make a replacement as early as possible, because using the electronic compulsory medical insurance policy, you can make an appointment with a doctor remotely, and besides, it is unlimited.

Conclusion

An electronic health insurance card is an extremely convenient and useful thing. Thanks to it, you can forget about queues at clinics by making an appointment online. In February 2017, the issuance of plastic cards was suspended, but on May 1 of the same year it was resumed - now every citizen can replace their old paper health insurance contract with a compact electronic compulsory medical insurance policy with a Russian-made micron chip.

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Almost every Russian has a compulsory health insurance policy, but not everyone has a clear idea of ​​where and what kind of medical care can be obtained using it. About what rights we are entitled to under the compulsory medical insurance policy and how to use it correctly, including in a foreign city, and when the policy may be useless, in an educational lesson from Tatyana Serebryakova, an expert at the Interregional Union of Medical Insurers.

What treatment does the compulsory medical insurance policy not entitle you to and should you not insist on it?

The patient cannot qualify for treatment under the compulsory medical insurance policy in the two most common situations.

Firstly, when applying to a medical institution that is not funded by compulsory medical insurance for a specific profile. Each medical organization, both private and public, applies once a year to participate in the compulsory medical insurance system. Moreover, not “in general,” but according to specific profiles and types of treatment. And it is not a fact that the hospital or clinic you choose provides exactly the services that you need under the compulsory medical insurance policy. That is, when contacting a medical institution, you need to find out two main parameters: whether it participates in the compulsory medical insurance system, and under what types and conditions (all or some specific ones) in terms of profiles, medical specialists, assistance to children or adults.

Secondly, if the treatment itself is not among those financed by compulsory medical insurance. This applies, for example, to sexually transmitted diseases, HIV, AIDS, tuberculosis, mental and behavioral disorders, palliative care (both inpatient and outpatient). Such medical care is financed from other sources of the State Guarantee Program - funds from the federal, regional or local budget. The compulsory medical insurance policy does not cover treatment of citizens outside the Russian Federation, plastic aesthetic surgery (if there are no medical indications for this), preferential dental prosthetics, sanatorium treatment, as well as the provision of medical care in conditions exceeding the level of comfort established by the program.

In addition, the number of services that are not financed by compulsory medical insurance, and therefore are not provided under the policy, does not include social benefits. For example, related to preferential drug coverage for outpatient treatment. That is, if in a hospital all medications are provided free of charge, then a patient who does not have the right to benefits pays for a prescription received at an appointment in a clinic independently. Sick leave payments are also not related to the compulsory medical insurance policy - this is a type of social benefit that is paid from social insurance funds.

Does it matter if a person gets sick while in a place where he does not have permanent registration?

You can get treatment for free anywhere in the country, the main thing is not to forget to take a compulsory health insurance policy when traveling. But this applies to medical care under the basic compulsory medical insurance program, which is approved by the Decree of the Government of the Russian Federation and is absolutely the same in all regions of Russia. That is, any acute condition or exacerbation of a chronic disease, toothache, bruises, poisoning, allergies or sunstroke - all these are reasons to seek free help from a clinic or hospital operating in the compulsory medical insurance system.

If your condition worsens, you also have the right to free ambulance and emergency outpatient care. Moreover, when providing emergency medical care in cases that threaten a person’s life, presentation of a compulsory medical insurance policy is not required. Such assistance is provided to everyone, without exception, free of charge and without delay.

However, in other cases there is a difference between permanent residence and temporary residence region. This difference applies to those medical services that are provided in addition to the basic compulsory medical insurance program. For example, in a number of regions of the Russian Federation with a high level of socio-economic development, the Territorial Compulsory Medical Insurance program is much broader - due to certain types of high-tech medical care that are not included in the basic program. In addition, due to the “super-basic compulsory medical insurance program” the scope of preventive measures can be expanded. But the extended program is available only for residents of this specific region. A non-resident patient will not be provided with services beyond the basic compulsory medical insurance program free of charge under the compulsory medical insurance policy.

What if the disease is associated with some local characteristics? For example, a Muscovite traveling in Transbaikalia was bitten by a tick.

Medical care under the compulsory medical insurance policy (including tick removal) is required at any emergency room. If a bite-related disease develops, it should also be treated free of charge - at the expense of compulsory medical insurance funds. This also applies to other similar situations, regardless of where the sick person is located.

Is it possible to get sick leave if you get sick while traveling?

A person has the right to receive sick leave in any region of the country. It all depends on medical indications that indicate that he is incapacitated. If you cannot go to the clinic, call a doctor at home. Medical care at home must also be provided under the compulsory medical insurance policy.

