The law provides for the right of a citizen to choose an insurance medical organization. How is this done in practice?

Firstly, I note that the choice or replacement of an insurance medical organization is carried out by an insured person who has reached the age of majority (for a child before he reaches the age of majority - his parents or other legal representatives).

The choice can be made from the number of insurance medical organizations that operate in this particular territory.

To make a choice, a citizen must simply submit an application (in the prescribed form, the insurance company will offer it to you) to the selected medical insurance organization.

At the same time, in order to prevent chaos in the formation of lists of insured persons in the context of insurance companies and to ensure systematic financing of the compulsory medical insurance program, it was determined that the replacement of an insurance company with an insured one can be carried out once a year no later than November 1.

When changing the place of residence - within a month, and only if there is no insurance at the place of the new place of residence medical company in which the citizen was previously insured.

If within the established time limits (before November 1) a citizen has not made a choice to replace the insurance medical organization, then for the next year he is considered insured in the same insurance medical organization in which he was insured earlier.

Now everywhere they write what you can choose insurance company. How is your company different from others?

This is not true, and especially in the light of new approaches in the compulsory health insurance system.

I'll tell you briefly about what work we do in the interests of the insured.

First, I want to note that ROSNO-MS is one of the two largest federal CMOs with the highest financial stability. Whatever happens, we will provide insurance coverage citizens in any volume and in any place.

The main slogan of our employees is to do the best possible so that our insured are satisfied and satisfied with the quality of the received medical care.

This work has several directions.

First of all, we widely inform our insured about their rights in the compulsory health insurance system. How? Circulation of memos, brochures, other information materials published by the Company for the insured for 9 months. this year exceeded 900 thousand copies. We place information stands in medical institutions, our specialists appear in the media, on radio, and television. We are constantly working with complaints and applications for the examination of the quality of medical care provided to our insured. In order to study the opinions of clients - surveys, both in healthcare facilities and "on the street".

Another line of work is to enable our insured to contact the company at any time. For this purpose, we have a 24-hour hotline, 365 days a year (tel. ru). If necessary, you can contact any of our branches at the phone number indicated on the policy, or contact the branch directly. We guarantee that all appeals and complaints will be quickly and objectively considered.

We employ more than half a thousand highly qualified medical experts with their help, we constantly monitor the quality of medical care provided to our insured.

For 9 months of 2010, the Company considered over 1 million applications on various issues. Wherein free phone « hotline More than 150,000 people have used it. In total we had 2192 complaints. All complaints received were considered and over 70% of them were confirmed. Where money was unlawfully received from our insured by a medical institution, after the intervention of the company, they were returned to the insured. In total, 1.2 million rubles were returned, paid by citizens to medical organizations for assistance that should have been provided free of charge.

If the insured considers it necessary to file a lawsuit for poor-quality medical care, the Company's lawyers will provide him with the necessary advisory assistance. This year, the courts have satisfied 10 out of 14 considered claims. By the tribunal's decision medical institutions paid over 600 thousand rubles in the form of material compensation, and in the form of compensation moral damage paid another 450 thousand rubles.

Let me tell you a few cases:

1) The insured F. applied for the purchase of the drug "vancomycin" at his own expense during the period of inpatient treatment in the Central City Hospital of one of the cities of the Moscow Region. The complaint was investigated by ROSNO-MS specialists, recognized as justified, the hospital returned the patient the 37,368 rubles spent by him.

2) After the intervention of the company, the money in the amount of 760 rubles was returned to two mothers. and 950 rubles illegally taken from them in a children's clinic for preventive examination of children for registration in kindergarten. (Moscow region).

3) the insured L. applied to the company with a request to organize a consultation with a pediatrician for the child, because there was no such doctor in the local polyclinic. Our specialists arranged for the child to be seen by a pediatrician at the Central District Hospital, where he received the necessary assistance.)

We consider it very important for us to develop medical services and introduce the latest technologies in CHI.

We are one of the reformers and technological leaders of the system. We implement all new ideas, the best technologies for serving citizens immediately, at first - pilot projects(availability, IT projects), then - distribution to all territories where ROSNO-MS operates.

In addition, we are striving to expand the possibilities of compulsory medical insurance for the insured. We have developed whole line additional products (features) that, in addition to CHI program allow you to get a better, faster, or additional service.

I briefly dwelled on some aspects of the work that the Company is doing to ensure the rights of the insured to receive free medical care.

Of course, we do not stop there, convenience for the insured will remain our priority. And the choice is yours.

The compulsory health insurance system provides insured citizens with free medical care.

The role of insurance companies in CHI

Adopted in 2011 new law"On Compulsory Health Insurance". With its introduction, the powers conferred on the insurance medical organizations(SMO), expanded.

The functions of insurance organizations now include:

• protection of the rights of insured citizens;
• registration of insurance policies;
• organization and financing of medical care;
• determination of tariffs for services provided by medical institutions;
• quality control of services;
• representing the interests of insured persons in court.

