In accordance with the Law Russian Federation"On the medical insurance of citizens in the Russian Federation", the Rules of Compulsory Medical Insurance for the Population of the City of Moscow, the Territorial Program of State Guarantees for the Provision of Free Medical Care to the Population of the City of Moscow, and in order to improve the organization of the provision of medical care within the framework of the Moscow City Program of Compulsory Medical Insurance, we order:
1. Approve the Procedure and conditions for the provision of medical care under the Moscow city compulsory medical insurance program ().
2. Heads of health departments of administrative districts of Moscow, heads of medical institutions to bring this document to the attention of subordinate medical institutions and structural divisions for management and execution.
3. To ensure that the Moscow City Compulsory Medical Insurance Fund informs the population of Moscow about the procedure and conditions for providing medical care under the Moscow City Compulsory Medical Insurance Program.
4. Consider invalid the order of the Department of Health of the city of Moscow and the Moscow City Fund for Compulsory Medical Insurance dated November 14, 2008 No. 931/131 “On Approval of the Procedure and Conditions for the Provision of Medical Assistance under the Moscow City Compulsory Medical Insurance Program”
5. Control over the execution of this order shall be entrusted to the First Deputy Head of the Department of Health of the City of Moscow Polyakov S.V. and Deputy Executive Director of the Moscow City Compulsory Medical Insurance Fund Yuryev T.I.
Appendix
to the Department
health care in Moscow
and Moscow City CHI fund
dated October 11, 2010 N 1794/130
Terms and Conditions
provision of medical care under the Moscow city CHI program
1. Medical care under the Moscow City Compulsory Medical Insurance Program (CHI) is provided by medical institutions operating in the CHI system of Moscow to citizens subject to compulsory health insurance:
Citizens insured under compulsory medical insurance in Moscow;
Citizens insured under compulsory medical insurance in the territory of other constituent entities of the Russian Federation (hereinafter referred to as "non-resident citizens");
Patients who, for objective reasons, are not identified (under the CHI policy) when they are provided with primary health care and specialized medical care for emergency indications, on an outpatient or inpatient basis (hereinafter referred to as "unidentified patients").
2. Citizens insured under compulsory medical insurance in Moscow receive medical assistance upon presentation of the compulsory medical insurance policy (when first applying to a medical institution, in addition to the compulsory medical insurance policy, you must present a passport).
In the absence of a compulsory medical insurance policy for patients (in case they apply on an emergency basis), medical institutions take measures to identify the patient in order to identify the insurer or classify him (according to his passport) as a non-resident citizen or unidentified patient.
Planned inpatient medical care for citizens insured under compulsory medical insurance in Moscow is provided at the direction of the outpatient clinic to which they are attached for medical care.
Medical assistance to citizens insured under compulsory medical insurance in Moscow in departmental and non-state medical institutions participating in the implementation of the Moscow city compulsory medical insurance program is provided taking into account the volumes (types) of medical care planned by the medical institution and approved by the Moscow City Health Department.
3. For non-resident citizens, planned medical care in the scope of the Moscow city CHI program is provided at medical institutions of the Moscow Department of Health upon presentation of a territorial CHI policy and a passport (in the absence of a CHI policy for objective reasons - only a passport, and for children - a passport of one of the parents or other legal representatives).
In order to implement the principle of accessibility of free medical care, non-resident citizens living in Moscow are attached to medical care with entry into the register of the attached population of a medical institution on the basis of a written application addressed to the head physician.
Planned inpatient medical care for nonresident citizens is provided on the basis of referrals issued by the Moscow Department of Health, the health departments of the administrative districts of Moscow (in accordance with the subordination of the institution), as well as referrals issued by medical institutions in the presence of nonresident citizens attached to them, incl. h. children and pregnant women for medical care.
4. Diagnostic examinations and advisory assistance are carried out according to medical indications and are prescribed by the attending physician.
The attending physician selects specialists for consultations and selects medicines, materials and medical products.
If the standard workload of a specialist and/or a medical institution is exceeded, consultative, diagnostic and planned medical care under the CHI program is carried out in order of priority.
5. Realization of the right of citizens insured under compulsory medical insurance in Moscow to choose a medical institution in the compulsory medical insurance system of Moscow is carried out on the basis of a written application addressed to the head physician, in accordance with the resource capabilities of the institution: capacity, staffing of medical personnel and the Procedure organization of medical care for the population according to the district principle, approved by order of the Ministry of Health and Social Development of Russia dated 04.08.06 N 584.
Home care is provided by medical workers of institutions located in the territory of actual residence of citizens.
Realization of the right of those insured under MHI to choose a doctor, including a family doctor and a doctor, is carried out subject to his consent.
