Announcement. Compulsory health insurance in the Russian Federation in 2020. Features of registration and necessary knowledge.

Dear readers! The article talks about typical ways to resolve legal issues, but each case is individual. If you want to know how solve exactly your problem- contact a consultant:

APPLICATIONS AND CALLS ARE ACCEPTED 24/7 and 7 days a week.

It's fast and FOR FREE!

Many citizens have already appreciated the value of compulsory health insurance. That is why he does not save on his health and actively pays for the pole.

So what is compulsory health insurance in Russia? And what are the main nuances of this procedure?

What you need to know

In accordance with the law, all citizens included in the system have the right to receive free medical care throughout the Russian Federation.

How the fund is organized and financed

The Compulsory Medical Insurance Fund is an independent state credit company that implements government policy in the medical industry.

Such organizations are designed to accumulate insurance premiums, as well as ensure financial stability.

This is already regulated by an additional agreement on the part of the medical institution and the applicant.

The clauses of the contract must include:

• date of conclusion;
• name of the insurer;
• basis for activity;
• subject of the contract;
• volume of medical care;
• date and signature.

Required documents

To register you will need:

• passport of a Russian citizen;
• birth certificate if it is a minor citizen;
• application of the established form.

For refugees, you must additionally provide a certificate of recognition as such. The foreigner must provide a residence permit or passport.

Stateless persons must provide registration and passport details.

Calculation procedure

How to calculate compulsory health insurance, according to the Federal Law, payment for medical care is carried out after the medical organization provides a register of accounts and an invoice for payment within the established limit.

Insurance Company:

• submits an application to the territorial body to receive a target remuneration for an advance payment;
• submits an application to receive an amount for services rendered.

Then the territorial authority reviews the application and satisfies it, transferring the required amount.

Details about insurance premiums for compulsory health insurance (CHI)

The duration of the billing period is determined for each year of time worked. This is exactly how accounting works.

The duration of the service is the entire life of the insured person. The payer of insurance premiums is an individual or an employer.

If a person is not employed, then he can independently contribute funds to the Social Insurance Fund. Insurance premiums are credited to the federal fund.

The quality of medical care in Russia depends on the efficiency of the medical insurance organization, which is the link between territorial health insurance funds, medical institutions and consumers of insurance services. Every citizen of Russia has the right to choose and change a medical insurance organization in the compulsory medical insurance system, which is enshrined in law. These companies have a lot in common, but there are also nuances that affect the final attractiveness for a potential client.

General characteristics of medical insurance organizations

The employer acts as the insurer for working citizens, and the local administration for the unemployed. Self-employed persons, which include individual entrepreneurs, lawyers, farmers, etc., must independently decide on the issue of concluding an insurance contract. If a citizen is not satisfied with the services provided by an insurance medical organization, then he has the right to enter into an agreement with another company. Each medical insurance organization:

• Operates under a license to provide compulsory medical insurance services and carry out measures to control the quality of medical care;
• Concludes standard agreements with Territorial Compulsory Medical Insurance Funds and medical institutions;
• Pays for medical services provided to insured persons by medical organizations at a single rate. It is approved for each subject of the Russian Federation;
• Works only in the field of compulsory or compulsory and additional health insurance;
• Receives the same amount of funds from the Territorial Fund per insured person;
• Has an authorized capital of 10 million rubles. (with additional provision of medicines - from 30 million rubles).

A medical insurance organization is obliged to protect the interests of insured citizens, including in court, by filing claims against medical institutions for material compensation for physical or moral damage caused to the insured person through their fault. Medical insurance organizations advise and inform insured citizens about regulatory legal acts on issues of compulsory health insurance.

Differences between medical insurance organizations

Equal conditions for the start of work of medical insurance organizations do not mean that they will function equally. Differences can be traced in the organization of work with a specific client. Companies that enter into contracts with large enterprises and institutions operate more efficiently. Negative employee reviews and constant complaints can lead to termination of the insurance contract, which means the simultaneous loss of a large number of insured persons and funds. In the process of interaction between an insured citizen and an insurance medical organization, it is important how quickly controversial issues and conflicts can be resolved: is it possible to communicate with consultants around the clock, the territorial accessibility of the branch, the competence and ability of employees to adequately respond to complaints.

