A compulsory health insurance policy provides access to free healthcare services. But does everyone know what opportunities the compulsory medical insurance policy provides, what is included in the free service, what types of examinations and operations can be performed?

Legislative acts regulating the compulsory medical insurance system

Free healthcare services are provided as part of compulsory health insurance. The compulsory medical insurance system guarantees citizens equal rights to receive medical services. It is regulated by a number of legal acts:

• Law No. 326-FZ “On compulsory health insurance in Russian Federation»;
• Government Decree No. 1403 “On the program state guarantees free provision of medical care to citizens for 2017 and for the planning period of 2018 and 2019,” which contains the basic compulsory medical insurance program. This document, in particular, explains what is included in compulsory medical insurance in 2017;
• a number of other acts allowing citizens to receive a minimum guaranteed volume of services.

Who is entitled to free health care?

Both Russians (for an indefinite period) and persons without Russian citizenship (with a limited validity period) can receive a compulsory medical insurance policy. The presence of this document means that the patient is under the protection of the insurance company with which he has entered into an agreement.

Medical care is provided by a health care organization (in compulsory medical insurance system both public and private institutions participate) to which the patient is assigned. At the same time, he has the right to change the clinic and attending physician once a year and an unlimited number of times when moving to another place of residence. Once a year, you are allowed to change your insurer; this must be done no later than November 1.

List of services under the compulsory medical insurance policy

What types of medical care are available under the policy, are high-tech diagnostic methods included in it, is MRI included in the list free services according to compulsory medical insurance?
The legislation provides for the following forms of medical care:

• emergency (ambulance);
• outpatient, including examinations (in basic list included MRI, ultrasound and endoscopic methods (gastroscopy, colonoscopy, etc.);
• stationary:

- in cases of exacerbation of diseases;
— referral for treatment and operations (available services include chemotherapy, removal of prostate adenoma, treatment of gynecological diseases, etc.);
— medical services for pregnant women, as well as childbirth, recovery after it, abortions;
- when intensive care is required (in case of poisoning, severe injuries);

• high-tech;
• palliative.

The last point regarding serious illnesses was added in 2017. In total, the basic list includes about 20 cases for which free medical care is available.

Is it allowed to carry out therapeutic massage, remove papillomas, warts - are such procedures provided by the compulsory medical insurance policy, which is included in the program? Having indications for the procedure will allow you to take a massage course free of charge. As for skin defects, the operation will be performed free of charge if the growth is bleeding or damaged, that is, there is a danger to the life and health of the patient.

Within the framework of the compulsory medical insurance system, there are basic and territorial programs: the first is applied throughout the country, the rest - within a specific subject of the Russian Federation. The list of services under regional programs is wider. Some of them provide free tests for chlamydia and spermogram, some allergy tests (such types of examinations, for example, are carried out under the compulsory medical insurance policy in Moscow, the Moscow region and St. Petersburg).

From time to time, the media report on public initiatives to add or remove this or that service from the list. Thus, proposals to exclude abortion from the compulsory medical insurance system and include the work of a nutritionist in it were previously discussed, but they were not reflected in legislative acts.

Dental services under compulsory medical insurance policy

Is free dentistry available under the compulsory medical insurance policy? This question interests many, since dentists’ services, as we know, are not cheap. So, what opportunities does dentistry provide under the compulsory medical insurance policy, and what is included in the free service?
A visitor to a clinic participating in the compulsory medical insurance system can count on:

• for reception, examination and consultation;
• for the prevention and treatment of inflammation of the oral cavity;
• for dental fillings;
• for surgical intervention (tooth extraction, opening of an abscess, etc.);
• for an x-ray examination.

Please remember that dental services are also subject to restrictions. For example, filling will not require payment if cement material is used during the treatment. But they won’t install a light seal for free.

Certain services are possible with a referral, for example, the surgeon will perform trimming of the tongue frenulum upon presentation of a certificate from the orthodontist.

How to find out if a service is included in the compulsory medical insurance program?

Information on services provided free of charge is contained in regulatory documents adopted in a particular subject. A detailed list is also provided by healthcare institutions and insurance companies operating in the compulsory medical insurance system.
There is no list of compulsory medical insurance services on the official healthcare website in 2018, but from the Ministry of Health resource you can go to the Compulsory Medical Insurance website, where all regulations concerning the compulsory health insurance system.