6. Medical institutions provide citizens with free and accessible information:
About species medical services provided free of charge within the framework of targeted programs for the development of the capital's health care and the Territorial Program of State Guarantees for the Provision of Free Medical Care to the Population of the City of Moscow, a component of which is the Moscow City Program of Compulsory Medical Insurance;
On the types of medical services provided by a medical institution at the expense of personal funds of citizens or other sources of funding within the framework of voluntary medical insurance;
On the possibilities of a medical institution to provide services at the request of citizens for a fee, at prices that reflect the full cost of a medical service, and (or) provide services for an additional fee (without paying the full cost of a medical service);
On the conditions for the provision and receipt of paid services;
About benefits for certain categories citizens.
7. The medical insurance organization that issued the CHI policy considers the applications of the insured in order to ensure and protect their rights to receive medical care under the Moscow city CHI program. If in the application of a citizen insured under MHI there are claims to the organization and (or) quality of medical care provided, the insurance medical organization is obliged to organize an examination of the quality of medical care in the manner and within the time limits stipulated by the Regulations on medical and economic control of the volumes and examination of the quality of medical care provided under the OMS program.
If necessary, the insurance medical organization takes measures to provide certain types of medical care to the insured under compulsory medical insurance in other medical institutions that are in contractual relations with it.
8. Citizens insured under MHI in Moscow, citizens from other cities and unidentified patients, when receiving free medical care, have the rights established by the Fundamentals of the Legislation of the Russian Federation on the protection of the health of citizens and the Law of the Russian Federation "On medical insurance of citizens in the Russian Federation".
In case of violation of the rights, the patient can contact:
Directly to the head or other official of the medical institution in which he received medical care;
To the health department of the corresponding administrative district of Moscow;
To the Department of Health of the city of Moscow;
To the insurance medical organization that issued the compulsory medical insurance policy to the insured and assumed obligations to protect his interests;
To the City Arbitration Expert Commission (GAEK) if the patient's claims have already been considered by the insurance medical organization and the requirements of the insured have not been satisfied (applications for transfer to the GAEK are accepted by the Office of the MHI Organization of the Moscow City Compulsory Medical Insurance Fund);
9. Unreasonable refusals to provide citizens insured under compulsory medical insurance with free medical care in medical institutions participating in the implementation of the Moscow city compulsory medical insurance program are not allowed.
Note.
1. In accordance with Decree of the Government of Moscow No. 145-PP dated 04.03.2008, the Moscow Department of Health issues a referral for hospitalization (consultation), including those insured under compulsory health insurance in the city of Moscow and on the territory of other constituent entities of the Russian Federation, within the framework of Territorial program of state guarantees for the provision of free medical care to the population of the city of Moscow to citizens, as well as citizens living in the territory of the CIS countries, at the expense of the Healthcare industry within the framework of existing intergovernmental agreements (contracts) that determine the procedure for interaction in the field of healthcare.
2. In accordance with the Decree of the Government of the Russian Federation of September 1, 2005 N 546, emergency medical care foreign citizens is provided by medical and preventive institutions of the state and municipal health care system in case of occurrence of conditions that pose a direct threat to their lives or require urgent medical intervention free of charge (at the expense of the budget). After exiting from these states, foreign citizens can be provided with planned medical care on a paid basis. If an international treaty of the Russian Federation establishes a different procedure for the provision of medical care to foreign citizens, the rules of the international treaty shall apply.
Order of the Department of Health of Moscow and the Moscow City Compulsory Medical Insurance Fund dated October 11, 2010 N 1794/130 “On approval of the Procedure and conditions for the provision of medical care under the Moscow city CHI program”
Document overview
It has been established that medical care under the Moscow city CHI program is provided by medical institutions operating in the CHI system to citizens subject to compulsory medical insurance: those insured under CHI in Moscow; insured in the territory of other subjects of the Russian Federation; patients who, for objective reasons, are not identified (according to the CHI policy) when they are provided with primary health care and specialized medical care for emergency indications.
Citizens insured under compulsory medical insurance have the right to choose a medical institution in the compulsory medical insurance system. To do this, they need to apply to the head physician.
Unreasonable refusals to provide citizens insured under compulsory medical insurance with free medical care in medical institutions participating in the implementation of the Moscow city compulsory medical insurance program are not allowed.
What is OMS? What are you entitled to under the CHI policy? How to get or change the CHI policy? How to be treated by non-residents in Moscow?
If you live in another city and want to come for planned treatment
In this case, there are two scenarios for how you can be hospitalized for free under the MHI policy in a Moscow hospital.
Option 1. Get a referral to a Moscow hospital from the hospital where you live
If you live in another city and want to get planned treatment in a Moscow hospital for free, you can get a referral from a medical institution at your place of residence. You come to your doctor, and if there is evidence, he writes you a referral to one of the hospitals in the capital.