The difference can also be seen in the list of insurance services. When a company provides additional medical insurance, it is beneficial for it that the insured is satisfied with the service. In this case, there is a chance that the client will want to conclude an agreement on additional medical insurance, which will have a beneficial effect on the organization’s budget. The number of clients also significantly influences the funds provided by the Territorial Fund, which are also spent on conducting medical examinations in response to complaints from insured persons. If an insurance company has more than 100 thousand clients, then the chance of a full-fledged expert assessment of the quality of medical care is higher.

The level of customer awareness varies from organization to organization. An informal approach to the advisory work of insurance company employees allows the client to better navigate the list of free medical services, the rights and capabilities of the insured person. The client's complaint must be considered within a month (with a written application). When the insured person is denied services if he has a policy, the insurance company is obliged to respond within 3 days: take measures to eliminate the problem, and if these are not taken, then explain the reasons to the client in writing.

The largest medical insurance companies in Russia for 2017

In 2017, the insurance market continued to show positive dynamics, although the growth rate decreased relative to 2016. According to official statistics of the Central Bank of the Russian Federation, 316 billion rubles of insurance premiums were collected for all types of insurance in the first quarter of 2017, which is 5.3% or 16 billion rubles more than in the same period in 2016. According to RIA Rating, the TOP 3 largest medical insurance companies included SOGAZ, Rosgosstrakh and MAKS-M.

Limited Liability Company "Rosgosstrakh-Medicine"

From 2011 to 2017, this company included several medical insurance organizations (Ikar, Ecofond, Lipetsk-Health), including the Closed Joint Stock Company Capital Medical Insurance. "Rosgosstrakh-Medicine" was officially registered in 2002, today its authorized capital is 210 million rubles, it works only with compulsory health insurance policies. The main office is located in Moscow, there are 42 regional branches, the total number of insured persons is more than 22 million. Company employees provide telephone consultations around the clock.

Closed Joint Stock Company "MAKS-M"

It has been operating since 1994, has representative offices in 24 constituent entities of the Russian Federation, and has an authorized capital of 220 million rubles. About 18.5 million clients are insured; the company operates only in the field of compulsory health insurance. The main office is located in the capital, there are 80 regional branches. There is a hotline and a contact center. In 2017, the company acquired a full stake in the insurance company Astro-Volga-Med, which was one of the largest in the Volga region.

Joint Stock Company SK SOGAZ-Med

It has been operating since 1998, serving 40 constituent entities of the Russian Federation, 640 regional branches. Authorized capital – 123 million rubles. The company's clients are about 18.8 million Russians; work is carried out in two directions: compulsory and voluntary health insurance. The consultation center is open 24/7. In 2003, the Gazprommedstrakh company became part of JSC SK SOGAZ-Med.

Conclusion

All medical insurance organizations in the Russian Federation operate under state licenses and receive funds from territorial funds, which assume the obligations of policyholders in the event of bankruptcy. The insured person has the right to change the insurance company if the quality of its services is unsatisfactory. The choice of the optimal company depends on a number of factors: organization of work, availability of information, number of clients, etc.

Compulsory medical insurance is compulsory health insurance. With its help, absolutely every citizen of the Russian Federation has the right to restore their health completely free of charge. It is noteworthy that the main advantage of the program is to ensure equal conditions for receiving medical care for residents of different regions of the country.

In other words, those services that should be provided to citizens free of charge according to compulsory medical insurance do not depend on the place of registration of the population. But the quality of these services directly depends on the choice of insurer. Let's look at how not to make a mistake with your choice and conclude a profitable contract.

It should immediately be noted that the program involves providing the same services to citizens of the Russian Federation. But when choosing a suitable insurance company, you need to pay attention to the extent of coverage of the territory it can guarantee. This is the most important point, which will directly determine where exactly a person can receive the necessary medical care. The differences are as follows:

• regional medical insurance organizations will be able to guarantee the provision of medical care only within the location of their own offices. For example, if there are no company offices in Krasnodar, then a person will not be able to receive medical care;
• Federal companies are more profitable in terms of cooperation, since they can provide qualified medical care throughout the entire Russian Federation. In other words, they do not and cannot have any obstacles, which is very convenient. Especially for people who have to travel frequently or go on business trips;
• It is easier for large companies to protect client rights that have been violated. The same applies to issues related to the settlement of disputes that have arisen.

To make it easier for Russians to make their final choice, a special official website of the FFMS was created. This site provides ratings of insurance companies and all the necessary information about them. But the most important thing is that the page also has a section with reviews from real people who have collaborated with such companies. Having familiarized yourself with this information, choosing the most suitable insurer becomes much easier.

