Law on Compulsory Health Insurance court decision. Law on Compulsory Health Insurance
GUARANTOR's comment
See a graphic copy of the official publication
the federal law dated November 29, 2010 N 326-fz "On mandatory health insurance in the Russian Federation" (as amended on June 14, November 30, December 3, 2011)
GUARANTOR's comment
Cm. comments to this Federal Law
Chapter 1. General Provisions
Article 1 Subject of regulation of this Federal Law
This Federal Law regulates relations arising in connection with the implementation of compulsory medical insurance, including determining the legal status of subjects of compulsory medical insurance and participants in compulsory medical insurance, the grounds for the emergence of their rights and obligations, guarantees for their implementation, relations and liability associated with the payment of insurance contributions to the unemployed.
GUARANTOR's comment
Cm. comments to Article 1 of this Federal Law
Article 2 Legal basis for compulsory health insurance
1. Legislation on compulsory health insurance is based on Constitution Russian Federation and consists of Fundamentals of legislation of the Russian Federation on the protection of the health of citizens, federal law dated July 16, 1999 N 165-FZ "On the basics of compulsory social insurance", this Federal Law, other federal laws, laws of the constituent entities of the Russian Federation. Relations related to compulsory health insurance are also regulated by other regulatory legal acts of the Russian Federation, other regulatory legal acts of the constituent entities of the Russian Federation.
GUARANTOR's comment
Cm. the federal law dated November 21, 2011 N 323-FZ "On the basics of protecting the health of citizens in the Russian Federation"
2. If an international treaty of the Russian Federation establishes other rules than those provided for by this Federal Law, the rules of the international treaty of the Russian Federation shall apply.
3. For the purposes of the uniform application of this Federal Law, if necessary, appropriate explanations may be issued in okay established by the Government of the Russian Federation.
GUARANTOR's comment
Cm. comments to Article 2 of this Federal Law
Article 3 Basic concepts used in this Federal Law
For the purposes of this Federal Law, the following basic concepts are used:
1)compulsory health insurance- a type of compulsory social insurance, which is a system of legal, economic and organizational measures created by the state aimed at ensuring, in the event of an insured event, guarantees of free provision of medical care to the insured person at the expense of compulsory medical insurance within the territorial program of compulsory medical insurance and within the limits established by this Federal by law cases within the framework of the basic program of compulsory health insurance;
2)obligatory medical insurance object-insurance risk associated with the occurrence insured event;
3)insurance risk- an expected event, upon the occurrence of which it becomes necessary to pay for the costs of medical care provided to the insured person;
4)insurance case- an event that has taken place (illness, injury, other state of health of the insured person, preventive measures), upon the occurrence of which the insured person is provided with insurance coverage on obligatory medical insurance;
5)compulsory health insurance coverage(hereinafter - insurance coverage) - fulfillment of obligations to provide the insured person with the necessary medical care in the event of an insured event and to pay for it to a medical organization;
6)insurance premiums for compulsory health insurance- obligatory payments, which are paid by the insurers, have an impersonal nature and the intended purpose of which is to ensure the rights of the insured person to receive insurance coverage;
7)insured person- natural person to whom compulsory health insurance in accordance with this Federal Law;
8)basic program of compulsory health insurance- an integral part of the program of state guarantees of free provision of medical care to citizens, which determines the rights of insured persons to provide them with free medical care at the expense of compulsory medical insurance throughout the territory of the Russian Federation and establishes uniform requirements for territorial programs of compulsory medical insurance;
9)territorial program of compulsory medical insurance- an integral part of the territorial program of state guarantees of free provision of medical care to citizens, which determines the rights of insured persons to free provision of medical care to them on the territory of a constituent entity of the Russian Federation and meets the uniform requirements of the basic program of compulsory medical insurance.
Law of the Russian Federation “On health insurance of citizens in the Russian Federation” (Extracts) Section 1. General provisions Article 1. Medical insurance
Health insurance is a form of social protection of the population's interests in health protection.
The purpose of health insurance is to guarantee citizens, in the event of an insured event, receiving medical care at the expense of accumulated funds and to finance preventive measures.
Medical insurance is carried out in two types: compulsory and voluntary.
Compulsory medical insurance is an integral part of the state social insurance and provides all citizens of the Russian Federation with equal opportunities to receive medical and drug assistance provided at the expense of compulsory medical insurance in the amount and on conditions corresponding to compulsory medical insurance programs.
Voluntary medical insurance is carried out on the basis of voluntary medical insurance programs and provides citizens with additional medical and other services in excess of those established by compulsory medical insurance programs.
Voluntary health insurance can be collective and individual.
Article 2. Subjects of health insurance
The subjects of health insurance are: a citizen, an insurer, an insurance medical organization, a medical institution.
The insurers for compulsory health insurance are the executive authorities of the constituent entities of the Russian Federation and local governments - for the non-working population; organizations, individuals registered as individual entrepreneurs, private notaries, lawyers, individuals who have concluded employment contracts with employees, as well as paying remuneration under civil law contracts, on which, in accordance with the legislation of the Russian Federation, taxes are charged in the part subject to enrollment in the compulsory health insurance funds - for the working population.
The insurers in case of voluntary medical insurance are individual citizens with legal capacity and/or enterprises representing the interests of citizens.
Insurance medical organizations are legal entities that carry out health insurance and have a state permit (license) for the right to engage in health insurance.
Medical institutions in the health insurance system are licensed medical and preventive institutions, research and medical institutes, other institutions providing medical care, as well as persons engaged in medical activities, both individually and collectively.
Section 2. Health insurance system
Article 3. Object of voluntary medical insurance
The object of voluntary medical insurance is the insured risk associated with the costs of providing medical care in the event of an insured event.
Article 4. Medical insurance contract
Medical insurance is carried out in the form of an agreement concluded between the subjects of medical insurance. Subjects of health insurance fulfill obligations under the concluded contract in accordance with the legislation of the Russian Federation. A medical insurance contract is an agreement between the insured and the insurance medical organization, according to which the latter undertakes to organize and finance the provision of medical care of a certain volume and quality or other services to the insured contingent under the programs of compulsory medical insurance and voluntary medical insurance.
The health insurance contract must contain:
names of the parties;
the duration of the contract;
number of insured persons;
the amount, terms and procedure for making insurance premiums;
a list of medical services corresponding to programs of compulsory or voluntary medical insurance;
rights, obligations, liability of the parties and other conditions that do not contradict the legislation of the Russian Federation. (as amended by the Law of the Russian Federation of 04/02/1993 N 4741-1)
The form of standard contracts for compulsory and voluntary medical insurance, the procedure and conditions for their conclusion are established by the Council of Ministers of the Russian Federation.
The health insurance contract is considered concluded from the moment of payment of the first insurance premium, unless otherwise provided by the terms of the contract.
In the event that the insured loses the rights of a legal entity during the term of the contract of compulsory medical insurance due to the reorganization or liquidation of the enterprise, the rights and obligations under the specified contract are transferred to its successor.
During the validity period of the contract of voluntary medical insurance, if the court recognizes the insured as incapable or limited in capacity, his rights and obligations are transferred to the guardian or custodian acting in the interests of the insured.
Article 5. Medical insurance policy
Each citizen in respect of whom a medical insurance contract has been concluded or who has concluded such an agreement independently receives an insurance medical policy. The health insurance policy is in the hands of the insured.
Form of insurance medical policy and instructions for its maintenance are approved by the Council of Ministers of the Russian Federation.
The insurance medical policy is valid throughout the territory of the Russian Federation, as well as in the territories of other states with which the Russian Federation has agreements on medical insurance of citizens.