The Government of the Russian Federation annually approves the Program of State Guarantees for the provision of free medical care to citizens, which contains information on:

• forms and conditions of medical care,
• diseases and conditions,
• categories of citizens for whom medical care is provided free of charge.

In addition, it contains information on average standards for the volume of medical care, average standards financial costs per unit volume of medical care, average per capita financing standards, as well as the procedure and structure for setting tariffs for medical care and methods of payment.

It is important that the state guarantee program contains a basic compulsory medical insurance program, as well as requirements for territorial compulsory medical insurance programs subjects of the Russian Federation, where programs may differ from the basic one due to the specifics of the region.

To receive the free medical care mentioned in the program, a citizen of the Russian Federation must obtain a compulsory medical insurance policy. The entire procedure for dealing with a compulsory health insurance policy is very clearly regulated at the legislative level. And every person should know their rights and responsibilities when using such a document.

What services are provided free of charge?

According to their compulsory medical insurance policy, each person can use ambulance services free of charge, receive outpatient care, including at home, and also visit a day hospital. In addition, the policy guarantees free planned hospitalization.

The compulsory health insurance program pays special attention to pregnant women, so such complex medical procedures as childbirth are also paid for through compulsory medical insurance.

Compulsory medical insurance does not include: treatment of sexually transmitted diseases, tuberculosis, HIV infection and acquired immunodeficiency syndrome, mental disorders and behavioral disorders. However, treatment of these diseases is also free for citizens of the Russian Federation, since they are paid from the budget of the constituent entities of the Russian Federation.

Treat, you can’t refuse

There is also a nuance: if suddenly a person gets into trouble - he lost consciousness, suffered a fracture, felt pain in his heart, was injured, etc., he can call an ambulance or go to the emergency room, and they are required to admit him there even without presenting an insurance policy. Compulsory medical insurance. Emergency medical care is provided immediately and without bureaucratic delays. The policy may be asked to present later, when the person’s life and health are not in danger.

Since 2011, a uniform compulsory medical insurance policy has been in force in Russia - this means that its effect extends throughout the country, and a person who finds himself in another region can receive the necessary medical care upon presentation of the compulsory medical insurance policy.

Issue and change

All Russian citizens can apply for a policy at compulsory medical insurance policy issuance points, which are located in any city. Just to begin with, you need to choose a medical insurance company that will accompany the insured. You can change your insurance policy once a year, so you need to approach your choice responsibly.

To obtain a policy, you will need a number of documents. For adult citizens and children over 14 years of age, this is a Russian passport and SNILS; for children, this is a birth certificate, documents of their legal representative and SNILS. Everyone also needs to write an application for the issuance of a policy.

The insured is obliged

There are only 4 responsibilities of the insured that should be known and observed. This:

• present a compulsory medical insurance policy when seeking medical care, with the exception of cases of emergency medical care;
• submit to the medical insurance organization personally or through your representative an application for choosing a medical insurance organization in accordance with the rules of compulsory health insurance;
• notify the medical insurance organization of changes in last name, first name, patronymic, place of residence within one month from the day these changes occurred. In cases of change of surname, name, patronymic, the policy is reissued;
• select a medical insurance organization at a new place of residence within one month in the event of a change of residence and the absence of a medical insurance organization in which the citizen was previously insured.

Which medical services are free and which ones will you have to pay for? Why do you need a health insurance policy and how to get it? How to register with a clinic and how long to wait to see a specialist? Why might you be denied an ambulance call and where to complain if you are faced with rudeness or negligence of doctors?

Free services and medicines

The right to free medical care is guaranteed by Article 41 of the Constitution of the Russian Federation. But what does the concept of “free medicine” include, if in practice you have to pay for a lot?

According to the law, patients are entitled to the following free medical services:

• emergency help ( ambulance)


• outpatient care in a clinic (examinations and treatment)


• inpatient medical care:

1. - abortion, pregnancy and childbirth


2. - in case of exacerbation of chronic and acute diseases, poisoning, injuries requiring intensive care or round-the-clock medical supervision


3. - planned hospitalization

• high-tech medical care, including the use of complex and unique treatment methods, new technologies and equipment


• medical care for people with incurable diseases.

A complete list of cases in which you are entitled to free medical care is included in the basic compulsory health insurance program. To check this list, you can contact your insurance company(you will find the company's telephone number in your policy).

Please note that you also have the right to free receipt medicines if your disease is rare, life-shortening or disabling. The list of vital and essential drugs has been approved by the state and is spelled out in the text of the law.

