How to use a compulsory health insurance policy

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

To pay bills, the money to the insurance company comes from the compulsory health insurance funds, which, in turn, are financed from the federal and regional budgets, income from the placement of free funds and other sources. Including insurance premiums paid by your employer every month. Each visit to the doctor, each prescribed study is paid by the insurance company at the rates established in the framework of the program.

All citizens of the Russian Federation, foreign citizens permanently or temporarily residing in the territory of the Russian Federation, as well as persons entitled to medical assistance in accordance with the federal law on refugees can get the MHI policy. Military personnel and persons equated to them in the organization of medical care are excluded from the compulsory medical insurance program. We will try to give answers to the most common but still relevant questions related to CHI.

How to get a compulsory medical insurance policy

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

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

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

Do I need an MHI policy for foreign citizens

Foreign citizens who are permanently or temporarily residing in the territory of the Russian Federation, as well as those entitled to medical assistance in accordance with the federal law on refugees, can receive the MHI policy. The policy is issued for a limited period. To obtain a policy, a foreign citizen must document his status and provide the insurance company with the appropriate document: residence permit, refugee certificate or certificate of consideration of the application for refugee status, a foreign citizen’s passport or other identification document with a note on a temporary residence permit . Foreign citizens who have arrived in Russia on the basis of a visa or in a manner that does not require a visa, and who have received a migration card, but who do not have a temporary residence permit, cannot receive a compulsory medical insurance policy.

Moreover, from January 1, 2015, for foreign citizens planning to obtain a patent for the right to work, the conclusion of the VHI policy is mandatory. Foreign citizens who are not insured under the compulsory medical insurance and VHI programs are provided with medical assistance only in emergency form.

How to choose a medical insurance company

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

The main function of the insurance company is to protect the rights and interests of the insured. Within the framework of these obligations, the insurance company executes, reissues, issues the policy, informs the insured about the types, quality and conditions of providing them with medical care, and controls the provision of medical care. Therefore, the choice of an insurance company should be seriously considered.

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

The main indicators characterizing the quality of work of the insurance company: the number of insured, the availability of points of issue, specialist experts, the availability of information for the insured, the availability of reasonable complaints. Having visited the sites of companies with the best indicators, study the completeness and relevance of the information, the possibility of obtaining round-the-clock consultation of specialists both by phone and via the Internet, the number and availability of offices. The list of required services is the same for all companies, but the quality of service can vary greatly.

What is included in the compulsory medical insurance program?

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

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

A list of types, forms and conditions for the provision of assistance within the framework of the territorial program can be found on the websites of the territorial compulsory health insurance funds, directly in the medical organization and in the insurance company. For ordinary consumers, this information will not be particularly informative, since the program description does not contain a clear list of services provided. To find out about the availability of services in the territorial program, if such a question arose, and also to avoid the imposition of paid services by the medical organization, it is easiest for the insured to contact his insurance company. She should provide an initial consultation and, if necessary, conduct an examination of the quality of medical care.

Charging for medical care included in the CHI program is one of the most common violations. Treatment prescribed by a doctor, and not recommended, should be provided free of charge if it is included in the compulsory medical insurance program. In the absence of the necessary doctor or equipment at the medical organization, the insured should not be sent to a paid clinic, but should be given a referral for the necessary free procedures to another medical organization working under the compulsory medical insurance program. If you paid for treatment at a medical organization working under the compulsory medical insurance program, but found out that it should be carried out free of charge, you must save all checks and file a complaint with the insurance company. The insurer is obliged to organize an inspection and, if a violation is detected by a medical organization,

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