Article 6. Rights of citizens of the Russian Federation in the system of medical insurance
Citizens of the Russian Federation have the right to:
compulsory and voluntary medical insurance;
choice of medical insurance company;
the choice of a medical institution and a doctor in accordance with the contracts of compulsory and voluntary medical insurance;
receiving medical care throughout the Russian Federation, including outside the permanent place of residence;
receipt of medical services corresponding in volume and quality to the terms of the contract, regardless of the amount of the actually paid insurance premium;
filing a claim against the policyholder, medical insurance organization, medical institution, including for material compensation for damage caused through their fault, regardless of whether it is provided for in the health insurance contract or not;
repayment of a part of insurance premiums for voluntary medical insurance, if it is determined by the terms of the contract.
The norms relating to compulsory medical insurance established by this Law and the normative acts adopted in accordance with it shall apply to working citizens from the moment an employment contract is concluded with them.
The interests of citizens are protected by the Councils of Ministers of the Russian Federation and the republics within the Russian Federation, government bodies of the autonomous region, autonomous districts, territories, regions, cities of Moscow and St. Petersburg, local administration, trade unions, public or other organizations (associations).
Article 7. Rights and obligations of stateless persons in the health insurance system
On the territory of the Russian Federation, stateless persons have the same rights and obligations in the health insurance system as citizens of the Russian Federation.
Article 8. Medical insurance of citizens of the Russian Federation abroad and foreign citizens on the territory of the Russian Federation
Medical insurance of citizens of the Russian Federation who are abroad is carried out on the basis of bilateral agreements between the Russian Federation and the host countries of citizens.
Medical insurance of foreign citizens temporarily staying in the Russian Federation is carried out in accordance with the procedure established by the Council of Ministers of the Russian Federation.
Foreign citizens permanently residing in the Russian Federation have the same rights and obligations in the field of health insurance as citizens of the Russian Federation, if international treaties otherwise provided.
Article 9. Rights and obligations of the insured
The insured has the right to:
participation in all types of health insurance;
free choice of insurance company;
control over the fulfillment of the terms of the medical insurance contract;
repayment of a part of insurance premiums from an insurance medical organization in case of voluntary medical insurance in accordance with the terms of the contract.
The insured company, in addition to the rights listed in the first part of this article, has the right to:
attraction of funds from the profit (income) of the enterprise for voluntary medical insurance of its employees.
The insured is obliged:
conclude a compulsory medical insurance contract with an insurance medical organization;
pay insurance premiums in the manner prescribed by this Law and the medical insurance contract;
within its competence, take measures to eliminate adverse factors affecting the health of citizens;
provide the insurance medical organization with information on the health indicators of the contingent subject to insurance;
register as an insurer in the territorial compulsory health insurance fund in the manner prescribed by Article 9.1 of this Law.
Article 9.1. Registration of insurers under compulsory health insurance
Registration of policyholders under compulsory medical insurance is carried out in the territorial funds of compulsory medical insurance:
insured organizations and individual entrepreneurs within five days from the date of submission to the territorial funds of compulsory medical insurance by the federal executive body that carries out state registration of legal entities and individual entrepreneurs, the information contained, respectively, in the unified state register of legal entities, the unified state register of individual entrepreneurs and submitted in the manner established by the Government of the Russian Federation;
policyholders - private notaries at their place of residence (if they carry out activities in another place at the place of these activities) on the basis of an application submitted no later than 30 days from the date of receipt of a license for the right to notarial activities of an application for registration as an insurant and submitted simultaneously with application of copies of the license for the right to notarial activities, documents proving the identity of the insured and confirming his registration at the place of residence, as well as his registration with the tax authority;
The amendments introduced by Federal Law No. 137-FZ of July 27, 2006 apply to legal relations regulated by the legislation on taxes and fees that arose after December 31, 2006.
policyholders-lawyers at their place of residence (if they carry out activities in another place at the place of carrying out this activity) on the basis of an application submitted no later than 30 days from the date of issuance of an attorney’s certificate for registration as an insurant and copies of an attorney’s certificate submitted simultaneously with the application , documents proving the identity of the insured and confirming his registration at the place of residence;
policyholders - individuals who have entered into employment contracts with employees, as well as paying remuneration under civil law contracts, on which, in accordance with the legislation of the Russian Federation, taxes are charged in the part that is subject to crediting to the compulsory medical insurance funds, at the place of residence of these individuals on on the basis of an application for registration as an insured, submitted no later than 30 days from the date of conclusion of the relevant agreements;
policyholders-organizations at the location of their separate subdivisions on the basis of an application for registration as an insurant, submitted no later than 30 days from the date of the creation of a separate subdivision;
policyholders - state authorities and local governments on the basis of an application for registration as an insurer, submitted no later than 30 days from the date of their establishment.
The procedure for registration of policyholders in the territorial fund of compulsory medical insurance and the form of the certificate of registration of the policyholder are established by the Government of the Russian Federation.
Article 10. Sources of financing of the healthcare system in the Russian Federation
The sources of financial resources for the healthcare system in the Russian Federation are:
funds of the republican (Russian Federation) budget, the budgets of the republics within the Russian Federation and the budgets of local Soviets of People's Deputies;
funds of state and public organizations (associations), enterprises and other economic entities;
personal funds of citizens;
gratuitous and (or) charitable contributions and donations;
income from securities;
loans from banks and other creditors;
other sources not prohibited by the legislation of the Russian Federation and the republics within the Russian Federation.
From these sources, the financial resources of the state, municipal health care systems and the financial resources of the state system of compulsory medical insurance are formed.
Article 11. Financial resources of the state, municipal health care systems
The financial resources of the state, municipal health care systems are intended for the implementation public policy in the field of public health. The government of the Russian Federation, the governments of the republics within the Russian Federation, the government bodies of the autonomous region, autonomous districts, territories, regions, cities of Moscow and St. Petersburg, the local administration determine the amount of funding for the state, municipal healthcare systems.
The financial resources of the state, municipal health care systems are used for:
financing of activities for the development and implementation of targeted programs approved by the Councils of Ministers of the Russian Federation and the republics within the Russian Federation, government bodies of the autonomous region, autonomous districts, territories, regions, cities of Moscow and St. Petersburg, local administration;
providing professional training of personnel;
research funding;
development of the material and technical base of healthcare institutions;
subsidizing specific territories in order to equalize the conditions for providing medical care to the population under compulsory medical insurance;
payment for especially expensive types of medical care;
financing of medical institutions providing assistance in socially significant diseases;
providing medical care in case of mass diseases, in areas of natural disasters, catastrophes and other purposes in the field of public health protection.
Funds not spent in the past year are not subject to withdrawal and are not taken into account when appropriating appropriations from the budget for the next year.
Article 12. Financial resources of the state system of compulsory medical insurance
The financial resources of the state system of compulsory medical insurance are formed at the expense of deductions from insurers for compulsory medical insurance.
To implement the state policy in the field of compulsory medical insurance, the Federal and territorial funds of compulsory medical insurance are being created as independent non-profit financial and credit institutions.
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This law guarantees free medical care to Russian citizens through the creation of a system compulsory insurance health. The regulatory document (FZ RF 326 on compulsory health insurance) regulates relations between structural units, the procedure for financing and control.
The structure of the social system for providing the population with medical services
The system of compulsory medical insurance (CHI), as well as, includes policyholders, an insurer and insured persons.
OMC members:
- citizens;
- organizations and enterprises;
- medical institutions;
- insurance organizations;
- Social Security Fund;
- territorial funds.
The role of the insurer is played by the state represented by the Government of the Russian Federation. It transfers part of its functions to the local authorities, to the heads of the subjects of the federation. Normative base, including tariffs, definition of the list of services, is established by the Government.
The video simply and clearly talks about compulsory health insurance:
Territorial conditions are developed and implemented on the basis of the State Program.
