In accordance with the Law of the Russian Federation “On medical insurance of citizens in the Russian Federation”, the Rules of compulsory medical insurance of the population of the city of Moscow, the Territorial program of state guarantees for the provision of free medical care to the population of the city of Moscow and in order to improve the organization of the provision of medical care within the framework of the Moscow city program of compulsory medical care insurance we order:

1. Approve the Procedure and conditions for the provision of medical care under the Moscow City Compulsory Medical Insurance Program ().

2. The heads of health care departments of the administrative districts of Moscow, the heads of medical institutions, bring this document to the attention of subordinate medical institutions and structural divisions for management and execution.

3. The Moscow City Compulsory Medical Insurance Fund ensures that the Moscow population is informed about the procedure and conditions for providing medical care under the Moscow City Compulsory Medical Insurance Program.

4. Consider the order of the Moscow City Health Department and the Moscow City Compulsory Health Insurance Fund dated November 14, 2008 No. 931/131 “On approval of the Procedure and conditions for the provision of medical care under the Moscow City Compulsory Medical Insurance Program” as no longer in force.

5. Entrust control over the implementation of this order to the First Deputy Head of the Moscow Department of Health, S.V. Polyakov. and Deputy Executive Director of the Moscow City Compulsory Medical Insurance Fund T.I. Yuryev.

Application
to the Department
Moscow health care
and the Moscow City Compulsory Medical Insurance Fund
dated October 11, 2010 N 1794/130

Terms and Conditions
provision of medical care under the Moscow city compulsory medical insurance program

1. Medical care within the framework of the Moscow City Compulsory Health Insurance (CHI) program is provided by medical institutions operating in the Moscow compulsory medical insurance system to citizens subject to compulsory health insurance:

Citizens insured under compulsory medical insurance in Moscow;

Citizens insured under compulsory medical insurance on the territory of other constituent entities of the Russian Federation (hereinafter referred to as “non-resident citizens”);

Patients who, for objective reasons, are not identified (according to the compulsory medical insurance policy) when they are provided with primary health care and specialized medical care for emergency indications, in an outpatient or inpatient setting (hereinafter referred to as “unidentified patients”).

2. Citizens insured under compulsory medical insurance in Moscow receive medical care upon presentation of a compulsory medical insurance policy (when first contacting a medical institution, in addition to the compulsory medical insurance policy, you must present a passport).

In the absence of a compulsory medical insurance policy for patients (if they apply in an emergency), medical institutions take measures to identify the patient in order to identify the insurer or classify him (according to his passport) as a non-resident citizen or unidentified patient.

Planned inpatient medical care for citizens insured under compulsory medical insurance in Moscow is provided at the direction of the outpatient clinic to which they are assigned for medical care.

Medical care to citizens insured under compulsory medical insurance in Moscow in departmental and non-governmental medical institutions participating in the implementation of the Moscow city compulsory medical insurance program is provided taking into account the volumes (types) of medical care planned by the medical institution and approved by the Moscow Department of Health.

3. For non-resident citizens, planned medical care in the scope of the Moscow City Compulsory Medical Insurance Program is provided in medical institutions of the Moscow City Health Department upon presentation of a territorial compulsory medical insurance policy and a passport (in the absence of a compulsory medical insurance policy for objective reasons - only passports, and for children - the passport of one of the parents or other legal representatives).

In order to implement the principle of accessibility to free medical care, nonresident citizens living in Moscow are assigned to medical care and are included in the register of the assigned population of a medical institution on the basis of a written application addressed to the chief physician.

Planned inpatient medical care for nonresident citizens is provided on the basis of referrals issued by the Moscow Department of Health, health departments of the administrative districts of Moscow (in accordance with the subordination of the institution), as well as referrals issued by medical institutions if nonresident citizens are attached to them, incl. h. children and pregnant women for medical care.

4. Diagnostic examinations and advisory assistance are carried out for medical reasons and are prescribed by the attending physician.