You will have to pay for other services and medications.

Medical policy

A compulsory health insurance policy (CHI policy) is a document that allows a person to receive free medical care in hospitals and clinics throughout the Russian Federation. It is issued by insurance companies that are licensed to operate in this field. The insurance company that issued your compulsory medical insurance policy pays for medical services and protects your interests in conflicts with medical institutions. Keep in mind that in order to receive free medical services by law, you must have the insurance policy with you. Without its presentation, only emergency assistance is provided. Compulsory medical insurance policy Anyone who is on the territory of the Russian Federation, including foreigners and refugees, can receive it.

How to get a compulsory medical insurance policy?

To do this, you need to contact an insurance company that has the appropriate license. The official rating of insurance companies will help you choose it. medical organizations. Over time, you can change the insurer if you are unhappy with the quality of its work. Remember that by law this can be done no more than once a year and no later than November 1.

What documents are needed to apply for a compulsory medical insurance policy?

For a citizen of the Russian Federation under 14 years of age,:

• birth certificate


• passport of the legal representative (for example, one of the parents)


• SNILS (if available).

For a citizen of the Russian Federation over 14 years old, required:

• passport of a citizen of the Russian Federation


• SNILS (if available).

What is the validity period of the compulsory medical insurance policy?

For citizens of the Russian Federation, the policy is unlimited, temporary policy is done for refugees and foreigners temporarily residing in the Russian Federation.

In what cases can a compulsory medical insurance policy be replaced with a new one?

Despite the fact that the policy is unlimited, it can be replaced with a new one:

• during a planned change of compulsory medical insurance policy (for example, when a new model is introduced)


• when changing residence within the Russian Federation, if the insurer does not have a representative office at the new place of residence


• if inaccuracies or errors are detected in the policy


• when the policy is dilapidated, which creates an identification problem


• upon loss of the policy


• when changing the personal data of the policy owner (full name, passport details, place of residence).

Clinic

When receiving a compulsory medical insurance policy, a clinic is selected where you will seek medical care (that is, you are “attached” to it). You have the right to choose any clinic that is convenient for you to visit (closer to home, work, dacha). The only condition is that she must be able to accept a new patient (the planned workload is determined by the standards).

How to attach to the clinic?

Your appointment to the clinic at your place of residence occurred automatically if:

• you live under the same registration as when you received the policy


• you live at the same address that you gave when receiving the policy (even if it differs from your registration).

To attach yourself, you will need to write an application to the clinic administration. Keep in mind that if you are assigned to a clinic other than your place of residence, you will not be able to call a doctor to your home.

Remember that by law you can change a clinic no more than once a year, with the exception of cases of change of residence or stay.

What documents are required to register with the clinic?

List of documents for a child under 14 years of age:

• compulsory medical insurance policy (original and copy)


• birth certificate


• identification document of the child’s legal representative (for example, parent)


• SNILS (if available).

List of documents for citizens over 14 years of age:

• application addressed to the chief physician of a medical organization


• compulsory medical insurance policy (original and copy)


• passport of a citizen of the Russian Federation


• SNILS (if available).

Can you be denied access to a clinic and why?

They may refuse your appointment if the selected clinic is overcrowded and is not located in your area of ​​residence. You have the right to demand a written refusal, on the basis of which you can complain to the insurance company, the Ministry of Health or Roszdravnadzor.

Make an appointment with a doctor. How to get to him and how long will you have to wait?

You can make an appointment with a doctor (receive an appointment voucher) in person through the registry of a medical organization or remotely through an electronic registry (if available). But doing this often turns out to be quite difficult. The next appointment with doctors may be only a few months later or may not be available at all (“no coupons”). How long can you wait by law, and what to do if you are not provided with a service on time?

Each region independently sets waiting times for medical care on its territory. For information about the deadlines in your region, please contact territorial fund compulsory health insurance or from your insurance company (you will find the company's telephone number in your compulsory medical insurance policy).

As an example, we will give the deadlines established in Moscow. According to the resolution of the Moscow Government, maximum terms have been established:

• initial appointment with a local therapist, local pediatrician and doctor general practice(family doctor) occurs on the day of treatment;


• for appointments with medical specialists - up to 7 working days;


• The urgency of laboratory and instrumental studies is determined by a medical specialist; the waiting period should not exceed 7 working days. An exception is angiography, computed tomography and magnetic resonance imaging, the waiting period for which can be up to 20 working days;

If a medical organization cannot meet the specified deadlines or does not have the necessary specialist or equipment, then according to the law the patient must be sent to the nearest medical institution for diagnostics, absolutely free of charge. If these provisions are violated, you can file a complaint against the medical organization with your insurance company or other institutions that we talk about in the “Where to Complain?” section.