HIOs conduct consultations and explanatory work among the insured persons on the legal acts regulating the provision of medical care.

To control the quality of services, CMO experts are sent to medical institutions, sociological surveys are conducted among citizens.

To carry out the activities of the company, it is necessary to obtain a license. Then notify the territorial MHIF of the intention to work in the CHI system. It is necessary to submit documents to the TFOMS no later than September 1 of the year preceding the start of the provision of services.

The insurance organization is responsible for financing medical care within the framework of the basic budget, reports to the TFOMS for compliance with the law on compulsory medical insurance.

Information about insurance medical organizations is placed on the Internet in the public domain.

Differences between companies

All CMOs operating in Russia - commercial organizations operating on the basis of a license issued by the state.

Such companies have equal opportunities at the beginning of their work, but they function differently.

Companies differ in their approach to working with clients:

• response time to complaints;
• support of the insured persons (round the clock, during working hours);
• informing about free services;
• availability of branches;
• preparedness of employees.

Another difference is the number of clients. The more people insured, the more funding the company receives from the health insurance fund.

With a lack of funding, the insurance company will not be able to spend enough money on expertise, consultations and legal support for insured persons. This, ultimately, can lead to a decrease in the quality of services and the loss of customers.

CMOs also differ in the volume of insurance services. If a company, in addition to CHI, offers VHI services, then it is interested in improving the quality of service in order to attract customers and extract additional profit.

Insured persons have the right to change insurance at will, but not more than once a year. To do this, you must submit an application to the company - a new insurer no later than November 1 of the current year.

Only citizens who have reached the age of 18 can use this right. For children under 18, the decision to change the insurance company is made by the parents.

An exception is a change of residence, provided there are no HMO branches in the territory of residence, or the closure of an insurance company.

Ratings of insurance companies

The assessment is carried out according to the following criteria:

• financial stability;
• infrastructure;
• service quality.

Based on the results of the analysis, an opinion is made on the ability of the insurance organization to fulfill its obligations under the CHI.

You can get acquainted with information about the reliability of insurers on the official website of Expert RA - https://raexpert.ru/ratings/insurance/.

The data provided by the FFOMS is an objective assessment of the activity, since the organization was created to implement public policy in the field of OMS.

You can get acquainted with the opinion of the FFOMS on the official website of the organization - http://ffoms.ru/system-oms/analyst-ratings/.

At the same time, on the page you can evaluate insurance organizations in each region according to the selected evaluation criterion.

However, if a large number of people leave negative reviews, this is an occasion to think about the quality of services.

How to choose a CMO

The volume of medical care within the framework of CHI is the same for all subjects of the Russian Federation. It does not depend on the insurance company, but the HMO interacts with medical institutions and TFOMS.
The comfort, time and health of the insured will depend on how “well” the insurance company performs its work.

You need to choose from organizations operating in your area. Please note if there is an office or distribution points in your city. The presence of an office, a multi-channel telephone allows you to quickly contact the CMO for advice.

On the official website of the insurance medical organization or from the media, you can clarify information about the company:

• active work with clients;
• activity information;
• rating;
• availability of hotlines.

What else to look for when choosing insurance for CHI?

• Company size
  Small regional HMOs will not be able to control the provision of medical care outside the location of the departments. Federal HMOs cover the entire country and open branches in every city.

  Federal-level insurance organizations are more likely to provide customers with 24/7 phone support, have great opportunities to protect the rights of insured persons in court.

• Specialist level
  The presence of specialists in various fields: physicians, lawyers, experts. This will protect the interests of the client in the event of a dispute.

OMS is mandatory health insurance. With its help, absolutely every citizen of the Russian Federation has the right to restore their health for free. It is noteworthy that the main advantage of the program is the provision level playing field obtaining medical care for residents of different regions of the country.

In other words, the services that should be provided to citizens free of charge according to the MHI do not depend on the place of registration of the population. But the quality of these services directly depends on the choice of the insurer. Consider how not to make a mistake with the choice and conclude a profitable contract.

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

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

To make it easier for Russians to make their final choice, a special official website of the FFMS was created. This site provides a rating of insurance companies and all the necessary information about them. But most importantly, the page also has a section with testimonials from real people who have worked with such firms. With this information, it becomes much easier to choose the most suitable insurer.

How not to become a victim of scammers?

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

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

TOP-10 insurance companies

Representatives of the official department insist that the Russians should choose the company with which they will cooperate in the future, focusing on a special rating. It is he who will help protect against scammers and choose a conscientious insurer. This rating was formed based on data on the number of insured clients.

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

Moscow insurance companies

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

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

Change of insurance company

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

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

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

List of documents

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

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

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

Cancellation policy: what to do?

By law, a company cannot refuse to issue a policy to a citizen if all Required documents. But if this happened, you should receive a written refusal from the company and then inform the MHIF about what happened. If no further action is taken on this issue, then the only way out is to file a claim.

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

• by the policy number on the FFOMS website;
• request for information in the SMO.

As soon as the data is received, you can submit a claim.