The essence of the system is the receipt of the basic package of medical care at the place of residence. An emergency ambulance service is available throughout the territory.
Insurers are legal entities, individual entrepreneurs paying insurance premiums to the FSS.
It can be:
- state;
- municipal;
- private enterprises.
Insured persons are working citizens who have a CHI policy.
The Social Insurance Fund was established as a non-profit organization and has its own structural units in the form of territorial funds. Its functions include the accumulation of insurance premiums, co-financing of regional programs.
Rights and obligations of the FSS:
- is one of the developers of the state program for guaranteed free medical care;
- controls and manages financial resources;
- maintains a record of all insured persons;
- determines the number of regional insurance organizations;
- medical institutions providing services;
- checks the competence of territorial funds;
- cooperates with international organizations in the field of CHI.
Territorial funds are representatives of the regional insurer, which is the highest body of local executive power.
Functions of territorial funds:
- collection, accounting and spending of social insurance funds;
- development of regional programs based on federal, including per capita standards;
- formation of the register of insurers;
- insured persons;
- protection of the rights of citizens when receiving low-quality assistance;
- audit of the activities of medical institutions and medical insurance organizations.
A health insurance organization is an intermediate link between the Terfund and medical institutions, between insured persons and a polyclinic (hospital).
It concludes a contract for the provision of services with each institution and monitors their implementation. Based on the data provided, the regional fund allocates funds to the health insurance company, which then disposes of them according to the agreed conditions.
To provide outpatient, inpatient, emergency services, you must obtain a state license.
If you ask yourself, then in order to participate in the state compulsory medical insurance program, you need to submit an application to the Terfund. Organizations of all types of ownership have the right to be included in the register of medical institutions providing compulsory medical services.
Legal guarantees and obligations of medical organizations:
- timely and in full receipt of funds for the provided insurance services;
- appeal against the actions of insurance organizations;
- the provision of free medical care in accordance with the MHI, in some cases the patient is provided;
- providing the necessary information to patients about the services provided, the mode of operation;
- keeping records of insured persons;
- informing the territorial fund about the services rendered.
In the case of incomplete assistance, poor quality, funding is reduced, or the issue of deprivation of the license is resolved.
The video explains the difference between compulsory and voluntary health insurance:
Financing of the State CHI program in accordance with the federal law
Contributions for each insured person to the insurance fund are made by enterprises and organizations registered in the territory of the Russian Federation. Do you need OSAGO, if there is CASCO, find out.
The amount of contributions is approved in each subject on the basis of an agreement between the executive power, the territorial fund, the insurance organization and the medical institution. The tariff structure (cost items) is determined by the federal executive body.
Its composition includes:
- staff salaries and accruals;
- the cost of medicines, tools, consumables;
- nutrition of patients;
- payment for diagnostics in other institutions;
- communal payments;
- social contributions for health workers;
- communication services, Internet;
- software installation and support;
- purchase of equipment up to 100 thousand rubles.
The established rate of compensation for the service rendered to the insured person in a polyclinic (hospital) is constant for all insurance organizations in a given region. He will tell you about car insurance without life insurance.
On the video Financing the State CHI Program:
The income part of the Federal Fund consists of:
- from mandatory insurance premiums;
- amounts of fines and penalties;
- unreceived payments;
- subsidies from the federal budget;
- profits from free funds placed in credit or investment organizations. Find out how to add a driver to an electronic OSAGO policy at.
Expenditure items of the Federal Insurance Fund:
- subventions territorial funds;
- fulfillment of the obligations of the Government;
- device content.
The budget of the territorial fund is formed on the basis of:
- additional deductions for compulsory medical insurance from enterprises and organizations;
- regional payments for the provision of services not included in the basic program;
- subsidies from the FSS;
- accrued arrears, fines, penalties.
Territorial funds in case of insufficiency own funds receive subventions (subsidies) from the Federal Fund.
Financial support is provided under the following conditions:
- fulfillment of the requirement for insurance of the non-working population in the amount specified in the regional budget;
- its compliance with the indicator calculated according to the federal standard;
- monthly transfer of 1/12 of the approved annual amount to the FSS.
Expenses of terfunds are mainly the implementation of regional compulsory medical insurance programs.
As part of the Federal and territorial funds, a normalized reserve is created, which is necessary for stable financing, the amount and procedure for using which are determined by the highest federal and regional bodies. Read about the compulsory medical insurance policy from Rosgosstrakh.
Basic program of compulsory medical insurance of citizens in accordance with the Federal Law of the Russian Federation 326
The federal standard laid down in the mandatory medical insurance is adjusted at the level of the subjects of the federation, based on local conditions: age categories, the state of public health and infrastructure. Find out about the life and health insurance of a child athlete at.
Territorial programs should ensure a reduction in mortality from diseases and an increase in the quality of medical services.
Insured citizens who have registered are entitled to receive all types of assistance free of charge: from emergency to preventive care using modern diagnostic equipment and tools.
On the video - the basic program of compulsory health insurance:
Federal Law 326-FZ, adopted in 2010, is the basis for the functioning of the compulsory health insurance system. The purpose of the document is to establish legal relations between the participants, determine the basic Program, sources of funding and responsibilities of the parties, which is mandatory for.
CHI is one of several types of compulsory social insurance for residents of the Russian Federation. To provide insurance to every citizen, a complex of economic, legal and organizational methods is applied. They are directed to ensure guarantees for the provision of free medical care to the insured person on high level, in accordance with the volume and established deadlines. Payment is made at the expense of the state insurance company.
The current Federal Law was created on the basis of the Constitution of the Russian Federation. It regulates the relations that are formed in the process of obtaining a compulsory insurance policy (CHI). The law defines the rights of such citizens, their obligations, as well as guarantees, thanks to which the state insurance company is still operating.
The law was adopted by the State Duma on November 19, 2010, and approved by the Federation Council 6 days later. The last changes were made on December 28, 2016.
- General provisions of the Federal Law;
- Enumeration of the powers of the constituent entities of the Russian Federation in the field of providing services for compulsory insurance;
- Definition of participants and subjects;
- Identification of the rights and obligations of the insured persons;
- Determining the amount of compulsory health insurance payment;
- Description of the legal provision of the law;
- Listing of programs in the field of CHI;
- Signing contracts in the field of CHI;
- Control of the volume of conditions, quality and timing of assistance;
- Registration of each member of the CHI according to the law;
- Final information.
Download
The law "On compulsory health insurance in the Russian Federation" consists of 11 chapters and 53 articles. It contains the main principles.
What do you know about compulsory pension insurance? Details
These are:
- Provision of medical care at the expense of the state insurance company. In the event of an insured event, you can use the following services;
- High stability financial system on obligatory medical insurance;
- The obligation to the insurers to pay insurance premiums. The amount of contributions is established in accordance with the Federal legislation;
- Compliance with the rights of the insured clients on the part of the state. All health insurance obligations between the parties must be fulfilled within the time period specified in the contract;
- Compliance with the conditions for ensuring the quality of care and general accessibility to the services of the insurance company.
To download the latest version of the law with the changes, additions and amendments, go to the following.
In addition, you should know the basics of social services for citizens in the Russian Federation. To do this, study.
Recent changes made to the Federal Law "On Compulsory Medical Insurance in the Russian Federation"
The last changes were made to the edition of December 28, 2016. Part 1 of Article 31, the title of Article 32, part 1 of Article 32 and part 2 of Article 32 were changed.
Ch 1 article 31
Part 1 of Article 31 of the law describes the methods for calculating costs, including cash to purchase a health insurance policy. The client is provided with a payment after a severe accident at work or at home. If the company proves that the infliction of harm to health was not an accident, then the person who caused harm to the health of the insured citizen must reimburse the funds for treatment.
