According to OMS rules in the territory Russian Federation uniform policies apply. The document may be in the form of a paper or electronic policy (EPOMS). What is an electronic compulsory medical insurance policy? Policy of a single sample in the form plastic card can only be issued by citizens of the Russian Federation. The document has an embedded chip that contains data about its owner, the reverse side contains the signature and photograph of the insured person, which excludes the use of your document by another person and guarantees the receipt of medical care throughout Russia.
You can apply for EPOMS in our

8-800-200-92-04

24/7 contact center

HOW TO USE
ELECTRONIC POLICY

HOW TO USE
ELECTRONIC POLICY

When insured event many people wonder how to use electronic policy CHI.

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

With an electronic policy, it is possible to make an appointment with a doctor through a terminal or online, without standing in line at the reception, and at the same time, it is convenient to use.

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

A few years ago, a new model of compulsory medical insurance policies began to be issued on the territory of the Russian Federation. Now, instead of a paper carrier, you can get a mobile and convenient plastic card. What an electronic compulsory medical insurance policy looks like and what it is, you will learn further.

Appearance of the new CHI policy

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

On the front of the card you can see:

• in the upper part - the coat of arms of the Russian Federation, the name of the document "Policy of compulsory medical insurance", the logo of the CHI system;
• in the middle - a microchip for reading data from the electronic compulsory medical insurance policy about the insured person, about the insurer, about the features of the insurance program;
• at the bottom 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, its contact details.

Example:

The reverse side of the document looks like this:

• in the upper part - the contact phone number of the Territorial Compulsory Medical Insurance Fund (TFOMS), the signature of the insured, the blue POMS badge
• in the middle - a holographic sign confirming the authenticity of the document;
• below - full name and photograph of the owner, serial number (below it), validity period of the document, sex 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 holders face the advantages as well as the disadvantages of this document.

Advantages:

1. Convenience and compactness. Due to its small size, EPOMS fits easily into a wallet. This paper policy different from plastic.
2. Strength and wear resistance. The plastic is not torn, and the data on it is not overwritten - the information can always be easily read.
3. Replacing a paper OMS with an electronic one is absolutely free.
4. Only the insured person can use the CHI policy in public hospitals and clinics. The card is protected from scammers by a pin code, a chip, a photo of the owner.
5. Thanks to EPOMS, the insured person can make an appointment with a doctor through Personal Area Internet portal of public services or through the terminal.

Flaws:

1. Not all polyclinics are equipped with the necessary equipment and software to work with scanners or chip readers.
2. Not all insurers are engaged in issuing EPOMS.
3. When changing personal data, you cannot simply rewrite them on the chip - you will have to change the card itself.

Where to apply for a plastic health insurance card?

Owners medical insurance often postpone the replacement of paper media for EPOMS until later, as they fear that this procedure may be delayed for a long time. Actually arrange plastic policy not problematic. How to get EPOMS?

You can apply for a replacement:

• to your insurer. You can find out which company has insurance in your medical institution. 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 company. If there is a desire to change the insurer, you can familiarize yourself with the list of insurance companies on the website of the regional TFOMS, and you can also check the EPOMS there;
• on the public services website. To do this, you need to register on this resource, go to the section "What is a CHI policy and how to get it" and fill out an application. However, at the moment this option is being finalized, so it is temporarily not possible to issue an electronic compulsory medical insurance policy through public services. You can order EPOMS online only in some regions of the country, for example, in Moscow or St. Petersburg;
• through the 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 personnel department at their enterprise of their desire to receive an electronic policy. Large organizations themselves send papers to the insurer, but you will have to personally receive EPOMS.

The list of insurers who deal with medical insurance includes large and reliable organizations such as SOGAZ-Med, RESO-Med, Rosgosstrakh-Medicina, Ingosstrakh-M.

Step-by-step instructions for obtaining

To replace an old-style agreement 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 office of the insurer;
3. Write an application, submit documents for consideration and receive a temporary certificate of insurance;
4. Come get new insurance. Usually it takes no more than 10 days to make it. By law, the card must be issued no later than 30 days after the application is submitted.

Together with the card, a pin code and a pack code are issued. What are they needed for? The pin code is required to confirm that the information is entered with the knowledge of the user, and the pack code is needed to unlock the card in case of an incorrectly entered pin code three times. EPOMS activation occurs on first use.

Required documents

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

• civil passport or birth certificate of the insured person;
• replacement request;
• insurance number of an individual personal account (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 compulsory medical insurance. For children under 14 years of age, the presence of SNILS is not a prerequisite.