The attending physician selects specialists for consultations and selects medicines, materials and medical products.

If the standard workload of a specialist and/or medical institution is exceeded, consultation, diagnostic and routine medical care under the compulsory medical insurance program is provided on a first-come, first-served basis.

5. The exercise of the right of citizens insured under compulsory medical insurance in Moscow to choose a treatment and preventive institution in the compulsory medical insurance system of Moscow is carried out on the basis of a written application addressed to the chief physician, in accordance with the resource capabilities of the institution: capacity, staffing of medical personnel and the Procedure organizing medical care for the population on a local basis, approved by order of the Ministry of Health and Social Development of Russia dated 04.08.06 N 584.

Home care is provided by medical workers of institutions located in the territory of actual residence of citizens.

The exercise of the right of those insured under compulsory medical insurance to choose a doctor, including a family doctor and a physician, is carried out taking into account his consent.

6. Medical institutions provide citizens with free and accessible information:

On the types of medical services provided free of charge within the framework of targeted programs for the development of metropolitan healthcare and the Territorial Program of State Guarantees for the provision of free medical care to the population of the city of Moscow, a component of which is the Moscow City Compulsory Health Insurance Program;

On the types of medical services provided by a medical institution at the expense of citizens’ personal funds or other sources of financing within the framework of voluntary health insurance;

On the ability of a medical institution to provide services at the request of citizens for a fee, at prices reflecting the full cost of medical services, and (or) to provide services for an additional fee (without paying the full cost of medical services);

On the conditions for the provision and receipt of paid services;

About benefits for certain categories of citizens.

7. The medical insurance organization that issued the compulsory medical insurance policy considers requests from the insured in order to ensure and protect their rights to receive medical care within the framework of the Moscow city compulsory medical insurance program. If the application of a citizen insured under compulsory medical insurance contains claims against the organization and (or) the quality of the medical care provided, the insurance medical organization is obliged to organize an examination of the quality of medical care in the manner and within the time frame provided for by the Regulations on medical and economic control of the volumes and examination of the quality of medical care provided under the compulsory medical insurance program.

If necessary, the medical insurance organization takes measures to provide those insured under compulsory medical insurance with certain types of medical care in other medical institutions that have a contractual relationship with it.

8. Citizens insured under compulsory medical insurance in Moscow, non-resident citizens and unidentified patients, when receiving free medical care, have the rights established by the Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens and the Law of the Russian Federation “On medical insurance of citizens in the Russian Federation”.

In case of violation of rights, the patient can contact:

Directly to the head or other official of the medical institution in which he received medical care;

To the health department of the corresponding administrative district of Moscow;

To the Moscow City Health Department;

To the medical insurance organization that issued the compulsory medical insurance policy to the insured and assumed obligations to protect his interests;

To the City Arbitration Expert Commission (SAEC) in the event that the patient’s claims have already been considered by the medical insurance organization and the demands of the insured have not been satisfied (applications for transfer to the SAEC are accepted by the Department of the Compulsory Medical Insurance Organization of the Moscow City Compulsory Health Insurance Fund);

9. Unreasonable refusals to provide free medical care to citizens insured under compulsory medical insurance in medical institutions participating in the implementation of the Moscow city compulsory medical insurance program are not permitted.

Note.

1. In accordance with the Decree of the Moscow Government dated March 4, 2008 N 145-PP, the Moscow City Health Department issues a referral for hospitalization (consultation), including to those insured under compulsory medical insurance in the city of Moscow and in other constituent entities of the Russian Federation, within the framework Territorial program of state guarantees for the provision of free medical care to the population of the city of Moscow, as well as citizens living in the CIS countries, at the expense of the Healthcare industry within the framework of existing intergovernmental agreements (treaties) defining the procedure for interaction in the field of healthcare.