Article 32
In article 32 of the law, the name was changed. Now it sounds like this: “Payment of medical expenses to the insured person immediately after a severe accident at work.”
Part 1 article 32
The sentence was changed from "treatment of the insured person" to "medical assistance to the insured person".
Part 2 Article 32
In part 2 of article 32 of the law, the sentence was changed from “treatment of the insured person” to “medical assistance to the insured person”.
Below is another article.
Article 16
326-FZ article 16 lists the rights and obligations of the insured person.
"On Compulsory Medical Insurance in the Russian Federation" Federal Law No. 313-FZ of November 29, 2010 "On Amendments to Certain Legislative Acts of the Russian Federation in Connection with the Adoption of the Federal Law "On Compulsory Medical Insurance in the Russian Federation"*1
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*1. The texts of the documents are not given. Texts of all normative documents see www.site.
A comment
L.P. Fomichev
auditor, tax consultant
New Law on Compulsory Health Insurance
Medical insurance in the Russian Federation is provided in two types: compulsory and voluntary.
Compulsory health insurance (CHI) is an integral part of state social insurance and provides all Russian citizens with equal opportunities to receive medical and drug assistance provided at the expense of MHI funds in the amount and on the terms of the relevant programs.
The current Law of the Russian Federation of June 28, 1991 N 1499-1 "On medical insurance of citizens in the Russian Federation" was adopted in difficult conditions. The need for its adoption was primarily due to insufficient budget funding. Russian healthcare. The introduction of insurance made it possible to maintain the system medical care of the population, prevent a collapse in the level of financing of medical institutions and begin a consistent reform of healthcare.
At the same time, many provisions of this Law do not work, because they are declarative in nature, not supported by the material and technical condition of medical institutions necessary for their implementation and their financing. This led to the development of a new federal law, adopted State Duma November 19 and approved by the Federation Council on November 24, 2010.
Federal Law No. 326-FZ of November 29, 2010 (Further - Law N 326-FZ ) entered into force on January 1, 2011, with the exception of provisions that will enter into force on January 1, 2012. The purpose of the law is to strengthen the guarantees of citizens' rights to free medical care and to regulate relations arising in connection with the implementation of compulsory medical insurance.
Law N 326-FZ will allow gradually, during 2012-2014, to increase funding for health care, ensure a balance between state guarantees for free medical care for the population and financial obligations of the state, strengthen the material and technical base of health care and, as a result, improve the availability and quality of medical care.
Article 4 of Law N 326-FZ the basic principles for the implementation of compulsory medical insurance are established: the availability and quality of medical care provided; guarantees of free medical care to the insured person under compulsory medical insurance programs, regardless of financial position insurer; autonomy of the financial system.
The legal status and powers of the Federal (FFOMS) and territorial (TFOMS) compulsory medical insurance funds, insurance medical organizations and medical organizations in the compulsory medical insurance system were also determined; their rights, duties and responsibilities; rights and obligations of insured persons and policyholders.
Relations relating to the financial support of compulsory medical insurance have been regulated: the procedure for the formation of compulsory medical insurance funds has been prescribed; the amount of the insurance premium for compulsory medical insurance of the non-working population; period, procedure and terms of payment of insurance premiums; liability for violations in the area of their payment; the procedure for setting tariffs for paying for medical care under CHI; the procedure for the formation and expenditure of funds by an insurance medical organization.
Generally Law N 326-FZ regulates in sufficient detail the rights and obligations of all subjects and participants of compulsory medical insurance, their relationship, provides for the modernization of compulsory medical insurance and is aimed at further development of health care.
Let us consider the main provisions of the Law in more detail.
Insured persons
IN article 10 of the Law N 326-FZ it is established that the insured persons are:
- citizens of the Russian Federation (working and non-working);
- foreigners permanently or temporarily residing in our country, and stateless persons (with the exception of highly qualified specialists and members of their families in accordance with Federal Law No. 115-FZ of July 25, 2002 "On the Legal Status of Foreign Citizens in the Russian Federation" );
Persons entitled to medical care in accordance with the Federal Law of February 19, 1993 N 4528-1 "On Refugees" .
Actually, these same persons were insured before, according to the previous legislation.
Foreigners, incl. citizens of the member states of the Commonwealth of Independent States permanently residing in the Russian Federation had the same rights and obligations in the field of health insurance as Russian citizens, unless otherwise provided by international treaties (Article 8 of Law N 1499-1). Foreign citizens permanently residing in Russia include persons who have the appropriate permit and residence permit issued by the internal affairs authorities.
Income foreign workers who had a temporary residence permit in Russia were subject to insurance premiums in 2010, so they were also entitled to medical assistance under the CHI policy.
Such workers could receive sick leaves in the polyclinic in case of temporary disability. This is also confirmed by clause 1 of the Procedure for issuing sick leave certificates by medical organizations, approved. by order of the Ministry of Health and Social Development of Russia dated 01.08.2007 N 514 : sick leave certificates are issued to citizens of Russia, as well as to foreigners with a residence permit or a temporary residence permit.
Foreign workers permanently or temporarily residing in the territory of the Russian Federation are entitled to receive temporary disability benefits upon the occurrence of a relevant insured event if they work under an employment contract ( Art. 2 of the Federal Law of December 29, 2006 N 255-FZ "On compulsory social insurance in case of temporary disability and in connection with motherhood" ).
A refugee and members of his family who arrived with him have the right to medical and medicinal assistance on an equal basis with Russian citizens in accordance with federal law, unless otherwise provided by international treaties of the Russian Federation (subparagraph 7 paragraph 1 of Art. 8 of the Federal Law of February 19, 1993 N 4528-1 "On Refugees" ). An obligatory condition is the establishment by the Federal Migration Service of the legal status of a refugee and the issuance of the appropriate "Certificate of a forced migrant".
Foreign citizens temporarily staying in the Russian Federation are not named in the new Law. They enter the territory of Russia under valid documents and are required to in due course register their foreign passports or documents replacing them with the internal affairs bodies and leave our country after a certain period of stay. The status of a temporary resident implies that a foreign citizen has a migration card, a document that only confirms the right of a foreign citizen to be on the territory of Russia (clause 1, article 2 of Law N 115-FZ). Since 2010, the amounts of payments and other remuneration under labor and civil law contracts in favor of foreign citizens and stateless persons temporarily residing on the territory of the Russian Federation are not subject to insurance premiums ( sub. 15 p. 1 art. 9 of the Federal Law of July 24, 2009 N 212-FZ "On insurance premiums in Pension Fund Russian Federation, Social Insurance Fund of the Russian Federation, federal fund compulsory medical insurance and territorial funds of compulsory medical insurance" ; Further - Law N 212-FZ ). If a foreign citizen has the status of a temporary resident in the territory of Russia, he is not an insured person and, accordingly, insurance premiums for compulsory pension insurance are not charged for payments in his favor. From Art. 2 Law N 255-FZ it also follows that foreigners and stateless persons temporarily residing on the territory of Russia have not been insured since 2010 and are not entitled to receive compulsory social insurance.
The possibility of voluntary payment of insurance premiums by the employer for such citizens is not provided by law. If the company includes employment contract concluded with such an employee, the condition of payment to him sick leave and voluntary transfer of contributions, the FSS of Russia will not reimburse these benefits in any case. Letter No. 04-03-11/652 of the Moscow Oblast branch of the MHIF dated January 29, 2010 explains that since such persons are not subject to compulsory medical insurance, employers should not issue compulsory medical insurance policies to them. If the policy has already been issued, the document must be returned to the insurance company.