Then you need to make an appointment at the polyclinic department of a Moscow hospital (by referral) and get additional information from the doctor of this hospital about the possibility of hospitalization, the date of hospitalization and a list of necessary tests and documents.
Option 2. Call the hotline for planned hospitalization of patients from other cities "Moscow - the capital of health"
To date, the websites of all Moscow hospitals operating under compulsory medical insurance indicate the number hotline free assistance in obtaining planned hospitalization of out-of-town patients "Moscow - the capital of health".
To contact the hotline of the project "Moscow - the capital of health" you need to have only an officially established diagnosis and a compulsory health insurance policy.
The curators of the project "Moscow - the Capital of Health" take into account the patient's wishes regarding planned hospitalization and select a hospital according to the profile of his illness.
The rest depends on the availability of places in the selected hospitals at the time of the desired date of hospitalization.
In addition, you can get a distance consultation on choosing a medical institution even before your arrival in the capital. Doctors first assess the patient's condition according to medical documents, recommend a hospital, and then he comes to Moscow for hospitalization.
In any case, a decision on hospitalization will require an on-site examination to diagnose diseases of unknown origin and comorbidities.
Documents required for hospitalization:
The passport;
- insurance policy (original and copy);
- birth certificate (for children's hospitalization);
- SNILS;
- medical documents.
Hotline specialists supervise the patient until his discharge.
All services are provided free of charge.
This scheme is valid only for receiving assistance under the CHI program. High-tech medical care is directly funded by the state. To receive high-tech treatment, you must apply for a federal quota.
To whom is the policy issued and what to do with it?
The compulsory medical insurance policy is issued at birth and is required for every citizen of the Russian Federation. If you have not changed your old policy to a new version, you should not worry. Any officially registered policy is valid.
But if the policy is completely absent, you will not be able to use free medical care (except for emergency). You will not even be able to consult at the district clinic or simply apply for a sick leave.
Therefore, if for some reason you do not have a CHI policy at all, we strongly recommend that you apply for it at any compulsory health insurance company in the city at the place of residence, work or actual residence. You can find out which insurance companies operate in your region on the website of the territorial CHI fund in your region. A complete list of territorial funds websites can be found here.
Both working citizens and unemployed persons, children and pensioners are equally entitled to receive a CHI policy.
The policy must be presented at the time of making an appointment and a face-to-face visit to the clinic, to doctors when calling an ambulance, when registering for planned hospitalization, etc.
Insured persons have the right to receive standard dental care, can do a lot of tests and examinations free of charge, and as part of the additional examination during treatment, computed and magnetic resonance imaging.
What is the right of a citizen under the MHI policy?
According to the Federal Law "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation", an insured citizen has the right to receive emergency and planned care in any medical institution of the Russian Federation (operating under the CHI program) even outside the region of his permanent residence.
For example, you can come from the region to a Moscow hospital according to your profile and receive free conservative and surgical treatment of a wide range of diseases, such as: cholecystitis, urolithiasis, stomach ulcers, hypospadias and phimosis, progressive spinal deformities, valgus flatfoot, Crohn's disease, arrhythmia, adenoids, etc.
A complete list of diseases that can be treated in Moscow under compulsory medical insurance, as well as analyzes and studies, can be found on the website of the Moscow City Compulsory Medical Insurance Fund. Also, a list of those provided in hospitals in your area under the policy CHI services can be found in the Territorial program of state guarantees of free provision of medical care to citizens.
Treatment is free, but it is only free for you. The hospital and medical staff receive money for your treatment from the Compulsory Health Insurance Fund. This money, which is formed from taxes paid by citizens and employers.
In any unclear situation, call the insurance company
If you are denied medical care or you are asked for money for treatment, and you did not ask for any paid services, your insurance company is your first resort. They are responsible not only for financing the services provided, but also for their quality and timely delivery of assistance.
The current number can be found on your new policy (A4 card or document) or on the website of the indicated insurance company.
What you are not entitled to under the CHI policy
The OMS does not include:
Treatment without a doctor's prescription, simply because I "want";
- cosmetic services;
- treatment with homeopathic preparations and traditional medicine;
- installation of dentures, veneers, etc.;
- accommodation in a superior room and a personal nurse to boot.
If you are a non-resident, but live in Moscow
The possibility and ways of receiving treatment in a Moscow hospital free of charge under compulsory medical insurance for a nonresident patient depend on his goals, capabilities and life circumstances.
For example, being a non-resident living in Moscow, it will be more convenient for you to get a Moscow CHI policy.
Its presence will provide you with the right to attach to any city clinic operating under the CHI program.
