MS- industry personal insurance, under which the insurer is obliged to organize and finance the provision of medical care and other medical services to insured persons for a conditional insurance premium (insurance premium).

Legal regulation:

CHI- the law on compulsory medical insurance, on the basics of protecting the health of citizens.

CHI rules - order of the Ministry of Health and Social Development - check.

VHI- general norms - 48 chapter of the Civil Code of the Russian Federation, the law on the organization of insurance business in the Russian Federation.

VHI rules are developed by the insurer. Mandatory indication of the sum insured. The exhaustion of the amount entails the termination of the contract.

Peculiarities:

Availability of CHI and VHI

MC can be carried out by insurers engaged exclusively in health insurance

Possibility to choose a VHI program

According to CHI - a list of services in the law

VHI - the insurer can determine how justified the appeal was.

Medicalinsurance is a form social protection interests of the population in the field of health protection, its main goal is to guarantee citizens in the event of insured event receive medical care at the expense of accumulated funds and finance preventive measures. Medicalinsurance is a set of types of insurance that provide for the obligations of the insurer to make insurance payments (payments of insurance coverage) in the amount of partial or full compensation for the additional expenses of the insured person, caused by the insured person applying to medical institutions for medical services included in the health insurance program.

Unlike classical types of insurance, with medical insurance payment is made not in cash, but in kind, in the form of a complex of medical and other services paid by the insurer. At the same time, the insured is a consumer of insurance and at the same time medical services, which leads to a high degree of responsibility of the insurer for the quality of organization of medical care, for the safety and efficiency of the services provided. medical services.

The legislation provides for two types of health insurance - mandatory and voluntary. Mandatorymedical insurance (CHI) is an integral part of 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 that correspond to compulsory medical insurance programs. The CHI system is based on the principle of social solidarity, when the rich pay for the poor, the healthy pay for the sick, it is based on a stable source of health care financing through targeted contributions.

In this system, payment for medical care should be made depending on the volume and quality of the work done, while monitoring the intended use of funds.

CHI is based on the following principles:

universal character. All citizens of the Russian Federation, regardless of gender, age, state of health, place of residence, level of personal income, have the right to receive medical services included in the state (basic) CHI program.

state character. CHI funds are state-owned by the Russian Federation. The state, represented by local executive authorities, acts as a direct insurer of the non-working population. It exercises control over the collection, redistribution and use of compulsory medical insurance funds, ensures financial stability CHI system, guarantees the fulfillment of obligations to the insured.

Non-commercial character. Compulsory medical insurance funds cannot become income (profit) of legal entities and individuals who are shareholders or founders of medical insurance organizations participating in compulsory medical insurance operations. The profit (income) received from CHI operations can only be directed to the development of the CHI system and health care institutions.

Social solidarity and social justice. All members of society have equal rights to receive medical care at the expense of compulsory medical insurance, however, in fact, the consumption of medical services is carried out only by individuals who need them and seek medical help.

Federal Law of July 24, 2009 N 212-FZ "On insurance premiums in Pension Fund Russian Federation, the Social Insurance Fund of the Russian Federation, the Federal Compulsory Medical Insurance Fund and territorial compulsory medical insurance funds"

Article 12. Rates of insurance premiums

1. Tariff insurance premium- the amount of the insurance premium per unit of measurement of the base for calculating insurance premiums.

2. The following insurance premium rates apply, unless otherwise provided by this Federal Law:

1) The Pension Fund of the Russian Federation - 26 percent;

2) Foundation social insurance RF - 2.9 percent;

3) Federal Compulsory Medical Insurance Fund - from January 1, 2011 - 3.1 percent, from January 1, 2012 - 5.1 percent;

The sources of CHI funds are:

parts of deductions of enterprises, organizations and other legal entities to the MHI fund from accrued wages;

other receipts stipulated by the legislation of the Russian Federation.

The financial resources of the territorial compulsory medical insurance funds are formed from:

parts of the unified social tax at the rates established by the legislation of the Russian Federation; parts of the unified tax on imputed income for certain types of activities in the amount established by law;

insurance premiums for compulsory health insurance of the non-working population paid by the executive authorities of the constituent entities of the Russian Federation, local self-government, taking into account the territorial programs of compulsory medical insurance within the funds provided for in the relevant budgets for health care;

other receipts stipulated by the legislation of the Russian Federation.