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

It is advisable to replace medical insurance contracts received before 2011 with new documents, but this is not a prerequisite. Insurance is considered valid until its term has expired - this is stated in Art. 51 p. 2 of the Federal Law "On Compulsory Medical Insurance in the Russian Federation". Therefore, health workers do not have the right to refuse to provide medical care when they see an old-style document, since it is valid.

Sooner or later, the document will need to be replaced, because earlier medical insurance was issued with a validity period. Thus, it is advisable to make a replacement as early as possible, because using the electronic MHI policy, you can make an appointment with a doctor remotely, moreover, it is unlimited.

Conclusion

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

Please rate this post and like it.

Our lawyer is always in touch, who can provide all the necessary support in resolving various disputes in the family and with the state. Just sign up for a free consultation in a special form.

Almost every Russian has a compulsory medical insurance policy, but not everyone has a clear idea of ​​where and what kind of medical care can be obtained under 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 the educational program from the expert of the Interregional Union of Medical Insurers Tatyana Serebryakova.

What kind of treatment does not entitle the CHI policy and do not have to insist on it?

The patient cannot qualify for treatment under the CHI policy in the two most common situations.

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

Secondly: if the treatment itself is not among those funded by compulsory medical insurance. This concerns, for example, 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 providing the State Guarantee Program - funds from the federal, regional or local budget. Due to the CHI policy, treatment of citizens outside the Russian Federation, plastic aesthetic surgery (if there are no medical indications for this), preferential dental prosthetics, Spa treatment, as well as the provision of medical care in conditions that exceed 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 provision for outpatient treatment. That is, if all medicines are provided free of charge in a hospital, then a patient who does not have the right to benefits pays for the prescription received at the clinic. Not related to the compulsory medical insurance policy and sick leave payments - this is a type of social benefit that is paid from social insurance funds.

Does it matter that a person fell ill while being in a place where he does not have a permanent registration?

You can get treatment for free anywhere in the country, the main thing is not to forget to take a compulsory medical insurance policy on your trip. But this applies to basic medical care. CHI 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 at a polyclinic or hospital operating in the CHI system.

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

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

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

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

Is it possible to get sick on a trip? sick leave?

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

If the situation is not urgent, but a person on vacation just has time to deal with his chronic illness, will he be provided with planned assistance?

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

Or can they say in another region that the CHI policy is invalid?

The current policy guarantees the provision of free medical care under the basic CHI program throughout Russia. Enter the hotline number of your insurance company in your notebook mobile phone, and call him in any disputed case. If you have not used the policy for a long time, call hotline of your insurance company (the phone number is indicated on the policy), check if there is information about it in the relevant register of the insured. Your best bet is to replace it with new policy OMS of a single sample. To do this, just contact any insurance company, but it is better to plan a visit to it 1.5 months before the intended trip.

What if the patient is forced to pay for treatment?

Contact the head of the medical organization, call the Territorial Compulsory Medical Insurance Fund of the region where you are not at the place of insurance, and where you were denied medical care or demanded to pay for it. To date, each subject of the Russian Federation has organized the work of Contact Centers in compulsory medical insurance, the telephone number of such a Contact Center should be posted on the stands in each 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 asked to sign a contract for the provision of paid services(and in another way, payment for medical care in the Russian Federation is not legal) - carefully read it and do not sign if it indicates that you are aware that you can receive medical care for free, but voluntarily decided to pay.

The CHI policy - compulsory medical insurance, guarantees a person the right to medical care in any corner of our country. However, the amount of this assistance can vary significantly. We understand the intricacies of obtaining and using the CHI policy.

The child was born, but there is no policy!

Newborn children receive medical care under the MHI policies of their mothers until they receive a birth certificate, that is, registration with the registry office.

After receiving a birth certificate, you need to contact Pension Fund For obtaining SNILS- green laminated card ( from 05/16/2016 without fail, according to the order of the Ministry of Health of the Russian Federation No. 192n dated 03/25/16). It takes about a week to complete. It is better to do this right away, since it is almost impossible to plan exactly when your baby will need medical help.

Important! Emergency care for newborns is provided even without a medical policy.

Having received SNILS, one of the parents goes to the insurance company to receive the baby's MHI policy. For this you need:

• SNILS;
• passport of the applied parent;
• child's birth certificate.

A temporary policy will be issued immediately (it is valid for 30 days), and a permanent one - after 2-4 weeks.

Note! You can also issue a CHI policy at the MFC (multifunctional center), where you can choose any insurance company operating in your region.

What does the new CHI policy look like?