How to avoid becoming a victim of scammers?

Insurance fraud is not uncommon. And therefore, Russians need to exercise maximum caution when signing a contract with an insurer, so as not to ultimately become another victim of deception. It should be remembered that:

• Every company that issues insurance policies has a license. Before signing the contract, be sure to ask to see a document proving that such a license has been obtained. This information can also be found on the MHIF page;
• companies never require the client to pay for concluding a contract or issuing a policy. This is a completely free service;
• the company always attaches to the contract a list of those medical services that will be provided free of charge. If a representative demands payment for printing this list, he is a common scammer;
• immediately after concluding an agreement with the company, a temporary policy is issued. Since a permanent one is issued within 60 days. Therefore, no one can immediately issue a permanent one. The exception is scammers;
• the list of documents required to obtain insurance is clearly indicated in the regulatory documents. Only scammers can demand that you provide them with some additional papers.

TOP 10 insurance companies

Representatives of the official department insist that Russians should choose a company with which they will cooperate in the future, focusing on a special rating. This will help you protect yourself from scammers and choose a reputable insurer. This rating was formed based on data on the number of insured clients.

1. LLC "Rosgosstrakh-Medicine"
2. JSC "MASK MASK-M"
3. OJSC SK SOGAZ-Med
4. VTB MS LLC
5. Alfa Insurance MS LLC
6. VTB-Medicine LLC
7. LLC "RESO-MED"
8. LLC "Ingosstrakh-M"
9. JSC SMK "ASTRAMED-MS"
10. CJSC "Spasskiye Vorota-M"

Moscow insurance companies

Residents of the capital can choose a suitable company using the list below:

1. "Health insurance"
2. Insurance company "UralSib"
3. "MAX-M"
4. LLC "MEDSTRAKH"
5. "Spassky Gate - M"
6. "RESO-MED"
7. "SOGAZ-Med"
8. "Ingosstrakh-M"
9. "Rosgosstrakh-Medicine"

Change of insurance company

The state provides every citizen with the opportunity to renew an insurance contract with another company in the future. This guarantees that if a person nevertheless makes a mistake and enters into a contract that is unfavorable for him, he will be able to terminate it. Indeed, sometimes it happens that, having studied other market offers, a citizen finds something more attractive. And then the need arises to renegotiate the contract. According to current legislation, replacement of insurance is possible only once per calendar year, not more often. But in some cases there may still be exceptions:

• relocation - if a citizen has changed his place of registration, he may think about concluding an agreement with another insurance company. This is especially true if cooperation was envisaged with a regional organization;
• change of personal data - according to the law, a citizen of the Russian Federation can change his last name, first name and even in some cases patronymic. If this happens, then you are given the opportunity to renew the insurance contract;
• The closure of an insurance company is an extremely undesirable event, but it does not threaten any losses for citizens, since they can immediately terminate the contract and enter into a new one.

In all of the above cases, a citizen can contact the company and conclude a new contract.

List of documents

In order for the company to issue an insurance policy, the client must provide a certain package of documents. As mentioned above in the article, the law establishes a list of documents that Russians are required to provide to the insurer. And it includes:

• application - it should be written according to the template provided by the company representative;
• passport (including national), residence permit, documents confirming temporary registration;
• SNILS (if available).

Please note that persons who have not yet determined their citizenship are required to provide proof of identity. Refugees must present a document that confirms their status. Since minor children can be enrolled in this program, additional paperwork may be required. In this case, you must attach their birth certificate and parent’s passport to the application.

Refusal to take out a policy: what to do?

By law, a company cannot refuse a citizen to issue a policy if all the necessary documents have been provided. But if this happens, you should receive a written refusal from the company and then inform the MHIF about what happened. If no measures are taken on this issue in the future, then the only way out is to file a statement of claim.

Sometimes citizens receive a partial refusal. That is, the company refuses to include in the policy those medical services that are required by law. In this case, you must first file a claim. It should, of course, indicate the exact details of the company to which the citizen has claims. There are two ways to find them out:

• by policy number on the FFOMS website;
• request information to the CMO.

Once the data is received, you can submit a claim.

Updated 06/04/2018

Central point for issuing compulsory medical insurance policies

The central point for issuing compulsory medical insurance policies, which previously operated at the address: Bolotnikovskaya, 53, bldg. 1 works at the address: Profsoyuznaya, 108.