The procedure for paying insurance premiums for compulsory medical insurance of the non-working population in territorial funds provided for by the Regulations on the procedure for paying insurance premiums to the Federal and territorial compulsory insurance funds, approved by the Decree of the Supreme Council of the Russian Federation of February 24, 1993 N 4543-1 "On the procedure for financing compulsory medical insurance of citizens for 1993", other regulatory legal acts, regulatory methodological documents approved in the prescribed manner.

Thus, compulsory medical insurance premiums are paid for all citizens, but the demand for financial resources is carried out only when they apply for medical care.

The range and volume of services provided does not depend on the absolute amount of payment under compulsory medical insurance.

Citizens with different income levels (for example, a large businessman, housewife, janitor) and, accordingly, with different amounts of accruals for wages have the same rights to receive medical services included in the compulsory health insurance program. Approved federal body protocols and standards for diagnostics and treatment, basic lists of medicines are designed to serve as the implementation of guarantees for citizens of the Russian Federation for the provision of free medical care, the provision of vital and essential medicines.

Such a federal executive body in the field of healthcare is the Ministry of Health of the Russian Federation (since May 21, 2012, previously the Ministry of Health and Social Development), which performs the functions of developing state policy and legal regulation in the field of healthcare, social development, labor and consumer protection, including issues of organizing medical prevention, including infectious diseases and AIDS, medical care and medical rehabilitation, pharmaceutical activities, quality, efficacy and safety of medicines, sanitary and epidemiological well-being, living standards and incomes of the population, demographic policy, health care for workers in certain sectors of the economy with especially dangerous working conditions, biomedical assessment of the impact on the human body of especially dangerous factors of physical and chemical nature, etc.

Model rules for compulsory medical insurance of citizens (approved by FFOMS on October 3, 2003 N 3856 / 30-3 / and) establish that citizens of the Russian Federation are guaranteed the provision of medical care and payment for it through the system of compulsory medical insurance in the amount and on the terms of the operating on the territory of the subject RF territorial program of compulsory medical insurance.

In accordance with the Law of the Russian Federation "On the organization of insurance business in the Russian Federation" (Article 3), voluntary insurance is carried out on the basis of an insurance contract and insurance rules that determine the general conditions and procedure for its implementation. The insurance rules are adopted and approved by the insurer or the association of insurers independently in accordance with the Civil Code of the Russian Federation and the specified Law and contain provisions on the subjects of insurance, on the objects of insurance, on insured events, on insurance risks, on the procedure for determining the sum insured, insurance rate, insurance premium ( insurance premiums), on the procedure for concluding, executing and terminating insurance contracts, on the rights and obligations of the parties, on determining the amount of loss or damage, on the procedure for determining insurance payment, on cases of refusal of insurance payment and other provisions.

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. Insurance premiums are made in various forms (cash payment, non-cash transfer, use of plastic cards, etc.). Voluntary medical insurance is provided in the form of collective and individual insurance.

The concept of compulsory health insurance

Compulsory health insurance (CMI) is at the heart of the functioning of the Russian health care system. In accordance with the law, all citizens included in the insurance system are entitled to receive free medical care throughout the Russian Federation. Federal Law No. 326-FZ of November 29, 2010 (as amended on February 6, 2019) "On Mandatory health insurance in the Russian Federation" gives the following definition of CHI:

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 statutory cases within the framework of the basic program of compulsory health insurance.

Priority of insurance development in social sphere is also accepted in the provisions of the Constitution of the Russian Federation, which proclaims the promotion of voluntary social insurance, and guarantees of free medical care are provided at the expense of the relevant budget, insurance premiums, and other revenues (clause 3, article 39, clause 1, article 41).

Principles of compulsory health insurance

Compulsory health insurance as an object legal regulation endowed with a system of principles. They are reflected in the Federal Law "On Compulsory Medical Insurance in the Russian Federation".