Is it possible to change the attending physician and how?

Yes, according to the law, you can change not only the medical organization, but also the attending physician (local doctor, general practitioner, pediatrician, general practitioner and paramedic). To do this, you need to submit an application addressed to the head of the medical institution. You can change your doctor no more than once a year, with the exception of cases of change of residence or stay.

Emergency

TO free medicine This also includes first aid. Anyone in the Russian Federation can use it, including those who do not have a compulsory medical insurance policy. Many people complain about the waiting time for an ambulance, but not everyone knows that the arrival time of a medical team primarily depends on its type, their two:

• ambulance service. She responds to emergency calls if there is a threat to the patient’s life: injuries, accidents, acute diseases, poisoning, burns and others. According to the standard, this assistance must arrive at the patient within 20 minutes;


• urgent Care. Deals with the same cases as an ambulance, but only if there is no threat to the patient’s life. This assistance must arrive within two hours.

The dispatcher decides what type of assistance to send to you.

How to call an ambulance?

We all remember the truth learned by heart from childhood that to call an ambulance it is enough to call the number “03”. Landline telephones are becoming a thing of the past over time and are being replaced by mobile communications. Almost everyone has a mobile phone at hand, but not everyone knows how to call an ambulance from it.

You can call an ambulance by numbers:

• 03 from a landline phone


• 103 s mobile phone


• 112 from a mobile phone (single emergency number).

Number 112 is universal. Using this number you can call the fire department, police, ambulance, emergency gas service, and rescuers. You can call this number even if you have a zero balance, a blocked SIM card or if it is not in your phone. However, this service does not currently work in all regions of the Russian Federation.

In what cases will an ambulance arrive?:

• for acute diseases that occur at home, on the street or in a public place;


• in case of disasters and mass disasters;


• in case of accidents: burns, injuries, frostbite and others;


• in case of sudden diseases that threaten human life: disruption of the cardiovascular and nervous systems, respiratory organs, abdominal cavity, and so on;


• during childbirth and disruption of pregnancy;


• for any reason to children under 1 year of age;


• to psychoneurological patients with acute mental disorders that threaten the safety of others.

In what case will the ambulance not arrive?:

• if the patient’s condition worsens and is observed by a local doctor;


• when calling to patients with alcoholism to relieve hangover;


• to provide dental care;


• to provide medical procedures prescribed as part of planned treatment (dressings, injections, etc.);


• for issuance sick leave, recipes and certificates;


• for issuing forensic and expert reports;


• to draw up a death certificate and examine the corpse;


• for transporting patients from hospital to hospital or home.

What are the responsibilities of an ambulance?

The arriving team will provide emergency medical care and, if necessary, admit you to a hospital inpatient unit. The team's doctors can give oral recommendations for treatment, but they do not issue certificates or sick leave.

Where can I complain about my doctor?

There are times when a conflict arises between you and your doctor. What to do in such a situation? Complain.

1. The easiest way to complain is to write a statement addressed to the chief physician. This will help resolve the problem at the local level.


2. If you have complaints about the quality of service in a medical institution or are offered to pay for medical services that are free by law, you can contact your insurance company.


3. If you are unable to resolve the problem at the local level, you can contact the Ministry of Health. You can submit a complaint in person at the ministry’s reception desk, send it to the department’s regular postal or email address, or leave a complaint on the official website.


4. If your problem has not been resolved by the Ministry of Health, then you can contact Roszdravnadzor, which exercises control in the healthcare sector. The application can be left on the department’s website, sent by regular mail or email.


5. If previous actions did not lead to the desired result, you can contact the prosecutor's office. She will conduct an audit of the work of government agencies.


6. If the conflict is still not resolved by these methods, then you can go to court. The claim must indicate the essence of the case, explain what rights were violated (with references to the relevant articles of law), and attach documents proving the defendant’s guilt.


7. Contacting the police is appropriate if the doctor intentionally caused harm to your health, threatened, extorted or insulted your honor and dignity.

Please keep in mind that the legal period for consideration of applications in each case is 30 calendar days.