To apply for a compulsory medical insurance policy, you must contact the selected medical insurance organization and provide:
Application for the choice / replacement of an insurance company (application form can be downloaded here);
- an identity document (passport of a citizen of the Russian Federation, birth certificate, temporary identity card of a citizen of the Russian Federation, issued for the period of issuing a passport);
- SNILS (for persons over 18 years old).
At the time of issuing the policy, the insurance company is obliged to issue a temporary certificate that provides the opportunity to use similar services of compulsory health insurance. The certificate is valid for 30 working days.
Having a Moscow policy makes it possible to freely attach to a Moscow medical institution and the right to a full range of medical care, including outpatient care.
More information about all the possibilities can be found on the website of the Moscow City Compulsory Medical Insurance Fund.
In accordance with Article 41 of the Constitution of the Russian Federation, every citizen has the right to health protection and free medical care provided in a guaranteed amount without charging a fee in accordance with the Program of State Guarantees of Free Medical Care for Citizens (hereinafter referred to as the Program), annually approved by the Government of the Russian Federation.
The main state sources of funding for the Program are the funds of the compulsory medical insurance system and budgetary funds.
On the basis of the Program, the subjects of the Russian Federation annually approve territorial programs of state guarantees of free medical care (hereinafter referred to as territorial programs).
1. What types of medical care are provided to you free of charge
The Program provides free of charge:
1. Primary health care, including:
- primary pre-medical care, which is provided by paramedics, obstetricians and other medical workers with secondary medical education on an outpatient basis, in a day hospital;
- primary medical care, which is provided by general practitioners, district general practitioners, pediatricians, district pediatricians and general practitioners (family doctors);
- Primary specialized medical care, which is provided by medical specialists.
2. Specialized medical care which is provided in inpatient and day hospital conditions by specialist doctors, and includes the prevention, diagnosis and treatment of diseases and conditions, including during pregnancy, childbirth and the postpartum period, requiring the use of special methods and complex medical technologies.
3. High-tech medical care using new complex and (or) unique methods of treatment, as well as resource-intensive methods of treatment with scientifically proven effectiveness, including cell technologies, robotic technology. With a list of types of high-tech medical care, including, among other things, treatment methods and sources financial support. You can find it in the appendix to the Program.
4. Ambulance, which is provided by state and municipal medical organizations in case of diseases, accidents, injuries, poisonings and other conditions requiring urgent medical intervention. If necessary, medical evacuation is carried out.
To get rid of pain and alleviate other severe manifestations of the disease, in order to improve the quality of life of terminally ill patients, citizens are provided with palliative care in outpatient and inpatient settings.
The above types of medical care include free of charge:
– medical rehabilitation;
– in vitro fertilization (IVF);
- various types of dialysis;
- chemotherapy for malignant diseases;
- preventive measures, including:
- preventive medical examinations, including for children, working and non-working citizens studying in educational institutions on a full-time basis, in connection with physical education and sports;
— prophylactic medical examination, including orphans and children in difficult life situations staying in stationary institutions, as well as orphans and children left without parental care, including those adopted (adopted), taken under guardianship (guardianship) in foster or foster family. Citizens undergo medical examination free of charge in a medical organization where they receive primary health care. Most of the activities within the framework of medical examinations are carried out once every 3 years, with the exception of mammography for women aged 51 to 69 years and fecal occult blood testing for citizens from 49 to 73 years, which are carried out once every 2 years;
– dispensary observation of citizens suffering from socially significant diseases and diseases that pose a danger to others, as well as persons suffering from chronic diseases, functional disorders, and other conditions.
In addition, the Program guarantees:
- prenatal (prenatal) diagnosis of developmental disorders of the child in pregnant women;
- neonatal screening for 5 hereditary and congenital diseases in newborns;
- audiological screening in newborns and children of the first year of life.
Citizens are provided with medicines in accordance with the Program.
2. What are the deadlines for waiting for medical care
Medical assistance is provided to citizens in three forms - planned, urgent and emergency.
emergency form provides for the provision of medical care in case of sudden acute diseases, conditions, exacerbation of chronic diseases that pose a threat to the patient's life. At the same time, medical assistance in an emergency form is provided by a medical organization and a medical worker to a citizen without delay and free of charge. Refusal to provide it is not allowed.
urgent form provides for the provision of medical care for sudden acute diseases, conditions, exacerbation of chronic diseases without obvious signs of a threat to the patient's life.
Planned form provides for the provision of medical care in the course of preventive measures, in case of diseases and conditions that are not accompanied by a threat to the life of the patient, do not require emergency and urgent medical care, and the delay in the provision of which for a certain time will not entail a deterioration in the patient's condition, a threat to his life and health.
Depending on these forms, the Government of the Russian Federation establishes waiting times for medical care
.