Each of the above principles of compulsory health insurance needs to be considered separately. You should start with the principle of providing free medical care to the insured person in the event of an insured event. This principle is built on the basis of Article 41 of the Constitution of the Russian Federation. Compliance with this principle guarantees that every person in need will receive certain types of medical care free of charge. Medical assistance is provided free of charge within the framework of the territorial program of compulsory medical insurance and the basic program of compulsory medical insurance.

Of no less interest is the principle of sustainability of the financial system of compulsory health insurance. It means that the presence of effective economic levers, with the help of which the state provides continuous and timely financing of obligations within the framework of compulsory health insurance relations, in particular, for the timely transfer from the budget Money medical and healthcare organizations. In fact, financial system compulsory health insurance proclaimed autonomous.

Then the principle of obligatory payment by insurers of insurance premiums for compulsory health insurance is considered. Like any insurance, compulsory health insurance is provided mainly at the expense of the funds that the insurer receives from the insured.

An equally important principle of CHI is the state guarantee of protection of insured persons from social risks. The state ensures the observance of the rights of the insured persons to the fulfillment of obligations for the obligatory occurrence of expenses by the Insurer, and the claim for damages was rightfully dismissed.

The principle of creating conditions for ensuring the availability and quality of medical care provided under compulsory health insurance programs allows citizens to have full access to medical services and gives them the right to demand high quality medical care.

Normative legal acts regulating compulsory medical insurance in the Russian Federation

Legislation in the field of regulation of legal relations in CHI is constantly evolving. The legal foundations of compulsory health insurance are laid down in the Federal Law of November 21, 2011 N 323-FZ "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation". This legal act defines:

• legal, organizational and economic foundations for protecting the health of citizens;
• the rights and obligations of a person and a citizen, certain groups of the population in the field of protecting the health of citizens, guarantees for the implementation of these rights;
• the powers of state authorities of the Russian Federation, state authorities of the constituent entities of the Russian Federation and local governments in the field of protecting the health of citizens;
• rights and obligations of organizations, individual entrepreneurs in carrying out activities in the field of protecting the health of citizens;
• rights and obligations medical workers and pharmaceutical workers.

The principle of observance of the rights and freedoms of citizens of the Russian Federation is put in the first place in this Law.

The next most important regulatory legal act in relation to the establishment of the legal framework in the field of compulsory medical insurance is the Federal Law of July 16, 1999 N 165-FZ FZ "On the Fundamentals of Compulsory Social Insurance". This Law, in accordance with the generally recognized principles and norms of international law, regulates relations in the system of compulsory social insurance, determines legal status subjects of compulsory social insurance, the grounds for the emergence and procedure for exercising their rights and obligations, the responsibility of subjects of compulsory social insurance, and also establishes the foundations state regulation compulsory social insurance.

Law of the Russian Federation of November 27, 1992 N 4015-1 (as amended on November 28, 2018) "On the organization of insurance business in the Russian Federation" (as amended and supplemented, entered into force on January 1, 2019) regulates relations between persons engaged in types of activities in the field of insurance business, or with their participation, relations for the implementation state supervision over the activities of the subjects of the insurance business, as well as other relations related to the organization of the insurance business.

Federal Law No. 212-FZ of July 24, 2009 "On Insurance Contributions to the Pension Fund of the Russian Federation, the Social Insurance Fund of the Russian Federation, the Federal Compulsory Medical Insurance Fund" governs relations related to the calculation and payment (transfer) of insurance premiums to various funds.

The Tax Code of the Russian Federation determines the procedure for paying taxes and fees for any organization. The special composition has the norm of Art. 294.1 tax code RF, which contains the features of determining the income and expenses of insurance organizations that carry out compulsory health insurance. According to Article 294.1 of the Tax Code of the Russian Federation, the income of insurance organizations providing compulsory medical insurance, in addition to the income provided for in Articles 249 and 250 of the Tax Code of the Russian Federation, includes funds transferred by territorial compulsory medical insurance funds (TFOMS).