Medical insurance for foreigners temporarily staying in Russia, incl. citizens of the CIS member states, is carried out in the manner determined by Decree of the Government of the Russian Federation of December 11, 1998 N 1488 "On health insurance for foreign citizens temporarily staying in the Russian Federation and Russian citizens when leaving the Russian Federation" , which approved the Regulation on medical insurance of foreign citizens temporarily staying in the Russian Federation.
As a rule, such persons have the opportunity to receive free of charge only emergency and emergency medical care in conditions requiring urgent medical intervention (in case of accidents, injuries, poisoning and acute illnesses). In this case, medical assistance is provided to them at the expense of the budgets of all levels by medical and preventive institutions of the state and municipal health care systems, as well as medical workers or persons obliged to provide first aid by law or a special rule. From the moment when the threat to the life of the patient or the health of others has been eliminated and the transportation of the patient is possible, the payment for the medical care provided is charged as planned.
Planned medical care of all kinds can be provided to citizens of this category only on the basis of voluntary medical insurance or on a paid basis.
A single insurance policy for all territories of Russia
One of the big drawbacks of the existing system is the inability to receive medical assistance under the CHI policy while in another region. At present, the policy of compulsory medical insurance is not uniform for all regions of Russia. Each insurance company printed its own policies for its insured, which had to be changed as it expired. When changing jobs, a person was obliged to hand over the CHI policy to the employer and get a new one where he was employed. This took time, during which the employee, with whom wages paid contributions to the MHIF, actually had no opportunity to receive medical care. And when moving into the category of unemployed, he had to receive a policy from an insurance medical organization, which, according to the results of the competition, insured unemployed citizens.
Formally, a citizen can still receive medical assistance under a compulsory medical insurance policy not at the place of registration. But hospitals and polyclinics most often, violating the current Law, refuse to admit citizens from other cities and citizens living in another area of the city. This happens for several reasons: firstly, no single base insured, by which it would be possible to determine where the money for the patient will come from, and whether they will come. Secondly, in large regions, such as Moscow or St. Petersburg, the compulsory medical insurance program is much more expensive than in the whole country, hence the reluctance to accept "foreign" patients. In this regard, medical institutions often refuse to take into account policies issued in other regions, and try to treat people from other cities only for money.
Law N 326-FZ provides for the development of basic and territorial CHI programs ( Art. 3 Law N 326-FZ ). Chapter 7 The law specifies which types of assistance are included in each of them. Since 2013, emergency medical care has been included in the basic CHI program, and high-tech - since 2015 ( Art. 51 Law N 326-FZ ). Programs are approved at the federal and regional levels respectively. The basic program operates on the entire territory of Russia, and the territorial one - within the limits of the subject of the Russian Federation. Subjects will have the right to add types of medical assistance to the basic program and insured events not included in the MHI, and additionally finance them.
To implement throughout the territory of the Russian Federation the rights of citizens to receive free medical care Law N 326-FZ the following is envisaged: starting from May 2011, citizens will be issued compulsory medical insurance policies of a single sample, guaranteeing free medical care under the basic compulsory medical insurance program in any region of the country, regardless of the place of residence of the insured (Article 45). On the territory of the subject of the Russian Federation, where the CHI policy was issued, citizens can count on assistance in the scope of the territorial CHI program (Article 3). The policy can be omitted if emergency medical care is required (clause 2, article 16).
The replacement of issued and valid regional compulsory medical insurance policies with policies of a single sample will be carried out not urgently, but gradually (Article 51).
Until May 1, 2011, if necessary, old-style policies will be issued in the same order, and from May 1, 2011 to January 1, 2012, new uniform policies will be issued. The electronic policy will be valid throughout Russia. Outwardly, the "substitutes" for paper documents familiar to us resemble plastic cards with a chip and represent an electronic card of a single sample. This policy is designed to be machine-readable for patient information.
The new termless policy will be valid even if the person did not have time to insure himself with the insurance company. It will serve as a guarantor of medical care in any region of the country, regardless of place of residence, and will be issued to everyone - both working citizens and the unemployed. The replacement of the policy is supposed only due to its loss or wear, change of the last name, first name, patronymic of the insured. When changing the insurance medical organization, place of residence, status of the insured person, replacement is not provided.
policies CHI of the old samples issued to persons insured under compulsory health insurance before entry into force Law N 326-FZ , are valid until they are replaced with compulsory medical insurance policies of a single sample or universal electronic cards of a citizen of the Russian Federation. All medical institutions after January 1, 2011 are required to accept patients under the old policies.
Policies are subject to replacement if a person wants to change insurance organization or expire, or in the event of a change of residence. In order to avoid problems with the provision of medical care, all citizens insured in the MHI system should look at the document and inquire about the expiration date of its validity. The complete replacement of "paper" old-style policies with electronic cards should be completed by January 1, 2014.
From January 1, 2012, the CHI policy will be included in the universal electronic card of a citizen in accordance with Federal Law of July 27, 2010 N 210-FZ "On the organization of the provision of state and municipal services" ( Art. 45 of Law N 326-FZ ).
Moscow will switch to a universal electronic card during 2011. It will begin to replace Muscovites with a compulsory medical insurance policy and a certificate of pension insurance. In addition, with the help of this card it will be possible to pay for travel in public transport and exercise your right to receive the majority public services. New electronic document will retain all the opportunities that today provides social card Muscovite.
From 2014, a single universal "three in one" card will operate in Russia, including a medical policy, a pension insurance policy, and information about the benefits due to a person.
Of course, the new policies will allow citizens to receive the necessary assistance on vacation or on a business trip. At the same time, for the introduction in Russia of a unified electronic policy A new sample requires special preparation: special equipment both for making a document and for hospitals and clinics to be able to "read" it.
For the first time, a strict rule on the timing of payments for the medical care provided to patients is established by law. Medical institutions have a guarantee of payment for the assistance provided to a nonresident citizen, and they will now be interested in providing it.
In case of delay in payment, the insurance medical organization at its own expense pays to the medical organization penalties in the amount of 1/300 of the refinancing rate Central Bank RF, effective on the day of the delay, from not transferred amounts for every day of her paragraph 7 of Art. 39 of Law N 326-FZ ).
In addition to a single medical policy, the possibility of replacing the usual paper medical records with electronic ones is being discussed. To receive non-resident citizens, the doctor needs a history of his illness. After all, this person was not observed in the clinic, and most often he does not carry a medical history with him. If a medical history were automatically attached to a single policy, it would be great. Better yet, have your medical card online, in electronic form. This is important, especially for those who often travel on business trips. In this case, a doctor from any clinic in the country will be able to get all the information about the state of human health. This reduces the time of diagnosis, which in some diseases can save lives.
At the same time, in some European countries usage electronic cards in the global network is prohibited, because there is no reliable data protection. In addition, information posted on the Internet can become available not only to the doctor. A violation of confidentiality threatens to turn into a lawsuit against a medical institution.
Personalized medical records
The lack of a unified database of insured persons leads to the fact that the number of those insured under compulsory medical insurance exceeds the number of Russian citizens.
In order to implement the rights of citizens to receive free medical care throughout the Russian Federation, it is planned to create a single information space that includes all subjects and participants in compulsory medical insurance, and to introduce personalized accounting of information about insured persons and the assistance provided to them ( ch. 10 of Law N 326-FZ ).
On January 1, 2011, the creation of a unified database will begin, which will allow citizens to receive medical care in any region of Russia. An electronic database of the insured will be created as they apply for medical assistance, as well as replacing old policies with new ones.
A single database will ensure reliability and eliminate duplication of information about the insured. Within two years, the bulk of the insured will be included in this electronic database.
Ideally, thanks to the creation of a single information base, everyone will be able to make an appointment with a doctor without leaving home - from their home computer via the Internet.
