A law has been developed on the territory of the Russian Federation that makes it possible to correct actions related to the suspension or complete termination of insurance. In order to carry out various optimization processes, it was decided to develop documents that would abolish compulsory health insurance for those employees who work in the structure of the Ministry of Internal Affairs and the Federal Penitentiary Service.

On August 10, a new law came into force on the territory of the Russian Federation, abolishing the registration of compulsory medical insurance for persons who work in the Ministry of Internal Affairs and the Federal Penitentiary Service

Official information was provided by the head of the Federal Compulsory Medical Insurance Fund (FFOMS) Natalya Stadchenko. She says that the law abolishes compulsory insurance for those persons who previously took out a compulsory medical insurance policy. After the adoption of this law, the budget of the Federal Compulsory Medical Insurance Fund will be more carefully formed. Also, the adoption of the bill provides for improving the quality of formation of the necessary budget for all regions of the Russian Federation.

After the implementation of the considered bill, compulsory health insurance organizations located in the constituent entities of the Russian Federation will form the budget differently. The last resort is also subject to the new obligation. Regional compulsory medical insurance will be able to control all processes that take place when insuring citizens of the Russian Federation.

In order to determine the reliable number of insured persons in the country, the Cabinet of Ministers will develop a methodology that allows for a full calculation. Despite the fact that employees of the Ministry of Internal Affairs and the Federal Penitentiary Service are no longer required to issue a compulsory health insurance policy, the law also establishes a standard for providing information for those institutions that issue this document.

Every calendar month, compulsory medical insurance funds will provide all the necessary information

Territorial and Federal compulsory health insurance funds must prepare information every month that relates to the number of insured people. It is also necessary to display objective indicators that relate to the suspension or complete termination of people's cooperation with the institution.

Only those people who work in the internal affairs bodies of the Russian Federation, as well as in the fire service, courier communications and the Federal Penitentiary Service are now exempt from compulsory health insurance. Also, customs officers do not need compulsory medical insurance. The document was adopted because many citizens who become military personnel receive double support from the state.

Regional authorities pay contributions to the Compulsory Medical Insurance Fund for unemployed insured people. In turn, employees of internal affairs bodies receive medical care, which is financed by the state. Enterprising citizens do not close their compulsory medical insurance policies and receive double assistance.

Military personnel who use regular rather than departmental clinics will be fined; the wives and children of migrants from the EAEU countries will be deprived of the opportunity to receive free medical care.

According to the Federal Compulsory Medical Insurance Fund, more than half of Russians (85 million out of 146.5 million) are considered unemployed. These are a variety of groups - children, pensioners, disabled people, those whom the government has nicknamed. They have the same right to medical care as workers. Since our health insurance is compulsory, contributions are paid into the system for each citizen. Workers pay contributions from their salaries (or rather, they are deducted by the employer). And for those who do not work, their region pays contributions. It was planned that in 2017 contributions for the non-working population would amount to (and for the working population - 1 trillion rubles).

Finding these 619 billion rubles is difficult. In 2016, 10 constituent entities of the Russian Federation experienced “constant difficulties in paying contributions for the non-working population.” About it says a letter from Deputy Head of the Ministry of Health Dmitry Kostennikov dated November 21, 2016, which was sent to the Ministry of Labor, the Ministry of Foreign Affairs, the Ministry of Finance and other departments (Life has a copy). Exactly which regions are not specified; the federal compulsory medical insurance has also not yet responded to our request.

Of course, the main burden that officials want to rid the system of is parasites. A bill is currently being developed, according to which citizens who do not work without a good reason will have to pay a tax for the use of medical infrastructure.

Children and wives of migrant workers will be left without compulsory medical insurance

But the Ministry of Health continues to think through other ways to dump the “ballast”.One of the proposals is to deprive migrants from the EAEU countries (Belarus, Kazakhstan, Armenia, Kyrgyzstan) and their families of the right to compulsory medical insurance (this proposal is discussed in Kostennikov’s letter). To do this, it is necessary to make changes to the Treaty on the Eurasian Economic Union.