So, the waiting time for rendering emergency primary health care should not exceed 2 hours from the moment the patient contacts the medical organization.
Waiting periods for rendering planned medical care for:
- appointments by district general practitioners, general practitioners (family doctors), district pediatricians should not exceed 24 hours from the moment the patient contacts the medical organization;
- consultations of medical specialists should not exceed 14 calendar days from the date the patient applied to the medical organization;
- conducting diagnostic instrumental (X-ray studies, including mammography, functional diagnostics, ultrasound studies) and laboratory studies in the provision of primary health care should not exceed 14 calendar days from the date of appointment;
- conducting computed tomography (including single photon emission computed tomography), magnetic resonance imaging and angiography in the provision of primary health care should not exceed 30 calendar days, and for patients with oncological diseases 14 calendar days from the date of appointment:
- specialized (with the exception of high-tech) medical care should not exceed 30 calendar days from the date the attending physician issued a referral for hospitalization, and for patients with oncological diseases - 14 calendar days from the date of diagnosis of the disease.
The time of arrival to the patient of ambulance teams when providing emergency medical care in an emergency form should not exceed 20 minutes from the moment it was called. At the same time, in the territorial programs, the time of arrival of ambulance teams can be reasonably adjusted taking into account transport accessibility, population density, as well as climatic and geographical features of the regions.
3. What you don't have to pay for
In accordance with the legislation of the Russian Federation in the field of protecting the health of citizens when providing medical care under the Program and territorial programs, the following are not subject to payment at the expense of personal funds of citizens:
- provision of medical services;
- appointment and use in stationary conditions, in a day hospital, in the provision of medical care in an emergency and emergency form of drugs for medical reasons:
a) included in the list of vital and essential medicines;
b) not included in the list of vital and essential drugs, in cases of their replacement due to individual intolerance, for health reasons;
- appointment and use of medical devices, blood components, medical nutrition, including specialized medical nutrition products for medical reasons;
- accommodation in small wards (boxes) of patients for medical and (or) epidemiological indications;
for children under the age of four years, the creation of conditions for staying in a hospital, including the provision of a bed and food, when one of the parents, another family member or other legal representative is in a medical organization, and for a child older than this age - if there are medical indications ;
transportation services when a medical worker accompanies a patient who is being treated in a hospital, if it is necessary to conduct diagnostic tests for him in the absence of the possibility of their conduct by a medical organization providing medical care.
4. About paid medical services
In accordance with the legislation of the Russian Federation, citizens have the right to receive paid medical services provided at their request when providing medical care, and paid non-medical services (household, service, transport and other services) provided additionally when providing medical care. At the same time, paid medical services can be provided in full medical care, or at your request in the form of individual consultations or medical interventions.
Medical organizations participating in the implementation of the Program and territorial programs have the right to provide you with paid medical services:
on other terms than provided by the Program, territorial programs and (or) target programs:
- when providing medical services anonymously, with the exception of cases stipulated by the legislation of the Russian Federation;
- citizens of foreign states, stateless persons, with the exception of persons insured under compulsory health insurance, and citizens of the Russian Federation who do not permanently reside on its territory and are not insured under compulsory health insurance, unless otherwise provided by international treaties of the Russian Federation;
- when applying for medical services on your own, with the exception of:
a) self-appeal of a citizen to a medical organization chosen by him no more than once a year (with the exception of changing the place of residence or place of stay);
b) provision of medical care in an emergency and emergency form when a citizen independently applies to a medical organization;
c) referrals for the provision of medical services by a general practitioner
district, district pediatrician, general practitioner (family doctor), specialist doctor, paramedic, as well as provision of primary specialized health care,
specialized medical care in the direction of the attending physician;
d) other cases stipulated by the legislation in the field of health protection.
Refusal of the patient from the offered paid medical services cannot be the reason for reducing the types and volume of medical care provided to such a patient without charging a fee within the framework of the Program and territorial programs.
5. Where to contact for emerging issues and in case of violation of your rights to free medical care
On issues of free provision of medical care and in case of violation of the rights of citizens to its provision, resolution of conflict situations, including in case of refusals to provide medical care, collection Money for its provision, please contact:
- the administration of the medical organization - to the head of the department, the head of the medical organization;
- to the office of the insurance medical organization, including the insurance representative, in person or by phone, the number of which is indicated in insurance policy;
- territorial health management body and territorial body of Roszdravnadzor, territorial compulsory medical insurance fund;
public councils (organizations) for the protection of patients' rights under the state authority of the constituent entity of the Russian Federation in the field of health care and under the territorial body of Roszdravnadzor;
- professional non-profit medical and patient organizations;
- federal authorities and organizations, including the Ministry of Health of the Russian Federation, the Federal Compulsory Medical Insurance Fund, Roszdravnadzor, etc.