Previously, each region and each insurance company had its own policies. Now they are all issued on Goznak paper and have a single look. Rather, they can be made in several formats:

1. A5 format- paper, with a barcode and number - issued by all insurance companies, in all settlements;
2. plastic card format with photo- children under 14 are not done - they change quickly and do not know how to sign;
3. electronic application format(universal electronic card with a number) - is issued not at all points, but acts in the same way as a paper policy;
4. virtual policy format- can be obtained only in St. Petersburg, it is convenient to use - you do not need to take a policy with you, only a passport or birth certificate.

However, our polyclinics, especially those located in small towns, do not have the appropriate equipment and health workers enter policy data manually, and therefore paper ones are popular.

Advice: make a photocopy of the child's policy and put it in the birth certificate. This way you won't forget an important document in case of a rush.

How does the OMS policy work?

As with the story of bread, all medical services have a cost. That is why they are not given out for free. The state pays for these services through insurance companies or budgetary funds. Therefore, by presenting the policy, you, in fact, pay for the work of doctors.

The doctor examines the child, the nurse gives an injection - they work. The invoice for the work is not issued to you, but to the insurance company, which pays it within 25 working days.

Asking a doctor to see you without a compulsory medical insurance policy is similar to asking for bread in a store for free. They can give out of pity and pay out of their own pocket.

What to do if there is no compulsory medical insurance policy?

If you don’t have a CHI policy with you, but it is issued, you need to call your insurance company (or any - now single base policies) and find out your number there. A medical institution can also make a request to the insurance company.

There are three types of medical care:

1. emergency, when the child's condition is so serious that he can die without medical assistance right now. No policy needed;
2. urgent, when the condition is serious, but there is no threat to life - in this case, a policy is needed;
3. planned - any other assistance is provided only upon presentation of the policy.

What volume of medical services is included in the CHI policy?

The amount of medical care that a child can receive varies from region to region, depending on wealth and accepted traditions. Therefore, at the state level, the following terms are used:

• basic medical care is the amount that anyone can receive in any place:
• raceswide- what a particular region guarantees to its inhabitants.

It is clear that the volume of included medical care is different for Moscow and, for example, the regional center in the Rostov region.

Now mothers themselves cannot schedule an examination for their child (but should we give urine?) - only a pediatrician, if he considers it necessary. Therefore, it is necessary to find a common language with a pediatrician. If the doctor does not suit you at all, you can complain about him to the insurance company or the administration of the clinic, or you can simply attach yourself to another doctor within the framework of the law, unless, of course, the other doctor agrees to take you.

Note. If you still really want to go through some kind of research, but the pediatrician reasonably does not give a referral, you can go through it for a fee, in accordance with the law of the Russian Federation "On the basics of protecting the health of citizens of the Russian Federation", Article 84.

If the doctor prescribes an examination, then it should be carried out free of charge as part of the MHI, even if your clinic does not have the opportunity to do this. A request is submitted to another clinic, and then financial settlements will be made between them.

Advice: carefully read the signed documents, they may indicate that you yourself refuse free help by choosing a paid service.

Do you use an OMS policy? Satisfied with the performance of your insurance company? Or have you already changed a doctor, a clinic, an insurance company? Tell us about your experience!

CHI policy - a document certifying the right to receive free medical care under the compulsory medical insurance program throughout Russia. Compulsory health insurance (CHI) is a part of the state social insurance system that provides the opportunity to receive free medical and pharmaceutical care. A client who has a CHI policy applies to a medical organization participating in the CHI system and receives the necessary treatment. For the assistance provided, the medical organization issues an invoice, which is paid by the insurance company.

To pay bills, the insurance company receives money from compulsory medical insurance funds. which, in turn, are financed from the federal and regional budgets, income from the placement of free funds and other sources. Including insurance premiums that your employer pays monthly. Each visit to the doctor, each scheduled examination is paid by the insurance company at the rates established under the program.

All citizens of the Russian Federation can get a compulsory medical insurance policy, foreign citizens permanently or temporarily residing in the territory of the Russian Federation, as well as persons entitled to medical care in accordance with federal law about refugees. Excluded from the CHI program are military personnel and persons equated to them in the organization of medical care. We will try to give answers to the most frequent, but remaining relevant questions related to CHI.

How to get an OMS policy

To apply for a policy, you need apply to an insurance company operating in the field of health insurance with an application for choosing (changing) an insurance company. This application can be filled out either on the website of the insurance company or in the office. You will also need a set of documents to apply, depending on which group of people you belong to. Information on the required set of documents can be found on the website of the selected insurance company or on the website of the territorial CHI fund. The application can be submitted both independently and through your representative, but in this case you will need a power of attorney for the representative and notarized documents.