Law N 326-FZ the procedure for the implementation of personalized (individual) accounting in the compulsory medical insurance system, as well as the procedures for the interaction of medical, insurance medical organizations and the territorial fund in the system of personalized accounting of information about medical care provided to the insured person.
Determines the procedure for maintaining personalized records in the field of compulsory medical insurance FFOMS ( Art. 7 Law N 326-FZ ).
Article 16 of Law N 326-FZ establishes that insured persons have the right to protection of personal data necessary for maintaining personalized records in the field of compulsory health insurance.
Articles 47And 48The law establishes the procedure for interaction between insurance medical and medical organizations with the TFOMS in maintaining personalized records of information about medical care provided to insured persons, in Art. 49- the procedure for interaction of the territorial body of the PFR with the TFOMS and insurers for non-working citizens.
In pursuance of this Law, Federal Law No. 313-FZ of November 29, 2010 (Further - Law N 313-FZ ), making appropriate changes to personalized (individual) accounting. We will consider it separately.
The choice of insurance organization, clinic and doctor is up to the patient
The role of the insurance organization is somewhat different from the current system. Now the choice of the insurance organization remains with the insured, i.е. the employer for whom the person works, because he pays insurance premiums for the employee. Non-working people are insured by the regional authorities. As a result, it turns out that insurance companies have no motivation to fight for consumers of services.
According to Art. 16 Law N 326-FZ a citizen acquires the right to independently choose an insurance medical organization dealing with CHI. At the same time, the right of the employer and municipal authorities to do so is excluded.
The choice can be made by a citizen who has reached the age of majority. From the day of birth until the day of registration of their birth, children are insured by organizations where their mothers or legal representatives are insured. After the child is registered and until the age of majority, it is insured by insurers chosen by one of the parents or their legal representative.
If a person does not choose a company or does not submit an application to change it, it is considered that he is insured in the organization where the insurance was carried out earlier. The only exception is a change of residence. In this case, within a month, the citizen is obliged to choose a new organization in the absence of the previous insurer in this territory. A person must notify the insurer of a change of residence, last name, first name, patronymic within a month.
If citizens have not chosen an insurer, TFOMS sends information about them to insurers every month before the 10th. The division of the number of citizens between insurance companies is carried out in proportion to the number of insured persons in each of them, and the ratio of working and non-working citizens who have not applied to the medical insurance organization, which is reflected in this information, should be equal. Insurers who have received such information from the TFOMS send a letter to the citizen. It confirms the fact of insurance in this organization and informs about the need to obtain a CHI policy.
The insured person will have the right to replace the insurance medical organization chosen by him with another one. Insurance medical organizations have no right to refuse him such a choice.
True, one should not hope that the number of medical services depends on the choice - they will be the same in all companies. All Insurance companies will have agreements with all clinics of the CHI system. Insurance companies will perform intermediary functions, act as defenders of patients, defending their rights, and organize an independent examination of the services provided by doctors. Specialists do not predict a mass transition from one company to another. Most likely, the majority will remain in companies where they are already insured.
As a rule, the desire to change the insurance company arises at critical moments when the patient realizes that in a difficult situation assistance was not provided in full, and the company was unable to protect his rights, i.e. failed to fulfill its basic obligations. The replacement of the insurance medical organization, where the citizen was previously insured, can be carried out once during the calendar year, but no later than November 1. More often - in the event of a change of residence or termination of the agreement on the financial provision of compulsory health insurance in the manner prescribed by the rules of compulsory health insurance - by submitting an application to the newly selected medical insurance organization with which he would like to cooperate. On the basis of this application, the insured person or his representative is issued a compulsory medical insurance policy by the medical insurance organization.
Insurance organizations working with CHI will be tightly controlled. They need stability. For this new law prescribes an increase authorized capital such companies doubled - from 30 to 60 million rubles. Insurance medical organizations are not entitled to carry out other activities, except for compulsory and voluntary medical insurance ( Art. 14 Law N 326-FZ ).
Today, medical institutions in most cases are maintained at the expense of budgets of various levels. At the same time, they receive money regardless of how many patients were admitted and cured. And even more so regardless of the quality of the treatment.
The new Law changes this situation - the money will follow the patient, i.e. the service rendered is funded, not the institution.
From the list of medical institutions operating in the CHI system, citizens will be able to choose the hospital where they would like to receive assistance. Their list is available on the official websites of the territorial CHI funds. At the same time, a medical institution included in the register and which has entered into an agreement for the provision of services under the CHI program is not entitled to refuse to provide assistance to the insured person.
Upon a written application, the patient can choose an attending physician in accordance with the legislation of the Russian Federation (after all, the new Law does not cancel the territorial principle of medical care, for example). True, there is one caveat - with the consent of the doctor. If a person lives in one area of the city, but wants to be treated by a doctor working in another area, you need to ask his consent - is he ready to go to the call through the whole city. Therefore, a doctor's call to the house will need to be done in the clinic serving the patient's territory of residence. The right to choose a hospital becomes legal. The polyclinic doctor who writes out the referral will now be obliged to listen to our wishes.
Another requirement of the new Law is that now all medical institutions must have their own websites on the Internet with detailed information.
If we assume that patients still get a real right to choose a polyclinic and a doctor, medical institutions will find themselves in conditions of fierce competition. After all, the more patients, the more money the insurance company will pay the hospital.
The right to choose a doctor and a medical institution has long been enshrined in the Federal Laws "On the Protection of the Health of Citizens" and "On the Medical Insurance of Citizens in the Russian Federation", but in fact this does not happen. Citizens are mostly treated according to the territorial principle: in the municipal polyclinic at the place of residence. And we are not talking about any choice of a medical institution, let alone a doctor. Here it is appropriate to recall birth certificates, which also gave the right to expectant mothers to seek help from any maternity hospital that had vacant places. However, in reality, the promises were empty. Will the same situation repeat itself now?
Fundamental innovation Law N 326-FZ is that not only state (municipal) medical institutions, but also organizations of any organizational and legal form, as well as individual entrepreneurs engaged in private medical practice ( Art. 15 of Law N 326-FZ ). The main thing is that they have the right (license) to carry out medical activities, they must be included in a special register of medical organizations and keep separate records of operations with CHI funds and other operations. The register of such organizations is maintained by the TFOMS and published on the Internet or otherwise. The register indicates the name, address of medical organizations and the list of services provided by them within the framework of the territorial CHI program. The procedure for maintaining, the form and list of information in the register are established by the rules of compulsory medical insurance.
Previously, "private traders" also worked with CHI, but received special permission from the city administration for certain services. Now private clinics can simply apply to join the system.
But here a reasonable question arises: will private clinics be interested in the meager money that the MHIF departments pay for each citizen under the policy? Recall: the annual per capita standard for state program provision of free medical care is 4059 rubles. 60 kop. No one is going to review it yet.
Tariffs for the CHI system are significantly lower than in private clinics, and it is prohibited by law to make a "discount" out of the policy for patients. According to insurers, this is done to protect us from mind manipulation. You should not expect that a person from the street can come with a policy and receive treatment. These clinics will give a referral to a specific service under the state order. For example, the clinic will receive a state order for dental prosthetics for veterans. Then the pensioner will receive a referral to this clinic. The same will happen with complex operations or technologies. CHI policy, maybe it will be used by private clinics, but in complex treatment, where some of the services will be free, and some - for decent money.
The Law clearly spells out the rights of medical insurance organizations to control the provision of medical care. The protection of the rights of the insured should become the basis in relations with consumers and include such parameters as the selection of a medical organization to provide assistance, managing your client at all stages of its provision and monitoring how it was provided. If a person comes to the hospital with a policy, and they begin to demand money from him for services that are free of charge, he must first call his insurance company with a demand to sort out the situation. And the insurance company becomes a "lawyer", protecting his rights. This is not bringing to court, but proceedings at the earliest stage of the conflict.