6. What you should know about insurance representatives of health insurance organizations
An insurance representative is an employee of an insurance medical organization who has undergone special training, represents your interests and provides your individual support in the provision of medical care provided for by law.
Insurance representative:
- provides you with reference and advisory information, including on the right to choose (replace) and the procedure for choosing (replacing) an insurance medical organization, a medical organization and a doctor, as well as on the procedure for obtaining a compulsory medical insurance policy;
-informs you about the need to undergo medical examination and asks you based on the results of its passage;
- advising you on the provision of medical care;
-informs about the conditions for the provision of medical care and the availability of vacant places for hospitalization in a planned manner;
- helps you choose a medical organization, including those providing specialized medical care;
- supervises your medical examination;
-organizes consideration of complaints of insured citizens about the quality and availability of medical care.
In addition, you can contact the office of the insurance medical organization to the insurance representative when:
- refusal to make an appointment with a specialist doctor if there is a referral from the attending physician;
- Violation of the deadlines for waiting for medical care in planned, urgent and emergency forms;
- refusal to provide free medicines, medical devices, medical nutrition - everything that is provided for by the Program;
-situations when you are asked to pay for those medical services that are prescribed by your doctor for medical reasons. If you have already paid for medical services, be sure to keep the cashier's receipt, sales receipts and contact the insurance medical organization, where they will help you establish the legality of collecting funds, and in case of illegality, organize their reimbursement;
- other cases when you think that your rights are being violated.
Citizens of Russia are guaranteed free medical care by the state. A policy is issued to people - a document embodying support state system healthcare in case of illness.
And what does it really mean? What types of services in the clinic are required to provide at no additional charge, and which ones will you have to pay for yourself? Under what circumstances is a free medical examination carried out? Let's look at all the questions in detail.
About free medicine
The 41st article of the Constitution of the Russian Federation lists guarantees to citizens of the country from the state. In particular, it says:
“Everyone has the right to health care and medical care. Medical assistance in state and municipal health care institutions is provided to citizens free of charge at the expense of the relevant budget, insurance premiums, and other revenues.
Thus, the list of free medical services should be determined by the relevant state bodies, that is, the healthcare system. This happens on two levels:
- federal;
- regional.
Important! The budget fund for the development of medical institutions is formed from several sources. One of them is tax revenues from citizens.
What types of services are guaranteed by the state
By virtue of the current legislative acts, patients are guaranteed the right to the following types of medical care:
- emergency (ambulance), including special;
- outpatient treatment, including examination;
- hospital services:
- gynecological, pregnancy and childbirth;
- with exacerbation of ailments, ordinary and chronic;
- in cases of acute poisoning, in case of injury, when intensive care is required, associated with round-the-clock supervision;
- planned outpatient care:
- high-tech, including the use of complex, unique methods;
- medical care for citizens with incurable ailments.
Medicines are issued at the expense of the budget to people suffering from the following types of diseases:
- shortening life;
- rare;
- leading to disability.
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New in legislation since 2017
- pre-medical (primary);
- ambulance;
- specialized;
- palliative.
In addition, the text of the document contains a list of medical professionals who are subject to the obligation to treat patients without charging money.
These include:
- paramedics;
- obstetricians;
- other health workers with secondary specialized education;
- general practitioners of all profiles, including doctors of family medicine and pediatricians;
- doctors-specialists of medical organizations providing specialized, including high-tech, medical care.
Medical policy
Important! Not only citizens of the Russian Federation have the right to issue a compulsory medical insurance policy. It is issued (for a small fee) to foreigners permanently residing in the country.
The MHI policy has the following semantic content:
- the citizen is guaranteed medical support;
- medical organizations perceive it as a client identifier (for it, the hospital will transfer funds from the Compulsory Medical Insurance Fund).
How to get an OMS policy
The document is issued by the relevant companies operating within the framework of the legislation of the Russian Federation. Their rating is regularly printed on official websites, allowing citizens to make their choice.
To be issued a CHI policy, you must provide a minimum number of documents.
Namely:
- for children under 14:
- birth certificate;
- parent's (guardian's) passport;
- SNILS (if any);
- for citizens over 14 years old:
- the passport;
- SNILS (if available).
Important! For citizens of the Russian Federation, the policy is valid indefinitely. Only foreigners are provided with a temporary document:
- refugees;
- temporarily residing in the country.
Rules for replacing the compulsory medical insurance policy
In some situations, the document is supposed to be changed to a new one. These include the following:
- when moving to a region where the insurer does not work;
- in case of filling out the paper with errors or inaccuracies;
- in case of loss or damage to the document;
- when it fell into disrepair (dilapidated) and it is impossible to make out the text;
- in the event of a change in personal data (marriage, for example);
- in the case of a planned update of the sample form.
