It will not be a secret for anyone that today the cost of various medicines is very high, and for many it is not even available. The state is striving to create a healthy gene pool of the population, therefore it is constantly working to improve the quality of medical care. Moreover, absolutely all citizens, regardless of the level of wealth and social status, have equal rights to receive medical care. However, in order to be able to go to the hospital and receive treatment if necessary, you must have a compulsory medical insurance. What is CHI and what benefits does it provide? What is the MHI fund for? The answers to these questions are presented in the article.
How are the compulsory medical insurance funds formed?
Examination and treatment of citizens is free due to the fact that they are paid from the health insurance fund. It is formed from taxes of entrepreneurs (3.6 percent of income is deducted to the fund) and revenues from the state budget.
What are the benefits of compulsory medical insurance for citizens?
So, we figured out what is the compulsory medical insurance, but what benefits do citizens receive when it is issued? The compulsory medical insurance policy provides a guarantee that any citizen of the Russian Federation will equally receive medical care regardless of their age, gender, religious and political views, place of residence and other factors.
What does the basic compulsory medical insurance program include?
Any compulsory insurance policy includes a certain set of cases, upon the occurrence of which a person is guaranteed to receive the necessary assistance completely free of charge. The policy is valid throughout the country, therefore, regardless of the place of registration or official residence, a citizen will be able to receive medical care in any region of Russia.
So, what is the MLA is known. Now let’s see what it includes.
The basic MHI policy includes the following list of free services:
- primary emergency care;
- preventive actions;
- ambulance call;
- specialized and high-tech medical care.
As for high-tech medical care, which includes insurance of compulsory medical insurance, it implies the treatment of the following diseases:
- infectious diseases, except for STDs, HIV, AIDS and all forms of tuberculosis;
- tumors;
- diseases of the endocrine glands;
- disruption of the digestive system and metabolic processes;
- nervous disorders;
- eco procedure for compulsory medical insurance;
- diseases of the circulatory system;
- disorders related to the immune system;
- eye and ear diseases;
- diseases of the respiratory system and organs;
- urinary tract diseases;
- skin diseases;
- diseases of bone, muscle and connective tissue;
- chromosomal diseases;
- injuries resulting from external factors;
- poisoning;
- birth defects;
- pregnancy, childbirth, abortion and recovery.
Thus, the MHI policy, wherever you are, will allow you to receive free medical care.
Territorial MHI program
The territorial compulsory health insurance program is a state guarantee that any citizen of the country who has insurance has the legal right to receive free medical services.
It regulates the following:
- what types of diseases and medical services are free for the population;
- which categories of the population are served out of turn;
- a list of drugs of vital importance;
- a list of medicines that are given to a patient by a medical institution for free or at a 50 percent discount if he undergoes outpatient treatment;
- list of hospitals that are required to accept citizens under the compulsory medical insurance policy.
You can get more detailed information about compulsory medical insurance in any medical institution or organization issuing an insurance policy. And also the MHI fund has a website where you can find everything for each territorial region.
Types of medical services for which fees may apply
Not all medical services are free when citizens apply to the hospital for compulsory medical insurance. Moscow is a city with a million-plus population, so its residents, as well as visitors, often encounter a situation when they are denied access to free medical care when they go to the hospital.
The following cases are commercial:
- not provided for by the insurance program;
- when treatment is carried out in stationary conditions;
- when treatment requires the use of drugs that do not fall under the category of free;
- in which the patient expresses a desire to undergo treatment in strict anonymity;
- when during an independent appeal of a patient for help to a medical institution (if this does not contradict the current legislation);
- when the cost of treatment exceeds the maximum allowable amount;
- when the person applying is not a citizen of the Russian Federation and does not have a residence permit, as well as medical insurance.
All other medical services that are not listed in this list are provided to citizens under medical insurance completely free of charge.
What cases of denial of health care are illegal?
So, you already know what the compulsory medical insurance is, how it works and what types of medical care you can get for free on the policy. However, very often, when applying to the hospital for insurance, people face many problems, many of which are illegal.
The following cases are considered a violation of your rights:
- extorting money for first aid or treatment by doctors or medical personnel;
- collection of fees for issuing directions for examination or treatment, as well as prescribing and sick leave;
- purchase of drugs at the expense of the patient;
- refusal of a medical institution to provide insurance policy services;
- non-observance of the terms of medical care on a commercial basis;
- extortion of payment for eco-insurance through mandatory medical insurance and other procedures that are free.
If you encounter any of the above cases when you go to the hospital, you must immediately file a complaint against a specific doctor or medical institution and file it with the Ministry of Health.
Registration and extension of insurance policy
The Law on Compulsory Health Insurance entered into force on November 29, 2010, and on January 1, 2011, amendments were made to it, according to which each citizen has the right to independently choose an insurance company for insurance.
Today in Russia, many companies are engaged in the design of compulsory medical insurance. Sberbank is one of the national leaders in this field. This bank offers optimal rates and insurance conditions. If you want to use the services of another insurer, then to search for it, you can go to the site of the territorial fund, which provides a complete list of insurance companies involved in obtaining health insurance.
When you decide on an insurer, you need to contact the company office to apply. After signing the insurance contract and paying for services, you will be issued with the original or a copy of the compulsory medical insurance policy.
Where is the insurance valid?
Regardless of the address of your registration and place of physical residence, medical insurance is valid throughout the country.This is clearly spelled out in the current legislation, so if you suddenly refuse to accept a medical institution, then keep in mind that this is against the law.
Renewal of the policy: how it happens and in what cases it may be necessary?
A compulsory MHI policy, Sberbank can provide you with any information that is of interest to it, does not have a validity period. Simply put, you can use it throughout your life. However, in some cases, it may be necessary to renew it.
The most common reasons for this are as follows:
- change of personal data of the insured;
- when filling out the policy, any errors were made.
If you find any discrepancies between your data and the information specified in the policy, you must inform the insurer about this. If you have changed personal data, for example, last name, then you have one month to notify the insurance company. In this case, you will need to present a document that confirms these changes.
If you have changed your place of residence, then to resolve any issues related to compulsory health insurance, but your insurer does not have a new office, then you can contact any insurance company that is listed in the territorial fund registry.
What to do in case of loss of a policy?
In order to restore the policy, you need to contact the office of SK. The reason for this may be the physical deterioration of the document, as a result of which it is impossible to consider information about the policyholder. You must go to the UK when the policy is torn or unsuitable for further use. Or was lost.
You can restore the MHI policy at the office of the insurer, with whom an insurance contract has been concluded. This can be done both by the policyholder himself and his agent. At the office of the company you will need to write a statement of loss or describe another reason why you need to restore the policy.
According to the current legislation, insurance policies are not subject to recovery. Therefore, in case of damage or loss of a document, it is recognized as invalid, and its number is excluded from a single database. In return, the insurance company will issue you a new form. It is worth noting that the policy glued or restored in some other way has no legal force. Therefore, if the insurer tries to do something similar, insist on filling out a new form.
But be that as it may, try to always monitor your health. After all, you can’t buy it for any money.