Article 16 of Law N 326-FZ gives patients the right to indemnify for damage caused by an insurance medical or medical organization in connection with non-fulfillment or improper performance their responsibility to provide medical care. Article 31 of Law N 326-FZ the procedure for such compensation is determined in a situation where the damage is not related to a serious accident at work. If the latter has occurred, please contact Art. 32 Laws , which established that treatment after a serious injury at work should be at the expense of funds received by the FFOMS in accordance with Federal Law No. 125-FZ of July 24, 1998 "On Compulsory Social Insurance against Occupational Accidents and Occupational Diseases" (Further - Law N 125-FZ ).
Unfortunately, our state practically does not engage in educational activities in the field of patients' rights. We have almost no lawyers dealing with judicial practice on medical topics. In addition, there should be an institution of independent medical experts who could not be influenced by the medical community. After all, this is the only way to give an independent conclusion about the quality and correctness of treatment. No one is talking about such things yet, but for the correct receipt medical service we need to have information at our fingertips so that we can challenge the wrong actions of doctors and hold the perpetrators accountable. And for this it is necessary to have a really working judicial mechanism, which, alas, does not exist today.
Chapter 9 of Law N 326-FZ a system of examinations of the quality of medical care is being established - the identification of violations in the provision of medical care, incl. assessment of the correctness of the choice of medical technology, the degree of achievement of the planned result and the establishment of cause-and-effect relationships of identified defects in the provision of medical care. It is indicated who can act as an expert. It has been established that a medical organization does not have the right to prevent experts from accessing the materials necessary for conducting a medical and economic examination, an examination of the quality of medical care, and is obliged to provide experts with the requested information. The results of the examination are formalized by the relevant acts in the forms established by the FFOMS.
Based on the results of monitoring the volumes, terms, quality and conditions for the provision of medical care, the measures provided for Art. 41 of Law N 326-FZ and the terms of the contract for the provision and payment of medical care under compulsory medical insurance. In addition to non-payment for poor-quality care, the medical organization will compensate for the harm caused to the patient through its fault.
Financial support
The management structure of the MHI system is changing. The FFOMS is recognized as an insurer within the framework of the implementation of the basic CHI program; from 2012, all medical contributions. It is a non-profit organization created Russian Federation for the implementation of state policy in the field of CHI ( Art. 12 Law N 326-FZ ).
Chapter 5 of Law N 326-FZ the issues of financial support of compulsory medical insurance were settled (including the procedure for the formation of compulsory medical insurance funds); the procedure and terms for payment of insurance premiums are determined; established liability for violations in the area of their payment; the procedure for calculating tariffs for paying for medical care under compulsory medical insurance has been determined.
CHI funds are formed from:
Income from the payment of insurance premiums for CHI;
- arrears on contributions, tax payments;
- accrued penalties and fines;
- funds federal budget transferred to the budget of the Federal Compulsory Medical Insurance Fund in cases established by federal laws, in terms of compensating for shortfalls in income due to the establishment of reduced rates of insurance premiums for compulsory medical insurance; funds from the budgets of the constituent entities of the Russian Federation transferred to the budgets of the TFOMS in accordance with federal and regional legislation;
- income from the placement of temporarily free funds;
- other sources provided for Russian legislation ( Art. 21 , 26And 27 of Law N 326-FZ ).
The procedure and conditions for the placement of temporarily free funds of the Federal and territorial CHI funds are established by the Government of the Russian Federation ( Art. 29 of Law N 326-FZ ).
For the first time, a rule appeared in the Law indicating that the funds of the Compulsory Medical Insurance Fund can be used not only in Russia, but also in medical institutions foreign countries, but there is no specific information about what kind of medical institutions these will be.
Separate powers of the insurer will be exercised by the TFOMS and insurance medical organizations ( Art. 13 And 14 Law N 326-FZ ).
The legal status of the FFOMS and TFOMS is defined in ch. 6 Law N 326-FZ . It is envisaged to strengthen the role of TFOMS as a controlling organization. Within its powers, it will conduct checks on the intended use of compulsory medical insurance funds not only in insurance medical companies, but also in medical organizations, as well as, independently of the insurer, to carry out all types of medical examinations of cases of treatment of insured citizens ( Art. 40 of Law N 326-FZ ). TFOMS is controlled and subordinated to FFOMS.
The Ministry of Health and Social Development of Russia has already developed a draft model regulation on TFOMS, a draft departmental order of December 6, 2010 on its approval is presented on the official website of the ministry. According to the document TFOMS is non-profit organization, created by the subject of the Russian Federation for the implementation of state policy in the field of compulsory medical insurance in the region. The document approves the main tasks, functions and means of TFOMS, as well as the procedure for monitoring their activities and the mechanism for their liquidation.
Insurers for working citizens are still recognized as organizations, individual entrepreneurs and individuals not recognized as individual entrepreneurs ( paragraph 1 of Art. 11 Law N 326-FZ ). A separate group includes individual entrepreneurs, private notaries and lawyers. The insured is registered with the territorial bodies of the Pension Fund of the Russian Federation. Features of registration certain categories policyholders and their payment of insurance premiums for CHI from January 1, 2012 are established by the Government of the Russian Federation. Insurers are payers of mandatory health insurance contributions in accordance with Law N 212-FZ ( Art. 22 of Law N 326-FZ ).
The territorial bodies of the PFR provide information on the payment of insurance premiums for compulsory medical insurance of the working population to the TFOMS in the manner determined by the agreement on information exchange between the PFR and the FFOMS.
The insurers for non-working citizens are the executive authorities of the constituent entity of the Russian Federation ( paragraph 2 of Art. 11 Law N 326-FZ ). Now the regional authorities are transferring money for them to the MHIF according to the residual principle, as much as they can. This leads to an imbalance in the compulsory medical insurance system and, accordingly, to the lack of standards of medical care necessary for Russian citizens.
First Art. 23 And 24 Law N 326-FZ a phased transition to a fixed payment for the non-working population has been established. This payment will be the same for all regions of the Russian Federation due to the fact that it is the same insurance premium as the employer's payments in the CHI system. Article 25 This Law establishes liability for non-payment of these contributions.
In 2011, payments for the non-working population are rigidly fixed at the 2010 level. Starting from 2012, a uniform for the whole country will be established. CHI tariff for the unemployed population. The law on establishing payments to the system of compulsory health insurance for the non-working population is scheduled to be adopted in the first half of 2011.
Medical tariffs will become uniform for all insurance medical organizations paying for medical care provided in one medical organization.
The tariff for paying for medical care is established by an agreement between the authorized regional body, TFOMS, representatives of medical and insurance organizations, professional medical associations, trade unions of medical workers ( Art. 30 of Law N 326-FZ ).
The provisions defining the legal status, features of the formation and spending of funds of insurance medical organizations have been clarified. Such funds are divided into targeted and own ( Art. 14 Law N 326-FZ ).
Insurance medical organizations keep separate records of their own funds and funds of compulsory medical insurance intended to pay for medical care. Target funds cannot become the property of the insurance organization ( Art. 28 of Law N 326-FZ ), with the exception of cases stipulated by this Law.
Contract system
A citizen receives free medical care under compulsory medical insurance on the basis of an agreement concluded in his favor by the participants in this form of service.
A medical organization provides services under compulsory medical insurance on the basis of an agreement for the provision and payment of medical care concluded with an insurance organization. A medical organization is not entitled to refuse to provide medical care to insured persons in accordance with territorial program OMS ( paragraph 5 of Art. 15 of Law N 326-FZ ).