The main parameters for the implementation of compulsory medical insurance are enshrined in the Federal Law of November 29, 2010 N 326-FZ "On Compulsory Medical Insurance in the Russian Federation". In its provisions, the Law on Compulsory Health Insurance contains key tools for achieving long-term goals and objectives.

The laws of the constituent entities of the Russian Federation, unlike federal laws and laws of the Russian Federation, have a limited scope - only within the limits of the subject by which this regulatory legal act was adopted. Federal executive authorities adopt normative acts based on the provisions of laws and not contradicting them.

An important place is occupied by the Rules of Compulsory Medical Insurance, which are approved by the Order of the Ministry of Health and Social Development of Russia of February 28, 2011 N 158n (as amended on January 11, 2017) "On Approval of the Rules of Compulsory Medical Insurance" (Registered in the Ministry of Justice of Russia on March 3, 2011 N 19998). These rules regulate the basics of the functioning of the CHI. This is reflected in the figure below.

The procedure for concluding compulsory medical insurance agreements is regulated by Chapter 28 of the Civil Code of the Russian Federation. International treaties of the Russian Federation, along with generally recognized principles and norms of international law, are an integral part of the legal system of the Russian Federation.

Currently, there are a number of agreements on health insurance for citizens of the Commonwealth of Independent States, who are temporarily in Russia. Regional rule-making is designed to reflect the territorial features in the field of compulsory health insurance. However, this process is often plagued by general problems in the formation of legal acts that do not always take into account the system of legislation.

Important elements of the legal regulation of CHI are territorial programs of compulsory medical insurance. According to paragraph 9 of Art. 3 of Law N 326-FZ, the territorial program of compulsory medical insurance is an integral part of the Territorial program of state guarantees for the provision of free medical care to citizens, developed and approved in the subject of the Federation in the manner established by the Government of the Russian Federation.

Territorial CHI program determines the rights of insured persons to free medical care on the territory of a subject of the Federation and meets the uniform requirements of the basic program of compulsory medical insurance.

The law on CHI requires a significant amount of sub-legal regulatory framework to ensure in practice the mechanism of compulsory medical insurance.

All citizens of the Russian Federation, without exception, are insured in the CHI system. Eligibility insurance policy have foreigners permanently residing in Russia.

The following are the insurers in the system of this type:

• institutions;
• enterprises;
• the state directly.

Enterprises transfer 5.1% of the total amount of wages to the territorial or federal compulsory medical insurance funds. Health insurance for non-working citizens is paid directly by the state.

Special funds are the most important part of compulsory medical insurance. They are non-profit organizations that accumulate all money transfers in favor of the health insurance system.

They provide financial stability and, if necessary, provide financial support to insurance companies.

Commercial insurance companies are the direct participants of MHI. They are required to have an appropriate state license to carry out insurance activities.

They sign contracts with medical institutions to provide services to their clients, issue medical policies, control the quality and timing of medical care.

Medical institutions are the final segment of CHI. Citizens of the Russian Federation apply to them to receive appropriate assistance. The presence of a policy of the described sample gives the full right to free medical services.

Law on CHI

To date, the basis for the action of compulsory medical insurance is the Federal Law "On Compulsory Medical Insurance in the Russian Federation".

The main function of this law is to regulate the relationship of all participants in the compulsory health insurance system (insurers, policyholders, funds, state bodies).

It also determines the legal status of subjects and objects in the MLA. The basis for the adoption and operation of the law under consideration is the Constitution of the Russian Federation.

Supplement the action of Federal Law No. 326:

• Law of November 21, 2011 “On the Fundamentals of Protecting the Health of Citizens of the Russian Federation”;
• Law of July 16, 1999 "On the Fundamentals of Compulsory Medical Insurance".

The relationship between the subjects of the CHI system is also regulated by various other provisions and acts of the regions of the Russian Federation. Each insured event is considered separately, on an individual basis.

The observance of the law under consideration is primarily monitored by the federal and regional compulsory medical insurance fund.

Each organization has a special legal and legal department that performs the function of supervision in the field of compliance with the legislation in force on the territory of the Russian Federation.

What does the policy give

The MHI policy confirms that a citizen has the right to receive free medical care.