If the situation is not an emergency, and a person on vacation simply has time to take care of his chronic illness, will he be provided with planned assistance?

The compulsory medical insurance policy allows you to seek routine medical care anywhere in the country. The disease profiles for which such assistance is provided are listed in the basic compulsory medical insurance program. However, planned treatment, for example, adjusting the dose of insulin or selecting a hypertensive drug, is a rather lengthy process that requires a lot of examinations, additional consultations, etc. Therefore, it is better to do this at home, in consultation with your doctor. If you are planning to leave for another region for a long time and know that at this time you may need routine medical care, attach yourself to the clinic at your place of stay.

Or maybe in another region they will declare that the compulsory medical insurance policy is invalid?

The current policy guarantees the provision of free medical care under the basic compulsory medical insurance program throughout Russia. Enter your insurance company's hotline number in your mobile phone address book and call it in any case of dispute. If you have not used your policy for a long time, call your insurance company’s hotline (the telephone number is indicated on the policy) and find out if there is data about it in the corresponding register of insured persons. The best thing is to replace it with a new compulsory medical insurance policy of a single standard. To do this, it is enough to contact any insurance company, but it is better to schedule a visit 1.5 months before the intended trip.

What to do if a patient is forced to pay for treatment?

Contact the head of the medical organization, call the Territorial Compulsory Medical Insurance Fund of the region in which you are not in the place of insurance, and where you were denied medical care or required to pay for it. Today, in every subject of the Russian Federation, the work of Contact Centers in the field of compulsory medical insurance has been organized; the telephone number of such a Contact Center should be posted on stands in every medical institution, on the website of each Territorial Compulsory Medical Insurance Fund. This number and other details of the Contact Center will always prompt you if you call the hotline of your insurance company.

If you had to pay, keep the receipt and warn that you will appeal this forced payment (write a complaint). If you are offered to sign an agreement for the provision of paid services (otherwise, paying for medical care in the Russian Federation is not legal) - read it carefully and do not sign if it states that you are aware that you can receive medical care for free, but have voluntarily decided pay.

Irina Reznik

According to the Compulsory Medical Insurance Rules, policies of a single type are valid on the territory of the Russian Federation. The document can be in the form of a paper or electronic policy (EPOMS). What is an electronic compulsory medical insurance policy? A uniform policy in the form of a plastic card can only be issued by citizens of the Russian Federation. The document has a built-in chip that contains data about its owner; the reverse side contains the signature and photograph of the insured person, which prevents the use of your document by another person and guarantees receipt of medical care throughout Russia.
You can apply for an EPOMS in our

8-800-200-92-04

24/7 contact center

HOW TO USE
ELECTRONIC POLICY

HOW TO USE
ELECTRONIC POLICY

When an insured event occurs, many people wonder: how to use the electronic compulsory medical insurance policy.

There are no differences in the use of a plastic analogue of compulsory medical insurance and a document on paper. This document also gives the right to use the full range of medical care free of charge anywhere in Russia, according to the state guarantee program.

Using an electronic policy, it is possible to make an appointment with a doctor through a terminal or online, without queuing at the reception desk, and at the same time, it is easy to use.

Along with the policy, the insurance medical organization provides information to the insured person about the rights of the insured persons in the field of compulsory health insurance, about the procedure for information support at all stages of providing them with medical care in the form of a memo or brochure.

The policy is either a paper form or a plastic card. It can also exist in electronic form.

To start using VHI, you need a printout of the policy and an identity document.

Supporting chronically ill people who need expensive treatment on an ongoing basis is not included.

You can receive an expensive procedure either free of charge, under a VHI policy, or receive monetary compensation for the expenses incurred at your own expense.

If the insured person is admitted to a public hospital with which the insurance company has an agreement, or this hospitalization is agreed upon with the insurance company, then voluntary insurance covers the cost of paid examinations and expensive medications.

Medical assistance in this case is provided by the most highly qualified doctors of the department. The insurance may also include the costs of transportation or repatriation of the patient.

What is an insured event?

An insured event for the company occurs in the event of an acute, as well as exacerbation of a chronic disease, injury and other sudden circumstances.

Treatment of conditions resulting from:

• illegal actions;
• suicidal actions;
• nuclear explosion and radiation effects;
• military actions, riots, natural disasters, and other force majeure circumstances.

Also, insurance companies do not pay for conditions that occur outside the insurance period.

The exception is situations when a person needs urgent hospitalization, the beginning of which relates to the insurance period, and the end of which falls outside this period.

Sometimes the question of whether an event is an insured event or not requires expert approval.

At the first stage, such disputes are resolved by company specialists. In case of disagreement with their opinion, the issue can be resolved in court.