2. In accordance with Decree of the Government of the Russian Federation dated 01.09.2005 N 546, emergency medical care is provided to foreign citizens by treatment and preventive institutions of the state and municipal health care system in the event of conditions that pose an immediate threat to their life or require urgent medical intervention free of charge (at the expense of budget). After recovering from these conditions, foreign citizens can be provided with planned medical care on a paid basis. If an international treaty of the Russian Federation establishes a different procedure for providing medical care to foreign citizens, the rules of the international treaty apply.

Order of the Moscow Department of Health and the Moscow City Compulsory Medical Insurance Fund dated October 11, 2010 N 1794/130 “On approval of the Procedure and conditions for the provision of medical care under the Moscow City Compulsory Medical Insurance Program”

Document overview

It has been established that medical care within the framework of the Moscow city compulsory medical insurance program is provided by medical institutions operating in the compulsory medical insurance system to citizens subject to compulsory health insurance: those insured under compulsory medical insurance in Moscow; insured on the territory of other constituent entities of the Russian Federation; patients who, for objective reasons, are not identified (according to the compulsory medical insurance policy) when providing them with primary health care and specialized medical care for emergency indications.

Citizens insured under compulsory medical insurance have the right to choose a treatment and preventive institution in the compulsory medical insurance system. To do this, they need to submit an application to the chief physician.

Unreasonable refusals to provide citizens insured under compulsory medical insurance with free medical care in medical institutions participating in the implementation of the Moscow city compulsory medical insurance program are not permitted.

Compulsory health insurance (CHI) provides citizens of the Russian Federation with high-quality medical care.

We will tell you what help you can get, how to do it and where you can go if your rights are violated.

Medical insurance is the main form of social protection of citizens of the Russian Federation in the field of health care.

The essence of insurance is that when an insured event occurs, the patient’s treatment is paid for by the insurer. There are many medical insurers in Russia, and the most famous among them are Max-M, SOGAZ-Med, ROSNO-MS.

This article describes in detail the rights of patients under the compulsory health insurance system. After reading the contents of the article, you will find out in what cases free medical care is provided.

Sometimes a patient may be denied medical care, and he will have to defend his rights. You will learn further about who can help with this.

Features of insurance

Compulsory medical insurance is a set of government measures that are aimed at providing free medical care to a citizen of the Russian Federation in the event of an insured event.

Special compulsory medical insurance funds are used to pay for assistance. The insurance program includes legal, economic and organizational measures.

The state not only provides free medical care for the patient, but also ensures that it is of high quality and occurs in accordance with the law.

Compulsory health insurance occurs under the compulsory medical insurance policy. This policy has a unified state model, which is approved by Federal Law No. 326 “On Compulsory Health Insurance”.

The modern policy was put into circulation in the spring of 2011. An insured event under compulsory medical insurance is considered to be any health disorder.

A person who for some reason does not have compulsory medical insurance cannot demand free medical care

What does the Law say?

The Law “On Medical Insurance of Citizens of the Russian Federation” in Article 15 states that insurers are obliged to protect the interests of the insured.

Based on this, compulsory medical insurance is a set of rights, interests and responsibilities of a citizen. He has only one duty - to insure himself under compulsory medical insurance.

In the “Fundamentals of the legislation of the Russian Federation on healthcare of citizens”, in articles 19 and 20, the rights of patients are formulated:

1. for free medical care in the healthcare system, including municipal
2. to receive information about factors that affect health
3. for a range of additional medical services

The same document, in articles 30-32, indicates what the patient can count on:

• respect and humane attitude of medical staff
• for treatment and examination in conditions that meet sanitary and hygienic standards
• for additional consultations and consultations at the request of the patient
• to relieve pain using available means and methods
• on the confidentiality of information about applying for medical care
• to maintain confidentiality of information about a person’s health status
• to refuse surgical and other interventions

The Law “On Medical Insurance of Citizens in the Russian Federation” in Article 6 provides the following rights:

• for compulsory and voluntary medical insurance
• at the insurer's discretion
• choice of doctor and desired medical institution
• to receive assistance throughout the country, even far from the place of registration
• to receive medical care of the volume and quality that corresponds to the insurance contract
• to file a claim in case of refusal of medical care or its inadequate quality, even if the claim is not provided for in the insurance contract

These are only the basic rights of patients under compulsory medical insurance. To find out all the rights, we recommend that you read the specified documents and articles in full

Who provides protection and how?