Central Administrative District

Address	Directions	Operating mode
		Mon.	Tue	Wed.	Thurs.	Fri.	Sat.	Sun.
Lesnaya street, 43 (BUSINESS CENTER "Lesnaya, 43"), 4th floor, office 419.	entrance from the street Lesnaya, entrance 1, yellow door under the canopy Art. m. "Belorusskaya" - ring. exit to the street Lesnaya, walk along Lesnaya Street along the tram tracks for 5-7 minutes (opposite - food mall "Depo. Moscow") Art. m. "Mendeleevskaya", walk 9 minutes

Eastern administrative district

Address	Directions	Operating mode
		Mon.	Tue	Wed.	Thurs.	Fri.	Sat.	Sun.
st. Veshnyakovskaya, 17 "B", pavilion "ROS APTEKA" issuance of electronic compulsory medical insurance policies	Art. m. "Novokosino", bus. 706 to the stop "Reutovskaya str. 22", Art. m. "Vykhino", bus. 247, 232, 706, troll. 30, 64 to ost. "Veshnyaki District Administration", Art. m. "Novogireevo", bus. 247, 615, troll. 64 to the stop. "Veshnyaki District Administration"
The point has been closed since June 18, 2019. You can receive previously ordered policies from June 19, 2019 at the address: st. Veshnyakovskaya, 22A, TD "Veshnyakovsky Passage", 2nd floor.

Address	Directions	Operating mode
		Mon.	Tue	Wed.	Thurs.	Fri.	Sat.	Sun.
st. Novokosinskaya, 17, issuance of electronic compulsory medical insurance policies	Art. m. "Novokosino", last car from the center, along the underground passage to the left, bus. 14, 21, 79, 502, 723, 1064 to the stop. "Novokosinskaya street, 17", further on foot (above the entrance door to the room there is a sign "PHARMACY")

North-Eastern Administrative District

South-Eastern Administrative District

Southern Administrative District

Southwestern Administrative District

Address	Directions	Operating mode
		Mon.	Tue	Wed.	Thurs.	Fri.	Sat.	Sun.
st. Ostrovityanova, 9, bldg. 4 issuance of electronic compulsory medical insurance policies	Art. m. "Konkovo", bus. 145, 295, 712 to the stop. "VNIITs for maternal and child health"; 9th microdistrict of Teply Stan (1 km from Troparevo metro station), bus. S2, 295, 712, 718 to the stop. "Scientific Center for Obstetrics and Gynecology". Passage from Academician Oparin Street behind the barrier	11:00-20:00	9:00-18:00	11:00-20:00	9:00-18:00	9:00-13:00

Western administrative district

Address	Directions	Operating mode
st. Bagritskogo, 3, bldg. 1 issuance of electronic compulsory medical insurance policies	m. Slavyansky Boulevard, bus. 190, 610, 103, 139, 157, 883, 205, 818, 840, 867 to the stop. "st. Bagritsky".			8:00-20:00	8:00-20:00	8:00-20:00	10:00-16:00

Novomoskovsk administrative district

Address	Directions	Operating mode
		Mon.	Tue	Wed.	Thurs.	Fri.	Sat.	Sun.
issuance of electronic compulsory medical insurance policies	metro station "Dmitry Donskoy Boulevard", auto 737, 753, 858, 108; Art. m "Akademika Yangelya Street, bus. 906 to the stop "Turn to the police village"						10:00-16:00

Points for issuing compulsory medical insurance policies, equipped with intercoms or operator call buttons for issuing compulsory medical insurance policies to persons with disabilities.

Points for issuing compulsory medical insurance policies, adapted for issuing compulsory medical insurance policies to persons with disabilities, equipped with ramps, freight elevators and free passage for wheelchairs.

This section is found by queries:
Where to get a compulsory medical insurance policy in Moscow?
Where to apply for a compulsory medical insurance policy in Moscow?
Where can I get health insurance?

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

Dear reader! Our articles talk about typical ways to resolve legal issues, but each case is unique.

If you want to know how to solve exactly your problem - contact the online consultant form on the right or call by phone.

It's fast and free!

The right to choose an insurer

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

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

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

Each subject has the right to:

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

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

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

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

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

Why are insurance companies needed (functions)

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

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

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

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

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

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

Learn more about insurance companies

Basically, insurance companies deal with commercial insurance; to carry out this function, the company needs a license from the municipal insurance supervision body.

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

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

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

Insurance contract

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

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

Pros and cons for patients

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

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

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

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

Rating of insurance companies

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

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