If it is available, the insured person has the right to apply to the following institutions:

• the clinic to which the insured is assigned;
• traumatology;
• dentistry;
• oncology departments, dispensaries;
• hospitals participating in the CHI.

Having a compulsory medical insurance policy allows you to receive almost any medical care without any financial costs.

This document is currently mandatory for submission to a medical institution when applying. If the CHI policy is missing for some reason, then individual can receive medical care for a fee.

What does he look like

Today, the compulsory health insurance policy has a standard form. Moreover, its format does not depend on the services of which insurance company the citizen uses. Appearance depends only on the type of medical policy.

Recently, the health insurance system has been reformed. It was in connection with this that a new type of insurance policy was issued. It looks like plastic card, on the front side of which there is an individual card number.

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The back has the following information:

• the signature of the insured;
• photo of the insured;
• validity;
• gender and date of birth.

A copy of the image is applied to the policy, it is not a digital signature. Even a picture with not very high quality can be used as a photo. The duration of the document is determined by many factors.

There is also another type of policy - temporary. It is issued for a period of 30 days in the event of a situation where plastic policy withdrawn.

This happens if previously a person simply did not have a policy of the type in question, or if it is being replaced. Upon the expiration of thirty days from the date of receipt, the temporary policy shall cease to be valid.

It itself is an A5 paper and contains the following information:

• date of issue;
• the signature of the insured;
• name of the representative of the insurance medical organization.

Previously, old-style policies were in effect. They had an A3 format and contained information similar to that presented on the temporary CHI policy.

Terms of an agreement

The terms of the compulsory medical insurance contract were approved by the Director of the Federal Compulsory Medical Insurance Fund A.M. Taranov 03.10.03.

All documents of this type should be formed only taking into account this provision, not contradict it. Otherwise, this agreement may be considered partially invalid.

The document in question necessarily contains clauses to avoid the occurrence of various kinds of conflicts, the boundaries of responsibility are indicated.

The section "Subject of the contract" specifies the conditions under which the insurer provides its services to the insured. A certain amount (insurance premium) is paid in favor of the insurance company.

Based on this, in the event of an insured event, the company pays for its client to go to a medical institution.

In this section, the object of insurance is indicated - the property interest of the client. That is, in fact medical policy CHI protects its owner, first of all, from financial damage. Also in this section, the concept of an insured event is indicated.

Chapter " Sum insured, the order of its introduction” reveals these two terms in detail. The amount of the insurance premium, the limit of liability, the procedure for paying the insurance premium and the moment of this operation are also indicated.

When issuing a standard policy CHI given there is no section - it is displayed in the agreement between the UK and the regional (federal) CHI fund. The section “Terms of the agreement” determines the duration of the agreement of the type in question.

The clause “rights and obligations of the parties” reads out the obligations arising between the insured and the insurer in the event of its conclusion.

The rights of the parties are also considered in as much detail as possible. The occurrence of serious violations of at least one clause is a serious reason for terminating the contract.

The insurance company must ensure the confidentiality of information relating to the policyholder. An exception is possible only in cases provided for by the current legislation of the Russian Federation.

The following information is confidential:

• the content of the contract, its form;
• the state of health of the insured, all available cases of seeking medical help;
• personal data of the insured (place of residence, home phone and other).

The section "Change and termination of the contract" lists the situations when it is possible to make any amendments to the text of the document.

Lists all cases when the contract can be terminated, and the procedure for implementing this process. At the end of the contract, the details of the parties are indicated: the actual and legal address, telephone numbers.

Validity

Different regions issued different policies a few years ago compulsory insurance. That is why their duration varies significantly. In 2011, a gradual transition to a single compulsory health insurance policy was launched.

To date, policies of this type, which are a plastic card, usually do not have expiration dates. The only exception is the issuance of a policy to a foreign citizen.

If an individual uses an old policy (today this is quite acceptable), then you can find out the expiration date for its validity directly on him.

Most often, this information is present at the back of the document. Previously, contracts under compulsory medical insurance policies were most often concluded for 12 months.

After that, it was necessary to carry out their extension. The expiration of the policy is the basis for its replacement.