This agreement states that labor migrants from these countries and their families have the same rights to medical care as Russian citizens (and vice versa, Russians who come to work, for example, in Belarus, will have the same rights as Belarusians).

The Ministry of Health proposes to change the wording so that it reads like this: " Citizens of the EAEU member states working in the state of employment on the basis of employment contracts are subject to compulsory health insurance." At the same time, all other categories of migrants, as well as family members of migrant workers, are excluded from the compulsory medical insurance system."

One of the arguments of the Ministry of Health: to Russia from Belarus, Kazakhstan, etc. they travel much more often than vice versa, so Russia has more expenses, which is unfair. In addition, not all EAEU countries have a compulsory medical insurance system, which means parity is violated.

The Ministry of Labor has already considered the proposal of the Ministry of Health (Deputy Head of the Ministry of Labor Alexey Cherkasov sent a response to the Ministry of Health on December 27, Life has a copy). The position of the Ministry of Labor is that labor migrants from the EAEU countries who work not under a labor contract, but under a civil law contract, should also be left in compulsory medical insurance. After all, contributions to the Russian compulsory medical insurance system are paid from the salaries of these migrants.

The difference between contracts is, for example, that according to civil law, an employee does not receive a salary strictly twice a month, and when he completes a certain amount of work, he may not be paid for sick leave and vacation.

At the same time, the Ministry of Labor did not object to the exclusion of families of migrants from the EAEU countries from compulsory health insurance.

Military personnel who fail to submit their compulsory medical insurance policy on time will receive a fine of 5 thousand rubles

The second proposal of the Ministry of Health is the bill “On amendments to certain legislative acts of the Russian Federation on issues of personalized accounting in the field of compulsory medical insurance.” The measures that are prescribed there should reduce the unreasonable costs of the compulsory medical insurance system.

The bill more clearly defines who is not insured under compulsory medical insurance. These are military personnel, employees of the Ministry of Internal Affairs, the Ministry of Emergency Situations, employees of the National Guard and other categories. They have their own departmental medicine; they receive medical care at the expense of the budget, and not at the expense of compulsory medical insurance. The Accounts Chamber, having analyzed the bill, proposed to include in this list also prosecutors and employees of the Investigative Committee (they receive medical care according to the same principles).

And if these people, upon receiving their status or position, do not submit their compulsory medical insurance policies on time, then they receive a fine of 5 thousand rubles. And if insurance companies, tax authorities and regional compulsory medical insurance funds provide false information to the unified register of insured people (that is, for example, they indicate among the insured military personnel), they must pay a fine of up to 100 thousand rubles (if repeated - up to 200 thousand rubles).

Previously, insurers admitted that the state could pay twice for the treatment of such groups of citizens.

A citizen who has the right to departmental medical care (for example, a military serviceman) and has a passport of a citizen of the Russian Federation in his hands applies for a compulsory medical insurance policy to an insurance company without informing about his departmental affiliation, said Dr. Development Director of Alfastrakhovanie-OMS Alexander Troshin. - As a result, funds for the provision of medical care to such a citizen begin to be budgeted both through the department and through compulsory medical insurance.

True, as I clarified Director of the Institute of Health Economics at the Higher School of Economics Larisa Popovich, it happens that departmental clinics agree with clinics working in compulsory medical insurance on cooperation - and then military personnel go there quite legally.

Another innovation spelled out in the bill: regional compulsory medical insurance funds are responsible for checking whether insurance companies correctly provide information about the insured. But the Accounts Chamber objects: “The proposed innovation is obviously unfeasible, since the territorial compulsory health insurance funds are not endowed with a sufficient amount of administrative power.”

From rich people to smokers. Who else can be thrown overboard?

Doctor of Economic Sciences, one of the creators of the compulsory medical insurance system, Vladimir Grishin, said that “in a number of countries, people who receive incomes above a certain level are excluded from compulsory medical insurance.”