Making a policy for a newborn baby required after obtaining a birth certificate. Until the certificate is received, the child is served by the insurance company of the mother or other legal representative. The term of the MHI policy is unlimited. During the term of the policy, when changing the last name, first name, patronymic, place of residence, the insured is obliged to notify the insurance company within one month from the day these changes occurred, in order to reissue the policy. In case of moving to a region where there is no representative office of the current insurance company, the insured must choose any other one represented in this region.

When applying for a choice (change) of an insurance company, an employee of the company issues a temporary certificate that provides the same rights as the policy. Within a 30-day period, the insurance company must prepare a policy and notify the client about it. If this does not happen, the client has the right to file a complaint with the territorial compulsory health insurance fund, since penalties are provided for insurance companies for violating the terms for issuing policies.

Do foreign citizens need a compulsory medical insurance policy?

Get an OMS policy foreign citizens permanently or temporarily residing in the territory of the Russian Federation, as well as persons entitled to medical care in accordance with the federal law on refugees. The policy is issued for a limited period. To obtain a policy, a foreign citizen must document their status and provide the insurance company with the appropriate document: a residence permit, a refugee certificate or a certificate of consideration of an application for recognition as a refugee, a foreign citizen's passport or other identification document with a mark on a temporary residence permit . Foreign citizens who arrived in Russia on the basis of a visa or in a manner not requiring a visa, and who received a migration card, but do not have a temporary residence permit, cannot receive a CHI policy. They can receive medical care (in addition to emergency) only on a paid basis by concluding an agreement with a medical organization on the provision of paid services. medical services or by taking out a voluntary medical insurance policy (VHI).

At the same time, from January 1, 2015, for foreign citizens planning to obtain a patent for the right to carry out labor activities, the conclusion of a VHI policy is mandatory. For foreign citizens Those who are not insured under the CHI and VHI programs are provided with medical care only in an emergency form.

How to choose a health insurance company

Each citizen can independently choose an insurance company. A citizen can make his choice no more than once a year by submitting an appropriate application to the selected medical insurance organization before November 1 of the current year.

The main function of the insurance company is ensuring the protection of the rights and interests of the insured. As part of these duties, the insurance company carries out registration, re-issuance, issuance of a policy, informing the insured persons about the types, quality and conditions of providing them with medical care, and monitoring the provision of medical care. Therefore, it is worth thinking seriously about choosing an insurance company.

The first thing you should focus on is a list of insurance companies operating in your area. Information on them can be found on the website of the Territorial Compulsory Medical Insurance Fund. In a number of regions, only one medical insurance organization is represented, and there may be no choice. But in most regions there are several companies that compete intensely for the right to serve as many customers as possible. As a next step, you should familiarize yourself with the rating of medical insurance organizations posted on the website Federal Fund compulsory health insurance.

The main indicators characterizing the quality of the work of the insurance company: the number of insured persons, the availability of points of issue, specialist experts, the availability of information for the insured, the presence of justified complaints. Going to the websites of companies with the best performance, study the completeness and relevance of information, the possibility of obtaining round-the-clock advice from specialists both by phone and via the Internet, the number and availability of offices. The list of mandatory services provided by all companies is the same, but the quality of service can vary greatly.

What is included in the OMS program

The Basic Program of Compulsory Medical Insurance is annually approved by the Decree of the Government of the Russian Federation. This document contains the types and volumes of medical care provided free of charge throughout the country.

On the basis of the basic program in each constituent entity of the Russian Federation, a territorial insurance program has been developed, which contains a wider list of medical care provided, financed at the expense of the constituent entity of the Federation. When a client applies for medical assistance in a region other than the region where the policy was issued, assistance is provided in the amount provided for by the Basic Program.

The list of types, forms and conditions for providing assistance under the territorial program can be found on the websites territorial funds compulsory health insurance, directly in medical organization and in an insurance company. For a simple consumer this information will not be particularly informative, since the description of the program does not contain a clear list of services provided. To find out about the availability of services in the territorial program, if such a question has arisen, as well as to avoid the imposition of paid services by a medical organization, it is easiest for the insured to contact their insurance company. She should provide an initial consultation and, if necessary, conduct an examination of the quality of medical care.

Charging fees for the provision of medical care included in the CHI program is one of the most common violations. Treatment prescribed by a doctor, and not recommended, should be provided free of charge if it is included in the CHI program. If the medical organization does not have the necessary doctor or equipment, the insured person should not be sent to a paid clinic, but issued a referral for the necessary free procedures to another medical organization working under the CHI program. If you paid for treatment in a medical organization working under the CHI program, but found out that it should be free of charge, you must keep all receipts and file a complaint with the insurance company. The insurer is obliged to organize an audit and, if a violation is found on the part of the medical organization, return the money to you and impose a fine on the organization.