Required documents for registration

The list of documents required for issuing a CHI policy varies depending on the age, as well as the legal status of the person applying to the insurance company.

Children over 14 years old (citizens of the Russian Federation) must submit the following documents to the UK in order to obtain a policy:

• identity card (birth certificate or other document);
• (if available).

If the papers for issuing a policy of the appropriate sample are provided by a parent, guardian, then a passport or other identification document is required.

If the policy is issued by relatives, then they are required to present:

• identification;
• a document allowing registration as an insured person (power of attorney).

Citizens of the Russian Federation who have not reached the age of 18, but have overcome the age threshold of 14 years:

• temporary identity card or passport;
• SNILS (if already available);
• identity card of the representative of the insured person;
• a power of attorney allowing registration (if the representative is a grandmother or grandfather);
• representative's ID.

Persons over the age of 18:

• identity document or passport;
• SNILS.

Refugees who can legally become members of the health insurance system (Law on Refugees) are required to provide:

• petition;
• certificate of the corresponding sample;
• an appeal against a court decision to deprive the FMS of refugee status;
• a document confirming the receipt of temporary asylum.

For individuals who do not have permanent citizenship, but who own real estate, a residence permit:

• passport of a foreign citizen;
• SNILS (if any);
• resident card.

Individuals with no citizenship (refugees or otherwise) require the following documents to participate in CHI:

• identity card and a document confirming statelessness;
• SNILS (if any);
• resident card.

In the absence of any document, obtaining an insurance policy becomes simply impossible.

Insurance premiums

Insurance premiums for CHI are payments transferred to the Federal Compulsory Medical Insurance Fund of the Russian Federation.

To date, insurance payers MHI contributions, according to the Federal Law "On Compulsory Medical Insurance" are:

• organizations;
• individual entrepreneurs;
• individuals who are not individual entrepreneurs(in private practice).

The amount of insurance premiums itself is calculated and then paid depending on the type of organization, the taxation system used, as well as other factors.

The contribution to the federal compulsory medical insurance fund is 5.1% of the total wage fund, which is paid to employees.

The duration of the settlement period for contributions of the type in question is one calendar year. Reporting periods are:

• quarter;
• half a year;
• nine month;
• twelve months.

Register of rendered services

The basic list of compulsory health insurance includes the following types help:

• ambulance;
• preventive;
• primary health care.

There is also a list of specialized services that are provided completely free of charge or on a preferential basis.

Under the compulsory health insurance policy, you can have an abortion, childbirth or the postpartum period free of charge.

The CHI system provides the following types of medical care:

• dental, oncological (the list is approved by the Health Committee of the Russian Federation);
• implementation of preventive fluorographic studies in order to detect tuberculosis in the early stages;
• prevention of various diseases with the help of special types of vaccines;
• preferential prosthetics, provision of medicines;
• inpatient, provided in special outpatient departments.

Dental treatment under the policy

To date, the list of services provided under the MHI policy includes dental treatment.

Free of charge if available:

• conducting an initial examination and consultation (including for patients who are not capable of independent movement);
• drawing up a preventive map of diseases;
• treatment:
  • carious formations;
  • pulpitis;
  • periodontitis;
  • periodontal diseases;
  • diseases of the oral cavity, mucous membrane;

• treatment of injuries by surgical intervention, extraction of foreign bodies from the canals of the teeth;
• removal of teeth and malignant tumors;
• operations on the soft tissues of the oral cavity;
• reduction of dislocations of various types.

For children under the age of 14, many clinics provide treatment for:

• non-carious lesions of hard tissues of the tooth;
• demineralization;
• orthodontics using special removable equipment.

What are the types

To date, there are three types of CHI policy:

• a sheet of A5 paper with a special barcode on it;
• plastic card, which is a spiked electronic media;
• an electronic application with a number printed on the UEC (universal electronic card).

Previously, until 2011, CHI policies of various formats were issued. Today, this area of ​​insurance is more streamlined.

The legislation was amended to allow any citizen to choose the format of the policy on their own.

Policies in electronic form have one important advantage over paper ones - there is no need to renew them.