According to the adopted legislation, almost every person registered and living on the territory of the Russian Federation has the right assigned to him to apply to any medical institution to obtain appropriate treatment if the need arises. However, there is one important nuance - services of this kind, as well as the right to receive medications free of charge, that is, free of charge, are provided only if the citizen has a document such as a compulsory health insurance policy.

Who can receive free medical services?

Any citizen who owns the following has the right to use the services of medical institutions:

• Employed citizens. That is, the category of persons who regularly pay taxes to the state budget. That is, in essence, he pays for his treatment in advance.
• Unemployed citizens. In this case, the payment Money Treatment of these persons is also paid for from the federal budget.
• Children, teenagers, and who have not reached the age of eighteen and are not taxpayers.

If a person is officially employed, he has the right to register, as well as . If he is not employed, works unofficially, or has not reached the age of majority, you can apply for the specified document to any company that provides insurance services.

In the event that any citizen needs to contact a specialist who receives outside settlement where the said person lives individual, a referral from the attending physician is also required.

There is a certain list of medical services, the provision of which is free of charge. These include the following:

1. Emergency assistance, that is, the departure of an ambulance when a patient is called. This service is provided free of charge not only to persons who have, but also to those who do not have this document. In the recent past, there were unreliable rumors that if a person does not have a compulsory health insurance policy, he will have to pay about one and a half to two thousand rubles for calling emergency help. This is wrong. This service is provided absolutely free of charge in any case.
2. Ambulatory treatment in a medical institution that is part of the insurance system and includes a number of different manipulations: examination and diagnosis of the patient’s disease, performing the necessary procedures and prescribing adequate treatment. However, when a patient is under so-called outpatient, daytime or home treatment, all necessary medications must be purchased by him at his own expense, since there are no benefits in this case.
3. Working with the public to raise awareness of sanitary and hygienic issues. That is, holding various lectures, seminars and so on.
4. Diagnosis and treatment of the population using expensive innovative drugs and methods. For example, in some regions of the Russian Federation, in vitro fertilization is carried out free of charge.
5. Diagnosis of the disease followed by hospitalization.
6. in dental clinics and offices that have state status.

Free services under compulsory medical insurance policy

For example, while undergoing treatment in a state hospital, a citizen has the right to receive free services for the treatment of diseases of the following kind: support of pregnancy during its complicated course, as well as in the presence of pathologies of any kind, medical abortion, the presence of chronic diseases, or in case of exacerbation of the disease, poisoning , causing bodily harm and so on. In this case, the provision of medications necessary for adequate treatment is free of charge.

The diseases that, according to the list, are treated free of charge include the following:

1. Diseases of an infectious nature, with the exception of those categories classified as sexually transmitted infections.
2. Various diseases of the blood, vascular system, heart.
3. Diseases of the stomach, as well as the gastrointestinal tract in general.
4. Any disease caused by a nervous disorder.
5. Diseases of joints, bones, muscles and so on.
6. All kinds of defects in vision, hearing, speech.
7. Tumors of both benign and malignant nature.
8. Diseases of tissues and skin.
9. Diseases of the genitourinary area.
10. Diseases of the respiratory system.

What to do if treatment is denied if you have a policy?

Currently, not every citizen is fully aware of the rights that are granted to him in accordance with this, which is often taken advantage of by unscrupulous workers in this field of activity, demanding a certain payment for the provision of the necessary assistance.

What to do if your rights are violated

Every citizen of the Russian Federation who has insurance has the right to seek help from any medical institution located on the territory of the state. The specified institution is obliged to admit him and carry out appropriate diagnosis, treatment, as well as other manipulations that are necessary. However, it often happens that doctors, as well as hospital staff, refuse to admit the patient in such cases. This is not legal and violates human rights. It is important to produce.

To restore the violated right, a person who has been denied medical services must file a complaint with the medical service, whose employees will take appropriate measures. If such a case is detected, administrative penalties may be applied to medical service workers.

What can you expect with a compulsory medical insurance policy?

In order to know which services the compulsory health insurance policy gives you, you need to carefully read the list of services provided to the population free of charge.

It should be remembered that, in essence, these services are not free at all due to the fact that wages Each employed citizen is deducted a certain amount every month, intended specifically for this purpose. Consequently, in this way, each individual pays in advance for his treatment in a state-type institution. In our other articles you can familiarize yourself with and .