For example, if a person receives more than 10 million rubles a year, he said.

True, in Russia this measure would not make sense: rich people don’t go to district clinics anyway.

Earlier he told Life that people suffering from smoking addiction should not be treated within the compulsory medical insurance system.

If a person wants to receive a service, he goes to a paid doctor or through voluntary health insurance, he said. - This will at least stimulate him to think about whether he should smoke or not. Will we continue to include all types of addiction in the compulsory medical insurance system? Nobody is increasing contributions, we don’t have enough money for high-tech types of help, but we will treat addictions. Everything is real, but what will it look like? I'm treating him, and tomorrow he smokes again! Money down the drain, money up in smoke,” Grishin emphasized.

And Moscow’s vice-mayor for social development, Leonid Pechatnikov, previously made a proposal to issue compulsory medical insurance policies only to those who have undergone medical examination. According to his idea, policies will have to be changed every three years - and every three years a person will be forced to undergo a medical examination. This will help to detect diseases in a timely manner - thus the patient will be healthier and money for his treatment will be spent more economically.

From August 10, control over recipients of medical care under the compulsory health insurance system will be tightened

The method of monitoring whether citizens have a compulsory health insurance policy (CHI) will be changed, after which some Russians will lose this insurance. The law providing for such rules came into force on August 10.

“Double” health insurance will be a thing of the past

As explained by the head of the Federal Compulsory Medical Insurance Fund Natalia Stadchenko, the document is aimed at excluding insurance for those Russians who are not entitled to insurance policies. In particular, these are military personnel, whose treatment costs are covered from the federal budget, and categories of citizens equated to them - employees of the Ministry of Internal Affairs of the Russian Federation, the National Guard, the Federal Fire Service, the Federal Courier Communications, the Criminal Executive System, as well as customs authorities. The policy will be suspended if a citizen’s residence permit in Russia or temporary residence permit is revoked, as well as if he has lost his refugee status. According to Natalya Stadchenko, such measures will improve the quality of budget planning for the Compulsory Medical Insurance Fund, constituent entities of the Federation and territorial compulsory medical insurance funds.

According to current legislation, regions are required to pay contributions to the Compulsory Health Insurance Fund for unemployed citizens; in total, they spend 618 billion rubles a year on this. At the same time, the subjects make part of the contributions for those who really do not need it. In particular, many people, having enlisted in military service, also keep their compulsory medical insurance policy, thereby starting the process of “double medical insurance.” “Once information interaction between territorial compulsory health insurance funds is established with the Federal Tax Service, military commissariats and the Ministry of Internal Affairs, such citizens can be identified in a timely manner,” the chairman of the State Duma Committee on Health Protection told the Parliamentary Newspaper.

Now federal and territorial compulsory medical insurance funds will begin to record all the information provided every month, after which the insurance of those citizens who do not actually need it will be suspended or terminated.

Don't stop there

The Government came up with this legislative initiative after a joint appeal from the governors to the Federation Council. In 2016, the heads of the constituent entities drew the attention of senators to the fact that the expenditures of regional budgets on contributions to the Compulsory Medical Insurance Fund for non-working citizens have become a serious financial burden for them, and in many cases such expenditures turn out to be unjustified.

“It took more than six months to agree on the law,” the chairman of the Federation Council Committee on Social Policy told the Parliamentary Gazette. - Its specificity lies in the fact that it was necessary to establish information interaction between many departments and structural divisions. Now local authorities will be able to use the information they provide when calculating the budget resources needed for the compulsory medical insurance fund.”

According to the senator, so far parliamentarians do not have accurate data on how much money the law will allow the regions to save. “Further monitoring will show this,” he noted. - However, no one has any doubts - it was necessary to adopt the document; we need to understand how many citizens - of those for whom the regions pay into the compulsory medical insurance fund - really do not work, and who do work and, accordingly, cannot belong to the category unemployed."