A standard A5 policy can be obtained at any point of issue. To receive a universal electronic card or a plastic card, you need to visit a specialized point of issue.

The legislation in force on the territory of the Russian Federation allows all citizens to receive medical care in full free of charge. Only in some cases it will be necessary to pay, but this applies only to very rare cases.

Most often, when visiting a polyclinic, you just need to provide a compulsory medical insurance policy to the registry - this will be enough.

Video: Protecting the rights of patients in the CHI system

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State guarantees of free provision of medical care to citizens, approved by the Government of the Russian Federation.

2. The basic program of compulsory medical insurance determines the types of medical care (including the list of types of high-tech medical care, which includes methods of treatment), the list of insured events, the structure of the tariff for paying for medical care, methods of paying for medical care provided to insured persons under compulsory medical insurance. insurance in the Russian Federation at the expense of compulsory medical insurance, as well as criteria for the availability and quality of medical care.

3. The basic program of compulsory medical insurance establishes the requirements for the conditions for the provision of medical care, the standards for the volume of medical care provided per insured person, the standards for financial costs per unit of the volume of medical care, the standards financial support the basic program of compulsory health insurance per insured person, as well as the calculation of the coefficient of appreciation of the basic program of compulsory medical insurance. The standards of financial costs per unit volume of medical care provided in this part are also established according to the list of types of high-tech medical care, which includes, among other things, methods of treatment.

(see text in previous edition)

4. Insurance coverage in accordance with the basic program of compulsory medical insurance is established based on the standards of medical care and procedures for the provision of medical care established by the authorized federal executive body.

5. The rights of insured persons to free medical care, established by the basic program of compulsory medical insurance, are uniform throughout the Russian Federation.

6. Within the framework of the basic program of compulsory medical insurance, primary health care is provided, including preventive care, emergency medical care (with the exception of air ambulance evacuation carried out by aircraft), specialized medical care, including high-tech medical care, in the following cases :

(see text in previous edition)

2) neoplasms;

3) diseases of the endocrine system;

4) eating disorders and metabolic disorders;

5) diseases of the nervous system;

6) diseases of the blood, blood-forming organs;

7) individual disorders involving the immune mechanism;

8) diseases of the eye and adnexa;

9) diseases of the ear and mastoid process;

10) diseases of the circulatory system;

11) respiratory diseases;

12) diseases of the digestive system;

13) diseases of the genitourinary system;

14) diseases of the skin and subcutaneous tissue;

15) diseases of the musculoskeletal system and connective tissue;

16) injuries, poisoning and some other consequences of external causes;

17) congenital anomalies (malformations);

18) deformities and chromosomal disorders;

19) pregnancy, childbirth, postpartum period and abortions;

20) individual conditions that occur in children during the perinatal period.

7. The structure of the tariff for paying for medical care includes the cost of wages, accruals for wages, other payments, the purchase of medicines, consumables, food, soft inventory, medical instruments, reagents and chemicals, other inventories, expenses for payment of the cost of laboratory and instrumental studies conducted in other institutions (in the absence of a laboratory and diagnostic equipment in a medical organization), catering (in the absence of organized catering in a medical organization), expenses for payment for communication services, transport services, utilities, works and services for the maintenance of property, expenses for rent for the use of property, payment for software and other services, social security for employees of medical organizations established by the legislation of the Russian Federation, other expenses, expenses for the acquisition of fixed assets (equipment, production personal and household inventory) worth up to one hundred thousand rubles per unit.

The level of physical, mental and social well-being is defined as a person's health. The right to protection and protection of health is enshrined in paragraph 1 of Article 41 of the Constitution of the Russian Federation.

Health is the highest blessing given to a person, without which everything else loses its meaning. Each person should take care of their own health, but society is also obliged to create conditions for maintaining and improving the health of its members. This set of measures is called medical care.

The Constitution of the Russian Federation declares human life and health as the highest value. Guided by this principle, emergency medical care in the event of a threat to human life is provided in the absence of a medical policy or other form of payment for this service.

Insurance plays an important role in the complex of measures to protect the right to health.