Protection of rights is provided by medical insurance organizations. Their duty under the law is to defend the interests of insured citizens of the Russian Federation.

Insurers are required to pay for medical care if it is provided in accordance with a compulsory insurance agreement.

This is the main means of ensuring the protection of patients' rights. Other responsibilities for protecting patients' rights include:

1. control of the quality, volumes, terms and conditions of medical care
2. carrying out medical and economic examinations and control, if necessary
3. creating reports on the results of control or examination

The medical insurance organization assumes full responsibility for protecting the rights of the patient. If these duties were not fulfilled or performed insufficiently, then the citizen can file a lawsuit against his insurer.

What kind of medical care can I get?

The basic compulsory medical insurance program includes:

1. primary health care
2. emergency medical care
3. preventative care
4. additional medical care

You can find out what additional assistance is offered under the compulsory medical insurance policy in your city at any government medical institution. Specialized ambulance (sanitary and aviation) is not included in the basic compulsory medical insurance program

Receipt procedure

To receive free medical care, a citizen of the Russian Federation must provide his compulsory medical insurance policy to the medical institution.

Before this, you need to make sure that the insured event (health impairment) complies with the terms of the insurance contract.

Medical services should be chosen independently, although only on the recommendation of a doctor.

If you give the right to choose services to the employees of the institution, they may go beyond the scope of the insurance contract, and the patient will have to pay. General algorithm of actions:

1. Contact a medical facility
2. Show current compulsory medical insurance policy
3. Select medical care included in the insurance contract
4. Get medical help

If a person becomes ill on the street and does not have a compulsory medical insurance policy with him, he will still receive free medical care. The law defines emergency assistance as free, even if it is not included in the terms of the insurance contract

What to do in case of refusal?

In government agencies, refusals occur extremely rarely. But municipal and other medical institutions “sin” from time to time.

They may refuse free treatment, citing the cost of medications or other factors, or they may provide medical care with violations and poor quality.

Where to go in such a situation?

State health insurance of citizens

State health insurance of citizens is a mandatory procedure. Due to this, free medical care is provided. The insurers are territorial or federal authorities.

Citizens are persons who have, and the insurer is a municipal or village budget. What is included in the free service if you have a compulsory medical insurance policy?

Professional assistance from medical workers can be obtained free of charge. Moreover, the planned examinations are carried out in the territory where the person is insured, that is, in order to receive the services of specialists, it is necessary to purchase a policy. Insurance calculations are based on contractual obligations. The policy is issued directly in organizations, enterprises or funds located in different areas.

For each locality, a register of medical services is approved. Any hospital or clinic has this list, agreed with municipal or regional authorities.

The modern program includes the following areas of assistance:

• first medical;
• specialized;
• ambulance;
• used in the treatment of pain in incurable pathologies.

These directions are defined by regulatory documents.

About types of assistance

Types of first aid and which specialists provide it:

1. Nurses provide health care support to the patient.
2. Paramedics or obstetrician-gynecologists provide pre-medical care.
3. Medical care is provided by local doctors, including therapists and pediatricians.

First aid is provided by medical staff in a clinic, directly at the patient’s home or in a day hospital.

The specialist's responsibilities include:

• reception of a citizen;
• prescribing procedures to clarify the diagnosis;
• determining the name of the disease;
• prescription of complex therapy;
• control over recovery.

Moreover, the purchase of medicines is not included in the list of free services.

Specialized medical care is provided when the patient is under observation in a day hospital.

This includes IVs, injections, massage, physiotherapy and surgery that does not require hospitalization.

Ambulance services are divided into:

1. Specialized and urgent. That is, the deterioration of a citizen’s well-being does not threaten his life as a whole.
2. Emergency urgent or emergency. The citizen's condition is dangerous to his life.