What is included in the free service under the MHI policy
In paragraph 6 of Article 35 federal law No. 326-FZ provides a complete list free services under the medical policy provided to the owners of the document. They are provided in:
- polyclinic;
- dispensaries;
- hospital;
- Ambulance.
What can OMS policy holders expect?
In particular, patients are entitled to free medical care and treatment in the following situations:
Dentists, like other professionals, are required to work with patients without pay.
They provide the following types of assistance:
- treatment of caries, pulpitis and other diseases (enamel, inflammation of the body and roots of the tooth, gums, connective tissues);
- surgical intervention;
- dislocations of the jaws;
- preventive actions;
- research and diagnostics.
Important! Services for children are provided free of charge:
- to correct an overbite;
- enamel strengthening;
- treatment of other lesions not related to carious.
How to apply the CHI policy
In order to organize the treatment of patients, they are attached to the clinic. The choice of a medical institution is given to the choice of the client.
It is defined:
- convenience of visiting;
- location (near the house);
- other factors.
How to "attach" to the clinic
You can do this with the help of an insurer (choose an institution when receiving a policy) or on your own.
To attach to the clinic, you should go to the institution and write an application there. Copies of the following documents are attached to the paper:
- identity cards:
- passports for citizens over 14 years old;
- birth certificates of a child under 14 years of age and passports of a legal representative;
- compulsory medical insurance policy (original is also required);
- SNILS.
Important! Citizens registered in another region can legally refuse to attach to a polyclinic if the institution is overcrowded (the maximum norm of patients has been exceeded).
In case of refusal, it should be requested in writing. You can complain about a medical institution to the Ministry of Health of the Russian Federation or Roszdravnadzor.
Visit to the doctor
In order to get help from a specialist, you must register with him through the registry. This department issues admission vouchers. Terms and rules of registration, patient care are established at the regional level. They can be found in the same registry.
In addition, the insurer must provide this information to customers (you need to call the number indicated on the policy form).
For example, in the capital there are such rules for providing patients with medical services:
- referral to an initial appointment with a therapist, pediatrician - on the day of treatment;
- coupon to specialist doctors - up to 7 working days;
- carrying out laboratory and other types of examination - also up to 7 days (in some cases up to 20).
Ambulance
All people in the country can use emergency medical services (the presence of a CHI policy is optional).
There are regulations governing the activities of ambulance crews. They are:
- the ambulance service responds to emergency calls within 20 minutes in case of a threat to people's lives:
- accidents;
- wounds and injuries;
- exacerbation of the disease;
- poisoning, burns and so on.
- emergency care arrives within two hours if there is no threat to life.
How to call an ambulance
There are several options for seeking emergency medical care. They are:
- From a landline, dial 03.
- By mobile connection:
- 103;
Important! The last number is universal - 112. This is the coordination center for all emergency services: hide, fire, emergency and others. This number works on all devices if there is a network connection:
- with zero balance;
- with the absence or blocking of the SIM card.
Ambulance Response Rules
The service operator determines if the call is justified. An ambulance will arrive if:
- the patient has signs of an acute illness (regardless of its location);
- there was a catastrophe, a mass disaster;
- received information about the accident: injuries, burns, frostbite, and so on;
- violation of the activity of the main body systems, life-threatening;
- if childbirth or termination of pregnancy has begun;
- the disorder of the neuropsychiatric patient threatens the lives of other people.
Calls due to such factors are considered unreasonable:
- the patient's alcoholism;
- non-critical deterioration of the patient's condition of the clinic;
- dental diseases;
- carrying out procedures in the order of planned treatment (dressings, injections, etc.);
- organization of workflow (issuance of sick leave, certificates, drawing up an act of death);
- the need to transport the patient to another place (clinic, home).
Where to file medical complaints
In the event of conflict situations, rude treatment, insufficient level of services provided, you can complain to the doctor:
- chief physician (in writing);
- to the insurance company (by phone and in writing);
- to the Ministry of Health (in writing, via the Internet);
- Prosecutor's office (also).
Attention! The term for consideration of the complaint is 30 working days. Based on the results of the check, the patient is required to send a reasoned response in writing.
If necessary, the attending doctor can be changed to another specialist. To do this, write an application addressed to the head physician of the hospital. However, the change of specialists is allowed to be carried out no more than once a year (except in cases of relocation).
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Last changes
On May 28, 2019, new CHI rules came into force, which provide for the introduction in Russia of policies of a single sample (paper or electronic format). At the same time, there is no need to replace the previously issued policy. In addition, if it is technically possible to unambiguously identify the insured person in the unified register of insured persons, then instead of the CHI policy, a passport can be presented (Order of the Ministry of Health of Russia dated February 28, 2019 No. 108n “On Approval of the Rules for Compulsory Medical Insurance“).