Types of life and health insurance coverage. All citizens of the Russian Federation are participants in the system of compulsory medical insurance (OMI). Regulates relations in the system Federal Law No. 326-FZ of November 29, 2010. "On Compulsory Medical Insurance in the Russian Federation".

The insurers are: for non-working citizens - the executive committees of the constituent entities of the Russian Federation and self-government bodies. For the working population - organizations, enterprises, individual entrepreneurs and other individuals who have entered into labor and civil law contracts involving remuneration.

The insurers are medical organizations licensed to provide health insurance.

Under the MHI program, citizens are provided free of charge:

emergency care in conditions threatening life and health caused by sudden illnesses, accidents, exacerbations of chronic diseases, difficult childbirth or pregnancy complications;

outpatient care, including prevention, diagnosis, including in specialized diagnostic centers, home treatment and day hospitals;

inpatient care;

Placement in isolation rooms according to epidemiological indicators;

planned hospitalization for diagnosis, treatment and rehabilitation;

assistance in case of pathology of pregnancy, childbirth and abortion;

Assistance during the neonatal period.

The financial base of compulsory medical insurance is formed by deductions from insurers to the Federal Fund for Compulsory Medical Insurance, as well as from receipts from business entities to the territorial funds of compulsory medical insurance. Evasion of policyholders - enterprises or organizations, from paying insurance premiums or understating the base from which the premium is paid, entail penalties.

Insurers interact with medical institutions and bear legal and financial responsibility for the volume and quality of medical services they provide. In case of violation of the conditions for the provision of medical services, the insurer has the right to refuse to pay for the services to the medical institution, or to make it in full.

CHI standards regulate the financing of medical institutions of the compulsory health insurance system. According to the existing International Classification of Diseases ICD-10, for example, with influenza of any form, it is necessary to take tests and measure temperature. Nothing else is included in the flu treatment program.

Previously, until 2011, voluntary medical insurance (VHI) was regulated by the Law of the Russian Federation of 06/28/1991. No. 1499-1 "On medical insurance of citizens of the Russian Federation". In 2010, a new Law of the Russian Federation on CHI was adopted. In it, the issue of voluntary health insurance was not considered.

Currently, VHI is regulated by the provisions of the Civil Code of the Russian Federation on insurance and the Law of the Russian Federation of November 27, 1992 No. No. 4015-1 "On the organization of insurance business in the Russian Federation".

Voluntary health insurance, where the insured is an individual, who, as a rule, is also insured, has not yet become widespread for a number of reasons. Low insurance culture, insufficient awareness of the population about the essence of the services offered, the incompetence and lack of professionalism of some insurers are the main reasons for the “underdevelopment” of this segment of the insurance market.

The situation is much better with regard to VHI, where the insured is a legal entity. In this case, the owner or administration of the enterprise receive a number of undeniable advantages. So according to federal law RF dated July 24, 2007. “On Amendments to Part Two of the Tax Code of the Russian Federation” the amounts spent by the employer on employee insurance are charged to the payroll fund and withdrawn from the taxable base.

Insured employees who have the opportunity to receive medical care in medical institutions of the VHI system are more motivated to perform their duties efficiently and are loyal to the organization that provided them with this type of social package.

Some Benefits VHI programs:

Possibility to choose any medical institution within the given price category;

round-the-clock opportunity to receive qualified advice by phone;

The program may include a number of expensive diagnostic methods, such as computed tomography or magnetic resonance imaging;

dental care.

A clinic with a narrow specialization often has more modern and expensive equipment, unlike budget polyclinics. There are many options for the cost and volume of services provided in the VHI system.

Another type of protection of life and health. This is long-term life insurance (LTLI).

The essence of the proposal is that a citizen enters into a long-term contract (5, 10, 15, 20, 25 years, etc.) with an insurance company for the financial protection of life and health in the event of an accident resulting in injury, disability or death of the insured person. There are programs to provide financial assistance for treatment, in case of diagnosing a number of deadly diseases such as cancer, heart attack, stroke, paralysis, coronary artery bypass grafting, organ transplantation, terminal renal failure in the insured.

If the end of the insurance period is successfully reached, the client receives back the insurance premiums he has paid.