In the presence of acute diseases, hospitalization is prescribed, namely in case of:

• vascular hemorrhages;
• heart attack conditions;
• in case of poisoning;
• injuries;
• infectious pathologies.

According to the order of the Ministry of Health, in the next two years there will be a complete medical examination of all Russian citizens. As a result of this examination, each person will be assigned a specific health group.

If any chronic disease is detected, you will be required to undergo a medical examination as many times a year as necessary based on the diagnosis.

If a person misses this examination, he will receive a message about this in the form of an SMS message. According to the introduced rules, insurance companies will have to process requests and complaints from citizens and provide assistance in the event of controversial situations.

If a patient has doubts about the quality of medical services provided to him, insurance workers will have to order an examination.

Amendments will be introduced to the Labor Code that will legislate an additional annual leave day. This day will be provided to workers over 40 years of age to undergo a medical examination while maintaining their average earnings.

The policy can be issued in paper form, as before, or in the form of an electronic card, which will not require presenting a passport at medical institutions. The temporary policy will be valid for 45 days.

Modern assistance programs provide for:

1. Providing free medicines to patients with chronic pathologies.
2. Surveys of workers employed in hazardous or difficult conditions, as well as whose activities are related to food.
3. Ensuring control over the condition of young children, including those under guardianship or orphans.
4. Conducting examinations of pregnant women on the eve of childbirth.
5. Examinations of newly born babies for hereditary pathologies.

Maternity services

The policy provides women with the right to free qualified medical care while expecting a baby. The document provides for the possibility of choosing a clinic and a doctor for the expectant mother while she is expecting her baby.

When presenting the policy to the clinic, a woman has the right to a whole range of procedures and examinations, which include:

1. Treatments are therapeutic or preventive.
2. Visiting a visiting nurse at home.
3. Study of biomaterial in specialized laboratories.
4. Hospitalization, if necessary.
5. Diagnosis of pathologies of the unborn child.
6. Preparing for...
7. Rules and recommendations for breastfeeding.
8. Consultations with specialists of other profiles.
9. Choosing a gynecologist with the consent of the specialist himself.
10. Preventive, therapeutic and diagnostic measures in special organizations that have the right to engage in these activities.
11. Pain relief if surgery is necessary.
12. Ensuring the protection of health information.
13. Right to refuse assistance.
14. Presence of relatives or friends at the birth.

If a premature baby was born, then according to a free program, such children are nursed and operated on for organ transplantation.

Benefits in dentistry

Dentist services are quite expensive, so many people are confused about what kind of help they are entitled to receive without paying. To do this, you must have health insurance.

In each territory there is an individual Program according to which dental services are provided, and throughout Russia only provision of emergency care is provided.

Specialized dental care covers:

1. Treatment in regional clinics.
2. Treatment of children in children's clinics.

Moreover, each institution must approve a list of services, and the patient must be informed:

1. About the types of services.
2. About the working hours of specialists.
3. About telephone numbers and locations of insurers.
4. About the benefits provided.

Many private medical institutions also provide services without payment, and you can learn about this from the operators.

The following types of services are provided for children:

• restoration of tooth enamel not affected by caries;
• silver treatment and remineralization of teeth;
• orthodontic appointments and services.

Free service

Free adult service includes:

• doctor's appointment, specialist consultation and examination of the oral cavity;
• treatment of the pathology of periodontal disease and gingivitis, caries and pulpitis;
• elimination of exacerbation;
• building up hard tooth tissues with damaged roots;
• surgical interventions;
• cleaning teeth from stones;
• straightening the jawbone;
• removal of decayed teeth;
• radiography;
• treatment of salivary glands;
• physiotherapy;
• local and general anesthesia.

Medicines can be issued free of charge if they are on the list of free medicines approved at the regional level. Typically, these are domestically produced products.

Complaints about specialists

If controversial issues arise and conflict situations are brewing, you can file a complaint against the doctor.