The new Rules provide for stricter control over the observance of the rights of the insured, as well as close electronic interaction between the territorial MHIF, insurance organizations and medical organizations:
- polyclinics every year until January 31 will have to report to the TFOMS (through a single portal) the number of those attached, the number of people under dispensary observation, schedules of professional examinations / medical examinations with a quarterly / monthly breakdown by therapeutic areas; work schedules);
- polyclinics every day on working days before 9 am must report (through the TFOMS portal) on insured persons who have passed a medical examination, as well as on persons undergoing medical examination;
- medical organizations, a medical insurance organization (HIO) and TFOMS will exchange information in electronic form every day on the TFOMS portal: hospitals must update data on the implementation of medical care volumes, free beds, accepted / non-admitted patients by 9 am; polyclinics update information on hospital referrals issued yesterday until 9 am; medical organizations that provide specialized, including high-tech, medical care, post information about patients who have had a telemedicine consultation, and the CMO is obliged to monitor the implementation of the recommendations received from the NMIC doctors, and has the right to conduct an in-person examination within the next 2 working days ;
- regardless of the mentioned interaction, every day no later than 10 am, the CMO informs hospitals about patients referred to such hospitals the day before, and also every day no later than 10 am informs medical organizations about the number of free beds in the context of profiles / departments, about patients whose hospitalization did not take place;
- On the basis of the database from the TFOMS portal, the HMO checks during the working day whether the patients were correctly referred to specialized medical organizations. If hospitalization took place out of time, not according to the profile, the HMO must file a complaint with the head physician of the violating medical organization and the regional Ministry of Health, and, if necessary, take measures and transfer the patient;
- insurance representatives of HIOs received a wide range of responsibilities - working with citizens' complaints, organizing examinations of the quality of medical care, informing and accompanying them when providing them with medical care, inviting them to medical examination, monitoring its passage, forming lists of "persons for medical examination" and lists of citizens who fell under the dispensary observation;
- patients will be able to see when and what medical services were provided to them, and at what cost: in personal account on the portal of public services or through the TFOMS - by means of authorization in the ESIA;
- for oncological patients, the HMO undertakes to create (on the TFOMS portal) an individual history of insurance events (based on registers-accounts) throughout all stages of medical care.
The updated MHI Rules directly impose on the CMO the obligation to carry out pre-trial protection of the rights of insured persons. When they file complaints about poor-quality medical care or charging for services under the compulsory medical insurance program, the CMO registers written appeals, conducts a medical and economic examination and an examination of the quality of medical care.
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The receipt by citizens of Russia of free medical care is regulated by the order of the Ministry of Health and Social Development No. 406n and the Federal Law “On the Protection of the Health of Citizens”. These legislative acts clearly formulate the possibility for a Russian citizen to receive free medical care in a polyclinic or other medical institution in any region of the country, regardless of the place of registration.
This means that the patient has the right to be attached to a polyclinic in any city or region, regardless of the place of residence. The only restriction enshrined in law is that the choice or replacement of a medical institution can be made no more than once a year. However, this restriction does not apply in the event of a change of place of permanent residence. Persons with out-of-town registration and wishing to be served at the selected polyclinic institution must update the "attachment" procedure annually.
The order of attachment to the clinic
To attach to the selected clinic, you must write an application addressed to the head doctor, as well as provide a passport or birth certificate (for persons under 14 years old), SNILS and a medical insurance policy to the reception. In the application for attachment, a citizen must indicate the following information:
- Surname, name, patronymic;
- Passport data;
- Address of the actual residence;
- Health insurance policy number;
- Details of the previous clinic.
The medical institution has 2 days to review the received application, which consists in verifying the information provided. In case of passing the check, the management of the polyclinic notifies the applicant of acceptance for medical care. The document flow for deregistration in one medical institution and registration in another will take about 1 more week. Thus, the minimum period required for the full procedure of attachment to the new clinic is 12 days.
If a patient needs immediate medical attention, a doctor in a state polyclinic is obliged to accept him, regardless of the place of registration of the patient and whether he is attached to this medical institution or not. A scheduled or emergency examination is possible if a citizen has a compulsory medical insurance policy.
Refusal to attach to a medical institution
If all of the above conditions are met, they have no right to refuse to attach a patient to a polyclinic, or to provide emergency / planned medical care. However, there are cases of illegal refusals or demands that the patient provide additional documents. In cases of violations of the law by medical institutions, one should contact the insurance company, the territorial MHIF or the Department of Health. You can use hotlines or trust services, which are organized by the territorial branches of the compulsory health insurance funds. The coordinates and numbers of the relevant organizations can be found on the official websites of the TFOMS and various reference resources on the Internet.