An insurance medical organization sends a medical organization target funds to pay for medical care under such contracts ( paragraph 2 of Art. 28 of Law N 326-FZ ). She receives these funds from TFOMS. Funds are sent to the medical organization initially in advance, unused targeted funds must be returned by the medical organization to the insurer, and then to the TFOMS. Responsibility for misappropriation of funds has been established.
IN Chapter 8 of Law N 326-FZ the system of contracts in compulsory health insurance and the mechanism for organizing control over the volume, timing, quality and conditions of providing medical care to insured persons are defined in detail.
In the standard forms of contracts approved by the Ministry of Health and Social Development of the Russian Federation, these rights and obligations will be specified, and penalties will be provided for each violation of the terms of the contract.
Modernization of healthcare
Since 2011, deductions to the FFOMS will increase by 2%. The money, as you know, will be directed to the modernization of healthcare. Regional modernization programs provide for an increase in the availability of outpatient care, within the framework of which the salary of specialist doctors working in polyclinics should increase. The situation is similar with doctors in hospitals.
Chapter 11 "Final Provisions" of Law N 326-FZ determined: in order to improve the quality and accessibility of medical care provided to the insured, during 2011-2012 the implementation of regional programs for the modernization of healthcare in the constituent entities of the Russian Federation and programs for the modernization of federal state institutions providing medical care will be carried out, norms and rules for the transition period for 2011-2012 are prescribed years.
Of course, a one-time transition "to new rails" is impossible in principle. Currently, the MHIF, insurance companies, and medical institutions are studying Law N 326-FZ . Until the financial flows are debugged, the necessary programs are not prepared, the algorithm of actions is not formed. Everything takes time.
Time will tell whether the working citizen, for whom the FFOMS receives contributions, will become the central figure in healthcare. In the meantime, our system of medical care is set up more for pensioners, and not for working citizens. In other words, the person who can spend the most time queuing in front of the doctor's office gets the most favors.
And all of us are not even interested in how our money comes into the compulsory medical insurance system, how and what it is spent there, what are the costs for administrative staff, maintenance of buildings, all kinds of trips, participation of doctors in conferences, etc. And it's all waste of money. As consumers of this service, as citizens, we do not know anything about this, but we pay.
Changes in legislation in connection with the adoption of the Law on Compulsory Medical Insurance
Law N 313-FZ makes changes to individual legislative acts, in particular in Tax Code of the Russian Federation , Federal laws N 212-FZ, "On the organization of insurance business in the Russian Federation" , " On individual (personalized) accounting in the system of compulsory pension insurance ", " On the circulation of medicines ", Budget Code of the Russian Federation , Code of the Russian Federation on Administrative Offenses .
Let us briefly consider the main changes affecting the activities of organizations and entrepreneurs.
In Law N 212-FZ no mention of TFOMS
Because the Law N 326-FZ since 2012, a single insurer has been established - FFOMS, the mention of territorial CHI funds from January 1, 2012 will be excluded from the title and a number of articles Law N 212-FZ . For example, in Art. 58 and 58.1 of this Law, the mention of TFOMS will be excluded from the text of the tables with a breakdown of insurance rates by extra-budgetary funds. Previously, it was established that from 2012, contributions at a rate of 0% must be paid to this fund. Now it is established that the territories will receive transfers from the FFOMS to finance the powers transferred to the regions in the field of compulsory medical insurance.
IN Tax Code of the Russian Federation benefits for insurers and physicians
IN Tax Code of the Russian Federation changes are being made to clarify the list of benefits in relation to the amounts paid in the system of compulsory health insurance.
First, in accordance with sub. 7 p. 3 art. 149 Tax Code of the Russian Federation VAT is not charged on insurance, co-insurance and reinsurance services rendered by insurance companies. From January 1, 2012, medical insurance organizations - CHI participants do not pay VAT upon receipt of funds from TFOMS, if these funds:
- are targeted and transferred on the basis of an agreement on the financial support of CHI;
- are intended for conducting business on compulsory medical insurance;
- are remuneration for the performance of actions stipulated by the agreement on the financial support of compulsory medical insurance.
The same funds are not taken into account in income when determining the income tax base (new sub. 14 p. 1 art. 251 Tax Code of the Russian Federation ). Accordingly, from that date sub. 30 p. 1 art. 251 Tax Code of the Russian Federation lapses, and therefore clause 48.1 of Art. 270 The Code also clarified the list of costs that are not taken into account when calculating income tax.
The expenses will not include funds transferred to medical organizations to pay for medical care to insured persons in accordance with the contract for the provision and payment of medical care.
Article 294.1 of the Tax Code of the Russian Federation , which establishes the features of determining the income and expenses of insurance medical organizations, is set out in a new edition.
Now the funds received from the TFOMS will be included in income if they are intended for conducting a case under compulsory medical insurance or are remuneration under an agreement on financial security of compulsory medical insurance.
Changes in personalized accounting
Law N 313-FZ changes have been made to Federal Law No. 27-FZ of April 1, 1996 "On Individual (Personalized) Accounting in the System of Compulsory Pension Insurance" (Further - Law N 27-FZ ). The preamble of the Law is supplemented with the following provision: personalized accounting under this Law also applies to persons entitled to receive state social assistance, to additional measures of state support in accordance with Federal Law No. 256-FZ of December 29, 2006 "On Additional Measures of State Support for Families with Children" . This record will be maintained for the purposes of compulsory medical insurance by the Pension Fund of the Russian Federation. The FIU will be obliged to submit to the FFOMS information on working insured persons in the system of individual (personalized) accounting, necessary for compulsory medical insurance. The procedure for such an exchange of information will be established by an agreement between the FIU and the FFOMS ( Art. 16 Law N 326-FZ ).
Clarifications have been made and in paragraph 1 of Art. 8 of Law N 27-FZ .
It is indicated that the documents electronic form containing information about the insured persons sent by the insured to the Pension Fund of the Russian Federation must be certified by electronic digital signature in accordance with Federal Law No. 1-FZ of January 10, 2002 "On Electronic Digital Signature" .
Changes in the position of insurance organizations
In particular, from January 1, 2012, the requirements for minimum size the authorized capital of an insurer providing exclusively medical insurance (changes in paragraph 3 of Art. 25 of the Law "On the organization of insurance business in the Russian Federation" ).
In accordance with the new edition paragraph 2 of Art. 18 Law N 125-FZ the insurer will be required to send information about decision on payment of expenses for the treatment of the insured immediately after a severe accident at work at the expense of compulsory social insurance against accidents at work and occupational diseases. The form and procedure for sending such information must be approved by the insurer in agreement with the FFOMS.
Other innovations
From January 1, 2012, the procedure and conditions for the provision of interbudgetary transfers and subventions from FFOMS budget territorial compulsory medical insurance funds in accordance with Law N 326-FZ (changes made in Budget Code of the Russian Federation ).
IN Federal Law No. 61-FZ of April 12, 2010 "On the Circulation of Medicines" numerous changes are made.
For example, in Art. 44 of this Law establishes that an organization that has received permission to conduct a clinical trial of a medicinal product for medical use is obliged to insure the risk of harm to the life and health of the patient by concluding a compulsory insurance contract. Participation of the patient in such a study in the absence of a compulsory insurance contract is not allowed. The procedure for exercising the rights and obligations of the parties under a compulsory insurance contract is established by standard rules.
Besides, in Art. 71 Law N 313-FZ specified:
- requirements for information submitted by applicants on medical organizations where clinical trials of a medicinal product for medical use are supposed to be conducted, and on the quality of medicinal products;
- requirements for the procedure and conditions for life insurance, health insurance of patients participating in a clinical trial of a medicinal product;
- mechanisms that allow to carry out the procedures for the examination and registration of medicinal products on the basis of documents submitted for registration before September 1, 2010;
- terms of circulation of medicines in packages with marking applied in accordance with the requirements that were in force before September 1, 2010.